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non-dairy alternative to Ensure?


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#1 wacbc

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Posted 05 April 2011 - 10:12 PM

Hi, Kathrynne,

My family member was recently recommended by her PD specialist to take a bottle of Ensure a day, split between 2 eating/Stalevo windows if necessary, to regain/maintain weight (she's lost 25 pounds in 2-3mos due to food/Stalevo conflict). She has trouble with this, even (just 1/2, or even 1/3 a bottle of Ensure in one eating window). We understand milk is a problem for many PD patients. Is there any non-dairy nutrition formula you know of that you could recommend?

Many thanks...
wacbc

#2 Kathrynne Holden, MS

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Posted 07 April 2011 - 06:46 PM

Dear Friend,
First, I would recommend consulting a registered dietitian for help with weight regain; a 25-pound weight loss in such a short time is clinically of great concern and requires medical nutrition therapy. She has almost certainly lost muscle mass, and probably requires extra protein. The dietitian can assess her individual needs and make appropriate recommendations.

In the meantime, consider making a non-dairy smoothie to be taken between the Stalevo windows. Use 8-10 ounces Rice Dream or perhaps an organic soy milk; add fruit, a tablespoon of unrefined safflower or sunflower oil, and a crushed multivitamin. Split this into two portions to be taken during the two “windows.” It will not contain the dairy (nor the protein) of Ensure, but will contain calories, vitamins and minerals, natural vitamin E, and the benefits of fresh fruit.

Be certain, though, that her other meals contain sufficient protein to meet her needs. She needs at least ½ gram protein per pound of body weight per day (preferably more, in view of her weight loss), to restore and repair cells, hair, skin and nails, and muscles (including the heart). I would divide this amount about equally among morning, midday, and evening meals, taking Stalevo about 30 minutes before the meals. This will make it a bit easier to time protein and levodopa.

Then, between meals, try the smoothie for added nourishment. Other small snacks, such as a piece of fruit or glass of fruit juice; a slice of bread with a teaspoon of peanut butter; a tablespoon of mixed raw nuts; ½ of a hard-boiled egg, can also be substituted, depending upon her tolerance.

Let me know if you have other questions.
Best regards,

Kathrynne Holden, MS

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#3 wacbc

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Posted 07 April 2011 - 07:14 PM

Hi, Kathrynne,

Thanks for the reply. I have just now submitted my question with more detailed information as a new thread before seeing your reply (it will be a separate thread, so, of course, feel free to merge it, or whatever is the best).

We will try the smoothie, as well as your suggestions for other small snacks, between the windows. I do agree that there's some urgency and seriousness to her weight and muscle loss. The muscle regaining certainly seems as if it may be quite tricky (with the additional protein intake) and we hope that a local dietitian will be able to help us with that.

Many thanks for your help,
wacbc

#4 Kathrynne Holden, MS

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Posted 08 April 2011 - 05:22 PM

I will check for your post; and do not be discouraged if I can't always respond immediately. Sometimes I am traveling and a full schedule does not allow me time to respond.
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#5 Kathrynne Holden, MS

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Posted 08 April 2011 - 06:19 PM

Dear Friend,
A list of the medications used (both PD, and other medications, including over-the-counter medications, vitamins, herbal or other supplements) taken prior to January 10, 2011 – as well as currently – would be helpful. Also any other conditions or diagnoses, such as heartburn, anxiety, depression, constipation, nausea, edema, etc.

I continue to believe that neither Ensure nor Instant Breakfast would be a good choice, at present. Until her condition stabilizes, it would be best to avoid milk protein; hopefully, it will ultimately be found not to be a problem, but for now, I would make homemade liquid supplements as I described in the previous post. For the short term, it may be better to focus on plant proteins rather than animal proteins, to reduce protein-levodopa interaction, although vitamin and mineral supplements will be important.


Regarding the dystonia, ask her neurologist about a short-term trial of high-dose vitamin E. In some cases, this has led to an improvement. Begin with about 1200 IU/day for 8-10 days and note whether there is any improvement. If so, then begin reducing the amount and continue to reduce unless dystonia increases. Her neurologist can tell you whether this is appropriate for her.

All stressors can and do upset the balance provided by PD medications, and SIADH should be considered a major stressor in this regard. With rest and nourishment, she should gradually improve, with more on time and lessened dystonia. Her treatment ended about 10 days ago, and she may well be still experiencing the effects of the stress induced by SIADH.

Let me know if you have other questions; I will help if I can.
Best regards,

Kathrynne Holden, MS

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