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Michael Ehlers

Diet for Gastroparesis

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Kathrynne,

I'm a new member and read your article "Nutrition Matters" - the first nutrition article I've seen for PD patients.It was excellent. I was diagnosed with PD in 2006. I'm 62 and retired/disability June 2014. I have been losing weight slightly every year since 2010 when I was 155/160. I am 5'11, and never weighed more that 170.  Worked out a lot, played softball till I was 34. Always been in shape.

 

I've gradually been having increased cramping/bloating and gradually lost more weight. I evened out to 130-135 the past year. November 2014 and January 2015 had blood work and stool testing. Tests show no cancer, no parasites. Doctor said every looks fine but I have a slow gut.

 

 I recently have seen my weight hit 121. And this is not healthy. I just started seeing a RD who works a lot with Gastroparesis. But she is not as knowledgeable with problems of Parkinsons as you.  She suggested a liquid diet and I have a NutriBullet and have been not eating as well as I should, avoiding being 'OFF' to get things done. The RD theory is that a liquid diet won't stay in the stomach as long as before, just by gravity alone.

 

I have not been officially diagnosed with Gastroparesis

 

She is not that knowledge about protein and sinemet. Her plan to add weight might not be healthy for me having PD. I felt okay the first week or so, but the bloating seems to be getting worse.

 

Can you make any recommendations for an RD trained with Parkinsons? Or can I give you more information on what some

 

Options might be?

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Hi, mikeincincy, and welcome. It does sound like you have gastroparesis, but let me make some suggestions.

- Ask your doctor to test both for gastroparesis, and for small intestine bacterial overgrowth (SIBO). SIBO can occur independently of, or as a result of, gastroparesis, and you need correct, accurate diagnoses here, as the treatment is somewhat different.

SIBO is a condition in which dangerous bacteria are able to grow in the small intestine. A healthy intestine does not contain unfriendly bacteria, because its normal movement prevents bacteria from attaching to the walls of the intestine. It causes a condition called “malabsorption syndrome (MAS).” The attached bacteria compete with the human host for nutrients. The bacteria may inflame and damage the walls of the small intestine, so that nutrients cannot cross the walls and enter the bloodstream.

Some signs of SIBO: Abdominal bloating after meals; gas; weight loss; feeling full after starting to eat; abdominal cramping; diarrhea or constipation (may alternate); nausea; steatorrhea (fatty, floating stool that sticks to the bowl); vitamin deficiency - A, D, E, B12; macrocytic anemia (caused by deficiency of B12); fatigue (due to anemia); eventual loss of night vision (deficiency of vitamin A).

Treatment may consist of antibiotics, and correcting any nutritional deficiencies.

If the problem is gastroparesis only
:
- delayed stomach emptying means food may remain in the stomach for 5 hours or more. Any Sinemet taken during that time is unable to clear the stomach, because it cannot get past the food content. Thus the person experiences frequent off time.

- the person does not feel hungry, or feels full after a few bites of food, resulting in both weight loss and malnutrition.

In this case, a liquid diet can help, as indeed it does exit the stomach quicker. But it needs to contain sufficient protein, essential fatty acids, and all vital nutrients, not always easy to combine. If your RD has recommended a liquid diet that is complete, then it should exit the stomach in time for you to be able to avoid off time.

Another possibility is use of liquid Sinemet, which though it has a shorter half-life, is absorbed very quickly and can cut down on off time. For instructions for liquid Sinemet:

Go to: www.parkinson.org Click "Publications" Click "Medications" If in the U.S. you can then order a free copy. Otherwise you can download the entire booklet as a pdf, or go to Appendix C page 63 and print out just the page with the "Formula for Liquid Sinemet."

I also recommend you ask your doctor to conduct tests for 25(OH)D  – this is serum vitamin D. Deficiency of vitamin D is widespread among people with PD and can be very serious, yet is usually easy to remedy.

Also, ask to be tested for elevated homocysteine, a substance that is normally cleared from the blood by B vitamins. When elevated, it can lead to stroke, heart disease, dementia, and other concerns. People with PD have been found to be at greater risk for elevated homocysteine, and it should be checked.

Finally, ask to be tested for the “methylenetetrahydrofolate reductase (NAD(P)H)," or MTHFR gene mutation, also associated with PD. It too can cause elevated homocysteine, and requires methylated B vitamins for correction.

If you could give me your medication schedule, also any and all medications both Rx and over-the-counter, that you are using, that would help. And if you could give me a sample typical day’s meals, and the timing of your medications, then perhaps I could help you plan some meals that might help. I am very concerned that you get sufficient protein to meet your needs, your weight loss is of immediate importance.

I hope that you can see your doctor(s) as quickly as possible for testing. I include a journal reference on SIBO, which I recommend you print out and take to your doctor, as this is not necessarily widely known or understood with regard to PD.

I look forward to hearing from you and will help as much as I can.
=================================

Small intestinal bacterial overgrowth and PD


Mov Disord. 2011 Apr;26(5):889-92. doi: 10.1002/mds.23566. Epub 2011 Feb 1.

Prevalence of small intestinal bacterial overgrowth in Parkinson's disease.
Gabrielli M, Bonazzi P, Scarpellini E, Bendia E, Lauritano EC, Fasano A, Ceravolo MG, Capecci M, Rita Bentivoglio A, Provinciali L, Tonali PA, Gasbarrini A.

Internal Medicine Department, Catholic University of Sacred Heart, Rome, Italy. mauriziogabrielli@gmail.com.
Abstract
BACKGROUND:

Parkinson's disease (PD) is associated with gastrointestinal motility abnormalities that could favor the occurrence of small intestinal bacterial overgrowth. The aim of the study was to assess the prevalence of small intestinal bacterial overgrowth in PD patients.
METHODS:

Consecutive PD patients were enrolled. The controls were subjects without PD. All patients and controls underwent the glucose breath test to assess small intestinal bacterial overgrowth.

RESULTS:

Forty-eight PD patients and 36 controls were enrolled. The prevalence of small intestinal bacterial overgrowth was significantly higher in PD patients than in controls (54.17% vs 8.33%; P < .0001; OR, 2.24; 95% CI, 3.50-48.24). Multivariate analysis showed Hoehn and Yahr stage (OR, 3.07; 95% CI, 1.14-8.27) and Unified PD Rating score (OR, 1.12; 95% CI, 1.02-1.23) were significantly associated with small intestinal bacterial overgrowth in PD patients.

CONCLUSIONS:

Small intestinal bacterial overgrowth is highly prevalent in PD. Gastrointestinal motility abnormalities might explain this association. © 2011 Movement Disorder Society.

Copyright © 2011 Movement Disorder Society.

PMID:
    21520278

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Kathrynne,

Thank you for responding

Here is my RX/Pills

 

Rx Dosage Qty Freq Sinemet  25-100 mg 3 Every 2 hrs Linzess 290 mcg 1 Morning Paxil 40 mg 1 Morning Foltabs Folic acid 800 mcg, B6 10mg, B12 115 mcg 1 Morning Requip 3 mg 1 Bedtime Clonazepam 1 mg 1 Bedtime Bentyl 10 mg 1 As needed (rarely) Alprazolam .5 mg 1 As needed (rarely) Vicotin 5-325 TB 1 As needed (rarely) Stool softener 100 1 Once a day Probiotic Walgreens 1 Once a day Vitafusion Calcium Vit D 1000 IU, Calcium 500 mg 2 Once a day Vitafusion MultiVites Multi 2 Once a day

 

 

I hope this is readable, but here is last week's food list.

 

 

March 30, 2015 Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber Breakfast Kellogg's Pop-tarts - Frosted Brown Sugar Cinnamon, 2 pastry 420 70g 14g 4g 0mg 350mg 30g 1g Yoplait - Orange Creme Light Yogurt, 1 container 90 16g 0g 5g 5mg 80mg 10g 0g Ocean Spray - Cran Apple Juice, 8 ounces 120 31g 0g 0g 0mg 45mg 31g 0g Oscar Meyer - Center Cut Bacon, 39 grams 180 0g 11g 18g 45mg 630mg 0g 0g Mid Afternoon Generic - Black Olives, Pitted - Small, 45 gr. (6 olives) 75 3g 8g 0g 0mg 345mg 0g 0g Kroger - Blended Grade A Lowfat Yogurt, Vanilla, 170.25 g (1 cup) 158 28g 3g 8g 11mg 113mg 28g 0g Evening Nabisco - Nutter Butter - 16 oz Package, 2 cookies (28g) 130 19g 6g 2g 0mg 105mg 8g 1g Silk® - Vanilla Almondmilk (Half Gallon), 1 cup (240 ml) 90 16g 3g 1g 0mg 160mg 16g 1g Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Snack Menchie's - Reese's Pourable Peanut Butter Topping, 2 tbsp 190 9g 16g 6g 0mg 190mg 4g 2g Reese's - Big Cup - Peanut Butter Lovers Cup, 1.4 oz 200 22g 12g 5g 5mg 150mg 19g 1g Kroger Deluxe - Death by Chocolate Ice Cream, 0.65 cup 208 26g 10g 4g 33mg 98mg 16g 0g Homemade Brand - Chocolate Chip Cookie Dough Ice Cream, 0.65 cup 273 34g 14g 5g 39mg 117mg 27g 0g TOTAL: 2,234 294g 99g 58g 138mg 2,518mg 202g 7g March 31, 2015 Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber Breakfast Benton's Cookies (ALDI) - Crackers, Honey Graham, 4 whole crackers 260 48g 6g 4g 0mg 270mg 16g 2g Aldi Lunch Buddies - Diced Pears, 1 cup 70 18g 0g 0g 0mg 10mg 16g 1g Generic - Kroger 1% Low Fat Milk, 8 oz 100 12g 3g 8g 10mg 120mg 11g 0g V8 V-fusion Juice - Light Strawberry Banana, 4 oz 25 6g 0g 0g 0mg 23mg 5g 0g Simple Truth Organic - Plain Lowfat Yogurt, 113.5 g (1 cup) 85 11g 2g 6g 10mg 75mg 8g 0g Great Value - Maraschino Cherries, 3 cherry 30 6g 0g 0g 0mg 0mg 3g 0g Lunch Generic - 1 Slice Watermelon, 1 slice 40 17g 0g 0g 0mg 0mg 9g 0g Del Monte No Sugar Added - Sliced Peaches, 1/2 cup (121g) 35 8g 0g 0g 0mg 5mg 7g 1g Turkey, Deli Sliced - Turkey, 2 oz. 50 1g 3g 6g 25mg 430mg 0g 0g Greek Gods Greek Yogurt - Honey Strawberry, 0.75 cup 225 27g 11g 6g 38mg 98mg 26g 0g Generic - Black Olives, Pitted - Small, 15 gr. (6 olives) 25 1g 3g 0g 0mg 115mg 0g 0g Aldi - Peanut Butter Creamy, 2 Tblsp 180 8g 15g 7g 0mg 140mg 3g 2g Conagra - Vanilla Pudding - Snack Pack, 1 pudding cup 100 18g 3g 0g 0mg 110mg 12g 0g Smith's - Heavy Whipping Cream, 2 Tbsp (15ml) 100 0g 10g 0g 40mg 10mg 0g 0g Dinner Strawberries - Raw, 1 cup, halves 49 12g 0g 1g 0mg 2mg 7g 3g Benton's Cookies (ALDI) - Crackers, Honey Graham, 1 whole crackers 65 12g 2g 1g 0mg 68mg 4g 1g V8 V-fusion Juice - Light Strawberry Banana, 4 oz 25 6g 0g 0g 0mg 23mg 5g 0g Generic - 1 Slice Watermelon, 1 slice 40 17g 0g 0g 0mg 0mg 9g 0g Fruit - Grapes Red - Seedless, 0.25 cup (151g) 26 7g 0g 0g 0mg 1mg 6g 0g Earths Best - First Pears, 3.1 oz 50 12g 0g 1g 0mg 10mg 10g 2g Carnation - Breakfast Essentials Chocolate Powder, 36 g 130 27g 1g 5g 4mg 90mg 19g 1g Silk® - Vanilla Almondmilk (Half Gallon), 1 cup (240 ml) 90 16g 3g 1g 0mg 160mg 16g 1g Aldi - Peanut Butter Creamy, 2 Tblsp 180 8g 15g 7g 0mg 140mg 3g 2g TOTAL: 1,980 298g 77g 53g 127mg 1,900mg 195g 16g April 1, 2015 Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber Breakfast Dole Banana - Bananas, 3.5 inch medium Banana 50 13g 0g 1g 0mg 1mg 7g 1g Del Monte No Sugar Added - Sliced Peaches, 1/2 cup (121g) 35 8g 0g 0g 0mg 5mg 7g 1g Generic - 1 Slice Watermelon, 1 slice 40 17g 0g 0g 0mg 0mg 9g 0g V8 V-fusion Juice - Light Strawberry Banana, 4 oz 25 6g 0g 0g 0mg 23mg 5g 0g Carnation - Instant Breakfast With Nonfat Milk, 8 oz 220 27g 1g 13g 0mg 90mg 19g 0g Yoplait Light Fat Free - Very Vanilla Yogurt No Aspartame, 1 container 6oz 90 16g 0g 5g 5mg 80mg 10g 0g Kroger - 100% Juice Apple, 4 fl. oz 55 14g 0g 0g 0mg 5mg 13g 0g Vita Fusion - Adult Gummy Multivites, 2 pieces 15 3g 0g 0g 0mg 0mg 3g 0g vitafusion - calcium, 2 pieces 30 7g 0g 0g 0mg 15mg 6g 0g Lunch Greek Gods Greek Yogurt - Honey Strawberry, 0.5 cup 150 18g 7g 4g 25mg 65mg 18g 0g Great Value - Maraschino Cherries, 1 cherry 10 2g 0g 0g 0mg 0mg 1g 0g John Morrell - Cubed Ham - 96% Fat Free, 2 oz. 70 3g 2g 11g 30mg 700mg 3g 0g Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Kroger - Strawberry Syrup, 2 tbs 90 24g 0g 0g 0mg 10mg 23g 0g Turkey, Deli Sliced - Turkey, 2 oz. 50 1g 3g 6g 25mg 430mg 0g 0g Smith's - Heavy Whipping Cream, 2 Tbsp (15ml) 100 0g 10g 0g 40mg 10mg 0g 0g Dinner Potatoes - Betty Crocker Butter, 2/3 cup prepared 80 17g 1g 2g 5mg 350mg 0g 1g Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Cream of Rice Cereal - Cream of Rice, 1/4 cup 160 36g 0g 3g 3mg 0mg 0g 0g Kroger - 100% Juice Apple, 4 fl. oz 55 14g 0g 0g 0mg 5mg 13g 0g Great Value - Maraschino Cherries, 1 cherry 10 2g 0g 0g 0mg 0mg 1g 0g TOTAL: 1,535 268g 28g 45g 133mg 2,059mg 164g 5g April 2, 2015 Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber Breakfast Cafe Escapes (Keurig) - Chai Latte, 1 K-Cup Portion Pack (14g) 60 9g 3g 1g 0mg 170mg 7g 0g Belvita Breakfast Biscuits Nabisco - Golden Oat, 4 Biscuits 230 35g 8g 4g 0mg 220mg 11g 3g Egg - Plain Scrambled, 1 large egg 78 1g 5g 6g 187mg 62mg 1g 0g Generic - Kroger 1% Low Fat Milk, 4 oz 50 6g 1g 4g 5mg 60mg 6g 0g Quacker - Instant Oatmeal - Lower Sugar Apple and Cinnamon, 1 Packet 110 22g 2g 3g 0mg 170mg 6g 3g 35 calorie a nut millies - potato bread, 1 slices 35 10g 0g 2g 0mg 90mg 1g 3g Smucker's - Concord Grape - Jelly, 1 Tbsp. (20g) 50 13g 0g 0g 0mg 5mg 12g 0g V8 V-fusion Juice - Light Strawberry Banana, 8 oz 50 12g 0g 0g 0mg 45mg 10g 0g Vita Fusion - Adult Gummy Multivites, 2 pieces 15 3g 0g 0g 0mg 0mg 3g 0g Generic - Calcium, 2 TABLETS 0 0g 0g 0g 0mg 0mg 0g 0g Lunch Campbell's - Chicken Noodle, 3/4 cup 90 12g 3g 5g 23mg 1,335mg 2g 2g Smuckers's Uncrustables - Peanut Butter & Strawberry Jam Sandwich Soft Bread, 1 Sandwich (58g) 210 28g 9g 6g 0mg 240mg 9g 2g Del Monte No Sugar Added - Very Cherry, 1/2 cup (121g) 40 9g 0g 0g 0mg 5mg 7g 1g Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Strawberries - Raw, 1 cup, halves 49 12g 0g 1g 0mg 2mg 7g 3g Chiquita - Bananas, 63 g (1 med banana) 55 15g 0g 1g 0mg 1mg 7g 2g Dinner Simple Truth Organic - Plain Lowfat Yogurt, 56.75 g (1 cup) 43 6g 1g 3g 5mg 38mg 4g 0g Lunch Buddies - Aldi - Pineapple Tidbits, 1 cup (113g) 60 15g 0g 1g 0mg 0mg 11g 1g idhoan - mashed potatos, 1 cup 360 34g 0g 4g 0mg 0mg 0g 0g Evening Ocean Spray - Cran Apple Juice, 8 ounces 120 31g 0g 0g 0mg 45mg 31g 0g Snack Reese's Milk Chocolate - Peanut Butter Egg, 1 Egg (1.2 oz or 34 g) 170 18g 10g 4g 0mg 135mg 16g 1g Mott's - Applesauce - Natural, 123 g (123g / 1/2 cup) 50 14g 0g 0g 0mg 0mg 12g 1g Kraft - Deli Deluxe American Yellow Cheese, 2 Slice (19g.) 140 0g 12g 6g 40mg 600mg 0g 0g Benton's Cookies (ALDI) - Crackers, Honey Graham, 2 whole crackers 130 24g 3g 2g 0mg 135mg 8g 1g Generic - Kroger 1% Low Fat Milk, 4 oz 50 6g 1g 4g 5mg 60mg 6g 0g Aldi-benton's Vanilla Wafers - Vanilla Wafers, 8 Wafers 140 25g 4g 1g 0mg 120mg 12g 0g TOTAL: 2,485 380g 64g 58g 265mg 3,673mg 202g 24g April 3, 2015 Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber Breakfast Benton's Cookies (ALDI) - Crackers, Honey Graham, 2 whole crackers 130 24g 3g 2g 0mg 135mg 8g 1g 35 calorie a nut millies - potato bread, 2 slices 70 19g 1g 4g 0mg 180mg 1g 6g Land O Lakes - Spreadable Butter With Canola Oil, 1 Tbsp 100 0g 11g 0g 15mg 85mg 0g 0g Smucker's - Concord Grape - Jelly, 2 Tbsp. (20g) 100 26g 0g 0g 0mg 10mg 24g 0g Yoplait - Light Boston Cream Pie, 1 container 90 16g 0g 5g 5mg 80mg 10g 0g Lunch Ocean Spray - Cran Apple Juice, 8 ounces 120 31g 0g 0g 0mg 45mg 31g 0g Chiquita - Bananas, 63 g (1 med banana) 55 15g 0g 1g 0mg 1mg 7g 2g Smith's - Heavy Whipping Cream, 2 Tbsp (15ml) 100 0g 10g 0g 40mg 10mg 0g 0g Del Monte No Sugar Added - Sliced Peaches, 1/2 cup (121g) 35 8g 0g 0g 0mg 5mg 7g 1g Carnation Instant Breakfast - Packet, 1 packet 36 g 130 27g 0g 5g 5mg 90mg 19g 0g Dinner Idahoan - Four Cheese Mashed Potatoes, Microwaveable Bowl, 1/2 cup prepared 110 20g 3g 2g 0mg 570mg 2g 1g Ocean Spray - Cran Apple Juice, 4 ounces 60 16g 0g 0g 0mg 23mg 16g 0g Lunch Buddies - Aldi - Pineapple Tidbits, 1 cup (113g) 60 15g 0g 1g 0mg 0mg 11g 1g Simple Truth Organic - Plain Lowfat Yogurt, 113.5 g (1 cup) 85 11g 2g 6g 10mg 75mg 8g 0g Land O Lakes - Spreadable Butter With Canola Oil, 0.5 Tbsp 50 0g 6g 0g 8mg 43mg 0g 0g Snack Special K - Pastry Crisps - Brown Sugar Cinnamon, 2 Crisps per pouch 100 20g 2g 1g 0mg 80mg 7g 0g Café Escapes (Keurig) - Chai Latte, 1 K-Cup Portion Pack (14g) 60 9g 3g 1g 0mg 170mg 7g 0g TOTAL: 1,455 257g 41g 28g 83mg 1,602mg 158g 12g April 4, 2015 Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber Breakfast Cafe Escapes (Keurig) - Chai Latte, 1 K-Cup Portion Pack (14g) 60 9g 3g 1g 0mg 170mg 7g 0g Kroger - Cinnamon Applesauce Naturally Fat Free 48oz Jar, 1/2 cup 90 22g 0g 0g 0mg 10mg 17g 2g Aldi Lunch Buddies - Diced Pears, 1 cup 70 18g 0g 0g 0mg 10mg 16g 1g Quaker - Low Sugar Oatmeal, Apples and Cinnamon, 1 packet 110 22g 2g 3g 0mg 170mg 6g 3g Chiquita - Bananas, 63 g (1 med banana) 55 15g 0g 1g 0mg 1mg 7g 2g Simple Truth Organic - Plain Lowfat Yogurt, 113.5 g (1 cup) 85 11g 2g 6g 10mg 75mg 8g 0g Vita Fusion - Adult Gummy Multivites, 2 pieces 15 3g 0g 0g 0mg 0mg 3g 0g vitafusion - calcium, 2 pieces 30 7g 0g 0g 0mg 15mg 6g 0g Lunch Condiment ~ Kraft - Miracle Whip, 1 tbsp (15g) 40 2g 4g 0g 5mg 95mg 1g 0g Kroger - Wild Caught Chunk Light Tuna, 2 oz 60 0g 1g 13g 25mg 180mg 0g 0g 35 calorie a nut millies - potato bread, 1 slices 35 10g 0g 2g 0mg 90mg 1g 3g Minute Maid - Premium Lemonade, 8 fl oz (240ml) 110 29g 0g 0g 0mg 15mg 28g 0g Del Monte No Sugar Added - Very Cherry, 1/2 cup (121g) 40 9g 0g 0g 0mg 5mg 7g 1g Greek Gods Greek Yogurt - Honey Strawberry, 0.25 cup 75 9g 4g 2g 13mg 33mg 9g 0g Aldi - Peanut Butter Creamy, 1.6 Tblsp 144 6g 12g 6g 0mg 112mg 2g 2g Dinner idhoan - mashed potatos, 1 cup 360 34g 0g 4g 0mg 0mg 0g 0g Silk® - Vanilla Almondmilk (Half Gallon), 1 cup (240 ml) 90 16g 3g 1g 0mg 160mg 16g 1g Snack Special K - Pastry Crisps - Brown Sugar Cinnamon, 2 Crisps per pouch 100 20g 2g 1g 0mg 80mg 7g 0g Benton's Cookies (ALDI) - Crackers, Honey Graham, 2 whole crackers 130 24g 3g 2g 0mg 135mg 8g 1g TOTAL: 1,699 266g 36g 42g 53mg 1,356mg 149g 16g

         

 

I will try to contact my doctor(s) today.

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Kathrynne,

 

Here is my Rx/Pill listing.

 

 

Rx Dosage Qty Freq Sinemet  25-100 mg 3 Every 2 hrs Linzess 290 mcg 1 Morning Paxil 40 mg 1 Morning Foltabs Folic acid 800 mcg, B6 10mg, B12 115 mcg 1 Morning Requip 3 mg 1 Bedtime Clonazepam 1 mg 1 Bedtime Bentyl 10 mg 1 As needed (rarely) Alprazolam .5 mg 1 As needed (rarely) Vicotin 5-325 TB 1 As needed (rarely) Stool softener 100 1 Once a day Probiotic Walgreens 1 Once a day Vitafusion Calcium Vit D 1000 IU, Calcium 500 mg 2 Once a day Vitafusion MultiVites Multi 2 Once a day

 

 

Here are a few days food diary

 

March 30, 2015
Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber
Breakfast
Kellogg's Pop-tarts - Frosted Brown Sugar Cinnamon, 2 pastry 420 70g 14g 4g 0mg 350mg 30g 1g
Yoplait - Orange Creme Light Yogurt, 1 container 90 16g 0g 5g 5mg 80mg 10g 0g
Ocean Spray - Cran Apple Juice, 8 ounces 120 31g 0g 0g 0mg 45mg 31g 0g
Oscar Meyer - Center Cut Bacon, 39 grams 180 0g 11g 18g 45mg 630mg 0g 0g

Mid Afternoon Generic -
Black Olives, Pitted - Small, 45 gr. (6 olives) 75 3g 8g 0g 0mg 345mg 0g 0g
Kroger - Blended Grade A Lowfat Yogurt, Vanilla, 170.25 g (1 cup) 158 28g 3g 8g 11mg 113mg 28g 0g

Evening Nabisco - Nutter Butter - 16 oz Package, 2 cookies (28g) 130 19g 6g 2g 0mg 105mg 8g 1g
Silk® - Vanilla Almondmilk (Half Gallon), 1 cup (240 ml) 90 16g 3g 1g 0mg 160mg 16g 1g Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Snack Menchie's - Reese's Pourable Peanut Butter Topping, 2 tbsp 190 9g 16g 6g 0mg 190mg 4g 2g
Reese's - Big Cup - Peanut Butter Lovers Cup, 1.4 oz 200 22g 12g 5g 5mg 150mg 19g 1g
Kroger Deluxe - Death by Chocolate Ice Cream, 0.65 cup 208 26g 10g 4g 33mg 98mg 16g 0g Homemade Brand - Chocolate Chip Cookie Dough Ice Cream, 0.65 cup 273 34g 14g 5g 39mg 117mg 27g 0g

Calories      Carbs     Fat     Protein     Cholest     Sodium     Sugars     Fiber
2,234         294g         99g     58g         138mg     2,518mg     202g         7g

March 31, 2015
Breakfast
Benton's Cookies (ALDI) - Crackers, Honey Graham, 4 whole crackers 260 48g 6g 4g 0mg 270mg 16g 2g
Aldi Lunch Buddies - Diced Pears, 1 cup 70 18g 0g 0g 0mg 10mg 16g 1g
Generic - Kroger 1% Low Fat Milk, 8 oz 100 12g 3g 8g 10mg 120mg 11g 0g
V8 V-fusion Juice - Light Strawberry Banana, 4 oz 25 6g 0g 0g 0mg 23mg 5g 0g
Simple Truth Organic - Plain Lowfat Yogurt, 113.5 g (1 cup) 85 11g 2g 6g 10mg 75mg 8g 0g Great Value - Maraschino Cherries, 3 cherry 30 6g 0g 0g 0mg 0mg 3g 0g
Lunch
Generic - 1 Slice Watermelon, 1 slice 40 17g 0g 0g 0mg 0mg 9g 0g
Del Monte No Sugar Added - Sliced Peaches, 1/2 cup (121g) 35 8g 0g 0g 0mg 5mg 7g 1g Turkey, Deli Sliced - Turkey, 2 oz. 50 1g 3g 6g 25mg 430mg 0g 0g
Greek Gods Greek Yogurt - Honey Strawberry, 0.75 cup 225 27g 11g 6g 38mg 98mg 26g 0g Generic - Black Olives, Pitted - Small, 15 gr. (6 olives) 25 1g 3g 0g 0mg 115mg 0g 0g
Aldi - Peanut Butter Creamy, 2 Tblsp 180 8g 15g 7g 0mg 140mg 3g 2g
Conagra - Vanilla Pudding - Snack Pack, 1 pudding cup 100 18g 3g 0g 0mg 110mg 12g 0g Smith's - Heavy Whipping Cream, 2 Tbsp (15ml) 100 0g 10g 0g 40mg 10mg 0g 0g

Dinner
Strawberries - Raw, 1 cup, halves 49 12g 0g 1g 0mg 2mg 7g 3g
Benton's Cookies (ALDI) - Crackers, Honey Graham, 1 whole crackers 65 12g 2g 1g 0mg 68mg 4g 1g
V8 V-fusion Juice - Light Strawberry Banana, 4 oz 25 6g 0g 0g 0mg 23mg 5g 0g
Generic - 1 Slice Watermelon, 1 slice 40 17g 0g 0g 0mg 0mg 9g 0g
Fruit - Grapes Red - Seedless, 0.25 cup (151g) 26 7g 0g 0g 0mg 1mg 6g 0g
Earths Best - First Pears, 3.1 oz 50 12g 0g 1g 0mg 10mg 10g 2g
Carnation - Breakfast Essentials Chocolate Powder, 36 g 130 27g 1g 5g 4mg 90mg 19g 1g
Silk® - Vanilla Almondmilk (Half Gallon), 1 cup (240 ml) 90 16g 3g 1g 0mg 160mg 16g 1g Aldi - Peanut Butter Creamy, 2 Tblsp 180 8g 15g 7g 0mg 140mg 3g 2g

Calories      Carbs     Fat     Protein     Cholest     Sodium     Sugars     Fiber
1,980         298g         77g     53g         127mg     1,900mg     195g         16g


April 1, 2015 Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber

Breakfast
Dole Banana - Bananas, 3.5 inch medium Banana 50 13g 0g 1g 0mg 1mg 7g 1g
Del Monte No Sugar Added - Sliced Peaches, 1/2 cup (121g) 35 8g 0g 0g 0mg 5mg 7g 1g Generic - 1 Slice Watermelon, 1 slice 40 17g 0g 0g 0mg 0mg 9g 0g
V8 V-fusion Juice - Light Strawberry Banana, 4 oz 25 6g 0g 0g 0mg 23mg 5g 0g
Carnation - Instant Breakfast With Nonfat Milk, 8 oz 220 27g 1g 13g 0mg 90mg 19g 0g
Yoplait Light Fat Free - Very Vanilla Yogurt No Aspartame, 1 container 6oz 90 16g 0g 5g 5mg 80mg 10g 0g
Kroger - 100% Juice Apple, 4 fl. oz 55 14g 0g 0g 0mg 5mg 13g 0g
Vita Fusion - Adult Gummy Multivites, 2 pieces 15 3g 0g 0g 0mg 0mg 3g 0g
vitafusion - calcium, 2 pieces 30 7g 0g 0g 0mg 15mg 6g 0g

 Lunch
Greek Gods Greek Yogurt - Honey Strawberry, 0.5 cup 150 18g 7g 4g 25mg 65mg 18g 0g
Great Value - Maraschino Cherries, 1 cherry 10 2g 0g 0g 0mg 0mg 1g 0g
John Morrell - Cubed Ham - 96% Fat Free, 2 oz. 70 3g 2g 11g 30mg 700mg 3g 0g
Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Kroger - Strawberry Syrup, 2 tbs 90 24g 0g 0g 0mg 10mg 23g 0g
Turkey, Deli Sliced - Turkey, 2 oz. 50 1g 3g 6g 25mg 430mg 0g 0g
Smith's - Heavy Whipping Cream, 2 Tbsp (15ml) 100 0g 10g 0g 40mg 10mg 0g 0g

Dinner
Potatoes - Betty Crocker Butter, 2/3 cup prepared 80 17g 1g 2g 5mg 350mg 0g 1g
Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Cream of Rice Cereal - Cream of Rice, 1/4 cup 160 36g 0g 3g 3mg 0mg 0g 0g
Kroger - 100% Juice Apple, 4 fl. oz 55 14g 0g 0g 0mg 5mg 13g 0g
Great Value - Maraschino Cherries, 1 cherry 10 2g 0g 0g 0mg 0mg 1g 0g

Calories      Carbs     Fat     Protein     Cholest     Sodium     Sugars     Fiber
1,535         268g         28g     45g         133mg     2,059mg     164g         5g


April 2, 2015
Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber
Breakfast
Cafe Escapes (Keurig) - Chai Latte, 1 K-Cup Portion Pack (14g) 60 9g 3g 1g 0mg 170mg 7g 0g
Belvita Breakfast Biscuits Nabisco - Golden Oat, 4 Biscuits 230 35g 8g 4g 0mg 220mg 11g 3g
Egg - Plain Scrambled, 1 large egg 78 1g 5g 6g 187mg 62mg 1g 0g
Generic - Kroger 1% Low Fat Milk, 4 oz 50 6g 1g 4g 5mg 60mg 6g 0g
Quacker - Instant Oatmeal - Lower Sugar Apple and Cinnamon, 1 Packet 110 22g 2g 3g 0mg 170mg 6g 3g 35 calorie
a nut millies - potato bread, 1 slices 35 10g 0g 2g 0mg 90mg 1g 3g
Smucker's - Concord Grape - Jelly, 1 Tbsp. (20g) 50 13g 0g 0g 0mg 5mg 12g 0g
V8 V-fusion Juice - Light Strawberry Banana, 8 oz 50 12g 0g 0g 0mg 45mg 10g 0g
Vita Fusion - Adult Gummy Multivites, 2 pieces 15 3g 0g 0g 0mg 0mg 3g 0g
Generic - Calcium, 2 TABLETS 0 0g 0g 0g 0mg 0mg 0g 0g

Lunch
Campbell's - Chicken Noodle, 3/4 cup 90 12g 3g 5g 23mg 1,335mg 2g 2g
Smuckers's Uncrustables - Peanut Butter & Strawberry Jam Sandwich Soft Bread, 1 Sandwich (58g) 210 28g 9g 6g 0mg 240mg 9g 2g
Del Monte No Sugar Added - Very Cherry, 1/2 cup (121g) 40 9g 0g 0g 0mg 5mg 7g 1g
Snack Pack - Butterscotch Pudding, 1 pudding cup (92 g) 100 20g 2g 0g 0mg 135mg 13g 1g Strawberries - Raw, 1 cup, halves 49 12g 0g 1g 0mg 2mg 7g 3g
Chiquita - Bananas, 63 g (1 med banana) 55 15g 0g 1g 0mg 1mg 7g 2g
Dinner Simple Truth Organic - Plain Lowfat Yogurt, 56.75 g (1 cup) 43 6g 1g 3g 5mg 38mg 4g 0g
 Lunch Buddies - Aldi - Pineapple Tidbits, 1 cup (113g) 60 15g 0g 1g 0mg 0mg 11g 1g
idhoan - mashed potatos, 1 cup 360 34g 0g 4g 0mg 0mg 0g 0g

Evening
Ocean Spray - Cran Apple Juice, 8 ounces 120 31g 0g 0g 0mg 45mg 31g 0g
Snack Reese's Milk Chocolate - Peanut Butter Egg, 1 Egg (1.2 oz or 34 g) 170 18g 10g 4g 0mg 135mg 16g 1g
Mott's - Applesauce - Natural, 123 g (123g / 1/2 cup) 50 14g 0g 0g 0mg 0mg 12g 1g
Kraft - Deli Deluxe American Yellow Cheese, 2 Slice (19g.) 140 0g 12g 6g 40mg 600mg 0g 0g
Benton's Cookies (ALDI) - Crackers, Honey Graham, 2 whole crackers 130 24g 3g 2g 0mg 135mg 8g 1g
Generic - Kroger 1% Low Fat Milk, 4 oz 50 6g 1g 4g 5mg 60mg 6g 0g
Aldi-benton's Vanilla Wafers - Vanilla Wafers, 8 Wafers 140 25g 4g 1g 0mg 120mg 12g 0g

Calories      Carbs     Fat     Protein     Cholest     Sodium     Sugars     Fiber  
2,485         380g         64g     58g         265mg     3,673mg     202g         24g

April 3, 2015
Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber
Breakfast Benton's Cookies (ALDI) - Crackers, Honey Graham, 2 whole crackers 130 24g 3g 2g 0mg 135mg 8g 1g 35 calorie
a nut millies - potato bread, 2 slices 70 19g 1g 4g 0mg 180mg 1g 6g
Land O Lakes - Spreadable Butter With Canola Oil, 1 Tbsp 100 0g 11g 0g 15mg 85mg 0g 0g Smucker's - Concord Grape - Jelly, 2 Tbsp. (20g) 100 26g 0g 0g 0mg 10mg 24g 0g
Yoplait - Light Boston Cream Pie, 1 container 90 16g 0g 5g 5mg 80mg 10g 0g

Lunch
Ocean Spray - Cran Apple Juice, 8 ounces 120 31g 0g 0g 0mg 45mg 31g 0g
Chiquita - Bananas, 63 g (1 med banana) 55 15g 0g 1g 0mg 1mg 7g 2g
Smith's - Heavy Whipping Cream, 2 Tbsp (15ml) 100 0g 10g 0g 40mg 10mg 0g 0g
Del Monte No Sugar Added - Sliced Peaches, 1/2 cup (121g) 35 8g 0g 0g 0mg 5mg 7g 1g Carnation Instant Breakfast - Packet, 1 packet 36 g 130 27g 0g 5g 5mg 90mg 19g 0g

Dinner
Idahoan - Four Cheese Mashed Potatoes, Microwaveable Bowl, 1/2 cup prepared 110 20g 3g 2g 0mg 570mg 2g 1g
Ocean Spray - Cran Apple Juice, 4 ounces 60 16g 0g 0g 0mg 23mg 16g 0g
Lunch Buddies - Aldi - Pineapple Tidbits, 1 cup (113g) 60 15g 0g 1g 0mg 0mg 11g 1g
Simple Truth Organic - Plain Lowfat Yogurt, 113.5 g (1 cup) 85 11g 2g 6g 10mg 75mg 8g 0g Land O Lakes - Spreadable Butter With Canola Oil, 0.5 Tbsp 50 0g 6g 0g 8mg 43mg 0g 0g Snack Special K - Pastry Crisps - Brown Sugar Cinnamon, 2 Crisps per pouch 100 20g 2g 1g 0mg 80mg 7g 0g
Café Escapes (Keurig) - Chai Latte, 1 K-Cup Portion Pack (14g) 60 9g 3g 1g 0mg 170mg 7g 0g

Calories      Carbs     Fat     Protein     Cholest     Sodium     Sugars     Fiber
1,455         257g         41g     28g         83mg         1,602mg     158g         12g

                        


April 4, 2015
Foods Calories Carbs Fat Protein Cholest Sodium Sugars Fiber

Breakfast Cafe Escapes (Keurig) - Chai Latte, 1 K-Cup Portion Pack (14g) 60 9g 3g 1g 0mg 170mg 7g 0g
Kroger - Cinnamon Applesauce Naturally Fat Free 48oz Jar, 1/2 cup 90 22g 0g 0g 0mg 10mg 17g 2g
Aldi Lunch Buddies - Diced Pears, 1 cup 70 18g 0g 0g 0mg 10mg 16g 1g
Quaker - Low Sugar Oatmeal, Apples and Cinnamon, 1 packet 110 22g 2g 3g 0mg 170mg 6g 3g Chiquita - Bananas, 63 g (1 med banana) 55 15g 0g 1g 0mg 1mg 7g 2g
Simple Truth Organic - Plain Lowfat Yogurt, 113.5 g (1 cup) 85 11g 2g 6g 10mg 75mg 8g 0g Vita Fusion - Adult Gummy Multivites, 2 pieces 15 3g 0g 0g 0mg 0mg 3g 0g
vitafusion - calcium, 2 pieces 30 7g 0g 0g 0mg 15mg 6g 0g

Lunch
Condiment ~ Kraft - Miracle Whip, 1 tbsp (15g) 40 2g 4g 0g 5mg 95mg 1g 0g
Kroger - Wild Caught Chunk Light Tuna, 2 oz 60 0g 1g 13g 25mg 180mg 0g 0g 35 calorie
a nut millies - potato bread, 1 slices 35 10g 0g 2g 0mg 90mg 1g 3g
Minute Maid - Premium Lemonade, 8 fl oz (240ml) 110 29g 0g 0g 0mg 15mg 28g 0g
Del Monte No Sugar Added - Very Cherry, 1/2 cup (121g) 40 9g 0g 0g 0mg 5mg 7g 1g
Greek Gods Greek Yogurt - Honey Strawberry, 0.25 cup 75 9g 4g 2g 13mg 33mg 9g 0g
Aldi - Peanut Butter Creamy, 1.6 Tblsp 144 6g 12g 6g 0mg 112mg 2g 2g

Dinner
idhoan - mashed potatos, 1 cup 360 34g 0g 4g 0mg 0mg 0g 0g
Silk® - Vanilla Almondmilk (Half Gallon), 1 cup (240 ml) 90 16g 3g 1g 0mg 160mg 16g 1g Snack Special K - Pastry Crisps - Brown Sugar Cinnamon, 2 Crisps per pouch 100 20g 2g 1g 0mg 80mg 7g 0g
Benton's Cookies (ALDI) - Crackers, Honey Graham, 2 whole crackers 130 24g 3g 2g 0mg 135mg 8g 1g

Calories      Carbs     Fat     Protein     Cholest     Sodium     Sugars     Fiber  
1,699         266g         36g     42g         53mg         1,356mg     149g         16g
 
I will try to contact my doctor(s) today.




 

Edited by Kathrynne Holden, MS

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Kathrynne,

 

Do any particular food cause the symptoms of SIBO. This morning I ate:

 

French toast made with Silk vanilla almondmilk.

 2 eggs.

2 slices of white bread.

Low sodium V8 juice.

And Simple truth organic plain lowfat yogurt on apple sauce

This was not liquefied. I ate it with a fork like normal. I walked some after I ate and cramping was minimal.

 

Then for lunch I drank this via Nutribullet:

 

Silk Vanilla Almondmilk,

Carnation Instant Breakfast packet

no sugar added delmonte peach slices 1/3 cup

no sugar added Del monte Sliced pears 1/2 cup

1/2 Banana

2 Tblsp Peanut butter

 

I walked some but within 10 minutes I cramped up bad where I can't pick up  my feet or walk much at all. That lasted about 30-40 minutes

 

Just searching for any clues.

Thank

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Mike, thanks, this information is very helpful. (Our computers don’t seem to like each other, the data were a bit scrambled so it took awhile to figure out, but I think I have it down.) I’m happy to see you’re taking supplements of B vitamins, calcium, vitamin D, and a multivitamin, this is extra important when you’re unable to eat normally. Here are some comments:


First of all, are you seeing a neurologist who is a Movement Disorders Specialist, preferably an MDS who is also a PD specialist? I am concerned that you are taking Sinemet every 2 hours – has your doctor discussed use of controlled-release Sinemet, Stalevo, or Rytary? It is very difficult to time meals when taking levodopa so frequently, and if you could tolerate a longer-acting levodopa preparation it would make it easier.

A further concern, there are two drugs which could decrease the effects of Sinemet. From Drugs.com:

- ALPRAZolam can decrease the effects of levodopa in some people. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your Parkinson symptoms worsen. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.Using dicyclomine together with levodopa may decrease the effects of levodopa. Contact your doctor if your condition changes. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

- ClonazePAM can decrease the effects of levodopa in some people. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your Parkinson symptoms worsen. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Further, hydrocodone commonly causes constipation, sometimes quite severe. Another possible interaction:

- Using HYDROcodone together with dicyclomine can increase the effects of either medication. This can commonly cause dizziness, drowsiness, difficulty concentrating, dry mouth, abdominal cramping, and constipation. Some people may also experience some impairment in thinking and judgment. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

I think this may be at least part of the reason for the cramping, bloating and constipation, but I nevertheless continue to recommend asking for a firm diagnosis or ruling out of gastroparesis, SIBO, MTHFR, and for blood tests for homocysteine, and vitamin D.

Now let us consider your food record, for which I thank you – it is very helpful. For the time period given, I have formulated the following:

Calories      Carbs     Fat     Protein     Cholest     Sodium     Sugars     Fiber
2,234         294g         99g     58g         138mg     2,518mg     202g         7g
1,980         298g         77g     53g         127mg     1,900mg     195g         16g
1,535         268g         28g     45g         133mg     2,059mg     164g         5g
2,485         380g         64g     58g         265mg     3,673mg     202g         24g
1,455         257g         41g     28g         83mg         1,602mg     158g         12g
1,699         266g         36g     42g         53mg         1,356mg     149g         16g


Even if you are inactive, I doubt the calorie intake is sufficient most days. A total of 2500 kcal might be enough, but certainly 1500 is too little. Also, your protein needs are not being met. Under normal conditions, you require about ½ gram protein per pound of normal body weight (155 lbs) per day, to restore and repair cells, hair, skin and nails, and muscles (including the heart). This would be 75-80 grams protein daily. With your weight loss, you probably need closer to 1 gram per pound of current body weight per day. This may not be possible for you with such frequent use of levodopa, but at least aim for 80 grams daily.

I would divide this amount about equally among light morning, midday, and evening meals, taking levodopa about 30 minutes before the meals. This should be high-quality protein, eggs, fatty fish (salmon, halibut, sardines, mackerel, herring), poultry, and beef. The fish is especially important for its omega-3 fatty acids which support the brain and nervous system.

Then, in between meals, eat non-protein snacks like fruit, juices, oatmeal, vegetables, bread, pasta, rice. These will not interfere with levodopa absorption.

The stomach can handle several small meals much quicker than 3 full meals daily, which should help if gastroparesis is a factor. However, if liquid meals are needed, ask the RD to design liquid meals that contain adequate complete protein, fiber, and omega-3 fatty acids (or you can use fish oil capsules, though fish itself is a better choice).

Next, let us consider the carbohydrate content of your meals. On March 30, 295 grams of carbs are listed, of which 202 grams were sugars. Fiber constituted just 7 grams that day. Sugars are simple carbs, not the complex carbs of oatmeal, brown rice, whole wheat, cooked dried beans. They should represent a much smaller amount of your daily carb intake – about 10-15%. You require at least 25 - 30 grams of fiber daily to combat constipation (I assume constipation as you are using a stool softener daily). Here, your RD can help – if she believes a liquid diet is needed, she can design foods to put in your blender that will meet these needs.

I do hope you will discuss use of longer-acting levodopa preparations with your neurologist, or if need be, use of a combination of Sinemet alternating with liquid Sinemet for quicker absorption, to provide longer on time. You might post your concerns to Dr. Okun, who may be able to provide you with questions for your doctors. Please let us know how you are doing and keep us updated on your progress; if I can help further, let me know.

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Kathrynne,

For the past 3 weeks I have been eating a lot more than usual. Mixing a lot in the Nutribullet sometimes, and eating it regularly. My RD called me the other day saying that she had me on too many calories etc. That due to Parkinsons I may need to be start out lower and work up. That it could be harmful.

Well today I had a bowel movement for the first time since last Friday.

A little while afterwards my stomach started cramping and luckily it was time for my meds because I was going off. The cramping made me swell so much and wouldn't let up, and I could not swallow all 3 pills. So I got 2 down and thought I better take my Alprazolam because I was starting to panic. I couldn't swallow very well and felt like I was suffocating.

I even told my wife to take me to the ER. But I could still cough and I had peed earlier, but my mouth was so dry. She got me to swallow the pill crushed in applesauce. I began to calm down, but still cramp near the time my pills wear off.

Could having a bm have injured or weakened my intestinal area?

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Kathrynne,

 

Do any particular food cause the symptoms of SIBO. This morning I ate:

 

French toast made with Silk vanilla almondmilk.

 2 eggs.

2 slices of white bread.

Low sodium V8 juice.

And Simple truth organic plain lowfat yogurt on apple sauce

This was not liquefied. I ate it with a fork like normal. I walked some after I ate and cramping was minimal.

 

Then for lunch I drank this via Nutribullet:

 

Silk Vanilla Almondmilk,

Carnation Instant Breakfast packet

no sugar added delmonte peach slices 1/3 cup

no sugar added Del monte Sliced pears 1/2 cup

1/2 Banana

2 Tblsp Peanut butter

 

I walked some but within 10 minutes I cramped up bad where I can't pick up  my feet or walk much at all. That lasted about 30-40 minutes

 

Just searching for any clues.

Thank

 

Mike, I can only speculate, as there are a number of possibilities -- irritable bowel syndrome, gastroparesis, SIBO, Crohns, celiac disease -- but here is an example:

 

Carnation Instant Breakfast contains powdered milk and milk contains the sugar lactose. Lactose isn't very well absorbed by those with lactose intolerance, SIBO, Crohn's or celiac disease. You wisely used almond milk to prepare it, but CIB itself has powdered dried milk as a chief component.

 

Your yogurt is made from milk, which also contains lactose; but the probiotic enzymes digest most of the lactose, so if lactose is a problem for you, then that would explain why your yogurt at breakfast did not affect you as much as the Carnation Instant Breakfast at lunch.

 

But this is just one possible example. That is why it is imperative that you discuss further testing with your doctor, and arrive at a clear diagnosis. I could send you numerous recipes for nourishing smoothies; but until we understand the nature of the concern, they might contain ingredients that make the cramping worse.

 

I hope you can see your doctor very soon, and that you will keep us updated on any tests, advice, etc. from your doctor. I will help as much as I can.

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Kathrynne,

For the past 3 weeks I have been eating a lot more than usual. Mixing a lot in the Nutribullet sometimes, and eating it regularly. My RD called me the other day saying that she had me on too many calories etc. That due to Parkinsons I may need to be start out lower and work up. That it could be harmful.

Well today I had a bowel movement for the first time since last Friday.

A little while afterwards my stomach started cramping and luckily it was time for my meds because I was going off. The cramping made me swell so much and wouldn't let up, and I could not swallow all 3 pills. So I got 2 down and thought I better take my Alprazolam because I was starting to panic. I couldn't swallow very well and felt like I was suffocating.

I even told my wife to take me to the ER. But I could still cough and I had peed earlier, but my mouth was so dry. She got me to swallow the pill crushed in applesauce. I began to calm down, but still cramp near the time my pills wear off.

Could having a bm have injured or weakened my intestinal area?

 

Mike, this seems unusual to me. Very often, prolonged constipation causes ineffectiveness of PD medications; then when a bowel movement occurs, the PD medications kick in. I’ve not heard of a BM weakening the colon, although in extreme cases that could be the case.

 

I would be inclined to think it more likely that some ingredient in your liquid meals is causing the cramping, due to one of the conditions I mentioned earlier – gluten intolerance, lactose intolerance, SIBO, Crohn’s, irritable bowel syndrome, etc.

 

Another thing that occurs to me, although I don’t think it will solve all your concerns, is – I wonder if you are getting sufficient magnesium. Lack of magnesium is of concern for many reasons, among them constipation. Adult males require about 350 mg magnesium per day. Foods rich in magnesium are pumpkin seeds, spinach and chard, sesame seeds, quinoa, many nuts and legumes. Because you are on a liquid diet, these foods may not be possible for you.

 

I’m wondering if a magnesium supplement might be warranted. For constipation, chelated magnesium (magnesium glycinate) is easily absorbed and highly bioavailable. The magnesium content per tablet or capsule is usually 100 mg. For muscle pain, magnesium citrate malate is a good choice. But if you feel you are already getting enough magnesium, don’t worry about it.

 

Please continue to let us know how you are doing, in particular testing for the above-named conditions.

 

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Kathrynne,

Hopefully I helped one of my issues with cramping.(forgetfulness)

You see, I'm suppose to walk my daughter down the aisle tomorrow.

And having PD, I'm probably a little anxious about how I will do and look.

Well it seems I forgot to take my Linzess for a few days, and that probably cause my severe cramping.

I started back yesterday taking Linzess and though yesterday was a terrible day with cramping, I think I'm feeling better today.

I don't know about my magnesium input, I usually try to watch my potassium, but still seem to come up short.

 

So should I be eating yogurt for the probiotics or not eat it because of the lactose?

 

Thank you

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Mike, congratulations to your daughter, I'm sure the wedding and the bride were beautiful, and I know you are a very proud father. Congratulations also for figuring out that it was the Linzess that was causing the severe cramping.

 

I cannot say, though, whether yogurt is a concern or not. If indeed the cramping was due to the Linzess, then yogurt and CIB may not be a problem for you at all. Please re-read my post from April 7. I continue to wonder whether you are seeing a neurologist who is experienced in PD, and I think it is necessary to discuss use of longer-acting medications such as Rytary, Sinemet CR, etc., as I mentioned. You also need to mention the Alprazolam and Clonazepam as they might be decreasing the effects of levodopa. I think you may need an adjustment to your medication regime. I would post your medications to Dr. Okun and ask for guidance in discuss them with your doctor. Please post to his forum, and let me know his response.

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Kathrynne,

The wedding was a success. I was nervous and survived so let's move on.

MY PD neurologist is with a movements disorder area. The University of Cincinnati has one of the best in the country. They were/are heavily involved in the duadopa study. I see him early May and will ask about the longer lasting new pill.

I spoke to my Gastro doctor and asked for some tests. He is going to give me the breath test for SIBO, and some blood tests. He is hesitant because all my workup on blood and stool back in January 2015 were all good except for a slow gut.

I do feel better overall since the wedding planning/event are done now. Did anyone ever mention how stress effects us? Amazing. I'm sleeping better and that helps for starters. But also my need for Alazopram, Bentyl, ???

But I did find something that's helps my bloating a lot. It's Gas-X. OTC medicine. Go figure.

I need to use it more than the box says to, so I asked my Gastro doctor and he said he doesn't see any problem with it. So I obviously need more than just Linzess for my bloating. But eating 3 pieces of wedding cake cannot be controlled by anything apparently.

As far as my eating, I'm learning a few things. I'm trying not to liquefy as much except maybe mixing fruits, melon, things for a tasty drink. I tended to mix more than I would eat and in the end it was not was the stomach liked apparently.

I am also finding out I can handle more food in the morning and afternoon, than in the evening. I am also not eating until about and hour after my Sinemet dose. I tried that today, and had a lot better day as far as bloatingand my 'on' time was better. I will work on more protein/calories at these times also. After 5:00 or so I have to watch my volume. I'm laying off milk and staying with Silk.

So the wedding pressure is gone, and we'll see what the tests show.

I'll keep you informed.

 

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I'm very happy to know you're seeing a movement disorders specialist, not everyone has that opportunity and it can make a great difference in treatment. And also that it looks like you're solving your own problems -- weddings are definitely stressful for everyone involved, and stress is a major -- and yes, often overlooked -- factor in PD. I do think it's good that your gastro doc is willing to rule out SIBO -- the more concerns that are ruled out, the more one can narrow down the possibilities and determine the actual cause; and I wish he would test for gastroparesis also, so that you could have a definitive diagnosis.

 

Wonderful that Gas-X has proved so successful for you -- you are your own best detective, I'm thinking. And you won't be eating any more wedding cake for awhile, I'm thinking, so that won't be a factor.

 

Some people do need more than 30 minutes after taking Sinemet. However, as you take it every 2 hours, I wonder if you have tried the "Liquid Sinemet" recipe I mentioned earlier. Like liquid drinks, liquid Sinemet exits the stomach quickly and gets to the brain much faster than the tablet, sometimes in 10-15 minutes. That would give you a quicker kick-in, so that you might be able to eat your meals sooner, and also experience less off time, and hopefully also less bloating. I am hoping you will gradually be able to consume more calories and definitely more protein, so as to regain weight. Please do continue to keep us updated, I'll be hoping for good news.

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Kathrynne,

 

You stated "Go to: www.parkinson.org Click "Publications" Click "Medications" If in the U.S. you can then order a free copy. Otherwise you can download the entire booklet as a pdf, or go to Appendix C page 63 and print out just the page with the "Formula for Liquid Sinemet."
 

I do not see a Publications button to Click.

Can you recheck or send me the link?

 

Thank you

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Kathrynne,

Thank you for that information.

 

Well my Gastro doctor scheduled my SIBO breath test,  along with some blood level tests.

But it's not until May 8.

I feel like I'm getting more bloated and now nausea than previous weeks.

I woke up last night from a good sleep at 1:30 AM, had a immediate need to urinate, and then by the time I went back to bed I had a painful bloat in my gut. Well I couldn't sleep the rest of the night. I have a big cold sore on my upper lip and some mouth sores that I wasn't expecting.

Can you use Gas x too often? It seems to be making me more gassy.

 

Thank you

 

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Mike, have you used Gas-X before? If not, I'm wondering if you might be allergic to simethecone. However, yes, you should follow dosage instructions carefully, and not use too much. See: http://www.drugs.com/mtm/gas-x.html

 

Also, if you have other conditions, such as those I mentioned before -- gluten intolerance, lactose intolerance, SIBO, Crohn’s, irritable bowel syndrome -- then Gas-X might have adverse effects. That is why it is so important to have a correct diagnosis. I would not rule out the possibility of going to the Emergency Room -- you might be able to get some of the tests you need earlier than your doctor's appointment. Please keep in touch

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Kathrynne,

I have a question about food.

First, I had to 'dismiss' my RD because she kept calling my PCP and Gastro and that never helps when you suggest to a doctor test they should run.

Also, since she does not know the PD side, it was not helping me much.

But anyway, I learned a few things about what I eat and wanted your opinion. I have been walking/stretching more with the nicer weather and need to help my digestive function any way I can. Sitting too much definitely effects the stomach. My increased walking is helping out.

Sunday 4/19, being the good husband I am, I ate a little steak that my wife prepared. It was Omaha steak. It was about 3 inches in diameter and I ate 1/4 of it and cut it into very tiny pieces.

Now granted that my timing of meds wasn't perfect. I was due for Sinemet about 30 minutes after the meal, which also included 3 Pierogies. Well I cramped up within 40 minutes and it lasted for hours.

So I guess note to self -Don't Eat Steak.

 

I eat Cream of Rice cereal for the iron and fat free benefits and I can handle it very well.

So I thought I would try Cream of Wheat for its nutrients and fat free benefits

So today for mid-morning food I had 1 packet of Cream off Wheat.

Well maybe I should know by now, but the cramping and bloated started and is still going on.

Can you help at all?

Thank you

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Meat is definitely more work for the stomach; so even though you cut it up very well and had only a small portion, it seems that your stomach will not tolerate it, perhaps the muscle protein is too difficult to assimilate and pass into the small intestine.

 

The fact that Cream of Rice is well metabolized, whereas Cream of Wheat raises the question of possible wheat allergy or gluten intolerance. It might be best to eliminate gluten for a few weeks and see if that helps. Gluten is also found in barley and rye, and is an ingredient in many products, but you can continue to make your own smoothies to avoid these.

 

Also, you may have difficulty with milk protein, so consider eliminating all milk and dairy products as well. You did seem to do well with almond milk, so I would stick with that and Cream of Rice.

 

Please bring all of these concerns up with your gastro doc on May 8. If it is, for example, irritable bowel syndrome, then there are very specific dietary instructions that your RD can provide that should help. Same with gluten intolerance, wheat allergy, Crohn's, etc. Please be sure he rules out all possibilities.

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Kathrynne,

 

I've been read some articles about the benefits of drinking a glass of warm water along with the juice from1/2 lemon first thing every morning. it sounds too good to be true, but I think it might be helping me. it is suppose to help the acid in the intestines, help the liver, help the ph level, has more potassium, calcium, and magnesium than most fruits.

 

I'd like your opinion on this. it sounds too good

 

 

 

Thanks

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Lemon juice is rich in vitamin C and potassium, and is alkalinizing when metabolized; I would say it would be an excellent way to begin the day. And certainly, if you are feeling better since starting it, then that says it all -- it is providing some benefit that you need.

 

I will still be much happier, though, when your doctor has tested for the GI concerns I listed earlier. If any of these are present, lemon juice will not be sufficient to correct the condition, although it may well be a very useful addition.

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Kathrynne,

 

I don't know about the blood tests, but here is what they will do for the SIBO;

Give me 8 oz of water with enulose  when I arrive.

Take a breath sample every 15 and 30 minute intervals.

I may be in the office up to 2 1/2 hours

The one of the PAs will discuss the results with me and send them to my GI doctor.

 

I know that lemon juice won't solve my issues. But I seem to be having less bubbles/gas in my stomach now. And the meds seem to be 'on' a little longer and later in the night. And I have increased my calorie goal in Myfitnesspal to 2210, and have included Boost in my diet, taking gulps now and then instead of drinking it at one sitting. Sometimes I will have 2 a day.

 

 

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Mike, that's wonderful news that the bloating is reduced, I'm really glad you've updated us on that. Also that the meds are lasting longer, and that you've been able to increase your calorie intake. I'm really happy to hear this. Next, I hope to hear that you've been able to gain back some weight, that would make my day! Keep up your excellent work, you are a very good detective.

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Hi Kathrynne,

Well I had my SIBO test last Friday 3/8

My numbers actually went down from the initial baseline breath, concluding I don't have SIBO.

They drew some blood for Phosphorus. His nurse called me yesterday and said my blood levels have stabilized (??) And that the doctor might request 1 more test from my blood sample if there is enough left. She didn't say what the test was.

 

I do know that the enulose that they gave me for the breath test is some sugar that a normal small intestine cannot digest, so if it does that apparently will produce hydrogen. Well that enulose must have had an effect on my large intestine because later that evening around 11:00 pm my gut started cramping worse than usual. I ended up awake all night accept for a few hours sleep between 3-6 am. Then after breakfast I had a somewhat painful bm that included constipated stool, then fatty stool, them diarrhea. And the rest of that day I was having cramping most of the day.

 

Then this morning I had a bm, the first since Saturday, that was the same except for no diarrhea.

 

I'm getting a little concerned about not being able to meet my calorie goal everyday because the later in the day some days I can't  take anymore food.

 

So I scheduled a doctor appointment with my PCP, hoping he will look at the my overall health and recommend some work.

 

My stomach cramping seems to tighten up the muscles or tendons down the sides of my groin area now making everything worse.

 

PS - If you get a urge for sweets, I don't recommend the McDonalds Reese's McFlurry if you have IBS or whatever I have.

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