How to deal with constipation and nausea in Parkinson’s disease?
In the latest episode of our podcast, gastroenterologist specializing in helping patients with Parkinson’s disease, Gulnaz Zagitova, answers questions.
Do not take these answers as medical advice for your case and do not self-medicate! Each case is individual and requires specialist consultation, You can easily get an online consultation here. Answers to frequently asked questions are provided for educational purposes.
Briefly about what’s in the latest podcast episode:
1. How are Parkinson’s disease and the gastrointestinal tract connected?
The gastrointestinal tract is an amazing organ. It is the second brain in terms of the number of neurons. The vagus nerve emerges from the brain and innervates the entire gastrointestinal tract. There are theories that signals are transmitted from the gut microbiota to the brain via the vagus nerve, and changes in the brain affect the digestive organs.
2. How does a person’s emotional state affect the functioning of the gastrointestinal tract?
Your mood and feelings greatly affect the digestive organs. A significant part of a gastroenterologist’s consultation is dedicated to discussing this connection.
3. What gastrointestinal symptoms can manifest in Parkinson’s disease?
Swallowing difficulties, constipation, drooling — all these symptoms can be early manifestations of Parkinson’s disease.
4. Can constipation be an early symptom of Parkinson’s disease?
Yes, constipation is one of the first manifestations of Parkinson’s disease. The vagus nerve innervates the intestines, and if there is a problem, the intestines also suffer.
5. How can a gastroenterologist suspect Parkinson’s disease?
A gastroenterologist may suspect Parkinson’s disease if they observe changes in behavior, mood, slight hand tremor, as well as complaints of constipation, drooling, and difficulty swallowing.
6. What dietary recommendations are given to patients with Parkinson’s disease?
Increase fiber, water intake, and add supplements to the diet. Laxatives are also prescribed if dietary recommendations do not work.
7. What role does fiber play in the diet of patients with Parkinson’s disease?
Fiber helps improve bowel function, which is especially important for constipation characteristic of Parkinson’s disease.
8. Why is it important to drink enough water with Parkinson’s disease?
Water helps the intestines function properly and aids in the movement of food.
9. What medications are used to treat constipation in patients with Parkinson’s disease?
Laxatives from different groups are prescribed, which are selected individually for each patient.
10. How does a gastroenterologist help improve the quality of life for patients with Parkinson’s disease?
A gastroenterologist helps through dietary adjustments, prescribing medications, and addressing gastrointestinal issues such as constipation and swallowing difficulties.
11. Is it possible to prevent the deterioration of the gastrointestinal tract in patients with Parkinson’s disease?
Yes, through adherence to the principles of healthy eating, increasing fiber and water in the diet, and timely treatment of constipation.
12. How does the microbiota affect the health of patients with Parkinson’s disease?
The microbiota affects drug absorption, gut health, and the connection between the brain and the gastrointestinal tract.
13. What is microbiota transplantation and how can it help with Parkinson’s disease?
Microbiota transplantation is a method in which the purified stool of one person is transplanted into the intestine of another to improve health and gastrointestinal function.
14. What dietary features are important for patients with swallowing disorders?
It is recommended to consume thicker foods, such as pureed soups, to ease the swallowing process.
15. How to properly organize nutrition for a patient with Parkinson’s disease?
Follow the principles of healthy eating: increase fiber, drink more water, add a variety of vegetables and fruits.
16. Should the entire family’s diet be changed if one member has Parkinson’s disease?
Yes, a healthy diet for the whole family contributes to the improved health of all its members, including the patient.
17. How does the microbiota affect drug absorption in Parkinson’s disease?
The microbiota influences the absorption of medications, which is important for treatment efficacy.
18. What factors worsen bowel function in patients with Parkinson’s disease?
The intestine becomes sluggish and atonic against the backdrop of the disease, which worsens its function.
19. How to Properly Organize Daily Life for a Patient with Parkinson’s Disease?
Create a pleasant atmosphere, use convenient dining accessories such as napkins and comfortable footstools.
20. What devices can make life easier for a patient with Parkinson’s disease?
Special devices for the legs to change the angle between the femur and the spine, comfortable furniture and plumbing.
21. How does the aesthetics of eating affect the patient’s condition?
The aesthetics of eating, a calm atmosphere, and a clean table surface help improve the patient’s mood.
22. Why are pureed soups recommended for patients with swallowing disorders?
Pureed soups are easier to swallow, they don’t splash and don’t cause discomfort.
23. How to properly choose furniture and sanitary ware for a patient with Parkinson’s disease?
Patient comfort should be considered, for example, by using footrests and comfortable toilets.
24. What are the advantages of team-based medical work in treating Parkinson’s disease?
Teamwork allows for quick and effective improvement of a patient’s condition using a comprehensive approach.
25. How does studying the microbiota help in treating Parkinson’s disease?
Studying the microbiota helps to understand how to improve gut health and the connection between the brain and the gastrointestinal tract (GIT)
26. What are the prospects for microbiota transplantation in Russia?
The method is not yet approved in Russia, but it is actively being studied. In foreign countries, it is already widely used.
Video podcast transcript:
– So, we continue. My interlocutor is another member of the V.S. Buzaev International Medical Centre team, gastroenterologist, dietitian, nutritionist, and ultrasound diagnostics doctor, Gulnaz Danisovna Zagitova. Hello!
– Good afternoon!
– We don’t know what time of day those who are dealing with Parkinson’s disease will be watching. Our podcast is dedicated to everything related to this disease, and as it turns out, almost everything is related. And I think today we will be exploring the connection between Parkinson’s disease and the gastrointestinal tract with you. Can you explain the connection?
– The gastrointestinal tract is an amazing organ. Although, probably every doctor who comes here says that their specialty is unique and “their organs” are the most interesting. But the intestine is truly an amazing organ in that it is considered the second brain due to the number of neurons. When we have any problems in the brain, whether functional or organic, the digestive organs suffer in one way or another. A very large nerve, the vagus nerve, emerges from the brain and innervates the entire gastrointestinal tract. There are even theories suggesting that signals are transmitted from the gut microbiota to the brain via the vagus nerve. In turn, changes from the brain via the vagus nerve affect the digestive organs.
– As a layperson, I can tell you that if there’s something unpleasant in my stomach or something “gurgling,” it extremely negatively affects the brain, mood, and everything else, really.
– In turn, your mood and feelings greatly affect the digestive organs. Therefore, asking if there is a connection—yes, undoubtedly, there is. I dedicate most of the consultation to this, emphasizing that your gastrointestinal tract is highly dependent on your mood.
– We are talking about the fact that Parkinson’s disease is not a sentence, but it is a long process that is much more pleasant to go through with specialists who, firstly, understand their narrow fields, but at the same time are ready to solve problems associated with this complex and quite challenging disease comprehensively. So, tell us how this is addressed in your field? Perhaps you could provide some examples. And, of course, we would be interested to know how it can be diagnosed if a patient comes to you specifically with gastrointestinal problems. Can you somehow determine if there are any prerequisites or primary symptoms of Parkinson’s disease?
– Parkinson’s disease is a nervous system disorder, and it manifests through the digestive organs as well. For example, impaired swallowing. A person might consult a gastroenterologist or a neurologist. Our task is to work together. If a neurologist knows or suspects Parkinson’s disease, I, as a gastroenterologist, can help improve the patient’s life through dietary measures or certain medications. Our goal is to enhance the patient’s quality of life and extend it without succumbing to the disease. Speaking about the possibility of a gastroenterologist suspecting the diagnosis during an appointment… There are cases where, before the onset of tremor, the patient suffered from constipation. There is even scientific evidence that constipation is one of the first manifestations of Parkinson’s disease. Because the vagus nerve, which I mentioned at the beginning of the dialogue, innervates the intestines. If there is a problem, the intestines suffer as well. Constipation is one of the most prominent manifestations. Continuing on how a gastroenterologist might suspect Parkinson’s disease… Constipation is generally a common problem among our population, especially when we are sedentary and have everything at our fingertips, making it difficult to suspect this particular disease. But if I notice changes in behavior, mood, or slight hand tremor, I naturally invite a neurologist for a consultation. This is the advantage of our clinic, where we can convene a council and examine the patient together. Therefore, yes, I believe a gastroenterologist can suspect Parkinson’s disease, not with a high probability, of course, but nonetheless, yes.
– So, am I correct in understanding that tremor can manifest in the digestive system earlier?
– Yes, yes, constipation, drooling, difficulty swallowing – all these symptoms can be early manifestations of Parkinson’s disease.
-I think it would be helpful to mention how Parkinson’s disease progresses from a gastroenterologist’s perspective and what actions should be taken: special nutrition, diet? What to recommend?
– In a team of specialists helping people with Parkinson’s disease, it is essential to include dietitians-nutritionists and gastroenterologists, as this issue is not only related to neurologists. We can ease the work of neurologists by addressing some of the patient care aspects, reducing the number of questions they face. Regarding “gastroenterological problems” in patients with Parkinson’s disease, there are specific medications. For example, constipation, one of the most prominent symptoms of Parkinson’s, can be treated with medications if dietary recommendations are ineffective. The intestines and stomach become “sluggish” and atonic due to this disease. Our task is to help them function. The gastrointestinal tract is a 9-meter muscular tube. Sounds impressive, right? Our goal is to ensure it contracts properly and aids in food movement. There are both dietary recommendations and medications. Some patients are prescribed laxatives from different groups for a long time, tailored individually with the neurology team. For others, dietary recommendations suffice: increasing fiber, for instance, increasing water intake, adding certain supplements… This work is always comprehensive and individualized for each patient. Some may experience Parkinson’s disease only through swallowing difficulties, while others may feel heaviness after eating, an unpleasant symptom that might lead them to avoid food altogether. Our relationship with food lasts from birth to death, making it one of the most important relationships. Regarding nutrition, we will emphasize adhering to the principles of a healthy diet.
– I can’t help but mention those people who encounter not as a patient, but as those who surround the patient – family and loved ones. So tell me, is there a need to create a personal diet for a patient with Parkinson’s disease, to prepare something special for them? Or can the whole family perhaps eat properly, and it will suit the entire family?
– It depends on the manifestation of the disease in a particular patient because they are all different. In general, we adhere to a basic diet, which includes the principle of a healthy plate, the “rainbow” principle among vegetables and fruits, and the principle of the number of ingredients per week. This ensures that a person receives all micro- and macronutrients from their diet. Yes, we can get everything from nutrition. Speaking of the environment, naturally, they need to follow the same recommendations. This way, they will also be healthier and work on their microbiota. By the way, microbiota is a separate organ. There are three kilograms of bacteria in you, just so you know. In me, there are about two to three kilograms of bacteria. Their quality depends on what we eat.
– Is mine bigger than yours? (laughs)
– Well, you’re bigger than I am. (laughs). But nevertheless, the ratio of bacteria in the gut… It’s like a separate state on which the degree of health and mood depends. By the way, the hormone of happiness, serotonin, is synthesized there. Therefore, a healthy diet for the whole family is a must. If we talk specifically about a patient with Parkinson’s disease… There may be nuances and features depending on what bothers them more.
– It would probably be strange to say that we do not recommend anyone to eat properly. But, nevertheless, have you tracked any dynamics? For example, you manage patients with Parkinson’s disease: one eats properly, and another ignores your recommendations. Is there any observable dynamic in maintaining quality of life? Positive in the case of proper nutrition and, let’s say, negative if a person eats improperly?
– In general, our population is not accustomed to eating vegetables and fruits. They are not accustomed to consuming enough protein and not accustomed to drinking water.
– What is this? This is due to…
– These are just dietary features and lack of awareness. Additionally, post-war eating habits, when it was cheaper and easier to eat soup, for example, than to add a lot of vegetables.
– I remember how our grandmothers used to say, “What kind of lunch is it if there’s no soup?” More bread makes it more filling, and here we have such an imbalance in the percentage on the plate. Now we have everything, and we can afford enough vegetables, enough fruits, and enough protein. Therefore, when we introduce small corrections to the patient’s diet, like “increase the amount of vegetables,” “add water,” the patient’s well-being improves. Some experience fewer cases of constipation, meaning better bowel function. Some feel less heaviness after eating. Even such small recommendations from a gastroenterologist-dietitian during a consultation with a patient with Parkinson’s disease improve the situation. The gut microbiota has a significant impact on the absorption of medications.
– Well, you said that every doctor loves their field of activity the most and considers it the best. But the V.S. Buzaev International Medical Centre is distinguished by the fact that the medical professionals work as a team. Tell us, with whom do you interact the most, who is your “dream team,” especially when working with patients with Parkinson’s disease?
– Certainly, we work here with a team of neurologists. They are the most advanced. In the case of Parkinson’s disease, the neurologist hands over the patient to me with complete information, carefully, from hand to hand. In turn, after making some adjustments, I can return the patient to the neurologist in the same manner. This “neurologist-gastroenterologist” tandem leads to more productive work and a faster improvement in the patient’s well-being.
– Our podcast is not only for patients but also for those who are dealing with this issue – relatives, close ones. Can you tell us how to adjust your daily life, how should those around approach a patient with Parkinson’s disease? Are there any practical tips? Yes, we know there are issues like nausea, drooling, constipation, heaviness in the stomach. What needs to be adjusted or maybe slightly corrected… Well, we understand about the diet. What about the daily routine or any special approach?
– In general, it’s important to approach the specific patient’s situation with understanding, as this illness significantly changes the life of our patient. Approach it with empathy, with understanding, immerse yourself, and help them through this journey. Because adjustments in daily life will happen one way or another. When it comes to nausea, create a pleasant atmosphere: a clean table surface, a calm environment, perhaps some relaxing music.
– Aesthetics, in general?
– Aesthetics, yes. That is, we must cultivate a culture not only among patients with the disease but also among all the people around them.
– I like everything you are telling me.
– I say that I love you in gastroenterology! (laughs). Yes, to create such a favorable atmosphere. Considering that swallowing is impaired – naturally, soups may not be suitable. Here, the food should be thicker, with some adaptations like napkins.
– What is a specific example of thicker food, for instance?
– For example, cream soups
– This is more adapted food that won’t spill, fall, and so on. Some special napkins to prevent the patient from getting dirty. Of course, it will still spoil the mood and be upsetting. Those who care for them must support the patient at all stages. Speaking of constipation, a comfortable toilet and a convenient stool near the feet will be necessary.
– This is very good, but by the way, I didn’t even think about it. Is there any specialized plumbing, or can you really just choose the one that suits best?
– I haven’t seen such toilets, of course, but there is a special device for the feet to change the angle between the femur and the spine. At home, we have a basin, and I have three children who put their feet on it. It’s a habit that will improve bowel movements and cause less discomfort because our toilets are actually a bit improperly designed. The angles are not right. And for patients who suffer from constipation, it’s even harder for them.
– Not orthopedic, right?
– Not orthopedic, well, you could say that. It’s simply determined through dialogue: is it comfortable or not? Observe, watch the patient. Talk. Communication is what quickly improves any situation. That’s why we talk, we tell patients to share everything, to open up, because the doctor might not remember or mention many things. Nevertheless, when there is a “patient-doctor” relationship, or even better, for example, “neurologist-gastroenterologist-patient.” This is the model at our V.S. Buzaev International Medical Centre, where we hand over the patient from one specialist to another.
– I would like to emphasize that when you hand over patients from one person to another, it doesn’t mean the patient will be going from office to office with a bunch of papers. Handing over means literally taking them by the hand and passing them to another. I’ve observed this, and I really want to clarify because it’s very important when a patient is left alone with their illness, wandering through endless medical corridors—it seems like a very discouraging situation. But in your bright medical center, in every sense, what he…
– Especially when a patient is vulnerable, they are left with their illness and don’t know what to do next. Our task is to show them that life goes on, just with some adjustments and a bit more interaction with certain doctors. Life will be just as bright and fulfilling. The main thing is to believe in it. That is, not to be alone with this illness, but to involve the patient’s loved ones and relatives, if they have any, of course.
– The V.S. Buzaev International Medical Centre has brought together doctors who are at the forefront of research and are constantly engaged in scientific activities. Is there something you can already share? What are you currently working on?
– There is currently a great interest in the state of the microbiota. The whole world is studying it. We are all trying to understand how it works, how we can influence it, and how we can study it. It consists of trillions of microorganisms—microbes that affect our entire body. One of the current interests, including in Parkinson’s disease, is the impact on the microbiota to improve health, medication absorption, and influence on the brain, the “brain-gut axis.” There is a method called fecal transplantation, where one person’s stool is taken, purified, studied, and transplanted into another person’s intestine.
– You must forgive the analogy, but it’s very similar to a blood transfusion, essentially, only related to feces.
– Yes, with the microbiota of the intestine.
– In principle, roughly speaking, the method is the same. But naturally, everything is purified, and everything is studied.
– What is the principle of this method?
– We take microbiota.
– No, I understood that. And what about…
– Through changes in the qualitative composition of the microbiota, our health improves, including in Parkinson’s disease. There are research studies, they are not very large, but they exist and show their effectiveness.
– That is, the “working mechanisms” of a healthy body are simply transferred to a body that lacks something. Right?
– Yes. And in this way, the condition improves. A series of such “intrusions” into the intestinal tract of the body is performed, several procedures. These are enemas or endoscopic procedures through which the necessary microflora—bacteria—are introduced.
– Is there practical application already in Russia?
– In Russia, this is not officially permitted yet, but we are studying this area.
– The method sounds quite strange, doesn’t it? But what difference does it make if it works in the end, right? If we set aside prejudices.
– The difference is huge because the number of side effects from chemical drugs is higher than from fecal transplantation. There are risks, of course, but this still needs to be studied, effectiveness proven, and implemented at the national level… However, for example, abroad, it is already practiced and used quite widely.
– I’m precisely talking about the fact that it doesn’t matter how it sounds if it works?
– Sounds a bit off, of course.
– I wish you success in your research activities and, of course, in your work with patients with Parkinson’s disease.
– Thank you, Damir!
Additional resources:
For more information, read other articles on Parkinson’s disease treatment:
- Strategy and Tactics on How to Overcome Parkinson’s Disease
- On the Treatment of Tremor and Stiffness with Focused Ultrasound
- Our Mission and Vision
- Safe and Comfortable Home for Parkinson’s Disease
- New and Future Treatment Methods
- Parkinson’s Disease. Microflora and Intestinal Dysbiosis
- Constipation in Parkinson’s Disease
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Gulnaz Zagitova
Gulnaz Zagitova