If you asked me to name the one nutrient of greatest importance to
those with PD, what do you think it would be? Protein? B vitamins?
Fiber? Calcium? All of the above?

They're all extremely important; but I would bypass each of them, and
immediately answer: Water.

We can get along pretty well for quite awhile without protein; we can
live for weeks without B vitamins, fiber, and, in fact, even food.
But if someone took away water, we could live only about three days
at best. Of course, that doesn't happen; but what does often happen
is that we take in a bit less fluid than we need, day after day. Over
time, this leads to chronic mild dehydration, and this can cause many
problems that often go unidentified.

Dehydration may mimic other symptoms
For example, dizziness, confusion, balance problems, back pain, and
behavior changes are often thought of as PD symptoms, or medication
side effects, and sometimes this is the case. But if dehydration is
present, it's quite likely that these concerns could be resolved by
drinking sufficient water. Kidney stones are also a possible effect
of dehydration.

Urinary tract infections — a common cause of illness, hospitalization
Another problem caused by dehydration is urinary tract infections
(UTIs), and this occurs in both men and women. When we urinate
frequently, we flush harmful bacteria out of the urinary tract; but
without sufficient fluid intake urination decreases, and this allows
bacteria to multiply and form colonies that block the tract. This
painful condition can lead to kidney failure if not resolved.
Antibiotics can cure the infection, but at the cost of killing
the "friendly" bacteria that are needed for colon health; it may take
weeks for the colon to return to a normal state. Recurring UTIs can
deplete the health to such an extent that the individual is left
weakened and less able to fight off disease. This is a frequent cause
of hospitalization among those with PD. Further, both the infection
and the antibiotics can block the effectiveness of PD medications,
making the PD symptoms even worse.

How do you know if it's dehydration?
Signs of dehydration include:

Mental Confusion
A Change to Unusual or Strange Behavior
Dizziness
Heart Palpitations
Fatigue
Dry Tongue, Longitudinal Furrows in the Tongue
Dry Mouth, Cracked Lips, Sunken Eyes
Dark Urine, Infrequent Need to Urinate
Difficulty Swallowing Liquids
Difficulty Speaking
Low Back Pain
Upper Body Weakness
Constipation and Impaction
Weight Loss
How much water do you need?
There are many ways to look at this, depending on the weather, the
amount of physical activity you get, and your state of health. A
healthy, sedentary person who stays in air-conditioned buildings most
of the time doesn't need much extra fluid. An athlete who exercises
vigorously, especially in hot weather, may need several quarts of
fluid daily. Those with PD have different needs.

PD creates a need for extra water in most people for a number of
reasons:

The medications can cause frequent urination and thus fluid loss
The autonomic system may be affected, causing excessive sweating,
with loss of fluid
Medications can lead to dry mouth, and dehydration will make this
much worse; extra water, on the other hand, helps keep the mouth and
tongue moist
Constipation is very common, and fluids are vitally important — they
combine with fiber and act as "sponges" to keep the stool soft and
bulky
A quick rule of thumb is to divide your body weight by two; the
resulting figure is about the number of ounces of fluids needed
daily. For example, a person weighing 150 pounds would divide by two;
the result is 75. Thus the person should aim for about 75 ounces of
fluids daily.

About twenty percent of our fluid needs come from food. Twenty
percent of 75 ounces is 15 ounces, bringing the total to 60 ounces of
fluids needed. So, this 150-pound person should aim for about two
quarts (or two litres), of fluids daily. That's the same as eight 8-
ounce glasses of fluids.

What's the best fluid to drink?
Juices and tea, especially green tea, are excellent choices for those
with PD. Milk is very good also; however, some folks using levodopa
find that milk can have a long-lasting interference with levodopa
absorption, and if this is the case for you, milk is likely not a
good choice. Soy or rice milk substitutes are fine alternatives; and
coffee counts also. About one-half your fluid intake should be plain
water, and tap water is fine — you don't need to purchase expensive
bottled water unless you prefer it.

If you're in any doubt about your fluid needs or your intake, ask
your doctor for a referral to a registered dietitian, who can assess
your personal needs and help you plan the best fluid choices.

Here's to your good health!


Kathrynne Holden, MS, RD