Re: Water needs with Parkinson's medications

["Kathrynne Holden, MS, RD" <fivstar@xxxxxxxxxxx>]

> Would be most grateful for a  e copy of your NEwslter.   ThanksThanks f=
or your interest--the June issue follows:

        Spotlight on Food
        --nutrition news for people 60-plus
        Copyright 1996, Five Star Living, Inc., All Rights Reserved

        June 1996 -- Vol. 2, No. 6=20

        Water Power--a natural force for better living!

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(Future Spotlights: Everything you ever wanted to know about fiber! --=20
Food that celebrates summer -- Give your body a "road test", Part II --=20
A cancer check that could save your life!)
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Dear Reader,            =09
=09
        What do you think would happen if I were to give a talk about a=20
precious substance that would carry life-giving minerals and vitamins=20
across the cell membranes of your body? That would rid your body of=20
wastes and toxic matter?
That would help keep you from overheating in hot weather? That would=20
help prevent dry, itchy skin in cold weather? That helps prevent=20
constipation? Why, tickets to that talk would be sold out! Most folks=20
would ask, "Where can I buy this stuff? I'll pay anything!"
        Now--what if I told you that the stuff  I'm talking about is=20
easy to find; cheap; available in your own home; and is commonly=20
ignored? What if I told you this precious substance is water?
        If I offered to give a talk about water, I guarantee no one=20
would come, not even if the talk were free! Water is so cheap, so=20
plentiful, and so easy to get, that I guess we take it for granted. Soda=20
pop, lemonade, coffee, iced tea and fruit juices taste so good that we=20
often ignore water. We forget all the special things about water that no=20
other drink can match.
        Water dissolves the vitamins and minerals we need. Then blood,=20
which is mostly water, carries them throughout the body. Water helps=20
lubricate our joints. Water acts as a shock absorber inside the eyes and=20
spinal cord.=20
        And think what happens when we eat a meal. When the digestive=20
system changes the food into fuel for the body, many toxins and wastes=20
are produced. Water is the force that carries these wastes out of the=20
body in the breath, in the urine, and in fecal matter. If not for water,=20
the wastes would become poisonous, and we would die as a result of the=20
food we eat and the air we breathe! Truly, water is a miraculous=20
substance.
        There's nothing like it. Coffee, juices, and other fluids, as=20
well as most foods, contain water. But no substance can match all the=20
qualities of plain, pure water.=20
        For example, coffee, tea, and many kinds of soda pop contain=20
caffeine. Because caffeine is an irritant, the body uses up some of its=20
precious store of water to flush the caffeine out of its cells. This=20
means that caffeine-containing fluids actually cause a slight=20
dehydration! This is also true of alcoholic drinks--that ice-cold beer=20
contains alcohol that will draw some water out of your body.
        Sweet drinks like lemonade, pop, and other sugary fluids are=20
different--they cause water to concentrate in the stomach and=20
intestines, instead of getting absorbed into the rest of the body, where=20
it's needed.=20
        Is your skin dry and itchy? Especially in winter? Well, it could=20
be because your skin doesn't produce as much oil as it used to. But--if=20
we don't drink enough water, there won't be enough to supply all our=20
body's needs. The skin gets left out. It becomes dry, and itchiness=20
follows.
        Tip: Lay your right hand flat on the table, palm down. Then take=20
the finger and thumb of your left hand and pinch up some skin from the=20
back of the right hand. Hold it while counting to ten, then release. If=20
the pinched skin quickly flattens out, you're probably getting enough=20
water. But if it stays pinched up while you count to twenty, it's likely=20
you're dehydrated, and need to drink more water.
        How does water help constipation? In times when the body has too=20
little water, it will give top priority to organs like the brain, and=20
the kidneys. The brain needs water to keep its delicate balance. The=20
kidneys must have water to flush out body wastes. The colon's job is to=20
add water to the stool to keep it soft. But a hard stool is not=20
life-threatening, so the colon has a low priority on water. When there's=20
not enough  to go around, some water is removed from the colon and given=20
to other organs. The stool becomes dry and hard, and difficult to pass,=20
resulting in constipation.=20
        Constipation that lasts more than a few days can lead to fecal=20
impaction. This is a large mass of hard feces that cannot be passed from=20
the bowel. Fecal impaction can require hospitalization. Although there=20
are many other causes of constipation, without water, constipation is a=20
sure bet.=20
        Sweating means your hot, right? Wrong! Sweating means you're=20
cool. During the hot months of summer, water can make a life-or-death=20
difference. Water forms lifesaving perspiration that allows us to stay=20
healthy in hot weather.=20
        How? When it's hot out, the body heats up, too. But water in our=20
tissues absorbs the heat. When the water has absorbed all the heat it=20
can hold, it leaves the body as perspiration. The evaporating sweat=20
takes the absorbed heat with it, leaving our insides cooler--a safe 98.6=20
.=09
        And with summer coming up, that's important. Hundreds of people,=20
mostly older adults, died last summer from the heat. Most of those=20
deaths could have been prevented just by drinking plenty of water.
        If we don't replace perspiration by drinking extra water, heat=20
stays in the blood, and body temperature begins to rise    .Atabout105=20
the body's mechanisms start to break down. Signs of heat stroke are:=20
flushed skin, headache, fatigue, confusion, and lessened sweating,=20
followed by unconsciousness.
        We can't depend on thirst to warn us to drink enough water.=20
You'd think we should eat when we're hungry, and drink when we're=20
thirsty. It's true that hunger is a  timely reminder to eat. But for=20
some reason, our thirst mechanism doesn't work the same way. By the time=20
we feel thirsty, we're already dehydrated. And extreme heat affects the=20
brain, causing confusion. At this point, a person may not be able to=20
think clearly enough to drink water.
        Older adults are more at risk. The thirst mechanism slows down=20
with age. Also, older adults are more likely to take medications that=20
decrease sweating. Among these are drugs used to treat asthma, urinary=20
incontinence, and Parkinson's disease.
        Unless your doctor has ordered a fluid restriction, or other=20
dietary plan, the best bet is drink plenty of plain water, plus  milk=20
and juices. Experts recommend at least two quarts (8 large glasses) of=20
water daily. If you drink coffee, tea, or other caffeine-containing=20
drinks, or alcohol, be sure to drink an equal amount of water.
        Tip: I use a one-quart sports bottle, the kind with a straw that=20
sticks out the top. I take it with me all day. It's an easy to make sure=20
I get my two quarts daily!
        But if you're not used to drinking water, start gradually adding=20
a glass or two a day, and work up to 8 glasses. Your system may take=20
some time to adjust. You could find that you retain water at first, but=20
gradually your body will release the extra fluids and stay at a=20
well-hydrated level.=20
        Tip: For a free brochure, Hyperthermia: A Hot Weather Hazard for=20
Older People, send your name and address to: NIA Information Center,=20
P.O. Box 8057, Gaithersburg, MD 20898-8057.
        Fresh strawberries are in season, so here's a simple dessert=20
that's high in taste and easy to make. You can use different kinds of=20
fruit, like pineapple and orange slices; or experiment with other=20
flavors of yogurt. To lower sugar, try sugar-free yogurt.

Strawberries on a couch
2 slices angel food cake
1 8-oz container lemon yogurt
1 banana, sliced
1 cup sliced strawberries

Place cake slices on a pretty plate; spread =BD cup yogurt over each=20
slice. Divide banana slices between the two plates, then top with=20
strawberry slices. Makes two portions.
Nutrition information per portion:
2 servings fruit
=BD serving calcium
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        I've had many requests from people who are concerned about=20
restaurant dining. Some travel a lot, others simply enjoy going out to=20
eat. They want to know whether they're getting healthful choices. My=20
advice is: if you dine out seldom, I=0Cwouldn't worry too much about the=20
salt and fat in the food. However, if you regularly eat at restaurants,=20
it's a good practice to make healthful choices. So I've put together a=20
sample one-day menu from some popular restaurant chains.=20
Food and Number of Servings from Food Pyramid

Breakfast:      McDonald's=09
Orange juice:   1 fruit
Cheerios:               1 bread
1% milk:                1 calcium
Apple-bran muffin (fat-free): 2 bread

Lunch:  Applebee's (This restaurant cooks some dishes to order; bring=20
your                    own salt substitute and ask the waiter to leave=20
out salt)
Low-fat Veggie Quesadilla:      2 bread, 1 calcium, 2 vegetable
Skinny Minny Carrot Cake
Iced tea

Dinner:  Olive Garden (You can ask your waiter to bring low-fat salad =09
                        dressing; also bread sticks without the added=20
margarine)
House salad with low-fat dressing:  2 vegetables
Grilled Herb Chicken with Peppers:  1 protein, 1 vegetable
2 bread sticks:  2 bread
Raspberry Sorbetto, Coffee or Tea

        Is this a balanced one-day menu? Well, it's close. We have seven=20
servings of bread, five of vegetables, and two calcium-rich foods. But=20
there's only one serving of fruit and one of protein. However, the=20
quesadilla has cheese, which contains protein as well as calcium, so=20
there's enough protein for the day.
        It can be difficult, though, to get two or more servings of=20
fruit when eating at restaurants. If you eat most or all your meals at=20
restaurants, I encourage you to pack some grapes, bananas, apples, or=20
other fruits, to eat as snacks between meals. Fruit is rich in nutrients=20
that other foods don't have.
        Of course, many restaurants offer fruit selections, and I'd=20
certainly take advantage of these whenever you can. Also any dark-green,=20
leafy or yellow vegetables. Restaurant dining has gotten some hard=20
knocks, but I think we should all enjoy dining out--it's fun, relaxing,=20
and can be perfectly healthful. Bon appetit!
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Nonessentials: "It is proverbial of the American people that they bolt=20
their food whole, washing it down with various fluids, thus forcing the=20
stomach to perform not only its own duties, but also those of the teeth=20
and salivary glands. This manner of dispatching food...is not without=20
its baleful consequences, for the Americans are called a nation of=20
dyspeptics." The People's Common Sense Medical Adviser, pub. 1886.
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        You and your doctor=20
        This month a family practitioner talks about Parkinson's=20
disease. Dr. William J. Thieman, M.D., has been a family practitioner=20
for 15 years. He understands and treats the health needs of older=20
adults, including hypertension, diabetes, arthritis and impotence.

        Is it really Parkinson's disease? Parkinson's disease is a=20
disorder that results from damage to the brain. Doctors don't yet know=20
what causes it, but the signs of Parkinson's disease include trembling=20
in the arm, hand, or leg; rigid posture;  and unbalanced, shuffling=20
walk. As the disease progresses, there may be shaking of the head and a=20
stooped posture. Everyday activities, like bathing and dressing, become=20
difficult to perform.
        Now, the National Institute on Aging reports on medications that=20
may produce symptoms like Parkinson's disease. Researchers have found=20
that several commonly-prescribed drugs can produce effects that are much=20
like Parkinson's--so similar, in fact, that some people have been=20
wrongly diagnosed with Parkinson's disease.
        For example, sometimes people have nausea or vomiting during=20
cancer treatment. The drug Reglan (metoclopramide) is often prescribed=20
to prevent this stomach upset, allowing the patient to eat normally.=20
Reglan may also be used for heartburn.=20
        Although Reglan is a useful medication, some older adults=20
experience reactions, especially if they use it for a long time, or use=20
large doses.Undesirable reactions to Reglan include rigidity, trembling,=20
or mask-like faces.=20
        Doctors may believe the patient has Parkinson's, and begin=20
prescri       bingdrugsforParkinson'sdisease.Certaintranquilizerstaken=20
for nervous disorders can also cause Parkinson-like symptoms in some=20
older adults.
        The National Institute on Aging cautions older adults to be=20
aware of possible side effects of these and other drugs. If you or=20
someone you know begins to have symptoms after starting a new=20
medication, it's important to let your doctors know.
         Your family doctor can be very helpful in dealing with other=20
specialists. You must tell your family doctor about all the medications=20
you receive from other physicians. And it's important to explain the=20
symptoms you experience.
        New and better medications are being developed each year,=20
providing relief from Parkinson's disease, and other illnesses. However,=20
older adults are more likely than younger persons to experience=20
undesirable reactions from drugs. Your doctor wants to choose the=20
medication that's best for you. So it's important to work closely=20
together.=20
        Be extra alert to side effects when starting any new medication.=20
It helps to inform those near to you--a spouse, a neighbor, a loved=20
one--so that they can be on the lookout for unusual behavior, too. And=20
it may help to bring that person with you when you go to the doctor.=20
Sometimes a second person can bring a different perspective or=20
explanation.
        Always be sure your family doctor knows of any new symptoms you=20
have after starting a new medication. Together, you can find a treatment=20
that's best for you.
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        Exercise your potential ! =20
        Ever wondered just how fit you are? Thinking of starting an=20
exercise program? If you're planning strenuous activity, your doctor may=20
suggest a medical evaluation, including exercise testing, before you get=20
started. Here's up-to-date information from the director of an acclaimed=20
cardiac rehabilitation program.. This is the first of a two-part series.

Giving your body a =91Road Test.' Barry Franklin, Ph.D. What is exercise=20
stress testing? It's a medical procedure that measures how your heart=20
and blood vessels respond to increasing exercise. Testing your heart as=20
you exercise can be more revealing than a test done while you're at=20
rest. A stress test gives your heart, lungs, and blood vessels a "road=20
test," so to speak.
        There are several reasons why your doctor might recommend a=20
stress test: 1) to help detect heart disease; 2) to check your physical=20
fitness;    3) to see if it's safe for you to exercise vigorously; or 4)=20
to measure your heart's response to various medical treatments.
        During the test you'll pedal a stationery bicycle or walk on a=20
treadmill. Throughout the test--which usually lasts 8 to12 minutes--you=20
gradually pedal faster or walk harder until you are too tired to=20
continue or until you show signs of significant heart strain.
        A doctor or technician monitors your blood pressure and heart=20
with a blood pressure cuff and an electrocardiograph (ECG). The ECG=20
shows whether something is wrong with the way your heart is beating, and=20
helps to determine whether you have heart disease.
        Is it dangerous to push yourself to maximum effort during a=20
stress test?  Serious problems, like heart attacks, are very rare,=20
because you are carefully monitored. Occasionally, patients may become=20
dizzy or faint, or may feel chest pain or tightness during the test. But=20
these effects are rare. The test is remarkably safe, in spite of its=20
strenuous nature.
        How can the test help to  diagnose heart disease? Blockage of=20
the arteries that supply blood to the heart can cause heart attacks. An=20
oxygen supply-demand imbalance can often be detected with a stress test.=20
At rest, the blockage may not be severe enough to deprive the heart of=20
oxygen. During exercise, though, the reduced blood supply may cause=20
chest pain or changes on the ECG.
        Exercise stress testing best detects heart disease in people at=20
increased risk of heart problems. Those at risk include middle-aged or=20
older people who have one or more major risk factors (such as high=20
cholesterol, high blood pressure, cigarette smoking, or an inactive=20
lifestyle) or symptoms (such as chest pain, left arm pain with exertion,=20
dizziness, shortness of breath, or fatigue).
        Sometimes heart disease may not show up on an ECG. Or the ECG=20
may suggest heart disease when none exists. So doctors use other medical=20
findings in addition to the stress test to interpret its results.=20

        Next month:  Exercise safety. Dr. Franklin is Director, Cardiac=20
Rehabilitation and Exercise Laboratories, William Beaumont Hospital, and=20
Professor of Physiology, Wayne State University, School of Medicine.
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        Ask an RD=20
        Now you can get personal nutrition information from a registered=20
dietitian. Kathrynne Holden, MS, RD, will answer your questions. Your=20
age, height and weight, plus any medications you take, are helpful.=20
Write to Five Star Living, Inc. (address on back page).

Q: I'm an 86-year-old man with high triglycerides and high blood sugar.=20
I'm taking atenolol, Capoten, furosemide, gemfibrozil, and, since last=20
month, Glucotrol for blood sugar. My cholesterol is OK, but what are=20
triglycerides, anyway?

A: Triglycerides are a type of fat found in fatty foods. The body also=20
makes triglycerides from the food we eat. Normally, we store extra=20
triglycerides as fat. But sometimes these fats stay in the blood. This=20
can happen when we eat too many starches or sugar, or too much fat.=20
Frequently triglyceride levels rise as we age. Weight gain can also=20
cause  increased triglycerides, as can stress.
        Normally the blood level of triglycerides should be around=20
40-160 for men, a bit lower for women. Your doctor is concerned about=20
your triglyceride level because many people with coronary heart disease=20
also have high levels of triglycerides in the blood.
        However, not everyone with high triglycerides has heart=20
disease.Your doctor considers your age, blood pressure, fluid =20
retention, medical history, and other factors, in treating your=20
condition.
        Many people find that weight loss will lower their=20
triglycerides. Other good practices are to limit or eliminate alcohol;=20
limit sweets and fatty foods; and, unless you have food allergies or=20
other conditions, eat plenty of high-fiber foods, fish, and seafood. I=20
encourage you to eat at least three to five servings of cooked dried=20
beans each week, for their fiber, protein, minerals, and other=20
nutrients. I'd use whole grains as much as possible, too, like oatmeal,=20
whole wheat bread, and cereals like Shredded Wheat.
        The atenolol prescribed by your doctor should be used with a=20
low-sodium, low-fat diet. It can raise levels of triglycerides. The=20
Capoten and furosemide are also best taken with a low-sodium, low-fat=20
diet. Both these drugs can raise blood sugar.
        The gemfibrozil should help lower your triglycerides; it should=20
be combined with a low-fat diet with limited sugar. It, too, can raise=20
blood sugar.
        The Glucotrol may help control your blood sugar. Be sure to eat=20
within 30 minutes of taking Glucotrol. It's important to space your=20
meals 4-6 hours apart, and to limit sugary foods.
        You don't say how long you have had high triglycerides or high=20
blood sugar. It could be that some of your medications may be causing=20
these conditions. If you see more than one doctor, be sure that each one=20
is aware of all the drugs you use. A doctor may want to change or stop a=20
drug, depending on those other doctors have ordered. And I'd ask your=20
doctor whether you're getting enough exercise. It can help lower blood=20
sugar, blood pressure, and weight.
        If you follow the kind of menus in Spotlight, you're on the=20
right track--they're moderate in fat, sodium, and sugar. Here's  to your=20
good health!
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        TOP TIP: Ever go into the doctor's office and forget everything=20
you had prepared to ask about? The National Institute on Aging has a=20
free new booklet that will help! Entitled Talking With Your Doctor: A=20
Guide for Older People, it helps solve the kind of problems you=20
sometimes have with your doctors. Topics like Tips for good=20
communication; Getting started with a new doctor; How to talk about your=20
health issues; and many more, will help you get more out of your=20
checkups. Call NIA weekdays from 8:30 AM-5:00 PM EST: 1-800-222-2225 for=20
your free booklet.
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Serving sizes from the food guide pyramid:

Bread (complex carbohydrate) group
6-11 servings daily
1 slice bread; 1 oz dry cereal; =BD cup cooked cereal, rice or pasta; 4=20
small crackers;=20
2 large crackers; =BD bagel or English muffin

Vegetable group
3-5 servings daily
=BD cup cooked vegetables; =BD cup chopped raw veg.; 6 oz vegetable juice=
;
1 cup raw leafy greens

Fruit group
2-4 servings daily
1 medium apple, banana, or orange; =BD cup fresh berries; 15 grapes; =BD =
cup=20
applesauce
1/4 cup dried fruit; 3/4 cup fruit juice

Calcium (dairy) group
2-3 servings daily
4 oz canned sardines; 1 cup cooked spinach; 2 cups cooked navy beans
1 cup milk or yogurt; 1-1/2 oz cheese; 2 cups cottage cheese

Protein (meat) group
2-3 servings daily
2-3 oz cooked meat, fish or poultry; 1 cup cooked dry beans; 2 large=20
eggs
4 TB peanut butter

Fats, oils, & sweets
Use sparingly
Fats:  Butter, margarine, sour cream, mayonnaise, salad dressing, oil
Sweets: sugar, jam, jelly, honey, syrup, soft drinks, desserts.


        Send your questions, comments, and opinions to:
        Five Star Living, Inc.=20
        at this address -- we look forward to hearing from you!!=20

Five Star Living, Inc.   =09
604 East Pitkin         =09
Fort Collins CO 80524
Tel: 970-493-6532
Fax: 970-493-6538
E-mail:                 fivstar@xxxxxxxxxxx
URL:     

E-mail subscription: $12.00 per year.=20

Spotlight on Food=99 (ISSN 1083-3056) is published monthly by: Five Star=20
Living, Inc., 604 East Pitkin, Fort Collins CO 80524. Tel: 970-493-6532=20
 Fax: 970-493-6538  E-mail: <fivstar@xxxxxxxxxxxxxxxxxx>        URL:=09
<>

Please contact this office if you have questions for "Ask an RD" or=20
about a subscription.  Editor: Kathrynne Holden, M.S., R.D. Contributing=20
Editor: Barry Franklin, Ph.D. Editorial advisor: William J. Thieman,=20
M.D.=20

Spotlight on Food is intended to provide timely nutrition information of=20
a general nature.  Mention of a product by brand name does not=20
constitute an endorsement of that product. Spotlight on Food cannot=20
offer medical services, and is not intended to substitute for medical=20
services. Readers are encouraged to seek professional medical advice for=20
their personal health needs. Copyright 1996 Five Star Living, Inc., all=20
rights reserved. Photocopying, reproduction, or quotation in whole or in=20
part is forbidden without the publisher's written permission.

--=20
Kathrynne Holden, MS, RD
Editor-in-Chief,
"Spotlight on Food--nutrition news for people 60-plus"
Tel: 970-493-6532   Fax: 970-493-6538=20

Contact  Better Business Bureau of the Mountain States,
< msbbb@xxxxxxx>