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Post-DBS-STN Weight Gain

Posted Aug 23 2008 10:25pm

My Question to Kathrynne Holden from Ask a Parkinson Dietician

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Hi Kathrynne,

I am a 58 year old post-menopausal woman who has experienced significant weight gain (15-20 pounds) since DBS-STN for PD in May 2005. I am also concerned about my increasing cholesterol level.

I was diagnosed with PD 12 years ago.

The explanation that I've always heard is that DBS-STN changes one's metabolism and if DBS-STN is successful, generally one shakes less. I had a significant tremor prior to DBS which has almost completely subsided. I never had dyskinesia pre-DBS but developed some after DBS, and the dyskinesia is now almost non-existent through excellent programming.

I continue with the same vegetarian diet as I have for the past 25 years. Also, I walk 2x/week, do yoga 2x/week and dance 2x/week. Before my PD diagnosis, I enjoyed running and biking but currently I'm afraid to run or bike.

I am delighted with the overall benefits of DBS-STN. Is there anything you would suggest to combat the weight gain and rising cholesterol level?

Here's a link to an article that may shed some light:

Thanks for your commitment to PD patients,

Kate Kelsall

Kathrynne Holden’s Response:

Dear Kate,

You are both proactive and well-informed, and this is of immeasurable benefit in combating PD. Your exercise program is very well-thought-out – walking benefits both muscles and bones, yoga counteracts some of the effect of PD upon the muscles and joints, and dance is proving repeatedly to improve PD symptoms as well as health.

Regarding weight gain, it’s likely that you now have less or no ‘off time,’ and you state your tremor is controlled. Both of these contribute to energy expenditure. Post-menopause, there is a decreased production of estrogen, which in most women is accompanied by fat gain.

If you are certain your daily calorie intake has not changed, then these, along with the decreased production of estrogen that accompanies menopause, are likely the contributing factors. However, if you are using an agonist, such as Mirapex or Requip, these can cause edema (fluid retention in the tissues), which is a very frequent cause of weight gain in PD. Your doctor can determine whether edema is present. If so, I would use salt very moderately, and include potassium-rich foods daily. The DASH diet is an excellent choice both for its natural diuretic properties and because it is rich in the foods of most benefit in PD, and can easily work for vegetarians.

If weight gain is due to increased fat, then, if it is possible I would try to add an extra walk or dancing weekly to increase energy expenditure. It may also be helpful to break up meals into 4-6 small meals daily; the body is more apt to store calories as fat from three large meals than several small ones.

Estrogen also helps to control serum cholesterol, and again, it’s likely that the post-menopausal condition is having an effect, despite a vegetarian diet. However, I would ask your doctor to review total cholesterol, HDL, LDL, triglycerides, C-reactive protein, and serum homocysteine. If your ratio of HDL to total cholesterol is high, the cholesterol may not be a concern, especially if triglycerides and CRP are normal. I mention homocysteine, in case you use levodopa. Long-time users of levodopa often develop elevated levels of homocysteine, and if you use levodopa, I strongly recommend you ask your doctor to establish a baseline. Homocysteine is associated with stroke and heart attack, depression, and dementia.

Regarding the increased cholesterol, if you are not already doing so, I would switch to extra-virgin olive oil both for cooking and for dipping bread with meals; it is a fine source of anti-inflammatory. Include a couple of tablespoons of mixed raw nuts daily – almonds and walnuts particularly, also Brazil nuts, filberts, and pecans. Nuts are a rich source of natural vitamin E as well as protective fatty acids.

Finally, does your diet allow you include fish? It is the finest source of omega-3 fatty acids, which are superb at helping to raise HDL and lower LDL and triglycerides. Fatty fish, and fish oil capsules, are both excellent. If you do not use any animal products, then I recommend use of flax seed oil; though not as effective, it is still a good product.

I hope this is helpful; write back and let me know how you are doing.

Best regards,

Kathrynne Holden, MS, RD


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