Accommodations in diet accompany many an illness or disease, from chicken soup for those with colds or the flu, to the carefully watched plates of the diabetic.

However, for persons living with Parkinson’s Disease, the sorts of food prepared and eaten matter less than the ways that food is cooked and consumed.

Of course, most who counsel people living with Parkinson’s Disease suggest that maintaining a nutritious, well-balanced, Mediterranean diet should fare them well overall, in the same way that these food choices benefit everyone.

“Beyond that,” says Jessica Hinkley, an outpatient dietician neuroscience specialist at UCHealth, “the main thing that I talk with them about is to prevent malnutrition. [Parkinson’s] can cause people to be down or depressed, and that can cause malnutrition.”

So, Mediterranean diet, check. And within that, because Parkinson’s is, in the main, a disease of the brain, an emphasis on eating fish rich in omega-3 fatty acids, promotes brain health.

“I think we are missing out,” says Hinkley, “on potential anti-inflammatory benefits if we don’t eat enough fatty fish. Tuna, salmon, and trout are good options. For those who like mackerel, sardines, and anchovies, those are great, too.”

But unlike many others bearing under disease or illness, persons living with Parkinson’s Disease and their caregivers must attend to matters peripheral to the food itself. Tinkering with everything from the kitchen cabinet to the way to scoop up peas matters to persons living with Parkinson’s Disease.

In general, the classic symptoms of Parkinson’s are slow muscle movement, muscle stiffness and rigidity, and involuntary tremors. These especially affect the face, mouth, tongue, and throat when eating food in mid- and late-stage Parkinson’s. Furthermore, tremors affect the fine motor control of the hands and fingers.

All of these conspire to make chewing and swallowing food difficult. Holding, grasping or using both kitchen utensils and tableware becomes challenging, even dangerous. (In early-stage Parkinson’s, by and large, these issues do not present.)

Addressing Parkinson’s symptoms while at the table

Some adjustments to dining protocols can help. For example, because it can be difficult, due to tremors, to steadily grasp and hold a fork, it helps to use instead a large-handled spoon to move especially small foods such as peas or rice to the mouth.

Because large pieces of food are unwieldy, even dangerous (for fear of choking), cutting up foods into small pieces is advisable. Likewise, harder foods such as raw or crisp vegetables can be difficult, not to say perilous, for the person living with Parkinson’s Disease to chew and swallow. Hence, long-cooked, softer foods are a norm.

Dry mouth, an effect of some medications, affects many people living with Parkinson’s Disease at the table. A lack of saliva can be remedied with sips of liquid before introducing food to the palate. An abundance of fluid also assists in moving food through the intestinal tract when slowed peristalsis is also complicated by medication.

A short list of recommended tableware:

• Utensils with oversized handles.
• Plates with high, well-defined edges, even plates with compartments.
• Lidded drinks containers, perhaps with perforations for straws.

Workarounds for Parkinson’s symptoms while in the kitchen

All of a sudden, the hearth can become a hazardous place for a Parkinson’s patient. Tremors and decreased muscle control can make merely holding, not to say using, a chef’s knife a dangerous affair. Perhaps best to avoid it, or request a caregiver to do the food prep.

Here is a list of other workarounds or adjustments that can help a person living with Parkinson’s Disease in the kitchen:

• Parkinson’s patients may have limited range of motion, so rearrange foods in cabinetry so that commonly used items are close within reach (not too high because stretching is difficult, nor too low so as to avoid difficult crouching).
• Leave regularly used appliances such as can openers or blenders on the counter and plugged in.
• Because they are a falling hazard, throw away throw rugs or other floor clutter. In the kitchen, clear, clean access to the stove, refrigerator, sink, and counter spaces is essential to safety.
• Opt for large containers with handles or other holders for liquids such as milk, purified water, tea, and juice. It will be difficult for a person with Parkinson’s to grasp and carry a heavy container by the mere neck.
• “A good blender or food processor can be essential,” says Jessica Hinkley, “plus grippy things to help open jars.”

A heavy measure of sensitivity needs to season all this advice. Such changes in the life of a person with Parkinson’s signal a great loss of independence. Tasks which earlier in life were done with ease now are much more difficult, even dodgy.

If aiding a person with Parkinson’s, keeping that in mind might make your help feel less of a threat than the gift that you mean it to be.

The recipes here embody two directives reiterated above: the benefits of the Mediterranean diet and the profit of the piscine. Eat more fish, all of us.

Minestrone Speziato (Spicy Vegetable and Pasta Soup)

As an ingredient, the mushroom soup is especially important because it adds terrific umami. Serves 6-10 depending on portion size.

Ingredients

• 2 tablespoons extra virgin olive oil
• 1 medium yellow onion, peeled and diced
• 4 garlic cloves, peeled and minced
• 1 medium jalapeño pepper, trimmed, deveined and minced
• 2 medium or 4 small parsnips, peeled and cut into small chunks (about 2 cups)
• 1 medium zucchini, partially peeled and cut into chunks (about 1 cup)
• 3 to 4 stalks celery, cut into small chunks on the bias (about 2 cups)
• 2-3 tablespoons celery leaves, roughly chopped
• 1 teaspoon hot pepper flakes (Mexican, for example, or American, Urfa or Aleppo)
• 1/2 to 3/4 teaspoon herbes de Provence, to taste
• 1/2 teaspoon freshly ground black pepper, to taste
• Salt to taste
• 1 32-ounce box vegetable broth
• 8 ounces (1 cup) mushroom or cream of mushroom soup (see note)
• 1 15-ounce can red kidney beans and their liquid
• 1 15-ounce can garbanzo or Great Northern beans and their liquid
• 1 heaping cup short-form pasta, uncooked

Directions

In a large pot or Dutch oven, over medium-high heat, warm the olive oil and, in it, cook the onions for 5-6 minutes, then make a space by pushing them to the side and cook the garlic and jalapeño for 90 seconds, assuring that none of the garlic burns.

Add all the remaining ingredients, stirring them together and bring the contents of the pot to a boil. Lower to a simmer, place the cover ajar, and cook for 30-40 minutes, stirring occasionally, until the pasta is cooked through and soft. (If you wish the pasta al dente, back off on the simmering time 5-10 minutes, sampling as you go.)

Note: Substitutes for the soup would include chopped caps of button or cremini mushrooms (6-8 small, 3-4 medium, 1 very large), or the equivalent in dried, reconstituted, chopped mushrooms (porcini, say, or shiitake).

Trout Amandine (Trout Almondine)

Adapted from “From Julia Child’s Kitchen,” Julia Child (Knopf, 1978) and williams-sonoma.com. Serves 1-2, easily multiplied.

Ingredients

• 1 whole trout, dressed, rinsed and dried, head removed, opened up and flat
• 6-8 plain Marcona Almonds, roughly chopped
• Sea or kosher salt and freshly ground black pepper, to taste
• Flour, enough to lightly dust the fish, on a plate or platter
• 1/2 cup ghee or clarified butter, or a 50/50 mix of sunflower oil and softened unsalted butter
• 2 tablespoons unsalted butter, room temperature
• The juice of 1/2 small lemon
• 6-8 salted capers, rinsed 2 times and squeezed lightly
• 2 tablespoons flat-leaf parsley, chopped fine
• Lemon wedges for serving

Directions

Before cooking, assure that the trout is patted dry and sprinkle it on both sides with salt and pepper. In a large non-stick skillet over medium-low heat, toast the almonds, stirring frequently, until they slightly tan, 1-2 minutes only. Transfer to a plate and reserve.

Dust both sides of the trout with flour. Melt or pour about 1/8-inch of the fat you’re using into the pan and raise the heat to medium-high. When the fat is slightly shimmering, add the trout, skin side up and cook for 4-5 minutes, shaking the skillet 2-3 times. (The fat should be bubbling but not blackening.) Holding the tail with tongs, turn over the trout using a large spatula and cook it 4-5 minutes on the other side.

Transfer the trout to a large, warmed plate or platter and keep warm. Wipe the skillet with a few paper towels and in it melt the 2 tablespoons butter. When it begins to foam, add the lemon juice, capers and parsley, stirring. Add the reserved chopped almonds and check for seasoning, adding more salt and pepper if needed.

Spoon the sauce over the cooked fish and serve immediately, lemon wedges to the side.

Reach Bill St. John at [email protected]