Parkinson’s and Nutrition: Food for Thought
A healthy lifestyle and balanced nutrition are essential pillars of good health for all people.
A balanced diet is even more critical for people with a neurodegenerative condition, such as Parkinson's disease (PD).
PD influences many systems in the body, making those living with PD susceptible to malnutrition. Involuntary movements associated with PD result in increased energy expenditure. Constipation caused by slowed gastrointestinal transit, disease symptoms (swallowing problems, loss of the sense of smell and taste), and medication side effects (nausea and appetite loss) can all limit food consumption. In addition, one of the most used medications, levodopa, competes with proteins for absorption from the small intestine.
Although no single specific diet is recommended for everyone with PD, there has been growing research on the potential health benefits for PD patients of a balanced diet that includes high quality and nutritional food. Nutrition may affect PD patients’ wellbeing in several ways, from neuroprotection to symptom relief. This article provides a taste of the latest research in the field.
Neurodegeneration and neuroprotection
Neurodegeneration is characterized by loss of nerve structure and function. Neuroinflammation and oxidative stress are pathologic signatures of neurodegeneration. Innate immune cells are a source of reactive oxygen species (ROS) within the central nervous system. ROS are potentially toxic to cells and promote oxidative stress; their overproduction may contribute to neuronal damage and loss via neuroinflammation. Changing your diet to fight inflammation and oxidative stress may be an important strategy for keeping your brain healthy. Anti-inflammatory and antioxidative nutrients include alpha-lipoic acid (found in yeast, liver, kidney, spinach, broccoli, and potatoes), curcumin (found in the spice turmeric), omega-3 fatty acids (found in salmon, tuna, mackerel, herring, and other oily fish), gingerol (found in ginger), resveratrol (found in grapes), and β-carotene (found in carrots, broccoli, spinach, sweet potatoes, winter squash, and fruits like cantaloupe and apricots).
Food for relief of Parkinson’s symptoms
Parkinson’s disease causes a multitude of symptoms beyond the well-known motor symptoms. These symptoms are also known as “non-motor symptoms” and include constipation, weight gain and weight loss, memory problems, psychological and emotional disturbances, lack of energy, sleepiness, and fatigue. All these symptoms may be alleviated by dietary improvements.
Constipation is the most commonly reported (50–80%) gastrointestinal symptom in PD. It often precedes the diagnosis by many years and is a significant cause of discomfort and impaired quality of life. Moreover, constipation may impair the absorption of your medications. To relieve constipation, try drinking more fluids and increasing your intake of fiber (found in vegetables, fresh fruits, and legumes such as beans and lentils). Probiotic supplements that add healthy bacteria to the gut may also be helpful.
Both weight gain and weight loss can be a problem for people with PD and your diet should be altered accordingly.
Weight loss occurs when Parkinson’s symptoms are poorly controlled or when there is disease progression causing increased muscle activity from either tremors, muscle stiffness or dyskinesis. A loss of the sense of smell and taste and medication side effects may cause reduced appetite which in turn could result in weight loss as well.
If you struggle with weight loss or loss of appetite, try increasing your calorie intake by eating nuts and foods that contain healthy fats, such as coconut and avocado. Try bitter greens such as collard and beet greens, or spicy foods to stimulate your appetite. Exercise can increase muscle mass and hunger.
Weight loss may also occur due to swallowing problems. A solution for swallowing difficulties may be diet changes such as thickening liquids or making foods softer.
People with PD are also at increased risk of bone thinning. As PD advances, mobility challenges become more common, including an increased risk of falls. It is therefore especially important for people with PD to eat meals that provide bone-strengthening nutrients — particularly calcium, magnesium, and vitamins D and K. Also important is regular exposure to sunlight (which provides vitamin D), and engaging in weight-bearing exercise, such as walking.
Constipation is the most commonly reported (50–80%) gastrointestinal symptom in PD
Food and Parkinson’s medication
If you take certain PD drugs, dietary adjustments may improve their effectiveness or help avoid side effects.
Protein and levodopa use the same transporter to cross the small intestine wall, meaning that levodopa and proteins may compete for absorption and that taking levodopa while eating protein (meat, fish, cheese, beans or nuts) may mean that less medication is absorbed. If you find that protein-rich foods delay the time it takes your medicines to take effect or cause them to wear off before the next dose is scheduled — consider separating medicine-taking from meals, for example by taking your meds on an empty stomach half an hour to an hour before meals. If this causes nausea, combine it with a low- or no-protein snack, such as crackers, dry toast, or oatmeal.
Another option is to redistribute your protein consumption and have small portions of protein several times a day or save higher amounts of protein for dinner and eat more vegetables and carbohydrates during the day when it's important for medication to work well.
MAO-B inhibitors (Rasagiline or Selegiline) increase tyramine levels. Tyramine is an amino acid that helps regulate blood pressure. Tyramine occurs naturally in the body and is found in certain foods. MAO-B inhibitors block monoamine oxidase, an enzyme that breaks down excess tyramine in the body. When MAO-B inhibitors are mixed with foods that contain high amounts of tyramine, the combination could raise blood pressure. Those who take MAO-B inhibitors should moderate their consumption of tyramine-containing foods (such as pickled fish, meats that are cured, smoked, or processed, aged cheeses and soybean products), but not necessarily eliminate them.
In summary
There are many potential benefits to eating a healthy and balanced diet if you have PD, including having more energy, sleeping better, maximizing the effectiveness of your medications, helping avoid or ease your constipation, and maybe even slowing the progression of the disease.
References
Fullard ME, Duda JE. A Review of the Relationship Between Vitamin D and Parkinson Disease Symptoms. Front Neurol. 2020 May 27;11:454. doi: 10.3389/fneur.2020.00454. PMID: 32536905; PMCID: PMC7267215.
Ciulla M, Marinelli L, Cacciatore I, Stefano AD. Role of Dietary Supplements in the Management of Parkinson's Disease. Biomolecules. 2019;9(7):271. Published 2019 Jul 10. doi:10.3390/biom9070271
Shah SP, Duda JE. Dietary modifications in Parkinson's disease: A neuroprotective intervention? Med Hypotheses. 2015 Dec;85(6):1002-5. doi: 10.1016/j.mehy.2015.08.018. Epub 2015 Sep 6. PMID: 26364043.
Mischley LK, Lau RC, Bennett RD. Role of Diet and Nutritional Supplements in Parkinson's Disease Progression. Oxid Med Cell Longev. 2017;2017:6405278. doi:10.1155/2017/6405278
Seidl SE, Santiago JA, Bilyk H, Potashkin JA. The emerging role of nutrition in Parkinson's disease. Front Aging Neurosci. 2014;6:36. Published 2014 Mar 7. doi:10.3389/fnagi.2014.00036
Khasnavis S, Pahan K. Cinnamon treatment upregulates neuroprotective proteins Parkin and DJ-1 and protects dopaminergic neurons in a mouse model of Parkinson's disease. J Neuroimmune Pharmacol. 2014 Sep;9(4):569-81. doi: 10.1007/s11481-014-9552-2. Epub 2014 Jun 20. PMID: 24946862; PMCID: PMC4167597.
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