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What the Experts Say: Diet and Nutrition for People with Parkinson's Disease

In this installment of our Voice of the Experts series, Parkinson News Today asked Dr. Christine C. Ferguson to answer several questions about diet and nutrition for people with Parkinson’s disease.

Ferguson is a Registered Dietitian (RD) and Postdoctoral Fellow at the University of Alabama at Birmingham and Nutrition Research Coordinator at the National Center for Health, Physical Activity and Disability. She earned her doctorate in human nutrition from the University of Alabama. She has worked as her RD in clinical settings, mentored emerging her RDs and medical professionals in academic settings, and worked with people with disabilities, including those with Parkinson’s disease, through organizations such as NCHPAD and the Michael J. Fox Foundation. I have experience educating communities. , the Tanner Foundation, and the Parkinson Society of Alabama.

Christine C. Ferguson holds a PhD in Human Nutrition, is a registered dietitian, and has assisted many Parkinson’s disease non-profit organizations in providing nutrition education. (Photo credit: Christine Ferguson)

Do you recommend a specific diet for people with Parkinson’s disease? Why?

There are several diets being studied in Parkinson’s disease, and it is difficult to recommend a specific diet when this field of research is still new. We recommend taking an individualized approach under the guidance of a registered dietitian.

What we do know is that a diverse, whole-food, plant-based diet is considered a healthy eating pattern for most people, including those with Parkinson’s disease. It doesn’t mean being completely vegetarian or vegan, but there is a particular emphasis on getting most of your nutrients from plant sources rather than animal products.

Although there is compelling evidence to support recommended diets such as the Mediterranean diet and the Mediterranean Dash Intervention for Delayed Neurodegeneration (MIND) diet, at present there is no conclusive evidence to support that these diets slow disease progression. Yet these are both plant-based diets that have evidence to support the prevention of cardiovascular disease and cognitive decline, which are often priorities for people with Parkinson’s disease.

Are there any popular diets in the Parkinson’s community that I should be aware of? Why?

I usually voice my concern with diets and meal plans that recommend cutting out entire food groups, buying expensive supplements or packets, and providing “quick” results. There are no magic pills or detox treatments that will give you bad results.

A more specific diet that I hesitate to promote is the ketogenic diet, which is a very high-fat, low-carbohydrate diet. Although there is supporting evidence, there are no data to support long-term effects in people with Parkinson’s disease. From a practical standpoint, following a true ketogenic diet is difficult to adhere to and even harder to maintain. It is always recommended that anyone considering this diet be monitored by a medical professional.

Are there surprising ways diet and nutrition can affect Parkinson’s disease?

Certain food and drug interactions have surprised me. It is the interaction of proteins, drugs and levodopa (e.g. Sinemet, Rytary, Duopa, Parcopa). In essence, taking a levodopa drug at the same time as a protein-containing food may not absorb all of the drug. Because of this, the body chooses to absorb protein over levodopa. As a result of this, levodopa is not fully absorbed and some of it is excreted, and Parkinson’s patients are more likely to suffer because the drug does not work effectively. You may experience more side effects.

What always amazes me about this interaction is that it is not yet fully understood. Not everyone with Parkinson’s disease experiences an increase in symptoms after taking the drug (called “off” time) when eating protein-containing foods, but why do some do and others don’t? There is some evidence to suggest that this interaction does not occur only in the small intestine. . There is still much to learn about how protein and this type of drug interact, including the most effective diet to mitigate this interaction.

What vitamins and nutrients should people with Parkinson’s disease pay special attention to? Why?

We have already mentioned how important protein is for Parkinson’s patients taking levodopa. I would also like to add that you need to consume enough protein to maintain muscle, physical function, and the ability to perform daily activities.

There are certain vitamins and minerals that have been studied in relation to Parkinson’s disease. Here I add a disclaimer that these nutrients are preferably obtained from food rather than supplements. should be recommended under the advice of a medical professional. It’s also a good idea to discuss reputable brands with your pharmacist, doctor, and/or RD, as there are regulatory loopholes in the supplement industry regarding quality.

Among other nutrients being studied in Parkinson’s disease, the highlights here are vitamin D, coenzyme Q10 (CoQ10), and fish oil. Patients with Parkinson’s disease are at increased risk of vitamin D deficiency, which may be related to areas of the brain affected during the course of the disease. Vitamin D deficiency increases the risk of osteoporosis and fractures, so it is important to get enough. Dairy alternatives are fine!), fortified cereals and juices, eggs, and fish (maximum prices for salmon, tuna, and sardines).

CoQ10 is of interest in Parkinson’s disease because it acts as a neuroprotective antioxidant. It has also been shown that people with Parkinson’s disease may be deficient in CoQ10, something that is checked through regular medical care. However, other studies have shown inconsistent results. Moderate doses (up to 2,400 mg daily) have been shown to do no harm . Food sources of CoQ10 include fatty fish (salmon, tuna, mackerel, sardines) and whole grains.

We already recommend eating fish because fish is a natural source of vitamin D and CoQ10. Again, taking fish in food form is preferable to taking fish oil as a supplement. Of note, other non-fish sources of omega-3 fatty acids include flaxseeds, chia seeds, walnuts, and vegetable oils (olive, canola, avocado).

What should people with Parkinson’s disease emphasize when developing a nutrition plan?

A healthy diet includes whole grains, lean protein, fruits and vegetables, and low-fat dairy products. This may not be groundbreaking information for some, but I think we tend to overcomplicate it. No need to follow a strict diet. Find a recipe that fits your abilities, the equipment you have access to, and the deliciousness! Remember that even small changes are important, because a big change in your diet overnight won’t last long. Look at your average diet right now and pick one or three things you think you could easily change. Switching from sweetened teas to half-sweetened/unsweetened teas, baking fries instead of frying them, and eating one donut that you would normally eat two. Planning a nutrition plan can be overwhelming. If so, we encourage you to find and help an RD.Use this link from the Academy of Nutrition and Dietetics to find a provider near you, or ask your GP for a referral.

Also, people with Parkinson’s disease and other physical disabilities can participate in eight weeks through the National Center for Health, Physical Activity and Disability called the Mindfulness, Exercise and Nutrition for Optimizing Resilience (MENTOR) program. I also share that I am eligible to participate in a virtual wellness program. This program can be offered free of charge. Funded through the Centers for Disease Control and Prevention, it costs nothing but your time. I help with the nutrition portion of the program.We have an excellent RD who teaches weekly classes that include cooking demonstrations with adaptive tools and offers free nutrition counseling during the program. , is intended to help develop a basic understanding of nutrition and does not recommend any specific diet. You can attend coaching sessions.You also get some great training equipment. See here for details.

What conversations would you like more people with Parkinson’s to have with their nutritionists and nutritionists?

First, I want more people to see RD. At least in the United States, it is not common for RDs to be part of most people’s health care teams, including those with Parkinson’s disease. There is an incredible amount of misinformation shared on the internet and social media, and it is difficult to sort it all out and decide what is credible. One of the many ways RD can help is by clarifying this misinformation and providing practical suggestions for making healthy lifestyle changes.

Expert Voices is a monthly series that includes Q&A with experts in the Parkinson’s disease area on specific topics. These topics and questions are handpicked from a survey that asks readers what they would like to know about from experts. Click here if you’d like to submit a topic or question for consideration in future articles in the series. take the survey here.

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