Michael J Fox, the famous actor from Family Ties, put Parkinson’s Disease on everyone’s radar when he was diagnosed in 1991. Back then, not much was known about this chronic neurogenerative disease. Thankfully, there’s growing interest in how nutrition may help prevent and slow the progression of Parkinson’s disease (PD).
John Duda, a physician and national director of the VA Parkinson’s Disease Research, Education and Clinical Centers also serves as director of the Brain Wellness Clinic at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, noticed the lack of medications to treat symptoms and how he could support his patients with other science-backed methods.
“I recognized that nutritional approaches within a broader program that includes medication review, stress management, social connections, adequate sleep, and physical exercise could make a real difference”.
Previous studies show an inverse association between PD risk and eating patterns, age of onset, the severity of symptoms, and mortality rates. This is especially clear with the Mediterranean Diet and the MIND diet, which combines the DASH and Mediterranean Diets. Duda notes that while randomized controlled trials are needed, current epidemiologic data in favor of dietary interventions is “compelling”, states Duda. 1
He cites a cross-sectional trial comparing 167 subjects with PD to 119 controls and age of onset. Women who followed a MIND diet had PD onset of up to 17.4 years later when looking at low and high dietary tertiles.
In men, the Mediterranean diet was associated with later onset, with an 8.4-year difference in diagnosis. The healthy diet focused on fruits, vegetables, nuts, and grains and helped reduce symptoms such as constipation, depression, and excessive daytime fatigue in PD. Lower rates of Parkinson’s have also been observed in populations adhering to vegetarian and vegan diets.
Does Gut Health Impact the Risk for PD?
In PD, fewer beneficial short-chain acid-producing (beneficial) bacteria and more pro-inflammatory bacteria are associated with intestinal inflammation and accumulation of a-synuclein, a protein that regulates neurotransmitters in the brain.
Before motor symptoms of PD are observed, gastrointestinal symptoms may be seen. When the gut microbiome is impaired due to a poor diet, it may impact the gut-brain axis. Several studies suggest that gut inflammation may be at play with PD. 3
Common Issues in PD
Other PD symptoms such as orthostatic hypotension may be alleviated through diet. Duda advises avoiding large meals, decreasing alcohol intake, and increasing fluid, and dietary salt intake.
Malnutrition is also common in PD patients with up to 25% being affected. Decreased sense of smell may reduce appetite. Duda suggests using herbs, spices, and other flavors in food in addition to high-calorie foods like nuts, seeds, and nut butter to increase weight. Seeing a dietitian for advice is also recommended.
Patients with PD may also experience constipation. Eating a high-fiber diet with plenty of fluids and using stool softeners or laxatives is suggested. A Mediterranean diet may alleviate symptoms of constipation and positively affect the gut microbiome. 4
Good news for coffee and tea lovers. Research suggests caffeine may reduce the symptoms of PD such as sleepiness and dyskinesia. Coffee has been associated with reduced risk of development PD. 5, 6 Three cups of coffee daily shows the most benefit.
Problematic Foods for PD
It should come as no surprise that ultra-processed foods (UPF) should be discouraged. A recent systematic review and meta-analysis of nearly 30 studies indicates that higher UPF intake is linked with a higher risk of developing PD. Cognitive decline and stroke are also linked with higher UPF intake. 7
Including protein in your diet when you have PD can be tricky. While protein is a necessary macronutrient, it may interfere with the medication levodopa, a large neutral amino acid. It may compete with other amino acids (from protein) for transport from the small intestine to the brain. PD patients should take medications 30 minutes before or 60 minutes after meals.
Patients with PD may consider eating protein later in the day and focusing their other meals and snacks on carbohydrates and vegetables, advises Rebecca Gilbert, MD, PhD, chief mission officer of the American Parkinson Disease Association. Protein redistribution diets may also be appropriate to improve the response to levodopa and lessen motor disturbances. 8
Bottom Line on Diet and PD:
· Moderate coffee and tea intake may reduce the risk of developing PD.
· Reducing ultra-processed foods reduces the risk of PD.
· Adhering to a plant-forward, Mediterranean diet may improve gut function and microbiome in PD patients.
· Drinking adequate fluids helps reduce orthostatic hypotension and constipation.
· Malnutrition and decreased sense of smell are common in PD patients.
· Use high-calorie foods, herbs, spices, and flavorings to make meals more palatable.
· Time protein intake with medication use to make medications more effective.
· Refer patients to Registered Dietitians for evaluation and treatment of nutrition-related issues with PD.
Lisa Andrews, MEd, RD, LD
References:
1. Tosefsky KN, Zhu J, Wang YN, Lam JST, Cammalleri A, Appel-Cresswell S. The Role of Diet in Parkinson's Disease. J Parkinsons Dis. 2024;14(s1):S21-S34. doi: 10.3233/JPD-230264. PMID: 38251061; PMCID: PMC11380239.
2. Fox DJ, Park SJ, Mischley LK. Comparison of Associations between MIND and Mediterranean Diet Scores with Patient-Reported Outcomes in Parkinson's Disease. Nutrients. 2022 Dec 6;14(23):5185. doi: 10.3390/nu14235185. PMID: 36501214; PMCID: PMC9739738.
3. Romano S, Savva GM, Bedarf JR, Charles IG, Hildebrand F, Narbad A. Meta-analysis of the Parkinson's disease gut microbiome suggests alterations linked to intestinal inflammation. NPJ Parkinsons Dis. 2021 Mar 10;7(1):27. doi: 10.1038/s41531-021-00156-z. PMID: 33692356; PMCID: PMC7946946.
4. Rusch C, Beke M, Tucciarone L, Nieves C Jr, Ukhanova M, Tagliamonte MS, Mai V, Suh JH, Wang Y, Chiu S, Patel B, Ramirez-Zamora A, Langkamp-Henken B. Mediterranean Diet Adherence in People With Parkinson's Disease Reduces Constipation Symptoms and Changes Fecal Microbiota After a 5-Week Single-Arm Pilot Study. Front Neurol. 2021 Dec 23;12:794640. doi: 10.3389/fneur.2021.794640. PMID: 35002935; PMCID: PMC8733603.
5. Postuma RB, Anang J, Pelletier A, Joseph L, Moscovich M, Grimes D, Furtado S, Munhoz RP, Appel-Cresswell S, Moro A, Borys A, Hobson D, Lang AE. Caffeine as symptomatic treatment for Parkinson disease (Café-PD): A randomized trial. Neurology. 2017 Oct 24;89(17):1795-1803. doi: 10.1212/WNL.0000000000004568. Epub 2017 Sep 27. PMID: 28954882; PMCID: PMC5664303.
6. Safe S, Kothari J, Hailemariam A, Upadhyay S, Davidson LA, Chapkin RS. Health Benefits of Coffee Consumption for Cancer and Other Diseases and Mechanisms of Action. Int J Mol Sci. 2023 Jan 31;24(3):2706. doi: 10.3390/ijms24032706. PMID: 36769029; PMCID: PMC9916720.
7. Pourmotabbed, A., Talebi, S., Mehrabani, S., Babaei, A., Khosroshahi, R. A., Bagheri, R., … Moradi, S. (2024). The association of ultra-processed food intake with neurodegenerative disorders: a systematic review and dose-response meta-analysis of large-scale cohorts. Nutritional Neuroscience, 28(1), 73–86. https://doi.org/10.1080/1028415X.2024.2351320
8. Boelens Keun JT, Arnoldussen IA, Vriend C, van de Rest O. Dietary Approaches to Improve Efficacy and Control Side Effects of Levodopa Therapy in Parkinson's Disease: A Systematic Review. Adv Nutr. 2021 Dec 1;12(6):2265-2287. doi: 10.1093/advances/nmab060. PMID: 34113965; PMCID: PMC8634393.
Lisa Andrews, MEd, RD, LD, is a registered dietitian and owner of Sound Bites Nutrition in Cincinnati. She shares her clinical, culinary, and community nutrition knowledge through cooking demos, teaching, and freelance writing. Lisa is a regular contributor to Food and Health Communications and Today’s Dietitian and is the author of the Healing Gout Cookbook, Complete Thyroid Cookbook, and Heart Healthy Meal Prep Cookbook. Her line of food pun merchandise, Lettuce beet hunger, supports those suffering food insecurity in Cincinnati. For more information,
How Diet May Impact Parkinson’s Disease
Michael J Fox, the famous actor from Family Ties, put Parkinson’s Disease on everyone’s radar when he was diagnosed in 1991. Back then, not much was known about this chronic neurogenerative disease. Thankfully, there’s growing interest in how nutrition may help prevent and slow the progression of Parkinson’s disease (PD).
John Duda, a physician and national director of the VA Parkinson’s Disease Research, Education and Clinical Centers also serves as director of the Brain Wellness Clinic at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, noticed the lack of medications to treat symptoms and how he could support his patients with other science-backed methods.
“I recognized that nutritional approaches within a broader program that includes medication review, stress management, social connections, adequate sleep, and physical exercise could make a real difference”.
Previous studies show an inverse association between PD risk and eating patterns, age of onset, the severity of symptoms, and mortality rates. This is especially clear with the Mediterranean Diet and the MIND diet, which combines the DASH and Mediterranean Diets. Duda notes that while randomized controlled trials are needed, current epidemiologic data in favor of dietary interventions is “compelling”, states Duda. 1
He cites a cross-sectional trial comparing 167 subjects with PD to 119 controls and age of onset. Women who followed a MIND diet had PD onset of up to 17.4 years later when looking at low and high dietary tertiles.
In men, the Mediterranean diet was associated with later onset, with an 8.4-year difference in diagnosis. The healthy diet focused on fruits, vegetables, nuts, and grains and helped reduce symptoms such as constipation, depression, and excessive daytime fatigue in PD. Lower rates of Parkinson’s have also been observed in populations adhering to vegetarian and vegan diets.
Does Gut Health Impact the Risk for PD?
In PD, fewer beneficial short-chain acid-producing (beneficial) bacteria and more pro-inflammatory bacteria are associated with intestinal inflammation and accumulation of a-synuclein, a protein that regulates neurotransmitters in the brain.
Before motor symptoms of PD are observed, gastrointestinal symptoms may be seen. When the gut microbiome is impaired due to a poor diet, it may impact the gut-brain axis. Several studies suggest that gut inflammation may be at play with PD. 3
Common Issues in PD
Other PD symptoms such as orthostatic hypotension may be alleviated through diet. Duda advises avoiding large meals, decreasing alcohol intake, and increasing fluid, and dietary salt intake.
Malnutrition is also common in PD patients with up to 25% being affected. Decreased sense of smell may reduce appetite. Duda suggests using herbs, spices, and other flavors in food in addition to high-calorie foods like nuts, seeds, and nut butter to increase weight. Seeing a dietitian for advice is also recommended.
Patients with PD may also experience constipation. Eating a high-fiber diet with plenty of fluids and using stool softeners or laxatives is suggested. A Mediterranean diet may alleviate symptoms of constipation and positively affect the gut microbiome. 4
Good news for coffee and tea lovers. Research suggests caffeine may reduce the symptoms of PD such as sleepiness and dyskinesia. Coffee has been associated with reduced risk of development PD. 5, 6 Three cups of coffee daily shows the most benefit.
Problematic Foods for PD
It should come as no surprise that ultra-processed foods (UPF) should be discouraged. A recent systematic review and meta-analysis of nearly 30 studies indicates that higher UPF intake is linked with a higher risk of developing PD. Cognitive decline and stroke are also linked with higher UPF intake. 7
Including protein in your diet when you have PD can be tricky. While protein is a necessary macronutrient, it may interfere with the medication levodopa, a large neutral amino acid. It may compete with other amino acids (from protein) for transport from the small intestine to the brain. PD patients should take medications 30 minutes before or 60 minutes after meals.
Patients with PD may consider eating protein later in the day and focusing their other meals and snacks on carbohydrates and vegetables, advises Rebecca Gilbert, MD, PhD, chief mission officer of the American Parkinson Disease Association. Protein redistribution diets may also be appropriate to improve the response to levodopa and lessen motor disturbances. 8
Bottom Line on Diet and PD:
· Moderate coffee and tea intake may reduce the risk of developing PD.
· Reducing ultra-processed foods reduces the risk of PD.
· Adhering to a plant-forward, Mediterranean diet may improve gut function and microbiome in PD patients.
· Drinking adequate fluids helps reduce orthostatic hypotension and constipation.
· Malnutrition and decreased sense of smell are common in PD patients.
· Use high-calorie foods, herbs, spices, and flavorings to make meals more palatable.
· Time protein intake with medication use to make medications more effective.
· Refer patients to Registered Dietitians for evaluation and treatment of nutrition-related issues with PD.
Lisa Andrews, MEd, RD, LD
References:
1. Tosefsky KN, Zhu J, Wang YN, Lam JST, Cammalleri A, Appel-Cresswell S. The Role of Diet in Parkinson's Disease. J Parkinsons Dis. 2024;14(s1):S21-S34. doi: 10.3233/JPD-230264. PMID: 38251061; PMCID: PMC11380239.
2. Fox DJ, Park SJ, Mischley LK. Comparison of Associations between MIND and Mediterranean Diet Scores with Patient-Reported Outcomes in Parkinson's Disease. Nutrients. 2022 Dec 6;14(23):5185. doi: 10.3390/nu14235185. PMID: 36501214; PMCID: PMC9739738.
3. Romano S, Savva GM, Bedarf JR, Charles IG, Hildebrand F, Narbad A. Meta-analysis of the Parkinson's disease gut microbiome suggests alterations linked to intestinal inflammation. NPJ Parkinsons Dis. 2021 Mar 10;7(1):27. doi: 10.1038/s41531-021-00156-z. PMID: 33692356; PMCID: PMC7946946.
4. Rusch C, Beke M, Tucciarone L, Nieves C Jr, Ukhanova M, Tagliamonte MS, Mai V, Suh JH, Wang Y, Chiu S, Patel B, Ramirez-Zamora A, Langkamp-Henken B. Mediterranean Diet Adherence in People With Parkinson's Disease Reduces Constipation Symptoms and Changes Fecal Microbiota After a 5-Week Single-Arm Pilot Study. Front Neurol. 2021 Dec 23;12:794640. doi: 10.3389/fneur.2021.794640. PMID: 35002935; PMCID: PMC8733603.
5. Postuma RB, Anang J, Pelletier A, Joseph L, Moscovich M, Grimes D, Furtado S, Munhoz RP, Appel-Cresswell S, Moro A, Borys A, Hobson D, Lang AE. Caffeine as symptomatic treatment for Parkinson disease (Café-PD): A randomized trial. Neurology. 2017 Oct 24;89(17):1795-1803. doi: 10.1212/WNL.0000000000004568. Epub 2017 Sep 27. PMID: 28954882; PMCID: PMC5664303.
6. Safe S, Kothari J, Hailemariam A, Upadhyay S, Davidson LA, Chapkin RS. Health Benefits of Coffee Consumption for Cancer and Other Diseases and Mechanisms of Action. Int J Mol Sci. 2023 Jan 31;24(3):2706. doi: 10.3390/ijms24032706. PMID: 36769029; PMCID: PMC9916720.
7. Pourmotabbed, A., Talebi, S., Mehrabani, S., Babaei, A., Khosroshahi, R. A., Bagheri, R., … Moradi, S. (2024). The association of ultra-processed food intake with neurodegenerative disorders: a systematic review and dose-response meta-analysis of large-scale cohorts. Nutritional Neuroscience, 28(1), 73–86. https://doi.org/10.1080/1028415X.2024.2351320
8. Boelens Keun JT, Arnoldussen IA, Vriend C, van de Rest O. Dietary Approaches to Improve Efficacy and Control Side Effects of Levodopa Therapy in Parkinson's Disease: A Systematic Review. Adv Nutr. 2021 Dec 1;12(6):2265-2287. doi: 10.1093/advances/nmab060. PMID: 34113965; PMCID: PMC8634393.
Lisa Andrews, MEd, RD, LD, is a registered dietitian and owner of Sound Bites Nutrition in Cincinnati. She shares her clinical, culinary, and community nutrition knowledge through cooking demos, teaching, and freelance writing. Lisa is a regular contributor to Food and Health Communications and Today’s Dietitian and is the author of the Healing Gout Cookbook, Complete Thyroid Cookbook, and Heart Healthy Meal Prep Cookbook. Her line of food pun merchandise, Lettuce beet hunger, supports those suffering food insecurity in Cincinnati. For more information,
The Scoop on Seed Oils and Health
Poor Diet Linked with Multi-generational Health Issues