Nutrition & Parkinson’s: You are what you eat

Sue Vaughan

How can nutrition help?

• Reduce symptoms 
• Reduce inflammation
• Slow the progression of your Parkinson’s
• Help you take control and feel your best

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Symptoms not relieved by Levodopa

• Fatigue and low energy

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• Digestive issues – swallowing, bloating, constipation

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• Low blood pressure

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• Weight loss and risk of malnutrition

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• Risk of osteoporosis.

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Fatigue and low energy

• Blood sugar regulation
• 50-80% PwP experience problems balancing blood sugar levels
• Regular meals and snacks which release sugars slowly.

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• B vitamins for cellular energy production – fish, eggs, milk, leafy greens, bananas, legumes, seeds, meat, liver.

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Digestive problems

60% PwP don’t produce enough gastric acid (Mischley)

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• Softer and broken-down foods:

Scrambled eggs, smoothies, soups, porridge, slow cooked stews, stewed apple, peanut butter.

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• Eat slowly, chew 20 times!

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• Lemon juice/apple cider vinegar and warm water before a meal

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• Ask to see a dietician or gastro-neuro-enterologist.

Constipation�

• Sufficient natural fiber – fruit and veg, flaxseeds, chia seeds
• Psyllium Husks – capsule or powder with 2 glasses of water
• Hydration – 1.5 – 2L filtered water per day
• 2 kiwi fruit, thinly sliced with skin on
• 2/3 prunes a day
• Probiotics; Symprove study
• Caffeine 3-4 cups/day
• GP – Lactulose, Magnesium (avoid senna).

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Low blood pressure

• Blood sugar regulation

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• Hydration 1.5-2L filtered water/day

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• Natural salt – olives, sea salt, anchovies.

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• Glass of cold water on waking

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Avoiding weight loss and malnutrition

• A decline in nutritional status associated with faster progression of P’s
• Healthy BMI 18-25 –lower BMI associated with worsening symptoms
• Ask GP to test key markers - Vitamin D, B12, Folate, Ferritin
• Test nutrient status at home – Medichecks
• Full fat foods eg, yoghurt, proper butter.
• Healthy fats – avocado, extra virgin olive oil, nuts, seeds, oily fish
• If dairy/red meat removed from diet replace nutrients, ( calcium, iron from fortified foods, spinach, tinned fish, eggs )
• Make it easier - try Hello Fresh, Mindful Chef, Cook, easy cook-books like ‘The Roasting Tin’ series.

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Reducing the risk of Osteoporosis

• Vitamin D – sunshine and supplements 4000iu/day

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• Green leafy veg, tinned fish, fortified foods, nuts, dark chocolate for calcium and magnesium

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• Eggs, fish, green leafy veg for vitamin B12 and Folate

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Research Suggests:

• Dairy and gluten can be pro-inflammatory for PwP – so eat in moderation (Leader 2017)
• Fizzy drinks/soda associated with faster progression of Parkinsons – likely linked to artificial sweeteners and chemicals (Mischley 2021)
• Fresh herbs and spices associated with statistically significantly reduced rate of PD progression (Mischley 2021, Bloem 2021)
• MIND diet twice as effective as Mediterranean diet at reducing symptom severity in PWP (Metcalf-Roach 2021). Most beneficial foods shown to reduce symptoms: berries, green leafy veg, herbs, spices, olive oil, nuts, seeds, pulses, fish.

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A Mediterranean diet��

Closely associated with lower levels of inflammation

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• Focus on fish, poultry, local seasonal fruit and vegetables, E.V olive oil, nuts, seeds and wholegrains
• Green leafy veg once a day to support liver
• Limit processed/convenience foods
• Healthy cooking methods
• Relax, sit down and take your time over meals.

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MIND diet – Mediterranean Intervention for Neurogenerative Delay

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Add:

• Berries
• Green Leafy Veg (Vitamins E, C, Phytonutrients)
• Herbs and Spices
• Olive oil as the main source of fat

Reduce:

• Red Meat

Mechanisms of MIND

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1. High fibre content reduces constipation and thereby improves uptake of Ldopa into the brain
2. Plant foods improve balance of gut bacteria which we know play a role in Parkinsons
3. Anti-inflammatory properties of phytonutrients (berries, green leafy veg) having an effect
4. Synergistic effect of all of the above

Green Leafy Vegetables

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Broccoli, spinach, cabbage, watercress, brussels sprouts, kale, lettuce, chard, rocket, bok/pak choi, herbs (basil, parsley etc)

How to maximise absorption of LevoDopa

• Protein rich foods compete with LevoDopa for absorption

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• Commonly eaten protein rich foods which compete for absorption:
• Meat, poultry, eggs
• All dairy products except butter
• Soy and pulses
• Wheat, rye, oats, barley, spelt
• Coconut
• Nuts, seeds
• Avocado, asparagus.

(Leader and Leader, 2017)

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The Protein Redistribution Diet (PRD)

1. Take L-Dopa Med on empty stomach
2. Wait 1 hour OR until the L-Dopa has taken effect before eating protein
3. Then – wait 2 hours if possible before taking L-Dopa again
4. This allows the protein to clear the receptor sites.

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OR

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• Try 4 days with no protein during the day, then gradually re-introduce, using the PRD and monitor effect of the medication
• Aim to eat the main portion of protein in the evening
• Be aware of protein in snacks – eg, nuts, milk

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Some suggestions:

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7am

• Glass of cold water and meds
• Toast and butter, porridge with water, fruit/berries

7:45/8am

• Eggs, avocado, tomatoes, mushrooms, porridge, nut butter, smoothie (banana, berries, spinach, flaxseeds), overnight oats/granola, berries, apple, yoghurt

12pm

• Meds
• ( Fruit, Vegetable soup, veg wrap)

1pm

• Chicken salad/sandwich, veg omelette, soup, sardines on toast/salad, leftovers **

Evening

• 1 x protein, 2/3 x veg (incl. green leafy), 1 x carb (potatoes, brown rice, lentils, couscous – herbs and spices)

Take tablets with freshly squeezed orange juice and plenty of water. Sparkling water/100mg ascorbic acid

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Personalised nutrition

• Keep a food diary, monitor your med timing, nutrition and symptoms

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• Test your nutrient status. GP or Medichecks will give you a full report with recommendations. Always run it by your healthcare team!

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Food timings with other dopaminergic drugs

• Cabergoline – with meal
• Pergolide – with meal
• Ropinerole – with meals (no alcohol) (‘Requip’)
• Pramipexole – with meals (‘Mirapexin’)
• Selegiline – with meals (‘Eldepryl’)
• Rasagiline – with food or alone (‘Azilect’)
• Entacapone – take with L-dopa or food. With iron supplements wait 2 to 3 hours before taking (‘Comtess’)
• Amantadine – take with food
• Apomorphine Pump – as medically directed

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Drugs may be taken at the end of meals to reduce nausea (Leader 2021)

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Should I consider taking supplements?

• Know your nutrient status before adding in supplements (except Vitamin D – your level should be 100nmol/L - recommended dose is 4000iu/day (Leader 2022)

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• A Multivitamin and Mineral Complex is a good insurance policy (chose one without iron) – Biocare, Solgar, Lamberts, Cytoplan

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• Be aware that supplements can interact with medication so always check with your health professional before adding in

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• Consider Omega 3 Fish Oil, Magnesium, B vitamin complex- always check DNI’s first with a professional

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• Food First is always best.

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Emerging areas of research:

• Microbiome and Probiotic foods

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• Change in gut bacteria in PwP

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• Symprove Study

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• Benefits of caffeine

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• Pesticides

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• Anti-oxidants

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Small changes to your diet can make BIG changes to your health

My top tips are:

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• Aim for several different plant foods every day
• Buy an easy and inspiring recipe book
• Try a meal kit 2/3 x a week
• Use a measured water bottle
• Swap one cup of tea for green/herbal tea
• Berries,nuts,seeds,green leafy veg every day
• Find your daily fiber - One poop a day keeps the doctor away!

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Questions

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