Expert Voices: Diet and Nutrition for People With Parkinson’s Disease
Dietitian notes importance of getting nutrients from food rather than supplements
In this installment of our “Expert Voices” series, Parkinson’s News Today asked Christine C. Ferguson, PhD, to answer some of your questions about diet and nutrition for people with Parkinson’s disease.
Ferguson is a registered dietitian (RD) and postdoctoral scholar at the University of Alabama at Birmingham, and nutrition research coordinator at the National Center on Health, Physical Activity and Disability. She earned her PhD in human nutrition from the University of Alabama. She has experience working in the clinical setting as an RD, instructing emerging RDs and health professionals in the academic setting, and educating the community of people with disabilities, including those with Parkinson’s disease, through organizations such as NCHPAD, the Michael J. Fox Foundation, the Tanner Foundation, and the Parkinson Association of Alabama.
Do you advocate for any particular diets for people with Parkinson’s? Why?
There are several diets that are being investigated in Parkinson disease, and it is challenging to recommend a particular diet when this area of research is still new. Since there is not one diet recommended for people with Parkinson’s, taking an individualized approach under the guidance of a registered dietitian is advised.
What we do know is that a varied, whole food, plant-based diet is considered a healthy dietary pattern for most individuals, including those with Parkinson’s. Plant-based does not mean it is exclusively vegetarian or vegan, but there is a special emphasis on getting most of your nutrients from plant sources rather than animal products.
There is compelling evidence to support recommending diets such as the Mediterranean diet and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, but there is not conclusive research at this time to support these diets in slowing disease progression. Yet, these are both plant-based diets that have evidence to support their prevention of cardiovascular disease and cognitive decline, which is often a priority of people with Parkinson disease.
Are there any diets trending in the Parkinson’s community you’d caution against? Why?
I usually express concern with any diets or meal plans that recommend cutting out entire food groups, purchasing expensive supplements and packets, and offering “quick” results. Unfortunately, there is no magic pill or detox treatment that will produce miraculous results in a short timeframe.
A more specific diet I am hesitant to promote is the ketogenic diet, which is a very high-fat and low-carbohydrate diet. From a biochemical perspective, there is evidence to support that a ketogenic diet may offer neuroprotective benefits, but there is no data to support any long-term benefit in people with Parkinson’s. From a practical perspective, following a true ketogenic diet is challenging to adhere to and even more so to sustain. There are key nutrients from fruits, vegetables, and whole grains that will be missed when cutting back carbohydrates to the degree that it requires. For anyone who is considering this diet, I always recommend they be monitored by a healthcare professional.
Are there any surprising ways that diet and nutrition can affect Parkinson’s?
A specific food-medication interaction surprised me, and it is the interaction of protein and medications with levodopa (e.g., Sinemet, Rytary, Duopa, Parcopa). Essentially, when someone takes their levodopa medicine simultaneously with food that contains protein, there is the possibility that they are not able to absorb all of their medication. This is due to them needing the same transporter in the small intestine (like needing to use the same door), but the body will choose to absorb protein over the levodopa. The consequence of this can be that the levodopa is not fully absorbed, part of it is excreted, and the person with Parkinson’s can experience more side effects since their medication is not working effectively.
What continues to surprise me about this interaction is that it is still not fully understood. Not every person with Parkinson’s experiences an increase in symptoms (referred to as “off” times) after taking their medication when eating food with protein, but we do not know why some people experience it and others do not. There is also evidence to suggest this interaction is not just happening in the small intestine. Rather, it may occur at various other locations within the body, including the blood-brain barrier. There is still a lot more to learn about exactly how protein and this type of medication interacts, including the most effective dietary approaches to mitigate this interaction.
What particular vitamins or nutrients should people with Parkinson’s pay special attention to? Why?
I have already mentioned how protein may be important to some people with Parkinson’s who take levodopa. I want to also add that protein is still important for people with Parkinson’s because as we all age, we gradually lose muscle mass. Consuming enough protein is needed in order to maintain muscle, physical function, and the ability to perform daily activities.
With vitamins and minerals, there are specific ones that have been studied in relation to Parkinson’s. I will add the disclaimer here that it is preferred to get these nutrients from food rather than supplements. If supplements are needed, they should be recommended under the advice of a health professional, especially considering how some may negatively interact with a person’s medications. The supplement industry has loopholes in its regulations on quality, so discussing reputable brands with pharmacists, physicians, and/or RDs is also recommended.
Of the other nutrients that have been studied in Parkinson’s, the few I will highlight here are vitamin D, Coenzyme Q10 (CoQ10), and fish oil. People with Parkinson’s have an increased risk of vitamin D deficiency, and this may be related to the area of the brain that is affected by the disease process. Vitamin D deficiency can lead to increased risks of osteoporosis and bone fractures, so it is important to make sure you are getting enough. Food sources of vitamin D include dairy (traditional dairy alternatives, like soy, almond, oat milks, that are fortified with vitamin D are OK, too!), fortified cereals and juices, eggs, and fish (salmon, tuna, sardines have the highest amount).
CoQ10 is of interest in Parkinson’s, as it acts as an antioxidant that can be neuroprotective. It’s also been shown that people with Parkinson’s may be deficient in CoQ10, but this is something that is checked through routine medical care. While some studies support CoQ10 supplementation in decreasing disease severity, there are inconsistent results in others. It has been shown that a moderate dose (no more than 2,400 mg/day) is not harmful to people with Parkinson’s. Food sources of CoQ10 include fatty fish (salmon, tuna, mackerel, sardines) and whole grains.
I have already recommended fish intake because of it being a natural source of vitamin D and CoQ10, and I will continue to emphasis fish consumption because of it containing omega-3 fatty acids. This is a type of healthy, unsaturated fat that has been shown to be beneficial for heart and brain health. Again, consuming fish in its food form is going to be recommended over taking fish oil as a supplement. However, if a person dislikes fish, fish oil supplements of 1,000 mg is generally well-tolerated. To note, other nonfish sources of omega-3 fatty acids include ground flaxseeds, chia seeds, walnuts, and vegetable oils (olive, canola, avocado).
What should a person with Parkinson’s emphasize when building a nutrition plan?
Building a healthy plate includes whole grains, lean proteins, fruit and vegetables, and low-fat dairy. While this may not be groundbreaking information to some, I do think we tend to overcomplicate it. You don’t have to have an incredibly complex and strict diet to be healthy. Find recipes that make sense for your ability, the equipment you have access to, and what tastes good! Remember that making small changes is also key, because drastically changing your diet overnight will not be sustainable for long. Look at your average diet right now, and pick one to three things that seem simple to change. It can be something like switching from sweet tea to half sweet/unsweet tea, baking your french fries rather than frying, or eating one doughnut when you normally eat two. Building a nutrition plan can feel overwhelming, and if that is the case, I recommend finding an RD to help. You can find one near you using this link through the Academy of Nutrition and Dietetics, or you can ask your physician for a referral.
I will also share that people with Parkinson’s and other physical disabilities are eligible to participate in an eight-week, virtual wellness program through the National Center on Health, Physical Activity and Disability called the Mindfulness, Exercise and Nutrition to Optimize Resilience (MENTOR) Program. We are able to offer this program for free, and it doesn’t cost anything except your time, because it is funded through the Centers for Disease Control and Prevention. I help with the nutrition component of the program, and we have excellent RDs who teach weekly classes that include cooking demonstrations with adaptive tools, and they offer free nutrition counseling during the program. The nutrition content is intended to help build a foundational understanding in nutrition, and there is not a specific diet that is pushed. In addition to the nutrition component, participants can attend an exercise class for all abilities, mindfulness classes, and group health coaching sessions. You also get some great workout equipment, too! More information can be found here.
What types of conversations do you wish more people with Parkinson’s would have with their nutritionist or dietitian?
First, I wish more people in general saw an RD. At least in the United States, RDs are not commonly a part of most people’s healthcare team, including people with Parkinson disease. There is an incredible amount of misinformation shared on the internet and social media, and it is difficult to sort through it all and determine what is credible. One of the many ways RDs can help is by clarifying this misinformation and providing practical suggestions to making healthy lifestyle changes.
Expert Voices is a monthly series involving a Q&A with an expert in the Parkinson’s space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. If you’d like to submit topics or questions for consideration in a future installment of the series, click here to take the survey.
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