Patients’ Diets Need Monitoring for Balance and Levodopa Use, Study Finds

The diets of people with Parkinson’s disease  mostly match those of the general population, but a large portion consume inadequate levels of vitamin D, vitamin B1, zinc, and iron, a Belgian study based on patient questionnaires and dietary pattern records found.

Fewer than 20% of these patients were taking their levodopa medication outside of meals, despite nearly two-thirds being aware that food proteins can affect how this treatment is absorbed by the body.

Investigators advise patients’ eating habits be regularly monitored, and professional guidance be given to improve their diets and better manage their symptoms.

The study, “Dietary Intake of Parkinson’s Disease Patients,” was published in Frontiers in Nutrition.

Consuming the right amount of nutrients and vitamins is important to minimizing Parkinson’s symptoms and improving quality of life. But problems such as difficulty swallowing, loss of smell and taste, and treatment side effects make malnutrition harder to avoid  in these patients. Their meals may not provide enough or adequate nutrients for the body to work properly.

The timing of meals is also important, as some amino acids in foods use the same transporter as levodopa to reach the bloodstream and enter the central nervous system. Patients are advised to take their medication either 30 minutes before or one hour after a meal.

Still, little is known about the dietary habits of Parkinson’s patients and their awareness of food-drug interactions.

Researchers in Belgium aimed to compare the nutrient intake of patients to that of the general Belgian population, and to investigate how they handled their medication and meals.

Their study included 74 patients, 52 men and 22 women, who were recruited between November and December 2015. Participants (mean age, 67) were asked to fill a questionnaire about their habits and to keep a dietary record for two non-consecutive days.

Of this group, four patients were excluded due to lack of information regarding medication, and only 34 delivered complete food diaries.

Overall, patients consumed 2,194 kcal each day, with lunch and dinner supplying the most energy. Protein intake was within recommended levels for all participants, the researchers noted. But about 44% were eating fewer carbohydrates than recommended, and 50% were not eating enough fiber.

Higher than recommended levels of fats were in the diets of 70% of the women and 41.7% of the men.

Despite these dietary shortcomings, the researchers noted that overall nutrient consumption “was similar to the dietary pattern of the general Belgian population.”

Regarding vitamins and essential minerals, 11.8% of patients had an inadequate intake of vitamin B1, and 55.9% were not consuming enough vitamin D. Lower-than-recommended doses of iron were evident in 76.5% of patients, and 14.7% did not consume enough zinc.

Overall, participants reported that their dietary habits had changed since their diagnosis, mostly due to constipation, problems with chewing and swallowing, and the loss of the sense of smell. Still, most (89%) had never consulted a disease-specific dietician.

Most participants (97.2%) were taking levodopa, and 64.4% reported being aware that food can impact how it is absorbed. But only 18.2% of these patients always took their medication outside of a meal, as indicated.

A majority (68.2%) did not take their medication at fixed time points, with some doing so during meals and others outside of meals. The remaining 13.6% of these patients always took their levodopa with meals.

“[A]lthough the dietary intake of PD [Parkinson’s disease] patients is similar to that of the general Belgian population, monitoring dietary intake in PD patients is of importance to detect possible micronutrient insufficiencies,” the researchers wrote.

They noted several limitations to their study’s finding, including its small  size and that it recruited patients who were participating in cooking workshops, suggesting they may have a better adherence to a healthy diet.

“Nonetheless, this study still provides useful information regarding the dietary intake of Belgian PD patients,” the team wrote. “We provided evidence that there is room for improvement regarding medication taking behavior in PD patients.”