There is no set diet for Parkinson’s however diet should prevent against nutritional deficiencies and research studies have found that some nutrients and foods can slow the progression of Parkinson’s. An individual’s diet must be discussed with their own consultant and dietitian. The aim of #NourishMe is to raise awareness of the importance of diet, provide inspiration on how to include nutrients and foods in your diet, eliminate symptoms of nutritional deficiency and keep you informed on new research.
Getting the basics of a healthy diet right is important. Ask anyone that has a poor, nutritionally deficient diet how they feel, their response will be tired, lacking energy, constipated, low. Add to this a condition such as Parkinson’s where these are known symptoms then quality of life can be severely impacted. In fact, a recent study found this to be the case, malnourished people with Parkinson’s disease had poorer quality of life compared to those well-nourished. However, importantly when nutritional status was improved there were significant improvements in mobility and day to day activities. These findings are supported by other studies showing that a balanced diet improves motor performance. By eating a healthy diet the side effects of nutritional deficiency are erased, symptoms of Parkinson’s lessened and potentially progression slowed.
Your diet should be based on the Eatwell Plate, a fuller explanation of this can be found at The Eatwell Guide. Extreme diets are not necessary and not advised. There are however some considerations that you may want to discuss with your consultant or dietician. Starting with protein. Protein is an essential nutrient – you must have it in your diet. However dietary protein reduces the response of levodopa, which is a precursor of dopamine and commonly forms part of drug treatment for people with Parkinson’s disease. The amount and timing of protein will impact the effectiveness of medication. The recommended nutritional intake of protein for men 19 – 50 years is 55.5g, women 45g, men 51 years or older is 53.3g and women 46.5g – this is approximately a chicken breast and a fillet of fish a day. Low protein diets and consuming the majority of protein in the evening for most reduce motor fluctuations. However, those in the earlier stages may benefit from eating protein through the day to reduce nausea.
Milk has been found to increase the risk of Parkinson’s disease. This is thought to be due to it lowering serum urate, which is a potent antioxidant that protects against oxidative damage in the brain. High serum urate has been associated with a reduced rate of progression in Parkinson’s disease. It is also thought that pesticides ingested by the cows may be involved. It is not the calcium in the milk that is of concern. Calcium is essential to bone density and muscle contraction, if taking milk out of your diet use calcium fortified milk alternatives, other good sources of calcium include fish with edible bones – such as tinned sardines, sesame, almonds and green leafy vegetables; also advise your doctor who may prescribe calcium supplements. Milk in the UK is also high in iodine, an essential nutrient for metabolism. Other good sources of iodine are anything that comes from the sea such as fish and seaweed.
Carbohydrate, for example rice, pasta, bread should make up around a third of your diet. Wholegrain versions are higher in fibre (and nutrients) which will help ease constipation and create a good environment for gut bacteria. Having a small amount of carbohydrate such as an oatcake with medication will help absorbency and reduce nausea. High sugar intake is detrimental to wellbeing and causes inflammation in the body.
Fruit and vegetables. Now these are important, very important. Fruit and vegetables are packed with antioxidants that reduce oxidative stress, free radicals and inflammation in the brain – all thought to be possible causes of Parkinson’s disease. Diets high in antioxidants have been shown to slow progression of the disease. Aim for a minimum of 5 a day, optimally 8 – 2 maximum 3 portions of fruit and the rest from vegetables. This may sound quite daunting but it is easily achievable if you have at least one fruit or vegetable portion with every snack or meal. This will also help with constipation. There is however a negative side to fruit and vegetables and that’s pesticides. Wash thoroughly before consuming, where possible peel and consider a switch to organic produce.
The impact of fat specifically on Parkinson’s disease is less well researched. From fat studies it has been found that saturated fat – predominantly from animal sources and solid at room temperature, causes inflammation and oxidative stress. Unsaturated fat – predominantly from non-animal sources and liquid at room temperature such as rapeseed, olive, nut and seed oils, are high in antioxidants. Of most interest is omega 3 and in particular DHA found in oily fish such as salmon which is anti-inflammatory but also an important constituent of the brain cell membrane. Whilst not proven in Parkinson’s disease Omega 3 appears to be neuroprotective for several other neurodegenerative diseases.
Seid.S. E et al, The Emerging Role of Nutrition in Parkinson’s disease, Frontiers in Aging Neuroscience, volume 6 2014
Studies suggest that certain foods are neuroprotective or neurodegenerative. Foods shown in the red zone inthe picture above are thought to cause neurodegeneration, foods and nutrients in the green zone are thought to promote neuroprotection. For the foods and nutrients in the middle yellow section there are conflicting results from studies; research in these areas is inconclusive.
A more recent focus has been gut bacteria. The discovering of a gut- brain axis has been instrumental in advancing knowledge on the impact of gut bacteria on neurological conditions. There are three ‘families’ of bacteria that have received particular interest – Helicobacter pylori, Enterobacteriaceae and Prevotellaceae. A study conducted by Dr Traci Testerman and colleagues published in 2011 found that mice infected with Helicobacter pylori later went on to develop Parkinson’s. There is also some evidence that Helicobacter pylori may prevent the absorption of Parkinson’s medications in the gut. So potentially eradicating Helicobacter pylori may help make drugs more efficient at lower doses.
More recently studies have found that the balance of Enterobacteriaceae and Prevotellaceae is different in people with Parkinson compared to healthy controls. A correlation between higher levels of Enterobacteriaceae and greater severity measured by difficulties in walking and balancing has been observed. In contrast, very low levels of Prevotellaceae have been found in the guts of people with Parkinson. Interestingly, Prevotellaceae aids in the maintenance of the intestinal barrier protecting against environmental toxins.
Changes in gut bacteria start years before the clinical onset of symptoms; constipation commonly precedes diagnosis. This supports thinking that Parkinson’s spreads from the gut to the brain. Via the gut-brain axis a toxin, bacteria, or virus from the environment may in genetically susceptible people start a cascade of αlpha-synuclein (the protein that clumps in the brains of all people with Parkinson’s) aggregation. Research is now being conducted on the usefulness of early detection of gut bacteria changes and whether gut bacteria manipulation at this stage could slow or possibly prevent neurodegeneration in Parkinson’s.
There is still much to learn but it is important to be aware of the research that is happening. Our aim here at Parkinsons.Me is to keep you up to date with developments. Other good ways to keep up to date with new finding are to subscribe to newsletters by DailyScience.com and follow Oxford Parkinson’s Disease Centre (OPDC) on twitter @OxfordPDCentre. OPDC is a world class research centre at the University of Oxford looking at developments in the early stages of Parkinson’s, more information is available on the OPDC website
For now the strong consensus of opinion is that people with Parkinson’s are going to feel better and possibly slow the progression of Parkinson’s disease eating a healthy diet based on the Eatwell Plate with particular emphasis on foods that are high in antioxidants with possible manipulation of protein intake and replacing milk with other calcium rich foods.
Other good sources of dietary advice for Parkinson’s
For more information on specialist Parkinson’s dietitians and how to get a referral visit Parkinsons UK Dietary therapy