​Nutrition and Parkinson’s
Norika Malhado-Chang, MD Associate Professor of Neurology, UC Davis 
Erin Lavin, RD, CNSC   Senior Neuroscience Dietitian, UC Davis

We all know the adage, “You Are What You Eat!” but we are now learning that this is more important than ever in neurological conditions such as Parkinson’s. While there is no specific “Parkinson’s Diet,” nutrition has been found to have an increasingly important role in delaying disease progression. Here is a quick to-do list to make your food work best for you.

1. Make sure you are eating enough                                                                                                                                                                Research has shown that unintentional weight loss and muscle loss is associated with loss of independence and increased PD severity. 
2. Add an additional fresh fruit or vegetable to your day.                                                                                                                            Better yet, add both! Fresh fruits (particularly berries) and vegetables are mainstays of popular diets researched in regard to Parkinson’s.  These include the Mediterranean Diet and the MIND Diet where both have been associated with delayed disease progression.
3. Eat more whole foods and whole grains                                                                                                                                                      Whole grains and foods such as beans and nuts are richer in fiber than their refined counterparts.  Fiber can be helpful with managing   constipation and some smaller trials have found that additional fiber or psyllium husk may lead to more stable Levodopa concentrations.

A note about supplements: A note about supplements: There is not a lot of significant research showing benefit to particular supplements (such as Co-Q10) and some (such as turmeric) may have interactions with your medications. Please check with your provider before use. 

​We may need to make some adjustments to the timing of our meals if we are taking levodopa (such as Sinemet or Rytary).  Levodopa competes with protein in the intestines for absorption, and protein usually wins.  That means that if you are eating a high protein meal and taking Sinemet at the same time, the Sinemet may feel less effective.  Taking levodopa 30 minutes before a meal or 60 minutes after a meal will give levodopa the best chance to work.  If having levodopa on an empty stomach is uncomfortable due to nausea, take it with some saltine crackers. Speaking of saltines, salt helps to raise blood pressure, so salty foods or drinks can be helpful if you experience the low blood pressure that is common in PD.  Staying well hydrated and having a high fiber diet will also help with constipation. Keeping our bowels moving well will not only help our medications work better, but will help us feel better overall!
 
References:

• Agarwal, P., Wang, Y., Buchman, A. S., Holland, T. M., Bennett, D. A., & Morris, M. C. (2018). MIND Diet Associated with Reduced Incidence and  Delayed Progression of Parkinsonism in Old Age. The journal of nutrition, health & aging, 22(10), 1211-1215.
• Beal, M. F., Oakes, D., Shoulson, I., Henchcliffe, C., Galpern, W. R., Haas, R., ... & Shults, C. M. (2014). A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA neurology, 71(5), 543-552.
• Cumming, K., Macleod, A. D., Myint, P. K., & Counsell, C. E. (2017). Early weight loss in parkinsonism predicts poor outcomes: evidence from an incident cohort study. Neurology, 89(22), 2254-2261.
• Erro, R., Brigo, F., Tamburin, S., Zamboni, M., Antonini, A., & Tinazzi, M. (2018). Nutritional habits, risk, and progression of Parkinson disease.       Journal of Neurology, 265(1), 12-23.
• Garcia, J. J., Fernandez, N., Carriedo, D., Diez, M. J., Sahagun, A., Gonzalez, A., ... & Sierra, M. (2005). Hydrosoluble fiber (Plantago ovata husk)       and levodopa I: experimental study of the pharmacokinetic interaction. European neuropsychopharmacology, 15(5), 497-503.
• Gu, Y., Scarmeas, N., Stern, Y., Manly, J. J., Schupf, N., Mayeux, R., & Brickman, A. M. (2016). MEDITERRANEAN DIET IS ASSOCIATED WITH SLOWER RATE OF HIPPOCAMPAL ATROPHY: A LONGITUDINAL STUDY IN COGNITIVELY NORMAL OLDER ADULTS. Alzheimer's & Dementia: The Journal      of the Alzheimer's Association, 12(7), P193-P194.
• Guebila, M. B., & Thiele, I. (2016). Model-based dietary optimization for late-stage, levodopa-treated, Parkinson's disease patients. NPJ Systems Biology and Applications, 2, 16013.
• Mischley, L. K., Lau, R. C., & Bennett, R. D. (2017). Role of diet and nutritional supplements in Parkinson’s disease progression. Oxidative Medicine  and Cellular Longevity, 2017.

• Pak, K., Shin, H. K., Kim, E. J., Lee, J. H., Lyoo, C. H., Son, J., & Lee, M. J. (2018). Weight loss is associated with rapid striatal dopaminergic degeneration in Parkinson's disease. Parkinsonism & related disorders, 51, 67-72.
• Vetrano, D. L., Pisciotta, M. S., Laudisio, A., Monaco, M. R. L., Onder, G., Brandi, V., ... & Zuccalà, G. (2018). Sarcopenia in Parkinson disease:  comparison of different criteria and association with disease severity. Journal of the American Medical Directors Association, 19(6), 523-527.

COVID-19: There is still limited information about the effects of COVID-19 specifically regarding Parkinson’s disease, having said that, given the frailty associated with Parkinson’s disease, it would be prudent to be cautious, prepared and follow the precautions recommended by public health departments/ CDC.   During these challenging times, it cannot be emphasized enough the need for all, PD community specifically and the
​community at large, to reach out to each other, offer support and assistance to those most vulnerable and share our resources.