Primary Nutritional Issues with Parkinson's Disease

Parkinson's disease is a progressive, disabling, neurodegenerative disease resulting from a decreased production of dopamine by the substantia nigra cells in the basal ganglia of the brain. It affects approximately 1% to 2% of the population that is over 60 years of age. The main treatments for managing this disease are prescription drugs, such as levodopa and monoamine oxidase inhibitors (MAOIs), surgical interventions and physical and occupational therapy.

As the disease and its symptoms progress, patients with Parkinson's disease can have trouble walking, talking or doing everyday tasks. Issues such as difficulty chewing and swallowing, excessive salivation and decreased gastric motility may be experienced. In addition, medication-related side effects such as dry mouth, nausea, vomiting, appetite loss and anorexia can alter food intake and result in unintentional weight loss. There also may be a need for adaptive utensils, modified consistency diets or enteral nutrition. A recent study on "food-related activities" of people with Parkinson's disease and their care-partners found the role of nutrition, awareness of possible drug-nutrient interactions and confidence to follow a healthy eating plan to be lacking.

Nutritional goals may include improving fiber intake and hydration status to address constipation, which is a common symptom experienced by patients with Parkinson's disease. Dysphagia and gastrointestinal problems, such as gastroparesis or gastroesophageal reflux disease, can influence the nutrition intervention. Providing adequate energy to prevent unintentional weight loss or excessive gain due to lack of physical activity is especially important for individuals with

Parkinson's disease. For patients who are taking levodopa, modifying intake of dietary protein so that a larger amount is consumed in the evening may help to minimize its interaction with this medication. There are cons to doing this, however, such as inadequate protein intake. An alternative option would be to alter the carbohydrate to protein ratio with meals. Patients who are prescribed MAOIs may need to limit foods and beverages that contain tyramine, such as aged meats and cheeses.

Research studies using various dietary components or supplement regimens to prevent or treat Parkinson's disease have been inconclusive. As with any nutrition assessment, the use of dietary supplements should be evaluated. For patients with Parkinson's disease, supplementation of vitamin D and B₁₂ may be warranted, and there are concerns regarding supplements that provide more than 100% of the Daily Value for iron and manganese, as well as the timing of vitamin B₆ and levodopa. Dietary supplements that patients with Parkinson's disease have reported taking include coenzyme Q10, creatine, glutathione, vitamin E and other antioxidants.

While there is currently no scientific evidence that any specific dietary factor is beneficial, a general, healthful eating plan can promote overall well-being for people with Parkinson's disease. Registered dietitian nutritionists working with patients who have Parkinson's disease will need to individualize the nutrition intervention based on a review of the patient's symptoms and reassess the nutrition care plan as the disease progresses in order to meet the individual's health needs on an ongoing basis.

References:

• Academy of Nutrition and Dietetics. Nutrition Care Manual^®. Parkinson's Disease. Accessed December 21, 2022.
• Escott-Stump S. Nutrition and Diagnosis-Related Care, 9th ed, Chicago, IL: Academy of Nutrition and Dietetics; 2021.
• Mahan KL, Escott-Stump S, Raymond JL. Krause's Food & Nutrition Therapy, 14th ed. St Louis, MO: Elsevier Saunders; 2017.
• Ferguson CC, Jung SE, Lawrence JC, Douglas JW, Halli-Tierney A, Bui C, Ellis AC. A Qualitative Analysis of Experiences With Food-Related Activities Among People Living With Parkinson Disease and Their Care-Partners. J Appl Gerontol. 2022 Sep 3:7334648221118358. doi