Nutrition therapy for patients with Parkinson’s disease

Neurological disorders affect an individual’s brain and can stem from several causes including aging, genetics, comorbidities, infections, and environmental exposures. In the United States alone, more than 1 million individuals have Parkinson’s disease, one of the more prevalent neurological disorders, with risk for diagnosis increasing with an aging population. Different forms of therapy, diet, lifestyle modifications, and medications are integral as part of care for these patients. If you haven’t recently worked with this patient population, read on for an update of recent research that highlights the potential benefits of nutrition with Parkinson’s disease.

What is Parkinson’s disease?

Parkinson’s disease is a neurodegenerative disorder that results from a change in the gray matter of the brain. Destruction of brains cells and a decrease in dopamine production occurs when alpha-synuclein proteins accumulate to form Lewy bodies. Most often, diagnosis is more common in men rather than women and most individuals are age 50 or older at disease onset. Symptoms may start as mild and then increase in severity with disease progression and include tremors, a shuffled gait, muscle stiffness, balance problems, and in some cases, dysphagia.

Nutrition implications with Parkinson’s disease

Nutritional status in the patient with Parkinson’s disease often goes hand-in-hand with how well their symptoms are managed. Initially, the patient may be stable with no specific nutrition concerns. As the disease progresses, increased swallowing difficulties, hand tremors, early satiety, and intermittent periods of constipation may impact how well the patient is able to maintain their nutrition status. As part of their care, the registered dietitian nutritionist should acknowledge each of these concerns and make individualized dietary recommendations.

Dietary patterns

Specific dietary patterns have been recognized as beneficial with Parkinson’s disease, especially in earlier disease. The nutrient-rich Mediterranean diet and the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) diet have both been associated with a decrease in Parkinson’s disease risk and progression. For individuals taking the medication levodopa, it should be taken away from meals as protein can interfere with its absorption. In addition, adequate fluids and fiber are recommended to help support normal gut function.

Nutrients of interest

Over the years, numerous research trials have evaluated the effect of nutrient supplementation on Parkinson’s disease. Because of the brain’s need for certain dietary micronutrients, it makes sense that ensuring the presence of these vitamins and minerals could be helpful with Parkinson’s disease.  Vitamins A, D, E, B-complex, and coenzyme Q10 are just a few that have been evaluated.

Vitamin A: Two types of vitamin A can come from the diet in the forms of preformed vitamin A or pro-vitamin carotenoids. This nutrient is needed as part of the dopaminergic system involved with Parkinson’s disease. Even with this connection, vitamin A sources should be included as part of a healthy diet rather than through high dose supplementation. Currently, there is not enough data to indicate vitamin A can lessen the risk for Parkinson’s disease.

Vitamin D: Insufficient levels of vitamin D are common in the patient with Parkinson’s disease and may have an impact on bone health and balance concerns with these individuals. Certain studies have suggested that daily supplementation and correction of low vitamin D levels helped with symptom management. While current vitamin D supplementation and correction is in line with that of a healthy adult, more research is needed to find specific dosing and duration of the supplementation for the Parkinson’s disease patient.

Vitamin E: Vitamin E is known for being an antioxidant and is needed to support neurological function. Research varies regarding the impact of vitamin E from diet or with supplementation on Parkinson’s disease risk. Like the other vitamins, vitamin E sources from different foods should be included in a well-balanced diet for the benefits of this nutrient.

B-complex vitamins: The B-complex vitamins are critical in the brain to help regulate homocysteine, as too much can contribute to the cell death seen as part of Parkinson’s disease. While research is limited on specific vitamins, B-complex supplementation is recommended in individuals who may not be getting enough of these vitamins from their diet.

Coenzyme Q10: This nutrient has been more widely studied because of a higher risk for deficiency with Parkinson’s disease and mixed findings. Oral supplementation has not always been found to be effective because only limited amounts reach the brain. On the other hand, recent research in limited trials suggests that daily dosing of 300-1,200 mg can support improvement with disease symptoms. In general, the patient should discuss the pros and cons of supplementing coenzyme Q10 with their doctor. This nutrient can also be found in limited amounts in foods such as meat, fish, and nuts.

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References:

Lister T. Nutrition and lifestyle interventions for managing Parkinson’s Disease: a narrative review. J Mov Disord. 2020;13(2):97-104.

Mayo Clinic. Parkinson’s disease. Available at: https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055. Accessed July 30, 2022.

Nutrition Care Manual. Parkinson’s Disease. Available:www.nutritioncaremanual.org. Accessed August 1, 2022.

Parkinson’s Foundation. Statistics. Available at: https://www.parkinson.org/Understanding-Parkinsons/Statistics. Accessed July 30, 2022.

Sherzai A, Tagliati M, Park K, Pezeshkian S, Sherzai D. Micronutrients and risk of Parkinson’s Disease: a systemic review. Gerontol Geriatr Med. 2016;2:1-11.