What’s the best Parkinson’s diet?
Kathrynne Holden MS, RD (ret.)
What’s the best Parkinson’s diet?? I’ve been asked this question hundreds of times down through the years, and I understand why. PD is a complex condition, difficult to understand, and it often creates many nutritional problems. Protein interactions with levodopa, unplanned weight loss or gain, chewing and/or swallowing problems, and many others occur. And, we all would like to know if any dietary means can slow progression of PD. Yet, there is no single best Parkinson’s diet for everyone with PD.
Why is that? Well, there are about 7 ½ billion people in the world. Like our DNA strands, every one of these individuals is different, with different nutrient needs, metabolic pathways, food allergies and aversions, and available food supply among many other differences.
Now, if we add PD to the mix, it becomes even more complicated. I’ve given talks attended by 300 people with Parkinson’s. I am certain that each person was at a different stage of PD, and/or had different combinations of medications, different timing of those medications, and different side effects from them, not to mention different PD symptoms.
So I have been reluctant to endorse a great many of the numerous diet plans that have appeared over the years. Why? Because a) they often have a “one size fits all” approach, whereas there is no single best Parkinson’s diet that is suitable for everyone with PD; and b) very few have reliable research on safety or effectiveness to back them up. Some are extremely restrictive, potentially dangerous, and require trials, to determine whether they are safe and effective. Here, we will discuss some diet plans that have shown promise via research.
There are several versions of the Paleo Diet, including the Wahls Protocol, developed for Multiple Sclerosis. The emphasis is on animal protein, fats, and non-starchy vegetables, while avoiding grains, milk and dairy products, beans / legumes, plant oils, and processed foods. Reportedly, PD symptoms improve, pain diminishes, and progression of PD appears to be slowed, although as of this writing, we lack research to confirm its effects upon PD.
Reviewing research for cancer and metabolic syndrome, however, we find three published studies that showed the Mediterranean, Paleolithic and Dietary Approaches to Stop Hypertension (DASH) diets showed promise for reducing risk for colorectal cancer.1 A larger study found an association between Paleolithic and Mediterranean diet patterns and lower levels of inflammation and oxidative stress, decreasing risk for cancer and other chronic diseases.2 Reviewers studying trials of Paleolithic diets vs other diets to treat metabolic syndrome, found that the Paleolithic diet resulted in greater short-term improvements in metabolic syndrome components than did control diets.3
Although not yet conclusive, these are all encouraging. However, no research has yet addressed the Paleolithic diet for use in Parkinson’s disease. If you would like to try this plan, discuss it with your doctor first, and preferably work closely with a registered dietitian as well.
There are some individuals with PD whose gastrointestinal tract is affected by gluten, a protein found in wheat, barley, and rye grains. This can be due to celiac disease, non-celiac gluten sensitivity, or an allergy to gluten. Some have intestinal permeability, known as ‘leaky gut.’ Leaky gut may be caused by small intestine bacterial overgrowth, by celiac disease, or by an autoimmune reaction. For these people, avoidance of gluten-containing grains may help lessen PD symptoms. There is a case study of a gentleman diagnosed with PD who was found to have ‘silent celiac disease.’ When gluten was removed from his diet, he experienced almost complete relief from PD symptoms.4 If you suspect leaky gut or celiac disease, ask your doctor to refer you to a gastroenterologist for diagnosis.
Interestingly, a small study found that PD symptoms improved by eliminating red meat while supplementing with the B vitamin riboflavin.5 However, the study, of only nineteen individuals, was too small to provide conclusive evidence. It is likely that some people will benefit from a vegetarian diet, perhaps due to the prebiotic content of foods consumed, or to the fiber, antioxidants or other nutrients in the regimen.
The ketogenic diet has been in use for nearly a century to treat epilepsy. It is high in fat, and low in the protein and carbohydrates which are normally used as fuel sources. This forces the body to use stored fat to produce ketone bodies to use for fuel. More recently, science has studied the diet for possible use in other neurological diseases, including PD.
In PD, the death of neurons that supply dopamine appears to be due to a weakened mitochondrial function. Researchers theorize that ketone bodies may protect the mitochondria and support their function.
In a small study, five patients with PD used the ketogenic diet for four weeks. Their UPDRS scores improved, dropping by 43%,6 which is very encouraging, although study authors could not rule out a placebo effect. However, cell and animal studies have showed promise, and researchers continue to study the diet for use in PD and other neurodegenerative disorders.
The diet is considered difficult to prepare, and for many people also difficult to maintain. It should not be attempted except under the supervision of a physician and qualified dietitian.
The Mediterranean way of eating is based on a variety of fresh, unprocessed vegetables and fruits, fish, small amounts of meat and poultry, beans of all kinds, and whole grains like spelt, barley, farro, and traditional strains of wheat. Fish, especially fatty fish, like herring, sardines, and salmon, have been shown to support the brain and nervous system. Vegetables, fruits, and whole grains contain valuable antioxidants, vitamins, minerals, fibers, and polyphenols (antioxidant phytochemicals found in plant foods). These destroy the free radicals caused, in some cases, by the stresses of Parkinson’s disease.
The diet has not been studied specifically for PD. However, its high polyphenol content appears to protect against amyloid deposits – abnormal clumps of proteins that cause diseases such as PD and Alzheimer’s disease. In experimental studies, resveratrol, a polyphenol found in grapes, red wine, nuts and dried fruits, has been found neuroprotective, although human studies have not been conducted.7
The Mediterranean diet may lower the risk for Alzheimer’s disease. A French study found that the diet was associated with better-preserved white matter of the brain and strong cognitive benefits.8
Also, two reviews have studied the components of olive oil, fundamental to the Mediterranean diet. The study authors discuss polyphenols, vitamins, and types of fat and their preventive effect on neurodegenerative diseases, heart disease, and cancers.9, 10
There are many other diets and eating plans – raw foods, fruitarian, vegan, for example – and the future will surely see still more.
So, how do you pick the best Parkinson’s diet?
Start with two basic ideas:
1) DO EAT whole, organically-grown foods as much as possible. There is a strong association between pesticide and herbicide use and risk for PD. Whether you choose animal or plant foods, select those that are raised as naturally as possible. For example, meat and dairy from grass-fed cows; meat and eggs from pastured poultry; organically-grown whole grains, fresh vegetables and fruits. These nourish and maintain the body’s brain, bones, and organs. They may be more expensive, but consider the cost of disease, which is much greater.
2) AVOID anti-nutrients – foods that have been made from refined or highly-processed ingredients, such as refined flour and sugar, canned meats and soups, frozen ready-to-eat meals. Over time, these rob the body of health, strength, and thinking ability, and lead to cancer, diabetes, heart disease, stroke, and other diseases.
Who are the healthiest, longest-lived people, and what do they eat?
Next, consider the diets of the longest-lived populations in the world. According to “Blue Zone” author Dan Buettner, the places in the world where people live the longest, and the foods that make up their usual diet, are:
Ikaria, Greece. Staple foods: potatoes, wild greens, goat’s milk, honey, garbanzo beans, black-eyed peas, lentils, fruit, wine, and small amounts of fish.
Okinawa, Japan. Staple foods: tofu, sweet potatoes, seaweed, turmeric, sake, bitter melons, garlic, brown rice, green tea, shitake mushrooms, small amounts of fish.
Sardinia, Italy. Staple foods: goat’s and sheep’s milk and cheese, durum wheat, barley, fennel, fava beans, chickpeas, tomatoes, olive oil, almonds, milk thistle tea, red wine.
Nicoya Peninsula, Costa Rica. Staple foods: beans, rice, corn, squash, yams, green vegetables, papayas, bananas and other fruits, cheese, eggs, small amounts of meat.
Loma Linda, California. Staple foods: avocados, nuts, beans, oatmeal, whole wheat bread, soy milk, grains, fruits, nuts and vegetables. They drink only water; some choose to eat small amounts of meat and fish.
But what makes the best Parkinson’s diet for you?
Lastly, choose a plan that appeals to you, and try it for a few months. Keep a daily journal and write down what you ate, at what time, how you felt afterward, whether your PD symptoms are affected, and in what way. This will tell you whether the diet choice is a good one for you personally – meeting your individual needs as a person with Parkinson’s disease. After all, the best Parkinson’s diet is one that works for you in all aspects – preparation, taste, and individual health needs.
If you have gastroparesis, you may find that a diet lower in fat helps your medications take effect more quickly. If you suffer from constipation, you may find that a diet that includes plenty of prebiotic foods and fiber is ideal. Yet, you might have both gastroparesis and constipation and still find that a paleo diet improves your PD symptoms and that you can cut back on your medications.
You are the best judge of what constitutes the best Parkinson’s diet.
Your doctor only sees you for a few minutes every few months. Diet gurus will probably never meet you at all. You, on the other hand, live in your body 24 hours a day, 7 days a week. No one knows you better than you, yourself. That makes you best person to discover and take control of the best Parkinson’s diet for you.
1 Godos J1, Bella F1, Torrisi A1, Sciacca S1, Galvano F2, Grosso G1. Dietary patterns and risk of colorectal adenoma: a systematic review and meta-analysis of observational studies. J Hum Nutr Diet. 2016 Jul 14.
2 Whalen KA1, McCullough ML2, Flanders WD3, Hartman TJ4, Judd S5, Bostick RM6. Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with Biomarkers of Inflammation and Oxidative Balance in Adults. J Nutr. 2016 Jun;146(6):1217-26.
3 Manheimer EW1, van Zuuren EJ2, Fedorowicz Z3, Pijl H4. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. Am J Clin Nutr. 2015 Oct;102(4):922-32.
4 Di Lazzaro V1, Capone F, Cammarota G, Di Giuda D, Ranieri F. Dramatic improvement of parkinsonian symptoms after gluten-free diet introduction in a patient with silent celiac disease. J Neurol. 2014 Feb;261(2):443-5.
5 Coimbra CG, Junqueira VB. High doses of riboflavin and the elimination of dietary red meat promote the recovery of some motor functions in Parkinson’s disease patients. Braz J Med Biol Res. 2003 Oct;36(10):1409-17.
6 Vanitallie TB1, Nonas C, Di Rocco A, Boyar K, Hyams K, Heymsfield SB. Treatment of Parkinson disease with diet-induced hyperketonemia: a feasibility study. Neurology. 2005 Feb 22;64(4):728-30.
7 López-Miranda V1, Soto-Montenegro ML, Vera G, Herradón E, Desco M, Abalo R. Resveratrol: a neuroprotective polyphenol in the Mediterranean diet. Rev Neurol. 2012 Mar 16;54(6):349-56.
8 Pelletier A1, Barul C1, Féart C1, Helmer C1, Bernard C2, Periot O3, Dilharreguy B2, Dartigues JF1, Allard M4, Barberger-Gateau P1, Catheline G5, Samieri C6. Mediterranean diet and preserved brain structural connectivity in older subjects. Alzheimers Dement. 2015 Sep;11(9):1023-31.
9 Piroddi M1, Albini A2, Fabiani R3, Giovannelli L4, Luceri C4, Natella F5, Rosignoli P3, Rossi T6, Taticchi A7, Servili M7, Galli F1. Nutrigenomics of extra-virgin olive oil: A review. Biofactors. 2016 Sep 1.
10 Rigacci S1, Stefani M2. Nutraceutical Properties of Olive Oil Polyphenols. An Itinerary from Cultured Cells through Animal Models to Humans. Int J Mol Sci. 2016 May 31;17(6).