Nutrition and PD

The Importance of Nutrition in Parkinson’s Disease

Written by: MCSP Cynthia Karyna López-Botello

Introduction

Nutrition science talks about the nature and distribution of nutrients in food, how these nutrients affect the metabolism of living beings, and the possible consequences that can be caused by insufficient or excessive food intake. For this reason, nutrition is essential during all stages of life to maintain good health. In neurological diseases, nutrition is compromised, causing serious consequences. Such is the case of Parkinson’s Disease, which is associated with nutritional problems such as malnutrition caused by involuntary weight loss, loss of muscle mass and gastrointestinal problems such as constipation. Adequate nutritional treatment as part of transdisciplinary care is essential so that people with Parkinson’s disease can lead a good quality of life.

Nutritional Status

Nutritional status is understood as the balance that exists between energy intake and energy expenditure. The energy intake comes from the consumption of foods with a good nutritional value and the energy expenditure is the relationship that exists between the consumption of energy from food and the energy that the body uses to correctly perform its functions. To obtain balance and obtain good nutritional status, the energy consumed must be equal to that expended by the body.

In most Parkinson’s cases, there is no adequate balance in nutritional status. At one extreme, there are those patients with a higher energy expenditure caused by involuntary movements, thus causing a noticeable weight loss, which in severe cases leads to malnutrition and loss of muscle mass. On the other hand, there are those patients who have an excessive food intake, with little energy expenditure, causing problems with overweight and obesity (these cases are scarcer, and it is more common to find weight loss in patients).

There are several factors that favor weight loss in Parkinson’s disease, among which include gastrointestinal disorders such as constipation, loss of appetite, difficulty passing or swallowing food (also known as dysphagia) and as mentioned previously – increased energy expenditure arising from symptoms of stiffness, tremor, and dyskinesias. Weight loss has been associated with a poor quality of life in patients and a rapid progression of the disease. Therefore, the role of the nutritionist throughout the Parkinson’s disease stages is essential to prevent serious consequences from happening and to help the patient lead a better quality of life.

To maintain a good nutritional state during the illness, it is important to have a balanced diet that is adequate to the personal needs of each patient. There has been a lot of controversy on the issue of proper diet in Parkinson’s patients, however, one of the most important aspects to consider is to stop involuntary weight loss and increase muscle mass.

Parkinson’s Disease Diet

To determine the type of diet that a Parkinson’s patient should follow, it is important to first know the role that each nutrient play in the body during illness and the interaction that can exist between medications and nutrients from foods.

Energy Intake

Due to the malnutrition present in most cases of Parkinson’s, it is important to emphasize the importance of necessary energy intake during this pathology. As we have previously mentioned, each patient is different and each one will have a different nutritional status, as well as different symptoms of the disease. Due to characteristic symptoms of the disease such as tremor and stiffness, a greater number of calories must be provided per day to avoid the excess energy expenditure that can lead to weight loss. Hypercaloric eating plans are normally recommended to counteract involuntary weight loss.

Fats or Lipids

There are several types of fats that are considered essential for the proper functioning of the body. Among the most important essential fats during the treatment of Parkinson’s Disease is Omega 3. It has been proven in several studies that a supplementation of this fat helps to increase the levels of dopamine in the brain and decrease neuroinflammation. This happens by their anti-inflammatory properties. In addition to finding these Omega 3’s in the presentation of supplements, there are several foods that have them such as tuna, salmon, soybean oil, flaxseed, canola oil and in certain nuts such as almonds, walnuts, peanuts, and others.

Proteins and their Interaction with Levadopa

Proteins are one of the primary and most important nutrients for treating Parkinson’s disease. Studies have already shown that muscle mass of both female and male patients is severely affected by unintentional weight loss. Therefore, protein is a nutrient that cannot be left out and diets must supply enough protein to avoid serious consequences. However, an important factor to consider is that proteins of animal origin such as dairy, cheese, meat, fish, chicken and eggs, create an interaction with one of the most essential medications for the treatment of disease, which is levodopa, specifically at the level of brain receptors.

For this reason, special care must be taken in the diet prescribed to patients. The nutritional objective is that both the protein and the medicine are correctly absorbed by the body and thus prevent the progression of the disease. Various investigations carried out worldwide have created experiments with different types of diets, some where there is a low proportion of animal protein, another where protein redistribution is made, and another that adjusts food consumption together with the drug to avoid competing in absorption. Offering patients a diet with a low proportion of protein of animal origin carries the risk of consequences. This happens because we can put the patient’s muscle mass at risk and cause sarcopenia, which is defined as muscle malnutrition. Parkinson’s disease affects all patients differently, therefore, it is very important to assess the nutritional status of each patient to determine the indicated diet according to their needs.

Not all patients have this high sensitivity to dietary proteins, therefore, it is important to be evaluated by a nutrition professional in order to prepare an individualized eating plan. In my professional experience as a nutritionist specializing in Parkinson’s disease, one of the diets that have worked best with patients is the one where it is decided to redistribute the proteins during the day. Proteins of animal origin are distributed in the evening to avoid a bad absorption of the drug, however, it is important that dinner is not consumed too late in the evening, because intestinal mobility is reduced and can cause gastrointestinal disorders. During the day, patients consume a higher proportion of vegetable proteins, which can be found in beans, lentils, beans, chickpeas, among others.

Another highly recommended diet alternative is one with an amount of protein balanced according to the weight of the patient, normally according to the needs of each person, 1.5 to 2 grams / kilogram of the patient’s healthy weight is recommended. The amount reached is divided into the main mealtimes in equal amounts. This meal plan will offer the required amount of protein individually and thus be somewhat reduced compared to other methods. An important fact is that the levodopa medication must be consumed from 30 minutes to 1 hour before each meal.

Vitamins and Minerals

The consumption of vitamins is essential for the proper functioning of the body. In recent years, vitamins have become more important in Parkinson’s disease. B vitamins play an important role as enzyme cofactors helping to regulate metabolism, improving the function of the nervous system and promoting growth and cell division. Among all the B vitamins, only those that perform the most important functions in Parkinson’s disease will be mentioned.

Vitamin B3 or also known as Niacin, is responsible for eliminating all toxic chemicals from the body, in addition, it participates in the production of steroid hormones. This vitamin is found in various foods such as coffee, meat, eggs, wheat, tomatoes, among others. Furthermore, it can also be synthesized from tryptophan. A deficiency of this vitamin can cause dermatitis, diarrhea and in some cases depression and in one study it was suggested that an excess of it was related to the evolution of Parkinson’s disease. The consumption of this vitamin in low doses helps neuroprotection and works as an antioxidant, but when its intake is not controlled it can lead to neurotoxicity, specifically dopaminergic.

Likewise, a possible interaction between the medications of Sinemet or Madopar with vitamin B3 has been found. This happens because carbidopa or benserazide can inhibit the synthesis of the vitamin, therefore, it is important to have a diet with foods that provide an adequate amount of this vitamin.

Vitamin B6 or pyridoxine, is also part of the B complex. This vitamin has the function of intervening in the brain substances that are in charge of regulating mood, as is the case of serotonin. Therefore, it is important to administer sufficient amounts, especially in those patients with sleep disturbances, depression, and stress. Foods with a good content of vitamin B6 include salmon, tuna, whole grains, legumes, broccoli, peppers, avocado, among others.

Antioxidants also play an important role during Parkinson’s disease. Among the most essential is, vitamin C, also called ascorbic acid. It is responsible for significantly reducing oxidative stress and is involved in many other functions such as collagen synthesis, carnitine synthesis, cholesterol metabolism, amino acid absorption, and regulation of some hormones. In the metabolism of dopamine, oxidative stress occurs, which causes an accumulation of abnormal proteins in Parkinson’s disease. Therefore, an adequate consumption of ascorbic acid can protect the patient from toxicity by levodopa and also increase the absorption of the drug. Vitamin C is essential in brain development. We can find it in the following foods: orange, lemon, grapefruit, mandarin, kiwi, spinach, strawberries, raspberries, blackberries, peppers, among others.

Vitamin E is also a powerful antioxidant that participates in cognitive, immune, physical performance and also protects the body’s tissues from substances called free radicals. In Parkinson’s disease, several researchers have shown that a high consumption of this vitamin can help prevent the disease from occurring and prolong treatment with levodopa. There is still insufficient evidence to prove this function well, but its antioxidant function can help protect against oxidative stress. Some foods with high content of vitamin E, are, olive oil, asparagus, chard, mango, among others.

Lastly, vitamin D is considered a steroid hormone that aids in calcium absorption and bone health. This vitamin is related to Parkinson’s disease because it protects dopaminergic neurons from neurotoxicity. Many studies have shown that adequate supplementation of this vitamin can attenuate the deterioration of Parkinson’s disease and decrease the risk of fractures in patients. Among the foods with the highest content of this vitamin are: salmon, sardines, and tuna – but vitamin D is especially obtained from the sun.

Finally, to conclude with the most important nutrients we will talk about minerals. Like vitamins, some minerals play an essential role in slowing the progression of Parkinson’s Disease and an adequate consumption of these minerals either through the diet or supplemented is necessary. Among the most important functions of minerals are, the formation of bones, production of new hormones, and improved functioning of the heart. Here are some of the most important ones.

An accumulation of iron has often been found in the brain in patients with Parkinson’s disease, especially in the substantia nigra and the basal ganglia. This observed accumulation may be due to a dysfunction of iron homeostasis in the brain. Several studies have verified that a high consumption of this mineral is related to an increased risk of Parkinson’s disease, however, it is a mineral that also performs important functions such as the formation of blood cells in the body. For this reason, iron intake should be adjusted to the needs of each patient to avoid the risk of consuming excess. Among the foods with the highest content are nuts, whole grains, legumes, among others.

Magnesium is a mineral that helps protect neurons. A deficiency can increase the damage caused by toxic substances. It is very easy to obtain through the diet since it is mainly found in nuts, tuna and green vegetables. Due to its regulating and toning function of the muscles, it may help Parkinson’s disease patients who have symptoms of muscle stiffness, however, there is still little evidence about this relationship.

Constipation

More than 50% of Parkinson’s disease patients suffer constipation. It is one of the most common symptoms and may even have an impact on the patient’s emotional and psychological state. Several studies have shown that proper supplementation of dietary fiber and probiotics can help improve it. The modification of the patient’s lifestyle, thus increasing the consumption of fiber from fruits, vegetables and whole grains, together with an adequate consumption of natural water, helps significantly to decrease it, since it increases intestinal motility.

It is important to mention that the consumption of fruits and vegetables should be together with the peel, since when removing it, the amount of fiber decreases considerably. In patients who have difficulty passing food, it is recommended to cook food slightly to avoid choking.

Conclusion

Even though nutrition has not been proven to cure the disease, good nutrition as prescribed by a qualified professional may help to slow disease progression. It is important that all appropriate changes are made together with a nutrition professional so as not to alter other functions of the organism. A healthy diet very much helps to improve the quality of life of patients with Parkinson’s disease.

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