Heather Zwickey, PhD

This article provides some straightforward nutritional recommendations that neurologists can share with their patients.1. Open a dialogue with patientsWhen patients are newly diagnosed with Parkinson disease (PD), physicians often tell them to pay attention to diet and exercise. But what does that mean, exactly? Are there more specific recommendations that could be made based on the medical literature?While there are no randomized controlled trials of particular diets for PD, we can glean information from epidemiological studies, nutritional deficiency studies, and single nutrient studies. This slideshow shares some straight-forward nutritional recommendations that neurologists can share with their patients.2. Eliminate high-fructose corn syrup and sugarMost physicians are aware that high fructose corn syrup (HFCS) is not healthy for people with blood glucose misregulation.1 What physicians may not know is that PD can involve blood glucose misregulation and insulin resistence.2 While diabetes is commonly comorbid with PD, it is not necessary for a patient with PD to have diabetes in order to have blood glucose misregulation.Diabetes in PD results in increased gait disturbance, postural instability, and cognitive defects.3 The relationship of blood glucose to Alzheimer disease and PD have resulted in these disorders in being called type III diabetes.4In addition to the blood glucose relationship, foods with HFCS may be contaminated with heavy metals. A 2009 report from the Environmental Protection Agency found mercury levels in HFCS.5 Because heavy metals are known to deposit in the brain, HFCS are even more dangerous for people with PD who have neuroinflammation.3. Eliminate trans-fatRemoving trans-fat from the diet is smart, as trans-fat increases inflammation.6Â  As with many diseases, inflammation has been associated with PD, and decreasing inflammation has been shown to lessen its impact on PD.7 Although there is no research that specifically demonstrates trans-fat is dangerous for people with PD, cutting trans-fat certainly will not hurt patients and may help slow their disease progression.4. Drink green tea and coffeeGreen tea has been shown to delay PD onset in many epidemiological studies.8 Green tea’s effects on PD are being elucidated.9 Because the same neuro-inflammatory processes that are involved in disease onset are also involved in disease progression, green tea is likely to be beneficial for people with PD.If your patient is not a tea drinker, coffee may also be a good option.10 Two ingredients in coffee-quercetin and caffeine-are likely to be responsible for the positive effects.10 Quercetin is a flavonoid with strong anti-oxidant properties. Because reducing oxidative stress also reduces inflammation, strategies that reduce oxidative stress are good for people with PD.115. Eat nuts and berriesAnother way to reduce oxidative stress is to increase consumption of nuts and berries. Nuts, specifically walnuts, macadamia nuts, and cashews, have healthy oils that reduce oxidative stress.12 Berries also contain anthocyanins, powerful antioxidants.13 Replacing sugary foods with nuts and berries reduces inflammation in PD through multiple mechanisms.116. Eliminate dairyMany epidemiological studies have demonstrated that dairy is associated with increased risk of PD disease.14 There are several potential mechanisms by which dairy could be detrimental. Dairy is known to be contaminated with herbicides and pesticides.15,16 There is evidence that people with PD are sensitive to these chemicals.17 In addition, dairy is known to decrease uric acid, which is protective for PD disease.18While the association with disease progression is less clear than the association with risk, recommending that people with PD avoid dairy is reasonable. Patients should be reminded to get calcium from other sources.Final thoughtsNutrition is the fuel for every cell in the body. As said best by Ann Wigmore, “The food you eat can be either the safest and most powerful form of medicine or the slowest form of poison.”19It is not necessary to make all dietary changes at once. In fact, by taking time to implement healthier eating, patients are more likely to adhere to the changes. Try eliminating something for a month. Then add the nut and berries the next month. Then eliminate the next thing. Then add the green tea/coffee. Then eliminate the next thing. So that over 6 months to a year, the diet has been completely transformed.Remember, it may not be easy for patients to make these dietary changes, because dietary change is difficult. However, for patients willing to do the work, the benefits will be worth it. Every meal is a chance for people to combat inflammation and be good to their body and brain.When in doubt, consider referring the patient to a nutritionist. Although they may not have much more information, since research is lacking, they can add insights and help patients build healthy eating behaviors.About the authorDr. Zwickey is the Dean of Research and Graduate Studies, Director of Helfgott Research Institute, and Professor of Immunology at National University of Natural Medicine.References1. Aragno M, Mastrocola R. Dietary sugars and endogenous formation of advanced glycation endproducts: emerging mechanisms of disease. Nutrients. 2017;9:385.2.Â  Ashraghi MR, Pagano G, Polychronis S, et al. Parkinson disease, diabetes and cognitive impairment. Recent Pat Endocr Metab Immune Drug Discov. 2016;10:11-21.3.Â  Csoti I, Jost WH, Reichmann H. Parkinson disease between internal medicine and neurology. J Neural Transm. 2016;123:3-17.4. de la Monte SM, Wands JR. Alzheimer disease is type 3 diabetes: evidence reviewed. J Diabetes Sci Technol. 2008;2:1101-1113.5. Dufault R, LeBlanc B, Schnoll R, et al. Mercury from chlor-alkali plants: measured concentrations in food product sugar. Environ Heal. 2009;8:2.6. de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ. 2015;351:h3978.7. Seidl SE, Santiago J, Bilyk H, Potashkin J. The emerging role of nutrition in Parkinson’s disease. Front Aging Neurosci. 2014;6(March):36.8. Caruana M, Vassallo N. Tea polyphenols in Parkinson disease. Adv Exp Med Biol. 2015;863:117-137.9. Weinreb O, Mandel S, Amit T, Youdim MBH. Neurological mechanisms of green tea polyphenols in Alzheimer and Parkinson diseases. J Nutr Biochem. 2004;15:506-516.10. HernÃ¡n MA, Takkouche B, CaamaÃ±o-Isorna F, Gestal-Otero JJ. A meta-analysis of coffee drinking, cigarette smoking, and the risk of Parkinson disease. Ann Neurol. 2002;52:276-284.11. Magalingam KB, Radhakrishnan AK, Haleagrahara N. Protective mechanisms of flavonoids in Parkinson disease. Oxid Med Cell Longev. 2015;2015:314560.12. Alasalvar C, Bolling BW. Review of nut phytochemicals, fat-soluble bioactives, antioxidant components and health effects. Br J Nutr. 2015;113(Suppl 2):S68-78.13. Kong J-M, Chia L-S, Goh N-K, et al. Analysis and biological activities of anthocyanins. Phytochemistry. 2003;64:923-933.14. Seidl SE, Santiago JA, Bilyk H, Potashkin JA, Camins A, Ruano D. The emerging role of nutrition in Parkinson’s disease. 2014.15. Heineman HEO, Jaynes HO, Heflin JL. Pesticides: a dairy industry problem. J Dairy Sci. 1966;49:509-516.16. Chen H, O’Reilly E, McCullough ML, et al. Consumption of dairy products and risk of Parkinson disease. Am J Epidemiol. 2007;165:998-1006.17. Biernacka JM, Chung SJ, Armasu SM, et al. Genome-wide gene-environment interaction analysis of pesticide exposure and risk of Parkinson disease. Parkinsonism Relat Disord. 2016;32:25-30.18.Wang L, Hu W, Wang J, et al. Impact of serum uric acid, albumin and their interaction on Parkinson disease. Neurol Sci. 2017;38:331-336.19. Wignore A. https://annwigmore.org/. Accessed September 28, 2017.

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This article provides some straightforward nutritional recommendations that neurologists can share with their patients.

Heather Zwickey, PhD

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6 Essential Nutrition Recommendations for Parkinson Disease