The most important dietary advice for a person with Parkinson’s disease (PD) is to eat a healthy, balanced diet, with plenty of fibre and fluids. It’s as simple as that. A routine of three balanced meals a day is a good start, although some people with PD may find it easier to manage more frequent and smaller meals.
At different times, certain foods, vitamins or unusual diets may be advertised as being able to help PD, but there is no proof that this is the case. One common story is that broad beans (fava beans) are able to help relieve PD symptoms. It is true that broad beans do contain levodopa, but in variable, small amounts, and at nowhere near the level that is found in levodopa medications. The number of beans you would have to eat for them to have an effect would probably make you ill in other ways. If you are tempted by any unusual ‘dietary therapies’ like this, then please discuss the idea with your medical team. Members of the team who may be able to advise on diet and practical issues with eating include the doctor/specialist, registered dietician, occupational therapist, speech and language therapist, and PD nurse.
If you already eat a healthy, balanced diet, then you may not need to make any changes to your routine. However, in some specific cases, there may be other factors to consider, and many of these are discussed in the following pages.
Developing PD may have an effect on body weight. In some people, movement problems mean less exercise, and they find that they put on weight. Excess weight can put a strain on the joints, and make movement difficult, worsening the problems of PD. Therefore, if people do put on a lot of weight, or are overweight already, then they may be advised to go on a calorie-controlled diet.
However, in most cases, people with PD find that they lose weight. Weight loss can occur for several reasons:
Therefore, people with PD often need to be encouraged to eat more calories. Rather than trying bigger portions, smaller tempting meals and snacks at regular times during the day may be more acceptable. High calorie foods like peanut butter, biscuits/desserts and milkshakes can help to increase weight. If you find that you are eating more sugary snacks to increase your calories, then remember to brush your teeth more often too.
To make sure that your weight is under control, weigh yourself regularly and keep a record of any changes.
If you have been prescribed levodopa, your doctor will have given you instructions on how your dose should be taken in relation to food. Most other PD medications do not have specific instructions for whether they should be taken with or without food.
Some people with advanced PD and motor fluctuations may be advised to alter their protein intake (examples of foods rich in protein include meat, eggs and cheese – see section on ‘Nutrients’). Protein can interfere with the uptake of levodopa into the body and the brain and, as a result, reduce the effectiveness of the drug.
Therefore, it may improve matters if the normal daily intake of protein is taken all together in one meal at the end of the day. If you need to do this, foods low in protein, e.g., bread, cereals, vegetables, fruit, clear or vegetable soups (not creamed or containing lentils or peas), spreads (honey, jam, vegemite), sweets and fats, should make up the bulk of your other meals. This prevents the protein interfering with the effect of levodopa during the day. However, this does not help in all cases, and some doctors will not recommend this change in diet. Therefore, the diet should never be altered in this way before speaking to a doctor or registered dietician. Also, it should be noted that although protein may be taken at a different time of day, the total daily amount of protein should not be reduced, as it is needed by the body for repair and to fight infection.
Another way to avoid the ‘protein effect’ is to take levodopa on an empty stomach (1 hour before or after a meal), as long as this doesn’t cause nausea.
As well as protein worsening motor fluctuations, people with advanced disease may find that their dyskinesias become worse after eating foods high in carbohydrate/sugar. However, carbohydrates should not be excluded from the diet – a good overall balance of foods is still recommended, and carbohydrates are needed to maintain body weight and energy levels.
Antioxidants are a group of vitamins and minerals that can help lessen the damage caused by a normal body process called oxidation. Oxidation occurs inside the cells of the body, and can produce substances known as free radicals, which cause damage to the body and may play a part in conditions such as heart disease, cancer and PD. However, there is presently no evidence that intake of antioxidants will slow the progression of PD or increase the effects of PD drugs. In addition, anyone consuming a regular well-balanced diet should already have an adequate intake of antioxidants.
Constipation is a common problem with PD, because the condition reduces the action of muscles in the bowel. However, it is one problem that can be easily managed – and remember that the bowels only need to be emptied 3 or 4 times a week. If relief can be achieved with a natural diet, then that is the ideal and most healthy way. If constipation becomes a more serious problem, then your doctor will be able to recommend some medication.
Drinking plenty of fluids (8-10 glasses a day) is beneficial in many ways (remember, coffee and tea are dehydrating, so they don’t provide as much fluid as other drinks). It is an essential part of a healthy diet and, as described earlier, it helps to relieve constipation.
Dry mouth is a common problem in PD, and this can be eased by drinking more fluids, taking frequent sips of water, sucking ice chips or using a mouth spray or oral rinse (pharmacists sell these specifically for dry mouth). Sucking a sweet, or chewing gum, can also help to produce more saliva and relieve a dry mouth.
Unless your doctor advises you otherwise, the drinking of moderate amounts of alcohol is allowed in people receiving PD medication.
The following section contains information about the different elements that make up a balanced diet, and how to ensure healthy eating throughout the day. These ideas can be simply fitted into the daily routine in place of (not in addition to!) current eating habits. However, if you have particular concerns about any aspect of your diet, then speak to your doctor or PD nurse, who may recommend speaking to a dietician.
A balanced diet should contain a combination of all the nutrients that are required to keep the body healthy and in good repair. There are two main types of nutrients needed by the body:
Saturated and unsaturated fats
Saturated fats can cause an increase in blood cholesterol. They are also known as animal fats as they are found mainly in animal products such as fatty cuts of meat, lard and dripping, some margarines and dairy products such as full fat milk, hard cheese, cream and butter, and in cakes, biscuits, pies and pastries. Saturated fat may also be found in some vegetable oils such as coconut and palm oil.
Unsaturated fats may lower blood cholesterol, and include the polyunsaturated fats found in sunflower, corn or soya oil, and the monounsaturated fats found in rapeseed (canola) and olive oil.
Consuming a varied and balanced diet, including foods rich in micronutrients, can remove the need for vitamin and mineral supplements. If you are taking supplements containing large amounts of vitamins or minerals and/or need further advice, then speak to your doctor or dietician.
All the foods we consume fall into one of the following five groups, each containing different amounts of the nutrients listed previously.
f you have a special requirement for food intake in relation to your PD medication, then you should consult your doctor or dietician about the best choice of daily diet. For those without specific medication guidelines, a balanced daily food intake, or diet, contains the items in the list on the right.
If your medication means that you need to have most of your protein intake at the end of the day, omit foods from the meat, fish and alternatives, and milk and dairy products groups earlier in the day, and instead take these protein-rich foods for your evening meal or supper. In order to determine how balanced your diet is, try comparing the amount you eat and drink in one day with the tables on the following page. (Please note that this only serves as a rough guide, as people differ in the amount of energy/ calories they require, according to their age, gender, body size, activity level, and whether or not they need to eat extra amounts to gain weight.)
So-called ‘free foods’ do not count towards the daily nutritional intake, although some of them do contain high levels of salt (marked with *), and should therefore be avoided in large quantities. ‘Free foods’ include:
The following snacks and alcohol each count as three ‘extra’ portions (150 kcal):
To help you put these guidelines for a balanced diet into practice, here are some ideas that allow you to eat a healthy combination of the different food groups together in one meal. If you require extra fibre in your diet, remember to choose wholegrain breads and cereals, and have at least five portions of fruit and vegetables daily. Increase your fibre intake gradually to avoid bloating or flatulence (wind) – introduce one new high-fibre food every three days to allow your system to adapt.
All the meal ideas listed below should be accompanied by plenty of fluids, e.g., a glass of water or fruit juice.
If you have a good appetite in the morning, a full breakfast gives you a good start to the day – meat, cheese, yoghurt, bread and fruit.
Main meals can be simple to prepare, and don’t always need to be homemade – frozen, chilled or tinned ready meals are convenient when you don’t feel like cooking.
Use low-fat varieties of these desserts if you are watching your weight, and regular varieties if you need to gain weight.
Many people find that they need extra snacks between meals – either to raise their calorie intake, or because they find many smaller meals easier to manage than fewer large meals. It is important that these snacks also adhere to a healthy diet, so you might like to try some of the following.
Remember that these snacks should be taken in place of unhealthier choices – not in addition to them!
Although it is always good to include fresh food in your diet, in order to make things a bit easier when deciding on meals to prepare, here are some useful ‘store cupboard’ foods to keep on hand:
Remember to use and replace your store cupboard foods, and to regularly check the ‘use by’ dates on the packaging.