Parkinson’s Disease: The Basics of Good Nutrition

When you have Parkinson’s disease, eating well might help you feel better and manage symptoms of the disease. An overall healthy diet and drinking plenty of fluids is important, but real evidence does not show that any food or dietary supplement will delay the progression of the disease.

If your physician prescribed levodopa (L-dopa) to help control the symptoms of Parkinson’s disease, it is important to know that this drug does have some nutritional implications. 

Protein
Your health care professional may recommend that you limit your intake of protein at breakfast and lunch, and eat a sizable amount at dinner, or recommend that you split your total daily intake of protein evenly throughout the day. Talk to your doctor or dietitian before proceeding with either plan. 

Vitamin B6
If you take a vitamin supplement that contains vitamin B6, also known as pyridoxine, you may need to stop taking it while on some forms of levodopa. Ask your doctor or dietitian if this is something that you need to do. If it is OK to continue taking your vitamin supplement, choose one that contains no more than 10–15 milligrams (mg) of vitamin B6. 

Nausea
Some people experience nausea with levodopa. It may help to eat several small meals throughout the day, rather than the traditional three square meals.

It is best to take levodopa on an empty stomach. However, if this makes you nauseous, a few crackers or a glass of ginger ale or juice may help. Do not eat anything containing fat or protein with your medication.

The following foods contain large amounts of protein: 

• Meat
• Fish
• Poultry
• Dairy
• Dairy products (cheese, yogurt, etc)
• Beans
• Nuts
• Legumes
• Eggs

Fava beans
Fava beans contain naturally occurring levodopa, and many people with Parkinson’s disease have eaten them with varying results. Some people report excellent results, while others report no results or adverse effects. Do not begin eating fava beans without talking to your doctor first. Under a doctor’s supervision, you might start with a very small amount and gradually increase your intake.

Some people have a genetic enzyme deficiency, commonly known as favism, which leads to hemolytic anemia in people who consume fava beans. It sometimes is fatal. Favism is most common in people of African, Mediterranean, and Southeast Asian ancestry. A lab test can determine whether you have this enzyme deficiency. Some people are allergic to fava beans, particularly in the raw form. If you are on a monoamine oxidase inhibitor (MAOI), you should not eat fava beans. 

Dry mouth from medications
Several medications used in the treatment of Parkinson’s disease can lead to dry mouth.

These tips may help: 

• Rinses: Use over-the-counter fluoride rinses
• Candy, mints, and gum: Keep sugarless candies, mints, or gum on hand 
• Moist foods: Moisten dry foods with gravy or broth
• Water: Make sure to drink 8–12 cups (C) of water/day 

Risk of developing osteoporosis
People with Parkinson’s disease are at increased risk for developing osteoporosis. Make sure you consume an adequate amount of foods containing calcium, magnesium, vitamin K, and vitamin D.

• Calcium: Found in milk, dairy products, canned salmon with bones, cooked rhubarb, spinach, blackstrap molasses, almonds, oranges, calcium-fortified orange juice, broccoli, and enriched breads and grain products (best absorbed from dairy products) 
• Magnesium: Found in seeds, nuts, legumes, and milk
• Vitamin K: Found in broccoli, Brussels sprouts, cabbage, turnip greens, and dark lettuces
• Note: If you are on Coumadin® or another blood thinner, talk to you doctor before increasing your intake of these foods 
• Vitamin D: Found in herring, salmon, milk, milk products, fortified cereal, canned sardines and shrimp, chicken and calf livers, and egg yolks (also absorbed from sun exposure) 
• Supplements: If you dislike or cannot tolerate these foods, ask your doctor about the need for supplementation
• Bone density: Consider having a bone density test
• Exercise: Walking and other weight-bearing exercise helps to prevent skeletal weakening 

Constipation
People with Parkinson’s disease often experience constipation. This often is caused by the medication used, but also is a symptom of the disease itself.

The following tips may help with constipation: 

• Fiber: Eat plenty of fiber-containing foods, such as fruits, vegetables, whole-grain bread, cereals, beans, and legumes, aiming for 25–35 grams (g) of fiber/day 
• Prunes or prune juice: Consider eating a serving of prunes or drinking a glass of prune juice, because many people find this helpful
• Fluids: Make sure to drink plenty of fluids
• Exercise: Exercise whenever you are able 
• Fiber supplement: Talk to your doctor about using a fiber supplement, if you are not getting relief from the previous tips

Too tired to eat, no appetite, or nauseous
If you find that you are too tired to eat, do not have an appetite, or are nauseous, try these suggestions:

• Simple preparation: Make easy-to-prepare foods
• Already prepared meals: Prepare food when you feel good and freeze in single-serving portions, so meals are on hand on days when you feel tired
• Nutritional supplements: Consider drinking a nutritional supplement on days when you do not feel well enough to eat as much as you normally do
• Carbonated beverages: Avoid filling up on carbonated beverages before or during your meal—save your energy for nutrient-filled food
• Soft foods: Choose soft foods that do not require much chewing 
• Finger foods: Select finger foods that do not require the use of silverware, which can take energy to manipulate 
• Nutritious foods: Eat foods that offer the most calories, protein, vitamins, and minerals, such as the following good choices:
• Cheese
• Peanut butter
• Whole milk
• Ice cream
• Dried fruits
• Nuts
• Fruit juice
• Vegetable juice
• Instant breakfast mixes or medical nutritional products, such as Ensure®
• Butter, cream cheese, jam, syrup, sour cream, and salad dressing to top your foods
• Beans
• Lentils
• Eggs (deviled eggs provide extra calories)
• Depression: Speak to your doctor about treatment options, if you think that you might have depression
• Mealtimes: Try to eat with other people whenever possible 

References and recommended readings
Remig VM, Weeden A. Medical nutrition therapy for neurologic disorders. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:952-953. 

Traviss K. Nutrition and Parkinson’s disease: what matters most? Available at: http://www.pdf.org/en/winter06_07_Nutrition_and_Parkinson. Accessed April 28, 2012.

Review Date 5/12
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