Nutrition & protein intake for Parkinsons

Registered Dietitians are fortunate to have a wealth of scientific data from which to draw reliable recommendations.  Recently the recommendation for protein has been updated, this has been a subject that I have debated with a variety of patients that I’ve seen with Parkinsons disease.

I will quote:

A 2010 review found that on average, protein redistribution diets resulted in improved motor function in people who responded to levodopa, although the acceptability of the diet decreased over the long term (i.e. >1 month). The most frequently reported complications of the diet included severe dyskinesias (due to reduced levodopa dose), weight loss and hunger before the evening meal. Occasional complications included psychiatric disorders and hallucinations (due to levodopa overdose).

1.  Cereda E, Barichella M, Pedrolli C, Pezzoli G. Low-protein and protein-redistribution diets for Parkinson’s disease patients with motor fluctuations: A systematic review. Mov Disord. 2010 Jul 28. [Epub ahead of print]. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/20669318

A 2017 narrative review noted two large observational studies. One study found that the prevalence of protein-levodopa interaction in those taking levodopa was about 12.4%. The other study suggested that a protein-restricted diet may improve motor function in some people taking levodopa, and that those eating more than 10 g protein/day above the RDA may need a higher levodopa dosage than those eating less protein

2 .Xiong N, Huang J, Guo S, Liu L, Han C, et al. Protein-restricted diets for ameliorating motor fluctuations in Parkinson’s disease. Front Aging Neurosci. 2017 Jun 28;9:206. doi: 10.3389/fnagi.2017.00206. eCollection 2017. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/28701947

In 2019, the 2012 Canadian guidelines for Parkinson disease were updated by an expert panel led by Parkinson Canada (9) and they adopted a NICE guidelines:

People with PD should be advised to avoid a reduction in their total daily consumption of protein” and “discussion should take place about a diet in which most of the protein is eaten in the final main meal of the day (a protein redistribution diet) for people with PD on levodopa who experience motor fluctuations.

3.  Parkinson’s disease in adults. NICE guideline [NG71}. 2017 Jul. Available from: nice.org.uk/guidance/ng71

Its important for patients with Parkinson’s consume adequate protein.   Patients who are taking their levodopa medication 30 minutes before a meal and do not experience relief can trial a protein redistribution for 2 weeks and if they do not experience relief, discontinue the diet.   As well, when a patient experiences relief, they need to make sure their overall protein intake is adequate or they may need to increase the levodopa dosage to manage symptoms and maintain their protein status.

Regardless, it is advised that patients seek the advice of a registered dietitian to advise on bloating, constipation, early satiety, swallowing problems and the overall balance of their nutritional intake.

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