Mind And Mediterranean Diets Associated With Later Onset Of Parkinsons Disease
Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
Michael Smith Laboratories, UBC, Vancouver, British Columbia, Canada
Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
Michael Smith Laboratories, UBC, Vancouver, British Columbia, Canada
Pacific Parkinsons Research Centre and Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada
Division of Neurology, Faculty of Medicine, UBC, Vancouver, British Columbia, Canada
Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
Michael Smith Laboratories, UBC, Vancouver, British Columbia, Canada
Department of Biochemistry and Molecular Biology, UBC, Vancouver, British Columbia, Canada
Pacific Parkinsons Research Centre and Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada
Division of Neurology, Faculty of Medicine, UBC, Vancouver, British Columbia, Canada
Correspondence to: Dr. Silke Appel-Cresswell, Pacific Parkinsons Research Centre, University of British Columbia, 2221 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada E-mail:
Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
Michael Smith Laboratories, UBC, Vancouver, British Columbia, Canada
Michael Smith Laboratories, UBC, Vancouver, British Columbia, Canada
Funding agencies:
Mediterranean Diet Adherence And Dietary Intake
Mediterranean diet adherence scores significantly increased after the 5-week diet intervention in the PD group , indicating good adherence. All participants with PD completed at least 3 out of 4 scheduled telephone calls with study dietitians. Average dietary intake was compared before and after the Mediterranean diet intervention . Carbohydrate density , dietary fiber, total fat, total fat density, monounsaturated fat and polyunsaturated fat significantly increased after the Mediterranean diet while cholesterol intake significantly decreased. Despite no significant changes in total energy intake after the diet, body weight decreased from 77.4 ± 5.4 kg to 74.9 ± 5.4 kg .
Parkinsons Increases As Alzheimers Decreases
Recent research shows that dementia rates have declined by 13% each decade over the last 25 years.
When asked why Parkinsons might be increases as Alzheimers and other forms of dementia seem to be decreasing, Matt Farrer, Ph.D., neurologist and Lauren and Lee Fixel Chair and Professor of Neurology at the University of Florida, not involved in the study, explained to MNT:
Dementias decline in incidence adjusted for life expectancy and population size which are increasing can be ascribed to changes in lifestyle and education and more widespread use of blood pressure, cholesterol, and anti-inflammatory medications in elderly populations.
Dr. Farrer added that its difficult to say why PD is becoming more common. While a general rise in the condition correlates with industrialization he noted that its tricky to try to pin down specific causes.
Dr. Paulina Gonzalez-Latapi, MSc, instructor of neurology at Northwestern University, not involved in the study, told MNT that environment plays an important role in most cases of PD. Pesticide and heavy metal exposure may contribute to the development of PD even decades before the onset of symptoms, Dr. Gonzalez-Latapi explained.
MNT also spoke with Paramita Chakrabarty, Ph.D., associate professor at the Department of Neuroscience at the University of Florida.
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What Particular Vitamins Or Nutrients Should People With Parkinsons Pay Special Attention To Why
I have already mentioned how protein may be important to some people with Parkinsons who take levodopa. I want to also add that protein is still important for people with Parkinsons because as we all age, we gradually lose muscle mass. Consuming enough protein is needed in order to maintain muscle, physical function, and the ability to perform daily activities.
With vitamins and minerals, there are specific ones that have been studied in relation to Parkinsons. I will add the disclaimer here that it is preferred to get these nutrients from food rather than supplements. If supplements are needed, they should be recommended under the advice of a health professional, especially considering how some may negatively interact with a persons medications. The supplement industry has loopholes in its regulations on quality, so discussing reputable brands with pharmacists, physicians, and/or RDs is also recommended.
Of the other nutrients that have been studied in Parkinsons, the few I will highlight here are vitamin D, Coenzyme Q10 , and fish oil. People with Parkinsons have an increased risk of vitamin D deficiency, and this may be related to the area of the brain that is affected by the disease process. Vitamin D deficiency can lead to increased risks of osteoporosis and bone fractures, so it is important to make sure you are getting enough. Food sources of vitamin D include dairy , fortified cereals and juices, eggs, and fish .
A Complete Parkinsons Diet Guide
When living with Parkinsons, diet can help you stay healthy and may help with some of the symptoms. Eating a healthy diet will lead you to not only feel better but will also lead to more likely living a longer and more full life.
Before we get started it is important to say that the only evidence-based diets that are shown to be good for Parkinsons are general healthy diets that work for everyone regardless of Parkinsons. The Mediterranean diet is one of the healthiest diets out there, which is why we recommend it to those with Parkinsons.
So, with that said here are some tips and foods you should consider including in your diet if you have Parkinsons.
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What This Means For You
You dont need to have an increased risk of Parkinsons to benefit from the Mediterranean diet or the MIND diet. If either of these eating plans appeal to you, a registered dietitian can help you get started and ensure you choose foods that provide all the necessary nutrients.
If you have any questions about diet and Parkinsons disease, you can contact the free Parkinsons Foundation Helpline on 1-800-4PD-INFO .
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Study Design And Participant Timeline
This is a randomised controlled superiority study with two parallel groups that will be conducted at the University of Florida in Gainesville, Florida, USA. After a virtual visit and providing informed consent, a parallel design will be implemented with a 2-week prebaseline period to assess preintervention GI function and an 8-week intervention to compare standard of care for constipation to standard of care plus a Mediterranean diet . During the 2-week prebaseline period, participants will begin questionnaires, be instructed to maintain their usual diet and will attend their first study visit . Nutritional and neurological evaluations will be conducted at this visit. Participants randomised to the control group will be provided a handout on recommendations for managing constipation symptoms . Those randomised to the intervention group will be provided the same constipation handout and counselled on the Mediterranean diet. Following the 2-week prebaseline period, all participants will be asked to begin incorporating the dietary recommendations into their daily routine . Participants will return to the study site after 4 weeks and 8 weeks .
Schedule of activities per visit
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Parkinsons Disease Is On The Rise
For the study, researchers examined Parkinsons incidence from 2012 healthcare data in North America. The data included cohorts of 6.7 million person-years of adults aged 45 and older and 9.3 million person-years of adults aged 65 and older.
The researchers found that 60,000095,000 people were diagnosed with PD in North America in 2012, significantly more than previous estimates of 40,00060,000 .
Advanced age was strongly linked to an increased rate of PD, and males were consistently more likely to develop the condition than females.
The findings also revealed that PD was more common in southern California, southeastern Texas, central Pennsylvania, and Florida. Incidence was lower in the Mountain West region, the western Midwest, and the far Northwest.
To help inform health policy, the researchers suggest an incidence rate of 62 per 100,000 people per year for those aged 45 an older. They noted that this would equate to 77,000 diagnoses in 2012 and 86,000 cases in 2020.
Dr. Jean-Philippe Langevin, a neurosurgeon and director of the Restorative Neurosurgery and Deep Brain Stimulation Program for Pacific Neuroscience Institute at Providence Saint Johns Health Center in Santa Monica, CA, not involved in the study, told Medical News Today:
Do You Advocate For Any Particular Diets For People With Parkinsons Why
There are several diets that are being investigated in Parkinson disease, and it is challenging to recommend a particular diet when this area of research is still new. Since there is not one diet recommended for people with Parkinsons, taking an individualized approach under the guidance of a registered dietitian is advised.
What we do know is that a varied, whole food, plant-based diet is considered a healthy dietary pattern for most individuals, including those with Parkinsons. Plant-based does not mean it is exclusively vegetarian or vegan, but there is a special emphasis on getting most of your nutrients from plant sources rather than animal products.
There is compelling evidence to support recommending diets such as the Mediterranean diet and the Mediterranean-DASH Intervention for Neurodegenerative Delay diet, but there is not conclusive research at this time to support these diets in slowing disease progression. Yet, these are both plant-based diets that have evidence to support their prevention of cardiovascular disease and cognitive decline, which is often a priority of people with Parkinson disease.
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What Should A Person With Parkinsons Emphasize When Building A Nutrition Plan
Building a healthy plate includes whole grains, lean proteins, fruit and vegetables, and low-fat dairy. While this may not be groundbreaking information to some, I do think we tend to overcomplicate it. You dont have to have an incredibly complex and strict diet to be healthy. Find recipes that make sense for your ability, the equipment you have access to, and what tastes good! Remember that making small changes is also key, because drastically changing your diet overnight will not be sustainable for long. Look at your average diet right now, and pick one to three things that seem simple to change. It can be something like switching from sweet tea to half sweet/unsweet tea, baking your french fries rather than frying, or eating one doughnut when you normally eat two. Building a nutrition plan can feel overwhelming, and if that is the case, I recommend finding an RD to help. You can find one near you using this link through the Academy of Nutrition and Dietetics, or you can ask your physician for a referral.
Incidence And Progression Of Parkinsonism
Study Agarwal et al.
A study published in 2018 examined the relationship of dietary patterns with the incidence and progression of parkinsonism in older adults. 706 older adults participated in this study which involved annual assessments for the presence of four parkinsonian signs . Participants were followed for an average of 4.6 years. While it was the MIND diet that was significantly associated with lower rates of developing parkinsonism, and with slower progression of parkinsonian signs, researchers observed more moderate protective associations for the Mediterranean diet.
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Foods And Fad Diets To Avoid With Parkinsons
While eating a Mediterranean diet can help with Parkinsons, you need to make sure you are also avoiding the foods and fad diets that are detrimental to your health and may exacerbate your Parkinsons symptoms.
Below is a list of some foods you should avoid eating or limit the amount you eat for Parkinsons:
- Hard to chew foods
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Data Management And Confidentiality
After informed consent, participants will be assigned a study number for all data collection. Daily, weekly, physical activity, Mediterranean diet adherence and quality of life questionnaires will be administered electronically using Qualtrics Survey Software . Paper questionnaires will be offered and mailed, when requested. Dietary recalls will be administered electronically by the ASA-24. Participants who are unable to complete the dietary recalls electronically will do so over the phone with a trained study coordinator who will enter the diet recall into ASA-24. Any source data and/or questionnaires completed on paper will be entered into a spreadsheet by at least two study coordinators and data will be compared for quality control. Non-identical entries will be corrected using paper source documents. Auditing of source document completion will be completed after each study visit. Data collected during the trial will be deidentified on study closure. Protected health information concerning study data or participants will not be released to any unauthorised third party.
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Drawbacks To The Study
The study did not answer a number of other questions: Is there a benefit to the person with PD if the diets are only started once PD is already diagnosed? And if so, what elements of PD may improve? It seems likely that the diets would offer benefit even after symptoms are manifest, but this question is not answered directly in the current study.
Another aspect to note is that the study relies on people filling out questionnaires about what they eat. People may not be accurate in their accounting and may record a better diet than they actually ingest. However, this tendency to over-report good dietary habits should be equivalent for everyone in the study and may therefore not affect the results substantially.
Since these diets focus on healthy and nutritious foods, even though the study does not provide all of the answers, there is minimal risk, and considerable potential benefit to incorporating them into your life.
What Types Of Conversations Do You Wish More People With Parkinsons Would Have With Their Nutritionist Or Dietitian
First, I wish more people in general saw an RD. At least in the United States, RDs are not commonly a part of most peoples healthcare team, including people with Parkinson disease. There is an incredible amount of misinformation shared on the internet and social media, and it is difficult to sort through it all and determine what is credible. One of the many ways RDs can help is by clarifying this misinformation and providing practical suggestions to making healthy lifestyle changes.
Expert Voices is a monthly series involving a Q& A with an expert in the Parkinsons space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. If youd like to submit topics or questions for consideration in a future installment of the series, click here to take the survey.
Parkinsons News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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Study Population And Participant Recruitment
Two hundred twentyfive participants with PD and 156 control participants were recruited through the Pacific Parkinson’s Research Centre at the University of British Columbia , Canada, using inclusion/exclusion criteria described previously.11 Dietary surveys with missing data were not included in the analysis, as well as PD participants with no recorded age of onset , leaving a total of 167 PD and 119 control participants. Thirtyone spousal pairs, all of which consisted of 1 PD and 1 control participant, were identified from the remaining cohort and excluded from all analyses that involved the control group. The study was approved by the UBC Clinical Research Ethics Board and written informed consent was obtained from each participant.
Sample Collection And Analysis
Participants will provide a stool sample at 0, 4 and 8 weeks. Sample collection at week 4 will allow for a secondary analysis point if participant adherence to the intervention is suboptimal in the second half of the study. Stool samples will be collected using a commode specimen collection system . Participants will be instructed to portion approximately 1 g of stool sample into four tubes containing preservative and 3 mm glass beads and vigorously shake. Two samples will be preserved in 3 mL RNAlater and the other two samples will be preserved in 3 mL phosphate-buffered saline solution with a final concentration of 3% protease-free bovine serum albumin, 0.05% Tween-20 and 1% protease inhibitor for microbiota and inflammatory analyses, respectively. Participants will ship the samples overnight to the study site the day of or the following day after collection, and then stored at 80 until processing.
Measurements of intestinal permeability and inflammation
Faecal zonulin will be measured as an indicator of intestinal permeability. Intestinal inflammation will be assessed by measuring faecal calprotectin. Both biomarkers will be measured by ELISA. These inflammatory markers have been observed to be altered with PD and may lead to increased intestinal permeability.
Intestinal microbiota studies
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Are There Any Diets Trending In The Parkinsons Community Youd Caution Against Why
I usually express concern with any diets or meal plans that recommend cutting out entire food groups, purchasing expensive supplements and packets, and offering quick results. Unfortunately, there is no magic pill or detox treatment that will produce miraculous results in a short timeframe.
A more specific diet I am hesitant to promote is the ketogenic diet, which is a very high-fat and low-carbohydrate diet. From a biochemical perspective, there is evidence to support that a ketogenic diet may offer neuroprotective benefits, but there is no data to support any long-term benefit in people with Parkinsons. From a practical perspective, following a true ketogenic diet is challenging to adhere to and even more so to sustain. There are key nutrients from fruits, vegetables, and whole grains that will be missed when cutting back carbohydrates to the degree that it requires. For anyone who is considering this diet, I always recommend they be monitored by a healthcare professional.