• Abbott, R. A., M. Cox, et al. (1992).
    Diet, body size and micronutrient status in Parkinson's disease.
    Eur J Clin Nutr 46(12): 879-84.
    Nutritional status was assessed in a group of patients with Parkinson's disease. Weight loss since the onset of disease occurred in 52% of the patients and 22% had lost more than 12.8 kg. Although 67% of patients experienced eating difficulties of some kind, dietary intakes of protein and energy were not significantly lower than recommended intakes. Levels of ferritin, total iron-binding capacity and copper were similar between groups. The potential significance of low levels of vitamin E and zinc are discussed in relation to oxidative stress in the pathogenesis of this disease.
  • Astarloa, R., M. A. Mena, et al. (1992).
    Clinical and pharmacokinetic effects of a diet rich in insoluble fiber on Parkinson disease.
    Clin Neuropharmacol 15(5): 375-80.
    In this study, the effects of a diet rich in insoluble fiber (DRIF) on motor disability and the peripheral pharmacokinetics of orally administered L-dopa in Parkinsonian patients with marked constipation are analyzed. We found a useful effect of a DRIF on plasma L-dopa concentration and motor function. The greatest effect on the plasma L- dopa levels was found early (at 30 and 60 min) after oral administration. There was a relationship between the improvement of constipation and the higher bioavailability of L-dopa. DRIF can be a coadjuvant treatment in patients with Parkinson's disease.
  • Davies, K. N., D. King, et al. (1994).
    A study of the nutritional status of elderly patients with Parkinson's disease.
    Age Ageing 23(2): 142-5.
    Patients with Parkinson's disease tend to lose weight although the reasons are uncertain. Fifteen patients with stable Parkinson's disease who had lost at least 5 kg in weight, and 15 age- and sex-matched control subjects were studied. All subjects underwent physical examination, anthropometric measurements, biochemical and haematological screening, measurement of tumour necrosis factor and full dietary assessment. The Parkinson's disease patients who had lost a mean of 6.2 kg had significantly less body fat and a lower total peripheral lymphocyte count than the control subjects. Dietary analysis showed a higher daily intake of calories in the patients which was derived from an increased carbohydrate intake. Tumour necrosis factor was not detected in either the patients or control subjects. Parkinson's disease patients lose weight in spite of an increased calorie intake. This may reflect an increased metabolic rate.
  • de Rijk, M. C., M. M. Breteler, et al. (1997).
    Dietary antioxidants and Parkinson disease. The Rotterdam Study.
    Arch Neurol 54(6): 762-5.
    OBJECTIVE: To investigate whether high dietary intake of antioxidants decreases the risk of Parkinson disease (PD). SETTING: The community- based Rotterdam Study, the Netherlands. DESIGN: The cross-sectional study formed part of a large community-based study in which all participants were individually screened for parkinsonism and were administered a semiquantitative food frequency questionnaire. The study population consisted of 5342 independently living individuals without dementia between 55 and 95 years of age, including 31 participants with PD (Hoehn-Yahr stages 1-3). .. CONCLUSION: Our data suggest that a high intake of dietary vitamin E may protect against the occurrence of PD.
  • Gimenez-Roldan, S. and D. Mateo (1991).
    Predicting beneficial response to a protein-redistribution diet in fluctuating Parkinson's disease.
    Acta Neurol Belg 91(4): 189-200.
    To identify factors that might help in predicting the benefit to be gained from a protein-redistribution diet (PRD) we subjected 26 parkinsonian patients with motor fluctuations refractory to optimal timing and dosage of levodopa plus bromocriptine to a 2,000-2,500 Kcal., 65-80 g/d protein containing diet maintained for 8-12 weeks. .. Wearing-off failures responded unpredictably while random "on-off" fluctuations were present only in the diet-failure group. Nocturnal akinesia and peak-dose dyskinesias often worsened. In no patient "on"-time quality was modified by the diet. In addition, the diet-failure group was characterized by a younger mean age at onset (p less than 0.05) and by longer duration in their fluctuations (p less than 0.001). Though requiring confirmation in a larger series, our results suggest that parkinsonian patients showing fluctuations over prolonged periods, particularly those having a pattern of random "on-off" oscillations in motor performance and dose- failures unrelated to meals are unlikely to benefit from a PRD.
  • Gimenez-Roldan, S., D. Mateo, et al. (1991).
    Proposal for a protein redistribution diet in the control of motor fluctuations in Parkinson's disease: acceptance and efficacy.
    Neurologia 6(1): 3-9.
    Some patients with Parkinson's disease (PD) and fluctuations of motor response to levodopa therapy may benefit by avoiding proteins during daytime meals, while leaving them unrestricted until bedtime. The acceptance and benefits of a protein redistribution diet (PRD) was studied in 26 PD patients whose fluctuations were refractory to current medications. Only 15 patients (57.2%) were still adhered to the diet 3 months later. Non compliance was more often justified on the basis of the changes in alimentary habits, as a too heavy supper (37%), scanty variation of meals (27%) and difficulties in preparing the diet (18%), rather than do to adverse effects of the diet on PD which occurred in 2 patients (exacerbation of the dyskinesias and lack of effectiveness, respectively). The PRD proved beneficial to 67% of those patients able to keep adhered to it, 4 patients shifting to stable responses. Five diet-benefit patients who performed daily "on-off" charts decreased their mean daily "off" time from 13 to 3 % (p less than 0.05), but "on" time quality remained unimproved by the diet. The PRD introduces a heavy change in dietary habits which is not readily accepted by many PD patients. However, the fact that fluctuations disappeared in one fourth of those able to maintain the diet warrants a closely supervised, short- time trial to identify those in whom benefits override the inconveniences of such new changes in the patient's way of life.
  • Hirata, H., M. Asanuma, et al. (1992).
    [Influence of protein-restricted diet on motor response fluctuations in Parkinson's disease].
    Rinsho Shinkeigaku 32(9): 973-8.
    The clinical management of Parkinson's disease has been revolutionized by the introduction of levodopa therapy. It has significantly reduced disability and has extended life expectancies of patients with Parkinson's disease. However, motor response fluctuations frequently appear in patients after long-term treatment with levodopa. In this study, we investigated the effect of protein-restricted diet on fluctuations in eight patients with Parkinson's disease who had been receiving long-term levodopa treatment (mean 12.5 years). Two weeks of protein-restricted daytime diet (7.5 g total at breakfast and lunch) was followed by 12.5 g total at breakfast and lunch. At night, high- protein diet (40-50 g at dinner) was offered to the patients in order to maintain total daily protein intake at Japanese standard level. The medication schedule of levodopa and other antiparkinsonian drugs was not changed within 2 weeks after the study was began. Fluctuations were reduced in 7 of the 8 patients. But in only one patient (case 6), dyskinesia and general condition got worse and stopped this therapy. Body weight, serum protein and albumin levels did not change significantly for at least three month after the study was begun in every 6 patients who were examined. Homovanillic acid level of cerebrospinal fluid reduced in every 4 patients who were examined. We concluded that protein-restricted diet during the daytime offers a fascinating technique for the control of motor response fluctuations in patients with Parkinson's disease undergoing long-term levodopa treatment. But this therapy must be indicated carefully. Mechanism of this therapy may has something to do with improvement of dopamine metabolism in the brain
  • Jimenez-Jimenez, F. J., L. Ayuso-Peralta, et al. (1999).
    [Do antioxidants in the diet affect the risk of developing Parkinson disease?].
    Rev Neurol 29(8): 741-4.
    OBJECTIVE: A number of studies suggest the existence of 'oxidative stress' in the substantia nigra from parkinsonian patients. If 'oxidative stress' should be relevant in the pathogenesis of Parkinson's disease (PD), the consumption of antioxidant or prooxidant substances in the diet could theoretically influence the risk for this disease. DEVELOPMENT: A critical up to date review of the literature regarding premorbid consumption of antioxidants or prooxidants by PD patients and controls has been done. Most studies have been retrospective, they have been performed following different designs, and disclosed contradictory results. CONCLUSION: From the current literature, it is unlikely that dietetic consumption of prooxidants and antioxidant, specially vitamin E (the most frequently studied antioxidant) have any influence on the risk for PD.
  • Johnson, C. C., J. M. Gorell, et al. (1999).
    Adult nutrient intake as a risk factor for Parkinson's disease.
    Int J Epidemiol 28(6): 1102-9.

    BACKGROUND: This population-based case-control study evaluated nutrient intake as a risk factor for Parkinson's disease (PD) among people aged > or =50 years in metropolitan Detroit. .. RESULTS: Estimating the association between PD and risk of being in the highest versus the lowest intake quartile, there were elevated odds ratios for total fat (OR 1.94, 95% confidence interval [CI] : 1.05-3.58), cholesterol (OR 2.11, 95% CI: 1.14-3.90), lutein (OR 2.52, 95% CI: 1.32-4.84) and iron (OR 1.88, 95% CI: 1.05-3.38). CONCLUSIONS: These results suggest an association of PD with high intake of total fat, saturated fats, cholesterol, lutein and iron.
  • Markus, H. S., A. M. Tomkins, et al. (1993).
    Increased prevalence of undernutrition in Parkinson's disease and its relationship to clinical disease parameters.
    J Neural Transm Park Dis Dement Sect 5(2): 117-25.
    An anthropometric study was performed in 95 subjects (53 male, 42 female) with Parkinson's disease. ..The reduction in anthropometric indices was most marked for skin fold thickness (related to percentage body fat) and least for arm muscle circumference (related to lean body mass); therefore the weight loss seen in Parkinson's disease is primarily due to fat loss rather than muscle loss.

    McCarty, M. F. (2001).
    Does a vegan diet reduce risk for Parkinson's disease?
    Med Hypotheses 57(3): 318-323.
    Three recent case-control studies conclude that diets high in animal fat or cholesterol are associated with a substantial increase in risk for ParkinsonOs disease (PD); in contrast, fat of plant origin does not appear to increase risk. Whereas reported age-adjusted prevalence rates of PD tend to be relatively uniform throughout Europe and the Americas, sub-Saharan black Africans, rural Chinese, and Japanese, groups whose diets tend to be vegan or quasi-vegan, appear to enjoy substantially lower rates. Since current PD prevalence in African-Americans is little different from that in whites, environmental factors are likely to be responsible for the low PD risk in black Africans. In aggregate, these findings suggest that vegan diets may be notably protective with respect to PD. However, they offer no insight into whether saturated fat, compounds associated with animal fat, animal protein, or the integrated impact of the components of animal products mediates the risk associated with animal fat consumption. Caloric restriction has recently been shown to protect the central dopaminergic neurons of mice from neurotoxins, at least in part by induction of heat-shock proteins; conceivably, the protection afforded by vegan diets reflects a similar mechanism. The possibility that vegan diets could be therapeutically beneficial in PD, by slowing the loss of surviving dopaminergic neurons, thus retarding progression of the syndrome, may merit examination. Vegan diets could also be helpful to PD patients by promoting vascular health and aiding blood brain barrier transport of L- dopa.

    Morens, D. M., A. Grandinetti, et al. (1996).
    Case-control study of idiopathic Parkinson's disease and dietary vitamin E intake.
    Neurology 46(5): 1270-4.
    A nested case-control study of 84 incident cases of patients with idiopathic Parkinson's disease (PD) detected by June 30, 1994 and 336 age-matched control subjects, compared previously-documented intake of total dietary vitamin E and of selected vitamin E-containing foods. All study subjects had been followed for 27 to 30 years after diet recording in the 8,006-man Honolulu Heart Study cohort. .. Although absence of PD was significantly associated with prior consumption of legumes (adjusted OR = 0.27, 95% CI 0.09 to 0.78), a dietary variable preselected for high vitamin E content, neither food categories nor quartiles nor continuous variables of vitamin E consumption were significantly associated with PD occurrence. Though consistent with prior reports of PD protection afforded by legumes, and with speculation on the possible benefits of dietary or supplemental vitamin E in preventing PD, these preliminary data do not conclusively document a beneficial effect of dietary vitamin E on PD occurrence.

    Vieregge, P. and J. Dethlefsen (1992).
    [Physical therapy and speech therapy in Parkinson syndrome--a status assessment].
    Fortschr Neurol Psychiatr 60(10): 369-74.
    74 inpatients and outpatients (mean age 71.9 years) with idiopathic Parkinson's disease, a vascular pseudo-parkinsonian syndrome or a Parkinson-associated dementia were analysed by present-state clinical rating with regard to use and needs of physical and speech therapy. 55% of the patients had physical therapy whatsoever, 32% of them on a daily schedule. 58% of patients without everyday physical therapy indicated to do less physical therapy than one year ago or that they have quite any exercise. .. The study suggests that the need for physical therapy might be derived more from patient's assessment of reduced daytime motor activities than from a scaled item rating of an external observer. Use and continuity of physical and speech therapy in Parkinsonism seems to be limited largely by cognitive disturbances and social variables. Speech therapy appears to be useful only for a subgroup of Parkinsonian patients.

    Vieregge, P., C. von Maravic, et al. (1992).
    Life-style and dietary factors early and late in Parkinson's disease.
    Can J Neurol Sci 19(2): 170-3.
    The study investigated features of life-style and dietary habits early and late in life of patients with idiopathic Parkinson's disease (IPD). Seventy-one patients and 103 controls were interviewed personally with a structured questionnaire. Living in villages during primary school time was significantly more frequent among patients, and in the urban environment patients had lived less frequently in larger-sized towns. Mushroom harvesting during childhood was more frequent among patients. No difference between patients and controls was found in childhood water supply, habits of fishing in the countryside or at the seaside, and eating such fish. Actual food preference in patients was greater for almonds and plums, while no difference was found in the actual intake of mushrooms, peanuts, oil-dressed salad, fish and animal offals. The study did not indicate a higher consumption of foods known to harbour heavy metals and pesticides in IPD patients either long before or during the disease. Reduced consumption of foodstuffs rich in vitamin E, as reported previously for premorbid patients, is no longer observed in patients with overt disease.

    Vilming, S. T. (1995).
    [Diet therapy in Parkinson disease].
    Tidsskr Nor Laegeforen 115(10): 1244-7.
    The significance of restrictions on protein for patients with Parkinson's disease is reviewed. Large neutral amino acids and levodopa share the same saturated carrier system through the blood-brain- barrier. Fluctuating patients are sensitive to a decreased supply of levodopa from the blood, and clinical studies show that an increased concentration of large neutral amino acids in the blood decreases mobility and reduces "on-time". A reduction of protein intake to 0.75- 0.8 g/kg body weight/day has been recommended. A protein redistribution diet implying that less than 10% of the daily protein is taken in daytime and the rest in the evening, gives best results. However, in the elderly, protein restrictions may lead to a lasting negative nitrogen balance, and even in younger patients the supply of certain minerals and vitamins may become too low or marginally adequate. The diet must therefore be used with caution.

    Haglin, L. and B. Selander (2000).
    [Diet in Parkinson disease].
    Tidsskr Nor Laegeforen 120(5): 576-8.
    The interest in a protein redistribution diet, also called daytime protein restriction diet, has increased among patients with Parkinson's disease. Since certain amino acids compete with L-dopa in the intestine and at the blood-brain barrier, daytime protein restriction may improve fluctuations in motor ability. However, this diet can contribute to weight loss, nutrient deficiencies and cause cognitive disabilities if the diet is not correctly observed. Further studies are needed to clarify how medication with L-dopa in combination with different diets (relative contributions of protein, fat and carbohydrate) may affect motor fluctuations, nutritional status and cognitive ability.