Nutrition and the Parkinson’s Brain
ANNA PATTEN M A Y 2 0 1 6 The brain Neuron communication
Brain Plasticity
Lifelong Capacity for Physical and Functional Change
The structure and function of individual neurons and more importantly, the connections they make, can change.
These changes are influenced by genetics, our environment and our actions Brain Plasticity
Through these changes memories are stored or lost, skills are learned or unlearned, and personalities are shaped.
Targeting of the plastic processes that strengthen the brain can provide a foundation for therapies to restore cognitive systems in aging and trauma.
Parkinson’s Disease
Second most common neurodegenerative disorder and the most common motor disorder Degeneration & loss of dopamine-producing neurons in the substantia nigra Lewy body aggregates in brain Symptoms include: Difficulty initiating movement Slowness of movement Shaking at rest Postural imbalance PD Normal Rigidity, Bradykinesia & Tremor
Our bodies and nutrition
Nutrition can substantially affect mood, behavior, and brain function
Our food intake influences brain chemistry and neural function
Deficiencies or excesses of certain vitamins or minerals may impair brain and body function.
The gut-brain relationship
Enteric Nervous System Controls digestion Physical and mental well-being Unconscious… Produces 50% of all dopamine Produces 95% of all serotonin
PD and the gut
The bacterium Prevotella is present at lower levels in the gut of people with PD. This bacteria is important for creating the vitamins thiamine and folate and the maintenance of an intestinal barrier protecting against environmental toxins.
In PD, Lewy bodies (protein aggregates) show up in dopamine-producing neurons in the gut. Degeneration may start in the gut as the result of an environmental trigger (e.g. virus) and then spread to the brain via the vagus nerve.
Gut symptoms include hypersalivation, dysphagia, gastroparesis, dyspepsia, heartburn and constipation
Gut symptoms may occur up to 10 years earlier than motor symptoms
Detection of α-synuclein in the gut could have early diagnostic potential
Nutrition in PD
Tremor, slowness and stiffness can make eating difficult and lead to nutritional deficits.
Nausea as a result of medications can also be a problem.
Some foods may interact with PD medications making them less effective. E.G. Levodopa and Protein
Nutrition and PD
Weight loss since the onset of disease occurs in 52% of patients.
Albumin, Vitamin A, Vitamin E, Vitamin D, Iron and Zinc are significantly lower in patients with PD compared to healthy age-matched controls.
Constipation occurs in >75% of patients with PD Often accompanied by other gastrointestinal issues Risks/benefits of different nutrients in PD
Some nutrients are associated with increased risk of developing PD Dairy products (particularly in men) May be linked to pesticides/additives in dairy products
Some nutrients are associated with a decreased risk of developing PD or a slowing of disease progression Phytochemicals (found in fruits and vegetables) Mediterranean diet Antioxidant-rich foods Caffeine (more so in males than females – estrogen/caffeine interactions) Green Tea
Antioxidants
Compounds that detoxify reactive oxygen species in the brain
Antioxidants protect the brain from damage
Natural antioxidants include vitamin C, vitamin E and glutathione
Antioxidants and PD
There have been studies indicating that endogenous antioxidants are reduced in the PD brain
This decrease may lead to cellular damage and increased neurodegeneration Oxidative stress Sources of oxidants
DNA OxidativeDAMAGE damage The Brain is susceptible to Oxidative Stress
Neuronal High O2 membrane lipids consumption are rich in fatty acids which ROS attack
Antioxidant defenses are modest
Several neurotransmitters are autoxidizable Foods high in antioxidants Antioxidants and memory
Evidence is mounting that cumulative oxidative damage to brain cells causes the fuzzy memory, slow learning, and loss of coordination that often accompanies aging
Long-term study in Japanese-American Men Elderly men who took supplements of both vitamin C and E had an 88% reduction in the frequency of vascular dementia compared with men who did not take the supplements. The protective effect was substantially greater in men who reported long-term use of both vitamins. Antioxidants and PD
There are currently studies investigating antioxidants such as CoQ10, vitamin E, creatine, inosine and glutathione for their role in PD No scientific evidence…..yet Anecdotal evidence
Always check with your doctor prior to taking a supplement in case it interferes with your other medications Good Fats
Of the solid matter in the brain, 60% is fat, since the brain consists largely of fatty membranes.
Bad fats: trans and saturated fats Good fats: polyunsaturated – omega-3 and omega-6
Good fats help maintain flexible, dynamic membranes that are able to transmit and receive information, and maintain other cell functions such as energy production, and water storage.
Omega-3 fatty acids
Essential polyunsaturated fatty acids DHA, EPA Biggest source is fatty fish
Fish eat algae and omega-3 gets Algae produce omega-3 incorporated into their organs fatty acids
Happy Heart Happy Brain Humans eat fish and omega-3 gets Happy Body incorporated into their organs Omega-3 and the cell membrane Omega-3’s and the brain
Important for membrane fluidity
Important for brain growth and function
Improve learning and memory
Anti-depressant actions
?Prevent onset of Alzheimer's disease Omega-3 and depression Fats and PD
Omega-3’s No evidence as yet to any neuroprotection Some evidence that omega-3’s reduce depression in PD patients May reduce side effects (dyskinesias) that result from levodopa
Coconut oil High in medium chain fatty acids Mainly anecdotal evidence for benefits in PD presently
Potential drug/food interactions
Carbidopa/levodopa (Sinemet, Stalevo, Parcopa, Rytary) Competes with protein absorption in the intestine Try to avoid high protein meals when you take your medication Take medication on an empty stomach 30 – 60 min prior to eating meal. If nausea is experienced, you can take the medication with a cracker or toast Fava beans and PD
Fava beans contain levodopa
The concentration and availability of levodopa in fava beans is variable so the response can be inconsistent.
If you are taking prescribed levodopa and you also eat a large amount of fava beans this could result in too much levodopa = dyskinesia (involuntary movement) Mucuna Pruriens and PD
Kapikacchu/Velvet bean Contains L-DOPA and serotonin
A study compared LD/CD to mucuna pruriens, and found that mucana pruriens had a rapid onset of action and longer on-time. Natural source of L-DOPA might possess advantages over conventional methods. Long-term studies on efficacy and tolerability are needed. Nutritional recommendations from the PD Foundation
Eat a variety of foods whenever possible
Mediterranean-style diet is recommended Lower risk of heart disease and diabetes
Atkins diet (low carb) is NOT recommended High protein to replace carbs can interfere with PD medications such as Sinemet/levodopa
Drink lots of water Helps to alleviate constipation Improves mental function Nutritional recommendations from the PD Foundation
Eat lots of fibre (cereal, whole grains, brown rice) Helps to alleviate constipation
Ensure adequate Vitamin D Sunlight in small doses Drink fortified milk/eat fish (especially salmon) Ask doctor about taking a supplement (400IU/day minimum)
Discuss with your doctor the best way to balance your meals and medications E.g. take levodopa half an hour before food to avoid interactions with protein Summary
Having a well balanced diet is the best way to keep both mentally and physically healthy
Parkinson’s may affect the gut (ENS) as well as the brain (CNS)
Foods rich in antioxidants or good fats may play a role in PD prevention or a slowing of disease progression.
Thank you!