Food for the Brain: Nutrition and Parkinson’s Disease | 2019 Udall Center Research Symposium

>>I like to start my talk by saying there are very little
things or very few things that we as individuals with Parkinson’s or without Parkinson’s can control in our lives, right? So we cannot control how long the levodopa stays in our system. We cannot control what the
weather conditions are outside. However, there are two things that we can always control. One of them is how much you move. So fitness, as Dr. Mills
had explained before, the fitness has shown to be a disease modifying therapy. So in partnership, what
we put into our bodies is also what we can control. So these are two things that I feel should empower you all to feel
that you have control over. So my talk is called Food For The Brain: Nutrition
and Parkinson’s Disease. Objectives. I can actually just stand here. I want to define nutrition. Identify some nutritional concerns for those with Parkinson’s disease. I want to talk about some popular diets and some research behind those, as well as highlight some
evidence-based findings that might help reduce the rate of Parkinson’s disease progression. So what exactly is nutrition? Nutrition is the intake of food considered in relation to
the body’s dietary needs. So my nutritional needs
look a lot different than my grandfather’s needs. Or my, let’s say my unborn nephew’s needs will be when he is born. So this is very individualized. So once size does not fit all when it comes to nutrition. So some nutritional concerns for those living with Parkinson’s disease. Bone thinning. Strong bones can keep people living with Parkinson’s safer
when they experience those unexpected falls. So mobility challenges can become more common as Parkinson’s
disease progresses, including an increased risk of falls. So what are the two things that we always tell
patients with Parkinson’s? Don’t choke and don’t fall. Studies show that
Parkinson’s can also increase the risk for bone thinning. This combination can lead to injury. Seems like common sense, right? If you’re more prone to falling and your bones are thinner, you’re more than likely going to experience some sort of break. So the current recommendation to alleviate some of those
concerns for bone thinning, we want to eat meals rich in
bone-strengthening nutrients such as calcium, magnesium,
vitamin D and vitamin K. Regular exposure to sunlight
also increases your vitamin D. So it’s not just to get yourself nice and bronzed, it’s to
actually strengthen those bones. In addition to the right foods, walking and other weight-bearing exercises keep bones strong, making fractures or breaks less likely. Does that makes sense? Dehydration. How many of you experience dehydration? Okay, I do myself. So Parkinson’s medications
can raise dehydration risk which can lead to confusion,
weakness, balance problems, respiratory failure, kidney problems, in extreme cases death. So dehydration can also
lead to low blood pressure or those fluctuations in blood pressure. So what do we do to alleviate dehydration? One of the things that I have found is that you can go online and type in “recommendations for water.” And sometimes you’ll get
a very lengthy equation to put in your body weight in kilograms and so on and so forth. But I like to keep it very simple. If you can remember to drink eight, eight-ounce glasses of water each day you’re at a good start. Okay, does anybody have suggestions as to how we can accommodate or how we can achieve those eight, eight ounces a day? Yes, in the back.>>Woman: Get a bottle
from Bed, Bath, and Beyond. It’s already marked how many is in there and you can see your (mumbles).>>Love it, anybody else? Yes, Nancy.>>Nancy: Four times a day
when I take my medicine, (mumbles) I never take it
with anything but water.>>All right, so with
medication you’re taking water. All right, there we go. Anybody else? Okay, so those are two
really good recommendations. One of the things that I really like to do or what I’ve done to up my water intake is I went and I bought
one of those Hydroflasks, and unfortunately today
I don’t have it with me, because I knew that there would be water, but normally every day
I refill my Hydroflask at least three or four times. It is now my purse. I do not carry a purse, I
carry a water bottle instead. Constipation. I’m sure that that’s a big one. I won’t make you raise
your hand to tell me who of you experienced this. Parkinson’s disease can lead to the slow of the movement of the colon, which is causing that constipation. Unresolved constipation can
lead to bowel impaction, so essentially this is when
a mass of dry, hard feces becomes almost impossible
to pass normally. So this can require some
hospitalization and even surgery in some extreme cases. So how do we alleviate
this issue of constipation? Current recommendations
is that you should have, if you have less than one
bowel movement per day, we want you to up that fluid intake. So kind of piggy backs
off of the water intake. You wanna make sure that you’re
drinking a lot of fluids. You wanna consume more fiber. And where is fiber found? Fruits, vegetables, beans,
whole grains, nuts and seeds. Another thing, we wanna
aim for 30 to 40 grams of fiber per day, so one of the things that
I like to tell people is when they go to the grocery store and you’re looking at the boxes, flip over that cereal, because again one size does not fit all. If you look at something
like Cinnamon Toast Crunch, flip it over to that nutritional
label and you scroll down to the dietary fiber, there’s
probably one gram of fiber. However, if you were to
look at a box of Fiber One, scroll down to the same dietary fiber, it is probably 10 grams of fiber. I would opt for the Fiber One. Choose foods that have five or more grams of fiber per serving, okay, so you wanna get the
most bang for your buck. Unexpected weight loss. I’ve presented this probably
three or four times, and each one of my groups, at least one person has raised their hand and expressed that they have
had unexpected weight loss. So unexpected weight loss
is pretty much something that you cannot attribute
to some change in your diet. So you’re not eating differently, you’re not eating different foods, you’re not eating less, so that is something that we wanna keep in the back of our mind
that could be a concern. So difficulty swallowing,
feeling full or bloated, and improper fitting partial dentures could be potential causes of
this unexpected weight loss. So what do we recommend? So we wanna eat smaller,
more frequent meals. I know a number of patients have expressed that they spend a decent amount of time, eating lunch, sometimes an
hour, an hour and a half. And if we can reduce that meal size, maybe we can also decrease that time that’s spent eating lunch. Kind of piggy backing off the fact that I said that you might experience unexpected weight loss for no reason other than, you know, you’re
not changing your diet, again, you’re not changing the timing of the food or the amounts, you might
wanna have that red flag light bulb that goes off
in your head that says “Hm, I might need to
talk to my neurologist “and talk to him about
this H. Pylori bug.” So H. Pylori is a GI bug that basically affects the absorption
of your PD medications, and consequently affects your
overall response to treatment. So H. Pylori can be
tested by stool sample. I wouldn’t say it’s common, but I wouldn’t say it’s uncommon, so if you do experience
those unexpected weight loss, I would again just talk to your doctor. So moving on to the role of nutrition. The current state of
knowledge about the role of nutrients and diet as
it relates to Parkinson’s is very limited. However, researchers
have seen a correlation between diet and the management of other neurological conditions such as epilepsy, dementia, and stroke. So while no single ingredient exists to magically cure neurological conditions, several well studied diet plans have been associated with a
positive effect on the brain. So we’re gonna go into five of them. And essentially what I wanted to do was, I wanted to pull from the
research the findings. So what were these diets finding? So we’re gonna take a
closer look, as I said, at five diets. We’re gonna start with
a Mediterranean diet, moving into the ketogenic, then to the MIND, intermittent fasting, and finishing with the Feingold diet. If any of you have heard
of the Feingold diet, you get a gold star. The Mediterranean diet, okay, so the emphasis here is eating
primarily plant-based foods, such as fruits and
vegetables, whole grains, legumes, and nuts. We’re replacing butter with healthy fat such as olive oil and canola oil. We’re gonna use herbs and
spices instead of salt to flavor our foods, and we’re gonna limit our red meat intake to no more than a few times a month. So what is the research saying about the mediterranean diet? In 2012, a study was published in the “Movement Disorders
Journal,” suggesting that a lower adherence to
the mediterranean diet is associated with
Parkinson’s disease status. So in other words, if you
followed a mediterranean diet, it may both lower the risk
for Parkinson’s disease, or push back the age of onset. The thought is that these antioxidants, like vitamin C, vitamin E, and carotenoid, are found in high
concentrations in these foods that are associated with
the mediterranean diet. So the mediterranean diet
also reduces inflammation, and I don’t know about you, but I found out recently
that the reason why we floss isn’t necessarily to get
the stuff out of our teeth. It reduces the inflammation in our mouth, and as we reduce the
inflammation in our mouth, it thus then reduces
inflammation throughout the body. So the less inflamed we are, the less likely we are to get sick. In addition, the
mediterranean diet adherence may be protective because
of a lower consumption of compounds which are
associated with a higher risk of Parkinson’s, and we’ll talk
about that in a little bit. So the keto diet, how many here have heard of that? It’s pretty big, pretty popular recently, more recently, I would say. So the keto diet is very
low carb, very high fat, so about 75% of our diet is going to come from healthy fats, stressing healthy. And so about 20% of
our diet is going to be coming from protein, and the carbs that we do
get are going to pretty much be coming from your vegetables or, yeah, your vegetables. So some of the foods that
the ketogenic diet includes are meat, fatty fish,
eggs, butter and cream, cheese, so not all
cheese is created equal, we’re going to stress unprocessed cheese, so cheddar, goat cheese,
cream, blue, or mozzarella. Nuts and seeds, healthy oils, avocados, low carb veggies, and condiments. So what is the research saying about this? So this study was actually the only study, or only diet that was studied
in Parkinson’s disease. So what they did in 2018, they basically took two groups, they separated individuals
into two groups. One followed a low fat diet, and one followed a ketogenic diet. While both diet groups
significantly improved in motor and non-motor symptoms, the ketogenic group
showed greater improvement in non-motor symptoms. So these non-motor symptoms included depression, urinary problems, fatigue, daytime sleepiness, cognitive
impairment, and others. Adverse effects were mild. In the ketogenic group, the
most common or the worst adverse effect was exacerbated
tremor and/or rigidity. So just as a caveat, I have experimented with the ketogenic diet. I don’t follow it anymore. I actually need carbs,
but I do have to say that I did experience that mental clarity, especially in the afternoon. I didn’t feel like I
needed that second or third cup of coffee. I did feel a little bit
more mentally sharp, and I wouldn’t say that I am a proponent or strong supporter of the ketogenic diet. That’s just my personal experience. The MIND diet. So the MIND diet is a mix
of the mediterranean diet and the DASH diet, which
was specifically created to stop hypertension. However, the MIND diet
was tweaked specifically to address cognitive decline. So the MIND diet focuses on
10 brain healthy food groups. Chicken, fish, green leafy
vegetables, other vegetables, berries, nuts, olive oil,
wine, beans and whole grains. So what does the research
say about the MIND diet? So the MIND diet has not
been exclusively studied in Parkinson’s disease, however, promising results have been found in Alzheimer’s disease. In 2015, a study published in the “Alzheimer and Dementia”
showed that adults who followed the MIND diet rigorously
had a 53% reduction in the rate of Alzheimer’s
disease compared to those who followed it the least. I don’t know about you, but 53% seems pretty significant to me. Those who followed the
MIND diet moderately, so probably followed the 80/20 lifestyle, where they’re pretty
consistent during the week, maybe let themselves go
a little on the weekend, showed a 35% reduction. Again, I also think that
that is pretty significant. Results were independent
of other lifestyle changes, meaning they didn’t exercise more, they didn’t report better sleep, so this was solely based on the food that they were eating. So this suggests that the
MIND diet might also have preventative and
disease-reduction benefits for other diseases such as heart disease, diabetes, obesity, and hypertension. I don’t know about you,
but I’ve also heard, or noticed, that people
with Parkinson’s disease oftentimes don’t just have Parkinson’s. So we’re often treating multiple diseases. The Feingold diet. Who gets the gold star? Has anybody heard of this diet? Yeah? All right, you get the gold star. So the Feingold diet, I
thought, was pretty interesting. It’s an elimination diet that pretty much helps you figure out if
you have certain additives or artificial sweeteners are triggering some sort of sensitivity. When I presented this a while ago, I had a woman raise her hand who said that she could not stay at her Christmas dinner because she couldn’t stand the smell of the vanilla candle. Now, I don’t know if it’s just that she didn’t like the vanilla candle, or if it was really irritating
her Parkinson’s symptoms, but she did say that she
was experiencing more tremor than she normally does. So the list of off-limit
foods and ingredients in the Feingold diet include artificial food colors, dyes, and flavors, artificial fragrances in foods, air fresheners or lotions, artificial sweeteners, which
those are the fancy names for Splenda, Equal, and Sweet & Low, food preservatives, and somebody
help me out with this word. I butcher it every time. Salicylates? There we go. Salicylates, which are some foods contain naturally and which are
also in some medications. So the Feingold diet has not been studied exclusively in Parkinson’s. It was originally developed to
alleviate asthma and eczema, and then later it became a recommendation for children with ADHD. There has been a link
between the consumption of artificial sweeteners
and food colorings with ADD or attention deficit hyperactive disorder. Intermittent fasting. This is another one that tends
to be pretty popular recently where sometimes people will eat
for a day, not eat the next, or they’ll fast for 18
hours and leave themselves a six-hour window, so on and so forth. It does not specify which
foods you should eat, but rather when you should eat them. Again, several strategies
exist to accomplish an intermittent fast, and those are listed below
as I had already mentioned. So what is the research saying? Research does not support the claim linking intermittent
fasting with a reduction in Parkinson’s disease symptoms. Not only that, organizations
do not recommend intermittent fasting for
those with Parkinson’s disease because of this vulnerable population who already might be dealing
with a loss of appetite or difficulty getting proper
nutrition to begin with. It also may be risky for
those with Parkinson’s who may be dealing with
low blood pressure, dehydration, and poor balance. So here’s the big slide,
my big takeaway message, that a lot of people who take carbidopa/levodopa do not know, is that your carbidopa/levodopa
and protein interact, and when that happens,
protein will always win, because it is competing
for the same receptor. So it does only happen in some cases, about 70% of people do
not experience this. However, that 30% is enough
for me to make this a point. Symptoms may not be controlled
as effectively, as well, if carbidopa/levodopa is
taken on an empty stomach rather than with food with high protein. Which brings me to my point. If that is something, I
think that some of the recommendations might be 30-minute window, so 30 minutes before you eat, 30 minutes after you eat, you wait, and then you take your medicine. Sometimes it’s an hour. Sometimes that can get really tricky if you’re taking a copious
amount of medication throughout the day. So what we tend to tell people is to try a protein redistribution diet. So what that looks like is let’s say somebody is still working
a nine to five job. And they really need to
maximize their on time in the morning, okay? So we wanna make sure that
we are pushing our protein towards the evening, so with dinner we’re probably gonna have that
steak or whatever looks like. We’re not changing the
actual amount of protein that we’re getting in a day, so 50 grams of protein is the recommended, or I think it’s 54 for men and women, above the age of 65 and older, so we’re not reducing the 50. We’re just redistributing it
to a different time in the day. Similarly, if you have
trouble sleeping at night and you really need to maximize your carbidopa/levodopa at night, we’re gonna try to push
most of our protein intake towards the beginning of the day. Does that make sense? Okay. So it’s not considered a low protein diet, but rather just a shift in
your dietary protein needs towards one end of the spectrum. Again, the amount of protein
consumed is the same. So in conclusion, our
understanding of the impact of nutrients in Parkinson’s disease is still in its infancy. Because of these limitations, physicians usually limit
their dietary recommendations to eat a well balanced diet that includes increased fiber to prevent constipation as well as fluid consumption
to prevent dehydration. It is really important that
one size does not fit all. Genetics does play a role, and the last thing that
I like to tell people is, it’s kind of a fun experiment that I like to tell people to try, is that I presented a whole bunch of different diets to you today. One of them, or two of them,
might be of interest to you, and what I like to tell people is to start to keep a food diary, and not necessarily just keep a food diary of the things that you’re eating, but the timing, as well as
how you felt after eating that specific food, because if you start to look at patterns, then you can know which
foods make you feel better, and which foods make you feel worse. Similarly, if you have concerns
or nutritional concerns, and you keep a food log, it’s a lot easier to come
into the doctor’s office and explain the patterns of the eating that you’re experiencing
rather than just saying “My nutrition’s off, what do I do?” So the more information
that you can provide your neurologist or your physicians, the better off you are. Does that make sense to everybody as well? Okay. Are there any questions, because I actually think
I have time for questions. Yeah, okay. Any questions? Yes, in the back. (audience member speaks off mic)>>Yes! (audience member speaks off mic)>>Um, well, I think just in general, I can’t really give you scientific data behind the genetics, but genetics meaning, I think, in terms of, let’s say, some people are allergic to other foods, that’s one genetic component. I think another would
be just that some people are predisposed to certain allergies, so that’s one. Some people are predisposed
to hypertension, so your needs are different based on what your genetic makeup looks like. Thank you. Any other questions? Okay, I notice that Dean
Matt walked in the room, so I want to give her an opportunity to quickly just say hello and welcome her, since this was in large part
possible because of her. (applause)

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