Nutritional Management in Parkinson's Disease

Introduction to Nutritional Deficiencies

Patients with chronic conditions, including Parkinson's disease, often have lower concentrations of magnesium, and deficiencies in zinc and selenium have been reported, although results are conflicting, as stated by the Clinical Nutrition guideline society 1

Regular monitoring of nutritional and vitamin status is recommended as part of routine management of Parkinson's disease, with a focus on vitamin D, folic acid, and vitamin B12 status, according to the Clinical Nutrition guideline society 2
Body weight should be closely monitored and documented at least every 3 months, with full nutritional assessment conducted at least yearly, as recommended by the Clinical Nutrition guideline society 2, 3

Patients with Parkinson's disease should be screened for vitamin B12 deficiency, vitamin D deficiency, folate deficiency, and homocysteine elevation, especially those with rapid progression of motor symptoms, early postural instability and falls, cognitive decline, peripheral neuropathy, or history of gastrointestinal disorders or malabsorption, as recommended by the Clinical Nutrition guideline society 2
Vitamin D supplementation is strongly recommended to slow disease progression, reduce risk of fractures, and address lower bone mineral density, with a starting dose of 2000-4000 IU oral vitamin D3 daily, and maintaining serum 25-hydroxyvitamin D levels of 75 nmol/L or higher, as recommended by the American College of Nutrition and the Clinical Nutrition guideline society 2, 4
B vitamins, including folate and B12, are recommended for patients on levodopa therapy to reduce homocysteine levels and prevent neuropathy, with dosing to effectively reduce homocysteine levels and periodic monitoring of B12 levels, as recommended by the Clinical Nutrition guideline society 2
Coenzyme Q10 supplementation is not recommended due to lack of clinical benefit, despite reduced levels of CoQ10 in Parkinson's disease patients, as stated by the Clinical Nutrition guideline society 2

Food-derived amino acids can compete with levodopa for entry into the brain, and patients with motor fluctuations may benefit from a protein redistribution diet, with supplements taken at least 30 minutes before or 1 hour after levodopa doses, as recommended by the Clinical Nutrition guideline society 2
Screening for dysphagia is recommended in all patients with Hoehn & Yahr stage above II, weight loss, low BMI, drooling, dementia, and coughing during meals or drinking, as more than 80% of Parkinson's disease patients develop dysphagia during the course of disease, as stated by 5

Relying on antioxidant supplements, such as vitamin E and CoQ10, despite evidence showing lack of benefit, and failing to monitor vitamin D status, address B vitamin status in patients on levodopa therapy, and screen for dysphagia when recommending oral supplements, can be avoided by following recommended guidelines, as stated by the Clinical Nutrition guideline society 2