Expert Briefing: Nourishing Wellness - Nutrition for Parkinson's

Crista Ellis 00:00:05
Hello, and welcome to today's Expert Briefings webinar hosted by the Parkinson's Foundation. We'll be starting shortly. For today's session, your microphone will be muted and your video will remain off. After the presentation, we will hold a live Q&A session with our expert presenter, Carolee Horner, and the Foundation's Chief Scientific Officer, Dr. James Beck. Please submit your questions through the Q&A feature, or if you're joining us on Facebook, just type your questions into the comments. We'll be sure to receive those. Please understand that topics that are specific to today's subject will be addressed first, and we'll cover as many questions as we can.

We'll begin our Expert Briefing momentarily. Thank you for joining us.

Dr. James Beck 00:01:25
Hello, everyone, and welcome to the Parkinson's Foundation Expert Briefings. I'm Dr. James Beck, Chief Scientific Officer of the Parkinson's Foundation, and it's a pleasure to have you with us today, our first Expert Briefing in what looks like a nice spring day. In today's briefing, we'll be focusing on how food plays a powerful role in how we think, feel, and move. We'll explore the connection between nutrition and Parkinson's, covering how diet influences brain health, gut function, and overall well-being. Thank you for joining us.

As we do at the start of every Expert Briefing, we'd like to get a sense of who's joining us today. So we're going to launch a poll. If you're joining us on Facebook Live, you can respond using the comment section on Facebook. Tell us, what best describes your connection to Parkinson's? Are you a person with Parkinson's, a spouse or partner? Does your parent have PD? Are you a healthcare professional, or perhaps you're joining us from a different perspective? Let us know by responding to that poll on your screen, and we'll be able to get a sense of who is a person with PD, who's a spouse or partner, and who is really interested to learn about our topic today.

We'll see, not surprisingly, a lot of people with Parkinson's and their care partners are joining us. A couple healthcare professionals. Welcome to everyone. Thank you for sharing your connection to Parkinson's disease. Next, I'd like to take a moment to introduce the Parkinson's Foundation. As a nonprofit organization, we are dedicated to improving the lives of those living with Parkinson's by enhancing care and advancing research. Our efforts are deeply rooted in collaboration with the Parkinson's community and ensuring that everything we do aligns with your needs and priorities. Today's program is just one example of how we're working with you to meet those goals.

The Parkinson's Foundation has invested over $449 million in research and care to improve diagnosis, treatment, and scientific breakthroughs. One of our key initiatives is PD GENEration. It offers free genetic testing and counseling to people with Parkinson's. By participating, you can learn about your genetic connection to Parkinson's and contribute to research that can drive new treatments and, we hope one day, a cure. We encourage you to share this opportunity with your own community. Together, we can make a difference.

Next, I just want to provide a friendly reminder that we are recording today's Expert Briefing. The recording will be available online shortly, so there's no need to check back regularly to see if it's posted. We'll be emailing a link to the recording and other resources related to today's topic for everyone who's already registered.

Now, I'm excited to introduce our speaker, Carolee Horner. Carolee is a functional nutritionist and health coach based in Atlanta, specializing in helping people with Parkinson's and their care partners manage symptoms and changes with PD progression. She takes a holistic approach to support gut and brain health for the whole family. Carolee holds a master's in integrative nutrition and is a nationally board-certified health and wellness coach. She also serves on the advisory council for the Center for Movement Challenges, focusing on holistic Parkinson's care, including the benefits of boxing. Outside of work, she's a proud mom of two, an avid cook, camper, and gardener, and believes that laughter is the best medicine. Please join me in welcoming Carolee Horner.

Carolee Horner 00:04:34
Hi, thank you so much. One second while I just share my slides with you.

All right. Do you see my screen?

Crista Ellis 00:04:48
Looks great, Carolee. Thank you.

Carolee Horner 00:04:50
Excellent. And let me just... Oops, sorry. I messed that up. One second, I'm just trying to get my own face off of here.

All right. I cannot get back to my slides. Here we go. One second. Sorry for my technical difficulties. I am not good at that.

Crista Ellis 00:05:16
It's all good.

Carolee Horner 00:05:17
Thank you so much. Hi, everyone. I am really honored to be asked to come and share my passion with you, which is using nutrition as a part of your journey to manage Parkinson's. Today I have no disclosures.

Our learning objectives are going to include understanding why nutrition matters for Parkinson's and how it influences brain health, gut function, and movement. We're going to explore how food affects the body systems, including digestion, detoxification, and inflammation. We're going to learn strategies to navigate challenges like poor taste, loss of smell, and digestive issues. We're going to gain insight into the role of protein timing and medication effectiveness, and discover how behavioral techniques can support sustainable nutrition habits.

Yes, we are going to attempt to cover all of this information in a very short 40 to 45 minutes. I'm going to provide you with a high-level overview with the hopes that this information can be a resource for you to refer back to as you explore nutrition and how food affects you.

I'm sure you've heard the phrase, you are what you eat. This isn't just a popular adage; it's rooted in biological fact. Everything we consume is broken down into its component parts: proteins into amino acids, carbohydrates into sugars, and fats into fatty acids. Our bodies then reassemble these components into whatever we need at the time, whether that's new cell membranes, neurotransmitters, or energy for our cells. When we eat whole, nutrient-dense foods, we're providing our bodies with the best possible building blocks for repair, maintenance, and optimal function.

In our discussion today, we'll look at food through a functional nutrition lens. This means we'll explore how food acts not just as fuel, but as a source of information for our bodies and even as a form of medicine. We'll be focusing on whole foods and evidence-based approaches. The field of nutrition, especially as it relates to Parkinson's disease, is constantly evolving. I'll be sharing insights from the latest research, including study results that have shown promising connections between certain dietary patterns and improved outcomes for people with Parkinson's.

Throughout this presentation, remember that while we'll discuss general principles that can benefit most people with Parkinson's, nutrition is also highly individual. What works best for one person may not be ideal for another. My goal today is to provide you with the knowledge and tools to make informed decisions about your nutrition. Let's begin by looking at what the current research tells us about the connection between nutrition and Parkinson's disease.

Carolee Horner 00:08:26
Throughout this presentation, you'll hear the terms inflammation and oxidative stress. Before we dive deeper, let's clarify what these mean. Inflammation is your body's natural response to harm or perceived threats. It's like a security system for your body. When triggered, it sends out guards, or immune cells, to protect against intruders or repair damage. This response is crucial for healing. However, if the alarm stays on too long, like in chronic systemic inflammation, the constant state of high alert can wear down your body's resources and potentially cause unintended damage to healthy tissues.

Oxidative stress occurs when there's an imbalance between free radicals and antioxidants in your body. Free radicals are unstable molecules that can damage cells, while antioxidants are the molecules that neutralize them. Imagine free radicals as rust on metal. Just as rust can weaken and damage metal over time, excess free radicals can harm your cells.

Antioxidants act like a protective coating, preventing this rusting process from occurring.

Both inflammation and oxidative stress are interconnected and play crucial roles in Parkinson's disease. Understanding these concepts will help you understand the importance of nutrition in managing PD symptoms and potentially slowing disease progression.

Recent research has shed light on how what we eat can influence brain health and potentially slow the progression of PD. Studies have shown that certain nutrients may have neuroprotective effects. For instance, antioxidants found in colorful fruits and vegetables can combat oxidative stress, which is believed to play a role in the development and progression of Parkinson's. Omega-3 fatty acids, abundant in fish and some plant sources, have been associated with better cognitive function and reduced inflammation.

The mechanisms behind these effects are complex, but they generally involve reducing oxidative stress, supporting mitochondrial function, the powerhouses of our cells, and modulating inflammation in the brain and body.

An exciting area of research is the gut-brain axis. We're discovering that there's a strong connection between our gut health and our brain function. This is particularly relevant for Parkinson's, as many people with PD experience gastrointestinal symptoms, often many years before motor symptoms appear. Our diet plays a crucial role in shaping our gut microbiome, the trillions of bacteria living in our digestive system. These bacteria can influence inflammation, produce neurotransmitters, and even affect the absorption of medications.

While research is still ongoing, there's growing evidence that a healthy, diverse microbiome could potentially influence PD symptoms and progression.

Carolee Horner 00:11:45
So how does this all translate to managing Parkinson's symptoms and improving quality of life? While we'll dive into specific strategies later, it's important to understand that nutrition can potentially influence both motor and non-motor symptoms of PD. For example, certain dietary patterns have been associated with improved motor function, potentially affecting tremors, rigidity, and balance. Nutrition also plays a role in non-motor symptoms like cognitive function, mood regulation, and sleep quality.

Moreover, a balanced diet can help manage common PD-related issues such as constipation, weight fluctuations, and fatigue. It's not just about managing symptoms, though. Good nutrition can contribute to overall well-being and quality of life.

So let's explore different dietary approaches that have shown promise for people with Parkinson's.

There are many dietary approaches, and each has its merits depending on what you are trying to achieve. For simplicity, I like to think of diets in two categories: everyday and therapeutic. Everyday diets are sustainable, long-term approaches that support overall health. Examples include the Mediterranean, MIND, and vegetarian or pescatarian diets.

Therapeutic diets, on the other hand, are short-term resets designed to target specific goals, such as reducing inflammation or improving mitochondrial function. Examples include vegan, ketogenic, and paleo diets. But before we dive into these approaches, let's take a moment to consider the Standard American Diet, which provides an important contrast.

The Standard American Diet, also known as SAD, is characterized by high consumption of processed foods, refined sugars, and unhealthy fats, as well as a low intake of vegetables and whole unprocessed foods. This diet often lacks essential nutrients like fiber, antioxidants, and healthy fats that are critical for brain and gut health.

The Standard American Diet contributes to chronic diseases such as heart disease, diabetes, obesity, and may exacerbate neurodegeneration. By understanding SAD's shortcomings, its reliance on processed foods and lack of nutrient density, we can better appreciate how other dietary approaches address these gaps and promote health.

Everyday diets are designed to be sustainable for the long term. They focus on nutrient-dense, whole foods that support overall health and well-being. These diets are not restrictive, but instead emphasize balance and variety.

Carolee Horner 00:14:54
The Mediterranean and MIND diets are two of the most well-researched dietary patterns, both emphasizing whole, nutrient-dense foods that support brain health and overall well-being. The Mediterranean diet focuses on whole foods like colorful fruits and vegetables, beans, whole grains, nuts, seeds, olive oil, fish, and poultry. It limits foods such as red meat, sweets, fried foods, butter, and processed foods.

The MIND diet combines elements of the Mediterranean and DASH diets, but specifically targets brain health. The MIND diet is very similar to the Mediterranean diet but has a special focus on daily intake of leafy greens and dark berries, as well as a few other minor differences. When discussing the Mediterranean-MIND diet style of eating, it is important not to confuse a style of eating with a certain type of cuisine. Any cuisine can be consumed in a Mediterranean style.

For example, an Asian stir-fry made with chicken or shrimp, a variety of colorful vegetables, and rice is an excellent example of eating Asian cuisine in the Mediterranean style.

Both diets, the MIND and Mediterranean, have been studied extensively for their health benefits. A few key findings include Dr. Laurie Mischley's CAM Care study, which links both diets to slower Parkinson's progression. A 2022 update to Dr. Mischley's research found that the MIND diet offers twice the symptom-reducing power of the Mediterranean diet.

Observational studies show that the Mediterranean diet can delay Parkinson's onset by up to 17 years in women and seven years in men. The MIND diet is linked to slower cognitive decline and a reduced risk of Alzheimer's disease, and both diets are rich in antioxidants like polyphenols from olive oil and flavonoids from berries, which reduce oxidative stress in the brain.

Vegetarian and pescatarian diets focus on plant-based foods while either including fish, which is pescatarian, or excluding animal flesh but allowing animal products, such as honey, dairy, and eggs, which is vegetarian. These diets are high in fiber and antioxidants, which support gut health by promoting microbiota diversity.

While there isn't extensive PD-specific research on these diets, they align with recommendations for slowing disease progression through nutrient-dense eating. They have also demonstrated benefits for reducing chronic disease risks, like cardiovascular disease and obesity.

Therapeutic diets are short-term resets designed to target specific body systems or symptoms. While they can be highly effective when used appropriately, they often require careful planning to ensure nutritional adequacy. Examples include vegan, ketogenic, and paleo diets. While none of these has a wealth of PD-specific research, they all show promise for a variety of reasons, depending on what you are trying to achieve. If you decide to implement a therapeutic diet, please be sure to notify your physicians and clinicians of the change in dietary pattern.

Carolee Horner 00:18:35
A vegan diet excludes all animal products and focuses entirely on plant-based foods like fruits, vegetables, legumes, nuts and seeds, and whole grains.

Research on vegan diets highlights several potential benefits, particularly for reducing inflammation and supporting gut health. Vegan diets are high in fiber and antioxidants, which can help reduce oxidative stress and inflammation, two key factors in Parkinson's progression. A plant-based diet supports a diverse gut microbiome, which may positively influence the gut-brain axis, a critical area of interest in Parkinson's research.

And studies suggest that plant-based eating can lower risks of chronic diseases like cardiovascular disease and diabetes, which are common comorbidities in Parkinson's.

But there are drawbacks. There is a risk of deficiencies such as B12, iron, calcium, and omega-3s without supplementation and careful planning. It also requires some knowledge of food pairings for sufficient protein intake.

The ketogenic diet is a high-fat, moderate-protein, very low-carbohydrate approach designed to induce ketosis, which is a metabolic state where your body uses fat for fuel instead of glucose.

Again, while there's not a lot of PD-specific studies, they do suggest potential benefits for motor symptoms due to improved mitochondrial function and reduced oxidative stress. Evidence from Alzheimer's research shows neuroprotective effects through anti-inflammatory mechanisms and enhanced energy production in the brain. Keto has been used successfully in epilepsy for over a century and shows promise in a lot of other neurological conditions as well. But again, there are some drawbacks.

This diet can cause constipation, high cholesterol levels, or nutrient imbalances if not managed carefully. Low intake of fruits and vegetables may result in reduced fiber and antioxidants.

Consumption of high fat can cause a variety of metabolic changes. You may need to have regular monitoring of kidney and liver function.

The paleo diet focuses on lean meats, fish, fruits, and vegetables while eliminating grains, legumes, dairy, and sometimes nightshades. It is called the caveman diet because it removes all cultivated foods and only focuses on those that were available in ancient hunter-gatherer-type societies.

Research on the paleo diet suggests several potential benefits. It may help reduce inflammation by eliminating processed foods and focusing on whole, nutrient-dense options. The diet can support gut health by removing potential irritants like gluten and dairy. This is particularly interesting given the growing understanding of the gut-brain connection and Parkinson's disease. Rich in antioxidants and omega-3s from fruits, vegetables, and fish, the diet may offer some neuroprotective benefits, though more PD-specific research is needed. Importantly, the paleo diet acts as an elimination diet.

Carolee Horner 00:22:04
By removing common trigger foods and then carefully reintroducing them, it can help identify specific food sensitivities or intolerances.

Therapeutic diets like vegan, keto, and paleo are often misunderstood or misrepresented, especially on social media. It's crucial to understand the true principles of these diets rather than following extreme or misleading versions online. For example, a healthy keto diet focuses on high-quality fats like avocado oil and nuts, not processed bacon and cheddar bombs. Similarly, a vegan diet should emphasize whole plant-based foods rather than relying on soy-based substitutes or processed convenience products.

It's worth noting that these diets can be restrictive and may be difficult to sustain over the long term. They're often intended as short-term resets rather than permanent solutions. Pay attention to how your body responds and be open to adjusting or transitioning to a more sustainable approach if needed. Given the complexity of these diets and individual health needs, considering professional guidance can be beneficial. A nutrition expert can help personalize the approach to your specific situation and ensure you're meeting all of your nutritional requirements.

Despite their differences in structure or purpose, whether everyday or therapeutic, all of these dietary approaches share key principles that contribute to their effectiveness. They emphasize whole foods over processed options. They focus on nutrient-dense choices rich in vitamins, minerals, fiber, and antioxidants.

Vegetables are central components across all of these diets, even keto. Healthy fats like olive oil, nuts, seeds, and avocados are prioritized over unhealthy fats. These shared principles highlight foundational nutrition strategies that promote overall health regardless of specific dietary pattern. If looking for a place to start, start here by beginning to add these foods to your diet.

As you can see, there is no perfect diet for Parkinson's. An individualized approach is really important. You will need to consider things such as medication interactions, your personal symptom profile, personal preferences, lifestyle, available resources, and more.

Now, let's explore how food impacts various body systems in Parkinson's disease. Understanding these connections is crucial for effective symptom management.

Carolee Horner 00:25:08
First, let's talk about digestion and nutrient absorption. Many people with PD face digestive challenges. Constipation affects up to 80% of PD patients, while delayed gastric emptying and small intestinal bacterial overgrowth are also common. These issues can significantly impact nutrient absorption. One key consideration is the protein-levodopa interaction. Protein can compete with levodopa for absorption, potentially affecting medication efficacy. Additionally, micronutrient deficiencies, particularly in vitamins D and B12, are common in PD. Strategies to improve digestion and absorption include timing protein intake, ensuring adequate fiber and hydration, and considering probiotics.

Next, let's discuss inflammation and oxidative stress. Chronic inflammation and oxidative stress play significant roles in PD progression. The good news is that diet can help combat these issues. Foods rich in antioxidants and anti-inflammatory compounds, such as colorful fruits and vegetables, omega-3 fatty acids found in fish, and spices like turmeric and ginger, may help slow disease progression. Conversely, reducing intake of inflammatory foods like processed, fried, or sugary items can also offer benefits.

Let's focus on the critical role of liver health and detoxification processes. It's important to understand that for many people with Parkinson's, environmental toxins play a significant role in the development and progression of the disease. The liver is our primary organ for detoxification, not just for medications, but for all of these environmental toxins as well. Supporting liver health through diet is crucial for several reasons. It helps eliminate toxins from the body, supports cognitive health, aids mitochondrial function, and reduces overall inflammation.

Foods that support liver health include cruciferous vegetables like broccoli and Brussels sprouts, sulfur-containing foods like garlic and onions, and foods rich in antioxidants.

Adequate hydration is also key for supporting the body's natural detoxification processes.

Lastly, let's talk about microbiome health. The gut-brain axis is increasingly recognized as important in PD. Studies have shown alterations in gut microbiome composition in PD patients. Diet significantly impacts our microbiome, and a diverse, plant-rich diet, especially one rich in fermented foods, can promote beneficial bacteria. Probiotics and prebiotics may also play a role, though more research is needed in the context of PD.

As you can see, food impacts multiple body systems relevant to PD, from digestion and nutrient absorption to inflammation, detoxification, and microbiome health. This underscores the importance of a holistic approach to nutrition and managing Parkinson's disease, with a particular emphasis on supporting gut health, liver health, and detoxification pathways.

Carolee Horner 00:28:40
Let's explore some specific nutritional challenges that people with Parkinson's disease often face and discuss strategies to navigate them effectively.

One common issue is changes in taste and smell. Up to 90% of people with PD experience some alteration in these senses, which can significantly impact appetite and nutrition. To enhance flavor, try experimenting with herbs and spices. Basil, oregano, or a squeeze of lemon can add zest to dishes. Not only do they add flavor, but they are powerhouses of nutrition. Use them liberally. Varying textures and temperatures in your meals can also make eating more enjoyable.

Remember, a diminished sense of smell can pose safety risks. Be sure to use dated labels on foods and rely on visual cues for food freshness.

Digestive issues, particularly constipation, may affect many people with PD. To manage this, focus on increasing dietary fiber. Aim for at least 25 to 30 grams of fiber daily. This can easily be achieved from sources like fruits, vegetables, legumes, and whole grains. Staying well hydrated is crucial. Try to drink at least six to eight glasses of water a day.

Probiotic foods or supplements may also support gut health. Be cautious and seek guidance when using supplements, as they are not one-size-fits-all.

For those experiencing dysphagia, or difficulty swallowing, seeking guidance from a speech therapist specializing in PD can be invaluable. They can recommend appropriate food textures and techniques for safe swallowing. In general, softer foods and thickened liquids may be easier to manage. Sitting upright and taking smaller bites can also help.

Fatigue is another common challenge. To maintain energy levels, focus on nutrient-dense foods that provide sustained energy. This might include legumes, lean proteins, and healthy fats. Regular, balanced meals and snacks can help stabilize blood sugar and energy levels. Pay attention to how the timing of your meals interacts with your medication schedule and symptoms. Some people find that smaller, more frequent meals work better for them.

Carolee Horner 00:31:17
It is important to note that some PD symptoms can overlap with nutrition-related issues. For instance, fatigue could be a symptom of PD, or it could be related to poor nutrition or hydration. Muscle stiffness, a common PD symptom, might be exacerbated by dehydration or electrolyte imbalances. Cognitive issues or brain fog could be related to PD progression, but they might also stem from nutritional deficiencies like low levels of B12 or iron.

Keeping a symptom and food diary can help identify patterns and distinguish between PD symptoms and nutrition-related issues.

Remember, these are general strategies, and what works best can vary from person to person. If possible, consider consulting with a nutritionist or dietitian who specializes in neurological conditions or who has experience with PD. They can help you develop personalized solutions to these nutritional challenges. By addressing these issues, you can improve your overall nutrition, which in turn can help manage PD symptoms and enhance your quality of life.

Let's discuss a crucial aspect of managing Parkinson's disease: the interaction between protein in your diet and the effectiveness of levodopa medication. Understanding this relationship can significantly impact symptom control and quality of life.

Levodopa, a primary medication for PD, competes with protein for absorption in the small intestine. This means that consuming protein around the same time as taking levodopa can potentially reduce the medication's effectiveness, leading to inconsistent symptom control. This impacts people along a spectrum, and your impact will vary.

The most common and easiest strategy to manage this interaction is protein spacing. This method involves taking levodopa on an empty stomach and waiting a specific amount of time before consuming protein-rich foods. Typically, it's recommended to take levodopa at least 30 minutes before a meal or 60 minutes after. This approach allows the medication to be absorbed more effectively, potentially leading to better symptom control throughout the day. If you are very constipated, you may need to increase the timing to 60 minutes before and two hours after. Here are a few examples of this method for you to have later so that you can adapt your own schedule.

Another strategy, which some find helpful but can be more challenging to implement, is the protein redistribution diet. This approach involves consuming the majority of your daily protein intake later in the day, typically after 3 p.m. or with your evening meal. The idea is to maximize levodopa effectiveness during daytime hours when you're most active.

Carolee Horner 00:34:34
Studies have shown that the redistribution diet can be effective for over 60% of PD patients experiencing motor fluctuations or unexplained off times. However, it's important to note that this approach can be difficult to maintain long-term due to the significant changes in eating habits that it requires.

Regardless of which method you choose, it is crucial to ensure you're still meeting your overall protein needs. Protein is essential for muscle maintenance, immune function, and overall health. The recommended daily allowance for protein is about 0.8 to one gram per kilogram of body weight, but individual needs do vary.

Remember, the effectiveness of these strategies can vary from person to person. It's often a process of trial and error to find what works best for you. Keep track of your symptoms and how they relate to your medication timing and protein intake. This information can be invaluable in fine-tuning your approach.

Lastly, while these strategies can be helpful, never adjust your medication regimen without first consulting your neurologist.

I'm not going to review this example, but I wanted to provide it here so that you can see how it's calculated and refer back to later.

This is what the protein requirements in that example might look like on the plate throughout the day. Again, I'm not going to review this right now, but it's here for your reference later.

Let's dive into some practical nutrition strategies that can make a real difference in managing Parkinson's disease. Again, we'll focus on whole foods and evidence-based approaches that you can easily incorporate into your daily life.

First, let's talk about eating the rainbow. This isn't just a catchy phrase; it's about the power of phytonutrients. These are natural compounds in plants that give them their vibrant colors, taste, and smell. They're not just pretty to look at; they have potent anti-inflammatory and neuroprotective properties that can be particularly beneficial for people with PD. To eat the rainbow, aim to include a variety of colorful fruits and vegetables in your diet. Not only will you be consuming phytonutrients that are beneficial for PD, but you'll also gain a wide range of other benefits.

Carolee Horner 00:37:05
Foods like tomatoes and watermelon contain lycopene, which may prevent cancer and reduce risk of heart attacks. Orange and yellow foods like carrots and squash are rich in beta-carotene, which is great for the immune system, eyes, and skin. Green leafy vegetables provide phytosterols, important for lowering LDL cholesterol. Blue and purple foods like berries are packed with anthocyanins that promote brain health. And that's just to name a few. By varying your choices, you're giving your body a wide range of these beneficial compounds.

There are some key nutrients that are particularly important for people with Parkinson's. Antioxidants like vitamins C and E can help combat oxidative stress. You can find these in citrus fruits, berries, nuts, and seeds. Omega-3 fatty acids found in fatty fish, flaxseeds, and walnuts have anti-inflammatory properties. B vitamins, especially B12, are crucial for neurological health. Natural sources of B12 include meat, fish, and eggs. Other B vitamins can be found in whole grains, legumes, nuts, seeds, and a variety of vegetables.

For those following a plant-based diet or who have absorption issues, which is common in Parkinson's, a B12 supplement may be necessary.

Vitamin D, which many people with PD are deficient in, can be obtained from sunlight exposure. Minerals like magnesium, zinc, and iron play important roles in brain health and can be found in a variety of whole foods.

Hydration is another crucial aspect of nutrition for Parkinson's. Proper hydration can help with constipation, a common PD symptom, and support overall health. A general rule of thumb is half your body weight in ounces. Regardless of your weight, the average woman doesn't really need more than 100 ounces and the average man really no more than 120.

If you find plain water unappetizing, try infusing it with fruits or herbs. Herbal teas and water-rich foods like cucumbers and watermelon can also contribute to your fluid intake.

Carolee Horner 00:39:23
Let's talk about one of my favorite nutrition rules, the 80/20 rule. This concept suggests aiming for nutritious, whole foods 80% of the time while allowing for more flexibility and fun with the other 20%. This works out to about one treat a day or one day a week where you eat fun or convenient foods. This balance can help you maintain a healthy diet without feeling overly restricted. Remember, stress around eating can sometimes be more harmful than the occasional less-than-ideal food choice.

Change doesn't have to be overwhelming. The key is to start where you are. Everyone's journey with Parkinson's and nutrition is unique, and it's important to meet yourself where you are today. Whether you're already making mindful food choices or just beginning to think about how nutrition can support your health, every step forward matters. Starting where you are means taking stock of your current habits without judgment. Instead of only focusing on what you're not doing, take note of and celebrate the things you're already doing well.

This mindset creates a foundation for positive change.

Small, consistent changes can lead to big, sustainable shifts over time. You don't need to overhaul your entire diet in one day. That rarely works. Instead, focus on one or two small, actionable steps that feel achievable for you. For example, add one extra serving of vegetables to your meals each day. Maybe swap a processed snack for a whole food. If you eat out a lot, try cooking a meal at home. Focus on what to add more than what to remove. If we tell ourselves we can't have something, it ends up being all we want.

Focus on adding nutrient-dense foods. These small changes add up and can create momentum. Over time, they lead to meaningful improvements in your overall health and well-being.

It's important to acknowledge that while research emphasizes eating whole, nutrient-dense foods, this isn't always accessible for everyone. Eating well requires both resources and access, which not everyone has. If you live in a food desert or have a limited income, do the best you can with what's available to you. For example, if fast food truly is your main option, try choosing healthier menu items, like swapping a burger for a baked chicken sandwich, exploring salad options, or choosing water or unsweetened tea instead of a fountain drink.

No matter your circumstances, the most important thing is to do the best you can with what's available.

Carolee Horner 00:42:28
As we wrap up our discussion on nutrition and Parkinson's disease, let's recap the key points we've covered today.

We've explored the crucial connection between nutrition and Parkinson's. What we eat doesn't just fuel our bodies; it impacts our brain health, influences our symptoms, and plays a role in the gut-brain axis, which is increasingly recognized as important in PD.

We've discussed various dietary approaches, emphasizing the power of whole foods. Remember, there's no one-size-fits-all diet for Parkinson's. The key is finding an approach that works for you, considering your unique symptoms, preferences, and lifestyle.

We've addressed specific nutritional challenges common in PD, like changes in taste and smell and digestive issues. We've also highlighted the importance of distinguishing between PD symptoms and nutrition-related issues, which can sometimes overlap.

We've delved into the critical topic of protein and medication management. The protein spacing method can be a valuable tool in optimizing your medication effectiveness. Remember, timing is key.

We've also covered practical nutrition strategies. Eating the rainbow to get a variety of phytonutrients, focusing on key nutrients important for PD, and staying well-hydrated are all crucial aspects of a neuroprotective diet. Throughout our discussion, we've emphasized the importance of a whole foods approach. Minimally processed foods provide a wealth of nutrients that work synergistically in our bodies, offering benefits that go beyond individual vitamins or minerals.

As you leave today, I encourage you to start with small, sustainable changes. Remember, nutrition is a journey, not a destination. Focus on progress, not perfection. Every positive choice you make is a step toward better health. Nutrition is a powerful tool in managing Parkinson's disease. By making informed dietary choices, you're taking an active role in your health. You have the power to influence your well-being through the foods you choose to eat.

I really want to thank you for your time and attention today. Wishing each of you lots of peace, love, and veggies. And for the recording, a few references in case you want to look a little further.

Thank you.

Dr. James Beck 00:45:17
Thank you, Carolee. That was a fantastic presentation, and I think we're going to have a lot of great questions coming in to share with you. Before we jump into those questions, I just want to encourage everyone who's listening to continue to submit your questions using the Q&A icon down below, or if you're on Facebook, share your questions in the comments. My colleagues are organizing questions as they come in and making them available to me. But please remember our topics are very specific to today's subject, so those will be addressed first. If we aren't able to address them, my colleagues at our Helpline and here today on our call will provide some resources for everyone as part of that process.

First, I'd like to really thank you, Carolee, because I think your approach to how to think about nutrition is really important. It is not a destination. It's a journey, because as I think about this, and I try to eat well, as I'm sure most people do, it can be overwhelming. You go into the grocery store, and I see this array of fruits and vegetables, and I'm like, and I just kind of mosey on past it. Maybe I'll pick up some bananas or something like that, right?

I think that encouragement, that mindset, is like, it's these little things. If you can just do something a little bit every time, you're on the pathway. It's being on the pathway, as opposed to reaching there and having that wonderful place where all the food is beautiful and well-prepared and should be in pictures in magazines. Life isn't like that. I thank you for acknowledging that and encouraging our listeners that any little bit makes a difference. As we think about this and going through some of the things that you raised, particularly about the keto diet and how it can lead to constipation, I think your point about really keeping your care team involved as you make decisions on this is really important.

If you do experience constipation with keto or some of the other issues as you try these different types of alternative diets, they're aware and can help support you as part of that process. When we look at the different things you present, I know you had a list of resources, and I couldn't scan through them fast enough, but it'll be on video, and people will be able to hit pause and hopefully read them. Are there cookbooks that can really help move someone forward? Are there online resources to do this? What is really the first step for trying to do this? Is it taking what you have and making a better meal, maybe cutting back on oils or using the right ones? Or is it really kind of like, tomorrow I go to the grocery store and I will try to pick two fruits and two vegetables to add to my meals? What's your approach?

Carolee Horner 00:48:07
I think it's individualized, right? Everything I do is individualized, but I always think the very first step is awareness. How many fruits and vegetables do I even eat a day? It's really surprising the answers I get when I ask that question. So I think just tuning in and even just getting honest with yourself. How many times are you going through the drive-through? How often are you cooking at home? Once you get honest and you draw awareness, there's probably going to be a gap. I always like to fill that gap with something positive. If I say, don't eat ice cream, all you want all day every day is ice cream.

Dr. James Beck 00:48:48
That's right.

Carolee Horner 00:48:49
But if you have an ice cream addiction, which many of our beloved people with Parkinson's really do have an affinity for ice cream, I start with, could you put some berries on that ice cream and make it maybe a little bit more of a sundae with some walnuts and some strawberries and some blueberries? Now we're getting those really good MIND diet foods in a fun way. That's where I like to start with, pardon the pun, the low-hanging fruit of adding some fruits and vegetables. You'd be surprised at how many people are dehydrated.

Just starting with even drinking more water can really change the way that your appetite works, that your digestion works, that your bowel movements work, and then that leads to just wanting to change more. So awareness and then starting where you are by adding something rather than focusing on taking away.

Dr. James Beck 00:49:40
Yeah, fantastic. You have a great emphasis on whole foods, and I think that's really important. But as we talk about, some people are in food deserts, they may be traveling, and there are different experiences that may limit their availability on it. What is the role of supplements? I know there are fruit and vegetable supplements, vitamins, and even maybe energy drinks, power drinks like Ensure, things like that. What's your approach to that? I assume it's a balanced one.

Carolee Horner 00:50:11
Yeah. There's always space for that, right? I use supplements to fill in nutritional gaps. I am very much a food-first type of clinician. Let's add some broccoli and some lettuce and see what happens. But if you can't get those, then supplements can be a really great stopgap. If you're looking for a meal replacement, I would go for more like a clean protein powder than something like Boost or Ensure because they have a lot of additives and a whole bunch of sugar.

Dr. James Beck 00:50:47
What's a clean protein powder? I've heard that expression used before when people talk about food, eat clean and things like that. What is clean? What does that mean when you say clean?

Carolee Horner 00:50:56
Clean means, do you know what the ingredients on the package are? Or are you reading things like dipotassium phosphate and mono- and diglycerides and all these chemicals that you have no idea what they are? That's what's kind of muddying our food up. Clean usually means no additives like dyes or preservatives, that kind of thing. So aiming for the least amount of ingredients and the least processing. We can do that by making sure things have ingredients that we recognize.

Dr. James Beck 00:51:32
So, like that you can even pronounce perhaps. Correct. This is a good way to put it. We may recognize those words you just said, but I have a hard time pronouncing them or even know what they mean.

Carolee Horner 00:51:43
Right. But you couldn't pick it off of a grocery store shelf and tell me what it does. You probably could tell me what cauliflower does, right?

Dr. James Beck 00:51:52
Yeah, for sure.

Carolee Horner 00:51:53
That's the difference. We're looking for words we recognize from the garden versus words that are from a chemistry textbook.

Dr. James Beck 00:52:01
Okay, that's a nice way to think about it. This approach with whole foods, you've already mentioned the emphasis on fruits and vegetables, which sound great. But sometimes, and you brought this up, people maybe have limited resources or even limited availability. What's the role of frozen foods in this process? Are those a good way to achieve these dietary guidelines without breaking the bank? Because I know that frozen sometimes, or frequently, is much less in price than getting those fresh vegetables.

Carolee Horner 00:52:36
Yeah, I think that frozen options are wonderful. Dr. Mischley's research will tell us that fresh is best, frozen not as good, and canned is the worst. But you have to have two options, right? Fresh, like you said, we can't always have. Even if you have resources and access, you don't have space. So frozen is your next best option. Often, those fruits and vegetables are picked right at the height of their freshness and then immediately frozen. We're not accounting for the life force that is taken out of the food when it's frozen, so we don't know exactly what's happening there.

But I tell my clients, you need two options. Fresh and frozen are your options. Please try to stay away from canned as much as you can.

Dr. James Beck 00:53:27
And I presume that's different than home canning.

Carolee Horner 00:53:30
Correct.

Dr. James Beck 00:53:31
Okay. Home canning, I remember my grandmother's stuff was always these very fresh tomatoes and things like that.

Carolee Horner 00:53:37
That is excellent. I am lucky enough I have some of my mom's home canning right on the shelf over there. And yes, we eat that as much as we can.

Dr. James Beck 00:53:47
Fantastic. One of the things you mentioned is trying to get your protein meal later in the afternoon, like after 3, as part of the process. It made me think, is that kind of like intermittent fasting? Is that aligned with that, or is that, and what are your thoughts on it if it's not?

Carolee Horner 00:54:05
It's not exactly because you're still eating. You're just eating carbohydrate- and fat-forward foods rather than protein-rich foods. I find that the protein redistribution diet is very challenging because the example that's there for later reference is a 6-foot, 180-pound, just normal average man, and he needs about 70-ish grams of protein a day. To get 70 grams of protein, which is like a half a pound of chicken or more, and after 3 p.m., can be quite a challenge.

I really push people toward testing out protein spacing. It is something that you should do an experiment on yourself and try different things. Because I've had clients where protein does not impact their medication at all. And I've had a client who we were starting with a quarter of a teaspoon of protein powder because she was so affected by protein and her medication that it shut it completely down. So everybody is unique across a spectrum. Try spacing first, and I would only try the redistribution if there are severe unexpected off times throughout the day. Otherwise, go more for protein spacing so that you can achieve better overall health.

Dr. James Beck 00:55:31
Okay, fantastic. People with Parkinson's unfortunately don't just have Parkinson's. They're living with other diseases as part of it. I think diabetes is part of that. A question came in from Jennifer asking, how can individuals with diabetes or reactive hypoglycemia, and I don't know what that means, balance this low-carb, high-protein diet and Mediterranean diet? How do they make good food choices based upon these other comorbid conditions?

Carolee Horner 00:55:59
Yes. All of these diets are excellent for, as long as we're talking about type 2 diabetes as a comorbidity, then all of these diets are reducing processed carbohydrates and sugars, which is good for diabetes. So the Mediterranean or even MIND diet is an excellent everyday diet, and something like keto could be a really great, or paleo or vegan. All of them. All of these dietary approaches are excellent for type 2 diabetes.

Dr. James Beck 00:56:33
Okay, fantastic. Dairy is a question we hear about, and I know that there is some research which may suggest it could play a role actually in the development of Parkinson's disease, but it seems more based upon pesticides which may have contaminated it versus anything else. What are your thoughts on dairy? It can be constipating, but it can be a good source of protein, and I think it's really the basis of a lot of protein powders, is it not?

Carolee Horner 00:57:00
It is.

Dr. James Beck 00:57:01
Protein. So how do you advise the people you work with about bringing this in? I mean, it's really a source of the fun in ice cream, right? But how do you advise people about how to handle dairy?

Carolee Horner 00:57:14
Again, unfortunately, very individualized. But when we have the conversation about dairy, I start with just a little bit of animal facts, which are humans are the only mammals that drink milk after adolescence. We are also the only mammal that proactively seeks out other mammals' milk to drink after our own. So things like cow's milk, they are wonderful for baby cows, right?

We'll start there and then go with half of the worldwide population is lactose intolerant because of the fact that we lose our ability to produce lactase because we don't usually need it after adolescence. So you have a one-in-two chance of being lactose intolerant and potentially not knowing it. My favorite is when people tell me, I was lactose intolerant when I was a kid and I grew out of it. You didn't grow out of it. You adapted to it. The research will say people who are consuming a lot of dairy are having worse outcomes.

But like you mentioned, especially in food deserts and places like that, it can be a cheap, easy source of protein. So here's what you do. If you want to know if dairy is impacting you, do an experiment. We call it a food elimination challenge experiment. Google this if you need a little more information, but for two to three weeks, get rid of all dairy products in your diet. Then choose one day where you eat dairy at every meal and snack, and then quit again for a few days. Across all of this time, what you're looking for are changes in how you feel.

If you give up dairy and all of a sudden your skin is glowing, you're pooping like a champ, and you have a lot of energy, maybe dairy's not so good. Conversely, if you add the dairy back in and symptoms pop up, you get big dark circles under your eyes, you have a lot of phlegm in your chest, your bowels will not move, this is your indication that dairy is a problem for you. If you have no problems, add it back in. But if you experience things, then you have to make that decision on your own about whether that's worth it or not.

Dr. James Beck 00:59:39
Fantastic. Thank you very much. I think that's running us out of time. This was our last question and a nice way to end it. Food is so individualized, and I appreciate your encouraging people to really experiment with what's available for them as part of that process. Thank you for your time today on our expert briefing on nutrition and Parkinson's, and a big thank you to everyone who joined us today. We had lots of questions come in as part of this process, but unfortunately we're not able to get to all of them. So please, if your question was not answered, call our Helpline at 1-800-4PD-INFO. Here is an outline coming up next of what's coming up for our expert briefings.

Our next session will be hosted on April 9, and we'll be exploring the latest advances in Parkinson's research and treatment. You can learn more about our future topics and register at the webpage listed here on the screen as part of that process.

In addition to today's expert briefing, the Parkinson's Foundation also offers a range of virtual education and wellness programs. We call them the PD Health @ Home series, and they occur each week. You can learn more and register for PD Health @ Home by taking your cell phone, if you've got it, and scanning the QR code, or you can visit our webpage, which is also listed there for PD Health @ Home. In the meantime, please do not hesitate to reach out to us. We have a comprehensive website and many more resources that address everything related to PD at Parkinson.org, or call our Helpline. Again, 1-800-4PD-INFO, or if you prefer, you can email us at Helpline@Parkinson.org.

As we come to the end of our webinar, your screen will go blank, but something will pop up, and that's a survey. As I mentioned at the top of our discussion, we really base everything we do upon feedback from the community. Take the moment, if you wouldn't mind, and give us some feedback on what you thought of our webinar. Tell us how you thought of our speaker. They appreciate that feedback too, because everyone's always trying to improve what they can do and bring to the PD community. So we always appreciate that.

Until then, take care, and we'll see you on our next expert briefing. Thank you.