Diet, Supplements, and Parkinson’s Disease

A cross-sectional analysis

By Joshua Z. Goldenberg, ND

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Reference

Mischley LK, Lau RC, Bennett RD. Role of diet and nutritional supplements in Parkinson’s disease progression. Oxid Med Cell Longev. 2017;2017:6405278.

Design

This study was a cross-sectional analysis of an online platform created by the author (Laurie Mischley, ND, PhD). The platform enrolls Parkinson’s patients in a longitudinal research study. The patients self-report their Parkinson’s symptoms, diet diary, and supplement intake.

Participants

The study population included 1,053 people with idiopathic Parkinson’s disease; 93% of the participants were Caucasian, with an average of 5.2 years since diagnosis.

Study Parameters Assessed

Parkinson’s symptoms, progression severity, diet (by recall), and supplement intake; symptoms were assessed using the patient-reported outcomes in Parkinson’s disease (PRO-PD) scale, an outcome tool created by the author.

Primary Outcome Measures

The analysis compared each patient’s rate of disease progression to their diet and supplement intake to search for any statistically significant associations.

Key Findings

The results below show which foods and supplements were significantly (P<0.05) associated with a slowed progression or a more rapid progression of Parkinsonian symptoms.

DELAYED PROGRESSION MORE RAPID PROGRESSION
Fresh fruits and vegetables Canned fruits and vegetables
Nuts and seeds Diet and non-diet soda
Non-fried fish Fried foods
Olive oil Beef
Wine Ice Cream
Coconut oil Yogurt
Fresh herbs and spices Cheese
CoQ10 Iron
Fish Oil  

Practice implications

Parkinson’s disease is an extremely debilitating condition and is poorly understood.1 Conventional options are limited, and studies suggest that many Parkinson’s patients turn towards diet, natural medicine, and supplements to slow disease progression.2 However, little is known about their efficacy. The present study is an effort to shed light on the effects of diet and supplement use on Parkinson’s disease progression.

Many of the findings of this study are not too surprising. Most of the dietary items associated with delayed progression are elements of a Mediterranean-style diet. This style of eating is anti-inflammatory and has been shown to be associated with fewer cases and later onset of Parkinson’s disease.3 Fish oil has been shown repeatedly to be neuroprotective4 and indeed this study found an association between fish intake and a delayed progression of Parkinsonian symptoms.

Most of the dietary items associated with delayed progression are elements of a Mediterranean-style diet.

The association of consumption of canned foods with a more rapid progression of Parkinson’s disease is intriguing. Because this association persisted after adjustment for income it is less likely to be related to diminished access to health care (which often accompanies low income status). Could there be something in the cans themselves? The authors postulate that bisphenol A (BPA) or aluminum, a known neurotoxin,5 might be contributory.

The association of soda consumption with more rapid progression of disease may be due to specific neurotoxicants, such as aspartame.6 The association with fried foods may be related to lipid peroxidation. The association of ice cream, yogurt, and cheese with rapid progression is consistent with prior research; a meta-analysis of dairy intake and Parkinson’s disease showed an association of dairy intake with Parkinson’s in a dose-dependent manner.7 Both iron supplements and beef, which has a high iron load, were associated with rapid progression in this study, consistent with the suggestion that iron drives symptom progression due to its oxidative nature.8

While coenzyme Q10 (CoQ10) showed early promise in Parkinson’s disease, more recent randomized controlled trials failed to show benefit.9 It is interesting that the association between delayed progression and CoQ10 in this study was no longer statistically significant after adjustment for income. The author postulates that CoQ10, an expensive supplement, might be a surrogate for high income status which itself was associated with a delayed progression, possibly due to better access to health care.

This study has some excellent strengths. The researchers adjusted all results for age, gender, years since diagnosis, and income level, and the results give us some initial clues regarding the effect of diet and supplements on Parkinson’s disease. Of course, there are limitations to this study as well. As a cross-sectional analysis, conclusions from the study design are limited. This study is a longitudinal one and this publication is preliminary and not meant to be exhaustive. Also, the researchers did not correct the P-values for multiple comparisons so it is possible that some statistically significant associations may be spurious.

In summary, this study presents some interesting preliminary findings regarding diet and supplements for Parkinson’s disease. It is an important first step that will be followed up with further work by the study authors and other researchers.

About the Author

Joshua Z Goldenberg, ND is a researcher, teacher, registered naturopathic doctor, and founder of Dr. Journal Club, LLC. He is most passionate about the interplay of evidence and clinical practice.

Goldenberg is an active researcher with numerous publications in high impact scientific journals such as JAMA, Annals of Internal Medicine and The Cochrane Library. His research focus includes irritable bowel syndrome, probiotics, evidence-informed practice, and research methodology. He is currently Research Investigator at the Bastyr University Research Institute and Visiting Research Scholar at the University of Technology Sydney. He has presented nationally and internationally on evidence-based medicine as well as probiotics and research methodology. His probiotics work has been highlighted by the BBC, The New York Times, The Seattle Times, Prevention Magazine, and Fox News.

Goldenberg is a passionate educator and currently is faculty for the Academy of Integrative Health and Medicine’s Interprofessional Fellowship in Integrative Health and Medicine, where he teaches critical evaluation of the literature and evidence-informed practice. He is past adjunct faculty at Bastyr University, his alma mater, in which he enrolled after receiving honors and distinction in molecular biology from the University of Pennsylvania. He also guest lectures widely.

To watch a free video review of this research article check out www.DrJournalClub.com/NMJ/.

References

  1. Kalia LV, Lang AE. Parkinson’s disease. Lancet. 2015;386(9996):896-912.
  2. Ren S, Cooper K, Cooper JA, Smith HT, Shaikh S. A systematic review and network meta-analysis of pharmacological therapies used for patients with advanced Parkinson’s disease. Value Heal. 2014;17(7):A390.
  3. Alcalay RN, Gu Y, Mejia-Santana H, Cote L, Marder KS, Scarmeas N. The association between Mediterranean diet adherence and Parkinson’s disease. Mov Disord. 2012;27(6):771-774.
  4. da Silva TM, Munhoz RP, Alvarez C, et al. Depression in Parkinson’s disease: a double-blind, randomized, placebo-controlled pilot study of omega-3 fatty-acid supplementation. J Affect Disord. 2008;111(2-3):351-359.
  5. Campdelacreu J. Parkinson disease and Alzheimer disease: environmental risk factors. Neurología. 2014;29(9):541-549.
  6. Rycerz K, Jaworska-Adamu JE. Effects of aspartame metabolites on astrocytes and neurons. Folia Neuropathol. 2013;51(1):10-17.
  7. Jiang W, Ju C, Jiang H, Zhang D. Dairy foods intake and risk of Parkinson’s disease: a dose-response meta-analysis of prospective cohort studies. Eur J Epidemiol. 2014;29(9):613-619.
  8. Medeiros MS, Schumacher-Schuh A, Cardoso AM, et al. Iron and oxidative stress in Parkinson’s disease: an observational study of injury biomarkers. PLoS ONE. 2016;11(1):e0146129.
  9. Parkinson Study Group QE3 Investigators, Beal MF, Oakes D, et al. A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol. 2014;71(5):543-552.