Q&A: Diet and Parkinson's
Maryanne Harrison is a dietitian who specialises in
neurological conditions. She joined our
discussion forum in January 2011 for a questions and answers
(Q&A) session covering all aspects of diet and Parkinson's.
Transcript of the session
Maryanne Harrison: Hello, I'm Maryanne
I have worked for many years as a dietitian and am currently a
specialist neurological dietitian for the Hertfordshire
I have a particular interest in Parkinson's and have been working towards
establishing best practice for working with people with the
I am a member of the Parkinson's UK Professionals' Network. I also work with a
large case load of Parkinson's patients as a part of a
multi-disciplinary team. I hope that I can use my experience to
answer your questions.
Questions and answers
Question via Facebook: I've heard vegetarian/vegan
diets can help symptoms... any evidence to support
Maryanne Harrison: It is important to use the eatwell
plate as the basis for optimum nutrition. Vegetarian diets can
provide optimum nutrition which in my clinical opinion is vital for
long-term conditions such as Parkinson's.
The timing of meals and enough carbohydrate can also be very
helpful, but there is no concrete evidence that a vegetarian/vegan
diet will help alleviate Parkinson's
John Rothwell via our website: Why do I go off after food. Is it
better to take Madopar before food or after?
Maryanne Harrison: Have you established which foods?
The consensus from the Neuroscience Dietitians' Interest Group
is that carbohydrate should be taken with all levodopa medications as this increases
absorption and prevents nausea associated with levodopa. For the
best effect Parkinson's medications
should be taken 3/4 hour before meals, not with main meals.
Joyce Baines-Holgate via the website: Is it better to take
ropinirole with food and does protein interfere with its
Maryanne Harrison: The advice for dopamine agonists is the same as for levodopa
medications. Please see the previous answer.
Question via Facebook: When I started taking rasagiline (5
months ago), I was very concerned about the warnings about
tyramine. I started by avoiding cheeses and sundry other foodstuffs
that I knew were likely to contain it, but have since been
reassured that the note about tyramine should be regarded as a
'caution' (more relevant to older drugs in the same class), and
that I should be OK with these foods.
I don't seem to be encountering any problems at present.
I understand that tyramine is a dopamine-releasing agent but that
it cannot cross the blood-brain barrier. Does tyramine have any
role in a Parkinson's-related diet?
Maryanne Harrison: I would agree with the person who has
reassured you about tyramine. If you follow the eatwell
plate model and have carbohydrate in liquid or solid form with
your medications, for example fruit juice, fruit smoothie or squash
containing sugar, or toast and jam or marmalade or fruit loaf or
Avoiding tyramine containing foods would mean avoiding certain
foods which could cause deficiencies.
Question via Facebook: I have been wondering whether common
stimulants like coffee are likely to have any effects, good or ill,
and also whether alcohol is best avoided.
Maryanne Harrison: There is some evidence that coffee plays a
protective role in Parkinson's but it is minor and the evidence is
not concrete. Speak to your consultant/ GP or clinical nurse
specialist if you have any concerns about alcohol and its
interaction with any of your medications.
My advice on alcohol is that, provided none of the medications
you are taking state no alcohol, 'a little bit of what you fancy
will do you no harm'.
Philippa via our website: My father has had Parkinson's for 20
years now (since he was 45) and requires constant care. One of the
side effects of his medication is that he suffers from
hallucinations (day and night) and I was wondering whether there
has been any research as to whether eating certain foods could
intensify/reduce these symptoms.
Maryanne Harrison: Unfortunately there is no evidence that food
has any beneficial or adverse effect on the your father's symptoms.
It is widely recognised that hallucinations are a common side
effect of Parkinson's medication.
English country dancer via our website: I notice that the diet
recommend by Parkinson's UK follows the recommendations for the
general public in that it recommends a large percentage of the diet
comprise of grains and/or potatoes and says aim for 5 fruit and
vegetables a day, rather than aim for at least 5 fruit and
vegetables a day. Would it not be better if carbohydrate was
obtained from vegetables and fruit?
Surely, any calorie and fibre deficiency could made up
from starchy vegetables. As vegetables and fruit contain
antioxidants as well as higher levels of vitamins and minerals,
surely it would be better and preferable to encourage the use of
more vegetables and fruit in the diet. Vegetables make lovely thick
soups and would be easier to swallow than bread, pasta or
What is so good about grains apart from providing energy
and fibre? Prunes, figs and other fruit would help to alleviate
constipation. Apart from cost I can see no reason for these
recommendations. Please could you explain.
Maryanne Harrison: The eatwell
plate forms the basis of good nutrition for the whole
population. You are right: The 5 a day message from fruit and
vegetables is a minimum but many people in this country do not
achieve it. This group provides vitamins A, C, E and folic acid,
fibre and some carbohydrate.
The bread, rice, potatoes and pasta group is important too as it
provides us with our main source of energy. It also provides fibre,
some calcium, iron and B vitamins. Wholegrains and seeds provide us
with B vitamins.
There is no harm in increasing your intake of starchy
vegetables, however they shouldn't cut out carbohydrate-rich foods
such as pasta, bread, rice, etc completely.
For people who suffer from swallowing difficulties should be
formally assessed by a speech and language
therapist. A texture modified diet may be required.
Kathleen via our website: Any advice on constipation? I don't wish to continue taking
Maryanne Harrison: The 3 main things that need to be considered
when trying to avoid or manage constipation are adequate fluid,
enough and the right type of dietary fibre, and physical
It helps if the bread and cereals eaten are wholegrain. It also
helps to eat peas, beans and lentils daily and up to 8 to 10 fruit
and or vegetables a day. But if these measures are not adequate the
most effective and easy ways to help are linseeds or flaxseeds (the
same thing) and prune juice.
I advise starting with one or the other at breakfast, eg 1
tablespoon of linseeds/flaxseeds on breakfast cereal or cooked in
porridge, or 100-200ml prune juice. Both of these can be taken in
more frequent and increasing amounts if necessary at each meal
until the constipation has resolved. Having found what works for
you, you will usually need to continue permanently. The
linseeds/flaxseeds can be put into yoghurt, custard, soups or
stirred into meals.
Parkinson's patients can suffer from a neurogenic bowel and may
require the use of laxatives along with diet to prevent or manage
It is advisable to speak with your GP/consultant or clinical
nurse specialist before you stop taking your laxatives.
Question via Facebook: Hi Maryanne, which vitamins,
antioxidants, supplements or foods would you advise for me/
Parkinson's sufferers? The problem being that they might interfere
with absorbtion of certain meds.
Maryanne Harrison: Dietitians do not routinely advise the use of
vitamins, antioxidants or supplements.
If you are able to follow the principles outlined in the
plate model, you should be able to meet your requirements for
all vitamins and minerals. However, if you are struggling to eat
full meals, are housebound, or have a poor appetite it may be
beneficial to have a well rounded vitamin and mineral
Wilco via the forum: I have read somewhere that certain enzymes can
help prevent the production of saliva,
hence calm the nasty side effect of Parkinson's disease: drooling.
Pineapple juice, cranberry juice... can you give us any
Last year in France I was eating a meal of entrecote
seignon when a piece too big to swallow sort of sat there in my
oesophagus neither moving up nor down. I rushed from the terrace,
leaned over the chateau wall and attempted to spit out the
offending morsel. You know what, I had a piece of sticky,
gummy drool hanging 12" beneath me before it would break away -
why? Where does it arise from, the oesophagus or the lungs, and
perhaps more importantly, how may I control it?
By the way, I suffered a bad bout of acid reflux about 5
years ago, a year before my Parkinson's diagnosis, which the
consultant informed me, had I neglected treatment for another month
might well have resulted in Barrett's Syndrome. All help gratefully
Maryanne Harrison: There is anecdotal evidence that pineapple
juice can help reduce the viscosity of saliva and that milk and
dairy products can sometimes increase the stickiness of it but
neither of these has a robust evidence base. It is obviously
important that you are well hydrated.
Also, there are medications that your doctor can prescribe that
can help. It would be helpful to discuss this problem with your
consultant/clinical nurse specialist or GP for more advice.
About Maryanne Harrison
Maryanne Harrison is a specialist neurological dietitian working
for the Hertfordshire Neurological Service. She has been
instrumental in setting up a neurological specialist dietitians'
group with other neurological dietitians working at The National
Hospital for Neurology and Neurosurgery, Northwick Park, the Royal
Free and other London hospitals.
The specialist group has been working on agreeing on best
practice for Parkinson's. As the recently-elected chair, she is
working towards having it recognised as a specialist group of the
She is a reviewer for Practice-Based Evidence in Nutrition (PEN)
which is a global resource for nutrition practice.
Maryanne is a member of our Professionals'
Network and presents on nutrition and Parkinson's nationally to
doctors, dietitians and nurses. She works with a large case
load of Parkinson's patients as a part of a multi-disciplinary
More on diet and Parkinson's
- You can leave feedback on this event or make
suggestions for future events by taking our short survey
For more information on the Q&A sessions