Protein diet - Parkinson's
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To provide a diet with a carbohydrate to protein ratio ≥5.
Characteristics
Protein is restricted and redistributed from breakfast and lunch to the evening meal. The diet also avoids foods that are natural sources of L-dopa, such as broad beans, and emphasises dietary fibre and fluid to reduce the common side-effect of constipation.
Indications
Parkinson’s disease.
Nutritional adequacy
This is a highly restrictive diet, and is not nutritionally complete. Patients will need a multivitamin and a calcium supplement.
Precautions
Must only be used when ordered by a physician and under the supervision of a dietitian.
Continuous levodopa replacement is the most efficacious treatment for patients with Parkinson’s disease. However, the neutral aromatic amino acids contained in dietary proteins may compete with this drug for intestinal absorption and transport across the blood-brain barrier, thus limiting its efficacy and leading to motor fluctuations. Current guidelines recommend low-protein dietary regimens with protein redistribution; shifting protein intake to the evening ameliorates the response to levodopa. However, adherence to this dietary regimen is difficult and response is variable. If no benefits are seen after one to two weeks, the diet should be discontinued.
Suggested meal outline.
| Meal | Protein (g) | Carbohydrate (g) | Suggested menu |
|---|---|---|---|
| Breakfast | 10 | 50 | Juice + cereal / cream + toast / margarine / jam + tea / coffee / sugar |
| Morning tea | 1 | 30 | Fruit + soft drink |
| Lunch | 10 | 50 | Vegetable soup + salad + bread / margarine + fruit |
| Afternoon tea | 2 | 30 | Biscuits + tea / coffee / sugar |
| Dinner | 33 | 120 | 60g meat / vegetables + dessert + soft drink / juice |
| Supper | 4 | 30 | Biscuits + fruit + milk |
| Total | 60 | 300 |
Paediatrics
Not suitable for use in paediatrics.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | Small serves of meat, poultry, fish or egg-based dishes (maximum 60g meat) at evening meal only | Any before dinner |
| Sauces, gravies | All | - |
| Starchy vegetables / pasta / rice | All | - |
| Vegetables | All others | Broad beans |
| Soups | Vegetable soups | Meat-based soups |
| Sandwiches | Salad sandwiches only | Cheese, meat, fish, egg, baked beans, peanut butter |
| Salads, dressings | Green salad, potato salad, rice salad, pasta salad All dressings | Cheese, meat, fish, egg, baked beans, peanut butter |
| Breads, cereals | All bread Breakfast cereals served with cream | - |
| Spreads | All others | Peanut butter |
| Hot breakfast choices | None | - |
| Fruit | All fruit | - |
| Yoghurt | - | All yoghurt |
| Desserts | Cakes, puddings, jelly Bread and butter pudding, creamy rice | Plain custard Ice-cream |
| Milk and cheese | Full-cream and skim milk (maximum 200mL per day) | High-protein milk (eg Shape™) Cheese |
| Beverages | Tea, coffee, fruit juice, soft drink, cordial | Milk, Milo® |
| Biscuits | All (low-protein biscuits preferred) | - |
| Miscellaneous | Low-protein dishes (e.g. pasta) Low-protein biscuits Cream, sugar, hard lollies | Nuts |
References
- Cereda E, Barichella M, Pezzoli G. Controlled-protein dietary regimens for Parkinson’s disease. Nutr Neurosci 2010;13:29-32.
- Mahon LK, Escott-Stump S. Krause’s food and nutrition therapy. 12th ed. St Louis: Saunders Elsevier; 2008.
- Thomas B, Bishop J, British Dietetic Association. The manual of dietetic practice. 4th ed. Oxford: Blackwell; 2007.
- Barichella M, Marczewska A, De Notaris R, Vairo A, Blado C, Mauri, A et al. Special low-protein foods ameliorate postprandial off in patients with advanced Parkinson’s disease. Mov Disord 2006;21:1682-7.
- Cushing ML, Traviss KA, Calne SM. Parkinson’s disease: implications for nutritional care. Can J Diet Prac Res 2002;63:81-7.
- Saint-Hilaire MH. Protein diet in the management of Parkinson’s disease. Loss, Grief & Care 2000;8:115-21.
- Kempster PA, Wahlqvist ML. Dietary factors in the management of Parkinson’s disease. Nutr Rev 1994;52:51-8.
- Karstead PJ, Pincus JH. Protein redistribution diet remains effective in patients with fluctuating parkinsonism. Arch Neurol 1992;49:149-51.
- Berry EM, Growdon JH, Wurtman JJ, Caballero B, Wurtman RJ: A balanced carbohydrate: protein diet in the management of Parkinson’s disease. Neurol 1991;41:1295-7.