Fact sheetDiet specifications

Published on 1 Nov 2011


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 dishesSmall serves of meat, poultry, fish or egg-based dishes (maximum 60g meat) at evening meal onlyAny before dinner
Sauces, graviesAll -
Starchy vegetables / pasta / rice

All

-
VegetablesAll othersBroad beans
SoupsVegetable soupsMeat-based soups
SandwichesSalad sandwiches onlyCheese, 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

-
SpreadsAll othersPeanut butter
Hot breakfast choicesNone -
FruitAll 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

BeveragesTea, coffee, fruit juice, soft drink, cordialMilk, Milo®
BiscuitsAll (low-protein biscuits preferred) -
Miscellaneous

Low-protein dishes (e.g. pasta)

Low-protein biscuits

Cream, sugar, hard lollies

Nuts

References

  1. Cereda E, Barichella M, Pezzoli G. Controlled-protein dietary regimens for Parkinson’s disease. Nutr Neurosci 2010;13:29-32.
  2. Mahon LK, Escott-Stump S. Krause’s food and nutrition therapy. 12th ed. St Louis: Saunders Elsevier; 2008.
  3. Thomas B, Bishop J, British Dietetic Association. The manual of dietetic practice. 4th ed. Oxford: Blackwell; 2007.
  4. 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.
  5. Cushing ML, Traviss KA, Calne SM. Parkinson’s disease: implications for nutritional care. Can J Diet Prac Res 2002;63:81-7.
  6. Saint-Hilaire MH. Protein diet in the management of Parkinson’s disease. Loss, Grief & Care 2000;8:115-21.
  7. Kempster PA, Wahlqvist ML. Dietary factors in the management of Parkinson’s disease. Nutr Rev 1994;52:51-8.
  8. Karstead PJ, Pincus JH. Protein redistribution diet remains effective in patients with fluctuating parkinsonism. Arch Neurol 1992;49:149-51.
  9. 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.
Back to top