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Ask the MD

Ask the MD: How a Dietitian Can Help with Parkinson’s

Doctor and Patients.

People with Parkinson’s often wonder what the best diet is for their disease. What you eat can improve well-being, energize you for activities such as exercise, and bring you together with others. For people with PD, it also may ease symptoms and increase medication effect. A registered dietitian can help you design a personalized eating plan that optimizes your health and quality of life by fitting your food preferences, schedule and medical needs. Christine Ferguson, MS, RD, LD, a doctoral student in human nutrition at the University of Alabama, tells us more.

Read more on this topic in MJFF’s Parkinson’s disease and diet guide (written with Christine).

The Michael J. Fox Foundation for Parkinson’s Research (MJFF): What is a registered dietitian?
Christine Ferguson (CF):
A registered dietitian, or a dietitian, is a food and nutrition expert. In general, we provide individualized nutrition recommendations based on a person’s lifestyle and medical conditions, as well as education about diets and the latest research.

One important note is that nutritionists are not the same as registered dietitians. A nutritionist does not have intensive educational training or state licensure; a registered dietitian has a bachelor’s degree, does an internship, sits for a national exam and has a state license. 

MJFF: How can a dietitian help in Parkinson’s?
A dietitian can help you debunk nutrition misinformation, take stress out of meal planning and eat to manage symptoms. There’s a lot of incorrect information out there about the best diet, the latest research, and what to eat when. A dietitian can help you understand what’s based in science and what’s appropriate for you. We also can help simplify the process of eating (planning meals and snacks, and separating medications and food, if necessary) with an individualized meal plan. And some symptoms, such as constipation, which is common in PD, can be managed with nutrition interventions.

Dietitians take into account lifestyles, food costs, preferences, and the social aspects of cooking and eating with others to design personalized plans.

MJFF: Why might someone with Parkinson’s want to see a dietitian?
You may want to talk with a dietitian if you experience:

  • Unintentional weight loss (losing weight when you aren’t trying to).
    Unintentional weight loss can lead to malnutrition. So after seeing your doctor, you’d want to work with a dietitian on ways to increase weight and nutrition.
  • Inability to eat well for any reason.

In Parkinson’s, this can happen because of poor appetite or constipation, for example. Dietitians take a “food first” (rather than medication) approach to target symptoms.

  • Trouble with timing medications and meals.
    Levodopa, the most commonly prescribed PD medication, and high-protein meals compete for absorption in the small intestine. For some people, this can make medication less effective and separating from protein-heavy meals (30 min before or two hours after eating) may help. Some people try a protein redistribution diet, eating the majority of their protein in the evening so that medication can be most effective during the day. Because this diet is strict and you need certain amounts of protein for muscle mass, nutrition and exercise, you should follow it under the recommendation and supervision of a dietitian.
  • Nutritional deficiencies or medical conditions.

If your yearly blood work shows, for example, high cholesterol or low vitamin B12 or vitamin D (all of which are common with aging and with Parkinson’s), you may want to talk to a dietitian about dietary adjustments that may help. Or, you may live with diabetes, high blood pressure or other medical conditions that can be at least partially managed with eating adjustments.

It’s also good to talk with a dietitian if you are considering a specific diet. Many people think about or follow specific regimens, such as the Mediterranean or MIND diets (these diets have the best evidence for overall well-being and for Parkinson’s) and many wonder about others, such as the ketogenic diet or intermittent fasting. A dietitian can evaluate whether a diet is appropriate for you and help you follow it correctly. (Read more about specific diets in our diet guide.)

MJFF: Should everyone with Parkinson’s see a dietitian?
CF: If it’s covered by your insurance and a dietitian is available in your area, then why not? There is no harm that can come from it. No matter if you are early on or have had disease for a while, there is so much you can learn: how to read nutrition labels, navigate nutrition information online and understand the latest research. The last point is particularly important. Dietitians can help you understand what diet research means for you and if and how to incorporate it in your life. Often diet studies are done in small groups of people for short periods of time. It can be hard to know how to interpret and apply the results to your life.

Whether a dietitian visit is covered by insurance, the number of visits covered and the amount, if any, of your co-pay depends on your insurance plan. Call the number on the back of your insurance card to learn more about your coverage.

MJFF: How do you find a dietitian?
You can search online to find a dietitian in your area at (The Academy of Nutrition and Dietetics, our national organization, maintains this database.) Or, you can ask your doctor for a referral. You also can reach out to your local or state PD organization or to other people or support groups in the Parkinson’s community, who may be able to recommend someone.

MJFF: What do you look for in a dietitian?
Aside from someone who is positive and whose personality meshes with yours, you want someone who works with your age group. (Some dietitians specialize in pediatrics or adolescents, for example.) Ask if they are familiar with Parkinson’s or other neurological conditions. But even if a dietitian doesn’t have a lot of experience in PD, don’t necessarily count them out. We’re all taught how to read research and stay up to date. And we know how to treat symptoms that are common in Parkinson’s, such as constipation, and how to discuss, recommend and implement specific diets. If someone is willing to work with you and learn from you, you way want to give them a try.

MJFF: How do you work best with a dietitian?

  • Be as open and honest as possible. Don’t worry about feeling judged for your food choices.
  • Before your first visit, reflect on what you eat, where you eat and what influences your choices. Some people eat differently on the weekends than during the week, for example, and others eat out a lot. The more information you can give, the more quality recommendations you will get.
  • Bring all your medications, supplements, oils, pills, powders and anything else you take in their bottles or packages so the dietitian can see exactly what you’re taking.
  • Track your symptoms (the most bothersome, such as constipation; “off” time, when symptoms return between medication doses; or nausea), foods and medications to see if there is a pattern or correlation. You can keep a journal or notes on your phone for a few days or weeks.
  • Set goals. A dietitian can help you determine, monitor and meet goals, one step at a time. Together, you’ll outline how to meet your goals and follow the plan.
  • Make small, gradual changes. You can’t change everything you eat overnight; that’s not sustainable. If your diet consists mainly of fast food and you want to switch to the Mediterranean diet, for example, you might start by adding one new food group, such as vegetables, at a time. Do that for a week and then add another.

MJFF: What tips do you have for people with Parkinson’s?

CF: Don’t stress about food. A lot of people get overwhelmed by what to eat for their disease. Don’t let your diet limit your life, activities or social interactions. (The social aspect of eating is one of the most important parts!) Give yourself grace and flexibility when it comes to eating. Try to find enjoyment, too. Me, I follow the 80/20 rule: I eat healthy at least 80 percent of the time. But I still enjoy food, like pizza, some of the time, but I pair it with something healthy, like a salad. If diet is too restrictive, it can affect your quality of life.

Find a dietitian, look at educational resources such as MJFF’s Parkinson’s disease and diet guide, and build your support system a spouse, child, sibling or support group who can make it more fun and show you that you aren’t alone in your dietary journey.

For more on diet and Parkinson’s, watch a webinar on the topic.
