A comprehensive examination of the evidence for whole of diet patterns in Parkinson's disease: a scoping review

ABSTRACT

Both motor and non-motor symptoms of Parkinson’s disease (PD), a progressive neurological condition, have broad-ranging impacts on nutritional intake and dietary behaviour. Historically studies focused on individual dietary components, but evidence demonstrating ameliorative outcomes with whole-of-diet patterns such as Mediterranean and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) is emerging. These diets provide plenty of antioxidant rich fruits, vegetables, nuts, wholegrains and healthy fats. Paradoxically, the ketogenic diet, high fat and very low carbohydrate, is also proving to be beneficial. Within the PD community, it is well advertised that nutritional intake is associated with disease progression and symptom severity but understandably, the messaging is inconsistent. With projected prevalence estimated to rise to 1.6 million by 2037, more data regarding the impact of whole-of-diet patterns is needed to develop diet-behaviour change programmes and provide clear advice for PD management. Objectives and Methods: Objectives of this scoping review of both peer-reviewed academic and grey literatures are to determine the current evidence-based consensus for best dietary practice in PD and to ascertain whether the grey literature aligns. Results and Discussion: The consensus from the academic literature was that a MeDi/MIND whole of diet pattern (fresh fruit, vegetables, wholegrains, omega-3 fish and olive oil) is the best practice for improving PD outcomes. Support for the KD is emerging, but further research is needed to determine long-term effects. Encouragingly, the grey literature mostly aligned but nutrition advice was rarely forefront. The importance of nutrition needs greater emphasis in the grey literature, with positive messaging on dietary approaches for management of day-to-day symptoms.

KEYWORDS:

• Parkinson’s disease
• vegetables
• fruits
• diet
• ketogenic
• grey literature
• disease progression
• symptom severity

Data availability statement

Authors agree to make data and materials supporting the results or analyses presented in their paper available upon reasonable request.

Acknowledgements

The authors would like to thank Vanessa Sutton for her assistance with the initial searches of the academic literature and her preliminary compilation of the grey literature.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by MSWA.

Notes on contributors

Joanna Rees

Dr Joanna Rees is a post-doctoral research academic and an Accredited Practicing Dietitian. She has 7 years' experience in gut health research where her studies have involved the impacts of a community-based food literacy cooking program on the gut microbiome and mental health. She has experience in dietary fibres, specifically from fruit and vegetables her recent work involves developing resources for improving fruit and vegetable/dietary fibre intakes and diet quality for the neurological community.

Jillian Ryan

Dr Jillian Ryan is a post-doctoral research consultant currently working for BVA BDRC and is involved in human-centred research focusing on qualitative and quantitative research methodologies. Her areas of research include behavioural change and developing digital products to address key health challenges. She is a champion of the end user's voice.

Manja Laws

Ms Manja Laws is currently the project coordinator for the Systematic Profiling in Neurological Conditions (SPIN) Research Program which aims to develop and implement treatment strategies that target specific health problems for individuals living with a neurological condition. SPIN prioritises engagement with those with lived experience of neurological conditions, and their relevant others, to direct the research program.

Amanda Devine

Amanda Devine has 25 years' experience in research at UWA and ECU. As a Professor of Public Health Nutrition at ECU she has worked on 60 nutrition-related research projects with total funding worth over $4.2m where research into practice is a priority. She is the Associate Dean of Public Health and OHS and Professor of Public Health Nutrition in the School of Medical and Health Sciences. Her research areas extend from regional and remote nutrition and include food security, how patterns of eating impact gut health across the life course, chronic disease and clinical nutrition, food literacy and food and nutrition education.