Ernährung bei der Parkinson-Krankheit

Andres Ceballos-Baumann; Urban M. Fietzek

doi:10.1055/a-2512-0254

Nervenheilkunde, Table of Contents

Nervenheilkunde 2025; 44(03): 106-114
DOI: 10.1055/a-2512-0254

Schwerpunkt

Ernährung bei der Parkinson-Krankheit

Nutrition in Parkinson‘s disease

Andres Ceballos-Baumann

¹Parkinson-Fachklinik und Abt. für Neurologie und klinische Neurophysiologie, Schön Klinik München-Schwabing

,

Urban M. Fietzek

¹Parkinson-Fachklinik und Abt. für Neurologie und klinische Neurophysiologie, Schön Klinik München-Schwabing

› Author Affiliations

Abstract

Zusammenfassung

Die Ernährung spielt eine bedeutende Rolle in der Behandlung der Parkinson-Krankheit (PK) und stößt bei Betroffenen auf großes Interesse. Levodopa bildet die Basis ihrer Pharmakotherapie und zeigt eine komplexe Interaktion mit der Ernährung. Aminosäuren können die Resorption und Wirkung von Levodopa durch kompetitive Hemmung im Dünndarm und an der Blut-Hirn-Schranke beeinträchtigen. Diäten mit eingeschränkter Proteinzufuhr am Tag haben Levodopa-Wirkungsschwankungen verbessert. Zusätzliche Faktoren wie eine verzögerte Magenentleerung, fettreiche Nahrung und ein gestörtes Darmmikrobiom können die Bioverfügbarkeit von Levodopa weiter vermindern. Obstipation ist das häufigste nicht-motorische Symptom der PK. Ernährungsansätze wie eine erhöhte Flüssigkeits- und Ballaststoffzufuhr (25–30 g/Tag) sind hilfreich. Verschiedene Ernährungsweisen können potenziell präventive und therapeutische Effekte bei der PK haben. Die MIND- und mediterrane Diäten korrelieren mit einem reduzierten Parkinson-Risiko und langsameren Krankheitsfortschritt bei schon Erkrankten.

Abstract

Nutrition plays a significant role in the treatment of Parkinson’s disease (PD) and is of great interest to those affected. Levodopa forms the cornerstone of PD pharmacotherapy but exhibits complex interactions with diet. Amino acids can impair the absorption and efficacy of levodopa through competitive inhibition in the small intestine and at the blood-brain barrier. Protein redistribution diets have shown improvements in levodopa-fluctuations. Additional factors, such as delayed gastric emptying, high-fat meals, and a disrupted gut microbiome, can further reduce levodopa bioavailability. Constipation is the most common non-motor symptom of PD. Nutritional strategies, such as increasing fluid and fiber intake (25–30 g/day), can be beneficial. Various diets also show potential preventive and therapeutic effects in PD. The MIND and Mediterranean diets are associated with a reduced risk of PD and slower disease progression.

Schlüsselwörter

Parkinson-Krankheit - Levodopa - Nahrung - Parkinson-Diät - Levodopa-Wirkungsschwankungen

Keywords

Parkinson disease - levodopa - protein redistribution - nutrition - levodopa fluctuations

Full Text

References

Literatur
1 König J, Fietzek UM. Gut Essen – Parkinson – 120 Rezepte: die medikamentöse Therapie unterstützen und den Körper beweglich halten. Stuttgart Thieme 2022;
2 Fahn S. The history of dopamine and levodopa in the treatment of Parkinson’s disease. Mov Disord 2008; 23 (Suppl. 3) S497-508
3 Waite JH, Tanzer ML. The bioadhesive of Mytilus byssus: a protein containing L-dopa. Biochem Biophys Res Commun 1980; 96 (4) 1554-61
4 Marrinan S, Emmanuel AV, Burn DJ. Delayed gastric emptying in Parkinson’s disease. Mov Disord 2014; 29 (1) 23-32
5 Wade DN, Mearrick PT, Morris JL. Active transport of L-dopa in the intestine. Nature 1973; 242 (5398) 463-5
6 Gundert-Remy U, Hildebrandt R, Stiehl A. et al. Intestinal absorption of levodopa in man. Eur J Clin Pharmacol 1983; 25 (1) 69-72
7 Fasano A, Visanji NP, Liu LW. et al. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol 2015; 14 (6) 625-39
8 Rusch C, Flanagan R, Suh H. et al. To restrict or not to restrict? Practical considerations for optimizing dietary protein interactions on levodopa absorption in Parkinson’s disease. NPJ Parkinsons Dis 2023; 9 (1) 98
9 Schrag A, Quinn N. Dyskinesias and motor fluctuations in Parkinson’s disease. A community-based study. Brain 2000; 123 Pt 11 2297-305
10 Koller WC, Hutton JT, Tolosa E. et al. Immediate-release and controlled-release carbidopa/levodopa in PD: a 5-year randomized multicenter study. Carbidopa/Levodopa Study Group. Neurology 1999; 53 (5) 1012-9
11 LeWitt PA. Levodopa therapy for Parkinson’s disease: Pharmacokinetics and pharmacodynamics. Mov Disord 2015; 30 (1) 64-72
12 Kempster PA, Frankel JP, Bovingdon M, Webster R, Lees AJ, Stern GM. Levodopa peripheral pharmacokinetics and duration of motor response in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1989; 52 (6) 718-23
13 Nutt JG, Holford NH. The response to levodopa in Parkinson’s disease: imposing pharmacological law and order. Ann Neurol 1996; 39 (5) 561-73
14 Cotzias GC, Van Woert MH, Schiffer LM. Aromatic amino acids and modification of parkinsonism. N Engl J Med 1967; 276 (7) 374-9
15 Nutt JG, Woodward WR, Hammerstad JP. et al. The ‘on-off’ phenomenon in Parkinson’s disease. Relation to levodopa absorption and transport. N Engl J Med 1984; 310 (8) 483-8
16 Leenders KL, Poewe WH, Palmer AJ. et al. Inhibition of L-[18 F]fluorodopa uptake into human brain by amino acids demonstrated by positron emission tomography. Ann Neurol 1986; 20 (2) 258-62
17 Baruzzi A, Contin M, Riva R. et al. Influence of meal ingestion time on pharmacokinetics of orally administered levodopa in parkinsonian patients. Clin Neuropharmacol 1987; 10 (6) 527-37
18 Simon N, Gantcheva R, Bruguerolle B. et al. The effects of a normal protein diet on levodopa plasma kinetics in advanced Parkinson’s disease. Parkinsonism Relat Disord 2004; 10 (3) 137-42
19 Camargo SM, Vuille-dit-Bille RN, Mariotta L. et al. The molecular mechanism of intestinal levodopa absorption and its possible implications for the treatment of Parkinson’s disease. J Pharmacol Exp Ther 2014; 351 (1) 114-23
20 Kageyama T, Nakamura M, Matsuo A. et al. The 4F2hc/LAT1 complex transports L-DOPA across the blood-brain barrier. Brain Res 2000; 879 (1/2) 115-21
21 Gillespie NG, Mena I, Cotzias GC. et al. Diets affecting treatment of parkinsonism with levodopa. J Am Diet Assoc 1973; 62 (5) 525-8
22 Mena I, Cotzias GC. Protein intake and treatment of Parkinson’s disease with levodopa. N Engl J Med 1975; 292 (4) 181-4
23 Pincus JH, Barry K. Influence of dietary protein on motor fluctuations in Parkinson’s disease. Arch Neurol 1987; 44 (3) 270-2
24 Ma K, Xiong N, Shen Y. et al. Weight Loss and Malnutrition in Patients with Parkinson’s Disease: Current Knowledge and Future Prospects. Front Aging Neurosci 2018; 10: 1
25 Cai Y, Feng F, Wei Q. et al. Sarcopenia in Patients With Parkinson’s Disease: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12: 598035
26 Pincus JH, Barry KM. Dietary method for reducing fluctuations in Parkinson’s disease. Yale J Biol Med 1987; 60 (2) 133-7
27 Carter JH, Nutt JG, Woodward WR. et al. Amount and distribution of dietary protein affects clinical response to levodopa in Parkinson’s disease. Neurology 1989; 39 (4) 552-6
28 Barichella M, Marczewska A, De Notaris R. et al. Special low-protein foods ameliorate postprandial off in patients with advanced Parkinson’s disease. Mov Disord 2006; 21 (10) 1682-7
29 Bracco F, Malesani R, Saladini M. et al. Protein redistribution diet and antiparkinsonian response to levodopa. Eur Neurol 1991; 31 (2) 68-71
30 Tsui JK, Ross S, Poulin K. et al. The effect of dietary protein on the efficacy of L-dopa: a double-blind study. Neurology 1989; 39 (4) 549-52
31 Gimenez-Roldan S, Mateo D. Predicting beneficial response to a protein-redistribution diet in fluctuating Parkinson’s disease. Acta Neurol Belg 1991; 91 (4) 189-200
32 Karstaedt PJ, Pincus JH. Protein redistribution diet remains effective in patients with fluctuating parkinsonism. Arch Neurol 1992; 49 (2) 149-51
33 Riley D, Lang AE. Practical application of a low-protein diet for Parkinson’s disease. Neurology 1988; 38 (7) 1026-31
34 Pare S, Barr SI, Ross SE. Effect of daytime protein restriction on nutrient intakes of free-living Parkinson’s disease patients. Am J Clin Nutr 1992; 55 (3) 701-7
35 Pincus JH, Barry K. Protein redistribution diet restores motor function in patients with dopa-resistant “off” periods. Neurology 1988; 38 (3) 481-3
36 Pincus JH, Barry KM. Plasma levels of amino acids correlate with motor fluctuations in parkinsonism. Arch Neurol 1987; 44 (10) 1006-9
37 Karstaedt PJ, Pincus JH. Protein redistribution diet remains effective in patients with fluctuating parkinsonism. Arch Neurol 1992; 49 (2) 149-51
38 Karstaedt PJ, Pincus JH, Coughlin SS. Standard and controlled-release levodopa/carbidopa in patients with fluctuating Parkinson’s disease on a protein redistribution diet. A preliminary report. Arch Neurol 1991; 48 (4) 402-5
39 DGN S3-Leitlinie Idiopathisches Parkinson-Syndrom, Stand: 1. Januar 2016, Gültig bis: 31. Dezember 2020, AWMFRegisternummer: 030/010. https://dnvp9c1uo2095.cloudfront.net/cms-content/030010_LL_kurzfassung_parkinson-syndrom_2016_archiviert_1685019710774.pdf
40 Höglinger G, Trenkwalder C. et al. Parkinson-Krankheit, S2k-Leitlinie. 2023 Accessed January 08, 2025 at: www.dgn.org/leitlinien
41 NICE. Parkinson’s disease in adults: diagnosis and management. Full guideline NG71. Methods, evidence and recommendations 2017. Accessed January 08, 2025 at: https://www.nice.org.uk/guidance/ng71
42 Knudsen K, Szwebs M, Hansen AK. et al. Gastric emptying in Parkinson’s disease – A mini-review. Parkinsonism Relat Disord 2018; 55: 18-25
43 Soenen S, Rayner CK, Horowitz M. et al. Gastric Emptying in the Elderly. Clin Geriatr Med 2015; 31 (3) 339-53
44 Kurlan R, Rothfield KP, Woodward WR. et al. Erratic gastric emptying of levodopa may cause ‘random’ fluctuations of parkinsonian mobility. Neurology 1988; 38 (3) 419-21
45 Pierantozzi M, Pietroiusti A, Brusa L. et al. Helicobacter pylori eradication and l-dopa absorption in patients with PD and motor fluctuations. Neurology 2006; 66 (12) 1824-9
46 Tan AH, Lim SY, Mahadeva S. et al. Helicobacter pylori Eradication in Parkinson’s Disease: A Randomized Placebo-Controlled Trial. Mov Disord 2020; 35 (12) 2250-60
47 Fasano A, Bove F, Gabrielli M. et al. The role of small intestinal bacterial overgrowth in Parkinson’s disease. Mov Disord 2012; 28 (9) 1241-9
48 Wielgosz-Grochowska JP, Domanski N, Drywien ME. Efficacy of an Irritable Bowel Syndrome Diet in the Treatment of Small Intestinal Bacterial Overgrowth: A Narrative Review. Nutrients 2022 14. (16)
49 Nyholm D, Lennernas H, Gomes-Trolin C. et al. Levodopa pharmacokinetics and motor performance during activities of daily living in patients with Parkinson’s disease on individual drug combinations. Clin Neuropharmacol 2002; 25 (2) 89-96
50 Kong F, Singh RP. Disintegration of solid foods in human stomach. J Food Sci 2008; 73 (5) R67-80
51 Olausson EA, Storsrud S, Grundin H. et al. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol 2014; 109 (3) 375-85
52 Kaye J, Gage H, Kimber A. et al. Excess burden of constipation in Parkinson’s disease: a pilot study. Mov Disord 2006; 21 (8) 1270-3
53 Rusch C, Beke M, Tucciarone L. et al. Mediterranean Diet Adherence in People With Parkinson’s Disease Reduces Constipation Symptoms and Changes Fecal Microbiota After a 5-Week Single-Arm Pilot Study. Front Neurol 2021; 12: 794640
54 Andresen V, Becker G, Frieling T. et al. Aktualisierte S2k-Leitlinie chronische Obstipation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie & Motilität (DGNM). Z Gastroenterol 2022; 60 (10) 1528-72
55 Seppi K, Ray Chaudhuri K, Coelho M. et al. Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review. Mov Disord 2019; 34 (2) 180-98
56 Barichella M, Pacchetti C, Bolliri C. et al. Probiotics and prebiotic fiber for constipation associated with Parkinson disease: An RCT. Neurology 2016; 87 (12) 1274-80
57 Tan AH, Lim SY, Chong KK. et al. Probiotics for constipation in Parkinson’s disease: A randomized placebo-controlled study. Neurology 2021; 96 (5) e772-e782
58 Zangaglia R, Martignoni E, Glorioso M. et al. Macrogol for the treatment of constipation in Parkinson’s disease. A randomized placebo-controlled study. Mov Disord 2007; 22 (9) 1239-44
59 Ondo WG, Kenney C, Sullivan K. et al. Placebo-controlled trial of lubiprostone for constipation associated with Parkinson disease. Neurology 2012; 78 (21) 1650-4
60 Eichhorn TE, Oertel WH. Macrogol 3350/electrolyte improves constipation in Parkinson’s disease and multiple system atrophy. Mov Disord 2001; 16 (6) 1176-7
61 Morris MC, Tangney CC, Wang Y. et al. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement 2015; 11 (9) 1007-14
62 Hosking DE, Eramudugolla R, Cherbuin N. et al. MIND not Mediterranean diet related to 12-year incidence of cognitive impairment in an Australian longitudinal cohort study. Alzheimers Dement 2019; 15 (4) 581-9
63 Agarwal P, Wang Y, Buchman AS, Holland TM, Bennett DA, Morris MC. MIND Diet Associated with Reduced Incidence and Delayed Progression of ParkinsonismA in Old Age. J Nutr Health Aging 2018; 22 (10) 1211-5
64 Metcalfe-Roach A, Yu AC, Golz E. et al. MIND and Mediterranean Diets Associated with Later Onset of Parkinson’s Disease. Mov Disord 2021; 36 (4) 977-84
65 Keramati M, Kheirouri S, Etemadifar M. Dietary approach to stop hypertension (DASH), but not Mediterranean and MIND, dietary pattern protects against Parkinson’s disease. Food Sci Nutr 2024; 12 (2) 943-51
66 Maraki MI, Yannakoulia M, Stamelou M. et al. Mediterranean diet adherence is related to reduced probability of prodromal Parkinson’s disease. Mov Disord 2019; 34 (1) 48-57
67 Intermittierendes Fasten: Wikipedia;. 2024 Accessed January 08, 2025 at: https://de.wikipedia.org/wiki/Intermittierendes_Fasten
68 Mattson MP, Moehl K, Ghena N. et al. Intermittent metabolic switching, neuroplasticity and brain health. Nat Rev Neurosci 2018; 19 (2) 63-80
69 Accessed January 08, 2025 at: https://www.dge.de/gesunde-ernaehrung/diaeten-und-fasten/intervallfasten/
70 Neth BJ, Bauer BA, Benarroch EE. et al. The Role of Intermittent Fasting in Parkinson’s Disease. Front Neurol 2021; 12: 682184
71 McCarty MF. Does a vegan diet reduce risk for Parkinson’s disease?. Med Hypotheses 2001; 57 (3) 318-23
72 Ben-Shlomo Y, Darweesh S, Llibre-Guerra J. et al. The epidemiology of Parkinson’s disease. Lancet 2024; 403 10423 283-92
73 NCT05238545. The Effect of Gluten-free Diet on Parkinsonism (GFREEPARK). 2024 Accessed January 08, 2025 at: https://ctv.veeva.com/study/the-effect-of-gluten-free-diet-on-parkinsonism
74 Di Lazzaro V, Capone F, Cammarota G. et al. Dramatic improvement of parkinsonian symptoms after gluten-free diet introduction in a patient with silent celiac disease. J Neurol 2014; 261 (2) 443-5
75 Bohnen JLB, Albin RL, Bohnen NI. Ketogenic interventions in mild cognitive impairment, Alzheimer’s disease, and Parkinson’s disease: A systematic review and critical appraisal. Front Neurol 2023; 14: 1123290
76 Choi AH, Delgado M, Chen KY. et al. A randomized feasibility trial of medium chain triglyceride-supplemented ketogenic diet in people with Parkinson’s disease. BMC Neurol 2024; 24 (1) 106
77 Tidman MM, White DR, White TA. Impact of a keto diet on symptoms of Parkinson’s disease, biomarkers, depression, anxiety and quality of life: a longitudinal study. Neurodegener Dis Manag 2024; 14 (3/4) 97-110
78 Phillips MCL, Murtagh DKJ, Gilbertson LJ. et al. Low-fat versus ketogenic diet in Parkinson’s disease: A pilot randomized controlled trial. Mov Disord 2018; 33 (8) 1306-14
79 Norwitz NG, Dearlove DJ, Lu M. et al. A Ketone Ester Drink Enhances Endurance Exercise Performance in Parkinson’s Disease. Front Neurosci 2020; 14: 584130
80 Barichella M, Garri F, Caronni S. et al. Vitamin D Status and Parkinson’s Disease. Brain Sci 2022 12. (6)
81 Tosefsky KN, Zhu J, Wang YN. et al. The Role of Diet in Parkinson’s Disease. J Parkinsons Dis 2024; 14 s1 S21-S34
82 Deleu D, Jacob P, Chand P. et al. Effects of caffeine on levodopa pharmacokinetics and pharmacodynamics in Parkinson disease. Neurology 2006; 67 (5) 897-9
83 Postuma RB, Lang AE, Munhoz RP. et al. Caffeine for treatment of Parkinson disease: a randomized controlled trial. Neurology 2012; 79 (7) 651-8
84 Postuma RB, Anang J, Pelletier A. et al. Caffeine as symptomatic treatment for Parkinson disease (Cafe-PD): A randomized trial. Neurology 2017; 89 (17) 1795-803
85 Kitagawa M, Houzen H, Tashiro K. Effects of caffeine on the freezing of gait in Parkinson’s disease. Mov Disord 2007; 22 (5) 710-2
86 Hong CT, Chan L, Bai CH. The Effect of Caffeine on the Risk and Progression of Parkinson’s Disease: A Meta-Analysis. Nutrients 2020 12. (6)
87 Mitchell E, Chohan H, Bestwick JP. et al. Alcohol and Parkinson’s Disease: A Systematic Review and Meta-Analysis. J Parkinsons Dis 2022; 12 (8) 2369-81
88 Evans AH, Lawrence AD, Potts J. et al. Relationship between impulsive sensation seeking traits, smoking, alcohol and caffeine intake, and Parkinson’s disease. J Neurol Neurosurg Psychiatry 2006; 77 (3) 317-21