Movers and Shakers: Diet

After last week’s heavyweight edition with our partners – which, by the way, got an amazing reaction from listeners – we have somewhat lighter fare this week. We discuss a subject which obsesses many of us, what we eat and how that affects our Parkinson’s.

The judge (retired) Nicholas Mostyn is in charge this week but struggles to maintain the same kind of discipline he used to instill in fearful barristers in his court. After a short tussle about the nutritional value of the scotch egg – the devil’s food according to the judge, a treat fit for an angel says Jeremy Paxman – he asks each of us whether we have a dietary plan.

Paul Mayhew-Archer reveals that in the 13 years since his diagnosis, he has never been told what to eat. Most of us have found the words diet or nutrition have never been uttered by the doctors and nurses treating us for our Parkinson’s. But Gillian Lacey-Solymar, as ever, has done a lot more research than us into this subject, partly because she suffered from Crohn’s disease when she was really quite young.

This awful condition, which involves the gut becoming inflamed, taught her to think very carefully about what she ate. Then, after being diagnosed with Parkinson’s, she had another unfortunate revelation about a food she needed to avoid:

“We were on a skiing holiday and I thought all I really fancied was an omelette at the top of the mountain. I had this huge omelette which was delicious -  and I then couldn't move, I was stuck at the top of the mountain.”

Gillian had discovered what others of us have experienced, that protein and Parky drugs don’t mix well. When I was using the PD Monitor system to measure my symptoms a couple of months ago, I noticed a real downward blip on Sunday mornings. I realised this was when I cook a big fryup for breakfast and I needed to take my drugs much further in advance if they were to be absorbed properly.

The judge mentions the Japanese island of Okinawa, which has a very low rate of Parkinson’s and a disproportionate number of residents living beyond 100:

“Their cuisine consists of small portions of green and yellow vegetables, soy, other legumes, very little rice compared to mainland Japan, as well as very occasional fish and pork.” By contrast, he says it’s the Gulf states where the incidence of Parkinson’s is at its highest. And what do they eat there? Lots of meat.

We realise that we need more than a grab bag of anecdotal evidence to understand this topic but luckily we have brought an expert to the pub.

In a cramped corner of. the pub Dr Lucia Batzu tells us about how diet affects Parkinson’s

Dr Lucia Batzu is a research fellow to Professor Ray Chaudhuri, the judge’s consultant and friend of the pod, and takes a special interest in the interaction between diet and Parkinson’s. She starts by explaining why protein and the main drug we all take don’t mix:

“Levodopa is a large neutral amino acid, proteins are made by amino acids, and at the level of the gut the absorption of the levodopa can be affected by the presence of other amino acids.” She says that the drug is best taken on an empty stomach and advises us to wait at least 30 to 45 minutes to eat after you have swallowed your pills.

Doctor Batzu also warns against having a latte or a cup of tea with your medication – the milk will not be beneficial in terms of absorbing levodopa .

So what kind of diet should we be having? Mark Mardell says his research has told him that something called flavonoids are good.  The doctor tells us flavonoids are “plant-based compounds”, particularly red or orange coloured vegetables and berries. A study in 2022 showed that diets rich in flavonoids might actually increase life expectancy for people with Parkinson’s. 

At this point Jeremy intervenes:”This is all guff, the guff you get from people who tell you what to eat.”

But Dr Batzu forges on with her recommendations for our diet. We should all be taking vitamin B12 to keep our nervous system healthy: “This has been shown to have a relationship with the gait in Parkinson's,” she explains. “On the other hand, the vitamin B 12 is essential in terms of cognition and cognitive function.“

And where do we get B12? Yes, our old friend the Mediterranean diet rich in olive oil and fresh vegetables.

The judge brings up probiotics and gut health, a hot topic in Parkinson’s research right now. First, the doctor gives us a useful definition:

“Probiotics are any substances that we introduced that contain live microorganism that could be beneficial for health.” She says there is evidence that probiotics can be effective in managing symptoms of Parkinson's, and points us towards a specific type which reaches the lower gut where the absorption of levodopa happens.

Our interview with Dr Batzu amounts to the best kind of consultation, ranging far and wide over the science of nutrition but also giving us practical tips and menu suggestions. What again strikes us is how this subject has been almost totally absent from our interactions with the health service. So when she says “the dietitian should be part of the multidisciplinary care for people with Parkinson's” we all nod in agreement.

As for Jeremy, who thought this was all “guff”, well he’s changed his tune; “I think you should come back,” he tells Lucia Batzu. “This has been the most interesting discussion we've had so far.” The Grand Inquisitor is right - so please listen, I’m sure you will learn a lot.