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Parkinson's disease: Let food be thy medicine and medicine be thy food (Hippocrates)

      There is increasing interest in the role of the gut-brain axis in Parkinson's disease (PD), most recently inspired by the Braak hypothesis of α-synuclein spread [
      • Braak H.
      • Del Tredici K.
      • Rub U.
      • de Vos R.A.
      • Jansen Steur E.N.
      • Braak E.
      Staging of brain pathology related to sporadic Parkinson's disease.
      ] and the explosion of research looking at the microbiome and its potential role in PD pathophysiology [
      • Keshavarzian A.
      • Engen P.
      • Bonvegna S.
      • Cilia R.
      The gut microbiome in Parkinson's disease: a culprit or a bystander?.
      ]. There were earlier clues that the gut-brain axis was important in PD. Bowel constipation was discovered to be a risk factor of future PD over two decades ago based on the pioneering work done by Ross and others [
      • Abbott R.D.
      • Petrovitch H.
      • White L.R.
      • Masaki K.H.
      • Tanner C.M.
      • Curb J.D.
      • Grandinetti A.
      • Blanchette P.L.
      • Popper J.S.
      • Ross G.W.
      Frequency of bowel movements and the future risk of Parkinson's disease.
      ]. Because of this work, PD neurologists are more familiar with the integration of the recognition, treatment and referral for gastrointestinal symptoms. Some movement disorder practices, like ours, even offer multi-disciplinary neurology-gastroenterology clinics for PD patients. Issues regarding nutrition in PD have been studied less.
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