# Nutrition and diets in progressive supranuclear palsy (PSP)
In progressive supranuclear palsy, nutritional choices play their own role. The disease gradually causes swallowing problems, changes in body composition and energy needs, and risks of malnutrition. This tab describes which nutritional approaches are being investigated or applied, and what is known about them.
Weight maintenance and energy-rich food
ResearchediPositive results in clinical studies, not yet standard treatment
In PSP, weight loss is a common problem. Research (2022, 2024) shows that patients change their body composition: muscles decrease while the amount of fat and water in the body can shift. This is accompanied by changes in daily food intake and energy needs.
To counteract this, attention is paid to energy-rich food — food that contains a lot of energy in small amounts, so less volume is needed. This can be important when swallowing becomes more difficult or when patients feel full more quickly.
Research suggests that monitoring food intake and body composition helps to intervene early. However, individual nutritional needs vary greatly, and therefore this should be tailored.
Soft, liquid and pureed food
ResearchediPositive results in clinical studies, not yet standard treatment
Because PSP gradually disrupts esophageal movements, a need for adapted food arises. Soft, easy-to-chew food and thicker liquid products (non-watery) reduce risks of choking and aspiration into the airway.
Research from 2024 and 2026 focuses on quality of life and safety while eating. A scoping review (2024) shows that swallowing problems in PSP are common and strongly determine food choices. Under the supervision of a speech therapist or dysphagia specialist, food texture and consistency are often adjusted.
This requires careful guidance, because soft food is not automatically easier to digest and nutritional value can vary.
Nutrition via tube (percutaneous endoscopic gastrostomy, PEG)
ResearchediPositive results in clinical studies, not yet standard treatment
As PSP progresses, some patients can no longer eat and drink safely by mouth. A PEG is a tube that is placed through a small opening in the stomach to deliver nutrition directly, without going through the esophagus.
International research (2026) on PEG in atypical parkinsonian syndromes such as PSP shows that this technique is used, especially when oral intake has become unsafe. The same studies point out that decisions about PEG are complex: they can extend lifespan, but offer no cure and have their own risks.
In the United Kingdom (2024), clinical practices and opinions about PEG in PSP and related diseases vary. This emphasizes that the choice for tube feeding should always be weighed personally, in consultation with the treatment team.
Micronutrients and thiamine
ExperimentaliOngoing in study setting, outcome still unknown
Research (2025) into carnitine supplementation in PSP is ongoing, but not yet completed. Carnitine is a substance that plays a role in cellular energy production.
Attention is also paid to thiamine (vitamin B1). Thiamine deficiency can cause neurological problems that may mask PSP (2026), and research from 2017 shows that thiamine deficiency can cause stress in nerve cells. This suggests that monitoring thiamine levels may be worthwhile, especially in severe malnutrition.
Additional supplements such as carnitine or B-vitamins are not routinely proven and require individual consideration.
Wheat or gluten-free food
UnproveniNo scientific evidence that it works
There is no specific research on gluten or wheat-free food in PSP. Gluten-free diets are sometimes considered in neurological disorders, but there is no scientific evidence that this affects PSP.
Exception: if someone has celiac disease (gluten sensitivity), gluten-free food is of course necessary — but this is a separate condition, not PSP itself.
Mediterranean dietary pattern
UnproveniNo scientific evidence that it works
The Mediterranean dietary pattern (abundant vegetables, fruit, olives, fish, grains) is widely studied for neurodegenerative diseases and dementia. For Alzheimer's and other dementias, there is evidence for a protective effect.
For PSP specifically, targeted research is lacking. Because PSP is often accompanied by swallowing difficulties, however, this pattern requires adaptations (softer prepared food). Whether the general benefit is retained with these adaptations has not been studied.
Probiotics and gut flora
ResearchediPositive results in clinical studies, not yet standard treatment
Research (2019) into gut flora (microbiota) in Parkinson's disease and atypical parkinsonian syndromes such as PSP is still in its infancy. The thinking is that certain gut flora composition may influence inflammation and neurological symptoms.
To date, there are no targeted probiotic recommendations or recommended types and amounts for PSP known. This remains an area of research.
---
**Summary**: dietary choices in PSP should be discussed with your treating physician, dietitian or speech therapist. Each patient has different needs, depending on how far the disease has progressed, how swallowing is functioning and how weight and nutritional status are developing. What works for one person may be unsuitable for another. Regular evaluation and adjustment is therefore important.
_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._