# Nutrition in progressive supranuclear palsy
Swallowing difficulties and nutritional intake
In PSP, swallowing problems (dysphagia) develop early in the disease. This occurs due to loss of control over muscles in the throat and oral cavity, which increases the risk of aspiration. This affects not only safety, but also what someone can eat and drink, and thus nutritional intake.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Studies show that swallowing problems severely limit nutritional quality and wellbeing, and that the severity of dysphagia is linked to the disease stages of PSP.
As the disease progresses, solid food and even liquids may become difficult. Some people then choose adapted food (finely minced, pureed or thickened) or consider artificial feeding via a tube into the stomach (percutaneous endoscopic gastrostomy, PEG). This is a decision that is personal and made together with a doctor, speech therapist and possibly a dietitian.
Weight changes and energy requirements
Research shows that people with PSP gradually lose weight and that their body composition changes. This is not only the result of eating less, but is also related to how the body uses energy and to the neurological damage itself.
ResearchediPositive results in clinical studies, not yet standard treatment
Long-term studies show that energy expenditure and body composition change during the disease, which requires attention to nutritional intake.
This loss can have consequences for muscle strength, susceptibility to infections and overall wellbeing. Therefore, many clinicians regularly monitor weight and nutritional status, especially if swallowing problems develop. A dietitian can help ensure that nutrition is appropriate for current capacities and needs.
Vitamin metabolism and carnitine
Carnitine is a substance the body needs for energy production in cells. Research has been conducted into carnitine supplementation in PSP, because theoretically a deficiency could increase fatigue.
ExperimentaliOngoing in study setting, outcome still unknown
Carnitine supplementation has been investigated as a possible approach, but evidence for effectiveness and optimal use in PSP is still limited.
Also Wernicke encephalopathy (an infrequent, serious condition due to vitamin B1 deficiency) can present in a masked way in older people with PSP. This underscores how important regular medical supervision is and that nutritional deficiencies must be prevented. However, this is something your clinician monitors; it is not a reason for self-administered supplementation.
Medication use and nutrition
When PSP-related symptoms are treated — particularly for rigidity, depression or other complaints — some medicines may interact with food or affect appetite, taste or digestion. This varies by medicine.
This is always something to discuss with your doctor or pharmacist, not to adjust independently.
Dietary choices and quality of life
For many people with PSP, nutrition becomes not only a medical issue, but also a matter of dignity and pleasure. In later stages, it may become impossible to eat normally, and this transition can be emotionally difficult.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Quality of life is strongly linked to the ability to eat and drink in the way one enjoys.
A dietitian, speech therapy and psychosocial support can help make this process meaningful in a way that aligns with your own values. The goal is to keep nutrition safe, nutritious and where possible enjoyable.
Practical guidance
For personal dietary choices, adapted recipes, supplementation or decisions about tube feeding: these topics are best handled with your treatment team, especially your general practitioner and a dietitian experienced in neurological conditions. They know your situation, your capacities and your wishes.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._