Useful Supplements for Parkinson’s Disease: Part 3

Dietary supplements, such as the vitamin B sup...
Dietary supplements, such as the vitamin B supplement show above, are typically sold in pill form. (Photo credit: Wikipedia)

This is part 3 of my series on nutrition and Parkinson’s Disease.  Part One and Part Two can be  found preceding, focusing on foods to eat or to avoid.  This section is on supplements.

While Dr. Terry  Wahls‘ experience with MS shows food to be more effective than supplements at providing nutrition for neurological diseases, there is a place for supplementation with vitamins and minerals, provided they are taken together with food to make up for deficient nutrients in our foods.  Paul Bergner researched the decline of minerals in the diet due to modern agricultural practices which have strip mined the soil and reduced food value in his book, The Healing Power of Minerals, Special Nutrients, and Trace Elements (out of print.)  Most minerals not included in the standard NPK commercial fertilizer declined between the mid 1970s and mid 1990s by 30% according to USDA data (and who knows since then), notably magnesium, calcium and iron.  Trace minerals often disappeared entirely: the boron in apples in the 1940s is  no longer present.  An apple a day in 1929 would be equivalent to nearly 30 a day today  in terms of iron.  So while nutritional supplements should not be relied upon alone, since they do not capture the full spectrum of antioxidants or special nutrients, they can fill some holes in the diet, particularly minerals which affect neurotransmitters like dopamine and serotonin.

Vitamins are made by plants from the sun so will not be deficient when first picked but can be destroyed in transport.  New hybrid fruits and vegetables often feature diminished nutrition along with their sweet milder flavors.  Lettuce has largely lost its bitterness, which means it is less effective at stimulating digestive juices, further reducing nutrient absorption.  The same goes with a variety of fruits and vegetables.

The taste of food is not merely aesthetic.  Tastes stimulate the body to prepare for nutrients.  Bitter tastes cause the secretion of hydrochloric acid (which closes the esophogeal sphincter preventing reflux)  and bile, which helps break down fats and  protein and moves the intestine.  Since 80% of serotonin and other neurotransmitters are made in the gut, stimulating digestive juices with something bitter can prevent or ameliorate depression found in Parkinson’s.  A bitters formula, biting down on lime peel, a radicchio salad or grapefruit before the meal can start digestion properly and will also regulate blood sugar which is of interest in Parkinson’s’ disease.  Bitters must be tasted to stimulate digestion, but do not require large amounts, so do not use pills or capsules. Food or tinctures work better.

It is important to eat looking at the health of the mitochondria, the energy powerhouses in cells, especially brain cells.  There are many aspects of this that warrant an article of its own.  A protein in the body called Parkin is believed to detect, and then clear out, damaged mitochondria from the cell. In PD cases associated with mutations in another protein called PINK1, however, Parkin doesn’t seem to do its job, and it’s thought that the damaged mitochondria that remains might lead to the cell death that causes the disease.  A number of supplements are chosen to benefit the mitochondria.

While the supplements below can be beneficial for most it is important to avoid a “one size fits all” approach.  People with Parkinson’s (PWP) differ significantly in their symptoms, medications and health conditions and they need to coordinate with the help of a doctor or trained pharmacist to make sure that effective treatment is not compromised.  Minimal research has been done on nutrients, and nothing can be said to be a cure.  But there are certainly supplements that can make PWP maximize their health.

Vitamins and minerals can be taken at the same time as foods while amino acids and herbs should be taken an hour before or two hours after meals.  Important supplements, vitamins and minerals include:

  • Probiotics.  Recent research shows that Parkinson’s disease affects the gut/brain axis and that when PWP have more enterobacteria the worse they get. Probiotic bacteria help outcompete enterobacteria and improve absorption of other nutrients.  I like the well-researched but often forgotten Saccharomyces bloulliardi and Pharmax’s human lactobacillis strain
  • Vitamin B Complex including NADH.  When Parkinson’s disease patients took 30 mg of vitamin B 2 three times each day over a period of six months, they had better motor capacity,( though these participants also  no longer ate red meat, according to the University of Michigan Health System.) NADH, an active type of vitamin B 3, helps with increasing the amount of dopamine in the brain.  Methyl folate is the preferred form of the B vitamin, folic acid.  Do not look for high Vitamin B complex levels as they will wash out, and too much B6 can interfere with Parkinson’s medication. Instead take a low dose  3 times a day:  30mg three times a day of a Vitamin B complex is sufficient but NADH, methyl folate and B12 may require separate supplementation.
  • Sublingual Vitamin B12, especially in the form of Methylcolbalamin, a form of bio-active B12 that is well absorbed and crosses the blood brain barrier.   This makes it suitable for brain-nerve disorders. It is the form of vitamin B12 active in the central nervous system, necessary for cell growth and replication. In some people the liver may not convert cyanocobalamin, the common supplemental form of vitamin B12, into adequate amounts of methylcobalamin needed for proper neuronal functioning. Methylcobalamin may exert its neuroprotective effects through enhanced methylation, acceleration of nerve cell growth, or its ability to maintain already healthy homocysteine levels.  1000 micrograms.
  • Fish or cod liver oil to provide 1000 mg of DHA (about 5 capsules or a teaspoon of Carlson’s lemon flavored fish oil which you can use to wash down other supplements.)  Make sure the oil is not rancid, which can be tested by smell. This reduces the inflammation that drives Parkinson’s. Blue Ice is another source of fermented fish liver oil that I recommend Vegetarian sources of Omega 3 oils like flax seed or chia must be converted to DHA, which is genetically impossible for a significant proportion of the population, is difficult for older patients and requires as much as 30 times the dose in those who can use it. There may be marine seaweed DHA.
  • Vitamin D3 should be taken by PD patients as few of them have sufficient sun unless they live south of Atlanta and are regularly out of doors without sunscreen at noon.  While most Americans are deficient in the vitamin, actually a hormone with hundreds of body functions, PD patients have even lower average levels.  In a long term prospective Finnish study participants who had the highest levels of serum vitamin D had a 67% lower risk of developing Parkinson’s than those in the lowest 25% of the group studied after 29 years.  People differ significantly in their ability to absorb Vitamin D and how fast it breaks down so optimum levels (50-100 ng/ml of  25 Hydroxy D) must be determined by blood testing.  It usually takes over 10,000 iu of the vitamin daily to budge numbers but people with many diseases need more, especially those who work indoors, are fat, elderly or  suffering from disease.  I needed 50,000 iu per day, twice the physiological dose one would get from the sun, to get to the low 50s after 10,000 iu for 6 months didn’t work.  It took 3 months to get there from the low 30s.  (I monitored high intake with quarterly blood tests.) In some PWP improvement is due to general health while PWP with certain Vitamin D receptor genotypes showed improvement in symptoms according to a small scale clinical trial, conducted by researchers at the Jikei University School of Medicine in Tokyo, where 114 people with Parkinson’s were randomly assigned to take a modest 1200 iu vitamin D supplement or a placebo during a one-year period. Those people with particular gene versions of the Vitamin D receptor called Fokl TT and Fokl CT benefited from the vitamin D supplement when compared with placebo. But those with another genotype called Fokl CC did not.  (At higher levels even those might have responded.)  Nonetheless proper Vitamin D status is essential for general health and makes everything work better.
  • CoQ10 plays an important role in the mitochondria and is also a potent antioxidant. In a multi-center trial published in 2002, patients with early PD took either a placebo or Coenzyme Q10, at 300mg to 1200mg per day. The results showed that CoQ10 was well tolerated and was safe at these doses. Over a sixteen-month period those PWPs who were on the higher dose showed slower disease progression than the others. Currently, a much larger trial (the QE3 trial) is underway to truly determine the role of CoQ10 in the treatment of PD. This trial is testing doses of 1200mg and 2400mg daily.
  • Glutathione, a compound with multiple effects on nerve cell metabolism as well as a powerful antioxidant, is of particular interest for PWPs because of studies showing its depletion in the substantia nigra (the site of major nerve cell damage in PD). Although laboratory tests are promising, it is still not clear what is the best way for PWPs to take this since oral doses are relatively ineffective unless liposomal.  Dosages and long term effects are not well determined.
  • Zinc participates in the superoxide dismutase and zinc-thioneine enzymes to reduce oxidative stress in the brain and oxidative stress is believed to reduce dopamine production. Zinc‘s role in inciting or inhibitory responses is not clear.  Like all metals it should be used conservatively.
  • Magnesium  is involved in a number of crucial bodily functions, from the creation of bone to the beating of the heart and the balance of sugar in the bloodstream, of special interest in Parkinson’s dementia.  Magnesium is a particularly crucial element for mediating the vital functions of the nervous and endocrine systems; it helps maintain normal muscle and nerve functions, reduces tremors,  keeps heart rhythm steady, supports a healthy immune system, prevents depression, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, prevents or treats constipation. and is known to be involved in energy metabolism and protein synthesis.In addition, magnesium stimulates activity of B vitamins,assists in clotting of blood, relaxes the muscles, aids in metabolism of carbohydrates and minerals, helps the body maintain a regular heart rhythm, and plays a central role in the formation of ATP (adenosine triphosphate), the mitochondrial-derived fuel on which the brain (and body) runs.  Magnesium balances out the potentially toxic increased levels of calcium in the cytosol.  The forms used should be chelated (end in “ate” like citrate or orotate) but there is a lot of individuality on which forms are good and switching can be done if one form doesn’t work.  Magnesium theronate crosses the blood brain barrier but is expensive so I combine.  I generally suggest 800 mg of magnesium citrate to start.  Topical magnesium chloride also  known as magnesium oil can be applied twice a day when diarrhea from oral magnesium  is a problem.  Most Americans are deficient in magnesium.
  • Iron can calm  some spasms if deficient, but must be used with care in Parkinson’s.  Iron is accumulated in different brain regions in presence of neuropathologies and increased levels of iron were found in the substantia nigra of patients with Parkinson’s. At this level, iron works with neuromelanin inducing oxidative stress and death of the dopamine-making neurons. Liver is better than supplements if iron is deficient and low dose tincture of Rumex crispus (Yellow  dock) to gastric tolerance allows more efficient use of iron without increasing the mineral itself.  Start at 10 drops twice daily of a standard 1:5 tincture and work up gradually.
  • Silica, appears to have the effect, as silicic acid,of reducing the bio-availability of aluminum, avoiding its deposit in neurofibrillary tangles which is associated with dementia.  Horsetail weed supplements provide this in a bioavailable form.
  • Creatinine increases levels of phosphocreatine, an energy source in the muscle and brain, and in experimental studies it protects against nerve cell injury. The National Institute of Neurological Disorders and Stroke (NINDS) has now funded a multi-center pilot study of creatinine (along with another agent, minocycline) in people with Parkinson’s. For PD, doses of 5 to 10 grams daily are under study.  Creatinine should be used cautiously by persons with impaired kidney function.
  • Citicholine (CDP choline, cytidinediphosphocholine) CDP choline, also known as citicoline, is often used by victims of stroke or head trauma. It may also have benefit in memory loss and PD.  CDP choline may help repair damaged nerve cells in brains, including those that produce dopamine. CDP choline may also increase levels of glutathione, an antioxidant.  Initial studies of CDP choline in PD suggest it may be most beneficial for the symptoms of rigidity and bradykinesia. Doses of 500 mg to 2,000 mg daily, either taken orally or given as an injection, have been used. The most common side effect reported with CDP choline is slight stomach upset. Use as directed on the supplement bottle
  • Phosphatidylserine was found by Tel Aviv University’s Department of Human Molecular Genetics and Biochemistry to improve the function of rat genes involved in disorders such as familial dysautonomia and Parkinson’s disease. Phosphatidylserine has already been .. The substance contains a molecule known to be essential in transmitting signals between nerve cells in the brain, and mitochondria require a constant and well-regulated supply of phospholipids for membrane integrity.  200-300 mg daily.
  • L-Tyrosine may be useful depending on your medication.  L-tyrosine, which is the precursor to L-dopa should improve Parkinson’s disease symptoms, as L-dopa converts into dopamine. But L-tyrosine can interfere in levadopa’s transport, and the University of Michigan Health System recommends that you do not combine the supplement L-tyrosine with the medication levadopa or take L-tyrosine instead. It may be useful when combined with St. John’s wort but more research needs to be done.
  • Alpha-Lipoic Acid & Acetyl-L-Carnitine may lower oxidative stress and a slowing of potential PD.  ALA is believed neuroprotective by increasing acetylcholine and lowering the damage from damaging proteins especially in the substantia nigra.  ALA may lessen the depletion of glutathione, lowering free radical damage, mitochondrial dysfunction and the death of dopaminergic neurons. Together with Acetyl-L-Carnitine, ALA has been found to protect in vitro human cells against mitochondrial dysfunction, oxidative damage and accumulation of alpha-synuclein and ubiquitin. Most notably, when combined, ALA and ALC worked at 100-1000-fold lower concentrations than they did individually.
  • SAM-e There is evidence suggesting that levodopa medication can reduce brain levels of SAMe. This depletion may contribute to the side effects of levodopa treatment, as well as the depression sometimes seen with  Parkinson’s disease. One study found that SAMe taken orally improved depression without changing the effectiveness of levodopa.  However, it is also possible that taking extra SAMe might have a long term interference with levodopa’s effectiveness. Contraindicated for bipolar disease and can interact with other antidepressants.  Deficiencies in methionine , folate , or vitamin B 12 can reduce SAMe levels so those supplements may help prevent depression. DMT is another potential precursor.  SAM-e is not found in appreciable quantities in foods, so it must be taken as a supplement by itself.  200-400 mg taken 3 to 4 times per day.
  • 5-HTP may help with depressive symptoms in Parkinson’s disease when combined with Levadopa and Carbidopa but get appropriate pharmaceutical advice.  Less expensive than SAM-e.
  • Melatonin can be taken an hour before bedtime if you have trouble sleeping.  Try not to use melatonin frequently as it is a hormone your body should make.  Sleep hygiene (no late TV or computer, low light an hour before bed, a hot bath) and essential oil of lavender smelled in bed are better.
  • EDTA orally can help remove heavy metals gradually. While IV chelation has not been found (or disproven) to be useful for Parkinson’s due to heavy metal toxicity, oral EDTA chelation is inexpensive and unlikely to cause harm and usually benefits most people.  The idea of using a chelator for Parkinson’s disease is not unreasonable: we know iron accumulates in the Parkinsonian brain, and iron seems to accumulate in important brain areas known to be part of the neurodegenerative process – including the substantia nigra.  Additionally, there are a few animal experiments that have shown a protective effect of chelation against the development of Parkinson’s disease.  Take as directed on the bottle.  Suppository form show no additional benefits and are quite expensive. Read Dr. Gary Gordon for more.
  • Trace mineral concentrate, netttles or seaweed provide trace minerals no longer found in food. I squirt 10 drops of my trace mineral concentrate into my grapefruit juice or a day’s ration of coffee.  Eating nettles grown on good soil or clean seaweed also provides trace minerals.

Do not take all supplements.  Most people will benefit from magnesium, turmeric, fish oil, Vitamin D,  B vitamins and trace minerals.  Take melatonin only if you have sleep problems that do not respond to sleep hygiene suggestions and lack of sleep makes you dysfunctional.  Don’t take iron unless you test low and also have leg cramps that do not respond to magnesium, blood sugar control, massage and exercise.  Exercise for circulation before using supplements. Walk in sunlight out of doors and exercise for depression before using supplements. Use detoxification supplements for a course of treatment which could be three months:  take organic meals, seaweeds, milk thistle, turmeric and EDTA, while doing dry brush massage and infrared saunas.  Consult with your doctor, pharmacist, acupuncturist or naturopath to make sure you are not working at cross-purposes.

Herbs

Herbs are generally a safe way to strengthen and tone the body’s systems and as complex organic substances they tend to have cofactors and buffers. As with any therapy, you should coordinate treatment from a trained herbalist ( look for titles like RH (AHG), NCCAOM in Herbal or Oriental Medicine, an Oriental Medicine degree, MS degrees in Ayurveda, western herbs or equivalent study) with your MD and to diagnose the pattern of your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). It is generally best to take herbs in a form you can taste because the taste signals your body to use them. Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 – 10 minutes for leaf or flowers, and 10 – 20 minutes for roots. Drink two to four cups per day. You may use tinctures alone or in combination as noted.

  • English: Turmeric root. Photo taken in Kent, O...
    English: Turmeric root. Photo taken in Kent, Ohio w  (Photo credit: Wikipedia)

    Ginkgo biloba 80 mg two times per day or 60 mils three times a day in tincture or liquid extract form.  Ginkgo leaf extract is an antioxidant that improves blood flow to the brain and may help with dopamine delivery.

  • Turmeric is an adaptogen which means it will balance your hormones and immune system and is nontoxic at  normal doses.  It helps with energy, liver detoxification, pain reduction and improved circulation.  In India it is considered a panacea herb.  I do not suggest taking it in curcumin capsules, even with bioperine from black pepper which enhances circulation.  Instead cook liberally with it (curries anyone?) or take turmeric honey on days when you don’t.
  • Mucuna pruriens contains levodopa. One small study showed that it had better results than the form of levodopa given as prescription medication. Doses ranged from 22.5 – 67.5 g per day divided in 2 – 5 doses. More studies are needed. Do not take cowhage without your doctor’ s supervision, especially if you already take levodopa. –
  • Brahmi (Bacopa monniera ) is an Ayurvedic herb that is often used to treat people with Parkinson’s. Studies suggest that it improves circulation to the brain, as well as improving mood, cognitive function, and general neurological function. Dosage guidelines vary, but some practitioners suggest 100 – 200 mg twice daily.
  • Milk thistle helps with liver detoxification and may be useful for dealing with high level toxins or side effects from medication. Milk thistle should be taken before meals with a tall glass of water. The usual dose is 70 mg to 140 mg three times daily.

Homeopathy

Homeopathy when it works, depends on resonance.  Unlike foods, meds and herbs which can allow significant improvement even when there is not perfect match with the patient, homeopathy appears to either work or it doesn’t at all.  Because of this you should consult a trained homeopath who can determine the right remedy for you and change it when your symptom picture (hence resonance) changes.

  • Argentum nitricum — for ataxia (loss of muscle coordination), trembling, awkwardness, painless paralysis
  • Causticum — for Parkinson’s with restless legs at night
  • Mercurius vivus — for Parkinson’s that is worse at night, especially with panic attacks
  • Plumbum metallicum — especially with arteriosclerosis
  • Zincum metallicum — for great restlessness, and depression
  • Mag-phos-for trembling; shaking of hands, cramps in calves, feet very tender. Twitching,worse on right side

Combined R-alpha lipoic acid and aetyl-L-carnitine exerts efficient preventative effects in a cellular model of Parkinson’s Disease  J Cell Mol Med. 2010 Jan;14(1-2):215-25. doi: 10.1111/j.1582-4934.2008.00390.x.

Nutritional Supplements and Vitamins: Alternatives to Help Parkinson’s Disease? Parkinson’s Disease Foundation

Low vitamin D concentration exacerbates adult brain dysfunction Am J Clin Nutr 2013 97: 5 907-908

EDTA and Chelation Therapy: History and Mechanisms of Action, an Update Garry F. Gordon, MD, DO, MD(H)

Calcium, copper, iron, magnesium, silicon and zinc content of hair in Parkinson’s disease  Journal of Trace Elements in Medicine and Biology 19 (2005) 195–201

Nutrition for Parkinson’s Disease acupuncturebrooklyn.com

How to Make Turmeric Honey for Inflammation acupuncturebrooklyn.com

 

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