19 - Parkinson's Disease

Question 1

Pathophysiology of Parkinson’s Disease (4)

Answer 1

• Misfolded alpha synuclein proteins, caused by oxidative stress
• This causes Lewy body proteins to accumulate around dopamine neurons, leading to further oxidative stress &
  mitochondrial dysfunction.
• Gradual loss of dopamine-producing neurons in the substantia nigra.
• Loss of dopamine supply from the substantia nigra to the striatum leads to tremor and movement disorders.

Question 2

Symptoms of Parkinson’s Disease (7)

Answer 2

• Characteristic tremor — ‘pill rolling’
• Muscle rigidity with dystonia (contractions)
• Shuffling gait (dragging feet)
• Constipation
• Loss of sense of smell
• Bradykinesia or slowness of movement
• Deterioration in handwriting, facial expression and speech

Question 3

Causes & risk factors of Parkinson’s Disease (9)

Answer 3

• Age
• Genetic predisposition
• Mitochondrial dysfunction, inflammation and oxidative stress.
• Traumatic brain injury.
• Pesticides and herbicides.
• Heavy metals: Manganese, iron, mercury, lead and aluminium toxicity.
• Poor calcium metabolism.
• Stress and depression.
• Recreational drugs, especially amphetamines.

Question 4

How is Parkinson’s Disease diagnosed (3)

Answer 4

• Symptoms, medical history & physical exam
• DaT scan
• PET scan

Question 5

What are the most common drugs prescribed for Parkinson’s Disease and how do they work? (2)

Answer 5

L-dopa & a decarboxylase inhibitor (e.g. Carbidopa) - often combined.
L-dopa can cross the BBB into the CNS where it converts into dopamine.
The decarboxylase inhibitor prevents conversion outside of the brain.

Question 6

What is the downside of using L-dopa?

Answer 6

Serotonin neurons can be damaged by L-dopa

Question 7

What vitamin should be taken away from L-dopa and why?

Answer 7

Vitamin B6 as it may interfere with decarboxylase inhibitors.

Question 8

What food might interfere with L-dopa and why?

Answer 8

Protein - it uses the same transporters and so competes for absorption

Question 9

What is the Catecholaldehyde theory in PD medication?

How can we support using foods/nutrients?

Answer 9

Dopamine is degraded by MAO-B to DOPAL (a toxic intermediate) and DOPAL is increased by L-Dopa medication. DOPAL causes misfolding of alpha synuclein proteins and Lewy Body accumulation.

Slow down degredation to DOPAL: Blackcurrant, blueberry, blackberry
Speed up detoxification to DOPAC: CoQ10, B5, ALA

Question 10

What does Dr David Perlmutter advise for a PD diet?

Answer 10

Same as Alzheimer’s general diet

• Whole unprocessed foods.
• Green leafy vegetables / brassicas
• Berries
• Healthy fats from olive oil, avocado, nuts and seeds.
• Oily fish
• Drink plenty of water

Question 11

What are the components of the MEND protocol for Parkinson’s Disease? (14)

Answer 11

Same as for Alzheimer’s Disease

• Optimise diet
• Exercise
• Reduce stress
• Optimise sleep
• Brain stimulation
• Test B6, 9, 12 - for methylation
• Gut repair protocol and probiotics
• Optimise fasting glucose & insulin
• Optimise Vit D status (50 - 100 nmol/L)
• Provide synaptic componenets (Citicholine & DHA)
• Optimise antioxidants (e.g. berries, fruit, veg)
• Support mitochondria (CoQ10, B vits)
• Heavy metal testing
• MCT / coconut oil

Question 12

What natural chelation agents might be useful in Parkinson’s Disease:
- For Aluminium
- For Iron

Answer 12

For aluminium - Chlorella and coriander

For iron - ALA

Question 13

What supplements are recommended for PD patients? Give doses. (11)

Answer 13

‘Same as Alzheimer’s Disease

• B complex
• Vitamin C (1 - 5g)
• Vitamin D (optimise levels / 2,000 iu)
• Vitamin E (1,000 iu)
• Turmeric (1g)
• Omega-3 (>1g EPA)
• Probiotics
• CoQ10 (600mg)
• ALA (300mg)
• Taurine (1g)
• Citicoline (250mg)

Question 14

Which herbs can help repair the blood brain barrier? (useful for PD) (4)

Answer 14

• Gotu kola
• Rosemary
• Gingko biloba
• Ashwagandha

Question 15

What is a natural L-dopa supplement?

Answer 15

Mucuna pruriens