• Julie Rowin MD

PARKINSON'S DISEASE: An Integrative Functional Medicine Approach

Parkinson’s Disease (PD) is the fastest growing neurological disorder in the world. From 1990 to 2015, the number of people with Parkinson’s disease has doubled to over 6 million. That number is expected to double again by 2040.[1] Because there is no cure for PD, the medications used to manage the disease are symptom-relieving medications with potentially unwanted side-effects. Therefore, more and more people are exploring alternative and complementary treatment strategies for living better with Parkinson’s and slowing or reversing the functional decline.

Chronic toxin exposure may be the single most important risk factor for idiopathic Parkinson’s disease.

About 10-15% of cases of PD are attributed to a genetic cause. Therefore, the overwhelming percentage of cases are largely attributed to each individual’s susceptibility to various environmental factors, most notably environmental toxins. There is a large body of evidence strongly implicating pesticides and other toxic chemical involvement in Parkinson’s disease development and high concentrations of these toxins are found in the blood and brains of people with Parkinson’s. [2] The impacts of pesticides on the nervous system including the brain are hazardous, especially for chronically exposed individuals. And considering that Parkinson’s disease cases are expected to double over the next 20 years, it is essential to mitigate this preventable risk factor. Fortunately, the clinical symptoms of PD may be improved, or the progression may be slowed through certain diet and lifestyle related practices as well as the use of some beneficial nutritional supplements.


What are the environmental toxins associated with Parkinson’s Diseases? [3]

  • Pesticides: organochlorine, organophosphates, paraquat, rotenone

  • Heavy metals: copper, manganese, lead and mercury

  • Agent Orange

  • Solvents: Trichloroethylene and perchloroethylene (dry cleaning and other industries)

  • Drugs: amphetamines and methamphetamine

  • Air and water pollution: nitrogen dioxide, BMAA


Other risk factors associated with Parkinson’s Disease

  • Poor gut health

  • Sedentary lifestyle

  • Insufficient nutrients

  • Traumatic brain injury

  • Aging

  • Stress and emotional trauma


FUNCTIONAL MEDICINE EVALUATION AND TREATMENT

In addition to conventional neurological evaluation, a functional medicine evaluation may pinpoint potential toxic exposures, gut issues and nutritional imbalances which may be useful for developing an individualized treatment plan.

1. Evaluating Gut Health

Recent research has shown that PD likely starts in the gut. Toxins that disrupt the gut lining integrity such as BMAA have been shown to cause Parkinson’s-like disease in the mouse via a gut to brain transmission.[4] BMAA is a neurotoxin found in aquatic organisms and has been implicated in the pathogenesis of neurodegenerative disease.

In PD, the microbes that live in the gut become imbalanced and the gut lining shows increased permeability years or even decades before the disease is seen clinically in the nervous system. As such, many PD patients have constipation or other bowel issues present for years or decades before neurological symptoms begin. Additionally, chronic gut infections, such as H. pylori may worsen Parkinson’s Disease and should be evaluated.[5] The functional medicine approach investigates gut infections, gut integrity and microbiome health.


2. Evaluating for heavy metals and other toxins[6]

The body burden of toxins is difficult to assess. Typically, blood and urine samples are used to determine acute or subacute exposures. Chronic exposures, which are believed to be a common culprit of chronic disease, can be evaluated indirectly by examining routine blood work more closely than is typically performed in conventional medicine. One can have a high toxic body burden and still be in what is considered the normal reference range on blood tests such as CBC, GGT, bilirubin, uric acid, fasting blood glucose and insulin levels. However, the normal reference range of these labs is too broad to be considered a “healthy” range. It is optimal to have the liver function tests, GGT, bilirubin and fasting blood glucose in the lower quartile of the normal range. In contrast the white blood cell count and platelet count should not be in the low range. A functional medicine approach determines if your blood work is in the optimal range.


What can be done to lessen the impact of environmental toxins on Parkinson’s?

  • Remove. A mainstay of treatment will be a systematic removal of toxins from your environment (non-organic foods, cleaning solutions and solvents, herbicides and pesticides, mercury laden seafood and other exposures) Additionally, avoid living near places that use significant toxins in the environment such as conventional farms, golf courses or conventional dry cleaners. See How Is Your Indoor Air Quality?

  • Choose organic produce. There is plentiful evidence that herbicide and pesticide exposures are associated with an increased risk of PD. Not only through agricultural use, but also through residue on food. If possible, eat local from the farmers market where you can inquire if the crops were sprayed. Avoid Gluten, dairy and processed foods and refined sugars and eat plenty of foods high in phytonutrients. I like to use the Mito food plan. It is a more robust brain food plan than other nutritional strategies such as the Mediterranean diet.

  • Eat plenty of foods that help remove heavy metals and other toxins from the body. See 6 Strategies to Detoxify Your Body.

  • Sweat (sauna or exercise). See The Importance of a daily sweat

  • Excrete. Make sure to have 1-3 bowel movements per day. Triphala, aloe vera and magnesium supplements can help here.

  • Hydrate. Most individuals do not get enough water daily. Water helps to flush out the toxins through your urine. Drink ½ body weight (lbs) in ounces per day of fresh filtered water.

  • Eliminate. Eating enough fiber helps to move toxins out of your body through the digestive tract and feeds your beneficial gut bacteria. Dietary guidelines for adults is about 28-35 grams of fiber daily.


3. Assessing and Improving Nutritional Status

A toxic burden, including medications, can exhaust nutrient supplies and antioxidants and wreak havoc on your gut, further inhibiting the absorption of nutrients.

In order for your brain, gut and detoxification pathways to function properly, they need the correct nutrients. Consider the use of nutritional supplements and dietary changes according to your individual needs.[7] Pay particular attention to:

  • B vitamins found in dark leafy greens, broccoli, spinach, Brussel sprouts

  • Omega-3’s found in fatty fish such as salmon, herring, mackerel, sardines. Eat pastured eggs, walnuts, flaxseeds and flaxseed oil and walnuts.

  • Vit D3. Get your level checked, and supplement as needed. Get some sun.

  • CoQ10. It can be found in significant amounts in organ meats as well as grass-fed beef and wild-caught fish.

  • Lion’s mane Mushroom has been shown to improve cognitive function and neuronal growth in a small human trial. [8] This is found in powdered form.

  • Selenium. 2-3 Brazil nuts supply the recommended daily allowance.

  • Coffee, cocao, green tea Inclusion of these anti-oxidants in the diet is associated with a lower risk for PD.

  • Curcumin found in turmeric and resveratrol found in the dark skin of grapes and berries are important antioxidants.

  • CDP-choline supplementation at dosages 500-1,200mg per day have been shown to help lower dosages of levodopa by as much as 50%.[9]

  • Lemon juice added to beverages improves digestion and absorption of nutrients including the absorption of levodopa.

  • Mucuna is a naturally occurring source of levadopa which can be added with caution to your medication regimen under the supervision of your provider.

Glutathione

A separate note is needed to explain glutathione. Glutathione is the major detoxification molecule of the body. It is depleted in many patients with PD and having genetic variations that lower the levels of glutathione increase the risk of PD significantly.[10] Glutathione is increased naturally through exercise, adequate sleep and nutrition, and preliminary studies of supplemental glutathione are promising. Intravenous and intranasal forms of administration of glutathione have better bioavailability than oral forms.[11]



4. Exercise and Movement-based Therapies

Exercise has been shown to improve gut health, lower the body's burden of toxins and improve the symptoms and slow the progression of PD. Exercise daily, including aerobics (at least 3 days per week for 40 minutes, preferably early in the day so as not to disrupt needed sleep patterns), functional muscle strengthening[12], tai chi and yoga. Exercise is one of the best strategies for improving and possibly preventing PD. At moderate to maximum level intensity, exercise also improves sleep and the sleep related disorders of PD. [13] Keep it exciting and think outside the box; try boxing, dancing or even rock climbing.[14] Additionally, participating in movement-based therapies such as the Alexander technique which emphasizes posture and balance and the Feldenkrais Method which aims to retrain the body movements are helpful to improve mobility and quality of life.[15]


5. Using Mindfulness for Symptom Improvement

Pain, depression, anxiety and restlessness are some of the non-motor symptoms of PD. Stress has a big impact on gut health and exacerbates the symptoms of PD. Since the brain is intimately linked with the mind, mindfulness practices can help to lessen the symptoms associated with PD. Some mindfulness practices to incorporate in your healing include:

  • a gratefulness journal

  • prayer

  • a daily meditation practice

  • tai chi and qi gong

  • yoga

  • acupuncture

  • breath work

  • dance

Tai chi, qi gong and yoga classes have the added benefit of improving balance and social connection.[16] Keep an open mind and consider alternative bodywork like Reiki. Breath work is also a very helpful adjuvant treatment in PD as the breath is often shallow and symptoms of shortness of breath can be aided with learning these techniques. Here is a link to basic Mindful Breathing Exercises.


6. Improving Your Sleep

Sleep disturbances are common in PD. Difficulty falling asleep, difficulty staying asleep and early awakening can all contribute to excessive daytime sleepiness. In addition to being disruptive, lack of sleep can negatively affect gut and brain health and reduce quality of life. A sleep study can evaluate the cause for disturbed sleep and day-time sleepiness in PD and help to tailor the appropriate treatment.


Natural interventions which may improve night-time sleep in PD include:

  • Exercise training at moderate to maximum intensity levels early in the day has been found to improve sleep and sleep-related disorders in PD.

  • A Bed-time routine. Keeping a consistent sleep schedule including relaxing music, a warm bath, soothing tea such as chamomile and calming essential oils such as lavender can aid in falling asleep.

  • Bright light therapy can have a positive effect on disrupted circadian rhythms in PD and may improve insomnia. Try to get outside into the sunshine first thing in the morning for at least 20-30 minutes a day. This would be a great time to exercise. It is also possible to use a light box if you live in an area without much natural sunlight or where winters are long and days are short.[17]

  • Avoid "screen time" and stimulants such as caffeine and alcohol close to bedtime.

  • Melatonin and Magnesium L-Threonate are supplements that may help with insomnia in PD.[18]


7. Using Brain-Based Therapies for Parkinson's Disease

Several alternative brain-based therapies are available that are non-surgical, non-invasive and safe modalities to assist with re-patterning or "re-wiring" the brain. These can be effective adjunctive treatments in PD.

  • Trans-cranial and trans-spinal magnetic stimulation (TMS) is a non-invasive and safe form of brain stimulation which uses a magnetic field to stimulate areas of the brain and spinal cord. The still evolving research into TMS and Parkinson's disease is very encouraging and has shown improvement in motor as well as non-motor symptoms.[19]

  • Neurofeedback is a technology-based learning technique that uses a computer program to give information to a person about his or her own brain wave pattern through sensors placed on the head. This information is then used to train the person to modify his or her own brain waves with the aim to improve PD symptoms.

  • Cognitive Behavioral Therapy is a kind of talk-based therapy that focuses on examining the connections between thought patterns, feelings and behaviors. This therapy provides the skills needed to change the negative thinking patterns that can be associated with the symptoms of PD. It has been shown to be an effective non-pharmacological treatment for chronic insomnia, anxiety and depression in PD.


Summary

An integrative/ functional medicine approach to PD is a holistic approach which can be used in addition to conventional treatment and has the desired goal of slowing disease progression, reducing symptoms, and decreasing use of medications. Chronic toxin exposure may be the single most important risk factor for idiopathic PD. Reducing your personal body burden of toxic exposures, optimizing your nutrition and the health of your gut, exploring movement-based therapies and non-invasive brain-based therapies are strategies that Dr. Rowin can help you with.


References

  1. Dorsey, E.R., et al., The Emerging Evidence of the Parkinson Pandemic. J Parkinsons Dis, 2018. 8(s1): p. S3-S8.

  2. Xu, S., et al., Analysis of serum levels of organochlorine pesticides and related factors in Parkinson's disease. Neurotoxicology, 2022. 88: p. 216-223.

  3. Ball, N., et al., Parkinson's Disease and the Environment. Front Neurol, 2019. 10: p. 218.

  4. Esteves, A.R., et al., Footprints of a microbial toxin from the gut microbiome to mesencephalic mitochondria. Gut, 2021.

  5. Zhong, R., et al., Helicobacter pylori infection is associated with a poor response to levodopa in patients with Parkinson's disease: a systematic review and meta-analysis. J Neurol, 2022. 269(2): p. 703-711.

  6. Pizzorno, J., Conventional Laboratory Tests to Assess Toxin Burden. Integr Med (Encinitas), 2015. 14(5): p. 8-16.

  7. Chiu, H.F., K. Venkatakrishnan, and C.K. Wang, The role of nutraceuticals as a complementary therapy against various neurodegenerative diseases: A mini-review. J Tradit Complement Med, 2020. 10(5): p. 434-439.

  8. Saitsu, Y., et al., Improvement of cognitive functions by oral intake of Hericium erinaceus. Biomed Res, 2019. 40(4): p. 125-131.

  9. Agnoli, A., et al., New strategies in the management of Parkinson's disease: a biological approach using a phospholipid precursor (CDP-choline). Neuropsychobiology. 1982. 8(6):p. 289-296.

  10. Rebai, A., et al., Effects of glutathione S-transferase M1 and T1 deletions on Parkinson's disease risk among a North African population. Rev Neurol (Paris), 2021. 177(3): p. 290-295.

  11. Mischley, L.K., et al., Phase IIb Study of Intranasal Glutathione in Parkinson's Disease. J Parkinsons Dis, 2017. 7(2): p. 289-299.

  12. de Moraes Filho, A., et al., Progressive Resistance Training Improves Bradykinesia, Motor Symptoms and Functional Performance in Patients with Parkinson's Disease. Clin Interv Aging, 2020. 15: p. 87-95.

  13. Ivy, C.C., et al., The impact of exercise on sleep in people with Parkinson's disease a scoping review. J Clin Neurosci, 2021. 86: p. 223-229.

  14. Hanc, j., The benefits of Rock Climbing for Parkinson's Disease, in Brain & Life. 2022.

  15. Kang, S.H., et al., Dance intervention using the Feldenkrais method improves, motor, non-motor symptoms and gait in Parkinson's Disease: A 12-month study. J Mov Disord, 2022. 15(1): p. 53-57.

  16. Zhang, T., Z. Lv, and S. Gao, Tai Chi Training as a Primary Daily Care Plan for Better Balance Ability in People With Parkinson's Disease: An Opinion and Positioning Article. Front Neurol, 2021.

  17. Lin, F., et al., The effects of bright light therapy on depression and sleep disturbances in patients with Parkinson's disease: a systemic review and meta-analysis of randomized controlled trials. Sleep Med. 2021. 83: p. 280-289.

  18. Ma, H., et al., Melatonin Treatment for Sleep Disorders in Parkinson's Disease: A Meta-Analysis and Systematic Review. Front Aging Neurosci, 2022. 14.

  19. Mitsui, T., et al., Efficacy of repetitive Trans-cranial Magnetic Stimulation for Patients with Parkinson's Disease: a Randomised Controlled Trial. Neurotherapeutics, June 27, 2022.


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