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Nutrition & Parkinson’s
Laurie K Mischley, ND PhD MPH
Disclosures
• Advisory Boards: Brian Grant Foundation, Next Frontier Biosciences
• Consulting: Synapse Medical Intelligence
• Founder: NeurRx, Social Purpose Corporation
• Owner of PRO-PD scale (free scores available at www.PROPD.org)
• Research funding: Michael J Fox Foundation, PD Families
• Institutional Affiliation: Bastyr University
• Clinical Practice: Seattle Integrative Medicine
May 2018 - Contact: [email protected]
Nutrition Science
The study of the human dependence on our environment.
• Think of us as parasites feeding on the planet.
• Exogenous supply of molecules, minerals, etc. required.
We think of ourselves as self-contained and separate from our environment.
In truth, we are dependent on the resources of this planet to sustain us.
Track Record of Success
Scurvy
Pellagra
Goiter
Cretinism
Rickets
Diabetes
People used to suffer greatly or die from these diseases.
Nutrition has served public health so well the public forgets.
Pellagra
Dr. Joseph Goldberger
Wiki
Reframing Parkinson’s as a Syndrome
• A metabolic disease
with neurological
consequences.
• A gut disorder than
spreads to the brain.
Rx: Find & Fix the Leaks
Photo from livingstingy.blogspot.com
Dopamine Deficiency
• Endogenous to the human body
• Principle behind levodopa (Nobel Prize in 2000)
• Biggest win PD has ever had
• Something the body normally makes in sufficient amounts
• In patients with PD, there is an apparent deficiency
• Dopamine augmentation improves PD outcomes
• Patients better off with dopamine supplementation than w/o
• Took a while to get the formula/ delivery right
• Sine met: without vomit… l-DOPA IS AN ORTHOMOLECULE
• Arguably still working on it… (GI absorption issues)
Nutraceuticals to
Consider in PD
• Vitamin D
• Fish oil
• Glutathione
• Coenzyme Q10
• CDP-choline
• Inosine
• Homocysteine-lowering
vitamins
• Lithium Not everyone with PD needs all of this.
Some of these can cause damage.
Work with a knowledgeable provider.
Nutraceuticals: Risks & Considerations
• Out of pocket costs, usually not covered by insurance.
• Questionable quality. Label claims don’t necessarily match contents.
• Not regulated by FDA.
• Can’t patent natural products, which deters investors/industry
• Commonly used in US, little guidance by conventional providers.
• Drug-Nutrient interactions
• Some make meds work better
• Some make meds work worse
Glutathione
• Reduced glutathione (GSH) is the primary
antioxidant of the central nervous system
(CNS).
• ~40% deficiency of brain GSH in early PD.
• Depletion comes before mitochondrial
dysfunction, protein aggregation, Lewy
body formation, loss of dopamine, or cell
death.
• Augmentation strategies have been
explored since the 80’s.
Phase I & II Studies (in)GSH in PD
• Safe & tolerable.
• Observed motor improvement in both; an appropriately-
powered Phase III study is required to determine whether
(in)GSH is better than placebo.
Mischley LK. Phase I Study of Intranasal glutathione for PD. 2015
Glutathione Augmentation Trials in PD
Phase IIb- (in)GSH
treatment arms &
placebo has
improvement in
symptoms.
Fish Oil
Does fish oil reduce dyskinesia in humans?
Assessing Lithium Status
Lithium plays a role in:
• Regulation of autophagy
• Induced BDNF
• Enhanced neuro genesis
• Protects cells against glutamate-induced excitotoxicity
• Inhibits glutamate-induced Ca influx
• Magnesium homeostasis
Haavaldsen R, Lancet 1973; Moore GJ, Lancet 2000; Bauer M Pharmacopsychiatry 2003; Fornai F, Autophage 2008; Sarkar S, J Cell Biol 2008; Su H, 2009)
Mischley LK. Lithium Deficiency in PD, 2015
Coenzyme Q10 in PD
• QE3 study vs. Phase I, Phase II, & population studies
In Search of the Secret to Success
Study Goals:
1. Describe lifestyle habits and therapies being used by individuals with PD.
2. Identify what those who are doing unusually well have in common.
For more information:
www.CAMCarePD.bastry.edu
Phone: 425-602-3306
Principle Investigator:
Laurie K Mischley, ND, MPH
DOES ANY OF IT MATTER???
Nutraceuticals Associated With:
• Improved Outcomes
• Coenzyme Q-10
• Fish oil
• Worse Outcomes
• Iron supplements
• (Melatonin seemed to be due to poor sleep, not the melatonin.)
Patient Reported Outcomes (PRO-PD)
o
www.PROPD.org
CDP-choline in PD
• Over-the-counter supplement
• Precursor to neurotransmitter Ach
• Learning & memory
• Boosts effectiveness of levodopa
• ~ 30% enhancement
• Takes ~ 30 days to see effects
Diet in PD Food choices associated with fewest symptoms
Measuring Dietary Intake
• Food frequency questionnaires
• 24-hour recall
• Cameras, scales, apps
ASSOCIATIONS WITH FOOD
Diet: Encourage
• Fresh veggies
• Fresh fruit
• Nuts & seeds
• Non-fried fish
• Olive oil
• Coconut oil
• Wine
• Spices
• Fresh herbs
Polyphenol Content of Food
Cloves: 15,188
Dried peppermint: 7,929
Star anise: 5,460
Cocoa powder: 3,294
Dark chocolate: 1,664
Flaxseed: 1,528
• (Perez–Jimenez J. EJCN 2010)
Diet: Avoid
• Red meat, processed meat
• Dairy
• Cheese
• Yogurt
• Ice cream
• Fried foods
• Soda / Diet soda
• Canned Fruits
• Canned Vegetables
https://www.huffingtonpost.com/2014/08/15/french-fries-healthy-
fast-food_n_5678580.html
Mischley LK, 2016.
Diet & Supps in PD
Progression.
The Quest for a Loophole
• “What about soft cheeses? Goat cheese? Camel milk?”
• “What about grass-fed beef?”
• “But the milk I buy is organic.”
• “I only use a little bit of cream in my coffee.”
Food Choices & PD Progression
Plant-based Diets— Reasonable Reservations
• More expensive [in the short term].
• More trips to grocery store.
• More food prep required.
• Initially tastes bland.
• Family support sometimes lacking.
• Don’t know what to eat.
• Weight loss concerns.
Social Health is a Nutrient
• We all need to feel needed and part of a community.
• Join support groups, dance/ yoga classes, volunteer,
poker, golf, travel, etc. with new people.
• Rx: REACH OUT.
THANK YOUDr. Mischley contact info:
www.EducationIsMedicine.com