Nutrition & Parkinson s. Laurie K Mischley, ND PhD MPH

Transcription

1 Nutrition & Parkinson s Laurie K Mischley, ND PhD MPH

2 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 Research funding: Michael J Fox Foundation, PD Families Institutional Affiliation: Bastyr University Clinical Practice: Seattle Integrative Medicine May Contact: info@educationismedicine.com

3 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.

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5 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.

6 Pellagra Dr. Joseph Goldberger Wiki

7 Reframing Parkinson s as a Syndrome A metabolic disease with neurological consequences. A gut disorder than spreads to the brain.

8 Rx: Find & Fix the Leaks Photo from livingstingy.blogspot.com

9 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)

10 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.

11 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

12 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.

13 Phase I & II Studies (in)gsh in PD Safe & tolerable. Observed motor improvement in both; an appropriatelypowered 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

14 Glutathione Augmentation Trials in PD Phase IIb- (in)gsh treatment arms & placebo has improvement in symptoms.

15 Fish Oil

16 Does fish oil reduce dyskinesia in humans?

17 Assessing Lithium Status

18 Lithium plays a role in: Regulation of autophagy Induced BDNF Enhanced neuro genesis Mischley LK. Lithium Deficiency in PD, 2015 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)

19 Coenzyme Q10 in PD QE3 study vs. Phase I, Phase II, & population studies

20 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: Phone: Principle Investigator: Laurie K Mischley, ND, MPH

21 DOES ANY OF IT MATTER???

22 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.)

23 Patient Reported Outcomes (PRO-PD) o

24 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

25 Diet in PD Food choices associated with fewest symptoms

26 Measuring Dietary Intake Food frequency questionnaires 24-hour recall Cameras, scales, apps

27 ASSOCIATIONS WITH FOOD

28 Diet: Encourage Fresh veggies Fresh fruit Nuts & seeds Non-fried fish Olive oil Coconut oil Wine Spices Fresh herbs

29 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)

30 Diet: Avoid Red meat, processed meat Dairy Cheese Yogurt Ice cream Fried foods Soda / Diet soda Canned Fruits Canned Vegetables Mischley LK, Diet & Supps in PD Progression.

31 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.

32 Food Choices & PD Progression

33 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.

34 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.

35 THANK YOU Dr. Mischley contact info: