nutrition & parkinson’s - parkinson association of the rockies › ... › 2018 › 07 ›...

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: info@EducationIsMedicine.com

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

neuroresearch@bastyr.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