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TRANSCRIPT
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Nutrition & Parkinson’s
Laurie K Mischley, ND PhD MPH
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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]
mailto:[email protected]
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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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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.
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Pellagra
Dr. Joseph Goldberger
Wiki
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Reframing Parkinson’s as a Syndrome
• A metabolic disease
with neurological
consequences.
• A gut disorder than
spreads to the brain.
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Rx: Find & Fix the Leaks
Photo from livingstingy.blogspot.com
http://livingstingy.blogspot.com/2008/11/life-in-rowboat.html
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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)
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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.
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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
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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.
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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
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Glutathione Augmentation Trials in PD
Phase IIb- (in)GSH
treatment arms &
placebo has
improvement in
symptoms.
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Fish Oil
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Does fish oil reduce dyskinesia in humans?
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Assessing Lithium Status
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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
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Coenzyme Q10 in PD
• QE3 study vs. Phase I, Phase II, & population studies
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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
http://www.CAMCareMS.bastry.edumailto:[email protected]
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DOES ANY OF IT MATTER???
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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.)
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Patient Reported Outcomes (PRO-PD)
o
www.PROPD.org
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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
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Diet in PD Food choices associated with fewest symptoms
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Measuring Dietary Intake
• Food frequency questionnaires
• 24-hour recall
• Cameras, scales, apps
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ASSOCIATIONS WITH FOOD
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Diet: Encourage
• Fresh veggies
• Fresh fruit
• Nuts & seeds
• Non-fried fish
• Olive oil
• Coconut oil
• Wine
• Spices
• Fresh herbs
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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)
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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.
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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.”
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Food Choices & PD Progression
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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.
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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.
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THANK YOUDr. Mischley contact info:
www.EducationIsMedicine.com