I offer this blog simply as a way to highlight potential ways to optimise your condition. I welcome comments - the good and the not so good. I want to learn from this community.
Navigating Parkinson's Disease – a conversation about a more natural approach,
Max Tomlinson N.D.
My personal clinical journey with Parkinson’s started seven years ago when my sister was diagnosed with young onset Parkinson’s (YOPD). Such a devastating diagnosis for a 51-year-old woman in her prime – she was senior vice-president of a major global music company and enjoying her life to the full. I am an Australian trained naturopath, with 38 years of clinical experience. I immediately turned my practice around, initially with the sole focus of stabilising my sister and then optimising her neurological function so that she could return to living with passion and joy. I specialised in Parkinson’s, creating a very successful Parkinson’s Clinic for patients across the globe. The journey has been intense, but we have won and my sister is thriving. We also recently created a plant-based, HPLC standardised support option that really works for her, and others looking for an alternative approach to their symptom management.
‘My diagnosis of Parkinson’s disease hit really hard. I was 51 and in an instant I felt my future and dreams evaporating. I needed hope, I needed to learn to live well with this strange and transformative disease. I decided then and there to win.’ CT, London.
What is Parkinson’s?
Parkinson's is a neurodegenerative disorder that affects the central nervous system. It is characterised by a decrease in dopamine levels due to the degeneration of dopamine-producing cells in the substantia nigra region of the brain.
This leads to a variety of motor symptoms, including tremors, bradykinesia (slowness of movement), rigidity, and postural instability. Shockingly, PD symptoms only start to show after losing around 80% of the dopamine producing cells in the brain. In addition to motor symptoms, PD can also cause non-motor symptoms such as cognitive impairment, lethargy, depression and sleep disturbances.
Parkinson's affects around ten million people worldwide. It is the fastest growing neurodegenerative condition in the world, with 145,000 people in the UK living with the condition. It is estimated that numbers will increase by nearly a fifth to 172,000 by 2030.
The incidence of PD increases with age, and the majority of cases are diagnosed in individuals over the age of 60. However, around 4% of people with PD are diagnosed around the age of 50, indicating early-onset Parkinson's (YOPD).
‘You don’t necessarily suffer from Parkinson’s – you do have to learn to live with it’. SB, South Africa
The pathology of Parkinson's Disease
The pathology of Parkinson's disease (PD) revolves around the gradual degeneration of specific regions of the brain, leading to the characteristic motor and non-motor symptoms associated with the disease. The primary pathology is the presence of abnormal protein aggregates called Lewy bodies.
Lewy bodies consist mostly of a protein called alpha-synuclein. In PD, alpha-synuclein misfolds and forms clumps, disrupting normal cellular function. These protein clumps accumulate within certain types of nerve cells, particularly the dopamine-producing neurons in a region of the brain called the substantia nigra.
The degeneration of dopamine-producing cells is critical in the development of the motor symptoms of PD. This is because dopamine is a neurotransmitter involved in regulating movement, and the loss of dopamine-producing cells leads to an imbalance in the brain's motor circuitry, leading to tremors, rigidity, bradykinesia (slowness of movement), and postural instability.
The pathology can extend to other regions of the brain, including the cortex and subcortical structures. This widespread involvement may explain the presence of non-motor symptoms in PD, such as cognitive impairment, depression, anxiety and sleep disturbances.
The exact mechanisms underlying the development and progression of alpha-synuclein pathology and Lewy body formation are still under investigation. Researchers believe that a combination of genetic factors, environmental factors, and impaired protein clearance mechanisms may contribute to the accumulation of alpha-synuclein and subsequent neuronal dysfunction and death.
Diet and Lifestyle Interventions
My naturopathic approach:
In my PD practice we start our investigations with a panel of blood tests that looks at biochemistry, nutrient levels, hormone function, neurotransmitters, microbiome, toxins, digestive function and analysis, viruses and other infections. The restorative protocol we create then sets out to restore, support and rebalance the test findings. In our PD clinic we analyse the following blood and urine markers as a starting point:
• Homocysteine, Haemoglobin A1c, fasting insulin,
• Lipid Panel: Total Cholesterol, HDL, Triglycerides, LDL-Cholesterol (calculated), Cholesterol/HDL Ratio (calculated), Non-HDL Cholesterol (calculated), Complete
• Metabolic Panel: Albumin, A/G Ratio, ALT, AST, BUN/Creatinine Ratio, Calcium, Carbon Dioxide, Chloride, Creatinine with GFR Estimated, Globulin, Glucose, Potassium, Urea Nitrogen, Hs-CRP (high sensitivity C-reactive protein),
• Hormone status: oestradiol, DHEA-S, total testosterone, free T3, reverse T3, free T4, TSH, progesterone, cortisol, Vitamin D, Vitamin B6, B12, folate, C, Vitamin E (Vitamin A, E, b-carotenoid Panel),
• Heavy Metals Panel: (Hg, Pb, As), Serum Zinc, Serum Copper (Total), RBC Mg, IL-6, Osmolality, Glutathione, Iron, Ferritin, Serum Iodine, Gluten sensitivity, Omega-6:Omega-3 Ratio, Antibodies to HSV-1, Ceruloplasmin, Microbiome and gut parasites
Strategies that have proven to be beneficial in my PD practice
Avoiding common food allergens:
The most common allergens are gluten, cow dairy (but not cream or butter) and alcohol. Avoiding these has made a significant difference in some of our patients. Conversely, reintroducing these foods has an immediate negative impact on the condition.
Balanced Nutrition:
In my clinic we generally recommend a diet tailored around nutrient-dense foods, very low sugar, low GI/GL fruits, low-starch vegetables, non-gluten whole grains, adequate animal and plant proteins, low allergy footprint and healthy fats. Antioxidant-rich foods (such as berries, leafy greens, and nuts) help combat the oxidative stress associated with PD.
Mediterranean Diet:
One of our top recommendations, especially in those who are new to dietary intervention, is to follow a Mediterranean-style diet rich in fruits, vegetables, whole grains, fish, and healthy fats. The Med diet has been associated with a lower risk of PD and slower disease progression. [3]
Ketogenic Diet:
We use a keto diet on occasions in clinic but monitor the patient’s weight and body composition carefully as older patients tend to lose weight very quickly on keto. Research suggests that a ketogenic diet (high in fats and low in carbohydrates) benefits individuals with PD. It helps reduce inflammation and improve mitochondrial function. Care must be taken with the elderly patient, however, as they tend to lose weight very quickly on a keto diet. [4]
Correcting sugar metabolism:
Dr David Perlmutter, a renowned neurologist, has made notable contributions to the understanding of neurodegenerative diseases, including Parkinson's. His work emphasises the role of a low-carbohydrate, high-fat (ketogenic) diet in reducing inflammation and supporting brain health.
Coffee and Caffeine:
A coffee a day keeps PD away? Research has consistently shown an inverse association between coffee consumption and the risk of PD. Caffeine, a component of coffee, may have neuroprotective effects. [5]
Exercise and Physical Therapy:
We encourage our patients to exercise like Olympians, albeit paying attention to their physical limitations and personal safety. Engaging in regular physical activity and participating in physical therapy programs tailored to PD improves motor symptoms, balance, flexibility, and overall physical function.
Emotional Support and Stress Management:
Parkinson's disease can have a significant impact on mental and emotional well-being. We ask patients to engage in stress-reducing activities, such as mindfulness meditation, yoga, or counselling, to help manage emotional challenges associated with the disease. Frank and open discussions regarding relationships, self-esteem and work can go a long way to alleviating the anxiety associated with a PD diagnosis.
Mucuna pruriens:
Our first choice for intervention is Mucuna pruriens, a tropical legume that contains a natural form of levodopa (L-DOPA), which is the primary medication used to manage motor symptoms in Parkinson's disease. L-DOPA is a precursor to dopamine and replenishes dopamine levels in the brain. The main stumbling block for mainstream medical acceptance of Mucuna as a natural approach to PD symptom management is the lack of standardisation of the active L-Dopa.
A large number of scientific studies have investigated the efficacy and safety of Mucuna pruriens in Parkinson's disease. This is one study that is a good summary of all findings:
A randomized controlled trial published in the journal Neurology compared the effects of Mucuna pruriens to synthetic levodopa/carbidopa in Parkinson's disease patients. The study found that Mucuna pruriens significantly improved motor function and quality of life compared to the synthetic levodopa/carbidopa treatment.
jnnp.bmj.com/content/75/12/...
It is worth noting again that the dosage and standardisation of Mucuna pruriens preparations can vary, which will impact its effectiveness and consistency in delivering the desired therapeutic effects. We suggest seeking out HPLC standardised Mucuna products.
Supplementation:
• Coenzyme Q10 (CoQ10) has shown in studies to slow the functional decline of Parkinson’s[6]. CoQ10 is an antioxidant and essential component of the mitochondrial respiratory chain. Some studies have shown potential benefits of CoQ10 supplementation in reducing motor symptoms and slowing PD progression. [13]
• Antioxidants: Several large studies have investigated the role of antioxidants in PD. Consuming foods rich in antioxidants, such as fruits and vegetables, has been associated with a lower risk of developing PD. [7]
• Omega-3 Fatty Acids: Studies suggest that omega-3 fatty acids, found in fatty fish and certain plant sources, have a protective effect against PD and help reduce inflammation. [8]
• Vitamin D: Low levels of vitamin D have been associated with an increased risk of PD. Adequate sun exposure and supplementation can help maintain optimal vitamin D levels. [9]
• Gut Microbiota: Strong evidence indicates a potential link between gut microbiota and PD. Alterations in the gut microbial composition have been observed in individuals with PD, suggesting a role for the gut-brain axis in disease development. [10], [11]
• Prebiotics and Probiotics: Once again the role of the gut flora has been shown in studies to have an influence on PD. Prebiotics and probiotics modulate the gut microbiota, positively influencing PD pathology. These interventions may have neuroprotective effects and improve motor symptoms. [12]
• Vitamin B12: Low levels of vitamin B12 have been associated with an increased risk of PD. Supplementation may help maintain optimal levels and support nerve health. [14]
• Polyphenols: Various polyphenols found in fruits, vegetables, and certain beverages, such as green tea, have demonstrated neuroprotective effects in experimental models of PD. Human studies are ongoing to determine their potential benefits. [15]
The last but the most vital part of the story: The Continuum Method™
Our view is that those newly diagnosed with PD strongly consider speaking to their doctor or neurologist about starting on natural HPLC standardised Mucuna pruriens. Evidence points to Mucuna being a gentler introduction to L-Dopa medication, especially when taken according to the Continuum method.
The Continuum Method
I tell my Parkinson’s patients that they do not need to have 'OFF' periods where the effect of the L-Dopa dose (especially when on Mucuna) is wearing off and they feel slow, sluggish, locked, shaky, vague or low energy. I tell them to use stay 'ON' with The Continuum Method. In this blog I will focus on how to optimise your Mucuna pruriens intake.
The Continuum Method process:
Start with a trial (example below) to find out how long it takes for Mucuna to work, how long the effect lasts and at what time the effect starts to wear off. This is valuable information for you and your practitioner and will help you to assess when to take your Mucuna and how often.
Pay strict attention to when you eat your breakfast. Do not have a strong protein as this will interfere with Mucuna absorption.
Carry out a 3-day trial, noting:
• The amount of Mucuna (how many capsules or powder).
• The time Mucuna takes to ‘kick-in’ (the time taken to have a positive effect on your movement). This should be between 20 and 35 minutes.
• The length of time the Mucuna is effective at supporting your symptoms. This is normally between 2 and 2.5 hours.
• Only eat breakfast once the Mucuna has ‘kicked-in’ as food will compromise the absorption of Mucuna. Ensure your breakfast does not have a strong protein source. It is, however, essential to eat as soon as the Mucuna has taken effect.
• After the morning’s trial, continue with your normal regime for the rest of the day. Start again on the morning of day 2.
Once you have established how long the Mucuna works for (eg: 2 hours) then please use the graph below to work out how often to take Mucuna during the day.
And then make sure that you take some more Mucuna when you know the effect will be wearing off. This ensures continuous support.
Latest Areas of Scientific Research
Genetic Factors:
Researchers have identified specific genetic mutations, such as mutations in the LRRK2, PARKIN, and PINK1 genes, that increase the risk of developing PD. Understanding these genetic factors can perhaps aid in early detection and the creation of personalised treatment approaches though the therapeutic manipulation of diet, lifestyle, and metabolism. Functional medicine and complementary medicine practitioners are uniquely placed to help with work on genetics/epigenetics.
Gut-Brain Connection:
Strong emerging evidence confirms a link between the gut and Parkinson's disease. Studies have found alterations in the gut microbiome of individuals with PD, indicating a role of the gut-brain axis in the development of the disease. This area of research holds promise for novel therapeutic interventions. [1]
Neuroinflammation:
Inflammation in the brain, known as neuroinflammation, is implicated in the progression of Parkinson's disease. Researchers are investigating anti-inflammatory strategies and their potential to slow down disease progression. Managing insulin resistance and the therapeutic application of ketogenic diet has shown great promise in reducing inflammatory markers like homocysteine and IL6.
Exercise and Physical Activity:
Numerous studies have demonstrated the positive impact of regular exercise on motor symptoms, functional abilities, and overall quality of life in individuals with PD. Physical activity has been shown to promote neuroplasticity and enhance dopamine production. Great care must be taken to guard against falls when exercising. [2]
About Max
I have worked as a naturopathic practitioner for over thirty-eight years, practicing in the United Kingdom and Australia. I have published two internationally acclaimed diet and lifestyle books, treated thousands of patients in my London-based clinic, advised leading global businesses on employee health and hosted health focused spa retreats across Europe and North Africa. I am currently working in conjunction with some of the best Parkinson’s doctors in the world, as we support patients to experience a happier, better and stronger journey with the disease.
Max Tomlinson N.D.
References:
1. Zhu M, Liu X, Ye Y, Yan X, Cheng Y, Zhao L, Chen F, Ling Z. Gut Microbiota: A Novel Therapeutic Target for Parkinson's Disease. Front Immunol. 2022 Jun 24;13:937555. doi: 10.3389/fimmu.2022.937555. PMID: 35812394; PMCID: PMC9263276.
2. Bhalsing KS, Abbas MM, Tan LCS. Role of Physical Activity in Parkinson's Disease. Ann Indian Acad Neurol. 2018 Oct-Dec;21(4):242-249. doi: 10.4103/aian.AIAN_169_18. PMID: 30532351; PMCID: PMC6238554.
3. Bisaglia M. Mediterranean Diet and Parkinson's Disease. Int J Mol Sci. 2022 Dec 20;24(1):42. doi: 10.3390/ijms24010042. PMID: 36613486; PMCID: PMC9820428.
4. Pietrzak D, Kasperek K, Rękawek P, Piątkowska-Chmiel I. The Therapeutic Role of Ketogenic Diet in Neurological Disorders. Nutrients. 2022 May 6;14(9):1952. doi: 10.3390/nu14091952. PMID: 35565918; PMCID: PMC9102882.
5. Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010 Mar;2(3):355-374. doi: 10.3390/nu2030355. Epub 2010 Mar 18. PMID: 22254027; PMCID: PMC3257651.
6. Shults CW, Oakes D, Kieburtz K, Beal MF, Haas R, Plumb S, Juncos JL, Nutt J, Shoulson I, Carter J, Kompoliti K, Perlmutter JS, Reich S, Stern M, Watts RL, Kurlan R, Molho E, Harrison M, Lew M; Parkinson Study Group. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. 2002 Oct;59(10):1541-50. doi: 10.1001/archneur.59.10.1541. PMID: 12374491.
7. Park HA, Ellis AC. Dietary Antioxidants and Parkinson's Disease. Antioxidants (Basel). 2020 Jul 1;9(7):570. doi: 10.3390/antiox9070570. PMID: 32630250; PMCID: PMC7402163.
8. Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010 Mar;2(3):355-374. doi: 10.3390/nu2030355. Epub 2010 Mar 18. PMID: 22254027; PMCID: PMC3257651.
9. Nair R, Maseeh A. Vitamin D: The "sunshine" vitamin. J Pharmacol Pharmacother. 2012 Apr;3(2):118-26. doi: 10.4103/0976-500X.95506. PMID: 22629085; PMCID: PMC3356951.
10. Zhu M, Liu X, Ye Y, Yan X, Cheng Y, Zhao L, Chen F, Ling Z. Gut Microbiota: A Novel Therapeutic Target for Parkinson's Disease. Front Immunol. 2022 Jun 24;13:937555. doi: 10.3389/fimmu.2022.937555. PMID: 35812394; PMCID: PMC9263276.
11. Suganya K, Koo BS. Gut-Brain Axis: Role of Gut Microbiota on Neurological Disorders and How Probiotics/Prebiotics Beneficially Modulate Microbial and Immune Pathways to Improve Brain Functions. Int J Mol Sci. 2020 Oct 13;21(20):7551. doi: 10.3390/ijms21207551. PMID: 33066156; PMCID: PMC7589356.
12. Zhu M, Liu X, Ye Y, Yan X, Cheng Y, Zhao L, Chen F, Ling Z. Gut Microbiota: A Novel Therapeutic Target for Parkinson's Disease. Front Immunol. 2022 Jun 24;13:937555. doi: 10.3389/fimmu.2022.937555. PMID: 35812394; PMCID: PMC9263276.
13. Hernández-Camacho JD, Bernier M, López-Lluch G, Navas P. Coenzyme Q10 Supplementation in Aging and Disease. Front Physiol. 2018 Feb 5;9:44. doi: 10.3389/fphys.2018.00044. PMID: 29459830; PMCID: PMC5807419.
14. Christine CW, Auinger P, Joslin A, Yelpaala Y, Green R; Parkinson Study Group-DATATOP Investigators. Vitamin B12 and Homocysteine Levels Predict Different Outcomes in Early Parkinson's Disease. Mov Disord. 2018 May;33(5):762-770. doi: 10.1002/mds.27301. Epub 2018 Mar 6. PMID: 29508904.
15. Pandey KB, Rizvi SI. Plant polyphenols as dietary antioxidants in human health and disease. Oxid Med Cell Longev. 2009 Nov-Dec;2(5):270-8. doi: 10.4161/oxim.2.5.9498. PMID: 20716914; PMCID: PMC2835915.
Herbs for PD?
Combining Different Ideas About PD Can Be Enlightening
