Interesting exchanges at the 2016 World Parkinson’s Congress
I had the opportunity to speak at the World Parkinson’s Congress this week. It was a fantastic experience. I’ve been speaking at wellness retreats for people with Parkinson’s for several years, and I really appreciated getting to share some of what I know about nutrition and Parkinson’s to a more widespread audience. For one of the talks, I was on a panel. After the panel presentations, an attendee asked a question about Parkinson’s supplements. One of the MDs on the panel took the microphone and said that, beyond vitamin D, he doesn’t recommend supplements for his patients. I had to disagree.
This question sparks a lot of arguments between physicians and patients and is far more than complex than it looks at first glance. In short, it depends on the person and it depends on the supplement. Asking if people should be taking supplements is like asking should ‘people’ be taking ‘drugs.’ For example, if you have a debilitating disease like Parkinson’s, yes, you should probably be taking L-dopa in some form. If you don’t have Parkinson’s, you probably don’t need the L-dopa.
FOOD AS NUTRITION: IDEAL, BUT HARD THESE DAYS
So what about supplements? In the natural medicine world, we would ideally love for everyone to be able to have their nutritional needs met by food. However, frankly, in this day in age, that’s rare. First of all, as a population, we eat more processed foods today that we did 50 years ago. What is a processed food? Quite simply, the food no longer looks like it did when it came off a tree or out of the ground. Typically processed food is anything sold on the inside aisles of the grocery store. The whole foods tend to be on the outside edges.
OUR FOOD IS LESS NUTRITIOUS THAN EVER
While the food industry fortifies some foods with nutrients when they process them, many foods lose vitamins and minerals when they are processed. In some cases, fiber content, phytic acid, and tannin content in food affects the bioavailability of the nutrients.1 While there are a lot of factors that influence how the processing affects the amount of a nutrient in a food, most often nutritional content is reduced. Thus people who rely on processed foods are likely not getting enough nutrients from their food, so food could be consider Parkinson’s supplements!
Today, an Orange is 8 times less nutritious than 40 years ago
But even if you are eating a whole food diet and not relying on processed foods, it’s unlikely you can get optimal nutrition from food alone today. Our soil today is depleted. It has less calcium, phosphorus, magnesium, zinc, and vitamins B-6 and E to name a few.2 Furthermore, while new breeds of vegetables allow them to grow more quickly and larger, it hasn’t meant that they are able to take more nutrients out of the soil. What that means is that someone has to eat more of a vegetable to get the same level of nutrients that they would have received in the smaller version 20 years ago. In some cases, the volume that someone would have to eat today is substantial. For example, it’s estimated that today someone would have to eat 8 oranges to get the same amount of vitamin A as we would have gotten from a single orange 40 or 50 years ago. That’s a lot of pulp.
Vitamin D RDA IS A MINIMUM NOT OPTIMAL
Then there’s vitamin D, which comes from sunlight, among other things. This particular vitamin is essential for more than 250 different biochemical processes in our bodies. But it’s estimated that less than only 25% of people have healthy vitamin D levels.3 Even if you live a sunny place, chances are you spend a lot of time inside in air conditioning. Adding to the complication of taking vitamin D, physicians and nutritionists can’t agree on what a ‘normal’ level of vitamin D is. (Side note: If you look on a nutrition label, you’ll see a ‘recommended daily allowance’ level for vitamins and minerals. However, that RDA is minimum, not the level that you need for optimum functioning.)
HOW TO COMPENSATE FOR OUR FOOD OPTIONS
I think I’ve established that even in a healthy individual, it’s not easy to get all of the nutrients you need from food. Now what happens if you have a disease – when healthy nutrition is essential to all of your cells functioning at optimum levels? In short, supplementing may become even more important.
CHRONIC INFLAMMATION AND PARKINSONS
As an immunologist, I find that chronic inflammation is one of the major culprits in disease. It plays an important role in Parkinson’s, as well as numerous other diseases. Chronic inflammation is made up of several processes, but one of the largest is oxidative stress. So, it is coincidence that many of the vitamins that are low in our vegetables and fruits are anti-oxidants? Probably not. As the amount of anti-oxidants that we’re exposed to in our diets has decreases, the diseases that have oxidative stress mechanisms have simultaneously increased. Yes, a number of other factors are also involved, and I don’t want to over-simply this complex process. Nevertheless, I do want to emphasize that the inflammatory and oxidative pathways are important.
So should people with Parkinson’s supplement with anti-inflammatory supplements? Possibly. For some individuals, anti-oxidant and anti-inflammatory herbs may have substantial effects as Parkinson’s supplements. Have all of the studies been done? No. The fact is, the supplement industry doesn’t have the same deep pockets as the pharmaceutical industry. As a result, the research is slower to be conducted. But lack of research doesn’t mean that supplements don’t work. It means only that they haven’t been fully studied in every combination and for every condition. I would caution anyone to equate a lack of evidence with ‘not working.’
CoQ10 a supplement for Parkinson’s?
The reality is that there is not going to be a one-size-fits-all approach. A supplement that works for one person may not work for another because the genetic background of the individual, other diseases they might have, and their particular situation. Recently a large study of CoQ10 was discontinued because not as many people as hoped responded to the CoQ10. It didn’t mean that CoQ10 wasn’t a supplement for Parkinson’s or that it didn’t work for anyone, but it didn’t work for everyone.4 In fact, an earlier study showed that CoQ10 on average did help with Parkinson’s symptoms, at lower doses.5 It is up to scientists to sort out the differences.
Supplements aren’t drugs
However, I would point out that our temptation to treat supplements like drugs. In a drug model, if a little is good, often more is better. That’s not always true in the nutrient world. In fact, with many minerals, we see that a deficiency and having too much of a nutrient can cause the same symptoms. Just as people have different symptom pictures and different disease progression, people will respond individually to different supplements. This is where individuals may want to test supplements on themselves to see if they have positive effects. From a biochemical mechanism standpoint, and from the animal studies that have been completed to date, likely anti-inflammatory supplements, anti-oxidant supplements, and supplements that effect neurochemical processes will benefit people with Parkinson’s.
See a physician
If you’re considering taking a supplement, I’d encourage you to find a naturopathic physician or nutrition expert who can counsel you with good brands and drug/supplement interaction. They can help you determine the right dose for you. They can test your blood to find out what deficiencies you might have. I wouldn’t recommend taking supplements just to take supplements. But in some cases, especially if you have chronic inflammation, they might help.
- Reddy, MB and Love, M. The impact of food processing on the nutritional quality of vitamins and minerals. Adv Exp Med Biol. 1999;459:99-106. PMID:10335371
- Davis, DR, et al. Changes in USDA Food Composition Data for 43 Garden Crops, 1950-1999. Journal of the American College of Nutrition, Vol. 23, No. 6, 669–682 (2004).
- Ginde, A.A. et al. Demographic Difference and Trends of Vitamin D Insufficiency in the US Population, 1988-2004. JAMA Internal Medicine. Vol 169, No. 6.
- Parkinson Study Group QE3 Investigators, et al. A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol. 2014 May; 71(5):543-52. doi: 10.1001/jamaneurol.2014.131. PMID:24664227.
- Shults, C.W. et al. Effects of Coenzyme Q10 in Early Parkinson Disease Evidence of Slowing of the Functional Decline. JAMA Neurology. Arch Neurol.2002;59(10):1541-1550