Program Update

Starting a Parkinson’s Program

Once the conceptual door is opened to the possibility of nutritional and antioxidant therapy for Parkinson’s disease, there are many options to chose from. My personal program consists of several dozen supplements. There are so many options, in fact, that it is easy for the average person to become paralyzed by the sheer number of choices. It is one thing to recognize that Parkinson’s disease is a neurodegenerative disease precipitated by oxidative stress, but it’s something else to specify what one should do to lessen or prevent that stress, and in which order one should try one’s options. What is the saying? “The Devil is in the details?”

The body’s antioxidant defense system is extremely complicated. One of its strengths (and complications) is its adaptability. When stressed, the antioxidant defense system adapts by increasing some mechanisms and/or decreasing others. When it is undermined, as it is in Parkinson’s disease, it is not only necessary to combat the increased oxidative stress, but to decreasing the stress in a manner that does not complicate the adaptations of the antioxidant defense system.

A good example of this problem is the use of deprenyl. Deprenyl has long-term neuro-protective properties that can be of immense benefit to those with Parkinson’s disease. However, deprenyl also increases mitochondrial energy production at the cellular level. This energy production has good and badpotential effects. On the good side, increased production of reducing agents (NADH, NADPH and FADH2) and ATP can improve the recycling of antioxidants and assist the antioxidant defense system. On the bad side, enhanced mitochondrial function can increase superoxide free radicals and aggravate oxidative stress, further burdening the antioxidant defense system.

Although not every Parkinson’s patient will experience such an adverse reaction to deprenyl, those who do can become disheartened and lose their will to pursue further therapy. Without an advance appreciation of such potential pitfalls, it is possible to lose the war in the first skirmish.

The most important concept to appreciate when undergoing therapy for almost any condition is that people are different. It is easy to see the superficial aspects of body shapes, hair, skin color, etc., but there are far more numerous and clinically important factors that lie beneath the skin. Some of these are psychological (i.e., the strength of our will, our spirituality, our emotional balance, our self-esteem and our love for other people in our lives). Some are metabolic (i.e., how much of how many antioxidants we’ve consumed, our vitamin/mineral nutrition reserves, our immune system activity, our hormone levels, our toxic burdens, etc.). These latter elements are generally termed “biochemical individuality.”

When one approaches a nutrition-and-antioxidant program, it is important to keep in mind that we are biochemically individual. My personal regimen (see SLN v6n4p1, and previously SDN v3n6p1) is not a blueprint for Parkinson’s disease treatment, but rather, an example of what worked for me. I offer it as an example to guide other people to help them find what will work for them.

Antioxidants First

Given the oxidative stress of Parkinson’s disease, you might be able to guess that I would say “start with the antioxidants.” Do what you can to contain the flames before you start feeding the fire.

Click here to view the Parkinson’s Pyramid sidebar.

The antioxidant defense system is composed of many categories of antioxidants. There are 1) dietary antioxidants (like vitamins C and E) that can be directly supplemented, 2) endogenous (internally manufactured) antioxidants (like glutathione peroxidase and catalase) which cannot be directly supplemented, 3) auxiliary antioxidants (like proanthocyanidins) that are not always reliably present in the diet that can be strongly augmented by supplementation, and 4) antioxidant cofactors (vitamins and minerals) that can easily be supplemented. The best place to start is probably the cofactors (vitamins and minerals), due to their extremely low cost and low-to-minimal toxicity. They may not be likely to cause dramatic improvement, but they are cheap insurance against possible nutritional deficiencies that might impair the recovery potential of other therapies.

People with cooperative doctors and financial resources can have nutritional assessment tests done to assist in “tuning” their basic vitamin-and-mineral supplement to known nutritional deficiencies. Those who do not have such resources can simply take a general supplement on faith.

An antioxidant that had an especially beneficial effect on me was Pycnogenol, a brand-name extract of pine bark which contains proanthocyanidins (a polyphenolic antioxidant) [grape-seed extract also contains proanthocyanidins and is generally more affordable]. I especially like Pycnogenol because it 1) is quite safe and well tolerated, 2) is normally only a minor dietary component, 3) greatly augments the antioxidant defense system, and 4) most importantly, it crosses the blood-brain barrier.

Another antioxidant which had a highly beneficial effect on me was lipoic acid. I was able to reduce my intake of Pycnogenol by half after adding lipoic acid to my program.

Digestion

After antioxidants, digestion should be checked. A good first step is to be tested for hydrochloric acid (stomach acid) to make sure that your digestion of proteins and absorption of minerals is up to par. Then, digestive enzymes should be checked. Enhancing digestion is good for the elderly (who are frequently impaired) and it is also recommended for people with food allergies (which I believe are common in people with Parkinson’s disease and other neurological disorders). Finally, one can cultivate beneficial intestinal microorganisms with probiotics (e.g., acidophilus, bifidus, etc.).

I now take betaine hydrochloride with my meals to increase my hydrochloric acid level, as well as a high-quality pro-biotic. Given the antibiotics that are used in so many of our meat products, everybody should probably be taking pro-biotics periodically.

Good digestion is not only important for proper assimilation of nutrients, it is also important for proper elimination. Constipation can be a major source of toxic chemicals that burden the brain, liver and kidneys.

Deprenyl

The next thing is deprenyl. The liquid deprenyl citrate remains a core part of my program. Not only does it raise dopamine levels, but it really does rejuvenate brain cells. You can stop the damage, I believe, with all of the vitamins, minerals, nutrients and antioxidants, but you can’t repair the brain without deprenyl.

Deprenyl can be tricky to implement in some people. One difficulty comes from deprenyl’s ability to stimulate dopamine, which can potentiate the effects of L-dopa (commonly prescribed as Sinemet). This can be minimized by the standard clinical practice of reducing the dose of Sinemet as deprenyl is added.

Another difficulty can arise from deprenyl’s ability to increase mitochondrial metabolism (cellular energy production). This increases ATP production (which is good) and can increase free radical (superoxide) “leakage” from the mitochondria (which is bad). This particular problem is the primary reason that it is good to start the antioxidants before the deprenyl. A similar upregulation of mitochondrial metabolism can occur with acetyl-L-carnitine (ALC).

Starting with a very low dose (2-3 mg) and working the deprenyl dose up slowly allows for a smooth adjustment to increased mitochondrial activity and the time to properly adjust Sinemet dosage in those taking medication. Increased tremor can indicate the need for additional antioxidants. It may be necessary to periodically re-adjust antioxidants as mitochondrial function is gradually restored to normal levels. A good understanding of mitochondrial function can help in balancing antioxidants. The importance of lipoic acid and coenzyme Q-10 must be emphasized in this respect. The bioavailability of the trace mineral manganese (Mn) may also be important. The SOD (superoxide dismutase) found in mitochondria uses manganese exclusively. The SOD found in the cell (outside the mitochondria) uses copper and zinc, not manganese.

Dealing with Tablets and Capsules

Everybody has some kind of attitude about pills. Some lucky people don’t mind them very much. Others may associate pills with illness. Pills may remind us of traumatic childhood experiences. Whatever our attitude towards pills, we need to take it into account when implementing an anti-Parkinson program, just like we would have to consider attitudes towards exercise when embarking on a fitness program. Even in people who do not mind pills, the sheer number required can become daunting.

The way I take pills has evolved over time. It has gotten easier. I used to put my tablets and capsules into bottles which I labeled with the times I was to take them (i.e., upon waking, breakfast, mid morning, lunch, afternoon, dinner, evening and before bed). If I went to get a batch and I found that I had missed the previous batch, I would take them both at that time. Anne is just barely past the stage of remembering to take them every morning and is working on spreading them out through the day.

My current strategy is to prepare my vitamins for two days at a time. I take 6 little bottles (usually the empty Pycnogenol bottles) and I label them morning, noon and evening (two of each). I then spread my daily dose between the bottles. For instance, I might put one vitamin E capsule in each of the three daily bottles. I take the alpha-lipoic acid only once a day, and I put that only in the morning bottle. The coenzyme Q-10 I put in the noon and evening bottle. I end up with about the same number of pills in each bottle.

Then I spread out the pills in the morning bottle all morning long, taking them in two or three separate doses. I’ll take part of the noon dose in the late morning, part before lunch, part after lunch and part early afternoon. Then I’ll pick up my evening bottle and start on that at about 4:00 and finish it off by 8:00 so that all day long I’m taking at least something.

Before I came up with this approach, I was taking a whole bunch in the morning and a whole bunch in the evening and my stomach felt overloaded. I didn’t feel I was getting the most benefit from it all. So now I take them all day long. And by setting up two days worth at a time, I don’t have to do the bottle loading-up process the next day.

I have the bottle in my hand or right next to me all day long, putting it in my purse if I go out. I also carry a bottle of water with me at all times. That way I don’t have to think about what I take and I spread it out better through the day.

Besides the bottles, I take two 5 mg Enada tablets first thing in the morning, Discovery-brand liquid deprenyl (3 mg after breakfast, 2 mg after lunch, 3 mg late afternoon, and 2 mg in the evening), and Sun Chlorella tablets in the evening (because the tablets are crumbly and tend to disintegrate when jostled around with other pills).

Anne’s program is looser than mine so far. She takes most of her vitamins right after or during breakfast along with betaine hydrochloride. She has substituted a multivitamin in the place of several of the things I am taking, but she still takes 2 mg deprenyl, 60 mg gingko, 200 mcg chromium, 100 mg alpha-lipoic acid, 100 mg coenzyme Q-10, 400 mg magnesium and 500 mg C (which she takes 3 times a day when she remembers).

Anne also substitutes grape-seed extract for Pycnogenol, and because she had a basal cell skin cancer she takes grape-skin extract and selenium. Anne and Steve buy bottled water and spike it with sodium selenite so that one quart of water provides 200 mcg of elemental selenium [at a Se cost of less than one cent per week].

Anne takes NADH in the late afternoon when she is starting to run out of steam. She chews up an oral tablet and holds it in her mouth for 10 minutes or so, swishing the saliva around to enhance sublingual absorption. She finds that she seems to get twice the mileage sublingually as she gets if she swallows them. She takes another one the same way in the evening if she gets chilled. Anne hasn’t yet started taking the more exotic things that I am taking.

Everything that I have on my program is there because I tried it and some area of my symptoms were lessened or I just felt better and when I went off them I got worse again. There are things which I tried that didn’t make any difference and I stopped taking them.

For a complete listing of what is currently in my program, you can refer to the sidebar in SLN v6n4p4. Good luck. And remember, keep a journal, drink lots of water, take your nutrients, use liquid deprenyl, and lower your stress.