Parkinson's Disease & Supplements: Benefits, Risks & Scientific Findings

Are you navigating the complex world of supplements for Parkinson's disease? In this episode of the Live Parkinson's - Live an Exceptional Life podcast, we cut through the hype and examine what the science actually says about dietary supplements and their potential impact on your Parkinson's journey. We delve into the evidence behind commonly discussed supplements, exploring their proposed benefits and potential risks, all grounded in scientific research.

In this episode, we'll cover:

• Unpacking the Rationale: Understanding why people with Parkinson's explore supplements, focusing on oxidative stress, inflammation, and mitochondrial dysfunction.
• Evidence-Based Insights: Examining the scientific studies on popular supplements like CoQ10, Creatine, Omega-3s, Vitamin D, and more.
• Clinical Trial Outcomes: Reviewing the results of key clinical trials – highlighting what the research truly shows (both positive, negative, and inconclusive).
• Gut Health & Probiotics: Exploring the emerging link between the gut microbiome and Parkinson's, and the potential role of probiotics and prebiotics.
• Navigating the Supplement Maze: Essential considerations including individualized approaches, potential drug interactions, quality and purity concerns, and red flags to watch out for.
• The Critical Role of Your Healthcare Team: Emphasizing why consulting your neurologist and other healthcare professionals is paramount.

Ready to make informed decisions about supplements and your Parkinson's care?

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Chapters

• 0:00 Introduction to Supplements and Parkinson's
• 5:14 Understanding Oxidative Stress in Parkinson's
• 8:36 Evidence-Based Decision Making Explained
• 10:49 CoQ10: Promises and Research Reality
• 16:22 Vitamin E and Vitamin C Effectiveness
• 29:01 Neuroprotective Agents and Research Findings
• 36:13 Gut Health and Probiotics Connection
• 43:05 Navigating Supplements Safely
• 46:24 Key Takeaways and Resources

Transcript

Speaker 1: 0:11

Whoa and welcome to Live Parkinson's. Live an Exceptional Life the podcast where we explore real life strategies, stories and science to help you live your best life with Parkinson's. I'm Chris Kastenbader and I've been walking my Parkinson's journey for 15 years. Today's topic is one where we're going to illuminate fact from fiction and provide you with science-backed information on products getting talked about a lot for Parkinson's, and that is supplements. So the title of today's episode is Parkinson's Disease and Supplements Benefits, risks and Scientific Findings.

Speaker 1: 0:45

Now we know that living with Parkinson's can be a constant search for answers. The internet seems to be buzzing with claims about supplements. Can a pill slow down Parkinson's? Are you wondering if that turmeric, coq10, or probiotic can make a difference? In this episode, we cut through the confusion and examine what the scientific studies actually reveal about supplements and Parkinson's management. So before we jump in feet, first let's set the stage for what we'll be discussing in this episode. First, we'll lead it off with understanding Parkinson's and the role of nutrition in helping us manage the disease, because this will help us understand why people are evaluating or taking supplements as part of their Parkinson's medication regimen and if they can be beneficial. Then it's time to focus on examining the evidence for specific supplements and provide the science on their effectiveness, benefits and risks relating to Parkinson's. In segment one, we'll evaluate the antioxidant, coq10, vitamin E and vitamin C, and then in segment two, we'll just we'll focus on neuroprotective agents like creatin and some of the uric acid precursors as examples, and then in segment three, we'll explore gut health and probiotics. We'll look at some of the most commonly used supplements in this category and then, in segment four, we'll discuss some other commonly used supplements, including vitamin D and omega-3 fatty acids. Then we'll roll into discussing how to navigate the supplement landscape, including the importance of individualized approaches, potential risks and interactions. We'll talk about quality and purity, concerns, red flags and misinformation and the critical role your healthcare provider plays. Then we'll close it out with key takeaways and future directions. So if you want to understand more about supplements, I hope you'll join me on this podcast.

Speaker 1: 2:38

Now, before we get too deep into supplements for Parkinson's, I just have a brief disclaimer. The information being provided in this episode is for educational purposes only and does not constitute medical advice. It is based solely on my research and the available science on supplements and their use in Parkinson's management. Please consult your health care provider for any questions or before taking any supplements. They'll provide you with the information on whether supplements are appropriate for you and your specific needs. All right, so if you're ready, let's get going Now.

Speaker 1: 3:14

Let me ask you a non-judgmental question. Do you take any supplements because you've heard it helps you manage your Parkinson's symptoms? If so, how familiar are you with the benefits and risk of taking the supplement, and do they actually work? Now, the reason I ask this question is we're all looking for ways to help us improve our motor and non-motor symptoms. Supplements are one of the hot topics in chats and other places on the internet, but how do we know if the information is accurate and reliable? You often see terms like clinically reviewed, clinically evaluated, natural, but what do these terms actually mean? That's what we'll be sharing in this episode to help you identify fact from hype by having a better understanding about the science and research behind the most common and popular supplements being recommended for Parkinson's.

Speaker 1: 4:10

Now I think it's important to first understand Parkinson's and the role that nutrition plays. As we all know, parkinson's is a neurodegenerative process that is due to the loss of dopaminergic neurons or the brain cells that produce dopamine, and dopamine is a neurotransmitter which is important in movement and motor control. So, as those neurons die, motor and non-motor symptoms may occur. So why are supplements being explored for Parkinson's? The interest stems from the understanding that several key cellular and molecular processes go awry in. Parkinson's is characterized by the progressive loss of dopamine-producing neurons in the area of the brain called the substantia nigra. So this loss of neurons is believed to be significantly driven by increased oxidative stress. So what is oxidative stress? Well, oxidative stress occurs when there is an imbalance between the production of harmful free radicals, so these are molecules that can go around and damage your cells and our body's ability to neutralize them with antioxidants. So these free radicals can damage some of our cellular components, like our DNA, proteins and lipids, which a lot of times make up the cell membranes, and that can lead to the dysfunction of the neurons in the brain and cause cell death. So what's the connection with supplements to oxidative stress? Well, many of the supplements are explored for their antioxidant properties. The idea is that, by increasing the antioxidant capacity, these supplements might help to neutralize the free radicals and reduce oxidative stress damage to neurons and potentially slow down the neurodegenerative process. So some examples would include coenzyme Q10, or also known as CoQ10, vitamin E and vitamin C.

Speaker 1: 6:24

All right, the next is inflammation. Chronic inflammation in the brain, known as neuroinflammation, is becoming increasingly recognized as a significant contributor to the progression of Parkinson's. So what's the supplement connection? Well, certain supplements possess anti-inflammatory properties. By helping to regulate the inflammatory response in the brain, the supplements may help protect neurons and alleviate some Parkinson's symptoms. So examples of supplements in this category would include curcumin from turmeric, omega-3 fatty acids and certain flavonoids.

Speaker 1: 7:02

Another that people look to supplements for help with is mitochondria dysfunction. So if you recall from the deep recesses of your mind from high school biology class that the mitochondria are the powerhouses of the cell, so they're responsible for producing energy for the cells. Now in Parkinson's, there is evidence of mitochondrial dysfunction in affected neurons. So what does this mean? Well, this impaired energy production can lead to cellular stress and ultimately contribute to the cells dying. So what supplements are often considered? Some supplements are investigated for the potential support of mitochondrial function. For example, coenzyme Q10 plays a crucial role in the electron transport chain within the mitochondria. Creatin is also explored for its powerful and potential to enhance intercellular metabolic metabolism intercellular metabolic metabolism.

Speaker 1: 8:07

It's crucial to remember that, while the rationale for exploring supplements is grounded in the underlying pathology of Parkinson's, the scientific evidence supporting their efficacy is often limited, mixed or preliminary. So many studies have been conducted in cell cultures or animal models, and the results do not always translate to humans. Well-designed, large-scale clinical trials in humans are essential to definitively determine the benefits and risk of specific supplements for Parkinson's. Also because everyone experiences Parkinson's differently, what may show promise for one individual may not work for somebody else. So, while the biological rationale for exploring supplements is compelling, people with Parkinson's should always consult with their neurologist or movement disorder specialist before you start any new supplement regimen.

Speaker 1: 8:56

Now, before we move into looking at specific supplements, I wanted to touch on evidence-based decision making, because it's what we'll use to evaluate the effectiveness of specific supplements. So what exactly is evidence-based decision-making? Well, evidence-based decision-making in healthcare uses three components. The first is the best available research evidence. So this involves finding, evaluating and using the most relevant and rigorous scientific studies to inform our healthcare choices. Second is clinical expertise. This refers to the knowledge, skills and experience of healthcare professionals in diagnosing and managing patient conditions. It involves understanding the nuances of each individual case and applying research findings appropriately. And then the third part is patient values and preferences. So what this does is it acknowledges that each individual has unique values, beliefs and preferences that should be considered when making healthcare decisions. Now, what is acceptable or desirable for one person may not be for somebody else. So, in the context of supplements and Parkinson's, evidence-based decision-making means not relying solely on anecdotal evidence, personal testimonies or marketing claims. Instead, it emphasizes looking at what well-designed scientific studies have actually found regarding the potential benefits and risks of specific supplements for individuals with Parkinson's.

Speaker 1: 10:34

All right, let's turn our attention now to looking at specific supplements that are being used for, and promoted for, parkinson's, and we'll lead it off with antioxidants, and we'll start with coenzyme Q10. That's one that most people heard about. So what is CoQ10? Well, it's a vitamin-like substance that plays a crucial role in cellular energy production, particularly within the mitochondria, which we just talked about earlier. Now, coq10 helps convert food into adenosine triphosphate and again, if you think back to high school biology and that may scare a lot of people but it's the primary source of energy for all our cellular functions, and it's also known as ATP. It's also a potent antioxidant. Antioxidants help protect cells from damage from free radicals, which are unstable molecules that harm cell membranes or DNA in our protein.

Speaker 1: 11:34

Now we mentioned earlier that oxidative stress is believed to be involved with Parkinson's. So the rationale in using CoQ10 for Parkinson's is twofold. First is its antioxidant properties. So by acting as an antioxidant, coq10 may help neutralize the excess free radicals present in the brain of people living with Parkinson's. So this could potentially reduce the oxidative stress damage to dopamine producing neurons and slow down their degeneration. Dopamine-producing neurons and slow down their degeneration. And that's, according to the study, the effect of neuronal CoQ10 deficiency and mitochondrial dysfunction on retinone-induced neurons cell model of Parkinson's disease. That was published in the International Journal of Molecular Sciences and that was definitely a mouthful. Now the second reason for potential use of CoQ10 is mitochondrial support. Now, with evidence of mitochondrial dysfunction in Parkinson's, coq10's role in energy production within the mitochondria suggests that it might help improve the cellular energy metabolism and the affected neurons, making them more resilient to stress. So the thought is that CoQ10 can help keep the energy production going and help those neurons survive the stress of oxidation from free radicals.

Speaker 1: 13:01

Now a review of key studies and findings on research on CoQ10 for Parkinson's has yielded mixed and largely disappointing results from well-designed clinical studies. There was a study called the QE2 trial and that was an earlier phase 2 trial and it showed some signals of slower functional decline in individuals with early Parkinson's who received high doses of CoQ10, which were 600 to 1,200 milligrams a day over 16 months, compared to placebo. So the results of this study generated initial optimism that this supplement could be beneficial. Now some open-label studies in smaller trials Now open-label refers to studies that participants know what medication that they're going to be taking and those smaller trials in the open-label studies suggested potential benefits in motor function and slowing the disease progression with CoQ10 supplementation. Now the ubiquinol study, which was a pilot study using the reduced form of CoQ10, suggested potential benefits in those wearing off effects from levodopa, but not in early untreated Parkinson's.

Speaker 1: 14:16

Now, while these studies seem to show promise, there are larger clinical studies with negative and inconclusive data. So let's take a look at these now. Now this data is from larger, more definitive trials the QE3 trial, which was a Phase III study, which was a large multicenter Phase III trial and it was sponsored by the National Institutes of Health, and what it did is it tested higher doses of CoQ10, up to 2,400 milligrams a day in individuals with early Parkinson's disease over a 16-month period, and the study was actually halted prematurely because it showed no clinical benefit in slowing disease progression compared to placebo. And then the NET-PD trial. Another large trial also tested high doses of CoQ10, 2,400 milligrams per day and found no significant decrease in disease progression compared to placebo. So, based on this data, let's summarize what the current consensus is with using CoQ10 as a primary treatment for Parkinson's. So, based on the evidence from large, well-controlled clinical trials, the current consensus is that high-dose CoQ10 supplementation has not been shown to provide a significant benefit in slowing the progression of Parkinson's disease or significantly improving its symptoms. The promising signals from earlier small studies were not confirmed in the more rigorous Phase 3 trials. While CoQ10 is generally considered safe and well-tolerated at the doses used in these studies, the lack of demonstrated clinical efficacy for Parkinson's does not currently support its routine use as a disease-modifying agent. So, to conclude, the current recommendation is that individuals with Parkinson's should discuss the use of CoQ10 with their neurologist.

Speaker 1: 16:17

All right, now let's look at the data on our next antioxidant supplement, vitamin E. Now, most of us have all heard of vitamin E, but what is it? Vitamin E is a group of fat-soluble compounds, meaning that it'll mix and dissolve into fat and therefore can be stored in our bodies. It's a potent antioxidant and the most biologically active form in humans is alpha-tocopherol. So what does that mean? Well, it means that vitamin E is an meaning that our bodies cannot produce it. So we need to get in our diets through such type of foods like nuts, seeds and vegetable oils and leafy greens, or through supplementation by taking vitamin E supplements. Now, vitamin E acts as a major chain-breaking antioxidant in cell membranes, which protects them from damage caused by what they call lipid perioxidation. Protects them from damage caused by what they call lipid perio-oxidation, which is a process where free radicals attack the lipids or fats and that causes cellular damage.

Speaker 1: 17:21

Now let's look at the theoretical basis for combating oxidative stress in PD with vitamin E. Now, as we mentioned before, oxidative stress is a significant factor in the progression of Parkinson's. Vitamin E, being a powerful antioxidant, theoretically could help with helping to scavenge free radicals. It could directly neutralize reactive oxygen and other free radicals, preventing them from damaging cell components. Another theoretical thought is that they can help protect the neural membranes. Vitamin E could help maintain the integrity and function of neuron cell membranes so that they don't become stressed and die off. So, given the rationale that vitamin E has been investigated as a potential neuroprotective agent in Parkinson's.

Speaker 1: 18:19

Let's review some of the key studies and findings Now. The research on vitamin E supplementation in Parkinson's has shown mixed results and let's look at some of these key studies Early observational studies and these were some early epidemiological studies, and they suggested an inverse association between dietary intake of vitamin E and the risk of developing Parkinson's. So what does that mean? It means that individuals with higher dietary vitamin E intake appeared to have a slightly lower risk. However, these studies could not establish a causal relationship, meaning that they couldn't say that because they were taking the vitamin E, that this caused a slightly lower risk of Parkinson's.

Speaker 1: 19:01

Now the DATATOP or Deprinil and Tocopherol Antioxidative Therapy of Parkinson's Trial was a large multicenter placebo-controlled double-blind trial that investigated the effects of both Deprinil or Selegiline and high-dose alpha-tocopherol and remember, that's one of the potent forms of vitamin E and they used 2,000 international units per day in early untreated Parkinson's patients. And the findings from this study showed that both Deprinil and alpha-tocopherol treatment groups reached the primary endpoint, or the need for levodopa therapy, significantly slower than the placebo group. So this suggested a potential disease-modifying effect. So this suggested a potential disease-modifying effect. Now, while the initial results were initially promising. Subsequent long-term follow-up of the DataTop cohort studies showed that the apparent benefit of alpha-tocopherol did not persist over many years. Additionally, the very high dose used in the study the 2,000 international units per day raised some concerns about the potential long-term safety of using that high dose.

Speaker 1: 20:24

Subsequent studies and meta-analysis there were several studies, smaller studies and meta-analysis that have investigated the effects of vitamin E supplementation on Parkinson's symptoms and disease progression with various doses. Let's look at the mixed results first. Some studies showed modest improvement in certain motor or non-motor symptoms, while others found no significant benefit compared to placebo. No significant benefit compared to placebo. So, based on the studies dietary vitamin E intake and risk of Parkinson's disease, a cross-sectional study published in Nutrition, psychology and Brain Health, and that study showed some inconclusive data with vitamin E studies. Many of the studies were limited by small sample sizes, short durations and inconsistencies in the vitamin E studies. Many of the studies were limited by small sample sizes, short durations and inconsistencies in the vitamin E formulations and dosages that were used. So it makes it hard to draw conclusions on the effectiveness of vitamin E in those studies. And then, finally, there were potential safety concerns with the high doses of vitamin E.

Speaker 1: 21:32

Some of the research has raised concerns about the potential risk of long-term supplementation with very high doses of vitamin E, including an increased risk of hemorrhagic stroke and potentially prostate cancer in men, although that evidence for this is debated. So this information comes from the article what are the Risks of Taking Too Much Vitamin E by Dr Sherilyn Davies, md. Okay, let's look at the current consensus on vitamin E use in Parkinson's. So, based on the available evidence, there's no current consensus to use high-dose vitamin E supplementation as a standard treatment for Parkinson's. The initial promise from the DATATOP trial did not hold up in the long term. Additional studies have shown inconsistent results, with many showing no significant clinical benefits. And then there was the concern with the potential long-term risk associated with the high-dose vitamin E supplementation, and they say that that may warrant some caution. And the reason for that is because vitamin E is a fat-soluble vitamin and if too much of it, you can store. However, eating a diet rich in vitamin E through foods generally as part of a healthy lifestyle for overall well-being is recommended. Lifestyle for overall well-being is recommended. So, to summarize, while the theory behind using vitamin E to combat oxidative stress in Parkinson's is sound, the clinical evidence to support regular use as a supplement for its therapeutic benefits is lacking, so future research is needed to determine if vitamin E might play a role in managing Parkinson's. So people with Parkinson's should discuss their dietary and any interest in vitamin E supplementation with their health care provider. I hope you're hanging in there with me now, because some of this does get a little bit technical.

Speaker 1: 23:28

And then next up is the antioxidant. Vitamin C is the antioxidant vitamin C, and most of us are all familiar with vitamin C, and we all might have heard of it and or taken it at some point or still be taking it. So what is vitamin C and what does it do? Well, vitamin D is also known as ascorbic acid and is an essential water-soluble vitamin, meaning that if you take too much of it, since it's water-soluble, you're just going to pee it out. Now our bodies can't produce vitamin C, so we need to get it from our diet, mostly from fruits and vegetables like citrus fruits, berries, peppers and broccoli.

Speaker 1: 24:06

And vitamin C is involved in a lot of processes in our bodies, including antioxidant activity. Vitamin C is a potent antioxidant helping to neutralize harmful free radicals both inside and outside the cell. And vitamin C helps us make collagen, which is a protein vital for our connective tissues and our blood vessels, and it's also involved in wound healing. Vitamin C also supports various immune system functions. And vitamin C helps us with the absorption of iron from plant-based foods. Finally, vitamin C is involved in the production of certain neurotransmitters, including norepinephrine, which helps play a key role in our body's response to stress and arousal. It helps regulate attention, focus, heart rate and blood pressure. Now you might remember from they talked about the early sailors coming over and not getting enough vitamin C and they developed a condition called scurvy and a lot of sailors died from that.

Speaker 1: 25:11

So let's take a look at why vitamin C might be a good candidate theoretically for combating oxidative stress in Parkinson's. Now, vitamin C's potent antioxidant properties make it a logical candidate for potentially helping to combat oxidative stress damage in Parkinson's. The theory is, by increasing the levels of vitamin C in the brain and the body, it might help to scavenge free radicals, which can again damage our cells and protect neurons and then shield vulnerable dopamine-producing neurons from oxidative damage. All right, so let's review some of the key studies and the findings with vitamin C Scientific data on vitamin C supplementation in Parkinson's is the key studies and the findings with vitamin C.

Speaker 1: 25:53

Scientific data on vitamin C supplementation in Parkinson's is somewhat limited and the findings have been mixed and inconclusive. So let's look at what studies are available using vitamin C for Parkinson's. There were some observational studies and these included epidemiological studies that have explored the association between dietary intake of vitamin C and the risk of developing Parkinson's. Now some of these studies have suggested a potential inverse relationship and association, meaning the higher the dietary intake of vitamin C might be linked to a lower risk of the disease. However, these studies cannot prove cause and effect, so you can't say that because you took more vitamin C, that you have a reduced risk of having Parkinson's. They only show a correlation.

Speaker 1: 26:46

Now let's look at some of the clinical trials and interventional studies that were conducted with vitamin C and interventional studies that were conducted with vitamin C. Actually, there have been relatively few well-designed clinical trials specifically investigating the effects of vitamin C supplementation on Parkinson's disease symptoms or progression, starting with the inconclusive, limited data. Positive signals from smaller, older studies on combining vitamin C with other antioxidants have shown modest or inconsistent benefits in certain aspects of Parkinson's, such as motor function or levodopa-induced dyskinesias. There were some small studies that included small sample sizes, lack of proper placebo control, making it difficult to isolate vitamin C's impact alone. And now let's look at some of the negative findings with vitamin C. Several studies, including large prospective cohort studies, did not find a significant association between vitamin C intake and a reduced risk of Parkinson's or a slower rate of disease progression.

Speaker 1: 27:56

All right, let's provide a summary, then, of the use of vitamin C. Currently, there is no strong scientific consensus supporting the routine use of high-dose vitamin C as a primary treatment or as a disease-modifying agent for Parkinson's. While vitamin C is an essential nutrient with important antioxidant properties and it plays a role in our overall health, the evidence from well-designed clinical trials does not convincingly demonstrate significant benefits in preventing or slowing disease progression in Parkinson's. So again, people with Parkinson's should focus on evidence-based treatments prescribed by their neurologist, along with a healthy diet. So if you're considering vitamin C supplementation, again consult with your healthcare provider to see if it's appropriate for your specific needs.

Speaker 1: 28:50

All right, now that we've examined antioxidants, let's move into our next segment, on neuroprotective agents, and let's discuss and evaluate the most commonly used commercially available supplements in this category. While a definitive neuroprotective supplement for Parkinson's hasn't been established in large clinical trials, several commercially available supplements are explored for their potential slow-down or halt disease progression by targeting the key pathways or pathological mechanisms. Now let's take a look at a few, and we'll lead it off again with CoQ10. Now we discussed this supplement when we discussed oxidative stress and we talked about it as an antioxidant. Now recall it's a crucial component for cellular energy production and it's also, again, a potent antioxidant helping to get rid of free radicals and protecting against oxidative stress. Our next neuroprotective supplement we're going to talk about is creatine, and creatine plays that role in energy metabolism, particularly in high-demand tissues like your brain. It may also have antioxidant and neuroprotective properties by reducing oxidative stress and potentially inhibiting mitochondrial dysfunction.

Speaker 1: 30:10

Now preclinical studies in animal models in Parkinson's showed some neuroprotective effects, but then clinical trials in humans with Parkinson's have yielded mixed results. Some smaller studies suggested potential benefits in slowing disease progression and improving motor symptoms, while larger trials have been less conclusive. Trials have been less conclusive. Now a large clinical trial NETPD-LS1, investigating creatin in early untreated Parkinson's patients, did not show a significant slowing of clinical progression over five years. So what are the outcomes? Current evidence from large clinical trials doses strongly support creatinine as a disease-modifying agent in Parkinson's. Potential benefits include creatinine have some symptomatic benefit, but robust neuroprotective effects have not been confirmed. Protective effects have not been confirmed. Potential risks Generally considered safe for most people at recommended doses. Some people may experience mild gastrointestinal issues or water retention, so it's important to talk to your doctor before you decide to start taking creatinine.

Speaker 1: 31:30

All right, now let's look at omega-3 fatty acids or fish oil. How do they work? Well, omega-3 fatty acids, particularly EPA, which is acosapentanoic acid, and DHA, docosahexaenoic acid, have anti-inflammatory and antioxidant properties. Now, they're crucial components of neurocell membranes and they may support overall brain health and function. Now, in terms of research, some observational studies have suggested a potential link between higher fish consumption and lower risk for Parkinson's. According to the study Omega-3 Fatty Acids and Neurodegenerative Diseases New Evidence in Clinical Trials that was published in the International Journal of Molecular Sciences, clinical trials investigating omega-3 supplementation in individuals with Parkinson's have generally shown limited or no significant impact on motor or non-motor symptoms or disease progression. So current clinical trial data does not support omega-3 fatty acids as a primary neuroprotective treatment for established Parkinson's disease. Now, potential benefits are that they may have benefits for overall cardiovascular health and brain health. Any potential risks Well, they're generally safe at recommended doses. Higher doses may cause gastrointestinal issues or interact with blood thinning medications.

Speaker 1: 32:59

Now moving on to vitamin D. Vitamin D is an essential nutrient that helps regulate calcium and phosphate in the body, keeping your bones, teeth and muscles strong, and it plays a role in immune function and overall well-being. Now you can get vitamin D in a few ways. One of the first ways is sunlight. Your skin produces vitamin E when exposed to sunlight, so if you just hop outside for just 10 to 30 minutes of direct sun exposure a few times a week, it can help your body to produce vitamin D, although you want to be careful when you use sunscreens as well, so you're not getting sunburned. Now, food sources like fatty fish, salmon, tuna, egg yolks, cheese and fortified foods like milk and cereal also contain vitamin D, and emerging research suggests it plays a role in brain health and immune modulation.

Speaker 1: 33:56

Lower vitamin D levels are frequently observed in individuals with Parkinson's, and some studies suggest a link between deficiency and disease severity. Observational studies have linked lower vitamin D levels to an increased risk and potentially faster progression of Parkinson's. Now, clinical trials supplementing vitamin D in Parkinson's patients have primarily focused on improving motor and non-motor symptoms, with inconsistent results. Now there's limited strong evidence that vitamin D directly impacts the underlying neurodegenerative process. While important for overall health, the current evidence does not definitively establish vitamin D supplementation as a neuroprotective agent in Parkinson's. However, maintaining adequate vitamin D levels is generally recommended due to its other health benefits. Potential benefits mood and potentially help with some of the non-motor symptoms. Potential risks it's generally safe at recommended doses. High doses can lead to toxicity, so it's important that you talk to your doctor about any vitamin D supplementation before you initiate that. All right. To summarize neuroprotective agents currently there is no commercially available supplement that has been definitively shown to have neuroprotective effects, and they're not routinely recommended for slowing Parkinson's disease. Based on clinical trial, data is strong and early studies seem to show promise, while the larger well-controlled placebo-controlled studies showed mostly negative or inconclusive results in terms of modifying disease progression. Now it's important to note that research is ongoing, and future studies with different dosages, formulations and combinations in specific patient subgroups may help to provide more definitive answers about whether supplements can help slow the progression of Parkinson's by helping to provide neuroprotection.

Speaker 1: 36:13

All right, now let's take a look at another category of supplements that are being used or promoted because of their benefit for gut health, and these include probiotics, which have gotten a lot of press lately, and let's start with commonly used supplements for gut health, which include both probiotics and prebiotics. Okay, now, most of us have heard the term probiotic and may even have taken some, but what are they exactly? Well, probiotics are live organisms, either bacteria or yeast, that are similar to the beneficial organisms naturally found in the human gut. They're often good or friendly bacteria, and common types include lactobacillus and bifidobacterium strains. Now, these are commercially available and they come in various forms, including capsules, powders and fermented products like yogurt and kefir. Probiotics are non-digestible food components, often types of fiber that selectively stimulate the growth or activity of beneficial bacteria that are already residing in our colon. Now, they essentially act as food for the good bacteria. So some examples would include inulin, frutiglyosaccharides and resistant starch, and they're available in powders or are naturally occurring in foods like onions, garlic, asparagus and bananas. Okay, so that begs the question why would we take these supplements for gut health to help with our Parkinson's symptoms? Well, recent research has shown that emerging link between the gut microbiome and Parkinson's. Now, the gut microbiome refers to the complex community of microorganisms, including bacteria, fungi and viruses and other microorganisms that live in our digestive tract as well as the digestive tract of animals. Now the gut microbiome is a diverse and dynamic ecosystem that plays a crucial role in various bodily functions, including digestion, nutrient absorption, immune system development and even brain health. Now the emerging link between gut microbiome and Parkinson's, which scientists call the gut-brain axis, is a rapidly evolving area of research.

Speaker 1: 38:34

Now let's look at the potential link between gut health and Parkinson's. First, gastrointestinal symptoms are often common in Parkinson's. Constipation is a great example. It's very common Non-motor symptoms that can often precede motor symptoms in Parkinson's by many years. Alternate gut mobility would be another example.

Speaker 1: 39:05

Pathology in the gut and alpha-synuclein is the protein that misfolds and clumps in the brains of people with Parkinson's, forming Lewy bodies, and has been found in the enteric nervous system, which is the nervous system of the gut. Now some researchers hypothesize that alpha-synuclein clumping might originate in the gut and then potentially spread to the brain via the vagus nerve. So kind of travel the highway of the vagus nerve up to the brain. And then inflammation in the gut is another factor. Now, believe it or not, the gut is a major site of immune activity. In fact, about 70% of the human immune system is located in the gut. So an imbalance in the gut microbiome called dysbiosis, can lead to increased intestinal permeability, which causes what they call leaky gut and triggers systemic and neuroinflammation, which we talked about earlier being a potential cause of Parkinson's. Now, these are just a few of the factors of the gut's protective role in the link between the gut microbiome and Parkinson's.

Speaker 1: 40:08

All right, now let's touch on the potential of using pre and probiotics in Parkinson's. With the emerging link between gut health and Parkinson's, the rationale for using pre and probiotics centers around the idea that helping the gut microbiome might have beneficial effects on Parkinson's by restoring the gut microbiome using probiotics, by introducing those beneficial bacteria Now, promoting the growth of beneficial bacteria with prebiotics and improving the gut environment might indirectly influence brain health through the gut-brain axis, potentially impacting neuroinflammation and the alpha-synuclein pathway that we just talked about. And then, finally, helping to alleviate GI symptoms with probiotics and prebiotics. Okay, so now that we understand the rationale for using pre and probiotics, let's look and see what the research says. Now it's important to note that research on probiotics and prebiotics in Parkinson's is still relatively early and many of the studies have been small and exploratory. Let's look at probiotics first. Now there may be some potential for symptom improvement. Now there may be some potential for symptom improvement.

Speaker 1: 41:26

Some studies have suggested that probiotic supplementation might lead to modest improvements in certain Parkinson's symptoms, particularly non-motor symptoms like constipation, disrupted sleep, anxiety and fatigue. Now, according to the article, probiotics may ease non-motor symptoms of Parkinson's. From UCLA Health, the doctors noted that the research is promising. However, it has not yet made the transition from the research phase to the therapeutic treatment phase. Now, each study used a unique blend of probiotics, none of which is commercially available. Next, some research has focused on specific strains of lactobacillus and Bifidobacterium, with varying results. The data is showing the effect of probiotics are likely strain-specific. Now, many of the studies have been small, with short duration, and have used different strains and dosages, making it difficult to draw potential conclusions.

Speaker 1: 42:24

So what's the current consensus in the use of pre and probiotics for Parkinson's? Well, currently there is no strong consensus to recommend pre and probiotics as a primary treatment for Parkinson's or as a proven way to slow disease progression. So, given the strong length between gut health and Parkinson's and the relatively safe profile of the probiotic and prebiotic supplements, they're an active area of research. So, for people with Parkinson's who have GI issues, discuss the potential use of pre and probiotics with your neurologist. It may be worthwhile, may help you with constipation and some other issues.

Speaker 1: 43:05

Now let's turn our attention to navigating the supplement landscape. The allure of potential benefits for managing Parkinson's symptoms can be strong, but it's crucial that we use caution, critical thinking and guidance of our healthcare professionals. Now here's some things to think about when you're considering using supplements. The first is individualized approaches. Now, the way we experience Parkinson's is different. Not everyone has the same experience. Our symptoms, disease progression and responses to treatment can vary significantly from person to person. So what might be helpful for one may have no effect or a detrimental effect on someone else. So the one-size-fits-all approach to supplements with Parkinson's is unlikely to be effective. So any use of supplements should be a personalized discussion with you and your doctor.

Speaker 1: 44:02

Next are the potential risks and interactions. Supplements are not without potential risks. They can interact with medications and other supplements and also some underlying health conditions as well. Drug interactions from supplements can occur from altering absorption, metabolism and excretion of prescription medications used to manage Parkinson's symptoms, and this can lead to reduced drug efficacy or increased side effects. For example, certain vitamins or minerals can interfere with levodopa absorption. Now, supplements can have side effects ranging from mild GI issues to more serious adverse events. High doses of certain vitamins or minerals can be toxic.

Speaker 1: 44:52

Now, another consideration is quality and purity concerns. The supplement industry is less regulated than the pharmaceutical industry. This can raise concerns with quality and purity of commercially available products. These can include variable ingredient amounts, especially with active ingredients. The presence of contaminants, mislabeling and their bioavailability are all other important factors that you need to take into consideration.

Speaker 1: 45:22

Choosing established, reputable brands can help reduce these concerns, though, so it's important to be aware of red flags and misinformation as well. There are a lot of unsubstantiated claims, and recognizing the red flags is essential. Be aware of miracle cures or guarantees. Now also testimonials. A lot of companies will use testimonials as a way to promote their products. Any anecdotal evidence can be compelling, especially when someone is sharing their personal story. Now, this may not represent every experience, and also be leery of when they use the term secret formula or proprietary blends. And then, finally, look for information based on scientific studies published in peer-reviewed journals. Be wary of claims without any supporting evidence. So it's crucial that you seek guidance from your healthcare professional before you start, because they can help you manage the supplement landscape and determine if they're appropriate for you. All right.

Speaker 1: 46:24

That brings us to the end of another important discussion, where we delved into the science behind supplements and Parkinson's. We've explored the theoretical promises of various nutrients and supplements and the often complex and sometimes inconclusive research findings and crucial considerations for navigating the supplement landscape. The key takeaway for today is that, while the idea of finding a simple supplement to halt or reverse Parkinson's is certainly appealing, the current research shows the need for caution and evidence-based approach. Remember, what you read online may not always line up with the rigorous scientific findings, and what works for one person may not work for another. Your journey with Parkinson's is unique and making informed decisions is going to be key. That's why we encourage you to take the next step in empowering yourself with reliable information.

Speaker 1: 47:21

Please visit liveparkinsonscom. It's a resource for navigating life with Parkinson's. There you can subscribe to the free monthly newsletter that's packed with the latest research and updates, practical tips and actionable information to help you on your Parkinson's journey. Or if you find value in the information that we share on this podcast and want to help continue bringing the in-depth discussions, please consider supporting me. You can visit ko-ficom slash liveparkinsons to contribute. Your support helps me cover some of the costs of producing the podcast and allows me to continue to provide evidence-based insights. Thank you for joining me today. Remember always consult with your neurologist or movement disorder specialist before starting any supplements. Until then, stay informed and empowered and remember you're not alone in this journey. So stay strong, stay healthy and live your best life with Parkinson's. Thank you so much for listening and I hope you join me on future podcasts.