Parkinson's disease (PD) is a well known neurological disease that is the result of damage to the nerves in the area of the brain that is responsible for controlling muscle tension and movement - the basal ganglia. The damaged cells are the ones needed to produce the neurotransmitter called dopamine. PD affects about 500,000 people in the United States. While conventional drugs can ease the symptoms of PD, they do not slow the course of the disease. However, recently coenzyme Q10 has been shown to accomplish this goal
What are the signs and symptoms of Parkinson's Disease?
The disease usually begins as a slight tremor of one hand, arm, or leg. In the early stages the tremors are more apparent while the person is at rest, such as while sitting or standing, and are less noticeable when the hand or limb is being used. A typical early symptom of PD is "pill-rolling," in which the person appears to be rolling a pill back and forth between the fingers. As the disease progresses, symptoms often get worse. The tremors and weakness affect the limbs on both sides of the body. The hands and the head may shake continuously. The person may walk with stiff, shuffling steps. In many cases, the disease causes a permanent rigid stooped posture and an unblinking, fixed expression.
What causes Parkinson's Disease?
The cause of Parkinson's disease is unknown, but it is thought that exposure to neurotoxins cause oxidative damage to the area of the brain that controls muscle tension and movement - the basal ganglia. In the oxidative damage model, oxidation reactions lead to the generation of free radicals that are capable of destroying the cell membranes and nerve cells. Some of the neurotoxins implicated include certain organochlorine insecticides (e.g., lindane and dieldrin).1,2 A diet that avoids pesticides and pesticide residues as well as a diet rich in antioxidant compounds that help protect against the damaging effects of these compounds is an important preventive measure for PD.
What Treatments are Available for Parkinson's Disease?
At this point in time, PD is best treated with drug therapy along with key dietary, nutritional, and herbal recommendations can be used to enhance the effectiveness of drug therapy. The most popular drug used is Sinemet(r) - a drug that contains two key ingredients: levodopa and carbidopa. Levodopa, or L-dopa, is the "middle step" in the conversion of the amino acid tyrosine into dopamine. L-dopa, but not dopamine (DA), crosses the blood-brain barrier. Carbidopa is a drug that works by ensuring that more L-dopa is converted to dopamine within the brain, where it is needed, and not within the other tissues of the body. Other drugs used include Eldepryl(r) (selegiline or deprenyl), bromocriptine, and amantadine.
These drugs are often effective at reducing symptoms, but because they fail to address the underlying disease process and degeneration of the basal ganglia it means that the drugs provide only temporary benefit. Clearly, the use of drug therapy to deal with the symptoms while attempting to treat the cause with natural products is the most rationale approach. Before discussing some key supplements for patients with PD, it is first important to point out that the value of a low protein diet in enhancing the action of L-dopa therapy has been demonstrated in several clinical studies and is now a well-accepted supportive therapy. The usual recommendation is to eliminate good sources of dietary protein from breakfast and lunch (i.e., keep daytime protein intake below 7 grams). This simple recommendation can offer an effective method for the reduction of tremors and other symptoms of Parkinson's disease during working hours.
What nutritional supplements should I take for Parkinson's Disease?
As I have previously described in other newsletters, I am a firm believer in building a strong foundation. In that goal, there are three key dietary supplements that I recommend:
As far as a specific supplements to address PD, I would recommend coenzyme Q10, ginkgo, and phosphatidylserine.
How is Coenzyme Q10 of Benefit in Parkinson's Disease?
CoQ10's role in the human body is similar to the role of a spark plug in a car engine. Just as the car cannot function without that initial spark, the energy producing units of the cell - the mitochondria - cannot function without CoQ10. While there is a growing list of conditions aided by CoQ10, most of the clinical research has focused on its ability to improve heart function. In fact, over 20 double-blind studies have shown CoQ10 supplementation improves heart function by increasing energy production in the heart muscle and by acting as an antioxidant.
Although the body makes some of its own CoQ10, considerable research shows significant benefits can occur with supplementation especially in people with low CoQ10 levels. How does this related to PD? People with PD have been shown to have low CoQ10 levels. Without the CoQ10, the cells of the basal ganglia become very susceptible to damage by circulating toxins.3
In addition, by improving the function of mitochondria, the "powerhouses" that produce energy in cells, CoQ10 helps provide the brain cells the energy necessary for proper function. Through this effect CoQ10 has been shown to be quite helpful to PD patients. To illustrate this benefit, let's take a look at the most recent study.4 All of the patients had the three primary features of PD - tremor, stiffness, and slowed movements - and had been diagnosed with the disease within 5 years of the time they were enrolled. After an initial screening and baseline blood tests, the patients were randomly divided into four groups. Three of the groups received CoQ10 at three different doses (300 mg/day, 600 mg/day, and 1,200 mg/day), while a fourth group received a matching placebo for 16 months. The group that received the largest dose of CoQ10 (1,200 mg/day) displayed a percent less decline in mental function, motor (movement) function, and ability to carry out activities of daily living, such as feeding or dressing themselves. The greatest effect was on activities of daily living. The groups that received 300 mg/day and 600 mg/day developed slightly less disability than the placebo group, but the effects were less than those in the group that received the highest dosage of CoQ10. These results indicate that the beneficial effects of CoQ10 in PD are achieved at these higher dosages. No significant side effects were seen in any of the patients.
Why is Such a High Dosage Necessary?
It may not be if CoQ10 is used along with other antioxidants or if more bioavailable forms are used. Scientists have known for quite some time that antioxidant could theoretically prevent or slow down the progression of PD. Several studies have shown quite clearly that high dietary intakes of antioxidant nutrientsare associated with a lower risk of developing PD.5 In addition, patients with early Parkinson's disease given 3,000 mg of vitamin C and 3,200 IU of vitamin E each day for a period of seven years fared better than the placebo group.6 Although all patients eventually required drug treatment, the patients receiving the vitamins were effectively able to delay the need for medication for up to 2 to 3 years longer. These results were quite promising, but a 10-year study with vitamin E only at a daily intake of 2,000 IU failed to show any real benefit in slowing or improving the disease.7
The failure of vitamin E alone reflects a major shortcoming of many intervention studies with antioxidants - researchers often focus on the effects of just one antioxidant. The problem is that these antioxidants do not work as single agents, instead they work as part of a system. Studying a single antioxidant, in a way, is like judging an entire symphony by listening to a single trombone. Such research has its value, but it's not complete and often raises more questions than it answers. It seems that many researchers become too focused on the tree instead of looking at the forest because they fail to understand the importance of the way that individual antioxidants interact within the entire antioxidant system of the human body to produce their benefits.
Mounting scientific evidence confirms that a combination of antioxidants will provide greater protection than any single nutritional antioxidant. The reason that I continually stress the importance of a strong foundation (MultiStart, Enriching Greens, and RxOmega-3 Factors) is to provide full-spectrum support. This foundation enhances the effectiveness of any specific natural product, whether it is glucosamine sulfate, ginkgo, or coenzyme Q10.
So, lack of supporting antioxidants may be a reason that vitamin E at high dosages alone was not effective. It may also be that vitamin E may not be the right antioxidant because it does not easily cross the blood-brain barrier. In one study, giving people a daily dosage of 4,000 IU of vitamin E did not raise the vitamin E level in the brain.8 In contrast, it appears that CoQ10 gets into the brain and provides more meaningful antioxidant protection to the brain than vitamin E.
Vitamin E is important to the action of CoQ10, however, because it is used to convert CoQ10 to its most active form. I believe that ultimately the dosage of CoQ10 required to provide benefit will be lowered because of the synergistic effects of other antioxidants. I also believe that the dosage of CoQ10 can be lowered by using formulas that enhance the absorption. To get the most benefit from CoQ10, look for products in soft-gelatin capsules with rice bran oil or, better yet, look for products where the CoQ10 has been dissolved in pure natural vitamin E (e.g., Clear Q from Natural Factors). In this latter form, both the CoQ10 and vitamin E are biologically enhanced due to increased absorption, utilization, and function. In a preliminary study, blood levels of CoQ10 at six hours after taking CoQ10 dissolved in pure vitamin E produced an increase that was 235% greater than the increase achieved with standard CoQ10. So, with improved absorption the dosage required may be lower.
What Else May Be Useful for Parkinson's Disease?
Ginkgo biloba extract (GBE) may also be helpful. In a one-year open trial of 25 patients with Parkinson's disease and additional signs of Alzheimer's disease, GBE was shown to produce significant improvement in brain wave tracings.9 These improvements were thought to signify improved brain metabolism. Obviously that is an important goal.
Phosphatidylserine is also an important supplement for patients with PD. Phosphatidylserine is the major fatty substance in the brain where it plays a major role in determining the integrity and fluidity of cell membranes. Normally the brain can manufacture sufficient levels of phosphatidylserine, but there is evidence that insufficient production in the elderly may be linked to depression and/or impaired mental function in the elderly. Good results have been obtained in numerous double-blind studies where phosphatidylserine supplementation has been shown to improve mental function, mood, and behavior in elderly subjects including those with early stages of Alzheimer's disease and Parkinson's disease.10
Summary of Supplement Recommendations for Parkinson's Disease:
- MultiStart - follow dosage recommendations on label.
- Enriching Greens - two serving daily.
- RxOmega-3 Factors - two capsules twice daily.
- ClearQ - 2 capsules daily (provides 100 mg CoQ10 and 800 IU vitamin E).
- CoEnzyme Q10 - 1,000 mg (Natural Factors provides a 200 mg CoQ10 capsule)
- Ginkgo biloba extract (GBE) - 420 mg.
- Phosphatidylserine - 300 mg daily
Parkinson's disease (PD) is a well known neurological disease that is the result of damage to the nerves in the area of the brain that is responsible for controlling muscle tension and movement - the basal ganglia. The damaged cells are the ones needed to produce the neurotransmitter called dopamine. PD affects about 500,000 people in the United States. While conventional drugs can ease the symptoms of PD, they do not slow the course of the disease. However, recently coenzyme Q10 has been shown to accomplish this goal 