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
Key References:
- Corrigan FM, Wienburg CL, Shore RF, et al. Organochlorine insecticides
in substantia nigra in Parkinson's disease. J Toxicol Environ
Health 2000;59:229-34.
- Ritz B, Yu F. Parkinson's disease mortality and pesticide exposure
in California 1984-1994. Int J Epidemiol 2000;29:323-9.
- Beal MF. Mitochondria, oxidative damage, and inflammation in
Parkinson's disease. Ann N Y Acad Sci. 2003;991:120-31.
- Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10
in early Parkinson disease: evidence of slowing of the functional
decline. Arch Neurol 2002;59(10):1541-50.
- de Rijk MC, Breteler MM, den Breeijen JH, et al. Dietary antioxidants
and Parkinson disease. The Rotterdam Study. Arch Neurol 1997;54:762-5.
- Fahn S. A pilot trial of high-dose alpha-tocopherol and ascorbate
in early Parkinson's disease. Ann Neurol 1992;32:S128-32.
- Shoulson I. DATATOP: a decade of neuroprotective inquiry. Parkinson
Study Group. Deprenyl And Tocopherol Antioxidative Therapy Of
Parkinsonism. Ann Neurol 1998;44:S160-6.
- Vatassery GT, Fahn S, Kuskowski MA. Alpha tocopherol in CSF
of subjects taking high-dose vitamin E in the DATATOP study. Parkinson
Study Group. Neurology 1998;50:1900-2.
- Youdim KA, Joseph JA. A possible emerging role of phytochemicals
in improving age-related neurological dysfunctions: a multiplicity
of effects. Free Radic Biol Med 2001;30(6):583-94.
- Funfgeld EW, Baggen M, Nedwidek P, et al. Double-blind study
with phosphatidylserine (PS) in parkinsonian patients with senile
dementia of Alzheimer's type (SDAT). Prog Clin Biol Res 1989;317:1235-46.
Michael T. Murray, N.D., is widely regarded as one of world's leading authorities on natural medicine. A prolific author, Dr. Murray has written over 20 books on health and nutrition including the best-selling Encyclopedia of Natural Medicine and his latest book The Encyclopedia of Healing Foods. Dr. Murray is also Director of Product Development and Education for Natural Factors one of the leading manufacturers of natural products.
