David Perlmutter, MD
It has been estimated that in the United States and Canada more than 1.2 million people suffer from Parkinsonâ??s disease. That translates to about one to two cases per 1,000 individuals in the general population.
It has been estimated that in the United States and Canada more than 1.2 million people suffer from Parkinson’s disease. That translates to about one to two cases per 1,000 individuals in the general population. This prevalence increases dramatically when looking at the over-55 population, approaching one in 100.
It has long been recognized that the fundamental abnormality in Parkinson’s disease patients is a deficiency of the brain’s production of the neurotransmitter dopamine. In 1959 the first true therapeutic approach to treating the symptoms of Parkinson’s disease was proposed attempting to replace dopamine. This is the basis for the use of the dopamine derivative L-dopa (Sinemet®) in the treatment of Parkinson’s disease symptoms today. Unfortunately, while L-dopa therapy may help to temporarily reduce the symptoms of Parkinson’s disease, many scientific reports are now appearing in medical journals warning that L-dopa therapy may actually increase the production of brain-damaging free radicals. This may speed up the progression of the illness, causing patients to worsen more quickly.
During the 1990s, scientists learned that the fundamental flaw not allowing certain brain cells to produce dopamine in the Parkinson’s patient is a deficiency in the actual energetics of these cells. It is as if these cells are simply unable to produce the energy needed for normal activity. Incredibly, the most widely prescribed medication for Parkinson’s disease, L-dopa (Sinemet®), has been shown to actually lead to further compromise of the brain’s ability to produce energy. This further reduces the production of dopamine, again possibly worsening the disease.
The good news is research now shows that brain energy can be increased, having a positive effect on Parkinson’s disease. A variety of interventions designed to “jump start” lethargic brain cells are now available. And best of all, most of the research has involved nonpharmacological products, the most promising of which include coenzyme Q10 (CoQ10) and phosphatidylserine.
Coenzyme Q10 is present in all living cells, where it plays a critical role in cellular energy production. Energy deficiencies in specific parts of the brain can produce inadequate production of important brain chemicals. According to Dr. M. Flint Beal at the Massachusetts General Hospital, Parkinson’s disease patients demonstrate a profound deficiency of coenzyme Q10, which may explain why their brains produce an inadequate supply of dopamine.
The encouraging news from Dr. Beal’s research is that orally administered CoQ10 is readily absorbed, well tolerated, and measurably increases cellular energy production. These qualities, coupled with its profound antioxidant properties, likely explain why coenzyme Q10 has been shown to decrease the functional decline in Parkinson’s patients by a dramatic 47 percent. Finally, recognizing the importance of coenzyme Q10 makes it critical to identify any factors that may lower its availability. Unfortunately, “statin drugs,” the most commonly prescribed medicines for lowering cholesterol, can dramatically lower serum coenzyme Q10 levels.
PDF Table of Relative Levels of Coenzyme Q10 in Parkinson's Disease (PD) Patients and Controls
Phosphatidylserine is one of the key components of neuronal membranes–where brain cells both receive and transmit chemical messages. Enhancing chemical transmission is of obvious importance to treating Parkinson’s disease. Increasing phosphatidylserine may enhance the effectiveness of what little dopamine remains in Parkinson’s disease patients–helping to preserve brain function. The energy-producing mitochondria also rely upon a healthy membrane to carry out the function of energy production. Like the cellular membrane, the mitochondrial membrane requires adequate phosphatidylserine to maintain normal function.
It has been estimated that as many as 30 percent of Parkinson’s disease patients suffer from a progressive decline not only in motor function, but in cognitive ability. This further supports the inclusion of phosphatidylserine in treating Parkinson’s disease, since research supports its profound therapeutic potential in dementia. This was confirmed in a 1991 article in the journal Neurology, in which researchers from Stanford University demonstrated a marked improvement on performance tests related to memory and learning in a group of 149 memory-impaired patients treated with phosphatidylserine for 12 weeks.
As in other neurodegenerative diseases, antioxidants have an important role in protecting the brain in Parkinson’s disease–a disease characterized by deficient antioxidant defenses. In a 1988 report entitled “Case-control study of early life dietary factors in Parkinson’s disease,” published in Archives of Neurology, researchers discovered that simple dietary sources of vitamin E reduced the risk of Parkinson’s disease by as much as 76 percent!
Retrospective epidemiological studies like these have prompted research to determine if administering antioxidants could slow the progression of disease in those already diagnosed. Dr. Stanley Fahn, former chairman of the Department of Neurology at Columbia University College of Physicians and Surgeons, evaluated the effectiveness of vitamins C and E in a large group of Parkinson’s disease patients over several years. At the beginning of the study, none of the patients were debilitated enough to need the standard Parkinson’s drug, L-dopa (Sinemet®). The time until patients required L-dopa therapy was extended an incredible 2.2 years in those taking these simple nonprescription vitamins. These results clearly indicate the power of the antioxidant vitamins C and E to slow the progression of Parkinson’s disease. This information should be provided to all Parkinson’s disease patients and their families, but vitamin and nutritional information is not typically conveyed on the prescription pad&the ultimate coin of medical commerce.
Alpha Lipoic Acid
The subject of intensive study in neurodegenerative diseases, alpha lipoic acid not only serves as an extremely powerful antioxidant in and of itself, it regenerates vitamins C and E as well as glutathione. Alpha lipoic acid is readily absorbed from the gut and has the unique ability to cross the blood-brain barrier and enter the central nervous system.
Yet another quality of alpha lipoic acid is its ability to serve as a metal chelator–it can bind to a variety of potentially toxic metals in the body, including cadmium and free iron, and enhance their excretion. This is an important function as these metals may increase the formation of damaging free radicals, and research demonstrates substantially increased concentrations of iron in the brains of Parkinson’s disease patients.
NAC is a potent brain antioxidant that has been shown to specifically reduce the formation of the free radical nitric oxide, which has been implicated as having a causative role in Parkinson’s disease, Alzheimer’s disease, and several other neurodegenerative disorders. NAC also plays an important role in the brain by enhancing the production of glutathione–perhaps the most important of all the brain-protecting antioxidants–and is also the subject of intense research at several major universities.
In a fascinating study reported in 1995, researchers demonstrated the ability of acetyl-L-carnitine to completely prevent parkinsonism in laboratory animals. When laboratory animals are exposed to the brain toxin MPTP, they immediately develop full-blown parkinsonism as a consequence of enhanced production of destructive free radicals, specifically in the brain area that produces dopamine. Pre-treating the animals with acetyl-L-carnitine prior to MPTP exposure offered complete protection–none of the animals developed parkinsonism. This study affirmed the potency of acetyl-L-carnitine as an antioxidant specifically useful in Parkinson’s disease.
These studies serve to emphasize there is more to Parkinson’s disease therapy than simply treating symptoms. Powerful nutritional supplements target the fundamental cause of the disease - treating the fire, not the smoke–and complement symptom-managing medications.
Coenzyme Q10 - 120 mg
Phosphatidylserine - 50 mg
Vitamin E - 1200 IU
Vitamin C - 800 mg
Alpha lipoic acid - 80 mg
N-acetyl-cysteine - 400 mg
Acetyl-L-carnitine - 400 mg