Supplements for Parkinson’s disease

Executive Summary
Here are the supplements for Parkinson’s disease.

Necessary:
Coenzyme Q10 (300 mg a day);
Antioxidant-dose vitamin C (1,500 mg a day);
Antioxidant-dose vitamin E (400 IU a day); and
Vitamin D (2,000–5,000 IU a day).

Optional:
Fish oils (3,000 mg a day);
A naturally-sourced B-vitamin complex; and
Probiotics (25 billion CFU a day).

There are many other good supplements such as Brahmi, Fiber, Curcumin, and Whey Protein. Read the article below to decide further.

Disclaimer: The information, including but not limited to, text, graphics, images, and other material, contained on this website is for informational and educational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Parkinson’s disease is a progressive medical condition for which currently there is no cure. So if you have a family history of Parkinson’s or if there is someone ailing in your home with it (both are true in my case), you may wish to learn about various complementary and alternative therapies for the same.

In this article, I will restrict myself to supplementation strategies in Parkinson’s disease. I will also provide links to various other therapies.

Introduction

Parkinson’s disease is a neurodegenerative medical condition. It involves body stiffness, tremors, as well as problems with balance, muscle coordination, and walking.

Parkinson’s symptoms usually develop after the age of 60 years. Nearly fifty percent more men are afflicted by the disease than women.

In the early stages, the symptoms develop gradually and then worsen with time. As the disease progresses, people also have difficulty talking. The condition may be accompanied by behavioural and emotional changes, sleep issues, tiredness, and even depression.

There are excellent information resources available on authority websites about Parkinson’s. So I will not repeat information about its signs, symptoms, diagnosis, progression, as well as dietary and lifestyle interventions. Please go through the links given at the end of this article to learn more.

Causes of Parkinson’s Disease

Science does not know what exactly triggers the development of Parkinson’s disease. However, genetic and environmental factors seem to be the most common causes.

Genetic Factors

In about fifteen percent of the cases, the development of Parkinson’s disease is attributed to genetic causes. There are many gene mutations that have been linked to the disease.

You are twice as likely to develop Parkinson’s if you have a family history of it. You cannot do much here except follow extra caution and do early testing if you notice any symptoms.

Environmental Factors

Exposure to certain metals and toxic chemicals can increase the risk of Parkinson’s disease.

• A strong link is found between Parkinson’s and the use of pesticides and herbicides in agriculture and foods that we consume;
• Traffic and air pollution have also been linked with Parkinson’s;
• An industrial solvent named Trichloroethylene (TCE) is found in groundwater. Its presence is associated with Parkinson’s;
• A highly toxic industrial compound called Polychlorinated Biphenyl (PCB) is known to accumulate in the brains of people with Parkinson’s;
• A major head injury can lead to Parkinson’s a few years after the injury;
• Household detergents, solvents, and heavy metals are linked with Parkinson’s. Hope that gives you a hint!

Miscellaneous Factors

• Drug-induced Parkinson’s: Certain antipsychotic medicines may cause Parkinson’s symptoms.
• A series of mini-strokes may kill a part of the brain, eventually leading to Parkinson’s.

It seems that Parkinson’s develops as a combination of multiple factors. If it appears before the age of 50 years, it is called ‘early-onset’ Parkinson’s, which is more likely due to genetic factors.

How Parkinson’s Develops

In the following section, I will briefly explain how Parkinson’s disease develops. The insight is meant to help you understand the prevailing thinking behind where, when, and why to intervene with supplements. However, if you prefer to skip this part, you can go to the section on Principles of Supplementation in Parkinson’s Disease.

Neurons or nerve cells in a part of the brain, called substantia nigra produce a chemical called dopamine. It is a neurotransmitter that helps transmit messages between nerves that control body movements. It is also involved in the proper functioning of the brain’s reward and pleasure centres.

In normal people, with age, the nerve cells in the substantia nigra die, reducing the dopamine levels in the brain. So as we get older, our movements, behaviour, and emotions are affected for the worse. But this happens at a very, very slow rate in normal individuals. As a result, normal people almost never display Parkinson’s symptoms.

Protein Deposits

In some unfortunate individuals, a protein called α-synuclein starts accumulating in the brain nerve cells. Scientists do not know why these deposits build up in the brain.

A hypothesis says that this protein’s molecules sometimes ‘fold’ in a wrong manner. Think of it like your trousers getting folded wrongly. As a result, those molecules start clumping together. Soon, the tangle starts growing in size. A laundry basket mess, figuratively. As more protein accumulates, it starts forming slender insoluble fibers called Lewy Bodies.

Inflammation of Neurons

Our brain’s immune system protects it from external substances such as microbes and toxic chemicals. When it encounters them inside the brain, it releases certain chemicals that either kill the parasites or neutralise the toxins. These chemicals are highly toxic themselves. Think of them as hand grenades, thrown by the immune system to destroy its enemies!

The release of these chemicals causes inflammation, just as a bomb would cause a conflagration. This inflammation is our brain’s protective mechanism against the enemy. But there is collateral damage to the surrounding healthy tissues in the process. After all, the grenade is exploding inside your territory.

When the inflammation is localised to a small area or is short-term, the collateral damage is limited and the immune system achieves its goal of neutralising its enemies. However, if it continues for too long, the brain cells face long-term damage.

The accumulation of Lewy bodies triggers the brain’s immune system to release inflammatory chemicals. In reality, Lewy bodies are not external agents; they are made by your body itself. But the brain’s immune system is not able to identify them as internal entities, perhaps because they are not present in the brain otherwise. So the immune system attacks these Lewy bodies and releases inflammatory chemicals. Their collateral damage to the brain neurons causes something called neuroinflammation.

Dopamine Shortfall

Neuroinflammation accelerates the damage or death of cells in substantia nigra. As a result, dopamine produced by those cells starts reducing. When about 80% of the neurons in substantia nigra are destroyed, dopamine levels go down by nearly 30% from the normal levels. That is when the body starts showing symptoms of Parkinson’s disease. Walking becomes abnormal, movement becomes slow, and muscles become stiff.

Norepinephrine Shortfall

Simultaneously, neurons in another part of the brain called locus coeruleus also start to die. Normally, these nerve cells produce norepinephrine, which is a neurotransmitter that controls involuntary body functions such as blood pressure and heart rate.

When norepinephrine levels stay down, patients face erratic blood pressure changes, fatigue, reduced movement of food in the bowels (called peristalsis) leading to constipation, and rapid fall in the blood pressure if the person gets up from a lying position (called orthostatic hypotension).

Acetylcholine Shortfall

The Lewy bodies also prevent the brain from making another vital neurotransmitter called Acetylcholine, which affects memory, thinking, and learning. Low levels of acetylcholine lead to dementia or memory loss symptoms.

Inside the brain, dopamine and acetylcholine work in balance. In Parkinson’s, the levels of both reduce but dopamine decreases more. As a result, the balance shifts towards acetylcholine. This makes the muscles more ‘excitable’, causing jerky movements and tremors.

Progression of Parkinson’s

Thus, Parkinson’s disease appears to be progressing through multiple mechanisms:

1. The protein α-synuclein starts accumulating in the brain, forming slender fibrous deposits;
2. This causes inflammation in the nerve cells or neuroinflammation;
3. That destroys nerve cells in the brain that produce dopamine and norepinephrine;
4. The cell mitochondria that are the energy production centres of the nerve cells (think of nuclear reactors that generate power) start functioning incorrectly;
5. This leads to something called oxidative stress;
6. That generates dangerous compounds (think of out-of-control spillage of hazardous nuclear waste) called Reactive Oxygen Species (ROS);
7. Together, they lead to more neuroinflammation;
8. This kills more nerve cells.

This cascade progresses and the patient’s condition worsens as more and more nerve cells die. Looks like a vicious circle in which we have no way to intervene. Or do we?

Principles of Supplementation in Parkinson’s Disease

Parkinson’s disease is not a condition you should manage yourself at home. You must take the help of a medical practitioner and seek appropriate treatment.

Supplementation falls under complementary and alternative therapies, which means that it is to be used along with or after trying medical treatment. Consult with your doctor before using any supplement regimen.

Supplementation in Parkinson’s disease relies on 4 pillars:

1. Reduce Parkinson’s Risk:
   It seems that once the Parkinson’s cascade is set in motion, it is difficult to control it. But there are a few nutrients that are associated with a lower risk of developing Parkinson’s. So they may help in prevention.
   
2. Slow Down Parkinson’s Progression:
   Reducing oxidative stress and free radical damage in the brain cells will help. Can we use antioxidants for that? Unfortunately (or fortunately), nature has protected our brain through something called the blood-brain barrier, which is a layer of cells that shields the brain from many undesirable substances in the blood. It allows only certain nutrients to get into the brain. So we need those antioxidants that can cross over the blood-brain barrier. Not all of them do.
   Cell mitochondria need various nutrients for their proper functioning. Can we restore the impaired functioning of the neuron cell mitochondria?
   
3. Manage Parkinson’s Symptoms:
   Can we increase the levels of dopamine and norepinephrine? Of course, we have medicines for them. But can we do the same with some nutrients?
   In my view, that would not be a proper decision. Dietary supplements cannot give the exact dosing of a neurotransmitter at the right time. Plus, if it is a herbal product, its constituents cannot be controlled precisely. For example, an Ayurvedic herb called Kapikacchu or Mucuna Pruriens has an active ingredient called levodopa. Your brain converts levodopa into dopamine. But I would not advise such a supplement when a levodopa tablet can be prescribed by your doctor.
   Can we consider some supplements that help in Parkinson’s symptoms such as fatigue?
   
4. Reduce Risk of Parkinson’s Complications:
   Many Parkinson’s patients have altered gait. That can lead to a fall, causing fractures. We should use a supplement to strengthen the bones.
   The patients may get complications such as sleep problems, memory loss, depression, and constipation. Can we use relevant supplements for their management?

Supplements for Reducing Parkinson’s Risk

Many nutrients are associated with a lower risk of developing Parkinson’s. But that does not mean they can prevent the disease. They have an association, not necessarily causation.

1. Vitamin B₃: Antioxidant. Neuroprotective;
2. Vitamin B₉: Reduces homocysteine, which is often high in brain disorders. Increases vascular integrity, which reduces chances of small blood vessels in the brain leaking and causing nerve cell death;
3. Vitamin B₁₂: In a trial, patients with early-onset Parkinson’s disease had lower vitamin B₁₂ levels. Plus, similar action to vitamin B₉. Best to take a good B-vitamin complex derived from natural sources such as yeast;
4. Curcumin: Extract of turmeric (5%). Prevents clumping of α-synuclein protein in lab tests—human trials are awaited;
5. Omega-3 fatty acids or fish oils: Anti-inflammatory. Has favourable effects on the development of Parkinson’s symptoms, management of free radicals, and oxidative stress reduction. Take 1,000 mg a day of omega-3 oils or 3,000 mg a day of fish oils (usually, omega-3 oils are one-third in weight in fish oils). For detailed coverage of this nutrient, read on this website: Omega–3 oils: A complete guide;
6. Caffeine: Caffeine consumption is associated with a lower risk of Parkinson’s disease. However, it is unclear whether consuming coffee prevents the disease. It turns out that a mutated LRRK2 gene in a person raises the risk of Parkinson’s but also causes low blood caffeine levels after consuming coffee. So such people are less likely to relish drinking coffee. In effect, the same person may consume less coffee and be more predisposed to developing Parkinson’s. Thus, it may not be the coffee drinking that reduces the risk of Parkinson’s.
   If you like to drink coffee, do it. But don’t start drinking coffee or worse, take caffeine supplements in the hope of managing your Parkinson’s;
7. Whey protein: Excellent dietary source of cysteine, which can help reduce oxidative stress by increasing the production of glutathione, one of the most powerful and important antioxidants. Make sure not to take it within an hour of your levodopa medication because it reduces the absorption of levodopa into the brain.

Supplements for Slowing Down Parkinson’s Progression

There are multiple supplements that offer antioxidant protection. Obviously, you do not need to take all these supplements.

1. Coenzyme Q10: Very powerful antioxidant. Has a role in energy production by nerve cell mitochondria. So it may help in neuroprotection in Parkinson’s. Take 300 mg a day; can go up to 2,400 mg a day on advice and under the supervision of a medical practitioner. For comprehensive coverage of this nutrient, read on this website: Coenzyme Q10: A complete guide;
2. Vitamin D: Lower levels of vitamin D in mid-life increase the risk of Parkinson’s disease. Antioxidant. Reduces neurotoxicity in Parkinson’s disease. Supports immune and central nervous systems. 2,000 to 5,000 IU a day;
3. Vitamin C: Antioxidant-dose vitamin C reduced risk of developing Parkinson’s by 32%; Reduces oxidative stress. Helps regenerate other antioxidants once they get used in the brain;
4. Vitamin E: Antioxidant-dose vitamin E reduced risk of developing Parkinson’s by 32%;
5. Curcumin: Antioxidant. Anti-inflammatory. Protects against nerve cell injury. 500 mg a day;
6. Glutathione: Very strong antioxidant. Helps in nerve cell metabolism. Unfortunately, very little glutathione is absorbed in the intestines;
7. N-Acetyl Cysteine (NAC): Raw material for glutathione production in the body. NAC is well absorbed in the intestines. So NAC is preferred to glutathione supplementation. 3 x 600 mg a day;
8. Melatonin: A good antioxidant option in Parkinson’s as it can easily cross the blood-brain barrier. Normally made by the body; so causes fewer side effects. Can prevent nerve cell death;
9. Quercetin: A plant pigment. Contains flavonoids, which are antioxidant, anti-inflammatory, and neuroprotective;
10. Epigallocatechin-3-gallate (EGCG): Green tea extract. Contains flavonoids, which are antioxidant, anti-inflammatory, and neuroprotective. 300 mg a day;
11. Gingko Biloba: A plant used for thousands of years in Chinese medicine. Contains flavonoids, which are antioxidant, anti-inflammatory, and neuroprotective.

I have mentioned different choices above because you may be taking or considering some of them for another condition, in which case, you can choose that particular one in preference to the others. For example:

• If you also have liver issues, curcumin is a better option;
• If you suffer from allergies, quercetin may be a better choice;
• For sleep problems, either due to Parkinson’s or otherwise, melatonin is a good option;
• One may consider EGCG for protection from cancer relapse; and
• Ginkgo Biloba helps with circulatory problems.

Supplements for Managing Parkinson’s Symptoms

1. Brahmi (Bacopa monnieri): A herb used in Ayurveda. Improves circulation to the brain. Improves mood and brain function. May slow down the disease progression and delay the onset of neurodegeneration in Parkinson’s disease. 500 mg a day;
2. Ashwagandha (Withania somnifera): A herb used in Ayurveda in all stages of Parkinson’s. Also known as Indian Ginseng. Anti-inflammatory. Reduces anxiety and may boost cognition. Ashwagandha was shown clinically to reduce stress and improve quality of life. 1300 mg a day;
3. Probiotics: It is known that the intestinal bacterial composition in Parkinson’s patients is quite different from that in normal people. So scientists are wondering if restoring gut microbiome or bacterial flora back to a healthy one will help in Parkinson’s. 25 billion CFU a day; CFU stands for Colony Forming Unit—roughly speaking, the number of viable bacteria;
4. Fiber: Dietary fiber is food for gut bacteria. Helps improve the number of healthy bacteria.

Supplements for Reducing Risk of Parkinson’s Complications

1. Fiber: Helps prevent constipation which is common in Parkinson’s. Take 5 to 10 g a day;
2. St. John’s Wort: Helps in depression, which is a complication of Parkinson’s;
3. Calcium and Vitamin D: For stronger bones, since the risk of falls and fractures is higher in Parkinson’s patients.

Long Term Complications

Parkinson’s disease progresses in a different manner and speed in each patient. Here are some of its long-term complications. Some patients will get a few; others will get a different combination of them. It is hard to predict who will get what.

• Difficulty in speaking;
• Constipation and urinary problems;
• Difficulty in chewing and swallowing;
• Sleep problems;
• Depression, dementia, or anxiety;
• Fluctuating blood pressure;
• Sexual dysfunction;
• Loss or diminished sense of smell; and
• Pain.

Due to body stiffness, tremors, and balance problems, there is always a risk of falls leading to fractures.

My Views

1. When it comes to clinical trials on nutrients, we need to be very careful about evaluating the evidence. There are inherent limitations in such clinical trials that don’t exist for medication trials. For starters, nutrients are a part of our diet even otherwise; a MAO-B inhibitor medicine is not. I have a detailed article on this website about that. Read here: How to understand the evidence from clinical trials of nutrients.
2. Do not take protein supplements along with your medicinal dose of levodopa because your intestines use the same receptors for absorption of proteins as well as levodopa, which is the most common medicine used in Parkinson’s. So you should avoid consuming protein two hours before and one hour after taking your Parkinson’s medication.
3. Many supplements help multiple body systems. So unless they are known to harm your medical treatment of Parkinson’s (e.g., protein supplement, as above), it might be worth taking them even if there is no clearcut evidence of benefit in a clinical trial.
4. Be cautious about evaluating a negative verdict such as “XYZ nutrient does not help in Parkinson’s”. The right way would be to say that “in a trial with these many patients, XYZ nutrient did not show benefit more than that can be ascribed to pure luck”. If you can’t find the moon in the sky, you can’t categorically conclude that there is no moon. 🙂
5. Doctors often prescribe one main medicine that helps the disease. So we expect one killer supplement for Parkinson’s. But there is rarely a single supplement that does it all. So don’t look for the best supplement. A combination of them will help you get small edges or odds in your favour.

To Read More

• National Institute on Aging: Parkinson’s Disease;
• National Health Portal (NHP), India: Kampavata/ Vepathu (Parkinson’s disease);
• Biomolecules: Role of Dietary Supplements in the Management of Parkinson’s Disease;
• University of Michigan Health: Exploring Alternative Therapies for Parkinson’s Disease;
• Journal of Movement Disorders: Complementary & Alternative Management of Parkinson’s Disease: An Evidence-Based Review of Eastern Influenced Practices;
• VeryWellHealth: The Best Vitamins for Parkinson’s Disease;
• Oxidative Medicine and Cellular Longevity: Benefits of Vitamins in the Treatment of Parkinson’s Disease;
• Topics in Geriatric Rehabilitation: Integrative Medicine and Health Therapy for Parkinson’s Disease;
• Parkinsonsdisease.net: Dietary Supplements for Parkinson’s Disease.

First published on: 26th March 2022
Image credit: Old care photo created by DCStudio – www.freepik.com
Last updated on: 7th July 2022