Monday, September 9, 2013

Highlights of The Inland Northwest Hope for Parkinson's Conference, 2013 (Part two)

We bring you now up to mid-morning at the Inland Hope for Parkinson's Conference, 2013. The second speaker in the "Making Your Medicines Work For You" panel, Laurie Mischley, N.D. a Naturopath who also holds a Master of Public Health in Epidemiology from the University of Washington.

Dr. Mischley had several worthwhile points to make. First, that Government-set RDA's (Recommended Dietary amounts) are guidelines for healthy people (Whoever THEY are) and  those of us with Parkinson's Disease need to address the differences in our needs. In her view, because of the presence of apparent cell-death in PD, we need to manage our diets for anti-oxidants. A good rule of thumb here is to follow the Mediterranean diet: lots of fruits and vegetables, preferably of rich color, the more colors the better. Not so much red meat, oily fish instead, (Wild Alaska Salmon fills the bill uniquely well) go very easy on the processed grains, whole grains in moderation. Cut way down on sugar.

Dr. Mischley emphasized the "Customized " nature of each person's case of PD (There is the complexity theme again) saying that each person has to assess their unique situation. One thing she recommended looking at was your homocysteine level. High levels are neuro-toxic. For such situations she recommends citicolene, citing a study that found that when administered at moderate levels it resulted in a drop in levedopa requirement of 30-50 %. This is to me an amazing claim, so I Googled and found this on Pubmed, from the NIH:

 "Eighty-five patients with an established diagnosis of primary Parkinson's disease were randomly assigned to receive their usual dose of levodopa (mean, 381 mg daily) plus 1,200 mg of citicoline daily or half their usual dose of levodopa (mean, 196 mg daily) plus the citicoline. Results of the Webster Rating Scale, a pegboard test, drawing, writing, and walking tests, a test of emotional state, and an overall assessment, administered before and after four weeks of treatment, revealed no significant between-group differences. Improvements on the tests were shown by more patients who received half their levodopa dose plus citicoline than by those who continued to receive their usual levodopa dose plus the citicoline. It is concluded that the levodopa-saving effect of citicoline could be used to decrease the incidence of side effects and retard the loss of efficacy of levodopa in long-term treatment." 

Citicoline is available as an over the counter supplement, common in health food stores. The ususal warnings about unregulated supplements apply. Further reading indicates no significant side effects or horrible interactions with PD meds, so talk it over with your doctor and see what feedback you get.

Dr. Mischley also cited a study in which the authors found that DHA  Fish oil. which is the form of fish oil with the longest molecule  was helpful with Dyskinesia, reducing it 40% with a tablespoon a day of the oil. Again I was floored, again I Googled, and came up with this, from the 2013 World Parkinson Congress in Sydney, Australia:


To objectively evaluate the effect of fish oil supplementation on levodopa-induced dyskinesia (LID) using a wearable inertial sensor.


Docosahexaenoic acid (DHA) is a long-chain omega-3 polyunsaturated fatty acid (PUFA) found in high concentrations in brain membrane phospholipids. In PD cell models, DHA has been associated with dopaminergic cell survival, up-regulation of neurotrophic factors, and antioxidant activity. LID are writhing, uncontrollable movements that occur as a side effect of levodopa treatment, an otherwise indispensible PD therapeutic. DHA is a recognized activator of nuclear receptors that operate as transcription factors, one of which is thought to contribute to the development of dyskinesia. In a nonhuman primate model of PD, DHA delayed the development and reduced the severity of LID.


This is a case report of a PD patient with severe dyskinesias was prescribed one tablespoon per day of high DHA Finest Pure fish oil (3600 mg DHA + 780 mg EPA) daily. So as to be able to objectively determine whether the fish oil corroborated the patient-reported outcome (PRO), the patient agreed to have his dyskinesia formally assessed using a wearable inertial sensor and validated clinical outcome measure before and three weeks after starting the intervention. The wearable sensor was worn on the wrist for 5 days and on the torso (front shirt pocket) for 9 days.


The sensor reported both the percentage of time that dyskinesia was detected and the dyskinesia magnitude during the detected periods. After five weeks of therapy, the dyskinesia magnitude on the torso and wrist were significantly reduced (P=0.0114 on wrist and P=0.0175 on torso). There was not a significant difference in how often dyskinesia was detected on the wrist, but it was detected significantly less on the trunk (P=0.0082). The Unified Dyskinesia Rating Scale (UDysRS) score decreased from 46 to 29, a 37% reduction.


Fish oil supplementation was associated with an improvement in dyskinesia, as evidenced by an objective wearable inertial sensor, supported by both patient report and the validated clinical outcome measure, UDysRS. This intervention warrants further evaluation in a larger population"

So this is a study of one guy for five weeks. The room here for the placebo effect is wide. It will be nice if they can confirm this with a larger study. The question for you is "How much do I like fish oil?"

Dr. Mischley then went on to offer some sensible thoughts on protein and levedopa, saying that people are a bit over-afraid of protein, and that you need it. She has found a 30-40 minute buffer time around meals does the trick for those who have the problem of with protein interference with levedopa.

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