Parkinson’s Disease, the Microbiome… and Things You Can Do Now

By now, you all know that I am particularly interested in Parkinson’s disease (PD) research as I have two friends who are both suffering from it – both diagnosed  early (one in his 40s, one in his 50s).   I’ve been following the research on the gut-brain connection, and have written several times about his already.

I was particularly excited then to come across an article yesterday entitled, The gut-brain axis in Parkinson’s disease:  Possibilities for food-based therapies.[i]  You also all know I get pretty pumped when research actually suggests treatment that can be instituted NOW.  This one made my day.

The writers emphasize that Parkinson’s “…symptoms go beyond motor dysfunction, since PD patients very often develop non-motor symptoms, including cognitive impairment…pain, depression, tiredness…and most commonly, gastrointestinal (GI) dysfunction.”  What was new to me is that these symptoms may appear years before the classic motor issues that lead to diagnosis and more than that –“…their occurrence in otherwise healthy people has been associated with an increased risk of developing PD.”

Research is showing pretty conclusively that PD likely starts in the nose or the gut, our gateways to the outside world.  The pathological process that appears to cause PD may start with a toxin, a pathogen or a negative change to the microbiome. The exact cause is still not known.  (Still, it seems like an awfully good idea to me to work on maintaining the health of your biome.  I may have mentioned that before…)

There is so much information in this article that I almost don’t know where to start.  A few of the highlights then, to not have this post be excessively long:

1. Constipation is the most common gut complaint among those with PD and may precede motor symptoms by 10 years or more.  87% of those subsequently diagnosed with PD had constipation beforehand:  “…constipation is assumed to be a harbinger and is associated with an increased risk of developing PD.”  So for all of you who think constipation is not a big deal (which, in my experience as a nutritionist is a hell of a lot of people), think again.
2. PD patients have increased intestinal permeability (leaky gut) and gut inflammation. The toxic byproducts of inflammatory gut species disrupt the blood-brain barrier, facilitating “…neuroinflammation and injury in the SN [subtantia nigra – the part of the brain most affected in PD]…”
3. The evidence for an altered microbiome in PD is mounting rapidly. Just one example:  those with PD have lower levels of the species Prevotella, which subsequently leads to lower levels of short chain fatty acids (SCFAs), and reduced ability to synthesize thiamine (vitamin B1) and folate.  This leads to higher levels of systemic inflammation.
4. SIBO (small intestine bacterial overgrowth) is exceedingly common in PD. And while those with PD suffering from it do not necessarily have worse GI symptoms than those without, their motor dysfunction is measurably worse.  How wild is that?!

So, what can be done now to potentially ameliorate some of the symptoms of PD and/or slow down the progression of the disease?

1. Specific nutrients can help, including those that are important in the formation and maintenance of neuronal membranes:  uridine (a component of RNA), the omega 3 fatty acid DHA, and choline (a phospholipid) – all of which can be bought commercially.
2. Also important: cofactors in the synthesis of phospholipids, including B-vitamins, vitamin C and E, selenium.
3. Prebiotics – have a beneficial effect on both the immune system and on the microbiome, increasing levels of anti-inflammatory species (those that produce SCFAs) and reducing levels of pro-inflammatory ones
4. Probiotics

Of course, I’d personally add helminths to this list, for both their direct anti-inflammatory effect (since inflammation and oxidative stress are both crucial in the development of PD) and their effect on the bacterial microbiome.

By the way, one last really important point:  the GI dysfunction found in PD causes poor absorption of l-dopa, the primary medication to treat the symptoms of the disease. Over time, l-dopa causes monstrous side effects and also, eventually stops working altogether. Improved GI function would allow doctors to have to prescribe less l-dopa…reducing side effects and making it effective for longer.

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[i] Perez-Pardo, P, Kliest, T, Dodiya, HB, Broersen, LM, Garssen, J, Keshavarzian, A, Kraneveld, AD. The gut-brain axis in Parkinson’s disease: Possibilities for food-based therapies.  European Journal of Pharmacology. 2017. http://dx.doi.org/10.1016/j.ejphar.2017.05.042.