Vitamins, supplements, & other drugs for Parkinson's disease – 2017 Parkinson Symposium



okay good morning to everyone and thank you so much to dr. Michael Okuda Creech it's not here but he here's the one that invited me and thank you to dr. mulatto for the introduction and especially for you come here Saturday morning to to see this lecture about medical marijuana and other supplements I have to say that we decisions have been overlooking this topic for a long time we have been sometimes you know criticize our patients for taking these supplements Hertz teas or other alternative therapies on Parkinson's so I was you know wondering if is d really are they really for real or not so that that's the question do we have some scientific scientific information on this and yes actually we have some and probably they are beneficial but we are very behind and I think that it's time to explore to make this question a little bit more you know punctual to our selves decisions but but also give you guys the information that you need but where you're taking personal I realize that there is a lot of patients taking supplements vitamins what we call now nutraceuticals and other rocks for Parkinson's so let's do it sorry for the logistic problem so first of all as you will known Parkinson's disease is a condition in where dopaminergic neurons and other neurons are having troubles to manage some physiological situations dopaminergic in certain are localized in the sub my granny and it's called like that in the middle of green because it's black and lost the Tincher while the generative process comes on several processes are involved in this from energy distension to metal accumulation to the accumulation of waste products so so far we don't have any drug or any therapy that could avoid this situation to happen when the modern symptoms began the Cecil Grady initiate years for and we know that because patients used to have a lot of things before for example sleep disturbances smells problems constipation and by the time that motor symptoms I'm Marcy may refer to slowness rigidity tremor or posture and balance when this happened this things happened the neurological degenerative process have a lot of time coming on and we know that medications for the moderate symptoms you will taken out as levodopa dopamine agonist just trying to restore or supply the dopamine deficiency that is happening we know that when the disease is there progressing the duration of the thickest E and the thickest e of this medication start to run out and we need to use all their location trying to stop this is a very you know problematic situation so this graphic is about that how life goes on I don't want to use those numbers to say that's going to happen to all patients but just it's graphically explaining what is happening in life through Parkinson's and what's happening with a medication response so it's a very tiny you know it's green there but it's about that and of course when time does God goes by other situation comes like the shortening of the duration of the medicine and we only try to feel that holes in the boat we only try to use medicines to restore quality of life that we can stop it now so at this time we had a lot of drugs that could help us and it seems like you know a complete arsenal for up there that vertical reality is a small and not only for motor symptoms the first slide but for non-motor season 2 since years ago before levodopa probably thousand used there is several remedies as dangerous curves teas and even marijuana that have been using for the treatment of parkinson's we know that a lot of these historical drugs have anticholinergic properties genetical energy like agenting for example that could stop some of the tremor that have some cognitive issues and it's not you know we use it anymore at least here in the United States and other countries still have some isn't something to do so well we know that this kind of alternative medication in the past still have a place in the treatment and still have a place in the minds of our societies so for the treatment of Parkinson's we used to treat in several ways trying to avoid risk factors try to either very p.m. the disease to restore to protect or rehabilitate dopamine neurons we try to use medication just for figured out the need of the dopamine we use exercise we even use surgery now DBS disease is a place very important for surgery where we are trying to do something else with gene therapy perks cell transplants but also alternative treatments have a place and from those we're going to speak about the specifically nutrition supplements this is a table that shows all the complementary and alternative medications and medicine general heavy use it for that from Ironman therapy from music therapy I know that you have a session after it is from energy healing whatever so but I'm going to focus in the nutritional supplements part let me tell you why it's not only because it's frequently used but also because some of them have potential interaction with our own drugs so that's one the other question that I did have actually Oh visit it seems very very tiny but I'm going to explain this table is showing several studies trying to figure out how frequent the complementary and alternative medicines are used in Parkinson's patients so there is it shows that studies from the UK more than 50 percent of patients using at one kind of alternative therapy especially acupuncture with them Argentina is to try to use some herbs and in the United States the most use it more than 66 percent of patients use some kind of nutritional complements multivitamins sometimes herbs and this this study didn't talk about marijuana we'll see in the future the information comes from this study made in Seattle and shows that patients with parkinson's disease the younger and the high i control is the ones that used to use more these alternative medications some others it shows that not it's not like that that it will not depend on the age or the stage of the disease or if that you're using or not you just use it okay so from nutritional complements herbs this is the the the main ones that we are using for example there is in her cold and mucuna proteins have you hear about mucuna no well vicuna is an extract of the skein of the seed that contains levodopa and as he didn't use him for more than two thousand years ago in India it's part of the Indian traditional Medicaid medication they try to use that in a disease called cam Tabata probably the first description in Parkinson's and let me stop here because we are celebrating 200 years or commemorating 200 years from the first publication of James Parkinson paper this years of NL so the Indians realized that these is tract of the plant health patients later on until 1990s we also realized that mucuna has levodopa incredible but well herbs helping something that way and some others like this study in Colorado shows that cannabis also is used by patients with Parkinson disease and we'll see if cannabis or marijuana have the spot in the treatment of the night but first well you know we use this are they cream are they working for the compression of a better compression to talk I use this table to refer on the quality of the studies that we have now on herbes on medical marijuana and multivitamins to comprehend better how the information the scientific Commission is fed so in blue you will see some squares there indicating the legal of evidence a level of evidence see B create meaning that see it has the less for the lesser quality information and they will eight means that has the best one that use multi centers starts for example and the recommendation they put it in green yellow orange or red means that it it had benefit if it's green and it has not benefited and it's not recommended it is in red so if I try to do these color-coded things the other thing they will see there is this kind of tables that are part of the of reviews or meta-analyses trying to compare different studies to see the evidence every time that you see a square that is to your left from the middle line of this graphic means that the risk is not there that it's protective maybe and every time you see a square going beyond the line will means that that study have risk or are not beneficial with that what's up with hurts there is a lot of things to there for example curcumin for example the almonds that could have some properties for SMT oxidant because they contain some vitamins but also because they contain substances that could help dopamine neurons in that this is a reveal or all of all hurts that could help important sense you see there in little squares how they are having trying in Parkinson's disease models to see if they have some benefit to protect cells or to protect animals from an insult in this case for example my sis or racks are exposed to a Michael : PTP and it's a very useful model for Parkinson and we see that a lot of herbs and a lot of leaves seeds roots could have some protect you can recognize they're decreasing tablets that is a current kind of flower you can recognize ginkgo biloba which is very used you can recognize it they're two genes and so all these plants have been used in in animal models Parkinson disease trying to find a way to protect the Diploma najuk cells but so far we don't have any study with them in humans so we can't say that we can't recommend the utility of them in Parkinson's but difference there is other tract that I already talked about mucuna pruriens these plan it fruit contains some seeds and the skin contains levodopa and as i told you before it was used in an Indian traditional medicine called agar diva and now we are live that they have levodopa or that we couldn't have the dropper because of this study made in India they try to figure out how useful could be using impatient they use the gift and mucuna is track impales to 60 patients before and after measuring the motor scale for Parkinson's and they realize it works and actually some of them got this Canisius which is a very good marker to see if a drug is working to other efforts try to figure out if it works and this is a very small study using 18 patients and you use another alternative treatment besides mucuna they try to clean Singh first and then use them construct to sieve they have some kind of impact and they measure the response we have murder scale that you you have to you have to know this one to use it recruit test and so forth how is the rigidity and the tremor and they show it works also they had to measure the amount of lipid OPA did each one of the extract half and this study is showing that levodopa is inside an akuna so we can say what we that will be very small studies it's possible beneficial for the treatment of symptoms of Parkinson's but we still to have more studies to rely to realize if it really helped in the treatment what we know is not only one mucuna there is several kind of plans having the same or varieties here in America and also in the Indian subcontinent and different plants have different amounts of levodopa and if you take out this plant and you try to raise it in a different environment the levodopa content will diminish that's amazing cause environmental have an impact on the um the amount of people dope as well this another thing I know that you know this the VEISHEA fava or the broad beans contains levodopa as well and this is study give given broad beans a plate of with 200 milligrams of visa father and try to measure before and after Parkinson symptoms and they saw they observed some benefits in six patients with Parkinsons is possible the way to treat same constitute this other one vanilla studies Kathy has the same element as one of the medicine are you taking wrestling Orsola dueling this this is a locker of an ensign that conserved dopamine inside the system so it will help so we have another way to treat it with this what about keys this is a study in Japan trying to see if Chinese teas or Japanese T's could protect Parkinson's they figure out that patients in Asia are a little bit you know have a little bit lower rate of Parkinson's and Beijing in the West so they try to figure out the teeth and dietary factors have an impact on that and since that yes but they cannot take a part fact that teeth contains caffeine and coffee caffeine have anti parkinsonian effects as we'll see next some other very complex herbalist tracks using more than one more than to make more than four Hertz in the same teas within pronounceable names you have an impact as well for example I squared there in bread one study that shows that using this tea the specific tea helps patients that have a kind of parkinsonism produced by other drugs what we call neuroleptics and before using i mean before the exposition to this medication using the the distract tea will help not to have parkinsonian like symptoms what about the West we also have something to say especially Mexico have to say but well maybe you you will hear about resveratrol have you hear about this inside of wine and has been been promoting as that well there's not his during a story there is no studies in human but so far that we know that where it's very talk will help dopamine cells in inserting ways action actually just in studies in animal model okay so this is another meta-analysis it means they try to convert several studies using different kind of herbs and they show that if they use if patient use levodopa plus one of these teas they do better if they use a compare using levodopa by itself well they never compare the using the utility of a tea versus levodopa which is a they call standard of treatment and would make is going to have a better information if they are helped or not but at least we know that so with a little B there is possible benefits in certainties and herb strikes but there is no a comparison from them to leave a dopa to tell exactly they are healthy what about medical marijuana and I put their medical marijuana could be not medical at all marijuana is not one thing is it what this is one of the person you have to say marijuana is more than sixty substances called cannabinoids and it's very important to not not note that because a some of them could have potentially beneficial effects that some others could have a contradictory or even get worse your symptoms not only in cognition which is the main concern we doctors and they use it but also imparting some symptoms so smoking may one I could you know make or eating marijuana I could make you feel a little bit more relaxed better in a better mood but not exactly helping symptoms for Parkinson's and in the end we we just try to guide you guys to have a very good quality of life that's the thing that it is important not if the scale improves or not but we have to look all the pictures at just one spot there so that's why it's needed to to understand what kind of things are we using so in terms of money one other is just a few studies this was made here in the United in the United States and try to see if an extract with marijuana could help on symptoms like motor symptoms I mean rigidity slowness and this kind of ease and it fails and this is the best study that we have only in 21 patients this is a survey in Colorado Colorado of course is we look at marijuana is legal now and surprisingly they having not using so far marijuana as I suspected only 4% of 200 patients are using it but they all report some beneficial things in sleep in mood and in pain which is not surprising that we know that Mariana has these kind of properties in Brazil the trial is specific cannot be no they cannot be deal that we know they have some dopamine agonist fusion but they fail they don't find any any responding motor scales from that the patients feel better but in reality and objectively they don't find any change in Parkinson's symptoms and this is so far the biggest study in in the literature now this is one in Israel smoking marijuana they use only 21 patients before and after smoking marijuana at for motor symptoms and non-motor symptoms included pain and sleep disorders and they find out that it works and this is a causative study one of the few positive ones and they find what that one patient and I want to highlight that because as you seen in the internet there is a median and especially in faith with circulating of adaptation smoking marijuana and the motor symptom that he has specifically tremor and gay disturbances in prayer they show from the 21 patients that one really happen on stage after smoking that's good but is that nothing at all and well the American Academy of Neurology three years ago joined to settle down some guidelines on the marijuana utility and they found just of two studies I found more studies some negative and in red and some others positive in green but only four with a good quality things to the recommendation and so far as currently with a little C we can recommend that so there is no benefit showing literature and medicine on that so it's an out but we have still have to look at under that we have to still have more studies and see if this has some kind of utility in the future I mean this is a new weapon for our arsenal maybe but we have to wait until more studies come what a bit what about vitamins then the so called now nutraceuticals and the three cervical it's a isolated product or purified product per net food the journalist is sold in in a medicine foreign a tablet cap or or any dollars normally not usual said it with that demonstrate you have some beneficial in physiology so this is the vitamins information first all vitamin A which you can in found in those all these products so for vitamin A we have some studies that says that the consumption of it which has antioxidant 'iv properties could help but in this review trying to figure out not only vitamin A but also the keratin that it contains them it seems that dealing work so for now with a little see just a small studies we can say that vitamin A is not beneficial for Parkinson's out what about vitamin D vitamin D is a complex is not just one it's one two and so far you have twelve and well for now what we should what this study shows is that vitamin b6 supplementation could be helpful but not the other ones actually patients to treat it with levodopa it seems that have some impact on b12 levels and patients with Parkinsons just to have the b12 levels a little bit lower than people that without Parkinson's so for now there is no specific recommendations for other B vitamins but probably the vitamins b6 should have an impact say what about vitamin C where it is just a small this is a small study trying to figure out in 21 pages what kind of impact does vitamin C could have it was made by dr. Stanley fine that I know that joined you last year and dr. fun in these 21 patients shows that they use the utility of vitamin C could be on a improve line improvement of the delay on so it could make the levodopa works a little bit more rapidly so vitamin C could be helpful in the absorption of levodopa so with a very small study we can say it has possible benefits safe at home what about vitamin E so far vitamin E is the most recognizable antioxidant and we have a lot of studies there that the main one is called data table and this study was not made for try to notice this vitamin is helpful none but for another medicine that you will probably are taking the ledger line or Deborah Neill and they show that patients taking vitamin E versus the one that take its allegedly are different but patients taking vitamin E compared to those that take placebo are not different it's means that vitamin E couldn't have an impact on the disease probably is because the amount of vitamin E used it in in these studies that was very low there's an 2,000 units and probably we need more than 3,500 and then to see an impact and there is once non studies today it shows more kind of over these doses so with a little be a recommendation we can say that there is no benefit from vitamin E but so far we need more studies in there so it's an out to 14 what about vitamin D vitamin D is very useful for the calcification and mineralisation phones so it will protect you not only for parkinson's mineral things but it seems that low-level vitamin d is actually one of the features of a parkinson's and that that produces a risk for Parkinson's that is twofold in comparison with people are not having Parkinson's now so there is several studies and only one of them try to supplement it with vitamin D patients with parkinson's seeing that yes good works so with a little via recommendation of these several studies we can say that it's a possible benefit to take vitamin D for Parkinson's so I think that we have to go on and one of the circumstance that that could happen and explain that is was that Parkinson's patient student exposed to sunlight and sunlight it is necessary for the production of vitamin D so this study shows here in Miami that known it all depends on the amount sun exposure and the amount of vitamin D that is related with that sun exposure it's about their metabolism the vitamin that is affected in Parkinson's as well what about cuffing which I was taking them so Kathleen it has been looking at as a protective factor for Parkinson's there is a lot of studies the ones that you see there like us hpfs NHS and HHS are studies not made for Parkinson it started in the through made for several risk factors hpfs study in health professional or only males males conditions and HS about nurses and a tree chases a Honolulu study in Hawaii the data from those are very useful and it seems that yes patients with Parkinsons use to consume later lesser caffeine and or lower lower coffee that patients will subjects without it and if they happened in the tree studies it happens also in other countries say seeing the same aspiration so it's intercultural and inter-country and there is this small study made in Canada actually Toronto and Montreal showing that with caffeine peels measuring the symptoms of Parkinson's before and after they have served that patients will benefit with caffeine pills too so it has some anti Parkinson properties so caffeine with a little B seems to be beneficial for Parkinson's how much we don't know you have to take it every evening the morning probably and keeps you a little bit bit more awake or whatever so it's good whatever the consumption are the things what about body acids have you hear about omega-3 and omega-6 fish oil specifically they contain what we call the polyunsaturated fatty acids and they seems to be protective there's just one study that mentioned that it doesn't matter the thing happened with in calorie intake it seems that fewer calories consumption today will protect for Parkinson's we don't know now having Parkinson's if you have to take the fewer colors that is not correct when you need more to be energized enough in the right so we will see we have to wait for other studies in terms of this specific kind of fatty acid a Pauline saturate containing in fish oil for example the other ones are not health what about metals minerals magnesium calcium iron well there is specific studies in that showing that iron is actually not beneficial but could be a risk factor for Parkinson's there is not study you know the taking iron in patients to see they could be worse or not but it has to be mentioned that iron is a product that we need in our body and there is a one theory importance in actually that the accumulation of iron wner and participate in its pathophysiology so we will see in this status I'm not going to you know put particular ages in each one of them it seems that they are not beneficial and actually the dietary content of iron is a little bit higher in Parkinson's patients and I did join with magnesium you see that double the risk for Parkinson's so we have to wait this sounds observations you know after there is no studies using supplementation of iron or supplementation with magnesium to see how patients is going to going to be what about Co Q 10 kakouton is a mitochondrial enhancer mitochondria is like the battery of our sales and kakouton makes that this mitochondria these batteries of the cells gets better engines were killed or work better so coq10 has been exploring several neurodegenerative conditions in animal models and specifically for Parkinson we have so far very good information this is a reveal net and the participation of some of you could be you know we actually here goes gangs will participate in one of the main studies for the q10 supplementation in Parkinson's and gets the one with a better level of evidence it seasons that Co Q 10 didn't work and out this is the study and the study includes more than 600 patients and you see the lines overlap it because the difference from the the ones that use the QQ 10 from the ones that not is it the same so there is no benefit on the queue cadet nation well you know studies are made in a in a temporal way just during some time we don't know what could happen in the future so I don't want that you know you guys think that everything that you might be taking or not could be wrong but well it's just the evidence what about creatine creatine has used it it was not too upgraded in the body we've said energy stabilizer as well as q10 and it works for make the muscles go bigger and it seems that the the utility of containing Parkinson's with a very low level of evidence it's in the mindfulness could the patients are taking creatine do a little bit better in vintagy so it could have some benefit we have to wait for more studies there so this is the end I think that we have a lot of information to give you and this but we have decisions I have to look at over what we are taking and what we are and you know what kind of interactions we deepen produce it because of this so we know the Parkinson disease treatment is complex and that medication that we use are limited we know that alternative treatment in Parkinson it's a reality and it's a very frequent among American inpatients Mexican patients and everywhere we know that horrible treatments as mucuna may have benefit and we have to explore that as we need to do more studies to see it we know that teeth and horrible oriental therapies could help but we need to compare with the drugs that we use now we know that medical marijuana is not recommended bases in the studies that we have in the in the medical scientific scientific literature now and we need more studies to explore this new weapon we need that vitamin D and b6 may have a benefit and we can recommend the you to use that we now now that your q10 don't have an impact in the progression of the disease and we can't recommend that now and we see that oh we see that the creatine could have an impact as well so this is my my team in Mexico I want to first role say thank you to dr. Oakland to dr. Malati and to dr. Daniel Ramirez one of my friends from out there and to you to attend to this lecture and I'm open to questions when the time comes this is the people that is working with Michel hi Martinez and dr. I went to a knowledge dr. fun which was my mentor at Columbia University the residents are working with me especially Navi and Mark who worked so hard on me every day for my patients of C and my partners in the ABC Hospital and the national institute of neurology in mexico see thank you so much [Applause]

9 Comments

  1. Do you need to maximize the dose of Levodopa/ Carbidopa to decrease symptoms of PD? What about dyskinesia is it in proportionate to the amount of Levodopa/Carbidopa intake?

  2. Learn how to spell “Messages” to take home NOT “massages”….Jeeze and we trust some some of these Dr.s with our PD treatment and health???

  3. B1 Thiamine therapy reference / stop progression, suppress motor and non-motor symptoms:
    (Thiamin HCL is oral substitute to IV B1) 2 x day (morning 2g and at lunch 2g)
    Doctor Costantini strategy that I find helpful "thiamine hcl stops the progression forever…".
    Parky people say the first five years is your honeymoon stage with Parkinson's. After that, progression more rapid.
    I have gone from slow motion to normal motor action since joining the growing number of PwP that have started B1 regimen/protocol. –
    Doctor Costantini – “Why is this? Because there is no medicine or drug that is able to affect all of the organs, whereas all of the organs function thanks to Thiamine. An important detail”, adds doctor Costantini, “the Thiamine therapy brings no collateral damage with time”.
    Google search: Doctor Costantini Parkinson

  4. Very suspect in regards to a lot of 'these very small studies' and who is pushing the 'yes/no's.. Pharmaceutical companies cannot be trusted in my mind, as it's just ALL business and how to continue to 'control'…

  5. with EVERY scientific paper = FOLLOW THE MONEY…. who paid for the study (big pharma) and what are the conflicts of interest (scientist / labo/ uni being paid by pharma companies)
    a lot of supplements not recommended… by whom ? where are the links ? who did the study , paid by whom, conflicts of interest…

    don't forget, MD's want to sell you DRUGS, that does not cure, only for symptoms… returning customers = $$$

    studies can be paid for, to make xyz look bad, using the wrong kind of the supplement form, a very low non therapeutic use and there is always the subjects / patients, if they really took or not what they were supposed to test… if they got paid…

  6. scientific & medical world lacks only about 80 – 100 years behind, because of massive profits in treating symptoms in stead of finding the CAUSE

  7. The prognosis graph at the very beginning was a real education for me. I will not be able to judge my thiamine treatment route until after the first six years from dx. I have only just reached the end of year 5 w/ Parkinson's.

  8. H

  9. Has a date been established for a Parkinson's Disease Symposium in 2018? I am a Nurse Practitioner who has PD, and I am interested in attending. Thank you.

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