Wednesday, May 28, 2008

What to do about essential tremor

I recently gave a presentation at UCLA, after which a very nice woman asked me if I knew anything about diet and essential tremor. I did not, and I promised to get back to her. What I learned took a little while to get through! For her benefit and the rest of you reading this, here is a short synopsis.

Essential tremor is very strongly genetic. Interestingly, at the same time I was reading research on the topic, I was reading a biography of our second President, John Adams. I learned that he, his son, and his famous cousin Samuel all experienced the affliction, as evidenced in handwriting samples available for analysis. Samuel's tremor was so bad that toward the end of his life he had to dictate all of his correspondence. There was some alcoholism in the family, to which some of this may be attributed, but even so, a genetic link seems to be apparent.

As far as dietary considerations, some of the more common considerations have been whether or not caffeine and ethanol (alcohol) consumption are correlated with tremor severity. While caffeine intake is lower in people who have tremors, tremor severity is not clearly correlated with total caffeine intake. So the reason for this association is not completely understood. Ethanol appears to have a more consistent influence on tremors.

Reduced body mass is a common problem with essential tremor, likely because of the energy spent in nonproductive muscle activity. One research group recommended that physicians pay attention to this and encourage adequate nutritional intake in persons with essential tremor. There may be an interesting conflict in this observation, in that individuals who are trying to gain weight tend to eat more protein...and red meat intake was recently associated with a greater degree of tremor severity in men (not women). This finding underlies the importance of not giving out dietary advice unless it is specifically evidence-based with regard to the problem at hand, not just general advice that might work on the average person.

My friend asked me specifically about the potential for using omega-3 fatty acids to help with tremors. To date, no research is in Pub Med regarding this possibility. However, it was only in April 2008 that the potential connection between omega-3 intake and Parkinson's disease showed up in the literature, so I would venture to guess it won't be long before this research is available.

Supporting my assumption is the fact that a correlation has been shown between a Mediterranean diet pattern and a lower incidence of essential tremor. Even though there is research suggesting that the blood components associated with essential tremor and red meat consumption don't consistently explain the origin of tremors, you have to admit, it certainly never hurts, for many reasons, to eat more fish and less red meat, more fruits and vegetables and healthy fats!

In going through my medication fact sheets, I find that three of the psychotropic medications I regularly research have been reported as being used in an off-label fashion for essential tremor. These medications are olanzapine (Zyprexa), pregabalin (Lyrica), and topiramate (Topamax). Olanzapine and pregabalin are associated with weight gain, and topiramate with weight loss. Given the fact that weight change even in the absence of medications is a problem, it would seem that minimizing the dosages of medications that might interfere with overall health would be an important consideration. Medications can also change one's appetite for certain kinds of food. My experience is that, especially with olanzapine, appetites for carbohydrates and the wrong kind of fats can intensify, which can make adherence to a Mediterranean diet challenging.

The dietary emphases I describe above, to start with the Mediterranean diet in hopes of decreasing the necessary dose of medication for tremor management, would be the most ideal combination of approaches.

I also found some interesting effective non-pharmaceutical therapies that might be worthwhile to try. Who knows, maybe they can help put all that good nutrition into muscle and nerve tissue where it's needed, and prevent unnecessary loss of important tissues. Weight training, for example, improved their steadiness and decreased the magnitude of their tremors. Behavioral relaxation training was also found to reduce tremor severity.

Quite an interesting--albeit unexpected research project! Thank you for stimulating my interest in compiling information with potential to help others.

Lundervold DA, Belwood MF, Craney JL, Poppen R. Reduction of tremor severity and disability following behavioral relaxation training. J Behav Ther Exp Psychiatry. 1999 Jun;30(2):119-35.

Paulson G. Illnesses of the brain in John Quincy Adams. J Hist Neurosci. 2004 Dec;13(4):336-44.

Louis ED, Kavanagh P, Gertrude H. John Adams' essential tremor. Mov Disord. 2005 Dec;20(12):1537-42.

Louis ED, Jurewicz EC, Applegate L, Luchsinger JA, Factor-Litvak P, Parides M.Semiquantitative study of current coffee, caffeine, and ethanol intake in essential tremor cases and controls. Mov Disord. 2004 May;19(5):499-504.

Dogu O, Sevim S, Louis ED, Kaleagasi H, Aral M. Reduced body mass index in patients with essential tremor: a population-based study in the province of Mersin, Turkey. Arch Neurol. 2004 Mar;61(3):386-9.

Louis ED, Keating GA, Bogen KT, Rios E, Pellegrino KM, Factor-Litvak P. Dietary epidemiology of essential tremor: meat consumption and meat cooking practices. Neuroepidemiology. 2008;30(3):161-6.

Scarmeas N, Louis ED. Mediterranean diet and essential tremor. A case-control study. Neuroepidemiology. 2007;29(3-4):170-7.

Louis ED, Zheng W, Applegate L, Shi L, Factor-Litvak P. Blood harmane concentrations and dietary protein consumption in essential tremor. Neurology. 2005 Aug 9;65(3):391-6.

Yetimalar Y, Irtman G, Gurgor N, Basoglu M. Olanzapine efficacy in the treatment of essential tremor. Eur J Neurol 2003 Jan;10(1): 79-82.

Zesiewicz TA, Ward CL, Hauser RA, Pease Campbell JA, Sullivan KL. Pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jan;22(1):139-41.

Zesiewicz TA, Ward CL, Hauser RA, Salemi JL, Siraj S, Wilson MC, Sullivan KL. A pilot, double-blind, placebo-controlled trial of pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jun 19.

Lyons K, Pahwa R, Comella CL, Eisa MS, Elble RJ, Fahn S, Jankovic J, Juncos JL, Koller WC, Ondo WG, Sethi KD, Stern MB, Tanner CM, Tintner R, Watts RL. Benefits and risks of pharmacological treatments for essential tremor. Drug Saf 2003; 26(7): 461-81.

Ondo WG, Jankovic J, Connor GS, Pahwa R, Elble R, Stacy MA, Koller WC, Schwarzman L, Wu SC, Hulihan JF; Topiramate Essential Tremor Study Investigators. Topiramate in essential tremor: a double-blind, placebo-controlled trial. Neurology 2006 Mar 14;66(5):672-7.

Connor GS, Edwards K, Tarsy D. Topiramate in essential tremor: findings from double-blind, placebo-controlled, crossover trials. Clin Neuropharmacol. 2008 Mar-Apr;31(2):97-103.

Bilodeau M, Keen DA, Sweeney PJ, Shields RW, Enoka RM. Strength training can improve steadiness in persons with essential tremor. Muscle Nerve. 2000 May;23(5):771-8.


George Murphy said...

I'm on the Mediterranean diet and I use a special olive oil imported from Italy, I can totally tell the difference between it and the stuff they sell at Whole Foods and grocery stores

hormonewoman said...

Hi George!

It really makes a difference when you focus on quality, doesn't it? Not just in food but in anything in life.

I'm curious, what brand do you use and where do you find it?


Betsy said...

Thanks for this useful post. Here is some additional information about the "genetics" of this condition that was written by our Genetic Counselor and other genetic professionals: Thanks, AccessDNA

survivor said...

Thank you for this information. There is SO little available, despite the hundreds of thousands of people suffering from this. I've been looking for the last 10 years at least, since I have the problem. I've tried Propanolol and Tremadone, with little to no success. The only help I've found so far is deep breathing/relaxation techniques. I'm happy to know Mediterranean diet may help, as I'm convinced good nutrition is key to overall good health.