Diet and Parkinson's disease

I've been studying nutrition and the brain for awhile now, and it's clear I'm a big fan of omega-3 fatty acids. It's only been recently that their role in Parkinson's disease prevention is becoming clear.

Oxidative stress, or aging, is to the brain what rust is to your car. In Parkinson's disease, oxidation appears to significantly affect the brain systems regulating dopamine.

In this study, rat brain tissue was exposed to several by-products of fatty acids found in the brain, docosahexaenoic acid and arachidonic acid. It turned out that the arachidonic acid--derived compound was the most toxic to brain cells.

Arachidonic acid is derived from two main sources, certain dietary oils, and meats. It's fairly easy to identify the oils that promote arachidonic acid production. They tend to be those, which in English, begin with the letters "S" and "C"; soybean, safflower, sunflower, sesame, corn, cottonseed...the only exception would be canola. These oils have been unloaded into the food supply in recent years and as they have, many diseases, not just Parkinson's, have been on the upswing. Start reading your labels!

Arachidonic acid is also found in meat. So if you are eating large portions of meat instead of balancing your protein with other types of food, your diet may be out of balance and promoting inflammation/oxidation/aging, particularly in the nervous system. Some rules to follow which you've heard before, for other reasons, include: eat more seafood and less red meat, eat more vegetarian meals, and limit your meat portions to the size of the palm of your hand without the fingers.

Parkinson's is not a problem to be taken lightly. If you have ever known someone who has had to deal with the tremors and deterioration in quality of life...you know what I mean. Some very simple dietary choices may help you to delay or prevent having to personally deal with this challenging diagnosis.

Liu X, Yamada N, Maruyama W, Osawa T. Formation of dopamine adducts derived from brain polyunsaturated fatty acids: mechanism for Parkinson disease. J Biol Chem. 2008 Dec 12;283(50):34887-95. Epub 2008 Oct 15.

Pregnant women and psychotropic medications really don't mix

What I hate about this study is that we even have to study whether or not a pregnant woman should be given psychotropic medications during pregnancy. It disturbs me that this many studies surrounding this question are showing up in Pub Med. My common sense would tell me absolutely not, without even having to do the research. However, I guess there are some situations where it is more dangerous to have a pregnant woman's psychopathology left completely untreated for an entire 9 months. So, despite my personal feelings, I'll share the findings.

Pregnant mice were given fluoxetine (Prozac) throughout their pregnancy and kept on the medication until their pups were weaned. The pups were then given other medications and their responses to those medications were evaluated. The effects seemed to be more significant in the female offspring, who did not seem to have normal responses related to dopamine function. (Dopamine is important for impulse control, which influences potential for chemical dependencies and troubles such as addictions, gambling, shoplifting, and carbohydrate bingeing). The researchers also suggested that if this relationship existed in humans, daughters of women who took Prozac during pregnancy may not effectively respond to certain medications later in life. Two important classes of medications this might include are Parkinson's medications and antipsychotics, both of which attempt to correct problems in dopamine systems.

So, MY take on this is that given the fact that fish oil is such a powerful antidepressant and it is important to have enough of it during pregnancy for both mother and baby, perhaps we're learning that we should lean more in that direction on behalf of the two individuals involved in a pregnancy.

My CONCERN is that a drug company R and D person is likely to read the very same study and think, "Hmmm...if we get started right now, we can have a new drug ready for all those babies coming down the pike whose dopamine systems aren't responding to anything we can currently script."

We'll see which direction this information takes science. I sure hope it's the one involving fewer trips to the pharmacy in 20 years.

Favaro PN, Costa LC, Moreira EG. Maternal fluoxetine treatment decreases behavioral response to dopaminergic drugs in female pups. Neurotoxicol Teratol. 2008 Nov-Dec;30(6):487-94. Epub 2008 May 14.

Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs.

As much trouble as I have with indiscriminate use of antipsychotic medications, I do think they have important uses in certain situations, and that we have to be very careful about overgeneralizing their negative aspects.

For example, these medications are increasingly being used to help control side effects in some serious illnesses such as Parkinson's disease and Alzheimer's disease. In some cases, especially when not managing these side effects can make things hard to manage for these individuals' caregivers (who are often family in a home situation), it is important to balance considerations about overall quality of care, caregiver sanity and health, and weight. Each situation is different, and there are no easy answers.

Sixty-one Parkinson's patients on either quetiapine (Seroquel) or clozapine (Clozaril) for at least six months were compared to 28 Alzheimer's patients in similar situations. The weight changes, though small, were statistically significant. Parkinson's patients trended toward weight loss compared to controls, and Alzheimer's patients trended toward weight gain.

It may not be that these medications cause weight changes in one direction or the other...but rather, they foster metabolism moving in a direction that genetic tendency long ago pre-programmed. It is important to not be afraid of a medication that can help ease the life of the caregiver. Of course, judicious use and close monitoring are always the caveats that go with any medication decision. Alzheimer's patients seem to be prone to developing diabetes and that should not be ignored.

I was glad to see this study attempt to parse out exactly what these medications do and why. That's a great use of scientific minds.

Sitburana O, Rountree S, Ondo WG. Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs. J Neurol Sci. 2008 Sep 15;272(1-2):77-82. Epub 2008 Jun 16.

It starts with Mom

It's so good to be back! I love my morning routine, which involves getting up, checking my email, giving milk to the cats, working out, fixing my coffee, then settling in for an hour or two of reading research that I end up sharing in my blogs. It's been about a month since I've been able to indulge that routine, and I am so glad to be back in the groove! Today I'm going to share some more research about what happens to the brains of developing babies whose mothers don't get enough omega-3 fatty acids. This time we're looking at linolenic acid (ALA), which comes primarily from flaxseed oil and nuts. This omega-3 appears to be important for the metabolism of the neurotransmitter dopamine.

When ALA is deficient, in the hippocampus, levels of enzymes that help to create dopamine from its building blocks drop. There is also a reduction in the number of vesicles that transport the finished product, dopamine, to where it can be released and used as a neurotransmitter. As a result, dopamine levels may back up in the neuron, which the researchers in this study propose may potentially damage the terminals in charge of processing dopamine.

In the cortex and striatum, under these same conditions, there is an increase in dopamine receptor levels. These same researchers propose that this is some sort of compensatory mechanism that allows cells "downstream" from the problem to maximize their ability to capture and use what dopamine is available.

Dopamine is important for impulse control. It is also the focus of much Parkinson's disease research. The D2 receptor mentioned in this study is especially important for managing weight, carbohydrate cravings, and addictions.

Could it be that many of the chronic problems medical professionals deal with and that we as people live with...have their origin before we're even born?

I've been saying for years that the population that needs the focus of our preventive nutrition and medical education is women of childbearing age. If we don't catch problems then, and if we focus on telling them what NOT to eat instead of helping them best eat for two...well, unfortunately, it may end up being job security for anyone whose work uniform includes a lab coat.

Kuperstein F, Eilam R, Yavin E. Altered expression of key dopaminergic regulatory proteins in the postnatal brain following perinatal n-3 fatty acid dietary deficiency. J Neurochem. 2008 Jul;106(2):662-71.

It's the marijuana, stupid

Much of my work is with polycystic ovary syndrome, PCOS, an inflammatory syndrome that is the leading cause of infertility in the United States. Women who have this syndrome are plagued with intense carbohydrate cravings that can make it nearly impossible to follow any kind of healthy diet.

A dietitian with the syndrome, who had a master's degree in nutrition, once told me, "If it's carbohydrate, and it's not nailed down...I eat it."

It happens more often than not, when I work with clients who have PCOS, that they cannot conceive of being in a physiological state where the majority of their thoughts revolve around sugar and where to find more. They might politely listen to what I have to say about how to eat to quell these cravings, but the inevitable question at the end of my pitch for my nutrition plan is, "OK, but what am I going to do when I crave sugar?" They have absolutely no knowledge of a time when cravings did not rule their food choices, and their experience causes them to assume that my program is going to fail their expectations just as every other diet has done.

That's why I work so hard for those clients who are willing to trust me and try my program. It's incredibly rewarding to talk to them a couple of weeks later and hear the surprised delight over not spending hours of time and energy trying to suppress the urge to binge on a chocolate cake.

It seems that one of the reasons women with PCOS have so much trouble with their carbohydrate cravings, is that their endocannabinoid systems are out of balance.

You may know of cannabinoids as the substance in marijuana that causes the munchies. These compounds have been found to be important appetite regulators.

Of course, in Western medicine, when receptor trouble is identified, that means dozens of scientists in drug companies around the world race to find the right chemical to fix the troubled receptor.

Currently, a drug has been developed designed to "improve" the function of cannabinoid receptors. For a lot of obesity scientists, this drug, rimonabant, (Acomplia), was supposed to be the obesity miracle drug. However, Acomplia was tripped up during the FDA approval process, because there were concerns about an increased risk of severe depression being a major side effect. That is what has been tested and observed with Acomplia use.

What is also apparently a concern is that since this drug is somewhat like "anti-marijuana," it has potential for antagonizing many of the neuroprotective properties that marijuana may actually have. In other words, users of Acomplia may find themselves at increased risk of neurodegenerative diseases such as Multiple sclerosis, Alzheimer's disease, Amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease.

So what are women with PCOS--and men whose obesity is also fueled by carbohydrate cravings supposed to do?

If you're a regular reader of this blog, you should know by now that the first answer to any question should always be fish oil. :) Yup, fish oil can help to silence the marijuana munchies.

I included a reference for your perusal, but I have to say, it was a client who taught me about this. We'd spent a couple of hours in our initial assessment, and I gave her my standard omega-3 and diet protocol. She had been embarrassed to tell me in that initial meeting, that every Sunday evening she baked a chocolate cake, which she used to satisfy her voracious carbohydrate appetite. Two weeks into using fish oil, she had thrown out two chocolate cakes, because her appetite for sweets had so radically diminished, she didn't even think about bingeing.

The relationship between carbohydrates and omega-3 balance is so strong, that I know I've titrated the right dose of fish oil with the right amount of other fats when the cravings are gone.

If you've taken fish oil and you have not experienced a drop in carb cravings, chances are you either aren't taking enough of the stuff...or you haven't eliminated enough of the other fats that get in the way of fish oil doing its amazing job.

So don't despair because the FDA kept rimonabant out of the drug supply and out of YOU. Give thanks, and look to the ocean for an even better way of getting the same results.

Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG. 2006 Oct;113(10):1148-59. Epub 2006 Jul 7.

http://www.springerlink.com/content/41v7536525023722/

Kim AH, Kerchner GA, and Choi DW. Blocking Excitotoxicity. Chapter 1 in CNS Neuroprotection. Marcoux FW and Choi DW, editors. Springer, New York. 2002. Pages 3-36.

Engeli S, Heusser K, Janke J, Gorzelniak K, Bátkai S, Pacher P, Harvey-White J, Luft FC, Jordan J. Peripheral endocannabinoid system activity in patients treated with sibutramine. Obesity (Silver Spring). 2008 May;16(5):1135-7.

Watanabe S, Doshi M, Hamazaki T. n-3 Polyunsaturated fatty acid (PUFA) deficiency elevates and n-3 PUFA enrichment reduces brain 2-arachidonoylglycerol level in mice. Prostaglandins Leukot Essent Fatty Acids. 2003 Jul;69(1):51-9.

New contributor--and great info to come on Parkinson's disease!

I'm really excited to announce, I will soon have a co-contributer to this blog! My partner in crime will be Kathrynne Holden, a registered dietitian who specializes in diet for Parkinson's disease. She has authored numerous publications on the topic and she has spoken at many conferences as well. Kathrynne is THE "go to" person in this area, and has agreed to share her expertise regarding medications and nutrition aspects of this diagnosis.

If Parkinson's disease is a special interest of yours, you can see more of Kathrynne at the National Parkinson Foundation website,

http://www.parkinson.org/,

where Kathrynne moderates a listserve and answers personal questions. Once you get to the website, click "Ask the Parkinson Dietitian", follow the instructions, then post your question.

A warm and excited welcome to Kathrynne!

Melatonin and REM sleep behavior disorder

REM sleep behavior disorder is a condition in which a person acts out dreams during his or her sleep...understandingly, it can be dangerous for that person's bed partner!

What is important to know, is that there is a link between this disorder and Parkinson's disease. So anything you can do to discourage the nervous system from progressing in this direction can be crucial.

Researchers recently reported that a variety of medications can be helpful in treating REM sleep disorder, especially clonazepam (Klonopin). Second in line was a natural hormone that is available as an over the counter supplement, melatonin.

While the researchers promoted clonazepam as their first choice, I would have to put my money on melatonin. Not only is it a sleep enhancer, it is a very powerful antioxidant, which means it can not only help with current symptoms, but do that preventive work I mentioned.

One of the biggest problems with the way medicine is practiced, in my opinion, is that we tend to focus on the current problem and what band-aid...er...drug...we can prescribe, to feel like we've fixed the problem. Rarely do we look deeper to the core issue. And that's why so many people are on so many medications today.

I can guarantee you, people with REM sleep disorder are not having problems because their bodies are deficient in clonazepam! But they could be having trouble with melatonin metabolism. Which is why this option makes so much sense to me.

Gugger JJ, Wagner ML. Rapid eye movement sleep behavior disorder. Ann Pharmacother. 2007 Nov;41(11):1833-41.

Bubenik GA, Blask DE, Brown GM, Maestroni GJ, Pang SF, Reiter RJ, ViswanathanM, Zisapel N. Prospects of the clinical utilization of melatonin. Biol Signals Recept 1998 jul-Aug;7(4):195-219.

Deigner HP, Haberkorn U, Kinscherf R. Apoptosis modulators in the therapy of neurodegenerative diseases. Expert Opin Investig Drugs 2000 Apr;9(4):747-64.

Srinivasan V, Pandi Perumal SR, Maestroni GJ, Esquifino AI, Hardeland R, Cardinali DP. Role of melatonin in neurodegenerative diseases. Neurotox Res 2005;7(4):293-318.

Antolin I, Mayo JC, Sainz RM, del Brio Mde L, Herrera F, Martin V, Rodriguez C. Protective effect of melatonin in a chronic experimental model of Parkinson's disease. Brain Res 2002 Jul 12;943(2):163-73.

Mayo JC, Sainz RM, Tan DX, Antolin I, Rodriguez C, Reiter RJ. Melatonin and Parkinson's disease. Endocrine 2005 Jul;27(2):169-78.