Update on Complementary and Alternative Medicine (CAM) Therapy in Parkinson’s

“The art of healing comes from nature, not from the physician. Therefore the physician must start from nature, with an open mind.” Paracelsus

“You know what they call alternative medicine that’s been proved to work? – Medicine.” Tim Minchin

Précis: Regularly, I am asked what I take for treating Parkinson’s. This blog post describes the various substances I take to treat my Parkinson’s. The strategy presented contains a traditional pharmacological approach, a complementary and alternative medicine (CAM) format, and several supplements based on an integrated medicine approach.

“A wise man ought to realize that health is his most valuable possession.” Hippocrates

Introduction: When thinking about therapy, one must consider the numerous pathways of initiation of Parkinson’s (shown in the schematic below). This suggests that for treatment to be effective, one should consider using or designing a multi-functional approach to deal with the motor- and non-motor defects and the numerous putative causes (etiology) of the disorder. For example, should one consider addressing neuroinflammation? Is some crucial nutrient deficient? Should one try to reduce the detrimental oxidative stress in the mid-brain? Does the immune system need to be re-focused? Each question could be answered yes. However, trying to orchestrate or design a treatment strategy for Parkinson’s may be far-fetched and impossible. This quote from John Wooden has always positively influenced me, “Do not let what you cannot do interfere with what you can do.” Therefore, you can try several approaches to slow the disorder’s progression, make the brain healthier while battling Parkinson’s, and stay hopeful and focused.

“The best cure for the body is a quiet mind.” Napoleon Bonaparte

Background: The overarching theme I follow is based on what I have read on the treatment of Parkinson’s and, hopefully, on the mode of action of each substance derived from experimental results or in support of some scientific principle. The bottom line, I want to take something safe, reasonably inexpensive, and has the potential to alter or improve my symptoms.

Here are two papers I published in peer-review journals that form the essence of my treatment philosophy. Both pieces are open-access and free to download:

1.   Hall, M.-F.E., and F.C. Church. Integrative Medicine and Health Therapy for Parkinson Disease.  Topics in Geriatric Rehabilitation 36.3 (2020): 176-186. https://bit.ly/3kIDY2K

2.   Church, F.C. Treatment Options for Motor and Non-Motor Symptoms of Parkinson’s Disease. Biomolecules (2021): 11, 612. https://doi.org/10.3390/biom11040612

Complementary and Alternative Medicine (CAM) – The first paper describes an integrative medicine approach to treating Parkinson’s. We defined and presented Complementary and Alternative Medicine (CAM) and the principles of CAM therapy as outlined by the National Institutes of Health ( NIH). The definition of CAM and its various categories are presented in the figure below.

Integrative Medicine and Health Therapy– We then described the concept of integrative medicine and health therapy, which combines traditional and non-traditional medicine. An integrative medicine approach emphasizes patient-centered care. Furthermore, in an integrative medicine approach, one must be mindful of the patient’s lifestyle, environment, and emotional well-being in deriving a treatment plan. The Table below shows examples of combining these two medical practices to give the person (people)-with-Parkinson’s (PwP) an effective and powerful therapeutic plan against Parkinson’s (see the blog post below to get the details).

Comparing Different Types of Medicine– Is integrative medicine the same as holistic medicine and functional medicine? WebMD describes holistic medicine as a form of healing that considers the whole person, which includes body, mind, spirit, and emotions, in the quest for optimal health and wellness. Thus, the primary goal of holistic medicine is to help one achieve proper balance in life. On the other hand, functional medicine is a form of alternative medicine that tries to restore health by addressing the root causes of disease. Physicians that practice functional medicine believe that the body is an interconnected system of natural processes, and they focus treatment on fixing imbalances and dysfunctions.

Overview of Treating Parkinson’s– The second paper mentioned above began as an integrated medicine and health therapy strategy expansion that described five treatment options for PwP, including Rehabilitate, Therapy, Restoration, Maintenance, and Surgery. This treatment scheme is described further in the figure below. The paper also summarizes each of the five treatment options for Parkinson’s.

The traditional approach for treating Parkinson’s usually begins with a pharmacologic dopamine replacement strategy. Since traditional treatment has no curative effect, we are left to explore CAM and integrative medicine approaches to improve brain health and support “quality of life” (QoL) in PwP. Non-motor symptoms are prevalent in Parkinson’s. Therefore, PwP must carefully communicate with their healthcare team to address these issues and treat PD’s motor and non-motor symptoms. Furthermore, the treatment options above can be used collectively, not sequentially. Therefore, seeking guidance and advice from movement disorder neurologists is crucial.

Goals for a Treatment Plan– There are some apparent goals for any Parkinson’s treatment plan:

• First, it should help suppress disorder symptoms, targeting motor or non-motor-related issues.
• Second, it should be reasonably inexpensive and easy to take.
• Third, hopefully, the treatment scheme may contribute to slowing down disease progression.
• Fourth, any substance, individually or together, should not be detrimental to one’s health.
• Fifth, the substances should be able to pass through the blood-brain barrier.
• And finally, “quality of life” should hopefully be maintained or improved by this treatment plan for Parkinson’s.

The Challenge of Treating Parkinson’s– The remainder of the second paper thoroughly presented available therapeutic options and substances used to treat Parkinson’s. Difficulty in treating Parkinson’s is found in the diverse motor and non-motor symptoms in each PwP. Our diagnosis of Parkinson’s unites us. However, the apparent amount of penetrance, the pace of progression, the amount of cognitive loss, and the expression of various motor- and non-motor symptoms differ in each PwP, making Parkinson’s a uniquely individualized disorder.

In other words, each PwP may require a different treatment plan than the next PwP. Therefore, my treatment plan may or may not work for you as it functions for me. However, there is a substantial overlap of symptoms, and the causes of the disorder are likely similar to some extent. This would indicate some generalized goodness could be realized by presenting a treatment plan with some tweaking. It at least would give the background and foundation to begin building and designing their own CAM treatment plan. Before trying any of these supplements, please consult with your Neurologist.

“The next major advance in the health of the American people will be determined by what the individual is willing to do for himself.” John Knowles

My Daily Use of Dopamine-related Products and CAM/OTC Supplements: The remainder of the blog post is not meant to walk one through the history of the different substances I have tried but to give you the current choices of substances I use to treat my Parkinson’s. The list of past blog posts reveals that I have tried several substances not included in the 2023 list. In addition, I have done several different rehabilitation programs, LSVT LOUD and LSVT BIG, which will also not be discussed. Furthermore, I have extensive written reports and current exercise programs, some of which are considered; this will not be further described. Primarily, I will focus on therapy, restorative, and maintenance categories for managing motor- and non-motor symptoms of Parkinson’s. Finally, a representative list of blog posts regarding these supplements will be at the end of the blog post, in addition to some literature references.

To download this material below as a PDF document entitled “Daily Medication and CAM Supplement Strategy for Treating Parkinson’s,” please click here.

“The treatments themselves do not ‘cure’ the condition, they simply restore the body’s self-healing ability.” Leon Chaitow

Therapy: The traditional approach for treating Parkinson:s is usually a pharmacological dopamine enhancement replacement plan. There are mimics of dopamine, using dopamine agonists. Furthermore, various inhibitors assist in prolonging the survival of Levodopa in dopaminergic-producing neurons in the brain.

Dopamine replacement– I need a steady course of Levodopa, the immediate precursor to dopamine. Thus, I take 10-12 Carbidopa/Levodopa tablets (25 mg/100 mg) daily. In addition, I use a Rotigotine dopamine-agonist patch (6 mg, which is released over 24 h). Recently, I added a COMT inhibitor, Entacapone (200 mg tablet), which I take with my first three Carbidopa/Levodopa doses. I can only speak for myself, but Entacapone is almost ‘magical’ in stabilizing the on/off issues of Carbidopa/Levodopa. Many days, I have skipped my final dose of Carbidopa/Levodopa. The chemical structures of these dopamine-replacement compounds are given below.

“A man may esteem himself happy when that which is his food is also his medicine.” Henry David Thoreau

Restorative: One of the ‘magic bullets’ for Parkinson’s is a substance that reverses or restores the dopamine-producing neurons. Growing evidence shows that sustained aerobic exercise may be both neuroprotective and possibly neurorestorative. In previous clinical trials of some substances, some studies ‘hinted’ at neuroprotection, but the FDA did not approve these findings. However, in my readings, one clinical trial performed in Italy with palmitoylethanolamide (PEA) showed substantial improvement. Using the Hoehn and Yahr (HY) Scale to determine the severity of Parkinson’s showed these changes, going from 1.8 ± 0.23 three months before the study to 2.5 ± 0.14 at the start of the clinical research. After a year of um-PEA therapy (ultra micronized-PEA), the collective HY score was 1.9 ± 0.15. See Brotini, Stefania, Carlo Schievano, and Leonello Guidi. “Ultra-micronized palmitoylethanolamide: an efficacious adjuvant therapy for Parkinson’s disease.” CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders) 16, no. 6 (2017): 705-713. No doubt, other examples in the literature are neuroprotective.

Neuroprotective Supplements– I am a fan of substances that propose they are neuroprotective. A sub-category would be compounds that reduce neuroinflammation. Thus, as mentioned above, I find PEA essential (NOTE: search out and use micronized and ultra-micronized products because it is easier for the body to assimilate). Likewise, both Luteolin and Sulforaphane have anti-inflammatory properties (stay tuned for future blog posts on both compounds). The other sub-category that I think is important is a substance that supports brain/nerve/neuron health. Magnesium L-Threonate and Taurine are reported to be good for a healthy brain in this group. The chemical structures of these compounds are given below.

“The person who takes medicine must recover twice, once from the disease and once from the medicine.” William Osler

Maintenance: It is usually mentioned when introduced to Parkinson’s that one has lost ~50% of the dopaminergic neurons. So, I thought using compounds that help maintain the remaining neurons in a healthy state would seem a critical goal of CAM therapy. Thus, any substance that supports brain health (those just mentioned) and those below all contribute to maintaining what we have left in dopamine-producing power.

Vitamins– I am a big fan of the below vitamins, including vitamin B₁, vitamin B₁₂, vitamin C, and vitamin D₃. Vitamin B_1, also called Thiamin (or Thiamine), has many devout followers of HDT (High Dose Thiamin) by titrating up to 3-4 grams daily. Many have had tremendous results with motor symptom relief. My arm tremor went nuts when I tried tapering up on Thiamin. So I have settled on 100 mg tablets twice/day. Vitamin B₁₂ has a unique role in nerve health, and Vitamin C is a potent antioxidant. Vitamin D₃ has been found to boost one’s immune system and is suitable for healthy brains by its anti-inflammatory properties. The chemical structures of these vitamins are given below.

Antioxidants: I think one cannot ignore the potential of neuroinflammation to continue to support the progression of Parkinson’s. Since I am currently using Luteolin and Sulforaphane, I have stopped taking the four compounds below. My worry is taking too much might harm these remaining neurons producing dopamine. In other words, I do not want a monsoon storm of antioxidants/anti-inflammatory substances bombarding the brain. Still, I would prefer a sustained and steady light rain shower turning down the neuroinflammation. The chemical structures of these antioxidants are given below.

Leftovers– I end by briefly describing the supplements that have not been mentioned. Melatonin helps me attempt to sleep more than four hours/night. And Ashwagandha has been used for centuries to reduce stress and anxiety, and it has some ability to boost cognition. A component of Ashwagandha has been identified with immune modulating action. There is growing evidence that Parkinson’s may be an autoimmune disorder. So until I understand the immune system effect on Parkinson’s, I am halting Ashwagandha. Finally, I take a probiotic to help regulate the composition of my gut microbiome. There is substantial data to suggest that one of the originating sites of neuroinflammation begins in the gut, and many recommend routinely taking a probiotic supplement.

CAM/OTC Supplement Storage Containers– I keep the supplement bottles in a nylon bag, and weekly, I carefully count out and place them into a 7-day 4-compartment pill case. Then daily, I take many pills first thing in the morning (and attach one Neupro patch to my arm). Finally, I use the small circular pill cases to keep the remaining supplements close when needed. And do not forget; you might need to invest in a pill cutter (mine was less than ~$3.00). The photos below demonstrate the collection of sustained. The photos below show the collection of supplements and the containers used to hold them for a week and a day, respectively.

Note of Caution– Most herbs and supplements have not been rigorously studied as safe and effective treatments for PD. The U.S. Food and Drug Administration (FDA) does not strictly regulate herbs and supplements; therefore, supplements’ safety, strength, or purity are not guaranteed.

“The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition.” Thomas A. Edison

Closing Comments: Every list of supplements shared by PwP for treating Parkinson’s will have some readers agree with it and some saying so and so said that this compound or that supplement is worthless. How do I feel about my Parkinson’s Supplement list? This is the best I have felt since long before my diagnosis. At times, I almost feel normal. Thus, I am pleased with this selection of supplements to treat Parkinson’s.

I am neither asking you to try the variety of supplements found on this list nor to endorse the list of supplements. I am just sharing the content and rationale I used to compose it. No doubt, by 2024, it may likely change again. My reasoning for spending so much time revising and evolving the supplements I take is simple- I want to contribute something to treat my Parkinson’s. I need to try to do something that potentially prolongs the lifetime of my remaining dopaminergic neurons and keeps the brain healthy. I need to do something that gives me hope, says I gave it my best shot, or have someone say, “Hey, that’s interesting. I may add substances A and B to my Parkinson’s-cocktail.” Good luck, everyone, as we continue to battle against Parkinson’s.

“We should listen less to the opinions of those who either overtly promote or stubbornly reject complementary and alternative medicine without acceptable evidence. The many patients who use complementary and alternative medicine deserve better. Patients and healthcare providers need to know which forms are safe and effective. Its future should (and hopefully will) be determined by unbiased scientific evaluation.” Edzard Ernst

A List of Past Blog Posts Regarding the Various Supplements Described Here, and Some Useful References on these Topics:
–CAM Review
Complementary and Alternative Medicine (CAM) and Over-the-Counter Therapies in Parkinson’s
Parkinson’s Treatment With Dopamine Agonist, Complementary and Alternative Medicine (CAM), and Exercise
Complementary and Alternative Medicine (CAM) in Parkinson’s
D. Bega, P. Gonzalez-Latapi, C. Zadikoff, T. Simuni, A review of the clinical evidence for complementary and alternative therapies in Parkinson’s disease, Current treatment options in neurology 16(10) (2014) 314.

F.L. Bishop, L. Yardley, G.T. Lewith, A systematic review of beliefs involved in the use of complementary and alternative medicine, Journal of health psychology 12(6) (2007) 851-867.

H.-i.P.s.D.S. Group, An alternative medicine treatment for Parkinson’s disease: results of a multicenter clinical trial, The Journal of Alternative and Complementary Medicine 1(3) (1995) 249-255.

–Levodopa
A Graph of Your Daily Level of Exogenous Levodopa
Treating Parkinson’s with Carbidopa/Levodopa
B Vitamins (Folate, B6, B12) Reduce Homocysteine Levels Produced by Carbidopa/Levodopa Therapy
J.E. Ahlskog, Cheaper, simpler, and better: tips for treating seniors with Parkinson disease, Mayo Clinic Proceedings, Elsevier, 2011, pp. 1211-1216.

[B.S. Connolly, A.E. Lang, Pharmacological treatment of Parkinson disease: a review, JAMA 311(16) (2014) 1670-1683.

-Dopamine Agonists
Brief Report: Hair Loss Linked to Dopamine Agonists
Dopamine Agonists and Impulse Control Disorders in Parkinson’s
Parkinson’s: Dopamine (A Neurotransmitter and the Title of Many Songs)
Treating Parkinson’s with a Dopamine Agonist: The Ropinirole Taper
Dopamine Agonist Withdrawal Syndrome (DAWS) in Parkinson’s
M.D. Latt, S. Lewis, O. Zekry, V.S. Fung, Factors to consider in the selection of dopamine agonists for older persons with Parkinson’s disease, Drugs & Aging 36 (2019) 189-202.

-COMT Inhibitor
COMT Inhibitors in Parkinson’s: Tell Me More, Tell Me More
Addendum to COMT Inhibitors in Parkinson’s
S. Kaakkola, Clinical pharmacology, therapeutic use and potential of COMT inhibitors in Parkinson’s disease, Drugs 59 (2000) 1233-1250.

-Palmitoylethanolamide (PEA)
Update on Palmitoylethanolamide (PEA) for the Treatment of Parkinson’s
Role of Palmitoylethanolamide to Control Neuroinflammation and Potential Therapy for Parkinson’s
S. Brotini, C. Schievano, L. Guidi, Ultra-micronized palmitoylethanolamide: an efficacious adjuvant therapy for Parkinson’s disease, CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders) 16(6) (2017) 705-713.

E. Landolfo, D. Cutuli, L. Petrosini, C. Caltagirone, Effects of palmitoylethanolamide on neurodegenerative diseases: a review from rodents to humans, Biomolecules 12(5) (2022) 667.

-Magnesium Threonate
Importance of Magnesium in the Brain and Magnesium Threonate is Neuroprotective in a Mouse Model of Parkinson’s
Y. Shen, L. Dai, H. Tian, R. Xu, F. Li, Z. Li, J. Zhou, L. Wang, J. Dong, L. Sun, Treatment Of Magnesium-L-Threonate Elevates The Magnesium Level In The Cerebrospinal Fluid And Attenuates Motor Deficits And Dopamine Neuron Loss In A Mouse Model Of Parkinson’s disease, Neuropsychiatric Disease and Treatment 15 (2019) 3143.

R. Yamanaka, Y. Shindo, K. Oka, Magnesium is a key player in neuronal maturation and neuropathology, International journal of molecular sciences 20(14) (2019) 3439.

-Vitamin B₁ and Vitamin B₁₂
B Vitamins (Folate, B6, B12) Reduce Homocysteine Levels Produced by Carbidopa/Levodopa Therapy
A. Costantini, R. Fancellu, An open-label pilot study with high-dose thiamine in Parkinson’s disease, Neural Regeneration Research 11(3) (2016) 406-407.
Y. Wu, Z. Zhao, N. Yang, C. Xin, Z. Li, J. Xu, B. Ma, K.-L. Lim, L. Li, Q. Wu, Vitamin B12 Ameliorates the Pathological Phenotypes of Multiple Parkinson’s Disease Models by Alleviating Oxidative Stress, Antioxidants 12(1) (2023) 153.

-Vitamin D₃
Hribar, C.A., P.H. Cobbold, and F.C. Church. Potential Role of Vitamin D in the Elderly to Resist COVID-19 and to Slow Progression of Parkinson’s Disease. Brain Sciences 10.5 (2020): 284. https://www.mdpi.com/2076-3425/10/5/284

–Taurine
Neuroprotection with Taurine in a Parkinson’s Model System
C.E. Wright, H.H. Tallan, Y.Y. Lin, G.E. Gaull, Taurine: biological update, Annual review of biochemistry 55(1) (1986) 427-453.Y. Che, L. Hou, F. Sun, C. Zhang, X. Liu, F. Piao, D. Zhang, H. Li, Q. Wang, Taurine protects dopaminergic neurons in a mouse Parkinson’s disease model through inhibition of microglial M1 polarization, Cell death & disease 9(4) (2018) 435.

-N-Acetyl-L-Cysteine (NAC)
The Yack on NAC (N-Acetyl-Cysteine) and Parkinson’s
D.A. Monti, G. Zabrecky, D. Kremens, T.-W. Liang, N.A. Wintering, J. Cai, X. Wei, A.J. Bazzan, L. Zhong, B. Bowen, N-acetyl cysteine may support dopamine neurons in Parkinson’s disease: preliminary clinical and cell line data, PLoS One 11(6) (2016) e0157602.

-Anti-Aging
Potential Anti-Aging and Neuroprotection Strategy for Parkinson’s
O.T. Phillipson, Inhibition of aging in Parkinson’s disease: a case study, The Journal of Alternative and Complementary Medicine 19(10) (2013) 851-851.

O.T. Phillipson, Management of the aging risk factor for Parkinson’s disease, Neurobiology of aging 35(4) (2014) 847-857.

–Ashwagandha
Science Sunday: Ashwagandha and Parkinson’s
Immunomodulating Activity of an Extract from Ashwagandha: Implications for Treatment of Parkinson’s
S. Zahiruddin, P. Basist, A. Parveen, R. Parveen, W. Khan, S. Ahmad, Ashwagandha in brain disorders: A review of recent developments, Journal of ethnopharmacology 257 (2020) 112876.

V.K. Joshi, A. Joshi, Rational use of Ashwagandha in Ayurveda (Traditional Indian Medicine) for health and healing, Journal of Ethnopharmacology 276 (2021) 114101.

Cover Photo Image by Jill Wellington from Pixabay