Wanted to report on my experience with mannitol- though I have zero evidence of cause and effect- I am convinced that initiating oral mannitol- 1 tbsp/d has had negative effects on my energy, rigidity and hypokinesia. Though I know any positive effect may take a month or more to manifest-- i've given up.

As we all know now - the gut-brain connection is f strong in PD--as with everything else-with marked individual differences.

Mannitol- a sugar alcohol with a low glycemic index-poorly absorbed from the gut-is used/along with lactulose to determine increased gut permeability-e.g with bacterial overgrowth-or CIBO- In patients with CIBO- the urine ( evidence of absorbtion into the blood) excretion of lactulose is up ( evidence of gut leak) but mannitol is not a (presumably evidence of loss of digestive surface area). In many people-(including me) lactulose ingestion in significant quamtities will be fermented by gut flora (especially "bad" gut bacteria to various metabolites- including gases. As I have written before- as with many of us- as my gut goes, so does my PD. From the moment i began taking mannitol ( and i take a daily probiotic) i had significantly more soft BM's, more bloating and a lot more flatulance (TMI- I know). I have also felt like sh---. Mannitol and other sugar alcohols are to be avoided in "leaky gut" and though there is a shot at a long term benefit- I am not willing to take the risk!. I would be interested if others have experienced this!