[lou_lou]

Principal Proposed Natural Treatments for PD

CDP-Choline
Short for cytidinediphosphocholine, CDP-choline (sometimes called citicholine) is a substance that occurs naturally in the human body. It is closely related to choline, a nutrient commonly put in the B-vitamin family. For reasons that are not completely clear, CDP-choline seems to increase the amount of dopamine in the brain.3,4 On this basis, it has been tried for Parkinson’s disease.

In a 4-week, single-blind study of 74 people with Parkinson's disease, researchers tested whether oral CDP-choline might help levodopa be more effective.5 Researchers divided participants into two groups: one group received their usual levodopa dose, the other received half their usual dose without knowing which dosage they were getting. All the participants took 400 mg of oral CDP-choline three times daily.

Even though 50% of the participants were taking only half their usual dose of levodopa, both groups scored equally well on standardized tests designed to evaluate the severity of Parkinson's disease symptoms.

Support for the use of CDP-choline also comes from studies in which the supplement was administered by injection.6–9

In general, CDP-choline appears to be safe.11 The study of oral CDP-choline for Parkinson's disease reported only a few brief, nonspecific side effects such as nausea, dizziness, and fatigue.12 In a study of 2,817 elderly people who took oral CDP-choline for up to 60 days for problems other than Parkinson's disease, side effects were few and mild and reported in only about 5% of participants.13 Two-thirds of these side effects were gastrointestinal (nausea, stomach pain, and diarrhea), and none required stopping CDP-choline. The dose in this study was 550 to 650 mg per day, about half the dose used for Parkinson's disease.

Coenzyme Q10
The supplement coenzyme Q10 has shown promise in the treatment of Parkinson’s disease.

In a double-blind trial, 28 people with Parkinson’s disease were given either placebo or 360 mg of CoQ10 daily, along with conventional care.45 The results indicated that use of the supplement produced a mild improvement in symptoms.

A previous study found suggestions that CoQ10 may help slow the progression of Parkinson’s disease. In this 16-month, double-blind, placebo-controlled trial, 80 people with Parkinson’s disease were given either CoQ10 (at a dose of 300, 600, or 1,200 mg daily) or placebo.44 Participants in this trial had early stages of the disease and did not yet need medication. The results suggested that CoQ10, especially at the highest dose, might have slowed disease progression. However, various statistical technicalities made the results inconclusive.

For more information, including dosage and safety issues, see the full CoQ10 article.


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Other Proposed Natural Treatments
Several other natural products have been studied for preventing or treating Parkinson’s disease, with mixed results.

SAMe
Whether a symptom of the disease or a response to disability, depression affects many people with Parkinson's disease, and long-term use of levodopa may contribute to this problem. Research suggests that levodopa can deplete the brain of a substance called S-adenosylmethionine (SAMe for short).14,15 As SAMe has been found in a number of small studies to have antidepressant effects,16 it is possible that depleting it might trigger depression.

Researchers conducted a trial to determine if taking SAMe supplements could decrease depression in 21 individuals with Parkinson's disease who were taking levodopa.17 In this double-blind study, each participant received either a combination of oral and injected SAMe or placebo daily for 30 days, followed by the alternate treatment for another 30 days. Although other symptoms of Parkinson's didn't change, 72% of people taking SAMe felt that their depression was improved after 2 weeks, while only 30% noted improvement with placebo. It is not yet known if oral SAMe alone would have similar effects.

Although SAMe might appear to be an excellent accompaniment to levodopa, there is another side to the issue. During treatment with levodopa, SAMe participates in breaking it down and gets used up in the process. It is possible that taking extra SAMe could lead to decreased effectiveness of levodopa.18 In the short-term study described above, SAMe did not interfere with levodopa's effects, but longer-term use might do so.

The bottom line: If you have Parkinson's disease, it's safest to use SAMe—if at all—only under the supervision of a physician.

For more information, including dosage and safety issues, see the full SAMe article.

Phosphatidylserine
Phosphatidylserine—PS for short—is a major component of cell membranes. Several studies have found PS supplementation effective for improving mental function in individuals with Alzheimer's disease. One trial examined its use in 62 people, all of whom had both Parkinson's disease and Alzheimer's-type dementia. The results appeared to indicate some benefit, but due to the incompleteness of the report on this trial, it is difficult to draw conclusions.23

For more information, including dosage and safety issues, see the full Phosphatidylserine article.

Vitamin E
Because of indications that free radicals play a role in causing Parkinson's disease, treatment with high doses of vitamin E has been tried to see if it can slow down the progression of Parkinson's disease. However, a large study yielded disappointing results. In this trial, 800 individuals newly diagnosed with Parkinson's disease took 2,000 IU of tocopherol (synthetic vitamin E) or placebo daily for an average of 14 months.24–26 Vitamin E had no effects in delaying symptoms of the disease—nor did it reduce side effects of levodopa.

For more information, including dosage and safety issues, see the full Vitamin E article.

Vitamin C
One problem with levodopa treatment for Parkinson's disease is the so-called "on-off effect," in which a person taking levodopa will move more freely for some hours, followed by sudden "freezing up." Vitamin C has been tried as a remedy for "on-off effects" in a small double-blind study,27 but the results were so minimal that the researchers didn't feel justified in recommending it.

For more information, including dosage and safety issues, see the full Vitamin C article.

Other Treatments
The herb Mucuna pruriens contains L-dopa. One very small study reportedly found evidence that use of the herb as an L-dopa source offers advantages over purified L-dopa given as a medication itself.49

Other proposed natural treatments for Parkinson's disease have minimal or conflicting evidence supporting them, including NADH,28–30glutathione,31policosanol,32 and the amino acids D-phenylalanine33 and L-methionine.34,35 Caution is advised with the latter three, as they might affect the function of levodopa.36,37 (See Herbs and Supplements to Use Only with Caution, below.)

Weak evidence hints that the supplement 5-HTP might be helpful for depression in people with Parkinson’s disease.19 However, 5-HTP should not be combined with the drug carbidopa. (See Herbs and Supplements to Use Only with Caution below.)

A 2-month, double-blind, placebo-controlled trial of 18 people found that rTMS (a special form of magnet therapy) improved Parkinson’s symptoms.46 Benefits were seen in another small conrolled study as well.50

A postural training method called Alexander technique has shown some promise.47

In two studies,acupuncture failed to provide much benefit for Parkinson’s disease.48, 52


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Herbs and Supplements to Use Only with Caution
If you have Parkinson's disease, it is best to avoid taking the herb kava. Preliminary reports suggest that kava may counter the effects of dopamine and possibly reduce the effectiveness of medications for Parkinson's.38

Other substances may also interact with Parkinson's drugs. Iron supplements can interfere with absorption of levodopa and carbidopa, and should not be taken within 2 hours of either medication.39 Amino acid supplements, such as BCAAs (branched-chain amino acids), can temporarily decrease levodopa's effectiveness, as may methionine and phenylalanine, two amino acids studied for treatment of Parkinson's disease.40,41

Vitamin B6 in doses higher than 5 mg per day might also impair the effectiveness of levodopa, and should be avoided.42 However, if you take levodopa/carbidopa combinations, this restriction may not necessarily apply. Talk with your physician about an appropriate dose of vitamin B6.

The supplement 5-HTP has a potentially dangerous interaction with carbidopa. Using the two substances together may increase your chance of developing symptoms resembling those of the disease scleroderma.20–22

As noted above, SAMe could conceivably impair the effectiveness of levodopa.

One report suggests that by amplifying the action of levodopa, policosanol might increase side effects called "dyskinesias."43

Very weak evidence hints that prolonged (many years) intake of high levels of iron and manganese might increase risk of developing Parkinson's disease.51


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References

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3. Garcia-Mas A, Rossinol A, Roca M, et al. Effects of citicholine in subcortical dementia associated with Parkinson's disease assessed by quantified electroencephalography. Clin Ther. 1992;14:718–729.

4. Secades JJ, Frontera G. CDP-choline: pharmacological and clinical review. Methods Find Exp Clin Pharmacol. 1995;17(suppl B):1–54.

5. Eberhardt R, Birbamer G, Gerstenbrand F, et al. Citicoline in the treatment of Parkinson's disease. Clin Ther. 1990;12:489–495.

6. Birbamer G, Gerstenbrand F, Rainer J, et al. CDP-choline in the treatment of Parkinson syndrome. New Trends in Clin Neuropharmacology. 1990;4:29–34.

7. Secades JJ, Frontera G. CDP-choline: pharmacological and clinical review. Methods Find Exp Clin Pharmacol. 1995;17(suppl B):1–54.

8. Agnoli A, Ruggieri S, Denaro A, et al. New strategies in the management of Parkinson's disease: a biological approach using a phospholipid precursor (CDP-choline). Neuropsychobiology. 1982;8:289–296.

9. Ruggieri S, Zamponi A, Casacchia M, et al. Therapeutic effects of cyticholine (cytidine-diphospho-choline) in Parkinsonian syndrome [in Italian]. Clin Ther. 1976;78:515–525.

10. Eberhardt R, Birbamer G, Gerstenbrand F, et al. Citicoline in the treatment of Parkinson's disease. Clin Ther. 1990;12:489–495.

11. Secades JJ, Frontera G. CDP-choline: pharmacological and clinical review. Methods Find Exp Clin Pharmacol. 1995;17(suppl B):1–54.

12. Eberhardt R, Birbamer G, Gerstenbrand F, et al. Citicoline in the treatment of Parkinson's disease. Clin Ther. 1990;12:489–495.

13. Lozano Fernndez R. Efficacy and safety of oral CDP-choline: drug surveillance study in 2817 cases. Arzneimittelforschung. 1983;33:1073–1080.

14. Liu X, Lamango N, Charlton C. L-dopa depletes S-adenosylmethionine and increases S-adenosyl homocysteine: relationship to the wearing-off effects [abstract]. Abstr Soc Neurosci. 1998;24:1469.

15. Bottiglieri T, Hyland K, Reynolds EH, et al. The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs. 1994;48:137–152.

16. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: meta-analysis of clinical studies. Acta Neurol Scand Suppl. 1994;154:7–14.

17. Carrieri PB, Indaco A, Gentile S, et al. S-adenosylmethionine treatment of depression in patients with Parkinson's disease: a double-blind, crossover study versus placebo. Curr Ther Res. 1990;48:154–160.

18. Liu X, Lamango N, Charlton C. L-dopa depletes S-adenosylmethionine and increases S-adenosyl homocysteine: relationship to the wearing-off effects [abstract]. Abstr Soc Neurosci. 1998;24:1469.

19. Mayeux R, Stern Y, Sano M, et al. The relationship of serotonin to depression in Parkinson's disease. Mov Disord. 1988;3:237–244.

20. Sternberg EM, Van Woert MH, Young SN, et al. Development of a scleroderma-like illness during therapy with L-5-hydroxytryptophan and carbidopa. N Engl J Med. 1980;303:782–787.

21. Joly P, Lampert A, Thomine E, et al. Development of pseudobullous morphea and scleroderma-like illness during therapy with L-5-hydroxytryptophan and carbidopa. J Am Acad Dermatol. 1991;25(2 pt 1):332–333.

22. Auffranc JC, Berbis P, Fabre JF, et al. Sclerodermiform and poikilodermal syndrome observed during treatment with carbidopa and 5-hydroxytryptophan [translated from French]. Ann Dermatol Venereol. 1985;112:691–692.

23. Funfgeld EW, Baggen M, Nedwidek P, et al. Double-blind study with phosphatidylserine (PS) in parkinsonian patients with senile dementia of Alzheimer's type (SDAT). Prog Clin Biol Res. 1989;317:1235–1246.

24. Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med. 1993;328:176–183.

25. Parkinson Study Group. Impact of deprenyl and tocopherol treatment on Parkinson's disease in DATATOP patients requiring levodopa. Ann Neurol. 1996;39:37–45.

26. Kieburtz K, McDermott M, Como P, et al. The effect of deprenyl and tocopherol on cognitive performance in early untreated Parkinson's disease. Parkinson's Study Group. Neurology. 1994;44:1756–1759.

27. Reilly DK, Hershey L, Rivera-Calimlim L, et al. On-off effects in Parkinson's disease: a controlled investigation of ascorbic acid therapy. Adv Neurol. 1983;37:51–60.

28. Dizdar N, Kgedal B, Lindvall B. Treatment of Parkinson's disease with NADH. Acta Neurol Scand. 1994;90:345–347.

29. Kuhn W, Mller T, Winkel R, et al. Parenteral application of NADH in Parkinson's disease: clinical improvement partially due to stimulation of endogenous levodopa biosynthesis. J Neural Transm. 1996;103:1187–1193.

30. Birkmayer JGD, Vrecko C, Volc D, et al. Nicotinamide adenine dinucleotide (NADH)—a new therapeutic approach to Parkinson's disease. Acta Neurol Scand. 1993;87(suppl 146):32–35.

31. Sechi G, Deledda MG, Bua G, et al. Reduced intravenous glutathione in the treatment of early Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry.1996;20:1159–1170.

32. Snider SR. Octacosanol in parkinsonism [letter]. Ann Neurol. 1984;16:723.

33. Heller B, Fischer E, Martin R. Therapeutic action of D-phenylalanine in Parkinson's disease. Arzneimittelforschung. 1976;26:577–579.

34. Smythies JR, Halsey JH. Treatment of Parkinson's disease with L-methionine. South Med J. 1984;77:1577.

35. Meininger V, Flamier A, Phan T, et al. L-methionine treatment of Parkinson's disease: preliminary results [in French]. Rev Neurol (Paris). 1982;138:297–303.

36. Snider SR. Octacosanol in parkinsonism [letter]. Ann Neurol. 1984;16:723.

37. Nutt JG, Woodward WR, Hammerstad JP, et al. The "on-off" phenomenon in Parkinson's disease. Relation to levodopa absorption and transport. N Engl J Med. 1984;310:483–488.

38. Schelosky L, Raffauf C, Jendroska K, et al. Kava and dopamine antagonism[letter]. J Neurol Neurosurg Psychiatry. 1995;58:639–640.

39. Campbell NRC, Hasinoff BB. Iron supplements: a common cause of drug interactions. Br J Clin Pharmacol. 1991;31:251–255.

40. Goodman LS, Gilman A.In: Hardman JG, Limbird LE, et al., eds. Goodman & Gilman's the Pharmacological Basis of Therapeutics. 9th ed. New York: McGraw-Hill, Health Professions Division;1996:510.

41. Nutt JG, Woodward WR, Hammerstad JP, et al. The "on-off" phenomenon in Parkinson's disease. Relation to levodopa absorption and transport. N Engl J Med. 1984;310:483–488.

42. Drug Evaluations Annual. (Subscription edition, section 4, chapter 2). Vol I. Chicago, Ill: American Medical Association. Division of Drugs and Toxicology; Summer 1992:12.

43. Snider SR. Octacosanol in parkinsonism [letter]. Ann Neurol. 1984;16:723.

44. Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. 2002;59:1541-1550.

45. Muller T, Buttner T, Gholipour AF, et al. Coenzyme Q(10) supplementation provides mild symptomatic benefit in patients with Parkinson's disease. Neurosci Lett. 2003;341:201–204.

46. Shimamoto H, Takasaki K, Shigemori M, et al. Therapeutic effect and mechanism of repetitive transcranial magnetic stimulation in Parkinson's disease. J Neurol. 2001;248(Suppl 3):III/48–III/52.

47. Stallibrass C, Sissons P, Chalmers C. Randomized controlled trial of the Alexander technique for idiopathic Parkinson's disease. Clin Rehabil. 2002;16:695–708.

48. Shulman LM, Wen X, Weiner WJ, et al. Acupuncture therapy for the symptoms of Parkinson’s disease. Mov Disord. 2002;17:799–802.

49. Katzenschlager R, Evans A, Manson A et al. Mucuna pruriens in Parkinson's disease: a double blind clinical and pharmacological study. J Neurol Neurosurg Psychiatry. 2004;75:1672-1677.

50. Khedr EM, Farweez HM, Islam H. Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson's disease patients. Eur J Neurol. 2003;10:567-72.

51. Powers KM, Smith-Weller T, Franklin GM, et al. Parkinson's disease risks associated with dietary iron, manganese, and other nutrient intakes. Neurology. 2003;60:1761-1766.

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http://healthlibrary.epnet.com/GetCo...chunkiid=21799

[reverett123]

As one who believes strongly in the value of natural treatments, I'd like to add a few comments:
1) CDP Choline - over at PDPower both myself and Juanhch both teste this one and came to the same conclusion. A little is good but a little more is a problem. In the latter case it tips your system over into producing acetyl-choline which is the opposing neurotransmitter to dopamine. When that happens, one is very unhappy.

2) Mucuna - Good but messy. Really does the job, but too much is, indeed, too much. Avoid the high end extracts since they are "too good."

I would add to the above list turmeric. It has long been a favorite and recently became more so when it was found that it balanced the HPA axis that is out of whack in, among other things, PD. This lowers cortisol which is one of the factors in the blood sugar problems being discussed. Add in antioxidant properties, anticancer, and the ability to dissolve the amyloid plaques of Alzheimer's and you have a respectable tool.

[ZucchiniFlower]

About turmeric (circumin), it may raise acetylcholine.

I'll repost my post and Rick's from the sticky thread:

A good article about mucuna pruriens:

http://www.parkinson.org/site/pp.asp...JLPwB&b=184301

Zandopa (HP200) source:

http://mall.coimbatore.com/bnh/zandu/zandopa.htm

This was ordered 10/4 and arrived from India on 10/13.

Herbal Powers has their mucuna extract back in stock. It's 60% L-Dopa, and a couple of posters use it with great benefit:

http://herbalpowers.stores.yahoo.net...apruriens.html

This arrived within three days of ordering.

FROM RICK:

mucuna experience

i've been using it for a year or so. some thoughts--

1- this is a real drug. treat it with respect.

2- the higher the level of ldopa the less mucuna. this is not necessarily a good thing since mp is a veritable chemical warehouse and our knowledge of its safety is based on the whole bean powder. herbal powers product is too good for me. i am currently using "dopabean" by solaray at 15% ldopa.

3- if you take it with sinemet and carbidopa enzyme inhibitor expect a different effect than if you don't.

4- don't take it if pregnant.

all that being said i still trust it more than sinemet.