Parkinsons Disease

Smoothing Out the Tremors

It's like going from automatic to manual.

That description of Parkinson's disease, from someone who has had firsthand experience, sums it up neatly. As this disease of the central nervous system progresses, movements that were once second nature, such as walking and writing, take on a ponderous and deliberate quality. And hand tremors can complicate simple tasks such as buttoning clothes. Frequently, it's tremors that send people to their doctors for diagnosis, but most people with the disease can recall years of vague symptoms before doctors pinpointed the cause.

"I was very slow and sluggish; I just didn't have the old pizzazz. But I didn't know if it was normal old age or not," explains Michael Locoputa, a retired electronics specialist from Syracuse, New York, who has had Parkinson's disease for about ten years.

He especially recalls problems with public speaking, something that gives most people the willies anyway. "I'd have to anchor my arms to the podium and lock my elbows and knees to keep my body still," he says.

It wasn't until he read an article about Muhammad Ali, also a Parkinson's sufferer, that Locoputa began to put the pieces together. "I told my wife 'That's what I have,' " he recalls. His suspicion was later confirmed by a doctor.

Parkinson's disease is caused by damage to brain cells in the substantia nigra, an area deep in the center of the brain that helps coordinate muscle movement. These cells produce a chemical called dopamine, a neurotransmitter that's essential for the brain to send messages to the muscles. As the cells die and dopamine levels drop, muscle control suffers.

Nobody knows for sure why the cells die, but a combination of exposure to environmental toxins and genetic susceptibility, along with normal wear and tear, seems to be the most likely reason, says Caroline M. Tanner, M.D., a researcher with the Parkinson's Institute in Sunnyvale, California. "Certain chemicals can cause symptoms similar to Parkinson's in both animals and humans," Dr. Tanner says. Locoputa, for instance, recalls years of exposure to the solvents used to make electronics components.

Getting the Rust Out

One aspect of nutritional therapy for Parkinson's is directly related to the disease's probable causes, says J. William Langston, M.D., president of the Parkinson's Institute.

"Both normal aging and possible exposure of this part of the brain to toxins may cause oxidative chemical reactions that allow the release of free radicals, molecular particles that steal electrons from other molecules, setting off a chain reaction of cell damage," Dr. Langston explains.

Even dopamine, the neurotransmitter highly concentrated in this part of the brain, is oxidized as part of the message-sending process, Dr. Langston explains. "It's as if dopamine were too hot to handle, and over many years, as it's oxidized, it may eventually kill the very same cells that make it and use it to cause normal motor function," he says.

Vitamin E and sometimes vitamin C have been recommended for people with Parkinson's because these two nutrients act as antioxidants. They stop the chain reaction of free radicals by offering their own electrons, sparing healthy molecules from harm. Most attention has been on vitamin E, since it acts in the fatty parts of cells (brain and nerve tissues contain lots of fatty membranes). Here's what research shows.

Vitamin E: Promise and Disappointment

"The theory behind giving vitamin E for Parkinson's disease is that this nutrient is a free radical scavenger and therefore can protect against free radical damage to the brain," Dr. Langston says. "If you have excessive production of all of these potentially damaging, reactive chemicals over time, and if you put in something like a sponge, something that can soak up or block their effects, you might protect against further damage to the brain."

That's the theory, anyway. In practice, research results so far have been mostly disappointing.

It's true that one study found that people with early Parkinson's disease who took vitamins E and C were able to postpone taking medication for symptoms for 2½ years longer than people not getting these vitamins. (The vitamin takers gradually increased to 3,200 international units of vitamin E and 3,000 milligrams of vitamin C daily, taken in four divided doses.)

But a large nationwide study that followed, the DATATOP study, found that 2,000 international units of vitamin E, taken for up to two years, offered no apparent benefit to people with Parkinson's.

"I would say vitamin E is down but not out," Dr. Langston says. "This is the type of study where if we had gotten positive results, it would have been considered important and well-accepted. Negative results, unfortunately, don't tell us much of anything. It could be that the dose was wrong, that we weren't getting enough vitamin E into the brain, that people were getting it too late in the course of the disease to help much. This negative finding certainly does not rule out the possibility that vitamin E and other antioxidants might be helpful in treating Parkinson's disease."

His research is looking at "prescription antioxidants," chemically engineered varieties not found in nature that get into the brain more easily than vitamin E.

Certainly, fewer neurologists now recommend vitamin E to their patients than before the disappointing results of the DATATOP study, but those who suggest it seem to be taking a can't-hurt-and-may-help position, says Jean Lee, education director for the United Parkinson Foundation in Chicago. "People with Parkinson's disease often don't eat well to begin with, so a complete nutritional supplement program may be appropriate for some of them," she says.

Dr. Langston doesn't recommend vitamin E, but he doesn't discourage his patients from taking it, either. He takes it himself to prevent heart
disease.

One doctor who believes that vitamin E may have antioxidant effects, Robert G. Feldman, M.D., professor and chairman of the Department of Neurology at Boston University Medical Center, suggests that people take 400 international units three times a day.

Michael Locoputa takes 800 international units of vitamin E daily. "I was in a vitamin study, but I found out later that I was in a placebo (blank pill) group, not a vitamin group," he says. "I figured that if they had enough reason to try vitamin E in a big study, then it's worth trying. I had used it for burns and cuts and was impressed with how well it heals. I had also heard that it is helpful in preventing heart disease and cancer. So I thought, why not?"

He has been taking vitamin E for about five years. "I can't say that I've noticed a difference," he says. "I can still play tennis, but I don't have the kind of coordination I used to."

The high amounts of vitamin E that are sometimes recommended for Parkinson's disease are not available from normal amounts of even the best food sources, such as hazelnut oil, sunflower oil, almond oil, wheat germ, nuts, whole grains and leafy greens. According to Dr. Feldman, no adverse side effects have been reported in people taking up to 1,600 international units of vitamin E daily. Also, many experts believe that taking up to 600 international units a day is safe without medical supervision. If you want to take high amounts of vitamin E, however, you should check with your doctor first.

If you have had a bleeding disorder or a stroke or have a family history of stroke, you should use large-dose supplements of vitamin E only under medical supervision. If you are taking anticoagulants, you should not take supplements of vitamin E. It's possible that these large amounts of vitamin E may interfere with the absorption and action of vitamin K, which is involved in blood coagulation, says James Sadowski, Ph.D., research leader at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.

Add a Little Insurance

Dr. Feldman recommends that his patients take a multivitamin/mineral tablet that includes the Daily Values of all of the essential vitamins and minerals, including the trace minerals. There's a bit of evidence that selenium, a mineral with antioxidant properties, may play a role in Parkinson's. In people with this disease, the part of the brain that's involved, the substantia nigra, is low in a selenium-based antioxidant called glutathione peroxidase. Some experts speculate that low levels of this substance may help set the stage for cell damage.

Dr. Feldman also recommends a supplement that offers up to a 50-milligram dose of thiamin in a B-complex vitamin preparation. "I give it because the patients I see who take it tell me that they feel much more alert and energetic," he explains. In fact, there's a bit of evidence that people with Parkinson's may be low in the B vitamins and may benefit from getting additional amounts.

People taking levodopa should check with their doctors before taking vitamin B₆, though. B₆ counteracts the effects of levodopa when the medicine is taken by itself. Medical experts say that B₆ does not have this effect if levodopa is taken in combination with carbidopa (in the drugs Sinemet and Atamet).