Insights from Dr. Britt Stone on APDA’s Dr. Gilbert Hosts

On a recent episode of APDA’s Dr. Gilbert Hosts, I spoke with Dr. Britt Stone, a movement disorders specialist with a particular interest in herbal remedies, medicinal plants, and supplements and their use in Parkinson’s disease (PD). We covered a lot of ground during the broadcast and answered questions from the audience. It was a very informative conversation, and we encourage you to watch the full episode (just click the video below). For your convenience, we have also listed the topics and questions from the episode below with timestamps, so you can skip to what interests you most. Additionally, today we are addressing some of the topics and questions we didn’t have time to get to during the program.

01:56 Dr. Stone’s introduction
30:14 Is the MIND diet good for PD?
32:32 Are there any plant-based supplements that protect neurons as opposed to just controlling symptoms?
34:41 Do you recommend the use of probiotics?
35:47 Are there any supplements that are good for Levodopa-induced dyskinesias?
36:30 Do you recommend Ashwagandha for PD?
37:34 Do you recommend a ketogenic diet?
38:56 What are your thoughts on Vitamin B1 and B6 supplementation in PD?
40:55 What’s the best way to treat constipation with herbal remedies?
44:26 Are there any supplements or plant-based therapies for fatigue?
45:26 There is some evidence to suggest that dairy should be avoided by people with PD. What are your thoughts on dairy?
48:04 Is there any way to get the advantages of medical marijuana without having vivid dreams?
49:11 Are there herbal remedies for urinary frequency and incontinence?
50:14 Do you recommend Rhodeola Rosea for fatigue?
50:44 Are there clinical trials being conducted on herbal remedies in PD?
54:25 Do you recommend Quercetin?

Additional questions about herbal remedies, supplements, and Parkinson’s disease

Our live audience was full of questions, and now we’ll address some of the supplements that we didn’t have time to discuss during the broadcast. 

Mannitol & Parkinson’s

Mannitol is a carbohydrate called a polyol, also known as a sugar alcohol. It is found in most fruits and vegetables and is used as a diuretic in certain medical situations to reduce the amount of fluid in the body, such as when there is swelling of the brain after brain injury.

Have there been any studies on Mannitol and PD?

Some research has explored its potential neuroprotective effects. In animal models of PD, mannitol has been shown to inhibit the clumping of alpha-synuclein which is a hallmark of PD pathology. In addition, mannitol treatment in an animal model of PD improved motor function.

A placebo-controlled randomized study was conducted in 14 people with PD who received mannitol and eight who received a different sugar called dextrose. The study lasted 36 weeks and included four dose escalations of oral mannitol or dextrose to a maximal dose of 18g per day. Gastrointestinal symptoms limited the dose of mannitol in six of the 14 people taking mannitol. Although the primary outcome of the study was the safety of mannitol, clinical and biochemical measures were collected as secondary outcomes, but none of those outcomes were different between the group receiving mannitol and controls. Currently therefore, there is not enough data to support the use of mannitol for PD.

Probiotic PS128 & Parkinson’s

Probiotic PS128 is a formulation of the bacteria Lactobacillus plantarum. In research studies, administration of this bacteria was shown to alleviate motor deficits and inhibit neurodegenerative processes in a PD animal model.

Have there been any studies on Probiotic PS128 and PD?

Results of a small, open-label (not placebo-controlled) study of PS128 showed that PS128 supplementation for 12 weeks in addition to anti-parkinsonian medication improved United Parkinson Disease Rating Scale (UPDRS) motor score and quality of life. However, more data is needed, and there is an ongoing randomized control trial of PS128 that APDA will continue to follow.

Glutathione and N acetyl cysteine (NAC) & Parkinson’s

Glutathione protects against oxidative stress-induced damage by neutralizing reactive oxygen species. Glutathione deficiency has been identified as an early event in the progression of PD. NAC works by increasing the levels of glutathione in the body, and both glutathione and NAC have been studied in small clinical trials in PD.

Have there been any studies on glutathione, NAC, and PD?

Because glutathione is poorly absorbed through the digestive tract, trials of intravenous glutathione and intranasal glutathione have been conducted. Recently, a meta-analysis was published that summarized the results of seven randomized clinical trials focused on glutathione, representing 450 people with PD. Overall, glutathione caused a very modest improvement of UPDRS motor score (half of one point on a 132-point scale).

One trial failed to demonstrate that orally administered NAC increased brain glutathione levels. Another trial however, showed that NAC increased dopamine transporter binding on DaTSCAN and significantly improved UPDRS scores. The number of patients was small, and larger trials will need to be conducted to support the use of NAC in PD.

Omega-3 fatty acids & Parkinson’s

Omega-3 fatty acids are polyunsaturated fats that perform important functions in the body. They are a component of the cell membrane which surrounds and protects the cell, supporting interactions between cells. Omega-3 fatty acids need to be ingested in food, as the body can’t manufacture enough of them on its own and are therefore considered essential nutrients.

There are three major types of omega-3 fatty acids:

• EPA (eicosapentaenoic acid) is found in fish
• DHA (docosahexaenoic acid) is also found in fish
• ALA (alpha-linolenic acid) is found in plants

Is there a diet that incorporates omega-3 fatty acids?

The Mediterranean and MIND diets are rich in these compounds, which are associated with cardiac and brain health. Whether omega-3 fatty acids are particularly helpful for PD symptoms is not as clear. One small study demonstrated that ingesting omega-3 fatty acids improved UPDRS scores. Regardless, eating a diet rich in these fatty acids can have health benefits, so feel free to incorporate them into your diet.

Citicoline & Parkinson’s

Citicoline is a chemical that occurs naturally in the body and supports the creation of the cell membrane. It is also important in the synthesis of the brain chemical acetylcholine which supports memory and other brain functions. There is some evidence that it increases dopamine synthesis and inhibits dopamine re-uptake. Most of the studies looking at citicoline and PD in people were performed many decades ago.

Have there been studies on Citicoline and PD?

A recent meta-analysis reviewed seven studies, which were difficult to compare with each other because varied outcome measures were used. Overall, results showed that people with PD who were taking citicoline had improvements in motor function (with reduction of Levodopa dosages) and cognitive function. The meta-analysis concluded that, because of the quality of the current studies, the field requires higher-quality studies to evaluate citicoline’s effects on PD.

Tips and Takeaways 

• Listen to a very interesting broadcast dedicated to answering questions about medicinal plants and supplements for PD.  
• Certain plant-based remedies may have a role in improving particular PD symptoms. Others may not have a significant impact.
• Despite some research that has been done, in many cases further research is needed before being able to determine if certain supplements are truly beneficial in humans with PD.
• Discuss any herbs or supplements that you are ingesting with your healthcare provider.
• If you have a PD-related question, you can submit it to our Ask A Doctor portal.