Supplements and Parkinson’s
This blog explains the research evidence behind some of the most asked about supplements and Parkinson’s.
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There is an overwhelming amount of information that can be found relating to health and supplements — bold claims, expensive products and little evidence. This blog aims to summarise some of the research that is happening in this area.
What are supplements?
When people talk about supplements this normally refers to adding something to a usual medication regime or healthy diet, with the aim to enhance and improve the management of health. It’s not uncommon to hear of people taking supplements to get extra vitamins — from multi-vitamin tablets to fizzy vitamin C drinks. But why and when should people be doing this?
Interestingly, NHS advice is that most people don’t need to take supplements if they are getting a healthy balanced diet. However, there is an acknowledgement that supplements can provide a helping hand for those that have lower levels of a vitamin or important mineral. This can be the case in certain individuals due to lifestyle factors or health conditions.
It is important to note that people with health conditions such as Parkinson’s, which usually have a controlled medication regime, need to be careful that alterations to diet and supplements don’t adversely impact their medication and health. This is why research in this area is so important, specifically evidence from studies investigating the benefits of supplements in people with Parkinson’s.
This blog is not health advice and people should consult their healthcare professionals about changes to their medication regime and about the use of supplements.
Why is this relevant to people with Parkinson’s?
Many factors contribute to Parkinson’s — from gut health to damaging agents that can cause harm to brain cells. It is thought that supplements could have a role to play in re balancing some of these factors, to help with general health or even in the battle to protect brain cells. But unfortunately, current recommendations and evidence of which supplements might be helpful for people with Parkinson’s is unclear. Here are a few reasons why:
- Historically there has been a lack of research and funding into supplements.
- Parkinson’s is complex and research studying a single supplement in isolation can be tricky to draw conclusions.
- It is not clear what deficiencies might be linked with Parkinson’s and people are not routinely tested for deficiencies that might be helped by supplements.
- Parkinson’s affects people differently and there’s a need for a more personalised approach when it comes to treating the condition.
What’s the evidence?
The rest of the blog is going to cover the research evidence for a selection of supplements that we most commonly get asked about.
Vitamin D
Vitamin D plays a role in bone health and muscle health and deficiencies have been implicated in many health conditions. The body naturally makes vitamin D when the skin is exposed to sunlight.
Research has shown that people with Parkinson’s are more likely to have low levels of vitamin D, and this is not just unique to Parkinson’s, other groups include the elderly, some breastfed babies and people who don’t regularly go outside. But unlike the other groups, healthcare professionals might not know that people with Parkinson’s may be at a higher risk of low vitamin D levels.
Further to this, vitamin D levels may be linked to how mobile someone with Parkinson’s is. But it is hard to know whether this is cause or effect. For instance,decreased mobility may cause the reduction in vitamin D rather than the low levels of vitamin D being responsible for a decrease in mobility.
More research is warranted in this area, as lab based research has also shown that vitamin D may offer protective properties towards brain cells.
In the meantime, dietician Richelle Flanagan is an advocate for people with Parkinson’s getting their levels of vitamin D checked to see if supplementation is an option. This would be done at the discretion of someone’s healthcare team and would involve a blood test.
Coenzyme Q10
This occurs naturally inside the cells in the body. It’s an important player in the production of energy, which is a process thought to be impacted in Parkinson’s. Finding ways to boost energy production in brain cells is something researchers are interested in.
However, multiple studies have shown that although coenzyme 10 is safe, there has been no evidence to suggest that it’s beneficial to people with Parkinson’s over a placebo. So as it stands there’s insufficient evidence to recommend it for people with Parkinson’s.
Nevertheless, there is active research underway looking in the lab to see if boosting coenzyme 10 in specific regions of the brain is beneficial in Parkinson’s models. So, it isn’t the end of the line for this supplement.
Mucuna pruriens
This is a tropical legume native to Africa and tropical Asia where its seeds provide a natural source of levodopa — the gold standard medication for Parkinson’s. In Ayurveda Indian medicine, Mucuna has long been used to treat conditions such as Parkinson’s, and it may still be used in some parts of the world where access to conventional medications is limited.
We often get asked if it offers a way to supplement or replace conventional medication. The answer is — not really.
Unlike Parkinson’s medications, it’s hard to control the amount of levodopa you receive when you use natural sources. We know that the amount of levodopa in mucuna seeds is low — between 0.58 to 6.42% of the dry weight of the seeds — and, because of the natural variability of levodopa content, someone could end up taking far too much or not enough.
Also, there is limited research into the effectiveness and safety of Mucuna pruriens for people with Parkinson’s. And on paper, it would seem that natural levodopa is unlikely to be as effective as, or replace, the medications that are already available.
Fish oil
Omega-3 is a family of fatty acids important for the growth and development of brain cells. It is made in our bodies, but very slowly, so we mostly get it from our diet. Oily fish, such as mackerel, tuna, herring, and salmon, have high levels of omega-3. Multiple surveys have shown that in the UK this is one of the most common supplements people take.
It’s not clear whether people with Parkinson’s have reduced levels of omega-3 inside the brain and lab studies have produced conflicting results as to whether it may be helpful or not in Parkinson’s — some show protective effects but others suggest it may contribute to a toxic build up of a protein called alpha-synuclein.
There have also not been any large, long-term clinical studies looking at fish oil supplements in people with Parkinson’s, that being said, a recent study in 60 people with Parkinson’s did suggest that omega-3 combined with vitamin E improved symptoms over a 12 week period, possibly due to their anti-inflammatory properties. So, let’s hope this may lead to further research in this area.
Vitamin B12
This vitamin helps keep blood and nerve cells functioning properly and low levels are thought to negatively impact thinking and memory as well as causing a feeling of weakness.
As people get older they are more likely to experience low levels of this vitamin. Research also suggests that people with Parkinson’s commonly have low levels of this vitamin, where lower levels may correlate with faster progression of symptoms. A recent study in 680 people with Parkinson’s supported this and showed that supplements to boost vitamin B12 might be beneficial. You can read a lay summary of this research here.
More research is now needed to better understand the potential of vitamin B12 supplements and how and when this might be beneficial to people with Parkinson’s.
Glutathione
Glutathione is an antioxidant — something that protects cells from damaging components — that occurs naturally inside the body. Its protective properties make it attractive as a potential supplement in Parkinson’s and because it is not easily absorbed into the bloodstream its precursor N-acetyl-cysteine (or NAC) is also being investigated.
Studies using postmortem brain tissue have suggested that glutathione levels are low in brain areas affected in Parkinson’s. What’s more, research in the lab has shown that NAC can prevent Parkinson’s-like damage to brain cells. But the evidence in people with Parkinson’s is not clear cut.
There’s been a total of seven randomised clinical trials but so far the studies have been small and some often lacked the gold standard controls. A small exploratory study published in 2016 showed promising effects in brain scans which offered hope that NAC supplements might have positive effects on dopamine function and potentially on symptoms. Whereas, results from a small, short clinical trial published in 2017 showed no difference in quality of life of people with Parkinson’s who received glutathione versus a placebo.
Unfortunately there is a common theme in that the jury is still out.
Vitamin B3
As the body cannot store this vitamin, having a healthy diet that contains adequate vitamin B3 is essential. Fortunately, it is found in many different foods, including turkey, tuna, cereal, mushrooms and peanuts. But now researchers think, for some people, taking larger doses of certain forms of this vitamin may have beneficial effects in Parkinson’s.
Research in the lab has shown that vitamin B3 may boost energy in nerve cells and help prevent them being lost in Parkinson’s. It did this by boosting levels of a compound called NAD that is used to generate energy inside cells.
The latest results come from a phase 1 clinical trial in 30 people with Parkinson’s showing further promise for this vitamin. Excitingly, a phase 2 study is also already underway.
There are many more supplements and foodstuffs that you may have read about from caffeine and probiotics to turmeric. But the jury is still out. Research gathering a more holistic insight into people’s lifestyle and symptoms will hopefully uncover further clues to focus clinical trials and recommendations when it comes to diet and supplements. This is a vital area of research for the 145 000 people currently living with Parkinson’s in the UK.
