Parkinson's Disease: A Functional and Integrative Approach

In this follow-up to their previous Parkinson’s Disease (PD) episode, Dr. McMinn and Coach Lindsay explore how functional and integrative medicine can complement traditional treatments for PD. They emphasize that their goal is not to replace conventional medicine, but to “fill in the gaps” with evidence-based holistic therapies that address the root causes and improve patient quality of life.

They define functional medicine as a root-cause approach that asks "why" a disease occurs, and integrative medicine as the use of non-conventional tools—like acupuncture or diet—to enhance care beyond drugs and surgery.

For PD, traditional medicine plays a vital role, especially in treating motor symptoms (e.g., tremor, rigidity, bradykinesia). However, functional and integrative approaches can address underlying contributors and may be especially useful for non-motor symptoms.

*Root Causes & Risk Factors of PD Discussed:

-Genetics & Epigenetics: Genetics increases risk, but lifestyle and environmental factors play a significant role in gene expression, via epigenetics.

-Toxins: Pesticides, solvents like TCE, heavy metals, mold, air pollution, and microplastics have all been linked to increased PD risk.

-Head trauma, especially from sports like football and soccer, increases PD risk.

-Gut-brain axis: Emerging evidence shows PD often starts in the gut, years before classic Parkinson's motor symptoms appear.

*Functional Prevention & Lifestyle Strategies:

-Diet: Mediterranean and MIND diets lower PD risk and delay symptom onset.

-Coffee: Regular consumption may lower PD risk by ~40%.

-Exercise: Reduces risk and helps with motor/non-motor symptoms. Boxing (e.g., Rock Steady Boxing), tai chi, yoga, walking, and especially dance (ParkinDance) improve motor control, cognition, and mood.

-Connection with Nature lowers PD risk.

-Avoid toxins and head injuries.

*Integrative Treatments for Non-Motor Symptoms:

-Constipation: Addressed via diet, hydration, and handouts available at www.McMinnMD.com.

-Fatigue: Covered in a previous 2018 fatigue-focused episode.

-Sarcopenia: Counteracted with resistance training, diet, TRT, and vitamin D.

-Urinary issues: Pelvic floor therapy and fluid strategies help.

-Sleep disorders: Melatonin, sleep hygiene, CBT-I, light therapy, acupuncture.

-Mood issues (anxiety, depression): Yoga, tai chi, CBT, group support, soci

Chapters

• 0:00 Introduction to Functional Parkinson's Approach
• 7:12 Understanding Root Causes of Parkinson's Disease
• 14:48 Toxins and Head Trauma Connection
• 22:43 The Gut-Brain Connection in Parkinson's
• 29:02 Exercise Benefits for Prevention and Treatment
• 35:30 Integrated Treatment Modalities Beyond Medication
• 41:59 Hormone Replacement Therapy Considerations
• 46:06 Nutritional Supplements with Scientific Backing

Transcript

Speaker 1: 0:00

Welcome to Wellness Connection MD. Today we have for you part two on a series on Parkinson's disease. In our last episode, we had two very special guests on the show who shared with us a great summary of traditional medical approaches to Parkinson's, and today we're picking up where we left off to bring you the scientific evidence on some proven holistic, integrative and functional therapeutic modalities in order to empower each patient to achieve his or her best possible quality of life. This is not about replacing traditional treatments, but instead we focus on some of the fundamental principles of functional medicine, such as the root cause of the disease, as well as preventive and integrated strategies in order to complement traditional medicine and to optimize outcomes. We hope that you learn something, that we can help some people and that you enjoy the show. And now on to the show.

Speaker 2: 0:46

Welcome to the Wellness Connection MD Podcast with Dr McMinn and Coach Lindsey, where we bring you the latest up-to-date, evidence-based information on a wide variety of health and wellness topics, along with practical take-home solutions. Dr McMinn is an integrated and functional MD and Lindsey Matthews is a registered nurse and IIN-certified health coach. Together, our goal is to help you optimize your health and wellness in mind, body and spirit. To see a list of all of our podcasts, visit McMinnMDcom and to stay up to date on the latest topics, be sure to subscribe to our podcast on your favorite podcast player so that you'll be notified when future episodes come out. The discussions contained in this podcast are for educational purposes only and are not intended to diagnose or treat any disease. Please do not apply any of this information without approval from your personal doctor. And now on to the show with Dr McMinn and Coach Lindsey.

Speaker 1: 1:42

Hello and welcome to the Wellness Connection MD podcast with Dr McMinn and Coach Lindsey, the evidence-based podcast on all things wellness, where we bring you honest, commercial-free, unbiased, up-to-date and evidence-based information, along with practical solutions to empower you to overcome your healthcare challenges, to optimize your wellness in mind, body and spirit and to become a great captain of your ship when it comes to your health and wellness. We thank you so much for joining us today. I'm Dr Jim McMinn. I'm here with our co-host, registered nurse and IIN certified coach, ms Lindsay Matthews. Good morning, coach.

Speaker 3: 2:17

Good morning, Dr Mack. I'm glad to be back and I'm sad I missed the last episode. It was just packed with good stuff with NP Laura and Sister Cindy. I really enjoyed tuning into that one.

Speaker 1: 2:28

In our last show, we did an expansive discussion about Parkinson's with Cindy and Laura, really more from a traditional medicine point of view, and while I feel that is very important to discuss from that perspective, I also think it may be helpful to discuss more of a complementary, functional and integrative approach in order to give the patient a full spectrum of therapeutic options, and so that will be the topic of our show today.

Speaker 3: 2:52

But before we get into Parkinson's disease, we need to take care of some business, and by that we always like to just let our listeners know that our podcast remains commercial-free, which, of course, is rare in podcast circles these days. However, it does cost us money to produce the podcast, so we greatly appreciate any contributions that you can make to our show here.

Speaker 1: 3:13

And making a contribution may actually save you money. Go figure, here's how. My hunch is that most of you listeners take some nutritional supplements now and then, and so, if you do, then consider purchasing supplements from our Fullscript dispensary at a 10% discount. You can see the link to Fullscript in the show notes, or go to mcmimdcom, and the link will also be there for you at the bottom of the homepage under helpful links. It's quite simple Just click on the link and they'll guide you through the process and they'll ship the supplements right to your front door. It's a win-win you get high quality supplements at a discount, and so you save money and we get your support for the show, for which we are very grateful.

Speaker 3: 3:50

Yes, another way is that you can safely help support our show is to make a contribution directly to it via credit card or by PayPal at the support the show link, which is also there in the show notes.

Speaker 1: 4:03

And please don't forget to subscribe to the show and please tell your friends and family about the show so we can keep it growing and we thank you so much. So now, with all that business out of the way, on to the show. And we certainly thank Laura and Cindy so much for their excellent review of Parkinson's last month. They certainly brought us a ton of useful information. However, our podcast generally focuses on functional and integrative approach to health, so we want to share some thoughts with you on functional root causes and integrative approaches to Parkinson's disease today.

Speaker 3: 4:33

For those who might be new to the show, let's be sure to briefly set the stage as far as what we mean by functional and integrative medicine. We did an entire podcast on this back in 2018, called An Introduction to Functional Medicine, so check back that out to hear a more in-depth discussion on the topic. But briefly, let's just talk about functional and integrative medicine and define it.

Speaker 1: 4:57

Well, I look at functional medicine as a symptoms biology-based approach to healthcare that focuses on identifying and addressing the root causes of disease. In my mind, the essence of functional medicine revolves around the question why? Why does the patient have the disease? And we have found that if you can identify and treat the why of the disease, that you can often make fundamental progress towards cure, even when traditional methods have failed.

Speaker 3: 5:22

And integrative medicine is what, dr Mack, you call the expanded toolbox, really, of therapies. So another way of saying that would be what else can we do for a particular disease above and beyond traditional medicine, which mainly focuses on drugs and surgery in the toolbox? So, for example, acupuncture might be something additionally added to the toolbox that's been proven to be effective for many disease states.

Speaker 1: 5:49

And let me just say there's a time and a place for traditional Western medicine, with an emphasis on drugs and surgery, and there's also a time and a place for what we might call alternative, integrative and functional therapies. Clearly, if you have a ruptured aorta, then you should not be messing around with acupuncture supplements or medication. You need stat life-saving surgery, right this. Second. However, I have also found over the years that certain conditions like, for instance, chronic fatigue syndrome or certain gut problems, often respond better to a functional, integrative approach. But to me, parkinson's is one of those things that can benefit from really from both is one of those things that can benefit from really from both. It's a complementary approach utilizing drugs and sometimes surgery, for instance, with deep brain stimulation, as well as evidence-based functional and integrative therapies, and it's our goal today to lay out the evidence in this podcast for a complementary approach to Parkinson's. So clearly, our goal is never to bash traditional medicine. Quite frankly, it has saved my life and I'm very grateful for it. Instead, we're just trying to fill in the gaps with credible, evidence-based complementary therapy in order to maximize outcomes for our patients.

Speaker 1: 6:52

So let's start by looking at the root causes of Parkinson's. The vast majority of Parkinson's cases are likely caused by a complex interplay of genetic and environmental factors rather than one single cause. We know that having a parent or sibling with Parkinson's increases one's odds of getting Parkinson's. So there's certainly a genetic role. And we also know that you can't change your genes. You've just got to pick your parents better next time. However, the science is very clear that you can change epigenetic expression. For instance, two identical twins may have the same genetic risk for Parkinson's and yet one gets it and one doesn't, and that is usually due to the epigenetic changes brought about by things like lifestyle factors, which we will discuss in great detail in just a moment. Age and sex also play a role, since advanced age is a major risk factor and since men get Parkinson's disease much more than women.

Speaker 3: 7:41

That's right and known environmental factors are linked to Parkinson's disease, so those include exposure to toxins like pesticides, herbicides, heavy metals, solvents and mycotoxins from mold. So, for example, agricultural workers exposed to these pesticides and herbicides show a substantially higher likelihood of developing Parkinson's compared to the general population. In fact, epidemiological studies estimate that up to 23 percent of Parkinson's disease cases are associated with pesticide exposure, and that just really highlights the potential for prevention, if we can even just start from the get-go of limiting contact with these chemicals.

Speaker 1: 8:24

Some of the industrial solvents, like trichoral ethylene, seem to be particularly bad actors. A study found that individuals exposed to TCE had a 500% higher risk of developing Parkinson's later in life.

Speaker 3: 8:36

Five zero zero percent.

Speaker 1: 8:38

That's so huge and I think that I would certainly try to avoid these chemicals if I could, but unfortunately some people go to work and that's just part of their work assignment and they just have no options. But certainly it does hugely increase the risk of getting Parkinson's later in life.

Speaker 3: 8:54

You know, microplastics are one of the hottest topics in discussion about toxins these days, and these microplastics are literally everywhere. Unless you live in a bubble, it's almost impossible to avoid them. Plastics are literally everywhere. Unless you live in a bubble, it's almost impossible to avoid them. But bad news is, the studies have found a definite link between microplastics and the development of Parkinson's disease.

Speaker 1: 9:15

We even see air pollution playing a role as a causative factor for Parkinson's, with people in high-exposure areas at much greater risk as compared to people in low-exposure areas, and this ultimately creates some environmental racism and classism, since you're much less likely to find high levels of air pollution in affluent white neighborhoods.

Speaker 3: 9:30

So if exposure to toxins is a cause for Parkinson's disease, then can reducing toxin exposure reduce the incident of Parkinson's disease? The answer is a solid yes, thank goodness. So reducing exposure to environmental toxins is strongly associated with a lower risk of developing Parkinson's disease later in life, with studies that suggest up to 30% of the cases in men and up to 25% in women could be prevented by just mitigating this toxin exposure risk.

Speaker 1: 10:03

And before we leave the topic of toxins, let me just mention that we did a complete podcast on toxins back in 2021. You might want to go back and listen to that. I think it was one of our better ones. Quite frankly, it was quite thorough. I do think that toxins are vastly underappreciated as a cause of disease, especially neurodegenerative diseases like Parkinson's.

Speaker 3: 10:22

So, dr Mack? The next obvious question then is if toxins cause Parkinson's disease, then can any detox protocol help to treat Parkinson's disease? Unfortunately, after searching the literature, we are not able to find any high-quality studies that point to significantly improved outcomes for Parkinson's disease with a detox protocol. However, we feel that there may be a research bias here. The mainstream medical and research communities seem to have their head in the sand when it comes to toxins. Unfortunately, the science is solid that toxins are a huge cause of disease, but it just seems to be largely ignored. Think about it when was the last time your doctor asked you about your toxin exposure? I would even go so far as to say that we tend to sweep the issue under the rug and conveniently ignore the obvious truth about the profound negative effects of toxins on our health. Maybe if there was a more expensive blockbuster drug for toxins, there would be a larger amount of money to make. Then we might have more interest in studies on the issues.

Speaker 1: 11:27

You know, as we'll talk about later, my dad had Parkinson's and he had quite a bit of toxin exposure. He was a farmer and so he sprayed the cattle with pesticides and he also was in Vietnam and exposed to Asian orange, and yet I think in his journey through Parkinson's I don't think they ever asked him about toxins, toxin exposure. So I'm just saying that, even when it's obviously connected, they don't ask about it. So I think, again, we kind of have our head in the sand on that issue. As we mentioned earlier, head injuries are also a causative factor for Parkinson's. Studies have shown that individuals who experience mild traumatic brain injury have a 56% increased risk of Parkinson's, while moderate to severe traumatic brain injury raises the risk by about 83%.

Speaker 3: 12:13

Both of those numbers are significant.

Speaker 1: 12:15

They are, aren't they? And?

Speaker 3: 12:16

one. You just think about mild trauma and what that could all constitute. So some common sense measures would be advisable then if we see these percentages being so high. So like wearing a seatbelt and a helmet when appropriate and avoiding high risk situations. I think as a mom out here, one could even make a case for not engaging in contact sports like football, as I tell my kids how many heads do you have?

Speaker 1: 12:45

Do you?

Speaker 3: 12:45

ever get another one.

Speaker 1: 12:46

No this is the only one you have, I know, I know, and yet we do some pretty stupid things, don't we? Lindsay Historically. But maybe we'll learn, I don't know. A study published in JAMA back in 2023 found that men who had played organized American football had a 61% higher odds of having a reported diagnosis of Parkinson's than those who played other organized sports. Wow, coach, that's really kind of scary for the footballers.

Speaker 1: 13:11

I'm a former footballer myself, and so, yeah, had I known, maybe I would have changed my mind. But at the end of the day, everybody's got to look at risk benefit. I mean, as a former ER doc, I look at the world through a different set of glasses. You know, I see people coming in having the results of making choices. You know, somebody makes a choice of riding, for instance, a motorcycle without a helmet, and okay, they love the wind in their hair. And and okay, they love the wind in their hair, and if that's worth taking the risk, fine. But at the end of the day, yeah, it's pretty bad for traumatic brain injury. And so, likewise with things like football and soccer and stuff like that, then we just have to make the best choice we can. I personally have always felt that using the head as a battering ram by purposely hitting a soccer ball is not a smart idea. Did you play soccer, lindsay?

Speaker 3: 14:00

I only for like one year.

Speaker 1: 14:03

I was not very good at soccer.

Speaker 3: 14:06

I was more interested in picking flowers, I think.

Speaker 1: 14:08

Yeah, you know, I didn't really play soccer on an organized team, but you know, in gym class and stuff. But that ball is not soft. No, it is not. I mean you hit it with your head, no, and indeed guess what? Studies have shown that repeated heading of a soccer ball may contribute to a higher risk of developing Parkinson's. So again, y'all might want to consider tennis or something like that, or rather than football or soccer. It seems to me like there could be some kind of a protective headband or something like that.

Speaker 3: 14:36

There actually is. I know that there is Soccer players. I never see it Lindsay, I remember. No, I don't think it's advertised big, but I remember having this conversation in nursing school because my nursing instructor was very avid about soccer players wearing these little headbands with. Now, that's only one. It's a headband, so it's not the entire head, so but I think it exists, but I never see anybody wear it.

Speaker 1: 14:58

I don't either, and you remember years ago, lindsay, professional hockey players never wore helmets.

Speaker 3: 15:03

Wow.

Speaker 1: 15:04

And then now all of them wear helmets. Yes, but they never wore helmets and there were a lot of head injuries and it was really tragic. But nowadays I think you know, we're seeing, we're on to realize it's just not worth having this brain trauma, repeated brain trauma from not wearing any kind of protective device, and so I would hope that some wise people along the way would get people to start wearing them. The pros wear them, or?

Speaker 1: 15:36

the college players wear them and they can set that example. Then the kids will start wearing them. But the kids have these really precious little reins and they're still forming and I think we just need to take better care of them.

Speaker 3: 15:48

But anyway, agreed, agreed. Another emerging theory of the cause of Parkinson's disease is that Parkinson's starts in the gut and there does seem to be ample evidence to support the gut Parkinson's disease is that Parkinson's starts in the gut and there does seem to be ample evidence to support the gut-Parkinson's connection. It's interesting that in most cases the classic constipation associated with Parkinson's disease usually comes on many years before the neurologic symptoms. There are actually multiple studies that indicate the alpha-synuclein proteins that are deposited in the gastrointestinal nerves up to 20 years before the onset of Parkinson's disease symptoms, and that really suggests that the gut may play a significant role in the development. And then there's another study that was published in Nature Abuse Neurology that reported that phosphorylated alpha-synuclein, which is the pathological form of the protein associated with Parkinson's, can be detected in the gastrointestinal tract up to two decades before that definitive diagnosis is made. So interesting to see that the development prior to actual diagnosis.

Speaker 1: 16:55

Yeah, that whole gut-brain connection is really one of the hottest topics of medicine these days. It's really fascinating and it's about 80% gut to brain rather than brain to gut. So that makes sense. And I remember I went to this wonderful lecture by a UAB world famous neurologist who talked about this. The title of the lecture was Parkinson's Disease Starts in your Gut, and it had a lot to do with many things, but including the gut microbiome, which we've talked about many times on the show. We've done some dedicated podcasts to that.

Speaker 1: 17:21

But anyway, she said one of the first things you want to do is to improve your diet. And when she was asked about what kind of diet, she said the key is a wide variety of fiber. That's kind of interesting, isn't it, Coach? So you know once again, does supporting gut health then help prevent Parkinson's disease? And guess what, Coach? It appears that it does. The first thing you want to do, again, is to optimize your diet. A study found that participants with the highest adherence to a Mediterranean diet had a 25% lower risk of developing Parkinson's compared to those with the lowest adherence, and a 2024 systematic review noted that for folks who do get Parkinson's disease, these healthy diets may delay symptom onset by several years.

Speaker 3: 18:14

And, on the contrary, poor diets marked by low fiber and high sugar are linked to pro may be particularly helpful for neurodegenerative diseases like Parkinson's. A great book on the subject is the MIND Diet Plan and Cookbook by Julie Andrews and we have that listed for you at mcminnmdcom under the References and Resources tab. Under the References and Resources tab.

Speaker 1: 18:36

You know, years ago, lindsay, I actually purchased every book I could find on that diet the MIND diet and I went through them all and I landed on this one because it's pretty simple, it's well-written and they actually have a cookbook with it, whereas a lot of the others didn't. So I think this would be a great resource, at least to start with Excellent, yeah, and also in the realm of nutrient intake. Coach, this is kind of interesting. A multiple large-scale long-term studies have found that individuals who regularly consume coffee have a significantly lower risk of Parkinson's. One such study followed over 184,000 individuals and found that those with the highest coffee intake had nearly a 40% lower risk of Parkinson's compared to non-consumers.

Speaker 3: 19:20

So here's to a cup of morning joe, there you go.

Speaker 1: 19:22

Seems like the coffee shop should advertise that. Yeah, that's right.

Speaker 3: 19:27

Continuing with gut health, a 2023 randomized trial showed 12 weeks of probiotic therapy significantly improved motor symptoms and constipation in Parkinson's disease patients. Other trials have also demonstrated improvements in associated non-motor symptoms like anxiety depression, with probiotic therapy.

Speaker 1: 19:48

Also, early-stage trials have demonstrated that fecal microbiota transplants from healthy donors improved motor symptoms in Parkinson's patients at 12 months post-treatment, also with sustained benefit in constipation symptoms.

Speaker 3: 20:02

However, we can't seem to find any robust clinical evidence that probiotic or prebiotic supplementation plays a preventative role as far as reducing the risk of developing Parkinson's.

Speaker 1: 20:12

So continuing with our functional root cause approach. Multiple studies have shown that individuals who are physically inactive or have a sedentary lifestyle have a higher risk of developing Parkinson's disease compared to those who are physically active. In fact, exercise does play a preventive role here. Large prospective studies and meta-analyses have found that individuals who engage in regular, moderate to vigorous physical activity during midlife have a significantly reduced risk of developing Parkinson's years later.

Speaker 3: 20:40

Regular exercise is not only preventative, but can also be an important part of an integrative treatment program, especially boxing drills, like we find with a program like Rock Steady Boxing. Multiple studies have found that boxing leads to significant improvements in motor symptoms, balance, mobility, gait and lower extremity strength for people with Parkinson's.

Speaker 1: 21:03

You know, Coach, one of my good friends I won't name names, but she had a boxing bag left over and was going to throw it away, so she gave it to me and I've used it every day. I love it. It's become my favorite exercise.

Speaker 3: 21:13

I didn't know that about you.

Speaker 1: 21:14

Yeah, yeah, yeah, I do it every day and it's really fun. I do it either to music or listen to a podcast or whatever, and it's good for everything Good for balance, good for strength, good for cardio coordination, lots of stuff. So, yeah, I really enjoy it. So y'all might want to check that out. You know you can get a bag and use that at home. I'll list the name of my bag online for y'all on the resources they're cheap, you can get them online. They'll send them right to you. Or you could go to a class like Rock Steady Boxing, and let me just talk about that just for a moment.

Speaker 1: 21:47

There are some people who don't want to go to any kind of a class, and here's why. Let's say, if you're early stage Parkinson's and then you go to a class and you see all these people who are much further advanced than you are, it's kind of a bummer because you say that's my future and so I can understand that. But you can still do this stuff at home and you know what I figure? I don't know this. This is not factual, but what I figure is okay. My dad had Parkinson's. I'm at risk genetically, and so if boxing can help treat it, could it help prevent it? And so I do it and I enjoy it. It's my favorite form of exercise these days, so interesting. But yeah, boxing and similar exercises can also improve non-motor aspects of Parkinson's, such as reducing depression, improvement in overall quality of life. The social and motivational aspects of group boxing may also contribute to some improved psychosocial well-being and some studies have also found improvements in attention, executive function and overall cognitive health following boxing-based exercise programs.

Speaker 3: 22:50

Other forms of exercise, like yoga, dance, tai chi and power walking also play an important role in improving the quality of life, reducing falls, improving mood and slowing disease progression. By the way, there are many excellent free videos available on YouTube. The internet is just a plethora of exercise and information, so you can find them specifically, too, about exercise and Parkinson's disease though.

Speaker 1: 23:15

Yeah, it's interesting. Youtube's such a valuable resource for me. Anytime I want to learn something, just go to YouTube. Yes, marvelous Coach. Years ago this is just a little bit of an aside I ran across this really interesting study. They had a big nursing home and they offered Tai Chi classes and the women who did Tai Chi versus women who didn't, there was a 75% reduction in fractures. Wow, yeah, yeah, because it's so great for balance, right, yeah, so interesting, yeah. So I think those things, and of course, fractures and falls, are a huge problem with Parkinson's, right, so those things can really help.

Speaker 1: 23:46

But now that we've discussed some functional causes, let's segue into a discussion about other integrative approaches to prevention and therapy. In other words, what can we do beyond traditional drugs and surgery? Let's start with prevention. There is solid science that diet, exercise, restorative sleep, avoiding toxins and avoiding head injuries all play a role in reducing the risk of Parkinson's. Also, it may help to drink some coffee on a regular basis and to avoid excessive alcohol. While mild to moderate drinking does not seem to increase the risk of Parkinson's, heavy drinking does increase the risk.

Speaker 3: 24:20

Interestingly, a large prospective study involving over 329,000 participants found that those who spent more time outdoors in nature had a significantly lower risk of developing Parkinson's. In this study, individuals who spent more than three and a half hours per day outdoors had a 15% lower risk compared to those spending one and a half hours or less. The power of nature never ceases to amaze me, Dr Mack.

Speaker 1: 24:50

Yeah, it's pretty incredible, isn't it, lindsay? I think we really underappreciate just time outdoors in sunshine connecting with nature. My wife Cheryl Dr Cheryl, I should say she's reading a book right now about forest bathing.

Speaker 3: 25:03

Yes, I love that term. I've heard this.

Speaker 1: 25:06

Yeah, which I think comes from a guy over in Japan, but it sounds like it's pretty powerful stuff. So yeah, that's interesting. We'll have to do a podcast on it sometime about forest bathing.

Speaker 1: 25:15

So now that we've discussed integrative modalities for prevention, let's move on to integrative approaches to treatment. As you may have heard on our previous Parkinson's podcast, my dad had Parkinson's so I was particularly interested in this. In studying the issue I ran across some interesting videos by neurologist Dr David Perlmutter showing remarkable improvements in motor function with Parkinson's patients using IV glutathione. So I tried this treatment on some of our patients and unfortunately I was never really able to fully replicate his results. I'm just being honest with you Now. Since he's a neurologist, I'm sure he saw many more patients than I did and therefore had many more of these IVs. So statistically he was more likely to have some success stories to show off and I'm sure he didn't show the videos of the treatment failure patients. He only showed off his success stories, which indeed were quite impressive. I'll put a link to a couple of those videos which you can find at mcminnmdcom on the homepage under helpful links, so you can see them for yourself. But again, I really didn't see much improvement with these patients with IV glutathione.

Speaker 3: 26:15

Another important factor is that any positive effect of the IV glutathione is short-lived. A patient would probably have to come in at least two to three times a week to sustain much benefit, so over time that would become both time-consuming and expensive and really not practical for most patients.

Speaker 1: 26:35

And so that's why I feel that what Laura and Cindy brought to us on our last podcast, which is the traditional approach with meds and things like carbidopa, levodopa, is really the main focus of therapy for patients struggling with the motor symptoms of Parkinson's. The other modalities that we discuss here today are complementary and may contribute to overall improvement, but in my view the mainstream medical therapy would be the appropriate cornerstone for therapy for motor symptoms of Parkinson's. And let me take just a moment to explain what those motor symptoms look like. The symptoms can vary from person to person and they typically include things like slowness of movement, difficulty initiating movement, like, for instance, starting to walk or rising from a chair, resting tremor of the hands, which is often that kind of pill rolling movement.

Speaker 1: 27:17

And, to be clear, not everybody with a hand tremor has Parkinson's. I want to be clear about that, because some people get a tremor and they think, oh my gosh, I've got Parkinson's. But no, it's usually a benign tremor. Facial expression often becomes masked like what I call the flat affect Muscle stiffness, impaired balance and coordination, tendency to sway or fall, especially when turning or standing, and a stooped posture, a stiff gait, small, cramped handwriting. Sometimes this is one of the first signs, people notice that their handwriting is very tiny, and then soft, monotone speech and lastly, drooling or difficulty swallowing, and so that's what Parkinson's looks like to the observer.

Speaker 3: 27:52

Right. But there's also so much more to Parkinson's than those external motor symptoms that one can see, and these non-motor symptoms are where some of our integrative tools can offer some significant relief. The main non-motor symptoms of Parkinson's are constipation, fatigue, depression, anxiety, apathy, nausea, urinary incontinence, cognitive changes, sleep disorders, weight loss with the loss of muscle mass, fall risk, drooling, speech and swallowing difficulties, loss of a sense of smell, low blood pressure when standing and sexual dysfunction as well.

Speaker 1: 28:32

So let's take a look at some of the integrated modalities that may help with many of these Parkinson's-related symptoms. We'll start with exercise, which may be the most important of the bunch. There are many ways that you can do this and we've already mentioned some of the ways, but one that and we've already mentioned some of the ways, like the boxing. But one thing we've not really talked about much is the dance programs. There's one called Parkin Dance and there are others out there. Studies have shown that dance can help with balance, enhance motor function, body control, increase gait speed, reduce gait variability, reduce rigidity, decrease tremors and gait freezing, and social benefits to reduce depression and anxiety, improved overall sense of well-being, enhanced quality of life and increases that social connection and a sense of belonging and it can also provide greater motivation to engage in physical activity.

Speaker 1: 29:30

And there are many physical therapists who specialize in folks with Parkinson's and it may be worth a visit to go to a good therapist to get a customized exercise program for you. What works for one person does not work for another.

Speaker 3: 29:40

Other integrated modalities that can help include acupuncture, which may help by reducing tremors and rigidity in some patients. Meditation, of course, can lower stress and improve sleep quality, which is a problem again with many with Parkinson's. Art therapy enhances the visual, spatial skills and emotional expression, particularly in late-stage Parkinson's patients, and then also cognitive behavioral therapy, CBT, which addresses depression, anxiety, and can also help with sleep disturbances too.

Speaker 1: 30:14

Socialization via group activities like choirs and exercise classes may help to build friendships and combat loneliness and improve mood, which tends to worsen with Parkinson's, and support groups like the one that we talked about on our last show may also be helpful. If you go to McMinnMDcom and look under the References and Resources tab, you'll find a section on Parkinson's that may guide you to such a group, and also our guests from our last show, cindy and Laura, were kind enough to leave their contact information for us under the Guest Biographies menu and you can reach out to them to get some help finding such a support group menu and you can reach out to them to get some help finding such a support group.

Speaker 3: 30:52

Hormone replacement therapy is certainly not a standard treatment for Parkinson's, but in our opinion there seems to be a strong place for it. Emerging evidence suggests testosterone replacement therapy may improve certain non-motor symptoms for Parkinson's disease, particularly in men with testosterone deficiency. It can help with apathy, mood, energy levels, sexual function and overall quality of life.

Speaker 1: 31:14

It can also help with loss of muscle mass, which we call sarcopenia. This is quite common in Parkinson's patients, and testosterone replacement therapy can help maintain muscle mass and strength. And since loss of strength and muscle mass is strongly associated with fall risk, then testosterone replacement therapy can indirectly reduce risk of falls. This is not to be taken lightly. As I mentioned previously, my dad had Parkinson's, but at the end of the day it was a fall that really took him out.

Speaker 3: 31:40

When it comes to hormone replacement therapy for women. Estrogen seems to play a neuroprotective role in the brain, and as women go through menopause, they lose that protection. One survey found that two-thirds of women diagnosed with Parkinson's reported an increase in the severity of their Parkinson's symptoms after menopause, and the symptoms that worsened most frequently were fatigue and urinary tract issues. Other Parkinson's symptoms that worsened with the onset of menopause included slowness of movement and tremor.

Speaker 1: 32:11

So a properly administered hormone replacement therapy program may help to alleviate menopause-related symptoms such as hot flashes and sleep disturbances that can exacerbate Parkinson's-related fatigue and mood disorders. This may result in an overall improved quality of life and may indirectly benefit non-motor symptoms like apathy and depression.

Speaker 3: 32:30

A retrospective study of women with early Parkinson's disease found positive association between estrogen use and lower symptom severity in those not taking levodopa, and another small-scale study found that low doses of estrogen produced a statistically significant improvement in motor function.

Speaker 1: 32:49

Estrogen replacement therapy has also been associated with improved cognitive function. One of the most dreaded aspects of Parkinson's is the associated Lewy body dementia. Estrogen-only therapy, that is, estrogen without a progestin, was linked to a 32% lower dementia risk in women with Parkinson's when initiated during midlife around menopause and used for at least five years.

Speaker 3: 33:10

Multiple observational studies and clinical trials have demonstrated that estrogen use can also attenuate bone loss. So if these women do fall, then there is a reduced risk of a fracture for the women on hormone replacement.

Speaker 1: 33:24

Another cornerstone of integrative medicine is the use of nutritional supplements when appropriate and, to be honest with you from the get-go, I don't look at the use of supplements as a major game-changer with Parkinson's patients for the motor symptoms. However, let's look at some of the supplements that have some scientific backing that may be considered for Parkinson's, and let me preface these comments by saying that I think there's a research and publication bias against supplements. As they say, follow the money, and the money is really in drugs and surgery. We'll start with curcumin. A randomized, double-blind placebo-controlled trial published in 2012 investigated the effects of curcumin on patients with Parkinson's disease. The study found that curcumin showed potential benefits in improving motor function.

Speaker 3: 34:04

One small pilot study in 2019 evaluated the effects of a standardized ashwagandha root extract in patients with Parkinson's, and that study found that ashwagandha supplementation for 12 weeks showed potential benefits in improving motor function, cognitive function and the overall quality of life for Parkinson's disease patients, compared to the placebo.

Speaker 1: 34:27

Bacopa minori. Another small study published in 2012, evaluated the effects of bacopa extract in patients with Parkinson's disease, and the study found that supplementation for six months showed potential health benefits improving cognitive function, attention and memory in Parkinson's disease patients, compared with the placebo group.

Speaker 3: 34:45

Anecdotal reports from patients suggest that magnesium supplements can help relieve muscle stiffness, cramps, anxiety and constipation associated with Parkinson's.

Speaker 1: 34:55

B12 deficiency is common with Parkinson's Patients with low B12 who improve their B12 status through supplementation or diet had slower progression of disability and less worsening of walking, balance and cognitive symptoms, compared to those who remain B12 deficient.

Speaker 3: 35:11

Multiple systematic reviews and meta-analysis of randomized controlled trials showed that melatonin treatment leads to both subjective and objective improvements in sleep quality compared to the placebo in patients with Parkinson's, and this may improve sleep onset insomnia and it reduces REM sleep behavior disorder.

Speaker 1: 35:32

And recent large-scale cohort studies found that omega-3 supplementation, like with fish oils, particularly when combined with regular physical activity, further reduced the risk of developing Parkinson's disease and enhanced symptom management. Some herbal supplements that might be considered would be valerian root and chamomile, which might help with anxiety, and ginger and peppermint oil for digestive issues like constipation.

Speaker 3: 35:55

A quick word of caution. Before you start taking a supplement, be sure to look up potential drug supplement interactions. You can ask your doctor or pharmacist or you can look on sites like WebMD Interaction Checker or MedlinePlus or Drugscom for interaction checks. And always check in with your health care provider. Advise them of any supplements that you are on or have changed.

Speaker 1: 36:19

Another integrative therapy that's getting some attention is red light therapy, with emerging evidence supporting its benefits for both motor and non-motor symptoms. And let's see, do you recall that Tyler uses that?

Speaker 3: 36:35

right, we do, we do. We as a family do, and we kind of you know, use it for a lot of whatever ails you, and I've actually seen a lot of really interesting improvements.

Speaker 1: 36:40

Yeah, yeah, and I think there's some pretty good science behind this, but here's a synthesis of some of the current scientific findings of improvement in upper and lower limb function, reduced tremor severity, improved facial expressions, enhanced balance and gait speed. The non-motor benefits include improved sleep quality and circadian rhythm regulation, reduced depression and anxiety and restored sense of smell in some patients. While red light therapy is generally well tolerated, patients should consult a movement disorder specialist before starting the program.

Speaker 3: 37:10

Finally, let's look at the issue from the perspective of each of the major non-motor symptoms. So let's start with fatigue. This is obviously very complicated and an important subject, and when you have no energy, it affects every aspect of your life. For instance, it's hard to get up out of the Lazy Boy and go to your boxing class if you have zero energy. We did a whole podcast on fatigue back in 2018, and a lot of the things we mentioned there would apply to Parkinson's disease patients. So, in the interest of time, we'll just refer you back to that podcast on fatigue.

Speaker 1: 37:44

Yeah, constipation is often ignored, but it's really very important for these patients and, as we mentioned earlier, it sometimes comes on for years and years before the motor symptoms come on. We just think it's just garden variety constipation, but no, it's early Parkinson's and these patients can be miserable. So we really have to get after this. But I'm not going to go into detail on this too much because I have for you an excellent free handout on constipation at wwwmcmdcom under the documents section.

Speaker 3: 38:11

Sarcopenia, which is the loss of muscle mass, can be helped with regular exercise, proper diet and testosterone replacement therapy. There is also some evidence that vitamin D supplementation can help prevent muscle loss.

Speaker 1: 38:26

And fall prevention is another big deal. As I said, it was the fall that really took my dad down and for many people, a fall can be the beginning of the end. I did an entire podcast on fall prevention back in 2024 that I'll refer you to for this, and I also have many excellent handouts on the issue of falls for you at mcminnmdcom under the documents menu.

Speaker 3: 38:46

Maintaining healthy sexuality during this time may be important and helpful for some Parkinson's disease patients and their partners. However, they may have some challenges here. We have a podcast for you to be able to listen to on both men's sexual health and women's sexual health from back in 2023. Again, this is an area where testosterone replacement therapy may be really helpful for both men and for women.

Speaker 1: 39:10

Also with women. It's important to attend to vaginal health, both from the sexual health point of view and also from the urinary health point of view. Pain with intercourse or UTIs after intercourse can be a real deal breaker. We did an entire podcast on vaginal dryness and one on vaginal microbiome. That might be helpful for you. And finally, it may also be helpful to see a sex health therapist who can give you some great info as to how to overcome challenges in order to maintain an intimate relationship that you desire 2021.

Speaker 3: 39:37

Study found that 68% of women with Parkinson's disease self-reported unwanted urinary symptoms. These symptoms included frequency, urgency, nocturia, incontinence, retention and hesitancy. Pelvic floor muscle training combined with bladder training and strategies for managing your fluid intake have been shown in randomized controlled trials to reduce symptoms and also improve quality of life.

Speaker 1: 40:04

Disorder. Sleep is another hallmark of Parkinson's. This is a huge problem. I remember my dad he used to be up all night andomatherapy, massage and TCM, which is traditional Chinese medicine. We have an excellent handout for you at mcmdcom in the document section on sleep hygiene. We also did an entire podcast years ago on CBTI, which is cognitive behavioral therapy for insomnia.

Speaker 3: 40:47

For the depression which is often accompanies Parkinson's. The following integrative modalities are supported by the evidence. So exercise, yoga, tai chi, qigong, dance therapy, mindfulness, meditation, acupuncture, transcranial magnetic stimulation, social support and lifestyle optimization, like healthy diet and restorative sleep, are all very helpful here For Parkinson's-associated anxiety.

Speaker 1: 41:14

The following integrative modalities are supported by the evidence Cognitive behavioral therapy, massage, aromatherapy, traditional Chinese medicine with herbs and acupuncture, exercise, dance, tai chi, yoga, qigong, meditation and socialization. Okay, as we wrap this up, let's get practical. I know that we have thrown a lot of material at you and, for better or for worse, we tend to err on the side of being thorough, so let me summarize and break it down for you. With this question, what would I do? First, especially if I had an increased genetic risk of Parkinson's, I would practice some common-s sense preventive measures, such as the things we talked about, like maybe avoiding head injuries and avoiding toxins, et cetera, all the things we've already talked about, which I won't repeat.

Speaker 1: 42:00

Then, if I got Parkinson's and there but for the grace of God, go any of us the first thing I would do is to assemble my team. The team members would be my neurologist, my primary care doctor and, if I could get one, a movement disorder specialist. Depending on my symptoms, I would consider inviting other folks to the team as well, including maybe a physical therapist, a nutritionist, a health coach, psychologist counselor, a psychiatrist, if I needed any kind of meds for mood disorder, If your nurse symptoms were predominant, then a urologist or a pelvic floor specialist might be in order. Previously we mentioned a sexual health therapist, if that is something you are interested in, If drooling and speech and swallowing become problematic, then a good speech therapist might also be helpful. And finally, you may consider finding a good functional medicine doctor to help you with things like hormone optimization, fatigue and other integrated modalities. Having this team on your side will allow you to get the ideal traditional medical protocol and also take advantage of the evidence-based complementary therapies that we have discussed in this podcast.

Speaker 3: 42:55

As Laura also pointed out on our last show, in group activities like support groups, Parkinson's patients can learn from each other about what works and what doesn't, as well as what questions to ask and how to think proactively. So your support group also becomes part of your team, and perhaps the most important members of your team are your family, friends, neighbors and especially your primary care partner. As the old saying goes, it takes a village and blessed are the caregivers.

Speaker 1: 43:22

You know, having any chronic progressive disease can be a lonely journey, often associated with significant psychological and emotional impact. These folks need a supportive team of providers to work with them, along with their care partner, to help them cope with their disease and to become the best version of themselves.

Speaker 3: 43:38

Let us close this discussion by saying that Parkinson's disease is the fastest-growing neurological disease worldwide and, as you said, dr Whitman but there, by the grace of God, go any of us to have Parkinson's and I hope that we've been able to help you by outlining some evidence-based strategies for you to reduce your risk of getting Parkinson's, and that we've been able to shed some light on some of the integrative therapies that may complement a traditional approach, so that you can be the best version of yourself as you navigate life with chronic disease.

Speaker 1: 44:11

And before we close, I'd like to give a shout out to the care partners of these patients. Being a care partner is often a long, difficult and sometimes lonely labor of love. As best we can, we as friends, family, neighbors and a society need to care for the caregivers.

Speaker 3: 44:25

In summary, the mainstream medical and surgical treatments outlined in our podcast should be the foundation of a Parkinson's treatment program. However, there are many evidence-based functional and integrative therapies that can complement traditional medical therapy in order to optimize prevention and treatment outcomes.

Speaker 1: 44:44

Well, that will about do it for this discussion of a functional and integrative approach to Parkinson's. Thank you so much for listening. We hope that we were able to share something with you that was interesting and helpful for you.

Speaker 3: 44:54

Do take a moment to rate us on iTunes. The reviews really do make a difference. And also, if you like the podcast, then take a moment today to let a friend know about it.

Speaker 1: 45:04

If you'd like to reach out to me to comment on the show or to make a recommendation for future topics, then you may do so at drmcmint at yahoocom. And Coach Lindsay, can you leave us with a? Coach Lindsay, pearl of wisdom.

Speaker 3: 45:16

You know, Parkinson's may be a disease of the brain, but healing happens in the whole person, From the gut to the heart, from your movement to your mindset. Every small choice matters, and what we've learned today is that you're not powerless. Whether it's red light therapy, hormone support, a boxing class or simple change in your morning routine, Each step is a vote for vitality. So keep showing up, build your team and, most of all, just believe in the possibility of progress. Neuroplasticity isn't just a scientific term. I think it's really a reason for all of us to have hope.

Speaker 1: 45:50

Well, this is Dr McMinn signing out, and this is Coach Lindsay. Take care and be well.