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Parkinson’s Update

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Parkinson’s Disease

What is Parkinson’s disease?
Parkinson’s disease is the second most common neurodegenerative disorder worldwide after Alzheimer’s disease. Parkinson’s affects nerve cells in the part of the mid-brain known as the substantia nigra, responsible for muscle movement. The result is tremors, rigidity, slow movements and difficulties with balance . Its signs and symptoms worsen over time, eventually leading to cognitive problems including dementia. But although Parkinson’s may result in disability, the disease often moves slowly, and most people have a number of years of only minor disability following a diagnosis.

The motor symptoms alone are known as parkinsonism – they may be due to Parkinson’s disease, or to a number of other causes that may be temporary or reversible.

The disease is named after James Parkinson, a British physician who published the first detailed description of the condition in 1817. Famous Americans including actor Michael J. Fox and boxer Muhammed Ali have the condition, and have raised awareness of it via books, appearances and interviews on behalf of groups such as the National Parkinson Foundation.

What are the causes?
There appears to be a genetic component, as people with a first-degree relative who has Parkinson’s, such as a parent, child or sibling, are at greater risk. In March of 2011, researchers at Mount Sinai School of Medicine published research indicating that mutations in a gene called LRRK2 are associated with the most common inherited form of the condition.

In addition, and even in people who are genetically predisposed to Parkinson’s disease, many experts believe that environmental exposures, such as unusual exposure to herbicides and pesticides, increase a person’s risk of developing Parkinson’s disease.

Certain drugs, when taken for long periods of time or in amounts greater than recommended, can cause parkinsonism. These include medications such as Haldol (Haloperidol) and Thorazine (Chlorpromazine), used to treat psychiatric disorders, as well as drugs used to treat nausea, such as Reglan (Metoclopramide ). The anti-seizure drug, Depakene (Valproic Acid), also may cause some of the features of parkinsonism, notably severe tremor. These medications do not result in Parkinson’s disease, however, and symptoms resolve when the medications are no longer used.

Who is likely to get it?
Parkinson’s disease generally begins in middle or late life, and the risk continues to increase as people age. Other risk factors include:

Gender – men are at greater risk than are women
Reduced estrogen levels
What are the symptoms?
Initial symptoms may include: an arm that refuses to swing when you walk, a mild tremor in the fingers of one hand or slurred speech. You may lack energy, feel sad or have difficulty sleeping. Daily activities may take longer than normal. Other signs and symptoms can include:

Tremor involving other parts of the body
Slowed motion
Stiff muscles
Impaired balance
Loss of automatic movements
Additional speech problems
Trouble swallowing
How is it diagnosed?
A diagnosis of Parkinson’s disease is made based on medical history and a thorough neurological evaluation – there are no specific blood test or x-ray results that can definitively support the diagnosis . Your physician will inquire about any medications you take and whether you have a family member with Parkinson’s. The doctor will assess your balance, walking, coordination and dexterity. Even if the symptoms are not apparent to you, a trained physician may detect subtle signs of parkinsonism – reduced facial expressions, a lack of gestures or a slight tremor.

What is the conventional medical treatment?
Conventional treatment often includes medication. The most commonly used drug is levodopa, also known as L-DOPA, which is converted to dopamine in the brain. Because motor symptoms are the result of a relative lack of dopamine, administration of levodopa can temporarily reduce motor symptoms.

Other classes of drugs used to counter Parkinson’s symptoms include:

Dopamine agonists
MAO-B inhibitors
Cholinesterase inhibitors
Treating motor symptoms with surgery was once common, but the advent of levodopa led to a reduction in surgeries. Today, for people with advanced cases for whom drug therapies no longer work well, surgery is again becoming a viable treatment option as surgical procedures become more targeted and sophisticated. The most common type of surgical intervention is deep brain stimulation (DBS). This involves implanting a device known as a brain pacemaker that sends electrical signals to specific parts of the brain to calm motor fluctuations and tremor.

What therapies does Dr. Weil recommend?
The tremor associated with Parkinson’s typically occurs when your hands are at rest. You can take the following steps to relieve or reduce shaky hands: Avoid caffeine, which can trigger production of adrenaline, a hormone that can worsen tremors. Avoid alcohol, which has pronounced effects on the central nervous system and can aggravate essential tremor, a condition that is sometimes confused with Parkinson’s disease. Regular exercise, including the use of light hand weights to promote stability in the hands and wrists, and consideration of tai chi to gently enhance balance, can be very beneficial. Ask your physician to recommend a physical therapist who can create an individualized fitness program for you .

Preliminary but promising evidence indicates that high-doses of coenzyme Q10, also known as CoQ10 – at a level of 1,200 mg a day – may be beneficial. Take CoQ10 with a meal containing fat for best absorption. The best form to use is a softgel capsule.

Parkinson’s disease can also be a predisposing factor in frozen shoulder (the medical term is adhesive capsulitis), a painful condition that can also limit arm movement on the affected side of the body. Dr. Weil suggests acupuncture and osteopathic manipulation; both can be helpful, and both are safer than more invasive measures. He also recommends trying DMSO (dimethyl sulfoxide) topically. You can buy it at your health food store or on the internet. It penetrates the skin and promotes healing of pockets of inflammation. Make a 70 percent solution of DMSO by diluting a 100 percent solution with distilled water and apply it to the shoulder with absorbent cotton. Let it dry. Apply the solution three times a day for three days. If you do not see any improvement, stop using it. If you do notice improvement, cut back to twice a day for three more days, then once a day for a final three days. After that your body can continue healing on its own.

One of the issues that people with Parkinson’s disease sometimes find themselves dealing with is an overactive bladder, or urge incontinence. Dr. Weil recommends trying these approaches for urge incontinence before resorting to drugs:

Watch your weight – excess pounds can stress the bladder and increase the risk of incontinence.
Do not smoke. Incontinence is twice as common among smokers as it is among nonsmokers.
Avoid bladder irritants such as caffeine, alcohol, and spicy foods. Avoid feminine deodorants, which can irritate the urethra.
Practice Kegel exercises to strengthen pelvic-floor muscles and improve bladder control.
Consider biofeedback, which can help you identify and strengthen your pelvic floor muscles and can help with Kegel exercises.
Discuss bladder retraining programs with your physicians. These can help you control the urge to “go” by scheduling bathroom trips and gradually lengthening the time between them.
In addition, try keeping a bladder diary, which may help reveal what triggers your urge symptoms.
Many people with chronic illness experience depression as a result of their health circumstances, but Parkinson’s disease can also precipitate biochemical changes in the brain that may result in depression. Mild forms of depression may not require medication. In Buddhist philosophy, depression represents the inevitable consequence of seeking stimulation. The centuries-old teachings suggest that we seek balance in our emotional lives, rather than continuously striving for the highs, and then complaining about the lows that follow. Its basic recommendation encourages the daily practice of meditation, and this is perhaps the best way to address the root of depression and change it. This approach to managing mild depression requires long-term commitment, however, as meditation does not produce immediate results. For more immediate, symptomatic treatment of depression, there is no better method than regular aerobic exercise. Numerous studies have demonstrated the efficacy of a daily workout for improving mood and boosting self-confidence. Dr. Weil recommends thirty minutes of continuous activity, at least five days a week for best results. For those with more advanced forms of depression, specific therapy may be advised by your doctor.

How is it prevented?
Avoid exposure to environmental toxins such as pesticides, as heavy pesticide exposure (such as that experienced by agricultural workers) is one of the most clearly established risk factors for the development of the disease. Beyond this precautionary principle, however, preventive strategies against Parkinson’s disease are general in nature.

The anti-inflammatory diet counteracts the chronic inflammation that is a root cause of many serious diseases that become more frequent after age 60. Normally, inflammation occurs in response to injury and attack by germs. It is marked by local heat, redness, swelling, and pain, and is the body’s way of getting more nourishment and more immune activity to an area that needs them.

But inflammation is not always helpful. It also has destructive potential. We see this when the immune system mistakenly attacks normal tissues in such autoimmune diseases as type 1 diabetes, rheumatoid arthritis, and lupus. And we now know that inflammation also plays a causative role in heart disease, Alzheimer’s and Parkinson’s diseases, as well as other age-related disorders, including cancer.

The anti-inflammatory diet emphasizes a variety of colorful vegetables and fruit, slow-digesting carbohydrates, plant-based protein, and healthy fats.

Glutathione, a compound with multiple effects on nerve cell metabolism as well as a powerful antioxidant, is of particular interest for PWPs because of studies showing its depletion in the substantia nigra (the site of major nerve cell damage in PD). With promising effects in the laboratory though, it is still not clear what is the best way for PWPs to take this, what would be the best doses and very importantly, what are the risks particularly over the long term. Other supplements at earlier stages of investigation in the laboratory include nicotinamide, riboflavin, acetyl carnitine and lipoic acid, but so far there is not enough evidence to recommend them specifically to PWPs.

Antioxidant therapy for PD: What’s the evidence?
Based on strong evidence linking oxidative damage of nerve cells to PD, there has been much hope that antioxidants could play a role in slowing the progression of the disease. (As mentioned above, CoQ10 has powerful antioxidant properties.) Many PWPs take antioxidants such as vitamin E or vitamin C; indeed, the Johns Hopkins study note above showed that more PWPs take vitamin E than any other supplement. Vitamin E can combat the damage caused by so called “free radicals”, and high dietary intake of vitamin E has been linked to lower risk of PD. Unfortunately, optimism over its use in PD has not been confirmed. A rigorous trial of a decade ago – the so-called DATATOP study – found no evidence that even high doses of vitamin E (up to 2000 IU per day) had any effect on progression or symptoms of PD. Still, given that vitamin E has very few side effects, many PWPs elect to take it at daily doses of 400 IU or more. Another potent antioxidant that may have some impact on PD is to be found in fermented papaya preparation available as a health food. Blueberries are also rich in antioxidants, and early experimental results have raised the possibility of their effectiveness in slowing nerve cell loss and age-related changes.

Herbal remedies may aid memory lapses and depression
Coordination and balance difficulties are only some of the problems faced by PWPs; for many, such effects as depression and memory decline may be even more troubling. One substance that seems to have mild benefit for memory in Alzheimer’s disease is ginkgo biloba, a plant extract consisting of a complex mixture of different chemicals. Studies show that doses between 120-240mg/day of the extract seem to have small but significant effect. It also seems to protect nerve cells from MPTP, a neurotoxin that leads to Parkinson’s disease. As yet, we don’t know whether it could be a good way to treat mild memory lapses in PD, and PWPs should discuss with their doctors how best to address these problems if they are present.

In efforts to ease the depression that is commonly associated with PD, some patients take St. John’s Wort (Hypericum perforatum). However, since it has properties similar to medicines such as Prozac or Paxil, it should not be taken alongside other antidepressants because of the risk of serious side effects. Finally, many PWPs look to herbal remedies for insomnia, calming properties or overall well-being. Although there is no rigorous evidence to support the efficacy of these remedies, individual PWPs may feel they contribute to a better quality of life.

So, what’s the bottom-line? For people who are interested in exploring complimentary approaches to easing PD, there does seem to be increasing scientific evidence of the efficacy of some available supplements, but safety has to come first. “Natural” remedies are not necessarily free of side effects or drug interactions. There are reports of serious side effects from some of these treatments, including movement disorders with Parkinson’s-like symptoms linked to Kava-Kava, a herbal supplement sometimes used for anxiety. In addition, supplements may be expensive, can vary widely between different manufacturers or even batches, and are regulated differently from the processes that govern prescription drugs.

Lets take a closer look at 19 of the balancing benefits of water, lemon, and salt, all in one cup.

Lemons are excellent for fighting inflammation. Lemons can help dissolve the uric acid in your joints, and also have been found to help build and repair tendons, ligaments, and bone. This anti-inflammatory property may be especially beneficial for people with rheumatoid arthritis and osteoarthritis, according to an American College of Physicians study on osteoarthritis, published in the Annals of Internal Medicine (2000).

Aids in proper food and water absorption. A daily glass of lemon water with Himalayan salt may provide a better overall mineral balance, which promotes proper food and water absorption in your body, allowing essential nutrients to get where they need to be.

Balances your bodys acidity (pH). The alkalizing effects of lemon and natural salt are highly useful for managing your bodys delicate pH balance, which is crucial for optimal functioning of the bodys systems.

Boosts immune function. One lemon serves up 139 percent of your daily value (DV) for vitamin C. Squeezing one lemon into your morning is a natural alternative to that vitamin C supplement you may be taking.

Its a detox for your cells. The all-natural Himalayan salt mixed with lemon juice and water helps to pull toxins from your cells, reducing cellular toxicity. This may reduce your risk for various chronic diseases, as well as make you feel generally awesome!

Reduces problematic cellulite. Natural salts like Himalayan salt have been used for centuries for skin care. Interestingly, most spa treatments for cellulitis contain some form of salt and/or citrus blend. A few daily gulps of lemon and salt water in the morning may firm up a few of those unsightly areas.

Clears up skin and adds a fresh glow. Using natural salt for skin problems, such as psoriasis and eczema, dates back to ancient Roman times. Roman emperor Marcus Aurelius doctor, Galen from Pergamum, used sea salt for skin diseases, according to Science Tribune (1999).

Glass of water with lemon/baking soda/apple cider vinegar
Useful for allergy season. It has been suggested that the combination of lemon and salt, specifically mixed into warm water, acts as a natural antihistamine for allergies. It may be the perfect alternative to those pink pills that leave you feeling drowsy.

Paves the way for better sleep. The natural hormone-balancing properties of lemon and Himalayan salt can be more than useful when it comes to bedtime. Getting the proper amount of sleep is essential for physical health, mental health, productivity, and much more. This hormone-balancing beverage can make an effective nightcap.

Helps controls blood sugar. The fiber content of lemons helps to balance blood glucose levels, which is useful for type 2 diabetes patients and prediabetics alike, according to a study published in the New England Journal of Medicine (2000).

Lemons may help detoxify your liver. Vitamin C is essential for producing glutathione, which plays a foundational role in detoxifying the liver. It also has antiseptic properties that are useful for liver function, as well.

Freshens breath! Lemon and Himalayan salt may not be the first things that come to mind when you think of fresh breath. However, the lemon and salt in this simple morning drink help kill the bad breath bacteria that build up while you are sleeping.

May help you chill out. When you get stressed out, do not be so quick to reach for those prescription pills. You may be able to chill out and return to that state of Zen by boosting your vitamin C levels first thing in the morning.

Useful for reducing blood pressure. Lemons are not all about vitamin C and fiber. They also boast potassium, which is vital for flushing excessive sodium from the body.

Boost your libido! The vitamin C content and hormone-balancing properties of this morning beverage can help lift your mood. This might be all it takes to boost your libido, without the need for that little blue pill.

Gets you hydrated right out of the gate. Many people forget how important hydration is, especially after a seven or eight-hour sleep period with no water. Start your morning off right and get hydrated. The water, salt and zesty lemon will get your day off to the perfect start.

An antioxidant powerhouse vital for, well, everything! Lemon offers up a wealth of vitamins and minerals, while Himalayan salt boosts your mineral and trace mineral levels even more. The antioxidant and detoxifying properties of lemon saltwater pack a powerful, free radical knockout punch.

May improve your heart health. Lemons and real salt are both exceptional for increasing heart health on their own. However, when you combine the two into one vibrant morning drink, you get even more vital heart-thumping health benefits.

Natural salt supports electrochemical reactions in the body, while negative ions assist in healthy heart rhythm. Lemons are rich in vitamin C, which is, associated with lower endothelial dysfunction in men with no history of cardiovascular disease or diabetes, according to a study published in the American Journal of Clinical Nutrition (2006).

Promotes digestive health. A glass of warm lemon water with Himalayan salt before breakfast, or any meal, helps signal your liver to produce the essential bile needed to clean out harmful gut bacteria. The fiber content and natural salt will also promote digestion.

Are you ready to commit to this simple and health-promoting morning drink? I have been drinking warm lemon water with a little bit of Himalayan salt every morning for months, and I absolutely love it. My energy levels are up, and I feel as cool as a cucumber throughout the day.

Want to join me? Combine 10 ounces of filtered water with one whole lemon, squeezed, and half a teaspoon of Himalayan salt.

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