RHR: A Functional Medicine Approach to Parkinson’s Disease

In this episode, we discuss:

• What is Parkinson’s disease?
• Eight underlying factors of Parkinson’s disease, including gut dysfunction, gluten, autoimmunity, blood sugar, iron overload, circadian disruption, stress, and environmental toxins
• Thirteen diet and lifestyle changes you can adopt to help prevent and treat Parkinson’s disease, including eating a nutrient-dense, whole foods diet, giving up gluten, getting enough vitamin D and omega-3s, considering a ketogenic diet, attending to your gut health, reducing your exposure to toxins, adopting a regular sleep rhythm, taking botanicals and supplements, reducing stress, getting more exercise, and using phototherapy, low-dose naltrexone, and medical cannabis.

Show notes:

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Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m going to answer a question that was sent in, which is, “What help can you give someone [who] has early-stage Parkinson’s [disease]?” The number of people who are diagnosed with Parkinson’s [disease] is on the rise, with researchers estimating that over a million Americans have this devastating condition as of 2020. [And] we’re in 2022 now, [so] that number is almost certainly a little bit higher. Unfortunately, the conventional treatments for Parkinson’s [disease] are limited to surgery and medications that come with a lot of nasty side effects.

The good news is that a growing body of research suggests that there are many modifiable risk factors that are associated with Parkinson’s [disease], which gives us some clues as to the actions we can take to prevent the onset of the disease. We also know that there are steps that you can take to slow the progression [of], or even, in some cases, reverse, the condition in its earlier stages. I’ve been working with patients with Parkinson’s [disease] in my clinic for many years and have had some significant successes when approaching this from a Functional Medicine perspective. In this podcast, I’m going to tell you about some of the underlying causes that contribute to Parkinson’s [disease] from the latest research, and then we’re going to talk about some steps you can take to lower the risk of getting Parkinson’s [disease] in the first place or potentially slow the progression of the disease if you already have it.

What Is Parkinson’s Disease?

Let’s start off with a definition of Parkinson’s disease and a basic understanding of the mechanisms and signs and symptoms. Parkinson’s disease is a neurodegenerative condition characterized by a number of factors. First, a gradual loss of neurons in the brain that produce dopamine. Second, mitochondrial dysfunction. Third, neuroinflammation or inflammation of the neurons in the brain. Fourth, oxidative stress. And fifth, an accumulation of misfolded or malformed dysfunctional proteins in the neurons. One particular protein called alpha-synuclein plays a significant role in how Parkinson’s [disease] is diagnosed. Together, these factors damage the central nervous system and impair motor function, causing the hallmark symptoms of Parkinson’s disease, which are stiff muscles, difficulty standing, walking, and with other bodily movements, involuntary movements or tics, rigidity, slow shuffling gait, difficulty speaking, dementia, reduced or lost sense of smell, change in facial expression, and constipation. Many scientists and doctors have dreamed of developing a cure for Parkinson’s disease, but the reality is Parkinson’s [disease] is caused by multiple factors and is therefore unlikely to respond to a single therapy. Rather than focusing our efforts on finding a silver bullet drug to cure Parkinson’s [disease], I think we could make more progress and better improve patients’ quality of life by addressing the many underlying causes of the disease. That approach may not only prevent Parkinson’s disease, or at least reduce its occurrence, [but] it could also potentially reverse some of the signs and symptoms in people [who] are already struggling with it.

If this sounds familiar, you’re not wrong. This is a similar thing [to] Alzheimer’s disease. I’ve had Dr. Dale Bredesen on the show a couple of times to talk about a Functional Medicine approach to Alzheimer’s [disease] and the problem with the typical conventional idea that we’re going to find a single drug, or even a group of drugs, that can address Alzheimer’s [disease]. That’s, I think, a pipe dream because Alzheimer’s [disease] is caused by many different underlying factors, and those factors vary from person to person. This is really one of the core insights of Functional Medicine. The difference between Functional Medicine and conventional medicine is that Functional Medicine is a systems-based approach. We understand that the whole is more than the sum of the parts. We understand that the etiology or causes of the same disease can be different from person to person, and therefore the treatments need to be different from person to person. The same is true for Parkinson’s disease. So with that in mind, let’s talk about eight of the underlying triggers or causes of Parkinson’s [disease] that have been identified in the scientific literature so far, and then we’ll move on to some of the steps you can take to prevent or slow the progression, or, in some cases, although I have to say that this is rare in my experience, [reverse] the condition in its earlier stages.

Eight Causes of Parkinson’s Disease

The first underlying cause is gut dysfunction. You’ve probably heard me talk about the gut–brain axis before. [It’s] a two-way communication system between the enteric nervous system, or the second brain of the gut, and our central nervous system. Chronic constipation has long been recognized as an early sign of Parkinson’s [disease], and it precedes the onset of the motor symptoms of Parkinson’s disease by many years, suggesting that changes in the gut have a causal relationship with Parkinson’s [disease]. Alpha-synuclein proteins are deposited in gastrointestinal nerves up to 20 years before the onset of Parkinson’s disease symptoms. This suggests that the gut may be “ground zero” in the development of Parkinson’s disease. I’ve seen [this] in all of my patients with Parkinson’s [disease], and I really think there’s a lot to [it].

Alpha-synuclein spreads from the gut to the brain. Epidemiological research supports this theory, as severing the nerve that connects the brain and the colon in animal studies reduces the risk of Parkinson’s disease. But what causes accumulation of abnormal alpha-synuclein in the gut in the first place? Some researchers think it might be triggered by changes to the gut microbiota. Normally, proteins in our cells form through folding into specific functional shapes. But sometimes misfolding occurs, and the result is a protein that doesn’t work as it should or that clumps together and accumulates, which is what happens with alpha-synuclein as it relates to Parkinson’s disease. And we know from research that gut dysbiosis triggers inflammation-induced misfolding of alpha-synuclein in gastrointestinal nerves, which subsequently link up with other nerves along the gut–brain axis. Those abnormal alpha-synuclein proteins travel along the gut–brain axis and may eventually lead to Parkinson’s [disease]. [Patients with] Parkinson’s disease also demonstrate distinct patterns of gut dysfunction that may eventually contribute to this condition, including elevated levels of inflammatory bacteria, lower levels of anti-inflammatory bacteria, [small intestinal bacterial overgrowth] (SIBO), [which] is very common in [patients with Parkinson’s disease] and may be both a cause and a result of Parkinson’s [disease], Helicobacter pylori infection, and increased intestinal permeability or leaky gut.

Dysbiosis results in an elevated production of lipopolysaccharide (LPS), which is an inflammatory byproduct of bacteria. When leaky gut is also involved, LPS can cross the gut barrier, enter the bloodstream, and then travel through the blood up to the brain and cross the blood–brain barrier, where it causes inflammation in the brain and leads to a loss of dopamine-producing neurons. [Those are] a lot of potential mechanisms, and pretty strong evidence that dysfunction and changes in the gut, and particularly the gut microbiota, may be driving Parkinson’s disease. This is, I think, the number one area of focus for anyone who has Parkinson’s [disease] in their family or who’s starting to experience some of the telltale signs and symptoms of Parkinson’s [disease]. The primary focus should be on healing the gut and correcting dysbiosis and SIBO and any other gastrointestinal issues that are present because I think this is probably the primary driver of the disease.

The second factor that can trigger or exacerbate Parkinson’s [disease] is gluten. Gluten ataxia, which is a loss of control of body movements, has long been recognized as a neurological symptom of gluten sensitivity. Gluten sensitivity, as well as celiac disease, has been shown to have many other neurological manifestations, including some of the same motor symptoms seen in Parkinson’s [disease]. Several case studies have found that a gluten-free diet can help alleviate those symptoms, and genetic research suggests that people with celiac disease often test positive for PARK7, which is a protein associated with Parkinson’s disease. I’m not suggesting that everyone with Parkinson’s [disease] has gluten sensitivity and that if they just remove gluten from their diet, [then] they won’t have Parkinson’s [disease] anymore. That’s ridiculous. But I am suggesting that the data I just shared indicate a possible relationship between gluten sensitivity and Parkinson’s disease. If someone tests positive for [the] PARK7 protein associated with Parkinson’s [disease] and they have gluten sensitivity, I think it absolutely makes sense to remove gluten from the diet. Parkinson’s [disease], as you know, is a serious disease with [a] potentially very serious outcome. Removing gluten from the diet is a very simple step you can take that could have a positive result. There’s no harm in trying [it], and possibly a lot of benefit.

[The] number three [factor] is autoimmunity. In the last few years, a number of researchers have begun to speculate that Parkinson’s [disease] might be an autoimmune disease. In one study published in Nature, the researchers found that fragments of alpha-synuclein caused the body’s immune system to mistakenly recognize dopamine-producing neurons as foreign tissues and start attacking them. What’s happening is [that] the body is, just like with any other autoimmune condition where the body is attacking itself, attacking the neurons that produce dopamine, and that’s leading to the signs and symptoms of Parkinson’s [disease]. Interestingly, Parkinson’s disease and autoimmune conditions share a common genetic basis. Together, I think these findings suggest that addressing Parkinson’s [disease] as if it’s an autoimmune condition is an interesting and potentially fruitful approach that is relatively novel. There’s not a lot of research on this yet, and certainly not being done in the conventional medical field. But in my practice, when we have patients with early-stage Parkinson’s [disease], we will sometimes experiment with some of the same autoimmune treatment protocols that we would do with any other autoimmune conditions. We might put them on [an autoimmune protocol] (AIP) [diet], [and] we’ll try to boost their glutathione levels and do other things to support T regulatory function. We might try low-dose naltrexone, which I’ll come back to later in the show, as a treatment for autoimmunity. I think this is certainly worth exploring further.

Number four is blood sugar imbalances. When the bloodstream contains a high concentration of sugar, like with hyperglycemia and insulin resistance, the protein circulating in the body can become damaged. Alpha-synuclein is no exception, and once [it’s] damaged, it can cause even more harm to the neurons in the brain. Insulin resistance is significantly underdiagnosed in non-diabetics with Parkinson’s disease. In other words, it’s not uncommon for people with Parkinson’s [disease] to have high-normal or prediabetic blood sugar. That’s a cause for concern because, once the disease develops, insulin resistance has been shown to worsen Parkinson’s [disease] by further damaging the alpha-synuclein proteins. The good news is that taking steps like a low-carb diet, more physical activity, [and] all the things we talk about to balance blood sugar levels has been shown to protect the brain’s neurons. Improving insulin sensitivity and normalizing blood sugar are critical steps to take for reducing the risk of Parkinson’s [disease], and also alleviating some of the symptoms if you already have it.

Number five is iron overload. This has been one of my interests, clinically, for many years. In fact, one of the first presentations I gave at one of the first ancestral health symposiums more than 10 years ago was on iron overload. This became an interest of mine because early on in my clinical practice, I [discovered] many patients who had iron overload. Far more than what [the] conventional approach to this condition would suggest. I recognized that it was a problem that was much more common than typically acknowledged and [that] it was something that could cause a lot of issues. Iron overload can occur in people with a genetic predisposition to storing excess iron or in those who’ve been supplementing with high doses of iron long-term or, in much more limited cases, people who are going overboard on iron-rich foods like shellfish or organ meats like liver. I’ve seen a couple of patients in my practice over the years who were eating liver every day because they got the message that it’s a very nutrient-dense food, which is certainly true. [But] they actually overdid it and developed excess iron levels.

Now for most people, if we eat too much iron, we can just eliminate it in the feces. But for some people who have certain genetic polymorphisms, the body [is] not able to recognize that excess iron and eliminate it. These are among the most common genetic polymorphisms in people of Northern European descent. In fact, they affect 1 in 200 people. So in a country of 300-plus million people, a lot of whom are of Northern European descent, iron overload is going to be a very common condition. Unfortunately, it’s rarely caught in the conventional medical world because most doctors are not doing complete iron panels with iron, iron saturation, [unsaturated iron-binding capacity] (UIBC), [total iron-binding capacity] (TIBC), ferritin, soluble transferrin receptor, etc. But I do a full iron panel on every patient I see, and I’ve caught many people with this condition.

Bringing it back to Parkinson’s [disease], in high concentration, iron causes oxidative stress in all body tissues, including the brain. And in fact, mostly in the brain. The brain is most likely to be affected. People with Parkinson’s disease have very high brain iron levels, suggesting that iron-induced oxidative stress plays a role in the disease process. Conversely, once people receive treatment, which is usually therapeutic phlebotomy, or removal of excess iron from their blood to reduce their iron levels, they often will see clinical improvements in their condition.

By the way, as we go through this, I have an article on Parkinson’s [disease] on my website, which has all the resources, studies, links, and information that I’m covering here. We’ll put a link to that in the show notes so you can check that out and get all the background [information] that you want.

Cause number six is circadian disruption. [The] circadian rhythm is the roughly 24-hour biological cycle in humans that regulates a huge array of physiological and behavioral functions. When that circadian rhythm is disrupted by factors like too much exposure to blue light at night, abnormal sleep-wake cycles, shift work, etc., that increases the risk of Parkinson’s [disease] by altering the expression of genes and proteins that regulate dopamine in the brain. So it shouldn’t be a surprise to see in the scientific literature that chronic insomnia is one of the major risk factors for Parkinson’s [disease], and [that] abnormal sleep-wake cycles can exacerbate the symptoms of the disease.

Cause number seven is stress. There’s really no modern chronic disease that is not associated with stress, and Parkinson’s [disease] is no exception. Chronic stress elevates cortisol, [which] promotes a pro-inflammatory state that ultimately kills dopamine-producing neurons in the brain. Cortisol can also interfere with neuronal plasticity, which is the brain’s ability to adapt and learn from new circumstances. In animal studies, a high frequency of stressful life events increases the risk of Parkinson’s disease. And I will say that in almost all of my [patients with Parkinson’s disease], their initial onset of symptoms was triggered by a major life event like [the] loss of a job or a major life transition. Again, that doesn’t mean that stress is the only cause or trigger. There’s always a collection of causes and triggers. But stress is almost always one of them. In people [who already have] Parkinson’s [disease], stress has been shown to exaggerate Parkinson’s-related motor dysfunction and non-motor symptoms. So this is a major factor that needs to be addressed for both prevention and treatment.

Cause number eight is really significant, so I’m going to spend a little bit more time on it. It’s [even] well recognized in the conventional medical establishment. [It] is the role of environmental toxins. Oxidative stress, which is caused by exposure to toxins, is a well-known cause of alpha-synuclein accumulation in the brain. There have been several different types of toxins that have been implicated in the pathogenesis of Parkinson’s disease. You can see these links in my article to the studies. They’re in PubMed; they’re published. Like I said, even fairly conventional sources and practitioners are aware of this connection, although, from what I’ve seen, very little is done to test for it and treat it because that’s not something that most conventional doctors are trained to do. Finding a Functional Medicine specialist [who] knows how to test for toxins and treat toxic exposure is really important for people with this condition.

One category is pesticides and herbicides. For example, rotenone is an insecticide commonly used in home gardens for pest control, and it has been shown to inhibit the activity of protein complexes that get rid of unneeded or damaged proteins like alpha-synuclein. [Getting] exposed to this insecticide can decrease the activity of [the] protein that clears out damaged alpha-synuclein, and then you get an accumulation of damaged alpha-synuclein, which is a hallmark of Parkinson’s disease.

Paraquat and maneb, which are an herbicide and fungicide, respectively, also cross into the brain from the bloodstream, are toxic to mitochondria, and damage neurons. Studies have shown that people with a lot of exposure to these pesticides, like pesticide applicators, agricultural workers, and people who live in rural areas, have a significantly increased risk of Parkinson’s [disease]. One of my patients with Parkinson’s [disease] lived in a rural area of Colorado that was surrounded by farms, ranches, and golf courses, where there was a lot of herbicide, pesticide, [and] insecticide application happening. When we tested her for toxic exposure, she was literally off the charts. She’d lived there all of her life, and Parkinson’s [disease] ran in her family. There was a high rate of Parkinson’s [disease] incidents in her local community. That was so [clearly] a contributing factor in her case, and when we did a detox program, she improved significantly. It didn’t cure her of the disease, but it made a huge difference. So this is something you really need to consider.

Another potential contributing factor is toxic mold. Mycotoxins, which are the metabolites produced by toxic molds, can contribute to the development of Parkinson’s [disease] by depleting dopamine and inducing an inflammatory response in the brain. Air pollution has [also] been linked to Parkinson’s [disease], including ambient particulate matter, nitrogen oxides, carbon monoxide, and ozone. Chronic exposure to air pollution has been shown to contribute to Parkinson’s [disease] by triggering oxidative stress and promoting the misfolding of alpha-synuclein. This, unfortunately, is not something that people necessarily have a lot of control over. If you have Parkinson’s [disease] and you’re living in an environment that has high air pollution, and you’re able to move to somewhere that has cleaner air, I think that’s an absolutely worthwhile step to take because we want to reduce as many of these potential exposures as we can.

Parkinson’s disease is increasingly common, but it doesn’t have to be. Tune into this episode of Revolution Health Radio to learn the most common causes of the disease and 13 ways you can prevent it through evidence-based dietary and lifestyle interventions. #chriskresser #functionalmedicine #parkinsons

How to Prevent Parkinson’s Disease

With that in mind, let’s talk about 13 different ways to lower your risk of Parkinson’s [disease] and even reduce the signs and symptoms if you already have it. Number one is to eat a nutrient-dense, whole-foods diet. This is pretty much the answer to every health condition, so I’m not going to spend a lot of time on this. Most people listening to the show are aware of this, and I don’t want to belabor the point. So, [a] nutrient-dense, whole-foods diet. Check the article on my website for a specific suggestion. I’ve written and spoken about this ad nauseam, so we’re just going to move on to the next one, which is making sure you get enough vitamin D and omega-3s. Vitamin D deficiency is associated with an increased risk of Parkinson’s [disease], whereas vitamin D supplementation and sun exposure are associated with [a] reduced risk. We know from recent statistics that 94 percent of Americans, and I would assume probably similar rates in many other countries in the world, are not getting enough vitamin D. This is an extremely low-hanging fruit and something that’s very easy to correct. It’s an absolute no-brainer to do to reduce your [risk of] Parkinson’s [disease]. And if you already have Parkinson’s [disease], it could actually, as I mentioned, improve the symptomology. Omega-3 fats like [eicosapentaenoic acid] (EPA) and [docosahexaenoic acid] (DHA) are critical for normal brain development and function across [the] lifespan. Low levels of EPA and DHA increase the risk of neurodegeneration, whereas getting enough EPA and DHA has been shown to reduce the death of neurons in the brain, reduce brain inflammation, boost antioxidant enzymes, and relieve motor symptoms in people with Parkinson’s [disease]. I recommend consuming two to three servings of seafood a week, or a total of 16 ounces of cold water fatty fish to get that EPA and DHA. If you’re not able to do that, then you can supplement with an equivalent amount of EPA and DHA.

Number three is to give up gluten. We talked about that earlier, so I won’t dwell on it.

Number four is to consider a ketogenic diet. There are some really good studies suggesting that a ketogenic or very low-carb diet can improve brain function in several different ways. There [are] some different thoughts about this. One is that in patients with both Alzheimer’s [disease] and dementia and Parkinson’s [disease], the brain is not processing glucose effectively. So the idea of a ketogenic diet is to replace glucose as a fuel source with ketones. The brain actually prefers ketones as a fuel source to glucose, especially in cases where it’s not processing glucose correctly. Some of the more exciting findings related to a ketogenic diet deal with its impact on neurological diseases like Parkinson’s [disease]. In animal models, the ketogenic diet reduces mitochondrial damage and improves motor function. In humans, the diet improves both motor and non-motor symptoms of Parkinson’s disease. In addition to ketones providing an alternative fuel source to glucose in the brain, ketone metabolism also decreases oxidative stress and reduces inflammation of the brain, which are two of the underlying causes of Parkinson’s [disease].

I don’t necessarily recommend that someone who has Parkinson’s [disease] in their family and is worried about getting it follow the ketogenic diet continuously because there can be some downsides of that. But you might consider doing a ketogenic diet phase for a month, three to four times a year. There’s some evidence that might be beneficial. If you already have Parkinson’s [disease], then it may be that a more consistent ketogenic approach is beneficial. I would highly recommend working with a Functional Medicine practitioner who has experience in this area because cycling on and off or incorporating intermittent fasting can also enhance the benefit of that and reduce some of the downsides.

Number five is attending to gut health. [There are] lots of ways to do this. I have a free eBook on gut health on my website, so check that out if you haven’t already. Probiotics and prebiotics have both been shown to benefit [patients with Parkinson’s disease]. Probiotics can help relieve constipation, improve insulin sensitivity, [and] improve antioxidant status in people with Parkinson’s [disease], which are some of the hallmark signs and symptoms. Seed is my favorite probiotic, as you know. If you go to kresser.co/seed, you can learn more about that. Prebiotics are fermentable fibers that feed beneficial gut bacteria [and] are another useful intervention. [Fructo-oligosaccharides] (FOS) and [galacto-oligosaccharides] (GOS), which are two types of prebiotic fibers, increase brain-derived neurotrophic factor (BDNF), which is a protein important for protection of the neurons and their survival and plasticity. BDNF is abnormally low in [patients with] Parkinson’s disease, so boosting it can have neuroprotective effects.

Number six is reducing your exposure to toxins as much as possible. We talked about how that’s a major factor in the pathogenesis of Parkinson’s [disease]. This means creating a healthy living environment at work and at home. One big step you can take is to filter or purify the air in your home or workplace using an air filter like AirDoctor or IQAir, and then making sure you’re drinking clean water. There are lots of good water filters. Berkey is one, [and] there’s some good under-the-sink options, as well. Making sure you’re drinking clean water and breathing clean air is critical. Testing your home for mold and addressing that if you suspect a problem there, reducing your exposure to pesticides, herbicides, and insecticides, looking out for compounds like bisphenol A (BPA), reducing your use of plastics and plastic containers, and taking steps overall to reduce your exposure to other toxins like toxic home cleaning and personal care products can go a long way.

Number seven is to adopt a regular sleep rhythm. We talked about how the disrupted circadian rhythm is a contributing factor to Parkinson’s [disease]. [Create] a regular sleep rhythm [by] going to bed and waking up at the same time or close to the same time, if possible, to create that regular sleep-wake cycle. Getting to bed earlier is going to work better [for most people], although some people do have a chronotype where they naturally fall asleep later and sleep later. But the key, I think, is regularity. [Avoid] blue light-emitting devices like smartphones and tablets and computers within a couple [of] hours before bed, [and reduce] your exposure to light while you’re sleeping. Even small amounts of light have been shown to disrupt the circadian rhythm, so getting rid of digital alarm clocks, not sleeping with your phone next to your bed, [and] all the stuff we’ve talked about over the years [to improve your sleep] is really important.

Number eight is to consider botanicals and supplements. There are several plant compounds that have been studied for their neuroprotective effects. Lion’s mane mushroom has been shown to regenerate neurons in the brain. It’s one of the few substances we know of that can do that. There are other mushrooms like reishi, turkey tail, chaga, and cordyceps that have significant neuroprotective effects. This is one of the reasons I’m so excited about mushrooms and included a mushroom product in my Adapt Naturals Core Plus bundle. It’s called Bio-Avail Myco. Mushrooms have incredible brain-protective effects. The incidents of Alzheimer’s [disease] and dementia and Parkinson’s [disease] and other neurodegenerative conditions [are] rising at a scary pace. I think we need to do everything we can [and] pull out all the stops to protect our brain because our brain is the control center for everything that happens in our body. If our brain goes south, so to speak, then nothing else is going to function properly. Protecting our brain as we age is, I think, the single most important thing we can do to extend our health span, and these mushrooms have incredible brain-protective effects and benefits on cognitive function, motor function, etc. So if you want to learn more about that, go to AdaptNaturals.com and check out the Core Plus bundle and, in particular, Bio-Avail Myco, the mushroom blend.

Curcumin has been shown to be neuroprotective. Sulforaphane, which is a phytochemical present in broccoli sprouts, protects against toxin-induced neurotoxicity and has a lot of interesting benefits for Parkinson’s [disease]. BrocElite is the product I recommend. It’s one of the only truly stabilized sulforaphane products on the market. Most sulforaphane products on the market contain sulforaphane precursors and don’t actually contain sulforaphane itself, so they’re going to be far less effective. BrocElite is the one that I recommend, and you can learn more about that at kresser.co/BrocElite. [Epigallocatechin gallate] (EGCG), which is a polyphenol found in green tea, has been shown to reduce the risk of Parkinson’s disease and may help once it’s already started. You can get that by consuming green tea or by taking a supplement that has EGCG in it. Bio-Avail Multi, which is my essential multivitamin, multimineral, and phytonutrient blend, does have EGCG in it. It’s one of the most researched compounds for addressing oxidative stress, inflammation, and neurodegenerative conditions.

Number nine is getting more exercise. There’s a lot of evidence that suggests that physical activity overall, and exercise, in particular, inhibits the progression of Parkinson’s disease by enhancing neuroplasticity and promoting the growth and survival of neurons. That’s also true for dementia and Alzheimer’s [disease]. Exercise increases BDNF, which we talked about earlier as being very low in [patients with Parkinson’s disease]. It’s also low in [patients with] dementia and Alzheimer’s [disease]. [Exercise is] one of the most potent ways that we can stimulate BDNF and [is] really, really critical for maintaining bone health.

Number 10 is reducing stress. We talked about how chronic stress is a major factor for Parkinson’s [disease]. There are lots of ways to do this. If you Google Chris Kresser, stress, you’ll see some of my articles that have a lot of practical suggestions for how you can integrate stress reduction practices into your daily routine.

Number 11 is phototherapy, aka light therapy. Light therapy has been shown to reduce neurodegeneration in Parkinson’s disease. In animal models, near-infrared light protects dopamine-producing neurons from cell death and improves motor symptoms by restoring normal cellular energy production and decreasing oxidative stress. And several human trials, although small, have shown that near-infrared light can help speech, cognition, gait, and the “freezing episodes” or moments [when] a person is temporarily unable to move. Near-infrared light can be administered either as low-level laser [light-emitting diode] (LED) therapy, or the easiest way to access it is a near-infrared sauna. I have a SaunaSpace at home, and it’s one of my favorite pleiotropic health interventions—pleiotropic, meaning an intervention that has multiple different benefits. It feels good, it helps with detoxification, [and] it helps by decreasing oxidative stress [and] improving mitochondrial function. All of these are mechanisms for Parkinson’s [disease], and it’s an ideal therapy for Parkinson’s [disease] because of this. It addresses multiple mechanisms of Parkinson’s disease. SaunaSpace offers a great discount for Revolution Health Radio listeners. I’ve been a huge fan of their saunas for many years. I use them myself daily and recommend them to patients. I think it’s the best near-infrared sauna out there. If you want to learn more about it and pick one up, go to kresser.co/SaunaSpace.

[Another] one is low-dose naltrexone (LDN). This is a medication you may have heard me talk about in the context of autoimmune disease. It’s been shown to benefit patients with Crohn’s [disease] and several other autoimmune conditions, including fibromyalgia. It reduces inflammation in the central nervous system, and it balances and regulates T-cell function. And, of course, Parkinson’s [disease] involves inflammation in the central nervous system in the brain. There’s not a lot of research on LDN in Parkinson’s [disease]. I think [there’s] only one or two small studies, and they’ve shown mixed results. But we’ve used it empirically in our practice for many years with [patients with Parkinson’s disease]. It’s certainly not a panacea. Some patients don’t notice much of a difference at all. But in others, it has a really, really significant effect. So, we always have to remember [that] we don’t treat conditions; we treat patients. The same treatment will affect different patients differently. Even [if] a study shows mixed results, if you’re one of the people [who] experienced a big benefit, that’s kind of irrelevant, right? If a study has five people with really great benefits and five people who didn’t experience any benefit, and five people who actually got worse, that’s going to be a null result [with] no benefit. But for the five people who experienced a phenomenal benefit, they don’t really care about that. That’s why we have to take an individualized approach to treating these conditions. [With LDN], you’d want to work with a Functional Medicine clinician or someone who has experience with that medication, and hopefully, [with] using that medication for Parkinson’s [disease]. There is a book called LDN for Parkinson’s Disease on Amazon. If you’re interested, you can check that out.

Medical cannabis is another emerging treatment for Parkinson’s disease, and it’s also one where the studies are quite mixed. A lot of the studies were not particularly well designed, [and] some had only a few participants. But there are some studies indicating significant benefits like improvements in anxiety, pain, sleep dysfunction, weight loss, nausea, [and] motor function. You can even see some videos on YouTube. There’s one video I’m thinking of, [where] an older man with Parkinson’s [disease] uses cannabis for the first time. You can see his hand shaking pretty violently before he uses cannabis, and then very shortly after he administers the cannabis, you can see his hand stop shaking almost entirely, and he’s in tears because he hasn’t been able to stop shaking for years. So again, it’s similar to LDN—for the people that it works for, it can be dramatic and life changing, but it doesn’t work for everybody. It can even have adverse effects in some cases. Parkinson’s [disease] is characterized already by impaired cognition and, certainly, some forms of cannabis can further impair cognition, executive function, planning, and judgment, and that can be problematic. [In] some people, it can cause dizziness, blurred vision, mood or behavior change, [and] loss of balance, which is already impaired with Parkinson’s [disease]. So there’s really no “one-size-fits-all” approach.

The other thing to keep in mind about medical cannabis, in general, not just for Parkinson’s [disease], is that we refer to cannabis as if it’s just one treatment approach. The reality is [that] cannabis is a phenomenally diverse plant, and the ways that cannabis therapy can be applied are numerous. For example, are we talking about sativa or indica? There are many different strains of cannabis plants, and those different strains have decidedly different impacts. And there are some conditions where patients would benefit more from indica, and there are some conditions where patients would benefit more from sativa. Another question is, “What is the cannabinoid profile?” Which cannabinoids are we targeting? Are we targeting [tetrahydrocannabinol] (THC), which usually produces the alteration of consciousness that’s associated with cannabis and has some unique effects on physiology? Are we talking about [cannabidiol] (CBD), which is usually non-psychoactive and has a different range of effects? Or are we talking about new cannabinoids that have been discovered in the past 10 to 20 years and we’re only starting to understand their effects, like [tetrahydrocannabinolic acid] (THCA), [cannabinol] (CBN), or [cannabigerol] (CBG)? There’s a lot of potential here in getting more specific about how we’re applying medical cannabis therapy. Then, of course, there’s the route of administration. Vaporizing cannabis has a different effect than eating it, which has a different effect than using a sublingual spray. When you put all this together, there’s an incredible range of potential ways to use medical cannabis, and they will have a very different impact to the point where they can change it from being not effective, or even potentially harmful, to being incredibly effective.

I have a lot of experience using medical cannabis with patients and have seen firsthand where a patient will come in and say, “Oh, I’ve tried medical cannabis; it doesn’t work.” I ask some questions about how they’ve done it and find that they probably haven’t used the correct approach for their particular condition. I change the recommendation based on that, and all of a sudden, they have a really positive response. So I would highly recommend, if you’re considering medical cannabis therapy, to work with a seasoned practitioner. There are also some good books out there. The one that I recommend if you’re primarily focusing on CBD is called CBD: A Patient’s Guide to Medical Cannabis—Healing Without the High by Leonard Leinow [and Juliana Birnbaum]. Leonard is also the founder of Synergy Wellness, which is the cannabis dispensary that I recommended and used in my practice in California [with] patients. It’s a medical cannabis dispensary, not for recreational use. Leonard is one of the most knowledgeable people on the planet when it comes to applying cannabis and CBD for a whole range of conditions like cancer, Parkinson’s [disease], autoimmune disease, gastrointestinal disorders, etc. I highly recommend that book if you want to learn more. Another good book about cannabis overall, not just CBD but also THC-containing strains and a lot of the newer strains that are being studied and explored now, is called Medical Cannabis: A Guide for Patients, Practitioners, and Caregivers by Michael Moskowitz. And finally, I’d recommend listening to one of my podcast episodes called “Discovering the Potential of Medical Cannabis, with Mikhail Kogan.” You can Google that [and] we’ll put a link to it in the show notes, as well. Mikhail is one of the most experienced practitioners that I know of [when it comes to] medical cannabis. He’s board-certified in geriatric medicine and has a lot of experience using medical cannabis in the geriatric population for conditions like Parkinson’s [disease] and other diseases of aging. He’s also incredibly knowledgeable about the use of medical cannabis—the power of different cannabinoids, tips for beginners, where to get started, and some thoughts about the future of medical cannabis. That was a phenomenal episode. I definitely recommend listening to it.

Okay, I know that was a lot, [and] I hope it was really helpful. I hope this gives you hope because there is hope when it comes to Parkinson’s [disease], both for people who are at the early stages or already are struggling with the disease, and for people who have a history of it in their family. There are lots of steps we can take to prevent, slow the progression, and, in some cases, if it’s early enough, possibly reverse the condition. So thanks for listening, and I will talk to you next time.

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