Approach Parkinson’s Like An Olympic Athlete

 

Does your competent? doctor even know of the need for this? So, EXACT PREVENTION PROTOCOLS CAN BE INITIATED! Your doctor's responsibility to get you recovered enough to become an athlete! Don't let him/her weasel out of that responsibility by using the craptastic saying; 'All strokes are different, all stroke recoveries are different'! If that comes out of their mouth, YOU NEED TO START SCREAMING INCOMPETENCE! In my opinion any stroke medical 'professional' that says that is COMPLETELY FUCKING INCOMPETENT! Because they have given up on solving stroke and are going thru the motions of treating you with interventions learned way back in medical school, nothing newer!

Parkinson’s Disease May Have Link to Stroke March 2017 The latest here: 

Approach Parkinson’s Like An Olympic Athlete

This transcript has been edited for clarity. 

Indu Subramanian, MD: Welcome, everyone, to Medscape. We’re so excited to have Professor Bas Bloem here today, speaking about all things related to lifestyle choices. He has really been a world expert in this area. He’s the director at Radboudumc Center of Expertise for Parkinson’s and Movement Disorder at Radboud University Medical Center in Nijmegen, Netherlands. I’ve been practicing that a little bit. 

I’m Indu Subramanian, at UCLA, coming to you from Los Angeles, California. Bas is inspiring in this field that he has been cheerleading for decades. The Wellness Task Force that I’m on at the Movement Disorder Society had a paper about a prescription for lifestyle choices, and Bas, you had a paper on the scientific basis and the pathophysiology behind this. 

Bas, welcome. Thank you for joining me. 

Bastiaan R. Bloem, MD, PhD: Thank you for inviting me on the show. It’s an honor to be here. 

Wellness and Lifestyle: A Perfect Pairing

Subramanian: Interestingly, these two papers came out right at the same time, and it was exciting because I think they pair very well. We have this idea of a prescription that can be given to pretty much anyone, even somebody living in Africa without any resources.

The thought is that we can do things around, sleep, diet, exercise, social connection, and stress management, yoga, mindfulness, tai chi, and things like that. We put out our paper, and then you had a beautiful paper talking about the pathophysiology and how we can think about the effects on the brain and the body in somebody living with Parkinson’s.

Maybe you can tell me a little bit about your thoughts.

Bloem: First of all, congratulations on your own paper on wellness. I think it’s a seminal contribution to the field.

Subramanian: Thank you.

Bloem: We’re seeing the shift away from treating tremor or treating bradykinesia until the doctor is happy toward wellness, which means more to people in their daily lives. Your paper was, to my mind, seminal in that regard and people should read it. 

The way to reach that state of wellness is, of course, partially pharmacotherapy, but increasingly I regard myself as a holistic doctor, and part of that holistic approach is lifestyle interventions. In a separate interview, we talked about exercise, but lifestyle is more than just exercise. Lifestyle is also healthy nutrition and that is now question number one when I see people with Parkinson’s in my clinic. I think exercise has moved from a belief into an evidence-based treatment.

Nutrition is lagging behind. We still need good clinical trials. At the same time, having a high-fiber diet and ample fluids to keep your bowel movements going is essential. We believe that a Mediterranean, probably plant-based, diet is good for people with Parkinson’s. 

What we don’t know, but what I suspect is good, is organic food free of or low in pesticides because we now know that pesticides and other toxic chemicals are not only the cause of Parkinson’s, but also they probably lead to a faster disease progression after your diagnosis. Once you’ve been diagnosed, you want to steer away from toxic chemicals as much as you can in your life. Organic food, even though there is no trial to prove it, to my mind is one avenue to achieve that healthier lifestyle.

The third element is stress. Stress is bad for everybody, but it is particularly bad for people with Parkinson’s. It worsens symptoms. Tremor, I always say, is the thermometer for stress. It worsens under stress, but freezing of gait is worse, dyskinesias, the involuntary movements induced by medication, get worse under stress. There is animal work to suggest that chronic stress may hasten disease progression, meaning that stress management, on a positive note, could slow down disease progression. 

I’m excited to announce that we now have two big trials in my center. One is the Plants for Parkinson’s study, where in the first large-scale, randomized clinical trial, we are testing a plant-based Mediterranean diet for primarily symptomatic effects, but secretly we’re looking at biomarkers for disease modification as well. We have a big trial of mindfulness, the MIND-PD study, where again, the primary goal is to look at symptomatic relief, but we’re doing neuroimaging and blood-based biomarkers to also see whether alleviation of stress may slow down the disease progression in Parkinson’s.

Now, things get really important because doctors either don’t talk about lifestyle, or because lifestyle is gaining momentum, they say, “Hang on, Mr. Johnson. You have to exercise, eat well, and avoid stress. Time to go. Bye-bye.”

The patient goes home and says, “What?” They have no idea. Doing one thing is difficult. Doing three things at the same time is extra difficult. I always say to do one thing and do it well, and after you’ve implemented it in a sustainable way in your life, start with a second.

Implement, Sustain, Perfect 

Bloem: I think it is essential that physicians address lifestyle issues with people with Parkinson’s. If you are living with Parkinson’s yourself, bring it up in a conversation with your physician, and my key advice is to prioritize. 

If you are full of energy, you may be able to do all three lifestyle interventions at the same time. If not, discuss with your physician, physiotherapist, or nurse which one should receive the highest priority in your life. Build it up, implement it, make it sustainable, and only then you move on to the second element of lifestyle. You don’t have to do it all at the same time because you may end up doing nothing properly. 

At the end of the day, I do strongly feel that combining interventions will have at least additive effects and maybe synergistic effects. “Synergistic” is the doctor’s terminology for 1 and 1 adds up to 3. I think, ultimately, if you manage to implement multiple lifestyle interventions, you’ll be even better off by just doing one thing, but build it up one at a time.

Subramanian: The paper was very exciting because it actually shows why it’s so hard to study any one of these interventions in a randomized, controlled fashion. I think we have these very old-school ways of thinking about how these studies should be done, and then often they end up being negative because it’s hard to really tease things apart, while following populations over time. 

You beautifully document the different overlapping areas of pathophysiology that many of these lifestyle interventions can impact. When we were writing our paper, we found that something like exercise can impact sleep, which can impact Parkinson’s. The notion that many of these things can be a web and impact different things in different ways is very exciting. 

It may be hard to tease out any one chemical that’s going up that’s improving something specifically. I think that we can look at these interventions holistically and think about quality of life and how the patient’s doing overall, rather than looking at just one chemical, a tremor score, or something like that. That’s my thought, what’s your sense, Bas?

Bloem: I absolutely agree. You mentioned sleep. If you look at the whole package of lifestyle as we already discussed — exercise, nutrition, and stress — it’s also sleep. It is supplements, which are important to people with Parkinson’s, and it is social connections. What I see is that many people with Parkinson’s become isolated. Remaining connected to your family, your friends, your neighbors is essential for the wellness concept that you introduced to the International Parkinson and Movement Disorder Society. 

Taken together, there are multiple knobs that you can turn. Think carefully about which knob you want to turn first and work on it. Ultimately, you want all the knobs to be turned. I drew an analogy between having Parkinson’s and being a professional athlete. 

The Olympics will soon be in northern Italy. For the athletes competing at the Olympics, everything needs to be right, including your training program, your nutrition, your stress, and your workouts. 

If you’ve got Parkinson’s, everything needs to be perfect, and it’s not just medication. Medication is important, but turn the other knobs as well. Sit down with your team, prioritize, and work on turning those knobs one by one to optimize your quality of life and to reach your state of wellness. 

Subramanian: I love that. Thank you so much, Bas, for taking the time. I know you have a crazy busy schedule yourself, so I appreciate you coming on here and helping us cheerlead this space.

Thank you, everyone, for joining us.