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  • Jeremy Likness

Parkinson's Disease Supplements and Drugs

Updated: May 4

In this post I will share the various vitamins, minerals, supplements, and drugs that I take for Parkinson's Disease. I started taking supplements on a regular basis several decades ago for overall health reasons. I learned with my diagnosis that certain changes might be beneficial. I will share a little bit about why I think supplements are so important, even with a healthy diet, and then break down the specifics. Let's get started!

Take your vitamins!

The Myth of a Healthy Diet


Many years ago, I worked as a health coach and was certified as a specialist in performance nutrition. The supplement industry underwent an explosion of unregulated growth and, unfortunately, many people blindly swallowed everything they could in pursuit of a "magic pill" to get fit, build muscle and lose weight. There was also a group who focused on the extreme opposite by insisting everything necessary can be found in whole foods. The answer, as with most things, lies somewhere in the middle.


There are a few reasons I believe whole foods are not enough.

  • Modern farming techniques have stripped soil of nutrients, resulting in fewer resources for crops to draw on

  • Selective breeding of fruits and vegetables has resulted in more visually appealing (and tasteful) foods at the expense of nutrients

  • Transportation of foods means many fruits and vegetables are picked prior to fully ripening, so they "ripen" in transit without being able to draw additional nutrients as they would if they were still planted

  • Toxins in the environment not only impact food, but also place extra stress and demands on the body

  • Some healthy compounds simply don't exist in regular food sources (such as beneficial herbal and fungal extracts)

As a side note, some cases of Parkinson's Disease are directly attributed to exposure to toxins. If you decide that supplementing is a good idea, the next question is "how much?"

Myth Bashing


Bashing myths about supplements was almost my full-time job for a while. It turns out there are a lot of erroneous assumptions that are made. Most people get their information from commercials or online "articles" that are really supplement sponsored works of propaganda. The supplement industry is not highly regulated so their advertisements often make outrageous claims. I will always do my best to share the truth based on independent science, not industry funded "research." I once received an email from the Corn Refiners Association threatening to file a "cease and desist" order because I wrote an article about the dangers of High Fructose Corn Syrup!

Let's bust some myths!

The Myth of the Recommended Daily Allowance


Most people mean well when they tackle vitamins and minerals. They look up the Recommended Daily Allowance (RDA) and find a supplement that fills the gaps. The problem is that RDA is abbreviated. Instead of the implied "RDA for optimal health" it's actually the minimal "RDA for survival." As an example, the RDA for Vitamin C (90 mg for adults) is designed to prevent scurvy. Research suggests that higher doses are extremely beneficial for everything from boosting the immune system to reducing risk of cancer. A better guideline to use is the tolerable upper limit, which, for Vitamin C, is 2,000 mg or 2 grams. It is a bit more complex because you do get vitamins and minerals from natural foods, and those tend to be more effectively absorbed than synthetic supplements.


The Myth of the "One Vitamin a Day"


The cheapest and easiest way to get additional vitamins and minerals to buy a "one-a-day", right? Like most cheap and easy solutions, you get what you pay for. The problem with a single multivitamin is that it doesn't really honor science. Most products simply load up their pill to hit the RDA so they can show "100%" on the label. Unfortunately, they ignore the fact that some vitamins are water soluble and don't stay in the system long. Other nutrients have interactions. Some vitamins block absorption of others, while others boost absorption. Fat soluble vitamins remain in your system and some are toxic at higher accumulative levels of intake.


The result? My multivitamin is the result of exhaustive research and it requires several doses throughout the day. I just try to capture "core" nutrients there and then fine tune with other supplements.


The Myth of Liquid Vitamins


This is one of the more frustrating myths because so many people think it's logical and believe it without digging deeper into the science. Some companies claim you will absorb nutrients faster if they are in liquid form. They also provide sublingual options because these go "directly to the bloodstream" and bypass conversion and filtering in the liver. Although there are many drugs that can be effectively delivered this way, the same is not true for all vitamins. Many vitamins are water soluble and break down in liquid form. Companies claim to have proprietary techniques to suspend the vitamin and prevent breakdown. Of course, when the sample is analyzed and only trace amounts of the vitamin remain, the response is "our proprietary technique prevents it from showing up in conventional testing, but our special secret testing shows it's 100%." Yeah, right.


Enough preamble. Here's what I take on a daily basis.

My Daily Regimen


This is what I take daily, with a little context around the "what" and "why" of each item.


Disclaimer: I am not a doctor, nor am I qualified to give medical advice. Everything you read here is based on what I've researched or been prescribed and is not a recommendation for you to do the same.


💡 Tip: measure twice, cut once. Have you heard that expression? I don't supplement blindly. Although I monitor my own health, much of how we feel is biased and anecdotal. To be more objective, I test. Every year during my annual physical, I ask for blood labs to test my levels of various vitamins and minerals like Vitamin B12, Vitamin D, and Iron. This helps me ensure I am not taking too much or too little. Depending on your health plan, these tests are often either included at no cost or available for a nominal fee. The price is worth piece of mind that I'm not going to suffer neurological issues from a Vitamin B12 deficiency or side effects from taking too much of a particular supplement.

Ashwagandha Extract


Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 80 mg (extract) 500 mg root

Frequency: 2x daily (160 mg/1 g total)

Reason: Stress, Parkinson's Disease symptoms


Some research suggests this root can help with natural thyroid function. It is considered an adaptogen that studies show may help the body deal with stress. Some research has shown that it can help reduce symptoms of Parkinson's Disease.

Cannabidiol (CBD) oil

Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 66 mg+10 mg

Frequency: 2x daily (140 mg total)

Reason: Pain, anxiety


Cannabidiol is a non-psychoactive component found in cannabis (marijuana) plants. Research suggests it may help reduce pain and lower stress. My wife started taking it for back pain as a result of major surgery and was able to wean completely off pain killers. There is plenty of anecdotal evidence from PD patients that this helps alleviate symptoms (clinical trials are inconclusive at the moment) and no major concerns of side effects, so I decided to start taking it. I take it to reduce the risk of non-motor symptoms of Parkinson's Disease such as depression and anxiety, and to ease the motor symptom of stiffness.

Cordyceps


Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 80 mg

Frequency: 2x daily (1.6 g total)

Reason: Oxygen uptake


This is an extract of Codyceps sinensis, a fungus that lives on caterpillars in China (you can't make this stuff up). Most supplemental forms are lab grown. It is claimed to help promote performance by increasing oxygen uptake and potentially improving the immune system. We found this while researching training for our first 14,000 meter summit (Mt. Sherman). There is not much scientific evidence to support the claims, but also no noted side effects so I continue to take it.

GABA (gamma-aminobutyric acid)


Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 1,000 mg

Frequency: once daily before bed

Reason: Insomnia and anxiety


Some small studies suggest that gamma-aminobutyric acid can reduce anxiety levels. It may also help prevent insomnia. Its role is to decrease neuron activity and prevent neurons from "over-firing" which is the cause of some Parkinson's Disease symptoms. Some believe this makes it beneficial for Parkinson's Disease, but there is no scientific evidence to support this. The optimal dose is considered to be as high as 5 to 18 grams daily, so I am considering increasing my intake to see if I notice any difference.

Glucosamine, Chondroitin, and MSM


Type: Over the Counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 750 mg Glucosamine Sulfate, 600 mg Chondroitin Sulfate, 500 mg MSM

Frequency: 2x daily (1.5 g, 1.2 g, 1.0 g daily)

Reason: Joint health.


There is plenty of scientific evidence this combination is helpful for maintaining joint health. I found a significant reduction in joint pain when I started taking this, and I assume this will carry through and help with joint stiffness from Parkinson's Disease as well.

Levothyroxine


Type: Prescription

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 112 mcg

Frequency: daily (1st thing in the morning)

Reason: Hypothyroidism


I was diagnosed with hypothyroidism (under-active thyroid) several years ago when some benign lumps on my thyroid were discovered. This dose maintains appropriate levels for me.

L-theanine

Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 100 mg

Frequency: 1x daily before bed

Reason: Relaxation


This amino acid has been shown to create a sense of calm and relaxation. It's one of many supplements I take to ensure I sleep well through the night.

Magnesium Taurate


Type: Over the counter

Recommended Daily Allowance: 420 mg (magnesium only)

Tolerable Upper Limit: 350 mg (magnesium only) from supplements (not from food)

Dose: 2500 mg (8.9% or 222 mg of magnesium)

Frequency: 1x daily before bed

Reason: Heart health, muscle recovery, nervous system health


This supplement is a compound of magnesium and the amino acid taurate. It may help with recovery from intense exercise. It is an important factor in muscle metabolism and an ideal mechanism to deliver magnesium (many elements are either toxic or poorly absorbed in raw form and are often delivered as compounds). Like all things, moderation is important because it is possible to overdose on magnesium resulting in loss of nerve function (tingling and/or paralysis).

Multivitamin


Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 2 tablets

Frequency: 2x daily (total 4)

Reason: Holistic health


This is the only supplement I'll mention by brand because multivitamins vary so widely. I use Synergy Men's Multivitamin in capsule form (I don't get pill form because those are hard to swallow). The bottle suggests 6 tablets daily but I reduce that due to other supplements I take. Breaking down all of the ingredients would require several more blog posts. This is what I found to contain the most compounds I feel are important to health from my research over the past two decades. It includes vitamins A, C, D, E, K, B1, B2, Niacin, B6, and B12. It includes folic acid, pantothenic acid and biotin. Minerals included are calcium, iodine, magnesium oxide, zinc, selenium, copper, manganese, chromium, and molybdenum. Other compounds included are alpha lipoic acid, green tea, pomegranate, saw palmetto, grape seed, CoQ10, Masson pine, turmeric, quercetin, pygeum, Knotweed, grape skin, lycopene, lutein, black pepper, boric acid and zeaxanthin.

Omega-3 (and 6) Fatty Acids (Fish Oil)


Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: 10,000 IU (Vitamin A)

Dose: 2.1 g fish oil, 800 mg EPA, 400 mg DHA

Frequency: 2x daily (total 4.2 g, 1.6 g, 800 mg)

Reason: Holistic health


Disclosure: this article contains affiliate links and I may receive commissions. Anything I link to is a product or service I recommend because I've purchased and/or personally verified and used it.


Fish oil is something I first researched in the early 2000s. I learned a tremendous amount from Udo Erasmus' "Fats that Heal, Fats that Kill." To make a short story boring, omega-3 and omega-6 fatty acids are essential for health. These fats are sensitive to light, heat, and air, so most modern foods lack the essential amounts as they are destroyed through cooking, processing, and exposure to air. Supplementing can help metabolic processes and result in scientifically proven benefits ranging from increased good cholesterol to lower triglycerides. I was originally "prescribed" a fish oil regimen because of high triglycerides (I was already taking them but was prompted to increase the dose). You can get them naturally from cold water fish like salmon. This is a tough one for vegans who follow a 100% plant-based diet. Some people tout the benefits of hemp and flaxseed oils. These oils provide alpha-linolenic acid (ALA) which some humans can synthesize into EPA and DHA. However, people like me with Scandinavian heritage likely possess a genetic defect that prevents the conversion (after all, Norwegians eat plenty of cold-water fish). That means moving to fish oil as a compromise, or spending a lot of money on the only plant-based alternative which is an expensively grown algae.


You can take too much fish oil. The main limiting factor is the Vitamin A it provides, which is toxic in high doses. It is also abundant in Vitamin D.

Pantoprazole


Type: Prescription, although available now over the counter as Omeprazole

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 20 mg

Frequency: once daily (first thing in the morning on an empty stomach)

Reason: Eosinophilic esophagitis


I have been plagued with intense, sporadic stomach pain for most of my life. It happens less frequently now, but I went through a gamut of tests to try to isolate it. In addition, I went through a phase with difficulty swallowing. A few times I'd get something stuck in my throat and have trouble getting it to pass. Once, in the office, I had a piece of bread stuck, so I washed it down with water. That resulted in me passing out due to vasovagal reflex or "swallow syncope." Another time my daughter waited patiently on a camping trip as I repeatedly drank, threw up, then tried to drink again (with the same result) for a few hours.


It turns out that acid reflux resulted in rings forming in my esophagus that were causing constrictions. I underwent a steroid therapy followed by pantoprazole. I still get stomach pain (blood analysis and two endoscopies ruled out ulcers, tumors, and other issues) but at least I don't have trouble swallowing! Ironically, difficult swallowing is one of the known symptoms of Parkinson's Disease so it may come back in the future. Only time will tell!

Probiotic


Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: Probiotic blend 200 mg, Fructooligosaccharides 200 mg

Frequency: once daily with breakfast

Reason: Parkinson's Disease and gut health


There is an established link between gut health and Parkinson's Disease. What's not clear is how they relate, i.e. whether PD causes poor gut health or if improving gut health can alleviate symptoms or possibly slow disease progression. I don't eat a lot of fermented products and dairy free means yogurt-free for me (I am aware of nondairy alternatives). There is a lot of hype and little consistent research I can find so this supplement is really a best guess of mine. I may change if I find there are different cultures or higher quality and independently tested alternatives (for example, how do I really know if the cultures are still active or able to be activated in my gut?). What I'm trying for now contains cultures of Lactobacillus acidophilus, L. plantarum, L. rhamnosus, L. casei, L. salivarius, Streptococcus thermophilus, Bifidobacterium bifidum, B. longum, L. helveticus, and L. brevis.


Wait, Helveticas? I'm ingesting a font?!


UPDATE: After more research I wrote more about this in Gut Check: Parkinson's Disease and the Brain-Gut Connection.

Ropinerole (Requip)


Type: Prescription

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 2 mg (was 1 mg prior to May 2020)

Frequency: 3x daily (6 mg total, was 3 mg total) evenly spaced

Reason: Parkinson's Disease motor symptoms


This is my "main" Parkinson's Disease drug. It is a dopamine agonist, which means it activates the body's dopamine receptors in the absence of dopamine (which my brain doesn't make enough of due to cells dying from the disease). It is usually prescribed to people diagnosed "young" like me (45 as opposed to the typical age of 60). It may not be as effective as central nervous system agents like Levodopa that are converted to actual dopamine, but it has fewer long-term side effects. After an initial bout of severe side effects (head ache, stomach pain, lethargy and fogginess) I've adapted well to the current dose. It increases my dexterity so I can type better, reduces some cramping and stiffness and has reduced my tremors (although it has not eliminated them).

Spirulina

Type: Over the counter

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 500 mg

Frequency: 4x daily (2 g total)

Reason: Blood sugar, heavy metals, antioxidants


Spirulina is basically "pond scum." It's a cyanobacteria (algae) that is rich in antioxidants and nutrients. Research shows it can help stabilize blood sugar levels and may help remove toxic heavy metals from the bloodstream.

Tetrahydrocannabinol (THC)


Type: Legal dispensary

Recommended Daily Allowance: n/a

Tolerable Upper Limit: n/a

Dose: 10 mg

Frequency: once daily before bed

Reason: Insomnia and anxiety


This is the most controversial item on my list. THC is the psychoactive ingredient of cannabis (marijuana) that is mostly responsible for the "high." Recently it has been legalized in many states and countries. Let's be clear: its predominant use is mostly recreational like tobacco and alcohol. However, there is plenty of research to suggest it can help alleviate pain, reduce nausea, and lower stress. I suffered from mild insomnia for a long time. Melatonin helps me stay asleep when I do fall asleep, but the challenge has always been an overactive mind that keeps me awake (and thus prevents me from falling asleep). I was also experiencing anxiety and depression when traveling. THC mitigates all of these for me: it lowers my stress levels and helps me fall asleep fast and sleep throughout the night. My nightly sleep went from 3 - 4 hours to a full 7 - 8 hours. I tend to focus on edibles and prefer those with a 1:1 THC:CBD ratio (so I get an additional 10 mg of CBD above what I take with drops).

Vitamin C (with bioflavonoids)


Type: Over the counter

Recommended Daily Allowance: 90 mg

Tolerable Upper Limit: 2,000 mg

Dose: 500 mg

Frequency: 4x daily

Reason: Immune system and general health


This is the staple of my supplement regimen. If I could only pick one supplement, it would be Vitamin C (my second pick is fish oil). Humans are incapable of synthesizing their own Vitamin C, so the sole source is food. If you study mammals that do produce Vitamin C, it's in very large amounts. There is plenty of research that shows benefits from mega-dosing multiple grams of Vitamin C daily. The problem is that most of that research is intravenous. Oral Vitamin C doesn't absorb at nearly the same level. Vitamin C is water soluble, so whatever is not metabolized and used by your system is passed through. Therefore, I prefer to take smaller doses throughout the day rather than one or two larger doses.


Research suggests that Vitamin C combined with bioflavonoids complement each other and produce better results than either taken alone. I've dosed at 2 grams per day for years now and increase to 3 - 5 grams when I feel a cold coming on, travel, or undergo stress (mental or physical).


This is completely anecdotal and not scientific, but since I started taking Vitamin C regularly, I went from 1 -2 sinus infections every year to none and any time I've felt a cold or possible flu coming on, it's resolved within a day or two.

Vitamin D3 (cholecalciferol) 25mcg


Type: Over the counter

Recommended Daily Allowance: 600 IU (15 mcg)

Tolerable Upper Limit: 4,000 IU (100 mcg)

Dose: 25 mcg

Frequency: 1x daily

Reason: Health and Parkinson's Disease


Studies show people with Parkinson's Disease have lower Vitamin D levels, which can lead to osteoporosis and increase risk of cancer. Although I have a nominal amount in my multivitamin, I decided to add the extra dose as insurance.

Conclusion


That was a lot of information! I hope by sharing my own regimen and the research behind it, that you may be better informed with your own decisions. My daily intake of supplements has evolved over the past 20 years and I'll continue to post updates as I learn more, tweak the amounts and change what I take. I am always open to suggestions and am continuously learning, so if you have insights and tips to share, please feel free to add them to the comments below!


Regards,


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