“Call me Sam,” Dr. Samantha Evans says, introducing herself at our February 3rd Zoom meeting. She shares her impressive educational and professional background, including “working with two of the most prominent naturopathic doctors in the country: Dr. Marco Vespignani and Dr. Laurie Mischley.”
The majority of Dr. Sam’s naturopathic practice is devoted to neurological issues: 80% of her patients have Parkinson’s disease. She also treats people with epilepsy and gastro-intestinal issues. Dr. Sam has a special interest in intestinal health. She is a fan of medication for Parkinson’s disease, which she likens to putting gas in your car to make it run.
“The gut and nutrition and exercise all connect with each other. Exercise does slow progression. There is a correlation between food and Parkinson’s disease,” Dr. Sam tells us, citing a study published in 2017, Role of Diet and Nutritional Supplements in Parkinson’s Disease Progression. The study, which began in 2009 and has collected data from about 2000 people, is headed by Dr. Mischley. It asked enrollees: (1) How are you doing? and (2) What are you doing? in order to identify behaviors associated with faster and slower progression. Dr. Sam lists, by memory, some of the study’s findings.
- Loneliness is the #1 indicator of Parkinson’s progression.
- People who exercise more than 5 days a week, 30 minutes a day, have slower progression.
- From a dietary standpoint, slows progression: (a) fresh fruits and vegetables, (b) nuts and seeds, (c) olive oil and coconut oil, (d) non-fried fish, and (e) wine (if appropriate).
- From a dietary standpoint, speeds progression: (a) dairy, such as ice cream, yogurt, cheese, etc. (increases progression the most), (b) fried foods, (c) soda, particular Diet Coke, (d) canned fruits and vegetables, and (e) meat, including beef, pork, and chicken.
Dr. Sam admits they don’t know why certain foods are on the slowing or speeding progression list; she can only hypothesize. There’s more glutathione in fresh foods and vegetables, for example. When vegetables have wilted in your fridge, their nutritional value has tanked. As to beef, it has a lot of iron. She notes that men are more likely to get Parkinson’s than women, until menopause when it evens out. She attributes this to one of two causes that are often co-conditions with Parkinson’s disease: inflammatory bowel and hereditary hemochromatosis, a disease where iron builds-up and is inappropriately stored in the part of the brain where dopamine is made. Dr. Sam suggests if you are going to eat pasta (yes, that’s on the list too!), eat a good quality one from Italy that doesn’t have added iron.
“There is community in food,” Dr. Sam says. She suggests following the 80/20 rule: 80% of the time, eat the way she suggests; 20% of the time, eat what you want, especially when it come to sharing meals with others (post-Covid for large groups, of course). “We have evolved to eat fast food on the run. You don’t digest food that way; the body was meant to sit and savor the sight and smell and taste of food,” she says, adding, “And yes, I know people with Parkinson’s can’t smell.” She explains how the vagus nerve connects the brain to the gut. The brain sends signals to produce stomach acid to digest food. Chewing food produces saliva and preps the body for digestion. Taking your time eating aids digestion.
The gut produces more dopamine than the brain; 60-80% of dopamine cells are gone by the time you lose motor function. Gut research is skyrocketing with Parkinson’s. The more diverse the bacteria in your intestines, the healthier you are. (This is true for all individuals.) The Parkinson’s Disease Summer School that Dr. Mischley facilitates and Dr. Sam participates in at Bastyr University each year includes $2000 worth of tests for attendees, including one for gut microbiome. Inflammation in the gut can come from what we feed ourselves. Research does not show sugar to be a problem, but sugar feeds fungus and some fungus is more prevalent in people with Parkinson’s disease. Sugar in the blood can also get stuck in arteries and prevent oxygen from getting to nerve cells in certain parts of the brain. (For more on this, Dr. Sam recommends the book Grain Brain by David Perlmutter, MD).
Dr. Sam’s goal is to optimize health, Parkinson’s or not. If a patient’s tests show candida overgrowth, she’ll limit sugar as sugar feeds candida. She cares more about processed and refined sugars and aspartame in products such as Sweet’N Low, which studies show causes inflammation in the intestinal tract. This can lead to gastrointestinal permeability, a research term commonly known as “leaky gut.” Dr. Sam is not a fan of taking probiotics as they only feed a few intestinal bacteria and we have millions of bacteria in our gut. The food we eat feeds both the good and bad bacteria. Lipopolysaccharides, for example, are inflammatory and are produced by the intestines when you eat a cheeseburger. With leaky gut, bacteria can go to the brain and break down the blood/brain barrier. In Alzheimers, misfolded proteins clump in the digestive track and travel up the vagus nerve to the brain. We don’t want what’s in our gut in our brain.
Too much iron is not good; there is a correlation between hemochromatosis (a disease where iron builds up in the body) and getting Parkinson’s disease, as well as liver cancer. Dr. Sam recommends a full iron panel (blood test). She also recommends Siggi’s non-dairy yogurt, which tastes great and contains no dairy! Yeast is involved in making yogurt. Signs that you could have candida include a white coating in your mouth, itchy skin, red patches or dandruff, and toenail fungus. Oregano is a good anti-fungal and anti-bacterial herb.
Parkinson’s non-motor symptoms can be more problematic than motor ones. People with constipation have a harder time managing their meds. You have to be consistent with your meds to dose appropriately. Relief from constipation, whether a side-effect of medication or Parkinson’s disease, can be alleviated by moving the body more (with a goal of seven days-a-week), drinking more water, and adjusting your diet. Keep in mind no matter how much water you drink, if you pee it out, you are dehydrated. You need salt to absorb water. Dr. Sam likes the Emergen-C packets. Most Parkinson’s patients have low Vitamin C, as do people with constipation.
Short-chain fatty acids promote movement of food through the gut. Slow transit can affect people with Parkinson’s, who in general don’t produce enough stomach acid. Some vegetables like kale are hard for the stomach to break down. Dr. Sam suggests tearing your vegetables up by hand before cooking, which is also good for your hands and fine motor movements. You can help reactivate your body’s signal to move food out of the stomach by adding lemon to your food and chewing it well.
SIBO (small bacteria intestinal overgrowth) results when bacteria from the large intestine back up into the small intestine. These bacteria steal nutrients as well as the medication you’re taking, which can cause dyskinesia and sudden off time. Research shows that off time is worse in Parkinson’s disease with SIBO. You can have SIBO with no gut symptoms.
Vitamin D is essential right now. Dr. Sam says it decreases the likelihood of getting Covid and if you do get it, Vitamin D decreases symptoms. She suggests supplementing with 4-5 units (IUs) a day. She prefers liquid (1 drop = 1,000 IU) or powder forms because if anything is going on in your intestines, you will have a hard time absorbing vitamins. Vitamin D is also protective for your gut lining. She also suggests Vitamin K-2, which helps absorb calcium into your bones, and Magnesium, good for dystonia, restless legs, and constipation (although she prefers you don’t use to have a bowel movement). Take your meds away from protein. If they upset your stomach, take them with an apple or banana. Lemon juice or Vitamin C will increase absorption of them.
In response to questions about what the next generation–our children–can do now to prevent or postpone any potential hereditary Parkinson’s disease, Dr. Sam says to think of it as a light switch. Even if Parkinson’s is in their genes, there is a lot they can do to make that light switch not work. Studies show that people who eat the way she’s suggested decrease their likelihood of developing Parkinson’s disease. In addition, studies indicate:
- No dairy, lots of exercise.
- People who drink coffee, live longer (although Dr. Sam cautions against drinking coffee or green tea past noon as it does affect your sleep, even if you think it doesn’t).
- Pesticides increase the likelihood of developing Parkinson’s disease. Eat organically. Try to buy organic when you can and cook most your meals at home. Be familiar with the dirty dozen, foods you should only buy organic, and the clean fifteen.
- Head injuries and concussions increase likelihood of developing Parkinson’s.
- Smoking decreases likelihood of developing Parkinson’s, although there are other associated risks.
- Use of ibuprofen decreases likelihood of developing Parkinson’s, in theory because it decreases inflammation.
Covid social distancing and isolation have increased symptoms and made them worse in people with Parkinson’s due to loneliness, not moving as much, and anxiety of the unknown. Diets, in general, are very individual. The Keto diet is difficult to sustain. Some people report positive results from intermittent fasting; others from low sugar diets. Rice is good to counter weight loss, and she suggests eating non-GMO and organic grains.
Dr. Sam works with movement disorders doctors–she handles diet and gut, but leaves the pharmaceuticals to their expertise. 70% of her practice is telemed. She sees patients all over the world and she’d be happy to see any of us. Medicare does not cover, and although some insurance plans do cover, the likelihood is small. Most patients pay cash. Sometimes insurance will cover the blood panel she orders. The cost is $250 for the first televisit; after that cost depends on time spent. There is also a less expensive option: Dr. Sam works with students at Bastyr and on Saturday mornings from 9.00 am to 1.00 pm Pacific Time, they offer a student clinic shift. Telemed visits are $25, but you are under the supervision of a student intern, not Dr. Sam.
Dr. Sam can be reached at firstname.lastname@example.org. Appointments can be made by calling Seattle Integrative Medicine at 206-525-8012 from 9.00 am to 5.00 pm PST.
Patient-Centered Outcomes, Research, and PD (YouTube)