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Why researchers sense a gut link in treating Parkinson’s

Why researchers sense a gut link in treating Parkinson’s

Over 80 percent of those with Parkinson’s Disease suffer from gastrointestinal symptoms

Gut microbiome

Given the nascency of research on gut microbiota, it is tempting to gloss over the effects of diet and nutrition, especially when it comes to neurodegenerative conditions. But there is increasing evidence to emphasise the impact of an unhealthy gut on Parkinson’s Disease. 

While doctors and researchers refrain from committing to the impact a healthy gut has on the condition, they nevertheless maintain that there is a ‘connection’. 

Microbiome testing has become commonplace as a diagnostic measure, but the gut-brain axis is still a relatively new postulate. “There is a definite connection, it would be hubristic to say otherwise because there’s a decent amount of evidence,” says Dr Vineet Ahuja, head of gastroenterology at the All India Institute of Medical Sciences (AIIMS), New Delhi. 

“But it is all still very new. More and more information is coming through these days and it is exciting. I mean, would it not be amazing if we could diagnose something like Parkinson’s Disease well before the first signs of the motor symptoms show up?” adds Ahuja. 

Parkinson’s Disease – also shortened as PD – is an imbalance in dopamine production in the midbrain which induces a host of non-motor and mobility symptoms. Non-motor symptoms include low blood pressure, fatigue, constipation, and eye problems. Motor symptoms include tremors, stooped posture, impaired dexterity, decreased arm swing etc. As for the gastrointestinal complaints, there could be drooling, dyspepsia (indigestion), constipation, abdominal pain and faecal incontinence. 

Gut dysbiosis or imbalance of the gut microbiota is postulated to exert a significant effect on brain function via inflammation. This in turn heightens the bleeding of microbiota-produced substances into the Central Nervous Systems (CNS), increasing the degree of neuron death. 

This explains why over 80 percent of those with Parkinson’s Disease suffer from gastrointestinal symptoms. Inflammatory bowel diseases such as ulcerative colitis and Crohn’s Disease are also known to increase the incidence of PD by 22–35 percent. 

“We cannot be sure at this stage because it is nascent, but improved gut health means better absorption of food and elimination of toxins,” says Dr Pramod Pal, head of neurology at the National Institute of Mental Health And Neurosciences, Bengaluru. 

“There is a hypothesis that probiotics improve cognition and alleviate symptoms of constipation, which is a massive concern for those suffering from Parkinson’s Disease. Still, we cannot be sure that probiotics can be of help to those suffering from neurodegenerative conditions at this point. It’s all very new and unproven,” he adds. 

Dr Murali Mohan, a senior neurosurgeon in Bengaluru, seconds Dr Pal on this aspect. “The gut is not just an organ; it has a nervous system. Effectively, the gut is our second brain, and it happens to be a natural source of bacteria. All of which is essential for our functioning because the gut communicates with the CNS,” he says, before adding quickly that it is still only a hypothesis. 

Both doctors agree that a good diet is imperative in the handling of PD.

Limiting the intake of sugar and salt and increasing the consumption of fibre and complex carbohydrates are some of the common dietary rules. Vitamin D is known to have positive effects, as do antioxidants from dark, leafy vegetables and nuts. Omega-3s (soybeans, flax seeds, salmon) are also known to delay the secondary symptoms such as dementia and confusion. Dairy consumption is also positively associated with warding off the risk of PD. 

“The timing of protein consumption when on medication (Levodopa is the most recommended) is said to affect the way the drug is absorbed. There is not enough evidence to prove it, but we have noticed that the drug is better absorbed on an empty stomach,” says Dr Pal. “Besides that, you need to drink a lot of water and maintain a healthy diet, most of which help in reducing constipation.” 

Levodopa, the gold-standard drug in the treatment of Parkinson’s Disease, is known to cause nausea for some individuals when consumed on an empty stomach. They are advised to have a snack to halt the side effects. Moreover, prolonged use of levodopa can cause complications such as dyskinesia, which makes it essential to try and control the dosage required.

Some experts suggest lifestyle modifications and diet as a way to do so, with this resembling some of the treatments prescribed by Ayurveda as well. According to the ancient texts, Vayu (or the air element) controls bodily movements and cognition.

Since PD is usually seen with symptoms related to movements and cognitive changes, its treatment mainly focuses on balancing vata and providing enough nourishment to the body with lifestyle modifications.

Apart from this, Ayurveda suggests purificatory measures such as enemas as a way to cleanse the gastrointestinal tract and rid the body of toxins as a treatment for PD, linking it to the ongoing research on acting on the gut microbiome to improve PD symptoms.

“We cannot say for sure what the right diet for Parkinson’s Disease is,” says Dr Ahuja. “A plant-based diet is gaining traction among those suffering from PD, but it cannot be recommended for every affected person. It must be studied and understood better. Until then, a simple and healthy diet goes a long way in how one feels. That is half the battle won in treating PD.” 

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