Apathy in PD

Dr. Fernandez



Joined: 20 Jan 2007
Posts: 90

Posted: Sun Sep 20, 2009 7:01 pm Post subject: Post of the Week: Apathy in PD

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How is apathy different from depression?

Apathy is characterized by “diminished motivation, a lack or absence of feeling, emotion, interest or concern”. Technically, it has three components: cognitive (loss of interest in new experiences, lack of concern for one’s problems), behavioral (lack of effort and productivity, dependence on others for structuring daily activities) and affective (flattened affect and lack of response to positive and negative events). Thus, there is some overlap with the symptoms of depression. However, while the symptoms of apathy can also be seen in depression, they differ in the sense that depressed patients feel intrinsically “blue” or sad. They are very bothered by this condition. While apathetic patients do not feel sad, they are indifferent, and they simply “don’t care”. They are not bothered or worried by this condition, rather it is often their spouse who is irritated by their lack of concern or unwillingness to participate in activities. The incidence of apathy in Parkinson’s disease is approximately 45% (Isela et al, 2002). Apathy can therefore be a feature of depression or stand alone as a separate behavioral symptom.

Unfortunately, there have been no consistently reported effective treatments for apathy in Parkinson’s disease. Antidepressants may be tried, and improvement can be seen usually if apathy is a component of depression. But the best remedy is assurance and education. Caregivers need to be assured that their loved one’s “lack of care” does not mean lack of love, or sadness or frustration. Once the spouse is assured and the Parkinson’s patient confirms that this is indeed what he or she is feeling, tension in the household eases up significantly. There is a therapy called cognitive behavioral therapy that researchers are currently testing for treatment of apathy.
_________________
Hubert H. Fernandez

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Lloydtan-trust & Malaysia Parkinson's information centre

Thank you sooo much for this link. The care and compassion in the writings is very touching and so respectful to those who suffer with PD. When I read the article on Parkinson's Hero's I was shocked to see it was written by a doctor. He wrote more like a compassionate father then a physician.

To have someone write with so much respect and compassion made me feel like a person again not a "patient". Respect and compassion are powerful "medications" to a person who has an illness. When treated and acknowledge this way you feel as if you can do and get through anything.

Thank you for showing me how I need to treat and perceive those how have chronic illnesses.

Tina

parkinson and B6-B12

Anonymous






Posted: Wed Jul 29, 2009 10:40 pm Post subject: parkinson and b-6-b12

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what is a good dosage of b-6 and b12 your help would gratly be of use to help i have had parkinson for 20 yrs plus. thanks

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Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Sun Aug 02, 2009 1:19 pm Post subject:

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Dear Friend,
That’s a very good question. Folks with PD need to be certain to get enough B vitamins, because studies have shown that long-time users of levodopa can develop elevated homocysteine – a substance in the blood that is normally cleared by a combination of the vitamins B6, B12, and folate.

If you are using levodopa, you should be able to take 10 mg of B6 daily, possibly as much as 25 mg; very high amounts can interfere with levodopa absorption, however, so you will need to be cautious. The daily requirement for adults is 1.3 mg per day, and the upper safe limit is 100 mg/day.

Regarding vitamin B12, the minimum for adults is 2.4 mcg per day, with a safe upper limit not determined. B12 does not interfere with levodopa absorption.

I will separately post an article I wrote on B vitamins and Parkinson’s disease that may be helpful. Let me know if you have other questions.


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_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/

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NPF Forum: My Book

teokimhoe



Joined: 03 Mar 2007
Posts: 157
Location: Malaysia
Posted: Sat Sep 19, 2009 6:10 pm Post subject: My Book

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http://www.heroteo.com/heroteo_book.pdf
_________________
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families

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Rogerstar1



Joined: 14 Mar 2007
Posts: 463

Posted: Sat Sep 19, 2009 7:19 pm Post subject:

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Teo- I know a very little about Parkinsons Disease but can recognize superb translating by a professional a mile away. You've brought on a talented one. Congratulations and best wishes with your book.

Rogerstar

http://www.patientslikeme.com/forum/show/54379

NPF Discussion : secret recipe behind the mask

teokimhoe



Joined: 03 Mar 2007
Posts: 155
Location: Malaysia
Posted: Fri Sep 18, 2009 8:17 am Post subject: secret recipe behind the mask

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Secret recipe behind the mask

I often smiled as I watched the video recording of my kick-boxing exercise which I have uploaded to YouTube a few weeks ago. My trainers and videographer told me the same thing – “You do not look like a Parkinson’s patient at all”. Even my doctor shook his head in disbelief and said, “This is shocking. I can’t imagine a 70-year-old Parkinson’s patient doing such a strenuous exercise such as kickboxing. I am sure that you are the only Parkinson’s patient in Malaysia who is doing the kickboxing exercise.”

As early as 1998, I already had both the motor and non-motor symptoms. Since my diagnosis in 2002, I went through a period of depression, anxiety, denial and anger. Subsequently, I bounced back after discovering a secret recipe for fighting Parkinson’s, which consisted of: knowledge (is power), exercise, medications, nutrition / supplements and prayer. In my quest for knowledge, I browsed various Parkinson’s websites, raining them with questions, questions and questions. I even started the first Parkinson’s blog in Malaysia (www.heroteo.com). I tried to learn everything about Parkinson’s in order to overcome all complications - the Chinese heroes won their battles by understanding their enemies first.
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Animal experiments showed that exercises may be neuroprotective. Rats which were forced to exercise had a lesser degree of brain damage after they were exposed to poison. In mice which were made to undergo treadmill exercises, there was increased production of dopamine.

Parkinson’s patients are comparable to the car. The medications are needed to help patients to start walking, while fuel or battery is needed to help start the car engine. Exercises are needed to improve the patients’ physical mobility and endurance, while driving helps to recharge the battery. Thus, exercises help our “engines” warm up before leaving home and keep the “cars” going everyday. Even healthy people such as Bruce Lee, the Chinese kungfu master, know that exercises are beneficial.

As such, since 2005, I decided to “get physical”. I am spending 3-4 hours everyday at the California Fitness gym, doing a wide range of “heavy” exercises such as kick-boxing, weight-training and spinning (indoor cycling). Twice a week, I do yoga exercises at home with the guidance of a trainer.

Since this year, my physical condition has drastically improved. I sleep and eat well (I eat to live a healthy and good life). I enjoy driving around the Kuala Lumpur city with my wife everyday and going overseas for holiday. I managed to reduce the daily dose of Parkinson’s medications recently. Sometimes, I wonder whether I am just a “normal person” behind the mask.





Am I a Parkinson’s patient? – Try taking my “killer” punch and you’d wonder whether I really have Parkinson’s.


I know that it is technically difficult to prove that exercise has neuroprotective effect in Parkinson’s patients. Despite this, I believe that exercise has slowed down my disease progression. I hope that my video recording will bring hope and happiness to all Parkinson’s patients in this world, by reminding them that they can still live a physically active life.

Mr. Hero Teo, Kuala Lumpur, Malaysia
10th July 2009.
_________________
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families

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Stargazer



Joined: 26 Dec 2007
Posts: 276
Location: Eastern Washington
Posted: Fri Sep 18, 2009 2:31 pm Post subject:

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Mr. Hero Teo I have followed your posts since around 2,007 or shortly there after. I can fully agree from reading your posts that you have come along way from day one. You have every right to be proud of your accomplishments.

I pray that the newly dx and younger people will heed your advice, being an older person my limitations to a great deal of excercise is limited but none the less even I can notice the difference in how I feel a good day w/exercise versus one with out. 100% on the knowledge part the more I read the more I get inspired and grow more content.

Keep it up Teo you have done well and am sure your wife and that little one are proud of you also.
Deeann

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NPF Nut.,Disc:complimentary and alternative medicine

Anonymous






Posted: Fri Sep 18, 2009 4:15 am Post subject: complimentary and alternative medicine

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Due to sideeffect of the medication there are growing interest for parkinson's patients in alternative and complementary medicine or therapies who will live with disease for a longer peroid of time.

The CAM offers helpful information related to non motor and motor symptoms i.e proper diet, exercise, constipation, fatigue, insomina, massage, pain managment, Tai chi, rehabilation,speech therapy,acupuncture,spa treatment & etc.

As the result they try the above therapy to minimize their usage of medication they take to increase comfort or minimize effect of the physical or mental on them.

There are some doctors who do not agree for the above therapies as they are yet medical proven? Besides there are potential risks for the complementary/ alterative therapies



Sometimes the best treatment plans involve a wide range of interventions with their usage of the medications.

Over prescription on certain supplements interaction with medication have effect on each other i.e vitamin B6,iron and mineral .

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Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Fri Sep 18, 2009 7:09 am Post subject:

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Dear Friend,
I believe that many complementary and alternative therapies are most beneficial for people with PD. Although I’m not aware of any that slow progression of PD, there are other benefits. Tai Chi is an excellent exercise for improving balance; acupuncture and reflexology can help to relax muscles, improve digestion, and relieve some types of pain. Some herbs, such as chamomile tea, can help promote sleep.

I also know physicians who recommend such treatments, although not all are aware of the possible benefits.

However, one must also be aware of the many fraudulent schemes that are available – pills, juices, and other treatments designed to make money for the sellers rather than to provide relief for illnesses. These are expensive and useless, and in a few cases, even dangerous. It’s best to seek licensed practitioners for treatment and counseling.

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_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/

Major nutritional issues in the management of PD

Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Wed Aug 26, 2009 7:37 am Post subject: News: Major nutritional issues in the management of PD Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Wed Aug 26, 2009 7:37 am Post subject: News: Major nutritional issues in the management of PD

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Dear Friends,
As long-time members know, I firmly believe that everyone with PD should see a registered dietitian on a regular basis, as nutritional concerns can occur, and can change, throughout the stages of PD. Best, Kathrynne

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Mov Disord. 2009 Aug 18.

Major nutritional issues in the management of Parkinson's disease.

Barichella M, Cereda E, Pezzoli G.

Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy.

As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research.

Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa).

During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute.

Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account.

Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micronutrients or vitamins).

A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens. (c) 2009 Movement Disorder Society.

PMID: 19691125 [PubMed - as supplied by publisher]

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_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:



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.

Dear Friends,
As long-time members know, I firmly believe that everyone with PD should see a registered dietitian on a regular basis, as nutritional concerns can occur, and can change, throughout the stages of PD. Best, Kathrynne

========================================================

Mov Disord. 2009 Aug 18.

Major nutritional issues in the management of Parkinson's disease.

Barichella M, Cereda E, Pezzoli G.

Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy.

As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research.

Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa).

During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute.

Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account.

Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micronutrients or vitamins).

A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens. (c) 2009 Movement Disorder Society.

PMID: 19691125 [PubMed - as supplied by publisher]

.
_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:

Suicide and PD

Dr. Okun



Joined: 19 Jan 2007
Posts: 251
Location: University of Florida
Posted: Thu Sep 10, 2009 10:57 am Post subject: New Study: Suicide and PD

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Dear forum members,

There is a new study out looking at suicide in PD. It has long been suspected by many authors it is actually slightly lower than in the general population. There is also debate as to whether it is higher in those receiving DBS. It is important to keep these numbers in mind and remember---PD patients commonly report having thought about suicide. Further, depression is treatable!!

Here is the abstract:

J Neurol Sci. 2009 Sep 7. [Epub ahead of print]
Suicide and suicidal ideation in Parkinson's disease.

Kostić VS, Pekmezović T, Tomić A, Ječmenica-Lukić M, Stojković T, Spica V, Svetel M, Stefanova E, Petrović I, Džoljić E.
Institute of Neurology CCS, School of Medicine, Belgrade, Serbia.
Little is known about the prevalence and correlates of suicidal behavior in Parkinson's disease (PD). In the first part of the study, we followed a cohort of 102 consecutive PD patients for 8years and found that the suicide-specific mortality was 5.3 (95% CI 2.1-12.7) times higher than expected. In the second part, we tested 128 PD patients for death and suicidal ideation and administered an extensive neurological, neuropsychological and psychiatric battery. Current death and/or suicidal ideation was registered in 22.7%. On univariate logistic regression analysis, psychiatric symptoms (depression, but also anxiety and hopelessness), but not the PD-related variables, were associated with such ideation. On multivariate logistic regression analysis this association held for major depression (odds ratio=4.6; 95% CI 2.2-9.4; p<0.001), psychosis (odds ratio=19.2; 95% CI 1.4-27.3; p=0.026), and increasing score of the Beck Hopelessness Scale (odds ratio=1.2; 95% CI 1.0-1.4; p=0.008). In conclusion, the suicide risk in PD may not be as high as it is expected, but it is certainly not trivial. According to our data almost a quarter of PD patients had death and/or suicidal ideation, that may significantly influence their quality of life.
_________________
Michael S. Okun, M.D.

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Lloydtan-trust & Malaysia Parkinson's information centre

teokimhoe



Joined: 03 Mar 2007
Posts: 154
Location: Malaysia
Posted: Wed Sep 09, 2009 3:46 am Post subject: lloydtan-trust & Malaysia Parkinson's Information centre

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http://www.lloydtan-trust.com/index.php?page=home
_________________
to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families

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Stargazer



Joined: 26 Dec 2007
Posts: 267
Location: Eastern Washington
Posted: Thu Sep 10, 2009 2:29 pm Post subject:

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Thank you Teo that was an interesting article Mr. Loyd Tan was most certainly a devoted man to his religion, Family and the Parkinson group in Malaysia.

Teo you are also a busy man helping your friends and doing what you can to educate your people about Parkinson, I am sure you are appreciated.

The best of Health to you and your Family,

Deeann

: B12 deficiency and Parkinsonism

Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Mon Aug 31, 2009 10:22 am Post subject: Research: B12 deficiency and Parkinsonism

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.
Dear Friends,
B12 deficiency is increasingly common as we age, and the symptoms can be varied and confusing. This study notes "Parkinsonism" as a possible sign, and for those who actually PD, symptoms could be increased with B12 deficiency. It's a reminder to all of us to ask for a test for B12 deficiency, whether we have PD or not.
Best,
Kathrynne
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High Prevalence of Vitamin B12 Deficiency among Elderly Neurology Patients

Reference: “An investigation of vitamin B12 deficiency in elderly inpatients in neurology department,” Wang YH, Yan F, et al, Neurosci Bull, 2009; 25(4): 209-15. (Address: Department of Neurology, Changzheng hospital, Second Military University, Shanghai 200003, China. E-mail: yhwangch@sina.com ).

Summary: In a study involving 827 patients over the age of 60 (average age: 77 years) from the department of neurology of Shanghai Punan Hospital in China, of which 19.7% were found to be vitamin B12 deficient (more prevalent in females than males), low levels of serum vitamin B12 were associated with higher rates of gastrointestinal diseases, unsteady walking in the darkness, hypopallesthesia, and chronic diseases such as cerebral ischemia, hypertension, Parkinsonism, diabetes mellitus, and coronary heart disease.

Moreover, most of the patients with vitamin B12 deficiency were found to exhibit neuroelectricphysiological abnormalities.

Interestingly, only 9.82% of patients with vitamin B12 deficiency were found to have megaloblastic anemia.

The authors conclude, “Vitamin B12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symp toms.”

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_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/

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When medications cause Parkinson's symptoms

Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Tue Jul 28, 2009 3:16 pm Post subject: News: When medications cause Parkinson's symptoms

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Dear Friends, the following may be of interest. Best, Kathrynne

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When medications cause Parkinson's symptoms
http://www.wrex.com/Global/story.asp?S=10707421


Any medication that blocks dopamine in the body can cause Parkinson's symptoms.

By Louis Neipris, M.D., Staff Writer, myOptumHealth

You may have heard of Parkinson's disease (PD), a movement disorder. Someone with it may have characteristic signs, such as a pill-rolling tremor in the fingers or a hunched forward posture. You may recognize someone with this disease from the faltering, tiny steps they take when they walk or by their rigidly emotionless face.

The cause of Parkinson's disease is mostly unknown. Some people develop Parkinson's-like symptoms after treatment with certain medications. This is called drug-induced parkinsonism (DIP) or secondary parkinsonism. Certain medications can also worsen symptoms in someone who already has Parkinson's disease.

Any medication that blocks dopamine in the body can cause Parkinson's symptoms. Dopamine is a brain chemical that helps control movement. Common dopamine-blocking drugs are antipsychotics. They are used to treat certain mental illnesses or severe nausea. Less commonly, certain types of calcium channel blockers cause drug-induced parkinsonism. These drugs may be used to treat chest pain and high blood pressure, or irregular heart rate.

Other types of medications that may cause drug-induced parkinsonism are:

* Some antidepressants
* Certain anti-nausea drugs
* Some drugs used to treat vertigo
* Certain drugs used to treat epilepsy
* Some anti-arrhythmics (used to treat irregular heart rhythm)

Not all drugs in these classes will cause symptoms of parkinsonism.

What's the difference?

Drug-induced parkinsonism usually develops on both sides of the body, while typical Parkinson's disease does not. Also, drug-induced parkinsonism usually does not progress like typical Parkinson's.

Unlike Parkinson's, drug-induced symptoms usually go away after the drug is stopped. It may take several months, though, for the symptoms to completely stop. If the symptoms remain, then it is possible that the drug may have "unmasked" underlying Parkinson's disease.

Who is at risk?

* Female: Women are twice as much at risk as men.
* Elderly: Older people are more likely to be on multiple medications or to have underlying Parkinson's disease.
* Those with a family history of Parkinson's disease.
* People with AIDS.

What to do to prevent drug-induced parkinsonism?

The most common drugs linked to this condition are two used to treat schizophrenia or psychotic symptoms of dementia. They are haloperidol (Haldol) and perphenazine (Trilafon). Ask your doctor about parkinsonism if you or a loved one is concerned about a drug, especially these two drugs.

In general:

* Make sure you or a loved one are on the lowest effective dose.
* If you already have Parkinson's disease, then tell your doctor if the symptoms appear to be getting worse since starting the drug.
* Never stop taking a drug on your own. Talk to your doctor about any concerns.

SOURCES:

* Parkinson's Disease Society. Drug-induced parkinsonism.
* Albin RL. Parkinson's disease: background, diagnosis, and initial management. Clinics in Geriatric Medicine. 2006;22(4):735-751.
* Alvarez MV, Evidente VG. Understanding drug-induced parkinsonism Separating pearls from oysters. Neurology. 2008;70(8):e32-e34.

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http://www.wrex.com/Global/story.asp?S=10707421
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_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/

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Parkinson's, B6, B12, and Folate - What's the Connection?

Sun Aug 02, 2009 1:22 pm Post subject: Parkinson's, B6, B12, and Folate - What's the Connection?

. Parkinson's, B6, B12, and Folate - What's the Connection? Kathrynne Holden, MS, RD Copyright 2008 Ms. Holden is a nutritionist specializing in Parkinson's disease. She has published research, books, articles, and manuals on nutrition and PD, including "Eat well, stay well with Parkinson's disease." She moderates the NPF forum Ask About Nutrition at: www.parkinson.org In the past decade, there has been increasing interest among researchers about the effects of three B vitamins - B6, B12, and folate. We now know that deficiencies occur with greater frequency than ever suspected previously, particularly in older adults. We also now know that deficiencies, if not corrected, can result in irreversible damage in some people. Some health professionals are beginning to suspect that these three vitamins may be significant factors in Parkinson's disease. What are B6, B12, and folate, and what do they do? These are essential nutrients, meaning that they are vital to life. These three vitamins work both independently and together in many of the body's systems. Vitamin B6 assists in making hormones, new proteins, and neurotransmitters ("messengers" between nerve cells) for the body's use. It also helps release stored sugar when we need it for fuel. It works together with B12 and folate to remove homocysteine from the blood. Homocysteine is a substance increasingly associated with a number of diseases; more about this later. Vitamin B12 plays a role in the synthesis of DNA, needed for formation of new red blood cells. It takes part in the manufacture of the myelin sheath - the protective coating that surrounds nerve cells. With B6 and folate it removes homocysteine from the blood. Folate, also called folacin or folic acid, is a partner with B12 in DNA synthesis and in removal of homocysteine, and is required in many other vital processes. Without folate, B12 would be unable to complete many of its functions, and vice versa. Folate is the form found in foods, folic acid is the form in dietary supplements. How much do we need of these vitamins? Nutrient needs are broken down by gender, age group, pregnancy, and lactation. New guidelines have also established a Tolerable Upper Intake Level. So, for example, while the RDA for vitamin B6 for males and females age 19-30 years is 1.3 mg/day, the Tolerable Upper Intake Level for both is 100 mg/day, making it easier to provide recommended amounts. RDA* Tolerable Upper Intake Level ** + Vitamin B6*** + 1.7 mg/day 100 mg/day (age 19 and older) Vitamin B12 + 2.4 mcg/day Not Determined Folate + 400 mcg/day 1000 mcg/day * Recommended Dietary Allowance ** The Tolerable Upper Intake Level is the maximum level of daily nutrient intake that is likely to pose no risk of adverse effects, and represents the total intake from food, water, and supplements. *** Adults age 51 and older + not applicable if pregnant or lactating Why do deficiencies occur, and what are signs of deficiencies? Vitamin B6. Mild deficiencies of B6 are fairly common in the U.S., mostly because of dietary deficiencies, but sometimes due to use of certain medications which interfere with B6, including hydralazine, isoniazid, MAO inhibitors, penicillamine, and theophylline. (Conversely, large amounts of B6 can interfere with the absorption of levodopa, an important medication for Parkinson's disease. Current use of the combinations of carbidopa-levodopa or benserazide-levodopa offset this interaction for the most part; but use of supplements containing more than 15 mg of B6 can overwhelm the protective effects of the carbidopa and benserazide.) Good food sources of B6 include chicken, fish, eggs, nuts and seeds, dried beans and peas, soybeans, wheat germ, bananas, avocados, and brewer's yeast. Also, some foods, including a number of breakfast cereals, are fortified with B6. Signs of B6 deficiency include irritability, depression, and confusion; sore tongue, sores or ulcers of the mouth, and ulcers of the skin at the corners of the mouth. Vitamin B12. The human body stores this vitamin so well that it can take a long time to deplete, sometimes several years. Nevertheless, there are several reasons why people sometimes do experience deficiency. Animal foods are the only source of B12, therefore people who eat few or no animal products (meat, fish, poultry, eggs, milk) are at risk unless they use vitamin supplements. Another problem is that B12 in foods cannot be absorbed by the body until it is freed from the proteins in the food; the stomach produces an acid that removes this protein. However, with age, we produce less and less of this stomach acid. Many older adults don't produce enough acid to allow them to absorb B12. Further, people who have acid reflux often use medications that reduce stomach acid, which unfortunately also decreases absorption of B12. Vitamin B12 is one of the few nutrients that is better absorbed in pill form than from dietary sources. Signs of B12 deficiency include numbness or a tingling "pins and needles" sensation, or a burning feeling; a red, sore, or burning tongue; loss of appetite; gait abnormalities, personality changes, an Alzheimer-like dementia, psychosis, depression, and agitation, particularly in older adults. Other signs are megaloblastic anemia, and elevated serum homocysteine, in people of all ages. Researchers believe that as many as 42% of people aged 65 and older may have some degree of B12 deficiency. Many people with PD are age 65 or older, and should be considered at risk and tested for B12 deficiency. Folate. Folate is available in many foods: lima beans, brewer's yeast, orange juice, dried beans, green peas, asparagus, beets, Brussels sprouts, broccoli, corn, spinach and other dark green leafy vegetables, soybeans, nuts and seeds. Further, the U.S. government requires that food manufacturers fortify processed grain products with folic acid. Yet, deficiencies of folate are not uncommon. This could be in part because folate is another of the few nutrients in which the synthetic form is absorbed much better (about 40 percent better) than the natural form. Because of the possibility of deficiency, women, including women with PD, who are pregnant or wish to become pregnant are advised to take supplements of folic acid; deficiencies can result in neural tube defects in the unborn child. Deficiencies of folate are also being increasingly studied for a possible role in other diseases: . A low intake of folic acid is associated with risk for colon cancer. Chronic constipation, experienced by many people with PD, also increases risk for colon cancer; it is prudent for those with PD to control constipation and to be sure the diet is adequate in folate. . A low level of folic acid in the blood is associated with higher levels of serum homocysteine, a substance in the blood that may contribute to heart disease, stroke, and dementias. . Animal studies point to a link between low levels of folic acid and Alzheimer's disease; and people with Alzheimer's are often found to have low levels of folic acid. Some people with PD develop an Alzheimer-type dementia. Again, prudence dictates consumption of adequate folate. . Another study using mice found that folic acid deficiency led to increased levels of homocysteine and symptoms of Parkinson's disease. Researchers speculate that homocysteine may damage DNA in the substantia nigra, the area of the brain affected in Parkinson's disease. . There are reports of improvement in restless leg syndrome (RLS) with use of folate supplements; this has not as yet been studied thoroughly, so it is too early to say whether there is a definite link. However, people with PD often complain of RLS, and physicians should rule out the possibility of folic acid deficiency. Signs of folic acid deficiency include appetite loss, weight loss, burning tongue, fatigue, weakness, shortness of breach, memory loss, irritability, megaloblastic anemia, and increased levels of serum homocysteine. Should people with PD be concerned about these vitamins? Although there are concerns, as mentioned above, that deserve further study, it's too early to say definitely that these three vitamins are of significance to people with PD. However, if you are over age 50 these vitamins are of importance independently of PD. Furthermore, studies have demonstrated that some people who use levodopa, considered the best medication for PD, develop elevated levels of serum homocysteine, due to the way in which the medication is metabolized. It is certainly a good idea to ask your doctor to test levels of serum homocysteine annually, and to check for signs of B vitamin deficiencies. Should you take supplements? There is growing agreement that older adults are at risk for nutrient deficiency, whether PD is present or not, and that supplements can help. . One study of older adults found that a multivitamin containing 100% of the Daily Value improved low levels of several nutrients, including vitamins B6, B12, and folate. . A recent study in the United Kingdom suggests that folic acid intake should be about three times that of the current recommendation for elderly people. . Other studies indicate that up to 10% of older adults with low-normal levels of B12 are actually deficient and could benefit from supplements. Because folate supplements can mask a B12 deficiency, it becomes extra important to get enough B12 daily. . The American Heart Association recommends a folate-rich diet to lower homocysteine levels, and supplements of 2 mg B6, 400 mcg folic acid, and 6 mcg of B12 if dietary means are not sufficient to lower the homocysteine. For people with PD who use a medication that contains levodopa (such as Sinemet, Madopar, Syndopa, Larodopa, etc.), you should be aware that large amounts of vitamin B6 (more than 15 mg) can affect the absorption of levodopa, by converting levodopa to dopamine in the stomach and bloodstream. Dopamine cannot cross the blood-brain barrier, so it is effectively blocked from its purpose. Sinemet and Madopar contain either carbidopa or benserazide, which "protect" the levodopa from B6; so ordinary supplements of B6 should not be a problem for most people. However, very large amounts of B6, greater than 15 mg (and in sensitive persons, possibly as low as 10 mg), could overwhelm the protective effects of the carbidopa or benserazide. Such a supplement should be taken at bedtime with a light snack, or with meals at least two hours separately from levodopa. In summary, older adults are acknowledged to be at increased risk for B vitamin deficiencies. People with PD who are age 50 and over, therefore, are at increased risk also. Whether younger people with PD should be concerned about such deficiencies remains to be seen. A prudent and rational approach for all those with PD is to: . Discuss the possibility with their physicians, and to request tests for B vitamin deficiencies . Be aware of the signs of B vitamin deficiency . Take a multivitamin/mineral supplement daily. Unless anemic, choose a supplement that does not contain iron . Take a B complex supplement if deficiencies occur; and take the supplement separately from levodopa by at least two hours, preferably with meals or a snack. Knowledge is strength; awareness of dietary needs can prevent illness, malnutrition, suffering, and hospitalization. If you have questions about B vitamins or other nutrition or dietary needs, please visit the National Parkinson Foundation website: http://www.nutritionucanlivewith.com/
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Ask about Nutrition: Can I mix these medication?

Anonymous
Posted: Mon Aug 31, 2009 4:04 am Post subject: Can I mix these medication?

I take Sinemet CR, Requip, Jumex and supplementary vitamins containing Zinc, calcium, T3, T4, Dhea,copper,Ferriltin , Folic acid,Vit D daily. I have unusual frequent tiredness,facial stiffness and feel sick.

Are they interacted each other and have effect? Kindly enligthen
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Kathrynne Holden, MSJoined: 22 Jan 2007Posts: 94Location: www.nutritionucanlivewith.com
Posted: Mon Aug 31, 2009 9:39 am Post subject:

. Dear Friend, You do not describe your “sick” feeling. However, the PD medications (Sinemet, Requip, and Jumex) can all have the effect of causing nausea, particularly when you first start taking them – perhaps that is the effect you are having? If so, try taking them with food for a few weeks until your body has time to adapt to the new medications. If you have been taking them for some time and still feel nausea, then ask your neurologist to prescribe Lodosyn (carbidopa); it can help overcome the nausea. I don’t think your vitamin and mineral supplements are interacting with the medications to make you feel sick or tired. However, if you are taking an iron supplement, I would take it about two hours apart from Sinemet, because iron can block levodopa absorption. Fatigue and tiredness are very common among people with PD, and there are a number of possible causes that need to be discussed with your doctor: - anemia (iron-deficiency, pernicious, megaloblastic) – anemia is not uncommon in PD and definitely causes tiredness, fatigue, sometimes shortness of breath and dizziness - B vitamin deficiency (can result in another type of anemia) - low blood sugar (hypoglycemia) – can lead to fatigue, dizziness, heart palpitations - deficiency of coenzyme Q10 – when present, taking supplements of CoQ10 10 often gives more energy - malnutrition - depression - PD can have “ups and downs” and you might be experiencing a temporary “down” that affects your energy or increases fatigue - do you take your Sinemet about 30 minutes before meals, so as to optimize its absorption and anti-PD effects? Sometimes people forget about this, and this can make a difference. - waning energy at the same time each day – sometimes energy levels drop after lunch; the body’s energy is diverted to metabolizing the food eaten, and it can result in sleepiness or fatigue; could that be a possibility? Let me know if you have further questions. ._________________Best regards, Kathrynne Holden, MS -- For a Parkinson Tip of the Day visit: http://www.nutritionucanlivewith.com/
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Anonymous
Posted: Wed Sep 02, 2009 2:40 am Post subject:

My frequent unusual tiredness and "sick "feeling was caused by vitamins and mineral supplements interacting with parkinson's medications and the effect on each other. I use to take my vitamin, mineral supplements about half an hours after my parkinson medications. As the result they block levodopa absorption. Therefore I have frequent .masked face; lack of blinking and expression and look "sick" and unusual tiredness. I feel much better after I take supplements two hours after the parkinson medication.
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Kathrynne Holden, MSJoined: 22 Jan 2007Posts: 94Location: www.nutritionucanlivewith.com
Posted: Wed Sep 02, 2009 12:25 pm Post subject:

. Dear Friend, Thank you for taking time to tell us about the changes you made to help you feel better. If you were taking iron supplements and/or large amounts of vitamin B6 (25 mg or more, and for some people as little as 10-15 mg), they would be very likely to cause the tired and sick feelings and the PD symptoms such as masked face. I generally recommend that people take levodopa about 30-60 minutes before meals, and iron and B6 supplements with the meal, or else at bedtime, so that they do not interfere with levodopa absorption. But everyone is different, so If it works best to take them two hours after the medications, then you have been your own best doctor! ._________________Best regards, Kathrynne Holden, MS -- For a Parkinson Tip of the Day visit: http://www.nutritionucanlivewith.com/
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Anonymous
Posted: Fri Sep 04, 2009 4:58 am Post subject:

My supplement vitamins containing: Boron Chelate 1mg,copper chelate 5mg, manganese chelate 2mg, Selenium chelate 200mg, Sod 300mg, Curcumin 500mg, chromium chelate 200mg,magnesium 200mg, molyodeum chelate 50mg, Alphalipoic acid 100mg, VIt A 2000 I.U, Vit 2 30mg, Vit 5 30mg, Vit H 300mg, Vit D 2500 IU,Vit 3 1000mg, Vit 1 200mg,Vit B3 40mg,Vit 6 50mg,VIt B9 1200 mg,Vit C 1000mg,Vit E (mixed nature) 200 IU, calcium 3000mg,Q10 200mg, Vit 5 30mg, VIt 2 30mg,VIt A 2000 I.U,tyl cysteine 1200mg VIt H 300mg,L-Tyrosne 50mg ,
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Kathrynne Holden, MSJoined: 22 Jan 2007Posts: 94Location: www.nutritionucanlivewith.com
Posted: Sat Sep 05, 2009 8:34 am Post subject:

. Dear Friend, Unfortunately, we do not normally refer to vitamins by number alone (i.e. vit. 2, vit 5), nor am I certain to which vitamins you refer when you mention vit. H, or vit B9. However, of all the B vitamins, only vitamin B6 is known to affect levodopa absorption. If by “vit 6" you are referring to vitamin B6, 50 mg would be quite a large amount, certainly more than enough to block your levodopa. And that would mean that PD symptoms were not controlled, resulting in the tiredness and masked face you describe. Since taking the supplements two hours after a meal is working for you, that should be fine. My personal recommendation would be to take everything but the vitamin B6 with a meal, as vitamins and minerals are usually best absorbed when taken with food. The B6, however, needs to be taken well apart from the levodopa, as you are doing. Bedtime is another good time to take B6. ._________________Best regards, Kathrynne Holden, MS -- For a Parkinson Tip of the Day visit: http://www.nutritionucanlivewith.com/
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Anonymous






Posted: Mon Sep 07, 2009 5:15 am Post subject:

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My vitamins namely : Riboflavin(Vit B2) 30mg ,Pantotheniv acid (vit.B5)30mg, Biotin (Vit H)m300mcg, Cyanocobalamin (Vit 12)200mcg, Vit C (TR) 1000mg,Thiamin (Vit B1)200mg,Niacinamide(Vit B3) 40 mg,Pyridoxin (Vit 6)50 mg, Zinc 70mg, Vit D3 2500 IU,fish oil(50%) 1000mg,Folic acid (Vit 9) 1200 mcg,Vit E (mixed natural) 200 IU, CoEnzyme Q10 200 mg

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Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Thu Sep 10, 2009 2:13 pm Post subject:

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.
Dear Friend,
50 mg of B6 is more than enough to interfere with levodopa absorption. Most people can take 10-15 mg, and some as much as 25 mg, without problem, but if PD symptoms are not well controlled it is likely that the amount is too much to be taken close to levodopa. If you're taking it singly, you might like to try taking all the other supplements with a meal, for best absorption, then taking the B6 about 2 hours separately from levodopa, or at bedtime.

.
_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/


Anonymous






Posted: Thu Sep 17, 2009 8:38 am Post subject:

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I look better now by cutting down the supplement vitamins B6 from 50mg to 25mg daily two hours after the medication.

The overdose of vitamin B6 25mg two times a day at morning and evening caused the blockage of absorption of levodopa.

As the result I have frequent tiredness, facial stiffness and look sick, symptom of parkinson's.

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Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Fri Sep 18, 2009 6:58 am Post subject:

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.
Dear Friend,
I am very happy to hear that cutting back on the B6 is helping you to look and feel better. A total of 50 mg per day, taken in divided doses as you are doing, should be ample for your needs. And taking it two hours after your levodopa should provide plenty of time for the levodopa to be absorbed, so that the B6 does not block it.

Let me know if you have other questions in the future, and congratulations on solving this problem so successfully.

.
_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/

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Anonymous






Posted: Sat Sep 19, 2009 9:58 pm Post subject:

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Kindly be informed I am taking Vit B6 25mg per day not 50mg as mentioned in your reply.

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Kathrynne Holden, MS



Joined: 22 Jan 2007
Posts: 94
Location: www.nutritionucanlivewith.com
Posted: Mon Sep 21, 2009 7:52 am Post subject:

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.
Dear Friend,
I misunderstood, thinking you were taking it twice daily. At any rate, 25 mg daily is approximately 4 times the daily requirement, and should be more than enough. And you have chosen to take it two hours after taking levodopa, which seems to correct your fatigue and other symptoms. Good for you for managing this problem so well.

.
_________________
Best regards,
Kathrynne Holden, MS
--
For a Parkinson Tip of the Day visit:
http://www.nutritionucanlivewith.com/

denture and saliva

Anonymous
Posted: Fri Jul 31, 2009 8:39 am Post subject: denture and saliva

There are complaint by parkinson's patient how to deal with saliva and dentures. The saliva causes the dentures slippery and loose even there are denture paste if a gap develops between the denture and the gummy ridge Therefore the denture may need repeated relines. Shrinkage of the bone and gums can be minimized or prevented with a proven technique
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Fri Jul 31, 2009 11:13 am Post subject:

This can be a troublesome issue. If you dry the saliva too much with an anticholinergic drug or botox you can also get cavities. I would suggest you work with the doctor to find the right solution for you, but to brush your remaining teeth frequently if you dry the saliva._________________Michael S. Okun, M.D.
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Anonymous
Posted: Sun Aug 02, 2009 8:39 pm Post subject:

You will find comfortable without dentures as your saliva easy to swallow.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Mon Aug 03, 2009 7:05 pm Post subject:

Thanks for the comment. Comfort I have found is patient specific!_________________Michael S. Okun, M.D.
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Anonymous
Posted: Fri Aug 07, 2009 4:56 am Post subject:

People with dentures have excess saliva as dentures are foreign substances in the mouth and the mouth produces excess saliva as a reaction perhaps treating the dentures as food.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Fri Aug 07, 2009 3:35 pm Post subject:

Thanks for the comment. Also remember botox and anticholinergics can dry you up but may also lead to cavities!_________________Michael S. Okun, M.D.
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Anonymous
Posted: Sun Aug 09, 2009 3:45 am Post subject:

There are complaint by the parkinson's patient to the doctor the drooling saliva and dentures Therefore Movement disorder specialist deal with medication to minimise the effect of saliva on the patient. They classified the excess of saliva is the slow saliva swallowing by PD neither the cause the saliva on dentures The dentist classified the saliva developing dentures slippery and loose is a gap develop between the denture and the gummy ridge. . Therefore the denture may need repeated relines. Shrinkage of the bone and gums can be minimized or prevented with a proven technique
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sun Aug 09, 2009 8:39 pm Post subject:

Thanks for the added comment._________________Michael S. Okun, M.D.

Major nutritional issues in the management of PD

Kathrynne Holden, MSJoined: 22 Jan 2007Posts: 94Location: www.nutritionucanlivewith.com
Posted: Wed Aug 26, 2009 7:37 am Post subject: News: Major nutritional issues in the management of PD

. Dear Friends, As long-time members know, I firmly believe that everyone with PD should see a registered dietitian on a regular basis, as nutritional concerns can occur, and can change, throughout the stages of PD. Best, Kathrynne ======================================================== Mov Disord. 2009 Aug 18. Major nutritional issues in the management of Parkinson's disease. Barichella M, Cereda E, Pezzoli G. Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy. As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research. Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa). During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute. Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account. Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micronutrients or vitamins). A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens. (c) 2009 Movement Disorder Society. PMID: 19691125 [PubMed - as supplied by publisher] ._________________Best regards, Kathrynne Holden, MS -- For a Parkinson Tip of the Day visit: http://www.nutritionucanlivewith.com/

Parkinson's medication interact with supplementary vitamins

Anonymous
Posted: Mon Aug 31, 2009 4:19 am Post subject: parkinson's medication interact with supplementary vitamins

I take Sinemet CR, Requip, Jumex and supplementary vitamins containing Zinc, calcium, T3, T4, Dhea,copper,Ferriltin , Folic acid,Vit D daily. I have unusual tiredness, and look sick. Can I mix these medication? Are they interact and have an effect with each other? Kindly brief
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Mon Aug 31, 2009 7:41 pm Post subject:

Your vitamins should not interact significantly with your PD meds. Rarely, the ferritin might interact. So to be safe, you can take it at a different time that you take your PD meds. Of see if you feel better not taking the iron pills at all. If you have anemia however, you may need iron pills, as anemia can cause tiredness. If you have no anemia, you dont really need to take iron pills and you can see if you feel better without it. Not sure why you are taking T3 and T4? If so, make sure your thyroid levels are good....they can cause tiredness. Finally, it can be that your PD medications may need to be increased...? Yours,_________________Hubert H. Fernandez
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I have frequent unususal tiredness because I take my supplement vitamins about half an hours my parkinson medications.

As the result they interacting and have effect on each others. They block levodopa absorption.

I feel much better now as I take my supplements vitamins two hours after my parkinson's medication.

Dr. Okun



Joined: 19 Jan 2007
Posts: 251
Location: University of Florida
Posted: Fri Sep 04, 2009 9:39 am Post subject:

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Thanks for the comment.
_________________
Michael S. Okun, M.D.

'