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DAVIDLKELLERMD

Brain Cell Protection

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I am a primary care physician (Internist) with early-onset PD formally diagnosed at age 49. My prescription medications are Azilect, Requip XL 8 mg a day and Sinemet CR 25/100 mg three times a day, which allow me to practice full-time. In addition, I take the following substances in the hope that they might be neuro-protective (slow down the loss of further brain cells): Coenzyme Q10 400 mg twice a day, ibuprofen 200 mg per day, and I am attempting to slowly add nicotine in the form of the lowest dose of Commit nicotine lozenges. I can only tolerate less than half a milligram of nicotine per day. I have never been a smoker or tobacco user, and I have no cardiac risk factors other than being a 53 year old male. In fact, like many people with PD, my blood pressure is low and my LDL is naturally very low (under 70). I tried isradapine (Dynacirc), a potentially neuro-protective calcium channel blocker, but it made my constipation and orthostatic hypotension intolerable. I took low-dose minocycline until it was proven to be not neuro-protective (actually, harmful) in ALS. I accept this risk, but I want to take every potentially neuro-protective substance which does not cause significant harm until it is proven or disproven. When I try to ask neuro-scientists about this, they tell me to sign up for clinical neuro-protection trials. I would do so, but I do not qualify because of the prescriptions I take. My questions for the neurologists are these: if you had Parkinson's, wouldn't you do as I am doing (be honest now)? If so, are there any other potentially neuro-protective substances you would consider "taking a chance on" until they are proven or disproven?

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Thank you for the question.

 

I would actually not do as you are doing. The reason I would not is that you have confused the studies a bit. Those who smoke for unexplained reasons have a decreased risk of getting PD. This does not matter to those (like you) who already have PD. Taking nicotine will not alter your risk of getting PD, and therefore its dangers (blood vessels and cardiac), should in most cases contraindicate its use.

 

The search for disease modifying drugs continues, and you are doing the right thing(s), but i would add daily exercise which may be better than anything you listed. The other drug which has shown promise is creatine.

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Thank you for your prompt reply, Dr. Okun. Based on your recommendation, and the adverse effects such as nausea I have experienced, I will stop the nicotine lozenges for now, and only restart them if they are proven beneficial at some time in the future. You are right, the known risks outweigh the unproven benefit (if any) in the case of nicotine. And thank you for reminding me about creatine, a relatively benign substance which has lab evidence of neuro-protection and has at least passed a non-futility study. I actually took it for a while, but I stopped when the manufacturer Neotine had problems supplying the "sachets" which were used in the study. It sounds like creatine, in your estimation, holds little possibility for harm, and may someday be proven beneficial. I plan to add it back to my regimen until the evidence is in. I understand and accept the risk that it may not be beneficial and may (like minocycline) actually surprise us and be proven harmful in some way. For now, I am leaving uric acid on my "watch list", because I have seen so much suffering in patients with gout and kidney stones. There is going to have to be some very impressive neuro-protection evidence obtained for uric acid before I consider taking anything to raise my own level. As for exercise, I am aware that it is the single best medicine for me, but like so many patients, I find it easier to pop another supplement than to get out there and go for a walk every day. I will try harder to do so!

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Thank you for the question.

 

I would actually not do as you are doing. The reason I would not is that you have confused the studies a bit. Those who smoke for unexplained reasons have a decreased risk of getting PD. This does not matter to those (like you) who already have PD. Taking nicotine will not alter your risk of getting PD, and therefore its dangers (blood vessels and cardiac), should in most cases contraindicate its use.

 

The search for disease modifying drugs continues, and you are doing the right thing(s), but i would add daily exercise which may be better than anything you listed. The other drug which has shown promise is creatine.

 

 

Growing List of Positive Effects of Nicotine Seen in Neurodegenerative Disorders

 

Neurology Today

19 January 2012; Volume 12(2); Pp 37,38

 

 

Dyskinesia and impulsivity in Parkinson disease, cognitive defects in attention deficit-hyperactivity disorder (ADHD), and now attention and memory in mild cognitive impairment (MCI): the list of reported neurological benefits just keeps growing in animal and human studies of nicotine.

 

Dr. Okun, how close is nicotine to being a credible candidate for neuro-protection ?

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I know people are experimenting with nicotine but I am unaware of it moving close toward neuroprotection.

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can you comment on this PCP's comments on creatine? Is that a supplement worth taking with minimal side effects?

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At the moment there is not enough data to recommend this for all patients. If you take creatine you should do so under your doc's guidance.

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I like your philosophy of taking supplements that may provide neuroprotection with little or no side effects. I think most of the supplements I am taking have health benefits beyond PD. Here is my list:

 

Azilect - 0.5 mg once daily

 

Creatine - 2,500 mg twice daily

 

Turmeric (Curcurmin bcm-95- more absorbable) - 300 mg twice daily

 

CoQ10 (Ubiquinol - more absorbable) - 100 mg twice daily

 

Vitamin D3 - 5,000 IU - once daily

 

Omega 3 Fish Oil - 250 mg of EPA/DHA twice daily

 

Exercise - 40 minutes of vigorous cardio five times weekly (stair climber, ellipical trainer and swimming)

Weight Lifting twice weekly

Golfing (walk and carry bag) twice weekly

Yoga twice weekly

 

Any comments? Anything I should add or subtract?

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No comments. Sounds like a great life. Remember not everything has an evidence base, but what you list all seem reasonably safe.

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