Tuesday, October 4, 2022

Parkinson’s And Gut Health

Eat A Healthy Breakfast

Nutrition, Parkinsonâs Disease and the Gut Microbiome

The first meal of the day should be packed with nutrients, fiber, and antioxidants needed for gut healing and building a balanced gut microbiome. Eating brain-boosting foods like fresh fruits and vegetables, healthy fats, nuts, and seeds will also keep your blood sugar balanced so you have more energy throughout the day.

Aim to have the first meal of the day be the healthiest, and ride the wave of success the rest of the day!

Understanding Gut Health Issues With Parkinsons Disease

Parkinsons is commonly known for motor symptoms caused by the disease, such as tremors and rigidity. Those living with Parkinsons, however, know that the disease is much more than that, and the challenges caused by their non-motor symptoms significantly affect their quality of life such as gastrointestinal issues.

In this article, well discuss gut health and Parkinsons disease to help you better understand and deal with your gut issues.

Can Altering The Microbiome Improve Parkinsons Symptoms

With the awareness that the microbiome may play a role in PD, came the idea that altering the microbiome may help with PD symptoms. While there is still a lot of research to be done, there have been some small, but promising findings so far.

Probiotics, or particular strains of bacteria that are ingested in order to alter the gut microbiome, have been studied to help PD symptoms. A number of small studies suggest that probiotics may improve constipation in people with PD, which is a common problem for many people with the disease.

As mentioned above, treatment of Helicobacter pylori and SIBO typically requires antibiotics, which are drugs designed to kill particular bacteria. Antibiotics can be helpful, but are only considered if a particular gut organism is being targeted. Otherwise, antibiotics can kill both good and bad bacteria, and potentially be detrimental to the overall health of the gut microbiome.

Another idea that has been considered is fecal transplantation, a technique in which fecal matter from a healthy person is delivered to the gut of a person with PD, with the goal of restoring a less PD-like microbiome. Only case reports and very small studies have been reported so far in the literature, but this may be an area worth exploring. There are a few additional studies underway which you can read about here:

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Microbiome Changes In The Appendix

The team collected tissue samples of the appendix from people with Parkinsons disease and a control group of people without the condition. Although many people consider the appendix not to have any biological function, there is mounting scientific evidence that it acts as a reservoir for gut microbes and alpha-synuclein, the hallmark protein in Parkinsons Disease.

They also collected samples from the ileum and the liver, both of which play a role in the production of bile.

The team collected tissue samples of the appendix, ileum, and liver all of which play a role in producing bile acids from people with Parkinsons disease and a control group of people without the condition.

Bile is made in the liver and stored in the gallbladder. After someone eats, the substance is released into their intestines to help break down fats.

Bile salts are one of the key components in bile that help it break down fats.

To study differences in microbial composition, the researchers compared the appendix microbiome of 12 people with Parkinsons disease with 16 from the control group.

They found the appendixes of those with the condition had higher levels of Peptostreptococcaceae, Lachnospiraceae, and Burkholderiales.

Primary bile acids are produced by the liver, whereas secondary bile acids are the result of bacterial action in the colon.

In addition, the appendixes of people with Parkinsons disease showed decreased:

  • Methanobacteriales

Prebiotic Probiotic And Faecal Microbiome Transplantation Approach In Pd Therapeutics

Parkinsons disease may start in gut

As reported in the review, studies have demonstrated altered gut microbiome is potentially associated with PD pathology and outcome. Faecal microbiome transplantation , prebiotics, and probiotics are potential options for restoring the altered microbiome in PD. An interventional study on a small group of PD subjects by Hegelmaier et al. suggests the inclusion of dietary SCFA has a positive influence on the gut microbiome and has a positive outcome on the course of the PD . Similarly, prebiotic intervention with the inclusion of resistant starch in the diet resulted in a decline in non-motors symptoms, stabilised faecal microbial diversity, improved butyrate levels, and reduced calprotectin concentration in PD . In clinical trials, increase in spontaneous bowel movements in PD patients with constipation , an improvement in abdominal pain and bloating , and a decrease in UPDRS score has been observed on using different strains of multi-strain probiotics. A randomized controlled trial showed the intake of fermented milk with prebiotic fibers and different probiotic strains significantly increased the frequency of complete bowel movements in PD patients improving constipation . Combination therapy is the only treatment recommended as efficacious and clinically useful by the latest MDS evidence-based guidelines .

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The Enteric Nervous System

The gut has its own nervous system, the enteric nervous system. Sometimes referred to as the second brain. The brain and enteric nervous systems developed from the same embryonic tissue. And a link still connects them. In the form of the vagus nerve.

Contrary to what we once thought scientists now know that communication between the gut and the brain is in both directions. This connection is called the gut-brain axis.

This is relevant for people with Parkinsons disease because almost all also have other, non-neurological symptoms. For example, over 80% of people with Parkinsons disease have digestive system problems, especially constipation. In fact, constipation usually precedes neurological symptoms by about ten years.

Other symptoms include:

  • pain

Parkinsons Disease: Are Gut Microbes Involved

Parkinsons disease is a common neurodegenerative disorder characterized by motor and gastrointestinal deficits. Despite its prevalence, the pathophysiology of PD is not well understood. Recent studies highlight the role of gut microbiota in neurological disorders. In this review, we summarize the potential role of gut microbiota in the pathophysiology of PD. We first describe how gut microbiota can be influenced by factors predisposing individuals to PD, such as environmental toxins, aging, and host genetics. We then highlight the effect of gut microbiota on mechanisms implicated in the pathophysiology of PD, including disrupted microbiota gut brain axis , barrier dysfunction, and immune dysfunction. It is too early to connect the dots between gut microbiota and PD to establish causation, and experiments focused on investigating interrelationship between gut microbiota and associated metabolites on GBA, barrier dysfunction, and immune activation will be crucial to fill in the gaps.

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What Can Be Done About These Unpleasant Gi Problems

Unfortunately, research studies on GI problems related to PD have been few and far between, so healthcare providers do not have any tried and true methods to deal with them. Some of the drugs to treat GI problems in people without PD cannot be used for those with PD because these drugs negatively impact dopamine systems in the brain.

If you have PD and experience constipation, it makes sense to try to use safe and simple methods to address this issue before you add new drugs to your daily regimen. Increasing dietary fiber and drinking lots of water and other fluids is a reasonable first step in treatment. If your healthcare provider approves it, you might also consider taking fiber supplements, such as psyllium or methylcellulose. If these simple methods dont work, your healthcare provider might consider giving you a stool softener or a laxative.

Statistical Analyses Of Single Studies

What is the Parkinson’s Gut Health Protocol?

Alpha-diversity indices at the species level were calculated using the microbiome R package after rarefying without re-sampling at the even depth of 5000. Due to rarefaction eight samples were further removed, leaving a total of 1203 samples . We measured richness using the number of observed species, Chao1, Fishers alpha, and ACE indices evenness using the Bulla and Simpson indices, dominance using the core abundance, which measures the relative proportion of core species that exceed relative abundance of 0.2% in over 50% of the samples, and the Simpsons index of dominance. Finally, we estimated rarity using the low abundance index, which considers the relative proportion of the least abundant species below a detection level of 0.2%, and the rare abundance index, which estimates the relative proportion of the non-core species exceeding the detection level of 0.2% at 50% prevalence. In addition, we calculated the ratios of Firmicutes to Bacteroidetes phyla and Prevotella to Bacteroides genera, as log2 ratios of their relative abundances. In each dataset, the differences in alpha-diversity between control and PD samples were assessed using Agrestis generalized odd ratios using the genodds function in the genodds R package. This statistic, based on ranks and analogous to the U statistic underlying the MannWhitney test, does not make strong assumptions about the distributions of measures and is comparable between measures of diversity with different scales.

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Exploring The Link Between Parkinsons Disease And Gut Health

Research at IPAN is finding growing evidence of a relationship between Parkinsons disease and gut health. Find out how you can get involved.

The impact of our gut bacteria on our overall health is an area of science that is generating a lot of interest. While it may seem unlikely that something in our gut can influence physiological processes in the brain, there is increasing evidence to show that it is possible.

IPAN PhD student Nathan Nuzum is specifically investigating the relationship between gut bacteria and Parkinsons disease.

He says not only is it likely that there is a relationship, but that this connection between our gut bacteria and brain may be modifiable through lifestyle factors like diet.

What we know about our gut bacteria and Parkinsons disease so far

Nathans systematic review on gut bacteria and Parkinsons disease found in nine of the 13 included studies that gut bacteria capable of producing a particular short chain fatty acid, butyrate, were less abundant in the Parkinsons groups compared to the groups without Parkinsons.

Nathan said this difference in butyrate-producing bacteria is relevant because of the health promoting functions of butyrate, including maintaining the health of our intestinal walls and providing anti-inflammatory actions within the immune system.

What role might diet play in this pathway?

But what impact might our dietary choices have on the different types of bacteria in our gut and the compounds that they produce?

Tips For Keeping Your Gut Healthy

Gut issues can cause significant disruption to your normal life, but that doesnt mean you have to accept them. Here are some tips to help you stay on top of your gut health:

  • Start your day right by hydrating properly and eating a healthy breakfast . To help with your diet, find a good registered dietician with experience in helping people with PD. A good way to check is by asking if they know about levodopa absorption issues with protein. Check out our diet and nutrition guide on what foods to eat and avoid.
  • Stay up to date on your colonoscopies. If you experience significant GI symptoms, you might need a colonoscopy and an upper endoscopy.
  • If possible, avoid opiates, as they can lead to GI side effects. If you have to take them, ask your physician for Symproic to treat the side effects.
  • Understand that most medication you receive to address severe constipation may fail unless you do a bowel cleanse first.
  • Keep track of the OTC treatments you try when you experience GI issues. Knowing what worked and what didnt can be helpful in a later GI appointment.
  • Watch out for weight loss , swallowing issues, and sudden severe abdominal pain. These issues can lead to further, possibly life-threatening complications, so its best to check in with a doctor.

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Braak And The Gut Theory

The onset of sporadic PD is unknown, but the Braak hypothesis offers to explain a mechanism for this. Braak et al. proposed the dual-hit theory which suggests that sporadic PD starts in two placesthe neurons of the olfactory system and the gastrointestinal tract . This review will only focus on the GIT aspect of Braaks theory and will only briefly touch upon the involvement of the olfactory network. Braak hypothesized that a foreign pathogen, either bacterial or viral, triggers a response which leads to LP that affects the olfactory and GIT system . Subsequently, neurons allow the retrograde transmission of alpha-synuclein enriched LB to the CNS from the olfactory and the vagus nerve, respectively. The transmission of alpha-synuclein pathology is believed to spread across the nervous system through a prion-like fashion .

A fundamental aspect of Braaks theory is the movement of alpha-synuclein from the enteric nervous system to the CNS via the vagus nerve and dorsal motor nucleus of vagus within the medulla oblongata . The ENS is a network of neurons within the gut wall which works separately from the CNS . The ENS consists of two plexuses, myenteric and submucosal, and has a number of different roles including regulating motility, mucosal blood flow and water transport . The vagal nerve plays an important part in functions of the body, e.g., stimulating salivation, gut peristalsis, and bladder contraction .

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The Gut Microbiome In Parkinson’s: Species Level Resolution And Function

Call for Participants

Although Parkinsons disease kills brain cells that affect our ability to move and to reason, the trillions of micro-organisms living in our gastrointestinal tracts may be important contributors to the illness.

At the University of British Columbia and with her colleagues at the University of Calgary, Dr. Silke Appel-Cresswell, a neurologist and associate professor, uses high-resolution screening tools to study the bacteria in the guts of people with Parkinsons. This colony of bacteria, fungi and viruses is known as the microbiota.

Appel-Cresswell is pinpointing the particular strains of bacteria driving inflammation or allowing too many toxic proteins to move from the gut to the brain.

From the evidence we have so far, it really seems that the microbiota in people with Parkinsons are different from those in people who do not have Parkinsons, she says.

If particular strains of bacteria cause inflammation, for example, it could trigger the body to mount a too-aggressive immune response. This could also lead to the accumulation of the protein alpha-synuclein, damaging brain cells, including those that produce dopamine. Lack of dopamine-producing cells causes the stiffness, tremors and difficulty walking that characterize Parkinsons disease.

From the evidence we have so far, it really seems that the microbiota in people with Parkinsons are different from those in people who do not have Parkinsons.

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Can An Altered Microbiome Contribute To A Diagnosis Of Pd

Research studies in animals have shown that an altered microbiome might contribute to PD pathology. For example, one study showed that in a mouse model of PD that overexpressed alpha-synuclein, there was more alpha-synuclein accumulation in the brain of the mice with an intact microbiome as compared to the same mice who were raised in a germ-free environment with no bacteria in their gut. This supports the theory that abnormal alpha-synuclein accumulation in the brain is enhanced by a particular microbiome in the gut.

Other studies showed that transplantation of fecal material from PD mice to normal mice, thereby introducing a PD microbiome into mice without PD pathology their brain, led to impairment of motor function and a decline in brain dopamine. These studies also support the theory that a particular microbiome might be integral in causing PD pathology in the brain.

Nausea Vomiting And Gastroparesis

Nausea and vomiting are reported by many Parkinsons patients, and may be the result of dopamine-based treatments aimed at alleviating motor symptoms.32 These symptoms can occur as the enteric nervous system of the GI tract, like the central nervous system, makes use of dopamine as a means of communication between neurons.33 Identical receptors for dopamine can be found in the GI tract as in the brain, and these play an important role in the movement of material through the intestinal tract.34 Nausea and vomiting can result from dopamine receptors within the gut interacting with Parkinsons treatments, such as levodopa, that are intended to act upon dopamine receptors in the brain. These symptoms can alleviate over time however, in cases of severe reaction to levodopa therapy, adjustments to treatment made in conjunction with a physician may be necessary. Such adjustments can include changes to dosage, or simply how such medication is taken, for example, by taking medication with a meal.21

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Statistical Analyses Of The Combined Studies

The Agrestis generalized odd ratios estimated for each alpha-diversity index and each individual study were pooled using a random-effect meta-analysis via the function metagen in the R package meta.

Count tables obtained for each dataset were pooled and beta-diversity analyses were performed using the three approaches described above . For each normalization approach, statistical differences between control and PD groups and the marginal effects of study and disease status were tested using the adonis2 function. We then used the distance measure that captured a highest fraction of the variability to compute distance-based redundancy analyses . dbRDAs were performed using the CAP option in phyloseq, which calls the capscale function in the vegan package. Data were clustered without conditioning for studies and without constraining, by conditioning for study, and by conditioning for study and constraining for disease status :

An Opportunity To Investigate

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The initial findings are promising, but there is still work to be done to investigate the effectiveness of Bacillus subtilis in treating Parkinsons symptoms.

Lead researcher, Dr Maria Doitsidou, from the Centre for Discovery Brain Sciences at the University of Edinburgh, said: The results provide an opportunity to investigate how changing the bacteria that make up our gut microbiome affects Parkinsons. The next steps are to confirm these results in mice, followed by fast-tracked clinical trials since the probiotic we tested is already commercially available.

Whilst the next stage of research is completed, anyone who is interested in improving their gut health, should consult a qualified health professional or specialist before making any changes to their diet, medications or supplement intake.

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