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Integrative Approach to Parkinson’s Disease with Dr. Karin Duncan

Dr. Karin Duncan discusses an Integrative Approach to Parkinson’s Disease with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

 

Podcast Highlights

5:34  Parkinson’s Disease is a neurodegenerative disease of accumulated motor dysfunction. Parkinson’s is marked by the accumulation of alpha-synuclein in the basal ganglia in the brain. It is usually classified by the hallmark symptoms of bradykinesia, or slow movement, stooped posture, masked face, and a tremor.  We are very late in diagnosing this disease and by the time most people are diagnosed, 80% of the dopaminergic neurons are depleted.  We don’t know what causes Parkinson’s, though there are theories that look at possible causes, including oxidative stress, environmental exposure, genetics, mitochondrial dysfunction, and gut dysbiosis. 

7:13  Dopaminergic neurons are unable to produce sufficient quantities of dopamine in patients with Parkinson’s. When these dopaminergic neurons, which are highly concentrated in that basal ganglia, as they die and they release their toxins and their cell debris, and this creates oxidative stress for their surrounding neurons.

8:35  Parkinson’s is a chronic disease, likely autoimmune in origin, that develops over decades. While we know that smoking, sedentary lifestyle, obesity and family history are risk factors for heart disease, most people don’t know that risk factors for Parkinson’s are anosmia (lack of sense of smell), REM sleep disorder and constipation, which are typically present for 10-20 years prior to a diagnosis of Parkinson’s.

 

 



Dr. Karin Duncan is a board certified Naturopathic physician with a focus on integrative neurology.  Dr. Duncan is a specialist in treating patients with Parkinson’s disease with an Integrative Approach.  Dr. Duncan works at Coeur d’Alene Healing Arts in Idaho and the website is cdahealingarts.com

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.

 



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates, and to learn more, check out my website, DrWeitz.com. Thanks for joining me and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Our topic for today is Parkinson’s disease with Dr. Karen Duncan. And this is the first time we’ve covered Parkinson’s disease. Dr. Karen Duncan is a board certified naturopathic physician with a focus on integrative neurology. Dr. Duncan is a specialist in treating patients with Parkinson’s disease, using an integrative functional medicine approach.  Dr. Dale Bredesen has blazed the trail in developing a functional medicine approach to the prevention and treatment of Alzheimer’s disease, but there are not many in the functional medicine world who have a specialty of treating patients with Parkinson’s disease which is the second, most common chronic neurological disease after Alzheimer’s.  Fortunately, there is quite a bit of literature looking at the potential benefits of specific nutritional and lifestyle approaches to helping patients with Parkinson’s disease, as Dr. Duncan helped me to discover when I asked her to send me some references, and she was very kind to send me more than 20 papers to read. And of course, being the science geek I am, I read most of them. So Dr. Duncan, thank you so much for joining us.

Dr. Duncan:        Of course. Hey, you’re already doing better than me. I don’t know if I’ve read all of them.

Dr. Weitz:            So before we get started, I just found out yesterday that there’s this big scandal about the research related to Alzheimer’s disease. This researcher investigator did this careful analysis of the hallmark study that really seemed to have proven the hypothesis that beta amyloid aggregation in the brain was the cause of Alzheimer’s disease. And this was referenced in thousands of other studies as a basis for all these drugs, which haven’t worked. And it’s really a major scandal in the Alzheimer’s world.

Dr. Duncan:        That really caught me off guard when I heard about that, and thank you for sharing that information. And it’s an incredible jumping off point to our conversation today, just about research, really. What is research and what does that mean for our patients? And I think, you haring that with me, the very first thing that hits me, especially in this profession, is just overwhelming sense of grief for the patients and the caregivers and these people who invested time and energy and their healing potentials into these therapeutics that were founded on a scandal. And I think that’s really, really unfortunate for the whole profession too. So disappointing to say the least.  But really the biggest question that I’d like to ask, because I’m a curious, nerd science geek too, is how do we know what we know? And my mentor always used the example of scurvy. She says, “Hey, scurvy was around for 300 years before we learned that the vitamin C in limes was the biochemical feature that was treating this disease of vitamin C deficiency in our sailors.”  But for 300 years, we were able to treat and save lives with limes. Parkinson’s disease has been around for about 300 years. We still have no disease modifiable medications on the market. And what the conventional researchers want us to prove is, why does this work? And really what we want to ask is, what works? What’s working out there and not causing harm, and then how can we kind of figure out what’s in the lime? So to speak. How do we do that? Because meanwhile, these are humans, these are patients. These are people with Parkinson’s and their families who are going through this. [inaudible 00:04:18]

Dr. Weitz:            And we also have Dr. Dale Bredesen’s work, who’s shown for the first time that Alzheimer’s disease can actually be not just slowed down, but reversed using a full functional medicine approach. And none of the medications for Alzheimer’s disease has ever been effective at doing anything other than possibly slowing the progression. And yet we have a functional medicine approach that can reverse it. But of course, this is falling on silent ears in the conventional medical world.

Dr. Duncan:        Yeah. I mean, we’re trying to yell louder. And I think the big explanation there is it’s slowing progression, and that’s with Parkinson’s disease. Are we slowing progression or are we masking symptoms? And of course, symptom palliation is really important. We want to improve quality of life with that medication, and that’s levodopa. That’s “Oh, I love it, prescribe it. I’m on it.” But what are we doing to slow progression?  And like you started at the beginning, we actually have the data that conventional research wants to see with these nutraceuticals, with food choices, with exercise, with lifestyle that is showing slowing of progression of the disease.  So as that marches on, when we’re palliating symptoms, we’re actually doing interventions that can actually slow the progression.

Dr. Weitz:            So let’s start right there.  And perhaps you could define for the listeners, what is Parkinson’s disease and then how is it best diagnosed?

Dr. Duncan:        Well, Parkinson’s disease is a motor degeneration, neurodegenerative disease of motor dysfunction accumulation. I mean, now we’re going to start asking questions, you’ve already put that down my ear. But the accumulation of alpha-synuclein in the basal ganglia there in the brain, which is our motor nucleus. So it’s usually classified by the hallmark symptoms of bradykinesia or slow movement, stooped posture, masked face, and a tremor.  And that tremor has really taken the load of diagnostic criteria to get to Parkinson’s disease. The truth is Ben, we’re 10 to 20 years late on diagnosis. Parkinson’s disease is starting decades before patients show up with a tremor. And by the time they’re diagnosed, 80% of their dopaminergic neurons are deplete. So we’re just late to the game, and diagnosis in specific.

So when you ask what is Parkinson’s disease, and I stutter, it’s like, well, we don’t really know yet. We know what we’ve been told and we know what we’re seeing 20 years after it begins, but we’re still not sure what causes it. And the theories out there for Parkinson’s as oxidative stress is that environmental exposure, genetics, mitochondrial dysfunction, gut dysbiosis. We’ll go into some of these. And the answer is yes, yes, yes, yes and yes. We’re seeing all these as being correlative.

Dr. Weitz:            And of course you just mentioned the dopaminergic neurons. So maybe you could explain what happens there. So part of the process is, is that the person with Parkinson’s is unable to produce sufficient quantities of dopamine. Correct?

Dr. Duncan:        Right, yep. And that’s exactly it. These dopaminergic neurons that are highly concentrated in that basal ganglia, as they die and they release their toxins and their cell debris, it creates oxidative stress for their surrounding neurons. And therefore, we have this accumulation of neuronal death and inability to create dopamine, which then will create at some threshold, again, unbeknownst to us, will start to create these motor symptoms that then lead patients to seek care.

Dr. Weitz:            And what you’re saying about the fact that this long, gradual onset of disease, and by the time these symptoms help us to diagnose this condition it’s been going on for decades, is very common for the majority of autoimmune diseases, right? Of which I think Parkinson’s is believed to be one, right?

Dr. Duncan:        There’s definitely theories out there that this is a type of autoimmune disease that’s similar to Alzheimer’s disease. Is this a type three diabetes? There’s so many different system implications, but a ton of research on the autoimmune part.

Dr. Weitz:            So these chronic diseases are slowly developing for long periods of time. And we should really be focused on trying to see some of the underlying triggers and other factors that are slowly causing our brain not to function properly or to lead to brain neural inflammation and try to identify some of those and intervene, rather than waiting until the person has already severe damage to their central nervous system.

Dr. Duncan:        Yeah. You nailed it, Ben. I mean, if I were to ask you, what are the top three risk factors for heart disease? Anybody in the medical profession can list them off, rattle them off. We’re looking at smoking, sedentary lifestyle, obesity, family history. We’ve got those, and you see this combination of symptoms in your office and you’re like, “Whoa, let’s get going. Let’s prevent.” It doesn’t matter what modality you practice.  What if I were to tell you that the largest percentage of patients that are diagnosed with Parkinson’s had 10 to 20 years of anosmia or lack of sense of smell, REM sleep disorder and constipation. Now, you see those in your clinical practice as a patient who’s showing up in these ways, can we respond in the same way and say, “Hey, do we know for a fact you’re going to get Parkinson’s?” No, but can we do something right now to say that you won’t?

Dr. Weitz:           Let’s shine a little light on what you just said. So those three are early prodromal symptoms. And can a person have one or two of those or is it more likely that they have all three of those and are more likely to develop Parkinson’s?

Dr. Duncan:        Honestly, I don’t think there’s data that will show what percentage of people with Parkinson’s have one, two or three of these motor symptoms. And when you’re looking- [inaudible 00:10:27]

Dr. Weitz:           Lack of sense of smell, constipation and, let’s see-

Dr. Duncan:        REM sleep disorder.

Dr. Weitz:           And REM sleep problems. Interesting.

Dr. Duncan:        So the majority of people with Parkinson’s will present with all three of those if not, like I said, one or two. I guess my point is, if somebody shows up to your office at 40 years old, with this [inaudible 00:10:50], can you respond as quickly as you would with the risk factors for heart disease?

Dr. Weitz:           Absolutely not. No.

Dr. Duncan:        No, no. I mean, we’re giving MiraLax and [inaudible 00:11:01]. I mean, in all actuality, I mean, these people are getting treated for those things. And I think this recognition of what does this mean and what could this show us? And we get this data again, because we’re doing these patient reported outcome measures, these studies that say, “Hey, I’m going to survey this population of Parkinson’s,” which you’ve already mentioned is vast and say, “Hey, what do you got going on? What did you have going on? What’s leading up to your disease and what’s making this hard for you?”  And when we look at pre-motor or non-motor symptoms, I mean, the list is a mile long. And I want to get into that. That’s really, I think the meat of what we’re doing here. But addressing that tremor I had mentioned before has taken the cake as far as measurement of success in treatment of Parkinson’s disease.

My patients will come in and they’ll say, “Hey, I went to my primary neurologist.”  I said, “Great. What did you cover?”  “I did the chicken dance, the UPDRS score. How well can my fingers move?”  I said, “Awesome. How’d you score?”  They’re like, “I don’t give a shit. Here’s what’s bothering me. I have anxiety. I still haven’t pooped in three days. I’m drooling in public. I wake up to pee four times a I mean, you dive into these conversations and this, tremor is a hallmark of diagnosis of Parkinson’s, it really just needs to step aside.

Dr. Weitz:            Okay. So is there a definitive way to diagnose Parkinson’s or is it mainly by symptoms?

Dr. Duncan:        It’s mainly by clinical presentation. Yep. You’re going to see that we have a DaTscan out there. So there’s imaging of the brain that can… I treat it kind of, as it can confirm a positive suspicion of diagnosis, but it won’t always not confirm that it’s not there. So the false positives and negatives there are high. Working with a lot of the movement disorder specialists in the area, I’m really well integrated with the conventional side here and they don’t rely on it heavily for diagnostic criteria. So it really is constellation of symptoms, patient presentation, and physical exam can’t be minimized. Can we actually get in there, and is their cogwheel rigidity? What does the tremor look like? Are we checking DTRs? Because these things help us support what else is happening in the body, not just Parkinson’s [inaudible 00:13:19].

Dr. Weitz:            So give us some things that we can look for on a physical exam that would really alert you that this may be a patient with Parkinson’s.

Dr. Duncan:        I mean, you’re looking for tremor, drooling, the outward bradykinesia. You’re going to do your gate analysis and posture. What I want to say is, when we’re looking for these things on a surface level, can you dive three steps deeper? A lot of times, yeah there’s going to be gait abnormalities. Are you asking, was there injury, surgeries? What else is happening there? Are you checking leg length discrepancies on physical exam? When you’re doing your range of motion tests, are you doing active and passive? Are you doing resisted? Again, injury, surgeries.

So I think we’re quick to the diagnosis of Parkinsonism if I can say that, to be so bold. Because I think there’s all these things that we’re trained in medical school to ask. And then there’s layers underneath. Most of the patients who are presenting it, they’re 70 years old, that’s a lot of life lived.  And while it might appear to be Parkinson’s disease, really ensuring that you’re familiar with the human body and how it moves in their personal history is important. So yeah, the gait analysis, the lack of arm swing, and then so much of the physical exam then is going to be the interview. What are your non-motor symptoms? There’s widely published questionnaires out there, MNS questionnaires for PD. I highly recommend all clinical practitioners to at least do one round of that- [inaudible 00:14:46]

Dr. Weitz:            Which do you consider the most accurate questionnaires? And I’ve seen some discussion in the literature about questionnaires that are filled out by the patient and questionnaires that are filled out by the practitioner. What do you think is the most effective questionnaire or questionnaires?

Dr. Duncan:        The one that you do. The one that you ask. Again, I just, I’m seeing so few actually being completed. But [inaudible 00:15:16] one, it’s a very, I don’t know, PD NMS questionnaire. I’d have to give you the resource, I don’t have it sitting in front of me. But it asks very specific questions. Are these non-motor symptoms that you’re having, on a scale of one to four, how frequently are you having them? And then, how much are they impacting your quality of life? So again, a three tiered questionnaire.

Now another one that we’re using in our research and that I use in my clinical practice is called the PRO-PD, and it a stands for patient reported outcomes in Parkinson’s disease. And this is something that I have my patients fill out every six months under my care. And it’s a patient filled out subjective survey. And it’s a slider bar, which I really like instead of the zero to 10, because people want to say four and a half and you’re like, I don’t have that button.  And they fill this out. And why I think that’s beneficial is, you can see it on interview. They come in December, there’s four feet of snow on the ground. They’re cold, they’re depressed, it’s COVID, we’re isolated. And I say, “How do you feel?” “I feel terrible.” And you look at their PRO-PD and it’s actually kind of decent. And then six months prior in June, they’re in and it’s sunny and they’re going for walks and their PRO-PD is much worse. So it does hold that a little bit accountable for that objective and subjective asking of questions.

But the main point here is you can’t look at somebody and know how they’re doing. One of the most poignant things one of my patients actually told me is, “You keep asking me about my anxiety.” And he goes, “I don’t think it’s anxiety in the typical definition of anxiety. What you see on the outside, this tremor, is what I feel on the inside. It’s just discomfort but the only way I can express it is through anxiety.” So really getting to know what this feels like for people.

 



Dr. Weitz:            I’ve really been enjoying this discussion, but I’d like to take a minute to tell you about a new product that I’m very excited about. I’d like to tell you about a new wearable called the Apollo. This is a device that can be worn on the wrist or the ankle, and it uses vibrations to stimulate your parasympathetic nervous system. This device has amazing benefits in terms of getting you out of that stressed out sympathetic nervous system and stimulating the parasympathetic nervous system. It has a number of different functions, especially helping you to relax, to focus, to concentrate, get into a deeper meditative state, even to help you sleep, and there’s even a mode to help you wake up. This all occurs through the scientific use of subtle vibrations.

                                For those of you who might be interested in getting the Apollo for yourself to help you reset your nervous system, go to apolloneuro.com and use the affiliate code, Weitz10. That’s my last name, WEITZ10. Now, back to the discussion.

 



 

Dr. Weitz:            So let’s just mention the most common pharmaceutical approaches to Parkinson’s and why this approach is problematic, which is typically to take a combination of Levodopa and Carbidopa.

Dr. Duncan:        That is really the goal standard in the first line therapy for Parkinson’s disease. And to be quite honest, Ben, I support it. I think there’s the, again, kind of likening it to type one diabetes. Somebody who can’t make the hormone that improves their quality of life and physiological being, we need to supplement that.

Dr. Weitz:            So Levodopa and Carbidopa help the brain to make dopamine, correct?

Dr. Duncan:        Not necessarily. They’re just giving the body that dopamine that the body is missing. So that’s why it’s a palliative medicine. Because we can’t make the dopamine, we’re going to give you the dopamine. Now where it’s really helpful, the Carbidopa and this again, I don’t see really out there in the education that much. And I was like, the metaphor of a car. Carbidopa is the car, it’s the shuttle bus. We have Levodopa receptors throughout our entire periphery, but that Carbidopa really holds on to Levodopa until it gets to that blood brain barrier and then releases it. So it’s a higher concentration of efficacy in the brain.

So on that note, why I always prefer the synthetic medications of Sinemet or Rytary for my patients is because it’s really hard to standardize with something like mucuna pruriens, which is the natural source of levodopa. It’s highly concentrated and potent, but that potency can vary from capsule to capsule, manufacturer to manufacturer, bottle to bottle within manufacturers.

So we’re still working on really getting a standardized process there. And then we’re lacking the carbidopa part of that. So I’ll tell patients, “Hey, if you want to take mucuna, that’s great. Drink it with your green tea.” And they come back two weeks later, “I can’t drink anymore green tea. It’s a lot of green tea.” So when we’re looking for standardization and what dose is required, I’m definitely on the, “Hey, let’s get you some Levodopa. Let’s improve that quality of life for you by symptom palliation.” But with the explanation, we are not slowing the progression of the disease by doing this.

Dr. Weitz:            Right. And then one of the problems with these drugs is that after a while they stop working as well, isn’t that correct?

Dr. Duncan:        That’s a really popular theory that we continue to challenge, and in my clinical practice… So when I first started, I was like, “I challenged this. [inaudible 00:20:43]. I challenge this.” Being further into clinical practice, Ben, I’m sitting there like, “I challenge this.” And so many patients will come in and say, “I just got diagnosed. But my doc said not to start right away because I’m going to wear off in 10 years.” And we start to get into further workup investigation. “How’s your thyroid, how’s your gut function? Let’s just dive into gut function.” Ben, if somebody’s constipated and they’re having one to two bowel movements a week, do you think their medications are going to be effective?

Dr. Weitz:            Of course not.

Dr. Duncan:        [inaudible 00:21:13] Right. It’s enhancing your absorption capability, your bioavailability, your absorption rate, metabolism, all of these different aspects. So what do we do? We go to the doc, “Hey, I’m not seeing the relief I want.” “Well, let’s add some more. Let’s add some more. Let’s add some more.” Five to 10 years in, “Oh, you hit your max dose. Sorry, we got to do something else.”  Well, what if we got people pooping? What if we detox the system? What if we reduced environmental exposures? What if we started really working with how the whole body’s physiology is optimal, and then we see these medications drop off. And why I’m able now to stand on the rooftop and say, “I challenge that concept,” is because for most of my patients, we’ve been able to decrease their dose of Carbidopa Levodopa and reduce medications by 30 to 50% within a year.

Dr. Weitz:            Interesting. I was wondering what you were going to say about this question. I was thinking that maybe you were going to say, “Let’s do all the functional medicine stuff first and then only throw in the medication later.” But you’re saying if they get on the medication, which is going to help them with some of their symptoms right away, and we do all the functional medicine stuff, then that medication won’t have the drop off effect that it does in a conventional approach.

Dr. Duncan:        That’s exactly it. It’s the top down, bottom up approach. And let’s not forget the mental, emotional side effects of Parkinson’s disease. I mean, apathy being the top one. So here we are on your prescription pad, conventional doc. “I am so proud of myself, I’m prescribing exercise,” right? Well that patient [inaudible 00:22:46] emotionally to get up and to go exercise, and to want to do these things. This is an aspect of neurologic health. And so when you’re speaking to a patient and their care provider and the care provider’s in there, “I can’t possibly… Pulling out the hair, try to motivate him to go out and go to the gym anymore. I’m losing my mind. This is so hard.”

And so why would we expect somebody to be able to go do lifestyle changes if they feel terrible? If they’re apathetic. So yes, giving this Levodopa, giving this synthetic medication to supplement that loss at the very beginning is really what I think promotes the healing process. And like I said before, 80% of your dopaminergic neurons are gone. So if we can get the benefit of supplemental Levodopa for the rest of your life, I’m in. And then, okay, now we’re enhancing those other potential side effects of apathy and depression and anxiety. So then they’re more apt to go out and exercise and build up their vitality and health and really slow the disease down.

Dr. Weitz:            So let’s go through some of the most common environmental triggers that you found tend to play a role in patients with Parkinson’s. You just mentioned gut health. Let’s talk about some of the gut health factors and things that you often see in patients with Parkinson’s.

Dr. Duncan:        Yeah. How much time do we have here?

Dr. Weitz:            No, I know. But …

Dr. Duncan:        I’m going to tell you something. By nature, I’m one of those devil’s advocate people. I drive everyone nuts. So I sat through all of school and said, “I will not be that doc that says it all happens in your gut.” The flow of the tide, you go through naturopathic medical school, you’re learning functional medicine, you’re doing all these things and it’s, it’s in the guts, it’s in gut, it’s in the gut. And I’m just like, “I challenge this.” Again, I’m like, I’m not real loud, because I’m still in school. But I’m like, I’m not going to be that doc.

Lo and behold here I am, that doc, being like, “How’s your gut, what’s happening in there? Let’s take a peek.” And if I throw out a guess in my patient population, 90% of people with Parkinson’s that I’m seeing have gut dysfunction. Either small intestinal bacterial overgrowth or SIBO, we’ve got dysbiosis. I mean, one of the hallmark nonmotor symptoms is constipation.

And I’m not talking your run of mill constipation, I need to go take a laxative once a while. I’m talking patients coming into my office, doubled over in pain saying, “I couldn’t sit down and watch a movie with my family yesterday because it hurts so bad. I haven’t had a bowel movement.” So this type of gut dysfunction and dysmotility, we really need to address this in a, again, holistic approach. Of course, that’s what I do. So that’s the word that comes to mind.

Dr. Weitz:            What are some of the most effective ways you’ve helped patients with Parkinson’s with constipation and some of these gut disorders? Dysbiosis.

Dr. Duncan:        I’m going to say the very first thing is one, normalizing it for them. Letting them know they’re not alone in this. And two, letting them know this is a huge contributing symptom to their disease severity. Again, so many people come into my office and they’re scared and they’re grieving and they’re pessimistic. And I don’t place blame anywhere other than maybe higher up on the insurance realm. But they’ve been told, “Hey, you have a neurodegenerative disease. Here’s your medication, I’ll see you in six months.”  And that’s scary. And you see, “I have Parkinson’s disease and here’s what I’m going to go Google.” So they come in here feeling very fearful, and what are they doing? And so what I like to say is, “This is a package deal. There’s so many aspects to this. Let’s teach you about what happens when you’re constipated in your gut. If the goal of pooping is to literally get rid of toxic sludge in your body and you’re not pooping, what’s happening in your body?”  And they go, oh. You know, can see the light bulbs come on. I’m reabsorbing those toxins and here’s what’s happening in my bloodstream. And so you just, really trying to say, this is our goal, this is what we want to do. And you can see them relax and really start to understand and become in tune with their bodies. So the education piece is huge.

The second thing is, there’s population studies out there that show people with Parkinson’s have a decreased sense of thirst. Now, whether it’s a decreased sense of thirst or they just don’t want to drink because they’re so sick of peeing every five minutes and then they have to stand up to go pee, and their orthostasis when they stand up, and then there’s this whole conglomerate of things that we have to think about. But if you’re not drinking water, Ben, you’re not pooping. We know this to be true.  So I have these in-depth conversations with people every time they walk in my office about water and electrolytes and how do we move poop. What is pooping? So we talk a lot about poop. But the important thing is that people start to understand their bodies. And when there’s understanding, then we shift into that parasympathetic nervous system and we can come out of that fear and that fight or flight. And oh, lo and behold, that’s vagal nerve function. And now we’re having better gut motility and better digestive enzymes. So we’re teaching people how to masticate and how to swallow because now there’s trouble swallowing, and enhancing absorption by different nutraceuticals.

I mean, I have a whole six week protocol and it’s called the gut overhaul. How do we remove triggers, decrease inflammation, increase gut motility, increase absorption? And at the end of six weeks, people are coming in and like, “I never thought this was possible.” And you’re talking about people who’ve had a disease for 20 years and now they’re pooping for the first time. And oftentimes, constipation goes back to childhood. So I get a lot of [inaudible 00:28:02] about poop and I think it’s full circle karma for my attitude in med school saying, “I’m not going to blame everything here on the gut.”

Dr. Weitz:            Right, good. So I know heavy metals can play a role and I’ve even seen a couple of papers about manganese, which I guess you can have excess amount of manganese that creates a Parkinson’s like syndrome. And it’s just so interesting how some of these heavy metals like manganese, which are absolutely crucial for health, you can have deficiencies and that creates problems, but too much is a problem too.

Dr. Duncan:        Yeah. Manganese associated Parkinsonism is really commonly known within the profession. And we’ll run a heavy metal screen. I usually do it on hair. It’s the least invasive and it’s a pretty easy one to comply with, to get a start there. And oftentimes if we do see manganism. So I’ll say in my clinical practice or in my professional career, I’ve seen three total patients, which is a pretty big in comparatively to how many I’ve seen that were misdiagnosis with IPD. So idiopathic Parkinson’s disease that we got to switch that over to Parkinsonism, do a detox protocol and watch their health improve by a significant amount. Yay, victory. That’s wonderful.

Dr. Weitz:            Great.

Dr. Duncan:        Manganism is definitely, like I said, it’s really well known. And what we’re seeing a lot of is, manganese is actually, like you alluded to, it’s actually an the essential element. So it’s not even so much a heavy metal toxicity. We’re looking for aluminum and uranium and different heavy metals in the body, but manganese, we actually see deficiencies of. So I get a little bit of cross eyed stares when I prescribe manganese as a supplement. We manage that carefully of course not to go in excess, but as you alluded to manganese deficiency creates its own set of problems. [inaudible 00:29:47]

Dr. Weitz:            So what are some of the most common heavy metals that you’ll see involved with Parkinson’s?

Dr. Duncan:        Heavy metal, mercury and lead. I mean those are kind of your [inaudible 00:29:58] with neurologic conditions. So those are really common, especially when we’re talking about the generation that’s most prevalent to have the condition. How they were growing up, what they were exposed to, what we didn’t know back then that accumulates in the body. And we know postmenopausal women… We usually will diagnose Parkinson’s disease earlier in men, and then usually not ’til post-menopause with women. And there’s a couple different theories out there with that. But one of them that I look at the most when we’re talking about heavy metals is that’s when the process of osteoporosis starts to come in. We’re using our [inaudible 00:30:36] and our supportive mechanisms for our bone health and-

Dr. Weitz:            So these metals are stored in the bones. And then when the bones start breaking down, they release the heavy metals?

Dr. Duncan:        Exactly. Yep. So now we have an increased toxic burden, and whether it’s creating Parkinson’s or exacerbating Parkinson’s is still a question that needs to be answered. Along those same lines, heavy metals and toxins are stored in our adipose tissue. And again, one of the metabolic side effects of Parkinson’s disease or a movement disorder is increased weight loss. So now we have this osteoporosis happening and we have this weight loss happening where we’re breaking down fat and we’re just increasing this toxic burden to our body.

Dr. Weitz:            And I guess chronic viral infections like HSV and EBV can be factors.

Dr. Duncan:        I mean, they absolutely can be factors. And when we’re starting to really tap into this greater theory of … I’m a big metaphor person. And like I said, is your Parkinson’s disease a suitcase that you’re lugging around? Is everything that you have in your body associated with Parkinson’s disease? Or can we look at you from 20,000 feet up and say, “Oh, you have a little thyroid dysfunction and you have this toxic metal burden. Oh, you have this chronic viral infection in there and you’ve got dysbiosis.”

And now when we start treating these things peripherally that we are so quick to say, “Ah, that’s just a symptom of Parkinson’s disease,” it makes that load a lot lighter. And I say, can we take Parkinson’s disease as a diagnosis and throw it on like a backpack and go about with your day instead of lugging that thing around. So I think what you’re really getting at here is that concept. All of these things that we associate with the disease, yeah, they’re there, but again, our patients are 70 years old for the most part. [inaudible 00:32:20] got some, a young onset Parkinson’s disease, of course, but they’ve accumulated some health crises. They’ve done it, they lived. So of course there’s going to be things in addition to that, that we’re just really quick to say, “Oh, that’s Parkinson’s, you’ve got to live with this.” And again, that quality of life and that patient centered care staying in your focus just has to be that primary goal.

Dr. Weitz:            So you mentioned hormonal imbalances. I know that Dr. Bredesen often with patients with say, women postmenopausal, even though they perhaps are in their seventies already, will sometimes put the patients on estrogen replacement. What do you think about hormone replacement therapy as part of the treatment protocol?

Dr. Duncan:        I mean, I feel like everything that I’m saying to you starts with it depends, but it really does.

Dr. Weitz:            Oh, I know. Of course it depends. And it’s a complicated factor and there’s risk factors, et cetera.

Dr. Duncan:        It’s really, really helpful. It’s a really helpful tool, as long as you’re screening the risk factors and you’re doing all the things, but there’s a boatload of data on DHEA as neuroprotective. Right?

Dr. Weitz:            I saw a couple of papers, yeah.

Dr. Duncan:        And we labeled DHEA, I mean, who doesn’t want this? The spunk and vitality hormone, right? I want some. I’m raising a toddler here. I’m sipping on coffee. I want some spunk and vitality. So when we’re looking at DHEA levels, we’re looking, trying to get them above 100, and those will fall post menopausally. So like I said, there’s a ton of data and research out there about these specific hormones and the protective mechanisms they have on the brain. Now, the one thing that I want to bring up again, as that person who said, I wouldn’t always talk about poop, is hormonal imbalances are often secondary to gut dysbiosis and inflammation. So making sure also that you’re covering that liver. I hate, do you have cholesterol? I know you mentioned you’re doing something this evening with Dr.- [inaudible 00:34:24].

Dr. Weitz:            Yeah, a tribute. We have a YouTube tribute to Dr. Sinatra.

Dr. Duncan:        To Dr. Sinatra. So, I mean, when we look at cholesterol, again, you want to see some side eyes from my patients’ cardiologists, like, “You took them off what?” And I’m like, “Yeah, we want cholesterol, we’re packaging hormones.” And these are things that we’re starting to challenge the status quo a little bit here, because it’s also the padding in the brain for neuronal connections. So all of those factors play into yes, hormone replacement therapy can be a safe and effective option for our patients. And often vastly improves quality of life.

Dr. Weitz:            Is it possible to have a purely natural approach to Parkinson’s without pharmaceuticals? Have you had any patients who were successful in an approach like that?

Dr. Duncan:        I have, yes. So there are some patients who are just really set on, we have the whole conversation and informed consent, shared decision making, but, “Here’s what I feel about Levodopa.” And they manage, there are some patients out there, exercise and diet and mindfulness and social connections are really managing their disease well.  And again, that’s why we want to shift this research paradigm and say, “Hey, you’ve had this condition for 10, 15, 20 years, and you’re climbing mountains here in Seattle. What are you doing? Give us your secret.” Then let’s isolate those against different variables and things to see, can we reproduce this? That’s what research all is. Is it reproducible? So yes. I mean, a short answer to your question is yes, I’ve absolutely seen patients live with, in a very high quality of life, their Parkinson’s with just a natural approach.

Take the pharmaceutical entacapone, for example. It’s a pharmaceutical that we give in conjunction with the Carbidopa Levodopa to help its efficacy over time. Hey, this makes it more effective. You’ll see a greater benefit. We also see that with CDP-choline. So acidic choline, a natural supplementation nutraceutical. When dosed appropriately, we can see a 30% reduction in the need for medication in 30 days, Ben, in a month of taking [inaudible 00:36:36] supplement. So if you’re taking mucuna and you’re taking some CDP-choline, and you’re taking some fish oil, high DHA, and you’re exercising and working on your vagal nerve function, I mean, you’re slowing the progression of disease at a very organic level without- [inaudible 00:36:54].

Dr. Weitz:            So what dosage of CDP-choline?

Dr. Duncan:        We’re looking at 250 milligrams. And I’m going to double check that. 250 milligrams, I believe that’s twice daily.

Dr. Weitz:            Okay, cool. So I want to go into the nutraceuticals, but before we do, I want to ask you another question that I’m sure your answer’s going to be it depends, but what is the best diet for Parkinson’s disease? I’ve seen people advocating the ketogenic diet, autoimmune paleo, avoiding dairy. Let’s talk about diet for Parkinson’s.

Dr. Duncan:        Let’s talk about diet for Parkinson’s. You’ll get some hate mail on this. When you know this is one of those factors that people get pretty upset about. The overwhelming research and data that we have for diet for Parkinson’s is Mediterranean, MIND, whole food plant based, that those three kind of conglomerate, that’s what we’re looking for. And really the constituent that we’re looking for in those foods is the antioxidants. We’re looking for those flavanoids and the anthocyanins and the things that we’re getting from these freshly harvested, fruits, vegetables, and things like that. And then your healthy fats.  So when you start breaking that down, and this is what I love about my mentor, and I have to give her a shout out at some point in time through this, because I’m really just downloading her brain into my mouth and- [inaudible 00:38:18]

Dr. Weitz:            Who’s your mentor?

Dr. Duncan:        My mentor’s Dr. Laurie Mischley. So she’s really spearheading the integrative research for Parkinson’s disease globally. She speaks at World Parkinson’s Congress.  She’s fun funded by the Michael J. Fox foundation and NAAH. And she’s got a seat at the table anywhere she wants to go to really start bringing this to light.

So I like to just use that. I’m downloading her brain to my mouth and here it comes. So, it’s fascinating. Smatterings of my clinical practice, but she’ll ask the tough questions. Is a whole foods diet effective because of the food, or is it effective because now we have to go chop and prepare and cook and you’re smelling your food and you’re involved in the eating and there’s this whole other integration and intimacy with your food when you’re not just getting it frozen out of the freezer and heating it up in the microwave? So there’s a component of that there. But the overwhelming data then is that this Mediterranean style diet is the most beneficial for Parkinson’s disease. Now we’ve already- [inaudible 00:39:17]

Dr. Weitz:            I guess one of the reasons why people advocate a ketogenic diet is because it’s been shown to be beneficial, I believe for Alzheimer’s and because of the whole concept of insulin resistance in the brain and having a higher fat, lower carb approach and having the brain work off of ketones, there is an argument that the brain works better that way.

Dr. Duncan:        And like I said, I’m pretty well versed in that data as well. And when it comes to food, I’m definitely one of those practitioners, the best diet is the one that somebody’s going to eat, that they’re going to comply with. So if we can move towards ketogenic through the Mediterranean diet and that’s supportive and working well for them, and it’s in alignment with their quality of life, great. However, I’m not seeing the research really push it far enough over that I’m going to sit here and say this or bust, right? So I really like to take that into account.

The second thing that I just want to bring out, and I’d always be remiss if I didn’t and just a quick snippet, we’re talking about a population that’s not often identified as having disordered eating habits. We reserve that for our 16-year-old athlete girls. And that’s a huge number. When you get into the conversation about how these individuals were raised from the World War II, depression, parents, and stoicism, and you eat what’s on the table and here’s how you look and here’s how you act, the very different mindset that we’re in now, there’s a lot of disordered eating habits that I’m seeing in my practice.

So I just wanted to bring that to light a little bit too, to be really cautious when we’re talking about food with our patients and really establishing what that relationship is with them and food. Because that’s, again, we’re talking vagal nerve dysfunction. If I prescribe a diet for you that’s going to cause you stress and anxiety, screw that diet, right. That’s not what we’re going here for. But really, yes. So to just kind of get back to the thick of it there, that Mediterranean MIND diet is what we’re going for here. Some people do, I’ve had people come in and say, “I feel better on the carnivore diet.” “Okay, great. Let’s check your metabolic markers and make sure that you’re healthy.”

And this really again goes into the individualized care. We can prescribe diets, but we have to be considering insulin, other metabolic conditions, other thyroid conditions. And I have a patient who had esophageal cancer. Can you even digest animal proteins? So now we’re really, again getting into that it depends area, but the overwhelming research we share is that. And we have the data. I think I shared it with you, what foods all the way from frozen vegetables to canned vegetables, to fresh vegetables, what’s better? Which do you choose. So it’s there, it’s available.

Dr. Weitz:            And I guess there’s some data showing that dairy in particular can be problematic as a trigger.

Dr. Duncan:        I usually put up my desk shield when I talk about that with patients. And they’re like, “Does that mean cheese?” And it’s like, “Well, yeah.” And then they’ll say, “But what about this?” And the answer to that goes back to the initial conversations. There’s not going to be a randomized controlled trial, double blinded, placebo controlled with goat cheese versus sheep cheese versus cow cheese. So you choose, but we have overwhelming data that not only people who consume [inaudible 00:42:39] dairy have a higher incidence rate of developing Parkinson’s disease, but also those who have already been diagnosed have faster progression rates. So that is one thing that I kind of put my foot in the sand and say, this is, if you’re going to do anything dietary, do this, take this out.

Dr. Weitz:            Which forms of exercise are most beneficial?

Dr. Duncan:        I just wanted to add one more thing to dairy because it helps when it’s not taking away your food. We have found in the data that a higher uric acid level, so not gut levels, but above four in the bloodstream, it’s actually a potent antioxidant for the central nervous system. So uric acid does have a purpose, right? [inaudible 00:43:16]

Dr. Weitz:            Wait, wait a minute. So uric acid level above four? Below four would be really low though. Right?

Dr. Duncan:        Right. And so four to six, we’re looking at to say, “Hey, we don’t want gout, but we want to keep this at a healthy level.”, And that it is a potent antioxidant for the central nervous system. So again, here’s something that we villainized, oh my gosh, uric acid is bad, but there’s a reason our body has uric acid. We have this sensical being to us that we still don’t understand. And while we know-

Dr. Weitz:            That’s interesting. Because lately with Dr. Perlmutter and the Drop Acid, his book, there’s been a big focus in the functional medicine world on trying to keep uric acid levels lower because it’s correlated with heart disease and other problems.

Dr. Duncan:        Right. And I can’t speak to heart disease, but what we know in the Parkinson’s population is that actually a higher uric acid level is beneficial, and the consumption of dairy inhibits uric acid production. So we have that, when people really come back with me about like, “Oh, I just don’t know about dairy.” I’m like, “Here’s a biochemical rational for you that shows what you can do.” And then if you’ve got a gout patient on the side with no allergy to dairy, bring on the dairy, right? How do we naturally bring [inaudible 00:44:32] your uric acid classic levels? [inaudible 00:44:35]

 



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Dr. Weitz:            So exercise, I saw a study on, I think you sent me a study on cardiovascular, aerobic exercises, being beneficial. What forms of exercise do you find most beneficial?

Dr. Duncan:        The form that you don’t know how to do. Something [inaudible 00:46:25]. Ballroom dancing is one of my favorite ones to recommend. Number one, I’m a huge advocate for caregivers, support partners, things like that. If you can find an activity that you can do together, it’s using both sides of your brain and you’re in this and you’re so worried about stepping on your partner’s foot, that you forgot you had a tremor for a minute, right? That’s the kind of neuroplasticity we’re going here. How do we support that neuroplasticity and growing new neuronal structures and learning how to do something new? Rock steady boxing is a phenomenal way to create community again, using both sides of your brain, being able to do some of that cognitive support with that as well. But really those things, Tai Chi has been really hugely studied in the Parkinson’s population, as far as that slow controlled movement and conjunction with your breath.

So cardiovascular exercise in general, yes, do it. But we do have some data. And I think it’s just the ones that they’ve selected to research. So biking and boxing and things like that. So again, it’s the one that you do and the one that’s new. So pick something new and then actually go do it.N.

Now, [inaudible 00:47:37] and really fascinating is, exercise is dose dependent. So when you have your prescription pad and you’re like, “Look at me, I’m so proud of myself, dabbling into this cam world. I’m going to prescribe exercise.” How were you doing it? What exercise are you prescribing and how frequent should patients take it. Put it in your orange bottle and actually give it directions. Because we have studies that show if you exercise fewer than four days per week, it doesn’t show any benefit at all. And then it’s an increase in benefit based on how many more days you do it. So six is better than five is better than four. So it is dose dependent, how often we’re doing these exercise routines and what type you’re doing.

Dr. Weitz:            I wonder if there’s been any data on strength training, because if you’re trying to do new, novel, different exercise movements, then strength training is something that would certainly lend itself to doing different exercises in different ways, on different equipment that would be a way to easily have a different movement that you’re bringing into your body on a regular basis.

Dr. Duncan:        I agree. And the very first thought that comes to mind on strength training is fall prevention, right? Practicality. How do we keep our fall prevention? The second thing that comes to mind is just thinking of myself when I’m lifting a really heavy weight. And what do you do? You grunt. You know, you use a big voice. We already know the [inaudible 00:49:03] program works for this minimal voice and some of these side effects. So I love it. I think there’s probably data out there somewhere that I’m not familiar with, but- [inaudible 00:49:14]

Dr. Weitz:            Let’s go into specific nutraceuticals for patients with Parkinson’s disease. And I would appreciate if you could be specific about dosages or even products that you like. The nutrient that I’ve talked to more doctors who feel that is the biggest game changer is intravenous glutathione. And yet I just saw a meta-analysis on glutathione that seemed to show that there was not necessarily any great benefits.

Dr. Duncan:        I mean, that’s a great place to start. Right off the bat, I practice individualized, personalized medicine. I do pride myself on that, and I can also say every person with Parkinson’s that walks through my door, walks out with a prescription for three natural medicines. And they’re the most highly studied and researched to either help with symptom management or slow progression. And that’s glutathione, high DHA fish oil, and Co Q10. And those have the data behind it to say it makes sense. And I’ll go into each one.

But to answer your question, I, glutathione. I mean, that research has been around since the ’80s. I want to say maybe even the ’70s, when they first did that study, you know, you walked down the hall, you get your IV and then we can watch you walk down the hall again. Again, it’s a very elementary like, “Hey, look at this guy walk better.”

The benefits are limited with IV glutathione. So it’s a high dose. It’s pretty invasive. They have to go twice a week to get the benefits of it, the long lasting benefit of it. And then it’s an IV. Like I said, it’s a little bit of an invasive therapy. The other thing it’s not accessible, it’s expensive. This isn’t something that insurance is covering right now. And the research that we have, it actually can show that either an internasal application of glutathione, or even an oral glutathione, and we do this through the buccal mucosa, has just as much benefit to our patients when they can take this on a daily basis from the home. It’s more cost effective and it’s showing benefit.

Dr. Laurie Mischley actually published a study. She got to phase two clinical trial, and I’ll tell you about why that kind of fizzled out after phase one. But the phase one was just overwhelming improvement in the UPDRS scores and handwriting. And this is well published out there on PopMed, with the use of intranasal glutathione.

So they moved it to phase two with the funding and people were so excited to be part of this study and to get, using this. And this is your double blinded randomized placebo controlled study that the placebos did just as well as the glutathione, which all [inaudible 00:51:50]. Yay, placebo. There’s so much more to medicine than just what we’re putting in our patient’s bodies about how we can get them excited for new therapies.

And again, alluding to my grief for these poor Alzheimer’s patients who bought into this theory that was a scam, but we have that power as physicians to get people really excited and hopeful about their therapies. But we are seeing benefit, especially in motor symptoms with the use of, like I said, oral or intranasal glutathione.

Dr. Weitz:            So tell us about the oral glutathione. Is there a particular product or products that you like, and is there a particular dosage that you tend to favor?

Dr. Duncan:        Yeah, so, I mean, I want to take this opportunity before we really dive into nutraceuticals, Ben, because I never thought that this was going to be one of my testaments as a practitioner. But because the supplement industry isn’t regulated by the FDA, it makes it really challenging for patients to navigate these waters. And it’s really frustrating as a healthcare provider to say, “Hey, that’s not a quality assured product, but I know that you don’t have access to maybe this or that.” So as often as you can, I just really advocate to share information, share resources, especially as our integrative care providers get out and do community chalk talks, get out and do webinars and podcasts and say, “This isn’t a thing that’s being done, but you can ask me questions. What are legit reputable sources for these supplements?”

Because they aren’t benign. They aren’t always safe. And just because your neighbor’s cousin’s brother’s dog saw benefit doesn’t mean you … And that’s where we’re really going in this healthcare field with so much research and resources on the internet and from your neighbor, that it’s really becoming harmful. And that’s what I’m seeing, patients unloading 30 to 50 supplements on my desk. “Look, Hey, this is what I’m taking.” It’s like, “No. I applaud your advocacy and resourcefulness, but here’s what we need to do for your body.” On that line, so for glutathione, we use a couple different brands. Quicksilver and Designs for Health have a really great oral liquid glutathione. I use the pump. It needs to stay refrigerated, and then it’s absorbed through the buccal mucosa. So I get a little bit of a bypass from the gut absorption dysfunction that we have.

Dr. Weitz:            And how many sprays do you like? And then how many times a day?

Dr. Duncan:        I dose that at two pumps twice a day away from food.

Dr. Weitz:            Okay.

Dr. Duncan:        Yep. And the side effect of oral glutathione is it taste like sulfur, which is not a fun taste. It’s a sulfur based compound. But I have learned that orange juice is a great chaser. So we find those to help with compliance a bit. The interesting thing about that is most of the studies that Laurie published were this intranasal application, right? Because we know we have a direct access to the brain through our nasal cavity. A little bit more challenging to do, not quite as cost effective. And what she did notice is that so much of it was draining down the throat anyway, but that’s kind of where it was going. So again, there’s a hierarchy of effectiveness of glutathione, and you do what works for your patient. And I found that an oral glutathione supplement is the most effective because people can access it for long periods of time and are compliant.

Dr. Weitz:            Okay. And then Co Q-10, I think I saw that you prefer MitoQ. Is that right? Or was that maybe in another article I read?

Dr. Duncan:        That might, I’m not sure which article it’s in. We usually do [inaudible 00:55:29] right, and activated Co Q-10 is a little bit more bioavailable. As far as brands go, we carry Protocol for Life here. There’s a lot of really great reputable brands of Co Q-10. I mean even Costco carries a really good one.

Dr. Weitz:            So you’re using Ubiquinol, and what dosage?

Dr. Duncan:        And that can be anywhere from 100 to 300 milligrams. And this is a really subtle effect that I tell patients, you’re not going to start taking this and in a month you’re going to be like, “Whew, I can go run a marathon.” But what we’re doing there, as you’re aware of, is we’re supporting the mitochondrial health. And mitochondrial dysfunction is one of the theories that is causative for Parkinson’s disease. But the big thing that I like to explain to patients in the education realm is if you have a movement disorder, and we know that the mitochondrial are really heavily populated in your heart your brain and your skeletal muscle, and you’re moving at a rate much more than I am, who can sit here still, then you’re utilizing a lot of that ATP. So we need to support this at a cellular level. Are you going to see this giant change? Not necessarily, but we are seeing in our population studies that people who do supplement with Co Q-10 have an improved quality of life. [inaudible 00:56:38]

Dr. Weitz:            And then you said you like a high DHA fish oil?

Dr. Duncan:        Yep. High DHA fish oil. And this part of the education comes in really important as well because one, the marketing, again, to go back to this regulatory body that we don’t have. You go look at the store. And I challenge a lot of my patients, say, “Go to the store and look at the dosing or look at the labels on the front. 3 million omega threes.” We’re blasting all of this on the front label, and then you turn it around and it’s, from other sources and here’s this and here’s that. And when you really break it down to the EPA and DHA, we’re at very few. And then you got to look at serving size, right? “Oh, you’re getting 500 milligrams of omega threes in four capsules.” Well, now we’ve got somebody who has difficulty swallowing and taking these giant horse pills and they’re getting a very minimal result.

So it is something that we as integrative healthcare providers have to be really well educated on to say, “Hey, I know this bottle of liquid fish oil costs three times as much as that one you’re going to get. Here’s why it matters. You have a higher D potency here. You have a less, it’s a teaspoon. You keep it refrigerated. Fish oil can go rancid, how it’s stored.” So that educational piece is really important. And we’re looking anywhere from two to four grams. So these aren’t milligram dosing, these are really high dosing. If you’re looking at somebody’s fish oil supplement, I’ll say, “Hey, go ahead and finish that bottle. And then don’t ever buy that again, because you’re going to finish it by tomorrow.” You’re taking 12 capsules a day to get the dose that you want.

Dr. Weitz:            Yeah. I saw some good data on vitamin D as being a factor.

Dr. Duncan:        Oh yeah. Vitamin D and neurodegenerative diseases across the board. We have this Venn diagram of Alzheimer’s and lewy body dementia and frontal lobe dementia and Parkinson’s disease and all these things. And they all kind of mishmosh in a lot of different symptom, presentations and theories of etiology and all these other things there. And then the nutrients that really support it. And vitamin D, as Dr. Bredesen has proven, has been hugely helpful in his Alzheimer’s protocol. So we definitely look at vitamin D status. I’m looking between 60 and 80 as a lab value. And I like to see your number be in the age decade that you’re in. You’re 75. Let’s keep you in the 70s. 68, let’s keep you in the 60s. Let’s just keep it in that range. And people really resonate with that.

Dr. Weitz:            That’s great. I saw lithium as being beneficial.

Dr. Duncan:        Lithium is hugely beneficial. And again, another side I write from the conventional. We know lithium is a medication for what condition?

Dr. Weitz:            Bipolar.

Dr. Duncan:        Bipolar, right. So when you’re dosing lithium, and you get these questions, lithium is an essential nutrient. It’s a cofactor for tons of enzymatic reactions and biochemical reactions in the body. And the most crucial one is it’s a cofactor for BDNF, it’s brain derived neurotropic factor. It’s how we grow new neurons. So we can’t grow new neurons if we don’t have lithium.

Now, there’s been studies again, since I want to say the ’80s or ’90s, and Dr. Laurie has published some of those as well, lithium deficiency as well as other minerals in our soil becoming deplete. People in the Pacific Northwest. It’s just all of the rain and the washout and everything else. There’s no lithium anymore. And there was actually even a petition a while back to lithianate the water, just like you fluorinate some water, to say, we need this in our body, and the incidents of mental health concerns in the Pacific Northwest. So we’re starting to see this correlation of lithium deficiency mental health concerns. And then we know that this is a treatment protocol. When you’re looking at lithium as the treatment protocol for bipolar, this is at a super physiologic dose. These are pharmacologic doses that we’re doing and we- [inaudible 01:00:23]

Dr. Weitz:            If we could just find some industry that has lithium byproduct as a part of their manufacturing process, so they can make profit off it. Then maybe it’ll be done.

Dr. Duncan:        We’ll just use the system as it … Yeah, I like your thinking. If it’s already in place and we’re causing damage, let’s have it. I like it.

Dr. Weitz:            So are you-

Dr. Duncan:        We’re talking [inaudible 01:00:47] doses of lithium. We’re supplementing. So there’s a big difference between natural medicine and-

Dr. Weitz:            So you’re using a low dose nutritional product.

Dr. Duncan:        I call it a physiologic dose. So I explain, there’s pharmacologic doses, there’s physiologic doses. And we’re supporting the mechanisms that are already existing in your body.

Dr. Weitz:            Resveratrol seems to have some potential benefit. Resveratrol is an incredible nutrient that seems to have all sorts of potential benefits for longevity, for cardiovascular disease and for brain health.

Dr. Duncan:        Right. Yeah. I mean just potently, potently, antioxidant, really phenomenal nutrient that we go for, and it’s food based, right? So that’s a really great one that you can say, you don’t have to go out and buy this or have it in a supplement of sorts. And that education is really helpful. I have patients come in again with all these things lined up and they’ve got a bottle of, “Oh, I have this Resveratrol.” I’m like, “Cool. How about we do this from food? These are some delicious sources. Hey, do you drink red wine? Great. What about dark chocolate and spices?

I mean, you can’t minimize the effect of spicing up our food. Us and our Western diet, man. The blandness of our food as a society is just sad in and of itself. But you use some curcumin and clove. My favorite concoction here in my coffee is a teaspoon of cinnamon and clove, and you get yourself a whole new ballgame with how do we have this loss of sense of smell, which leads to a loss of sense of taste. And so now we’re spicing up our food in a way that’s proving physiologic benefit and then increasing those taste receptors. And, oh my gosh, right now, now I’m salivating just talking about, how do we taste? How do we really engage with our food, which then creates the digestive enzymes that we need in our stomach and stimulates the hydrochloric acid secretion. So, okay, now we’re breaking down our food for better absorption and bowel motility and boom. Right ,here we go.

Dr. Weitz:            It’s interesting as you talk about loss of sense of smell and taste, and I think about the current viral situation we’re in, and you wonder about the long term effects in potentially triggering Parkinson’s.

Dr. Duncan:        Oh, yeah. I mean, think it’s a huge risk factor. And I have these conversations with people that this is something that we need to prioritize getting back online. Especially if I have some of these long term patients who are like, “Hey, I got the OG COVID and I still can’t smell.” All right, well, we’re going to have to work on that and really prioritize that. And if we can’t get the smell back, how do we substitute that cephalic phase of digestion, right, that thinking about food, the smell that elicits the whole process to start, how do we do that in different ways in the body?

And so mindfulness, gratitude, eating with community, harvesting your own food, cooking your own food. And then there is some smell retraining protocols that you can start working on as well. But you can’t substitute that phase of digestion. And we already know, and then we’re talking memory. So when you talk to me, I go in all these directions because it matters. Now we’re talking memory, right? The smell trigger is one of the first things we do for our memory retrieval. And now that’s gone, and oh, I’m having some cognitive impairment. Well, is there a link there?

Dr. Weitz:            Right? Absolutely. So one final question. I saw, and this is following up on the train of nutraceuticals. I saw Ginkgo, vinpocetine. And both of these are products that are often seen in brain formulas, neurotropics. Do you have a favorite neurotropic brain formula?

Dr. Duncan:        I do. I do. And of course, it’s individual. So botanical medicine is the heart of my practice outside of everything that we’ve done in research to treat the individual. Formulating a tincture for somebody with urinary urgency frequency, some neotropics, some cardiovascular support, some antidiabetic, some anti lipidemic. We can do these things with botanical medicine that helps the patient feel less like a pharmaceutical carrying case and more like they’re in tune with their body.

So I love those. My favorite neotropics, I mean, [inaudible 01:05:00] goes up there for sure. But I studied under the great Dr. Eric Yarnell, who is the naturopathic herbalist of all herbalists, and bacopa and gotu kola are really two of my favorites. Centella, and then there’s also rosemary. And so I’ll tell people, you can just do an essential oil and carry it around and sniff it as a neotrpic [inaudible 01:05:21] the time. And that actually stimulates blood flow to the brain. So there’s some really phenomenal new atropic herbs out there. And ginkgo really is the most researched one. Now there’s the environmental part of me that says we’re also losing our ginkgo trees at a rapid rate. So there’s other resources that are just effective for cognitive impairment and brain health.

Dr. Weitz:            I see. Interesting. Great. All right. So this has been a fascinating podcast. Thank you so much. How can viewers, listeners find out more about you? Get in contact with you?

Dr. Duncan:        Yeah, so I work at a practice called Coeur d’Alene Healing Arts. I’m here in Northern Idaho, Coeur d’Alene, and the contact info here is (208) 664-1644, or info@CDAHealingArts.com. I do offer discovery calls, so free 15 minute consultations if you just have some questions, concerns. I don’t offer medical advice, but I can share some more education and insight and see if we can work together, and I always offer resources. So patients and caregivers alike can reach out for support.

Dr. Weitz:            And what’s your website?

Dr. Duncan:         CDAHealingArts.com.

Dr. Weitz:            Excellent. Thank you, Dr. Duncan.

Dr. Duncan:         Thanks, Ben. I appreciate it.


Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness podcast. And if you enjoyed this podcast, please go to Apple Podcast and give us a five star ratings and review. That way more people will be able to find this Rational Wellness podcast when they’re searching for health podcasts.  And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition clinic. So if you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.

 

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