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Parkinson's Takes Guts

Monday July 31, 2017

Back in the good ol’ days, optimistic and inexplicably naive types would write sentences like "Parkinson’s will be the easiest of the neurodegenerative disorders to fix, because the problem is centered in one tiny structure in the brain." This belief fostered the idea that the cure for Parkinson’s was just around the corner, leaving patients angry and bitter when the cure did not materialize.

illo for blog #39

What happened? That hopeful approach overlooked a few things, like the gut problems many people with PD experience years before the classic symptoms like tremor, rigidity, degradation of speech, and gait disturbance emerge.

Now the gut is being implicated as a place where Parkinson’s starts. Suspicion about the gut, which has its own contingent of dopamine-creating cells, has been brewing for a while. It got a big boost recently when scientists learned that people who had a pathway between the brain and the gut called vagus nerve removed were much less likely to develop PD than those whose vagus nerve was intact. Science Alert reports "The operation removes sections of the vagus nerve - which links the digestive tract with the brain - and over the course of a five-year study, patients who had this link completely removed were 40 percent less likely to develop Parkinson's than those who hadn’t."   This prompted researchers to theorize that the whatever it is that causes Parkinson’s migrates up this nerve to the brain from the gut, where it had already begun inflicting harm on patients.

Scientists have also found abnormalities in the gut-dwelling colonies of microbes that inhabit the bowels of those of us with Parkinson’s. Even more confounding, scientists noted that certain mixes of gut microbes were linked to particular symptoms of the disease. The Michael J. Fox foundation recently found "In people with Parkinson's with more severe postural instability and gait difficulty, as opposed to tremor, the bacterium Enterobacteria was present at higher levels. The reasons for this association were not clear." 

So not only has a more complex picture of this already wretchedly complex disease emerged, I now have to give up one of my favorite lines about having PD, "Yes, I have Parkinson’s, but it’s all in my head." (Ha! worked it in one last time!)

This all seems rather discouraging. For years we have been barking up the wrong tree, or at least at the wrong part of the tree. How are we supposed to get the better of this malady when we don’t even understand how or where it starts? And the fact the study found people were 40% less likely to be diagnosed after the nerve was removed screams the question, what about the other 60%? There must be some alternate pathways to Parkinson’s we are ignoring. And how can bugs in your bowels be related to your likelihood to suffer gait disturbances?

As frustrating as this seems, it actually represents a step forward. For one thing, it suggests that diet could play a greater role in managing PD than previously thought.  As the Fox foundation put it "This finding may therefore have implications not only for diagnosis but also for dietary adjustments or vitamin supplementation for management of PD in the future." And second, the clearer the picture we have of what is really going on with this disease, the farther we are down the road to the goal of stopping it.  So, let's be glad that we’re a step nearer our goal, even as the path appears longer, and turns in surprising directions.

Peter Dunlap-ShohlPeter Dunlap-Shohl
NWPF Blogger

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