Laurie K Mischley, ND, MPH, PhD, is a naturopathic physician and a nutritional neuro-epidemiologist. The focus of her work is on describing conditionally essential nutrients in Parkinson’s disease (PD) and attempting to describe the nutritional status and requirements unique to individuals with neurodegenerative diseases. Her latest paper on the subject is the Role of Diet and Nutritional Supplements in Parkinson’s Disease. She is also Associate Clinical Research Professor at Bastyr University, where she is an associate clinical investigator of PD studies including, “CAM Care in PD” and “Cannabis in PD Tremor.”
The following has been paraphrased from an interview with Dr. Laurie Mischley on December 8th, 2017. I was joined by Prof. Gerold Riempp who is co-founder of a charitable organization in Germany that supports the development of therapies that aim to cure PD.
How did you come to study the role of diet and nutrition in Parkinson’s Disease?
I was 18 and I was in an advanced chemistry class studying pre-med when I learned about Linus Pauling, the only person in history to win two unshared Nobel prizes. There was a Scientific America article on him that mentioned the 4 radical ideas he had over the course of his life, 3 of the 4 were later proven correct. His fourth idea was that neurological diseases are actually nutritional deficiency syndromes. I sat there in that chemistry class reading this article thinking, ‘well he was right and the world was wrong in the past, show me where he is wrong about nutrition’. That started my fascination in how nutritional deficiency syndromes might be manifesting in these diseases we are labeling people with. That began my quest to either prove him wrong or figure out why he was being dismissed.
A year later I changed my major from pre-med to nutrition science. I then went to a medical school fair and when I went to apply they had two columns for either science degrees or bachelor of arts degrees. Under the list of bachelor of science degrees there was no option for nutrition science, I asked the people there what should I fill in and they joked among themselves for a minute and said ‘nutrition is not a science, just say you have a bachelor of arts’. That was my ‘aha’ moment where I realized the next 10 years of my life were going to be a fight and I didn’t see my place in the conventional system. I started looking for alternatives and found that the only medical school that had nutritional science training was Bastyr University and that is when I started learning about naturopathic medicine and alternatives to the conventional approach to medicine.
In your recent paper, Role of Diet and Nutritional Supplements in Parkinson’s Disease, you make a strong case for the Mediterranean diet and certain supplements for people with PD, however it is based on a population of people, how confidently would you be able to recommend the outcomes of that study to individuals?
That’s a really complicated question. All epidemiological data has some limitations, we don’t know that if you change your diet you are going to change your outcome. I have just trained myself to understand the limits of our capacity and to add at the end of every sentence that states a scientific fact, ‘that we know of’, just as a way for me to constantly remind myself that we might be looking under the wrong lamp post. My hunch with Parkinson’s and some of these other diseases is that we are not looking in the right place. We are looking at symptoms that happen 20 years after the disease has already started, if we just come to the table assuming we are totally off base, then take a step back and ask, “What can we say with confidence?” That’s where I started looking at clinical epidemiological data. In all the research that has been done so far on populations of people with PD, the end result has always been on the diagnosis of the disease. There are dozens of studies that say the more coffee or green tea or dairy you consume the more or less likely you are to get Parkinson’s. So patients go to their neurologist and ask ‘should I be drinking more green tea or stop drinking milk?’ The neurologist rightly so says ‘that data only tells us who is likely to get PD or not, you already have PD and we have no data on what happens from the point of diagnosis forward.’ So this was a really simple approach, I just took people who already had the disease and I looked at the variables associated with different rates of progression.
We are already sitting on some of the longitudinal data, I’ve been following the CAM care in Parkinson’s study which has been going on for almost five years. The data that I published was only the cross-sectional analysis data at the time of entry. Now that we have over 1500 people we will start to look at things like if somebody stops eating cheeseburgers and starts eating vegan does that change the course of their disease. As more and higher quality analysis of the data we already have gets underway we will be able to gleam more insight into how these kinds of behavioral changes affects outcomes. But at this point, given the potential risk of increasing your fruits and nuts and veggies and decreasing fried or canned foods, I think it’s a pretty safe to make the recommendation we have. And frankly it’s the best we have, over the last couple hundred years if you ask your doctor is there anything associated with slowing this disease, all we have had is exercise. This, in my mind, is groundbreaking to now be able to say, there is evidence that people who take fish oil or nuts and seeds or fresh fruits and vegetables seem to do better in the long run. There are very few reasons not to initiate that kind of a recommendation.
And you get people to evaluate their progression themselves?
Yes, one of the big problems we have in PD research is measuring progression. What we have (Hoehn & Yahr and UPDRS) doesn’t enable us to look at small changes over time. So one of the first things I needed to do was come up with a better scale, called the Patient Reported Outcomes in Parkinson’s disease scale (PRO-PD), which is a series of 33 slider bars each representing common symptoms of the disease and it gives a cumulative score that you can track over time. We found that a lower score correlates well with a higher quality of life.
What diagnostics would you suggest for an individual patient so a physician/neurologist can determine what to recommend in terms of nutrition and/or other therapeutic measures?
In my clinic I have put together a Parkinson’s disease panel. On the first visit I always do a hair test looking for lithium, which is essential and can only be obtained exogenously but for some reason is not on the list of required nutrients from the FDA. Here in the Pacific Northwest we have a huge problem of lithium deficiency. I also look at vitamin D levels, uric acid, chemical screens and a complete blood count, omega 3 fatty acids, homocysteine levels (as levodopa increases homocysteine levels and increased levels are associated with risk of dementia), F2-isoprostanes (as a measure of free radical burden), b12, iron, thyroid function, DHEA sulfate, and total cholesterol. I ask people to measure these levels once a year.
Have you measured these lab tests against the progression of the disease?
Not comprehensively, if there are any abnormal findings from this panel we try to fix them. We do track their PRO-PD scores but I haven’t been able to do a formal analysis yet. I can’t report it yet but we are excited by the outcomes we have seen so far.
Why don’t more neurologists screen for the things you mentioned?
I wish I knew. For me it’s common sense. It’s human physiology. I’m not saying anything radical. Every recommendation I make comes straight from the peer reviewed medical literature. One of my favorite quotes in science is ‘first people say something isn’t true, then they say it is true but not important, and then they say it is true and important but not new’. There will always be early adopters and those that are slow to change.
For better or worse, medicine is made up of people who follow the rules. To get in to medical school, to do well and get a job at a prestigious university, you kind of have to do what your mentors tell you to do and think the way they tell you to think. To come along with a radical idea and ask, “What if we are causing some of these problems by the way we are treating the disease or eating?” It isn’t easy for a lot of people to switch gears and admit that they have been barking up the wrong tree for decades. Also I don’t know that I am right, we are all learning as we go. My hope is that with enough publications and presentations that more and more people will come around.
How many of the causes associated with PD do you believe relate to diet and nutrition?
The vast majority but that is because I don’t see nutrition as only being about food. Nutrition is the human dependence on our environment. Anything that we have evolved to need from our environment is a nutrient. Even gravity, if you go up in space your bones start to fall apart. We don’t see many gravity deficient syndromes because most people don’t go without gravity. Sunlight is another good example, it is something we have evolved to need. So when we talk about the broader picture we have to ask are we getting the things we have evolved to need, and I think we are not. And this is a huge portion of the manifestation of disease. One of the huge variables I was surprised by is the social aspect of this disease and how loneliness might be contributing to this disease.
Would you recommend people get their DNA sequenced to alter their diet based on any relevant gene polymorphisms they might have?
I don’t right now. I’m excited to see that field emerge and grow. But my clinical experience doesn’t correlate with the data I have seen. I think we are moving in that direction, but for now we just don’t know what to do with all of that data.
How much does the quality of food matter?
The studies haven’t been done yet between organic and mass-produced food. But in our study we did see some evidence that people who eat local and organic progress slower than those who don’t. We have so many studies that link pesticides to Parkinson’s, but we don’t have studies specifically looking at if you switch to an organic diet you do better, but nobody is going to do those studies because there isn’t much money to be made from those kinds of expensive and exhaustive studies. But we did notice that the two things most associated with the slowest rate of progression were fresh fruits and vegetables, the fastest rate of progression was associated with canned fruits and vegetables. That was a real surprise to me as it did not cross my mind that people eating canned fruits and vegetables would actually have an accelerated rate of progression. But we hope in the future to delve deeper into food quality.
Should daily recommended intake of certain vitamins and nutrients be altered for people with neurodegenerative disorders?
Yes. The recommended daily allowances were made in the 70’s for healthy college age men. They do say that people with diseases are going to have different nutritional needs but we don’t have the resources to come up with standards for each disease that is out there so no one has tried to figure out what those standards should be. This is really what I have devoted my career to, how do we build those guidelines for people with Parkinson’s.
Do you think it would be worthwhile building a trial similar to this one for diabetes tailored for PD? If you were to design your ideal study where you had complete control over the patients, how would you design it?
Dale Bredesen has gotten pretty close to doing that in Alzheimer’s disease. All of these diseases are probably branches of the same tree. We have been calling Alzheimer’s type 3 diabetes and Parkinson’s seems pretty close behind. All of these diets are pretty similar, calorie restriction, plant based, nutrient dense, no processed foods, etc. In Dale’s study he put 10 patients with Alzheimer’s or dementia on a 36-step protocol that included everything from a good nights sleep to dietary changes and 12 hour fasts every night. He showed that 9 out of 10 had reversal of cognitive decline over a year and a half. It was really the first study to show that neurodegenerative diseases are not irreversible and progressive. Yet he was laughed at when he tried to get funding.
Last year we hosted our first Parkinson’s disease summer school and we will be doing another one this year. We had 23 people from around the world come spend a week with us where we did everything together and talked a lot about the science behind Parkinson’s. We also had a variety of specialists with us. This is the closest we have come to that type of study. But to be honest I don’t see anytime in the near future where any organization is going to fund that kind of study.