An Alternative Approach Complementary Therapies Can Be Effective Tools Against Parkinson’s Disease

Throughout the last decade or so, great strides have been made in the treatment of Parkinson’s disease (PD). New dopamine agonists and COMT inhibitors have improved motor function, and several new medications will soon become available. The treatment of other symptoms that may be present in PD, such as depression and sleep disorders, also has improved.

A select group of patients may benefit from surgical therapy for Parkinson’s. At a minimum, the addition of an exercise program is vital to maintaining good health.

Though significant, these developments are insufficient in treating every aspect of the disease. Unfortunately, there still exist many symptoms and medication side effects for which current, ‘traditional’ treatments are unsatisfactory or incomplete.

Because people with Parkinson’s generally tend to be well-educated and proactive about the care they receive, many have chosen to explore treatment options outside the realm of Western medicine. Alternative therapies have been slow to gain favor with some practitioners of traditional medicine because there is little research to demonstrate their effectiveness. But this is beginning to change.

For some patients and caregivers, complementary approaches to treatment are completely novel. Others have been raised in cultures where the use of herbal medicines or acupuncture are commonplace. In fact, many of these modalities have been in use for thousands of years. In the treatment of Parkinson’s disease, a number of complementary therapies, such as yoga and tai chi, are well-established companions to traditional medications. Acupuncture and therapeutic massage also have become popular in some PD centers, as have herbal therapies and dietary supplements.

This article presents an overview of various complementary therapies, and how some can be useful in the treatment of Parkinson’s disease.

Dietary Choices

The choices we make about food — what we consume, its quality, and its quantity — are crucial to our health and well-being. Of course, conflicting information abounds concerning what constitutes a healthy diet.

For example, are fats and carbohydrates ‘good’ or ‘bad’ dietary components? This may depend on which fad diet is currently in vogue. There is some agreement that it is generally wise to consume a varied diet high in fruits and vegetables and to avoid excessive saturated fats, especially trans fats.

There is also some evidence that the so-called Mediterranean diet, a diet high in monounsaturated fats, such as olive oil, may be beneficial in reducing blood pressure and cardiovascular disease. The diet also emphasizes fish, especially those high in Omega-3 fatty acids, such as salmon, and foods containing antioxidants.

People with Parkinson’s are often particularly concerned about the possibility that protein intake can decrease the effectiveness of carbidopa/levodopa, one of the common medications used to treat PD. While it is true that levodopa absorption into the brain can be slowed by a high-protein meal, most patients do not notice that their motor function varies along with their diet.

Since PD can affect digestive function, however, many patients do notice symptoms such as constipation and early satiety (the sensation of feeling very full after consuming a small amount of food). Since these changes can be of long-term duration, it may be advisable to treat them with dietary modifications such as frequent, small meals and increased fiber intake to avoid or delay the need for additional medications.

Ayurvedic Medicine, Yoga, and Tai Chi

One of the oldest systems of medicine is Ayurveda, which has been practiced in India for thousands of years. The practice is concerned more with establishing and maintaining one’s health in terms of body, mind, and spirit than with treating a particular disease entity. However, the principles of Ayurveda have been found to be useful by some practitioners for treating various conditions. The initial step is to determine the metabolic type of an individual. Then the practitioner looks at environmental factors, such as season and time of day. Diseases are diagnosed by assessing various pulse points and their relationship to internal organs.

Treatment of disease consists of detoxification through various cleansing therapies, then restoring balance with such modalities as yoga and meditation. Finally, a process of tonification, called rasayana, is initiated. Interestingly, one of the medications used in Ayurveda was derived from a legume that has been found to contain levodopa. The condition for which it was used, as described many centuries ago, most likely was Parkinson’s disease.

Yoga is an ancient practice associated with Ayurvedic medicine. A complete practice of yoga integrates mind, body, and spirit in a process involving one’s entire lifestyle. The most popular form of yoga is ‘asana’ or ‘hatha’ yoga, which involves execution of a series of postures with attention to breathing, meditation, and proper execution of the poses.

Most yoga centers offer a range of classes and list them as to level of experience required. Yoga classes are also offered at many senior centers, park districts, and fitness enters. Most instructors inquire about any physical limitations at the beginning of the class. As with any form of exercise, it is important to start slowly and build up gradually to a more advanced level to avoid injury.

Since exercise is so important in the treatment of Parkinson’s disease, patients are seeking to improve their strength, balance, and flexibility. Yoga and tai chi are both excellent for this. Tai chi, both a form of martial arts and a system of meditation, is part of an ancient Chinese system of healing called Qigong. Tai chi has been shown in several studies to improve balance in older patients as well as persons with PD. There may be other benefits as well, including reduction of stress and improvements in digestion and arthritis pain.

Traditional Chinese Medicine

Like Ayurveda, Chinese or oriental medicine has been in practice for thousands of years and also is concerned with maintaining health instead of just reacting to disease. Much emphasis is placed on maintaining a balance between opposites within the body — the ‘yin’ and ‘yang.’ Disease results from a disturbance in this balance.

The concept of qi (pronounced ‘chee’) is also important; this term refers to the life force and energy within the body. The energy flows in channels or ‘meridians’ along the surface of the body and through the internal organs for which they are named.

A condition described in the text Principles of Medicine, written in 1565, sounds very much like Parkinson’s disease: “Wind tremors are [caused by] by Wind entering the Liver and the Qi of the channels rebelling upward, [causing] tics of the face and tremors of the limbs.” In this context, ‘liver’ refers to the organ itself as well as the associated meridian and sphere of influence. The liver is believed to rule coordination and smooth movement.

Parkinson’s disease is thought to represent a defective liver (yin) and the invasion of wind (yang), which is thought to result in tremor. Imbalances between yin and yang are treated with modalities such as acupuncture and herbal medicine.

One of the methods used to help restore the balance of yin and yang is acupuncture, a technique developed more than 2,500 years ago in China. The treatment involves inserting hair-like needles into certain points on the body, known as ‘acupoints.’

This is done to restore the flow of qi to the organ system associated with that acupoint. As with most areas of complementary medicine, there is a paucity of data in the use of acupuncture in PD. Some persons with Parkinson’s describe temporary relief from symptoms such as tremor and rigidity.

Body Work and Massage

Body work comprises a group of ‘touch therapies’ such as reflexology, rolfing, and therapeutic massage. Massage therapy in particular has become very popular because of its beneficial effects on the muscle stiffness and aching that may accompany Parkinson’s. Massage may also help with associated conditions such as arthritis, as well as sleep and digestive disorders. In addition, a well-executed massage can be an extremely relaxing and enjoyable experience.

Of the many different styles of massage therapy, two in particular may be useful in PD. Shiatsu, or acupressure, uses touch rather than needles to treat the same pressure points as acupuncture. Swedish massage consists of gently kneading the muscles of the back, neck, scalp, and limbs.

In summary, many of these therapies are becoming accepted by patients and practitioners in the contemporary treatment of Parkinson disease and can work well in tandem with medications and other so-called traditional treatments. It is important to find practitioners who are well-trained and appropriately certified, and who have been recommended by a trusted source, such as one’s primary care physician, neurologist, or the regulatory board for that discipline.

Dr. Melanie Brandabur is clinic director of the Parkinson’s Institute and Clinical Center in Sunnyvale, Calif.