Monthly Archives: January 2017

Role of the microbiome in PD – webinar notes

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Role of the microbiome in PD – webinar notes

Here are some notes I took from today’s Michael J. Fox Foundation (michaeljfox.org) webinar on the role of the microbiome (gut bacteria) in Parkinson’s.

This was not my favorite MJFF webinar.  Very few practical things came out of the presentation and question-and-answer session.  It was mostly a high level overview of the little bit of research that’s been done on this topic.

Probably the best part was the section on diet.

If you’d like more than the gist of things provided below, you can wait for the recording of the conference to be posted to the MJFF website, michaeljfox.org.  Probably next week.

Robin

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Robin’s Notes from

The Michael J. Fox Foundation’s webinar
“Gut (Bacteria) Check on Parkinson’s: Role of the Microbiome”
January 19, 2017

Speakers:
Jeff Bronstein MD, PhD
Filip Scheperjans, MD, PhD

Slides:

Click to access gut_bacteria_january_2017_mjff_webinar_slides.pdf

Presentation and Notes:

WHAT IS GUT BACTERIA?
* Our intestinal tracts are home to about 100 trillion bacteria (3 lbs. worth).
* This community of microorganisms that calls us home is known as the microbiome.
* The gut microbiome plays a key role in developing and regulating our immune system.
* Gut bacteria may affect functioning of nerves in the gut, which could affect nerves of the brain.

Now talking about the “gut-brain axis.” There seems to be communication both ways.

The gut affects mood.

Does the bacteria release hormones and other chemicals that affect the brain?  Does the bacteria communicate with the neurons in the gut?

WHY DO WE LOOK AT THE GUT IN PARKINSON’S RESEARCH?
1. The gut is an entry point for environmental exposures such as pesticides.
2. Some researchers believe changes seen in the key Parkinson’s protein alpha-synuclein first happen in the gut.
3. Constipation is reported as one of the earliest Parkinson’s symptoms.
4. Slow emptying of the stomach (gastroparesis) is a Parkinson’s symptom and impacts medication absorption/effect.

Constipation is often present 4-5 years before motor symptoms.  Could even be 20 years before motor symptoms.  Why does this happen?

Jeff: No consensus that PD starts in the gut.  This might not be true for everyone.  There is evidence that there is early pathology in the gut.

Filip:  Gastroparesis is especially important in advanced PD given the link to dyskinesia.  Even in early PD, 60% of patients show signs of gastroparesis.  Gastroparesis – slowed emptying of the stomach to the small bowel.

Filip: There hasn’t been a study of the whole gut biome and its effect on PD symptoms.

WHAT DO WE KNOW ABOUT THE GUT AND PARKINSON’S CONNECTION?
* People with Parkinson’s may have less of bacteria that protect from environmental toxins and inflammation.
* Gut bacteria levels may be associated with different types of Parkinson’s symptoms, such as gait/balance difficulty.
* Bacteria in the gut may influence medication response.

Filip: Looked at stool samples to determine that those with PD are about 80% low on certain helpful bacteria.  This may affect the mucus layer of the gut which make you more susceptible to environmental toxins.  Other studies have pointed to inflammation.

Jeff: Cause and effect still not clear.  People who are constipated but not PD also have bacteria issues.

Jeff: CalTech study showed that those mice with a bad microbiome have worse motor symptoms.  This contradicts other studies on fatty acids.

Filip: Low-chain fatty acids seem to be reduced in those with PD.

DOES DIET PLAY A ROLE?
We don’t know yet, but a healthy diet is never a bad idea.
» Studies are capturing data on diet to make connections to Parkinson’s disease.
» We don’t know exactly which probiotics or how much would impact Parkinson’s-associated gut bacteria.
– Probiotics: bacteria found in food and thought to provide health benefits
» A healthy diet (high fiber, low sugar and saturated fat) does alter the microbiome.
» More on how a healthy diet can help manage Parkinson’s through the link in the Resource List.

Jeff: Some movement to pre-biotics.  Good diet most important.  No evidence that probiotics on their own can help.

Filip: To treat gastroparesis, eat smaller portions, many times a day.  Avoid fatty foods.  Perhaps avoid citrus fruits (or things that raise acidity).

Jeff: One study said that people who drink a lot of milk had a higher risk of getting PD.  Perhaps this is a route for pesticides getting into body.

Jeff: Eat organic as much as you can.  Avoid the “dirty dozen” – fruits and vegetables known to have high pesticide residue.  We don’t know the effect of pesticides on the microbiome.

Filip: H. Pylori is related to inflammation of the stomach.  Some studies show this bacteria leads to a risk in PD.  We do know that h. pylori worsens the motor symptoms of PD.  This is attributed to the inflammatory process this bacteria may induce.  It may worsen gastroparesis and reduce absorption of medication.  One study showed that the reduction of this bacteria may be helpful.  Bacteria was reduced due to antibiotics use.  But did the antibiotics also destroy good bacteria?

RESOURCE LIST
Video on diet and exercise:
www.michaeljfox.org/foundation/news-detail.php?ask-the-md-diet-and-parkinson

HOW COULD WE USE BACTERIA FINDINGS TO MEASURE/TREAT PD?
1. Slow progression of Parkinson’s disease and improve health
2. Screen for or track Parkinson’s disease
3. Learn about disease process from the role of bacteria linked to PD
4. Choose people for studies (such as for gait/balance trials)
5. Regulate gut bacteria to optimize medication response

Filip: Someone with constipation is 4 times more likely to develop PD.  We can’t identify which ones will get PD.

Q&A
A:  Neither MD recommends fecal transplants.

“Some say that illness is morally improving, others that there is nothing good about being sick.”

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“Some say that illness is morally improving, others that there is nothing good about being sick.”

This is a long essay from the online website Aeon (aeon.co) about whether having an illness can be a positive thing or if its always a negative.  The author, Ian Kidd, a philosophy professor, thinks that “we can find a balance between bright-siding and despair.”

Professor Kidd says:

“What I want to show is that illness can be edifying, for certain people – conducive to the cultivation and exercise of various virtues. If this is right, then it is indeed a life-transforming process that genuinely contains some good.”

He also says:  “It would be a terrible failure of empathy to demand that everyone explore the character-building possibilities for illness.”

And one more quotation:

“Empathy is, in fact, the virtue most people lack, according to [philosopher Havi] Carel – especially the obliviously healthy, who take the cooperation of their body for granted. Cultivating empathy for the experience of illness means learning to think about it ‘from the inside’, from within the lived body of someone who is unwell, rather than treating that condition as a mere biological or medical problem. This means trying to see the perspective of a person battling, not only against disease, but also against others’ lack of understanding of its relentless demands – bodily, psychological, emotional and social.”

Obviously, I thought this was a thought-provoking essay.  See what you think!

Here’s a link to the essay:

aeon.co/essays/can-there-be-anything-good-in-the-experience-of-illness

Being ill, living well
Some say that illness is morally improving, others that there is nothing good about being sick. Can philosophy adjudicate?
Aeon
Ian J Kidd
November 8, 2016

On the Aeon website, there are lots of comments to the question “What lessons have you learned by being ill?”

Robin

“Who Will Care for the Caregivers?” (NYT)

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“Who Will Care for the Caregivers?” (NYT)

In September, October, and November 2016, we posted several articles about the National Academies of Science, Engineering, and Medicine’s report on family caregiving.  The report looked at the state of family caregiving in the US, where 40 million people give assistance daily to a relative or neighbor.  “Assistance” includes all aspects of caregiving such as meal preparation, bathing, toileting, dressing, medication management, and transportation.

You can find the report “Families Caring for an Aging America” here:

www.nationalacademies.org/hmd/Reports/2016/families-caring-for-an-aging-america.aspx

Today’s New York Times has an article about by a physician, Dr. Dhruv Khullar, summarizing the September 2016 report.  I didn’t find a lot new here but it never hurts to re-state the needs of family caregivers.

Dr. Khullar says:

“[The report] suggests that society’s reliance on this ‘work force’ — largely taken for granted — is unsustainable. … In 2015, there were seven potential family caregivers for every person over 80. By 2030, this ratio is expected to be four-to-one, and by 2050, there will be fewer than three potential caregivers for every older American.”

The problems identified include:

* “This volunteer army is put at great financial risk. … One in five report significant financial strain.”

* “Even worse, perhaps, is the physical and emotional toll of extended caregiving. Family caregivers are more likely to experience negative health effects like anxiety, depression and chronic disease. One study found that those who experienced mental or emotional stress while caring for a disabled spouse were 63 percent more likely to die within four years than noncaregivers who were also tracked.”

* “As overworked and underappreciated as family caregivers are, health systems, under pressure to reduce costs, increasingly rely on them to manage illness at home.”

Some approaches that the medical community can take to support and educate family caregivers include:

* Medical professionals should list the family caregiver on the patient’s medical record.

* Medical professionals should engage family caregivers in “important decisions about a patient’s treatment plan.”

* Part of accomplishing the treatment plan is assessing the abilities of the family caregiver and anticipating challenges they may find.  One assessment tool mentioned is the “Next Step in Care” by the United Hospital Fund.  (See nextstepincare.org)

* “Having counseling and support services available to caregivers, as well as respite programs to temporarily relieve them of their responsibilities, could also help.”

* “[Clinicians] could be trained in how best to educate family caregivers, and to better meet their emotional and physical needs. A nurse might demonstrate how to turn a patient in bed without risking back strain. Or the right way to deliver an insulin injection — how to pinch the skin, what angle to insert the needle — and what signs to look out for if blood sugar levels get too low.”

Here’s a link to the NYT article:

www.nytimes.com/2017/01/19/upshot/who-will-care-for-the-caregivers.html

The Upshot
Short-Handed
Who Will Care for the Caregivers?
New York Times
Dhruv Khullar
Jan. 19, 2017

Robin

“Don’t wait till your dying words to say what’s most important”

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“Don’t wait till your dying words to say what’s most important”

Earlier today, we posted about hospice chaplain Kerry Egan’s new book titled “On Living.”

She was on the PBS Newshour (pbs.org/newshour) this evening (January 16th).  In this short video essay, Ms. Egan explains that a surprising number of people ask her “Should I plan out my last words?” Ms. Egan argues that we shouldn’t wait until our dying words to say what’s most important. Ask for forgiveness or share your wisdom now.

Here’s a link to the three-minute video clip and a transcript:

www.pbs.org/newshour/bb/dont-wait-till-dying-words-say-whats-important/

This is well worth three minutes!

Robin

 

“The Stem-Cell Revolution Is Coming – Slowly” (NYT)

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“The Stem-Cell Revolution Is Coming – Slowly” (NYT)

Thanks to local Brain Support Network member Christine for forwarding me this interesting article in today’s New York Times about the “stem-cell revolution.”  This is an interview with scientist Shinya Yamanaka, the Nobel Prize winner for discovering induced pluripotent stem cells (iPS cells).

Here are two key excerpts from the interview:

Q:  Was the promise of stem cells overstated?
A:  In some ways, yes, it is overstated. For example, target diseases for cell therapy are limited. There are about 10: Parkinson’s, retinal and corneal diseases, heart and liver failure, diabetes and only a few more — spinal cord injury, joint disorders and some blood disorders. But maybe that’s all.

Q:  What is needed before patients can receive stem cell treatments for the 10 or so diseases you identified?
A:  Time and money. … iPS cells are only 10 years old. The research takes time. That’s what everybody needs to understand.

Here’s a link to the full article:

www.nytimes.com/2017/01/16/science/shinya-yamanaka-stem-cells.html

Science

The Stem-Cell Revolution Is Coming — Slowly
A Conversation With
By Wallace Ravven
New York Times
Jan. 16, 2017

Here’s hoping something can be addressed by stem cells…

Robin