Additional Considerations

SAMe (s-adenosyl-methionine) and or Methionine

Treatment with L-dopa reduces S-adenosyl-methionine (SAMe) levels, yet supplementation with L-methionine,

an essential amino acid, can cross the blood-brain barrier and be converted into SAMe.17  A large majority of patients treated with 1 g and working up to 5 g of methionine experienced a dramatic reduction in symptom severity.18  Responses seen included increased activity levels, less rigidity, and improvements in attention span, concentration, voice control, muscular strength, and sleep and mood.

Niacin

Treatment with L-dopa, when given with carbidopa or other decarboxylase inhibitors, may increase the risk for the

development of niacin deficiency.19  In turn, supplementation with niacin may extend the elevation of dopamine levels that result from the treatment with l-dopa.20  In addition to niacin, 1-N-methylnicotinamide and the reduced form of nicotinamide adenine dinucleotide can also help to maintain dopamine levels.

Phenylalanine

Use of this amino acid may reduce the severity of some symptoms of Parkinson's disease without helping to control tremors. Phenylalanine should not be taken with, or near the time of, consumption of L-dopa because phenylalanine will compete for absorption with the therapeutic agent. In one study, after suspending the conventional medication  regimen,  15  patients were given diphenylanine, 100-250 mg, 2 times per day.  Four  weeks  later reexamination revealed significant improvements in speech and ability to walk as well as significant reduction in depression and rigidity.21

5-Hydroxytryptophan

Supplementation with this mood-enhancing amino acid, when given at different intervals than when L-dopa is administered, to avoid competitive absorption interference, can help to control Parkinson's disease-associated depressions and may improve functional ability.22,23

Iron

There is a strong correlation in animal models between dietary intake of iron and brain iron concentrations. In addition, there is a significant increase in oxidized glutathione and a decrease in total glutathione levels. Iron alone does not appear to have a causative effect on triggering Parkinson's disease. However, this supplement appears to set the stage for future oxidative insults that could trigger neurodegeneration that may, in turn, ultimately manifest  as  degenerative  disease.24,25   There  may  be a synergistic relationship between the consumption of dietary animal fat and a systemic defect in iron metabolism with regard to the progression of lipid peroxidation

in Parkinson's disease.30

Magnesium

Evidences suggests that a localized reduction in the caudate nucleus occurs in patients who are suffering form

Parkinson's and other neurodegenerative diseases.26  Because only 1 percent of all body magnesium is found

in the serum, a standard chemistry panel with magnesium will not give an accurate physiologic read on true available levels.  Instead, a cellular magnesium level test may provide a more accurate benchmark for checking supplementation efficacy.

Manganese

Measuring the body for elevated levels of manganese can offer insights regarding the presence of this possible causative, and promoting, metal in patients with Parkinson's disease. Elevated manganese levels have been attributed to neurodegeneration. When toxic levels arise from inhalation, accumulation occurs in the nasal ganglia.27

It appears that the neurotoxicity leads to dopamine depletion and the production of neurotoxins.28

Copper

Supplementation with copper should probably be avoided, including the copper that may be found in multivitamins. There is evidence that copper levels in the cerebrospinal fluid may become elevated in patients with Parkinson's disease, leading to increased oxidative damage.29

Zinc

It may be worth actively avoiding supplements, including multivitamins, with zinc unless there are definitive signs

of zinc deficiency. Research has shown that zinc levels are often elevated in the caudate nucleus, lateral putamen, and substantia nigra in Parkinson's disease. Until further evidence about the role that elevated zinc levels play

is discovered, cautious use is highly warranted.30