Alternative or complementary drugs and vitamins are non-prescription, off-patent, and have not been subjected to the vigorous trials prescription drugs undergo. For a prescription drug to be prescribed for PD, it must undergo extensive testing that follows these rules:
The test must be double-blind: both the patient and investigator not knowing what drug the patient is on.
The test must be placebo-controlled: the response of the patient to the drug compared to his response on the placebo.
The test must be multi-centered: more than one medical center must test the drug to eliminate individual bias.
However, there are several alternative drugs that patients with PD use. There are drugs and foods that supplement levodopa, including fava or broad beans, which are widely eaten in the Mediterranean basin, including Spain, Italy, Greece, Turkey, Israel and the Middle East. They’re an excellent source of fiber and have a high levodopa content; 3.5 ounces of fava beans are equivalent to 100 grams of levodopa if you’re also taking carbidopa.
If you’re not taking carbidopa, 3.5 ounces of fava beans are the equivalent of 20 grams of levodopa. Warning: If you’ve never eaten fava beans, note that a small number of people may develop anemia, a disorder in which your red blood cells break down. If you’re on a class of drugs called MAO-A inhibitors, or if you’re on rasagiline or selegiline, you shouldn’t eat fava beans.
Mucuna pruriens, or velvet beans, are widely eaten in India and Central America. Mucuna pruriens have a high protein and high levodopa content; 3.5 ounces of mucuna pruriens are equivalent to 100 grams of levodopa if you’re taking carbidopa or 20 grams of levodopa if you’re not. Touching the plant, but not the bean, causes itching—hence the name pruriens, or itching.
It’s been suggested, but not proven, that fava beans and mucuna pruriens are better sources of levodopa than levodopa/carbidopa pills. Many patients regularly eat fava beans and/or velvet beans (mucuna pruriens) and are convinced of their efficacy. I personally find them no different from levodopa/carbidopa pills.
The mitochondria in your cells require all the B vita-mins for optimal functioning. How much of the B vitamins do your mitochondria need? We know your minimal daily requirement, the amount you need to prevent certain deficiency states, but this amount may not be the amount you need for optimal function. I recommend all my patients take at least one B-100 per day.
This vitamin contains at least 100 mg of each of the B vitamins and a sufficient combination of niacin, folic acid and cyanocobalamine to decrease homocys-teine levels. Homocysteine, an amino acid generated by levodopa/carbidopa, may be a risk factor for heart disease and stroke. As 100 mg of pyridoxine may interfere with the absorption of levodopa/carbidopa, I recommend taking the B-100 at least 4 hours before you take a dose of levodopa/carbidopa.
Coenzyme Q 10 is a carrier that transports charged particles from one complex to another in the mito-chondria. As discussed in Question 31, it is also an antioxidant. It’s not known how much Coenzyme Q 10 your mitochondria need. It is known that drugs that lower cholesterol (statins) also lower Coenzyme Q 10 levels.
Some doctors tell their patients on statins to take Coenzyme Q 10. There is evidence that high doses of Coenzyme Q 10 may slow the progression of PD. At present, the National Institutes of Health (NIH) is conducting a study looking at the ability of 2,400 mg per day of Coenzyme Q 10 to slow the pro-gression of PD. At present, without benefit of the NIH study, I do not recommend taking high doses of Coenzyme Q 10. The efficacy is unproven and it is expensive.
Another category of alternative drugs is free radical scavengers (antioxidants) and metal chelators. Free radicals are charged particles that are able to attack and break down various components of the cell, espe-cially the fat lining the cell and its organelles, the cell’s RNA and DNA, and the cell’s proteins: its vital enzymes, receptors, and transporters.
Antioxidants can be water soluble, like vitamin C, or fat soluble, like vitamin E. As discussed in Question 31, it is unclear if antioxidants penetrate the cell in sufficient quantities to be effective. Some free radical scavengers/antioxi-dants such as alpha lipoic acid, gluthathione, and N acetyl cysteine have already been mentioned.
Addi-tional free radical scavengers include: Curcumin, the active substance in curry powder, is an antioxidant and an anti-inflammatory drug. Some experts attribute the relative low prevalence of Alzheimer’s disease in India to the wide-spread use of curry. Ginseng, the dried root of an herb, is also an antioxidant. There are several ginseng preparations and different claims are made for each. However, at present there is insufficient information to recommend either curcumin or ginseng.
Green tea contains a number of chemicals called polyphenols that are antioxidants. Several of these polyphenols are being studied for their ability to halt the progression of PD and Alzheimer’s disease. Drink-ing 4 to 8 cups of green tea is not unreasonable. If you enjoy green tea—drink it, it’s probably good for you.
Acetylcholine, a chemical messenger, is decreased in the brains of people with Alzheimer’s disease and Lewy Body Disease (LBD). Acetylcholine is also a chemical messenger in the gut, bladder, and testes.
Increased acetylcholine levels are said to improve memory, combat apathy, decrease anxiety and depres-sion, combat fatigue, increase energy, aid digestion and constipation, and to combat impotence. These claims were not generated by double-blind, placebo-controlled, multi-center studies and must be viewed skeptically.
And with some of the drugs it’s unclear if they actually increase acetylcholine levels in the brain and other tissues. Among the acetylcholine “enhancers” that people take are: Acetyl L-carnitine, curcumin, cytidine-5-diphosphocholine, ginseng, and licorice. Other alternative drugs include:
St. John’s Wort, an herb, increases brain serotonin levels. Serotonin is a chemical messenger involved in regulat-ing behavior, mood, and sleep. St. John’s Wort has been found to be effective in treating some forms of depression, though I’ve not found it effective in treating the depression of PD. In some people, St. John’s Wort may increase bleeding.
Magnesium chloride is a muscle relaxant used to treat preeclampsia (high blood pressure associated with pregnancy), as well as anxiety, chorea, and muscle spasms. I’ve not found it helpful in treating levodopa-induced dyskinesias nor in treating dystonic muscle spasms.
Melatonin is a hormone secreted by the pineal gland. At a dose of one to three milligrams, melatonin increases brain levels of serotonin, a chemical messenger that regulates sleep, though I’ve occasionally found it helpful in treating the sleep disorder of PD.