DEAR DOCTORS: A good friend has Parkinson's disease. She has mentioned trying probiotics to her doctor, but he doesn't seem interested in the idea. My friend worries she might alienate him if she gets help from another doctor. Is there guidance about using probiotics with PD?
DEAR READER: Parkinson's is a neurological disease that results in a gradual loss of the ability to produce smooth, sustained and controlled movement. It's a progressive disease, which means symptoms grow more pronounced over time.
Parkinson's is caused by a decrease in the production of dopamine, a chemical messenger in the brain. The resulting changes to brain chemistry adversely affect strength, balance, movement, coordination, endurance, bowel function and blood pressure control. The disease often also takes a toll on mood, emotions, sleep and cognition.
There is no cure for Parkinson's disease at this time. Treatment focuses on medications to increase dopamine production. In some cases, a surgical treatment known as deep brain stimulation can ease symptoms. Supportive care is also important. This includes physical, occupational and speech therapy, exercise, mental health care and attention to diet.
Now, thanks to a growing understanding of how gut microbes influence the brain, researchers are exploring a role for probiotics in managing Parkinson's disease. Known as the gut-brain connection, it's a two-way communication between the central nervous system and the gastrointestinal system. It has been found to affect digestion, immune function, mood and cognition, and is suspected to play a role in neurological diseases.
Several studies have found that certain strains and combinations of probiotics can ease some of the non-motor symptoms of Parkinson's disease. These include constipation and other gastrointestinal problems, disrupted sleep, anxiety and fatigue. The research is certainly promising; however, it has not yet made the transition from the research phase to therapeutic treatment. Each study used a unique blend of probiotics, none of which are commercially available. In order to add probiotics to the treatment regimen of someone living with Parkinson's, both the patient and the doctor must be willing to experiment.
Although your question focuses on probiotics, you have touched on an important topic. That is, shared decision-making in healthcare. It's just as it sounds -- a collaborative approach between patient and doctor. It's a departure from the days when patients were expected to have a passive role in their medical care.
Your friend would begin by being clear with her doctor about her interest in taking probiotics. Rather than just mentioning them, it is important for her to state that she wants to have an in-depth discussion about the pros and cons. If her doctor isn't interested in pursuing the issue, she can indicate that she will seek a second opinion. This is a common practice in medicine and should not affect her relationship with her doctor.
If your friend does add probiotics to her treatment regimen, it is important to let all her doctors know. Probiotics can sometimes cause side effects, such as diarrhoea. To provide optimal care, her doctors need to know about all the medications and supplements she is taking. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.
