Getting right to the point of this article, I'm 49 and suffer from early-onset Parkinson's disease: have had it for 5 years now and over that time, I developed a great exercise and diet routine. Unfortunately I got depressed and lazy about 2-3 months ago, curtailed my daily exercise to when "I felt like it" and ate lots of ribs, pizza and ice cream. I rather quickly gained 10 pounds. In response, rather than going back to good diet and exercise I put myself on the Atkins diet which after constantly craving pizza and hot pretzels for a solid week I quit and gained another 5 pounds.
I had become depressed, not over anything specific. In fact if anything, this recent bout of depression felt rather "biological." It's hard to say exactly what that means except once back during medical school I got very depressed over a relationship gone bad. The difference was that with that relationship, that depressed feeling was almost always associated with thoughts and images of me with my then former girlfriend. Here there was nothing specific bothering me: no recurrent specific thoughts about anything. In fact I felt more hopeless and immobile than sad.
Drill Doctor
I told this to my neurologist who recommended a psychiatrist, a calm reassuring father-type who expressed confidence that the depression was a normal blip to be expected during any lifetime course of Parkinson's disease, that it was all biological. He didn't even give me an antidepressant if you exclude seroquel given to help me sleep but not to be used every day. He said to call him if things got worse or persisted beyond a month more. I told him about my abandoned exercise and diet routines and he felt I would derive more value from just plain forcing myself back into a better lifestyle than from any antidepressant he could prescribe, with all its potential side effects and drug interactions. I was impressed at his old-school sense of plain logic. It must be why my neurologist recommended him regularly for his PD patients. Neurologists are really the engineer personalities of medicine. Every problem can be diagnosed via cold logic from interview, physical examination and appropriate tests. They generally eschew less logic intensive disciplines like psychiatry. This psychiatrist however was all logic and common sense: no magic, just go back to exercise and a healthy diet.
I have developed a very solid system for assigning a single number to my level of motor functioning that works well for me. Let me explain. Though I can no longer play drums at previous levels one could easily have called professional, I use an electronic drum set to do coordination exercises. Hell, if old ladies get symptom improvement by playing games like bowling on their grandson's Nintendo Wii, doing regular basic drumming drills could not hurt
I use a metronome and have a series of exercises that are all performed at the exact same pace. The fastest pace I can drill around the drum set is a very exact measure for me of symptom severity at any given day and even time of day. For example at my peak in my mid 20's there are songs that run at 180 beats (eighth notes) per minute that I could play easily. One was Rush's "Tom Sawyer" if you know anything about rock from the early 80's. So at my peak I was comfortable playing drums to complex songs with a "motor score" of "180" (we'll just assign it a number). Now without medication I'm lucky if I can break 75 and even that is shaky and irregular. At peak medication, I could drill at 115 and occasionally hit 125-130. Granted this is no where near my peak professional competence level of 180 however I've grown to accept this severe and worsening set of limitations. Still, I can enjoy drilling on the set,. It was initially extremely frustrating and once I even threw the bass drum across the room but it's OK now.
After letting myself go for 3 months with depression and neglectful exercise and diet, my drill speed went from my usual 120 average down to an absolute maximum of 90. That's a 25 percent drop in motor capability for that task in just 3 months!! Could I recover from this assault on my system or had more of my cherished remaining living 20 percent of dopamine neurons that were my birthright died. Eighty percent of these dopamine-manufacturing brain neurons are already dead and gone by the time Parkinson's symptoms appear in new patients.
Well today I can proudly say that with some changes in diet and lifestyle I can play my drum drills at 125. Maybe some of my dopamine neurons got sick but it seems they didn't die. The extra bonus was that the heavy cloud of depression which had hung over my life for 3 long months lightened-up considerably and today is nearly gone.
Was it the depression? The change in diet? The decrease in exercise and all activity? I can't say. Whatever was making me measurably worse got better when I made the following changes in lifestyle:
1. Exercise: I purchased the famous high intensity home workout system P90x with fitness guru Tony Horton. I don't have the endurance to complete each daily assignment so I divide it up and do it in 20-30 minute blocks throughout the day. Some of the Yoga-based balance exercises for instance, are impossible because of the Parkinson's so I just skip over those parts. I've also got back into getting out for a walk on most days and on wakeup I do a combo of push-ups/crunches/pull-ups and a dance flexibility hip exercise given to me by a dance instructor several years back before my right foot started dragging too much. Now I'm very understanding with myself. Of course I can't do any of this at anything close to Marine level. However I feel it's more important to keep it regular and consistent. I'm not going to win any contests or medals: accepted.
2. Diet : I have several rules that I abandoned during my depression that insure a high antioxidant healthy diet with adequate protein:
a. Eat mainly foods in their natural state, ie, raw/steamed/blendered veggies and fruits (especially berries) and nuts. I buy organic wherever it's not too expensive.
b. Minimal dairy products. Maybe milk in coffee or yogurt as part of a smoothie. Evidence for this choice is scant but I tend to feel less bloated.
c. No bread/pastas or wheat products. This is personal. I get very bloated and more hungry when I indulge in wheat products. I love pizza and am thankful that a nearby restaurant makes a delicious gluten-free pizza that hardly tastes different from normal pizza.
d. No diet soda or any other sources of aspartame or other artificial sweeteners. Also sodas contain sodium benzoate which has been accused of endangering dopamine neurons because it has the highly reactive benzene as part of its structure.
e. Protein mainly as salmon patties and chicken twice a day (I've got some recipes I should publish later) but the George Foreman grill has become an essential fixture in my kitchen.
f. Occasional and minimal sweets.
g. I avoid soy-based products. Soy contains compounds that act like estrogen in the body. The Parkinson's has already diminished my libido so I need all the help I can get.
h. Most importantly I never eat to fullness. I leave myself just satisfied or even slightly hungry after each meal.
i. I don't avoid caffeine and moderately consume alcohol (1-2 drinks every other day)...both are possibly neuro-protective in Parkinson's. See the previous post. Alcohol makes my daytime sleepiness worse so I am careful about the timing when I choose to indulge. With Parkinson's I rarely even have a single drink if driving.
j. Eight (8) glasses of Brita-filtered water each day. Filtered water is proven safer than bottled water which often contains residue from the plastic bottle. Additionally do you really imagine that all bottled water comes from pristine mountain springs? Where are they all? I've never run into one. By the way, some day I am going to write a piece about how I can prove to anyone why those ridiculously expensive alkaline water processors are a complete sham.
3. Supplements: I don't take a multivitamin because all I have shopped contain manganese, a known dopamine cell killer. I take the large dose of Coenzyme q10 at 1200mg per day. I also take a large dose of Vitamin C at 3000 mg per day. Studies have suggested that Vitamin B6 (pyridoxine) is associated with lower rates of Parkinson's so I take 100 mg of that each day. Ibuprofen has been shown to prevent Parkinson's and it might slow mental decline as well so I take 200mg in the AM. Hopefully the healthy diet above provides the other essential vitamins and minerals.
I can confidently say that sticking to the above regimen created a measurable change (via my drum drill timing), with my motor difficulties showing marked improvement to where they had been before the depression. Even the depression nearly completely dissipated. Hopefully in my state of neglect, I didn't kill off any of my surviving dopamine neurons.
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