The 8 Principles of YuthLabs

8 Principles to Slow Down Parkinson’s Disease

Approaches for slowing the disease, and reducing the need for increasingly higher doses of medication

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Principle 1
Delay the initiation of levodopa, or use the lowest effective dose (‘levodopa-sparing therapy’).

Principle 2
If you are still relatively “young”, associate a dopamine agonist.

Principle 3
Start or combine levodopa with drugs that are neuroprotective (e.g. MAO-inhibitors).

Principle 4
Take B vitamins (in the right forms) given that levodopa depletes B vitamin levels and increases homocysteine. Be careful with vitamin B6.

Principle 5
Consume a diet that slows down Parkinson’s disease.

Principle 6
Take supplements that slow the progress of Parkinson’s disease.

Principle 7
Consider photobiomodulation for slowing Parkinson’s disease.

Principle 8
Implement lifestyle changes to slow Parkinson’s disease

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Principle 1: Delay the initiation of levodopa or use the lowest effective dose (‘levodopa-sparing therapy’)

Levodopa (also called L-dopa, brand names Sinemet or Madopar) is the gold standard for relieving Parkinson’s symptoms like stiffness, tremor, and slowness.

However, over time, levodopa use (especially at higher doses) can lead to significant side effects, such as:

1. Motor fluctuations (also called “wearing-off”): the beneficial effects of levodopa fade faster before the next dose is due. In other words, tremor, stiffness, or slowness may return sooner or worsen.

2. Dyskinesias: involuntary, erratic, often dance-like movements that affect the face, arms, legs, or trunk. They are not a symptom of Parkinson’s itself, but a side effect of long-term levodopa use. In this video clip you can see Michael J. Fox doing an interview while having dyskinesias:

On average, around 50% of people suffer from motor fluctuations or dyskinesias after 5 years of levodopa therapy. The longer levodopa is used, the higher this percentage becomes.

It’s not yet clear why long-term use of levodopa leads to these complications. Some hypotheses are:

- As more neurons die off and become sick in the substantia nigra, the less they are able to address the dopamine fluctuations (e.g. sudden increase in dopamine) that occur when people take levodopa.

- Levodopa use leads to high dopamine peaks in the brain cells. Dopamine is easily oxidized and can damage neurons.

To postpone the advent of these symptoms for as long as possible, many neurologists use “levodopa-sparing therapy”. By prescribing other drugs than levodopa, the use of levodopa, or the use of higher doses of levodopa, is postponed for as long as possible.

Especially in the early stages of Parkinson’s, symptoms might be well-controlled with other Parkinson medications, such as:

- Dopamine agonists (e.g., pramipexole or ropinirole)
- MAO-B inhibitors (e.g., rasagiline or selegiline)
- Amantadine
- Anticholinergics (specifically for tremors)
- COMT Inhibitors (e.g. entacapone, tolcapone, opicapone)
- Lifestyle changes, such as proper nutrition, supplements, and exercise.

Some neurologists recommend using such medications first, before using levodopa. Or they combine these medications with levodopa, so lower doses of levodopa can be prescribed.

These approaches won’t postpone or replace (higher doses of) levodopa forever, but they may delay the need for higher doses, reducing long-term side effects such as levodopa-induced dyskinesias and motor fluctuations/wearing-off.

Importantly, the goal isn’t to avoid levodopa entirely, it’s to use it wisely.

Everyone with Parkinson’s is different. Some people benefit from starting low-dose levodopa early, especially if symptoms are interfering with daily life. Others can manage well for years without it.

If you’re unsure about your current treatment plan, talk with your doctor. Asking about levodopa-sparing strategies could be the first step to a more slowly progressing, smoother, less-side effect prone Parkinson journey.

Principle 2: If the patient is “young”, associate a dopamine agonist

Associating a dopamine agonist could postpone the use of (higher doses of) levodopa for the reasons mentioned above - in other words, to postpone the advent of levo-dopa associated dyskinesias and motor fluctuations for as long as possible.

Also, younger patients often can tolerate dopamine agonists better - meaning they tend to have less side effects.

“Young” is a relative term, which can still refer to patients who are in their fifties or sixties.

Principle 3: Start or combine levodopa with drugs that are neuroprotective (e.g. MAO-inhibitors)

Ideally, one uses drugs that not only treat the symptoms of Parkinson’s disease, but that could be neuroprotective.

All drugs for Parkinson’s disease treat symptoms, like reducing tremor or stiffness. Most of them however do not really slow down the progression of the disease.

For example, dopamine agonists (such as pramipexole / Mirepex, ropinirole / Requip, or rotigotine / Kynmobi), stimulate dopamine receptors, but they do not really address the root causes of Parkinson’s disease, like mitochondrial dysfunction, protein accumulation, and oxidative stress, which lead to a decline in dopamine(-producing cells).

However, some drugs could act more on the root causes of the disease, potentially slowing down Parkinson’s, instead of just suppressing symptoms.

This could be drugs like selegiline and rasagiline. These drugs are monoamine oxidase B (MAO-B) inhibitors. They suppress the MAO-B protein.

MAO-B is a protein (enzyme) that breaks down dopamine in neurons. MAO-B inhibitors inhibit this enzyme, so less dopamine is broken down, which increases dopamine levels in the brain (in Parkinson’s disease, there is a shortage of dopamine).

However, besides just increasing dopamine levels, MAO-B inhibitors also seem to have neuroprotective effects (R) due to the following mechanisms:

- Antioxidant function
- Anti-apoptosis effect (preventing cell death)
- Increasing production of protective enzymes, bcl-2 proteins, neurotrophic factors
- Promoting mitochondrial function
- Direct impact on the shape of alpha-synuclein

For example, MAO-B inhibitors can reduce oxidative damage due to their specific pharmacological mechanism of action, namely inhibiting MAO-B enzymes.

When MAO-B enzymes break down dopamine, they produce lots of free radicals. These are small, reactive particles that damage cell components (they cause oxidative damage).

By inhibiting MAO-B, less free radicals are produced, leading to less oxidative stress, especially in dopamine-producing cells; the cells that get damaged in Parkinson’s disease.

The TEMPO trial showed that rasagiline slowed down the progression of Parkinson’s disease (in early-disease patients who didn’t used dopaminergic therapy yet) (R):

The ADAGIO study found that rasagiline delayed the need for antiparkinsonian drugs and slowed the progression of the disease (R).

The PRESTO study found a benefit from associating rasagiline in levodopa-treated patients (R).

Studies show that selegiline (Deprenyl) can slow down the progress of Parkinson’s disease (while vitamin E supplements didn’t have an effect) (R).

Principle 4: Take B vitamins - and the right forms of B vitamins

Levodopa (L-dopa) depletes B vitamin levels, and increases homocysteine.

Homocysteine is an unhealthy substance of which the levels in the body rise when B vitamins are low.

B vitamins are very important for many processes in the cell, especially neurons.

Many proteins in our cells need B vitamins to function properly. For example, various B vitamins are involved in methylating DNA, which is a process that the cell uses to switch genes on or off.

When genes are “methylated” (which means methyl groups are put on them), they are often silenced (“turned off”).

However, when levodopa is broken down (metabolized) in cells, methyl groups are used. This puts extra strain on the cell, which needs more B vitamins (like folate, vitamin B12 and vitamin B6) to produce extra methyl groups (R).

However, it’s very important to take the proper forms of B vitamins. Most vitamin B supplements contain the wrong forms of B vitamins. For example, they contain vitamin B6 in the form of pyridoxine. Long-term use of pyridoxine can lead to neurotoxicity. This is because pyridoxine has a very long half-life (20 days), so it accumulates in cells.

Many governments claim that this neurotoxicity is only caused when taking very high amounts of pyridoxine over a long time (e.g. 100 mg over many months), but more recently, scientists and other governments are putting the dose much lower (e.g. even 2 mg of pyridoxine, when taken over a long time, could lead to problems in some people, especially given its long half life of 20 days) (R,R).

So a good B vitamin supplement should contain the right form of vitamin B6, namely pyridoxal phosphate (the active form of vitamin B6 our cells use), not pyridoxine.

Also, vitamin B9 (also called vitamin B11 in some countries) should be folate, not folic acid (which is the form of vitamin B9 found in most supplements).

It’s important to make sure you take the right B vitamin supplement. However, do know that most doctors and pharmacists are not well educated on this.

Principle 5: Consume a diet that slows down Parkinson’s disease

Scientific research shows that specific foods and diets can substantially slow down Parkinson’s disease.

For example, adhering to a more healthy diet was associated with 70% less risk of Parkinson’s disease (R).

Healthy foods contain many substances that can reduce the risk of Parkinson’s, or slow down the progress of Parkinson’s disease.

For example, people who consumed diets containing lots of flavonoids had 40% reduced risk of Parkinson’s disease, especially for flavonoids coming from berries (R).

A study following 30,000 people found that people who drank 1 - 5 or more cups of coffee had 45-60% less risk of Parkinson’s disease (R).

This way, the use of Parkinson medication, or the use of higher doses, can be postponed for longer.

Learn more about the best foods to slow down Parkinson’s disease here.

Principle 6: Take supplements that can slow the progress of Parkinson’s disease

Supplements are important for general health, but also to slow down Parkinson’s disease (and reduce the risk of the disease).

As we discussed earlier on this page, people with Parkinson’s who take levodopa need more B vitamins (given levodopa depletes B vitamins).

Supplements like PEA (palmitoylethanolamide), Rhodiola rosea, vitamin D and can impact Parkinson’s disease risk and progression.

For example, a study that followed more than 3,000 patients found that people with the highest vitamin D levels (highest quartile, or 25%) were 67% less likely to get Parkinson’s disease compared to people with the lowest levels of the vitamin (lowest quartile) (R).

Learn more about supplements for Parkinson’s disease here.

Principle 7: Consider photobiomodulation for slowing the progress of Parkinson’s disease

Photobiomodulation (PBM) is a non-invasive therapeutic approach that uses low-level red and near-infrared (NIR) light to stimulate cellular activity, with the goal of protecting neurons, reducing inflammation, and improving mitochondrial function in the brain.

Various studies demonstrate that photobiomodulation can improve brain health and positively impact Parkinson’s disease, Alzheimer’s disease and other neurodegenerative diseases (R,R,R).

Learn more about the science behind photobiomodulation for Parkinson's disease here.

Principle 8: Implement lifestyle changes to slow Parkinson’s disease

Besides nutrition, supplements, infrared light therapy, various other lifestyle changes can reduce the risk of Parkinson’s disease, or slow its progression, such as:

1. Improving sleep

Use natural sleep aids like magnesium (the glycinate or malate form), calcium, melatonin, Rhodiola rosea, or glycine. Incorporate meditation, mindfulness, or guided body scans before bed. Try sleep tracking apps (e.g. Sleep Cycle), sleep gadgets (e.g. Oura), wear blue-light blocking glasses before sleep, reduce screen time, keep a cool and dark bedroom, and maintain a regular sleep schedule.

2. Reducing stress

Practice daily meditation (e.g. using apps like Headspace or Calm), use relaxation devices such as massage devices, vibration devices, wearable vagus nerve stimulators. Do yoga, progressive muscle relaxation, or breathing exercises. Spend time in nature (e.g. forest, bathing) or listen to calming music.

3. Regular exercise

Engage in aerobic activities like walking, jogging, cycling, dancing, swimming, or Nordic walking.
Incorporate resistance training (e.g. light weights, resistance bands).
Join group classes like Zumba or aqua aerobics.
Gardening or housework can also contribute when done regularly.

4. Postural and balance exercises

Try Pilates, Alexander Technique, Feldenkrais method, Qi Gong, tai chi, balance board training, or gentle yoga. These help with body awareness, coordination, fall risk and brain health.

5. Having a positive outlook on life

Engage in gratitude journaling, acts of kindness, or volunteering. Read inspirational books, practice positive affirmations, or follow Cognitive Behavioral Therapy (CBT) techniques to reframe negative thoughts. Limit exposure to negative news or social media when possible.

6. Having social contacts

Meet friends for coffee or walks, call or video-chat with loved ones, attend community events, or join hobby clubs, event groups, or support groups. Consider volunteering or taking part in workshops or courses to meet like-minded people.

7. Stimulate your mind

Learn new skills like playing an instrument, knitting, or cooking new cuisines. Study a new language (e.g. via Duolingo), take online courses (e.g. Coursera, MasterClass), or try brain-training games like Lumosity. Play strategy games (e.g. chess, sudoku, bridge, crosswords), or participate in book clubs or discussion groups.

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