The Alarming Rise in Parkinson’s Disease with Dr. Ray Dorsey | The Empowering Neurologist EP. 167

we can slow the rate of progression by stopping exposure to certain pesticides and these dry cleaning chemicals or air pollution and then I think most powerfully we can create a world where these diseases are increasingly rare not increasingly common [Music] well hello everyone I'm Dr David Perlmutter welcome again to the empowering neurologist we are experiencing a virtual explosion in the number of new cases of Parkinson's disease I know we talked quite a bit about Alzheimer's in the program but all of a sudden Parkinson's is really becoming an issue and as it turns out there's very good data that relates risk for Parkinson's to some important modifiable issues like exposure to toxins uh head trauma for example we know there's a genetic component but it turns out that it's probably not that significant we also know interestingly that there is a contributor contributor in terms of risk brought on by changes in the gut bacteria who knew and today we're going to learn by looking at the book ending Parkinson's Disease by Dr Ray Dorsey hope that's in the frame uh he written a really terrific book and looking forward to a very exciting interview let me tell you a little bit more about Dr Dorsey Dr Ray Dorsey is the David M Levy professor of Neurology at the University of Rochester he's working to identify and eliminate the root causes of Parkinson's disease and his research on brain diseases and digital health has been published in leading academic journals and featured in multiple news outlets in 2020 Rey and his colleagues wrote this book ending Parkinson's disease a book that provides a prescription for basically ending the world's fastest growing brain disease Ray previously directed the movement disorders Division and neurology telemedicine at Johns Hopkins and worked as a consultant for McKenzie and Company in 2015 the White House recognized him as a champion for change for his work as it relates to Parkinson's so we're very delighted to have him on the program today let's get right to it hello Dr Dorsey welcome to the program I'm delighted to be with you David everyone calls me Ray okay uh you can call me Ray um terrific book and uh you know I'm reading this book in the context of what certainly we as neurologists but I think even perhaps the general population is is recognizing and that is suddenly you know it's well beyond Neil Diamond Linda Ronstadt and Michael J fox that we're seeing a really significant uptick in the number of cases of Parkinson's I mean it used to be sort of the the Forgotten a stepchild everything was about Alzheimer's and ratio was about one Parkinson's patient every 10 Alzheimer's but suddenly we're seeing a big uptick and you know I know we've got a lot to talk about but maybe let's first start with why that's happening yeah so um brain diseases are the leading source of disability in the world and the fastest growing of these brain diseases is Parkinson's Disease even faster than Alzheimer's as you mentioned over the last 25 years the number of people with Parkinson's has more than doubled and absent change is poised to double again and in our book we argue that numerous environmental factors three in particular outdoor air pollution certain pesticides and a common dry cleaning chemical called trichlorethylene All of which are mitochondrial toxicants are are fueling the rise of Parkinson's disease so they're all based on a mechanism probably more I would say probably microbiome changes as well but what you brought up is changes to function in the mitochondria the energy producers of the cells that are also involved in turning on the pre-programmed cell death pathway neuronal death pathway called apoptosis so why would these particular cells in the pars compact of the substantia or the dopaminergic cells why would they uniquely be at risk for these particular three events yes well as you know the brain is the gas guzzling organ of the body only counts for three percent of body weight but 20 of energy demands and the most among the most energy demanding cells are those in this substantia Nitro these nerve cells that produce a chemical called dopamine these cells have a million or more different connections to different nerve cells many of them are not insulated they're not covered with myelin so they have even higher energy demands if you stretch them out they're four meters in length which you know the double the height of even a tall person um and so I think those are the big reasons why these cells are particularly vulnerable or selectively vulnerable to mitochondrial toxicants so the reason that we have mitochondrial toxins is because they kill things for example paraquat was designed to kill weeds ostensibly or and other things I guess uh marijuana plantations uh but they they did so by damaging uh actually the mitochondrial function in the bacteria that are supportive in the soil and so it really I think goes a long way to supporting what you're talking about and also I think we get to this place back in the 1980s with the development of an illicit drug called mptp that was I think a synthetic Demerol that was injected it's a fascinating story maybe we could unpack that a little bit Yeah so this really goes um uh Dr Bill Langston was a neurologist at Santa Clara Valley Hospital in uh in Northern California when residents came to him and said we have young people with uh Parkinson what looks like Parkinson's disease and as you know 30 year olds with Parkinson's is really exceptionally rare uh and that these individuals weren't developing Parkinson's symptoms over years but we're developing it relatively acutely over days and so he went and saw one of these uh patients and I think in the emergency room and indeed this person in their 30s had developed what looked all the world look like Parkinson's disease but he was young and this had happened really acutely and it turned out that in the book called The Case of the Frozen addicts the addicts they identified that a contaminant mptp developed in a street form of heroin uh was likely causing Parkinson's disease now that mptp also damages the energy producing parts of cells which is a near Universal finding and Parkinson's regardless of its environmental or one of the rare genetic causes and MPP mptp has a very very very very similar chemical structure to the weed killer paraquat which is associated with 150 increased risk of Parkinson's disease I don't think we can underestimate like the impact of this is that finding an environmental cause for Parkinson's Disease based on just close clinical observation what an impact that has had on the field and I think we're here 40 years later saying that much of Parkinson's is likely man-made just as the the case of the Frozen addicts was well um you know nobody really talks about this uh we're seeing this explosive increase in incidents of of Parkinson's and people think well maybe that's just a genetic thing but that's not how genetics worked we haven't suddenly seen a genetic mutation uh in the human population that's explaining this obviously it's something environmental it's something extrinsic so then with this discovery that was made that this mptp contaminant of the the street drug uh induced almost instantaneous damage to this which uh interestingly these patients from my understanding were able to improve somewhat when they took standard pharmaceutical like cinemed l-dopa they actually had some improvements so really in many ways mimicked the so-called idiopathic form of Parkinson's so so that said thereafter mptp was used in research in animal research to actually produced Parkinson's wasn't it yeah so uh that was the basis for developing animal models of disease was to give them an environmental toxic toxicant to give mice and laboratory animals parkinsonism for the benefit of you know trying to determine which new therapies might be beneficial and to better understand the underlying pathology of the disease um interestingly I recall in uh in neurology that there was a a publication looking at uh two uh autopsies uh actually brain post-mortems of a couple of these mptp patients and years later they had passed away and they looked at their substantial the area involved in dopamine production uh as it relates to Parkinson's and interestingly what they found was this um microglial proliferation I.E a continued inflammatory response in the area of the brain that had been damaged years ago so it looks like it's set up a damage that was perpetuating that continued on long after the exposure yeah and we know that all these diseases uh in general take years to unfold so the the relevant exposure could have been in the case of regular Parkinson's could have been when a person was a child even potentially even a baby even potentially in the utero some of these pesticides and these dry cleaning chemicals can cross the the placenta um and that that triggers a response and a Cascade of events that takes years or decades to unfold before people develop the classic Tremor or slowness and movement that's very interesting because it makes it very difficult to do the detective work then and I think what you've done is you've demonstrated uh you know the risk from exposure retrospectively uh and to ultimately higher risk for having Parkinson's today so you've done a lot of work more recently in fact just publish a paper which is how you and I connected on a chemical that's called tce or trichloroethylene so let's first talk about what it is where and where how we're exposed to it so uh TC is a really really simple molecule so most of our listeners know that water has three atoms H2O two hydrogens and one oxygen trichlorethylene has six atoms so it's really simple two carbons in Black one uh hydrogen in white and then three chlorines in green hence its name trichloroethylene or tce a very closely related chemical is perchloroethylene widely used in dry cleaners just has one additional chlorine atom and this has or chlorine atoms TC was developed in 1864 first commercially used in the 1920s and been used to do everything from dry cleaning clothes as we mentioned to degreasing metal which is one of its principal uses to even decaffeinating coffee um in the 1970s two pounds per American were produced it was found in carpet cleaners it was found in typewriter correction fluid it was found in Gun Cleaners wide variety of commercial products um it still permitted a use is still permitted uh in the United States even though it's known to cause cancer so it's a carcinogen according to the World Health Organization according to Environmental Protection Agency it's known to cause cancer especially leukemia in kids liver kidney Non-Hodgkin's lymphoma prostate cancer multiple myeloma and likely many others and research done by Dr Sam Goldman and Dr Caroline Tanner 10 years ago indicated this chemical is associated with a 500 percent increased risk of Parkinson's disease well it really Harkens back to our earlier conversation that um the gun may not be smoking any longer that you know these could be exposures that we've had decades ago that have damaged that area in the brain and finally you get there's a there's apparently a threshold below which you begin to have symptoms of damage to those cells you have to lose a certain number of those dopaminergic cells in order to begin to manifest Parkinson's but maybe it's just that initial damage coupled with the normal loss of Aging might be why then things begin to manifest but yet uh clearly I I think when did James Parkinson's Parkinson write his book I think it was uh early 1800s yeah 1817. and when he described it he described six individuals with the disease 200 years later the global burden of disease study estimated that six million people had Parkinson's disease so you go from a disease of a rare disease a disease that he said had not been classified in the medical literature to one that's affecting over six million uh people worldwide the Spanish is 200. I'm tempted to turn around right now because somewhere on my uh and somewhere on my shelf I have a copy of the original book which is really quite interesting in those days the observation and the documentation was just so elegant uh and you know when you see what people were able to uh describe and how things have changed today of course uh now with chat CPT that'll probably change once again but but that said let's get back to the trichlorethylene story I mean I think most people were going to say yeah it's something in dry cleaning fluid so I don't dry clean my clothes anymore but despite that we're still exposed aren't we yeah so uh most of your listeners will know about the Marine Base Camp Lejeune where lots of Marines were exposed to this dry cleaning chemical which got into the groundwater and so Marines from 1953 to 1987 were drinking water at the Marine base while they're being trained that had levels up to 3 000 times which are that which are safe um a study done by whatever that means yeah is that yes unnatural chemical is safe but anyway sorry to interrupt exactly and um a study just came out two weeks ago but again the same individuals who looked found a 500 increased risk associated with a TC looked at Marines who served at Camp Lejeune and then compared that to Marines who served at Camp Pendleton on the west coast which is much less contaminated they found that the Marines who served at Camp Lejeune had a 70 increased risk of developing Parkinson's disease a 70 increased risk of developing Parkinson's and this is among healthy individuals so these marines obviously among the best and brightest of us um were on average 20 years old when they were at Camp Lejeune and were there for only two years so although the level of exposure was likely very high they were young they were healthy and they had a limited duration of exposure only two years and this was all environmental exposure this was not individual using this as decreasing the tanks or anything like this this is likely principally from drinking contaminated water or inhaling this volatile chemical and their Barracks or their homes so what does that tell us we should be doing right now I mean you know as you described in your book what what is the call to action for me and you yeah so uh it's time to ban the chemical uh for a hundred years it's been causing cancer and for four generations it's likely been contributing to the rise of Parkinson's disease Western European nations have banned it the EPA says that tce and the closer way chemical perchlorethylene both pose quote an unreasonable risk to to human health if chemicals pose an unreasonable risk to human health it's time to ban them um we have safer Alternatives companies even advertise safer Alternatives few of us would step into a car or none of us would fly an airplane from the 1920s why are we using chemicals from the 1920s that we know cause cancer and are likely uh uh causing or contributing to the rise of Parkinson's so um you're stepping out I think a little bit from mainstream mainstream medicine doesn't usually involve itself in uh castigating things like a particular chemical how are your colleagues responding to what you're doing I think neurologist you know we go from disease to treatment but really do we think about going from disease to cause and when you uh Story of My Life there you go when you go to disease to cause you get a couple great bonuses one you can find treatments so you and I both remember that uh also stomach ulcers we used to thought were due to stress and we would tell people you know stop working meanwhile they'll have a bigotomy or have a bigot in me and all of a sudden we found out it was due to the to a bacteria and we can we cure uh ulcers by giving people antibiotics the same thing happened with hepatitis C same thing happened with a wide range of things so if we identify what the causes we can cure it we can slow the rate of progression by stopping exposure to certain pesticides and these dry cleaning chemicals or air pollution and then I think most powerfully we can create a world where these diseases are increasingly rare not increasingly common and think about what a great gift would be to give future Generations one where Parkinson's is extraordinarily rare just like we live in a world where polio is extraordinarily rare we live in a world where drinking and driving is socially unacceptable we live in a world today where HIV is not only treatable but preventable and rates of HIV in the United States are decreasing things that we would never have considered and just in our lifetimes you were mentioning ulcers and forgive me for digressing but a thought came to mind uh have you mentioned the work of of Dr Barry Marshall and H pylori that in the day my day um prior to that Discovery uh we would do a surgical procedure called vigotomy pyloroplasty bit but part of that procedure for ulcers was to cut the vagus nerve with the now retrospectively misguided understanding that it was hyperactivity of the vagus nerve that may somehow be contributing to ulcers but that said interestingly back to our discussion in Parkinson's it was demonstrated subsequently and actually much more recently retrospectively that individuals who had their vagus nerve cut had a very significant reduction in risk for developing Parkinson's and it it's a little bit tangential to our our topic today but how interesting it is because the supposition was that this the precursors or actually fully formed uh protein called Alpha synuclein may come from the gut and travel up this vagus nerve getting its way into the brain Alpha synuclein being one of the markers Hallmarks of Parkinson in the brain and therefore when you cut the highway and this protein couldn't make its way to the brain that might explain the reduction in risk of Parkinson's so it seems that there certainly is a a developing uh interest in the role of things gut related as it relates to Parkinson's yes so if we said classically Parkinson's Tremor and Stillness movement difficulties with walking but the earliest features of Parkinson's don't have anything to do with movement they have to do with loss of smell and constipation both of which are found in over 80 percent of individuals both are found years if not decades before people develop these classical tremor for example I think that's telling us where the disease begins so these chemicals are either inhaled pesticides for example trichlorethylene often inhaled or they're ingested uh so TC contaminated the drinking water at Camp Lejeune pesticides can get into drinking water especially well water and it could be that these toxicants are causing misfolding of this protein Alpha synuclein which can be found in early individuals in the gut and as you suggest there's the biggest nerves the highway as you as you indicated it runs from the gut all the way up to the lower part of the brain the brain stem and that misfolded protein can spread from nerve cell to nerve cell and may explain why constipation is an early feature of the disease and then it as it spreads up to the part of the brain that's responsible for movement the substantial you get the classical Tremor and then spreads to other parts of the brain that are implicated in memory and then can cause in the late stages of Parkinson's disease dementia for example is it fair to say that um I don't mean to put well I guess I do mean to put on the spot that's what this that's what an interview is that by and large mainstream medicine slash neurology is really focused as relates to Parkinson's on symptom management fair to say yeah I I would just say that you know everyone's looking for cures in uh your book uh so as I indicated before I was reading green brain as I was flying in today can I read from your introduction of your book I think uh tells it all uh you quote um from a Chinese Chinese text from the second century BC Renee Jing prevention is the ultimate principle of wisdom if you're a disease after it has manifested like digging a well when one feels thirsty or forging weapons When The War has already begun is that the quote exactly and so what a greater I mean who wants to be cured of prostate cancer who wants to be cured of breast cancer I just assume never get prostate cancer I just assume never get uh uh prostate cancer or breast cancer and we can prevent Parkinson's disease we can probably prevent other brain diseases too and we've seen that we've seen like stroke you know rates of stroke have declined the in the United States because of efforts aimed at preventing the disease from ever happening um and we can do the exactly the same thing for Parkinson's Parkinson's to a large extent is preventable to a large extent Parkinson's is a preventable disease the sooner we recognize it recognize that the sooner we act on that the sooner we prevent millions of people in the United States and around the world from ever developing this disease and we can do that not just for now but for generations to come I'm almost speechless it's hard to make news pieces but um it they're not a lot of us out there uh and to hear you uh project what you just projected in terms of keeping people healthy in the first place so that they don't need these treatment protocols is uh really close to my heart because really what we've been doing for such a long time and it's great to know that there are people like you out there that are looking at these things and asking why you know um in my practice uh after 10 years of mainstream neurology I finally said why are all these people coming in in the first place what's causing their headaches could it be food related why are is there such a relationship between diabetes and Alzheimer's risk uh you know what's this exposure why you know with respect to uh toxins and and Parkinson's what can we do about it when I realized that interestingly the same chemicals used to create Parkinson's in the laboratory animal were being sold on animal on Amazon rather to be used on our vegetable gardens maneb and Manco zip that are used to create Parkinson's and laboratory animals I thought that was a little uh challenging and so it's it's great that you're out there um what do you see has developed since your book was published that you wish maybe you would have had the opportunity to include well I I I think I my colleagues that even my co-authors in the book I think were a little uh skeptical uh of the some of the directions I was pushing us and all this by the way is based on a great neurologist Dr Caroline Tannerite who's now at the University of California San Francisco who's detailed the environmental risk factors for Parkinson's for over a generation and all I've done is just read her work and agree um I I think there's nothing wrong with that there's nothing because now you're out doing what you're doing you've written this book you're on podcasts and you're spreading her word it's great I mean I I know what that's like and uh I think we know way way more about trichlorethylene I'll give you a story with that was a vignette from our recent paper Brian Grant the former NBA basketball player who has a Parkinson's disease and has a foundation a great foundation called the Brian Grant Foundation he was uh when he was three years old his father was a marine his father was stationed at Camp Lejeune at the peak of the contamination of tce and other chemicals at the Marine base he almost certainly was drinking uh the contaminated drinking water he while he his last year in the NBA developed a Tremor and was subsequently diagnosed with Parkinson's disease his father dies of esophageal cancer which is linked to tce his younger brother nearly dies from a respiratory illness that was likely associated with a tce so we found in this individual Brian Grant one of the most prominent individuals with Parkinson is a champion for the disease for millions of people across the country and around the world Early Childhood exposure at age three as a young boy uh based on a Marine base uh getting contaminated water and paying a really high price for it by getting Parkinson's three thirty years later the study that came out two weeks ago suggesting that Marines who served there and again adults who served there are 70 increased risk I think we just know much more the evidence from laboratory studies showing that feeding TC to mice and rats produces the clinical pathological features of Parkinson's this is all really hopeful that we're identifying what might be one of the principal causes of Parkinson's especially in suburban and urban areas and these contaminated sites are everywhere there are three dry cleaning sites that are contaminated with it near within five minutes of where I live in Suburban Rochester New York I'm hanging out in New York City today and that turns out you know many of the uh high rises in New York City have a dry cleaner on the ground floor and so these dry cleaners are obviously dry cleaning clothes many of them and they can find in the apartments above that dry cleaner these chemicals these dry cleaning chemicals per chlorethylene especially in the indoor air of apartments above dry cleaners and people are breathing this in not even knowing it and you can even go to supermarkets that are near dry cleaners and because TC and percoethylene dissolve in fat and as you indicate in one of your books I think the brain's the fattest organ in the body they find that perchlorethylene in the butter in the margarine and the cheese in those supermarkets so I was getting into the butter cheese and margarine of supermarkets that are near dry cleaners what's it doing to people when we are inhaling it in our Apartments our schools our workplaces or our homes and what does this mean for uh for both for cancer and for Parkinson's Disease and I think only thing you can conclude is very concerning uh answers when you pick up your dry cleaning how long does it outgas these chemicals so it's um so I now use a dry cleaner that does not use these chemicals um it's yeah these chemicals if you put the dry cleaning in your car your car will will soon fill up with these gases and you'll be inhaling these chemicals while you're bringing your dry cleaning back from the dry cleaners you put it in your house it'll do the exactly the same thing um if you have a kid and you bring a kid in with the kids having an ice cream cone looking as ice cream Coney goes in the dry cleaner with you when he's going out leaving the dry cleaner he's got perchlorethylene in his ice cream cone um so what is wrong with this picture I we're paying a really high price for dry cleaning yeah wow so the the notion of dry cleaning though it's not actually dry I mean you're soaking your clothes or they're being treated with a this chemical that's actually a liquid correct yeah so it's a liquid it really uh evaporates uh and hence its juice and dry cleaning and it doesn't shrink clothes so we're doing all this because water shrinks clothes and so we used to use flammable liquids uh for dry cleaning like kerosene um that you know has its limitations then we start using trichlorethane and then perchlorethylene which aren't flammable but they uh TC is known to cause cancer for chloroethylene is a probable carcinogen um and they're both associated with a 500 percent roughly 500 risk of Parkinson's disease the price is way way way too high if we ban these chemicals we're going to prevent people from Ever Getting cancer we're going to prevent kids from Ever Getting cancer we're going to prevent adults remember getting cancer what are you doing to help move that ball down the field in terms of getting uh raising awareness that these things need to be banned where do we stand in Washington for example so two states New York and Minnesota have banned uh trichlorethylene uh a couple states are trying to ban perklo I think I think California may have done so uh the EPA reaches conclusion about these chemicals posing an unreasonable risk to human health the hope is that they will follow on with that conclusion and lead to regulation and ideally Banning of these chemicals um we visit I visited uh dozens of Superfund sites throughout the entire United States that are contaminated with these chemicals and these Superfund sites are in neighborhoods they don't just know I thought I thought I would go see people with hazmat suits and you know uh security guards and fences and a skull and crossbone signs there was nothing of that nature there's no indication to the public at all if they live next to a Superfund Site you could be living next to one in Silicon Valley you could be living next one in New Jersey you could be living next to one in uh Woburn Massachusetts and not even know that you are right next to a site that's uh off-gassing uh tce and pce into people's homes schools and workplaces this is happening in Newport Beach California right now there are homes on top of an aerospace facility and they find these chemicals in the playroom of children and multi-million dollar homes in Newport Beach if that's happening in Newport Beach California multi-million dollar homes think about where else that's occurring you know now you paint the picture then understanding why this this incredible increase in Parkinson's instance uh you know there's no there's no question here there's no uh doubting in terms of this connection so how is your personal life been changed by these discoveries uh well you know I used to think the the air we breathed the water we drink and the food we eat is safe uh I no longer uh think that at all um so um I buy organic wherever possible I wash all my fruits and vegetables even the organic ones with water and a pesticide wash which is essentially just soap I put a carbon filter on my water um my kids bought my parents live in Southern California my kids bought them air filters for their homes uh because you know air pollution is a big issue and as as you know air pollution is linked to cognitive decline and Alzheimer's disease so there are lots of things that I do individually to decrease my risk I've upped my exercise level as as you know uh vigorous exercise can decrease your risk of developing Parkinson's disease and likely a wide range and a wide range of other conditions I always wear a helmet when I bicycle I was doing that we'll get to that in a moment but um I think there are lots of things that uh individuals like I can do and you can do and lots of things that uh others can do but the real solution to many of these things are societal we don't need to live in a world where pesticides are used indiscriminately we don't need to use pesticides on our lawn all the time I have lots of dandelions in our house um we we don't need to be exposing golfers to um or people who live near golf courses to toxic levels of pesticides we should be able in the wealthiest nation in the world should be able to have uh clean water and provide that for all of its citizens and have that we should be able to breathe our air in our homes without concern that we live near a dry cleaning site or an industrial site or a military site that's contaminated with these chemicals and so that people in Long Island or Wilbur Massachusetts or Toms River in New Jersey need not be concerned about the air that they're breathing in their own communities I should be frowning but I'm actually smiling I'm I'm smiling because you're out there getting the word out I I I I could frown because it's clearly it it's uh an S show if we'll leave it at that it's it's a scary proposition and it doesn't look like it there's any uh change in the direction that the ship is sailing right now and we're paying the price and the problem is as you mentioned earlier is there's no a direct chronological connection that's easy for people you know if uh you bend over and pick something up the next day your back hurts oh obviously I shouldn't have picked that up but here we are decades out it's very very challenging to make that connection but God you've done an incredible job in uh in raising our awareness one of the things that I I liked I'm going to just tell you you have these recommendations here about reduce your risk at work ban paraquat and trichlorethylene drink clean water I haven't heard that before on this program breathe fresh air avoid activities with high risk of concussion we should talk about that in just a moment but you said enjoy your coffee and you made a friend when you when you did that I'm all in so is there a mechanism that you're aware of or what do you think I mean the data would show that it's it's uh protective so uh caffeine has been Associated to with a decreased risk of uh Parkinson's and it may protect the dopaminergic neuron so that's one thought other thought is that it turns out Parkinson's it may be easier to give up habits because there's less of a reward mechanism so for example it may it turns out that people with Parkinson's have a little bit easier time uh giving up uh smoking for example so it's it's still unclear there are people far better educated on the effects of caffeine the brain probably you than me uh to speak more about that well you know as it relates to coffee if I may um people immediately go to the caffeine uh part of that uh discussion and um you know there are more than 200 bioactive components found in in caffeine importantly one called chlorogenic acid that really is quite protective as as it relates to mitochondrial function and as you indicated earlier this is we call it an acquired mitochondropathy complex one dysfunction which I think was the reason we saw the coenzyme Q10 work originally but you did mention something just now that I thought was kind of interesting that they can Parkinson's patients uh are able yeah yeah something else interesting as well they don't stay on things as readily they're able to give up smoking and yet uh interestingly we'll maybe get to the uh there's a certain drug used for Parkinson's it makes people a bit uh makes their decision making very challenging but let's talk about smoking for just a moment because there is some literature that suggests that cigarette smoking is somehow protective against Parkinson's it's a tough one to uh talk about but it is you know it is in peer-reviewed literature so what's going on with that so there have been a number of studies that have Associated a decreased risk of uh Parkinson's among smokers um since writing the book I'm moved by my colleague Jeff Bronson at UCLA who thinks this might be a case of reverse causation where smoking doesn't decrease your risk of Parkinson's but Parkinson's decreases your risk of smoking you mentioned so um as we indicated early on these disease plays out for years and by the time you're diagnosed 60 of those dopamine producing nerve cells have died off by the time you're diagnosed with Parkinson's you can imagine when 20 of them have died off it may be you have lesser reward mechanism and therefore it may be easier to give up smoking and there's evidence that that's the case for people with a Parkinson's disease so it may be that subclinical before people make the diagnosis uh that it's easier for people who are going to go on to develop Parkinson's for them to give up smoking therefore by the time that they're diagnosed non-smokers tend to be more commonly um what's interesting is you're talking about decision making and being able to modify one's Behavior Uh different in Parkinson's in comparison to the non-parkinson's patient and yet interestingly there are a a number of patients who are taking a particular drug that activates this dopaminergic pathway pramapexal mirapex who actually uh have been shown to have a real high risk for developing addiction to gambling so I mean I think the whole notion of this chemistry is that there are a lot of nuances to it when we go manipulating dopaminergic uh Pathways in the brain with various medications or how it's changed in the Parkinson's patient that relate to behavior yeah so every medication has its side effects and as you indicate um people with Parkinson's lose dopamine in the brain and so one class of drugs is an artificial dopamine synthetic dopamine and pramipexal repinarole are two of those and those have both been linked with a really high risk of developing something called impulse control disorders which is compulsive gambling compulsive sexual behavior compulsive eating and compulsive shopping and these things can be really disruptive and uh to people's lives one many people don't admit that you know they don't come to their doctor saying I'm watching too much porn doctor to help me out or I'm spending too much money or losing too much money in the casino unless doctors tell them when they prescribe these medicines which I rarely do I rarely prescribe this class of medications is that these are associated with them and then systematically assess for people for the risk of doing it you know I've seen priests who've been prescribed these medicines and you can imagine the kinds of things that that things that disrupting their lives and people have lost their a large portion of their life savings people have had their marriages ruined people have gained huge amounts of weight and general people with Parkinson's tend to lose weight so that's at least one thing you can often observe is that people gaining weight and that's a red flag so um these medicines if you're taking these medicines and you're experiencing these things go to your doctor and tell them that you're experiencing these things because the treatment's relatively easy in most cases which is reducing or limit getting the medication and there are other medications that are associated with much less risk of developing these side effects I want to cover before we close uh just the notion of and you mentioned wearing head protection the the notion of pugilistic Parkinson's or how repeated head trauma might predispose a person to this situation yeah so uh or co-author on the book Dr Michael Oaken uh was one of the neurologists who cared for the great uh late on Muhammad Ali and he wrote a piece in a Jama neurology recently in which he indicated that he thought repeated head trauma was a contributing factor to his uh Parkinson's disease all done with the permission of uh um Mr Ali's family um and so we know that uh significant head trauma increases your risk of Parkinson's and repeated head trauma increases even further I I think it's pretty clear that brain head trauma not surprisingly is not good for a wide range of brain diseases it's probably even worse for ALS is probably worse for chronic traumatic encephalopathy worse for dementia um so we should be thinking about some of the activities that we engage in seeking to minimize risk of head trauma because there are a wide range of brain diseases that again don't have their onset immediately after like a concussion those symptoms but will have put you at higher risk for developing a neurodegenerative condition later in life or later in your child's life so the message then is headgear at all times bikings you know look look how it's taken off in snow skiing yeah and you know think about all the lives we're saving the death and disability that we're preventing by doing this it's almost like seat belts and I think there are certain activities that may be inherently really too risky I think I think most people are reaching that conclusion about ground tackle football for young children um and I think there are ways that we can make the sports that we love including soccer including football all much safer all especially with the lower risk of developing a significant head trauma and allow athletes as well as us non-athletes non-professional athletes to live longer and more importantly healthier a lot what I read into that is at 68 I shouldn't be learning paragliding and I'm probably not going to anyway great great time to spend time with you this is a wonderful wonderful book and uh we'll put your contact information of course in uh in the blog that accompanies the podcast thank you so much for spending time with us today and really enjoyed meeting you this has been awesome thank you very much David it's great to be speaking with a neurologist who's a as passionate about that preventing disease and brain diseases as as I am and I can't think of a better gift for neurologists than to create a world where uh brain diseases are increasingly rare and don't even affect people so they can live long to healthy lives and not you be free of concerns about things that are robbing them of their minds and their own opponents it's it I'm telling you it's breathtaking for me to hear that coming from a fellow neurologist uh it makes the world worth living thank you very much we'll talk soon thank you bye for now so Dr Dorsey explains to us uh very interesting information that relates to why we're seeing this sudden and significant uptick in the number of cases of Parkinson's disease and you know interestingly there's a delay here that these exposures to the various things he talks about may have happened years decades before so it's really all about cleaning up our act and living a life that exposes us less to these potentially very toxic chemicals hope you enjoyed the program today I sure did thanks for joining us I'm Dr David Perlmutter bye for now thank you [Music]

Channel: DavidPerlmutterMD

Views: 616,599

Keywords: david perlmutter, dr. david perlmutter, grain brain, dr. perlmutter, brain maker

Id: nfsZOmSYJoo

Length: 43min 25sec (2605 seconds)

Published: Mon Jun 26 2023