Dietary Supplements for Parkinson’s
There are different perspectives on the safety and effectiveness of dietary supplements for Parkinson’s disease.
Proponents of Active Prescription of Dietary Supplements
On one side, there are supporters of actively prescribing various dietary supplements and experimenters, who prescribe supplements without sufficient grounds and based on hypothetical considerations.
Is the expert truly an expert in this field?
Very often, the appointment of a certain substance is advocated by an opinion leader who is authoritative in medicine or even far from medicine but respected. From the perspective of evidence-based medicine, this argument is called “expert opinion “, he is assigned a low level of trust in modern medicine
- Is the expert truly an expert and specifically in this field?
- Is there a personal interest of the speaker in recommending this dietary supplement?
- Could the expert be sincerely mistaken and overlooking something?
A positive effect in one does not guarantee the absence of harm in another
One of the drawbacks of an overly bold approach is that hypothetical assumptions about one link in metabolism may not work because another link is underestimated. For example, the valine mentioned in the article about amino acids is noted as potentially beneficial for emotions and muscles, yet it may increase the risk of diabetes (insulin resistance) and competes with levodopa. What will ultimately prevail, mood or diabetes?
Research as an Argument
In order to say that an intervention works or does not work, we need more than assumptions, hypotheses, or simple conclusions from knowledge of physics, chemistry, or biology. Sometimes, an intervention can lead to the opposite effect than expected. Then, something entirely new in metabolism may be discovered, which science previously did not know. To discuss effectiveness in humans as a whole organism, large, well-structured research studies are conducted across multiple centers and over a sufficiently long period (years).
Researchers compare how people feel who take a substance with those who take a placebo, or simply put “пустышку ” over a long observation period. You can read about it on the Cochrane Society website. After conducting a large study, scientists say: this substance causes improvement in X%, increases the risk of something by Y% and life expectancy at Z years. Then we have the right to officially recommend it to patients and compare it with other types of treatment.
On the other hand, conducting research is a very expensive undertaking. Some inexpensive folk remedies might work, but pharmaceutical companies are not always interested in investing in extensive research for something that is easily accessible and cheap, especially if it competes with their expensive drug.
When does the bold use of dietary supplements provide benefits?
We know examples of people who successfully experimented on themselves and achieved great heights. Many well-known bodybuilders in the sixties and seventies of the last century tested sports chemistry on themselves, kept diaries, and drew conclusions [Schwarzenegger, 2008 ]. Some of them have become famous and delight us with their health despite their chronological age. But how many of them have suffered from experiments and have not left us with vivid examples? Judging the effect by the bright manifestations we see can lead to “survivor bias ” and the formation of myths. On the other hand, these people drew the attention of research to the fact that the use of food supplements is promising and requires investigation.
Currently, there are scientists testing dietary supplements on themselves. In laboratories, for example on mice, they find candidates for “medicines for aging “. For example, David Sinclair [https://en.wikipedia.org/wiki/David_A._Sinclair] conducting research NMN found bright positive results in mice [Tarantini, 2019]. He promoted the drug as a dietary supplement, including using his own example, and as a result, since November 2022 the drug FDA considered as a medicinal product [Qin Song, 2023].
Radical Opponents of Dietary Supplements in Parkinson’s Disease
“С avendum esse ab homine unius libri” (beware of the person of one book)
Thomas Aquinas [Dushenko, 2020 ]
On the other hand, there are radical opponents of dietary supplements, claiming unpredictability, psychological dependence, and economic effects.
Dietary supplements have unpredictability in effectiveness and safety
The evidence base for dietary supplements is insufficient, leading to unclear dosing and overdose risks.
On one hand, we are afraid of the interaction between dietary supplements and medications. On the other hand, we know that a dietary supplement may contain 1 gram of omega-3, while wild salmon contains 8±3 milligrams of omega-3 per gram, and also wild salmon contains 0.13 – 1.19 picograms of polychlorinated dibenzodioxins + dibenzofurans and 0.23 – 0.95 picograms of dioxin-like polychlorinated biphenyls [Anne-Katrine Lundebye, 2017], are you sure there will be no additional interaction with them?
On one hand, radical opponents of dietary supplements say that there is no strict regulation of production purity for supplements. There is a known case of mass poisoning with curcumin in the form of a dietary supplement, where during its production in India, it was ground in lead mortars, and a large amount of lead ended up in the product. On the other hand, this does not mean that all dietary supplements “Dirty “. This is probability; the lack of strict regulation poses a risk of side effects, including from unpredictable composition and impurities. But, perhaps, there is a very pure and conscientious manufacturer somewhere. How could this be determined?
Supplements can cause psychological dependence, shift focus, and create an illusion of safety
On one hand, people may start relying on supplements as “miraculous remedy ” instead of addressing the problem through lifestyle changes, diet, or medical treatment. This can distract from the real causes of the disease or delay seeking qualified medical help. A person may prefer taking dietary supplements because it is an easy solution, whereas proper nutrition, exercise, and visiting doctors, for example, require effort.
On the other hand, surely among your acquaintances, there are people passionate about a healthy lifestyle. They train properly, eat right, and have a huge number of supplement jars—this is discipline and the start of their morning ritual.
Resource Allocation in Choosing Supplements for Parkinson’s
We live in a reality where resources are limited. With a certain amount, we can choose how we will eat, whether we go to a good pool, or buy supplements. It is dangerous to use supplements at the expense of proven beneficial effects, such as proper nutrition, physical culture, or good medications.
There is an opinion that a balanced diet is sufficient
There is an opinion that a balanced diet can compensate for everything. And there is an element of common sense in this. It would seem that nature has evolutionarily created us with what surrounds us for food. But it should be noted that animals run all day to find food, people lived under the sun, not in high-rise buildings, and ate food not contaminated with pesticides, fertilizers, hormones, and artificial feeds. And yet, the average life expectancy of people at the beginning of the last century, according to Rosstat, was about 30 years.
Systemic View on the Complex Issue of Dietary Supplement Prescription
The issue of nutrition is complex. To consume the necessary amount of protein, for example, we eat chicken that was fed with compound feed and we get extra fat, and some amount of hormones and antibiotics (even if allowed). If we replace chicken with pure protein, we won’t get calcium, iron, and vitamins. If we add calcium, iron, and vitamins to the protein, the intestines need to work for absorption, the gut flora needs to thrive, and so on endlessly.
Considering the issue of prescribing a dietary supplement to a patient, we are dealing with what is called in systems theory “wicked problem” (translated as “malicious problem ” or “insidious problem “).
They are characterized by:
- Complexity and Uncertainty: The problem lacks a clear definition, and its boundaries and parameters are constantly changing. Should vitamin D be called a dietary supplement or a medication? What about Omacor? If so, why and in what case? From a legal standpoint, some drugs are registered as medications in one country but are sold as dietary supplements in other countries. Does this change the essence of things?
- Multiple Stakeholders: Different groups with conflicting interests and values are involved in the decision-making process: doctor, patient, pharmaceutical companies, government, opinion of the medical community, media.
- Lack of a clear solution: There is no single correct answer, and any solution may create new problems, as we mentioned above.
- Uniqueness of the problem: prescribing for each patient – this is “wicked problem”, it is unique, and it cannot be fully compared to others
- Impossibility “Checks ” solutions: The results of the solution can only be assessed over time, and they may be ambiguous.
When we talk about a patient with Parkinson’s disease, we are not talking about a healthy person. Why is he unhealthy? Could the cause of the disease be partly in this? Does his illness interfere with normal absorption of, for example, protein? Of course, he takes levodopa, which is incompatible with protein. What happens if there is not enough protein? Muscles will weaken, the patient will stop moving and maintaining balance, and ultimately life expectancy may decrease. This leads us to a balanced approach. To a solution “insidious problem “.
Is placebo bad for patients with Parkinson’s?
Placebo is a dummy medicine, “пустая ” a pill that does not contain an active ingredient
In 2025, Knezevic NN published an interesting article, which may seem controversial, but I would like to mention his arguments in this post.
I am adapting his publication for you:
The study by Finniss et al. (2011) showed that a placebo can be beneficial for a wide range of conditions, such as pain, Parkinson’s disease, depression, anxiety, addictions, and even for improving overall well-being (Finniss D.G., 2010). This works because a placebo affects how a person perceives their condition, especially when results are difficult to measure objectively. In Parkinson’s disease, a placebo not only helps patients feel better but also genuinely improves movement. This is because dopamine, a substance important for movement control, is released in the brain (Quattrone A., 2018). For example, in one study, Lidstone et al. studied 35 patients with Parkinson’s disease. They were told they had a 25%, 50%, 75%, or 100% chance of receiving real medication or a placebo. Even when patients received a placebo, their brains released dopamine. Interestingly, the most dopamine was released in those who were told there was a 75% chance of receiving real medication, rather than those told there was a 100% chance (Lidstone S.C., 2010). Studies have also shown that a placebo activates important areas of the brain that help improve movement, providing scientists with an understanding of how the placebo effect works (Polgar, 2022). Another approach is to combine regular medication with a placebo. For example, the patient takes less medication, but their body “gets used to ” associate placebo with the treatment effect. This helps reduce the medication dose in chronic diseases such as Parkinson’s disease and hypertension without losing therapy effectiveness (Benedetti F., 2004)
So we see that even a placebo can work to reduce the symptoms of Parkinson’s disease if one believes in it.
- It’s important to understand that it should not harm you. Dietary supplements do contain some active ingredients. Read our article about amino acids in Parkinson’s disease and you’ll see that not all amino acids in excess are good for patients with Parkinson’s disease, even though we consume them every day with food.
- You pay money for supplements that could be used for proven types of treatment.
- Supplements May Contain Toxic Products. Remember the story with curcumin, which was ground with lead pestles in mortars in India.
A Balanced Approach to Prescribing Supplements
You should read only one newspaper: reading several is confusing, not to mention a waste of money
Bernard Shaw [quote by Dushenko, 2020 ]
The ironic statement by Bernard Shaw may characterize the feeling after reading this article. Indeed, the more you learn, the more questions and doubts arise.
We are very cautious about food additives and strive to follow the principles of evidence-based medicine
But we also think.
It is important to understand that the true definition of evidence-based medicine is not just blindly following clinical guidelines.
According to the Cochrane Society, evidence-based medicine lies at the intersection of three circles:
- Research data
- Doctor’s Experience
- Patient Values
A doctor must apply their experience, critical thinking, and skills to adapt scientific data to a specific situation, considering numerous factors, including the patient’s values (e.g., if they are vegetarian or vegan), and personalize the treatment approach.
Objectively confirmed deficiencies need to be addressed. It’s incorrect to ask the question “Are dietary supplements good or bad? “, is it correct to ask what exactly we want to add, for what purpose, to whom, when, and in what context?
If we see the need to make an exception to clinical guidelines, we always discuss all the pros and cons of this “insidious problem ” with the patient
Furthermore, a doctor cannot make such decisions alone; it should be done in collaboration with intelligent, experienced, critically-thinking colleagues with research experience
It is precisely the personalized and compassionate, yet scientific approach that is the art of modern medicine.
Sources:
Dushenko Konstantin HOMO UNIUS LIBRI, OR A PERSON OF ONE BOOK: EVOLUTION OF THE CONCEPT // Bulletin of Cultural Studies. 2020. No. 4 (95) URL: https://cyberleninka.ru/article/n/homo-unius-libri-ili-chelovek-odnoy-knigi-evolyutsiya-ponyatiya (date of request: 03/11/2025)
George Bernard Shaw. Aphorisms / compiled by Duschenko K. V. — M.: Eksmo-Press, Eksmo-Market, 2000 https://www.phantastike.com/folklore/shou_aforizmy/pdf/
Lundebye, A. K., Lock, E. J., Rasinger, J. D., Nøstbakken, O. J., Hannisdal, R., Karlsbakk, E., … & Ørnsrud, R. (2017). Lower levels of persistent organic pollutants, metals and the marine omega 3-fatty acid DHA in farmed compared to wild Atlantic salmon (Salmo salar). Environmental research, 155, 49-59. https://www.sciencedirect.com/science/article/abs/pii/S0013935116311811
RBC What is the “survivor bias”: examples from life and business https://trends.rbc.ru/trends/social/614b1ae49a794765f427679c
Do you want to learn more about evidence on health and healthcare? Cochrane https://www.cochrane.org/ru/evidence
Tarantini, S., Valcarcel-Ares, M.N., Toth, P., Yabluchanskiy, A., Tucsek, Z., Kiss, T., Hertelendy, P., Kinter, M., Ballabh, P., Süle, Z. and Farkas, E., 2019. Nicotinamide mononucleotide (NMN) supplementation rescues cerebromicrovascular endothelial function and neurovascular coupling responses and improves cognitive function in aged mice. Redox biology, 24, p.101192. https://www.sciencedirect.com/science/article/pii/S221323171930240X
Uddin, Golam Mezbah, et al. “Nicotinamide mononucleotide (NMN) supplementation ameliorates the impact of maternal obesity in mice: comparison with exercise.” Scientific reports 7.1 (2017): 15063. https://www.nature.com/articles/s41598-017-14866-z
Schwarzenegger, A. and Доббинс, B., 2008. New Encyclopedia of Bodybuilding . Eksmo. Page 36. https://www.books.ru/books/novaya-entsiklopediya-bodibildinga-8453/
Knezevic NN, Sic A, Worobey S, Knezevic E. Justice for Placebo: Placebo Effect in Clinical Trials and Everyday Practice. Medicines (Basel). 2025 Feb 24;12(1):5. doi: 10.3390/medicines12010005. PMID: 40137049; PMCID: PMC11944128. https://pubmed.ncbi.nlm.nih.gov/40137049/
Quattrone A., Barbagallo G., Cerasa A., Stoessl A.J. Neurobiology of Placebo Effect in Parkinson’s Disease: What We Have Learned and Where We Are Going. Mov Disord. 2018;33:1213–1227. doi: 10.1002/mds.27438. – DOI – PubMed
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