The Nutritional Supplement

58-year old African-American woman presentation:

• Several months ago, she began to trip often & felt like her legs were moving more slowly than normal. She also has noticed a slight resting tremor of her right first finger.
• She has no known history of neurological disease.
• She states that she has not noticed any memory deficits or cognitive changes.
• She declares that her hearing, sense of smell and taste and her vision are unchanged.
• She has occasional tension headaches, but has no history of head trauma.
• She became menopausal 7 years ago and has never taken hormone replacement therapy.
• The only other change that she has noticed over the past several months is increased constipation. She has a bowel movement every other day and passage requires straining.  She is also concerned about her risk of heart disease given that her cholesterol has been steadily increasing and her mother passed away from a heart attack at the age of 60.
• Her cholesterol has been a concern for the past 10 years, however as she approaches the age of her mother’s death, she is more worried and is now ready to “do something about this.”
• She has been told that she should take a statin medication, but has refused as she doesn’t “trust the safety of drugs”.
• She denies chest pain or epigastric pain.
• She does have shortness of breath with climbing stairs or when she walks her dog.
• Her hands and feet sometimes feel colder than the rest of her body.
• She has never smoked. Her husband smoked for 15 years (not in the house); gave up 20 years ago.

Review of Systems (pertinent only):

• Occasional headaches – tension
• Constipation – one b.m. every other day
• Dry skin
• Mild fatigue; worse when she is stressed

Typical Daily Diet (avoids cow’s dairy – causes loose stool):

• B: porridge with almond milk, nuts, coffee
• L: salad with protein or sandwich with chips
• D: home-cooked: pasta, pork or chicken, greens or stews and bread or
• occasional pizza or Thai food
• Alcohol: none
• Water: 8 glasses
• Snacks: cookies, pretzels

Sleep:

• 7 hours most nights

Labs:

• Blood glucose = 92 (rr 70-100mg/dL)
• HbA1c = 5.7% (H) (rr 4-5.6%)
• Total cholesterol = 250 mg/dL (H) (rr <200 mg/dL)
• HDL cholesterol = 42 mg/dL (L) (50 – 60 mg/dL in women)
• LDL-C = 115 mg/dL (H) (<100 mg/dL)
• Triglycerides = 170 mg/dL(H) (<150 mg/dL)
• No signs of anemia
• No elevation of LFTs
• TSH is normal at 4.6 mU/L (rr 0.5 – 5.0 mU/L)

Insights, Tips and Perspectives:

• Fish oil supplementation at 2 g twice a day with food may help to lower triglycerides by 30-50% and decrease inflammation, as well as have a favourable impact on Parkinson disease severity and increase antioxidant capacity.
• Garlic supplementation at 600 mg a day may improve endothelial function, reduce blood pressure and cholesterol. S-methyl-L-cysteine is found abundantly in garlic and may be therapeutic by enhancing the antioxidant system in neurodegenerative diseases.
• The herb Rauwolfia serpentina, commonly used to treat high blood pressure, is contraindicated in patients with Parkinson disease.
• Low carb lifestyles beneficially impact the entire lipid profile. The size and density of LDL, the inflammatory markers, the HDL and triglycerides all improve along with insulin sensitivity and metabolic risk.
• Lp(a) can help identify younger individuals at risk especially those with a family history of CVD.
• Niacin is an interesting intervention for Lp(a) but can worsen insulin resistance and risk of diabetes. Using it along with an aggressive low carb lifestyle theoretically could help protect against this concerning adverse effect.

Management Considerations:

• Untreated sleep apnoea is associated with increased blood pressure, coronary artery disease, arrhythmias, and heart failure. If present, be sure to review options such as weight loss, mouth exercises, or dental devices. There is even research showing patients that play digeridoo or a wind instrument have less sleep apnoea.
• Following results of a negative stress echo, implement an individualized physical activity plan tailored to the individual. For patients with Parkinson, consider dance-based therapies or stationary bike.

Addressing her metabolic syndrome should be 1st priority as that will affect her hypertension, her visceral adiposity, her insulin resistance and likely start a beneficial snowball effect for her overall health.