Dr. Jaime Hatcher-Martin: [00:00:00] Okay. Hi, everyone. Thank you for joining us again today for another Synapticure webinar. I have the pleasure today of introducing a colleague and a friend of mine, Dr. Catherine LeFavre. Before we get started, for those of you who are joining us at Synapticure for the first time, as a quick reminder, we are a specialized telemedicine clinic for people with Parkinson's disease, ALS, PLS and other neurodegenerative disorders.
And we're a team of specialized neurologists, care coordinators, genetic counselors, and insurance navigators that really try to help simplify a patient and a care partner journey. And this includes medication management, identifying local resources, referrals to clinical trials, as well as just regular medical management.
And this is all in partnership with your local care team. So your primary care doc, your neurologist, whoever's all. You know, whoever's tabling, take care of you, and this is all covered by insurance and it's from the comfort of your own home. So today I, again, as I mentioned, I have Dr. Katherine Lefebvre, who's going to talk to us about lifestyle medicine for brain [00:01:00] health, the prescription that we all need.
Dr. Lefebvre is a neurologist in Saratoga Springs, New York. After her residency at the Mayo Clinic, she completed a movement disorders fellowship at Beth Israel Deaconess in Boston, and then did a research fellowship at the NIH. She started her career in academic medicine and served as director for the movement division and was a professor at the University of Louisville in Kentucky for six years before joining Northwestern University in Chicago.
She's been a member of the Parkinson's study group and served as a site principal investigator on a number of Parkinson's related clinical trials. During the pandemic, she encountered several personal challenges that led her on a path of getting board certified in lifestyle medicine. And in 2021, she joined a community based medical practice in New York and emphasizes the importance of nutrition, exercise, social connectedness, stress reduction, and sleep to optimize self, optimize health for herself and for her patients.
She's also the co founder of the Women's Neurologist Group, which is a network of nearly 4, 000 women neurologists, and has [00:02:00] served on the American Academy of Neurology's Task Force for Gender Disparities. So Catherine, Dr. Lefebvre, it's great to have you today, and we're excited to hear you talk.
Dr. Kathrin Lafaver: Thank you so much for the very kind introduction and invitation.
I'm excited to, to speak to this group. And yeah, I mean, I think as you mentioned, this Synapticure, and then I'm excited about it, and I've share it with some of my patients as well. So thank you. Yeah. So I will be happy to talk today about lifestyle medicine and share a little bit, my own pathway, what got me interested in, in this, and hopefully some helpful tips that anyone can start applying today.
So just to give a bit of an outline of my talk. So we'll talk a bit about why we see more people with Alzheimer's disease Parkinson's disease and other brain disorders and what lifestyle medicine can do to optimize health and brain function. And as I mentioned, hopefully everyone can [00:03:00] take away some, some practical advice to, to make some of these changes.
So first of all, I'm going to start with my own story. So as you, as you mentioned, I was many years in academic medicine. Here's a couple pictures of me giving a talk at a conference in Chicago with some of my colleagues here. On the right side I'm actually, the background here is Hong Kong during the International Movement Disorder Congress a couple of years ago.
I don't even remember which year it was. 2017 maybe. So I was really busy seeing patients, doing research teaching medical students and residents doing patient events and, you know,
I was a lot and you also kind of were in academic medicine for many years. It can be a lot. And and so one of my challenges, you know, the pandemic, I mean, all of us, you know, we're kind of pulled in even more directions and this pandemic came a lot of anxiety, [00:04:00] you know among for our patients, for ourselves, you know, what does it all mean?
And my son was diagnosed with a rare. brain disorder. And here he is in the middle of getting an EEG done. So I was kind of not just a neurologist for my patients, but it was also kind of a role of a neurologist for my son with a neurologic disorder all of a sudden. And and then also was diagnosed myself with an autoimmune disorder.
Lots of lots of challenges, but that kind of really gave me a pause and and made me kind of reconsider. Well, you know, what am I all doing and my own health is suffering my my I'm not There as much for my children who kind of need me and and so I made all these changes And I kind of you know, tried to go down a path that improved my own health.
And you know, really allowed me to be more present for my own family and for my son, who is kind of depicted here with a rare disease kind of motto the earlier here. And one of the changes I [00:05:00] really made, you know, to optimize my own health was truly overhauling my own habits as far as diet and exercise goes.
And it got me down this path of really looking more into, well, you know, what, what should we all do and, and really kind of take this more front and center. So before we kind of come to the more specifics of how does this apply to Parkinson's and to other brain disorders I do want to speak a little bit about you know What is lifestyle medicine and and not many people may be familiar with this term so lifestyle is kind of a little bit vague wellness is kind of a similarly vague term, right?
So are we talking about fruit cleanses or taking lots of supplements? You know, what, what, what does it really mean? So the concept is certainly not a new bond and the foundation for lifestyle medicine goes back many, many a hundred thousand years. Far back. So this is a quote [00:06:00] attributed to Hippocrates.
Now not true if he really said it, but the idea is if he could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health. And I would say that this still holds true, you know, of course, we can't predict every everything and can prevent everything, but you know, again, the foundation for optimal health really lies within our daily habits.
And so the more modern definition of lifestyle medicine is a specialty. And let me see.
Video disconnected. Alright, so is the use of evidence based lifestyle therapeutic approaches using a predominantly whole food plant based diet, regular physical activity, adequate sleep and stress management, avoidance of toxic substances, and other non drug modalities to treat, [00:07:00] oftentimes reverse, and prevent lifestyle related chronic disease that's all too prevalent.
So if anyone is interested, I linked the Website here for more information. And so Lifestyle Medicine has been an officially board certified specialty in the U. S. for over 10 years now, and came mostly from the internal medicine practitioners who were interested to look at things like obesity, cardiovascular disease, diabetes, and, and really try to stop the rise.
in these conditions with lifestyle, lifestyle methods. But as it has been evolving it's really become clear that this applies very much as well to brain disorders. And let's see. So again, so the pillars of lifestyle medicine are physical activity healthful eating, and we'll, we'll talk more about what that means in detail managing stress.
Avoiding risky substances improving [00:08:00] sleep, and then interestingly, forming and maintaining relationships. And that's not often something that we address specifically in a doctor's office, but has really been shown, you know, the better our social networks are, the better our support networks are, the better people do in their health and daily life.
So it's not just important for our emotional health, but really also for our physical health. Okay. Thank you. So as I was mentioning, we have seen a rise in Parkinson's disease and Alzheimer's disease, and to a large part, it, it is related to just a general increase in population over 65. So this is kind of an example of the world population 65 and older between 1990 and 2040 predicted.
And, and there's obviously a huge increase here. And to a similar extent, we're also expecting the worldwide Parkinson population to go from 2. [00:09:00] 6 million in 1990 to over 17 million in 2040. And again, the mainstay is kind of an aging increase. So coming back to our lifestyle medicine story, and then how can this impact possibly the prevalence, but also how can applying these principles really change people's quality of life, this is one of my former patients and he has been kind enough to share some of his pictures and story with me and allowed me to use this for presentations. So this as I said, he was my patient actually back when I was in Louisville, Kentucky. He was diagnosed with Parkinson's in 2010, initially presenting with right hand tremor.
He had a good response to medications initially, although over the years he became more noticed more off time. So the [00:10:00] medication wasn't lasting as long. And then he was changed from the carbidopa levodopa, which as many people will recognize as the main treatment for Parkinson's disease, to a longer acting formulation also called vitari.
And then his Parkinson's movement symptoms were fairly well controlled, but visit after visit, he mentioned that he was really fatigued, his mood was low, and he had sleep problems. Now, we had talked about possibly changes he might try in doing attending better to his sleep exercising. But he was in a very high schist job.
He was, in fact, partner in a law firm. And as many lawyers do, you kind of do like 60, 80 hours, you know, depending on the week. So he was, he was just basically saying there is no time in my life. for exercise. Now he did decide to retire in 2019 and around that time was also diagnosed with [00:11:00] gastroparesis, which is kind of slowing of the digestion that can happen in people with Parkinson's and often leads to nausea.
And just kind of a feeling of fullness after just eating relatively small amounts of of food. So due to that diagnosis he did see a GI specialist and diet changes were recommended to him. was motivated at the time to actually put some of the this advice into practice. And so this is him last summer when he shared again, an updated picture with me.
And you can just kind of see it in his change in, in expression. So he's all smiling. He's all, he's all confident and has basically told me that despite now being three, four years further along with Parkinson's, his quality of life is actually better. Right? And that's pretty remarkable.
So as we all know, [00:12:00] Parkinson's along with other brain disorders are, you know, expected to progress every year, right? So you're kind of expecting that possibly people will do a little bit worse every year. But it's not always a one way street and there are indeed ways to to make changes to improve quality of life and it's not always medication.
So the way he changed his diet was partly related to this diagnosis of gastroparesis. So he ate smaller portions, more frequent smaller meals, avoided high fat and high sugar foods. And then he really made a Remarkable transformation from someone who was never exercising to starting this gentle physical therapy, balance training, and increasing this to walking every day for up to two hours.
So, he was hiking all around the Kentucky forests and, and hills and is still doing that. [00:13:00] So, among the 70 pounds. But the most sustained or benefits for him was really the increase in energy, feeling less tired and, and having improvements in mood. All right. So we're going to break, break things down a little bit.
And just want to talk about diet and, and a little bit more detail. So this is a quote from Michael Pollan, who's a famous food writer and columnist. And they're often confused, right? What is the best diet? There's so much conflicting news around and we get bombarded from, from all the, all the different articles and journals and friends and acquaintances, doctors, right, as if a keto diet should be avoid gluten, very, very, so much different advice.
And generally, I mean, a good principle where it kind of boils down to is, you know, eat real food, eat food, not too much, and mostly plants. [00:14:00] And why, but mostly plants, right? And so there's many research and again mostly initially done for cardiovascular health, heart health but this is kind of a pattern that comes out for, for lots of different health conditions, including cancer and including dementia is that if diets are predominantly plant based it reduces the risk for heart disease.
heart disease by about 40 percent, reduces the risk for stroke by close to 30 percent, and reduces the risk for developing type 2 diabetes by 50 percent. So we kind of know that those types of diets are really good for our general health and and then also for brain health. Now are you familiar with the concept of blue zones?
So this Blue Zones concept has become popular gosh, five years ago or so, there's a book by Dan [00:15:00] Buettner and this comes out of research in looking into areas in the world where most people in their 90s and above live. and are relatively healthy. So kind of this concept of healthy aging.
And so these are some of the spots that researchers did identify, and that includes here kind of some little Mediterranean islands in Italy, in Greece an island on the coast of Japan specific place in Costa Rica and interestingly, also Loma Linda in California. And and then researchers went to all these places and really studied, well, you know, what was different and what was kind of the The habits, the circumstances of these areas, but we're shared.
And so there's a lot of availability about this concept now, but essentially what came out of a research that people in those areas were in a way living more naturally. So those are all, you know, Sardinia, Italy, they're all. kind of pretty [00:16:00] tight, tighter knit communities. So people were moving quite a bit for eating a fairly natural diet.
So lots of food that was local and not highly processed. But then the interesting thing was also that there wasn't a more social connectedness in these areas. compared to other areas in the same countries. So it's I do highly recommend that, that kind of reading. It's, it's really interesting.
So it can, you can kind of easily find well, there's several books now on, on these so called blue zones and including diet suggestions and so on, but that's interesting research to look into. Now, how does this compare to ours? standard American diet. And if you haven't picked it up on my accent, I'm from Germany originally.
And I have to say, so I came to the U. S. after medical school and, you know, there's probably many reasons why people gain weight in internship and residency, but certainly that change in diet [00:17:00] pattern was, was certainly you know, a big one along with the stress, you know, for me. So when they go in, in a typical supermarket, There's many, many kind of processed food.
There's many added sugar, many added you know preservatives, and most of the food that is, that is offered. And and as we know, this does increase our risk for obesity, for diabetes, heart disease and is poor nutrition is actually cited as the leading cause of death globally. So if you contrast that with a whole food plant based eating pattern, we're kind of looking at filling half of a plate with fruits and vegetables, drinking mostly water instead of processed drinks and soda.
Getting most of a protein from plant based sources, so that include beans, legumes, but also nuts and seeds, and eating whole grains. So that's [00:18:00] interestingly, quite different and on this plate. There's also not actually a special place for dairy and we'll kind of come back to that. So especially as it goes to Parkinson's disease milk consumption has actually been linked to a greater risk for Parkinson's disease and that's mostly from large population based studies and not necessarily a causative link.
One of the thoughts was that milk intake is linked to greater intake in pesticides and I know that's been a topic that's already discussed in a previous episode of this webinar series. So if you do drink milk, organic milk is the safest source and otherwise plant based sources are a good alternative.
So what is the healthiest diet for our brains? There is not as much research out there as for [00:19:00] cardiovascular diseases, but a very interesting study that is longitudinal I wanted to highlight comes out of Rush University in Chicago, and they have the Rush Memory and Aging Project. And in that study around 1, 000 patients between the ages of 58 and 98 were followed and basically asked to adhere to the so called MIND diet, which is mainly plant based, limiting meat and what they found is that people who did adhere to the diet had a 53 percent reduction in the risk.
for Alzheimer's disease. So that is quite striking. And even moderate adherence to the diet. And we were just talking about that before the webinar starts. It's sometimes hard to be a hundred percent kind of compliant with, with any, with anything in life, but especially in, in our kind of society to live, it can be, it can be hard to completely avoid you know processed food, [00:20:00] but even people who only moderately They are here to the diet.
They were still seeing a lot of benefits and 35% of this production. So sometimes people say, oh, I could never do that. I could never give up, you know, certain food. And I think the message is, well, you know, you never need to be. A hundred percent if there's, you know, Thanksgiving or if there's a Christmas holiday or whatever it is, and your culture and your life, you know, it's always okay to, to have you know, a day of an ex an exception.
You don't need to be a hundred percent receive a benefit. So participants who showed the highest appear vote had cognitive function comparative to a person who was seven and a half years younger. So, That's quite striking. And, you know there currently is a lot of data among new medications out there for Alzheimer's disease.
And we're not going to get into this, but you know, we can see quite a bit of difference from things that we all can do and in our daily [00:21:00] life and can start doing today. There's another study that came out last summer that really looked at a very, very large registry looking at people's diet habits.
So these were 700, 000 people follow up years of 500 people of which 500 people developed dementia, and they showed association with people. Consuming high processed food had a much higher rate of dementia. And again showing that replacing just 10% of their food, the unprocessed, minimally processed food, had a 19% lower risk of dementia.
So it's not too late. Megan changes. You know, whatever, whatever stage, whatever, whatever age someone is can have positive positive effects down the line. And you know, what does ultra [00:22:00] high processed mean? So, we sometimes kind of use the concept of shopping around the aisles in the supermarket. So, where we have the vegetables, the fruits and so on.
So, kind of a, a concept of a one ingredient food is, is kind of considered a whole food. So, the top 10 best foods for your brain would be things such as leafy greens, such as whole grains seeds and beans berries. Nuts also teas herbs and spices, mushrooms, et cetera. And the bottom ten would be things that are highly processed and have you know, sugar especially added.
So, pastries processed foods, processed meats from the deli red meat and then also butter, fried food a lot of cheeses are highly processed and so on. Excessive alcohol would also be on the list. So I was kind of mostly talking about Parkinson and Alzheimer's disease. Now I did, I do know synapticure started in in the ALS world, so I did want [00:23:00] to Kind of touching that as well.
And you know, diet research and ALS is, is there's not a lot out there, but there's one very interesting study I found from JAMA Neurology, and this was published in 2016. And they looked at food journals from people with ALS. And they also found that people who had a high intake of fruit and vegetables which was associated with high antioxidant intake so again, a lot of fresh vegetables and fruit have antioxidants had higher quality of life and higher function at baseline compared to people who had sort of a less healthful diet index.
So I think as we kind of said before, this isn't necessarily just applicable for one particular disorder or illness. It really is you know, a principle that's true for all of us. And so in my own life, well, how does this look like in practice? So I often have a green smoothie for breakfast and it's a good way to [00:24:00] get some spinach and Possibly a carrot kind of in before, before just at the start of the day.
And I add almond milk or coconut milk. I add some flax seed. I add maybe half a banana, frozen banana. So lots of kind of, you can get really creative and add healthy sources of fat healthy vegetables, fruit, you can kind of. Get a lot of servings in your day. And then for the rest of the day, and especially during the week for my broke lunches, I do a lot of rainbow salads fruit.
So kind of pretty simple, but but it's, it's all filling and it's all good. And yeah, there's lots of resources out there that can help you with planning. So those are some examples. And I, I think the slides will be shared for those interested. So nutritionfacts. org is a wonderful website by Dr.
Michael Greger, who is a kind of a pioneer in the lifestyle medicine world. Forks over Knives, The Big Switch are all resources for people who [00:25:00] are really wanting more help with recipe planning, grocery shopping planning, and they're actually free. So good, good resources to check out. Here's Dr. Greger he also published a couple books now, so one, one of his books is called How Not to Die, or How Not to Die Prematurely and he has a checklist for every day, so lots of, lots of tools and resources available to kind of support people in their journey to, to change their diet, which is, is not always easy for, for sure.
All right. I see there are some questions. Do you want to break now before we switch over to the next topic or or more do it towards the end?
Dr. Jaime Hatcher-Martin: way, whatever you prefer. A lot of the questions are about diet and supplements. If you want to maybe take a quick pause. Okay. So there's a couple of questions. A lot of them focus we'll start off with the first one is that, you [00:26:00] know, given that obviously we need to have healthy fats for, you know, brain mitochondria to function.
Is there any recommendation for specific sources of fats? So this particular question asks about marine fats versus plant sources like nuts, avocados. So any recommendations there?
Dr. Kathrin Lafaver: Yeah, so I know that traditionally, or we often kind of do talk about the omega threes and, you know, fish sources, you know, in lifestyle medicine initially kind of came from more of a cardiovascular health and they were really trying to, to limit fat and, and kind of not, not kind of have the high fat food.
And so the best sources would be considered, you know, things like walnuts things like seeds, avocado so, so that's sort of the, the the answer based on the lifestyle medicine. Now, certainly, you know, as part of the Mediterranean diet, which is, you know, has a lot of similarities that does kind of, you know reinforce also fish, especially as a healthy fat source.
But yeah, I think for, you know, a lot of times I think the, [00:27:00] the overestimate a little bit or, you know, we kind of think we need, you know, for example, olive oil that we need kind of large quantities of fat. So it's, it's not as much as far as getting, getting the getting an adequate serving. It says maybe not as much as, as we need as, as, as we sometimes think we need.
And as far as supplements, just kind of answer that questions as well. So, so for most people, you know, it's, it's especially when you eat a most. a plant based diet, it's advisable to take a vitamin B12 supplement. And so especially for Parkinson's then you take a medication like carbidopa levodopa.
It's actually recommended now more and more to take vitamin B12 supplement to offset like homocysteine elevation kind of almost regardless off your B12 level in the blood. So that's the main supplement I recommend to almost everyone is a B12 supplement, usually a thousand to 500, 2000 microgram per day.
Apart from that, you know, for some people, it can make sense to, to check some [00:28:00] micronutrient deficiencies, especially if people lose weight quickly or, you know, have trouble with swallowing or with digestion but for most people, I, I I said, standard way of supplements. And then there is a lot of to be said that actually the body can often absorb nutrients better if you get it through your diet rather than through a vitamin pill, so to speak.
Dr. Jaime Hatcher-Martin: Great. And there's a question specifically about, you know, is there any, and this may not be specific for the neurological disorders, but any recommendations on ratios for the amount of omega 3 versus omega 6 or the, you know, ratios between those.
Dr. Kathrin Lafaver: Yeah, I don't think I would kind of be able to give one recommendation that's applicable for for everyone.
But like I said, I generally we don't, as long as you eat a varied diet and kind of, you know, this is kind of this daily dozen that's sort of recommended and you're going [00:29:00] to Hit sort of these these amounts and, you know, get your fibers, get your, get you, get you any oxidants for your berries, for your nuts, for your seeds you, you, you're, you're kind of generally should be able to get most of these most of these nutrients fulfilled.
Dr. Jaime Hatcher-Martin: And there's a question. I'm not sure if this is something that you've come across. We can certainly reach out to this person afterwards. Do you have any experience with particular types of tube feeds, formulas that are organic or that might more closely follow along with some of these recommendations?
Dr. Kathrin Lafaver: Yeah, that's an excellent question. So, so the answer is yes, there are companies who actually do have organic tube feeds. And yeah, I'm not sure if I'm, Supposed to endorse a specific company, but they can yeah, I can, I can maybe kind of offline kind of reach out or pass some, some things along.
So, and, and there's certainly more than one company, but, but that's a good point, you know, and, and I think it's true that a lot of times tube feeds are very high in sugar content and[00:30:00] maybe not ideally long term, so we, we, we can do better. And then, you know, if someone is. tube fed, you can also you know, make food yourself or, you know, that, that's best if you do it with the guidance of a a nutritionist, so you can kind of make sure you're hitting all the, all the macro, all the goals, but but that's also another way to kind of parade like real food yourself.
And there are some companies who that do more natural tube feeds.
Dr. Jaime Hatcher-Martin: Okay. And then for those people who actually need help, either maintaining or gaining weight and so obviously need to add on, you know, more protein, more healthy fats. Are there specific recommendations for those that really need to sort of, you know, increase that amount, you know, that balance on their plates, so to speak?
Dr. Kathrin Lafaver: I think, you know, sometimes if someone really is struggling and then losing a lot of weight and maybe sometimes are really trying to be as liberal as possible and just kind of say like, well, you know, focus on things but but do have a [00:31:00] relatively calorie dense, or high caloric, but also are enjoyable or pleasurable right and for certain people that can be Milkshakes, right?
You can kind of make a milk banana shake and add some peanut butter or almond butter, you know, or nuts in general, and that's an easy way to make your own kind of high calorie milkshake again, in a more natural way than some of the store bought products. But yeah, I think for, for you know, a specific goals, it's, it's never a bad idea to actually consult a nutritionist to have a bit of a better idea what your daily calorie intake should be, for example, you know, so I think that's a little bit hard to, to to answer so that it applies for everyone.
Dr. Jaime Hatcher-Martin: Absolutely. And then the last question for now is any foods that help maximize dopamine production or can, you know, natural sources of dopamine.
Dr. Kathrin Lafaver: Yeah, so I think most people are there, but for certain beans, [00:32:00] fava beans, you know, that have dopamine content we, it's a bit of a double edged sword because these things are not controlled and not sort of, you know, measured, so it can be a little bit hard to know exactly how much you're sort of getting if you're, if you're eating those types of foods.
Yeah. Beans and so generally if people are actually on prescription medication for parkinson v we're often not recommending to kind of mix because because you're the content of dopamine is going to be or the Quantity is going to kind of vary a lot from day to day but yeah, I think in general, again maximizing so There has there is actually a study that, that looks kind of in an ongoing manner on, on supplements that people take or what is kind of a healthiest diet for Parkinson's specifically.
And, and that's by Lori Mishler at in, in Portland it's called Modifiable Variables in Parkinson's. I'm going to be happy to share the link. And yeah, so I, and [00:33:00] then what they. seen in that study is really people who eat a large amount of vegetables and generally have, you know, report a better quality of life.
So again, I think it's, it's, it's really often more of the overall health and, and not necessarily focusing on one very specific nutrient or ingredient diet. Yeah.
Dr. Jaime Hatcher-Martin: Right. And I have a lot of patients that ask about things like mucuna pruriens, which, which can have can boost levodopa to some degree, but as you mentioned, there's no regulation on it.
So what you may get from one match to the next can be quite variable. And you know, there's no, there's no regulation. it's very hard for us to, to make any assumptions based on. you know, if symptoms vary from day to day, whether that's related to the underlying disease itself or whether you're just getting varying amounts of, of levodopa.
Dr. Kathrin Lafaver: Right, and then it's also sometimes versus nausea associated with it and so then that needs to be kind of navigated. So yeah, I mean, I generally am [00:34:00] very much in favor of using carbidopa levodopa just because it is as natural of a medication prescription medication as you can get and we just have a lot of experience with it and the carbidopa part and it really helps So it's a little bit more expensive offsetting the knowledge.
Dr. Jaime Hatcher-Martin: absolutely. Yeah. One more question. I'll just, I'll, I'll quickly answer. So somebody says organic food is expensive. If people can't buy everything organic, what foods are most important to get organic and to avoid the pesticides. So I don't know if you have any comments. I can certainly post a link.
There's a link that comes out every year that sort of talks about the dirty dozen sort of unrelated to this, the daily dozen but those that tend to have the most pesticides, mostly because they're the hardest to wash. So things like raspberries, strawberries there's a few others. So I can certainly post the link, but I don't know if you have any thoughts about that as well.
Dr. Kathrin Lafaver: Yeah, no, I agree with that. I think certain berries, and I think yeah, certain vegetables are always on my list celery, I think, so some, yeah, so, so, and, and yeah, with that being said, [00:35:00] not everything needs to be organic to get, you know, health benefits, but that dirty dozen is a good start, and you know, sometimes people, to kind of save money, will kind of, Start growing their own vegetables and you can kind of even there's more, you know, not everyone has a Huge garden to do that, but there's kind of more space saving ways to kind of do that you can kind of Grow vegetables inside, you know, there's there's kind of more creative ways more recently that people kind of And of course, some places have community gardens.
So there's some creative ways of kind of enforcing that kind of money saving way to actually grow your own vegetables and fruit. Okay. Yeah. Well, let's, let's move on and talk a bit about exercise. And, and we all know that exercise has many benefits for our body, for our mind which is, I think, sometimes overlooked, right?
So we know that we, we should exercise for our heart [00:36:00] health. But exercise is also good for our immune system and for our brain health and for our mental health. So it's one of the best ways to actually help with depression and anxiety. And so I just kind of picked out one study here, which I thought was really interesting in people with mild cognitive impairment.
So this was published last summer. It was a study that enrolled close to 300 sedentary men and women with mild cognitive impairment. some memory problems, not, not dementia. But the question of course is with mild cognitive impairment, how can we stop it from becoming dementia? And so in this group, people were assigned to either an aerobic exercise arm with moderate intensity or balance and stretching exercises with low intensity.
And this was done for four times a week for 30 to 40 minutes. And the findings were, interestingly, that at the end of the year, [00:37:00] both groups maintained their cognitive function and did not worsen their memory function. And I really love this study because a lot of times, you know, talking about exercise, people will say, gosh, you know, I have really bad knees and I can't, you know, go on a treadmill or I can't you know, have really bad balance.
But. Anything is better than nothing. So even doing really low impact things, just working on balance, stretching really makes a difference. So, this is, this is a nice, nice nice data and this is an ongoing study and there's hopefully more to come. So, in general, so I'm sorry, was there a question or?
Dr. Jaime Hatcher-Martin: No, I just posted something about one of the links.
Dr. Kathrin Lafaver: Got it, got it. Yeah, so people will kind of ask, well, what exercise should they do? How much? Right? And kind of there are many studies actually looking at comparing different types of exercise in Parkinson's, but to kind of just go back to [00:38:00] what, what is generally advised for, as far as physical guidelines for adults.
And in general, we should all be 150 minutes of moderate intensity exercise per week. Okay. or 75 minutes of vigorous physical activity per week. And there is actually concept by doing even just a couple minutes of really vigorous activity every day can make a difference. So again, nothing, nothing is too little.
So this Parkinson's specifically there's actually the Parkinson's foundation has kind of released some exercise guidelines. And in general, it's. best to, to mix it up. So to do some amount of exercise that is aerobic but also include some strength training and include some stretching, include some balance training.
So really kind of a mixture is, is, is advised and, and then things that train your coordination. So there are, this is the kind of a famous. boxing, but rock steady boxing, whether this is dancing, whether it's [00:39:00] bicycling, but things that train coordination or rhythmic seem to have like some specific benefit.
So with that being said, you know, there's many in the Parkinson's community who already do exercise on a regular basis and enjoy it. But I also have many patients who, you know, struggle a bit with finding or getting started. And you know, just some, some tips on how you can get started is, is really nothing is too small.
Even starting with 10 minutes per day can really lead to building up to longer exercise over time. Finding exercise that you enjoy doing it with others, right? So there's a reason why some of these group exercise classes are very popular. And then of course you have the benefit of adding that social aspect that is also so good for us.
So even seven minutes, even a few minutes per day can be helpful. So this is the seven minute workout became popular several [00:40:00] years ago. So you can kind of look that up and find out what exactly that entails. And then trying to set yourself a specific goal can be very helpful, right? Because we all kind of know how this goes with nourish resolutions when then we say like, oh, tomorrow I will be healthy
But we don't define really well what does that mean? So trying to make these goals the specific as we can, so we can really hold ourselves accountable and measure if we actually achieve the goal can, can be very helpful. So an example. What does smart goal really mean? So saying something like I will lose 10 pounds or I will eat less processed food is not really specific.
On the other hand, if you say this week I will exercise three times for 20 minutes each and best even writing it down exactly what you're planning to do, you're going to have a much higher chance of actually doing it, [00:41:00] especially if you do it with someone else, right? If you're meeting with a friend, you're going to.
I have a much lower chance of actually letting that friend down than you would if you just leave it very vague and might, might kind of forget about it. Yeah, so we're gonna just briefly touch on a few other things and sleep. Most of us know that sleep is very much tied to our health as well as to our brain health.
And sleep has many, many important functions. It cools the brain and the body. It regulates our many functions in the brain. It's actually really important for memory. It's important for growth. It reduces inflammation
in the So with all these things being said we know that in Parkinson's there can be specifically can be many sleep dysregulation or sleep disorders that can affect the [00:42:00] dream sleep or REM sleep. So as we cycle through these stages of sleep from lighter to deeper sleep and then to dream sleep that can be affected in Parkinson's.
And there are specific treatment avenues specifically for people who, who have that REM sleep or dream sleep disorder. Melatonin can be a very helpful medication for many people to, to regulate sleep better. But it's also really important to have a, have a look at our sleep habits.
Being as regular as we can for our sleep schedule, working on our bedtime routines. So many people, they'll tell me they have trouble shutting their brain off, right? I don't know, Jamie, if you can relate to that. So, yeah, so sometimes we have busy days, we have stress in our days, it can just be hard to actually, you know, get into that relaxed state and so finding a certain bedtime ritual or routine and whether that's reading a book or [00:43:00] doing a brief meditation, taking a bath, so kind of working on that transition time can often be very helpful.
Avoiding caffeine or smoking, especially late, late in the day and having a good, good sleep environment, especially now it's so hot outside. So making sure your sleep environment is ideally not too hot. And and spending, you know, spending some time and then planning that and avoiding too much napping during the day.
So lots of kind of ways to, to optimize our sleep. And and then, like I said, for people with specific sleep disorders related to Parkinson's can often be helpful to see a sleep specialist get screened for things like sleep apnea, which can be very common. So those can be more specific things that won't apply to everyone, but The sleep habits and working on that is, is definitely something we all can, can use.
So to end things up, I just want to talk a bit more of the [00:44:00] social connectedness I mentioned in the beginning, and we all know that being with friends and family often makes us feel good and you know, helps us enjoy life more, but what most of us do not realize is that the flip side being socially isolated.
is really bad for our health. And this study here social isolation was found to be a predictor of higher mortality compared to smoking. So very traditionally thought to be, you know, smoking, we all kind of know is bad for our health, bad for our heart health. But we often don't realize that things that, that, you know, yeah, sure, we feel alone, we might feel more depressed, but it's actually a truly risk factor for impaired mortality.
And this was specifically true for, for men and but also found to be, yeah, like I said, for smoking and high blood pressure, kind of very [00:45:00] comparable effects. Thanks. Bye. So what is the opposite of connection? Disconnection, separation, isolation. And this was especially true for all of us during the COVID pandemic.
So here's Dr. Subramanian and Dr. Mishley that I mentioned earlier for the Mary Wilson Parkinson's disease study. And they actually looked at how the COVID pandemic affected Affected quality of life in Parkinson's disease. And they they did find unfortunately that the more people did feel socially isolated, the lower they faded their quality of life.
So now that the pandemic is, you know, covid is not. Over, right? COVID is still around, but fortunately many restrictions due to the pandemic have been much different now and we're able in many and most parts of the countries to do real life meetings, gatherings, do exercise together. This is[00:46:00] you know, so part support groups have have kind of started again and better that is in person or also virtual.
These are just all good opportunities to sort of offset these negative effects of social isolation. And just some other ideas, you know, what, what we all can do to stay socially connected. So of course, you know, many of us have our circles of family and friends. But you know, especially in other circumstances, you might not have a close circle of family and friends.
And so finding other opportunities to be active and better that's. Involves volunteering, engaging online with groups of people like we're doing today being active in a religious or spiritual group being active with other activities such as animal shelters, other hobbies. sports event whatever it is, it can sometimes be, be hard to make that first step, but it's usually worth it.
[00:47:00] So I think we're close to the end of the hour, so I'm just going to sort of wrap it up. So we talked mostly about the diet and exercise aspect. We talked a little bit about the sleep and maintaining social relationships. We didn't talk about the avoidance of risky substances, but I know this was covered by Dr.
Dorsey in a previous event, and as far as Parkinson's goes, there's more data now on pollution, on pesticides being risk factors for Parkinson's, so things we often don't Direct control over in our day to day life, but things we can help on the advocacy side and policy side to get certain substances such as certain pesticides banned and then there's a very important efforts underway in that regard.
And managing stress, you know, all these other things we talked about, especially exercise, social connectedness, sleep, can all be helpful to achieve that goal. So with that being said I hope you did [00:48:00] find the information helpful and Get you know, we all like we like we kind of talked before it's it can be really hard to make those first steps and it feels sometimes overwhelming to to make changes in our lifestyles but starting some there is always better than not doing anything and and even small changes can really add up over time So thank you so much for listening and i'm happy to answer some additional questions if there are any Fantastic.
Dr. Jaime Hatcher-Martin: So I will just comment on a, on a an anonymous comment that came in, you know, a lot of the comments are a lot of the suggestions that we make today. You know, the goal is to really make suggestions for people across the spectrum of disease and not just ALS but also Parkinson's disease and some of the other disorders that we treat as well so.
You know, we 100% understand that some of the suggestions may not be accurate or adequate for one disease group or stage versus another. So, you know, we understand that. We just wanted to make sure that we're really trying to[00:49:00] address people across different diseases and across all stages. So please keep that in mind.
So one of the questions was about exercise. And you know, what is the best type of exercise? Anaerobic, aerobic, you know, there's some concerns about cortisol. Obviously it has some benefits, but there's also some concerns that it could be harmful as well. So any advice on specific types of exercise?
obviously that that will vary, you know, differently between Parkinson's disease versus ALS, where we don't want to encourage a significant amount of exercise because it may cause things to progress a little bit more quickly.
Dr. Kathrin Lafaver: Right. So as you said, it's a little bit hard, especially since there are different you know, to address.
people and with different neurologic disorders and different stages, different abilities to, to kind of give a general advice that will apply to everyone. You know, as I said before, for Parkinson's, we generally try to really mix the types of exercise. So I have many, I don't know, I have [00:50:00] some patients who really like weightlifting, you know, but so we kind of encourage them to do more aerobic exercise.
Yet generally as far as the cortisol is concerned, you know, I think it's just kind of a good idea to keep more strenuous exercise, aerobic exercise sort of early on the day and kind of not do it in the, you know, four or four or six hours before bedtime to be not be too activating. So that would be kind of my main advice as.
As far as that goes, but generally sort of mixing things up and, and, you know, if someone has a specific limitations or especially with more advanced Parkinson's or ALS, I think starting out with seeing a physical therapist and really, or a personal trainer and getting a program that's really tailored towards your capabilities, your goals, and I think is.
Always a good idea. So a lot of the general advice applies mostly to people in, you know, relatively early stages in, in a neurologic disease. I think, again, as people [00:51:00] have more limitations, starting out with a physical therapist or individualized personal trainer is always a good idea.
Dr. Jaime Hatcher-Martin: And I always recommend, you know, a couple of things, number one, find something you enjoy, right?
If you don't enjoy doing something, it's going to be really hard to stick to it. So find something that it is that, you know, that you really enjoy, that you feel like you can continue to do and use your body as a guide, right? If you, if you exercise, then it takes you, you know, six days to recover from it.
Then it's probably too much either for where you are or maybe for, for, you know, what stage you're in and your disease. But I always recommend to, especially for women, you know, we know that muscle mass can help improve bone density and bone health. So it's not that you have to go out and, you know, do weightlifting all the time, but having some weight bearing exercises, you know, where you can build muscle.
Not necessarily weight bearing, but at least, you know, exercises where you can help build muscle can help contribute to bone health and bone densities that if you do have falls, that your bones are more protected, that you're less risk of, of osteopenia and [00:52:00] osteoporosis as well.
Dr. Kathrin Lafaver: Absolutely. And there's also low, you know, bone health and bone weight bearing doesn't even, it doesn't always mean heavy weights.
There's really kind of one or two pound weights. can, can make a huge difference. And and there's even, there's yoga for osteoporosis, you know, so just body weight can bodyweight exercises can, can make a huge, make a huge difference. So I think there's, there's definitely safe exercises that can be applied for every, for everybody.
And, and then again, sometimes getting individual guidance is, is a good idea. So, you know, you do things that are safe for you.
Dr. Jaime Hatcher-Martin: Absolutely. So I don't think we have any more questions. I'm just looking through the list to see if there's any more. If anyone does have questions, feel free to continue to make comments and we'll try to answer those after the talk today.
I'm doing one last check to see if there's anything else that's come through. I don't see anything. So with that, we'll [00:53:00] end there. Dr. Lefebvre, thank you so much for joining us today. This is fantastic. Lots and lots of great information. These are a lot of the questions that I, I get from patients every day.
So I feel like this is really helpful for me as an individual and for my family, but also to be able to give more information to patients as well. Thank you everyone who joined us today. This will be available for listening and watching later. And we hope to see you next time. We've got another one coming up on August 11th.
That's doing motion analysis. So we've got 3d motion analysis for Parkinson's disease and tremor. Thanks so much. Appreciate it. Take care.
Dr. Kathrin Lafaver: Thank you for having me. Have a good rest of your day. Bye.