Tips for Adding Integrative Medicine into my Parkinson's Care
Who is the author Indu Subramanian MD and what is her connection to integrative medicine and Parkinson’s disease?
Dr. Subramanian is an expert neurologist in Parkinson’s disease and integrative medicine. Dr. Indu Subramanian received her medical degree in 1996 from the University of Toronto, Canada. She did her neurology residency and Movement Disorders fellowship training at UCLA. Dr. Subramanian has stayed on at UCLA and is now a Clinical Professor of Neurology. She established the movement disorder clinic at the West Los Angeles Veterans Administration and has assumed the position of the Director of the South West PADRECC (Parkinson Disease Research, Education and Clinical Care) Center of Excellence in Parkinson Disease. She has developed a strong interest in integrative medicine with a special interest in Yoga and Mindfulness. She underwent a 200 hour yoga teacher training in 2015 with Annie Carpenter and studied mindfulness at the VA under the direction of J.G.Serpa and Christian Wolfe through Insight LA. She is designing a yoga teacher training program for yoga instructors who are interested in working with PD patients. Dr. Subramanian recently got board certified in Integrative medicine. She is also passionate about palliative care in Parkinson Disease
We sat down with her and picked her brain about integrative medicine and Parkinson’s disease.
Indu Subramanian MD
What is Integrative Medicine?
Integrative medicine is a medical approach that Integrates aspects from other health care systems (Ayurveda, Traditional Chinese Medicine, etc) along with western approaches (not instead of). It is a system of care that attempts to activate the body’s innate healing process rather than relying on cure-oriented medicine. There is an understanding that the mind and body can be incredibly resilient and that they are fundamentally connected. It speaks to the World Heatlh Organization’s definition that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. It includes a holistic, lifestyle-oriented approach, emphasizing health promotion and prevention It places the patient and their loved ones in the center of the circle of care with the team of providers working together around them, as partners in the healing process.
What do people with Parkinson disease want and why does Integrative Medicine appeal to them?
In surveys of persons with Parkinson’s (PWP) over 60% are using integrative medicine modalities and many have not told their treating neurologist(s) . PWP’s would like to decrease their pill burden. They want guidance on what wellness/stress management strategies to incorporate that can help them with their quality of life, but would avoid unnecessary cost and waste of resources. They want guidance to filter the “Hope vs hype” and help with approaching the barrage of information on social media. They want guidance with communicating with their health care providers especially when it comes to approaches outside of standard western treatments and their non-motor symptoms. They want a “road map” on what to expect in their PD future and to help to guide their care partners. They want a recognition of the unique gender/race/socio-economic specific issues in their identity (guilt, grief), quality of life, definition of health, and advocacy. Integrative medicine approaches can help with all of these unmet needs.
What kind of treatments should I beware of?
PWP should be wary of treatments that are touted as a cure or a miracle. They should be careful about treatments that are only available outside of the US/Europe or that are very expensive or profit driven. The source of information should be reputable, and not just be from “informercials” on the internet, tv or social media. If a provider asks you to stop conventional treatments, then you should also beware. It is imperative that you speak to all of your providers about any treatments that you are considering. Good communication is the key to success and to integrating treatments
What are some tips for communicating about integrative approaches with your team?
Add supplements/herbs that you are taking to the bottom of the medication list that you bring to your doctor/pharmacist. Inform all of your health care providers of what integrative approaches you have adopted. Include your doctor in the conversation of weighing the risks and benefits of any integrative therapies before you start them. If you try something new, just change one thing at a time so that you can track if there is an improvement or side effect; keep a diary. In general, the goal is to stay on your conventional therapy – we do not advise stopping conventional therapies and starting integrative therapies alone. Do not delay conventional dopaminergic therapies if you are having difficulty with exercising robustly, working, hobbies, activities of daily living -or things that bring you joy.
Are there other safety issues with Integrative approaches that I should consider?
It is important to be aware that supplements and herbs can be very potent and have the potential to interact with your medications (eg St John’s Wort). They are metabolized (broken down) by the liver or kidney and may affect those organs. Some of them can be toxic (eg vitamin B6 can cause a neuropathy). Some can have side effects that can be harmful to your safety (eg sleepiness on cannabis may compromise driving or decision making; apathy can make you less motivated to exercise). Some have been historically beneficial when practiced in a health care system or were often beneficial when cooked into a food or as part of a holistic diet plan ( eg turmeric is absorbed best with fat and black pepper in curry in an Ayurvedic diet). These supplements are not regulated by the FDA and so it is not clear about what dose and what the formulation of the product may contain (eg looking at THC vs CBD amounts in cannabis products)
To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD #ParkinsonPACT #Parkinsonsecrets and https://www.tourettetreatment.com/