Interventional Influence of the Intestinal Microbiome Through Dietary Intervention and Bowel Cleansing Might Improve Motor Symptoms in Parkinson’s Disease

Abstract

The impact of the gut microbiome is being increasingly appreciated in health and in various chronic diseases, among them neurodegenerative disorders such as Parkinson’s disease (PD). In the pathogenesis of PD, the role of the gut has been previously established. In conjunction with a better understanding of the intestinal microbiome, a link to the misfolding and spread of alpha-synuclein via inflammatory processes within the gut is discussed. In a case-control study, we assessed the gut microbiome of 54 PD patients and 32 healthy controls (HC). Additionally, we tested in this proof-of-concept study whether dietary intervention alone or additional physical colon cleaning may lead to changes of the gut microbiome in PD. 16 PD patients underwent a well-controlled balanced, ovo-lacto vegetarian diet intervention including short fatty acids for 14 days. 10 of those patients received additional treatment with daily fecal enema over 8 days. Stool samples were collected before and after 14 days of intervention. In comparison to HC, we could confirm previously reported PD associated microbiome changes. The UDPRS III significantly improved and the levodopa-equivalent daily dose decreased after vegetarian diet and fecal enema in a one-year follow-up. Additionally, we observed a significant association between the gut microbiome diversity and the UPDRS III and the abundance of Ruminococcaceae. Additionally, the abundance of Clostridiaceae was significantly reduced after enema. Dietary intervention and bowel cleansing may provide an additional non-pharmacologic therapeutic option for PD patients.

New Avenues for Parkinson’s Disease Therapeutics: Disease-Modifying Strategies Based on the Gut Microbiota

“…More recently, a German population-based cohort study tested whether a dietary intervention (i.e., ovo-lacto vegetarian diet including SCFA for 14 days) alone or combined with an additional physical colon cleaning (i.e., daily fecal enema over 8 days) may lead to changes of the gut microbiota in PD patients. Their results showed significant improvement in the Unified PD rating scale III (UPDRS III) score after the dietary intervention combined with fecal enema after a one-year follow-up [ 297 ]. Interestingly, another study showed neuroprotective effects of Vitis vinifera red grape seed and skin extract (GSSE) on midbrain dopaminergic neurons, both in vitro and in vivo, against 6-OHDA-induced toxicity [ 298 ].…”

A Complementary Approach on Olfactory Dysfunction in Parkinsons Disease- Retrospective Observational Study

“…Dietary interventions and bowel cleansing are sufficient methods to impact the gut microbiome in patients with PD. Therefore, a positive impact on the clinical course is feasible [19] . Professor Braak in his hypothesis on 6 stage pathogenesis of PD has mentioned caudorostral trajectory of pathology in brain.…”

The Role of The Gut Microbiome in Parkinson’s Disease

“…This diet, along with rectal enemas for a short period of time, may result in a lower levodopa requirement. 101 In the study by Hegelmaier et al, enemas were used to manage constipation and were also noted to decrease levels of Clostridiaceae and an increase in microbial diversity. 101 Direct supplementation of short chain fatty acids may be neuroprotective and have anti-inflammatory properties for PD.…”