Parkinson's Disease Safety Caveats

An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

Acetyl-L-Carnitine

• Acetyl-L-carnitine can cause gastrointestinal symptoms such as nausea and diarrhea.

Choline

• Do not take choline if you have primary genetic trimethylaminuria.
• Choline can cause fishy body odor, excessive perspiration, hypotension (low blood pressure), depression, and gastrointestinal symptoms such as nausea and diarrhea.

Coenzyme Q10

• See your doctor and monitor your blood glucose level frequently if you take CoQ10 and have diabetes. Several clinical reports suggest that taking CoQ10 may improve glycemic control and the function of beta cells in people who have type 2 diabetes.
• Statin drugs (such as lovastatin, simvastatin, and pravastatin) are known to decrease CoQ10 levels.

DHEA

• Do not take DHEA if you could be pregnant, are breastfeeding, or could have prostate, breast, uterine, or ovarian cancer.
• DHEA can cause androgenic effects in woman such as acne, deepening of the voice, facial hair growth and hair loss.

D,L-Phenylalanine

• Do not take D,L-phenylalanine if you have phenylketonuria.
• Do not take D,L-phenylalanine if you are taking nonselective monoamine oxidase inhibitors (MAOIs).
• Do not take D,L-phenylalanine if you have schizophrenia. D,L-phenylalanine can exacerbate tardive dyskinesia (involuntary facial movements) in people who have schizophrenia.
• Consult your doctor before taking D,L-phenylalanine if you have high blood pressure. D,L-phenylalanine can exacerbate high blood pressure. D,L-phenylalanine can also cause high blood pressure.

EPA/DHA

• Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking EPA/DHA with warfarin may increase the risk of bleeding.
• Discontinue using EPA/DHA 2 weeks before any surgical procedure.

Folic acid

• Consult your doctor before taking folic acid if you have a vitamin B12 deficiency.
• Daily doses of more than 1 milligram of folic acid can precipitate or exacerbate the neurological damage caused by a vitamin B12 deficiency.

Garlic

• Garlic has blood-thinning, anticlotting properties.
• Discontinue using garlic before any surgical procedure.
• Garlic can cause headache, muscle pain, fatigue, vertigo, watery eyes, asthma, and gastrointestinal symptoms such as nausea and diarrhea.
• Ingesting large amounts of garlic can cause bad breath and body odor.

Ginkgo biloba

• Do not take ginkgo biloba if you have a known risk factor for intracranial hemorrhage such as systematic arterial hypertension, diabetes, or amyloid senile plaque.
• Ginkgo biloba can cause allergic skin reactions, elevated blood pressure, and gastrointestinal symptoms such as nausea and diarrhea.

Ginseng

• Consult your doctor before taking ginseng if you have high blood pressure. Overuse of ginseng can increase blood pressure.
• Consult your doctor before taking ginseng if you take nonsteroidal anti-inflammatory drugs (NSAIDs) and/or warfarin (Coumadin). Taking NSAIDs or warfarin with ginseng can increase the risk of bleeding.
• Consult your doctor before taking ginseng if you have diabetes. Taking ginseng can cause an extreme drop in your blood glucose level.
• Ginseng can cause breast pain, vaginal bleeding after menopause, insomnia, headaches, and nosebleeds.

Green Tea

• Consult your doctor before taking green tea extract if you take aspirin or warfarin (Coumadin). Taking green tea extract and aspirin or warfarin can increase the risk of bleeding.
• Discontinue using green tea extract 2 weeks before any surgical procedure. Green tea extract may decrease platelet aggregation.
• Green tea extract contains caffeine, which may produce a variety of symptoms including restlessness, nausea, headache, muscle tension, sleep disturbances, and rapid heartbeat.

L-Tryptophan

• Do not take L-tryptophan if you have carcinoid tumors.
• Do not take L-tryptophan while taking monoamine oxidase inhibitors (MAOIs) (type A) or within 2 weeks of discontinuing MAOIs.
• Do not take L-tryptophan with any antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants or MAOIs.
• Do not take L-tryptophan with serotonin 5-HT receptor agonists, including naratriptan, sumatriptan and zolmitriptan.
• Do not take L-tryptophan if you have ischemic heart disease (e.g., a history of myocardial infarction, angina pectoris or documented silent ischemia), coronary artery spasm (e.g., Prinzmetal sangina), uncontrolled hypertension or any other significant cardiovascular disease.
• L-tryptophan can trigger excess serotonin formation in tissues other than the target organ and cause significant adverse reactions.?
• L-tryptophan can cause nausea, diarrhea, loss of appetite, vomiting, difficulty breathing, pupil dilation, abnormally sensitive reflexes, loss of muscle coordination, blurry vision and cardiac dysrhythmia.

L-Tyrosine

• Do not take L-tyrosine if you have inborn errors of metabolism alkaptonuria and tyrosinemia type I and type II.
• Do not take L-tyrosine if you are taking non-selective monoamine oxidase (MAO) inhibitors.
• Do not take L-tyrosine if you have hypertension.
• Do not take L-tyrosine if you have melanoma

Licorice

• Do not take licorice extract if you have diabetes, high blood pressure, heart irregularities, abnormal muscle tension, poor kidney function, low blood potassium levels, or chronic hepatitis, cirrhosis of the liver, or any disease that impedes the flow of bile from the liver.
• Do not take licorice for more than 6 weeks in a row. High doses of licorice (more than 20 grams of licorice extract daily or 50 grams of licorice root daily) taken for extended periods may lead to excessive loss of sodium from the blood, water retention, high blood pressure, heart irregularities, fatigue, headaches, and muscle cramps.

Lipoic Acid

• Consult your doctor before taking lipoic acid if you have diabetes and glucose intolerance. Monitor your blood glucose level frequently. Lipoic acid may lower blood glucose levels.

Magnesium

• Do not take magnesium if you have kidney failure or myasthenia gravis.

Melatonin

• Do not take melatonin if you are depressed.
• Do not take high doses of melatonin if you are trying to conceive. High doses of melatonin have been shown to inhibit ovulation.
• Melatonin can cause morning grogginess, a feeling of having a hangover or a “heavy head,” or gastrointestinal symptoms such as nausea and diarrhea.

NADH (Nicotinamide Adenine Dinucleotide)

• NADH can cause gastrointestinal symptoms such as nausea and loss of appetite.

Niacin (nicotinic acid)

• Do not take high doses of nicotinic acid (1.5 to 5 grams daily or more) if you have liver dysfunction, an unexplained elevation in your serum aminotransferase (transaminase) level, active peptic ulcer disease, arterial bleeding, or if you consume large amounts of alcohol.
• Consult your doctor before taking high doses of nicotinic acid if you have a history of jaundice, peptic ulcer disease, gastritis, disease of the liver or bile ducts, gout, kidney dysfunction, or cardiovascular disease (especially acute myocardial infarction or unstable angina).
• Consult your doctor before taking high doses of nicotinic acid if you have diabetes. High doses of nicotinic acid can negatively affect glucose tolerance. Monitor your serum glucose level frequently if you take nicotinic acid and have diabetes.
• Have your doctor monitor your serum aminotransferase level if you take high-doses of nicotinic acid.
• Nicotinic acid may cause flushing, principally of the face, neck, and chest. This flushing is thought to be prostaglandin-prostacyclin mediated. Histamine may also play a role in the flushing.
• Nicotinic acid can cause dizziness, palpitations, rapid heartbeat, shortness of breath, sweating, chills, insomnia, nausea, vomiting, abdominal pain, and muscle pain.
• High doses of nicotinic acid can cause blurred vision, macular edema, toxic amblyopia, and cystic maculopathy.

PABA (Para-aminobenzoic Acid)

• Do not take PABA if you are taking sulfonamides or have a kidney disease.
• PABA can cause anorexia, nausea, vomiting, fever, and rash.

Phosphatidylserine

• Phosphatidylserine can cause gastrointestinal symptoms such as nausea and indigestion
• Consult your doctor before taking phosphatidylserine if you have antiphospholipid-antibody syndrome. See your doctor frequently if you take phosphatidylserine and have antiphospholipid-antibody syndrome.

Selenium

• High doses of selenium (1000 micrograms or more daily) for prolonged periods may cause adverse reactions.
• High doses of selenium taken for prolonged periods may cause chronic selenium poisoning. Symptoms include loss of hair and nails or brittle hair and nails.
• Selenium can cause rash, breath that smells like garlic, fatigue, irritability, and nausea and vomiting.

Trimethylglycine (betaine)

• Do not take trimethylglycine (betaine) if you have gastritis, gastroesophageal reflux disease (GERD), or peptic ulcer disease.

Vitamin B1 (Thiamin)

• Consult your doctor before taking vitamin B1 for a thiamin deficiency, lactic acidosis secondary to thiamin deficiency, Wernicke-Korsakoff syndrome, Wernicke's encephalopathy, or Korsakoff's psychosis.

Vitamin B2 (riboflavin)

• High doses of vitamin B2 (riboflavin) may interfere with the Abbott TDx drugs-of-abuse assay.
• Riboflavin absorption is increased in hypothyroidism and decreased in hyperthyroidism.
• If you are taking nucleoside reverse-transcriptase inhibitors, even a mild riboflavin deficiency can increase your risk of lactic acidosis.

Vitamin B6

• Individuals who are being treated with levodopa without taking carbidopa at the same time should avoid doses of 5 milligrams or greater daily of vitamin B6.

Vitamin B12 (cyanocobalamin)

• Do not take cyanocobalamin if you have Leber's optic atrophy.

Vitamin C

• Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.
• Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.

Vitamin E

• Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
• Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
• Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.
• Discontinue using vitamin E 1 month before any surgical procedure.

For more information see the Safety Appendix