When I was growing up, my mother had a long list of subjects unsuitable for polite conversation. Sex, religion and politics were obvious chart-toppers but any mentions of “tummy trouble”, the human digestive system, or bowel movements were strictly forbidden outside the confines of home.
But suddenly everyone is talking about their gut, or more precisely their gut health. Terms like the ‘microbiome’ are sprinkled over conversations, you can buy a Zoe Gut Shot ‘packed with over 5 billion live cultures” at Marks & Spencer, and in the six years that I have been trying to keep up with Parkinson’s research I have noticed that the word “gut” pops up ever more frequently in medical studies.
So, in this week’s Movers and Shakers we try to get to grips with the gut, its role in Parkinson’s and what we can do to keep it healthy. We begin by remarking on the fact that the one Parkinson’s symptom that is common to just about all of us is constipation - and wonder which comes first, the Parkinson’s or the constipation.
Gillian Lacey-Solymar tells us that she was diagnosed with Crohn’s Disease - inflammation of the digestive system - at just 21: “When I got my Parkinson's, aged 48, I asked my gastroenterologist whether the two were related, and he looked at me and he said, very clearly, no. I then asked the same question to my Parkinson's specialist, who said, yes.”
But since then, a lot more research has been done and there is a growing consensus that there are links between gut health and Parkinson’s. Our first guest, in an interview recorded by Nick Mostyn, is a gastroenterologist at King’s College Hospital Dr Guy Chung-Fae: “About two thirds of patients with Parkinson's will have some form of gastrointestinal symptoms,” he tells us, “and just working my way down from the top to the bottom, people have problems where they're swallowing.” He explains reduced swallowing of saliva can lead to another embarrassing symptom, drooling. “They may have difficulty swallowing because of weak muscles and have aspiration pneumonia, and then you go down to the lower bowel, where you talk about constipation.”
Dr. Chung-Fae says the arrival of constipation can actually predate the onset of Parkinson's by up to 10 years, and can also be associated with cognitive impairment.
In the pub with us we have Kieran Tuohy, professor of energy metabolism and microbiome at Leeds University, and first of all we have one question on our minds - what exactly is the microbiome? “Microbiome is a fairly new term, but it's used to describe all the living organisms in your intestine and their genes. So we're not just talking about the names - who's there - but also some indication of what they might do, because it's also measuring their genetic makeup.”
It turns out that the microbiome of a person with Parkinson’s looks very different from that of someone in good health but that applies to a number of other conditions too. Why, though, we wanted to know, were we hearing so much about it now?
“It really stems from the fact that maybe about 10 years ago, we developed the technical ability to study the microbiome without having to grow them in a laboratory. So we've got access to new ways of studying them, then comparing between different groups, we see that they're different.”
We learned that the microbiome plays a whole lot of important roles in “keepimg things moving” through the digestive system and in regulating inflammation. So we came back to our “chicken or egg” question about the relationship between the gut and Parkinson’s.
Professor Tuohy described an experment in which Israeli researchers had taken people at risk of Type 2 diabetes and given them a Mediterranean diet for a few months. They lost weight and did not progress down the road to diabetes. But the really interesting part came next.
When the trial ended and participants returned to their normal diet, one group was fed back for 100 days samples of the microbiome they had developed during the previous six months, and compared with a control group. “And then that group, the diabetes didn't come back, whereas in the control group, the diabetes started to come back and the body weight started to increase. So just by transferring the microbiome when it had been trained on this Mediterranean diet, they were able to prevent the return of the metabolic disease.”
It seems then not only that the microbiome may play a role in the development of diseases like Parkinson’s but that we can do something about it by changing what we eat. Next, we want to know a bit more about that Mediterranean diet - and Kieran tells us that the term dates from just after the Second World War when people in Mediterranean countries were facing starvation and ate what they could grow - “lots of fruit and veg, unprocessed or unrefined cereals, salad, dairy products, sourdough bread and whole fibres.” He stresses that “Mediterranean” can be a bit misleading today in that in countries like Italy many people now have a far richer - and sweeter - diet.
Our final guest has spent forty years battling to persuade doctors that a probiotic supplement- essentially live microorganisms - is a handy way of improving the gut health of people with Parkinson’s and so alleviating their symptoms. Barry Smith first developed Symprove as a supplement given to farm animals. It seemed to work, keeping animals alive longer but it was a huge struggle to persuade a cautious farming industry to adopt it: “But someone picked up some of our product for the ostrich market, where the mortality rate was commonly 80% and they took it down to about 5%.”
When we ask about the leap from the animal to the human market, Barry describes it as more of a crawl. The big breakthrough came in 2014 when arandomised clinical trial suggested that Symprove was beneficial for people with Irritable Bowel Syndrome. More recently, some Parkinson’s doctors, including Nick “Judge” Mostyn’s neurologist Professor Ray Chaudhuri, have been recommending the probiotic to their patients. But at the moment Symprove is not available to be prescribed on the NHS so patients have to pay quite a chunky fee to get it, around £50 per month, although Barry Smith insists that is coming down fast.
There has been rather too much downbeat news lately about the search for a disease modifying drug. So it was good to hear that looking after your gut health, while not providing a miracle cure, seems to be one route to living better with Parkinson’s.
Two reminders this week - don’t forget tosign our petition calling for the Parky Charter to be implemented so that Parkinson’s care can be improved.
And on April 11th - World Parkinson’s Day -come to Westminster for theBig Sing where you can join in the singing of our anthem We Will Survive. More details on ourwebsite.