A randomised clinical trial to evaluate the effects of Plantago ovata husk in Parkinson patients: changes in levodopa pharmacokinetics and biochemical parameters

Plantago consumption significantly reduces total cholesterol and low-density lipoprotein cholesterol in adults: A systematic review and meta-analysis

Plantago is rich in soluble fiber, known for its beneficial health effects. Given this, we hypothesized that Plantago consumption might positively influence blood lipid in adults. Researchers have conducted numerous randomized controlled trials (RCTs), revealing the impacts of Plantago consumption on various blood lipid parameters. However, findings regarding specific blood lipid parameters have shown variability. This study aimed to comprehensively assess the effect of Plantago consumption on blood lipid parameters. Eligible studies evaluating the effects of Plantago consumption on blood lipid were searched in 5 electronic databases published up to August 2023. Analysis used a random effects model to determine weighted mean difference and 95% confidence intervals. In total, 29 RCTs including 2769 participants were included. Compared with the control group, Plantago consumption significantly reduced total cholesterol (TC) by 0.28 mmol/L and low-density lipoprotein cholesterol (LDL-C) by 0.35 mmol/L, correlating to an estimated 7% decrease in cardiovascular event risk. Conversely, no substantial effects were observed on high-density lipoprotein cholesterol or triglycerides. Subgroup analyses of 29 RCTs revealed that TC concentrations were significantly lowered in studies that included male participants, those who were healthy, or had lipid disorders. Additionally, TC and LDL-C were significantly lower in participants consuming Plantago husk or psyllium, and soluble fiber intake was specifically effective in lowering TC, LDL-C, and triglycerides. In conclusion, Plantago consumption can significantly lower TC and LDL-C concentrations. The findings will provide crucial insights into the potential of Plantago in dietary strategies for blood lipid management.

Effects of dietary supplements, foods, and dietary patterns in Parkinson's disease: meta-analysis and systematic review of randomized and crossover studies

BACKGROUND

Diet significantly impacts Parkinson's disease (PD) with plausible biological hypotheses. Although the thesis has been explored in several human clinical trials, no current meta-analyses or reviews summarize the results. We examined the effect of intervention of dietary supplements, foods, and dietary patterns in treating PD.

METHODS

We conducted a meta-analysis and systematic review of randomized and crossover studies published between 1989 and 26 June 2022, searching from PubMed, Embase, Medline, Scopus, Cochrane Library databases, and Chinese databases. Twenty-four studies were included in this review.

RESULTS

The meta-analysis results show that dietary supplements intervention significantly increased the quantitative insulin sensitivity check index (QUICKI) [MD = 0.02, 95% CI (0.01, 0.02), p < 0.00001]. Dietary supplement intervention does not significantly affect the total Unified Parkinson Disease Rating Scale (UPDRS) score and six-min walk test (6MWT) distance. We did not find evidence that dietary supplements or food intervention may minimize the UPDRS III score. However, systematic review results indicated that the Mediterranean, low-fat, and ketogenic diets significantly reduced the total UPDRS score; low-protein diets meaningfully mitigated motor symptoms.

CONCLUSIONS

This meta-analysis result displays that diet and diet supplements had a very modest but statistically significant impact on QUICKI but no effect on motor and non-motor symptoms in PD. The systematic review concludes that dietary patterns intervention may positively attenuate the overall symptoms of PD, including both motor and non-motor symptoms.

How to Optimize the Effectiveness and Safety of Parkinson's Disease Therapy? - A Systematic Review of Drugs Interactions with Food and Dietary Supplements

BACKGROUND

Despite increasing worldwide incidence of Parkinson's disease, the therapy is still suboptimal due to the diversified clinical manifestations, lack of sufficient treatment, the poor adherence in advanced patients, and varied response. Proper intake of medications regarding food and managing drug-food interactions may optimize Parkinson's disease treatment.

OBJECTIVES

We investigated potential effects that food, beverages, and dietary supplements may have on the pharmacokinetics and pharmacodynamics of drugs used by parkinsonian patients; identified the most probable interactions; and shaped recommendations for the optimal intake of drugs regarding food.

METHODS

We performed a systematic review in adherence to PRISMA guidelines, and included a total of 81 studies in the qualitative synthesis.

RESULTS AND CONCLUSION

We found evidence for levodopa positive interaction with coffee, fiber and vitamin C, as well as for the potential beneficial impact of low-fat and protein redistribution diet. Contrastingly, high-protein diet and ferrous sulfate supplements can negatively affect levodopa pharmacokinetics and effectiveness. For other drugs, the data of food impact are scarce. Based on the available limited evidence, all dopamine agonists (bromocriptine, cabergoline, ropinirole), tolcapone, rasagiline, selegiline in tablets, safinamide, amantadine and pimavanserin can be taken with or without a meal. Opicapone and orally disintegrating selegiline tablets should be administered on an empty stomach. Of monoamine oxidase B inhibitors, safinamide is the least susceptible for interaction with the tyramine-rich food, whereas selegiline and rasagiline may lose selectivity to monoamine oxidase B when administered in supratherapeutic doses. The level of presented evidence is low due to the poor studies design, their insufficient actuality, and missing data.

Gastrointestinal Dysfunction in Parkinson’s Disease: Current and Potential Therapeutics

Abnormalities in the gastrointestinal (GI) tract of Parkinson’s disease (PD) sufferers were first reported over 200 years ago; however, the extent and role of GI dysfunction in PD disease progression is still unknown. GI dysfunctions, including dysphagia, gastroparesis, and constipation, are amongst the most prevalent non-motor symptoms in PD. These symptoms not only impact patient quality of life, but also complicate disease management. Conventional treatment pathways for GI dysfunctions (i.e., constipation), such as increasing fibre and fluid intake, and the use of over-the-counter laxatives, are generally ineffective in PD patients, and approved compounds such as guanylate cyclase C agonists and selective 5-hyroxytryptamine 4 receptor agonists have demonstrated limited efficacy. Thus, identification of potential targets for novel therapies to alleviate PD-induced GI dysfunctions are essential to improve clinical outcomes and quality of life in people with PD. Unlike the central nervous system (CNS), where PD pathology and the mechanisms involved in CNS damage are relatively well characterised, the effect of PD at the cellular and tissue level in the enteric nervous system (ENS) remains unclear, making it difficult to alleviate or reverse GI symptoms. However, the resurgence of interest in understanding how the GI tract is involved in various disease states, such as PD, has resulted in the identification of novel therapeutic avenues. This review focuses on common PD-related GI symptoms, and summarizes the current treatments available and their limitations. We propose that by targeting the intestinal barrier, ENS, and/or the gut microbiome, may prove successful in alleviating PD-related GI symptoms, and discuss emerging therapies and potential drugs that could be repurposed to target these areas.

Suplementy diety – specyficzna żywność

Rynek suplementów diety rozwija się bardzo dynamicznie, co ma związek z rozpowszechnieniem tej kategorii produktów w środkach masowego przekazu, stosunkowo bezproblemową procedurą wprowadzenia na polski rynek oraz powszechną dostępnością (można je nabyć w aptece, sklepach zielarskich, spożywczych oraz w Internecie). Z definicji suplementy mają być uzupełnieniem diety, zaliczają się do żywności oraz nie mogą wykazywać działania leczniczego. Ich postać, która została ustawowo określona, może być wizualnie identyczna z postacią farmaceutyczną produktów leczniczych, co może wprowadzać konsumentów w błąd, jeżeli nie wiedzą, jak rozróżniać te dwie grupy. Polska legislacja nie uwzględnia żadnych wymogów dotyczących parametrów technologicznych czy właściwości fizycznych gotowych produktów. Na bezpieczeństwo stosowania suplementów diety, oprócz ich jakości i rzeczywistej zawartości deklarowanych składników, składa się również ewentualna obecność zanieczyszczeń i niedozwolonych substancji dodatkowych. Wybiórcza kontrola rynku oraz brak szczegółowych wytycznych dotyczących parametrów postaci suplementów daje znaczną dowolność producentom, jednocześnie umożliwia wprowadzenie na rynek produktów o wątpliwej jakości, które mogą zagrażać konsumentom, będąc całkowicie pozbawionymi działania prozdrowotnego. Ze względu na rosnące zainteresowanie tą grupą produktów przez konsumentów, przedstawiono w pracy sytuację prawną suplementów diety na polskim rynku, odnosząc się także do legislacji europejskiej i amerykańskiej. Omówiono procedurę wprowadzania na rynek, podstawowe wytyczne stawiane tej grupie produktów, wskazania do stosowania oraz aspekty związane z bezpieczeństwem i zagrożeniami wynikającymi ze stosowania suplementów diety.

Dietary Approaches to Improve Efficacy and Control Side Effects of Levodopa Therapy in Parkinson's Disease: A Systematic Review

Although levodopa remains the most effective drug for symptomatic management of Parkinson's Disease (PD), treatment during advanced disease stages may raise unpredictable motor fluctuations and other complications. Counteracting these complications with other pharmacological therapies may prompt a vicious circle of side effects, and here, nutritional therapy may have great potential. Knowledge about the role of diet in PD is emerging and multiple studies have investigated nutritional support specifically with respect to levodopa therapy. With this systematic review, we aim to give a comprehensive overview of dietary approaches to optimize levodopa treatment in PD. A systematic search was performed using the databases of PubMed and Scopus between January 1985 and September 2020. Nutritional interventions with the rationale to optimize levodopa therapy in human PD patients were eligible for this study and their quality was assessed with the Cochrane risk-of-bias tool. In total, we included 22 papers that addressed the effects of dietary proteins (n = 10), vitamins (n = 7), fiber (n = 2), soybeans (n = 1), caffeine (n = 1), and ketogenic diets (n = 1) on levodopa therapy. Interventions with protein redistribution diets (PRDs), dietary fiber, vitamin C, and caffeine improved levodopa absorption, thereby enhancing clinical response and reducing motor fluctuations. Furthermore, supplementation of vitamin B-12, vitamin B-6, and folic acid successfully reduced high homocysteine concentrations that emerged from levodopa metabolism and promoted many metabolic and clinical complications, such as neuropathology and osteoporosis. In conclusion, dietary interventions have the potential to optimize levodopa efficacy and control side effects. Nutrition that improves levodopa absorption, including PRDs, fiber, vitamin C, and caffeine, is specifically recommended when fluctuating clinical responses appear. Supplements of vitamin B-12, vitamin B-6, and folic acid are advised along with levodopa initiation to attenuate hyperhomocysteinemia, and importantly, their potential to treat consequent metabolic and clinical complications warrants future research.