Drinking, Drugs and Genes
This week we're offering listeners a bit of a 'potpourri' episode, featuring updates from each of us, as well as our loyal Northern Correspondent, Christopher Lambton. We're focussing on drinking, drugs and genes, asking the questions we all want answers to: Does drinking actually make our Parkinson's worse? What new developments are there in the field of drugs trials? And could gene-oriented treatments pave the way for a cure? Well, there's good news and bad news..
Each week, Rory Cellan-Jones guides us between the laughs and moans in the pub. To read Rory's summary of this week's episode, click here.
Want to find out more about whether you should be drinking with Parkinson's? Find Mark's email exchanges with top neurologists below!
Alcohol and Parkinson’s
In our most recent pot pourri episode, I led a discussion on alcohol, featuring some
friendly neurologists' thoughts about it. Yet, because we found ourselves short of time
for each discussion, I couldn't use all the answers in the podcast itself so I thought I'd set
out here all of their answers. First of all, my questions:
Is there any reliable evidence that alcohol use can cause Parkinson’s? I have
never seen any reliable evidence that it does, but I have seen research suggesting that
wine drinkers may be more likely to develop Parkinson’s, while beer drinkers are less
likely. I wonder whether that tells us as much about the research as it does about
alcohol. Could wine versus beer partly be a class distinction, and could occupation and
reluctance to disclose a Parkinson’s diagnosis then skew the figures? Someone doing
manual work — a plumber or labourer, say — may have much stronger reasons not to
disclose Parkinson’s, or may be less able to continue working with it, than a barrister or
journalist. Could that sort of effect help explain the apparent association, or is there good
evidence that the type of alcohol itself matters?
Second, what do you advise your patients with Parkinson’s about drinking? Some
people with Parkinson’s say they want to drink less than they used to, or that alcohol
affects them more. This isn’t particularly my experience, but is there a physical effect of
Parkinson’s that might explain it, or might other factors be involved?
Finally, there’s the proposition: “Alcohol is a poison and bad for the brain.” How does
that fit with the evidence on Parkinson’s? Discuss.
Rimona Weil - Professor of Neurology, University College London (UCL)
I hadn’t heard about wine vs beer and possibly opposite effects, so I looked it up.
There is a study that looks at several different studies on alcohol and it overall suggests
slightly lower risk of PD in people who drink alcohol. And as you say, slightly higher risk
if people drink wine; with possibly a stronger effect showing that the risk might be lower in beer drinkers. You are right to think about confounders eg class factors. I had wondered about fermentation, as fermented foods are in general good for protection against neurodegeneration.
But the study suggests the effect might be to do with urate, as there are higher levels of
blood urate in beer drinkers, and animal models suggest a protective effect of urate in
Parkinson’s. The study didn’t look at what alcohol does to people who already have alcohol and any effects on progression – so clearly more research is needed in this area!
The advice I give to people about alcohol in my clinic is that life is for living. If people have a very large amount of alcohol every day, it is probably not going to help their cognition, so would be worth cutting down. But interestingly, I don’t have many patients who drink excessively (or admit to it). And as there isn’t really evidence that it is specifically harmful if people drink moderate amounts, I encourage people to enjoy their lives and have a glass of wine if they feel like it. Being sociable is also probably protective, so a glass of wine with a friend in the evening, would be overall quite good for people. Now that I have seen that paper about alcohol and Parkinson’s, it might nudge me to suggest beer, but I think people should drink what they enjoy and the differences are probably marginal.
K Ray Chaudhuri -Professor of Neurology and Movement Disorders; Director of Research and Clinical Trials, King’s College Hospital London and Dubai; Professor, Dementech Neuroscience Clinical Academic Centre, London
You pose very interesting questions in an area little is reliably known .
1. there is not much reliable research dealing with wine vs beer . A German study
showed beer may be beneficial or even "protective" in PD . But it's not proven. The
association of wine drinkers (in moderation) and parkinson is likely to be coincidental as
there are so many other factors operating . Red wine has flavonoids and polyphenols .
these are proposed ( but not proven ) as protective in Parkinson . So in moderation red
wine may be beneficial in early stages of PD . but regular and heavy drinking is damaging, can worsen memory issues as well as balance and falls .
Regarding recommendations : I do not object to patients in early stages of pd to have
red wine or alcohol in evenings in moderation , It can help with onset of sleep as well . In patients with severe tremor , alcohol , can also dampen the tremor in about 30% or cases and therefore a glass of wine or beer in a social setting may be useful . Like always advice must be individualised for each patient . One size does not fit all . Acute parkinsonism has been reported after alcohol withdrawal in people who are heavy drinkers and in excess alcohol is neurotoxic. Also those with impulse control disorder may also be susceptible to heavy drinking and need close monitoring.
Tom Warner - Professor of Clinical Neurology; Director, Reta Lila Weston Institute for Neurological Studies; Head, Queen Square Brain Bank; UCL Queen Square Institute of Neurology and National Hospital for Neurology
Nice to hear from you and an interesting topic. However, the largest studies conclude no
increased risk from alcohol drinking. Possible high intake may, and also the difference between types of drink, but by and large these are trends and not significant. Excess alcohol undoubtedly can affect balance, cognition etc, probably more so that for those without PD, due to the cell loss that has occurred in in the brain.
As regards recommendations - I usually stick to guidelines for drinking in general,14 units per week, spread out over 3 or more days. I suspect we could dig up some interesting studies with about types of alcohol, but most are either underpowered or not significant - although more newsworthy!
Roger Barker - Professor of Clinical Neuroscience, University of Cambridge; John van Geest Centre for Brain Repair
I don't know about alcohol causing parkinson's. It can clearly cause all sorts of other neurological problems with a particular electivity for the cerebellum (balance part of the brain) and peripheral nerves. it can also obviously cause major liver disease and there is a neurology with that , which can include getting parkinsonian like conditions, also getting true measures of alcohol consumption is hard and often under estimated but i imagine one could start to get some handle on this using big data sets on the population such as our future health or uk biobank and then see how this maps onto getting parkinson's. I never offer any strong advice on this. in general if you have a neurological problem then alcohol can have more of an effect but all i really advise is moderation as the relaxing aspects of a drink can also help some people with their parkinson's heavy alcohol use is bad for the brain both directly and indirectly through poor sleep, diet and accidents/falls etc, so i would more likely go with: alcohol and parkinson's are a bad combination.
