Two professionals amongst those I’ve worked with or followed stand out as good sources of advice on complementary approaches to managing and recovering from PD. Much of what follows is informed by their wisdom:

John Coleman ‘Rethinking Parkinson’s Disease’ is a must-read book, describing a naturopathic approach to recovery that brought him back from stage 4 PD to no symptoms (that I am following with some success).
See https://www.returntostillness.com.au/index.html
and podcast https://www.buzzsprout.com/2042385/13001129

Dr. Laura Mischley  is an MD and a functional medicine practitioner, who has pioneered patient-reported outcome research ; her website has useful resources and a PD ‘school’
See https://lauriemischley.com
video https://www.youtube.com/watch?v=LdpfNnnAzKI&t=2831s
and https://educationismedicine.com

Current medications focus on dopamine supplementation, with variants on the precursor levodopa in combination with cardidopa or equivalent, or on drugs that reduce the degradation of dopamine. These offer symptomatic relief but do not address the underlying causes or pathology of the condition, and come with side effects such as the on-off effect and dyskinesia, and decreasing efficacy with time.

Mayo clinic summary of medical treatments

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062#:~:text=Dopamine%20agonists%20include%20pramipexole%20(Mirapex,shot%20used%20for%20quick%20relief

Whilst these drugs may give solace for some years, this current protocol is limited if long term wellness is sought.  The best way to look at these drugs may be to enable a window of time in which to work hard on optimising wellness, so that the body’s amazing immune and repair system can be given its best chance to work. It could be unwise to be complacent if the drugs work well at first, and no other health strategies are followed.

Research by Cure Parkinson’s found a total of 139 active clinical trials in 2022 aimed towards developing new drugs aimed at slowing, stopping or reversing progression or better addressing symptoms. Of these 45% show some efficacy.  However, only 14% of the total clinical trials underway were in phase 3, highlighting the ongoing challenge of progressing drugs onwards after phase 2.  Getting from initial launch of a drug test to licensing can take 10-15 years.

Parkinson’s drug therapies in the clinical trial pipeline: 2023 update

https://cureparkinsons.org.uk/2023/06/parkinsons-clinical-trial-pipeline-2023/

So there maybe progress with medication in the future, but given the complexity and individuality of expression of this condition, I’m not going to put too much hope on this making much difference in the next few years.

Mucuna, a natural levadopa substitute, is discussed in the supplements section below.

John Coleman calls for Western medical doctors to embrace naturopathic approaches in association with medication, yet anecdotally few medics communicate any of the following therapeutic approaches except exercise.

The one complimentary intervention that all professionals seem to agree on is the need for regular exercise. Exercise has been shown to have neuro-protective, and neuro-regenerative effects, as well as benefiting cardiovascular and other functions.

The Mayo Clinic calls exercise a first line treatment for Parkinson’s disease.

There is a useful podcast here: https://mcpress.mayoclinic.org/nutrition-fitness/exercise-is-first-line-treatment-for-parkinsons/#:~:text=There's%20voluminous%20evidence%20that%20supports,think%20exercise%20has%20neuroprotective%20effects

See a useful article here about aerobic exercise: https://www.mayoclinicproceedings.org/article/S0025-6196(17)30898-4/fulltext

It seems useful to include different forms of exercise, Four example

• Aerobic and cardiovascular exercise, such as high-intensity interval training
• Strength exercise, such as using weights
• Balance and flexibility, such as yoga tai Chi or dance

There are also some useful programmes that combine strong powerful movements, with brain challenges at the same time. One such programme is PD warrior, which can be done online if you do not have a local practitioner, see https://pdwarrior.com/.

John Pepper, who has PD and lives in South Africa, has developed protocol including fast walking, and conscious movement that appears to be having great success; as long as he keeps up the work he is largely symptom-free. See https://www.reverseparkinsons.net/  and a video here https://www.youtube.com/watch?v=_QVIdPo71gI

Probably the best form of exercise is the one that you enjoy and will do regularly.

Sleeping well is a blessing when it’s working as it should. But in a survey of 15,000 people in 2016, 64% said that they are not happy with how much sleep they get. In fact only 8% say they are completely happy with their sleep.

Most of us need 8 hours, with few exceptions.  Lack of sleep affects us in many ways, from feeling physically unwell, being more anxious, to contributing to heart disease, premature ageing and road accident deaths.

Sleep is often poor with PD, so we need to take extra care to establish good habits and get the best chance of sleeping well.

Here are my top tips:

1. Keep up your mindfulness practice, especially working on ‘letting go’ – in particular use the out-breath to let tensions dissolve. Going to sleep is a process of letting-go of our hold on waking consciousness.
2. Take short naps – no more than 20 minutes – in the daytime.
3. Exercise regularly – even a brisk 20 minute walk in the evening may help.
4. Make the room really dark – eg with black-out curtain linings
5. Do not use blue light devices such as mobiles or tablets in the hour before bed time, and switch them off before you turn out the light.
6. Keep your bedroom clutter-free.
7. Practice gratitude, to put a positive spin on the day that’s past.
8. Avoid serious discussion or arguments before bed – resolve things early.
9. Go to bed earlier – and wake up earlier which makes time for mindfulness practice!
10. If you wake in the night with worries, do something positive. For example, restart the breathing or body scan practice, plug in headphones and listen to voice radio, or a long meditation talk, or soothing music.
11. If sleep evades you, accept it. Just resting in bed is doing you good. Take that time as an opportunity for mindfulness practice, such as a body scan (wishing every part of your body well as it comes to mind).
12. Keep regular routines of when you go to bed.
13. Get outside during the morning, to reset your internal clock.

A great book is ‘Why we Sleep’ by Matthew Walker

What we eat is critical to the make-up and health of our gut microbiome and our neurological health.

The MIND diet has been shown to be neuroprotective and related it to change in cognition. The difference in decline rates for being in the top third of MIND diet scores versus the lowest was equivalent to being 7.5 years younger in age.

Here are the 10 foods the MIND diet encourages:

• Green, leafy vegetables: Aim for six or more servings per week. This includes kale, spinach, cooked greens, and salads.
• All other vegetables: Try to eat another vegetable in addition to the green leafy vegetables at least once per day. It’s best to choose non-starchy vegetables because they provide a lot of nutrients for a low number of calories.
• Berries: Eat berries at least twice per week. Berries such as strawberries, blueberries, raspberries, and blackberries all have antioxidant benefits.
• Nuts: Try to get five or more servings of nuts each week (it is wise to soak nuts for a few hours and rinse before eating to remove tannins, lectins and nutritional inhibitors).
• Olive oil: Use olive oil as your main cooking oil (research by Dr. Mischley indicates that coconut oil is associated with good outcomes in PD).
• Whole grains: Aim for at least three servings daily. Choose whole grains like oatmeal, quinoa, brown rice, whole grain pasta and bread (buckwheat is excellent, and black rice is the best type as considered a seed). John Coleman suggests avoiding grains, especially wheat, altogether as inflammatory.
• Fish: Eat fish at least once per week. It is best to choose fatty fish such as salmon, sardines, trout, tuna, and mackerel for their high amounts of omega-3 fatty acids.
• Beans: Include beans in at least four meals per week. This category includes all beans, lentils, and soybeans.
• Poultry: Try to eat chicken or turkey at least twice per week. Note that fried chicken is not encouraged on the MIND diet ; however, Dr. Mischley suggests limiting poultry consumption.
• Wine: Aim for no more than one glass daily (red contains more resveratrol and polyphenols).

The MIND diet recommends limiting the following five foods:

• Butter and margarine: Try to eat less than 1 tablespoon (about 14 grams) daily. Instead, try using olive oil as your primary cooking fat (John Coleman suggests avoiding animal dairy altogether as inflammatory, although butter has minimal caseine and lactose, the real culprits).
• Cheese: The MIND diet recommends eating cheese less than once per week.
• Red meat: Aim for no more than three servings per week (research by Dr. Mischley suggests avoiding red meat altogether).
• Fried food: The MIND diet highly discourages fried food, especially the kind from fast-food restaurants.
• Pastries and sweets: This includes most processed snack foods and desserts — ice cream, cookies, brownies, snack cakes, doughnuts, candy, and more. John Coleman suggests avoiding sugar altogether as inflammatory and damaging to the arteries.

Note that most conventionally/mass produced foods contain pesticide, antibiotic, hormone or other toxic residues so buying organic/local food is a wise precaution and is associated with better outcomes in PD.
See https://downloads.hindawi.com/journals/omcl/2017/6405278.pdf

Organic food consumption offers the avoidance of pesticide and herbicide residues (which are some of the most potent and persistent neurological toxins, such as glyphosate and paraquat) and antibiotic residues which may adversely affect the gut microbiome. Given the potential harm caused by non-organic food it seems wise to avoid it.
See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019963/

Evidence for the benefit of food from organic production as opposed to conventional agriculture and industrial production is strong, and some studies show the better nutrient density and presence of micronutrients, phytochemicals like polyphenols, flavonoids, and anthocyanins of organic fresh produce. Plus the environmental benefits are significant.

See article: https://www.frontiersin.org/articles/10.3389/fsufs.2021.699147/full

Other diets, such as a ketogenic diet are not well researched and yet have some strong adherents.

It is useful to refer to the patient-reported outcome research on food choices by Dr. Mischley.
https://downloads.hindawi.com/journals/omcl/2017/6405278.pdf

Eating can be an opportunity for mindfulness practice. Mindful eating means slowing down to notice the experience coming from all the senses; from sight, taste and texture, smell, sound, and the thoughts we have about the food we are eating. It’s also an opportunity for gratitude practice, recognising the complex when of natural processes and human interventions which had brought food to plate. By being fully tuned in to the effect of certain foods have on how you feel, you may also gather intelligence about what kind of food is good for you.

I have already mentioned the importance of gut health, which is often compromised in PWP.

‘gut pathogens and dysbiosis can contribute to peripheral inflammatory states or trigger downstream metabolic effects that exacerbate the neurodegenerative process in PD. Several preclinical and clinical studies have demonstrated disrupted intestinal permeability, intestinal inflammation, altered gut microbiome, and reduced fecal short‐chain fatty acids in PD. In this regard, microbial‐directed therapies such as probiotics are emerging as potential therapeutic options.’
From article on Probiotics for Parkinson's disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035463/

In addition to the recommendations on diet above, research by the ZOE team (the world’s largest nutrition study) indicates several other strategies to build optimum gut health:

• eat a diverse rainbow diet, with at least 30 plants a week of different colours (latest advice ups the number to 50)
• avoid ultra processed foods - most fast food, ready meals, and snacks are highly altered and typically contain a lot of added salt, sugar, fat, and industrial chemical additives; they may also increase of potentially harmful gut microbes
• eat fermented foods, plus probiotics (Symprove is undergoing clinical trials for PD) and prebiotics (such as inulin which is easily included in drinks)
• eat unprocessed fruit especially berries, with the skin on
• reduce consumption of meat and non-fermented dairy
• eat plenty of legumes, partly as an alternative to animal protein
• eat long fermented or sourdough bread
• eat diverse fungi
• organic free range eggs are a good source of nutrients
• dark chocolate and spices contain healthy polyphenols
• unprocessed nuts (best soaked) and seeds are very nutritious

Good books:

‘Food for Life’ Tim Spector - website  https://joinzoe.com/learn

Dr. Michael Moseley ‘Clever Guts’

This is a rabbit hole, with a huge industry trying to cash in and sell us a magic bullet.  Whilst some supplements may be useful, probably none will make a significant difference on their own. Too many supplements stress the liver and could interact with medication.

It is useful to get a blood test to check your levels of vitamins and minerals, although some therapeutic use of supplements (like Vitamin C) may go well beyond the RDA (which is based on what an average healthy person may need).  You should get informed medical or nutritional advice as appropriate, combined with your own research, to make a plan for supplementation.

However, the following supplements seem to be those most commonly taken for PD:

• Vitamin C, best as buffered powder with bioflavanoids
• Vitamin B complex
• Folate, if using levodopa medication
• Vitamin D3 with K2
• Magnesium citrate
• CoQ10 ubiquinol
• Zinc
• Ashwagandha
• Turmeric
• Triphala for constipation
• Mushroom powders such as Lion’s mane
• Mucuna, but note potential overdosing in conjunction with levodopa medication. (Mucuna is a bean that has typically 5-15% ldopa. This may not be readily available to the body or cross the blood brain barrier by itself, so it is reportedly variable in its efficacy. It has other effects that are potentially useful, such as being neuroprotective and anti-inflammatory. On the Facebook forums some people swear by it.) See this research review.
• Probiotics (I take an expensive one - Megasporebiotic) and prebiotics (such as inulin).
• I also take MagPhos tissue salts to deal with leg cramps at night.

High dose B1 has a big following too, see video https://www.youtube.com/watch?v=iu1vJ8eN8HM

There are also indications about which supplements seem to be most useful from patient-reported outcomes research by Dr. Mischley^. Nutraceuticals associated with improved outcomes were Ginkgo biloba (GB), NAD+ or its precursors (but note negative effects unless informed), 5-methyltetrahydrofolate, glutathione, mucuna, CoQ10, low dose lithium (particularly to counter side effects of Levadopa medication), curcumin, homocysteine factors (eg. B vitamins and folate), DHEA, coconut oil, vitamin C, and omega-3 fatty acids (fish oil).

We need at least 2 litres of clean water daily. Dehydration is the enemy of wellness. Drinking adequate water daily flushes our system, hydrates tissues and organs, softens stools and assists with bowel function.

Try keeping a big glass or a bottle beside you at all times, and sip frequently rather than gulp a whole glass at once.

You might like to try Aqua Hydration drops. Their website has useful information about hydration. Also see this article on hydration benefits.

We live in a toxic environment; even with care exposure to toxins are unavoidable.  I believe that detoxing has been a key factor in my own health programme.

With permission, I am replicating the advice John Coleman gave me, after testing had been done (I found high levels of mercury, arsenic, glyphosate and other industrial chemicals; levels of mercury for example have reduced significantly on this protocol).

‘In order to maximise immune function, optimise antimicrobial activity, and maintain a reasonable level of wellness during recovery, we MUST be active in removing toxins from our body and environment every day.’

Here is the protocol:

Clean diet free from gluten/grains, dairy (cows, sheep & goats), refined sugar, caffeine, aspartame, additives. Lots of fresh vegetables and living food, plus eat lots of parsley and coriander.

Warm Lemon Water before meals. This simple activity stimulates production of hydrochloric acid in our stomach (needed for protein digestion and systemic alkalising), and a variety of digestive enzymes in our gut. It can contribute to improved bowel function as well.

Chia seeds. Soak overnight and add some lemon juice in the morning before drinking. Chia seeds MUST be soaked overnight to be effective. They will bulk up and hydrate stools and assist bowel function without the adverse effects of harsh laxatives. Chia seeds are also a good source of omega 3 fatty acids (anti-inflammatory) and a number of trace minerals.

Dry skin brushing. Use a natural bristle brush only. Always skin brush BEFORE showering or bathing. Start at the periphery (hands/feet) and brush firmly in small circular motions moving towards the heart. Brush your thorax and back towards the heart as well (it’s great if you have a partner to brush your back). Brushing removes dead skin and superficial toxins, stimulates blood and lymph flow, and makes you feel great.

Epsom Salts baths and foot baths. Put two tablespoons in a basin with warm (not hot water) and soak your feet for 20 minutes. Or put a cup of Epsom Salts in your bath (again, warm, not hot) and soak luxuriously for 15-20 minutes. The Epsom Salts will draw toxins out through our skin. However, if we soak for too long, we start to reabsorb the toxins floating in the water. If the water is too hot for immediate comfort, it can affect fascia function and reduce our detoxing efficiency.

Oil pulling. To oil pull, simply swish your choice of unrefined, high quality oil in your mouth, similar to the way you would use a mouthwash, for five to 20 minutes.

The process attracts and removes bacteria, toxins, and parasites that live in your mouth or lymph system, and also pulls congestion and mucus from your throat and loosens up your sinuses. Coconut oil is probably the best to use because it has antimicrobial, anti-inflammatory, and enzymatic properties.

To start, scoop 1 tablespoon of coconut oil into the mouth; if it’s cold, allow the oil to melt. Now push, swirl, and pull the oil between your teeth, around your gums, and allow it to touch every part of your mouth except your throat. You don’t want the oil getting in contact with your throat because it’s now carrying somewhat toxic material. No gargling! Once your time pulling is over, spit into the trash or toilet, but never the sink - the oil could solidify and clog your drain. Now rinse your mouth out with clean water two or three times. Finally, drink a glass of water and relax. 

I also use Byron White detox and anti-inflammatory formulas, a herbal detox powder (Matrix Phase detox) plus a zeolite (Toxaprevent).

Again, get advice on this from an expert (but note that what seems worrying to a naturopath/functional doctor may not worry a toxicologist, so you need to decide whose advice you will follow).

Ayurvedic medicine is an ancient Indian health system. It has a theory about PD and practitioners will suggest detox regimes and a particular diet and herbs, plus yoga, breath-work and meditation. I have learned a lot from this. If you want to follow it up, find a well experienced practitioner, ideally trained in India. The ayurvedic understanding of PD  is an accumulation of and imbalance of Vata energy in the gut (which is the current focus of a lot of medical research).

This interesting, in-depth article is by an excellent practitioner in the USA.
https://www.gersonayurveda.com/giam-blog/2019/2/12/the-ayurvedic-approach-to-parkinsons-disease-kampavata-by-scott-gerson-md-m-phil-ayu-phd-ayu

Traditional Chinese Medicine has a similarly ancient ancestry, and focuses on balancing body energies, through acupuncture, diet and herbs. I regularly get acupuncture treatment and take a bespoke herb mix (I won't share my formula as it would be different for each person). I find acupuncture remarkably effective.

My one firm suggestion if you go down this route, is to find a properly trained TCM practitioner (eg see the BAC register in the UK). Avoid 'medical acupuncturists', who may have western medical training and have taken a quick course over a few days. The proper training takes years; anything else is amateur.

One of the common factors for just about everyone I’ve communicated with who has PD, is that they have experienced trauma, ongoing high levels of stress or intense periods of anxiety. We know how stress affects many aspects of our health, and there are many pointers to this as one of the primary causes of PD.

This trauma or chronic stress may take the form of early childhood experiences, or later life stresses (my own relates to bringing up an autistic child plus work stress).  Whatever the cause, trauma gets expressed and stuck in the body, causing illness.

I am no expert in this area but I do think resolving trauma is one of the pathways to wellness, and should be explored.

As a starting point, read this great book on the effects of trauma and stress: Gabor Maté ‘When the Body Says No: The Cost of Hidden Stress’ and a video on how stress causes illness: https://youtu.be/Rik5E7wey0w