Proposed causes of Progressive Supranuclear Palsy (PSP)

As you may know, the current stated opinion regarding PSP, Progressive Supranuclear Palsy, is that there is no known cause and no known cure. I am a holistic clinician in Los Angeles who fortunately had the opportunity to give a second opinion and intervene in one person's experience with the course of this rare progressive neurological disease, despite the patient's family bias against any more than five follow-up evaluations. Five follow-up evaluations was supposed to be the initial care phase; not the end of care. So in such an extremely limited clinical window of only 5 visits, we could only expect a minimal move toward our initial goal to possibly slow the disease's known progressive course of neurodegeneration.

Progress toward our goal was measured by our observation of any positive changes compared to her initial physical tests. Additionally, to enable another way to track progress, we obtained a broad array of new blood test values that were intended to be correlated with a subsequent set of blood test values after our initial phase of care, but due to bias from the patient's family, that subsequent blood test panel never happened.

Unfortunately, regardless of any clinically observed progress, the patient's husband believed only in outcome failure, and his blame was on my initial course of care, but not on any of the patient's previous and concurrent long-term medications, nor any long-term treatments prescribed by other doctors before me, because, as the patient's husband said, "they aren't promising anything."

With conventional medical interventions, the disease of PSP is presently considered just as predictably progressive as it was when the famous actor Dudley Moore first presented with symptoms of this disease in February of 1998. As far as I know, there has been no advancement in therapies and certainly no new drugs that have shown any promise at all for those suffering with this progressive neurological disease called PSP. Any drug therapy used today is strictly to hide as many symptoms as possible while the PSP disease continually progresses on its known course. Eventually this symptom management strategy will fail. My patient stated that her doctor told her to try to keep using her walker and keep out of a wheelchair for as long as she could, because once she would start using a wheelchair she would never get out.

According to Dr. Lawrence Golbe, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ: "[PSP] typically produces a chair-bound state 5 or 6 years into the illness." (1) A lady from Greece wrote to tell me her mother didn't even last 4 years after the PSP diagnosis.

The drugs my patient had been prescribed, by well-meaning doctors, for the off-label implication of slowing the progression of the disease (they're not promising anything? really?), have descriptions that clearly state they do NOT slow the progression of the disease (the neurodegeneration) AT ALL, and are NOT a cure. "No drug treatment significantly and consistently benefits patients, and novel therapies are urgently required."

Furthermore, the description of one of the acute-care drugs that was prescribed for her, "Namenda" (Memantine) says that it might decrease brain plasticity. Decrease brain plasticity? This is a clear contraindication for a person with PSP, or any chronic neurodegenerative condition affecting the brain. That is, of course, unless the prescribing doctor fully believes that the patient has no chance anyway. If the doctors believe the patient just has no chance, then it explains why they wouldn't bother to care about about brain plasticity. In the face of such a chronic disease, brain plasticity is all she's got! It's her only hope!

I discussed this stated side effect of Namenda with my patient and spouse, and asked them to mention it to her prescribing doctor, but at our next visit they said their doctor suggested she keep taking that drug (and they're "not promising anything?" Really?). Let me tell you what her other doctors are promising: they are promising certain clinical failure.

Brain plasticity is the healing and repairing mechanism of the brain.

Brain plasticity is the inherent potential ability of the brain to remodel and rebuild. Current scientific literature supports the idea that the potential for brain plasticity can be influenced with clinical nutrition.

Regarding NMDA receptor antagonists, which is what Namenda is: "blockade of synaptic transmission mediated by NMDA receptors hinders neuronal survival." But you WANT neuronal survival. Neurons are nerve cells. We want to ENHANCE neuronal survival any way we can, otherwise you get progressive brain degeneration (nerve cell death) with no way to prevent brain decline, or neurodegeneration. This current prescription guarantees failure of alternative therapeutic interventions, i.e., any alternative therapy, alternative nutritional support, or alternative to failing treatment, because these prescription treatments block brain plasticity and hinder nerve survival. Don't believe the commercials about this drug that you may have seen on TV, or the manufacturer's website!

I saw the patient, a woman of 69 years, approximately once every 2 weeks for 5 visits. At each visit, I examined her and observed the numerous neuromuscular reactions elicited during my examination. This is a key component of my approach. The purpose of these repeated tests are to observe if the neuromuscular responses are normal or not, and to observe what natural medicine appears to have a normalizing influence on the mechanisms behind those responses, in real time (critics and skeptics, see below).

By observing and evaluating the meaning of the multiple elicited responses during the physical testing process, I was able to recommend the best course of supportive functional nutrition that she needed. Upon follow-up visits, the re-evaluation of the neuromuscular responses can be used as a measuring tool for the success, or not, of the apparent normalizing factors that were introduced at the previous visit. To observe increasingly more normal responses upon follow-up visits with repeated testing suggests better functioning of the core systems which play some role in each specific response—and increasingly more normal is what I was observing with this patient's responses.

"Increasingly more normal is what I was observing with this patient's responses"

This is a functional medicine approach. Part of our goal is to influence epigenetics, when these tests indicate that doing so would be beneficial. What this means, in more simplistic terms, is that "detoxication," (supporting purification mechanisms) may be one of the major factors needed for greater function. The premise here, that appears to be supported by the latest scientific research, is that epigenetic mechanisms can be at the core of the capacity of the CNS [Central Nervous System] to regenerate. *

* R. Puttagunta et al. 'PCAF-dependent epigenetic changes promote axonal regeneration in the central nervous system', Nature Communications (2014)

If I would have known about infrared video oculography and if it were available locally, I would have ordered that test at the outset of my care to objectively monitor any progress under my care; where "progress" would be a positive outcome. As Dr. Stephen Reich of the Johns Hopkins School of Medicine, Baltimore, MD once wrote: "at the New Jersey Neuroscience Institute. Using a technique known as infrared video oculography, they were able to measure the speed of Mr. Moore's eye movements. This demonstrated that his vertical eye movements were very slow and this is one of the earliest features of PSP, but often difficult to appreciate clinically."

I didn't have that test at my disposal, but I did run a full panel of blood tests at the outset of care and evaluated the lab results from a functional medicine perspective. All this is background for my own clinical observations regarding one woman with a diagnosis of PSP.

Through my clinical testing, I found that she had a very high level of oxidative stress, as revealed by her need (derived through repeated testing) for one particular supplement (Glutathione Recycler) at a level of 4 per day for several weeks (re-evaluations were done at 2 week intervals). Comparatively, this is the highest pill requirement per day, for that long, that I had ever seen for this particular clinical nutrition supplement. This finding coincides with the current science showing that oxidative stress depletes the levels of glutathione needed for efficient NMDA function at the NMDA receptors of the brain. You don't need to stimulate those receptors, you need to protect them! Glutathione is the body's own protector from oxidative stress. It's in every cell. We can support that protection mechanism with the proper clinical nutrition.

The Potential Set-Up of a Person To Get PSP

The following factors are what I think MUST be considered in any person diagnosed with PSP, as their combination may be the true underlying keys to the mechanisms that could cause PSP. In other words, I think these things, combined, caused her PSP. Addressing these core factors, naturally, not with drugs that cover-over symptoms, is the key.

Hemoglobin A1C above 5.6% or any Type II diabetes (insulin resistance), especially type II diabetes being treated with insulin Type III diabetes is insulin resistance in the brain, and needs a metabolic correction with diet and supplementation. Drug therapy fails.

Total cholesterol lower than 150 units, and still using cholesterol-lowering drugs. You will have to ask the prescribing doctor to come off this slow brain destroyer.

Any Thyroid Condition requiring Thyroid hormones. Sub Optimal Thyroid markers such as: Total T3 less than 100 ng/dL, Free T3 less than 3.0 pg/ml, reverse T3 out of range. The functional medicine aspects of thyroid must be addressed. It's NOT enough to just take Thyroxine (T4).

Please Note: Several people have contacted me regarding PSP and a Thyriod diagnosis was part of the picture. Thyrioid hormones drive brain function. Thyroid medicines only correct one marker related to thyroid hormone balance. The rest of the lab markers for thyroid make a big difference, yet they are not routinely checked. Some doctors flatly refuse to check the full thyroid panel (thyroid antibodies, free T3, total T3, T3 uptake, reverse T3, free T4, total T4, and TSH).

Please also note that Amiodarone Induced Hypothyroidism (AIH) should definitely be evaluated any time a person is taking that drug for longer than just temporarily. Do not overlook this cause of hypothyroidism via prolonged use of Amiodarone. The cause of AIH is lazy doctors who won't take a patient off a medicine when it is no longer needed.

CRP (c-reactive protein) above 3.0 mg/L. This lab result shows underlying inflammation and a need for a functional medicine approach.

Any indication of immune system activation: WBCs >8.0, or infection: WBCs >11.0. Please note: vaccines activate the immune system, that's what they are designed to do.

Any indication of chronic immune depletion, where WBC count is less than 5.0.

Regular use of antacids of any kind; prescription, or OTC; Tums or Rolaids included. This needs proper functional medicine management.

Diuretic use.

Neuroinflammation (brain on fire) as documented in advanced imaging studies.

Any indication of oxidative stress overload (can be as simple as an oxidata urine test, which we have at my office). Oxidative stress makes everything worse.

I propose that these factors ARE the key players in the development of PSP, and that the prevention and correction of these factors (not the covering-over of symptoms by more pharmaceuticals) could be the only way available to stop the progression of this rare neuro-degenerative disease known as progressive supra-nuclear palsy. Don't let any doctor tell you that the mentioned lab results and drug usage have nothing to do with brain function. They ALL do.

Even top expert medical doctors, or neurologists are not looking at these factors as causative of PSP, because the textbooks still say that PSP has no known cause and no known cure. Misguided PSP research looks for drugs that can only cover-up some symptoms of the disease, without affecting the disease itself. In PSP, one such symptom is difficulty in swallowing liquids. The doctors write prescriptions of a drug that slows down saliva production to counteract this symptom. Is that all we've got? With that kind of treatment, anyone diagnosed with PSP really doesn't have a chance. That is a terribly hopeless fate.

Why is there no investigation into the causation of this disease? Perhaps it would be too embarrassing to discover that the prescription drugs themselves, that were administered for all those years, contributed to the underlying mechanisms for the initiation of the condition in the first place!

I would be willing to be a team member in new clinical research investigating PSP. If you are interested in funding such a research project, please let me know.

If you are caring for a person that was diagnosed with progressive supranuclear palsy (PSP) and would like me to help put this information to work for you, to possibly slow the progression of the disease, or to possibly regain some function, I would be willing to be part of your medical team, so you may contact me.

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