"Parkinson’s is a Man Made Disease, But Reversal is Possible" | Dr. Ray Dorsey

Said another way, 87% of Americans with Parkinson's disease do not have any underlying known genetic cause for the disease.

So that's a powerful argument in favor of the idea that this is an environmental-related entity, that this disease is caused by something that aside from our genetics, because it's increasing so dramatically. And in fact, there is no other neurodegenerative condition that's increasing. If you live near a golf course, you have dramatically increased your risk for getting Parkinson's disease. That is the subject of a new study just published in the Journal of the American Medical Association. One of the authors is Dr. Ray Dorsey. He's been on the Empowering Neurologists program before with us, and he's the author of a new book, The Parkinson's Plan, that talks about the environmental risks posed by Our modern world as it relates to Parkinson's disease. He's got a lot to share with us. Let me tell you a little bit more about Dr. Dorsey. Dr. Ray Dorsey is the director of the Center for the Brain and the Environment at Atria Health and Research Institute. The center's mission is to identify the root causes of brain diseases, everything from autism to Alzheimer's, so that we can prevent them. With his colleagues, he has written Ending Parkinson's Disease, which we've talked about on the program before, And the new book, as mentioned, is The Parkinson's Plan, which details a new path to preventing and treating this terrible disease. Ray previously directed the Center for Health and Technology at the University of Rochester, where he chaired the International Huntington Study Group, led the Movement Disorders Division at Johns Hopkins, and consulted for McKinsey and Company. In 2015, the White House recognized Ray as a Champion for Change for Parkinson's disease. He's really made it clear that our environment is dramatically responsible for the incredible rise that we're seeing in Parkinson's incidence. So let's get right to our interview today. Well, Dr. Ray Dorsey, it's a pleasure to have you back on the program.

My pleasure to be with you, David. Thank you very much for having me.

And, you know, the time— purpose of our time together is, of course, to talk about your new book, The Parkinson's Plan, which is excellent. I read it, I think, at least 3 times in preparation for today. It's certainly an area that I've been interested in for decades, you know, as to why this is happening. But I'd like to start off by recognizing that you have a publication that appeared just 2 weeks ago in the Journal of the American Medical Association that looked at the risk of Parkinson's based upon where a person lived in terms of proximity to a golf course. So let's begin with that. Talk about how that study was designed, what you looked at, and more importantly then, what were the findings?

Yeah, so this— the work here, the credit all goes to Dr. Brittany Krzyzanowski, a geographer if you can believe it, at the Barrow Neurological Institute, and her colleagues in Rochester, Minnesota, Dr. Savica and other colleagues who've been following epidemiology of Parkinson's disease for quite some time. And they found that individuals who live within 1 mile of a golf course have a 120% increased risk of developing Parkinson's disease compared to people who live 6 miles or more away. So the closer you live to a golf course, the higher your risk of Parkinson's disease, and not just a little bit higher, twice as high. And then it begs the question, why? And as you know, pesticides, many pesticides are nerve toxins. That's how they kill insects, for example. And, uh, golf courses are huge consumers of pesticides, you know, per acre, far more, maybe 50 times more than farming. And it's likely that some of these pesticides are either inhaled or contaminate the drinking water for individuals who live near the golf course.

Well, you mentioned in the book, and of course this is written prior to this study being released, uh, that in the 1990s, the New York State Attorney published something called Toxic Fairways. That really brought this information to public awareness, indicating that somewhere around 2 tons of pesticides are used per golf course per year. And then another finding in your recent report was, had to do with sourcing of water. If that water was sourced near the golf course, that was even associated with a higher risk of Parkinson's. Again, you know, getting back to what you, I think, have been really clear about is that this is a disease of modern man. It's not by and large a genetic issue that's related to, you know, our environment.

Yeah, so chemicals in our food, water, and air are fueling the rise of chronic diseases. Parkinson's disease is the poster child for that, for chronic diseases. And Parkinson's, unlike seizures, unlike strokes, unlike migraines, which have been described for centuries if not millennia— you can even find biblical accounts of them— Parkinson's disease is a new disease. Its major description, as you know, was by Dr. James Parkinson, a British surgeon, in '61. Who described the condition in 1817. Here it is.

Essays on the Shaking Palsy. This was given to a colleague of mine back in 1971 from Merck, a drug company. Merck. But anyway, I've kept it. It, you know, kind of looks like the real thing. But you're right. So James Parkinson observed, you know, lots of this disease in London, which, as your book talks about, was incredibly polluted even back then.

Yeah. And so, what was he describing? He was describing among— well, one, his first case actually was a gardener. So, there weren't obviously synthetic pesticides then, but plants produce their own pesticides. Plants don't like to get eaten by insects. So, I wonder whether his first case was a man who was a gardener, was working with chrysanthemums, which produce a class of pesticides called pyrethrins, which have since been linked to Parkinson's disease. But his other cases weren't gardeners, and so were unlikely to have significant exposure to naturally occurring pesticides, but they were breathing very polluted air. Air quality in 1800 London was what New Yorkers experienced 2 or 3 summers ago when the Canadian wildfires turned the skies over the Big Apple orange, and equivalent to what people in Delhi, India breathe on a daily basis. So I think he's describing perhaps the chronic effects of high levels of air pollution We now, from this, just from the Gulf study, we have suggestions that chemicals in our air or water pesticides are also contributing to the disease.

Well, we'll get to that in a bit. I want to talk quite a bit about air pollution, these PM2.5 particles that are really in the news quite a bit, and, you know, just the whole notion of wildfire and how, what a risk that poses to our general health and certainly our brain health as well. But you spend a lot of time in the book talking about toxins that maybe people are not so familiar with. Nonetheless, we have great risk for being exposed to them, things like trichloroethylene and PERC, which, you know, I think were used quite a bit in dry cleaning and used as solvents to clean machinery, et cetera. So give us a little overview of these 2 toxins and Really with the nuance that, well, we're not out of the woods yet in terms of our exposure.

Yeah. So, as we wrote in the book, I think trichloroethylene or TCE, this is what trichloroethylene looks like. So, most of your listeners know that chemicals are made of atoms. And so, water, for example, is made up of 3 atoms, 2 hydrogens and 1 oxygen. Trichloroethylene is made up of 6 atoms, 2 carbons in black, a hydrogen atom in white, and 3 chlorines in blue, hence its name trichloroethylene. It's got a cousin named perchloroethylene or tetrachloroethylene, which has one additional chlorine atom. Unfortunately, almost all of us have been exposed to this. If you dry clean your clothes, you're likely exposed to perchloroethylene, which is used by about 60% of dry cleaners in the United States. And TCE was in everything from typewriter correction fluid— David, you and I are old enough to remember typewriters, and you had, when you made a mistake, you had a little Uh, thing to correct it, and that had this chemical in it. It was also used to decaffeinate coffee, used to be used as a dry cleaner, widely used as a degreaser, and it's contaminated over half of Superfund sites. The most toxic sites in the United States are contaminated with TCE, including Camp Lejeune, the Marine base in North Carolina where a million Marines and civilians drank TCE in their drinking water, bathed in it, cooked in it. for a period of 25 years. And those Marines had a 70% increased risk of developing Parkinson's disease 30 years later. And the thing to note about those Marines who were exposed to TC in their drinking water is that they were by death— almost by definition healthy, right? They were young, right? They were only 20 on average. Some were teenagers. And you're only at a Marine base for a short period of time. They're only there for 2 years on average, 25 months. Yet 33 years later, they had a 70% increased risk of developing Parkinson's. And that cohort's young, and still the average age is only 60. And as you know, as this cohort ages, it's likely more and more cases of Parkinson's will emerge. In the book, we talk about chemicals in our indoor air, in our water, and TCs in water, but it's also in indoor air because if you live above a dry cleaner, for example, these chemicals can evaporate and go into your home. And you can breathe 'em in your home and not even realize it. I live now in New York City and I walk past dry cleaners that have apartments above them and I get concerned about those.

So these are called volatile organic compounds, VOCs, and they're volatile, meaning that they evaporate quite readily and enter the air that people then breathe. As you say, who are in proximity to these dry cleaning establishments.

Yes. And so you can either get exposed to them in your environment— up to 30% of groundwater in the United States is contaminated with TCE, and many people get their water from wells, for example, which aren't regulated by the Safe Drinking Water Act and thus could be contaminated and not be unaware. Or like radon, which, you know, people know evaporates from the ground and enters your home and can cause lung cancer. And many people have had their homes tested for radon. And then the nice thing about this is it's readily remediable. Just like you can put a radon remediation system in your house, which sucks the air from underneath your foundation and vents it above your roof, you can do the same thing to prevent it. And as much as I care about TCE and Parkinson's disease, its real problem is that it causes cancer. According to the EPA, the World Health Organization, And the Department of Health and Human Services, TC's a known carcinogen, which is a fancy way of just saying it causes cancer, especially liver cancer, kidney cancer, non-Hodgkin's lymphoma, likely breast, prostate, myeloma, and even potentially brain cancer.

All the things related to Camp Lejeune, for example, that you see.

Exactly.

You know, you see all these class action suits. What is happening with Parkinson's incidence In America and globally, I mean, and I'd like you to couch this response in in a way that argues against the fact that this is a purely genetic issue. If mom had it, I'm likely to get it; otherwise, I'm okay.

Yeah. So when Dr. Parkinson described the condition in the book you just showed, he described six people with the disease in 1817. In 2017, two centuries later, global Parkinson's the global burden of disease has. Disease Study estimated 6 million people had it. So, you went from something that was rare, 6 case reports, case series of 6, to 6 million. And then last year, the Global Burden of Disease Study estimated that 11.8 million people had it. So, their estimate essentially doubled in the span of 5 years. And if you look between 1990 and 2021, a near quadrupling of the— number of people with Parkinson's disease. Now, there are limited high-quality studies of the new cases of Parkinson's disease, the incidence, but what evidence there is suggests that this is growing much faster than it could be explained by aging alone. So, for example, the prevalence of Parkinson's disease is growing after you adjust for age, holding age constant, growing by 60%, and is growing much faster. And it's unlike— and genetics don't play a great, a huge role in the disease. And there have been 2 Big studies on this. One is called PD Generation. Some of your listeners might have even participated, led by the Parkinson's Foundation, tested over 10,000 individuals who have Parkinson's disease who signed up to participate in a study of the genetics of Parkinson's disease. And they found of these 10,000 that 12.5%, only 1 out of every 8, had either a genetic cause or genetic risk factor for the disease. Said another way, 87% of Americans with Parkinson's disease do not have any underlying known genetic cause for the disease. 87% of Americans do not have any known underlying genetic cause or risk factor.

So that's a powerful argument in favor of the idea that this is an environmental-related entity, that this disease is caused by something that, aside from our genetics, because it's increasing so dramatically, And in fact, there is no other neurodegenerative condition that's increasing at this pace, no matter even if we look at Alzheimer's, uh, other neurodegenerative conditions.

This is the one that's exploding. Yeah.

Now, you mentioned PERC and you mentioned trichloroethylene. Now, these dry cleaning related, but, and certainly there you have a, I think there's a page where you have a chart showing all the area, all the people in their occupations who've have potential to be exposed to these chemicals, but they were not outlawed until 2024, correct? Or banned until 2024.

So it's estimated that 1 in 12 workers in the United Kingdom— 1 in 12, just think about that— worked with TCE in England. In 1970, it's estimated 10 million Americans worked with the chemical. If you degreased metal in any way, if you were a mechanic, if you worked on an assembly line, if you were a printer, if you were a painter, You were quite likely exposed to or may have been exposed to TCE. And we wrote a case series of 7 individuals who were exposed, likely had exposure to TCE and developed Parkinson's disease. Only one of them, a rocket scientist, actually knew of the exposure at the time it happened. So, it's not like, you know, most people are just unaware that they're exposed to it. So, if you're unaware of your exposure, it's hard to tie it to Parkinson's disease. And like the Marines at Camp Lejeune, they didn't— when they're 20 years old, they didn't know they were drinking TCE in their water. So I get really, really, really concerned about the man-made nature of it. And the beauty is, if we ban it— that ban has been frozen. I just emailed colleagues today to find out what the latest status of it, but that ban on TCE and perchloroethylene has been frozen. If that ban goes into effect, future generations will not bear the burden of Parkinson's disease that we're bearing today.

So there is a move to keep the ban from happening despite all of the science demonstrating how threatening these chemicals are?

Yeah. So I'm not an expert in the policy, but it was— the ban was put into place late in 2024, and evidently there's some window that if you— there was a lawsuit and a window of like 60 days Which allowed that ban to be frozen. I have not heard what has happened since then. I literally, before we got on the call, right before I got on your podcast, sent an email to my colleagues to find out the latest. If we ban it, we prevent cancer. If we ban it, we likely prevent Parkinson's disease. If we ban it, we likely prevent congenital heart disease. If we ban it, we likely prevent miscarriages. No one's calling for lead to be put back into paint. No one's calling for lead to be put back And gasoline because our children have lower levels, 95% lower levels than you and I had as kids when we were kids, and are smarter because of it. We can do the same thing. We can prevent Parkinson's, we can prevent cancer, we can prevent congenital heart disease, miscarriages, low birth weight babies by just getting rid of some of these chemicals in our environment.

Let's shift a little bit laterally then to Paraquat. I mean, I think many of us remember Paraquat That was sprayed on marijuana fields way back when. But paraquat is similarly linked to increasing risk for Parkinson's, is it not?

Yes. So paraquat, it's a weed killer. It's widely used on corn, soybeans, cotton, and grapes. It's sprayed on fields today. It's so toxic because it's been used to commit homicide and suicide. Over 50 countries, including China, have banned it. In epidemiological studies, studies involving farmers, for example, the risk of Parkinson's disease is 150% higher among farmers exposed to Paraquat than others. Laboratory studies by multiple investigators around the world have demonstrated that Paraquat leads to loss of the dopamine-producing nerve cells in Parkinson's disease and reproduces the features of Parkinson's disease in laboratory animals. Turns out that reporting by Kerry Gilliam, outstanding investigative journalist for The Lead and The Guardian, looked at documents that were filed as part of lawsuits from farmers who developed Parkinson's disease after working with Paraquat. And it turned out the manufacturer of Paraquat, according to her reporting, had exposed laboratory animals— rats, mice, and rabbits— to Paraquat, and they developed features of Parkinson's, including tremors, in the 1960s, 30 years before academic scientists had reached the same conclusion that Paraquat reproduces features of Parkinson's in laboratory animals. According to reporting from The Guardian, the company knew the same thing, and they didn't withdraw their product. They didn't make it safer. They continued to market under a, according to Ms. Gilliam, a freedom to sell campaign. And so this weed killer is still sprayed on fields in the United States, in just about every state in the union. And I think along with it, likely potentially seeds of future cases of Parkinson's.

I think without question, and I think that the EPA continued its validation of its use in 2021, and in the report stated—I think you write this in your book—one sip can kill, talking about how toxic it is, and yet we go ahead and approve it. I mean, yeah, what more do we need?

If you just EP—if you Google EPA plus one sip can kill—you can see the website for paraquat from the United States Environmental Protection Agency, and it says one sip can kill. It talks about an 8-year-old boy whose older brother had, you know, put excess paraquat into a can, a soda can, just to, you know, for storage presumably. And the 8-year-old drank it thinking he's drinking soda and he dies. You

know, and yet that's allowed to be put on our food crops.

Yeah. And, and, you know, research done by Consumer Reports, by the Environmental Working Group, finds pesticides in name-brand foods that we're consuming every day, foods that we feed to our children.

All right. I want to go a little deeper if we can. I know we have a lot of viewers who'd like the science part of this. And I think I'd like to look at mechanistically what these drugs seem to be doing. And I think a good entrée for that would be, can we unpack the MPTP story and how that all unfolded and how that led us to understand the role of Mitochondrial dysfunction as it relates to ultimately manifesting as Parkinson's. Well, hi everyone, Dr. David Perlmutter here. We hope you're enjoying this content, and if you would do so, go ahead and hit the like button. And if you're not already a subscriber to our channel, please consider doing so. We're really grateful to have you as part of our community. So let's get right back to the presentation.

Yes, and so as most of your listeners know, Parkinson's disease has generally been found in older individuals, but in the 1980s in Northern California, in Sunnyvale, California. Young adults, 20s, 30s, maybe 40s, were showing up in emergency rooms, and a neurologist named Dr. Bill Langston, who's still with us, was called to investigate. And these people looked like they had Parkinson's, but they were young, and this had developed in a short— over a short period of time. And it turned out that these individuals had been using a street form A street form of heroin that was contaminated with a chemical called MPTP. And, as you know, David, our brain's only about 2% of our body mass, but 20% of our energy consumption is from the brain. And, the big cells that generate the energy consumption are neurons or nerve cells. And, nerve cells have huge metabolic needs. And so, they're chock-full of mitochondria. And mitochondria are just like jellybean-sized things, not jellybean-sized, they look like jellybeans. that take sugar and produce energy out of them. And that's what neurons are full of, especially the ones in the parts of brain affected in Parkinson's, the substantia nigra. Well, it turns out that MPTP damages the mitochondria. They are a mitochondrial toxin. And so that, that's how it was producing acute forms of Parkinsonism among these individuals in Northern California. Well, it turns out paraquat has a structural— its chemical structure is very similar, if not nearly identical, to that for MPTP. And it turns out that paraquat and TCE and PCE and other toxicants linked to Parkinson's disease all damage the mitochondria. Some even damage the same complex, same part of the respiratory chain as MPTP. So I think we have a clear uniform mechanism that these chemicals, not all chemicals, it's the chemicals that damage the energy-producing parts of cells. Neurons are chock-full of these mitochondria and are very sensitive to chemicals that damage them.

So the dopaminergic neurons in the substantia nigra that fail, that are destroyed in Parkinson's, those neurons selectively take up MPTP. And then intracellularly it's converted to another mediate, which is MPP+, which then threatens the mitochondria. So essentially it's like a slow cyanide. You know, cyanide is a mitochondrial toxin, but in this case it's not, you know, it's a slow death to these mitochondria that are really very, very active producing the dopamine that is so necessary for normal motor activity. And as such, in the area of the brain This substantia nigra, this is a sudden failure induced by this street drug, which provided an incredible model then for research. Didn't they start using MPTP in primates and rodents to study Parkinson's?

Yeah. So if you put a laboratory animal, you put a mice in the lab and let it age, it doesn't spontaneously develop Parkinson's. It doesn't spontaneously develop Alzheimer's. The only way that animal is going to develop Parkinson's is either if you manipulate its genes or you expose it to chemicals. And the chemical that— one of the chemicals that's used to create an animal model of Parkinson's is MPTP, which damages the mitochondria. There are other pesticides that are used. There are other chemicals, including some pesticides, that are also used to generate animal models. And the reason we have animal models is, one, to understand the pathology and pathophysiology of the disease, and two, to screen potential new therapies against them. So, it's not because scientists like to produce Parkinson's in animals, but there's a reason for this. But, again, these animals don't spontaneously naturally develop Parkinson's disease. You either have to manipulate their genes or expose them to chemicals, and that's what we've been doing to humans.

So, we can say then that by and large Parkinson's is an acquired mitochondropathy. It's an acquired Mitochondrial disease. And, you know, your thesis that seems incredibly validated is that this is as a result of toxic exposure, by and large, aside from that very small number of individuals who have mitochondrial gene issues or the LRRK mutation, which affects— well, actually affects how microglia are able to transfer mitochondria from one to the next to help those mitochondria that are Or those microglial cells that are having issues with respect to their function.

And we know this, like, we've known this for 100 years. Sir William Gowers wrote in the late 1800s that only 15% of people with Parkinson's disease have a family history of disease. Most of your listeners who have a family member with Parkinson's, they're the only one in their family to have Parkinson's disease. So, we know that the genetic contributions to Parkinson's disease are modest. We've known this for 100 years. We know from twin studies that environmental Chemicals are the predominant— the environment is the predominant cause of the disease. And now we have 3 ones: pesticides, certain pesticides, paraquat being the poster child, industrial solvents, trichloroethylene and perchloroethylene, and air pollution. All of which are addressable, all of which can suggest that we can create a world without Parkinson's disease or one where Parkinson's disease is incredibly rare instead of incredibly common by cleaning up our food, water, and air.

Dr. Dorsey, studies suggest that having type 2 diabetes variably increases your risk for Parkinson's as much as 42 to 48%. Why might that be?

Yeah, so I don't know. So I'll give you a couple hypotheses. One, it seems pretty clear that having diabetes and high blood glucose is bad for almost all brain diseases. And that it likely is an important modifier of the disease. I don't think in and of itself diabetes doesn't in and of itself cause Parkinson's disease, but it could be a modifier and make the symptoms progress more rapidly, for example. Recently, just in the last few months, I've been reading, and as you know, I'm not an epidemiologist. I didn't come to— I spent my first decade of my life doing research around Huntington's disease, essentially a purely genetic disorder, before having the gift of a sabbatical and coming to read the work of Dr. Caroline Tanner and finding out about the environmental causes of Parkinson's. It turns out that certain pesticides increase your risk for diabetes and increase your risk for Parkinson's disease. So I wonder, I wonder, I don't know if some of the relationship is driven by a common toxicant that predisposes people to get diabetes and predisposes people to get Parkinson's disease, and that's why. We know, for example, that in Parkinson's disease, prostate cancer seems to be at a higher risk. People with Parkinson's appear to have a higher risk of prostate cancer. Again, I don't think Parkinson's is causing prostate cancer or prostate cancer causing Parkinson's. I think a chemical, TCE, is linked to both those conditions and could be the common cause for why Parkinson's is— prostate cancer is more common in Parkinson's. I wonder, but do not know, whether certain pesticides are increasing risk for Parkinson's and increasing the risk for diabetes.

I would offer up another consideration, and that is changes in the microbiome. We know that diabetes is associated with some pretty significant changes in the microbiome predictably, and that this may be yet another unifying factor. We, I don't know that we'll have time to talk about the gut-brain connection as it relates to the theories on Lewy body, et cetera. But having said that, you know, the other thing is that we do note that in the substantia nigra, there's evidence of activated microglial cells because their metabolism has been compromised. And that, you know, this is the whole field of what's called immunometabolism, whereby these microglial cells are dependent from their mitochondrial function perspective, again, back to the mitochondria, To remain supportive in their M2 configuration versus when their metabolism is compromised, as we see in diabetes, getting to the M1 or threatening phenotype, which we do see clustered around the neurons in the substantia nigra in— it was certainly around the MPTP patients after they have died years later too. So one wonders about that. Let's move over to— we talked about it earlier, the particulate matter in the atmosphere, the air pollution, indoor and outdoor. And you dedicated quite a bit of the book talking about how, what a threat this represents. And I think this is really, and you mentioned earlier today, you know, the idea that when the skies of New York became orange during the wildfires that were coming from Canada, that our exposure to these PM2.5s based on climate change seems to be increasing. And that, you know, that these particles in and of themselves are threatening, but they carry along with them various hitchhikers that are brain-threatening. So let's talk a little bit about these PM2.5s as it relates to inducing a risk for Parkinson's.

Sure. So anyone who's been to Los Angeles has seen smog, and you might be wondering, what, what am I actually seeing when I see smog? I've wondered the same thing. And it turns out you're seeing little pieces of dirt and soot that are suspended in the air. And scientists have given that name, those little pieces of dirt and soot, the name particulate matter. And then most of them are large enough that we cough out or sneeze them out. We know we have hairs in our nose, we have mucous membranes that are designed not to let anything that we breathe in get into our bodies. But some are so small, 1/30th the width of our hair, that they're called PM2.5, which just means they're 2.5 microns. Hmm. They're 1/1,000th of a millimeter in diameter, 2/1,000ths of a millimeter in diameter. Some are so small that they can penetrate the nerves called the olfactory nerve, responsible for smell, that hangs up in our upper nasal passages and enter the brain. So some of these particulate matter are so small that they can enter the nerve that's responsible for smell and go back to the brain. And as you alluded to, these things are like a Trojan horse. Instead of bringing troops into Athens, They're bringing toxic heavy metals into the brain, likely. And these metals include lead from leaded gasoline, iron from brakes, platinum from catalytic converters. And as you know, um, probably better than I do, that people with Alzheimer's and Parkinson's have high levels of metals in their brain, and no one's really been able to explain why. And these heavy metals may be contributing to misfolding of proteins, alpha-synuclein in Parkinson's disease, beta amyloid in Alzheimer's disease. We also know that in the pathology of both Parkinson's and Alzheimer's, one of the first places you see the pathology, or place that you see it most commonly, is in the olfactory bulb, the smell center of the brain. And we also know that one of the earliest features of both Parkinson's and Alzheimer's disease is loss of smell. And there have been increasing research just in the last 2, 3 years linking air pollution in many studies, not all, in many studies, air pollution and Parkinson's disease, And really, really, really increasingly robust evidence linking air pollution to Alzheimer's disease. And so if you want, if you want, if you wanna avoid living a short, unhealthy life, don't breathe polluted air.

Well, you know, with all the fires that we've been seeing lately and increasing with time, I, you know, I always make the point that, well, this isn't a campfire. It's not time to bust out the marshmallows that, you know, wildfire is a lot of toxic stuff. Especially when it's gone through, you know, buildings, residential areas, there's all kinds of horrible things being launched into the atmosphere that rides along with these particles that you then breathe. And, you know, like you say, we see higher levels in the Alzheimer's and Parkinson's brain that may be causative, but also may be reflective of an increased permeability in the first place of the blood-brain barrier, allowing these things in. carrying all kinds of stuff. So I guess we can get to the Parkinson's 25 because I know on that list of things that you made so clear that are very important, like washing our vegetables, changing our diets, not becoming diabetic, drinking decaf coffee, going for the organic wine, et cetera.

Drinking caffeinated coffee.

Caffeinated coffee, yes. We don't want to decaf, especially with TCE. And you talk about using an air purifier. And I thought that was really quite interesting because that's indoors. And I think it's a really important point. People think, well, I'm indoors, that pollution is outdoors. But let's talk about that for just a moment. Hey everyone, I wanted to let you know we're going to get right back to our program in just a moment. But this podcast is being sponsored by Lycan Air. Lycan Air makes an incredible home air purifier. It's the one that we use. This has a HEPA 14 filter to really help us dramatically reduce our exposure to these dangerous PM2.5 particles, as well as help us get rid of the volatile organic chemicals, the VOCs, that are also brain-threatening and health-threatening. So, excited to let you all know that you can get a discount on your Lycan Air air purifier by using a promo code, DRPERLMUTTER10. So, that's DRPERLMUTTER10 at the time of checkout for your Lycan Air air purifier. Let's get right back to the podcast.

Yeah, so there's indoor air pollution has multiple different sources. Some are just coming from what's outside and coming inside. And the nice thing about air purifiers is that they're really good at filtering out a lot of this particulate matter and chemicals that can be evaporating into your home. So just like radon, um, TC can enter your home like radon. Air purifiers might help reduce exposure to some of the volatile organic chemicals, but a really good at addressing particulate matter. And it's relatively easy to do. They're, you know, they're about $100 to $200. They're not expensive. I mean, they're not cheap, but they're not cost prohibitive for many families. For some, they are. And they can decrease your risk of getting many of these diseases. And it turns out that air pollution is more disabling than high blood pressure. It's among the most disabling of the risk factors in terms of reducing disability in the world. So if you want to— if you If you live in an area with high levels of air pollution, I strongly recommend that people get an air purifier to decrease their exposure.

I agree. I have, uh, we have one in our bedroom and it actually monitors the levels of PM2.5s. And the other day I, uh, wanted to challenge it and I lit a, uh, incense and this thing went crazy. It went from 0 PM2.5s to 500 and ramped itself up, uh, in terms of trying to purify the air in our room, which it did do once. Once it was running for a little while. So you were kind enough in your book to go through this list of 25 things we should be paying attention to. This is really important information, how we can lower our risk for this disease for which there's no meaningful treatment. Yes, we have treatments for the symptoms, the tremor, the rigidity, et cetera, the constipation, et cetera. But in terms of treating the underlying fire as opposed to just treating the smoke, there really is nothing as of Yet though, having said that, I mean, I think we're all aware of the publication last year in the New England Journal that demonstrated how effective a particular GLP-1 agonist drug that targets metabolism was in slowing down the progression of Parkinson's. But that said, wash your produce even if it's organic. If it's organic, why do we need to wash it?

Unfortunately, organic doesn't necessarily mean that it's pesticide-free. Studies done by Consumer Reports has found that there are One, that there are pesticide residues on organic produce, and some cases unsafe levels of pesticide residue on organic produce. So what I do is I wash all my produce. I tend to buy organic wherever possible, and I wash it with water. And then I use a vegetable wash, essentially like just like we wash our bodies with water and soap, because some pesticides dissolve in fat, and those fat-soluble or fat-loving pesticides might be more important to causing Parkinson's than those that aren't, or those certainly are maybe higher risk. And so I use water and a vegetable wash. I get like a $4 bottle from the grocery store. Other studies have looked at salt, other studies have looked at vinegar as other ways to decrease your risk to pesticides in your diet.

Okay, number 2. I don't know if we'll have time to go through all these, but change your diet. I mean, What sort of diet do you think is best as it relates to Parkinson's?

So the research suggests that eating Mediterranean diet, high in fruits and vegetables, low in animal products, might lower your risk of ever getting Parkinson's and might slow the rate of progression. I tend to think, and you know far more about diet than I do, David, but I get concerned about what's in the animal products. So In the book, we talk about cows eating grass or pineapple chop that's been sprayed with pesticide that's fat-loving and then concentrating that pesticide in their milk, milk making its way onto the grocery stores in Hawaii, and then that pesticide being found in high consumers of milk in Hawaii along with loss of those dopamine-producing nerve cells. So, I get worried about pesticides and other chemicals getting concentrated as they make their way up the food chain. And therefore, if you're eating more and more animal products at the top of that food chain, you might be getting exposed to more and more of these environmental toxins.

You call out wine, and I think you alluded to that earlier talking about how aggressive grapes need to be sprayed. So you say drink wine without— enjoy wine without pesticides. So what should we be looking for?

So one of my colleagues, Dr. Alexis Elbaz, is a neurologist and epidemiologist, and he did this beautiful study in France, in the south of France, And, he showed a near-perfect correlation with pesticide use on French vineyards and rates of Parkinson's disease, near-perfect correlation between pesticide use in the South of France and Parkinson's disease. And then, basically, the Consumer Reports of France, Quatre Saisons— I can't speak French— looked at tested French wines and found pesticide residues in nearly every bottle of wine that they tested. Organic wines had lower residues than, than conventional wines, but had lower ones. And so the, the idea about drinking organic wines is just decreasing your exposure to chemicals, even in products like wine, which you, I think, a priori would not be thinking would be a source of pesticides.

Number 6, you made a friend from, from with me. And that is drink caffeinated coffee. I'm all in.

So there are some humorous and lighter ones in there. It appears that caffeine decreases your risk of Parkinson's, and we're not sure why. Caffeine may protect dopaminergic neurons from the effects of toxins, but it appears to be specific to caffeine and not to coffee. So if you're enjoying your caffeinated coffee, you can continue to enjoy it. Recognizing that caffeine has other side effects, migraines, headaches, and anxiety. But if you're enjoying your caffeine, this is a reason to continue to do

so. There are other things in coffee too, like chlorogenic acid and certain polyphenols that we know are metabolically favorable for your body in general. And it gets back to your, I think, diabetes kind of comment as it relates to don't become diabetic and enhancing metabolism even of the brain's immune system, the microglial cells. Helping them to be supportive as opposed to destructive. Farm safely. What does that mean?

So, well, just like the golfers, we know that farmers are at higher risk for Parkinson's disease. There are 3 studies that link green space workers like landscapers to an increased risk of Parkinson's disease. And there are ways we can protect farmers from the harmful effects of these chemicals. It turns out that protective gloves, And respirators, for example, might lower your risk and reduce your exposure to these toxic pesticides and decrease the likelihood of developing Parkinson's disease if you wear the appropriate protective gear. Unfortunately, many people don't. Many people are unaware of it. Many people aren't provided this gear. And sometimes the gear can be expensive, and sometimes the gear can be, you know, uncomfortable, especially if you're working on a hot farm.

Next is dry clean carefully. I mean, everybody has to dry clean something, I guess, from time to time. And we'll talk about what you mean by carefully, but I've seen dry cleaners advertise completely organic things that are used to clean your clothes. So what does it mean?

So I would avoid trichloroethylene and perchloroethylene like the plague. I think its effects on cancer and for Parkinson's disease are incredible and very concerning. And so I mentioned 60 to 70%, my understanding is, of dry cleaners in the United States still use perchloroethylene or PCE. And I tell people to avoid that. There are green dry cleaners that use usually petroleum-based products rather than these chemicals to do so. California has banned PCE and dry cleaners are phasing it out. Other European nations have taken much stronger regulations around trichloroethylene. And perchloroethylene. So if you're going to dry clean, um, I would find a green dry cleaner. I just found one in New York City, uh, for my wife and me. For men, it turns out your shirts are generally laundered, uh, so they're not dry cleaned, so less concerning. And if you do dry clean, um, it's important to air out your clothes before you bring them inside, uh, maybe even air them out outside before you bring them in your car. Studies have shown that if you bring your car— bring your dry cleaning into your car, you're breathing these chemicals on your way home. And I just think it's a really high price to pay so our clothes don't shrink.

What do you say to our golfers?

I get concerned. I'm not making friends. Some of my friends, they're neurologists, and as you know, neurologists like to golf. I get concerned. And again, is there a need that we need to use 2 tons of pesticides on golf courses? Can we use safer pesticides instead of the more toxic ones? Can we use lower amounts? Can we spray less frequently? Can we protect landscapers when they are sprayed? I think all these things are really achievable. I think these are things that people can do in their own community. Why not just ask your golf course, what pesticides are you using? Are they linked to Parkinson's? And can we use less of them? I think there are just lots and lots of things that we can do in our community to reduce our risk for everyone. It appears like secondhand smoke, right? It's not just the smoker who gets— is at higher risk, but people who live near where the pesticides are sprayed. There was another great study done by my colleagues Kimberly Paul and Beata Ritz at UCLA, I think in 2024 or 2023, That showed that simply living or working near where Paraquat, that weed killer, is sprayed is associated with a doubling of your risk of Parkinson's disease. So these are high prices to pay, and these are involuntary exposures that people are experiencing.

Well, you've listed some thou shalt nots. What about things that we can be doing? You talk about sleep and exercise. Let's talk about exercise. Why is that a protection for us?

Yeah, so there's just increasing evidence, you know, since you and I went to medical school, probably the biggest therapeutic advance for Parkinson's this century is the recognition that exercise is really beneficial for people with Parkinson's disease. Sir William Gowers, who said that only 15% of people had a family history of the disease, was right. Those studies have been replicated. He said people should live lives, a quiet and peaceful life, and I don't think he was right on that one though. Increasing evidence suggests, including research by my colleague, Dr. Bas Bloem, that exercise releases growth factors in the brain and therefore may protect the remaining nerve cells or mitigate the effects of exposure to toxic chemicals. I tell people with Parkinson's disease to exercise at least an hour a day if they can, and that if I had Parkinson's disease, I would exercise 2 hours a day. There's a study that suggests vigorous exercise, 3.5 4 hours a week equivalent of jogging or swimming can reduce your— is associated with a 20% reduction in your risk of getting Parkinson's. So if you want to live a full, productive, independent life well into your 60s, 70s, and 80s, and 90s, and beyond, exercise now.

Well, you actually have a lot of case studies in the book of people who, once they were diagnosed, you know, were able to accomplish some incredible feats of physical activity. I think you had, you know, a marathon runner, and then there was a basketball player who actually was— who got Parkinson's at a relatively young age, but yet still played that next season when things weren't going well. With respect, he wasn't able to jump shot or something like that.

Yeah, Brian Grant, NBA basketball player, formed the Brian Grant Foundation. You know, hats off to him and all those people who not only bear the burden of Parkinson's disease, but make the burden less for others. I mean, what a great gift. And it turned out that he was a 3-year-old boy at Camp Lejeune when his father was a Marine, was training there, and he was exposed in all likelihood to TCE. His father dies of esophageal cancer linked to the chemical. His younger brother nearly dies while on the base, but miraculously gets better as soon as they leave the base. And then 33 years after his exposure as a 3-year-old boy, he's diagnosed with Parkinson's disease. But in his last seasons of the NBA playing for the Los Angeles Lakers, he noticed he couldn't jump as well off his left foot and even developed a tremor and still played a season of basketball. Just tells you what people with Parkinson's disease can do, in this case untreated.

Yeah, I mean, Muhammad Ali still fought when he had the tremor.

And other people like Michael J. Fox has written 3 books, starred in 2 TV shows. We talked— I don't know, in the book, Rich Clifford walked in space after he was diagnosed with Parkinson's disease. People have served in the U.S. House of Representatives and the U.S. Senate. We've had cabinet members. We had the head of the Catholic Church, all with Parkinson's or Parkinson's-related diseases.

Well, that was actually a very interesting story when you talked about the Pope and his Parkinson's, that he as a younger man was working in mining manganese, right?

Yeah. So, one of my hobbies is trying to figure out why people get Parkinson's, because once you figure out the Once you figure out the cause of a disease, you can, one, prevent it, and two, you can cure it. Once you figure out the cause of a disease, you can, one, prevent it, and two, cure it. So why did Pope John Paul II— why would a pope get Parkinson's disease? And it turned out he's Polish, and it turned out during World War II, Germany occupied Poland and forced everyone basically into a labor camp or worse. And he was working in a labor camp at a mine, and his job was to Mine in this mine in Poland. I can't pronounce the Polish name of the mine. And I looked at that mine and it turned out that mine was— had a high concentration of manganese. And he evidently worked fairly deep into the mine. And manganese, as you know, is a metal, toxic metal, that's associated with a form of Parkinsonism that is generally resistant to treatment. And my suspicion, I don't know for certain, is that the cause of Pope John Paul II's Parkinsonism was exposure to manganese when he was mining as a young man before he had entered the clergy during World War II.

One question that I've been puzzled by for a long time and hoping you have some insight, and I don't mean to put you on the spot, but I'm going to anyway. We know that Alzheimer's is 2 to 1 women to men. And pretty much the opposite is true as it relates to Parkinson's. Any speculation as to why men are far more likely to get Parkinson's compared to women?

Yeah, so, um, in almost every part of the world, men are 50% more likely to get Parkinson's. Um, and there's animal studies that suggest that male laboratory animals are more susceptible to the effects of the chemicals than female laboratory animals. I tend to think it has to do more with sociology than biology. It turns out that there are some studies in Japan and Taiwan, I believe, that show that the rates of Parkinson's are equal between men and women. In some cases, women are more. And I look back and it turns out that women in those countries did most of the farming and therefore were more likely to be exposed. Interesting. So, in the United States, 75% of farmers are men, 97% of pesticide applicators are men. So if you look at all the occupations that would be associated with an increased risk of Parkinson's disease, they're largely men in the United States and the Western world. But in the Eastern world, farming, for example, was predominantly done by women and may suggest why the differences are more muted, in some cases women at higher risk. So again, I think it's sociology rather than biology, but it could be both.

Yeah. Well, I want you, if you could, as we close, to Really, you know, speak to our audience in terms of your life mission here, in terms of, you know, their recognition that this doesn't have to be, and just give, give them a sense of empowerment in terms of making the changes that you so beautifully described in the book and what the impact can be of making those changes in terms of risk.

Well, first of all, thank you for letting me be a guest for a second time on your show and giving the voice to these to these important issues and you have millions of people listen. And there's a clear reason why. No one prepares, reads as much, thinks as much when doing an interview as you do. So thank you, David. Thank you, Ray. So we're both neurologists. And, you know, at the end of the day, what's the best gift that we can give the future world? I'll back up even a little bit. So my son is a philosophy— studying philosophy. And he goes, Dad, do you know who David Parfit is? You know David Parfit? And I go, no. And he goes, Dad, he's only the most influential philosopher of the second half of the 20th century. So as a good father, I went and read Parfit's book, or a biography about Parfit. And it turned out Parfit had this notion that we should care about people regardless of geography, that we should care about our neighbor just as well as we care about someone 1,000 miles away. He has this beautiful analogy that if you had an infinitely long arm, you should comfort your neighbor and you should comfort someone on the other side of the world. And he says, if we care about people regardless of space, we should care about people regardless of time. We should not just care about our contemporaries, but we should care about future generations. And I can't think of a better gift that we can give future generations than a world without Parkinson's disease. And we've inherited a world without polio, largely free of polio, right? And that's because of our predecessors doing the hard work to get rid of polio, finding out what the root causes, finding that it was a virus. People didn't think it was a virus, finding out what specific virus it was, and then coming up with a vaccine to address it. We live in a world where HIV is decreasing, where it's likely that HIV may disappear as a major clinical entity in our lifetime if we continue to support HIV prevention efforts. We can do the same thing for Parkinson's disease. We can turn it back into the medical textbooks and the historical books and Just like Dr. Parkinson's, we can dust off this old thing. You remember when Ray came in and thing— this is a dusty old thing from 30 or 40 years ago? Because we live in a world where Parkinson's is increasingly less common, and we can accomplish that. In Germany, the incidence of Parkinson's where they're cleaning up their environment is going down. The incidence of Parkinson's in the Netherlands appears to be going down. If we clean up our air, as these countries have done, if we clean up our food supply and we get rid of toxic pesticides, And we get rid of chemicals that we know are linked to cancer and likely to Parkinson's disease, we create a world where Parkinson's disease is increasingly rare instead of increasingly common. And I can't think of a better gift as a neurologist that we can give the future world than that.

Wow. Preventive neurology. That is, you know, what an idea. Well, Ray, thank you for joining us today on the program, and thank Dr. Okum as well. You guys have done a really, you know, terrific service for all of us bringing this to light. You know, it's sort of been in the background of neurology for so long, and you've put it, you know, you shine the light on it, and it's so important, uh, you know, with widespread application as well, not just Parkinson's, but you've mentioned, you know, all of the manifestations of living at Camp Lejeune. And if we clean up our act, uh, I think we're going to be a lot better for it and recognize that these are not genetic issues, these are man-made issues. I think you've been quoted as saying Parkinson's is a man-made disease, and I think, you know, you're spot on. So thank you for joining us today. It's been really great to connect with you again.

Perfect. And, and just one last little seed. As much as I care about Parkinson's, we get rid of these chemicals, not only do we get cancer and Parkinson's, but it's likely ALS, it's likely intellectual disabilities, it's likely brain cancer, it's likely Alzheimer's. We can make all of these diseases, which are now the world's leading source of disability, less common, spend less as a society, Suffer less, enjoy life more. I can't think of a better thing that we should be doing as physicians and helping people.

Well said. All right, my friend, talk soon. Thank you again for joining us.

Thank you, David.

Well, again, thank you to Dr. Ray Dorsey for spending time with us. This is really very important information,

and what valuable steps he has provided for us that will help us reduce our risk for this disease for which you really have no meaningful treatment with the exception of some management of symptoms ideas that have been out there for decades. We really want to learn what we can do to prevent Parkinson's in the first place. Again, the book, I strongly urge you to take a look at it, whether you have a family member or have Parkinson's yourself, or like me, you don't want to get it.

The Parkinson's Plan by Dr. Ray Dorsey and by Dr. Michael Okun. I'm Dr. David Perlmutter. And thank you for joining us today on The Empowering Neurologist.

We will be back soon.

Bye for now.