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Muhammed Ali: Parkinson's Breakthroughs are Coming

muhammed aliMuhammed Ali was honored by presidents and kings as the most famous athlete in the world.  He was an Olympic gold medalist and three-time heavyweight world champion.  His ancestors were slaves in the pre-Civil War South with some Irish and English in their heritage.  His mother, Odessa O'Grady Clay, was a domestic and his father was a sign painter.  As a child, he suffered all of the indignities of segregation in the South and he told reporters, "I started boxing because I thought this was the fastest way for a black person to make it in this country." 
 
His behavior in and out of the ring was often outrageous, but he ended up being recognized as one of the most courageous people of the 20th century.  He stood up for his convictions and became a role model for the black pride movement. 
• He converted to Islam and joined the Nation of Islam, a radical group that many people saw as a threat to America's social order.
• In 1964, he got rid of his “slave name", Cassius Clay, and became Muhammed Ali, a "free name" that reflected his new religion.
• In 1966, he gave up his world boxing championship and millions of dollars when he refused to be drafted, citing his religious beliefs and opposition to the Vietnam War.  
• He rejected integration at the height of the civil rights movement, 
• He was one of the strongest voices against the prevailing racial, religious and political beliefs.  However, while he had joined an organization that emphasized strong family values, he had five marriages and two children outside of marriage.
 


 

Early Signs of Health Problems
In 1978 at age 36, as one of the greatest fighters ever, he lost a 15 round decision to Leon Spinks who was smaller and 12 years younger. Seven months later, he won the rematch and regained the heavyweight championship for the third time.  By then, something was wrong. He was not as quick or coordinated as he had always been, but did not know why.  He told reporters: "I'd be a fool to fight again."  
 
He did fight two more bouts and lost them both.  In 1981, he stopped fighting for good because his hands shook, he walked with a shuffle, and he had slurred speech, even though he did not have the classic boxer's broken nose and cauliflower ears. It wasn't until 1984, at age 42, that doctors finally diagnosed him as having Parkinson's disease that took away his incredible athleticism and even his ability to speak clearly.  Doctors told him that Parkinson's disease was the result of his long boxing career, but I think that is unlikely.   
 
He lit the flame at the opening ceremony of the 1996 Summer Olympics in Atlanta with hands shaking so badly that he almost dropped the torch he was carrying.  In 2006, an entertainment company, CKX Inc., paid him and his wife $50 million for the commercial rights to his name.  On June 3, 2016, he died of a respiratory ailment common to people who suffer from Parkinson's disease. 
 


 

Not Chronic Traumatic Encephalopathy (CTE)  
Many of Ali's obituaries reported that his Parkinson's disease was a form of Chronic Traumatic Encephalopathy (CTE), a progressive degenerative disease found in people who have been hit in the head in sports such as boxing, football, ice hockey, wrestling and so forth, or from domestic violence.  There is a link between head trauma and Parkinson's disease (Occup Environ Med, Dec, 2013;70(12):839-44), but if it is the cause, it is rare because the vast majority of people with Parkinson's disease do not have a history of head trauma  and Parkinson's disease has its own progressive list of symptoms that are much different from those of CTE.  
 
New Research on Parkinson's Disease
Several papers presented last month at the European Academy of Neurology show how Parkinson's disease develops and they propose new methods for early diagnosis (Science Daily, May 30, 2016). People with Parkinson' disease have a lengthy list of progressive symptoms long before they are diagnosed. They often start with loss of smell, then constipation, dizziness and urinary problems, then a type of sleep disorder called REM-sleep behavior disorder in which they physically enact their dreams. They usually have breathing problems. 
 
Their progression of symptoms differs from head trauma (CTE) victims.  Parkinson's patients typically have:  
• inability to swallow, drooling, tremor, muscle rigidity and slow movement 
• symptoms usually beginning on one side of the body and always worse on that side 
• shaking that starts in the fingers and moves up the arms, slowed movement that can eventually prevent a person from doing simple tasks, dragging feet, short steps, difficulty getting out of a chair, rigid and stiff muscles, bent over posture, loss of balance 
• inability to blink or smile or to move arms while walking 
• speech changes such as soft voice, monotones, slurring or delayed speech 
• inability to write legibly  
• sleep disorders such as frequent waking during the night and falling asleep during the day
• loss of sexual function
• great fatigue 
• pain anywhere in the body .
 


 

The Latest Breakthroughs in Parkinson's Disease
At the American College of Physicians meetings in Washington, D.C. this month, strong evidence was presented to explain the cause of Parkinson's disease.  Parkinson's disease is caused by damage to the substantia nigra part of the brain that makes dopamine, the chemical that sends messages from one nerve to another.   Now we have to explain how a person loses dopamine to develop Parkinson's disease. 
 
In 1991, Heiko Braak, a neurologist at Ulm University in Germany made the brilliant proposal that Parkinson’s disease starts outside the body.  He explained how Parkinson's disease symptoms progress.  First damage is to the involuntary nerves that cover the eye, stomach, salivary glands, and intestines; then to the motor nerves that move your muscles; and finally to the nerves that help you to think and reason. 
 
He proposed that something is:
• inhaled from the air to damage the nerves that allow you to smell (loss of smell),
• then swallowed to be absorbed into the gut (belching and terrible constipation)
• there it causes alpha-synuclein to be made in the nerves in the stomach and 
• travel up the vagus nerve that runs from the stomach 
• to the brain stem from the medulla to the pons (tremor, rigidity and slow movements)
• to the midbrain 
• to accumulate in the substantia nigra and the brain cortex (loss of cells that make dopamine)
 
Proof from an Outdated Procedure
Many years ago, doctors incorrectly treated stomach ulcers by cutting the vagus nerve that increases acid secretion in the stomach.  Recently, researchers reviewed medical records of patients who had undergone this vagus nerve cutting called truncal vagotomy.  They found that people who had a truncal vagotomy were protected significantly against the development of Parkinson's disease, compared to those who had another procedure called superselective vagotomy.  This confirms that Heiko Braak's theory is most likely correct. Cutting the vagus nerve blocks the pathway that misfolded proteins or prions travel from the stomach up to the brain to destroy the nerve cells that make dopamine.  Lack of dopamine causes Parkinson’s disease. 
 
• We do not know what triggers Parkinson's disease. 
• Most likely it is caused by something that is eaten or inhaled, possibly a prion.
• Head trauma may be an unusual or contributing cause.
• The drugs that are currently used to treat Parkinson's disease lose their effect over time.
• In the near future, Parkinson's disease is likely to be diagnosed by a biopsy of the intestines and nose to look for the protein alpha-synuclein.

Muhammed Ali
January 17, 1942 - June 3, 2016


 

June 12th, 2016
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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