An interview with Bastiaan R. Bloem, MD, PhD, FRCPE: Professor of Neurology at Radboud University Medical Center and Co-Author of End Parkinson’s Disease on December 14, 2023 by George Ackerman, Ph.D, J.D.
Professor Bas Bloem is a neurologist at the Radboud University Medical Centre, Nijmegen, The Netherlands. He received his medical degree, with honours, at Leiden University Medical Centre in 1993 and obtained his PhD degree in 1994. He trained as a neurologist between 1994 and 2000. He received additional training as specialist in movement disorders during fellowships at The Parkinson’s Institute, Sunnyvale, California, and the Institute of Neurology, Queen Square, London. In September 2008, he was appointed professor of neurology, with movement disorders as special area of interest.
Professor Bloem is on the editorial board of leading national and international (scientific ) journals. Since 2020 he serves as Co-Editor in Chief of the Journal of Parkinson’s Disease. In 2002, Professor Bloem founded the Radboudumc Center of Expertise for Parkinson’s & Movement Disorders and, together with Dr. Marten Munneke, developed ParkinsonNet, an innovative care concept for Parkinson’s patients consisting of 70 professional regional networks.
Professor Bloem has published over 850 publications, including more than 780 peer-reviewed international papers. This includes a series of large clinical trials, all of which were published in high-end scientific journals. He has also supervised 57 successfully completed PhD dissertations. His H-index is 89 (Web of Science) / 102 (Research Gate) / 117 (Google Scholar). In 2021, he was ranked among the top 1% of most cited scientists of the past 10 years (https://bit.ly/3QOFHEw).
Professor Bloem is attached to the following societies:
– Royal Holland Society of Sciences
– Academia Europaea
– Fellow of the Royal College of Physicians of Edinburgh
– Royal Netherlands Academy of Arts and Sciences
In 2018, he won the Tom Isaacs award in recognition of his long-standing achievements in the field of Parkinson’s disease. In 2022 he received the Stevin Award, the highest recognition for a Dutch scientist who has had greatest impact on society.
Professor Bloem has two main research interests: cerebral compensatory mechanisms, especially in the field of gait and balance; and healthcare innovation, aiming to develop and scientifically evaluate patient-centered collaborative care. More recently, his work is also focusing on wearable sensors, machine learning and artificial intelligence. In his latest work, he also focuses on prevention of Parkinson’s disease, with emphasis on eradication of environmental toxins, and use of lifestyle interventions. Bloem also values the publication of remarkable observations in single patients.
Can you tell me more about your co-authored book End Parkinson’s Disease?
A lot of credit goes to Dr Ray Dorsey. He is the first author of the book. He is really the one who put me on the path that the fact that Parkinson’s could be preventable condition. At least to an extent. He has been my muse and source of inspiration. It was wonderful to write this book together because it is for people with very complimentary expertise. Dr. Michal Okon is brilliant, very efficient and runs a beautiful multidisciplinary clinic in Florida. Dr Dorsey has experience in remote medicine and reads everything about the environment and is very knowledgeable. Todd Sherer, PhD. from the Michael J. Fox Foundation. And then myself on the lifestyle perspective. It was a wonderful experience.
More on the book:
Brain diseases are now the world’s leading source of disability. The fastest growing of these is Parkinson’s: the number of impacted patients has doubled to more than six million over the last twenty-five years and is projected to double again by 2040. Harmful pesticides that increase the risk of Parkinson’s continue to proliferate, many people remain undiagnosed and untreated, research funding stagnates, and the most effective treatment is now a half century old.
In Ending Parkinson’s Disease, four top experts provide a plan to help prevent Parkinson’s, improve care and treatment, and end the silence associated with this devastating disease.
What is your passion and how did you get involved in Parkinson’s awareness and hope for a cure?
It is a sheer coincidence. I became a neurologist because my mother had Multiple Sclerosis. So, I wanted to become a doctor and a neurologist from early childhood to cure my mom. In order to become a resident in neurology, which was very difficult when I was a medical student, you needed to do something to boost your career and help your chances. Going abroad helped. So, I asked my professor can I go to America. He said sure. I said is it an MS doctor? He said no I would be studying with a Parkinson’s doctor. I said let’s go do it. Then I met people with Parkinsons and now I am one of the world’s leading experts on Parkinson’s. I thought I would be a neurological expert by now and that is how it all started.
I have to say, I am grateful it was Parkinson’s from the bottom of my heart. The people with Parkinson’s are wonderful and amazing. They are a delight to work with. They are faithful, resourceful, and resilient. They are without exceptions wonderful people to work with.
The disease is fascinating, it is non-motor features, is progressive and requires a very complex multi-disciplinary team. Everything about Parkinsons from its phenomenology to its treatment is complex. The word complexity is synonymous with Parkinson’s. For me as a scientist and clinician it is fascinating and then there are these wonderful people. It is a gratifying time.
What do you feel about the future of research in Parkinson’s?
I am a truly born optimist. By working together, scientists and clinicians across the world we can bring a better method to end Parkinson’s. Along with advocates and patients we all must come together.
What type of goals do individuals with Parkinson’s have when working with you?
Nutrition and PD are important topics. Whenever my patients tell me that they feel better, I am happy, and I celebrate. Whatever makes you feel better makes me feel great. I will not prescribe anything unless it shows rigor to be put to the test and safety for each specific individual. I often see people in my clinic who start a dietary intervention and they say they feel better, but this is different for every person.
Alternative medicine. I believe dietary interventions are important but some call it alternative medicine which I dislike. It is important to look at how the patients feel. In 125% Dutch patients use plant based natural products. Only 40% of those had told their practitioner. I think that is not wise. I am happy for my patients to take the initiative, but I do want to be informed of what they are doing.
What effect can it have on an individual with Parkinson’s?
Other types of treatment can have an important affect on those diagnosed with Parkinson’s. For example, there is no such thing as alternative medicine vs regular medicine. To me there is one type of medicine which is medicine. There is a range of scientific credibility to these variations.
We also have therapies based on results. We need to unite, and everything revolves around credibility. This has 2 dimensions. Is there a reasonable rational behind treatment? Ther is a reason and rational to prescribe medications. Also, evidence-based medicines are critical. Medicine today requires scientific evidence and a clinical trial where people receive a placebo and comparisons.
The chance of a treatment being accepted increases as the credibility rises.
Other areas of my research are critical. You should drink 2 liters of water per day. Weight loss is also important. Proteins like meat interact with many medicines and pills may not work as strongly. Each person though differs. Don’t avoid proteins but do avoid peaks. Spread proteins throughout the day. Speak to a dietitian for further information.
Extra salt is helpful in meals. Drinking a glass of ice-cold water in the morning in bed helps treat hypertension in the early morning.
Many ask if nutrition can slow down Parkinson’s. There are risk factors like body weight. There are protective factors like caffeine. Several studies have shown that dairy products increase the risk of getting Parkinson’s.
Pesticides can be measured in our meals which studies are being done throughout the world to see if it can cause Parkinson’s.
If you were to get Parkinson’s disease, what would you do?
I would live on the treadmill, exercise everyday and steer away from pesticides and toxins. If you have a few neurons left protect them with everything you can steer away from pesticides. Studies link exposure to pesticides and the progression of Parkinson’s.
My main concern is in a paper I published; the problem is the pesticides we use are not proven to be safe throughout the world. Current pesticides are not safe. It is not proven they cause Parkinson’s, but I believe we need more research on the topic.
Research shows that caffeine could be an issue with individuals who have Parkinson’s. There are many diets on food and eating and its effect on PD such as Greek food. The Mediterranean diet shows a lower risk of PD. It is also linked to a lower risk of dying with PD plus more physical activity. Eating healthier and exercising is key.
Always wash your fruit to combat pesticides although it could also be within the fruits.
Can Parkinson’s be slowed down?
The earlier the better and changing lifestyle can make some impact but it is too early to tell. It needs to be tested in trials. There are uncertainties if diets can prevent PD.
Knowledge can develop and insights can progress. When I started my practice there was not a lot of data and today, I use the European Physiotherapy Guideline for PD. Boxing 10 years ago was a religion but today it is evidence-based treatment for PD along with dancing and fitness.
Evidence is emerging but some evidence is getting worse. Red Wine today shows there was bias in trials and does not show that red wine is good for us unfortunately.
What would you like to see as a future goal for your research?
We are doing trials now through antibiotics for the gut. We try to bypass the gut if it is resilient to treatment.
We need more evidence of areas such as supplements, probiotics and many other areas affecting those diagnosed with Parkinson’s.
Parkinson’s is not a death sentence. You must be careful of what people are trying to sell and recommend for PD. It is fraud to exploit individual’s despair. For example, do not buy stem cells through the Internet. I have people who have sold homes in my practice to buy stem cells.
Can marijuana use help Parkinson’s patients?
Today there is insufficient evidence to provide it as a treatment. There is a good rationale. There is evidence that people benefit but it can lead to delirium, hallucinations, and danger for driving. Sleep and pain have provided some benefits for. I point out the positive and negative effects and ask people to join trial studies.
What events do you participate in?
World Parkinson’s Congress is close to my heart.
The Parkinson’s Foundation is doing magnificent work.
I have been an officer for the Movement Disorder Society and haven’t missed a single conference since 1990.
I tried to follow almost everything in Parkinson’s.
What are some future areas of research that interest you?
The gut, constipation and areas of health are important to me. Constipation is a sign for potential future Parkinson’s diagnosis.
How can we improve funding for research in the field?
I am an optimist. Holistic medicine is important. You need medicine plus a proper diet. Pills, sometimes surgery, always lifestyle measures and a well-informed patient and family. It is not a competition.
Today foundations are shifting and realize things like yoga, mindfulness and nutrition are all gaining new funding.
How can someone get in touch? What is your website?
Why will everybody get Parkinson’s disease?
See Dr Bloem’s lecture here: https://www.youtube.com/watch?v=3JKECIJDFXU
In your opinion what is the key to effective advocacy?
I think advocacy is critical. The Parkinson world, what we said in the book, I think the community has been too silent. In part the people with Parkinson’s are so nice and wonderful. Sometimes they are too nice and too wonderful. People with Parkinson’s have every right to complain. This is a horrible decision, and we need more funding. It will help with better care and possibly a disease intervention. Hopefully and eventually a cure or prevention of Parkinsons is what I am focusing on right now.
Advocacy is critical to raise awarness that this is a horrible disease. You may have seen a recent podcast for the Davis Phinney Foundation. People lose years of life. It is time and the elephant in the room. Fortunately, most live long with Parkinsons’. But they do lose many years of their life and struggle. It is time to name the beast by its name and say this is a deadly disease. Advocacy is needed to get the funding we deserve so scientists can ultimately solve this puzzle.
What other activities do you undertake to help improve and support your daily living Eg exercise and alternative remedies?
There is an importance of nutrition in exercise and Parkinson’s. Supplements can cause secondary problems. They are not evidence-based treatments. The delays can lead to an adverse issue with the future treatment. For example, Curcumin was one of the largest used with people who have Parkinson’s. there is not evidence or adverse effects, but no evidence shows it helps for Parkinson’s disease.
Nutrition to alleviate symptoms and clinically manifest Parkinsons. Muccuna Dopa is an example of a vitamin. It is plant based and provides Leva Dopa. The exact same used to prescribe for Parkinsons patients. The problem is a lot of the Leva Dopa is needed and that convers in your brain does not help through supplements only. Leva dopa goes to the brain to help but with this Muccuna Dopa you will not get a proper benefit from the treatment.
With Carbidopa the Parkinson can see improvement. Without Carbidopa the supplements do not work as well.
Why should people who don’t have Parkinson’s care about this?
Well, if Parkinsons’s is largely an environmentally driven disease which it is, we are all at risk. That is one reason why everyone should be concerned. Second, prevention is so important because we are facing an aging population. Fewer young people to look after an ageing population. If we don’t start looking to prevent Parkinson’s today, healthcare will become unattainable, so we need to do something. That is why it should affect everyone for their own personal health.
If you had one final statement or quote you could leave for the Parkinson’s community, what would it be?
That is a tough one. Don’t become too much dependent on the health care system. Focus on what you can do yourself. The people in my clinic that do the best are the ones who actively take a role with every lifestyle measure you can take. Exercise, with all its variants, stress management, healthy diet, steering away from pesticides and education and self-management. The better you take up the gloves and pick up self-management the better you will be. The most important message is don’t be passive and think your doctor will solve the problem for you because he won’t.
Dorsey. R.; Sherer. T., Okun, M. & Bastiaan. B. (2021). Ending Parkinson’s Disease: A Prescription for Action. PublicAffairs.
nosilverbullet4pd (2023). Prof Bas Bloem presents “The importance of nutrition in managing Parkinson’s disease” https://www.youtube.com/watch?v=QqCa5r9v0gY&feature=youtu.be