Environmental Factors and Parkinson’s Disease with Dr. Michael Okun

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katy Peters and this is the Brain & Life Podcast.

Dr. Correa:
Welcome back to the Brain & Life Podcast. We've been getting so many great questions from you that today, we're going to start with some questions and lead into the topic for the episode. Katy, what were some of the ones that you liked?

Dr. Peters:
Well, at first... I mean, oh my gosh. So many questions. And what's great is I think that not only do we have listeners. But now, you're contributors, contributors to our podcast. I think that's great. So I guess for our first question, I'm going to go directly to it, is the one that I liked was Jason R., and it says... Jason R. said, "How do you choose guests and topics for this podcast?", and he said he'd love to hear more about Parkinson's. He said he had some influencers that I follow who have it, "Can I recommend them for the podcast?" So I said, "Jason R., definitely. Thank you for the question, but thank you also for doing our job." Don't you think that's great, Daniel?

Dr. Correa:
I know. It's going to be so much easier now that we have thousands of people to send us suggestions.

Dr. Peters:
Yes. So we have had some great interviews with advocates and celebrities with Parkinson's Disease. Namely, actor, Ed Begley Jr., comedian, Richard Lewis, NBA Star, Brian Grant, our American Ninja Warrior, Jimmy Choi. And then, of course, if you have some recommendations, Jason, please send them to us. We're always eager to learn from you and from those influencers

Dr. Correa:
Yeah. And your suggestions, they might make it to the podcast. We bring your suggestions and input also to the Brain and Life Magazine. There's many different ways we can promote more awareness throughout our communities, including those living with Parkinson's.

Dr. Peters:
And Daniel, do you have some favorite questions?

Dr. Correa:
Yeah. So Michelle Y. wrote for us and said, "Hi, doctors. Parkinson's runs in my family. I'm in my 30s and do my best to eat healthy, stay active, et cetera. But is there anything else I can do to try and keep myself healthy and functioning? I worry a lot about what may happen in the future and want to make sure that every choice I make is a smart one whenever possible." Thank you for all that you put into the podcast.
I really appreciate Michelle's context and her question. I think it's the thing we all worry about both for ourselves, for those in our family who are aging. Now, unfortunately or fortunately, Katy, we're both probably in the aging category.

Dr. Peters:
What? Me? No.

Dr. Correa:
Well, everyone listening and, really, everyone in our community. And especially those with risk factors for a progressive neurologic condition, whether it runs in your family or you have medical conditions that might affect your heart. And other things that raise your risk for the changes of blood vessels to the brain or other things that may impact the brain, it's important we all try to focus on those brain healthy recommendations that you can find in our magazine, the website through, partners like the American Academy of Neurology, the AAN, and the American Heart Association. All have been working together to put together more recommendations on living better with neurologic conditions and helping prevent neurologic conditions in the future or what we like to think of and talk about as brain health.
At this point, one of the things that we're seeing throughout the evidence about brain health is one of the most important goals is to improve the quality and increase our sleep patterns. You also mentioned staying active and I want to reinforce and double down on that. Both exercise and nutrition are probably the next most important places to look. And wherever you can and wherever you are physically, try and see if you can aim to get ten more minutes of activity. There's lots of total numbers of goals. But really, just take a look at where you are and see if you can add ten more minutes of activity that gets you a little out of breath each day.
And then, in two to three months, look back and see where you are. Maybe you can change the type of activity to challenge yourself a little more or increase the number of minutes. In that way, you can put yourself on a strategy towards always improving and challenging yourself a little bit. So if walking or seated activity is where you are now, that is great. Do those activities, but don't just stay there. You might find out there are 150 minutes, 120 minutes. There's lots of different recommendations. But if you just stay there and it's not challenging at all for yourself, then you're not having that opportunity to improve your overall cardiovascular and brain health.
And in terms of nutrition, look at the Mediterranean diet or what often is referred to in an acronym called the Mind Diet, M-I-N-D. That's a combination of Mediterranean with a lower salt diet. Those can provide good options to improve brain healthy eating. You can find information about them in the magazine. We've done some episodes before on the diet and on different diets. And online, you can find recipes and there's lots of options out there about adjustments to your region, culture, and community. It's just that the term that has been set up, initially, to describe the Mediterranean diet much more being the balance of different nutrients. And it doesn't mean that all the recipes to eat, you have to be eating Mediterranean-style food. What do you think, Katy?

Dr. Peters:
I just remembered your wonderful podcast with Dan Buettner on the Blue Zones and how much we can learn about longevity. And so much of that is about the diet isn't just for tomorrow, it's for today. Start today. Start with a good diet. Start with that activity now. I know that, always, at the beginning of the new year, the resolutions come into play. Think about that for a resolution for not just this year, but for the year after that and the next. Maybe make resolutions on decades. So I think, Michelle, you're doing all the right things and just keep on moving forward.

Dr. Correa:
You're starting great work. And I think each and everyone, even joining today, listening and being part of this community, you can count that as work that you're doing for your brain health. There's this question about when to start something that's good for yourself and there's a famous saying out there that says, "When is the right time to plant a tree?"
Maybe that was probably 100 years ago when you were born, but the next best time is today. So if you can start today or even conceive in ways of helping others who are very early on in their path or even children in your family, about ways that they can incorporate these brain healthy things, we can improve brain health across all of our families in the lifespan.

Dr. Peters:
So another great question comes from Kelsey S. It said, "I read skin problems may be early signs of a neurologic condition in your magazine." Of course, the Brain and Life Magazine. "And I'm wondering what other random correlations there are out there? Like hair loss or anxiety, what are they signs of? Anything in the brain?"

Dr. Correa:
Well, you mentioned hair loss and hair loss has been associated and can be related to various different neurologic conditions. The hair cells in our body are actually some of the most metabolically active cells in our body. So many conditions that are affected by the metabolism. There are genetic conditions and rare metabolic conditions. One called Menkes Syndrome which is an impaired copper metabolism. Mitochondrial diseases, many of you might be aware as the mitochondria are the energy structures in our cells there are. If you have a condition that affects those mitochondria, then often hair losses can be a feature of that medical condition.
And there's other conditions that affect both the skin and the neurologic system or the brain and spinal cord and peripheral nerves. And they can have hair loss related with them in those medical conditions. Many conditions that cause autoimmune or inflammation throughout the body and then affect the skin. And therefore, also have hair loss. And some systemic conditions that cause peripheral neuropathy. If you have very uncontrolled diabetes, if there is bad issues with your blood vessels affecting your nerves, because it's getting to the extent where it's damaging the nerves and your hands and feet. And some people with those conditions, they can also have higher rates of hair loss.
You mentioned anxiety. And anxiety, itself, sometimes has been described as an early sign in some people who may be later at risk for Parkinson's disease. And there are sleep conditions that can be associated with Parkinson's disease later on in life. Many other neurologic conditions have either an association with a mood change. Either have an association with a change in mood or sometimes a mood change or disorder as an early sign. So that's points, to me, it's just one of those more reasons why when you have a concern for a mood condition or a mood disorder or really, a change in your mood that's affecting how you're operating each day, it's just that much, much more important to get support and need. Because many of the things that's done in the evaluation for those initial symptoms of depression and anxiety is starting to make sure that there's not some other condition that's related to it. Neurologic or some other one and systemically in your body.
And another important one is to remind us the importance of that brushing your teeth and flossing as many times as you remember. They say twice a day. But I will admit, I don't always make with a second time of the day, is that poor dental conditions or something called periodontitis. That's the chronic gum disease and inflammation has been linked to neurologic conditions including Alzheimer's disease and various neurologic conditions with cognitive decline and dementia.
So again, I think maybe like that exercise comment, the best time to start flossing was many years ago but the second best time is today. And taking care of our teeth has been shown, in many different studies, to be a factor in how early different neurologic conditions can show up later in life. What about you, Katy? I know you work with neuro-oncologic conditions or tumors that affect the brain and spinal cord. Are there systemic manifestations or skin manifestations that go along with some of those?

Dr. Peters:
I think it's so interesting that you mentioned skin. Because definitely in our pediatric or young adult population, checking out the skin for patients that have a newly diagnosed brain tumor is really critical because it can really point to an underlying genetic cause for that brain tumor or spinal cord tumor.
One such condition is a condition called neurofibromatosis. It actually can cause skin findings in addition to brain tumors. But the skin findings tend to happen much, much, much, much earlier before they ever have a brain tumor, so it's really important to detect those early. And for those conditions, the most common one is called a cafe au lait spot. It's a common birth mark. It's usually light brown in color. But again, it's very important to notice the natural pigment of a patient's skin because depending on what their pigment is, those spots may look different.
And so, it's really important to know that. They are definitely and they, usually, are present at birth and they may develop by the age of three. You can also get freckling underneath your armpits also known as the axilla. Also, in your groin. And that tends to occur. And then, you can even have little tumors that are of the peripheral nerves we call neurofibromas. And so, they can just look like bumps on the skin.
And tuberous sclerosis, which is another condition associated with having a brain tumor, called a subependymal giant cell astrocytoma, it can have a myriad of skin conditions. They tend to get hypopigmented patches often known as an ash leaf macule or a spot. They're at birth. You may have to use a special lamp called a Wood's lamp to see them. And they can also get just thickened skin that feels like dimpled skin or almost like an orange peel, like a rough skin to look at. And then, patients can also have associated changes in their nail beds.
So look at the skin, look at the nails. And I mean, have so many times I'll have an adult in my clinic and they're like, "I have this rare brain tumor all of a sudden." And I'm like, "Do you have any birthmarks?" And if their mom and dad are with them, I often ask mom or dad, "Do they have birthmarks?" And oftentimes they're like, "Yeah. Absolutely, they do and this is where they're located," and I'm like, "Aha." And we can diagnose those conditions and treat those patients appropriately. And sometimes you can even diagnose their family members just sitting there in clinic, because it is a genetic disease in some cases.

Dr. Correa:
So not all birthmarks or all how concerned-

Dr. Peters:
Not all birthmarks. No, no, no. It's usually very special. Usually, multiple of these. If you are concerned, you can definitely go see your primary care physician or also see your dermatologist if you have any concerns.

Dr. Correa:
Yeah. And a lot of these are showing up in children. And like you said, when there are multiple throughout the body, it's particularly more of a concern, but always something to discuss with your primary care doctors. These are things, actually, we learned early in med school and that many of our primary care physicians are familiar with, at least noticing, "You know what? That doesn't look like a typical or benign birthmark. Let's get some more information."
Now, you may have already caught on. We had a little bit of a theme with a few of our questions here. And that's going along with our episode and back to Jason's request for more episodes on Parkinson's disease. So in this episode, we are going to broaden our discussion on Parkinson's disease. Not with a new community or celebrity guest, but for a deeper conversation with a specialist, Dr. Michael Okun.
We're going to be discussing why there are increasing rates of Parkinson's disease diagnosis in our communities. And is it related to the environmental factors that may be affecting the distribution of disease throughout the United States and the world? And we're going to be discussing additionally important considerations for those living with Parkinson's disease, his books, and the recommendations that he's been championing out there and for the community living with Parkinson's.
Welcome back to the Brain & Life Podcast. Now, we've had a series of episodes discussing with you, our listeners, and many guests living with Parkinson's disease. But we wanted to broaden that conversation and we're looking forward today to welcoming Dr. Michael Okun. He's a renowned neurologist and movement disorder specialist and also the executive director of the Norman Fixel Institute of Neurologic Disease at University of Florida. He's dedicated his career to improving the lives of those affective neurologic disorders, including Parkinson's disease, and we're happy to have him here. Michael, thank you so much for joining us in this discussion.

Dr. Michael Okun:
Yeah. It's my pleasure to be here.

Dr. Correa:
So before we really get into more about Parkinson's disease itself. I'd like to hear, just how have you, yourself, and your family and your community been touched by neurologic conditions?

Dr. Michael Okun:
It's a great question. We are actually quite lucky in terms of a family. We have a lot of friends, a lot of people that have been touched in our family by Alzheimer's and neurodegenerative diseases. In our direct family, we've been pretty blessed not to have anyone with Parkinson's disease, but we're very concerned with seeing these numbers rise. Particularly the recent numbers in the Global Burden of Disease study that show we're at 11.8 million in 2024, which is where we thought we would be closer to 2040.
And so, it's now the fastest growing neurological disease. And then on the most recent numbers from Global Burden of Disease, it's the fastest growing neurodegenerative disease and it's growing even faster than we thought. And so, we're hoping, knock on wood, we don't wish the Parkinson's disease on anyone. We're hoping our family stays safe, but we do want to make sure to encourage people to start investing more than a few pennies of every dollar on prevention.

Dr. Correa:
Yeah. I think it's absolutely needed. And you, along with many other researchers and clinician advocates, have been pointing out this as you would describe as a pandemic of Parkinson's disease. Why those terms?

Dr. Michael Okun:
Yeah. So it's actually pretty straightforward. Back in 2013 or so, we had written a book called Parkinson Treatment: 10 Secrets to a Happier Life. It was a runaway bestseller. And in the beginning of the book, we talked about how the cases were growing and it was like a pandemic. If you look at the Greek derivation of the word pandemic or if you look in Merriam-Webster's dictionary or any common dictionary, you'll see that it's a Greek derivation. Pan means all. Demos means people. And you think about all people, when we think about why geography is growing. This term was brought forward as a noun in the 1800s and it wasn't originally used to describe just infectious diseases. In fact, in the time it was introduced, we didn't understand bacterias and viruses like we do today. But it's become synonymous for infectious diseases. But if you look at the growth of Parkinson's disease, we can make a pretty compelling argument that it does meet those criteria for thinking about it as a pandemic.

Dr. Correa:
And one of the things that's been pointed out as a clear concern for the onset of different neurodegenerative diseases, including Parkinson's, is air pollution and other pollution exposures. Can you tell us about what we're understanding and seeing so far in that?

Dr. Michael Okun:
Yeah. So super, super important area to be thinking about. First of all, for folks that are listening, we should always remember that when we're thinking about environmental exposures, we need to be more careful about how we do the research because it all depends on where you live. When we talk about bad air, it also depends on where you live.
A lot of what we know really goes back to the bad air that we saw in London during the Great Smogs from all the factories in the industrial revolution. And in fact, a lot of the environmental exposures, Daniel, they probably trace back to how we began to industrialize. And as we industrialized, we created chemicals, we created bad air. And so, we're now seeing the downstream effects of some of those things that happen.
Now, what we do know is if you take various populations in various cities. Like for example, let's take a recent cohort that was studied in German neurology. If you look in Korea and we look at pollution, we can tell that data is much cleaner because we know where people live, we know where people move, and we know what the pollution levels are within a city like Seoul or a similar sized city. And so then, we can use that to begin to look in large scale as to whether or not there is a higher or increased risk for diseases like Parkinson and other neurodegenerative diseases like Alzheimer's disease. And in fact, there are. You could look in other populations and other areas and not find that. And that is a clue.
And so, one of the mistakes that we've made in medicine is that we have begun to look at everything with a broad brush. We look at environmental exposures. We need to look with a more narrow brush and really change the focus from 50,000 feet above to 20,000 to 10,000 to 5,000 to a couple of cases and then back up. We need to move. It's like if you were looking at a microscope, you need to look at it from a high magnification, low magnification, and then back to the high. If you look at the United States, Daniel, what you'll see is that Rust Belt region that has all of the agriculture has a high incidence prevalence of Parkinson's disease. That is not an aberration in the data. That is a clue about what's going on with pesticides and things like that.

Dr. Correa:
So which pesticides are of most concern in relation with Parkinson's disease and movement disorders?

Dr. Michael Okun:
Yeah. So when we think about pesticides and Parkinson's and pesticides and movements, just very simply, we're thinking about the types of things that are killers. And why do I say killers? Well, it turns out that when we're thinking about pesticides, the word cide in Latin means killer. And so, when we're thinking about that, we're thinking, "Oh my gosh. These things were invented. They were brought onto the market to try to take care of the pests, to kill the pests, pesticide, that were on our crops."
And so, thinking about that in those types of exposures has really helped us to think about, "Hey, could there be certain pesticides that we're able to now track and see that they are associated with the later increasing the number of risks, the occurrence of Parkinson's disease?" The one we know the most about is Paraquat. It's been banned in 32 countries, but it has not been banned in the United States. It's more than doubled in its use in the last ten years.
And so, that's something that when we did our Red Card Campaign after the Ending Parkinson's Disease book came out, we said, "Hey, we should be thinking about getting rid of this pesticide like the rest of the world." And we see in areas like the Netherlands where they're starting to reduce these types of pesticides, the incidence of Parkinson potentially starting to tick down. That's a good thing.
Glyphosate is another one. And so, it's a controversial herbicide. Many of these also cause cancers as well and people are now beginning to get the data to put that together. Another one that you might find in your garage is Rotenone. And Rotenone is a really interesting one because if we inject Rotenone into rodents and animal models, we can actually cause Parkinson.
And one of the leading researchers who really described this was somebody named Tim Greenemeier. Tim Greenemeier and I were at Emory together. Now, he's at Pittsburgh. A fantastic researcher. He now has Parkinson disease himself and there's an article on Science about Tim. And he talks about he probably should have been more careful about handling the pesticides, unclear whether it was causative. But again, we start to think to ourselves, "What about these types of exposure?"
So those are just a few of many that are on the list. And what you will see is over the last 20 years, so 20 years ago, it was like, "Pesticides and Parkinson, there's probably nothing there." And then, over time, what we have seen is we've seen this uptick of papers. And when you see something that you're thinking, "Maybe this is related." One paper is one paper. But then, when you see another paper, another replication, another cohort in a different area, in a different region of the world, you start to think to yourself, "Wait a minute. Wait just a minute. Maybe there's something to this."
And so, we think about different pesticides and now we're beginning to try to put together that information and trying to create a picture. We think a lot of them are attacking something called the mitochondria within the system. Those are the muscles of each cell in your body. And so, we think there's some relationship to that. And we also think some folks that have pre-existing genetic abnormalities like LRRK2 in the laboratory may be at actually higher risk when exposed.

Dr. Correa:
Oh, wow.

Dr. Michael Okun:
So it may not be just the pesticide itself, it may be how the pesticide is operating along the way. And so, we look in general terms at insecticides, we look at fungicides, we look at herbicides. And then, we look per region and we are beginning to see the environmental research emerge. And we need more data. We need more replication. And so, anybody who's listening, put your data in from your area. The more data we have, the better we'll understand this.

Dr. Correa:
So I mean, it makes complete clear sense for the person who's working with these insecticides or that are living close to an agricultural region where these pesticides and insecticides are being used. Do we yet understand enough about the minimum threshold for that exposure? Is it to the extent where if even exposure off of vegetables and fruit that aren't washed, may meet enough of a threshold to contribute or is it much more of a proximity of exposure?

Dr. Michael Okun:
Yeah. So we don't actually know that yet. Although in our new book that's coming out in 2025, we talk about one of the things that you can do is you can wash your vegetables. And if you actually do the study and look at vegetables that are not washed versus vegetables that are, you will see that there are aspects of pesticides that are on there.

Dr. Correa:
Oh, wow.

Dr. Michael Okun:
If you look at wine, for example, wine and things that they use for wine. They've done studies where they've tested a lot of the wines and the majority of them have... They have evidence of trace chemicals of these things that are on them. And so, we actually do not pay enough attention to these things. It's something that's easy that you can do. It's something that we recommend, "Go ahead. Wash your fruit. Make sure you get the pesticides off the fruit if you can as much as possible."
It does help if they're organically run. And then, if you know if they come off of an organic farm that doesn't use pesticides, a lot of times you don't know how it's been developed over time. And so, it's hard to know but I think it's something simple that folks can do. They can get a good water filter for their house to make sure. Bad air, bad water, and then wash your fruit. So these are things that we can all do to be more proactive.
And then, of course, making sure that if you choose to live somewhere, that you have the water tested. It's your right to get that water tested. Make sure there's no TCE or anything's leaked in from dry cleaning chemicals or something else in the environment. You can check your water. You can put the water filters on. Make sure that you're not sitting on a TCE plume or somebody has... It is spilled and then it becomes gaseous. So if it gets into the soil, these pesticides and things, they can sometimes come up through the gaseous fumes and that can be a problem if you're living in these areas.
And so, I believe, Daniel, that people called everybody alarmists 20 years ago when there wasn't data. Now, we're getting enough data that I think the next generation is going to start thinking about where do you live and making sure that you're safe and you have good air, you have good water. And it might be that people start moving out of the big cities and away from the industry and starting to think about these things that we didn't really completely appreciate, that are somewhat man-made or human made.

Dr. Correa:
Now, not everybody has the financial and geographic flexibility just to move around in terms of where they live. So people who live in more industrial areas or live in very urban areas with more traffic pollution. Do we yet know that mitigating that exposure by time outside and time in parks and things like that may be something that could help reduce their risk?

Dr. Michael Okun:
I mean, we think, logically, that it would, but we can't tell you with certainty that it does. And so, I think that that's where the science is at. We're at the level of appreciation and not yet at the level of prevention or being proactive. Now, if we put things into place where we stop spraying these pesticides, move to organic pesticides, and we start to measure and re-measure as we begin to reduce the risks of exposure. Then, we would expect a coincident reduction in the number of cases. We are not there yet, but it's coming. I don't know about your mind. But in my mind, it can't come soon enough.

Dr. Correa:
Yeah. Now, another possible or even injury exposure that we wonder and think about in terms of progression to movement disorders, I see that you are a sports enthusiast, is head injuries and traumatic brain injury. Where are we right now in understanding its contribution and a progression to Parkinson's?

Dr. Michael Okun:
Yeah. So if you were going to take a bet in Las Vegas, in science, the number one equals a push. That means nobody wins. The house doesn't win, you don't win, okay? And if that number goes over one, cell is over one, then there's an increased risk that something's going to happen. And we know from head traumas that as you have more head traumas, particularly repeated head traumas, more severe head traumas, that there is a risk of Parkinsonism and Parkinson disease goes up. Does that mean everybody that has a head trauma is going to get Parkinson's? No, but it is definitely a risk factor and definitely something that we appreciate.
Now, if you look at other risk factors like, let's take for example TCE and organochlorines, that's way higher, five. Whereas, head trauma may be one to two increased risk. And so, thinking about these things, it is one of the considerations that we need to be thinking about. Pesticides, overall, might increase the risk by two times overall. But then, when you start to look at specific ones, some are higher, some are lower. And so, we think about this in that way. And then, Daniel, if you start to add them together. So you got a pesticide exposure, then you get hit in the head, and you've got a Parkinson gene, this is not good. And so, we begin to think about it in that way.

Dr. Correa:
Now, once someone is diagnosed with Parkinson's disease. We've discussed several aspects about it, its management, but I wanted to take two things that are beyond the movement and the tremor aspects. Early on or in its progression, some people can develop issues with managing their blood pressure or what we term dysautonomia. How much does that impact all the other aspects of their life and quality of life?

Dr. Michael Okun:
Yeah. I think that things that are modifiable... I mean, you're getting at this aspect of modifiable and then you're also beginning to get to this point where, as our listeners are thinking this through, there's a difference between risk and then when you actually get the disease. So a lot of what we're talking about is risk. So once you have Parkinson's disease, for one example, if we're talking about Parkinson's, you have Parkinson's, right? And so, nothing you could do is going to change that risk now. You've already converted over.
Once you have Parkinson, there's also some evidence that doing things like a Mediterranean diet, exercise, diet, watching to make sure you don't lower your blood pressure too much. Actually getting off some of the blood pressure medications that you mentioned because you tend to have lower blood pressure, more autonomic features with Parkinson's. So one silver lining is you might be able to come off of those medications. You take dopamine that lowers your blood pressure. So the ongoing management is important.
And it might be also that the environmental exposures are still bad once you've had Parkinson. And so, it still may be that you need to wash your fruit and live clean air. Because you're still attacking those same systems and cells of the brain: the mitochondria and other things that we're beginning to understand. So yeah, I think it's super important. But one thing that I remind people is, please recognize the difference between a risk of something and when you actually have the disease. And a lot of times, people mix those two things up. And so, once you have a degenerative disease, it's important that you live a good life too. You want to be able to do the things that you want to do. And then, it doesn't make as much difference. What we want to do is we want to prevent cases.

Dr. Correa:
And one of the other things that you've spent time also highlighting and raising the importance of is once someone has Parkinson's disease, how does that change their risk for skin cancer and the importance for continued screening?

Dr. Michael Okun:
So we think of Parkinson now as not just a disease of the brain, it's a multi-organ disease that affects many organs. And the skin is an organ and you can get these skin deposits. People are beginning to use... Chris Gibbons and colleagues introduced a new skin test, a skin biopsy for Parkinson. And so, we've realized for many years that not only is the skin affected, but the sweat is affected.
The sweat content is different. Sometimes people smell different. There's a woman in the UK who can smell people with Parkinson who knows that odor, that scent, that's different. And then, it turns out that in some way as the skin changes, the sweat content changes. There's some sort of interaction that's happening that we don't completely have our arms around and understand. But what we do know is that it's twice the risk of melanoma, of skin cancer.
So I tell every person that I see, "Every day I practice medicine, I know a little less. But one thing I can tell you that's totally true is twice the risk of melanoma. Completely preventable. If you have Parkinson, you need to be seeing a dermatologist once a year. You need to be applying good UV protection. Lotions that have good solid UV protection, probably 50 or above. Reapply every two to three hours. Wear hats. Protect your skin." And you know what, Daniel? Almost everybody that I talked to, nobody said that to them. And so, I think it's something that we could be doing that it's really important. Preventing even a few cases in your practice of melanoma is huge.

Dr. Correa:
And of all the things, what do you think has been the biggest change in your understanding of living with Parkinson's disease and its management over the years?

Dr. Michael Okun:
I think the biggest thing for me is that folks have been approached as you have Parkinson disease, "This is the end of the world. This is a death sentence," and we actually know that that's not true. We see lots of different phenotypes of Parkinson disease. It's not one disease. You could live for decades. You need to get good treatment. You need to make sure you have the universe around you. The patient, the person with disease, is the sun. We should be orbiting around you and there's so many things that we can do. And I think it starts right there: getting the diagnosis right. Making sure we understand your phenotype. And understanding that we're going to try to help you live for a long time with the disease and live well and have a good life.
And I think it's absolutely tragic that people get the diagnosis and they assume it's like Lou Gehrig's disease. No disrespect to my colleagues in ALS. They think it's Alzheimer's disease. No disrespect to my colleagues in Alzheimer's disease. But it's just different and there's so many things that we can do for people. And that it takes work, it takes a team. It shouldn't be like one practitioner trying to do it all, like Atlas holding up the world. We all should be working as a team. So those are a few of the take home points, for me, over the years.

Dr. Correa:
And Michael, thank you so much for joining us today. Now, if our listeners want to find out more information about your books and I believe you have your website, parkinsonsecrets.com. Correct?

Dr. Michael Okun:
Yeah, parkinsonsecrets.com. Ending Parkinson's Disease, our last book, we have our website up. We have a new book that's going to be coming out in 2025 called The Parkinson Plan. We give all the proceeds to charity from the books. And then, of course, I work for the Fixel Institute at the University of Florida.
All the social media handles that I have for the various voluntary organizations are all just simply my name, Michael Okun. So you can find me chatting it up with everybody trying to raise awareness. And then, we run a really great thing through the Parkinson Foundation called the Parkinson Helpline. It's 1-800, the number 4, PD-INFO and many people aren't old enough to know. If you look at a telephone, there are letters as well as numbers on them. So 1-800-4PD-INFO, we have a great team of over ten people that answer questions from all over the planet.
It's been terrific. We used to do this online in something called Ask the Doctor back in the early 2000s and through many decades. And now, we actually have a live group of highly brilliant people across many specialties that answer these phones. And I meet with them once a month. We talk about the difficult questions and we're really trying to raise awareness. There's a free hospitalization safety guide book for keeping you safe in the hospitals. And so, there's a lot of great resources and we just want people to live a great life and try to impact as many lives as we can. Feel free to join us on social media or online or however and get the word out.

Dr. Correa:
Thank you so much for taking the time with us and our listeners and we really appreciate everything that you're doing to help increase awareness and understanding.
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain and Life Magazine for free at brainandlife.org.

Dr. Peters:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at (612) 928-6206.

Dr. Correa:
You can also find that information in our show notes and you can follow Katy and me and the Brain and Life Magazine on many of your preferred social media channels. We are your host, Dr. Daniel Correa. Connecting with you from New York City and online, @neurodrcorrea.

Dr. Peters:
And Dr. Katy Peters joining you from Durham, North Carolina and online, @KatyPetersMDPhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope, together, we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Correa:
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Environmental Factors and Parkinson’s Disease with Dr. Michael Okun

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