Podcast Summary: Chasing Life – “A New Understanding of Parkinson’s Disease”

Host: Dr. Sanjay Gupta
Guest: Dr. Michael Okun (Neurologist, Movement Disorders Specialist; Author: The Parkinson’s Plan)
Date: December 5, 2025

Episode Overview

This episode of Chasing Life dives deep into Parkinson’s disease, emphasizing a dramatic shift in scientific understanding: Parkinson’s is not merely a brain disorder caused by dopamine loss, but a complex illness influenced by environment, lifestyle, and potentially preventable exposures. Dr. Sanjay Gupta and Dr. Michael Okun explore the latest research on causes, symptoms, diagnostic challenges, and the pressing need for prevention, with optimism for improved public awareness and patient outcomes.

Key Discussion Points & Insights

1. Rethinking Parkinson's Disease: Not Just a Disease of the Brain

• Initial Framing: Dr. Sanjay Gupta introduces the fear and mystery surrounding neurodegenerative diseases, then highlights Parkinson’s as the fastest-growing neurodegenerative disorder globally.

  • Quote: "The fastest growing neurodegenerative disease in the world is Parkinson's disease." [00:47 - Dr. Sanjay Gupta]

• Beyond Dopamine & the Brain: Dr. Okun challenges the common “dopamine-only” dogma.

  • Quote: "It becomes obvious, just absolutely obvious ... that this isn't just a disease of dopamine, it isn't just a disease of the brain. We see it in the gut, we see it in the skin, we see it in multiple organs." [01:36 - Dr. Michael Okun]
  • Parkinson’s affects many systems; symptoms include both movement (motor) and non-motor issues such as depression, anxiety, and apathy.

2. Parkinson’s Pandemic: Numbers and Causes

• Global Growth:

  • Parkinson’s cases are rising faster than Alzheimer’s, not explainable by aging alone.
    • "We already have 11.8 million people with Parkinson's. We're now growing as a neurodegenerative disease faster than Alzheimer's disease. That should grab Everybody's attention." [00:52 - Dr. Michael Okun]

• Genetics vs. Environment:

  • Only ~13% of patients have a single gene mutation linked to Parkinson’s; most cases are non-genetic.
  • Environmental exposure (pesticides, chemicals) and lifestyle factors play a larger role than traditionally believed.
  • "Diseases have causes. We need to get to the root causes. And the best treatment isn't a pill. It's prevention again." [11:29 - Dr. Michael Okun]

3. Environmental Risks and Routes of Exposure

• Hypotheses: Two Pathways to Parkinson’s

  • Brain-first: Inhaled toxins (e.g., air pollution, metals, pesticides) enter through the olfactory system.
    • "Brain first would be you get it through the air, you breathe it in...." [12:51 - Dr. Michael Okun]
  • Body-first: Ingested toxins (contaminated water/pesticides) enter via gut, move “upstream” to the brain.
    • "Another way is through your gut. So perhaps through bad water, through food, through pesticides and things." [13:16 - Dr. Michael Okun]

• Cluster Cases & Michael J. Fox:

  • Discusses clusters of early-onset Parkinson’s (e.g., Michael J. Fox and colleagues).
  • "The Michael J. Fox story of his cluster of Parkinson disease is just another drip, drip, drip on top of that faucet." [16:33 - Dr. Michael Okun]

• Pesticides in Focus:

  • Paraquat and Rotenone: Research shows strong linkage between certain pesticides and increased Parkinson’s risk.
    • Paraquat is not banned in the US, though banned elsewhere (e.g., UK, Netherlands) and reductions in use abroad may be flattening incidence.
    • "If you're a farmer, farmer, you have a much higher incidence of Parkinson S disease." [19:34 - Dr. Michael Okun]
    • "Paraquat goes very quickly to the brain and to the lungs... it hits an area we call complex one. And that's super important for Parkinson S, for dopamine and for some of these other circuits in Parkinson's." [21:23 - Dr. Michael Okun]

4. Actionable Prevention Strategies

• Dr. Okun’s 'Parkinson’s 25' (Highlighted Preventive Tips):
  • Use carbon water filters, especially if water testing isn’t feasible.
  • Use air purifiers in polluted areas or urban settings.
  • Wash vegetables and fruit thoroughly to reduce pesticide residue.
    • "Carbon water filter is so important to prevention of disease...." [22:58 - Dr. Michael Okun]
    • "You should be worried. And I think people are starting to get worried about these things as they learn more and they want to learn more, which is a good sign." [23:47 - Dr. Michael Okun]

5. The Complexity and Early Symptoms of Parkinson's

• Motor and Non-Motor Symptoms:
  • Early symptoms can include:
    • Constipation
    • Loss of sense of smell
    • Acting out dreams (REM sleep behavior disorder)
  • 20% of patients never have tremor, leading to missed diagnoses.
    • "It turns out that one of the first symptoms of Parkinson S can be constipation.... Another early symptom ... acting out your dreams...." [25:16 - Dr. Michael Okun]
    • "One in five causes a lot of folks to not be diagnosed because you think, oh, I don't have a tremor. I must not have Parkinson's." [26:17 - Dr. Michael Okun]

6. Diagnosis: The Challenge

• Diagnosis is primarily clinical, confirmed by response to dopamine drugs, but can be missed 1 in 5 times even by specialists.
• New biomarkers being researched (e.g., synuclein, skin biopsies, imaging) hold promise but aren't definitive yet.
  • "It turns out that the best diagnosis of Parkinson traditionally has always been the examination by a neurologist...." [27:16 - Dr. Michael Okun]
  • "We should be eating some humble pie and just sort of taking a step back and realizing we're not as good as we thought we were." [27:49 - Dr. Michael Okun]

7. Hope Through Treatment & Optimism for the Future

• A Message of Optimism:

  • Parkinson’s is not a death sentence—many find health improvements after diagnosis through proactive management (medicine, exercise, behavioral therapy, surgery).
    • "When we give that diagnosis ... it still should be a hopeful moment and not a moment of a death sentence." [29:30 - Dr. Michael Okun]
    • "We actually have folks ... who actually say they feel better, they have a better plan, they're doing better. They've never been healthier since getting the diagnosis." [29:54 - Dr. Michael Okun]

• 'The Parkinson’s Plan' (PLAN):

  • P – Prevention
  • L – Learn (understand why and how it starts, progresses)
  • A – Amplify (raise voices, advocacy)
  • N – Navigate (find best treatments)
  • Also highlights the need to "level" the rise by 2035 (0% increase), 10x funding for research, 100% global access to essential dopamine medications.
    • "It's optimistic ... The P is prevent, the L is ... why look upstream, ... The A is the amplification of our voices ... the N is the navigation of treatments." [31:31 - Dr. Michael Okun]
    • "Let's get generic dopamine to people so they can benefit." [32:09 - Dr. Michael Okun]

Notable Quotes & Memorable Moments

• On Clusters and Environmental Influence:

  • "We would all say, including me, oh, that's probably just a coincidence. Right? ... And now we are starting to focus in on clusters of disease to understand what are potential causes." [15:32 - Dr. Michael Okun]

• On Prevention:

  • “Why are we not thinking about primary prevention in diseases like Parkinson's disease if it's not all aging? ... The best treatment isn't a pill. It's prevention again.” [11:01 - Dr. Michael Okun]

• On Hope:

  • “We need to teach people that there are so many things we can do. Behavioral medications, surgeries, and then there's so much hope that's on the horizon.” [29:58 - Dr. Michael Okun]

• On Investment:

  • “We only invest two or three pennies of every dollar on prevention in this country and worldwide. This is not going to move the needle, Sanjay. So we have to proportionately reinvest.” [31:59 - Dr. Michael Okun]

Important Timestamps

• 00:47 – Parkinson’s as the world’s fastest-growing neurodegenerative disease
• 01:36 – Multisystem nature of Parkinson’s
• 07:45–10:13 – Rise is not just aging; environment plays a key role
• 11:01 – Primary prevention is possible
• 12:26–14:11 – Motor vs. non-motor symptoms, routes of exposure
• 15:32 – Clusters and environmental spillover
• 19:31–21:14 – US as an outlier; Paraquat discussion
• 22:58–24:06 – “Parkinson’s 25” actionable prevention tips
• 25:16–26:17 – Prodromal (early) symptoms and underdiagnosis
• 27:16–29:17 – Diagnostic challenges
• 29:24–31:28 – Hopeful approaches and treatment optimism
• 31:31–32:27 – Explanation of the “PLAN” in The Parkinson’s Plan

Tone & Takeaway

The conversation is warm, candid, and hopeful. Dr. Okun and Dr. Gupta demystify Parkinson’s and champion agency—emphasizing that prevention and proactive steps can make a real difference. They call for greater scientific humility, listening to patient stories, more research investment, and global equity in care. The message is clear: Parkinson’s is neither purely genetic destiny nor an inevitable result of aging; change is possible, both at an individual and societal level.

Summary for New Listeners

If you haven’t heard this episode, it’s an accessible, thorough insight into the new science of Parkinson’s. You’ll learn it’s not just a brain disease, it’s not just about aging, and, most crucially, it’s not inevitable. Preventive actions and a hopeful, proactive approach—both at home and in public policy—could change millions of lives.