Nutrition That Affects Our Lives

Thy food shall be thy remedy.

—Hippocrates

If we are really serious about controlling our Parkinson's symptoms, we are very deliberate about eating well. Our level of nutrition affects the quality of our lives.

For some of us, balancing a diet and meeting our special needs may be a bit tricky without proper management. In this chapter, I want to share with you the aspects of nutrition that are unique to people with Parkinson's and some techniques for assuring that our bodies get what they really need.

The first thing we have to remember is how important it is to maintain a body weight that is appropriate for our size and build. Your doctor should determine the optimum weight for you to maintain, but until you get his or her recommendation, you can use this method of calculation: for women, start with 100 pounds and add 5 pounds for every inch over 5 feet; for men, start with 106 pounds and add 6 pounds for every inch over 5 feet. Adjust the total down a bit if you have a very narrow build and up a bit if you have a wide build.

Ask your doctor or dietitian to tell you the total daily caloric intake that will maintain your appropriate weight. Pin up a calorie chart and become familiar with the caloric values of the foods you eat. Most high-protein foods are also high-calorie foods. (Proteins also contain important amino acids, which our bodies use in many ways.) Four portions of high-protein foods are recommended each day: generally, two portions from the meat-poultry-fish-and-eggs group of foods, and two portions from the milk-and-cheese group. Many people with Parkinson's lose more weight than they should, which depletes their bodies of protein and muscle, along with fat. They can't afford that because body protein and muscle are absolutely necessary, not only for strength and endurance but also for responding to physical and emotional stress.

People with Parkinson's tend to lose weight because of a number of problems. Some people have frequent tremors, which use up energy. Tremors also complicate getting food to the mouth, which discourages eating. Others have difficulty with cutting up food and give up in embarrassment or frustration. Some people find it hard to chew or swallow foods. Some have a sluggish digestive system and a feeling of fullness that keeps them from eating when mealtime comes. Yet others are simply depressed.

You can overcome a number of obstacles to eating by taking your Sinemet three-quarters of an hour or an hour before you eat. (Observe the length of time that's necessary for your pill to start working, and schedule your medication for that amount of time before the meal). Typically, people who take their Sinemet pill at mealtime are at the end of their last dose. By the time they get help from the new dose, they are finished with their meal. They have lost their appetite because of the struggle to get food to their mouths, chew, and swallow. But someone who takes the pill forty-five to sixty minutes before eating can have a more successful and enjoyable meal because the medication is already working.

Taking the first dose in the morning, almost an hour before breakfast, may present a problem at first. I remember the first morning I took my Sinemet that way and experienced "morning sickness," although I knew I wasn't pregnant. My doctor suggested that I take the early morning pill with milk, which I did. I found that milk eliminated the nausea. Once my body adapted to the medication, I was able to take the pill without milk or food of any kind. (Now scientists know that protein interferes with Sinemet, and they advise taking that early morning pill with a dry cracker or toast instead of milk.) Studies show that more benefit is derived from the Sinemet if it is taken on an empty stomach. It can be absorbed into the bloodstream immediately and can travel to the brain to start working. If it is taken with food, it has to compete with everything else that is eaten, and some of the effectiveness is lost. (Unfortunately, some Sinemet still comes from pharmacies with instructions that it be taken with food. Often, I talk with people who, mistakenly, think they have to take it with food. You may wish to discuss this point with your doctor.)

If you take your medication at the appropriate time but are still troubled by tremorous hands during eating, you may want to ask your doctor for an additional medication to control tremor. Or you may want to try strapping small, one-pound weights with Velcro closures onto your wrists while you eat; they help in controlling tremor. These weights can be found in a medical/surgical supply store or can be ordered through your local pharmacy or hospital.

If, despite medication, you still have difficulty cutting up your food, you may want to ask someone to do it for you before you sit down to eat. Or you could invest in an electric food processor to help with the task. The food processor is a good investment because it can also help you become a creative cook, preparing many tasty mixtures of foods.

If you have a dry mouth (caused by certain medications) or have difficulty chewing or swallowing, you can also use the food processor or, to a lesser extent, a blender to mix your food with liquid and chop or puree it. Eat slowly and deliberately. Give yourself time to eat your whole meal. Of course, if you have difficulty swallowing, you should ask your doctor to refer you to a therapist (usually, a speech therapist) who can teach you how to think through the steps of swallowing and enable you to eat your meal safely. Swallowing food improperly may cause food particles to travel into your lungs, where any foreign matter can cause pneumonia. You don't need that! Most people with swallowing difficulties know that liquid is even more difficult to swallow correctly than is pureed or well-chewed food. It seems to be harder for the muscles to direct liquid along the right pathway, and liquid that makes its way into the lungs can also cause pneumonia. The speech therapist will teach you how to swallow liquids correctly.

In the booklet Speech Problems and Swallowing Problems in Parkinson ''s Disease, the American Parkinson Disease Association offers the following suggestions for dealing with eating difficulties:

Before you actually start eating, think through the steps of swallowing: lips closed, teeth together, food on the tongue, lift the tongue up—then back and swallow. (Up-Back-Swallow.)

Prevent the problem of food buildup by eating slowly and taking small amounts at a time. Swallow small, well-chewed morsels only.

Chew your food hard, and move the food around with your tongue. Make an effort to chew first on one side, then the other.

Don't put additional food in your mouth until you have swallowed the previous mouthful.

Ask your family and other caring persons to learn the Heimlich maneuver in the event you suffer a choking episode. A physician or other health professional can explain the procedure.

Because people with Parkinson's slow down inside as well as outside, a common problem is constipation. Sometimes the constipation is caused by medications. With constipation comes a loss of the desire to eat, as well as gas buildup, headache, and increased rigidity and tremor. In order to combat constipation, people with Parkinson's need a great deal of liquid. You should drink at least eight to ten glasses of liquid a day, including water, fruit juices (especially prune and grape juice), bouillon, coffee, tea, and other soft drinks. The extra liquid helps to keep things moving along as they should.

To combat constipation, the Parkinson's diet must also include many high-fiber foods to add bulk, such as fresh and dried fruits, garden salads, cooked vegetables, legumes, brown rice, barley, pasta, bran and bran cereals, and whole-grain bread. The added bulk helps to keep things moving. Be sure to keep a covered dish of stewed fruit in the refrigerator: select a mixture of dried prunes, mixed dried fruits, and raisins or dried apricots; put them in a medium saucepan; sprinkle with a bit of ground cinnamon; add just enough water to cover the fruit; and cook for a few minutes until the fruit is soft. Yum! You can spoon out a little with any meal or make a snack of them. Alongside the stewed fruit, keep a bowl of cut-up raw veggies to dip into anytime. You can have salad at every lunch and dinner. Be creative about cooking your vegetables. In a small steamer pot, you can steam tasty medleys of several types of vegetables, including a small onion for flavor. When they are done, transfer them to a bowl and toss them either with a bit of olive oil and basil or oregano or with butter and salt.

Add split-pea soup, kidney beans, chickpeas, brown rice, and barley to your lunches and dinners. Cook enough for several meals, and store the leftovers in a covered bowl in the refrigerator. A portion can be taken out and rewarmed in a steamer pot (along with leftover meat or fish) and added to the vegetables or a cup of bouillon. (If someone wants to buy you a gift, ask for a very small steamer pot. You'll use it every day!) Buy a box of unprocessed bran at the supermarket or the health food store, and add bran to your soups, stews, tuna fish salad, and morning cereal. Keep a bowl of fresh fruit on the table for snacking. Be sure to add half a banana or an apple and raisins to your cereal in the morning.

If this regimen doesn't take care of the problem and more help is needed, several natural, non-habit forming stool softeners are available. Docusate (Colace) capsules are recommended and can be purchased without prescription. Exercise is also a very important aid. People with Parkinson's need to exercise every day for other reasons, too.

If your Sinemet is causing side effects such as bloating, cramping, and gassiness, you will want to avoid baked beans, cabbage, broccoli, cauliflower, brussels sprouts, beer, and carbonated beverages.

Many people with Parkinson's suffer from depression caused by chemical changes in the brain, and they lose their interest in eating. If your present medication does not relieve the depression, you may want to ask your doctor to prescribe an additional medication to control depression, so that you can go back to eating well and enjoying life.

An unusual problem that is easy to correct is associated with hot, spicy foods. Some people with Parkinson's report that they experience discomfort, even violent dyskinesias (wild movements of parts of their bodies), after a highly spiced meal. They feel much better when they eat bland or mildly seasoned foods.

Some people with Parkinson's are overweight (although there are far fewer overweight than underweight ones). Perhaps some are overweight because they don't exercise and keep busy and active. A vicious cycle can set in: because they are overweight, moving about becomes much more difficult, and they become even more inactive. But lack of activity isn't always to blame. Although I had always been slim, I began gaining weight steadily a few years ago until I was thirty pounds heavier. I disliked being overweight, but neither dieting nor exercising took any weight off. Finally, I had tests done that showed that my thyroid gland was underactive. With thyroid medication, I've finally been shedding the pounds. If you are overweight and have ruled out a low-thyroid problem, ask your doctor to put you on a well-balanced diet, and start an exercise regimen. Or perhaps you may want to ask your doctor to start you on the Parkinson's "protein redistribution diet," sometimes called the "low-protein diet."

The protein redistribution diet isn't for everyone. If you are seriously underweight, it isn't for you. If you are recuperating from surgery or any type of wound, you are not a candidate, either. And if you have diabetes, you can't even think of trying this diet! But if you are normal in weight or overweight, healthy in all respects except for your Parkinson's, and Sinemet (or another form of levodopa) is part of your drug regimen, you may want to consider the protein redistribution diet. Be sure to consult your doctor, and be sure that he or she knows what you are doing. Your doctor may have to modify your medication very soon after you begin the diet. Your Sinemet may have a much stronger effect, and you may need less of it or you will develop symptoms of overmedication.

What is the story of the protein redistribution diet? In the past, an increasing number of people with Parkinson's reported that they felt better and more energetic during the day if they ate very little protein for breakfast and lunch. These patients ate their whole day's protein at dinner, and because they slept at night, they did not need to worry about a lack of energy after dinner. Researchers looked into these claims and learned that there was a basis for them. They learned that protein competes with the lev-odopa in Sinemet. The amino acids that make up protein interfere with levodopa's ability to pass from the intestine into the bloodstream; these amino acids also interfere with the ability of levodopa to pass from the bloodstream into the brain. The researchers devised a diet that redistributes the protein that is eaten during the day.

In the protein redistribution diet, only about 7 grams of protein can be consumed during the day until just before the evening meal. During this time period, patients eat foods that contain only trace amounts of protein, including rice cereal; fresh and dried fruits; salad vegetables; cornstarch; jams and jellies; honey, oils, and fats; herbs and spices; vinegar; liquid or powdered non-dairy creamer; crackers made of potato starch or rice starch (but no flour); coffee, tea, lemonade, fruit juices, sodas, and alcoholic beverages (except beer); hard candies, sugar, and condiments. If dieters have a low cholesterol level, they may add an egg yolk or two to the list, because there is no protein in the yolk. (The egg whites, which are pure protein, can be saved for the evening meal.) Not one of these foods provides more than a few grams of protein.

During the day, the diet also permits two selections containing a bit more protein. These selections are from the foods made of grains: breads, crackers, cereals, pastas, popcorn, and rice; and from all the vegetables except legumes and nuts. Legumes, which include peas, lentils, soybeans, and dry beans (such as baked beans, kidney beans, and chickpeas), cannot be eaten during the day because they contain most of the amino acid building blocks of protein. Together, the two selections should contain no more than 4 or 5 grams of protein.

The 7 grams of permitted daytime protein enable the dieter to eat a serving of cereal with breakfast, such as a cup of corn flakes or puffed wheat or three-quarters of a cup of bran flakes or rice squares, containing about 2 grams of protein. (Cereal boxes can be checked; they usually show grams of protein per 1-ounce portion of cereal.) Cereal can be eaten with nondairy liquid creamer or apple juice, but not with milk. The daytime protein allowance also permits the dieter to take three-quarters of a cup of cooked vegetables or white rice with lunch (containing about 3 grams of protein). Of course, the dieter may not eat any meat, fish, egg white, milk, cheese, or other milk products for breakfast or lunch.

With such a list of restrictions, what can the dieter eat for breakfast? Actually, breakfast is fairly easy. A glass of fruit juice, an orange, or half a grapefruit can be followed by a portion of cereal (described earlier) in nondairy liquid creamer or apple juice and served with raisins, half a banana, or other fruit, and a cup of coffee or tea. For variety, half of an English muffin with butter and jam or a cup of popped corn (prepared with oil, butter, or margarine) could be substituted for the cereal. Other substitutes for cereal might include a slice of buttered toast or matzo, a small plain muffin with jelly, or a small doughnut. (To aid those of you who are not familiar with the U.S. system of measurement, here are the metric equivalents of American measurements used in the recipes in this chapter: 1 cup [8 fluid ounces] is approximately one-fourth of a liter; 1 fluid ounce is approximately 30 milliliters; 1 solid ounce is approximately 30 grams; 1 teaspoon is approximately 5 milliliters; 1 tablespoon is approximately 15 milliliters. Note that the American measuring cup is larger than an English teacup, and the teaspoon is much larger than the English spoon used for tea. American recipes use volume, rather than weight, for measuring ingredients; thus, a cup of sliced vegetables is the amount that fills the space occupied by one-fourth of a liter. Following the recipes should now require you to do only a few simple conversions.)

Before long, it is time for lunch. The list seems even more restrictive. What can you eat for lunch? You must use a little imagination. A cup of bouillon with a few crackers made of potato starch or rice starch could be followed by a garden salad with dressing, a cup of cooked vegetables seasoned with herbs and dressed with a pat of butter or a bit of olive oil, a dish of stewed fruit or fresh fruit salad, and a cup of coffee, tea, or soda.

For variety, the cooked vegetables could be served in some of the cooking liquid thickened with cornstarch and flavored with herbs. Or the vegetables could be pureed, flavored with seasonings and bouillon, and served as a soup. Cooked or canned green beans could be blended at low speed into a half cup of tomato juice, flavored with oregano and basil, heated, and served as a tasty, thickened soup. A medium-size boiled or baked potato served without the skin, about ten medium-size french fries, or a baked (or steamed) sweet potato may be substituted for the vegetables.

Three-quarters of a cup of cooked brown rice or pasta are other possible substitutes. The vegetables should be different each day to ensure that you obtain all the necessary nutrients.

Another good idea: a big pot of vegetable soup that can be divided into portions and kept in the refrigerator for a number of lunches. Vegetable soup combines the bouillon, vegetable, and starch (crackers) portions of lunch. Here is a recipe for a pot of delicious low-protein vegetable soup, contributed by Professor Judith Green of William Paterson College in New Jersey:

Margaret Green's Vegetable Soup (makes about 8 cups)

4 cups bouillon (chicken or beef)

2 cups water

1 stalk of celery, sliced

1 small parsnip, peeled and sliced

3 carrots, peeled and sliced

2 cups coarsely shredded cabbage

1 small onion, diced

2 large cloves of garlic, minced (about 3 tablespoons) 1/8 teaspoon ground black pepper

1 cup sliced green beans

2 cups drained canned corn 1 tablespoon salad oil

1/2 teaspoon dried oregano

1/4 teaspoon dried marjoram

1/4 teaspoon dried thyme leaves

1/2 teaspoon salt, or salt to taste (if desired)

1 or 2 tablespoons cornstarch (if desired)

1/2 teaspoon lemon juice

In a large pot, combine the bouillon, water, celery, parsnip, carrots, cabbage, onion, garlic, and pepper. Bring to a boil and then simmer for half an hour. Next, add the green beans, canned corn, oil, oregano, marjoram, thyme, and salt. Bring to a boil again and simmer for another half hour. (The soup can be thick ened by mixing a few tablespoons of cornstarch with a little cold water and stirring the mixture into the soup.) Just before turning off the heat, add the lemon juice and stir well. When dividing portions, mix the soup from the bottom of the pot to distribute the vegetables evenly. The entire pot of soup will contain about 14 grams of protein. If the pot is divided into seven equal portions, each portion will contain about 2 grams of protein.

With a very restricted lunch menu, tasty treats are very important. Fruit desserts can become routine and boring, or they can bring sensational flavor and variety. Fruit salads are refreshing in the summer. Professor Green's favorite is a mixture of sliced fresh mango, chunks of honeydew melon, and blueberries, sprinkled with lemon juice. She also recommends ripe pineapple chunks mixed with seedless orange pieces, sliced bananas, and seedless grapes, served in apricot nectar. Warm desserts are appreciated in the winter. Apples (cored and sliced) can be cooked with a little water, cinnamon, raisins, brown sugar, and a pat of butter and served with a dash of sweet wine. Banana chunks can be baked in orange juice, sprinkled with coconut extract (flavoring) and brown sugar, and served with a dash of orange liqueur. Professor Green offers a recipe for pears:

Sliced Poached Pears (makes about 5 portions)

3 cups apple juice or cider 2 sticks cinnamon 5 cloves

5 green cardamom seeds 5 firm, ripe Bartlett pears 2 teaspoons lemon juice

Combine the apple juice, cinnamon, cloves, and cardamom seeds in a 10-inch skillet. Bring to a boil, cover, and simmer for about 10 minutes. While the juice is simmering, wash and peel the pears, cut them in half, and core them. Arrange the pear halves (cut side up) in the liquid, spooning some of the fluid over the tops. Cover and simmer for 15 minutes. Add the lemon juice and simmer for another minute or two. Transfer the pears to a serving dish or a storage bowl. Pour the poaching liquid over the pears and let them steep until serving time. Discard the cloves, seeds, and sticks.

One must look for them, but special low-protein breads and low-protein noodles are available for people with special needs. (They are made with starch instead of flour.) Your local dietitian or pharmacist may know where they are sold.

Snacks can be eaten during the day. A snack may consist of fresh or stewed fruit, celery sticks or other salad vegetables, crackers made of rice starch spread with a little jam, hard candies, mints, coffee, tea, or soda. (Diet soda is not used because most diet sodas contain aspartame [Equal sweetener], a protein, rather than a carbohydrate. There is some evidence that aspartame interferes with the medication.)

At last, the dieter looks forward to dinner. Almost all of the day's requirements for protein are eaten at the evening meal. As we learned before, it is especially important for people with Parkinson's to consume an adequate amount of protein. They need to maintain their weight, and protein provides far more calories than carbohydrates do. Also, they need the amino acids that make up the protein, because the amino acids perform many important functions. For example, the amino acid tryptophan raises the level of serotonin in the brain. Serotonin, another chemical messenger of the brain, is thought to be low in people who have Parkinson's. It promotes normal sleep and lowers sensitivity to pain. Another amino acid in protein, tyrosine, increases the levels of dopamine and other brain chemicals that combat parkinsonism and depression. A high-protein meal helps raise the level of tyrosine in the brain.

But what is an adequate amount of protein? The minimum daily requirement for the general population is one-half a gram of protein for every kilogram of a person's body weight.

How do you calculate that? Divide your weight in pounds by 2.2 to find your weight in kilograms. For example, if you are a man who weighs 158 pounds, divide 158 by 2.2; you weigh approximately 72 kilograms. For every kilogram, you need to consume a half-gram of protein: 72 divided by 2 equals 36 grams of protein. If you are a woman who weighs 130 pounds, your weight in kilograms is 130 divided by 2.2, or approximately 60 kilograms; you would need at least 30 grams of protein daily. But the person with Parkinson's needs more protein than this minimum daily requirement and must plan his or her dinner and bedtime snack accordingly.

Cooked meats, poultry, fish, and most shellfish, as well as canned salmon and tuna, contain approximately 7 grams of protein per ounce. Thus the 158-pound man meets his 36-gram minimum requirement with a portion of meat or fish that weighs a bit more than 5 ounces (cooked weight, not counting the bones). The 130-pound woman needs a portion of approximately 41/2 ounces. Milk contains about 8 grams per cup; a large egg white contains about 7 grams; a half-cup of yogurt contains about 8 grams.

People with Parkinson's must not limit themselves to the minimum requirement. At the evening meal they can have as much protein as they wish. In addition to their meat or fish, they can mix leftover hard-boiled egg whites into their salads or vegetables. They can take a portion of cheese with their fish or melt it over their vegetables. They can indulge in a side dish of chickpeas, baked beans, or peas.

What should a typical dinner contain? Perhaps a broiled steak or a large hamburger, served with peas or baked beans and another vegetable, followed by a large glass of skim milk and a slice of cake. Or a helping of roast chicken or turkey, served over brown rice flavored with chopped peanuts or walnuts; accompanied by a salad or a vegetable; and followed by chocolate pudding and a large glass of skim milk. Or broiled fish covered by slivered almonds, served with a cheese-covered baked potato; accompanied by a three-bean salad or a garden salad generously garnished with chickpeas; followed by ice cream or yogurt and a large glass of skim milk. The possibilities are endless. One must only be sure to get enough protein and calcium.

Remember that the protein in meats, poultry, fish, egg whites, and milk products is a much more complete protein than that in legumes, grains, and vegetables. Still, people with Parkinson's need the fiber contained in legumes, grains, and vegetables. They can plan to include legumes and grains along with an animal source of protein. Note that if legumes and whole grains are taken together, they will provide some complete protein: the amino acids not supplied by the legumes are supplied by the grains.

Because almost all dietary calcium comes from milk, cheese, and other high-protein foods, the dieter must be sure to get them at the evening meal and the bedtime snack. A glass of skim milk at dinner and another at bedtime are required. Unfortunately, some people have milk allergies and others have trouble digesting cow's milk. Soy-milk substitutes can be used by people who cannot tolerate cow's milk; in addition, soy tofu and perhaps goat's milk or Lactaid are possibilities. Legumes (such as split peas), the bones in canned salmon, and broccoli are other (lesser) sources of calcium. A calcium supplement (preferably one that also contains magnesium) may be needed.

At the end of the dieter's day comes the bedtime snack. Again, there is no restriction on protein. The snack can consist of an optional sandwich of meat, fish, or poultry; cake, ice milk, ice cream, yogurt, or pudding (made with milk); and a glass of skim milk. A delicious way to take the milk is in a skim-milk shake: 8 or 10 ounces of cold skim milk blended with a half-dozen large strawberries, some crushed ice, and a teaspoon or two of sugar. (A heaping teaspoon of powdered instant decaffeinated coffee and a drop of vanilla can be substituted for the strawberries. Other flavorings and extracts can also be used.)

Many people are concerned about their cholesterol levels. If one's cholesterol level is higher than it should be, the protein redistribution diet can be modified. Instead of butter or margarine, monounsaturated oils can be used: olive oil, canola oil (such as Puritan), and peanut oil. (Peanut oil is somewhat more saturated than the other two.) Salad oils can be flavored with a little sesame oil to impart an exquisite flavor. More fish, shellfish, turkey breast, and chicken breast dinners can be eaten, and far fewer beef, pork, ham, and lamb dinners. Egg yolks, liver, and other organ meats can be avoided, as well as chocolate candy, ice cream, hard cheese, and whole milk. A cholesterol-lowering protein redistribution diet can be managed!

For the protein redistributor, menu planning is made much easier when a list of foods and their nutritional analyses is kept handy in the kitchen. Nutrition books, such as Applied Nutrition and Diet Therapy by Grace Burtis, contain these lists in their appendices. (See appendix D7, pages 784-787, in the Burtis book.) Lists can be photocopied from books in the library. The alert shopper also notices the nutritional breakdown (per portion of food) on every jar and package of food in the grocery store. Information from the labels of purchased foods can be added to the nutritional analysis list.

If you have read this far, you are probably wondering, "But does the protein redistribution diet really help?" Research has shown that the diet helps some people with Parkinson's very much, some moderately, and others not at all. Many patients with troubling "on-off" fluctuations are helped. Patients who are resistant to levodopa are not helped at all. The recommendation is that with the doctor's knowledge and supervision, the diet be tried for a week or two. Any benefits will begin to be felt in that time. If no benefits are felt by the end of that period, none will develop later, and the diet should be discontinued. If benefits are experienced, then the person can continue the diet and try adding another grain or vegetable product during the day, then judge whether the benefits are maintained. The doctor may have to reduce the medication of the successful dieter.

Two researchers, Dr. David Riley and Dr. Anthony E. Lang, conducted a study of thirty-eight people with Parkinson's on the

Pincus/Barry Low-Protein (protein redistribution) Diet. The results of this study, which were reported in the July 1988 issue of Neurology, showed that patients whose Parkinson's had never been responsive to levodopa received no benefit, but that 60 percent of patients who had experienced "on-off" fluctuations with levodopa were helped significantly. The majority of those who were helped significantly experienced a big decrease in the number of "off" hours during the daytime (before dinner). None of these participants reported that they were any worse in the evening than before they had started the diet.

Among the 40 percent of fluctuators who received no significant benefit, some had very mild reductions in daytime fluctuations, and others had no reduction at all.

One man who did not complete the study developed hallucinations and paranoia. One woman, who did complete the study, developed hallucinations and confusion (a symptom of drug overdose), but this problem ended when her bromocriptine (Parlodel) was discontinued and her dose of Sinemet was slightly lowered. Six patients developed dyskinesias (also symptoms of drug overdose) and, as a result, needed dosage reductions: with less protein, more levodopa reached their brains, and less medication was needed.

An interesting variation in the diet occurred after the study was completed. One former participant who wanted greater mobility during the later part of the day, rather than in the morning, decided to concentrate her high-protein meal in the morning and her low-protein meals at lunch and supper. People with Parkinson's who have obligations or social lives in the later part of the day might want to consult their doctors about following her example.

After the study, some participants who had benefited from the diet tried adding an extra portion of fruit, vegetables, or food made of flour during the day and found that they maintained their benefits.

The protein redistribution diet isn't for everyone. But a nutritious, delicious diet with plenty of liquids, fiber, and sufficient protein should be the aim of everyone who has Parkinson's. With or without the diet, the dosage of Sinemet should be taken forty-five to sixty minutes before the meal.

A large body of research now suggests that a diet with a ratio of 7 grams of carbohydrate to 1 gram of protein is the most effective formulation for maintaining a proper response to levodopa therapy.

Hearty appetite!

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  • gilly
    Does goats milk affect sinamet?
    26 days ago

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