About 60,000 new cases of Parkinson’s disease are diagnosed in the U.S. each year. It is the second most common neurodegenerative disorder after Alzheimer’s disease. Parkinson’s is a disease of the central nervous system where there is a loss of brain cells that produce the chemical dopamine. It affects nearly 10 million people around the world and there is no cure for the disease.
Symptoms develop gradually, and may start off as just a tremor in one hand, but include balance difficulties, stiff limbs, slower movement and facial, hand, arm and leg tremors. Medication and deep brain stimulation can only help make some of the debilitating symptoms tolerable.
I recently spoke at the Parkinson’s disease support group in Bangor. When I present to a disease-specific support group, I’m always just a bit intimidated because I feel that the people who are living with a disease every day know much more about it than I do. But since they invite me to come speak, they must think that I have something of value to say, so I agree to go, and I speak. What I found out at this support group was that not many people were aware of the impact that protein intake can have on the absorption of Sinemet, a common medication prescribed for PD.
Sinemet is a combination of levodopa with cardibopa or benserazide. Many people experience nausea when they first begin taking this medication. To help with nausea, it is best to eat some nonprotein food along with it. Ginger tea, ginger ale or ginger candy may help settle the stomach. A graham cracker or a soda cracker along with the ginger tea may be helpful.
Once you start taking Sinemet you should take it 30 to 60 minutes before a meal. This is because the protein in the meal is broken down in the intestine into amino acids. These amino acids travel across the intestinal wall to get into the blood. Then they have to cross the blood-brain barrier to get into the brain. Sinemet also has to travel across the intestine and the blood-brain barrier using the same carrier system as the amino acids. The amino acids use up all of the carriers so the Sinemet must wait until the carriers are free again so they can cross over into the bloodstream. By taking the Sinemet before a meal, it can be quickly absorbed before the food can interfere.
If you take Sinemet with a meal or just after a meal, it will take a very long time for the Sinemet to be absorbed. The stomach takes about one to three hours to empty, depending on the nutrient content. The Sinemet mixes with the food and therefore will take the same amount of time to leave the stomach as the food.
For people with PD who would like to adjust their protein intake, there are three protein plans that can be implemented: balanced protein, evening protein and a high-carbohydrate plan. Some people have found a high-carbohydrate plan to be so successful that they need less levodopa, so a physician needs to be involved to determine the correct amount. If either of these plans is of interest, I would strongly encourage you to contact a registered dietitian for assistance in working out the specifics of the macronutrients.
High-protein foods include meat, poultry, fish, milk, cheese and eggs. In particular, for many people milk blocks levodopa to a greater extent than other protein-rich foods. A diet that will help get better results from Sinemet is one where a large amount of fruits, vegetables and grains are consumed. At a meal a portion of meat should be no more than 3 or 4 ounces (about the size and thickness of a deck of playing cards). Substitutions for cow’s milk are soy or rice milk that are fortified with calcium and vitamin D.
It is beneficial to incorporate plant protein as part of your protein needs. Plant protein includes dried beans, peas, nuts and seeds. Legumes have more fiber than other foods and fiber helps with constipation which is a big problem for people with PD. Incorporate beans into soups, refried beans, three-bean salads and try premade soy protein burgers such as Boca Burgers or Morning Star Farms products which can be found in your grocery store freezer.
Note: The Parkinson’s disease support group meets at 1 p.m. the third Sunday of the month at Acadia Hospital.
Georgia Clark-Albert is a registered dietitian nutritionist and certified diabetes educator at Penobscot Community Health Care in Bangor. She provides nutrition consultant services through Mainely Nutrition in Athens. Read her columns and post questions at bangordailynews.com or email her at GeorgiaMaineMSRDCDE@gmail.com.