Food as Medicine for Parkinson's - Part 5: Protein, Levodopa & Metabolic Support

We are delighted to share the recording of last Thursday's webinar featuring Lucille Leader, the Nutrition Director of the Parkinson's Disease Integrated Nutrition Clinic in London, UK (www.lucilleleader.com) and a renowned expert in nutritional therapy for Parkinson's. Lucille has received the “Quality of Life in Parkinson’s Disease Award” in the USA and the “Outstanding Practice Award” in the UK. She is the author and co-author of 6 books on Parkinson’s Disease, academic lecturer on MSc degree courses and lectured at International Parkinson’s Disease Congresses.

In this highly practical session, Lucille explores the intricate relationship between protein intake and dopamine metabolism. She shares essential insights into managing the timing of your meals and supplements to optimise how L-DOPA medication works and to minimise side effects, demonstrating
how precision monitoring of L-dopa drug response at different doses, can enable the ability to smooth over the “Off-Period”.

Other Key takeaways from the session include:

• The Importance of Cellular Energy: Exploring how natural Cellular Energy produced in the Power Houses (Mitochondria) of our cells is compromised in Parkinson’s Disease and how L-dopa medication also impacts this process. Learning how essential it is in the metabolic management of Parkinson’s Disease to support the Cell Energy Cycle (The Citric Acid /Krebs Cycle) and which specific nutrients, specialised diet and oxygenation are indicated for this support.
• Broad Metabolic and Systemic Support: Discovering the vital role the Bowel plays in nutrient and drug absorption, some recommendations for chronic intestinal dysfunction with recommendations for specialist referrals, alongside practical advice on the importance of monitoring Skin health, Thyroid function, and the importance of Stress Management – techniques recommended.

Recommending Multidisciplinary Team Support, Medical as well as Specialised Nutritional, Genetic, Viral and Bacterial Laboratory Tests implicating functional health in Parkinson’s Disease.

Stay Connected via our new website: ParkinsonsInsights.com — Visit for daily curated news, expert commentaries, and our webinar archive.

Disclaimer: This session is for informational and educational purposes only. Always consult with your medical professional before making changes to your care plan.
See https://nosilverbullet4pd.com/disclam... for full disclaimer.

Questions and Answers: Lucille Leader

Have you had success with FOG and stiffness?

No specific improvements with FOG. Stiffness is for medical assessment and
dopaminergic or other recommendations.

I’ve had gastric bypass surgery, how does that affect the metabolism and
interaction with Levo-Dopa.? I already take B12 injections monthly, anything
else should I monitor?

If the bypass is after the absorption site in the proximal small bowel, there should be
no hindrance to absorption of L-dopa. However, I cannot comment for you,
personally, as I am not aware of your health status.

Re what to monitor as regards other nutrients and routine medical tests: On my
Webinar slide Presentation I have listed routine tests… but the choice for you is
dependent on your personal clinical health. You need to be guided by a Nutrition
Practitioner who works in collaboration with your Medical Practitioner.

In case this isn't covered in the presentation, may I ask if the dispersible
Levodopa tablets /madopar have the same issues regarding meal timing and
proteins impacting brain uptake as do the tablets that are swallowed?

Madopar dispersible has the same timing consideration as other L-dopa formulations

• it is L-dopa with the same absorption site and competition for absorption with the
  large neutral amino acid as any other form of the drug.

With the B6 element, is there a link between KPU and PD? Thank you for a very
clear presentation.

KPU is associated with Zinc and B6 deficiencies. Test for these and Kryptopyroles
for assessment. See the interesting research on this subject and PD.

Is coffee OK? Does half&half have enough protein to matter?

Coffee is not an issue. Trace amounts of protein only.

Re your example of calculating the time of dosing to avoid OFF times, how
would you modify that if you have 2 doses of Levodopa with different life
times. Say Sinemet starts in 20 mins and is a short acting and a longer acting
ER that starts at 60 mins and lasts 2 hours?

You need to change your timing of food according to the differing monitoring results
at different times.

Does the warning about protein include beans, (kidney, black, etc)

They and other high lectin content beans are of consideration as protein, at the time
of taking L-dopa.

Research demonstrates that red kidney beans can impact the permeability of the gut
mucosa. Therefore, the status of the intestinal mucosa also needs assessment when
advising on diet considerations.

Any advice for us on a slow release carbi/levodopa?

Slow Release L-dopa formulations can last for some hours – therefore during that
period, protein competition is an important consideration. If you cannot only take it at
night but need it during the day, you will need special attention to appropriate protein
administration when you have a window. A predigested hydrolysed protein drink may
be helpful as it is more rapidly absorbed than whole protein. Protein metabolises
endogenous L-dopa and is essential for general health.

With the importance of mitochondria does it make sense to encourage
mitophagy and if so how?

See the research on mitochondria, mitophagy and Parkinson’s disease.
I recommend for your interest the specialised Mitochondrial tests,
including Mitophagy, represented by AONM in the UK
(Gilian Crowther: Email: gilian@aonm.org Website: www.AONM.org)

I am taking 6 x 100/25 LDopa during the day meaning a tablet every 2.5 hours.
Over recent months I am wearing off as quickly as every approx 2 hours, I also
take Opicapone and Safinamide. Timing of meals is a real challenge and my PD
Dr says I should not take L Dopa more frequently than I currently do. A recent
blood test shows low B6 so maybe I need to take a supplement? Also I think a
patch might be prescribed to see if this helps. When ON I do get dyskinesia
but find this preferable to being OFF as I am prone to Freeze and falling - do
you agree that taking L Dopa more frequently than every 2.5 hours should be
avoided? A pump was suggested but a recent consultation at Kings London I
think is going to say no to a pump until a patch has been tried… but previously
my regular PD team have steered away from prescribing Agonists - this is an
excellent session thank you, Adrian.

Certainly your neurologist is correct in advising you to keep to that total dosage over
the day. However, for some people, taking a smaller dose more frequently (not
going beyond the total daily dosage prescribed) can be helpful. This needs to be
discussed with your doctor. Do recall that if you have a small window only for
protein, a predigested hydrolysed protein drink may be helpful as it is more rapidly
absorbed than whole protein. Protein metabolises endogenous L-dopa and is
essential for general health.

Are you saying don’t take soy at all? Or just in the 2 hours before taking pills?

Soy is a whole protein, so the timing of taking it is the same as for all dense proteins
which will compete for absorption with L-dopa. However, its suitability for
personalised diet needs to be assessed by a Nutrition Practitioner.

Many of your slides cite research that is 10-20 yrs old. Are these studies still
accurate and valid?

Interesting that these facts were already considered then.

I have heard that taking Levodopa medication with sparkling mineral water and
vitamin C improves absorption. Is there any research or evidence for this?

I do not have experience with sparkling water and absorption of L-dopa medication.

DISCLAIMER - CAUTIONARY NOTE: Lucille Leader does not take responsibility for the outcome or misinterpretation of any of her anwers as the aspects pertaining to the questions are essentially the responsibility of patients' inidvidual healthcare teams, who are familiar with the individual's clinical status.