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Amount and distribution of dietary protein affects clinical response to levodopa in Parkinson's disease

Department of Neurology, Oregon Health Sciences University. Portland, OR (Ms. Carter, Drs. Nutt and Woodward, and Ms. Trotman)
Department of Pharmacology, Oregon Health Sciences University. Portland, OR (Dr. Nutt)
Department of Biochemistry, Oregon Health Sciences University. Portland, OR (Dr. Woodward)
School of Medicine, Oregon Health Sciences University. Portland, OR (Ms. Carter, Drs. Nutt and Woodward, and Ms. Hatcher)
School of Nursing, Oregon Health Sciences University. Portland, OR (Ms. Carter).

Reducing dietary protein improves the effectiveness of levodopa (LD) but the most effective distribution of a low-protein diet (0.8 g/kg) is unclear. We compared a 1.6 g/kg protein diet, a 0.8 g/kg diet with protein evenly distributed between meals, and a 0.8 g/kg diet with protein restricted to the evening meal in 5 parkinsonian patients with motor fluctuations. We monitored clinical response, plasma LD, and plasma large amino acids (LNAAs) hourly throughout the day. Mean "on" times were 51% (1.6 g/kg diet), 67% (0.8 g/kg evenly distributed), and 77% (0.8 g/kg restricted). Hourly averages of plasma LD did not differ between the diets. The mean plasma LNAAs were 732 nmol/ml (l.6 g/kg diet), 640 (0.8 g/kg distributed), and 542 (0.8 g/kg restricted), and the diurnal pattern reflected the distribution of protein intake. In conclusion, the amount and distribution of dietary protein affect clinical response to LD. These effects are not related to LD absorption but are explained by the variation in plasma LNAAs.

Address correspondence and reprint requests to Ms. Carter, Department of Neurology–L226, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97201.

Supported by NIH-NINCDS R01NS21062-04 and Clinical Research Center grant RR 00334.

Presented in part at the fortieth annual meeting of the American Academy of Neurology. Cincinnati, OH, April 1988.

Received July 22, 1988. Accepted for publication in final form November 22.1988.

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