Re: Sinemet and food

["Kathrynne Holden, MS, RD" <fivstar@xxxxxxxxxxx>]

Camilla Flintermann wrote:
> I have to confess to some
> confusion about the Sinemet/food connection.  We have had very persuasi=
ve
> info from a number of people to the effect that Sinemet taken with food
> loses much of its value by the time it gets out of the stomach. It soun=
ds
> so reasonable--then I notice that Peter's new RX bottle of Sin.CR 50/20=
0
> has a label shouting "TAKE WITH FOOD" !=20

Camilla,
Regular Sinemet is best taken on an empty stomach. Also, protein=20
redistribution may help those who are beginning to experience "on/off"=20
periods. Protein in sizable amounts hinders its absorption; this may not=20
be a problem in early stages of PD, when the brain still produces some=20
dopamine, but may be a problem later on, causing some "freezing" or=20
"off" times. This is because both amino acids (from the protein) and=20
Sinemet require a special carrier to get across across the intestine and=20
into the blood. The aminos and Sinemet compete for these carriers, and=20
if Sinemet is taken with a lot of protein, the aminos win the race.

HOWEVER:
The sustained-release version (Sinemet CR) should be distinguished from=20
Sinemet in this respect. While both contain levodopa/carbidopa=20
combinations, the sustained-release version is designed to work very=20
slowly over a greater period of time, minimizing fluctuations=20
in mobility. It is best taken with food because food takes longer to get=20
through the stomach and intestine; the Sinemet CR goes with it, slowly=20
dissolving along the way.

Here's a paragraph from "Clinical Pharmacology" that may illustrate what=20
I'm saying.

"Pharmacokinetics: Sinemet=AE is administered orally. Following oral=20
administration, amino acid transport mechanisms carry levodopa across=20
the membrane of the GI tract, with approximately 30=9750% of the drug=20
entering the circulation. As a result, high concentrations of amino=20
acids in the GI tract (i.e., a high-protein diet) can interfere with=20
absorption of levodopa. "

As you see, only about 50% of Sinemet makes it out of the intestine and=20
into the blood. Taken with protein, even less Sinemet gets into the=20
blood. But this is not the case with Sinemet CR.

> Now I wonder, are we correct in believing there's a problem, and that w=
e need
> to wait 30-60 min. after taking it before eating?=20

This is true for regular Sinemet.

>Is there something about
> the CR form that makes a difference in this way? =20

As discussed, Sinemet CR should be fine taken with food.

The problem, as I see it, is that for many people, both Sinemet and=20
Sinemet CR must be used. In this case, I'd try to take the Sinemet on an=20
empty stomach, or with carbohydrates, like breads, crackers, etc. Then=20
take the Sin. CR with food.

For a listing of high-protein foods, I'll e-mail the notes I made up on=20
protein distribution separately.
Best regards,
--=20
Kathrynne Holden, MS, RD
Editor-in-Chief,
"Spotlight on Food--nutrition news for people 60-plus"
Tel: 970-493-6532   Fax: 970-493-6538=20

You may wish to contact:
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for further information.