Sinemet and protein

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

Five Star Living, Inc. -- nutrition you can live with !!
Kathrynne Holden, MS, RD

        NUTRITION AND PARKINSON'S DISEASE
          =20
        (Before making any dietary changes, be sure to consult your=20
personal physician and/or registered dietitian. If you decide to change=20
your protein intake, allow about two weeks for the change to have an=20
effect.)

        A nutritious, balanced daily menu is always important for good=20
health. While we each have slightly different needs, everyone must have=20
carbohydrates, fats, and protein. Minerals like calcium, magnesium, and=20
potassium help manage our blood pressure. Vitamins like A, D, K,  E, and=20
folate are responsible for good vision, heart health, proper blood=20
clotting, and healthy bones. And new nutrients are being discovered in=20
foods every day -- flavonoids, phytochemicals, genistein, omega-three=20
fatty acids -- we've all seen these words in the news lately. All these=20
nutrients, and many more, are important, especially for people with=20
Parkinson's disease.

        Yet those with PD have special needs with regard to nutrition.=20
While they must have carbohydrates, fats, and protein just like everyone=20
else, some foods can interfere with the absorption of the special=20
medications used for PD. Let's take a look at nutrient needs, then see=20
how the medications work, and how food affects them. Then we'll explore=20
ways to get a balanced menu while getting the full benefits from=20
medications.

CARBOHYDRATES
        The best sources of carbohydrates (starches) are whole-grain=20
breads, cereals, rice, and pasta.  This is the type of food that we need=20
in the greatest amount in our daily menu. Carbohydrates provide the=20
steady supply of energy needed by the brain, internal organs, and=20
muscles all day and throughout the night. If we don't get enough=20
carbohydrates, the body will break down the proteins of our own muscles=20
and organs, in order to get the energy supply it needs. Stored fat is=20
used in a different way; it can't replace starch. We must get plenty of=20
carbohydrate daily.

         A serving from the bread group is: one slice bread, 1 ounce=20
ready-to-eat cereal,  =BD cup cooked cereal, rice or pasta; 4 small=20
crackers or 2 large crackers; =BD bagel or English muffin. A very small o=
r=20
inactive woman needs about six servings a day. A large or very active=20
man needs eleven servings or more daily.=20

FATS
        Fats are very important, and we need to get them every day.=20
They're part of the coating around each nerve; the vitamins A, D, E, and=20
K cannot be absorbed without first being dissolved in fat; a layer of=20
fat protects our vital organs and cushions our bones.=20

        It's important to keep fat in the right proportion in the daily=20
menu, though. Fat takes a long time to get out of the stomach. This is=20
important in PD, because Sinemet mixes with the fat and stays in the=20
stomach along with it. This means it takes a long time for the Sinemet=20
to get to the brain and do its work. And, since Sinemet has a very short=20
lifespan, it's life may be nearly over by the time it gets to the brain.

        Good fatty foods are raw nuts, seeds, and avocadoes. They all=20
have heart-protective fats, as well as special vitamins and minerals not=20
found in other foods. Fatty foods to use in moderation are fried foods,=20
meats, high-fat dairy products, butter and other spreads, desserts,=20
candy, gravies and sauces.
        A good idea is to eat some raw nuts daily, and eat small=20
portions of lean meats, fish, and poultry daily. Desserts and fried=20
foods are OK once in awhile.

PROTEIN
        A protein is a long string of tiny molecules called amino acids.=20
Foods highest in protein  are meats, poultry, and fish. Next highest are=20
cheese,  milk, nuts, seeds, and cooked dried beans. Vegetables, and=20
starchy foods, like potatoes and breads, have protein, too, but only a=20
very tiny amount.

        Inside the stomach and intestine, the body breaks up the protein=20
string into separate amino acids. The aminos then are absorbed into the=20
bloodstream and delivered around the body to build new muscle, repair=20
damages, and form certain special chemicals in the brain.

        We need about =BD gram of protein per pound of body weight per=20
day. A 150-pound person needs about 55 grams (two ounces) of protein. =20
Most Americans eat far more protein than that.  If your Sinemet isn't=20
absorbed well, it could help to check the amount of protein you're=20
getting each day.

PARKINSON'S VS PROTEIN
        Each of us has different calorie and protein needs. People with=20
Parkinson's have further complications, because protein interferes with=20
levodopa (Sinemet) absorption, both in the intestine and at the brain.=20
And, each person takes different amounts of levodopa, at different=20
times, and in combination with different additional medications.=20
Finally, PD has different stages, and these stages can affect a person's=20
absorption of medications.

        During the early stages of PD, the brain continues to make some=20
dopamine, so it doesn't have to rely totally on Sinemet. Later on,=20
however, the brain stops producing dopamine. At this time, digestion of=20
protein can greatly slow absorption of sinemet. Why? Because amino acids=20
need a special "carrier" to get across the intestine and into the blood.=20
Then they need another carrier to get from the blood into the brain. The=20
Sinemet uses the same carrier as the aminos. So the aminos and the=20
Sinemet all compete for carriers -- to get into the bloodstream, and to=20
get into the brain. When we eat lots of protein, the aminos win the=20
race.

        Another problem is that Sinemet doesn't last very long. It only=20
stays in the blood for about one hour to an hour-and-a-half.  Once it's=20
gone, the "off" period or "freezing" may return, especially in the later=20
stages of PD. This means that it's imortant for the Sinemet to get to=20
the brain as fast as possible.=20

        Sinemet can travel quickly through the stomach, into the=20
intestine, and from there to the bloodstream when it's taken by itself.=20
Food takes longer to get out of the stomach--especially fatty foods and=20
fiber. If you take Sinemet with food, its short lifespan may be half=20
over by the time it gets out of the stomach. By the time it gets into=20
the bloodstream, and up to the brain, its life is almost at an end. So=20
it's important to get the Sinemet into the bloodstream as quickly as=20
possible.

PARKINSON'S AND CARBOHYDRATE
        Carbohydrate plays a special role in PD. Carbohydrates are=20
converted into  sugar, and released into the bloodstream. Sugar needs=20
insulin in order to get into cells where it's used for fuel. The rush of=20
insulin also removes some of the aminos that compete with levodopa. So=20
eating plenty of carbohydrates with protein may help some people.

 TO GET THE MOST OUT OF YOUR SINEMET:
1)      If your Sinemet works well, and you don't experience any "off"=20
or "freezing" periods, your brain is most likely making some dopamine.=20
That, plus the Sinemet, is probably sufficient for your needs, and=20
unless your doctor says otherwise, you don't need to worry about protein=20
at this time.

2)      If you have begun to experience some "off" times or "freezing"=20
it's possible that your brain's production of dopamine has slowed or=20
stopped; and that protein, excess fat, or fiber is preventing the=20
Sinemet from leaving the stomach quickly, and being absorbed by the=20
brain.=20

        The recommendation is to take Sinemet 30 to 60 minutes before a=20
meal.  The stomach needs about 45 minutes to empty; so the sinemet=20
passes out of the stomach into the intestine without interference from=20
protein.  The medication is absorbed from the intestine into the=20
bloodstream, and gets to the brain before the food can get out of the=20
stomach. If you find that Sinemet by itself makes you nauseous, try=20
taking it with some carbohydrates, such as fruit juice and crackers.=20
Then eat your meal 30-60 minutes later.

3)      If this approach doesn't work well, it may be that you're=20
getting too much protein. It's still recommended to take Sinemet 30-60=20
minutes before a meal. Then, to figure out your personal protein and=20
calorie needs:

        -Start with your weight
        -Divide this by 2.2 to get kilograms
        -multiply the result by 30 to get your calorie needs for one day
        -multiply the result by .8 to get your protein needs (in grams)=20
for the day

        Example: A 150-pound man would divide his weight by 2.2 to get=20
his weight in kilograms:        150/2.2 =3D 68.2 kg

        68.2 kg X 30 =3D 2045 calories per day

        68.2 kg X .8 =3D 55 grams of protein per day

        Now that we know his calorie and protein needs we'll use a=20
special food chart (see FOOD SERVING SIZES) to design two menu plans for=20
him. Calorie and protein amounts rarely come out exactly, so we'll aim=20
to stay within about 100-200 calories, and within about 10 grams of=20
protein. Our food chart shows the approximate amounts of carbohydrate=20
and protein in the main food groups. For more exact amounts, you need a=20
diet manual.

        NOTE: Some people with PD burn extra calories, leading to weight=20
loss. If you are losing weight, it's important to get extra servings,=20
especially of carbohydrates, fruits, and vegetables. You may need to=20
locate a source of low-protein breads, to cut down on protein. Aproten,=20
Paygel, and Cellu make such low-protein products. You may be able to=20
find them at health food stores, larger supermarkets, or specialty food=20
stores.

        FOOD SERVING SIZES

Breads, grains  1 slice bread
                        1 cup cold cereal
                        =BD cup cooked cereal, rice, or pasta=09
15 grams carb/ 3 grams protein/ 80 calories
-------------------------------------------------------------------------=
--------------------------
Vegetables              =BD cup cooked veg.
                        =BD cup chopped raw veg.
                        6 oz veg. Juice
                        l cup raw leafy greens=09
5 grams carb/ 2 grams protein/25 calories
-------------------------------------------------------------------------=
--------------------------
Fruit                   1 medium apple, banana, or orange;=20
                        =BD cup fresh berries;=20
                        15 grapes;=20
                        =BD cup applesauce;=20
                        1/4 cup dried fruit;=20
                        3/4 cup fruit juice=09
15 grams carb/ 0 protein/ 60 calories
-------------------------------------------------------------------------=
--------------------------

Dairy (low or reduced=20
fat choices)            8 oz milk or yogurt : 12 grams carb/ 8 grams=20
pro/ 100 calories
                        1 =BD oz cheese : 1 gram carb/ 10 grams protein/=20
150 calories
                        1 cup cottage cheese : 6 grams carb/ 28 grams=20
protein/ 160                            calories
-------------------------------------------------------------------------=
--------------------------
Protein
(medium-fat meat, poultry choices)=09
                        1 oz meat, poultry, fish: 3 grams carb/ 7 grams=20
protein/ 75                             calories
                        1 cup cooked dried beans : 30 grams carb/ 7=20
grams protein/ 225                              calories
                        1 egg : 0 grams carb/ 6 grams protein/ 80=20
calories
                        Mixed nuts, 1 ounce (4 TB) : 5 grams carb/ 7=20
grams protein/                          175 calories
                        Peanut butter, 2 TB     5 grams protein/ 9 grams=20
carbo/=20
                                185 calories

-------------------------------------------------------------------------=
--------------------------
Fats
                        Butter, margarine,  1 tsp: 0 carb/ 0 protein/ 45=20
calories
                        Avocado, 1/4 :  3 grams carb/ 1 gram protein/ =20
75 calories
-------------------------------------------------------------------------=
--------------------------

MENU PLANS
        One approach is to use the food chart to spread the protein=20
throughout the day, in small amounts (see PLAN 1). However, some people=20
still find that they have reduced mobility during the day. They may wish=20
to try eating the bulk of their protein at the evening meal (see PLAN=20
2).

        PLAN 1
(Protein is spread throughout the day. This plan may work best for=20
people with good mobility. Calories and protein are about right for a=20
150-pound person -- 2000 calories and 55 grams protein. Discuss this=20
plan with your physician before you start.)

BREAKFAST:              =09
6 oz orange juice : 15 grams carb/ 0 protein/ 60 calories
1 egg : 0 carb/ 6 gram protein/ 70 calories
2 slices whole-wheat toast : 30 grams carb/ 6 grams protein/ 160=20
calories
1 TB butter : 0 carb/ 0 protein/ 100 calories
2 TB jam : 26 grams carb/ 0 protein/ 100 calories
1 cup fresh fruit : 30 grams carb/ 0 protein/ 120 calories

Total for breakfast: 101 grams carb/ 12 grams protein/ 610 calories

LUNCH:=09
1 cup bean soup : 20 grams carb/ 6 grams protein/ 150 calories
8 saltines : 30 grams carb/ 6 grams protein/ 160 calories
2 TB pnut butter : 6 grams carb/ 9 grams protein/ 200 calories
=BD cup carrot sticks : 5 grams carb/ 2 grams protein/ 25 calories
1 cup fresh fruit : 30 grams carb/ 0 protein/ 120 calories
4 oz 1% or skim milk : 6 grams carb/ 4 grams protein/ 50 calories

Total for lunch: 96 grams carb/ 27 grams protein/ 705 calories

DINNER:=09
2 oz broiled chicken : 0 carb/ 14 grams protein/ 130 calories
1 small baked potato : 25 grams carb/ 2 grams protein/ 100 calories
2 TB sour cream : 1 gram carb/ 1 gram protein/ 50 calories
2 cups tossed salad : 4 grams carb/ 2 grams protein/ 25 calories
2 TB Oil & Vinegar Drsg. : 0 carb/ 0 protein/ 100 calories
1 dinner roll : 15 grams carb/ 3 grams protein/ 80 calories
1 TB butter : 0 grams carb/ 0 grams protein/ 100 calories
4 oz skim or 1% milk : 6 grams carb/ 4 grams protein/ 50 calories

Total for Dinner: 51 grams carb/ 26 grams protein/ 635 calories

TOTAL FOR DAY: 248 grams carb/ 65 grams protein/ 1950 calories
-------------------------------------------------------------------------=
--------------------------

        PLAN 2
(Protein is mainly restricted to the evening meal; this may improve=20
daytime mobility for people who have greater shifts "on and off" in=20
their ability to move. Calories and protein are about right for a=20
150-pound person -- 2000 calories and 55 grams protein. Discuss this=20
plan with your physician before you start.)

BREAKFAST               =09
6 oz orange juice : 15 grams carb/ 0 protein/ 60 calories
3/4 cup Whole Grain Total : 24 grams carb/ 3 grams protein/ 110 calories
4 oz non-dairy creamer : 16 grams carb/ 0 protein/ 176 calories
1 cup fresh fruit : 30 grams carb/ 0 protein/ 120 calories

Total for Breakfast: 85 grams carb/ 3 grams protein/ 466 calories

LUNCH           =09
1-1/2 cups vegetable soup (no meat, poultry or beans) : 30 grams carb/ 3=20
grams   protein/ 195 calories
2 large rye crackers : 15 grams carbohydrate/ 2 grams protein/ 80=20
calories
1 medium banana : 15 grams carb/ 0 protein/ 80 calories
8 oz tomato juice : 5 grams carb/ 0 protein/ 45 calories

Total for lunch: 65 grams carb/ 5 grams protein/ 400 calories

DINNER          =09
8 oz 1% or skim milk : 12 grams carb/ 8 grams protein/ 100 calories
Cheeseburger, containing --=20
4 oz hamburger : 0 carb/ 28 grams protein/ 300 calories
1-1/2 oz cheese : 0 carb/ 7 grams protein/ 150 calories
1  bun : 30 grams carb/ 5 grams protein/ 160 calories
1 sliced tomato : 5 grams carb/ 1 gram protein/ 25 calories
1 cup ice cream : 31 grams carb/ 5 grams protein/ 300 calories
2 oatmeal cookies : 16 grams carb/ 1.5 grams protein/ 120 calories

Total for Dinner: 94 grams carb/ 55.5 grams protein/ 1155 calories
TOTAL FOR DAY:  244 GRAMS CARB/ 64.5 GRAMS PROTEIN/ 2021        =09
                CALORIES
-------------------------------------------------------------------------=
--------------------------
=09
        Again, though, because PD may follow several stages, and is=20
further complicated by different types of medications, in different=20
dosages, these menu plans may require experimenting. One person may get=20
along fine getting most protein in the evening, while another may find=20
sleep impossible due to "freezing."

        You will need to try your Menu Plan for about two weeks; if you=20
don't feel any better by then, protein changes are probably not the=20
answer.  The amount of Sinemet you use and the stage of PD are important=20
factors. But studies show that about 60% of people respond favorably to=20
protein changes.

        Also, some people find that a particular protein food, such as=20
dairy products or meat, blocks absorption of Sinemet. First, try eating=20
a smaller amount of that food -- say, 4 ounces of milk, or one ounce of=20
meat at a meal. If symptoms still persist, it may be necessary to adopt=20
a vegetarian or semi-vegetarian menu plan. Cooked dried beans are an=20
excellent source of protein, minerals, fiber, and carbohydrates. They=20
also have a large proportion of carbohydrates, compared to protein.=20
Nuts, and seeds such as sunflower and sesame seeds, contain both protein=20
and heart-protective fats, as well as important trace minerals not=20
easily found in other foods.

        However, if you're not able to tolerate milk at all, it's best=20
to take a calcium supplement, as well as vitamins A and D. And if you=20
can't tolerate any animal protein, such as meat, poultry, fish, dairy=20
products, or eggs, you should also take a B12 supplement that meets the=20
RDA of two micrograms per day. A good idea is to take one of the many=20
excellent multivitamin/mineral supplements on the market. If you're in=20
doubt, ask your physician or a pharmacist.
--=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:
Better Business Bureau of the Mountain States,
< msbbb@xxxxxxx>
for further information.