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[log in to unmask] wrote: > There was a note here recently from someone who decided to take most of his > protein foods at suppertime however he noted that he > had difficulty sleeping at night and had leg cramps. > Sinemet seems to help but it can't get past the protein eaten at suppertime. > I am getting relief at the moment by eating all the day's protein before 3 > I wonder if many people with PD have this problem with protein? Dear Barbara, My comments must remain limited to the nutritional aspects of PD; however, I will offer what I can. In my experience, many people with PD begin to suffer such symptoms as "off" times, RLS, and cramping, after having used Sinemet successfully for some time. This is because initially the brain continues to produce some dopamine, and the Sinemet adds enough to allow a continuous supply of dopamine throughout the day. Later, when the brain stops dopamine production, the person must rely totally on Sinemet. The metabolism of Sinemet is doubtless affected by many factors unique to each person; but in many people is affected to a greater or lesser degree by competition with protein, both in the gut and, even more at the blood-brain barrier. Re-distributing protein seems to afford some degree of relief for about 2/3 of those who try it. There are three ways that I am aware of to manipulate protein with regard to PD. In each case, protein is cut back to the minimum amount necessary for health -- .8 grams protein per kilogram body weight, which is between 40-60 grams per day for most people. 1) The first way to redistribute protein is to spread it fairly evenly throughout the day. At 60 grams per day, this would mean roughly 20 grams at breakfast, 20/lunch, and 20/dinner. This is much less protein than people usually eat (at least in America) so this may give some relief, at least initially. 2) A second way is as Syd has described -- to cut back on daytime protein for better mobility during the daytime hours; then to get the bulk of protein at the evening meal. This plan may, as he relates, result in RLS at night. Or, conversely, as you describe, to get most protein during the day prior to 3:00 pm, to alleviate the nighttime RLS. 3) A third way is to use the 7-to-1 carbohydrate:protein ratio. This is a bit more complicated. Carbohydrate is changed to glucose in the intestine and the glucose is released into the blood. Protein is broken down into amino acids in the intestine; the aminos are released into the blood along with the glucose. The theory here is that the very large proportion of carbohydrate will create a corresponding insulin release, as insulin is needed to remove glucose from the blood. Insulin also removes aminos, however; and the small proportion of protein means that there will be relatively few aminos in the blood. Therefore, the insulin may be able to clear them from the blood before they reach the blood-brain barrier. This would leave Sinemet without competition at the blood-brain barrier. If you still have the notes I posted to this list earlier, you'll find that a bread serving contains about a 5:1 ratio of carb:protein. Vegetables are 5:2 or 5:1. Most fruits are almost entirely carbohydrate; syrup, honey, table sugar are pure carbohydrate also. Of the protein foods, cooked dried beans are about 4:1 carb:protein. To utilize this plan, use my earlier notes to determine amounts of carb and protein in foods. If you use meats in 1-ounce portions, combined with bread/pasta/cereals, and some fruit, sugar, etc. you can get the appropriate ratio of carb to protein. Some comments: 1) Your symptoms could depend to some extent on the type of protein eaten (animal vs plant protein). I would recommend strongly getting several servings of plant protein weekly -- unless, of course, you have allergies or aversions, or find that in your case, plant protein does not react well with Sinemet. I have, however, spoken with 3 people who find that plant protein produces more favorable results for them than animal protein. Besides this, beans are the best food source of fiber, both soluble and insoluble. 2) I would keep a food diary for several days, tallying the type and amount of food eaten, along with the time of day, and the timing of Sinemet. For one thing, this will tell a registered dietitian whether you are getting adequate nutrients for good health. It will also help you spot "trouble" proteins. My concern here is that in PD, as with certain other conditions, persons tend to avoid some food groups. In the long term, this can lead to various forms of malnutrition. I am especially concerned with low intake of dairy products, as they are an excellent source of a balanced ratio of calcium:phosphorus. Example: if a PD patient avoids dairy foods, doesn't get outdoors much, and leads a sedentary lifestyle, that person could experience a long-term inadequacy of calcium (from dairy) and vitamin D (found in dairy products and sunlight); the sedentary lifestyle could contribute to bone weakening; and this weakening combined with inadequate calcium and vit. D could seriously affect bone health -- of concern because the person with PD is more liable to fall. Additionally, dietary imbalances could mean inadequate magnesium and potassium, which might very well worsen RLS. I would advise anyone wishing to manipulate dietary protein to discuss it with their physician and ask for a referral to a registered dietitian. The physician can determine whether dietary manipulation is appropriate for the individual. The dietitian can check the food diary to see if present intake is nutritionally adequate, and can help plan daily menus, tailored to individual needs (such as allergies, aversions, adequate protein, weight loss/gain, etc.). Please do remember that the tools of a dietitian are: age, height, weight, recent weight loss/gain, blood pressure, blood cholesterol, diagnosis(es), medications used, food allergies and aversions, and a one-to-three-day diet record. More information may be needed, but this is a good start. With this information, an RD can help you plan daily menus, modify recipes, consider food-medication interactions, and assure nutritional adequacy. I believe this is of special importance with PD; many diseases are nutrition-related and the person with PD has enough concerns without the added worry of heart disease, stroke, diabetes, cancer, osteoporosis or fecal impaction. I'll be glad to answer questions as I am able; the more specific you can be, and the more information you can provide, the better I will be able to help. -- Kathrynne Holden, MS, RD Editor-in-Chief, "Spotlight on Food--nutrition news for people 60-plus" Tel: 970-493-6532 Fax: 970-493-6538 http://www.fortnet.org/~fivstar You may wish to contact: Better Business Bureau of the Mountain States, < [log in to unmask]> for further information.