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Dear Phil, > I'm wondering to what degree food intake is a factor. Is my > difficulty in finding just the right drug dose a result of not paying > enough attention to what did I eat and when did I eat it? There's no easy answer to your questions, because everyone with PD is affected differently by food. But here are some observations, for what they're worth. Avoiding protein throughout the day (no more than 10 grams before the evening meal) then having a large protein portion at the eve. meal works quite well for many people with PD who experience the motor fluctuations you describe. > I know about the desirability of maintaining that nice 1/7 ratio of > protein to other nutrients, although I haven't tried to observe this > rule consistently. I prefer the 7:1 eating plan when possible, because it's more natural than the "evening protein plan." I think it offers a better variety of protein, too. About 2/3 of PWP receive extended benefits from levodopa -- longer "on" time, fewer fluctuations. Some report they can reduce their Sinemet with this plan. However, not everyone benefits -- some are extremely sensitive to even small amounts of protein, and need to use the "evening protein" plan. > Are there other factors that can be important, > such as the quantity of food eaten, It's best to eat small meals with snacks in between; delayed stomach emptying can be a factor in PD, and means that food takes longer to empty from the stomach into the intestine. This can also delay Sinemet absorption. A large meal, or one that's high in fat, will take longer to empty from the stomach. > the time drugs are taken vs. > time of eating, It's important to take Sinemet 30-60 minutes before meals. Sinemet CR can be taken with meals, but studies have shown that this will delay the onset of effectiveness somewhat; taking Sinemet CR 30-60 minutes prior to meals will produce quicker results. > the frequency of food intake, Frequency should be a concern only if the foods are high in protein. > ratio of solids to liquids, Only if the solids or liquids contain protein (i.e., milk is high in protein, fruit is protein-free) > the effects of regularity and of constipation (and its > opposite), Constipation appears to delay effectiveness of levodopa, for reasons I don't understand. I counsel my clients to maintain a fiber-rich eating plan, with two quarts of fluids daily to help maintain regularity. Most report better regularity and increased benefit from levodopa. > Will I have to become really disciplined about food, and in the end > eat the same things every day at the same time and in the same > quantity in order to achieve the right drug effective doses? This varies greatly from one person to the next. I would suggest you work closely with your neurologist and a registered dietitian to develop an individual plan that works best for you. You should NOT have to eat the same things every day, but might have to time meals and meds pretty closely. > When I > pig out, do I in effect cast my pills before swine? (LOL!) Well -- only if you pig out on lots of protein! My very best regards, Kathrynne -- Kathrynne Holden, MS, RD "Nutrition you can live with!" Medical nutrition therapy http://www.nutritionucanlivewith.com/ Tel: 970-493-6532 // Fax: 970-493-6538 "If we knew what it was we were doing, it would not be called research, would it?" -Albert Einstein