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Dear Harlan, Welcome to the List. There are many other young-onset members besides yourself. Good for you for exercising regularly, and for seeking information. > Sometimes, I stiffen up, especially after a big meal, when my sinemet cannot > get into my small intestine because my lunch is in my stomach. This is the > most disturbing time for me. > If anyone has some advice, besides eating a smaller lunch, as to how to avoid > stiffening up in the afternoon after a big meal, I would be happy to receive > such. Are you taking regular Sinemet or Sinemet CR (or a combination)? Regular Sinemet must be taken at least 30 minutes prior to meals. Sinemet CR, taken WITH meals will take longer to get into the bloodstream, but may produce a more consistent effect; taken BEFORE meals, it will kick in sooner. Tasmar must be taken prior to meals. One of my clients esperienced the same problem you have; she was convinced she needed a pallidotomy, because Sinemet did not work for her. On reviewing her record of medications/meals, I discovered she was taking her midday Sinemet with her meal. I suggested she begin taking it 30-45 minutes prior to to meal, and her afternoon stiffness immediately cleared up. Regarding size of meals -- I understand that smaller, more frequent meals can be inconvenient, however these are often by far the most effective for people with PD. The GI tract may slow down, meaning that food takes longer to clear the stomach, and also to move through the intestines. A large meal will takes considerably longer than a small meal, and can significantly delay medication uptake. To get the most out of your medications, you may find it helps to eat a number of small meals and nutritious snacks, rather than 3 large meals a day. Best regards, Kathrynne -- Kathrynne Holden, MS, RD Medical nutrition therapy "Eat well, stay well with Parkinson's disease" "Parkinson's disease: assessing and managing unique nutrition needs" http://www.nutritionucanlivewith.com/