Objective: To compare levodopa/carbidopa intestinal gel (LCIG) with equally distributed dietary protein (Diet_EDP) versus restricted to twice daily (Diet_RP) and Mediterranean diet (Diet_M).

Background: Levodopa (LD) response in Parkinson’s (PD) becomes fluctuating after 5-10 years,¹ partly due to slow gastric emptying,² which is avoided with LCIG.³ However, neutral amino acids compete with LD for gut absorption and blood-brain transport,^4,5 posing a challenge for timing of protein-containing meals.

Method: We prospectively modified the diet of nine consecutive people with Parkinson (PwP’s) treated with LCIG attending a tertiary movement disorders clinic, thus: (1) Diet_M₁, active control, 3 weeks, (2) Diet_ EDP, 5-6 small protein portions of equal amount, 3 weeks, (3) Diet_M­₂ (washout), 2 weeks, (4) Diet_RP, a large portion of fast absorbing protein twice a day: prior to connecting to LCIG and after disconnecting from LCIG, 3 weeks. Hauser diary, extra-doses (ED), Parkinson’s Disease Questionnaire 39 (PDQ39), Clinical Global Impression scale (CGI) for patient, physician and care partner, bowel frequency (BF), and stool consistency (SC) were measured by blinded raters before and after each diet.

Results: Four PwP’s dropped out during Diet_ EDP due to withdrawal of consent unrelated to the study. Diet_ EDP was superior to Diet_M­₁ per OFF-time (2.5±0.8h vs. 5.7±2.1h, p<0.05), ON-time without dyskinesia (9.8±5.2 vs. 6.8±4.3h, p<0.05), ED (2.1±1.3 vs. 4.6±2.2, p<0.05), CGI by patient and care-partner (p<0.01 and <0.05, respectively), and SC (2.8±0.4 vs. 1.6±0.5, p<0.01). Washout worsened OFF-time (5.4±1.9 vs. 2.5±0.9h, p<.05) and CGI patient (p<0.05). One patient didn’t tolerate washout. Diet_RP worsened the symptoms in everyone (n=5) and only one patient completed Diet_RP.

Conclusion: Our study supports that equally redistributing dietary protein intake improves motor and global function. Whereas, concentrating protein intake to before and after LCIG infusion had low retention and poor tolerability. Larger studies are needed to confirm these findings and inform dietary recommendations for PwP’s treated with LCIG.

References: 1. Hauser RA, LeWitt PA, Comella CL. On demand therapy for Parkinson’s disease patients: Opportunities and choices. Postgrad Med. 2021 Sep;133(7):721-727. doi: 10.1080/00325481.2021.1936087. Epub 2021 Jun 30. PMID: 34082655.
2. Djaldetti R, Baron J, Ziv I, Melamed E. Gastric emptying in Parkinson’s disease: patients with and without response fluctuations. Neurology. 1996 Apr;46(4):1051-4. doi: 10.1212/wnl.46.4.1051. PMID: 8780089.
3. Williams LJ, Griffith J, Waller SE, Kwan VP, Fung VSC. The Profound Impact of Gastrointestinal Stasis on Levodopa Response in Parkinson’s Disease. Mov Disord Clin Pract. 2022 Feb 25;9(3):394–6. doi: 10.1002/mdc3.13425. PMCID: PMC8974886.
4. Nutt JG, Woodward WR, Hammerstad JP, Carter JH, Anderson JL. The “on-off” phenomenon in Parkinson’s disease. Relation to levodopa absorption and transport. N Engl J Med. 1984 Feb 23;310(8):483-8. doi: 10.1056/NEJM198402233100802. PMID: 6694694.
5. Nutt JG, Woodward WR, Carter JH, Trotman TL. Influence of fluctuations of plasma large neutral amino acids with normal diets on the clinical response to levodopa. J Neurol Neurosurg Psychiatry. 1989 Apr;52(4):481-7. doi: 10.1136/jnnp.52.4.481. PMID: 2738591; PMCID: PMC1032296.
6. Guebila MB, Thiele I. Model-based dietary optimization for late-stage, levodopa-treated, Parkinson’s disease patients. NPJ Syst Biol Appl. 2016 Jun 16;2:16013. doi: 10.1038/npjsba.2016.13. PMID: 28725472; PMCID:

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/dietary-protein-redistribution-influences-the-efficacy-of-levodopa-carbidopa-intestinal-gel-lcig-infusion/