The Protein-Levodopa Link

I’d heard about the value of a low-protein diet for many years, and always thought it was over-hyped. Because levodopa is an amino acid, the thinking is that too much protein in the gut would lessen the amount of levodopa taken up by the brain.

I ignored that thinking for the roughly four years I’ve been taking generic Sinemet (carbidopa/levedopa). I exercise heavily, five or six times a week, and paid no heed to protein consumption. If anything, I sought more of it in my diet, thinking it essential to recovery from those workouts.

But my thinking has completely changed during the past six months. Protein matters. The logic slowly crept up on me, as I struggled with managing my symptoms. 

I take a total of seven tabs of generic 25/100 six times a day. I realized that, from time of ingestion to time of wear off, was only two hours. A dose might take from 30 to 90 minutes to kick in, meaning I would get maybe an hour of relief from each tab. That meant I was getting relief for maybe half of my waking hours — and no relief from the tremors for the other half.

I was observing the standard rule of taking levodopa on an empty stomach: wait at least an hour after eating, then wait another half hour before eating. On a two-hour dosing regime, that meant spending a lot of conscious energy on the eating and dosing schedule.

I started supplementing with a protein shake (whey/casein) at bedtime, thinking that would be a good way to assure sufficient protein intake. But by this time, I was finding that more of my doses of levodopa were failing to provide any relief at all. Maybe I couldn’t wait the half-hour until eating. Maybe my meals were too large. 

But the moment of truth arrived in March, when I failed to get any relief at all from my first dose of the morning. This was a crisis: I live for the structure of my days, and the morning carpool to the kids’ school is the key event. Usually, that morning dose kicked in within a half-hour — the fastest of the day. Now I was getting no relief.

An offhand comment from one of my neurologists had primed me for an epiphany. I described a lunch (tomato soup, black bean soup) that I thought was ultra-healthy, but he pointed out that the beans may have had enough protein to screw up the subsequent dose. Hmm.

Then I got to thinking about that late-night shake (sooo yummy). I skipped the shake one night, and the morning medicine uptake was back to normal. Next night, I skipped the shake. Next morning, everything was fine. Within another day or two, I got serious about tracking my diet, my medicine intake, and my response to the meds. 

The results were immediately apparent, and shocking. I’ll elaborate in another post.