Managing Levodopa and Eating Protein: Not a One-Size Fits All Approach 

By Anna Shavers

Eating protein-rich foods (meat, eggs, fish, etc.) can impact the absorption of levodopa, a commonly prescribed Parkinson’s disease (PD) medication. 

This phenomenon occurs because levodopa and dietary protein use the same pathway to cross the gastrointestinal (GI) lining. When a person with PD (PWP) eats protein before taking levodopa, the dietary protein can directly compete in the gut for absorption making it more difficult for the body to fully absorb levodopa.

If levodopa is not properly absorbed, a PWP may experience fluctuations in their symptoms, which can be frustrating and challenging and can lead to concerns about their levodopa dosage not being effective.

Current research points to restricting and timing dietary protein intake when taking levodopa and sometimes increasing the dosage of levodopa, but these methods generally fall short when used as a “go-to” method as bodies are different and change over time.

“Addressing protein interactions in PWP is not a one size fits all approach. We need to customize the recommendations to fit the person we are treating,” said Carley Rusch, Ph.D., RDN, LDN, former nutrition doctoral student at the Norman Fixel Institute for Neurological Diseases at UF Health. 

In a recent study published in Nature, researchers provide a comprehensive look at these methods and highlight some considerations for the current and future needs in managing the protein and levodopa interaction for PWP.

“This is a very complex area with a lot of gaps in knowledge and evidence. Increased collaboration with allied health professionals and creation of dietary guidelines to manage diet in PWP among national organizations should be prioritized. Recognizing the critical role of nutrition and dietitians in the wellness of PWP is important,” said Indu Subramanian, M.D., movement disorder neurologist at the Parkinson’s Disease Research, Education and Clinical Center (PADRECCs) at UCLA Health.

Carefully planning when to take levodopa and when to eat protein-rich foods might help optimize levodopa absorption. 

PWP and their caregivers should work with their doctor and dietitians to create a personalized care plan that includes a well-balanced meal plan that takes into account their PD severity, age, gender, ethnicity, GI tract and genetics.

“With this study, we wanted to ensure a uniquely open-minded and transdisciplinary approach. That is why we included the voices of a PWP, a dietitian, a pharmacist and a movement disorders neurologist in our research analysis,” said Rusch. “We believe the best care plan for the protein-levodopa interactions is a holistic approach that emphasizes the patient-centered care and remains mindful of all the individual influences like age, PD severity and more.”

In addition to Rusch and Subramanian, the research team included Richelle Flanagan, co-founder and CEO of My Moves Matter and Hyojin Suh, Pharm.D, pharmacist at PADRECCS at UCLA Health.

Read the full article in Nature.