Treatment of Parkinson disease with diet-induced hyperketonemia: A feasibility study
Mazen G.Jabre, Parkinson, Memory & Movement Disorders Center, Notre Dame des Secours Hospital, Byblos/Jbeil-Lebanonparkin@terra.net.lb
Boulos-Paul W Bejjani
Submitted June 27, 2005
VanItallie et al shed light on an underestimated
therapeutic approach in the management of Parkinson disease (PD) based
on diet modulation. [1] In their article, five patients at
mild and advanced disease stages responded to a hyperketogenic diet (HKD)
with a marked improvement of general motor disability. Authors were
cautious, taking into consideration
the small number of patients, the lack of a control group, as well as the
possible placebo effect.
We agree with authors’ concerns but question the
applicability of and compliance with such a complex diet in a naturalistic
setting, even if there is firm evidence of HDK safety and efficacy in PD
patients.
Alternatively, the five reported PD patients were either overweight or
obese had a body-mass index range of 28.4 to 35.9 kg/m². Losing body
weight (mean, 6.1 kg; range 4.1-9.5 kg) was found to alter levodopa
pharmacokinetics and led to an increase in levodopa cumulative dosage per
kilogram of body weight. [2] Moreover, a greater levodopa bioavailability
and brain level would be reached using a very low-protein diet. [3]
At a lower body weight and under tight protein restriction, the same oral levodopa dose that patients used to take when they were heavier or on regular diet, would lead to higher systemic levels. We therefore expect an ensuing heightened efficacy on parkinsonian symptoms and motor fluctuations and,at times, a putatively dyskinesogenic effect, as to require dosage reduction.
References
1.VanItallie TB, Nonas C, Di Rocco A, Boyar K, Hyams K, Heymsfield
SB. Treatment of Parkinson’s disease with diet-induced hyperketonemia: A
feasibility study. Neurology 2005; 64: 728-730.
2.Zappia M, Crescibene L, Arabia G, Nicoletti G, Bagala A, Bastone L,
Caracciolo M, Bonavita S, Di Costanzo A, Scornaienchi M, Gambardella A,
Quattrone A. Body weight influences pharmacokinetics of levodopa in
Parkinson's disease. Clin Neuropharmacol 2002; 25: 79-82.
3.Pincus JH, Barry KM. Plasma levels of amino acids correlate with
motor fluctuations in parkinsonism. Arch Neurol 1987; 44:1006-1009.
VanItallie et al shed light on an underestimated therapeutic approach in the management of Parkinson disease (PD) based on diet modulation. [1] In their article, five patients at mild and advanced disease stages responded to a hyperketogenic diet (HKD) with a marked improvement of general motor disability. Authors were cautious, taking into consideration the small number of patients, the lack of a control group, as well as the possible placebo effect.
We agree with authors’ concerns but question the applicability of and compliance with such a complex diet in a naturalistic setting, even if there is firm evidence of HDK safety and efficacy in PD patients. Alternatively, the five reported PD patients were either overweight or obese had a body-mass index range of 28.4 to 35.9 kg/m². Losing body weight (mean, 6.1 kg; range 4.1-9.5 kg) was found to alter levodopa pharmacokinetics and led to an increase in levodopa cumulative dosage per kilogram of body weight. [2] Moreover, a greater levodopa bioavailability and brain level would be reached using a very low-protein diet. [3]
At a lower body weight and under tight protein restriction, the same oral levodopa dose that patients used to take when they were heavier or on regular diet, would lead to higher systemic levels. We therefore expect an ensuing heightened efficacy on parkinsonian symptoms and motor fluctuations and,at times, a putatively dyskinesogenic effect, as to require dosage reduction.
References
1.VanItallie TB, Nonas C, Di Rocco A, Boyar K, Hyams K, Heymsfield SB. Treatment of Parkinson’s disease with diet-induced hyperketonemia: A feasibility study. Neurology 2005; 64: 728-730.
2.Zappia M, Crescibene L, Arabia G, Nicoletti G, Bagala A, Bastone L, Caracciolo M, Bonavita S, Di Costanzo A, Scornaienchi M, Gambardella A, Quattrone A. Body weight influences pharmacokinetics of levodopa in Parkinson's disease. Clin Neuropharmacol 2002; 25: 79-82.
3.Pincus JH, Barry KM. Plasma levels of amino acids correlate with motor fluctuations in parkinsonism. Arch Neurol 1987; 44:1006-1009.
The authors report no conflicts of interest.