Large Neutral Amino Acid Levels Research Articles

Interplay of Large Neutral Amino Acids, Metabolic Syndrome, and ApoE ε4 on Brain Integrity at Midlife.

Introduction Large neutral amino acids (LNAA) tryptophan and phenylalanine have been implicated in the pathogenesis of neurodegenerative diseases. Given limited research on the effects of LNAA on brain health across different life stages, vascular risk, and genetic backgrounds, our study aimed to explore the interaction of LNAA levels, metabolic syndrome (MetS), and the presence of the apolipoprotein E ε4 (ApoE ε4) allele brain integrity at midlife. Methods Sixty-eight adults aged 40-61 underwent a health assessment to calculate the number of MetS components, quantify LNAA, measure white matter hyperintensity (WMH) volume, and genotype ApoE ε4. Multivariate linear regression analyses were performed to test the joint effect of LNAA, MetS, and ApoE ε4 on WMH while adjusting for sex, age, and education. Results Significant 3-way interactions were observed between serum tryptophan (β = 0.042, SE = 0.018, p < 0.05) and phenylalanine (β = 0.044, SE = 0.013, p < 0.01) levels, number of MetS components, and ApoE ε4 alleles status on WMH volume. Neither individual LNAA levels nor MetS components alone predicted WMH volume. Conclusions The study highlights significant 3-way interactions between LNAA, MetS, and genetic risk factors in the pathology of WMH, particularly in individuals genetically predisposed to Alzheimer's disease. These interactions suggest differential impacts of LNAA on WMH volume dependent on both genetic and metabolic factors. Results emphasize the need for personalized metabolic and genetic profile assessments in neurodegenerative disease management.

Large Neutral Amino Acids Moderate the Effects of Metabolic Syndrome on Cognitive Performance in Middle-Aged Adults

Introduction: Two large neutral amino acids (LNAA), tryptophan and tyrosine, are precursors to cerebral neurotransmitters and are involved in cognitive function. Higher levels of LNAA in young adults are associated with improved cognition, although these associations appear to reverse over time. Given that exposure to metabolic syndrome (MetS) may induce premature cognitive aging, the current project aims to fill the gap in the literature by examining the effect of LNAA on cognitive performance in midlife adults with metabolic risks. Methods: Eighty-eight adults, ages 40–61 years, participated in this cross-sectional study. LNAA metabolites were quantified, MetS components were measured using high-performance liquid chromatography, and MetS components were assessed in the laboratory. Composite verbal memory and executive functioning scores were computed using principal component analysis. We used linear regression models to test the interaction between LNAA and MetS while covarying for sex, age, and education. Results: The kynurenine/tryptophan ratio moderated the relation between MetS and verbal memory, even after adjusting for relevant covariates. Tyrosine metabolites were not significant moderators of the association between MetS and executive functioning. Conclusion: Our findings suggest that the detected weaker memory performance in adults with a high number of MetS components may be related to relative tryptophan depletion and possible decreases in serotonin production. Further investigation is warranted to examine the potential role of LNAA in associations between cognitive performance and metabolic risks over time.

Large neutral amino acid levels tune perinatal neuronal excitability and survival

Little is known about the critical metabolic changes that neural cells have to undergo during development and how temporary shifts in this program can influence brain circuitries and behavior. Inspired by the discovery that mutations in SLC7A5, a transporter of metabolically essential large neutral amino acids (LNAAs), lead to autism, we employed metabolomic profiling to study the metabolic states of the cerebral cortex across different developmental stages. We found that the forebrain undergoes significant metabolic remodeling throughout development, with certain groups of metabolites showing stage-specific changes, but what are the consequences of perturbing this metabolic program? By manipulating Slc7a5 expression in neural cells, we found that the metabolism of LNAAs and lipids are interconnected in the cortex. Deletion of Slc7a5 in neurons affects the postnatal metabolic state, leading to a shift in lipid metabolism. Additionally, it causes stage- and cell-type-specific alterations in neuronal activity patterns, resulting in a long-term circuit dysfunction.

17 Challenges and implications of feeding diets with excess concentrations of leucine to growing-finishing pigs

Abstract Excess dietary leucine stimulates the key enzymes involved in branched-chain catabolism causing breakdown of all branched-chain amino acids, including isoleucine and valine. Branched-chain amino acids share a common brain transporter with other large neutral amino acids (LNAA). Excess levels of one of the LNAA increases brain uptake of that amino acid and decreases the uptake of the other LNAA, including tryptophan. Thus, excess leucine can impact the requirements for many amino acids. From a practical basis, this effect was first demonstrated with diets containing blood meal, but was thought to be of limited concern unless high blood meal diets were fed. Use of corn dried distillers grains with solubles (DDGS) or high protein DDGS in corn-based diets results in diets containing excess leucine. These high leucine levels are of limited concern if adequate levels of other branched-chain amino acids and LNAA are fed, which is often the case if the diet consists largely of intact protein sources. Feed grade amino acids, such as L-lysine, L-threonine, L-tryptophan, DL-methionine, L-valine, and L-isoleucine have been widely adopted as a means to lower nitrogen excretion and diet cost. Including these amino acids in diets containing corn products reduces dietary leucine; but the resulting diets are formulated near the requirement for the first 6 limiting amino acids, including valine, isoleucine, and tryptophan, while still being high in leucine. The excess leucine increases the requirements for valine, isoleucine, and possibly other LNAA, such as tryptophan and possibly others. The exact relationship between these amino acids and how to handle them in practical diet formulation is still being elucidated; however, recent meta-analysis and experimental data confirm the importance of these ratios and provide useful direction for future research.

Large neutral amino acids levels in primate cerebrospinal fluid do not confirm competitive transport under baseline conditions

In rodents, transport of large neutral amino acids (LNAAs) across the blood brain barrier (BBB) and blood-cerebrospinal fluid (CSF) barrier is mediated by high affinity carriers. Net brain LNAA levels are thought to be determined mainly by this competitive transport from plasma. Since the affinity for LNAA transport at the BBB in primates is considerably higher than in rodents, brain influx and by extension LNAA brain levels, should be even more dependent on competitive transport. Given that LNAA levels in CSF and brain interstitial fluid are usually similar, we analyzed serum and CSF of fasted subjects (n=24) undergoing spinal anesthesia and calculated brain influx and transporter occupancy using a conventional model of transport. Despite predicted near-full transporter saturation (99.7%), correlations between CSF levels and brain influx were modest, limited to tyrosine (r=0.60, p<0.002) and tryptophan (r=0.50, p<0.01) and comparable to correlations between CSF and serum levels. We also analyzed serum and CSF in (n=5) fasted vervet monkeys. Tyrosine and phenylalanine levels in CSF were positively correlated with those in serum, but correlations with calculated brain influx, which takes competition into account, were weaker or absent. We conclude that in primates i) baseline CSF LNAA levels do not confirm competitive transport, ii) brain LNAA levels should not be estimated on the basis of serum indices alone. This has implications for amino acid challenge studies and for neuropsychiatric disorders associated with dysregulated LNAA transport in which quantitative information about brain LNAA levels is needed.

Large neutral amino acids: dietary effects on brain neurochemistry and function

The ingestion of large neutral amino acids (LNAA), notably tryptophan, tyrosine and the branched-chain amino acids (BCAA), modifies tryptophan and tyrosine uptake into brain and their conversion to serotonin and catecholamines, respectively. The particular effect reflects the competitive nature of the transporter for LNAA at the blood-brain barrier. For example, raising blood tryptophan or tyrosine levels raises their uptake into brain, while raising blood BCAA levels lowers tryptophan and tyrosine uptake; serotonin and catecholamine synthesis in brain parallel the tryptophan and tyrosine changes. By changing blood LNAA levels, the ingestion of particular proteins causes surprisingly large variations in brain tryptophan uptake and serotonin synthesis, with minimal effects on tyrosine uptake and catecholamine synthesis. Such variations elicit predictable effects on mood, cognition and hormone secretion (prolactin, cortisol). The ingestion of mixtures of LNAA, particularly BCAA, lowers brain tryptophan uptake and serotonin synthesis. Though argued to improve physical performance by reducing serotonin function, such effects are generally considered modest at best. However, BCAA ingestion also lowers tyrosine uptake, and dopamine synthesis in brain. Increasing dopamine function in brain improves performance, suggesting that BCAA may fail to increase performance because dopamine is reduced. Conceivably, BCAA administered with tyrosine could prevent the decline in dopamine, while still eliciting a drop in serotonin. Such an LNAA mixture might thus prove an effective enhancer of physical performance. The thoughtful development and application of dietary proteins and LNAA mixtures may thus produce treatments with predictable and useful functional effects.

Relationships between large neutral amino acid levels in plasma, cerebrospinal fluid, brain microdialysate and brain tissue in the rat

Experimental limitations may preclude direct measurement of large neutral amino acid (LNAA) levels in brain tissue. Some data suggest that serum or cerebrospinal fluid (CSF) may provide an index of LNAA brain levels. We examined this in a series of experiments in rats, administering tyrosine, phenylalanine or valine IP 60 min prior to harvesting of blood, CSF or brain tissue or during in vivo microdialysis of the brain. Serum indices of the administered LNAA generally showed a significant ( r > 0.8) correlation with brain tissue levels but the linear relationships varied significantly across brain regions, the LNAA and its dose. Increases in levels of an administered LNAA were consistently greater in CSF than in brain tissue. In contrast, changes in LNAA levels in brain tissue and in vivo microdialysate were generally comparable. We confirm that changes in serum and CSF LNAA levels can support limited, qualitative inferences about changes in brain tissue LNAA levels; quantitative inferences should not be drawn without prior validation under relevant experimental conditions.

Potentiation of brain serotonin activity may inhibit seizures, especially in drug-resistant epilepsy

In spite of the large number of antiepileptic drugs (AEDs) actually available, the problem of drug-resistant epilepsy has not been solved. No AEDs are efficacious in patients with pharmacoresitant epilepsy, so new hypothesises about the mechanisms of pharmacoresistance are needed. In the last years the ideas on the role of brain serotonin in epilepsy have been turned upside down: increasing the available brain serotonin is thought now to have an antiepileptic effect. Antidepressant drugs like selective serotonin re-uptake inhibitors, i.e., fluoxetine, have proved to be useful in seizure control. Tryptophan (Trp), an essential amino acid, is the only brain precursor of serotonin, it competes with the other large neutral amino acids (LNAAs) for the carrier of blood-brain barrier (BBB). Our own data has shown a lowering of plasmatic LNAA levels in epileptic patients, on the basis of these results we could estimate a decrease of a 1/3 in the Trp brain intake rate in epileptics in respect to controls. Increasing plasmatic Trp levels increases brain serotonin synthesis. Trp and 5-hydroxytryptophan (5-HTP) were tested as an add on in epilepsy, but the clinical outcome was controversial. Free amino acids are not fully adsorbed by the gastro-intestinal system, furthermore LNAAs, and also 5-HTP is a LNAA, compete to cross the intestinal membrane for the same carrier, like for the BBB. The best way to increase the plasmatic Trp level is a protein rich in Trp and poor in the other LNAAs. Unfortunately Trp is a limited amino acid in proteins. We report the clinical results obtained by adding a whey protein to the antiepileptic therapy of drug-resistant epileptic patients: alpha-lactoalbumin, rich in Trp and poor in the other LNAAs.

Large neutral amino acids auto exchange when infused by microdialysis into the rat brain: implication for maple syrup urine disease and phenylketonuria

Maple syrup urine disease (MSUD) and phenylketonuria (PKU) are associated with accumulation of large neutral amino acids (LNAA) in blood and tissues and a decrease of other LNAA not directly related to the enzyme defects. One characteristic shared by both the elevated and decreased amino acids is that all are substrates for transport via the large neutral amino acid transporter. In this study, the blood brain barrier was effectively bypassed using microdialysis to determine the immediate effect of infused phenylalanine, tyrosine, 2-amino-2-norborane-carboxylic acid (BCH), and leucine and α-ketoisocaproate on extracellular levels of LNAA. The concentration of non-infused LNAA increased in the interstitial fluid, presumably due to trans-stimulated exchange of these LNAA from intracellular pools as the infused LNAA entered the cells. Such trans-stimulated exchange can potentially deplete cells of multiple essential LNAA. It is proposed that brain cells in disorders such as MSUD and PKU may be subject to two mechanisms that limit the availability of a full complement of these amino acids: competition for transport of LNAAs at the blood brain barrier and trans-stimulated exchange out of neuronal cells for subsequent metabolism or sequestration in the periphery.

Reduction of large neutral amino acid levels in plasma and brain of hyperleucinemic rats

Neurological dysfunction is common in patients with maple syrup urine disease (MSUD). However, the mechanisms underlying the neuropathology of this disorder are poorly known. In the present study we investigated the effect of acute hyperleucinemia on plasma and brain concentrations of amino acids. Fifteen-day-old rats were injected subcutaneously with 6 μmol l-leucine per gram body weight. Controls received saline in the same volumes. The animals were sacrificed 30–120 min after injection, blood was collected and their brain rapidly removed and homogenized. The amino acid concentrations were determined by HPLC using orthophtaldialdehyde for derivatization and fluorescence for detection. The results showed significant reductions of the large neutral amino acids (LNAA) l-phenylalanine, l-tyrosine, l-isoleucine, l-valine and l-methionine, as well as l-alanine, l-serine and l-histidine in plasma and of l-phenylalanine, l-isoleucine, l-valine and l-methionine in brain, as compared to controls. In vitro experiments using brain slices to study the influence of leucine on amino acid transport and protein synthesis were also carried out. l-Leucine strongly inhibited [ 14C]- l-phenylalanine transport into brain, as well as the incorporation of the [ 14C]-amino acid mixture, [ 14C]- l-phenylalanine and [ 14C]- l-lysine into the brain proteins. Although additional studies are necessary to evaluate the importance of these effects for MSUD, considering previous findings of reduced levels of LNAA in plasma and CSF of MSUD patients during crises, it may be speculated that a decrease of essential amino acids in brain may lead to reduction of protein and neurotransmiter synthesis in this disorder.

Striatal Kinetic Modeling of FDOPA with a Cerebellar-Derived Constraint on the Distribution Volume of 3OMFD: A PET Investigation using Non-Human Primates

The peripherally born metabolite of FDOPA, 3-O-Methyl-FDOPA (3OMFD), crosses the blood-brain barrier, thus complicating positron emission tomography-FDOPA (PET-FDOPA) data analysis. In previous reports the distribution volume (DV) of 3OMFD was constrained to unity. We have recently shown that the forward transport rate-constant of FDOPA (K(S1)) and the cerebellum-to-plasma ratio (C(b)/C(p)), a measure for the DV of 3OMFD, are functions of plasma large neutral amino acid (LNAA) concentration. Given large interstudy and intersubject differences in plasma LNAA levels, variations in the DV of 3OMFD are significant. In this report, the authors propose a constraint on the DV of 3OMFD that accounts for these variations. Dynamic PET-FDOPA scans were performed on 12 squirrel monkeys and 12 vervet monkeys. Two sets of constraints were employed on the compartmental model--M1 or M2. In M1, the striatal DV of 3OMFD was constrained to unity; in M2, the striatal DV of 3OMFD was constrained to an estimate derived from the cerebellum. Striatal and cerebellar time-activity curves were fitted using FDOPA and 3OMFD plasma input functions. The estimate of K(S1) and that of the compartmental FDOPA uptake-constant (K(i)), both obtained using M2, were adjusted to values corresponding to average LNAA levels. Finally, K(i) was compared with the graphical uptake-constant (PK(j)). With the use of constraint M2, intersubject variability of squirrel monkey k(S3) and K(i) was reduced by 45% and 53%, respectively; and for vervet monkeys, by 54% and 44%, respectively. Intersubject variability of K(1) and K(i) was further reduced after correction for variations in intersubject plasma LNAA levels (for squirrel monkeys, by 67% and 41%; for vervet monkeys, by 40% and 36%, respectively). K(i) correlation to PK(i) was enhanced to identity. Finally, average cerebellar k(C2) estimates were more than 2.5-fold higher than striatal k(S2) estimates (P < 0.0001). In modeling of PET-FDOPA data, it cannot be assumed that the DV of 3OMFD is unity. The cerebellar-derived constraint furnishes a reliable estimate for the DV of 3OMFD. Invoking the constraint and correcting for variations in plasma LNAA significantly reduced interstudy and intersubject variations in parameter estimates.

Sex Differences in the Effect of Obesity on Human Plasma Tryptophan/Large Neutral Amino Acid Ratio

Backgrounds: The neurotransmitter serotonin (5-HT) contributes to the regulation of food intake and appetite behavior, and its rate of synthesis depends upon brain tryptophan (TRP) availability in relation to the large neutral amino acids (LNAAs). Thus, the ratio of TRP to the sum of LNAA (TRP/LNAA) will be representative of the 5-HT brain levels. Differences between men and women in the obesity-linked alterations in whole blood amino acid levels and compartmentation have been described. The aim of this work was to study the effect of obesity on brain TRP availability in men and women and to determine whether there are sex-linked differences. Methods: The plasma levels of TRP and LNAAs in 42 men and 46 women (classified according to their body mass index (BMI) into lean, overweight and obese) have been determined by HPLC. Results: The TRP/LNAA ratio shows a significant drop which is even more pronounced in men than in women as BMI increases. Moreover, the comparison of the values between the 3 BMI groups revealed that the drop in the TRP/LNAA ratio appears with overweight in men but only with obesity in women. Conclusion: These sex differences could affect hypothetical behavioral differences of feeling hunger when facing voluntary food restriction for weight loss in individuals of different genders and with varying degrees of obesity.

Phenylalanine kinetics are associated with tardive dyskinesia in men but not in women.

An association between tardive dyskinesia (TD) and severely impaired metabolism of the large neutral amino acid (LNAA), phenylalanine (Phe) was defined in a group of mentally retarded patients. Subsequently, an altered kinetics of Phe was associated with TD in men with schizophrenia based on plasma analyses subsequent to the ingestion of a protein meal. In the present study, a standardized oral challenge of pure Phe (100 mg/kg in 170 ml orange juice) was administered to psychiatric patients of both sexes (n = 312), with and without TD after an overnight fast. Plasma LNAA levels were assayed both fasting and 2 h subsequent to the ingestion of the challenge. The extent of the increase in plasma Phe levels 2 h following a standardized challenge is determined by the sum of the kinetic processes of plasma absorption, tissue distribution, metabolism and elimination. The study hypothesis, that TD would be associated with significantly higher post-challenge plasma Phe indices of an absolute plasma Phe level and plasma Phe/LNAA ratio (a brain availability measure), was verified for the study men (n = 209), but not for the study women (n = 103). The demonstrated altered kinetics of Phe in men with TD indicates a greater availability of Phe to the brain in these men. We suggest that the disorder may be related to the effects of this greater availability. Such effects could be the direct neurotoxic effects of Phe and its metabolites and/or the modulating effects of these compounds on the synthesis of the monoamine neurotransmitters. The fact that TD (Yes/No) group differences in post-challenge plasma Phe indices were not seen for the study women suggests the possibility of a sex difference in the biology of TD that we propose may be reflective of the young age of the study sample.

Age dependence of large neutral amino acid levels in plasma. Focus on Tryptophan.

Low levels of plasma tryptophan (TRP) and low values of plasma TRP ratios (total or free TRP concentration divided by the sum of the concentrations of the other large neutral amino acids [LNAA] valine [VAL], leucine [LEU], isoleucine [ILEU], tyrosine [TYR], and phenylalanine [PHE] have been attributed to depressive disorders (Moller et al. 1976, Maes et al. 1993), and it is well known that older people are especially prone to depression and suicide. Some studies have addressed the issue of physiological changes of plasma amino acid levels in connection with increasing age but there are only few data allowing for conclusions on TRP ratios (e.g., Rudman et al. 1989, Caballero et al. 1991). Age-dependent decrease of TRP and TRP ratio may contribute to the metabolic basis of affective disorders in elderly people. Therefore it seemed interesting to compare the fasting plasma TRP levels and TRP ratios of two different age groups with no psychiatric abnormalities.

Distribution volume of radiolabeled large neutral amino acids in brain tissue.

Variations in the cerebellum to plasma ratio at late times in 6-[18F]fluoro-L-DOPA studies are shown to be consistent with competitive binding of large neutral amino acids for a common transporter in the blood-brain barrier and the stability of brain tissue large neutral amino acid level in the presence of plasma level changes. The distribution volume of an inert large neutral amino acid can be estimated from plasma and tissue large neutral amino acid levels and apparent half-saturation concentrations (Km) of the transporter in the blood-brain barrier. Stability of brain large neutral amino acid levels is supported by literature findings and can be explained by high saturation of the large neutral amino acid transporter at physiologic conditions.

The effect of carbohydrate and protein administration on amino acids in the pancreas, brain, intestine, and plasma of the rat

We measured the concentration of the large neutral amino acids (LNAA) in the plasma, pancreas, brain and intestine of rats that were given protein or carbohydrate intragastrically. In the brain it is well known that competition for entry occurs at the level of the blood-brain barrier between the various LNAA and that brain levels of LNAA are predicted not by their plasma level but by the ratio of the plasma level of each of the LNAA to the sum of the other LNAA (the plasma amino acid ratio). We have found that carbohydrate ingestion increased brain histidine as well as brain tryptophan. Levels of amino acids in the pancreas, like those in the brain, were found to be correlated with their plasma ratios and not with the simple plasma levels. Thus, for example, after carbohydrate the level of the aromatic amino acids increased and the level of the branched chain amino acids decreased in both brain and pancreas. These changes were similar to those that occurred in the various plasma LNAA ratios. As expected, no such relationship was seen in the intestine. These results indicate that the system transporting LNAA into the pancreas is similar to that in the brain and different from the transport system in other tissues. Whether the competition is taking place at the level of the capillaries, as in the brain, or at the level of the cell membrane remains to be determined as does the functional significance of these findings.

Insulin-induced decline of plasma amino acid concentrations in obese subjects with and without non-insulin-dependent diabetes

Obesity-associated hyperaminoacidemia is traditionally interpreted as a consequence of insulin resistance. We performed two different experiments to investigate the effects of both obesity-associated insulin resistance and the insulin resistance of non-insulin-dependent diabetes mellitus (NIDDM) on amino acid metabolism. In the first experiment, we measured postabsorptive amino acid concentrations and their decline in response to an oral carbohydrate load in 19 obese nondiabetic women and 19 normal-weight nondiabetic controls. Obese subjects were more resistant to insulin with respect to its effects on glucose metabolism than normal-weight controls, as calculated by the method described by Matthews. However, postabsorptive plasma concentrations of the so-called large neutral amino acids (LNAA), namely phenylalanine, tyrosine, valine, leucine, and isoleucine, and their decrease in response to carbohydrate consumption were similar in both groups. In the second experiment, we compared the decrease of plasma concentrations of LNAA during a euglycemic, hyperinsulinemic clamp in obese subjects with and without NIDDM. Peripheral glucose uptake (PGU) was more impaired in NIDDM subjects compared with obese controls. Furthermore, hepatic glucose production (HGP) was less attenuated by insulin infusion in NIDDM than in control subjects. Postabsorptive plasma LNAA concentrations were not different in the two groups. Values obtained in either group were not different from the postabsorptive concentrations in the normal-weight control subjects of experiment 1. All amino acid levels decreased substantially in response to insulin infusion. The magnitude of the decrease was not significantly different in the two groups, except for a slightly greater decrease of the plasma isoleucine concentration in obese control subjects. These results indicate that insulin resistance in obesity and NIDDM has dissociated effects on insulin-mediated glucose and amino acid metabolism. Although obese subjects both with and without NIDDM were resistant to insulin with respect to its effects on glucose metabolism, postabsorptive plasma levels of LNAA and their decrease in response to carbohydrate consumption or insulin infusion were similar in obese subjects, irrespective of the presence of NIDDM, and normal-weight control subjects.

Aspartame use in Parkinson's disease

The artificial sweetener aspartame (NutraSweet) is hydrolyzed in the gut as phenylalanine (PA), a large neutral amino acid (LNAA). LNAAs compete with levodopa for uptake into the brain. To determine the effect of aspartame on levodopa-treated Parkinson's disease (PD) patients, we studied 18 PD patients with protein-sensitive motor fluctuations by administering in a double-blind and single-crossover design, on alternate days, aspartame (600 or 1,200 mg) and placebo. Every hour, we performed a motor examination and drew blood to estimate plasma LNAA, PA, and levodopa levels. Six-hundred mg of aspartame had no effect on plasma PA or motor status. Although 1,200 mg of aspartame significantly increased plasma PA, motor performance did not deteriorate. Aspartame consumption in amounts well in excess of what would be consumed by heavy users of aspartame-sweetened products has no adverse effect on PD patients.

A balanced carbohydrate

Although restricting dietary protein is a proposed adjunct to treating Parkinson's disease (PD), the effect of carbohydrate consumption is unknown. We measured plasma levodopa and large neutral amino acid (LNAA) levels in nine PD patients treated with carbidopa/levodopa and different isocaloric meals containing high protein-low carbohydrate, low protein-high carbohydrate, and balanced 5:1 carbohydrate:protein mixtures. We found that levodopa levels increased significantly regardless of the type of diet, but that plasma LNAA levels varied less and motor performance was superior after the balanced diet than after the other two meals. We conclude that PD patients can consume nutritionally adequate meals and still maintain a stable plasma levodopa:LNAA ratio.

Dietary influences on the antiparkinsonian response to levodopa.

The ability of dietary factors to modify the response to levodopa was evaluated in six patients with idiopathic Parkinson's disease who manifested fluctuations in motor performance. The single oral administration of a high-protein formula substantially elevated plasma large neutral amino acid levels, and prematurely terminated the antiparkinsonian response to levodopa/carbidopa. In contrast, during oral or intravenous administration of levodopa, the ingestion of diets meeting the recommended daily allowance (RDA) for protein had no significant effect on plasma levodopa or large neutral amino acid levels or variance, nor on parkinsonian scores or variance. The results suggest that while protein intake in excess of the RDA can diminish the antiparkinsonian response to orally administered levodopa/carbidopa in patients with advanced disease, diets adhering to RDA protein guidelines have no clinically appreciable effect.