Article: Riboflavin / Red Meat Study

[Kathrynne Holden, MS]

Riboflavin / Red Meat Study
Kathrynne Holden, MS, RD
Copyright 2006

Kathrynne Holden is a registered dietitian who specializes in Parkinson’s
disease. She is also author of “Eat Well, Stay Well with Parkinson’s Disease,” and “Cook Well, Stay Well with Parkinson’s Disease.” For more information see www.nutritionucanlivewith.com or call 877-565-2665.

Dear Friends,
In October 2003, Brazilian researchers published a study, "High
doses of riboflavin and the elimination of dietary red meat promote the
recovery of some motor functions in Parkinson's disease patients." Many
people have expressed interest in the results, and this column will focus
on the study and some frequently-asked questions.

What was the nature of the study?

Researchers enrolled 31 people in the study. Study subjects were in all
stages of PD, and taking various combinations of PD medications. They were asked to provide information about their usual food intake; and they were tested for riboflavin (vitamin B2) status. Researchers determined that their diets provided adequate riboflavin; however, all 31 subjects were found to be deficient in this vitamin, causing the study authors to
speculate that low B2 status could be a feature of PD. Further, the
scientists found that those with PD ate significantly more red meat than
subjects in a control group, often reporting a strong preference for meat.

Twelve patients dropped out of the study; the remaining 19 completed the
full six months. They were given 30 mg of riboflavin, three times daily,
at 8-hour intervals, for a total of 90 mg daily. Red meat was entirely
eliminated from the diet.

Most patients reported feeling better after about three weeks.
Researchers measured motor capacity each month and found that subjects showed significant improvement after three months; most reached a plateau at this point, but five continued to improve throughout the length of the study. Upon testing, riboflavin status was found to have returned to normal levels.

Important points obtained from this study were:

• Despite diets that contained ample riboflavin, all of the 31 people
originally enrolled in the study were found to have low levels of the
vitamin

• About two weeks after starting the treatment regimen, many of the 19
subjects reported improved sleep at night, gains in reasoning ability, and
less depression.

• All 19 persons who completed 6 months of treatment showed significant
gains in standing, walking and balance during the first three months

If you are interested in trying this diet, it is important that you speak
first with your family doctor about a lab test to determine your
riboflavin status. If it is low, then discuss the plan with your
neurologist, who may want to monitor its effects. Following are some
frequently-asked questions.

Q: I would like to try this; how long do I need to stay on the diet?

A: The study subjects stayed on the diet for six months; if your physician
agrees that this diet is appropriate for you, plan to try it for that
length of time. If you experience no changes, then it is likely that this
diet will not be effective for you.

Q: What meats are considered red meat?

A: Red meats are considered to be all forms of beef, pork, mutton/lamb, and goat.

Q: If I quit eating red meat, how will I get enough protein?

A: Excellent sources of high-quality protein include poultry, fish, eggs,
dairy products, legumes (dried beans, lentils, and peas), nuts, and seeds.
If you include these daily, you will not need to worry about getting
enough protein.

Q: If I don’t eat meat, will I get enough iron?

A: Iron is available in poultry, fish, and eggs, as well as dark leafy green
vegetables and legumes. Your annual physical will include a blood test for
iron sufficiency, which will tell you if you need iron supplements.

Q: Why do I need to give up meat? Does it destroy the B2?

A: The study authors observe that the digestion of red meat releases hemin, a toxin which is destroyed by a specific enzyme. This enzyme, however, requires adequate stores of riboflavin. Individuals who have a deficiency of riboflavin, therefore, may not be able to properly eliminate hemin. The researchers speculate that hemin might reach the brain and contribute to the damage seen in PD. Therefore, they decided to eliminate the red meat as well as provide riboflavin.

Q: What if I forget and eat some meat while on this diet?

A: The answer to that question isn’t known at this time; the study was
small, and more research is needed to determine the answers. Probably,
eating a portion of red meat would not reverse any possible effects of the
diet, assuming one then continued on the plan and did not eat any further
red meat; but that’s not known definitely.

Q: Why can’t I take all the riboflavin at once?

A: The dosages were spaced throughout the day because a high dose of
riboflavin given all at once is mostly excreted; whereas if given in
smaller amounts throughout the day, absorption is increased.

Q: I can only find B2 in 50mg tablets – should I take one in the morning and one in the evening?

A: It can be difficult to find riboflavin in 30 mg size. You can, however,
purchase a 50 mg size, split some of the pills, and take 50 mg one time,
and 25 mg two times daily, for a total of 100 mg daily. For example, 50 mg in the morning, 25 mg about 8 hours later, and 25 mg at bedtime. It’s
important to take the B2 in divided doses, as very large amounts are not
well absorbed.

Anecdotally, several people have tried this diet, and some have reported
feeling better, as well as having improvements in the PD symptoms. If you wish to try it yourself, be sure to check with your doctor first.

Editor’s Note: Kathrynne Holden is a registered dietitian who specializes
in Parkinson disease. She moderates the NPF forum “Ask the Parkinson
Dietitian.”