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johnnys

weight loss and medication ajustments

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johnnys    460

Hi Mark

I read a article overseas recently about patients should reduce sinemet  somewhat if losing weight.It went on to mention how body fat had some bearing in how much meds we need.Id like your input on this.The jerks still have not comeback and thanksfor your input  .

best

john

 

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MComes RPH    182

This is a great question. Sinemet can cause a side effect of weight loss. Parkinson's Disease itself can also cause weight loss. As far as increasing or decreasing medication due to weight loss and dosing medication due to weight are a different story when it comes to PD medication.

Parkinson medication is dosed based on symptoms and not weight. Many other medication, such as antibiotics, diabetic medications, cholesterol medications, etc.., are dosed based on weight and not symptoms. I guess one would have to weigh out the results of decreasing medication in order to gain weight back. If you decrease your PD medication in order to gain weight back, you have a situation of symptoms increasing with the possibility of gaining weight. I would rather have a few extra pounds and have control of my symptoms. Knowing that even if you decrease your Sinemet may help you gain some weight back, there is also the issue of the disease itself paying a role in weight loss also.

My recommendation is to take the medications at strengths that are needed to control your symptoms and help you keep a quality of life. I would also recommend asking your Neurologist or Movemet Disorder Specialist what hospital they are affiliated with. I say this because every hospital has a Nutritional Expert on staff and will be able to provide you with a good diet regime for a person with Parkinson's. Many times a person with Parkinson's who takes Sinemet may lose extra weight is due to the interaction between Sinemet and protein. It is recommended that Sinemet be taken at least 1 hour prior to eating a meal (especially protein) or 2 hours after consumption of a meal. Protein is a major building block for muscle development. 

The hospital will probably have a physical therapy program who could recommend some time of exercise to keep your muscles toned and in their best functioning ability. I usually recommend walking with good arm movement at the very least to help keep a good quality of life.

I hope this helps and please keep me posted.

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MIMILASTER    79

I find it difficult to understand why most dopamine agonists induce weight gain in a large number of people. DBS also has weight gain as a side effect. How  are these two opposite consequences possible ?

Mireille

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here's  a  study that recommends lemon juice.  i couldn't take 30ml with every dose and the study didn't say the dose kicked in any quicker.  but worth a try?

 

[Gastric acid secretion and absorption of levodopa in patients with Parkinson's disease--the effect of supplement therapy to gastric acid].

[Article in Japanese]

Abstract

Since an oral regimen of levodopa has been instituted for treatment of Parkinson's disease, its absorption and metabolism has been well demonstrated. However, its chemical characteristics of high solubility in acid solution and low solubility in water have not been well known. We paid attention to this characteristic and studied the relationship between its absorption and gastric acid secretion in 38 patients with Parkinson's disease who became refractory to therapy of levodopa. We measured the pH and amount of collected fasting gastric juice. Gastric acid secretion was decreased in 22 patients (58%). In ten of these 22 patients, 30 ml of lemon juice was prescribed in every administration of levodopa as a supplement to gastric acid for two weeks. Increases of L-dopa concentration after 60 min. and 180 min. were observed after lemon juice supplement therapy. Among the Parkinson symptoms, rigidity, akinesia, and small step gait were improved in every case except one patient who showed decrease of L-dopa concentration at 180 minutes. However, improvement of tremor was less remarkable. We consider this supplement therapy to gastric acid is one of the effective and useful methods in the management of Parkinson's disease.

 

the root of the problem is gastric emptying, you want this to happen as quickly as possible since the longer C/L stays in your stomach, the more is broken down and doesn't reach the small intestine or the brain.  so any food is going to delay gastric emptying, especially fatty foods. 

i was taking C/L every 2 hrs after 14 years from diagnosis and it's basically impossible to have a normal life with wearing off being so sudden and significant interference from food.  i played around with controlled release, trying to take it as soon as the IR kicked in along with 50mg of C/L.  The dose would be 150mgIR, wait for it to kick in, then take 50mg of IR + a 50/200CR + a tsp of olive oil, butter, anything  with fat which would delay gastric emptying which is just the opposite of what you do  when  taking IR, from what i understand, you want to delay gastric emptying when you take CR, you want it to remain in the stomach, slowly releasing C/L, rather than quickly make it intact to the small intestine where it just whizzes  past the area where C/L is absorbed.   So the logic was:

1. Taking the CR along with the IR would possibly counteract the competitive inhibition of C/L crossing into the small intestine and brain by some amino acids by providing a higher concentration of C/L but not too high as to cause dyskinesia.

2 . take the IR C/L by itself and assume 45min for the C/L IR to start to reach your brain.

3.  As soon as i feel the IR C/L kick in i take the 50mg of IR C/L and a 50/200CR.   It takes at least 90min for the CR to kick in for me, so if i take it with 50mg of IR the IR will give me the C/L i need until the CR kicks in.

I tried this and it worked a few times and i gave up.  It only worked with one and a half 50/200CR (75/300), i could eat a bowl of oatmeal and still be on but that dose  of  CR at times just made me sick.

But i solved my food problem.   it was as simple as just taking generic mirapex, something i resisted and my MDS never recommended it and i had to nudge him a little to write me a RX, he was worried about OCD and other side affects.  After 3 months i'm tolerating .75mg  3  times a day and have the option to go to a higher dose.  It was tough getting used to it, felt like a zombie at times and still do once in awhile.  the agonist pluses far outweigh the minuses.  i'm taking 150mg C/L every 3-4 hrs - still playing around with my C/L dose -  and if i take it an hour later than i should i'm not OFF, I can still function well enough that i feel confident to go out and socialize more.  I used to take a 200cr at bedtime and rigidity would wake me up 1-2 times and i'd have to take more C/L.   With the generic mirapex i take a 200cr and that's it,  not even sure if i really need it  My speech is better,  my OFF symptoms are less severe, i can't even say i have OFF's anymore.   So it's like having a 2nd honeymoon.  Maybe better.  A negative is i have put on weight and have to watch what i eat.  Another negative is i am lazier when ON, have to force myself to exercise and i feel slower.

i no longer have to worry about constipation seriously negating the affect of C/L which had very serious consequences, the fe times i was seriously constipated i was very immobile until i got unblocked.  I would try to explain to my doctor,my mds,my family that the constipation was slowing down my gastric emptying and my C/L was getting destroyed and just taking more wouldn't solve the problem.  as long as i take my generic mirapex every 8 hrs i'm going to have a little in my brain and that's all i need.  i'm 62 and i have no idea how long i'll be able to tolerate generic MIRAPEX but i'm enjoying it while i can.  i  know others can't tolerate it and i might be in the minority that can. i did have an interesting experience, the first fill of my generic mirapex RX was the generic made by GLENMARK.  My next fill was a generic from TURRANT, both INDIAN companies.  The TURRANT generic really screwed  me up,  just immense  mental fatigue and not able to do much of anything.  My independent pharmacist now gets the GLENMARK  generic for me.  The generics are completely different in color and size.  Just my experience, might  be the only person with this experience.

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MComes RPH    182

Mimilaster,

It is somewhat common, but confusing, how a medication can cause a side effect weight gain in some people and weight loss in others. With the dopamine agonist class of medications that activate dopamine receptors. Dopamine is what they call a "feel good" neurotransmitter. In some people, as stated by several studies and the patient insert, that too much of this type of medication can possibly cause and obsessive compulsive issue due to the fact that it increases dopamine levels. This obsessive compulsive issue may have to do with the weight gain issue. This effect can also be seen in certain antidepressants. When the "feel good" neurotransmitters (ie. Dopamine, Norepinephrine, and Serotonin) are working in harmony we get that constant happy feeling. It is when the concentrations of one or more of these neurotransmitters is not within normal range that there are problems. Serotonin helps maintain that happy feeling by keeping our moods in check by helping with relieving depression, anxiety, and controlling sleep. As I stated above, a medication that increases any of these "happy" neurotransmitters can cause a low level of obsessive compulsive issue, because we feel good, which could cause us to eat more. In some severe cases with Dopamine agonist it has been found to cause obsessive gambling, porn addiction, and risky behavior. The FDA has now forced the drug companies of these medications to place this warning in the Patient Information Sheet that you receive when you fill that medication. 

As far as DBS and weight gain is concerned, it could be a two pronged approach. Dr. Okun explained it best in one of his posts by stating, "The findings to date suggest the possibility that the weight gain may have been due to decreased energy expenditure that was in part due to reduced dyskensia , and in part due to a reduction in dopaminergic therapy. Also, the reduced overall energy expenditure directly resulting from DBS related dyskensia reduction has been postulated as a leading explanation for weight gain."

One thing that many of us forget is that the extra movements (ie. tremors, dyskensia, gait disturbances, and the attempted force we put on our muscles to try to get them to act a certain way) uses energy. The burning of this energy causes weight loss. Just a constant tremor can use a great deal of energy. So when we go on medication to suppress these symptoms we are actually using less energy due to the lack of movement. That is why I always recommend some sort of excercise routine or yoga. Walking is one of the best excercises a person with PD can do. You can also incorporate stretching or yoga into this routine to keep the muscles loose.

I hope this helps and if you have any other questions feel free to contact me.

 

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MComes RPH    182

Soccertese,

Thank for the information. It is greatly appreciated. When I read the title I was expecting a retort about acidic juices (ie. lemon or orange) when taking carbidopa/levodopa, which I believe we have spoken about before. I did not expect the segue into Dopamine agonists.

First, let me say that I am glad you have found something that is working for you. All this time we have been communicating about the in's and out's and up's and down's of Sinemet (carbidopa/levodopa), I took it for granted that you had already tried a Dopamine agonist. Sinemet usually comes after a trial and error with Dopamine Agonists. That is my fault and I am sorry for that. If I would have known that would have been one of the first things I would have suggested you try.

I know there has been some bad press about the Agonists, especially Mirapex, leading to OCD, and addictions to gambling and pornography. This, as with any PD medication, I always say, "start low and go slow." Especially with this type of medication. The "bad" effects of the medication are definitely dose related. The higher the dose the greater the possibility of these side effects.

The best way for me to describe it is to use your imagination and visualize an empty glass sitting on a table. The glass represents the dopamine we need to be functional if we have PD. The table it is sitting on are the "feel good" neurotransmitters and receptors. The water we pour into the glass represents the Dopamine Agonist. We slowly pour the water into the glass and are having good results, but not great results. We slowly incresze the dose, to which we get better results from our symptoms. Our optimal goal is to pour enough water (medication) into the glass to fill it up exactly to the top. This is where we will get the most bang for our buck and get the best results out of the medication. If we take just a little too much of the medication it will overflow, by maybe just a drip, the glass. This will then excite the "feel good" neurotransmitters and this is where the problems stem from. For example is someone is taking 1.5mg of Mirapex in the moring, 1.5mg in the afternoon, and 1.25mg at bedtime. The person feels they need more relief during the night so the Dr. increases the nightly dose to 1.5mg. Just that small increase of 0.25mg a day is enough to "overflow" the glass.

I am not trying to scare you, I just want you to be aware of how it works. I always recommend to anyone that is taking an agonist to have either a spouse, relative, or good friend the can trust and listen to keep them updated on your dosing regime of this medication. This side effect can happen at almost any dose, depending on how much dopamine we are lacking. It is usually a side effect that the patient may be aware of but cannot stop the untoward actions.

Also be aware of the spontaneous drowsiness that it can cause. You can be in the middle of a sentanc e and all of a sudden just nod off. Make sure you keep your Dr. updated if this should happen.

I am very happy you found something that helps, It is a great medication when used correctly and has helped a great number of people.

Please keep me updated as to the goings on of the regime.

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otolorin    30

Hi Mr Comes,

how much protien do you actually need to eat before sinemet works?I have read some article on MJFOX's website that stated,that one should avoid eating protien completely during the day till the evening.I am barely 2wks on sinemet,started low with half pill 2x/day for 1wk,then 1pill 2x/day for another wk.Noticed very very slight improvement in rigidity/balance,and this only lasted for 2hrs.Been experiencing on and off periods between doses despite just starting sinemet.Is this normal for a beginner like me?I tried the dopa agonists ,miraplex,ropinirole before for like a month but couldn't cope with the sleepiness side effect.I guess,I am still undermedicated with sinemet,and would be discussing dosing up with MD,At the right therapeutic dose,are you supposed to feel normal again?I know everybody is different as regards the therapeutic dose.I can actually function without meds,but with exercise.I sometimes drag my Lt leg with some rigidity and slight postural tremor in the Lt arm.

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MComes RPH    182

Otolorin,

There is not an amount of protein that requires Sinemet to work, rather it is the avoidance of protein for Sinemet to be effective. The interaction that happens when protein is taken too close Sinmet happens in the liver. The protein has a greater affinity for the liver enzymes so the protein will be metabolized first and then the Sinemet. This can delay the onset of action, depending on the amount of proyein you take, anywhere from 30 minutes to upto 2 hours.

The best rule of thumb to follow is this: take Sinemet at leaset 1 hour prior to ingesting protein or 2 hours after ingesting protein. these time frames will first: allow the Sinemet to be absorbed and metabolized before the protein is ingested, and secondly: it will take approximately 1 and 1/2 hours to 2 hours for the protein to be absorbed and metabolized by the liver before the Sinemet is taken. This will then allow the Sinemet to have a clear path to be metabolized by the liver with no interaction of protein.

I hope this helps and please keep me posted.

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