Dietary Therapy for Motor Fluctuations in Parkinson's Disease

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Abstract
In the October issue of the Archives, Pincus and Barry1 and Juncos and colleagues2 provided seemingly contradictory reports concerning the efficacy of a low-protein dietary approach for the treatment of motor fluctuations in Parkinson's disease. Fluctuations in motor performance remain a major problem in the long-term care of levodopa-treated patients with Parkinson's disease. Although the pathogenesis of such fluctuations remains incompletely understood, several recent findings are helping to clarify the underlying mechanisms, are contributing to improved therapeutic approaches, and can serve to help place dietary therapy in proper perspective. Both pharmacokinetic factors affecting the delivery of levodopa to the brain and pharmacodynamic factors influencing dopamine receptor function are postulated causes for the fluctuations. Guttman and colleagues3 measured densities of the dopamine receptor subtype (D2) linked to the motor disturbances of parkinsonism in postmortem samples of the striatum from 36 parkinsonian patients and found that D2 receptor