Multi Vitamins and PD

[maungwin56]

My neurologist told me not to take multi vitamins. He reckons vitamin B disrupts the absorption of Levodopa. Any comments?

[Kewlfox]

Iron blocks the uptake of Leva-dopa, not Vit B.

[lempa_nik]

Hi maungwin56, According to my information, your neurologist's comment is misleading. Vitamin Bs themselves do not conflict with levodopa (L-Dopa). The real conflict is specifically between Vit B6 and Carbidopa or Benserazide, two so-called Dopa Decarboxylase inhibitors (DDCI) that are included with all Levodopa drugs, such as Sinemet. The DDCIs increase the amount of L-Dopa that gets into the brain, thereby decreasing the dose needed and thus protecting against nausea. Vitamin B6 (tho' very essential to the body) binds with the Carbidopa and renders it ineffective; then you get far less of the L-Dopa reaching the brain.

If you are getting a pure form of L-Dopa--i.e., not admixed with DDCIs--such as from Mucuna Pruriens, there is no conflict and you can take vitamin B6 or VItamin B-complex without any worry. For the long-term health of your body, this is probably preferable since Vitamin B6 is required for hundreds of bodily reactions. ( I am not an MD.)

[Tryguy in reply to lempa_nik]

Thank you for confirming something that I've been thinking for quite a while - The whole discussion with "levodopa" versus "L-dopa" may be a gigantic semantic disconnect!! Both terms are used interchangeably and usually 'assumed' to be another name for C/L meds like Sinemet (and its cousins Stalevo, Rytary, etc..) which are usually manufactured compounds of synthetic L-Dopa (levodopa!) & a DDCI (like Carbidopa). Hence the continued patient misunderstanding regarding the use of vitamin B6.

Basically, Vitamin B6 amounts are an issue with medications containing DDCI's (along with nausea & other management issues) WHILE Vitamin B6 amounts with straight L-Dopa (the amino acid from Mucuna Pruriens) are generally not an issue.

I am not an MD, just a PW (Parkinson's Warrior)

Could this be true?

[lempa_nik in reply to Tryguy]

Hi Tryguy, I'm so embarrassed, but it looks like I was totally off the track on this. Please see what Hikoi and Silvestrov have to say below. Also, here is an additional early research, which, I expect, has probably been crucial in shaping the current thought on this subject:

jamanetwork.com/journals/ja...

As I mentioned to Hikoi, the puzzle is that I still benefit from natural levodopa (without carbidopa) even though I take simultaneously a megadose of vitamin B6.

[Hikoi in reply to lempa_nik]

I do not know the answer except by reading and the site i visited says the opposite to you dumplekin, that is if i understand both of you correctly.

Mayo Clinic Info:

For patients taking levodopa by itself:

Pyridoxine (vitamin B 6) has been found to reduce the effects of levodopa when levodopa is taken by itself. This does not happen with the combination of carbidopa and levodopa. If you are taking levodopa by itself, do not take vitamin products containing vitamin B 6 during treatment, unless prescribed by your doctor.

mayoclinic.org/drugs-supple...

[lempa_nik in reply to Hikoi]

Hikoi, Many thanks for that! I don't understand where my reasoning or information went wrong, but it must have. I have to bow to Silvestrov, you, and the expertise I have seen online about this subject. On the anecdotal side, all I can say is that, contrary to this expert opinion, taking 200 mg per day of B6 (i.e., P5P) has not hindered me from getting the benefit of natural Levodopa (from mucuna). But I am planning to see if my on-time improves when I stop taking the B6; and when I find out, I'll share the results.

[Donzim]

i would ask your doc to provide you with the source of that information...get the studies on that first hand. we successfully used large amounts of supplements for years and felt that they were very beneficial. this was verified by the doctors.

[Hidden in reply to Donzim]

The possible effect of PD levidopa/cardopa with vitamins/minerals is my major concern. I have been taking the Mega Vit/Min in liquid form sold by Amazon. Both my wife and I have consumed at least 7 bottles kn the last 7 months and we generally do not even get a cold. However, we did both contract covid 19 , My symptoms were mild although my already compromised appetite has been zero and we are cincerned about the rapid weight loss.

We live in Scottsdale and my neurologist, /movement disorder specialist has not been a great help. She just prescribed 'Mirtazapine 15 mg. This is an anti depressant???? I have never been depressed in my life and I am not know. I have a happy marriage and accept my disease. I am just needing help to get my appetite back or I will slowly die. I feel bad for mynwife, we have jimchildren, who is constantly researching for better solutions.

Any advice or experience with this dreadful disease is appreciated.

Thank you

Denis

[silvestrov]

I don't know who your doctor is but they can be deficient on nutritional issues. In the infancy of levodopa use there was a B vitamin called Larobec (which did not include pyridoxine (B6) because it, pyridoxine, increased the 'decarboxylation' - conversion of levodopa into dopamine, in the body prior to reaching the blood brain barrier. If all the levodopa is converted into dopamine prior to the BBB there is not therapeutic benefit of levodopa. Thus carbidopa was added to levodopa to decrease the conversion of levodopa to dopamine prior to reaching the BBB. Without carbidopa only 1-5% of levodopa reaches the BBB to be converted into dopamine in the central nervous system. Prior to carbidopa 2-6 grams of pure levodopa were used to treat Parkinson's disease patients. Here is a link explaining the Larobec/pyridoxine relationship:

jamanetwork.com/journals/ja...

But carbidopa/benserazide is a hydrazine derivative and it can cause pyridoxine deficiency so it has to be taken with pyridoxine. Regardless if you take natural levodopa or synthetic levodopa a niacin deficiency will occur so it is in your self interest to take 250 (low dose) niacin supplement to prevent deficiency and also relieve GPR109a (Niacin Receptor 1) inflammation.

Low-dose niacin supplementation modulates GPR109A, niacin index and ameliorates Parkinson's disease symptoms without side effects

onlinelibrary.wiley.com/doi...

Here is an old article about carbidopa/benserazide and niacin deficiency:

biochemsoctrans.org/content...

In summation, if you take Sinemet/Madopar you should be taking B6 - pyridoxal 5 phosphate (bioavailable B6) and 250 mg niacin.

If you are taking natural levodopa alone you should be taking 250 mg/day of niacin.

Niacin depletion in Parkinsonian patients treated with L-dopa, benserazide and carbidopa.

ncbi.nlm.nih.gov/pubmed/477187

[Hidden]

If you have a mega b tablet or b vitamins capsule just before you go to bed at night, then the b vitamins are taken care of. They are very important to your health, vitamin B3 deficiency can contribute towards brain damage as in Kosakoff Syndrome, or dementia, you need the full range of b vitamins. The average one a day multivitamin/mineral supplement does not contain enough b vitamins to block Levodopa.

[Tryguy]

Just to see what I am missing... Vitamin B6 should help levodopa catabolism, not 'block' it. However I can understand 'blocking' being said about vitamin B6 and C/L preparations (like Sinamet). One minute one minute that is what I meant by that is what I meant to go That is what I meant above... are we all speaking the same language?