4.6. Twice as effective
We have seen that the Mucuna seed extract naturally contains levodopa. If we quantify and compare it to the same dose of synthetic levodopa contained in tablets of Sinemet (or Madopar), we find that levodopa from Mucuna is approximately twice as powerful in controlling parkinsonian symptoms [31].
The efficacy of synthetic levodopa (without carbidopa) has been compared to that of natural levodopa (Mucuna) using rats with experimentally induced parkinsonism. The natural levodopa proved to be two times as effective at improving symptoms [32]. This test maintained the following proportions: 125 and 250 milligrams of synthetic levodopa were compared with the equivalent dose of natural levodopa (respectively, 2.5 and 5 grams of Mucuna powder 5%). Then the test was repeated, this time adding 50 mg of carbidopa to the two types of levodopa. Again, Mucuna proved to be more efficient.
4.7. The problem of volume
Mucuna is more effective, more rapid, and durable; however, to achieve a dose that will offer the same relief as Sinemet or Madopar, it would be necessary to prescribe large amounts of seed powder dissolved in liquid [24, 33]. The need to consume seed powder several times a day would soon overwhelm the patient, and the treatment would be abandoned as too cumbersome.
The solution to the problem can be found in concentrated extracts. This allows for the presentation of Mucuna in tablets or capsules, facilitating the application of different doses of the product and making it easy to manage daily consumption of Mucuna in the amounts deemed necessary. There is another choice that requires the cooperation of the neurologist: Mucuna could be used in association with carbidopa to achieve greater efficiency with less seed powder.
4.8. Mucuna with carbidopa
The first trials that compared the effects of Sinemet with Mucuna required six or seven daily sachets of powdered seeds. This can be maintained for a few days but becomes quite cumbersome with time. Actually those studies were done to compare natural levodopa (Mucuna) to a synthetic combination of levodopa and carbidopa (i.e., the contents of Sinemet).
The solution seems simple: add carbidopa to Mucuna. This increases the efficiency of the natural levodopa contained therein and therefore eliminates the need to take large amounts of seed powder. We must be careful when capsules of concentrated extracts are used because the dose can be excessive when you consider that Mucuna is more effective than synthetic levodopa.
There are published trials in which Mucuna is administered in combination with carbidopa and is compared to Sinemet. Rats with experimentally induced hemi-parkinsonism were treated with powdered Mucuna seeds (2.5 and 5 g) associated with carbidopa (50 mg) and in contrast to other groups wherein the equivalent synthetic levodopa dose (125 and 250 mg) was also associated with carbidopa. Mucuna-carbidopa proved to be more than twice as effective as Sinemet, and this was found by measuring the rotation contralateral (on the injured side) of the animals in each group [32].
Very recently, a new trial was performed to investigate whether Mucuna pruriens (MP) may be used as alternative source of levodopa for indigent individuals with Parkinson’s disease (PD) who cannot afford long-term therapy with marketed levodopa preparations. Eighteen patients were included in a double-blind, randomized, controlled, crossover study [34]. It shows that single-dose Mucuna pruriens intake met all noninferiority efficacy and safety outcome measures in comparison to dispersible levodopa/benserazide. Clinical effects of high-dose MP were similar to levodopa alone at the same dose, with a more favorable tolerability profile [34].
We know that the carbidopa in Sinemet prevents the peripheral side effects of levodopa (nausea, rapid heart rate) and enhances mobility. It appears that the carbidopa in Mucuna is even more effective: it decreases mild side effects and doubles or triples patients’ strength [1].
4.9. Other advantages of Mucuna
Mucuna does not produce dyskinesia. A different study, this time in monkeys (with unilateral parkinsonism induced experimentally), produced very interesting results on the possibility of dyskinesias. One group was treated with Sinemet (levodopa and carbidopa), another with Mucuna plus carbidopa, and the third only with Mucuna. All the animals experienced an improvement in their symptoms. Dyskinesia was then assessed by the study of spontaneous activity in the substantia nigra. Larger dyskinesia appeared in the Sinemet group. In those treated with the combination of Mucuna and carbidopa, dyskinesia seemed more moderate. Interestingly, in those who had only taken Mucuna, no dyskinesia was found [35].
Long-term Mucuna without dyskinesia. A similar experiment was performed, but this time Mucuna treatment was continuous, extending for a year. It was done in rodents and compared Mucuna with Madopar. One group was treated with Madopar (levodopa and benserazide), another with Mucuna plus benserazide, and the third only with Mucuna. All were controlled for a year. The symptoms were alleviated in all groups, but the improvement was significantly higher in those who were treated with Mucuna plus benserazide.
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