NEWS: Fava Beans - A Natural Source of Levodopa

[Guest guest]

This comes from the Parkinson's Ask the Doctor list. Those on the

Shydrager list who

are responsive to Levadopa might be interested in this article about the

benefits of Fava Beans.

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Fava Beans, A Natural Source of Levodopa - Prolongs “On”

Periods in Patients with Parkinson Disease

Adapted from an article by Hulya Apaydin, Sibel Ertan, Sibel

Ozekmekci Istanbul University, Department of Neurology, Istanbul, Turkey

Appearing in Movement Disorders volume 15, page 164, 2000

Introduction

In 1913, Guggenheim identified the chemical levodopa in the

seedlings, pods, and beans of Vicia faba, commonly known as “broad bean”

or fava bean. Fava beans are a widely cultivated vegetable

in the Mediterranean region. Its fresh green pods in the spring and also

dry seeds throughout the year are consumed in Mediterranean cuisine.

They are prepared by cooking with olive oil and traditionally

eaten after the main meal. Fava beans are regarded as being delicious,

especially when eaten with yogurt.

Recently, in our practice in our Movement Disorders Clinic, several

patients with Parkinson disease (PD) who have fluctuations described to

us

the beneficial effect of ingesting cooked fava beans on their symptoms.

These levodopa responsive patients reported that their “on” period was

prolonged after consuming a fava bean meal and stated that its effect

was similar to that of Sinemet (Merck Sharp and Dohme) or Madopar

(Roche) (levodopa and benserazide).

There is precedent for this effect on Parkinson symptoms. Spengos

and Cassilopoulos described the antiparkinson effect of fava beans and

others have corroborated this finding. Rabey et al. documented a

substantial

increase in levodopa plasma levels following fava bean ingestion that

correlated with substantial improvement in motor performance. In view of

our patients’ observations, we elected to assess their responses to

fava bean

through an out patient open-label clinical trial.

Methods

The eight patients who previously had reported favorable effects

from fava bean ingestion agreed to participate in our trial. They were

asked

to ingest one standard portion (approximately 250 grams or 9 ounces ) of

cooked fava bean at least twice a day without otherwise altering their

dietary

habits. The medical treatment was kept constant. Their predominant

problems

were disabling motor fluctuations and dyskinesia, despite appropriate

treatment

with levodopa combined with other dopamine drugs. These patients with

PD

were asked to complete a daily diary recording the times and durations

of “on”

and ”off” times during the 5-7 days of baseline assessment (without

fava bean

supplementation) and again corresponding to the 1-3 months during fava

bean administration.

Discussion

We observed a beneficial effect of fava beans in our patients

manifested by strikingly

prolonged “on” time and shortened “off” time. Previously all these

patients had been

administered higher doses of levodopa up to 800-1000 mg per day, which

failed to

optimize their “on” time and resulted in dyskinesia. We were surprised

by the reported

magnitude of our patients’ responses given the fact that previous trials

of higher doses

of levodopa seemed to provide no further benefit.

These observations are not readily explained by assuming that fava beans

are simply

a source of levodopa. For example, one patient was able to experience a

sustained

response from fava bean meals ingested on alternate days. This is

reminiscent of the

“long-duration response” of synthetic levodopa. Also, surprisingly,

another patient

experienced decreased dyskinesia with the addition of fava bean

supplementation and

reduction of levodopa. This patient had previously failed to respond

satisfactorily to

levodopa adjustments which would have accomplished the same result if

this was

simply a levodopa effect. A placebo effect may have contributed in this

trial but the magnitude of the reported responses raises the possibility

of other mechanisms.

For example, the amino acid milieu generated from broad bean

administrations may

favor the selective transport of levodopa across the blood-brain

barrier. Alternatively

other products derived from fava bean may complement the antiparkinson

effect.

Our experience with fava beans complements that of Rabey who described

the acute responses following a single administration of fava bean to

six patients with PD.

Rabey noted motor improvement of the same magnitude as seen following

single doses of

levodopa. Rabey also documented substantially increased plasma levodopa

concentrations

following fava bean administration and the motor response tended to

mirror these plasma

levodopa levels. In contrast to Rabey we assessed the effect of

prolonged fava bean meal

supplementation as opposed to a single administration. Elevation of

plasma levodopa following

fava bean administration has also been confirmed by Vered. Vered

noted that 40 grams

(1.5 ounces) of freshly chopped fava bean contained approximately 125

mg of levodopa.

Our patients ingested their broad bean meals garnished with yogurt,

which is rich in protein.

It is well known that as a large neutral amino acid, levodopa competes

with dietary

protein amino acid breakdown products in crossing the brain-blood

barrier: this competition

potentially results in reduced levodopa motor effects. Nonetheless, our

patients still experienced a

favorable motor response.

Some of our patients reported trying to cook and eat the dry seeds of

fava beans but did not

experience any benefit. Burbano . showed that only the fresh green pods

of broad bean were rich in

levodopa content, in contrast to that of dry matter, apparently

explaining the observations of our

patients.

Comment

Reports from many, but not all, people, document the beneficial

effects of fava beans.

There’s a question about how much fava beans to eat. Vered documented

that 40 grams of fava

beans (1.5 ounces) is the equivalent of 125 mg of levodopa

(approximately the same as one Sinemet

25/100 tablet). Yet the Turkish doctors advocated 250 grams of fava

beans (almost 9 ounces)

twice a day, the equivalent of 12 Sinemet (25/100) tablets. The reason

for the difference may have

to do with variations in the levodopa content of fava beans, differences

in the way the fava beans are

prepared, and other factors we do not yet know. Our own recommendation

is to use 3 ounces of

fava beans (110 grams) every other day. In addition to the levodopa

content, fava beans contain

fiber which helps with constipation.

[Guest guest]

After reading the article Pam forwarded about Fava Beans I had to turn to my

cookbooks as I have never tried them before. Here is a little bit about fava

beans from a cookbook called " The Complete Vegetarian Cuisine " by Rose Elliot.

Fava bean/broad bean:

" The original bean, cultivated since the Stone Age [in Asia and Europe]; can

be pale or mid-brown in color. Fava beans are popular in the Middle East and

Italy, where they are known as il carne del povero, " the meat of the poor. "

Regarding dried fava beans:

" More familiar in their fresh or frozen state, dried fava beans have quite a

strong, earthy flavor. They are widely used in the Middle East. I find

their tough skin a disadvantage, but if well-chopped in a food processor and

blended with olive oil, garlic, lemon and parsley, they make a good dip. "

Regarding fresh fava beans:

" Fava beans can be prepared in two ways. When they are young and tender, and

the pods not much bigger than green beans, they are excellent cooked in the

pod; just trim, then cut into even-sized lengths and cook in a little

fast-boiling water until just tender. Drain and serve with chopped parsley

and butter or a creamy sauce.

" Later, when the pods become too tough to eat, remove the beans from the pod

and cook in boiling water until tender. If the skins of the beans are tough,

and you have the time, the beans can be popped out of their skins, revealing

the bright green beans inside.

" Older fava beans can be made into a good soup. Whizzed in a blender or food

processor with olive oil and lemon juice, they also make an excellent pale

green dip, good served as a first course on top of large flat mushrooms which

have been fried in olive oil and cooled, or in a salad with lettuce and

grated carrot. "

And, from Martha 's Hor D'oeuveres Handbook:

Fava Bean and Pecorino Crostini

" When sliced paper-thin, pecorino and other hard cheeses become a delicate,

lacy topping for crostini. Fresh fava beans in their pods are available

sporadically throughout the spring and early summer months. The same beans

are available frozen year-round in Middle Eastern markets. The fava paste

may be made a day in advance and kept in an airtight container in the

refrigerator. Refrigerate the whole favas in a separate small container.

Buy the Pecorino in an 8-ounce chunk to make shaving it easier. "

2 pounds fresh fava beans, removed from pods (about 1 3/4 cups)

1 tablespoon extra-virgin olive oil

1 tablespoon chopped fresh mint

2 teaspoons fresh lemon juice

Kosher salt and freshly ground black pepper

24 slices of Crostini (baguette sliced, buttered, and broiled to golden)

Pecorino cheese, for garnish

1. Bring a medium pot of water to a boil and add the fava beans. Boil for 5

minutes, then drain, and rinse under cold water. Using your fingers, peel

the outer skin off the beans and discard. Separate 3 tablespoons of fava

beans and set them aside.

2. Place the remaining favas, olive oil, mint, lemon juice, and salt and

pepper to taste in the bowl of a food processor and quickly pulse to create a

thick, chunky paste. Transfer the fava mixture to a small bowl and taste for

seasoning.

3. Spread 1 teaspoon of fava paste onto each crostini. Garnish each

crostini with the remaining whole favas. Using a vegetable peeler, thinly

shave the Pecorino cheese over each crostini. Sprinkle with freshly ground

pepper and serve.

This recipe sounds like it would be good as a spread on lots of things if

crostini is too dry for some people to eat. It looks delicious in the photo

she shows!

Bon appetit!

V.