Letter to the Editor
Broad bean (Vicia faba) consumption and Parkinson's disease: a natural source of L-dopa to consider
Consumo de habas (Vicia faba) y enfermedad de Parkinson: una fuente natural de L-dopa a tener en cuenta
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Ramírez-Moreno, I. Salguero Bodes, O. Romaskevych, M.C. Duran-Herrera" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Ramírez-Moreno" "email" => array:1 [ 0 => "jramirezm@meditex.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Salguero Bodes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Romaskevych" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M.C." "apellidos" => "Duran-Herrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario Infanta Cristina, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Infanta Cristina, Badajoz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consumo de habas (<span class="elsevierStyleItalic">Vicia faba</span>) y enfermedad de Parkinson: una fuente natural de L-dopa a tener en cuenta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Scientists know that broad beans (<span class="elsevierStyleItalic">Vicia faba</span>) contain enough L-dopa to be pharmacologically active on patients with Parkinson's disease (PD). It has been shown that these beans increase plasma levels of L-dopa and improve motor function.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> We present the case of a patient with PD who suffered very intense on-time dyskinesias linked to the consumption of this legume.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This 73-year-old man had a 10-year history of PD, now in stage III on the Hoehn and Yahr scale, and well-controlled arterial hypertension and diabetes mellitus. His cognitive condition was good and he was active and independent; in fact, he tended the legume and vegetable crops in his garden every day.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He was being treated with L-dopa plus carbidopa dosed at 800<span class="elsevierStyleHsp" style=""></span>mg/day and a dopaminergic agonist, cabergoline, dosed at 3<span class="elsevierStyleHsp" style=""></span>mg/day. Doses had not been adjusted in the past year. According to his family and his medical history, the patient experienced rigidity and slowness on rising in the morning and noticed only mild choreic dyskinesias toward late morning, before lunchtime (on-time dyskinesias). These events did not cause discomfort as he was used to them and experienced no other motor fluctuations at the time. He had never experienced hallucinations or psychiatric disorders, and slept well at night with no need for benzodiazepines or other sleeping aids.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Family members brought him to the emergency department some 2<span class="elsevierStyleHsp" style=""></span>hours after lunch when he suddenly displayed involuntary movements, motor agitation, nausea, profuse sweating, and aggressiveness. Examination revealed choreic movements (including ballistic movements) of the limbs, trunk, and neck, accompanied by cervical dystonia, profound sweating, tachycardia, anxiety, nausea without vomiting, and some level of verbal aggressiveness. Arterial blood pressure was 90/55<span class="elsevierStyleHsp" style=""></span>mmHg. Routine laboratory analyses, electrocardiogram, and chest radiography did not reveal any relevant results. The family did not report the patient's taking any new drugs or having more than the normal dose of his usual medication. Doctors decided to provide fluid therapy, sedation with diazepam dosed at 20<span class="elsevierStyleHsp" style=""></span>mg, and temporary withdrawal of the antiparkinsonian treatment. Since nothing appeared to have triggered the patient's syndrome, doctors asked the patient and his family about his eating habits. They responded that he had eaten broad beans (<span class="elsevierStyleItalic">Vicia faba</span>). They had harvested the first broad beans of the season that morning, and the patient reported that they were exceptionally tender and juicy that year due to abundant rainfall. Family members stated that the patient had eaten many raw unshelled beans before consuming a generous helping of cooked beans, for a total amount between 300 and 400<span class="elsevierStyleHsp" style=""></span>g. After 24<span class="elsevierStyleHsp" style=""></span>hours, once the patient had improved and displayed only mild choreic dyskinesia and no peripheral autonomic symptoms, his normal drug treatment was resumed. He had returned to his baseline state by 48<span class="elsevierStyleHsp" style=""></span>hours and was discharged the following day. Doctors gave the patient some dietary recommendations since he did not know that broad beans had this effect; he stated that he had not eaten them in 2 years, and they had never been ‘problematic’.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Early sacred texts in Indian literature (second millennium BCE) refer to ‘trembling’ individuals who were prescribed a plant from the Fabaceae family to treat the condition. In 1913, Marcus Guggenheim was the first to isolate L-dopa (L-3,4-dihydroxyphenylalanine) from <span class="elsevierStyleItalic">Vicia faba</span> plants.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> The broad bean (<span class="elsevierStyleItalic">Vicia faba</span>) is a typical member of, and lends its name to, the Fabaceae family; it is a herbaceous climbing plant with an upright stalk that is cultivated for its edible seeds. Broad beans are cultivated around the world, but they originated in the Mediterranean basin or Central Asia. The entire plant, including the leaves, stalks, pods, and beans, is a source of L-dopa. The amount of levodopa may vary considerably, depending on the species, climate zone, soil conditions, precipitation, and other factors. Scientists know that the pods and young beans contain more L-dopa than mature beans. Approximately 100<span class="elsevierStyleHsp" style=""></span>g of fresh or green broad beans may contain 50 to 100<span class="elsevierStyleHsp" style=""></span>mg of L-dopa.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The literature describes anecdotal cases of patients with PD who showed substantial improvement after consumption of broad beans.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Studies carried out in healthy subjects and in patients with PD show that after controlled consumption of broad beans, plasma levodopa levels remain at higher levels for longer periods in patients than in healthy volunteers. This is probably caused by the potent long-term effect of carbidopa on peripheral decarboxylase.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> The increase in plasma levodopa in PD patients after broad bean consumption is accompanied by significant improvement in motor symptoms; in some cases, intense dyskinesia will disappear.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> The pathophysiology underlying motor fluctuations, and dyskinesias in particular, has yet to be fully explained.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Studies have demonstrated the presence of peripheral and central pharmacokinetic factors as well as central pharmacodynamic factors. Central factors are considered more important, and include pulsed dopaminergic stimulation (non-physiological) of striatal receptors and loss of ability to store dopamine in the striatum.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> The appearance of motor fluctuations in response to L-dopa indicates disease progression in PD. In our patient, whose long history of PD indicates severely impaired nigrostriatal terminals, a diet rich in broad beans provoked dopaminergic hyperstimulation that caused severe central nervous system effects (agitation, chorea) and peripheral autonomic effects.</p><p id="par0035" class="elsevierStylePara elsevierViewall">From a nutritional standpoint, broad beans are an excellent foodstuff and a potential means of combating the effects of PD, but doctors must inform patients about their effects. This clinical case illustrates a fact that is often overlooked: natural levodopa is present in certain foods that are frequently consumed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ramírez-Moreno JM, Salguero Bodes I, Romaskevych O, Duran-Herrera MC. Broad bean (<span class="elsevierStyleItalic">Vicia faba</span>) consumption and Parkinson's disease: a natural source of L-dopa to consider. Neurología. 2015;30:375–376.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fava beans and Parkinson's disease: useful ‘natural supplement’ or useless risk?" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 58 | 3 | 61 |
| 2024 October | 463 | 16 | 479 |
| 2024 September | 345 | 30 | 375 |
| 2024 August | 830 | 16 | 846 |
| 2024 July | 949 | 21 | 970 |
| 2024 June | 314 | 14 | 328 |
| 2024 May | 354 | 6 | 360 |
| 2024 April | 300 | 16 | 316 |
| 2024 March | 377 | 15 | 392 |
| 2024 February | 351 | 8 | 359 |
| 2024 January | 428 | 14 | 442 |
| 2023 December | 362 | 12 | 374 |
| 2023 November | 368 | 15 | 383 |
| 2023 October | 553 | 24 | 577 |
| 2023 September | 356 | 24 | 380 |
| 2023 August | 311 | 20 | 331 |
| 2023 July | 282 | 24 | 306 |
| 2023 June | 392 | 40 | 432 |
| 2023 May | 488 | 26 | 514 |
| 2023 April | 429 | 22 | 451 |
| 2023 March | 323 | 7 | 330 |
| 2023 February | 432 | 26 | 458 |
| 2023 January | 300 | 22 | 322 |
| 2022 December | 277 | 27 | 304 |
| 2022 November | 351 | 33 | 384 |
| 2022 October | 257 | 25 | 282 |
| 2022 September | 241 | 25 | 266 |
| 2022 August | 217 | 16 | 233 |
| 2022 July | 181 | 20 | 201 |
| 2022 June | 243 | 18 | 261 |
| 2022 May | 251 | 25 | 276 |
| 2022 April | 294 | 21 | 315 |
| 2022 March | 274 | 28 | 302 |
| 2022 February | 204 | 20 | 224 |
| 2022 January | 244 | 21 | 265 |
| 2021 December | 295 | 15 | 310 |
| 2021 November | 336 | 29 | 365 |
| 2021 October | 248 | 33 | 281 |
| 2021 September | 256 | 12 | 268 |
| 2021 August | 208 | 18 | 226 |
| 2021 July | 240 | 15 | 255 |
| 2021 June | 201 | 11 | 212 |
| 2021 May | 220 | 26 | 246 |
| 2021 April | 589 | 39 | 628 |
| 2021 March | 441 | 19 | 460 |
| 2021 February | 230 | 30 | 260 |
| 2021 January | 227 | 23 | 250 |
| 2020 December | 228 | 22 | 250 |
| 2020 November | 223 | 29 | 252 |
| 2020 October | 163 | 17 | 180 |
| 2020 September | 180 | 24 | 204 |
| 2020 August | 288 | 13 | 301 |
| 2020 July | 227 | 11 | 238 |
| 2020 June | 288 | 24 | 312 |
| 2020 May | 266 | 25 | 291 |
| 2020 April | 290 | 32 | 322 |
| 2020 March | 259 | 15 | 274 |
| 2020 February | 330 | 26 | 356 |
| 2020 January | 307 | 25 | 332 |
| 2019 December | 275 | 28 | 303 |
| 2019 November | 402 | 21 | 423 |
| 2019 October | 462 | 39 | 501 |
| 2019 September | 265 | 21 | 286 |
| 2019 August | 361 | 17 | 378 |
| 2019 July | 473 | 24 | 497 |
| 2019 June | 463 | 25 | 488 |
| 2019 May | 365 | 62 | 427 |
| 2019 April | 343 | 41 | 384 |
| 2019 March | 171 | 22 | 193 |
| 2019 February | 101 | 42 | 143 |
| 2019 January | 110 | 23 | 133 |
| 2018 December | 114 | 9 | 123 |
| 2018 November | 107 | 11 | 118 |
| 2018 October | 201 | 34 | 235 |
| 2018 September | 120 | 18 | 138 |
| 2018 August | 69 | 10 | 79 |
| 2018 July | 53 | 8 | 61 |
| 2018 June | 99 | 12 | 111 |
| 2018 May | 74 | 17 | 91 |
| 2018 April | 73 | 8 | 81 |
| 2018 March | 147 | 4 | 151 |
| 2018 February | 83 | 5 | 88 |
| 2018 January | 98 | 8 | 106 |
| 2017 December | 65 | 2 | 67 |
| 2017 November | 66 | 7 | 73 |
| 2017 October | 117 | 10 | 127 |
| 2017 September | 110 | 5 | 115 |
| 2017 August | 92 | 9 | 101 |
| 2017 July | 88 | 4 | 92 |
| 2017 June | 122 | 33 | 155 |
| 2017 May | 102 | 11 | 113 |
| 2017 April | 137 | 16 | 153 |
| 2017 March | 113 | 22 | 135 |
| 2017 February | 161 | 7 | 168 |
| 2017 January | 93 | 11 | 104 |
| 2016 December | 62 | 13 | 75 |
| 2016 November | 66 | 9 | 75 |
| 2016 October | 82 | 16 | 98 |
| 2016 September | 125 | 20 | 145 |
| 2016 August | 57 | 18 | 75 |
| 2016 July | 68 | 17 | 85 |
| 2016 June | 61 | 19 | 80 |
| 2016 May | 74 | 20 | 94 |
| 2016 April | 86 | 24 | 110 |
| 2016 March | 44 | 18 | 62 |
| 2016 February | 42 | 14 | 56 |
| 2016 January | 59 | 12 | 71 |
| 2015 December | 55 | 12 | 67 |
| 2015 November | 56 | 11 | 67 |
| 2015 October | 46 | 14 | 60 |
| 2015 September | 32 | 11 | 43 |
| 2015 August | 62 | 21 | 83 |
| 2015 July | 28 | 21 | 49 |
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