Journey with Parkinson’s: A Reminder About the Interference of Protein with the Uptake of Carbidopa/Levodopa

“Life is too short to worry about anything” Eric Davis

“Imperfections are not inadequacies; they are reminders that we’re all in this together.” Brené Brown

The Need for Increased Protein as We Age: As we age, we lose muscle mass, a condition called sarcopenia. To offset age-related muscle loss, one can start exercising and increase protein intake.

For a review of this topic, see the following article: Baum JI, Kim IY, Wolfe RR. Protein Consumption and the Elderly: What Is the Optimal Level of Intake? Nutrients. 2016 Jun 8;8(6):359. doi: 10.3390/nu8060359. PMID: 27338461; PMCID: PMC4924200.

“Would you rather live your life according to the approval of others or aligned with your truth and your dreams?” Robin S. Sharma

Extra Sources of Protein in Our Diet: The latest trend in American diets and health is the consumption of protein, and sometimes in large amounts. The trend exists for all kinds of medical conditions, and the use of animal (usually cow) proteins, such as collagen digests and isolated milk proteins.

Collagen Peptides- The collagens are typically fibrillar in structure and as such are not very soluble and very resistant to degradation or breaking down. Thus, collagen mixtures sold today are hydrolyzed to smaller units (what we call peptides). Remember, proteins are linear arrays of amino acids that fold into 3-dimensional shapes. The unit that binds proteins together is called a peptide bond, and the hydrolysis of these bonds yields a mixture of peptides. Moreover, the peptides are soluble and can be further processed by our gastrointestinal tract, absorbed into the bloodstream, and transported throughout the body.

Research suggests that collagen peptides may improve skin hydration and elasticity. Furthermore, they could help reduce pain and improve joint function in individuals with osteoarthritis.

Two excellent reviews of hydrolyzed collagens are provided by Khatri M, Naughton RJ, Clifford T, Harper LD, and Corr L. The effects of collagen peptide supplementation on body composition, collagen synthesis, and recovery from joint injury and exercise: a systematic review. Amino Acids. 2021 Oct;53(10):1493-1506. doi: 10.1007/s00726-021-03072-x. Epub 2021 Sep 7. PMID: 34491424; PMCID: PMC8521576.

Al Hajj, W.; Salla, M.; Krayem, M.; Khaled, S.; Hassan, H.F.; El Khatib, S. Hydrolyzed collagen: Exploring its applications in the food and beverage industries and assessing its impact on human health – A comprehensive review. Heliyon 2024, 10, doi:10.1016/j.heliyon.2024.e36433.

Milk Protein Concentrates- A popular source of protein for large-scale consumption is derived from milk. They are primarily composed of two types of proteins: casein and whey. Typically, these proteins are sold as highly purified products, either as caseins or as whey-derived proteins.

Milk provides health benefits primarily through its casein and whey proteins. Numerous studies have found that these milk proteins have anticancer, antihypertensive, and immune-modulating effects.

An excellent review of the health benefits of milk proteins is in Davoodi SH, Shahbazi R, Esmaeili S, Sohrabvandi S, Mortazavian A, Jazayeri S, Taslimi A. Health-Related Aspects of Milk Proteins. Iran J Pharm Res. 2016 Summer;15(3):573-591. PMID: 27980594; PMCID: PMC5149046.

“Men more frequently require to be reminded than informed.” Samuel Johnson

Protein May Interfere with Carbidopa/Levodopa Uptake in the Gut and Possibly Even the Blood-Brain Barrier: For some individuals with Parkinson’s, this problem may not affect everyone to the same degree. We came home from Costco last week with a container of collagen peptides, thinking it might help replenish depleted collagen levels in our skin and maybe even help replace collagen in joints prone to arthritis.

The instructions said to take four tablespoons of collagen peptides (20 grams) daily, and a straightforward way to do so is to add them to your morning coffee. Here is where I went “brain dead.” I added the collagen peptide product to my morning coffee and drank it before my first dose of carbidopa/levodopa (Crexont). I usually take up to an hour, and sometimes even over an hour, to drink this cup of coffee (which is in a YETI container, keeping it heated the entire time). Then I would take the Crexont. Moreover, soon I began to realize some of my motor issues were recurring, and the rest of the Crexont doses seemed not to be working as well as they were last week.

One of the benefits of Crexont is the rapid release of ~1/3 of the levodopa, followed by a slow release of the remaining ~2/3. Interestingly, the complete story of how Crexont is metabolized in the gut is not yet understood. However, an important take-home point regarding Crexont is the long-lasting residual levodopa fall-off. Thus, my thought now is that, by interfering with the first dose of Crexont and altering its action due to these collagen peptides, my body may not fully compensate for the loss of levodopa in the remaining doses. And continuing to take the collagen peptide mix with my first cup of coffee, kept my motor issues staying around. Then it hit me, “Frank, you were trained as a protein biochemist, what are the collagen peptides? They are protein, so stop using it!’

“For every failure, there’s an alternative course of action. You just have to find it. When you come to a roadblock, take a detour.” Mary Kay Ash

Some Things to Consider when Taking Carbidopa/Levodopa in the Presence of Proteins:
•Levodopa is derived from an amino acid- Proteins and peptides are likewise made of amino acids. And the uptake of levodopa in the gut requires the same amino acid transport system used by proteins/peptides. Thus, a large amount of protein/peptide digest could drastically interfere with levodopa uptake and processing.

•Timing is important– Most organizations recommend taking carbidopa/levodopa at least 30-60 minutes before or 1-2 hours after a meal/snack. Our actions determine how effectively carbidopa/levodopa works. Think, do not be brain dead like me, and eventually realize these protein products can disrupt your body’s uptake of carbidopa/levodopa.

•20 grams of protein in a morning drink or incorporated into a diet is a large amount of protein/peptide digest- And when taken close to taking your dose of carbidopa/levodopa, this amount of protein/peptide digest is large enough to affect the absorption of levodopa through the gut.

•This effect of protein/peptide digests is specific for levodopa, not carbidopa- Thus, protein is directly “competing” with levodopa for uptake, not interfering with carbidopa’s role to protect degradation of levodopa before uptake into the brain.

•Not everyone with Parkinson’s will have this sensitivity to protein/peptide digests when taking carbidopa/levodopa- Individuals with Parkinson’s should consult with their neurologist if they have any concerns.

“Each time you look up into the night sky, let the stars remind you that if you burn bright enough you can be a glimmer of hope to someone even if the are a million miles away.” Adeel Ahmed Khan

Cover photo credit image by Aussiepics from Pixabay