Does Supplemental Collagen Reduce Tendon Pain from Being Floxed?

Taking fluroquional antibiotics like Cipro has been associated with a significantly increased risk of tendinitis and tendon rupture.   Achilles tendon tear is the number one negative side of these antibiotics, with some people experiencing tendon tear with simple activities like getting out of a car.

My husband said he felt like there was a vice grip on his ankle shortly after he took Levaquin, a fluoroquinolone antibiotic.   His doctor and physical therapist told him to “take it easy” as he may tear his Achilles tendon—a pretty high price to pay for taking an antibiotic for a minor infection.

Fluoroquinolone antibiotic causes this by disrupting the production of collagen, the protein that the body uses to form our skin, tendon, muscles, bones, cartilage, and ligaments.   It might be noted that collagen is also used to form our nerves and nerve pain is another symptom of this toxicity.

What is Collagen?

Collagen is the most abundant protein in the body and is formed from key amino acids (protein building blocks).   The three critical amino acids that the body uses to make collagen is glycine, proline, and lysine.

There are four types of collagen, usually referred to as Type I-IV.   Type 1 and 3 collagen are found in our muscles, tendons, ligaments, skin, and cartilage.   Type 4 is found in our nerves and provides healthy nerve function and repair.

Key Factors in Collagen Production

We often hear of vitamin C as being a critical nutrient that stops the aging process in our skin.  This is because vitamin C plays a pivotal role in the formation of collagen.  Vitamin C is a co-factor in hydroxyproline production, which is a stabilizing factor in the collagen.

Vitamin C also helps iron to signal the production of enzymes that catalyze the reaction to form collagen.  I always like to say, “enzymes make things happen.”   Vitamin C also makes sure that our iron is recycled back into a safe form of iron, reducing oxidative stress.

How Does Fluoroquinolone Toxicity Affect Collagen Synthesis?

Remember that iron plays a role in collagen synthesis?  FQ toxicity reduces iron's ability to produce enzymes that trigger the production of hydroxyproline.

One research study showed the FQ toxicity reduced activity to the three enzymes that trigger collagen and hydroxyproline production.  Reduced hydroxyproline has found to cause significant changes in collagen's mechanical properties, causing the tendons to be stiff and rigid.

Other studies have shown that FQ toxicity enhances the enzymes known as extracellular matrix metalloproteinases, increasing collagen's breakdown, especially in tendons.  This increased breakdown of collagen increases the likelihood of tendonitis and tendon damage.

Fluoroquinolone Toxicity Can Lead to Long Term Tendon Pain & Damage

Have you ever wondered why your tendon pain and damage doesn't seem to go away even months after taking the medication?   This is because the gene expression or “recipe” on how your body creates collagen and hydroxyproline can be changed or altered. This changes the genetic instructions or recipe for healthy collagen faulty.

This change in genetic instructions is known as the science of epigenetics.  Epigenetics is the science of how specific genes that are not encoded in the DNA can be activated or silenced.  I like to think of the DNA as our cells' hardware that really cannot be changed.  Epigenes is like software on your computer that can be changed.

What can change our gene expression?  When the cell's environment is changed due to toxicity, nutrient deficiencies, or chronic stress, those genes can be expressed.  Fluoroquinolone toxicity leads to a gene expression that reduces the enzymes that are responsible for making healthy collagen.

Can You Reverse Gene Expression Caused by Fluoroquinolone Toxicity?

You can change gene expression by changing the cell environment, reducing oxidative stress, and providing plant nutrients known as bioactives. 

These bioactives are compounds known as polyphenols, and they upregulate a crucial gene known as NrF2.  This gene plays a pivotal role in the production of antioxidants reducing oxidative stress and inflammation.

Fluoroquinolone toxicity, like most toxicity, creates a much higher demand for antioxidants like glutathione.  This toxicity leads to oxidative stress.  By providing polyphenols that upregulate NrF2, you can change gene expression to create healthy collagen.

What are the key polyphenols that can reduce oxidative stress and upregulate NrF2?

• Lycopene – Tomatoes (cooked only), pink grapefruit, and watermelon.
• Quercetin – Elderberries, Fennel, Garlic, Onions, Radish Leaves
• Curcumin – Turmeric*
• Sulforaphane – Cruciferous Vegetables (Broccoli, Cabbage, Cauliflower, Radish, Kale, Chard)
• Epigallocatechin (EGCG) – Green Tea, Matcha

NOTE:  Supplemental high dosage turmeric has been found to lead to iron deficiency in some people.  Recommend supplementing with curcumin in the form known as BCM-95.  This form of curcumin has been found to be the best absorbed.  I like this product.  Get 15% off with NutriDyn Sign up Today!  Practitioner Code: 282711

Does Supplemental Collagen Help to Reduce Tendon Pain and Damage Caused by Fluoroquinolone Toxicity?

Supplemental collagen has all of the amino acids to form healthy collagen, making sense to supplement with collagen.  However, it doesn't contain the essential cofactor nutrients that help create collagen, like vitamin C, copper, and vitamin B6.  

Nor does it contain those bioactives or polyphenols that help to change gene expression.  The key to reducing FQ toxicity effects on tendons and nerves is to change the gene expression, thereby increasing the enzymes that produce healthy collagen.

Collagen supplementation would be more beneficial if taken along with these nutrients and bioactives.  Increasing polyphenols and antioxidants also has the bonus of reducing oxidative stress, a significant factor in how FQ toxicity causes so much damage.

Best Way to Reduce Tendon Pain and Damage Caused by Fluoroquinolone Toxicity

The best way to reduce tendon pain and damage from FQ toxicity is to combine the right foods, supplements, and if needed, supplemental collagen to help your body overcome the toxicity.  And, to change the gene expression to help the body naturally produce healthy collagen.

There are many foods that are naturally high in collagen-like bone broth.  The best way to enjoy bone broth is to make your own but if you are looking for a good bone broth powder, I like Ancient Nutrient bone broths.  I like them because they offer a wide variety of different bone broth made from different sources.  This helps to accommodate those that have food sensitivities to different protein sources, like beef or chicken.  Sign Up Today with my Fullscript and get 15% off.

Overall your diet should be rich in those foods that provide those polyphenols along with healthy sources of protein.  A more plant-based diet like the Mediterranean diet is best as it provides moderate sources of protein, high in vegetables, nuts, seeds, and legumes (beans, lentils). 

Support the process of making collagen instead of trying to supplement it just with collagen.   You can support collagen production with these key nutrients:

• Vitamin C – Choose a product that is more complete, like C 500 Chewables that is specific to collagen production.  Get 15% off at NutriDyn.
• Copper – Food high in copper are organ meats, oysters, spirulina, nuts, and seeds.  The leading cause of copper deficiency is taking too much zinc.  Always make sure if you are taking zinc, to also supplement with copper in small amounts.
• Vitamin B6 – B vitamins should all be taken together in a complex.  It is not uncommon to see deficiencies in vitamin B6 with being floxed and you should get levels tested before using high dosage vitamin B6.  High dosage vitamin B6 can lead to nerve damage, especially in the hands.  
• Iron – Make sure to test for iron levels as FQ toxicity can disrupt iron metabolism causing excessive iron absorption from food.  For some people that can lead to high levels of oxidative stress.

To help speed up your recovery, try using supplements that help to reduce inflammation and speed up recovery from tendonitis.  My favorite NutriDyn products for pain relief are Chrondo Jointade, Herbal Eze, and Nerve Eze.  These products not only contain essential nutrients that reduce pain, they also contain those nutrients that support healthy collagen products.   These can be found in NutriDyn Floxie Solutions Store.  Sign up Today and Get 15% off.  Practitioner Code: 282711

What Should You Look for In Collagen Supplementation?

Collagen supplementation along with nutrients like vitamin C, may be beneficial especially for those with genomic variants like COL1A2. 

This genetic variant affects how your body produces collagen and it has been shown that supplementing with collagen can help to repair tendon damage more quickly.  Learn more about genomics. 

What should you look for in a collagen supplement?  Collagen is a very large molecule and is hard to break down into the protein building blocks that form collagen. 

In most cases, fluoroquinolone toxicity leads to poor digestion and reduced digestive enzymes. Poor digestion reduces the ability to absorb and breakdown collagen.  

Using a collagen supplement that is broken down or in the form of polypeptides would be a better collagen supplement.

Always look for a quality collagen supplement product that is from grass fed cows and guaranteed to free of glyphosate contamination like this one. 

 A study done in 2020 found high levels of contamination of lead, mercury, and other heavy metals in some of the top-selling collagen brands. 

Collagen Supplement May Lead to Oxalate Toxicity

Fluoroquinolone antibiotics can lead to oxalate toxicity as it disrupts the gut microbiome and increases the likelihood of vitamin B6 deficiency.   Vitamin B6 plays a crucial role in the breakdown of oxalates.

The body naturally produces oxalates from the breakdown of hydroxyproline for collagen.  Collagen contains high amounts of hydroxyproline.  Therefore supplementing with collagen may lead to oxalate toxicity for some people.

Oxalates can also be formed from glycine, the number amino acid in collagen.  Glycine is produced in a reversible reaction where vitamin B6 acts as a co-factor.

The number one symptom of oxalate toxicity is kidney stones, yet only 7% of people with oxalate toxicity get kidney stones.  Before using collagen supplementation, you may want to rule out oxalate toxicity, as this may be the cause of your joint and tendon pain.   

Not sure if you have oxalate toxicity, get tested today with the Organic Acid Test.  The Organic Acid Test (OAT) is part of my Floxie Solutions because it not only tests for oxalates, it tests for vitamin B6 levels.  To learn more about my Floxie Solutions program, get your complimentary consult today!

References:

1. Treatment of the Fluoroquinolone-Associated Disability:  The Pathobiochemical Implications
2. Proline Precursors and Collagen Synthesis:  Biochemical Challenges of Nutrient Supplementation and Wound Healing
3. Collagen Diet, https://www.medicinenet.com/collagen_diet/article.htm
4. Primary and Secondary Hyperoxaluria: Understanding the Enigma
5. Advanced Nutrition and Human Metabolism, Sareen S. Gropper, Jack L. Smith, Sixth Edition