Does Supplemental Collagen Reduce Tendon Pain from Being Floxed?

Does Supplemental Collagen Reduce Tendon Pain from Being Floxed?

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.

Supplemental Collagen


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.

Kale Onions

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.


Vitamin C Rich Foods Collagen

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 StoreSign up Today and Get 15% off.  Practitioner Code: 282711


Collagen Supplementation

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 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!


  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,
  4. Primary and Secondary Hyperoxaluria: Understanding the Enigma
  5. Advanced Nutrition and Human Metabolism, Sareen S. Gropper, Jack L. Smith, Sixth Edition


Have you been Floxed?

Have you been Floxed?

What is being “floxed”?


When we think of the side effects of antibiotics, we usually think of digestive disturbances and upset stomach.  What doesn’t come to mind is tendon rupture, tendonitis, nerve damage and pain, chronic fatigue, nightmares and even hearing loss.

In April 2018 I watched my husband barely get up in the morning suffering from “burning knees”, extreme fatigue, nerve pain, and ringing in the ears.

He even got golf elbow (diagnosis from his doctor) despite not playing golf or doing repetitive action using his elbow.

Funny, this cleared up after he started recovery from the initial onset of systematic tendinitis.

In 2016, the FDA issued a black box warning on just these side effects on a class of antibiotics known as Fluoroquinolones often prescribed for urinary tract infections and upper respiratory infections.


What are Fluoroquinolones?

They are broad-spectrum antibiotics whose generic name ends in -floxin, oflxanin or -lox.

Hence the term, “floxed” or being floxed is used to refer to people who are suffering from the negative side effects of this class of antibiotics.  Some people refer to this as “fluoroquinolones toxicity”.

Whereas there are many different symptoms that occur with this “toxicity”, the most frequently reported are:

  • Tendon Rupture, Achilles.
  • Debilitating Chronic Fatigue
  • Hearing Loss, Tinnitus
  • Nerve Pain
  • Induction of Type 2 Diabetes
  • Histamine Intolerance – Mast Cell Activation
  • Gut Dysbiosis
  • High Oxlalates
  • Iron Toxicity
  • Electrolyte Imbalance – Magnesium Deficiency
  • Food Sensitivities/Intolerances

The most commonly prescribed antibiotics in this class are Levaquin (Levofloxacin), Cipro (Ciprofloxacin) and Moxifloxacin (Avelox).  There are many others in this class but the key is to look for the generic name ending in -flox.

Floxed Chronic Fatigue

Who are the most vulnerable for these negative side effects?

It is still pretty rare to have these negative side effects but it is known that certain people are more vulnerable.  Children, men over 65 years of age especially men who are athletic are more vulnerable.  In addition, people who have thyroid autoimmune conditions like Graves or Hashimoto’s.

There are also genomic variants that would make someone more likely to suffer from using these antibiotics.  Genomics is the science of slight variants in our genes that can impact our health.

For instance, variants in the thyroid hormone can a very big impact on how the body will respond to these antibiotics.  These variants usually impact how your body metabolizes and produces thyroid hormones.

Other variants include your ability to produce the powerful antioxidant known as glutathione.   Glutathione plays a major role in managing oxidative stress.  Fluoroquinolone toxicity creates large amounts of oxidative stress which is the main reason for the pain and tissue damage that occurs.

How do fluoroquinolones cause these symptoms?

These broad-spectrum antibiotics are designed to destroy bacteria by damaging their DNA.  This is very effective at eliminating the bacteria and making sure it does not survive.  However, it has been shown that also can do the same to our DNA.  Oops…

During this process, our bodies will also be releasing compounds known as reactive oxygen species (ROS).  These compounds are usually converted to water and safely eliminated.

But we do not have enough antioxidants to the job, this creates what is known as oxidative stress.  Oxidative stress leads to more inflammation, pain, and damage to the body.

Cruciferous Vegetables

What is oxidative stress?

What is oxidative stress?  It is where the body does not have enough antioxidants to manage reactive oxygen species (ROS) leading to tissue damage.  It also leads to chronic inflammation which is one of the key causes of most chronic diseases.

Vitamin A, C, E, and Zinc are powerful antioxidants that our bodies use to manage oxidative stress.  But our bodies also produce antioxidants which are 100 more powerful than dietary antioxidants.  This includes the king of antioxidants, glutathione.

Mitochondrial Damage 

The mitochondria are the powerhouse of our cells and flouroquiones actually change the DNA/RNA gene expression causing the production of “faulty” mitochondria.  This damage mitochondrial also causes high levels of ROS leading to more oxidative stress.

This is one of the reasons why the damage and symptoms can last up to one year or more after taking the antibiotic as the body continues to produce faulty mitochondria.  This can lead to chronic fatigue, tendinitis, and muscle pain.

People who have genomic variants in what is known as SOD2 will be more vulnerable to this damage greatly affecting their body's ability to produce energy.  This variant is also the enzyme that protects your mitochondria from damage.

Floxed Kale Chard Functional Nutrition

What are high oxalates and dysbiosis? 

Abrupt decline in diversity causes major shifts in the microbe community composition. Research shows that it can take over 6 months for the microbiome to recover from most antibiotics.  However, it takes even longer to recover a healthy gut microbiota with the use of these antibiotics.

When the diversity of microbes is reduced, it can lead to high oxalates  Oxalates are anti-nutrients commonly found in plants that help to protect from insects and bacteria.  One of the foods highest in oxalates is spinach and kale often touted as a superfood!  It may not be a superfood for everyone.

High oxalates can eventually lead to the formation of crystals and those crystals can settle into our joints, muscles, and our kidneys.  This can lead to muscle and joint pain as well as kidney stones.

The dysbiosis that occurs es wipes out the gut microbial known as oxalobacter formigenes which plays a major role in the removal of oxalates.

People who are deficient in vitamin B6 are more vulnerable to form oxalates.  In addition, there are genomic variants in vitamin B6 metabolism that would make them more likely to form oxalates crystals.

The best test to test for oxalates and your microbiota is the organic acid test.  Removing the oxalates requires an extensive nutritional support protocol and therapeutic diet.  Simply removing high oxalate foods from your diet can lead to what is called “oxalate dumping” which can cause everything from nerve and joint pain, severe IBS, and chronic fatigue.  Exactly what you are trying to overcome with being floxed. 

As a functional nutritionist, I worked with many clients with high oxalates walking them through how to lower their oxalates through supplementation and dietary changes.  And, I always have my client retest to make sure that they lowered their oxalate levels.  

Are there drugs to helps with the symptoms?

What is the prescription or drug to turn this around?  Medically there are no medications that really address these symptoms however antidepressants and pain medications are prescribed or recommended to get help with the side effects.

Why?  Because common lab blood work comes back, “everything normal”  therefore they can really cannot prescribe any medications.

And, the usual response beyond dealing with chronic fatigue, depression, and pain is that you “will just have to get through this”.

Physical therapy is sometimes prescribed but even physical therapists don't really know how to deal with nerve pain, muscle fatigue, and tendinitis.

Current research is showing some promise with nutritional therapy – nutrition and targeted supplementation.  Everyone is different in their response, as this is a complex condition with many different variables.

Woman Joy Nature Balanced Hormone

How you can get started on your road to recovery from being floxed?

Nutrition plays a major role in the recovery process.   Due to the fact that fluoroquinolone toxicity creates many imbalances in our bodies, it is not uncommon to have to take dietary supplementation and make major changes to your diet.

One of the reasons that fluoroquinolones impact some people more than others is because of genetics.  And, it is because of poor diet where you are already vulnerable to nutrition deficiencies and imbalances.

To get started on your road to recovery it is important to consider supplementing with the following supplements.  You can see my recommendations in my NutriDyn Store.

  • Quality Multiple Vitamin with Activated B Vitamins
  • Magnesium
  • L-Carnitine
  • Quality Probiotics
  • Vitamin D

My FREE Floxie Health Assessment is a great way to get started.  This assessment is followed up with a complimentary consult giving you the guidance that you need to move forward. 

It is also a way for me to get to know you and to see if functional nutrition is right for you.  Functional nutrition using a different approach to resolving being floxed, getting down to the root cause.

Some of the reasons people react more than others are their genomics.   Genetic variants such as MTHFR can greatly slow recovery; speaking to genes through food is a crucial element in recovery from being floxed.  Want to learn more about genomics and nutrigenomic testing?  Offering three levels of genomic testing and consulting.