What is the biggest issue for pwd (people with Parkinson’s? For many it is in fact constipation, certainly is a big issue for me. I know it is not a pleasant topic.

The idea is that Parkinson’s is caused by a shortage of dopamine in the brain. The current approach is to take levodopa tablets. I am diligently taking my tablets every four hours – but the symptoms don’t improve. Why is that? I put my hand on my head (no need to scratch – sorry Parkinson’s humor).

Levodopa is not dopamine but it is small enough to pass through the blood-brain barrier. It still needs to be converted by enzyme action to dopamine.

Once you take the levodopa tablet it must be absorbed in the small intestine. It so happens that levodopa competes with proteins in the absorption process, they both are made up of amino acids and compete for the amino acid absorption channels in the intestine wall. So try and take the tablets on an empty stomach. I would often pass on deserts like custard or ice cream for that reason.

The other problem is constipation. If you are all blocked up, it can interfere with the absorption. The disease interferes with the nerves controlling the peristaltic movement of your bowels.

A fairly new approach is to bypass the gut entirely by using a levodopa pump. These are expensive and not without complications of their own. Another option is the use and levodopa inhaler.

In the meantime traditional block busters are your best option – laxatives, enema or suppositories. Ah, what a topic to discuss 🙁