What do chocolate chip cookies and levodopa have in common?
A. At the right time and amount, they can be a great treat!
B. However, you can have too much of a good thing.
C. They should be included among the great inventions of the 20th century.
D. They may contain vanillin (artificial vanilla).
E. All of the above
The correct answer, as you may have suspected, is “All of the above”. Much explanation needed: First of all, what is levodopa (aka L-DOPA)? I think of it as fake dopamine. Technically, I believe the right term is that levadopa is a chemical precursor to dopamine. Dopamine is the chemical that Parkis are short on, a neurotransmitter that carries signals between nerve cells controlling mood and movement.
So why not give Parkis a shot of dopamine (like diabetics get insulin)? Nope, can’t do because of the “blood-brain barrier”. Blood in the brain is a bad thing, right? (Think strokes.) But most drugs you take need the bloodstream to travel to the right place in your body. Dopamine can’t travel directly to the brain via the bloodstream, but Levodopa can pass thru the barrier and convert to dopamine in the brain. (Forgive me for this very crude explanation; I am not doctor, chemist, or biologist!)
When Levodopa was formulated in the 1960s, it was a major breakthrough, as described by neurologist Oliver Sacks in his famous book Awakenings. However, just like too many chocolate chip cookies, levodopa has all sorts of nasty side effects: nausea, vomiting, dyskinesias (involuntary movements), and among many other side effects, my personal favorite- “a false sense of well being”. To reduce the amount of levodopa needed and otherwise mitigate side effects, another dopamine enhancer, carbidopa is typically dispensed in combination with levodopa.
(As an aside, how did the scientists come up with “dopa- this” and “that-dopa”? All this dopa stuff makes me feel…..well, like a dope. Couldn’t they have chosen a more dignified name for this critical chemical?)
(As another aside, nope, I’m not taking any dopa-dope yet. However, I will accept chocolate chip cookies.)
I was stunned when I recently learned that vanillin is not just used for cheap commercial chocolate chip cookies, but is also part of the chemical stew needed to produce Levodopa. Levodopa is also produced botanically by a bewildering variety of plants and fungus, ranging from aspergillus oryzae (a fungus used to ferment soy sauce) to bananas to fava beans. Most promising are velvet beans, aka Mucuna pruriens. The use of these beans to, ahem, restore one’s libido and otherwise improve your mood has been known for centuries by ayurvedic medical practitioners.
I did exhaustive journalistic research (in other words, I checked Wikipedia) as to why these magic beans are not currently used to make L-DOPA. One inevitably jumps to the conclusion that the natural botanical product is going to be better than the chemical stew (you know, like real vanilla vs. vanillin). However, Wikipedia had the somewhat disturbing line: “In large amounts (e.g. 30 g dose), [Mucuna pruriens seed powder] has been shown to be as effective as pure levodopa/carbidopa in the treatment of Parkinson’s disease, but no data on long-term efficacy and tolerability are available. ” However, this statement is based on a 2004 paper, a lifetime ago in terms of Parkinson research.
I could buy a supplement of Mucuna pruriens today. But I wouldn’t know what I was getting, since herbal supplements are (inexplicably) not regulated. Here is some good advice from a Michael J. Fox Foundation webinar: “Supplements are not standardized or tested to the same rigorous standard as FDA-approved therapies. You may not know how much levodopa is in each dose and therefore how often you should take the plant extract for optimal benefit. Especially with levodopa, where clinicians carefully manage the introduction of the drug to offset the risk of dyskinesias, relying on a natural supplement could lead to unexpected or undesired outcomes.”
This is not to dismiss the potential of Mucuna pruriens (or other botanical sources) to be an alternative source of L-DOPA and perhaps even reduce the side effects. There does seem to be continuing research about the magic beans. In the meantime, bring on those chocolate chip cookies!