Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Valentijn, Apr 13, 2012.
I doubt there is a medical term for 'brain zaps' Hixxy, as doctors deny withdrawal symptoms exist
What a fancy test. Is this through metametrix or something? I would add some tryptophan at night to restore serotonin. And I would take more tyrosine in the morning for more norepinephrine. Methyhistidine is high in the urine. Probably from gut issues. Do you get hyperactivity as well? I imagine so with low serotonin. Sorry I can't offer more at this point. I have know idea about the other stuff. And no one really does but Rich. lol A modest amount of DHEA like 50 mg a day could not hurt as Ema suggested. In any event maybe you are a candidate for his methylation protocol (did not read if u did that already yet or not)
Here are some comments on your test results:
You have deficiencies in vitamin B6 and magnesium.
You have glutathione depletion, a functional B12 deficiency, a partial methylation cycle block, and depletion of folates. (Your methylmalonate is normal because the B6 deficiency is preventing this pathway from being challenged.)
The B6 and magnesium deficiencies are both contributing to a low rate of synthesis of glutathione. You are in severe oxidative stress because of the glutathione depletion.
Your gut doesn't look too bad, but you may have a little dysbiosis and yeast overgrowth.
Your tryptophan is low, and that is likely contributing to the low serotonin, but low tetrahydrobiopterin and low B6 are probably contributing also.
The drop between dopamine and norepinephrine is probably due to the vitamin C depletion.
The early drop in your cortisol and your low-normal DHEA are likely due to dysfunction in the secretion of ACTH by the pituitary, secondary to glutathione depletion in the pituitary.
Your low-normal 24-hour urine volume suggests that you don't have diabetes insipidus (not to be confused with diabetes mellitus).
Your low-normal GABA with normal glutamic acid suggests that you might have some excitotoxicity.
You have low tetrahydrobiopterin (BH4) because of the methylation cycle block and the accompanying block in the folate metabolism.
Your cells are not burning carbohydrates, fats or amino acids at very high rates. I think the magnesium deficiency is blocking the carbohydrate metabolism, and the B6 deficiency is blocking the metabolism of fats and amino acids. I would guess that you don't have much energy, and that your body is running at a below-normal temperature. I wonder if you have had your thyroid hormones checked, including TSH, free T4, free T3 and reverse T3. Low thyroid could be contributing to this low metabolic rate
Your vitamin C is depleted because the low glutathione status prevents it from being recycled.
I think those are all of my comments.
Awesome analysis, Rich! It's incredible the amount of info you extract from these organic acid panels. I think I am going to have one done just to have it analyzed by you!
Just a quick thing in case you aren't yet aware of this: vitamin C also recycles BH3 back into BH4, after peroxynitrite oxidizes BH4. Here's a paper that talks about this: "Interactions of Peroxynitrite, Tetrahydrobiopterin, Ascorbic Acid, and Thiols". It seems that once oxidative stress gains the upper hand, it screws with everything including the body's ability to produce proper amounts of neurotransmitters.
If you run it, I will be happy to comment on the results, assuming I'm still kicking then and have not become too overwhelmed!
Thanks for the paper. Very cool! I didn't realize that.
Yes, oxidative stress messes with everything
I'm sure that there is still more in these lab tests that I have not figured out how to milk from them, but fortunately doing certain things like getting the B vitamins up and lifting the methylation cycle partial block covers a multitude of sins!
An interesting thing that strikes me from your analysis is the normal methylmalonate being indicative of b6 deficiency. My OAT from last year had normal methymalonate and I suffer pyroluria.
Is there anything that affects the reliability of FIGLU? My FIGLU was also normal.
The use of methylmalonate as a marker for functional B12 deficiency can be masked by low B2, low B6, low biotin, or low amino acids.
The use of figlu as a marker for low tetrahydrofolate can be masked by low histidine.
Quite a few PWMEs have these deficiencies, so it can take some "reading between the lines" to interpret the results of a urine organic acids panel sometimes. But if the markers for glutathione indicate that it is really low, it's pretty certain that the rest of the vicious circle mechanism is there, too. Nevertheless, I like to see a methylation pathways panel, because it is clearcut.
Thanks so much for the analysis. Some of the things you suggested I usually take (though not the week before the test), but it's good to see what I really need ... I'll try tweaking magnesium and B12/B6/folate doses and seeing if I can get vitamin C down without diarrhea resulting. And I'll add thyroid stuff to my list of things to look into with my next round of tests.
You're very much correct on both counts. I get PEM with very little exertion (once from tensing muscles as part of guided meditation at the ME clinic). My body temperature is always low, and that was true even before I got sick, though it seems worse now. My fiance thought I felt feverish last night, but when I took my temperature it was low (35.6 Celsius or 96.1 Fahrenheit).
Me too! I never had OI issues until I got them as a side effect of that drug. ...And then they never cleared up.
And yes...I second what others have said here. Everyone responds differently to different medications. But it's wise to know the risks, and this drug is definitely in the running as the worst thing that has ever happened to me. Really bad on it, and horrific effects trying to get clear of it.
Rich - Could you tell me which item indicates BH4 status? I've had an organic acids test done, but don't know what indicates that. ...Or if I were to scan mine in, do you think you could help me too? I wasn't off my supplements when the test was done, though. Was taking my usual pile of things.
I think because several of the neurotransmitters that rely on BH4 tested were low, plus tyrosine was on the low end of normal, something that also needs BH4.
Hi, Sparrow and Valentijn.
That's right. The most clear-cut marker for BH4 is the ratio of tyrosine to phenylalanine. The conversion of phenylalanine to tyrosine requires BH4. So if phenylalanine is relatively high in its reference range, and tyrosine is relatively low in its reference range, that suggests that BH4 is low. Low neurotransmitters can be a helpful clue, too, but there are other things that can cause that, such as low B6 or low B2, so if several things are going on at the same time, which is often the case, this marker becomes a little murky. In interpreting the urine organic acids panels together with the amino acids panels, it's necessary to sort of play one thing against another to get a consistent interpretation, because there are so many interactions. That's why the computer-programmed interpretation of these panels is difficult to write in a straightforward manner, and the advice given on the results by the lab does not always fit a particular case too well. I've been interpreting these panels for a long time now, and I am still learning new things about them. It gets particularly interesting when someone has an unusual polymorphism, so that the enzymes are not operating as usual.
Rich do u have an opinion on supplementing with tyrosine or acetyl tyrosine?
I have been using it of late and finding it helpful for cognitive energy etc
I think it can be helpful, particularly if tyrosine is low. I might mention that Dr. Karen Vrchota told me at the Ottawa IACFS/ME conference that she had found that it is important to supplement tyrosine and tryptophan together. I'm not sure I understand why. I think she said that if you supplement only one of them, the kidneys will dump too much of the other. I haven't tracked that down yet, but as I recall, that's what she told me, before she scooted off! I was stuck at my poster exhibit!
O.K., I think I understand it now. The same TAT1 transporters are used in the kidneys for the reabsorption of tyrosine, tryptophan, phenylalanine and L-dopa. So if you supplement one of these, you can overload the transporters with it, and then more of the others will be dumped into the urine. So to maintain blood levels of both tyrosine and tryptophan, it is best to supplement them together.
Interesting, after i posted i took some 5htp with the acetyl tyrosine. Im hoping it helps with alot of aches and pains im getting of late too. I think amino acids are interesting as by themselves many can have drug like effects and can gives us immediate effects.
Some people are supplementing with mucuna?? to increase dopamine. Have u seen anyone have success with this?
Increasing noradrenaline with tyrosine also increases dopamine too??
You would think it would increase dopamine first and possibly more than norepinephrine depending on how much your system converts dopamine to norepineprine.
I've read somewhere in the past that trypotophan (5-HTP too maybe?) and tyrosine compete to cross the BBB. So might pay to dose them separately.
Likewise only dose tyrosine (and mucuna) no later than lunch time (my previous doctor's instructions).
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