Archive for the ‘Nutrition’ Category

November 11, 2014

Pyrrole-mania.

“You only see what you look for…and only look for what you know.”  An axiom from medical school, often attributed to William Osler, though not confirmed.  Nevertheless, an important aphorism in how we understand and put together the collection of symptoms presenting in clinic, particularly in the case of pyroluria.

I hadn’t heard of pyrroles until well past my formal education, when  I started to unearth the orthomolecular medicine archives and explore that body of literature buried in the annals of nutritional interventions (the intervention likely the real reason why it isn’t so readily recognized in the mainstream medical community).

So what is pyroluria?

Pyrolouria is a genetic blood disorder having to do with the synthesis of red blood cells.  During the production of hemoglobin, hydroxyhemoppyrrolin-2-one (HPL)  is formed as a byproduct.   In most people, this “harmless” byproduct is easily excreted through the urine.  However, in some, the levels of HPL  accumulate too quickly to be excreted efficiently.  Pyrroles have a very high affinity for zinc and B6 (and also block the receptor sites for these two nutrients); as the excess pyrroles are excreted, they take with them these two vital nutrients, leading to zinc and B6 deficiency states.  Zinc has many functions, including in the immune system, gut integrity, and neurotransmitter synthesis; among other things, B6 is essential for the synthesis of serotonin, dopamine and GABA.  So as these nutrients dwindle, emotional and physical repercussion potentially crescendo.

The true etiology is unknown, but pyroluria appears to be a genetic condition as it does tend to run in families.  However, it might also be thought of as more of an epigenetic phenomenon, as there is some evidence that it gets “activated” with trauma or infection or another environmental insult early in life.  More on epigenetics will be written in a future post, but the gist is that epigenetics is the science of gene regulation- how our inherited genes get turned on and off.

It’s estimated that approximately 11% of people in the general population have pyroluria, often being referred to in functional medicine as the most common unknown disorder.  When you look at the psychiatric community, the incidence skyrockets (shown below in percentage with elevated pyrroles):*

71% in  Down’s syndrome,

59-80% in acute schizophrenia

40-50% in chronic schizophrenia

47-50% in manic depression/Bipolar

12-46% in major depression

46-48% in autism

40-47% in ADHD/ADD

40-47% in learning disabilities

20-84% in alcoholism

71% in acute onset adult ciminal behaviors

33% in young violent offenders

 

The common symptoms are (incomplete list):

  • very poor stress tolerance
  • white spots on finger nails (from zinc deficiency)
  • sensitivity to bright lights
  • sensitivity to loud noises
  • skin sensitivities (tags on shirts, textures/materials)
  • abnormal fat distribution (large middle, skinny arms/legs)
  •  irritable bowel syndrome
  • abdominal/splenic area pain
  • delayed onset of puberty (late bloomer, growth after 16years of age)
  • irregular periods/menstrual cycles
  • pale skin
  • tendency to burn (instead of tan)
  • overcrowded teeth/poor tooth enamel
  • joint pains (cold hands/feet, creaky knees)
  • anxiety
  • social isolation/withdrawal
  • mood swings/irritability/explosive anger/tantrums
  • depression
  • disorganization
  • history of reading disorder
  • focus/concentration difficulties
  • motion sickness
  • auditory processing disorders
  • poor short term-memory/poor dream recall
  • insomnia
  • fatigue
  • hyperactivity/ADHD symptoms
  • craving for sugar/carbs
  • carving for spicy/salty foods
  • poor morning appetite/morning nausea
  • frequent infections
  • impotence
  • glucose intolerance
  • sweet or fruity body odor or breath
  • paranoia/hallucinations
  • seizures
  • very dry skin
  • psoriasis
  • tendency to stay up late at night/night owl.

And of course, with deficient zinc, free copper levels might escalate with the ensuing problems of high anxiety, poor concentration, tinnitus, explosive anger, and estrogen intolerance.     As you can see from the list, these symptoms are very common to many disorders, so this condition is frequently diagnosed as ADHD, Bipolar Disorder, learning disorders, intermittent explosive disorder, etc, with the ensuing treatments for those disorders being put in place without replacing the essential micronutrients.

Diagnosis is typically clinical with substantiation through urinary kryptopyrrole testing.  It will be important to measure zinc, copper and ceruloplasmin as well to understand the degree of zinc deficiency and free copper excess so that the appropriate interventions can be made.   Treatment is largely based on replacing the deficient nutrients of B6 and Zinc,  but is also dependent on multiple other factors that generally require a health care professional to supervise.

Until we know what to look for, pyroluria will remain a largely unrecognized, and therefore untreated illness masquerading as (and exacerbating) the sundry other psychiatric ailments.

 

(*from Discerning the Mauve Factor, part 1: Alt Therapies, Mar/Apr 2008, Vol 14, #2).

Category: ADHD, Anxiety, Depression, epigenetics, Nutrition, pyrrole, Sleep, Treatment, Uncategorized

October 28, 2014

BAD MTHFR!

We really have to reconsider what MTHFR testing means, which also means re-evaluating my earlier post on MTHFR and its treatment.    Just to recap, MTHFR is an enzyme in the biochemical pathway to methylate folate (i.e. add a methyl-group- a carbon and 3 hydrogens-  to folic acid); methylfolate then donates its methyl group to vitamin B12 (cobalamin).  The sole purpose of this enzyme is to add this methyl-group.  There are numerous polymorphisms in the MTHFR enzyme, the two most significant being the C677T and  the A1298T.  However, there are A LOT of enzymes in the whole methylation cascade, all with potential SNPs (single nucleotide polymorphisms).   In our/my  nascent understanding of MTHFR mutations, all mutations were assumed to have a deleterious effect on the brain (and body) and were treated with methylfolate as a means to bypass this errant enzyme, with the assumption the under-methylation was the main problem.   However, MTHFR mutations do not necessarily mean methylation problems, as it could certainly be offset by another polymorphism elsewhere in the pathway.   Interestingly, folate is assumed to be a good methylator. The reality, though, is that for every methyl group donated by folate (in the cytoplasm), ten methyl groups are removed from the nucleus, where the effect on the DNA is really felt (thanks to Dr. Albert Mensah for his great insights and help in understanding this!).  Folate essentially exacerbates undermethylation problems and is likely why some people actually get worse when methylfolate (or any folate, including dietary folate like in kale) is added.  It is certainly more complex than this, but the gist of what I’m really saying is that MTHFR status might be important, like in the potential contribution to elevated homocysteine in heart disease, but the the bigger picture has to do with overall methylation status, for which MTHFR mutations are not a direct indicator.

A far better test to assess overall methylation status would be to look at histamine levels in the body, as histamine is cleared from the body through methylation.  High histamine levels roughly equate with under-methylation; low histamine, with over-methylation.  The test for whole blood histamine is fragile and requires special handling in the lab;  fortunately, the Chicago based Direct Health Care Access lab has mastered this process and can educate/coordinate with other labs around the county on this process (http://pyroluriatesting.com).

Methylation status is important to know as it dramatically effects how we think and feel, what are risks are (i.e. depression, anxiety, OCD, anxiety, etc), how we respond to certain interventions, and, most importantly, how we can potentially alter the course of our genetic inheritance to live longer, healthier, happier lives.  After all, it is about wellness in the end.

For more information on methylation (which will also be posted later), I highly recommend the pioneering work of Dr. William Walsh, and in particular his book, Nutrient Power.   He works closely with  Dr. Albert Mensah and Dr. Judith Bowman of  Mensah Medical (www.mensahmedical.com).  Their website is a tremendous wealth of information on biochemical interventions and understanding brain chemistry.

 

 

Category: ADHD, Anxiety, Books, Depression, Nutrition, Treatment

March 25, 2012

MTHFR!

MTHFR stands for the mehylenetetrahydrofolate reductase gene.  It is located on chromosome 1 and is responsible for making the MTHFR enzyme.  This enzyme is essential for processing amino acids.  Specifically, it converts folate (vitamin B9) into a usable form (converting 5,10-methylentetrahydrofolate to 5-methyltetrahydrofolate) which is needed in the reaction to convert the amino acid homocysteine to methionine. It is also needed to make neurotransmitters (dopamine, norepeniphrine, serotonin) and glutathione (which is your body’s main detoxifier). Excessive homocysteine (hyperhomocystenima)  can lead to cardiovascular disease and thrombosis (to name just a few problems) and is often associated with infertility. Read the rest of this entry »

Category: Anxiety, Depression, Nutrition, Treatment

January 24, 2012

What’s Eating Your Child?

According to an October 2010 study*,  the top sources for calories for 2-18 year-olds in the US were grain desserts (cookies, cakes, granola bars), pizza, and soda, with nearly 40% of the consumed calories coming from empty-calorie foods.  The fact that no one was surprised by these results is testament to our apathy and/or our own nutritional deprivation.  Also unfortunately not shocking in the general public is that  we are seeing illnesses escalating in this pediatric population that were formerly reserved for the middle & late age range, like type II diabetes.  Just look around and you’ll see evidence of our society’s declining health. And the main source of our woes is not bad genes (though, rest assured it is a nature and nurture situation), but our environment, and more specifically, our nutritional environment, our mealiue, as it were.  Read the rest of this entry »

Category: Books, Nutrition, Treatment

December 30, 2011

Got Milk (Allergies)?

There are 4 main food sensitivities that seem to affect kids the most:  milk, wheat, soy, & eggs.

I’ll spend a little time later on the wheat/gluten concerns, but for now I want to talk just a little about milk and dairy sensitivities, given that milk and cookies have pretty much formed the staple of the holiday diet.

Generally speaking, nutritional related problems fall into 2 broad categories: deficiencies and irritants.  As described in prior posts, we as a whole tend to be nutritionally deficient when it comes down to optimum health.  That slow & steady depletion, much like a slow leak, will eventually lead to health problems.  Except in extreme cases, gross, single nutrient deficiencies are relatively rare (though Vitamin D – which is technically a hormone- seems to be low in almost everyone that I test- but more on that in a later post). Read the rest of this entry »

Category: Nutrition, Treatment

December 15, 2011

Allergies, Sensitivities, and Intolerance

In the last post i talked about the association between a leaky-gut and a leaky-brain, and that the nexus is inflammation.   Inflammation, again, is part of an allergic reaction, which is narrowly defined as symptoms following a histamine response.

Since we have been focusing on food, nutrition, and gut health, i wanted to spend a few moments clarifying food allergies,  which are becoming a major concern in our society, so much so that peanuts are now banned in public schools. in fact, the incidence of food allergies has increased by 8% from 1997-2007 in children under 18 years of age.  There are many theories as to why food problems are on the rise, from our overly hygienic society to the surreptitious use of GMOs (genetically modified organisms), but that is for a later posting. Read the rest of this entry »

Category: Nutrition

November 18, 2011

Fire in the Whole

There is a phrase in functional medicine that says: fire in the gut, fire in the brain.

What this means is that inflammation (Latin for ignite or set alight) in the GI system will lead to inflammation in the brain (and body systemically).   GI irritation can come from multiple factors- food sensitivities, bacteria, yeast, medications, stress, etc. The intestinal wall is just one cell layer thick and bound together by “tight junctions.”  Just beneath this cell layer lies the GALT, or Gut-Associated Lymphoid Tissue), which constitutes approximately 60% of our immune system.  When the gut becomes inflamed or irritated, these tight junctions become permeable, allowing food-stuff, bacteria, yeast, etc -essentially anything in your intestine that is small enough to fit through that space- into your body, setting off the immune response cascade.  This process is commonly referred to as the  leaky-gut syndrome. Read the rest of this entry »

Category: Nutrition

November 10, 2011

TRUE HOPE (Part III)

So if we begin with the idea that we are likely all malnourished, and that nutrient deficiencies play a role mental illness, an obvious and safe place to begin would be with replacing those nutrients to see what emerges.  Given the interplay of all of the micronutrients, including essential fatty acids and amino acids, moving beyond the single nutrient interventions except where obviously devoid (i.e. beriberi) to utilize a potent micronutrient mixture in a somewhat sawed-off shotgun approach would make the most sense as a first line strategy.  To first use what your body has evolved to run on optimally, but may be missing, and thus give your body a chance to heal itself, before inserting some foreign chemical in there to literally alter neurological functioning (in the case of most psychotropics which alter neuronal firing, receptor expression and sensitivity, neurotransmitter expression, etc).  Medicines do have a place in mental health care and often times are necessary to quell urgent problems.  They can be life saving.  But as a first line remedy, nutrients make natural sense. To FIRST DO NO (p)Harm and to begin by replenishing the body and brain completely. Read the rest of this entry »

Category: Nutrition, Treatment

October 27, 2011

True Hope (Part II)

As I said previously, about 92% of children do not get their basic, daily nutrients.  When looking at the population at large, most Americans do not meet their recommended daily allowances.   According to the USDA, the percentages of US population not getting the RDA for a given micronutrient is as follows:

  • Calcium                     72.9%
  • Folate                        75.1%
  • Iron                             34.3%
  • Magnesium                68.0%
  • Niacin                          24.2%
  • Phosphorus             21.7%
  • Riboflavin                  21.8%
  • Selenium                    14.8%
  • Vitamin A                     54.7%
  • Vitamin B6                   35.3%
  • Vitamin B12                 29.9%
  • Vitamin C                    48.3%
  • Vitamin E                    85.9%
  • Zinc                             42.0%
  • Copper                       30.7%

(Data borrowed from a presentation by David Hardy, cofounder of Truehope, at the Micronutrients in Mental Health conference 2011). Read the rest of this entry »

Category: Nutrition, Treatment

October 7, 2011

True Hope (Part I)

“Leave your drugs in the chemist’s pot if you can heal the patient with food” – Hippocrates

It is possible to use micronutrients to treat mental illness.  This is a topic that I will come back to frequently as it is something in which I strongly believe and cannot emphasize enough.  Especially when it comes to first line remedies and our mandate to “first, do no harm.”   If we can use vitamins and elements that our body already naturally runs on to heal someone’s illness, rather than inserting some foreign chemical to block or alter a receptor  (the reality is we that we don’t really know how most psychotropics really work), it would be a far healthier, safer, and natural means of treatment, in spite of supposed industry standards of care.   Especially as a first line remedy, as we can always move on to the industry standard of care next if need be. Read the rest of this entry »

Category: Nutrition, Treatment