- To Change Your Mind - Details Matter
Urinary Neurotransmitters Measured
Intuniv Answers: ADHD Neurotransmitters – Glutamate Matters
August 29, 2010Virtual ADHD 2010 Conference: Plan To Go
September 6, 2010
- Lab Results Matter: Image via Wikipedia
Neurotransmitters as Biomarkers
Many have been following the evolving reportage here at CorePsych Blog regarding the metamorphosis of the technology of brain science and neurotransmitter measurement – and the implications for clinical understanding for any psychiatric presentation. The theme is simple: Neurotransmitters, Endocrine/Hormones and Immune System [NEI Supra System] communication networks all conspire to gum up refractory, unresponsive clinical presentations. If we don't look carefully we can't see.
If any one of these three is unbalanced, the rest will follow in rust and corruption. The brain won't work right in thinking, acting or feeling.
Must Review
Just in case you aren't sure, and want a clear, definitive set of references on all this complexity – I'm loading up this new paper just for you. Download this paper, read it, forward this message and tweet it. This paper will change the way you are assessing challenging cases that just don't get better with regular psych interventions.
Marc D, Ailts J, Ailts-Campeau D, Bull M, Olson K, Neurotransmitters excreted in the urine as biomarkers of nervous system activity: Validity and clinical applicability [in press]: Neuroscience and Biobehavioral Reviews, 2010
Do drop a comment here after reading this interesting paper:
cp
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15 Comments
Hey Dr Parker,
Could you help answer a question for me?
Why do so many doctors say you cannot measure Neurotransmitters, such as Dopamine, serotonin, etc levels, but as I have gotten done, you can.
Could you help me understand this
Eric,
It not so much a debate about if you can or cannot, but if the findings are valid and useful.
This debate is encouraged by the assertion by some that one can simply measure NTs and replace with precursors – done. I don’t agree with that point, but no do I agree with the other polarized position that the measurements aren’t useful at all.
My response be it psych meds, NTs or hormones: nothing works as a stand alone. The complexity is important as measurements then can become appreciated in the reality of the entire biomedical context.
cp
[…] phenomenon appears almost routinely on challenging, refractory cases when we explore results from urinary neurotransmitters. See the other laboratory markers […]
Neurotransmitters disorders is one of the diseases caused by the disturbance stream neural networks so that people affected by the disease can be transmitted to offspring and Brain of GABA.
AnDg,
Thanks for this note and the links to your Neurotransmitters-Disorders site. Deep info over there, interesting challenges not often seen in the office, but certainly part of what we are looking for… often on a lower, but nevertheless clinically significant level.
cp
Have you ever considered posting videos to your web site articles to have the visitors even more interested? What i’m saying is I just read through the whole write-up and it was really fantastic but because I am far more of a visual learner, I found videos to be alot more useful. well, let me know what you think.
Hanh,
Thanks – and, yes, I do plan a number of videos on the Neurotransmitters subject – stay tuned 😉
cp
Nick, Teaching society so them become believers is the challenge. It will take life changes for most Americans, take them out of their convenient and comfortable lifestyles to remove the toxins from their bodies and enjoy good health. Good article. Thanks
B-12 and Methylmalonic Acid
In the September, 2010 issue of UCLA’s Division of Geriatrics Healthy Years, there is an article on B vitamin deficiency tied with higher incidence of depression. In it, Dr. Lavretsky, states: “the lowest acceptable level for vitamin B12 in blood is about 200 picograms/mL. However, recent research has found that B12 deficiency may occur at B12 concentrations in the blood as high as 500 – 600 pg/mL. She says that elevated serum Homocysteine and Methylmalonic acid levels are considered more reliable indicators of B12 deficiency than the concentration of B12 in blood. Approximately 10% of patients with vitamin B12 levels between 200 – 400 pg/mL (in the “normal” range) will have vitamin B12 deficiency on the basis of elevated levels of homocysteine and mthylmalonic acid levels.”
Homocysteine
The amino acid, Homocysteine, plays a role in destroying the lining of your artery walls, promoting the formation of blood clots, and also accelerates the buildup of scar tissue.
• homocysteine levels may also be a risk factor for the development of many other conditions, including stroke,10 thromboembolism11 (blood clots that can dislodge and cause stroke, heart attack, and other complications), osteoporosis,12Crohn’s disease, ulcerative colitis,13Alzheimer’s disease,14 death from diabetes,15 miscarriage,16, 17, 18, 19, 20 other complications of pregnancy,21, 22, 23, 24, 25 and hypothyroidism.26
• Scientists have yet to prove that elevated homocysteine levels cause any of these diseases. However, most doctors believe that high homocysteine increases the risk of at least heart disease. Fortunately, homocysteine levels can easily be reduced with safe and inexpensive B vitamin supplementation.
• Homocysteine may or may not affect all of the above, the jury is still out, but it also may affect other conditions they have yet to discover. After all, a few years ago, they did not know about its relationship to the above conditions, so it only makes sense to have (and keep) levels within normal ranges. So what are high blood levels?
• What is considered a high level for homocysteine?
• Homocysteine levels are measured in the blood by taking a blood sample. Normal levels are in the range between 5 to 15 micromoles (measurement unit of small amount of a molecule) per liter. Elevated levels are classified as follows:
• 15-30 micromoles per liter as moderate
• 30-100 micromoles per liter as intermediate
• Greater than 100 micromoles per liter as severe
• But I’ve also seen recommendations for levels less than 9 as it is has been found that as levels of homocyteine rise, so does the risk for developing A.D. My own is at 8.5. Who knows what they’ll find it’s related to next?
Methylmalonic Acid
Also known as: MMA
Formal name: Methylmalonic Acid
Related tests: Vitamin B12 and Folate, Homocysteine
The Test
How is it used?
• MMA is primarily ordered, sometimes along with homocysteine, to help diagnose an early or mild B12 deficiency. It may be ordered as a follow-up to a vitamin B12 test result that is in the lower end of the normal range.
• Some researchers have suggested using MMA as a screening tool, especially among the elderly, who frequently have B12 deficiencies and may have few recognizable symptoms. However, this use is still controversial in the medical community and only a few doctors are using MMA for this purpose. MMA testing may not be suitable for monitoring because it is subject to variation and results do not reliably trend up or down in response to B12 treatment.
• Occasionally, specialized MMA testing may be ordered to help diagnose methylmalonic acidemia, a rare inherited metabolic disorder that occurs in about 1 in 50,000 to 100,000 people. Babies with this disease are unable to convert methylmalonyl CoA to succinyl CoA. They appear normal at birth but as they ingest protein, they begin to show symptoms such as seizures, failure to thrive, mental retardation, strokes, and severe metabolic acidosis. Many newborn screening programs are now testing for this disorder.
• When is it ordered?
• Methylmalonic acid is not ordered frequently. Until there are more data supporting its use and consensus on its clinical utility and long-term benefits, it will probably not be routinely used by doctors.
• However, MMA may be ordered, sometimes along with a homocysteine test, when a vitamin B12 test result is in the lower portion of the normal range, especially if the patient has symptoms associated with B12 deficiency. An MMA test also may be ordered as a follow-up to an elevated homocysteine level if the two tests are not ordered together.
• Occasionally, specialized MMA testing may be ordered when a doctor suspects that an acutely ill infant may have inherited methylmalonic acidemia. MMA testing may also be performed as part of an infant s newborn screening.
HDL
In the same UCLA Geriatric, September, 2010, another article talks about the potential benefits for increasing HDL levels other than for heart disease. In a recent study, they found high levels of HDL may also help fight the development of cancer (Journal of the Am College of Cardiology). They found a 36% lower risk of cancer for every 10 mg/dL increase in HDL!
• They do not know why, but some possible mechanisms that might give HDL anti-cancer properties could be from the antioxidant and anti-inflammatory properties of HDL to help protect against free radical damage and inflammation, which are both important in cancer.
• Of course everyone does not agree with this theory, but everyone does agree that having high HDL levels is desired for optimal health.
• According to another study, men in particular with HDL levels > 55 mg/dL had 3 times greater probability of belonging to the “best group” when it came to lower-extremity performance and knee extension. Higher levels of HDL, > 60, are associated with multiple health benefits. Last year at age 62, my HDL was at 78 – where I would like yours to be as well. I do NOT recommend that you begin drinking red wine which is known to increase HDL, but increasing those aerobic workouts to as best as you can handle would appear to be another improvement in overall health.
• Tufts Health & Nutrition Letter, September, 2010, and their headline was the same: Good Cholesterol Linked to Lower Cancer Danger. Here are some additional points not found from the other article:
• HDL could help the body’s immune system search out and destroy abnormal cells with the potential of growing into tumors
• (Nick’s comment: If HDL levels do in fact affect your immune system’s quality of performance, they certainly could be responsible for many yet unknown issues) {Parker agrees!]
• Low HDL may simply be a marker for less healthy lifestyles linked to cancer risk
• Results from an Australian study, Journal of Nutrition, showed that increased consumption of omega-3 fatty acids and fish was associated with moderate increases in HDL
• For every 1% increase in omega-3 intake, HDL levels rose by about 2.5 mg/dL – this is for long-chain (fish oil) omega-3, not plant derived omega-3s
• It is likely low HDL levels are actually an indicator of higher risk of chronic diseases that increase inflammation and insulin resistance, which in turn encourage tumor formation
• Healthy lifestyle changes designed to raise HDL levels can also reduce the risk of chronic conditions associated with aging and the risk of cancer
• Women participants in the VITAL study, who regularly took fish-oil supplements were 32% less likely to develop breast cancer than non-users. No other supplement studied showed a similar connection (Cancer Epidemiology, Biomarkers, & Prevention)
• Nick Tompanis, Nutrition Consultant, nicktompan@gmail.com
Nick,
Thanks again for your insightful comments – we completely agree that the jury is out on the details, but find that working with the evidence, as you so correctly suggest, can significantly improve/contribute to significant improvements – not all of the time, but enough to be watching these numbers.
cp
“Taken together, evidence suggests that neurotransmitters excreted in the urine may have a place in clinical practice as a biomarker of nervous system function to effectively assess disturbances and monitor treatment efficacy.” Why? Our body is talking to us, but are we really listening? Think about this for a moment. Mistreatment of our health through dietary mismanagement tactics will eventually result in unwanted consequences. In today’s society we frequently see the end results of dietary mismanaged tactics morphing into heart disease or cancer or type II diabetes. These diseases just do not appear out of nowhere – they are CREATED by our own forms of lifestyle mismanagement. But long before they do, our bodies are calling to us, they are singing to us, they are trying to communicate with us that something is amiss – something we are doing or not doing that IS taking a toll on our health. Yet, we continue to think (really deny) that this urging from our body either does not need to be addressed or that it can be addressed by ignoring the source of the problem. Through our Standard American Diet & Lifestyle habits we have become conditioned into eating (what can only be described accurately as) CRAP – because that is exactly what processed foods and fast-foods are, like it or not. Our talking bodies give us many signals that something is amiss, yet all too often we do not listen. When we do, our strategy for getting back to normal is SAP “therapy,” even though the Standard American Pill, is itself, yet another toxin that has no business being in our body. Unfortunately, SAP therapy does not address the source of the problem, the real reason why our body is constantly talking by saying our blood pressure is too high or our cholesterol is too high or our weight is way too high. When we eat crap most of the time as most American do, we literally become addicted to the Crap we eat. Yes, we are an addicted society – addicted to eating too much sugar, addicted to eating too much salt, addicted to eating synthetic anti-nutrients that have NO business being in our body. Think about that just for another second, please. For some reason, the FDA and all processed food manufacturers want us to believe that eating artificial or synthetic materials is fine for our health. Anyone that truly believes that eating small amounts of artificial, synthetic, or anti-nutrient materials is good for one’s health ought to feast on them to improve their health even further. Toxins do not belong in the earth, let alone in our bodies. True health requires being true to oneself, and then acting upon what is now known that is responsible for creating the health crisis this country now faces. When our body is talking to us through signs and symptoms TELLING us that we need to change our lifestyle habits, then we NEED to change our lifestyle habits to restore our health – rather than take a pill, while ignoring the cause of the problem and what our body is trying to tell us. We need to better understand body communication by DOING what is needed to remove the practice that brought about the problem in the first place. Imagine that you have a pet dog, Fido, who loves you and will do anything to keep you safe. One day, Fido begins barking and barking and barking, but you are unable to understand what is taking place. Instead of seeking out the problem, you put a muzzle on Fido to silence his barking and to silence his warning. Now you are at “peace” even though Fido smelled an electrical short taking place within the house that will eventually cause your home to catch fire. Fido knows something is amiss, but we revert to SAP “therapy” because we do not take the time to understand Fido’s warnings, and choose to go on living as we had as if nothing has taken place. This is exactly what is taking place when we revert to SAP therapy without changing our behaviors (dietary, exercise, stress, etc.). We are not only ignoring Fido, but we are killing ourselves in the process. Biomarkers make a great tool for better understanding the language of our body, but if we rely on SAP therapy and do nothing to address the problem, the use of the tool does nothing to change the status of our health. Listen to Fido! Address the root of the problem.
Nick Tompanis,
Nutrition Consultant
nicktompan@gmail.com
Well said Nick – it’s all about looking deeper and honoring the details of the new insights with evolving technology.
cp
I printed off a copy right away and am taking it to the pediatrician, who told me when I showed him Nathaniel’s NT test results that it was “garbage” because how could anyone have levels that high?
Kelly,
Cool, that’s why I sent it out – we have to get past the blinders, and peer-reviewed is peer reviewed.
cp
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