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5-HTP: A potential concern?

Posted by Sunnely on September 21, 2000, at 22:44:31

In reply to 5HTP, St John's Wort Wellbutrin, posted by Jirel on September 20, 2000, at 22:06:47

5-HTP, also known as 5-hydroxytryptophan, became available over the the counter (US) in 1994. This molecule is made from the body from the essential amino acid, tryptophan. Tryptophan, in turn, is the precursor of serotonin. Tryptophan can be obtained from foods containing protein such as meat, fish, dairy products, and certain legumes. 5-HTP is purported to have beneficial effects on certain psychiatric conditions including depression, anxiety disorders, insomnia, obesity, fibromyalgia, premenstrual syndrome, and migraine headaches.

Mentioning 5-HTP seems to remind clinicians of the several cases (US) that occurred at least a decade ago from a serious and sometimes fatal condition called EMS (eosinophilia myalgia syndrome). This condition was eventually linked to a contaminant of tryptophan which subsequently came to be known as "peak X." This contaminant was implicated in 1,500 cases of EMS which included 30 deaths. It was estimated that the total number of EMS cases could have been as high as 10,000. On further investigation by the CDC, almost all victims of EMS had taken tryptophan produced by Showa Denko, a Japanese chemical and pharmaceutical company. It seemed that the manufacturer had introduced a new strain of bacillus used in the production of the amino acid and that the impurity (contaminant) was a fermentation product of this bacillus. Due to these cases of EMS, all tryptophan products were removed from the (US) market.

You may ask, "What's the contaminant 'peak X' got to do with 5-HTP?" It appears that this contaminant may still be present in herbal products containing tryptophan's metabolic precursor, 5-hydroxytryptophan or 5-HTP. The conclusion that "peak X" contamination was a continuing problem came from an analysis of six 5-HTP products by Dr. Brian L. Williamson and his associates at the Mayo Clinic in Rochester, Minn., published as a letter to the editor (Nat. Med. 4[9];983,1998). The products tested by Mayo researchers contained 3% to 14% of "peak X" at levels that caused the 1989 EMS outbreak. But no one knows yet what constitute a safe level. These researchers are not sure what level is dangerous. The view that most people take with regard to the contaminant is that there should be zero levels of it in there. The FDA also has tested and confirmed similar levels of contamination in the six products cited in the Mayo study. Neither FDA nor the Mayo investigators would release the names of the contaminated 5-HTP pills. The FDA is investigating whether any adverse events have occurred in association with current lots of the products.

In EMS cases reported, muscle pain was the predominant symptom, accompanied by muscle weakness, rash, mouth ulcers, abdominal pain, and respiratory difficulty. The most striking laboratory abnormality was eosinophilia, the blood cells involved in allergic reactions. In one patient with ascites (accumulation of fluid in the abdominal wall), the fluid also contained many eosinophils.


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