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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by FourFeathers on July 13, 2009, at 12:34:00
I recently began seeing an ND to evaluate if I could find a root cause to my long-term dysthymia and anxiety symptoms. I am 36 and have had symptoms much of my life. After a comprehensive urine test of metablites the following items were found:
- Homovanillate was low
- Vanilmandelate was low
- 5-hydroxyindoleacetate was very high
- Phenylacetate was highI understand that urine tests are not the most accurate when it comes to neurotransmitter performance and all that is being shown is the metabolite markers of these. I have met with ND and he seemed to feel that this was all due to adrenal fatigue. As I got to researching this I had a couple of thoughts that I wanted additional input on from those much more knowledgeable than I. My questions are:
1) It is my understanding that Vanilmandelate and Homovanillate are markers of the catecholamines(epi, norepi, and dopamine), is this correct? If so, then a low level of metabolites would lead to believe a low level of neurotransmitter?
2) The very high level of 5-hydroxyindoleacetate I understand correlates to 5-HTP-Serotonin. Could a very high level of this decrease the levels of the two metabolites mentioned in 1 above? I should mention that the ND had put me on a supplement which included 5-HTP prior to this test which I believe may have increased these levels abnormally. This has now been decreased.
3) The phenylacetate being high was an interesting finding. It appears this is created when phenylalanine is not converted to tyrosine as in the case of PKU. Based on the other findings, is it plausible that I have a minor case of PKU which could be causing the above imbalances? If so, would it be a good idea to get a phenylalanine blood test done to confirm or refute this concern?4) With high levels of phenylacetate already I am assuming that I would want to stay away from phenylalanine supplements and would only want to look to Tyrosine to increase the catecholamines?
The rest of the testing did not provide any significant abnormal metabolite findings, including abnormalities of vitamin and mineral.
Thank you in advance to anyone that can offer some assistance in this area as I prepare to meet again with my ND later this week.
Posted by Phillipa on July 15, 2009, at 12:31:38
In reply to Attn: Larry Hoover or other biochemists, posted by FourFeathers on July 13, 2009, at 12:34:00
Not Larry or a biochemist but wasn't PKU tested about a week after your birth as that is one of the first tests given a newborn as to ingest it in formula can cause multiple problems. Phillipa now my kids are 40 and below.
Posted by bleauberry on July 15, 2009, at 20:14:40
In reply to Attn: Larry Hoover or other biochemists, posted by FourFeathers on July 13, 2009, at 12:34:00
I have had your tests and lots of other ND tests. In the real world, none were helpful in guiding treatment. We are talking genetic profile tests, methylation tests, fatty acid tests, vitamin and mineral status tests, neurotransmitter tests, thyroid, on and on. Too many. Their suggested direction of treatment were wrong.
Even in clinical studies on rats, it has been shown that rats with deficient noradrenaline function responded equally across the board to either serotonin agents or noradrenaline agents. Those were obviously not the results they were looking for, but that's what happened. Their theories of finding a way to predict which meds to choose were invalidated.
Serotonin deficient mice responded to either serotonin meds and noradrenaline meds equally.
Me, my serotonin metabolites were extremely low, most others fairly normal, epinephrine high, gaba high. Serotonin herbs, 5htp, tryptophan, ssris, etc, all looked like obvious good choices. In reality, the best choices by a long shot were noradrenaline things. In fact, despite my apparent deep deficiency in serotonin, any treatment involving even tiny amounts of serotonin quickly deepened my symptoms. Serotonin is not dysthymia-friendly in my opinion.
Noradrenaline aids, with noradrenaline already high to begin with, ended up being excellent for me. Just the opposite of what would have been expected based on test results. My theoretical reasoning to explain it involves feedback loop mechanisms.
Most people entering an ND office probably do have adrenal fatigue. My opinion. Most people who have symptoms but have never heard of adrenal fatigue, and many people attending pbabble, probably have adrenal fatigue. I believe it is a common epidemic as part of the fast paced stressed world with unfriendly food choices.
It is easily measurable, unlike the neurotransmitters. Ask for the Adrenal Stress Index test by Diagnost-Tecs labs. It collects saliva four times over a 24 hour period to see what your cortisol is doing. That is far more useful in guiding treatment than anything else I know of, except definitively concretely without out even a speck of doubt ruling out Lyme disease.
Has the ND looked in your mouth for silver fillings? That is a serious issue to consider too. Long story, but believe me, I know.
Has the ND given you challenge doses of Oregeno Oil, Grapefruit Seed Extract, Cat's Claw, Wormwood/Black Walnut Hull extract? Those would be taken to see if you become flulike or feel worse in a few days...malaise, aches, unwell. If so, that is significantly diagnostic of hidden infection. Either yeast (Candida), Lyme, or Lyme-like cousins, depending on the herb that was killing it. The yuck feeling is the mass die-off called a Herx reaction. It is the easiest quickest surest way to find hidden critters that lab tests can't. Overgrowth of gut yeast is in my opinion epidemic due to the high sugar content of typical diets, and a common symptom is low level depression or dysthymia.
Lots of things to look at. But honestly, simpler is better. Adrenal Stress Index, trials of various pathogen killing herbs, and trials of various mood herbs, is the only way to really know which direction to go.
I found none of the neuro precursors such as 5htp or tyrosine helpful. And in the real world outside of books and internet hype, hardly anyone does. 5hpt does improve sleep. Tyrosine can give a burst of energy if not used all the time. I think they are widely talked about based on theory, hope, and dreams, but not realworld reliable duplicateable results.
Of the herbals for dysthymia, the best I ever had was St Johns Wort Kira brand, the same one used in clinical studies, availbable in some local stores and by internet mailorder. Some people do best on cheap low hyperforin brands while others do best on expensive high hyperforin brands. The hypericin content they are measured by doesn't seem to be of much signifance. The various brands are similar, but almost as different as SSRIs are from one another. If one brand doesn't work, at least two others need to be tried before concluding SJW is not helpful. Doses should range from 150mg to 900mg, because people respond best to a certain given dose in that range, doing worse at a dose that is too high or too low for them. The bottle will say 3 300mg pills a day. That is bogus. The instructions should say, whatever you feel best at after a few weeks, which might be as low as 150mg or 300mg.
Adrenal fatigue is usually appoached first with herbal things like the Ginsengs, Ashwaganda, Astragulus, and a variety of others. I found them useless as most people do. Licorice actually extends the life of your existing cortisol and is helpful for many people. Adrenal cortex extracts are helpful for many people, with Isocort being a top favored brand. For some people like me, none of these things were good, and only low doses (1.25mg-5mg) of the real stuff...prescription hydrocortisone...to replace the missing cortisol, was of major benefit.
Adrenals and thyroid go together. So if adrenals are sluggish, thyroid has probably turned itself down too in order to stay in balance. Which would call for a small dash of Armour Thyroid, T3, or T4. Or, time and food choices will revive things. Lab tests for thyroid are not very useful except as a reference point. Clincal symptoms are what matter.
Foods should be: Mostly veggies, some fruits low in sugars, no or low sugars or sugar substitutes (Stevia is the only allowed one), low or no caffeine, proteins from meats, eggs, beans, very few breads, pastas, and similar carbs, lots and lots of purified water.
Outside of the naturals, the most potent and tame dysthymia destroyer I have ever known in personal trials of just about any med you can think of is low dose Nortriptyline. By low I'm talking 5mg to 50mg. Side effects in the first week are gone by week 4.
I hope some of this is helpful to you.
Posted by Phillipa on July 15, 2009, at 20:38:35
In reply to Re: Attn: Larry Hoover or other biochemists, posted by bleauberry on July 15, 2009, at 20:14:40
BB seriously seems they changed formulation of armour thyroid as was going to ask to try but now the users are having horrible time. See Mary Shomon or goggle armour thyroid. Love Phillipa
Posted by bleauberry on July 15, 2009, at 20:40:01
In reply to Attn: Larry Hoover or other biochemists, posted by FourFeathers on July 13, 2009, at 12:34:00
Hey, I know I gave you a lot to swallow all at once and I apoligize. I been there done that and just want to save other people the money, wasted time, and frustration. There are many bases to cover and stones to turn.
Simple it really boils down to this:
1. The specific food choices I mentioned will be the best therapy you will find for longterm success. It is hard to start, kind of like breaking an addiction, but rewarding several months later. I forgot to mention also, the fats of butter, cream, nuts, and avocados are very good fats...eat all you want of those.
2. St Johns Wort does possess good dysthymia busting power, given the right brand and right dose. Kira, Perika, Whole Foods Market brand, WalMart brand...all worth trying...all have worked marvelously for people, but only one in particular for each person did it while the others didn't. One thing about SJW though...it lowers cortisol. So if you do the cortisol test and you do have hypoadrenalism, SJW might not be a good choice. Common vitamins and minerals definitely won't help much but maybe one or another might help a little. Lots of trial and error there.
3. I know you are seeking the natural route. That said, there is nothing wrong with small doses of pharmaceutical meds. Either Nortriptyline or Desipramine in low doses will fit the bill of what you are looking for. They can get you feeling better rather fast, within a month, while you continue to your new food journey, diagnosing hidden infections, testing adrenals, etc. Those drugs will also normalize your hormone problems as well as the dysthymia. If one is not completely helpful, the other likely will be. Desip is stronger on norepinephrine than Nort. Early side effects are sleepiness, disappearance of pains, dry-ish mouth, mild constipation. Most of these are gone in a month, except for the pain relief, which is a welcome longterm side effect. Low doses. No need for the heavy hitting stuff.
Also forgot to mention part of your daily routine should be a high quality refrigerated probiotic supplement. Longterm benefits for mood, immune system, infections, and vitamin synthesis.
Going natural means attacking all health issues, known and unknown, as well as preventative measures, all simultaneously continuously. A low dose well chosen pharmaceutical can be a huge help. Avoid the SSRIs though. They will worsen every problem you want to fix.
Posted by Phillipa on July 15, 2009, at 23:29:45
In reply to Re: Attn: Larry Hoover or other biochemists » FourFeathers, posted by bleauberry on July 15, 2009, at 20:40:01
Just an Added note on armour thyroid. Phillipa
from Mary Shomon
Dear Readers, Those of you on Armour Thyroid who are having trouble with the new formulation are definitely not alone. After posting last week's Readers Respond request, we've had more than 100 thyroid patients share their stories about their experiences with the newly reformulated Armour Thyroid. If you're having trouble with Armour, you'll want to read this. Also, for those of you who have decided to give up on Forest Labs, due to their constant back orders, supply problems, and now the reformulation issue, I have some up-to-the-minute information on how to switch over to the other prescription natural desiccated thyroid drugs, Nature-Throid and Westhroid. Is your pharmacy saying that those drugs "aren't available anymore?" If they are, they're wrong, and I have the info for you. Please keep your stories, information and input coming, as we weather the latest crisis in dealing with thyroid drug manufacturers. Live well, Mary
In the Spotlight
Update from RLC Labs -- Maker of Nature-Throid and Westhroid
I had an opportunity to talk at length this week with both Rick Cox, the CEO of RLC Labs -- the company that makes natural desiccated thyroid drugs Nature-Throid and Westhroid -- and RLC's Chief Science Officer, Dai Jinn. So if you're on Armour, and want to switch to Nature-Throid or Westhroid, find out about availability, equivalence between the drugs, and how to make the switch.More Topics
Is Your Thyroid Making You Fat Phone Teleseminar
Sign up for free conference on July 13th
Attention Thyroid Patients: Is There Gluten in Synthroid?
Celiac/gluten sensitive patients beware!
Forest Labs in Hot Water with DOJ
Coverups, kickbacks, and marketing
Quiz: Could You Be Hypothyroid?
Online, interactive quiz
Are you Suffering From Adrenal Fatigue?
More common in thyroid patients
The controversy Over the TSH Test/Levels
The lowdown from an endocrinologist
Thyroid Disease Basics, Starting Point
Thyroid 101
Armour Thyroid's Spring 2009 Reformulation Causing Problems
Some thyroid patients are still not aware that during the spring of 2009, the natural desiccated thyroid drug, Armour Thyroid apparently underwent a reformulation. This resulted in a decrease in the amount of dextrose, an increase in the cellulose, and the addition of cornstarch to the tablets. Since that time, an increasing number of patients and doctors are reporting a variety of symptoms, problems, TSH changes and more, due to this new Armour formula. Find out more about the thyroid symptoms some patients are experiencing with the reformulated Armour.
Readers Respond: Armour Reformulation Problems
Last week I put out the call for input from thyroid patients who had thoughts about the reformulated Armour Thyroid. And just in one week, more than 100 of you have shared your experiences -- negative and positive -- with the reformulated Armour Thyroid. There are a number of themes that are coming through, in terms of symptoms and issues patients are having, so if you're on Armour and don't feel well, read through and see if you recognize any of your own symptoms here!
Sponsored Links
Armour Thyroid and Thyrolar Still Backordered
Why Doesn't Forest Seem to Care About Patients?
Varying strengths of Armour Thyroid and Thyrolar -- both products made by Forest Labs -- have been unavailable, on back-order, and going through mysterious "production delays" for more than two years and counting. At present, supplies of Armour are still not fully available. What's going on?
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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