Metametrix Monthly Teleconference Series: Understanding When

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Metametrix Monthly Teleconference Series
Understanding When Why to use Functional
Laboratory Tests08/10/07Case Studies
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Noreen, 63 yo female

• CC Depression x years
• SH EtOH 3-4d/wk good diet but craves sugar
  some exercise
• FH parents and siblings have depression.
• Current supplements medications
• Prozac 20mg qd
• Wellbutrin 300mg qd
• Vitamins D,C,E
• Calcium/mag
• Fish oil 2g qd
• COQ10 30 mg qd

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CoQ10 markers Great-- reduce dosage
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Low catacholamine status Note 5HIAA- SSRI
non-responder?
A bit of B6 needed
Other relevant markers contributing to Noreens
symptoms
Treatment Reduce COQ10, start 5HTP 100mg qd,
tyrosine 500- 1000mg qd, B6
50 mg qd, B12 1-2mg qd. Careful,
concurrent reduction of Prozac, Wellbutrin
with introduction of
tyrosine and 5HTP.
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Noreen, 63 follow-up 03/07
Resume higher COQ10 dosage, Check 8OHDG
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Neurotransmitter metabolites much improved. Note
elevated 5HIAA with 5HTP supplementation.
Clinically, depression is much better. Patient
continues 100mg 5HTP and 20 mg Prozac. Wellbutrin
has been discontinued. Consider titrating off
Prozac as tolerated, may increase 5HTP. Reduce
tyrosine Continue B6
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Understanding When Why to use Functional
Laboratory Tests

• Kim, 59 yo female
• CC1 Hypertension
• CC2 Paroxysmal supraventricular tachycardia
  (PSVT) x 2 years
• SH Vegetarian x years lots of supplements
• RX Propranolol 100mg qd

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Understanding When Why to use Functional
Laboratory Tests
Pertinent results from Plasma amino acid RBC
mineral profile
Questions for organic acid profile are other
markers of sulfur metabolism abnormal?
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OA pg 2 only
pHPLA Increased tissue turn-over
Sulfation markers normal, low taurine probably
due to vegetarianism
Severe dysbiosis will impact absorption,
contributing to poor mineral amino acid status
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Understanding When Why to Use Functional
Laboratory Tests

• Follow-up Patient less light-headed, normal
  blood pressure, reduced PSVT episodes
• Current treatment plan
• Taurine 1 gr qd
• Arginine 1gr qd
• Magnesium 1g qd
• Garlic
• Bifido saccharomyces
• Propranolol 50 mg/d (reduced by ½)
• Recommendations ION x 6mo

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Understanding When Why to Use Functional
Laboratory Tests

• Ellen, 60 yo female
• cc Fatigue

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Ellen 60 yo female cc fatigue

• Given the poor essential amino acid status, the
  metabolic
  
  
• rational for fatigue is clear, examples
• Amino acids fill TCA cycle
• Phe, Tyr gt catecholamines, thryoid hormones, PEA
• Less obvious is the depletion of the main
  substrates of
• transsulfuration and methylation, including
• homocysteine, Met, Gly (Thr,Ser)
• resulting in lowered glutathione, taurine and
  sulfate stores and
• elevated oxidative stress
• Without treatment, diseases associated with
  increased
• oxidative stress become issue-accelerated
  aging, cancer
• Treatment Restore amino acids, cofactors, aid
• macronutrient breakdown
  absorption
• (GI) antioxidant support!

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Ellen 60 yo female cc fatigue
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23 yo male- professional athlete

• Very healthy, strong pro cyclist
• Treatment goals
• Optimize performance - shave seconds off of best
  time
• Preventative/early interventions
• Wellness

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Looks good overall Glutamine getting low
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Key cofactors are very low
Watch these toxicants! Now hes doing great, but
a challenge test is no doubt in his future. For
the meantime, figure out the exposure sources,
treat the gut as needed, and supplement the
minerals.
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Looks Great!!
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Omega 6 - dominant, easy to fix!
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Medium chain Fatty acids - really
absorbable, quick energy source
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• Great to catch
• these so early-
• Tweaking these
• few abnormals
• will undoubtedly
• enhance his performance
• quickly as they are all key energy-producing
• nutrients
• Carnitine
• CoQ10
• B6
• Biotin

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Overall, looks good! Further B6 evidence The
liver is a little suspicious - address if
clinical picture warrants
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Treatment Plan

• Carnitine 500-1000mg/d
• B6 (as P5P) 50mg
• Biotin 1-2mg/d
• CoQ10 100mg/d
• Multi-vitamin mineral (extra magnesium)
• Glutamine - 4-5g/day
• Diet increase omega-3
• Consider digestive support/probiotic
• Follow Up - Chelation challenge prn, ION or OA x
  6 months

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Nathan, 5 year old male dx ASD s/sx
self-stimulation, poor vocalization
Why are his elements so depleted? Gut absorption?
Nutrient Intake? Constant immuno-stress?
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Understanding When Why to Use Functional
Laboratory Tests
Folic acid looks O.K. but B12, B6,1,2,3,5 and
biotin are indicated
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Key markers of methylation and sulfation are very
low, including homocysteine. Thus, the body is
unable to generate adequate endogenous
antioxidants and 8OHDG rises. Remember that the
key cofactors are also very depleted in this
child, and QUIN is elevated- pointing to
inflammation and elevated immune response.
Nathans profile is typical of ASD children.
Total body stores of cysteine are depleted-
including exogenous sources
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ROS
Circled intermediates all commonly seen as
abnormal on ASD metabolic studies Poor TMTS
ability!
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• Considerations for Nathan
• QUIN elevation-
• 1st locate, treat microbial presence-
• gf/cf diet, reduce GI other inflam/immune
• 2nd Modulate NMDA agonism
• Threonine
• Magnesium
• Taurine
• B vitamins, minerals as indicated
• Sulfur amino acids, antioxidants