February 7, 2016 at 6:28 pm #281
Hello Dr Woeller,
Can you describe
(1) any clinical situations that appear to be associated with patients who, on OAT testing, reveal low levels of 3 specific neurotransmitter metabolites: HVA, VMA, 5-HIAA, and
(2) the details and rationale of any treatment approaches, and
(3) the details and rationale of any treatment approaches that might differ from other patients who reveal low levels of 5-HIAA but possess normal or elevated HVA and normal VMA levels?
February 8, 2016 at 7:02 am #283
#1 – HVA linked to Dopamine, VMA linked to Norepinehrine and 5-HIAA linked similar converting enzyme pathwarys:
-Dopamine gets converted to Norepinephrine through the action of Dopamine Beta-Hydroxylase. Therefore, low activity of this enzyme will cause low VMA.
-Phenylalanine to L-Tyrosine, L-Tyrosine to L-DOPA and Tryptophan to 5-HTP is augmented by Tetrahydrobiopterin (BH4). Low activity of the BH4 system which is linked to folate metabolism through MTHFR A1298C can lead to low HVA, VMA and 5-HIAA. The assessments for these pathways gets into genomic testing and unfortunately one of the better options for treatment – BH4 supplementation – is not easy to obtain. Another approach is trying to boost dopamine through supplementation with Tyrosine. New Beginnings Nutritionals has a product called Dopa-Plus which works okay
#2 – Low level of 5-HIAA appears to be fairly common. There are a lot of potential causes of this such as poor tryptophan intake, high levels of large neutral amino acids which inhibit the passage of tryptophan across the blood brain barrier, chronic infections which increase activity of the IDO enzyme causing more tryptophan to enter the kynurenine-quinolinic acid pathway or poor activity of the MAO-A enzyme (which can have single nucleotide polymorphisms, SNP’s).
#3 – With low levels of 5-HIAA and normal HVA and VMA the first place I look is chronic infections. Also, adrenal stress will cause increase in IDO activity as well causing less tryptophan conversion to serotonin. Therefore, I work that angle first. I will use 5-HTP supplementation in these cases at the same time working on chronic infections and adrenal stress.
All of these scenarios are complicated and not easily remedied as they are linked to so many other biochemical pathways and problems.
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