Neurotransmitters are the body’s chemical messengers. The Organix test looks at the activity of four important ones that influence our energy levels, response to stress, mood, sleep patterns and weight regulation. Just like we determine the efficiency of a car’s engine by measuring the exhaust, we measure the function of these neurotransmitters by measuring their metabolites, or breakdown products, in urine.
The Stress Neurotransmitters: Norepinephrine, Epinephrine, and Dopamine
When we encounter a stressor, our body produces norepinephrine and epinephrine that stimulate our “fight or flight” or stress response. The by-product in urine is vanilmandelate (VMA). Dopamine is also involved in the stress response as well as in memory, movement and mood, and its by-product is homovanillate (HVA).
Low levels of these metabolites have been associated with low levels of these neurotransmitters in the central nervous system manifesting in symptoms such as depression, sleep disturbances, anxiety and fatigue. Supplementing with the precursor, tyrosine, will insure proper levels needed to make these neurotransmitters. In addition, low levels of VMA and HVA can indicate poor adrenal function, as these are also made in the adrenal medulla. Addressing stress, and supporting adrenal function with vitamin C, B-vitamins and herbs such as ginseng and ashwaganda may also improve levels.
High levels of VMA and HVA reflect a higher-than-normal turnover of these neurotransmitters due to a chronic stress response, elevated cortisol, or drugs such as caffeine, ephedra, pseudoephedrine and cocaine. Neuroblastic tumors can also cause a profound elevation in VMA. Stress management techniques, reduction in use of neuro-stimulating drugs, and addition of calming herbs and nutrients such as rhodiola, GABA, glycine or theanine, have all been used effectively to reduce levels of these neurotransmitters. If VMA levels are very high in relation to HVA, a workup to rule out tumor growth may be indicated.
The Mood Neurotransmitter: Serotonin
Serotonin is considered the “happy” neurotransmitter as it regulates mood, satiety, and sleep. 5-Hydroxyindoleacetate (5-HIAA) is a urinary metabolite of serotonin. Low levels of 5-HIAA represent low levels of circulating serotonin, and can manifest in symptoms such as depression, mood disorders and sleep disturbances or insomnia. Simple supplementation of 5-hydroxytryptophan or tryptophan or increased intake of tryptophan rich foods such as turkey, bananas, lentils, walnuts or eggs can help support the body’s production of serotonin to correct the low level.
High levels of 5-HIAA can occur in patients who are on 5-hydroxytryptophan, or tryptophan. Dietary intake of the tryptophan-rich foods the night before the urine collection can also mildly elevate 5-HIAA levels.
Selective serotonin reuptake inhibitors (SSRIs), which are used as anti-depressants, can also increase urinary 5-HIAA excretion. 5-HIAA is actually a good measure of the effectiveness of the SSRI. If your patient is taking an SSRI and 5-HIAA is low, it can mean that the patient is a “non-responder” to that SSRI—meaning there simply isn’t enough serotonin to make the SSRI effective.
Very high levels of 5-HIAA can be a sign of a carcinoid tumor when dietary tryptophan supplementation is ruled out. A 24-hour urinary 5-HIAA is recommended in cases like this.
The Kynurenin Pathway
Tryptophan, in addition to making serotonin, is the parent compound in the Kynurenin Pathway (see figure below). This pathway is very active in the liver and is the way that our bodies make niacin, a B-vitamin.
This pathway is also active in the brain as a way to fight off pathogens such as viruses or bacteria. These pathogens stimulate an inflammatory response by the body and this pathway becomes activated. Quinolinate, a member of this pathway, interacts with NMDA receptors of glutamatergic neurons in the brain and stimulates the release of glutamate—an excitatory neurotransmitter. The actions of quinolinate are responsible for the symptoms we experience when we have the flu, such as achy muscles and sensitivity to light and sounds. Chronic stimulation of this pathway can lead to glutamate excitotoxicity and can cause the neurons to degenerate.
Ultimately, the best solution for reducing the production of quinolinate is to identify the underlying cause of the inflammatory response such as viral infection, parasite infection, bacterial infections, or possibly food sensitivities. In the meantime, supplementing with magnesium and glycine can reduce the damaging effects of quinolinate.
The analytes kynurenate and picolinate are also a part of this pathway. They typically rise in concert with quinolinate when there is an inflammatory response. If kynurenate is elevated by itself, it becomes a marker of vitamin B-6 deficiency as does its partner, xanthurenate which we talked about in the B-vitamin status section.
In conclusion, the neurotransmitter section of the Organix profile provides valuable information about your patient’s response to stress and how he can improve mood, energy level, sleep and anxiety. It also gives insight into the patient’s inflammatory response and underlying viral or bacterial burdens.
We've reached the half-way point! Next week we'll move on to Step 4 of this great test.