Addressing elevated NH4 and Taurine

[Aaron Hartman]

I have a patient with elevated Taurine and NH4 in the prescence of a CBS mutation. Her homocystine levels are low (prob due to being pulled into CBS). How would you recommend addressing this?

[DrWoeller]

Dr. Hartman,
This sounds like an up-regulation of CBS which can lower homocysteine and drain the methylation cycle.

Is there + + or + – in BHMT? What about COMT or MTHFR?

Is this person sensitive to sulfur supplements, i.e. Epsom salt, MSM, chondroitin sulfate? or sensitive to supplements like L-glutamine or feel tired or irritable after coming protein foods?

Is there an increase in BUN or ALT on a blood panel?

What is her homocysteine level?

It can be difficult to just address these particular issues, i.e. elevated ammonia and taurine a part from other mutations, but a few things to consider:

-decrease high sulfur foods, i.e. garlic, onions, cruciferous vegetables
-heavy protein diet for some sensitive individuals, i.e. sedated or irritable after protein meals. I would start with the high sulfur foods first. BTW – eggs are high in sulfur as well. Check her Total Cholesterol though as well to make sure it isn’t low – below 160.

Some other suggestions:
-restricting vitamin b6, sulfur containing amino acids such as taurine, methionine and cysteine, as well as L-glutamine, SAMe and methylation support, i.e. methyl-b12, DMG.
-Activated charcoal can help to bind up intestine toxins and ammonia
-alpha ketoglutarate can help with cellular metabolism of ammonia
-fructooligosaccrides (FOS) are listed as a substance that can be helpful too.
-Hydroxy-B12

Have you done an Organic Acids Test?

I hope this helps.
Dr. Woeller

[Aaron Hartman]

Dr. Woeller,

She actually does well with most foods and doesn’t really have any mood issues. She does have significant oxylates and yeast markers so she is on 25mg of P5P (which I’ll be changing to HCL form). She is on SAMe but mostly on hydroxyB12 and then a 50/50 mix of adenosyl and methyl B12. I’ve attached her genetic testing and recent OAT as well as UAA.

Hopefully this can help. There are many wheels moving and with her fungal and claustridial markers up with the taruine and NH4 I wonder if it is all due to gut issues. However we have done a round of vanc and diflucan and she is on Biocidin and the markers are no much changed.

Thanks for any input you can give on the case.
Aaron Hartman MD

MTHFR C677T +/- MTR A2756G +/- MTRR A66G +/+ MTRR 11 +/+
BHMT 2 +/- BHMT 4 +/- BHMT 8 +/- CBS C699T +/- COMT V158M +/+ COMT H62H +/+ VDR Taq1 +/+ VDR Fok1 +/- MOA A +/- ACAT +/-

[DrWoeller]

Dr. Hartman,
The Food IgG and Urinary Peptide dates are similar so I know the tests where done close together. The Food IgG doesn’t reflect much issues with gluten or dairy, but the peptide test definitely does. It is actually an unusual pattern as normally you see either high IgG casein and/or gluten, along with high peptides.

Soy can interfere with the peptide test – is soy being consumed? Was there some type of gluten or dairy infraction recently near the peptide test collection?

What is the dose of Biodicin you are doing?

I didn’t see the genetic test attachment, but did see the ones you listed. The ongoing yeast and clostridia can certainly lead to some of the gut issues likely being reflected on the amino acid.

What is her NOS SNP?

Dr. Woeller

[Aaron Hartman]

We don’t eat soy. We actually have our own cows and chickens and drink A2 milk. I did purposefully give her milk for a few days prior to testing. I’m a little perplexed about that as well. In a normal person who consumes milk/wheat would their peptides be elevated? Is it more of a marker for consumption than reaction?

Her NOS is -/-. She currently is getting 5 drops TID of Biocidin. I discussed her labs with Dr. Shaw and he recommended doing pulsing of vacomycin.

Aaron Hartman MD

[DrWoeller]

Dr. Hartman,
My only experience with Urinary Peptide testing is on autistic individuals. However, in this group casein is most commonly high – approximately 80% of the time and gluten peptide about 60%. I see some kids with no peptide elevation even when eating gluten or casein. The markers an indicator of consumption, but also the inability to breakdown the peptides through dipeptidylpeptidase enzymes. The reaction is based clinically.

NOS -/- so not mutation in processing nitric oxide. One thing to study is the citrulline-ornithine-arginine cycle (urea cycle) pathway for elevated ammonia.

Dr. Woeller

P.S. the pulsing of vancomycin may be necessary

[Aaron Hartman]

Looking at her urea cycle metabolites, most of them are in the mid range on her UAA. Her NH4 is high but then her aspartate is low and citrulline and asparagine are low normal. To me it looks like the cycle is getting too much NH4 put into it, which may be from dysbiosis. Any other thoughts on that?

[DrWoeller]

Dr. Hartman,
This is likely the reason. All of these other tests are fine, but when there is persistent dysbiosis amino acids get through out of balance and these other systems get overwhelmed too.
Dr. Woeller

[Aaron Hartman]

Thanks
Aaron Hartman

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