High 3-Hydroxyglutaric

[Margaret Webb]

Hello Dr Woeller,
I just received an OAT back for my 16 year old daughter and was hoping you would take a look at it? The high 3-Hydroxlglutaric was concerning to me and I wondered if you could advise me about that specifically as well as the Neurotransmitter Metabolites sections. Her hx in brief: She was a late walker (27 months) and had a hx of hypotonia and motor planning issues. She developed speech and language normally. She was dx with Aspergers at age 8. She has tended to have some irritability issues and attention issues but has always been a bright creative person. In February she developed sudden onset (overnight) tics, OCD behaviors, extreme rages and our Functional Medicine Doc dx PANDAS based on extremely elevated AntiD-nase titer. We treated it botanically and with supplements and her titers dropped into normal range. She has also did a 2 months course of Nystatin with the Interphase product following the PANDAS protocol and finished that about 1 month ago (so the OAT test was run about 2 weeks out from the Nystatin) She has been gluten free and dairy free for years as well as doing probiotics, fish oil, folate supplementation, and mitochondrial support. She has wide swings in symptoms frequency: she will seem to be doing well for a week or two and then just nosedive again. I am thinking this OAT is pretty revealing about why she is so volatile but I would really appreciate your interpretation and advice. I appreciate your help!
Margaret Webb

[DrWoeller]

Margaret,
There are likely some mitochondrial issues as seen on the OAT. However, the most dramatic things is the high HVA. This equates to excess Dopamine which can trigger increased “fight or flight” responses via the nervous system. Typically this is seen high with clostridia, but that is not the case. However, the Vitamin C is low which can impact the enzyme which makes the dopamine to norepinephrine conversion. But, most likely your daughter has a polymorphism in either the dopamine-beta hydroxylase enzyme and/or catechol-o-methyltransferase (COMT) which can both cause the dopamine to rise.

The DBH is supposed to be added to the Great Plains SNP1000 profile after the first of the year. This profile would be worth running on your daughter to look at thing genetically.

Oxalates are high too which could contribute to stress, but I think the HVA is more of the issue. Also, notice the serotonin is very low too.

What is the status of Vitamin D? Using any 5-HTP?

Talk to the PANDAS doctor about low dose naltrexone (LDN) which can help with autoimmune reactions.

Dr. Woeller

[Margaret Webb]

Hi Dr Woeller,
Her Vit D is around 60. We have supplemented with some 5HTP in the past and will look at adding that back in. How would we look at supplementing with the Vit C When she had elevated oxalates? Her diet is already pretty low in oxlates so I am wondering if we
need to continue treating for yeast in addition. We did try LDN but it seemed to really effect her sleep in a negative way. I need to circle back and look at her gene test but I do think she was positive for the COMT.

Any cause for concern with the elevared 3 Hydroxl Glutaric? I am not sure how to intepret that one….

Thanks so much,
Margaret

Thank you!
Margaret

[DrWoeller]

Margaret,
The 3-hydroxyglutaric is likely not anything significant unless the level is extremely high. It can be linked to a lysine metabolism problem – which is rare. The use of L-carnitine (250mg to 500mg) daily may help.

Ascorbic acid – just keep the levels low, i.e. 250mg to 400mg daily.

Dr. Woeller

[Margaret Webb]

Thanks!

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