Finally found the past labwork

Supps:
NR 8
RE 8
CR 6

4/17 lab
Serotonin 2013
Dopamine 273
Norepinephrine 39
Epinephrine critical high

Supps:
NR 8
RE 4
D5M40. 2
TR 3
CR 6

5/6 lab
Serotonin 2449
Dopamine 701
Norepinephrine 17
Epinephrine 16

Supps:
NR 8
RE 0
D5M40 2
TR 6
CR 6

He stopped here from nausea after a week or so as it had gone on for all of the time he was on the supps. After he felt back to normal, he retested on just the cyteine and that was the cause of his nausea.

Quite interesting lab results. I am still confused as to why the doctor you were working with had you do tests that included Norepinephrine and Epinephrine as they hold no value in decision making until after the patient has been stabilized for at least a few months. Regardless, the only way to continue moving towards reaching the dosage needed for symptomatic alleviation is to do more tests to eventually get the serotonin and dopamine in the phase 3 therapeutic ranges. Based on the numbers of the lab tests it makes sense why he did not achieve relief of symptoms since the first test is a phase 1 or phase 3 serotonin with a phase 2 dopamine, and the 2nd test is a phase 1 serotonin and a phase 3 dopamine. They both need to be phase 3 within the range of 80-240 for serotonin and 475-1100 for dopamine simultaneously. Read this paper for a better understanding on this entire system of interaction if interested: APRESS: apical regulatory super system, serotonin, and dopamine interaction

I'd be very interested in seeing what the lab results of the 3rd test would have been after that change in dosage of 4 RE to 0 RE and upping the TR to 6. They were able to push him out of a phase 2 dopamine by adding 240 mg of L-dopa after the first test and then given that they decreased the 5 htp after the 2nd test indicates that the serotonin was a high phase 3 so they were trying to bring it down by decreasing the 5-htp. Well at least that's my initial analysis of it, I definitely could be wrong on a few things haha.

Anyways, based on your previous post you stated that your husband did not have any side effects to the methionine, has that continued? Are you still planning on getting into contact with Dr. Oler to continue with this?

My understanding is he just tried it long enough to make sure it wouldn't make him sick like the cysteine did, but he didn't want to use it for very long without the other amino acids so as not to deplete anything else. Dr Chad is the one he would like to go with.

Your explanation of the phases helped me translate another part of the lab I couldn't figure out:

4/17 Serotonin phase 3. Dopamine phase 2
5/6. Serotonin phase 3. Dopamine phase 3

What do the phases mean? And what would the norepinephrine and epinephrine be used for eventually?
Thanks.

Yeah you are right about the Methionine. He shouldn't be taking it without the other amino acids as it will induce depletion and over the long term exasperate his condition. Seen here: Neurotransmitter depletion | AMA Certified Category 1 CME Relative Nutritional Deficiency Conference. Whenever you have that initial consult with Dr. Chad make sure to give all the details about the issues with the Cysteine and you will also probably want to ask which supplement brand you should get for the Methionine because it is absolutely essential to make sure that what you are getting is actually what it claims to be. Some supplement companies will put fillers in there products which will make a claim of lets say 500 mg of Methionine per capsule into actually being 200 or something. So you could take 11 of the 500 mg pills thinking you are getting the 5500 mg of Methionine needed but you are actually only getting 2200 which would mess everything up.

With the phases I think the best way to describe them is by pasting an excerpt from their dual-gate lumen model of renal monamine transport paper that describes what each phase status represents.

"To determine the phase of serotonin and dopamine with certainty requires two urinary monoamine neurotransmitter assays to be performed with the subject simultaneously taking a different amino acid dosing of dopamine and/or serotonin amino acid precursors on each test and comparing the results.1,2

In phase 1, monoamine neurotransmitters synthesized by the kidneys are excreted into the urine instead of being secreted into the system via the renal vein where they are needed (Figures 1 and ​and2).2). Increasing the amino acid dose in phase 1 will correct the problem of urinary monoamine excretion into the urine at the expense of secretion into the system. The amino acid precursor dosing of serotonin and dopamine, where the individual patient is in phase 1 varies widely in the population. The level at which the urinary serotonin is no longer in phase 1 ranges from 37.5 mg of 5-HTP per day to 3,000 mg of 5-HTP per day. The level at which the urinary dopamine is no longer in phase 1 ranges from no L-dopa (with the use of L-tyrosine only in some subjects) to 540 mg of L-dopa per day in the subjects not under treatment for Parkinsonism or Restless Leg Syndrome.1,2

By increasing the amino acid dosing of serotonin and dopamine precursors above the dosing of phase 1, the phase 2 response is observed (Figures 1 and ​and2).2). In phase 2, urinary monoamine levels are low (<475 micrograms dopamine per gram of creatinine or <80 micrograms serotonin per gram of creatinine, the neurotransmitter – creatinine ratio compensates for dilution of the urine), and the inappropriate excretion of neurotransmitters into the urine has ceased. When in phase 2, serotonin and/or dopamine is being primarily secreted into the system and not excreted into the urine. The model used to explain phase 2 is, “inappropriate excretion of neurotransmitters has now ceased as the amino acid precursor dosing is increased and systemic levels are not increasing appropriately.”1,2

As serotonin and dopamine amino acid precursors are increased above the phase 1 and the phase 2 levels, all subjects enter the phase 3 response (Figures 1 and ​and2).2). Further increases in the amino acid dosing lead to increases in urinary dopamine and serotonin neurotransmitter levels if they are in phase 3. Phase 3 represents appropriate secretion into the system and appropriate excretion of excess neurotransmitters synthesized by the kidneys into the urine."

Source: The dual-gate lumen model of renal monoamine transport

Also the ranges of the 5-htp and L-dopa for non-parkinsonism have expanded beyond the 3000 mg 5-htp and 540 mg l-dopa range since this paper was written.

So with your husband on the last test that he did being in both phase 3 for serotonin and dopamine is a very good sign for him being able to quickly get relief of symptoms. To explain why, think about what the description of the phases talks about. When you are in phase 3 any increase in amino acid administration will just increase the # value in phase 3. For instance he had a 2449 serotonin in phase 3 which means that the 5-htp administration is too high. The dopamine is a 701 phase 3 which actually means it is in the therapeutic range for phase 3. So with knowing this it now makes sense as to why they were decreasing the 5-htp administration because they were trying to get that 2449 phase 3 serotonin to drop back down to the 80-240 phase 3 range. My guess is that when he starts this back up he will probably start on that last recommended dosage and do a test on it to see what it does to the serotonin value. It could drop the serotonin too far back into phase 2 or phase 1 so they might then have to increase it back to 8 NR and 2 RE a day or something like that. It could also push the dopamine into a high phase 3 because with decreased 5-htp intake means increased L-dopa synthesis (they function in competitive inhibition in synthesis, transport, and metabolism. Source: APRESS: apical regulatory super system, serotonin, and dopamine interaction) which could cause the dopamine to get to high.

With the Norepinephrine and Epinephrine they have no involvement in the initial stabilization of most monamine conditions as they are primarily serotonin and dopamine caused. They also hold no value in the initial determination of administration of the nutrients. They come into play after the serotonin and dopamine have been optimized in the phase 3 therapeutic range and the patient has taken the supplements continuously for 6 months. My memory on this is not perfect so I many be wrong on specifics but I believe they determined for the Norepinephrine it takes 1-3 months for it to stabilize and for the Epinephrine it takes 3-6 months. Norepinephrine controls the Hypothalamic Pituitary Axis which includes the Adrenal cortex, sex hormones, cortisol, and many other things. Norepinephrine and Epinephrine don't get talked about that much in the videos I have seen of his or the papers I have read so to get a full explanation of their full involvement you would likely need to get Dr. Hinz or Dr. Chad to fully explain it. The main thing to note is that the main things that regulate function are serotonin and dopamine. You can see how all of these things function together in this chart though: https://web.archive.org/web/20161015...atary-axis.jpg

If none of that really made sense to you don't sweat it either haha. It took me quite a while to really grasp all of this information, and it works whether or not you understand it all! And sorry if this was a bit of a lengthy post to read, its hard to explain all of this without doing so.

Edit: One thing I want to add with the phases is that the excerpt that I pasted was only describing the phase description in the kidneys. The OCT-2 transporter is identical and homologous in both the kidneys and brain (and other organs), so when you determine the status of the OCT-2 as being phase 1 in the kidneys for example it is then known that it is also phase 1 in the brain. Phase 1 in the brain means the transporter is preventing reuptake into the presynaptic neuron because it is trying to increase post-synaptic firing. Phase 2 indicates that their is adequate amounts of neurotransmitters in the synapse which is allowing for adequate post-synaptic firing, but their is inadequate amounts of neurotransmitters in the pre-synaptic vesicles so that is why you see the number decrease because the neurotransmitters are being reuptaked back into the pre-synaptic neuron. This is represented by phase 2 in the kidneys the neurotransmitters are reuptaked back into the blood rather than into the urine. With phase 3 you now have both adequate amounts of neurotransmitters in the synapse and adequate amounts in the pre-synaptic vesicles which is represented by a now increase in urinary values.

Thank you for the great info. I would much rather have something that was a little over my head and know I'm getting my questions answered as I can always find someone to explain the parts I don't understand. In this case, my husband is the chemistry type and found it very helpful. He is hoping his schedule will let him start with Dr. Chad in November. I'll update as we go along.

Is anyone familiar with Dr Ted Cole? He is at the Cole Center for Healing in Cincinnati, OH.
Wondering if he is trustworthy. His name is on a research article.
He is the closest provider to me living in VA. I was diagnosed with Parkinson's in Oct 2014.
thx

Just a heads up that Dr Chad Oler is obviously a popular guy and it may be a 3-5 week wait for a first time phone consultation, so plan accordingly!

The Amino Acid Therapy has been working for my husband and has gone much like you stated in your post. His serotonin went to zero on the testing dosage and so they have been increasing the 5HTP since the lab test was done. It's amazing how they can move the neurotransmitters with the supplements from way too high down to zero and back up again. He has another appointment in a few weeks. The question I had was what changes tend to be immediate in the first few months of stabilizing and what changes occur 6-12 months out?


Also, as a side question for myself, I didn't realize that restless legs syndrome is tied to neurotransmitters as well, which I have battled for years. Through experimentation, I learned that controlling saturated fat and sugar took it way down, but I was wondering, after reading about the high dopamine connection, did those of you with Parkinson's have restless legs for years before developing Parkinson's? An eye opener for me and I intend to start with Dr Oler myself. Can't thank you enough for telling us about the methionine substitute for the cysteine.





QUOTE=billbobby21;1226445]Yeah you are right about the Methionine. He shouldn't be taking it without the other amino acids as it will induce depletion and over the long term exasperate his condition. Seen here: Neurotransmitter depletion | AMA Certified Category 1 CME Relative Nutritional Deficiency Conference. Whenever you have that initial consult with Dr. Chad make sure to give all the details about the issues with the Cysteine and you will also probably want to ask which supplement brand you should get for the Methionine because it is absolutely essential to make sure that what you are getting is actually what it claims to be. Some supplement companies will put fillers in there products which will make a claim of lets say 500 mg of Methionine per capsule into actually being 200 or something. So you could take 11 of the 500 mg pills thinking you are getting the 5500 mg of Methionine needed but you are actually only getting 2200 which would mess everything up.

With the phases I think the best way to describe them is by pasting an excerpt from their dual-gate lumen model of renal monamine transport paper that describes what each phase status represents.

"To determine the phase of serotonin and dopamine with certainty requires two urinary monoamine neurotransmitter assays to be performed with the subject simultaneously taking a different amino acid dosing of dopamine and/or serotonin amino acid precursors on each test and comparing the results.1,2

In phase 1, monoamine neurotransmitters synthesized by the kidneys are excreted into the urine instead of being secreted into the system via the renal vein where they are needed (Figures 1 and ​and2).2). Increasing the amino acid dose in phase 1 will correct the problem of urinary monoamine excretion into the urine at the expense of secretion into the system. The amino acid precursor dosing of serotonin and dopamine, where the individual patient is in phase 1 varies widely in the population. The level at which the urinary serotonin is no longer in phase 1 ranges from 37.5 mg of 5-HTP per day to 3,000 mg of 5-HTP per day. The level at which the urinary dopamine is no longer in phase 1 ranges from no L-dopa (with the use of L-tyrosine only in some subjects) to 540 mg of L-dopa per day in the subjects not under treatment for Parkinsonism or Restless Leg Syndrome.1,2

By increasing the amino acid dosing of serotonin and dopamine precursors above the dosing of phase 1, the phase 2 response is observed (Figures 1 and ​and2).2). In phase 2, urinary monoamine levels are low (<475 micrograms dopamine per gram of creatinine or <80 micrograms serotonin per gram of creatinine, the neurotransmitter – creatinine ratio compensates for dilution of the urine), and the inappropriate excretion of neurotransmitters into the urine has ceased. When in phase 2, serotonin and/or dopamine is being primarily secreted into the system and not excreted into the urine. The model used to explain phase 2 is, “inappropriate excretion of neurotransmitters has now ceased as the amino acid precursor dosing is increased and systemic levels are not increasing appropriately.”1,2

As serotonin and dopamine amino acid precursors are increased above the phase 1 and the phase 2 levels, all subjects enter the phase 3 response (Figures 1 and ​and2).2). Further increases in the amino acid dosing lead to increases in urinary dopamine and serotonin neurotransmitter levels if they are in phase 3. Phase 3 represents appropriate secretion into the system and appropriate excretion of excess neurotransmitters synthesized by the kidneys into the urine."

Source: The dual-gate lumen model of renal monoamine transport

Also the ranges of the 5-htp and L-dopa for non-parkinsonism have expanded beyond the 3000 mg 5-htp and 540 mg l-dopa range since this paper was written.

So with your husband on the last test that he did being in both phase 3 for serotonin and dopamine is a very good sign for him being able to quickly get relief of symptoms. To explain why, think about what the description of the phases talks about. When you are in phase 3 any increase in amino acid administration will just increase the # value in phase 3. For instance he had a 2449 serotonin in phase 3 which means that the 5-htp administration is too high. The dopamine is a 701 phase 3 which actually means it is in the therapeutic range for phase 3. So with knowing this it now makes sense as to why they were decreasing the 5-htp administration because they were trying to get that 2449 phase 3 serotonin to drop back down to the 80-240 phase 3 range. My guess is that when he starts this back up he will probably start on that last recommended dosage and do a test on it to see what it does to the serotonin value. It could drop the serotonin too far back into phase 2 or phase 1 so they might then have to increase it back to 8 NR and 2 RE a day or something like that. It could also push the dopamine into a high phase 3 because with decreased 5-htp intake means increased L-dopa synthesis (they function in competitive inhibition in synthesis, transport, and metabolism. Source: APRESS: apical regulatory super system, serotonin, and dopamine interaction) which could cause the dopamine to get to high.

With the Norepinephrine and Epinephrine they have no involvement in the initial stabilization of most monamine conditions as they are primarily serotonin and dopamine caused. They also hold no value in the initial determination of administration of the nutrients. They come into play after the serotonin and dopamine have been optimized in the phase 3 therapeutic range and the patient has taken the supplements continuously for 6 months. My memory on this is not perfect so I many be wrong on specifics but I believe they determined for the Norepinephrine it takes 1-3 months for it to stabilize and for the Epinephrine it takes 3-6 months. Norepinephrine controls the Hypothalamic Pituitary Axis which includes the Adrenal cortex, sex hormones, cortisol, and many other things. Norepinephrine and Epinephrine don't get talked about that much in the videos I have seen of his or the papers I have read so to get a full explanation of their full involvement you would likely need to get Dr. Hinz or Dr. Chad to fully explain it. The main thing to note is that the main things that regulate function are serotonin and dopamine. You can see how all of these things function together in this chart though: https://web.archive.org/web/20161015...atary-axis.jpg

If none of that really made sense to you don't sweat it either haha. It took me quite a while to really grasp all of this information, and it works whether or not you understand it all! And sorry if this was a bit of a lengthy post to read, its hard to explain all of this without doing so.

Edit: One thing I want to add with the phases is that the excerpt that I pasted was only describing the phase description in the kidneys. The OCT-2 transporter is identical and homologous in both the kidneys and brain (and other organs), so when you determine the status of the OCT-2 as being phase 1 in the kidneys for example it is then known that it is also phase 1 in the brain. Phase 1 in the brain means the transporter is preventing reuptake into the presynaptic neuron because it is trying to increase post-synaptic firing. Phase 2 indicates that their is adequate amounts of neurotransmitters in the synapse which is allowing for adequate post-synaptic firing, but their is inadequate amounts of neurotransmitters in the pre-synaptic vesicles so that is why you see the number decrease because the neurotransmitters are being reuptaked back into the pre-synaptic neuron. This is represented by phase 2 in the kidneys the neurotransmitters are reuptaked back into the blood rather than into the urine. With phase 3 you now have both adequate amounts of neurotransmitters in the synapse and adequate amounts in the pre-synaptic vesicles which is represented by a now increase in urinary values.[/QUOTE]

What was the dosage that your husband was on that resulted in his serotonin going to zero? And what was the dosage that he was moved to after that test?

How much better are his symptoms compared to when he started?

In terms of what changes are immediate and which can take longer, your husband should expect 90-100% relief of depressive or other neurotransmitter related condition symptoms once both the serotonin and dopamine are established in the phase 3 therapeutic ranges. This is contingent on him being a three phase patient, which I am assuming he will be/is, rather than a dopamine dominant patient in which case things would be different. The average amount of time needed to establish both in the phase three ranges is 3.2 tests from what I have read. So if he were to average 1 test a month, then if he were an average patient he should expect stabilization in 3 months. With averages of anything, he could require less than 3 tests or he could require more. Depending on the amount of tests needed will determine the amount of time needed for relief of symptoms. Once the serotonin and dopamine are optimized in phase 3, he will then stay on that dosage. If there is still some residual symptoms remaining, they could be related to Norepinephrine, or Epinephrine function, which take longer to stabilize. Norepinephrine taking 1-3 months, and Epinephrine taking 3-6 months.

But most patients achieve full relief when the serotonin and dopamine are both put in the phase 3 therapeutic ranges, so that is what you should expect to happen in his case as well.

In regards to your other situation with having RLS, from what I have read, they consider RLS to be Stage 0 Parkinsons disease, as in it is the earliest sign of its presence, and is an indication of high likelihood of further progression. My personal opinion on what you should do is first have a thorough conversation with Dr. Oler over what he thinks the best course of action is to first relieve your current condition, as well as prevent any form of progression. After doing that you could either wait until your husband is done with the protocol and has achieved relief of symptoms as this would lower the financial burden on you, or you could simply choose to do it at the same time as him. You could talk to Dr. Oler about just getting on a maintenance dosage that would keep your Methylation in check to prevent any progression, until your husband is done with the protocol. Ultimately though, it is all up to you.

With treatment of RLS, you should be aware of the fact that you will be undergoing a different treatment modality than your husband. RLS is treated as a dopamine dominant disease which has less focus on using tests, higher L-dopa administration, pill stops, and can have more initial side effects that need addressing via 5-htp administration adjustments. The dopamine dominant treatment can be easier and quicker depending on the amount of L-dopa needed, and if side effects present themselves that require addressing. As I stated earlier, I would discuss everything with Dr. Oler before making a decision on what to do.

He has only had one test so far, the one that registered zero for the serotonin, and this week he is doing another test. Before the second test the doctor was having him double his serotonin twice to see how he felt on higher doses. The first step up was okay, but the second made him nauseous and so he stepped back down part way.

For the first test he was on:
150 mg 5HTP once in the morning only
300 mg L-Dopa twice a day
1500 mg Tyrosine three times a day

For this test he is on:
150 mg 5HTP three times a day
300 mg L-Dopa twice a day
5000 mg Tyrosine total, split for three times a day


The lab work doesn't state any phase info but my husband thought the doctor mentioned he was probably in phase 3 for the Dopamine but not the Serotonin?

He has felt what he says is about 60-70% better and feels it is definitely worth it, but is hoping it continues to get better as they adjust his doses.

The doctor also mentioned that having stable blood sugar levels was also very important for healthy neurotransmitters so he is working on that as well.

I am looking at starting the program myself, even though I've been able to get rid of most of the restless legs by watching sugar/saturated fats in my diet. I had no idea it was connected to anything else. So, dopamine dominance means you don't have enough dopamine? is it more difficult to treat then what my husband has or just different?


You have been so kind in helping with my many questions, thank you!