By Courtney Snyder, MD
Historically we've considered mental health and illness as coming from either one's life experiences or coming from one's genetics or biology. We've mistakenly considered the the brain separate from the rest of the body. We are more interconnected than those outdated views suggest. Our physical health impacts our brain health. Likewise, we experience emotions (fear, anger, sadness, and joy) not only in our brains, but in our bodies. Emotions influence our brain's biochemistry, and our biochemistry impacts our emotions, bodies and how we experience our lives.
A perfect example of this is Pyrrole Disorder - an inborn error of pyrrole chemistry. Those who are affected make an excessive amount of this metabolite. Pyrroles themselves are not a problem and do not cause disease. We all have them. They do however, bind Vitamin B6 and Zinc. When pyrroles leave the body (through urine), they take some B6 and zinc with them. This is not a problem either. The problem comes when pyrroles are being overproduced for genetic reasons or because of physical or emotional stress. This can lead to severe B6 and zinc deficiencies.
B6 AND ZINC
While there aren’t many nutrients that seem to directly affect neurotransmitters and brain functioning, zinc and B6 are two of the biggies. B6 is needed to make the neurotransmitters Dopamine, Serotonin and GABA in the brain. Zinc also has a great impact on the brain (and deserves a blog post of it's own). Separately zinc is important for the gastrointestinal and immune systems, both of which influence brain health.
As I mentioned, stress can cause an increase in the production of pyrroles. This stress could be from an a disrupted early attachment, trauma, starting a new school or job, an underlying medical condition, or even a cold or growth spurt.
For some, especially those with more severe elevations, it is believed there’s a genetic component. Though pyrrole disorder can occur in all ethnic groups, it seems to have a higher incidence in Celtic populations. The reason for this is unknown. That I'm of Irish descent brings Pyrrole Disorder particularly close to home for me.
More commonly, however, high pyrroles are a result of high oxidative stress, aka "toxicity." Oxidative stress occurs when there is an imbalance between free radicals (molecules that can destroy cells or impair biochemical processes) and our bodies ability to detoxify them or to repair the resulting damage. The toxins could be biotoxins (ie. mold, yeast or others), heavy metals or chemical toxins. Some electromagnetic fields (EMF) also contribute to oxidative stress
Most brain related conditions involve high oxidative stress. This is why Pyrrole Disorder is associated with Anxiety Disorders, Alcoholism, ADHD, Autism Spectrum Disorders, Bipolar Disorder, Criminal Behavior, Depression, Down's Syndrome, Epilepsy, Tourette’s, Learning Disorders, Oppositional Defiant Disorders, Psychotic Disorders, Substance Abuse and Schizophrenia.
Elevated pyrroles can be a result of these, but at the same time, can worsen these conditions. Pyrrole disorder is one of a handful of biochemical imbalances that affect brain functioning. For example, in depression we may see undermethylation, overmethylation, copper overload, pyrrole disorder and/or metal toxicity.
From the Walsh Research Institute of over 30,000 patients:
ADHD - 18 % (18% of individuals diagnosed with ADHD had elevated pyrroles)
Behavioral Disorders - 28 %
Autism - 35%
Depression - 24%
Bipolar Disorder - 35%
Schizophrenia - 30%
Post-Traumatic Stress Disorder - 12%
Alzheimers Disease - 14%
Healthy Controls (no psychiatric symptoms) - 8%
Most individuals with pyrrole disorder do not have all (or even most) of these symptoms. Some are more apparent in childhood; others are more obvious in adulthood.
There are other reported, though less common associations, including a preponderance of sisters in a family (for a male this could be having a mother with only sisters). This may be due to zinc deficiency. Zinc deficiency can cause infertility in men. Zinc supplementation has been shown to improve sperm count and sperm motility. And interestingly, men with lower sperm counts and slow sperm speeds have a greater likelihood of having daughters. For a woman to carry to term (and not miscarry), she has to have adequate levels of zinc. Relative to fertility treatments, addressing a possible zinc deficiency may be a simpler way to get closer to the root of the problem.
EVALUATION AND TREATMENT
Diagnosis of Pyrrole Disorder is based on both clinical information and a urine test that measures kryptopyrroles. Treatment involves a nutrient protocol that includes zinc, B6, P5P (the active form of B6) , magnesium, Evening Primrose Oil (Omega-6's) as well as antioxidants. Though Fish Oil or Omega-3 fatty acids can be beneficial for many others, they can worsen symptoms in individuals with Pyrrole Disorder and should be avoided initially.
No less important is addressing factors that may be causing high oxidative stress (ie. an underlying illness, diet, gut flora imbalances, intestinal yeast overgrowth, toxicity etc) or emotional stress. Psychotherapy, lifestyle changes, exercise, mindfulness, learning to prioritize and develop coping skills can all go a long way. Unaddressed stress can leave a person persistently pyrroluric, and thus deficient in zinc and B6. In some cases, such as during times of change, illness, and even growth spurts, stress dosing may be needed. This involves temporarily raising the dosages of zinc and B6/P5P.
Though first identified in the 1950's and first treated using zinc and B6 in the 1980's, Pyrrole Disorder is still relatively unknown. Until one year ago, I had never heard of it, though I'm sure in my previous practice, I saw many children and adults who would have benefited from this understanding. For many of those who do receive treatment, a lifetime of chronic inner tension, anxiety and fearfulness can begin to change within a few days to a couple of weeks of starting the nutrients. What was once impossible becomes possible.
If you are looking for a physician in your area trained in evaluating or treating Pyrrole Disorder or are a physician interested in training visit the Walsh Research Institute Resource Page. (Practitioners knowledgeable in Pyrrole Disorder are not limited to those trained at the Walsh Research Institute.)
I'm a conventionally trained child, adolescent and adult psychiatrist. My current approach to health is both holistic (pertaining to the whole person) and functional (addressing the root causes of illness). I write this blog to share what I've learned.