Pyroluria; a zinc and B6 deficiency that may be linked to autism, ADHD and other behavioural abnormalities

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Pyroluria
Pyroluria, (previously known as malvaria) and also known as kryptopyrroluria, is a chemical imbalance involving an abnormality in haemoglobin synthesis. People who have this condition produce too much of a by-product of haemoglobin synthesis called kryptopyrrole (KP).Kryptopyrroles bind to pyridoxine (vitamin B6) and zinc and make these very important nutrients unavailable for physiological and chemical functions including working as co-factors for metabolic enzymes.  These essential nutrients when bound to kryptopyrrole are removed from the bloodstream and excreted into the urine as pyrroles.The effect of pyroluria and the deficiency of zinc and B6 can be mild, moderate, or severe depending on the severity of the imbalance. Symptoms may include: inability to deal with stress, nervousness, anxiety, mood swings, severe inner tension, episodic anger, poor short-term memory and depression.
little boy crying
It’s onset often doesn’t manifest until teenage years, with a traumatic incident or stress, but it may be starting to show symptoms with behavioural issues in younger children. Depending on the degree of the disorder there may be severe depression, schizophrenia, alcoholism, autism, bipolar disorder (manic-depressive disorder) or on rare occasions, DID (dissociative identity disorder more commonly known as multiple personalities). All of these are different manifestations of pyroluria.Unfortunately pyroluria is not a recognized condition by many mental health practitioners or general practitioners but the following tables shows a significance in many mental disorders.
Disorder  % with Pyroluria
Autism                         50%
Alcoholism                   40%
Depression                  70%
ADD/ADHD                 30%
Bipolar                        18%
Schizophrenia             40%
General Population     11%Diagnosis
Pyroluria is diagnosed by a simple urine test which detects KPU in urine. Most people have less than 10 mcg/dL of KP. Persons with 10-20 mcg/dL are considered to have “borderline” pyroluria and can benefit from treatment. People with levels above 20 mcg/dL are considered to have pyroluria, especially if the following emotional and physical characteristics are present as well as signs of autism, depression, ADD and ADHD and other maladies already spoken about.
Sometimes it is necessary to repeat the urine test to properly determine the level of KP being excreted. For the initial diagnosis, no vitamins or minerals should be taken for two days before the urine is collected (This is to avoid false negative results).
A repeat test after treatment to determine if the condition has been improved will be helpful.
Common emotional and physical characteristics of pyroluria.
•    Poor morning appetite and/or tendency to skip breakfast
•    Morning nausea
•    Pale skin, poor tanning or easily burnt by the sun
•    Sensitivity to bright light
•    Hypersensitive to loud noises
•    Reading difficulties (e.g. dyslexia)
•    Histrionic (dramatic)
•    Argumentative/enjoy argument
•    Mood swings or temper outbursts
•    Much higher capability & alertness in the evening, compared to mornings
•    Anxiousness
•    Preference for spicy or heavily flavoured foods
•    Abnormal body fat distribution
•    Significant growth after the age of 16
•    White spots on finger nails
•    Little or no dream recall
Treatment 

Pyroluria is managed in part by restoring vitamin B6 and zinc.  The type of replacement therapy is very important as zinc must be provided in an efficiently absorbed form. Vitamin B6 is also available in several forms. Other nutrients may assist include niacinamide, pantothenic acid, manganese, vitamins C and E. Food sources and nutritional supplements containing copper and red/yellow food dyes should be avoided.People with mild-moderate pyroluria usually have a fairly rapid response to treatment if no other chemical imbalances are present. People with severe pyroluria usually require several weeks before progress is seen and improvement may be gradual over 3 – 12 months. Features of pyroluria usually recur within 2 – 4 weeks if the nutritional program is stopped.  Therefore, the need for treatment is indefinite.Diet of course is also extremely important. A diet filled with real foods including green leafy vegetables, meat, fish, chicken, fruit, nuts, seeds, eggs, and good quality dairy. I would stay away for the most part from many grains and cereals as they may bind with the zinc.Food sources high in zinc are most meats, chicken, fish, turkey, pumpkin seeds, yoghurt and cashews but the highest form of zinc is oysters.Food sources high in B6 are; tuna, salmon, beef liver, chicken, potatoes. banana, red pepper, pumpkin, shitake mushroom, chickpeas (cooked) and spinach, to name a few.

Though pyroluria was identified over 40 years ago, it has only been recognised as a medical condition for as little as 10 years and many mental health practitioners are not taught about it at university. People with pyroluria don’t respond well to common anti-depressants such as SSRIs and are often suicidal.  And the sad truth is that most people with pyroluria go undiagnosed.  Sadder is that many mental health and general practitioners do not think that diet has much to do with these conditions that are expressed with pyroluria.

Do I Have Pyroluria?
Some questions to ask yourself or loves ones, but this does not determine whether you have Pyroluria it merely indicates that a test for it may be wise.

1.   Do you tend to skip breakfast or have morning nausea?
2.   Do you tend to be anxious?
3.   Do you have other members in your immediate or extended family with schizophrenia?
4.   Are there members of your immediate or extended family who have committed suicide?
5.   Do you have white spots on your nails?
6.   Did you get a “stitch” in your side when you ran as a child?
7.   Did you have moderate to severe acne as a teenager?
8.   Do you have pain or creaking in your knees?
9.   Do you have cold hands and feet?
10. Do you have stretch marks as an adolescent or adult even without a large weight gain or loss?
11. Are your teeth or were your teeth before orthodontic treatment crowded with teeth growing over teeth?
12. Did puberty start a little later for you than others?
13. Are you easily tired?
14. Do you tend toward apathy?
15. Do you have a tendency toward iron-deficiency anemia or test borderline?
16. Do you have eczema or psoriasis?
17. Do you have tingling sensations or even tremors in your arms or legs?
18. Do you tend to have paler skin than other family members?
19. Do you tend to get overwhelmed in stressful situations?
20. Do you have trouble remembering your dreams?
21. Are you now or have you been a vegetarian?
22. Are you now or have you before been an alcoholic?
23. Do you find yourself socially withdrawn and dependent fairly strongly on one person?

If you answer yes to 12 or more of these questions, then you may have pyroluria and should consider getting a urine test done.

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