Laboratory testing for schizophrenia and bipolar disorder
Blake Graham, BSc (Honours), AACNEM
Clinical Nutritionist
Perth, Western Australia
1. Urine kryptopyrroles (pyroluria).
Pyroluria is a genetic deficiency of zinc and vitamin B6. Individuals with pyroluria tend to need many times more of these nutrients than others and are prone to psychiatric symptoms. The following table shows the patient distrubution of pyroluria.
| Pyroluria (high histamine) | |
|---|---|
| Bipolar disorder. | 18% |
| Schizophrenia. | 27% |
Read ♦Pyroluria: Hidden Cause of Schizophrenia, Bipolar, Depression, and Anxiety Symptoms♦ by Woody McGinnis, M.D. for more information on pyroluria.
2. Serum copper and serum ceruloplasmin.
Excess levels of copper are present in a large subgroup of those with psychiatric diagnoses. Excess copper levels alter neurotransmitter levels and cause oxidative stress. Copper status is best assessed by measuring both serum copper and ceruloplasmin levels. Ceruloplasmin is a copper transport protein. See the article Copper Excess for a more detailed discussion of this issue.
3. Hair mineral analysis.
Hair mineral analysis involves a laboratory analysing a sample of hair for essential minerals (e.g. zinc) and toxic elements (e.g. lead). The results give us some indication of the levels of these elements in our body. Hair analysis has the advantage of being cheap and simple. Hair is an excretory tissue rather than a functional tissue regarding mineral levels. It provides some information about mineral status and is thought to represent the level of heavy metals excreted that were in a persons general circulation over the past 12 weeks.
4. Blood essential fatty acids.
There is a huge amount of scientific literature suggesting that the balance of omega-3 and omega-6 fatty acids is strongly related to the health of our brain. Essential fatty acids are essential components of brain cell membranes, including those of neurotransmitter receptors. They also regulate signal transduction and electrical activity in brain cells, and control the synthesis inflammatory chemicals such as eicosanoids and cytokines, which may have a direct effect on mental health. Abnormalities in cell membrane fatty acid composition are related to the symptoms of schizophrenia and bipolar disorder. Research generally points to omega-3 fatty acid supplementation having a therapeutic effect on symptoms and correcting cell membrane abnormalities, however we all metabolize fats differently and some of us need a different distribution of essential fatty acids. Testing fatty acid levels allows us to determine exactly what types of oils we need to supplement and what types of changes in dietary fatty acid composition we need make to improve our health.
5. Provoked urine heavy metal testing.
Heavy metals (particularly lead and mercury) are commonly found to be elevated and contribute to psychiatric symptoms. See Toxic Metals and Mental Health by Mark Filidei, DO, for further information on this link. The ‘provoked’ (aka ‘post-chelation’ or ‘challenge’) urine heavy metals test is the gold standard laboratory test available to assess heavy metal burden. This is the ideal testing method recommended by various groups including:
- American Board of Clinical Metal Toxicology (ABCMT).
- American College for Advancement in Medicine (ACAM).
- The Institute for Functional Medicine (IFM).
- Defeat Autism Now! (DAN!).
When we are exposed to heavy metals from our environment, these chemicals are excreted or transported to various tissues in our body rather than remaining in our general circulation for long periods of time. As a result blood tests, hair tests and ‘unprovoked’ urine tests reflect only recent exposure to heavy metals. The ‘provocation’ test involves taking effective detoxification agents (DMSA & glycine) and collecting urine over a timed period (6 hours). These agents bind to and release some of the individuals tissue stores of heavy metals, allowing them to be excreted via the kidneys and enter urine. Collected urine is analyzed for heavy metals and levels reflect the burden of heavy metals retained by certain tissues. Doctors Data Inc. is a highly recommended lab for this test. The following link shows five recent reports I have got back using this test.
6. Organic Acid Testing.
Organic acid testing provides a view into the body�s cellular metabolic processes and the efficacy of metabolic function. Identifying metabolic blocks that can be treated nutritionally allows individual tailoring of interventions that maximize patient responses.
From a single urine specimen, the Organix Profile provides important information in the areas of:
- Vitamin and mineral insufficiencies
- Amino acid insufficiencies like carnitine and NAC
- Oxidative damage and anti-oxidant sufficiency markers
- Indicators to assess detoxification sufficiency
- Functional markers of B-complex deficiency
- Neurotransmitter metabolites to assess CNS function
- Mitochondrial energy production assessment via citric acid cycle components
- Methylation sufficiency status
- Lipoic acid and CoQ10 sufficiency markers
- Specific dysbiosis markers for bacterial and yeast overgrowth
Marked accumulation or deficit of specific organic acids detected in urine often signals a metabolic inhibition block. You can read more this comprehensive test at the following link:
7. Gastrointestinal microbial ecology profile.
Disturbance of the gastrointestinal ecosystem has been well documented to contribute to psychiatric symptoms. Adults are estimated to have more than 500 bacteria species comprising 100 trillion bacteria in our gastrointestinal tracts. This number is higher than the number of cells in our body. Huge volumes of research have gone into investigating the function of these bacteria in the last few decades, although we are only just beginning to understand their full health implications. Some of the currently known functions are listed below.
- Ferment foods to produce short chain fatty acids which are utilised by the intestine wall as fuel, improving gut health and preventing „leaky gut”
- Interact with the gut associated lymphoid tissue (GALT) component of our immune system
- Synthesize nutrients (certain amino acids and vitamins)
- Improve many aspects of digestion/absorption
- Inhibit the overgrowth of harmful bacteria, yeast and parasites
- Improve gut motility and stool formation, relieving constipation and diarrhoea
- Influence genetic expression
- Assist toxin elimination via stools and convert some toxins into less toxic forms
- Improve lipid (cholesterol, triglycerides) profile
- Influence hormone balance, e.g. estrogen
- Reduce potentially carcinogenic chemicals in the gut
Gastrointestinal overgrowth of harmful bacteria or yeast releases chemicals which alter neurological function, and in some cases contribute to schizophrenia and bipolar disorder. For example increased levels of enterococci and streptococci correlate highly with cognitive symptoms such as nervousness, memory loss, forgetfulness, confusion, mind going blank and sleep problems. (Bioscreen Data.) Dr. Natasha Campbell-McBride, Neurologist and nutritionist, discusses the link between intestinal ecology and mental health in great length in her book Gut and Psychology Syndrome: Natural Treatment for.
It is commonly believed that chronic intestinal parasitic infections, the most well known of which is Giardia, are rare in Western countries, and mainly confined to the tropics. The truth is that a wide range of parasites are common in countries such as Australia and North America. They are massively under-diagnosed due to laboratory method inadequacies and lack of consideration by doctors. Intestinal parasites are associated with malabsorption, allergies, nervous system symptoms and a variety of other complications. Read The Role of Infections in Mental Illness by Frank Strick CCN, Clinical Research Director of The Research Institute for Infectious Mental Illness (RIIMI) in California.
Metametrix laboratory offers a highly sensitive test for gastrointestinal bacteria, yeast and parasites. It utilizes a DNA technology rather than the old fashioned microscopy and culture, which have major limitations. o
8. Elimination/provokation testing and IgG food intolerance testing.
‘Cerebral allergies’ (allergies which affect mental health in some way) can contribute to irritability, depression and psychosis. Carl Pfeiffer, MD, PhD reported that for 10% of schizophrenics, cerebral allergy is the primary causative factor. William Philpott, MD (author of Brain Allergies: The Psycho-Nutrient Connection) claims that more than 50% of schizophrenics display some form of cerebral allergy which contributes to symptoms.
There are around 12 well known mechanisms of food intolerance. Individual laboratory tests test for one. My preference for people with schizophrenia and bipolar disorder is to start with a 30 day diagnostic trial of a gluten and casein free diet. A high number of people report a significant symptom reduction from avoiding these commonly problematic proteins. No laboratory test is definitive to rule out gluten and casein intolerance. The majority of people who find improvement from gluten elimination test negative for celiac disease. After gluten/casein a full range of food intolerances should be evaluated. The next most commonly reactive foods include:
- 1. Eggs.
- 2. Peanuts.
- 3. Corn.
- 4. Soy.
- 5. Cocoa.
- 6. Yeast.
- 7. Citrus fruits.
- 8. Tomatoes.
- 9. Beef.
The most reliable, and also free, method of identifying intolerances to these foods is via a comprehensive elimination diet. When this option is not possible for practical reasons I recommend paying for an IgG food intolerance profile.