CASE: Susie G, is a 40-year-old female with Metabolic Syndrome, Obesity, IBS (co

Question

CASE:

Susie G, is a 40-year-old female with Metabolic Syndrome, Obesity, IBS (constipation predominant), Infertility, Fatigue, and PCOS. Due to this combination of medical conditions, you decided to run an Amino Acid Panel to see if she was deficient in certain nutrients that could enhance her health and fertility. She has returned to you for a follow-up visit today to discuss the results of her urinary amino acid testing.

ABNORMAL Amino Acid Results (NORMAL results were NOT listed so assume all other pathways are functioning fine aside from the abnormal results listed below):

Low Tryptophan            

Low Tyrosine            

High Homocystine            

High Anserine and Carnosine           

High BCAA

Based upon the 5 abnormal results listed above:

1. a. What pathways are impaired by each of her abnormal results? What nutritional supplements would be warranted for each imbalance (ie. if low in Tyr, supplement with what nutrients? Do this for each of the 5 abnormal results.)? 2 points

1. b. What other dietary adjustments would you make to help offset these amino acid imbalances (ie. list foods that are high in the specific nutrients listed from 1. a. in case Susie would rather get her nutrients from food rather than supplements)? 1 point

2. Find an article on PubMed (PMC, Google Scholar, or other reputable peer reviewed journal article sites) discussing one of the abnormal urinary amino acids/missing nutrients and its links to fertility or one of her other medical conditions. Discuss the article in 1-3 sentences, upload the abstract, and provide a link to the full article. 1 point

3. Read at least one other student's information and provide a new peer-reviewed journal article that can assist in further understanding the use of amino acids (amino acid testing and/or supplementation) in health (have fun and find something on any topic that may interest you and your classmates). 1 point

Explanation / Answer

Aminoacids are the building blocks that make up protein in all bodily tissues, including bone, muscles, ligaments, tendons, nails, hair, glands and organs. Amino acids are also the basic constituents of all hormones, enzymes and neurotransmitters. Assessment of amino acid levels will help to identify contributors to illness and allow for precise replacement of deficient amino acids. Because various vitamins and minerals are used as cofactors in amino acid metabolism, imbalances in amino acids noted on the test report can also point to insufficiencies of some of these cofactor nutrients.

This test can either be performed on a 24- hour urine collection or a fasting plasma specimen.The Urine and Plasma Amino Acids Analysis reports consist of 43 and 41 individual metabolites, respectively . A Urine or Plasma "Representativeness" index provides a quick measurement of reliability of the specimen for testing.

The report includes detailed description on abnormal findings, a "Supplement Schedule" which gives recommended replacement amounts of the subnormal amino acids, and an "Interpretation At A Glance" which suggests the likelihood of imbalances in the various systems as well as insufficiencies of the nutrient cofactors.

1.a.Low Tryptophan :

It is a neuro transmitter precursor to serotonin and melanin and any elevated ot low levels of Tryptophan can suggestive of Neurological or Behavioral Problems. It affects the serotonin pathway as low levels of tryptophan in body can lresults in lower levels of Serotonin.

A diet or supplement with appropriate aminoacids, vitamin B6 can be used for desirable results. In 2002, the U.S. Institute of Medicine set a Recommended Dietary Allowance (RDA) of 5 mg/kg body weight/day of Tryptophan for adults 19 years and over.

Tryptophan is present in most protein-based foods or dietary proteins. It is particularly plentiful in chocolate, oats, dried dates, milk, yogurt, cottage cheese, red meat, eggs, fish, poultry, sesame, chickpeas, almonds, sunflower seeds, pumpkin seeds, buckwheat, spirulina, and peanuts.

Low Tyrosine:

Tyrosine is a nonessential amino acid the body makes from another amino acid called phenylalanine. It is an essential component for the production of several neurotransmitters, including epinephrine, norepinephrine, and dopamine. Neurotransmitters help nerve cells communicate and influence mood. Tyrosine also helps produce melanin, the pigment responsible for hair and skin color. It helps in the function of organs responsible for making and regulating hormones, including the adrenal, thyroid, and pituitary glands. It is involved in the structure of almost every protein in the body.

The neuro chemical pathwyas are affected as well endocrinal disorders can be observed if there is low Tyrosine levels in the body. Deficiency can give rise to sleep deprivation, stress because of the low levels of neurotransmitters. It can also interfere with the negative feedback mechanism of thyroid hormone as it is a precursor to thyroid hormone.

Tyrosine is found in soy products, chicken, turkey, fish, peanuts, almonds, avocados, bananas, milk, cheese, yogurt, cottage cheese, lima beans, pumpkin seeds, and sesame seeds.

High Homocystine:

Homocysteine is an amino acid and breakdown product of protein metabolism that, when present in high concentrations, has been linked to an increased risk of heart attacks and strokes. Elevated homocysteine levels are thought to contribute to the formation of clot and creates aggregation of platelets by damaging arterial walls. However still the conclusion is still under reasearch.

An inadequate intake of B vitamins, as well as genetic factors that affect the body’s absorption and use of folic acid, can lead to elevated homocysteine levels. Supplementing with appropriate aminoacids and Vitamin B6 in diet or as supplement can reduce the symptoms.

High Anserine and Carnosine:

These are dietary peptides neccesary for the functioning of gastro intestinbal system. It can rise the suspection of incomplete digestive proteolysis or leaky gut. The increased levels of anserine and carnosine can suggestive of gastro intestinal disorders.

High BCAA:

The BCAA means branched-chain amino acids -- leucine, isoleucine and valine -- are three of the eight essential amino acids you must obtain through your diet. The branched-chain amino acids, or BCAAs, are metabolized in your muscles, where they provide an important source of energy.

The foods which are rich in these amino acids are poultry, fish, beans, milk, meats, cheese and some of the vegetables like sweet potato, potato, green peas, asparagus, spinach, corn, brocolli, wheat, germ.

BCAA's act as nitrogen carriers which assist the muscles in synthesizing other aminos needed for anabolic muscle action. High levels of BCAA can affect the the metabolism of muscle functioning.

1.b. Other foods include a balanced diet with vegetables and fruits and vitamins and minerals. Adequate water for the human body depending on the clients life styles and body mass index. Alternaive change in nutrients for maintaining appropriate levels and avoiding toxication.

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