My Dr. is wanting to start me slowly on Folinic acid and CyanoB12 to attempt to open my pathway for heavy metal excretion.
He is supportive of Yasko's work but feels that she uses too many supplements in her protocol. He feels all that we really need is about 15 supplements. I'm already taking that many things and I dont really agree with him on this. I think he's overlooking many things and is just very quick to open the pathway. He's just looking at the area where its blocked and not really taking into consideration the impact that the blocks have had on the entire system.
My feeling is that its the wrong thing to do at this time. I feel that the supports should be layered in first. Its a big job for the body to start moving the toxins out and I dont think I'd do well without laying the groundwork first. Alot of people do try to skip the basics and just jump right into detox. Usually I see those people having setbacks and then stopping everything only to have to start all over and go back to add in the supports and address things that they'd originally skipped. I dont want to learn this the hard way. It only makes sense that when things are out of balance and when the body is lacking the nutrional support it needs....things are not going to go smoothly.
A couple things that my Dr. had included as starting supplements for me during my last visit would have set me back. They would have worsened my condition. This was my feeling so I never took those supplements and instead waited for my genetic results to confirm what I was thinking. He recognized this when he saw my results because he does have some knowledge about the mutations. However, since he was basing all of his decisions on labwork without ordering the genetics I'm being more catious with regards to his recommendations. Usually he is not ordering the genetics and I think alot of mistakes would be made that way. In my own case I could see that if I didnt get the testing done I would be going in circles and taking things that go against my genetics....as I've done in the past....and especially with things like DMPS.
I dont feel like its a matter of just giving the few supplements which will speed up methylation. Obviously during the time that this process has been impaired alot of other systems have also been affected. They dont bounce back just because my worst mutations are being supported. If all of the minerals are low the body isnt functioning too well, same with amino acids, hormones, etc. So I have to agree with Yasko as far as this is a whole body thing and so we do need to do alot to support all that has been affected by impaired detoxification, infections, toxins, food intolerances, etc.
I think I will continue to do what I've been doing but at the same time making adjustments to include my Dr.'s recommendations as long as they make sense to me. I'm changing my plans for follow-up testing since I think my Dr. uses more accurate methods of testing than Yasko does. She uses urine and I've always felt that bloodwork is more accurate for things like minerals. My Dr. does not want to use urine tests and I did ask him why Yasko prefers urine if its less accurate. He said its because she's not an MD...therefore she cant order bloodwork. She has no choice but to use urine. That made sense to me so I'm going with bloodwork for sure.
As far as getting the metals to come out his experience has been the same as what I've read from people on Yasko's discussion group. He said he very rarely ever uses chelation anymore because he finds that its not needed once methylation is restored. He finds that his patients excrete more metals when the methylation cycle is functioning vs. chelators.
Also, he said that he finds that for some reason once methylation is working the metals are mostly coming out in stool and not urine. He might see some in the urine tests but in stool he is seeing much more. So mostly we will do stool tests for metals....but I would also like to do urine once in awhile just to see whats being excreted there.
His plan is to have me start taking the B12 to slowly get the cycle moving. I'm already on the supports he recommended per Yasko's protocol. He wants me to get up to 1 subligual tab a day and then after 4 weeks he wants to test levels of SAM/SAH as well as homocysteine (blood). If these levels are up it would indicate that the proper conversions are taking place and that methylation is occuring. At that time we will test the stool for metal excretion.
If nothing is coming out he says we will have to go after Lyme to get the metals to come out. He said when he is not seeing excretions its always because of mutations and/or Lyme. Since we know my mutations he is saying that we should see metals unless Lyme is holding on....which he does think will be the case for me.
I dont disagree with him but I also feel that I have other issues which would still make it difficult to excrete alot of metals at this time. I'm lacking one glutathione gene and the CBS mutation takes time to get under control. It takes time to build up glutathione. It takes time to have the levels of various things in balance....it takes time to get the organs sufficiently supported. I think all of these things and more play a role in how well my body can excrete the toxins. There are alot of toxins stored...not just whatever metals that Lyme might be holding onto. From what I've seen on the Yasko board I think that adults take longer to start dumping metals. I would not expect to see big excretions just because I took some much needed B12. I'm willing to try it though.
I know that it might be too early for me to add in anything that provokes detox...but I plan on going VERY slow and definately stopping if I feel bad. I dont think I've addressed enough things yet but I'm at least having several supplements on board before making this attempt.
I will take maybe another month of adding in supps. before I try the B12. I think that the CBS mutation is my biggest problem and I think that it has had a negative impact on other important enzymes. If this were better controled I would do better with methylation supplements.
I'm doing a couple things to address it but I'm hoping that the addition of molybdenum, manganese and ammonia RNA will help to get this better under control. Dr. P. said yucca and curcumin should be enough to control CBS....however, I have not seen anything to support that and to the contrary I have only read that they are not enough by themselves. Low protein is important as well....but so far I have not been able to implement that. I'm hoping that I can make progress without having to limit protein but I'm not sure if its possible.
I'm posting a diagram of the cycle (below) and my most problematic mutations are in the last circle to the right where methylation conversions are mostly taking place.
Where the two circles meet on the right there are the MTR and MTRR enzymes. The two genes work together to regenerate and utilize B12 which helps to convert homocysteine to methionine. This process is critical in getting the intermediates to go the "long way" around this pathway. Mutations in any of these genes would indicate a greater need for B12. With more than one mutation here it would be difficult to generate enough B12 to keep the cycle moving the long way around the pathway.
I have 2 MTRR genes with double mutations....so I'm MTRR ++++. My need for B12 is significant....but since I also have CBS....I wont tolerate it without that being addressed first. CBS is always a first priority except for with mutations that are having a big impact on the gut (SHMT and ACAT)....then usually those should be addressed first. "The reason you want to look at SHMT and ACAT support as starting points if they are issues is that we tend to see more dysbiotic and imbalanced flora associated with these mutations. Until we get the flora in better balance we risk the problem of retention of toxic metals by the microbes."
MTR/MTRR mutations also will affect the gut environment because of the lack of B12.
In the case that there is inadequate function and we are not able to make it the "long way round" with this process...the BHMT enzyme (in the middle of the circle) provides a shortcut through the pathway. This "backdoor" will bypass the MTR/MTRR mutations. In my case I have 2 BHMT mutations so I have difficulties here as well. My amino acid results actually indicate that the long way around is not working and there seems to be too much emphasis on the "shortcut" (something I learned on the other forum).
Usually this shortcut should be supported before attempting to try to go the long way around. My Dr. is apparantly skipping that part and not very concerned with BHMT (probably because there is less info. available with regards to this mutation). This is another reason that I think attempts to add in B12 will not go over well.
Ideally we should be able to generate the B12 we need to convert homocysteine to methionine and continue with methylation. It starts with B12 which is then converted to methionine....which is then converted to SAMe.....and then to SAH....and finally to homocysteine. Thats the "long way around" the circle. Homocysteine is then removed by 3 possible reactions. Either it is converted back to methionine by way of the folate cycle (circle to the left of methylation) or it is going down into the transsulferation pathway where it is coverted to cystathione or it is converted to methione independantly (without the folate cycle).
MTR/MTRR mutations means that the long way around is impaired due to problems generating B12 (MTRR) or because B12 is being used up too quickly (MTR). Having both of these mutations means that lack of available B12 will be a major issue. CBS mutations means that homocysteine is being broken down through transsulferation at an increased rate which creates a situation of excess ammonia and sulfur.
The combination of these mutations means that methylation intermediates can be easily depleted.....so that the cycle isnt functioning.
These are my lab results which pointed to these particular mutations.
1. HIGH methylhistidine on urine amino acids (UAA). Methylhistidine may be high if assimilation of folic acid or B12 is insufficient.
2. HIGH Methylmalonic (OAT). This can be high when there is defective transport of B12.
3. LOW folic acid (Spectracell)
4. LOW methionine (UAA).
5. LOW SAMe in bloodwork
6. LOW SAH in bloodwork.
7. No detectable levels of homocysteine (UAA).
These results correlate with the effects of the mutations. All of the methylation cycle intermediates are low or depleted.
With regards to no detectable levels of homocysteine....Dr. P. said that he has been fooled by this in the past. He has seen this result in the urine amino acids but then found normal results for homocysteine in bloodwork. It seems logical that in my case the result is accurate since the other intermediates are all low and I have CBS+ which would break down homocysteine more rapidly. Most everything would be going downsteam through transsulferation...since it is not going the long way around and the CBS would be acting as an open drain.
The plan is that after adding in folic acid and B12 he will retest SAMe/SAH as well as homocysteine levels in blood. This will let us know if these conversions are taking place and if they are we will test for heavy metals in the stool.
I think all forms of B12 may be required....including methyl B12. I'm no where near being ready to add in MB12 and I will have to be extra catious with it due to other mutations that would increase my sensitivity to methyl donors. These are all different factors in why I dont think we'll see big heavy metal excretions....aside from Lyme. I do think that addressing Lyme would allow metals to flow since they will come out with the Lyme providing the methylation cycle is up and running....however, I dont think I'm ready for that to happen yet.