Amino acids are one of the most common supplements that I prescribe in my office for my rheumatology patients. What are amino acids? They are the tiny building blocks that make up proteins. Around this time of year before Thanksgiving, there is a lot of talk about L-tryptophan in turkey making you feel sleepy. In reality, the tryptophan in turkey is probably not what makes you feel tired. It is most likely the parasympathetic, “rest and digest” state that you enter after overeating, in addition to the presence of excess insulin in the blood stream after eating all those carbs.
However, tryptophan can make you sleepy because it is the precursor for serotonin, which is converted into melatonin, the “sleep chemical.” Tryptophan, or its derivative 5HTP, is a commonly prescribed amino acid in my practice. Why would I use 5HTP? Well, I often measure neurotransmitters in rheumatology patients as part of my medical investigation. When a patient first comes to my office, I want to investigate every single possible trigger that he/she might have for the disease. I want to know why the immune system is attacking itself. Amongst many other things, one of the major contributors that I test for is neurotransmitter imbalance. There is a very new and very complicated science out there called psychoneuroimmunology (try saying that 5 times fast!). Psychoneuroimmunology is really a passion of mine in my practice nowadays, as more and more information becomes available. Psychoneuroimmunology is basically the study of the relationship between psychological processes, neurotransmitters, and the immune system. It is the nitty-gritty science behind the “mind-body” connection. The most classic example of this connection is the relationship between an inflammatory cytokine called IL-6 and cortisol. IL-6 stimulates the adrenal axis and causes an increase in cortisol, which can be linked to depression, weight gain, and inflammation. This might be one of the ways that St. John’s Worts aids in depression, that is, through modulation of IL-6. Furthermore, there are some interesting preliminary studies showing the serotonin can inhibit Th1 cytokine processes (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219342/). So, this is why I test neurotransmitters in rheumatology patients. While the connections are not clearly mapped out just yet, we know that there are connections between immune dysfunction and neurotransmitter imbalance. By identifying and balancing neurotransmitter dysfunction, we can make improvements in the autoimmune process. 5-HTP is one amino acid supplement that can be considered when urinary 5-HIAA levels are under 4 on a lab test. However, I do not recommend taking 5HTP alone for long periods of time, as it can inhibit the production of another group of neurotransmitters called catecholamines and can actually worsen depression.
Catecholamines are another very important neurotransmitter family to investigate in rheumatological disease. Catecholamines are made by the adrenal medulla in response to stress signals and sympathetic (“fight or flight”) stimulation. It is not good to have catecholamines that are either too high or too low. Like most things, a balance is ideal. These can be measured through the urine, and when they are low, can be supported with a different type of amino acid therapy. In this case, Phenylalanine or Tyrosine would be indicated. When autoimmune patients are in adrenal fatigue or adrenal burnout, oftentimes the catecholamine support is neglected, with all of the focus placed on cortisol. The catecholamines also burnout, leading to depression, fatigue, inability to focus, and lack of motivation. Amino acid therapy, sometimes combined with B vitamins or methylating agents, can be immensely useful in these cases. Tyrosine is also the building block of thyroid hormone, so Hashimoto’s patients with low catecholamine levels may benefit greatly from a tyrosine test and supplementation. Phenylalanine has an added bonus of blocking pain sensation and amplifying the analgesic effects of acupuncture.
Another amino acid that is often used for my patients is GABA. GABA is Gamma amino butyric acid, and it is the major inhibitory neurotransmitter in the brain. An inhibitory neurotransmitter is incredibly important for calming sensations and reducing anxiety and overstimulation. However, GABA also has a very important role in fibromyalgia. Patients with fibromyalgia have upregulated pain sensation in the central nervous system, so that something feels painful to them that should not ordinarily feel painful. GABA can calm down this sensation by antagonizing glutamate. GABA can be tested and supplemented as needed, and it also has the side effect of easing anxiety and helping to enhance synaptic connections in the brain!
Glycine is another important amino acid for patients with autoimmune disease because it, similarly to GABA, is a calming, relaxing agent. It is another major inhibitory neurotransmitter in the brain, and its sweet taste makes it a great choice for kids (with anxiety, JIA, PANS, PANDAS). Glycine is also an important player in the detoxification pathways of the liver. Rheumatology patients with anxiety and heavy metal toxicity or solvent exposure might benefit from a glycine test and a trial of glycine supplementation.
These are just some of the many amino acids that can be used therapeutically for patients at ArthroWell Naturopathic. We can supplement these based solely on symptoms using a questionnaire (email us at firstname.lastname@example.org for details), or we can test these in the urine and supplement as needed. Amino acid therapy has a wonderful safety record and can make a huge difference for many patients!