Summary:
Because of potential negative effects on vascular function, methionine should be used with caution. These data show how plasma amino acid data reveals changes in methionine status with moderately aggressive methionine supplementation.

allergies
fatigue
headache
infections

K40 Fatty Acids - Plasma
K10 Amino Acid Analysis - 40 Plasma
K10 Amino Acid Analysis - 40 Plasma

62

M

7/31/2003

History This college professor has had a long history of extreme chemical sensitivity. He reports that multiple small environmental challenges cause him to loose focus and experience "brain fog" that affects his ability to carry on classroom lectures. He has frequent severe headaches, nasal allergies, and viral infections. He has used 200 mg of 5-HTP at bedtime for sleep for the past couple of years. Based on the initial clinical workup and evidence of heavy metal body burden elevation, he was treated with Redoxal, a product containing L-methionine and taurine. Description of Results The initial plasma amino acid report is shown below, followed by the follow up test, including a plasma fatty acid profile. His initial plasma amino acid profile showed slightly low arginine and histidine with other essential amino acids near the low limits. Glycine and serine were also significantly below their limits. On follow up testing seven months later, his arginine was essentially the same while plasma methionine had risen over two-fold and was now above the high limit. Concurrently, plasma taurine had almost doubled. These changes show the effectiveness of the product for causing increases in fasting plasma amino acid concentrations. The dramatic rise in methionine is likely to be accompanied by increased methylation of arginine to form the nitric oxide synthase inhibitor, asymmetric dimethyl arginine (ADMA). Increased ADMA has deleterious effects on endothelial function and vascular system status. Hypertension is a common result of ADMA inhibition of NOS. At the second testing, a profile of fatty acids in plasma was also ordered. Very low levels of EPA an DHA were found, and the AA/EPA ratio was 40 (high). The long-term EFA deficiency marker T/T ratio was also elevated, showing that there had been protracted history of n-3 fatty acid insufficiency. Recommendations Methionine supplementation should be discontinued until ADMA is evaluated. Although endothelial function may be impacted, neuronal NOS is possibly the more significant locus for metabolic interference because of the neurologically-related symptoms. Assessment of, homocysteine, and other cardiovascular risk factors is advised. Fish oils should be started at 6 gm/day or more, but only after a period of antioxidant buildup (1-2 weeks) to help avoid increased rates of oxidative damage from polyunsaturated fatty acid oxidation. Other Comments This case illustrates the degree to which a simple dietary supplement can shift plasma amino acids, thus shifting total body dynamic balance. It raises the question of functional status of nitric oxide since the nitric oxide synthase inhibitor ADMA is likely to be increased by the sustained methionine elevation, and arginine, the normal substrate, is in relatively low supply.

Lab Data Figure . Methionine overload initial.gif Figure . Methionine overload pFA at follow up.gif Figure . Methionine overshoot follow up.gif