Summary:
When follow up testing looks much worse while a young leukemia patient is improving, multiple factors are at play. Underlying dysbiosis and glutathione issues are involved in this case.

Lymphocytic leukemia

K91 Urine Organix Profile
K91 Urine Organix Profile

6

F

10/21/2003

History Diagnosed with acute lymphocytic leukemia, this child has been shown to carry the Philadelphia chromosome. Chronic myelogenous leukemia is frequently fond in patients with the Philadelphia chromosome as is the case with this 5 y/o girl. See http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/CML.html She has been treated with immunosuppressive drugs following bone marrow transplant. Many transfusions have raised her ferritin level to 775 mg/dL. To counteract infections, she has been on steady courses of diflucan, bactrum, penicillin, and pentimidine. Based on the first organic acid profile, she was supplemented with L-carnitine, riboflavin, coenzyme Q10, free-form amino acids, high-dose vitamin C, N-acetylcysteine, and a probiotic product containing L. acidophilus and strains of bifidus. At the time of the follow up testing (5 months later) she was reported as doing exceptionally well, having been taken off of prednisone and other prescription medications. She had fallen at play and broken her arm resulting in a temporary setback in physical activity. Her anemia has been improving as evidenced by RBC counts of 3.3, 3.6, 3nd 3.8. Description of Results The initial profile showed some degree of intestinal bacterial overgrowth and hepatic detoxification challenge with patterns suggesting insufficiencies of carnitine and coenzyme Q10. The elevated p-hydroxyphenyllactic acid indicated high-dose vitamin C supplementation should be considered. The follow up profile appeared significantly worse. Our interpretation must take into account the ongoing immunosuppressive therapy and the use of broad-spectrum systemic antimicrobials. The most telling changes are in the areas of dysbiosis and glutathione utilization. Bacterial markers had worsened across the spectrum, and the marker for overgrowth of L. acidophilus had jumped from 0.5 to 3.3 (Norm < 1.9), while she went from a single high yeast marker to having all three high, including the new D-arabinitol muco-invasive marker. The other remarkable change area is the shifting of sulfate from 138 to 830 mcg/mg creatinine. Concurrently the glutathione biosynthesis marker, a-hydroxybutyrate, has jumped from 3.5 to 24.0 mcg/mg creatinine, and pyroglutamate has doubled. All of these changes signal an ongoing heavy demand for glutathione synthesis. Steeply degenerating biotin status in indicated by the increased level of b-hydroxyisovalerate, and carnitine continues to be needed to stimulate mitochondrial fatty acid oxidation. Recommendations Since amino acid supplementation, and especially sources of cysteine can exacerbate intestinal yeast and bacterial growth, we recommend discontinuation of N-acetylcysteine and other free-from amino acids for 60 days. The heavy rate of glutathione synthesis suggests that these should be re-introduced when they can be tolerated. Discontinue all L. acidophilus and add non-D-lactate forming probiotics. Implement the specific carbohydrate diet to gain reduction in simple sugar and disaccharide intake that serves to stimulate acidophilus overgrowth. Introduce microbial suppressive herbals. Continue L-carnitine and CoQ10 while adding biotin at 200 mmcg/d. Vitamin C should be brought back to more moderate doses while the multiple other factors that may be stimulating p-hydroxyphenyllactate are managed. Other Comments The most compelling areas of challenge for her at the second testing are worsening intestinal bacterial and yeast overgrowth with specific micronutrient involvement. It appears that L. acidophilus colonization has proceeded too rapidly, most likely due to ongoing reductions in other populations of favorable strictly anaerobic bacteria that are more susceptible to the antibiotic regimen. The worsening bacterial situation has produced a biotin insufficiency.

Lab Data Figure . Philadelphia chromosome - OAU1a.gif Figure . Philadelphia chromosome - OAU1b.gif Figure . Philadelphia chromosome - OAU2a.gif Figure . Philadelphia chromosome - OAU2b.gif