Summary:
Extreme elevation of D-arabinitol presents an potential explanation of otherwise unexplained and unusual chronic symptoms.

brain "fog"
fatigue
global ligamental laxity
Sun sensitivity

K68 Serum Chemistries
K90 ION

51

M

2/12/2004

History This 50 year old chiropractor has given up his practice due to the severity of global ligamental laxity that prevents his full use of hands and arms. The condition has been gradually worsening over the past 2-3 years along with the development of hypersensitivity to the sun, general chemical sensitivity, brain "fog", and fatigue. His diet is largely vegetarian with much attention to maintaining balance and variety. Prior to 1 yr ago he had maintained a raw food diet for 2-3 years. Description of Results Plasma amino acids and erythrocyte elements show no evidence of insufficiency consistent with the favorable nutrient density of the diet. Although serum antioxidants are well within reference limits, both lipid peroxides and urinary 8-OH-deoxyguanosine are elevated, showing the presence of a metabolic disturbance producing high levels of reactive oxygen species. A part of the problem is found in the plasma fatty acid profile where alpha-linolenate and arachidonate are elevated, giving a polyunsaturate oxidation propensity. The high LA/DGLA ratio and the high relationship of ALA to EPA indicated insufficiency of zinc to support desaturase activity. This finding overrides the within-limit erythrocyte zinc and causes a recommendation to supplement zinc. Other evidence of zinc insufficiency is found in the serum chemistry result for Alk Phos which is low. The activity of this hepatic enzyme is strongly dependent on the zinc cofactor concentration. The most striking abnormality of the entire set is the D-arabinitol elevation above 1000 mcg/mg creatinine. Such readings are found in less than 0.5% of a general out-patient population. The organic acid profile shows a concurrent extreme elevation of pyroglutamate. Glycine insufficiency can cause such pyroglutamate elevation, and the requirement for glycine to supply 1/3 of the residues of collagen gives an obvious potential link to the ligamental pathology present in this patient. Recommendations Supplement glycine and zinc. Use anti-fungals and limit dietary carbohydrate (consider the specific carbohydrate diet that restricts all sources of maltose. Other Comments When such high levels of D-arabinitol are found in immunocompromised patients, aggressive intervention is needed to prevent severe invasive candidiasis. In immunocompetent individuals, the yeast is apparently being kept in check, but the yeast product D-arabinitol at levels over 1000 mcg/mg creatinine may well produce metabolic toxic effects. Glycine insufficiency for collagen biosynthesis and a concurrent zinc deficiency impact on connective tissue maintenance enzymes, along with toxic enzyme interferences by D-arabinitol offers a hypothesis for the observed connective tissue degeneration in this patient. Regarding the normal plasma glycine, it appears that this patient is carrying out threonine degradation to supply glycine as his tissues attempt to maintain adequate glycine levels. Plasma glycine is low normal, but threonine is uniquely low among the essential amino acids in plasma.

Lab Data Figure . Extreme arabinitol 1 pAA.gif Figure . Extreme arabinitol 2 eMin.gif Figure . Extreme arabinitol 3 Antiox.gif Figure . Extreme arabinitol 4 pFA.gif Figure . Extreme arabinitol 5 UOA.gif Figure . Extreme arabinitol 6 UOA2.gif