The TRIAD Profile in Depression and Migraine Headache: A Case Study

Summary

Standard medical treatments for major depressive disorder and migraine headache are only partially effective. Clinical improvement requires correction of underlying metabolic difficulties. This case illustrates the power of multiple markers to focus on key metabolic issues.

This content was created by the Metametrix Institute

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History

A 40-year-old female, suffered from severe depression as far back as she could remember. She never used antidepressants but had migraines triggered by exercise around the time of menstruation. She took fish oil and a multi-vitamin. She took Relpax for frequent, severe migraines. Relpax, or elitriptan hydrobromide, is effective for migraines because it is a 5-hydroxytryptamine (serotonin) receptor agonist.

Age

40

Gender

Female

Description of Results

In October 2006, a fasting plasma specimen revealed a general pattern of low essential amino acids. In particular, tryptophan and tyrosine were very low. Phenylalanine was low-normal. Vanilmandelate (VMA) and homovanillate (HVA), were low-normal; 5-hydroxyindoleacetate (5-HIA) was low. The other organic acids were within normal limits. Maggie showed food antibodies to many foods, although she did not complain of GI symptoms. The clinician was surprised to find so many food reactions. The second TRIAD panel, completed in April 2007, shows some essential amino acids were still low, but improved. Fasting phenylalanine, and especially tryptophan, have risen and are within normal limits. Tyrosine was still low, as well as other amino acids. In the interim, reference ranges changed, so quantitative results cannot be compared directly. Low, normal or high results may be compared relative to their previous quintile positions. Maggie should continue on amino acid supplementation as well as protein digestion and absorption support. Other organic acids were elevated. Previously she did not show B-vitamin or CoQ10 need. This is commonly seen after supplementing amino acids in an amino-acid deplete individual because amino acids are the precursors of organic acids. Further, the higher rates of protein synthesis, due to additional amino acids, places new strain on cofactor pools such as B vitamins and CoQ10. In the second TRIAD panel, Maggie showed need for CoQ10 and B vitamins to support the new levels of tissue maintenance and neurotransmitter synthesis.

Recommendations

The clinician encouraged the dietary changes as directed in the TRIAD rotation diet plan and gave the patient a basic amino acid blend starting at ¼ teaspoon in the morning and increasing ¼ teaspoon until reaching 1½ tsp in the mornings. In addition, she took one teaspoon of glutamine twice daily. She eliminated all foods with IgG4 levels of +3, +4, and +5 for 1 month and then rotated them sparingly into her diet. In the first month of treatment with the elimination diet and amino acid therapy, her headaches were triggered when some of the reactive foods were reintroduced.The patient was started on a plant sterol product that is an immune modulator. Thereafter, she avoided the allergenic foods but occasionally rotated them into her diet.

Other Comments

The TRIAD includes 20 amino acids, 90 food allergens, and 45 organic acids and can be used to evaluate multiple aspects of digestion, absorption, GI membrane permeability, long-term food reactions, small intestinal dysbiosis, energy metabolism, vitamin deficiencies, neurotransmitters and biotransformation. This case illustrates how simple dietary modification and focused nutrient interventions can bring relief from life-long depression and severe migraine headaches. The patient experienced great improvement in symptoms and decreased her reliance on prescription medication because she addressed the underlying causes of her illness, rather than the symptoms alone.