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My daughter's OAT test shows elevated ammonia in the urine. We have tested blood ammonia twice and both times the results were within the range for her age. What is the difference between both tests, do they show different things and if so, what exactly? So far, we have been working on bringing down elevated ammonia in the urine. CaringDad? Anyone?

remember the blood system is mostly a transport system
a bit like a freeway
counting cars on a freeway doesn't tell you have many people live in the city

however elevated ammonia can mean protein isn't being broken down
so I googled around and
http://www.ehow.com/how_5845643_natural ... -body.html
so support the liver
drink plenty of water
have plenty of citrus particularly lemon

WD

watermelon is another ammonia detoxiferator
it contains Citruline
http://en.wikipedia.org/wiki/Citrulline
http://www.healthvitaminsguide.com/amin ... ulline.htm

WD

HI Kastania!

Yes, you are right that there are differences between the blood ammonia and the urine ammonia test. However, the urine test does mirror the blood test. Both have their limitations as you will see towards the end of this post with the corresponding link that I have provided. Extra care must be exercised with both tests- the blood one should be taken in the hospital using special handling and the urine one also must be frozen, otherwise the representativeness of these tests can be dubious. The urine one may refect more of what is in the gut. Dr Yasko prefers the urine tests in that they are less stressful for kids (the tourniquet on an arm can elevate ammonia) and convenient. Here is a quote:

"Generally I have found that the blood work mirrors the urine tests and the
two are consistent with respect to ammonia levels. So, if the blood
ammonia is not high, I would be surprised to find that urine ammonia
levels were high."

(source: http://ch3nutrigenomics.com/phpBB2/viewtopic.php?t=2871)



I have done the urine one for my child from Genova, namely the ONE test. Here is what they say:

Ammonia an end product of nitrogen metabolism, is elevated in the urine. There are four possible causes.
1. Decay, even slight decay of urine, due to bacterial contamination or to urinary tract infection, can cause ammonia
levels to rise. Also, improper handling and preservation of urine specimens would result in elevated ammonia,
unrelated to the patient's ammonia level.
2. A dietary protein overload may result in elevated ammonia in urine (and possibly in blood). This may occur with
excessive use of amino acids supplements or protein powders, or with consumption of more than 4X the RDA of protein.
For adult women to protein RDA is 45 grams; for adult men it is 55 grams; for children of ages 5 to 12 the protein RDA
ranges from about 30 to about 40 grams. High-protein diets may be accompanied by constipation and increased
bacterial production of ammonia in the large intestine.
3. A less frequent cause is metabolic acidosis compensated by glutaminase in the kidney deaminating glutamine to
produce glutamate and ammonia which hydrolyzes to ammonium hydroxide. Confirming indicators would be lowered
urine glutamine, increased glutamic acid, elevated blood keto acids, lowered blood pH, and elevated partial pressure
of CO2 (arterial).
4. Hyperammonemia may feature elevated urine ammonia as well. Metabolic causes include hyperlysinemia,
cystinuria with urinary loss of ornithine and arginine, and enzymatic weakness in the urea cycle. Liver cirrhosis,
aluminum toxicity, bacterial infections, intestinal malabsorption, intestinal dysbiosis, and constipation can cause
elevated blood and urine ammonia levels.

Regarding #1, did you freeze the urine and package it properly? Did the courier deliver the specimen on time or was it delivered later in the day?

Regarding #2, are you on the SCD or SCD-like diet (GAPs)? This often means high amounts of protein which contributes to higher nitrogen which somehow has to be excreted via the urea cycle which takes place in the liver.

Regarding #3, metabolic acidoses of all types/causes can cause the body to compensate by forming ammonia as a pH balancing mechanism. Curiously, ammonia (NH3) is alkaline whereas ammonium (NH4) is acidic. Acidosis is a rarer cause, but it can occur in ASD kids. Moreover, the resulting attempt by the body to compensate for the acidosis by using ammonia can cause corresponding pH changes in the gut, thereby altering gut pH which in turn can affect flora.

Regarding #4, many of these things can affect ASD kids. Are you supplementing any of the mentioned aminos like lysine to fight virus? Does your child have an inborn defect like Nitric Oxide Synthase (NOS) or Cysthatione Beta Synthase (CBS) upregulation? Liver problems? Bad gut bugs? If so, these can also come into play to increase ammonia.

Provided the specimen was handled properly, here may be some considerations:

What to do? Yes, William's Dad gave some nice suggestions like citrulline which helps in the urea cycle. This would depend upon the child's levels on the urine aminos test. Although ornithine aspartate can be of great value in helping in the urea cycle to lower ammonia, I would avoid it as it can help encourage virus. Moreover, aspartate is an excitotoxin. If the child was low on citrulline, I would give the citrulline.

-Keep the bowels moving! Based upon how high the ammonia was, you may wish to do 1-2x/week a charcoal magnesium citrate flush...give 1-2 tabs of charcoal and wait 3 hours later to give magnesium to ensure a bowel movement the next day. If charcoal is not practical, you may wish to substitute enterosgel which will function similarly if not better than charcoal.

-you may wish to administer lactulose; this will help ensure regular bowel movements and help force the excess ammonia away. This will necessitate a mop up using something like charcoal or enterosgel. Moreover, lactulose will also act as a prebiotic to help support flora.

-you may wish to administer yucca; this tends to decrease gut ammonia.

-As William's dad said, nourish the liver...this is where the urea cycle takes place. additionally, nourish the pancreas and kidneys as they are strained. The former in trying to help digestion(especially with a SCD/gaps diet) and the inevitable excretion of waste products by the latter (kidneys). You may wish to reduce protein to a smaller amount, say no more than 80 dag/day. You may wish to add in glandular products to help support these like douglas labs products. Herbs can help, like dandelion root and leaf, milk thistle, curcumin.

-If bacterial dysbiosis and/or permeability are an issue, ongoing effort must be made to ameliorate these. Some gut flora helps detoxify ammonia. I like the Klaire therbiotic complete since it contains strains that help with this.

How was your child's urine taurine level? How was alpha ketoglutarate? Also, High? Was her phenylalanine and/or tyrosine high?

If an inborn issue such as NOS and/or CBS are present, the above mentioned measures are merely 'maintenance' as they are not addressing the root cause. Personally, I have found great use in the Yasko CBS or Ammonia support RNA, since my daughter has the CBS issue. I have seen the difference in that it has successfully lowered the ammonia by slowing down the cbs enzyme. If you decide to use this product, please go very slow...start with one drop and watch for any adverse reactions. I made the mistake of flippantly just adding one additional drop and BOOOM, huge detox reaction! Stools came out smelling like ammonia! It was just too much for my child in that it took her about 4 weeks to recover; too much, too fast. Let follow up testing be your guide in this; after starting with a drop or two, retest in about 6-8 weeks.

I can imagine that the increased ammonia is playing havoc with tetrahydrobiopterin (BH4) levels. Since 2 molecules are required to detox every one molecule of ammonia, the BH4 stores are strained. Consequently, if BH4 is strained, levels of neurotransmitters like dopamine and serotonin (which depend on BH4) are affected resulting in a inattentive/spaced out/confusion (low dopamine) look whereas at night there are sleep problems due to serotonin imbalances. Therefore, a final consideration would be perhaps to get prescription BH4 to help rebuild the depressed stores.

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http://www.labtestsonline.org/understan ... /test.html

quote from page:" Normal concentrations of ammonia do not rule out hepatic encephalopathy. Other wastes can contribute to changes in mental function and consciousness, and brain levels of ammonia may be much higher than blood levels. This can make correlation of patient symptoms to ammonia blood levels difficult "

Therefore, just because your daughter's blood ammonia was in the normal range doesn't necessarily mean ammonia is not a problem.

I hope that this helps! Please let us know how it goes!

Yasko suggests giving Yucca with protein when it is eaten also to bring down ammonia.

Thanks very much for this information, I have a lot to think about! CaringDad, one more question. My daughter does in fact have the CBS upregulation and I have purchased the Yasko Ammonia RNA product. The thing is, it says that it contains saccharomyces cerevisiae and I have read that this is disruptive to children and that is why I have not used it yet. In her book, 'Special Needs Kids Eat Right' Judy Converse also mentions this, so I have been wary about using this product. What do you think, have you had any problems with it? I wish Yasko would publish what the ingredients of her formulas are.

Hi,

Not to worry. The formulas do not actually contain yeast (S. Cerevisiae). Yasko explains this on her site as it is a frequently asked question. Yasko does not actually produce the formulas, but rather Prolongevity RNA does via Dr. Garry Gordon. Many different foods actually contain RNA. Sardines are actually a rich source of varied RNA. When faced with the decision of what source material to use to harvest the specified RNAs for each formula, the choice was narrowed down to 2 - salmon sperm or plain baker's yeast. The yeast was chosen as it probably is more cost effective. Yasko explains that even though the RNAs are harvested from yeast, it is not actually yeast. The analogy is given that if an old building is torn down and the bricks are then recycled, and thus to rebuild another new building. Neither the bricks nor the new structure can be considered to be the same as the old building. Let's take a look at some frequently asked questions in order to clear up misunderstanding:

1)Isn't RNA dangerous??? Some pharmaceutical companies have put out RNA medicines which have had side effects?
RNA interference is supposed to provide a way to precisely turn off specific disease-causing genes. Companies are trying to make drugs that consist of short sequences of double-stranded RNA, the chemical cousin of the DNA in genes. The drugs are designed to activate RNA interference to silence a gene with a sequence of letters of the genetic code corresponding to the sequence in the drug. For example, Ampligen was a promising candidate for fighting herpes ( type 6b;possible culprit in autism). Ampligen was recently shelved because there were side effect problems with it. It was a double stranded rna and these often have side effects. The prolongevity formulas from Yasko are single stranded and similar to what is contained in regular food and hence, not really dangerous.

2)I heard that RNA is really not stable??? How is it getting through saliva, GI tract? It breaks down!
Answer: After working in the biotech field for 20 years, Yasko explains that she found a way to prolong the stability of the RNA long enough for it to make a therapeutic difference. For this reason, the process is proprietary. This is her commercial right. The RNA is supposed to be held in the mouth so that the patient can enjoy sublingual/buccal entry, but if it is swallowed it really is not a problem since it is stabilized. However, if it is swallowed then, some efficacy is reduced and consequently, a slightly larger quantity must be swallowed to gain a benefit. Of course, eventually the sequences break down. If any parent has used glutathione, this compound is made of three amino acids - cysteine, glutamic acid and glycine and it, too, similarly will break down but not before having its effect. This is why some kids do not do well on this if their glutamate levels are still high. The glutathione will inevitably break down and the glutamic acid will make a bad situation worse with excitotoxin damage.

3)Why does she not publish the ingredients??? Actually, the basic nucleotides are listed on the bottle namely, cytidine, adenosine, guanosine and uridine (notice these are the bases in DNA). Each formula is different in that the sequences of nucleotides are different. A yeast capsule can contain over 100,000,000 such sequences! For a particular health concern, you may require perhaps 50 specific sequences of that 100,000,000. This process of finding the needle in the haystack is labor intensive and thus, costly. This might explain the relatively high cost of the formulas. Now, to list those specific 50 sequences on the bottle, the label would be too small. You would have to attach a very large label. Therefore, for simplicity sake only the basic nucleotides are listed, but the formulas have different sequences. Moreover, the information is once again proprietary. As I mentioned, you may use a TD cream or glutatione from a compounded pharmacy and they often use a proprietary technology to compound the vit b cream (think Lee Silsby, who on another thread pointed out that their MB12 TD cream is unique in its formulation). Do they list this on the container? Do you know how the glutathione is actually made? Yet, you can see that they do have their effect. This is common in business. Many companies, including drug companies, are not going to reveal their unique processes so that competitors can copy them.

4) If the RNAs are in food, why not just eat food?
Just as I mentioned that sardines are a rich source of RNA, it would not be a practical solution. All of those billions of sequences compete for uptake and they only have a narrow window of time before they break down. Yasko likens this to a huge classroom of kids waiting for the recess bell in school to ring and when it does for a brief period, all of the kids rush for the narrow door at once. By the time everyone would get out, recess would be over.

5) Do they contain yeast?
No. As I mentioned, the raw building blocks were harvested, isolated and purified. The raw materials no longer have the characteristics of the initial source. They could have been harvested from salmon sperm, but they no longer have the characteristics nor do they contain salmon. Furthermore, please take your bottle of ammonia support RNA and read the bottle. Mine explicity states: " Other ingredients: water. Does not contain yeast, sugar, dairy, wheat, corn, soy, artifical colors or flavors. Preservative free "

6)Are the RNA formulas homeopathic?
NO. If they were, they would conform to US homeopathic medicines standard and as such, would be listed on the label.

7)Those formulas are expensive! Unfortunately, they are relatively expensive. However, my kid is using just a couple drops each day and the bottle has lasted for 4-6 months. That is still manageable for me. Other formulas, if given at 3 droppers/day last maybe 1 - 1.5 months. Hey, aren't bioray products rather expensive at $50 - $60 per bottle and if administered at several droppers/day they last maybe a month.

The use of nucleotides is nothing new. The inital medicines used to treat HIV/AIDS are uridine (nucleotide) based in order to interfere with virus replication. Unfortunately, it is an underappreciated/underused tool. Please read here:

http://www.nature.com/horizon/rna/backg ... erapy.html

More about uridine in the treatment of HIV:
http://www.wellsphere.com/hiv-aids-arti ... ker/531836

The specific supplement used in the above studies in Germay was nucleomaxx which is here (very expensive!):
http://www.nucleomaxx.com/index.php?id=63&type=0

Finally, here is a thread in which Dr Yasko discusses this same issue which I summed up:

http://www.ch3nutrigenomics.com/phpBB2/ ... 9879014281

I can only say that they are visibly helping my child. In the beginning, I was skeptical of them and the price was a turnoff. I regret that I didn't use them earlier. Also, in the beginning, we did see side effects like temper tantrums within 20 minutes of giving the RNA. The initial detox reaction passes and the kid does better. If it were just 'water,' I doubt that we would have any reactions whatsoever. Yasko clearly states that if a parent does not wish to use the RNAs, then that is okay. She has stressed that her discussion forum is NOT a marketing forum to sell products, even ones that she helped formulate. The whole approach differentiates itself from others in that you are using genetic tools to help bypass weaknesses. Therefore, in my humble opinion the formulas do have their merit. Moreover, I think that in certain cases they are essential e.g., like in cbs upregulations. I can not see any other practical thing at the present time that would slow down (downregulate) the cbs enzyme. Without a normalization of the cbs reaction, the parent is just wasting money on MB12 and follinic/5MTHF/ TMG/DMG/SAMe because the methyl intermediates in the methylation cycle are simply being depleted by the overactive cbs enzyme. They will be helping to raise more ammonia, H2S and Alpha ketoglutarate. With the excess of cysteine, taurine synthesis will be excessive at the cost of glutatione production. Taurine wasting means magnesium wasting.

Hope That This Helps!

Thanks CaringDad, I am going to try it.

Hi,

You are quite welcome. Remember, please start with only a drop with that ammonia support formula. See how it goes. If there is no adverse reaction, then after about 2 weeks of stability on a single drop, you may cautiously increase by a second drop. Do not be tempted to give more! It looks like water, but packs a wallop if you overdo it. The reaction can happen often with a delay of weeks. If your child does have a reaction even with one drop, mix the single drop into a clean dropper bottle and give 1/2 of this liquid/day. If everything goes okay, then you can increase to one full drop and so on until you work up to about 6-8 drops. This may take awhile so be patient. If your child has the milder cbs A360A she will only require the dose once per day, best with methylation supplements and protein meals. If your child has the more severe cbs 699, she may require more frequent dosing. Let testing be your guide. After 6-8 weeks of stability in dosing, retest her urine amino acids. If ammonia is in range and taurine is in range, you have succeeded. The ammonia support must be on board for the duration of treatment in order to keep the ammonia and taurine within range.

Good Luck and Let us know how it goes!