In chronic fatigue and fibromyalgia, it is important to explore deeply as to the cause. Along with IgG food hypersensitivity, vitamin D 25OH, homocysteine and hormone levels, intracellular micronutrient analysis gives a perspective otherwise difficult to obtain. When in a patient it revealed deficiencies in glutathione, glutamine, cysteine and selenium, it was apparent that toxin overload was a major cause of symptoms. Glutathione is the primary nutrient detoxification substrate in the body, and maintaining adequate levels is crucial in our toxic world.

Despite visits to Cleveland Clinic, a Tourette’s syndrome was persisting essentially un-phased. Workup at our office revealed the highest homocysteine level we had measured since a Parkinson’s patient a year previously, a test not done at Cleveland. Homocysteine is a reflection of how effectively methylation is occurring, an important detoxification pathway. It is a byproduct of both animal product consumption and deficiencies in the active forms of vitamins B6, B12 and folic acid, and, when abnormal, usually indicates an underlying genetic polymorphism. Micronutrient analysis revealed both folate and B12 deficiencies. Due to the very high homocysteine level, this strongly suggested homozygous polymorphisms affecting both of those nutrients. Treatment with 5MTHF and daily injections of the reduced form of B12, methylcobalamin, which had to be compounded, along with elimination of foods that were severe on IgG food hypersensitivity testing (always a major problem in children with brain disorders in our experience), resulted in the first significant improvement in six months, and may pave the way to long-term resolution in this severe case.

After experiencing low back pain every morning for 2-3 years, associated with stiffness sufficient to make tying shoelaces a challenge, genetic testing revealed a homozygous vitamin D receptor polymorphism. As this associated with double the risk of Alzheimer’s dementia, vitamin D dosing was increased to 18,000IU daily (due to a small serious risk, this should be only done under physician supervision) with full resolution of morning low backache. Blood levels looked excellent, as high as 80ng/ml, but intracellular testing revealed a different picture, consistent with the polymorphism: vitamin D was mildly deficient, requiring a still larger dose.

Quality medical care requires optimal risk-free assessment. Without knowing the status of the basic building blocks, how can we expect to determine underlying etiologies of challenging clinical presentations? Intracellular micronutrient analysis is joining the list of essential information needed for complex clinical assessment. On November 5th, the Midway Foundation will be having national experts in town to describe Functional Medicine Approaches to Brain Disorders, focusing on ADHD, Tourette’s Syndrome, autism/Asperger’s syndrome, bipolar, panic and related brain disorders. Mind-body interventions are also important, but when there are fundamental underlying etiologies that are biochemical, and respond to biochemical intervention, or when promising safe interventions are available, powerful brain-altering drugs can usually be avoided. Never discontinue medicine without consulting with your healthcare provider. Seek underlying causes, learn promising safe approaches, and utilize mind-body principles. This CME and CEU conference is designed to educate physicians, nurses, PAs, NPs, psychologists and counselors.