I am often asked about urinary neurotransmitter testing and often a new client will come in with results from a test she/he has had done. I would like to share my thoughts on this rather controversial subject and say that I am not a fan and do not ever use this test. Let’s take a deeper dive into this topic.
The question
Here is a question I received right after the Anxiety Summit:
I have had good results using urinary neurotransmitter testing and targeted amino acid therapy and bioidentical hormones. I am able to see if all levels are low, indicating low stomach acid. I am also able to see if histamine or glutamate are high, indicating food hypersensitivities. I also use the levels for balancing and replacing. I know that Julia Ross is opposed to testing. What is your opinion and what did your other speakers [on the Anxiety Summit] say about this topic?
This is my answer:
I am very pleased that this person sees good results using urinary neurotransmitter testing and targeted amino acid therapy.
Why I am not in favor of this testing
However, I am not in favor of this testing for a few reasons:
1) Julia Ross is not in favor of it and having worked with her in her clinic for 2 years I respect her professional opinion and the results she saw when urinary neurotransmitter results didn’t correlate with amino acid questionnaire and trials of amino acids. Julia wrote a great article on this topic for the Townsend Letter and you can access this via the anxiety summit blog for her interview
2) Since leaving the clinic and starting my own practice, I’ve worked with folks who come in with urinary neurotransmitter test results that don’t always with correlate with amino acid questionnaire and trials of the amino acids. But I will be the first to admit that I have not done a thorough analysis of where they haven’t correlated simply because it didn’t seem worth my time.
3) I have heard some rather unpleasant stories from people who have had the urinary neurotransmitter testing done and have been given supplement recommendations based on the results. I just received an email recently from someone who said this:
I was doing xyz’s program last year and the aminos recommended based on urine neurotransmitter testing nearly sent me over the edge with extreme anxiety, insomnia and panic attacks. He had me take 300mg 5-HTP and 3000mg tyrosine a day, based on test results.
We know that anyone can have a bad reaction to supplements. But let me comment on this example: 5-HTP can raise cortisol and be stimulating for some people so it’s not something I recommend for everyone with low serotonin symptoms; 3000mg tyrosine a day is not excessive (1-2 x 500mg , 3 times a day is often typical) BUT will be too much if you don’t need it and can cause anxiety and insomnia.
4) A 2011 paper by Marty Hinz “Validity of urinary monoamine assay sales under the spot baseline urinary neurotransmitter testing marketing model” states that
No peer-reviewed published original research exists which demonstrates that these assays are valid in the treatment of individual patients in the clinical setting.
Low stomach acid and food hypersensitivities?
I’d like to also comment on two other parts of this question:
- “I am able to see if all levels are low, indicating low stomach acid.” I have not heard this correlation and would use other labs markers for low stomach acid – like total protein, globulin etc – and the person’s response to a HCl trial.
- “I am also able to see if histamine or glutamate are high, indicating food hypersensitivities.” I have also not heard of this correlation and would use an IgG test and food elimination and challenge to help figure out if someone has food sensitivities.
What do other speakers think?
It was also asked what other speakers on the Anxiety Summit said about this topic:
- Other than Julia Ross, the only person who mentioned urinary neurotransmitter testing briefly was Dr. Anna Cabeca and we didn’t go deeper into the topic.
- I did email Dr. Kelly Brogan and she said
I actually don’t use them. Occasionally I do serum amino acid testing (ION panel) but don’t feel that the science is there to support urinary neurotransmitter testing and feel that the reductionism around amino acids and behavioral translation is not consistent with my perspective and not needed for the outcomes I get.
If you listened to our interview on the Anxiety Summit, you’ll remember that Kelly doesn’t feel that low serotonin is a factor in anxiety and depression.
- I will be following up with some of the other speakers like Josh Friedman, Hyla Cass, Amy Day and Corey Schuler.
What do Dr Weil and Nora Gedgaudas think?
I’d like to share some perspectives from a few others:
I checked with David Perlmutter, M.D., a neurologist colleague in Florida, about the accuracy of urine testing for neurotransmitters. He told me that neurotransmitters and their precursors are produced in abundance throughout the body and to assume that what is collected in the urine reflects what’s going on in the brain is a stretch.
Unfortunately Dr. Weil goes on to discredit salivary cortisol testing which has plenty of research supporting how effective it is!
- Nora Gedgaudas, author of Primal Body Primal Mind states this on her site:
I have considered the urinary testing approach and was even enamored of the concept at first. Once I looked into the idea more closely, though, it just didn’t add up for me. I have been using amino acids now to address issues of mood, health and cognitive functioning for over 20 years. I have never used anything other than mood/symptomatic screening to guide amino acid supplementation. Results tend to be uniformly good to excellent. The sheer overwhelming complexity of amino acid/neurotransmitter activity in the human body/brain-and the compartmentalized nature of the biochemistry of each seems to best lend itself to a more functional and symptom-related evaluation. Lab testing simply falls short of the mark here.
I could not agree more with Nora’s comments. These are my exact thoughts. Here is the amino acids mood questionnaire I use with my clients. Based on symptoms we do amino acid trials and based on their response (which can happen as quickly as 5 minutes) we know if we’re on the right track.
I’ll be the first to say we don’t always have all the research to support what we do in the nutritional/integrative world and do agree that testing is extremely valuable but in this case I do not recommend urinary neurotransmitter testing as it does fall short in terms of accuracy and consistency.
I’d love to hear your thoughts and experiences. Have you been tested and had good results? Bad results? Are you a health practitioner and say ‘yes’ or ‘no’ to this testing?