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?
Trudy, what are your thoughts on the Dr Dan Kalish’s method of “mind mapping” using urinary neurotransmitter gateway testing? I had this done over a year ago. It is similar to the urinary testing except instead of the levels, they are testing the gateway activity in the kidneys somehow. Are you familiar? It was very exhausting as it takes several tests. But I was given a few combination amino acid supplements that seemed to be helping for a time and then, as you mentioned, I got extremely OVER stimulated and he told me I needed to UP the dosage. Ugh. I couldn’t handle it so I eventually just settled with a dose I feel comfortable with. Apparently, I live with a very dopamine deficient brain which really makes my quality of life quite challenging at times! I look forward to more research and better testing methods in the near future. I’ll be the first to sign up!
Hi Tana
Thank you for sharing here. I am not familiar with Dr Dan Kalish’s method of “mind mapping” using urinary neurotransmitter gateway testing and would love to know more. Would you share more about this approach and which amino acid/s you were taking? Tyrosine?
In the meantime you could consider platelet testing – it correlates closely with cerebrospinal levels. You can test the following in platelets: serotonin, dopamine, norepinephrine and epinephrine.
Trudy
Hi Trudy,
Dr. Dan Kalish’s method I believe actually comes from Dr Marty Hinz’s research. Apparently if the patient is given a consistent amount of amino acids over a period of time the neurotransmitter testing can have some validity. But a baseline test is inaccurate.
Here are a few links:
http://neurosupport.com/depletion/
https://docs.google.com/document/d/17cVmXgFSRaEDjHVR2kGS1HSZIYsyHRj2kUhy7gkaG5o/edit
http://amino-acid-dose.blogspot.ca/2013/02/dosing-for-beginner.html
Hi Mike
Thanks for sharing this. I’m certainly interested in attending this training to learn more about Dr Marty Hinz’s research and approach. Have you attended his training and do you use this approach with clients/patients success? Or are you a patient/client who has benefited from this approach?
One aspect I am having a hard time with is the 10:1 tyrosine to 5-HTP/tryptophan recommendation since I don’t believe there is ever a one-size-fits-all approach. I’ve certainly not seen the need for this with my clients – each person has their own unique needs for neurotransmitter balancing
Hi Trudy
I was wondering if you had investigated Dr. Heniz’ method of testing any further. I am working with a naturopath who wants me to do the testing and take the supplements. She seems to have had good success with it, but it is very expensive.
I have tried doing the questionaire and testing on my own, but because my case is complicated (depression, anxiety, OCD) I was unable to figure it out on my own. I spent about 4 months last year doing different trials, but I think I need a lot of precursors, and became really confused and overwhelmed.
Thank you
Jennifer
Jennifer
I’m afraid I have not had the opportunity to do so – it’s on my list though!
If you read the rest of Marty’s papers, you will find that neurotransmitter testing is very accurate IF done in the proper manner. We routinely are able to normalize the neurotransmitter system using urine testing as our guide. It is the only method currently available to track and correct neurotransmitter disruptions. For more complete info, visit http://www.neurosciencemyths.com.
Hi Dr Cole
Thanks for commenting – it’s great to hear this is working for you. I’d appreciate hearing what you mean by “IF done in the proper manner.” Do you find that symptoms correlate 100% of the time with the results? I’m curious if you also use the amino acid questionnaire or something similar?
Also per this comment: “It is the only method currently available to track and correct neurotransmitter disruptions” I’d like to add a few things: many people (including myself) successfully use the amino acid questionnaires and amino acid trials to assess for deficiencies and correct them; platelet testing is also available (for only serotonin and the catecholamines) and so is plasma testing. According to the research I’ve seen, platelet testing more closely correlates with CSF levels than does plasma.
Trudy
I have used neurotransmitter testing in my practice for several years with excellent results. I believe the problem with the validity of the test comes from inexperienced physicians trying to read the results. Neurotransmitter levels by themselves are useless, but when you can look at a full grouping of NT that are excitatory and calming you can get a very good idea of where the issues are. I recently did a study on Marines with PTSD/Burnout utilizing neurotransmitter and hormone tests to determine nutritional supplementation. The study showed that on average the there was a 40% improvement in both physical and emotional complaints in 90 days and a 80% improvement in 180 days. The 90 day study was published in a peer review journal in July, this is a link to the article https://www.dropbox.com/s/tvldg8eignzcvmz/apafinal.docx . If you would like to learn more about neurotransmitters and the reason for todays health issues read my Best Selling Book, Misdiagnosed: The Adrenal Fatigue Link
Hi Dr Zodkoy
Thanks for sharing and congrats on your success with the marines – that’s wonderful! Thanks for sharing the actual study too. Would you please share the journal link as I can’t seem to find it online?
I see your study addressed adrenal issues too and I can’t help but wonder if this was the main factor in their improvements. The research you list shows the links between PTSD and cortisol and DHEA, and not PTSD and the neurotransmitters tested.
It would be useful to see a similar study looking at only the urinary neurotransmitter testing and subsequent nutritional support.
I am also curious if you’ve correlated urinary neurotransmitter test results with the amino acid questionnaire?
At this stage I’m still not convinced about urinary neurotransmitter testing but will keep an open mind and look forward to learning more about your work and the approach you’re using. This statement certainly intrigues me: “Neurotransmitter levels by themselves are useless, but when you can look at a full grouping of NT that are excitatory and calming you can get a very good idea of where the issues are.”
Congrats on your new book!
Trudy
Where can I find someone who does neurotransmitter urine testing in the Auburn,Ithaca,Syracuse area? I have a mood disorder and would like to have this testing done.
Hi Anne
I don’t recommend this type of testing so I can’t recommend anyone. I would suggest doing the amino acid questionnaire and trials of relevant amino acids instead
Trudy
About a year ago I got excited about urinary neurotransmitter testing. I had been using Julia Ross’ pencil and paper neurotransmitter deficiency assessment for many years with good success. Over the past year I have done the neurotransmitter testing on about 10 people with very inconsistent results. With 2-3 we hit a home run, where the recommended supplements were just the right thing to diminish the presenting symptoms. More often than not the recommended supplements seemed to give little relief or even make the symptoms worse. Additionally the testing and supplements are quite expensive.
I have since given up on the testing and as I have found the pencil and paper NT deficiency sheet to me a more effective guide to treatment. When I am unable to make progress I will often turn to serum amino acid testing and the neurotransmitter markers on the Organic acid test offered by many functional medicine labs. In addition to information on about neurotransmitter functioning, the Organic Acid Test provides information about other factors involved in mental health symptoms including levels of the yeast Candida, the bacterial infection Clostridia and others.
Josh
Thanks for sharing your experiences with urinary neurotransmitter testing – inconsistent results are not good for our clients. It’s good to hear you also get such good results with Julia Ross’ pencil and paper neurotransmitter deficiency assessment. I find that it works so well!
Thanks too for sharing about amino acid testing and the neurotransmitter markers on the organic acid test, which I too have found to be valuable.
I learned about the clostridia mood connection when I interviewed Dr James Greenblatt during the June Anxiety Summit and am eager to learn more about this.
Trudy
Dr, Friedman ~
With regards to the neurotransmittor tests you were doing – was this the Heinz protocol and the gateway testing, or was it a standard urine test?
It is my understanding that these are both very different, and I’d be interested in knowing which type of testing you did not experience good results with.
Thank you
Sandra
Sandra
I believe it was the a Neuroscience test or from a similar lab. Do you mean the Hinz protocol? Please share what you know and/or have experienced
Hi Trudy,
Appreciate your work so much
My question is what brand of tryptophan do you recommend? Are there symptoms of allergic reaction?
I just started taking Source Natural L-tryptophan the past 2 nights (1,000 mg) . This morning I woke up feeling like something was biting my feet (itchy). I RARELY get bitten; plus my feet were covered up, no bedbugs etc. could it be an allergic reaction ? Was hoping tryptophan was my answer to insomnia.
Thanks for your kind consideration!
Hi Michele
I recommend Lidtke tryptophan and a starting dose of 500mg, less for someone who is very sensitive. Anything can cause a reaction and the best way to figure it out is to stop for a for days and then try again.
Trudy
I have noted the many comments on NT testing.
I too have found inconsistent results and have personally not recommended the supplement regimens. I have also found Julia Ross’ questionnaire useful and it fits with my philosophy of treating people not tests which is not to say testing may not be useful.
I believe clinical acumen and guidelines as Trudy discussed make sense.
I agree this is complex and I personally don’t believe the urine testing can reflect the CSF.
I also agree platelet NT testing is more relevant and useful but I am not able to obtain this where I practice.
Incidentally I believe using Julia Ross’ questionnaire and following those guidelines may be useful in the medical issues that are related to the emotional issues that I see in my integrative medical practice.
Attention to detail and prudent caution seem wise
Hi Thelma
I appreciate your expertise and valuable feedback on this controversial topic. It is rather unfortunate that you don’t have access to platelet NT testing. But the good news is that you have Julia Ross’ questionnaire and protocols. I’m so pleased you find them so useful. I could not help my clients without them!
Trudy
It is 10/24/14, almost time for the second summit. I have revisited this thread, as it was of great interest during the first summit. I am a patient who evidently did not get accurate results on the Neuroscience urinary transmitter test. My nutritionist consulted with the head of the company after my reaction to their supplements was very negative — adverse and non-effective.
Has there been any new information? I am also curious about the organic acids testing and why it seems to get good “press” when it is also a urine test and contains neurotransmitter testing.
Your input on this, Trudy, would be very much appreciated as I am about to make the decision about trying organic acids testing for my chronic issues. Amino acids have not worked for me in a number of trials over the years.
Thanks so much.
Hi Lynne
Organic acid testing many shed some light on other areas to focus on – possibly gut health and B vitamins and maybe toxicities. When amino acids don’t work for someone it typically means they don’t need them or the quality isn’t good or it’s not enough (or even too much) or low thyroid or bipolar or even poor digestion (sublingual may be better). I still prefer and use trials of amino acids and response. If there is no response despite symptoms then I start to dig deeper looking for other root causes to the anxiety/depression (gut, gene defects, toxins etc)
Trudy
Knowledge is so important. Neurotransmitter testing needs to be performed in conjunction with either plasma or urinary amino acid quantitation, if, for no other reason that one must ensure that there are sufficient tyrosine, tryptophan & phenylalanine for the brain (& gut) to manufacture sufficient quantities of these vital chemicals.
Malabsorption, iron deficiency, copper deficiency (or overload), Vit C & P-5-P deficiencies all impact on the manufacturing process. So will heavy metal toxicities by inhibiting vital enzyme functions. Methyl-transferases (PNMT, COMT)are particularly susceptible to their effects; hydroxylases possibly to a lesser extent. Polymorphisms (SNPs) in COMT are also important.
So, you see, a test used in isolation is just like using a hammer to build a house – you won’t get very far, very quickly!
Dr Jones
There are many factors that affect our production of neurotransmitters – thanks for sharing these ones.
I still stand by my statement that urinary neurotransmitter testing falls short.
But it sounds like you do use urinary neurotransmitter testing. Have you found it to be useful? and have you seen it to correlate with plasma results and symptoms?
Trudy
Hi there what is the best test to have
Christopher
I use the amino acid questionnaire and amino acid trials. Here is the questionnaire https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/ and info on doing a trial https://www.everywomanover29.com/blog/how-to-do-an-amino-acid-trial-for-anxiety/
Dear Doctor,
Can you recommend a good doctor in London for me. I have anxiety and depression.
Suresh
I would suggest checking for someone trained by Patrick Holford
So I just came upon this discussion. My mind is so out of whack from taking stimulants, and my anxiety has became severely worse.
What is my option to try and check to see what’s going on with my neurotransmitters?
I found this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818889/
Serotonin levels in the urine do not show what levels are in the brain and doing a urine test is not accurate because serotonin levels change all the time and have a half life of 1 second. So levels in the urine change all the time. I wanted to take my son for a urine NT test but after my research have decided against it.
Hi Trudy,
I can’t find now where I read it, but I think you said something about not using amino acids for Bipolar Disorder. Why is that?
Thanks for your time, Su.
Su
Here are the amino acid precautions https://www.everywomanover29.com/blog/amino-acid-precautions/
Hi Trudy, what do platelets have to do with amino acids if anything? Just curious because I have low platelets and high anxiety, and my platelets tend to dip with stress 🙂
And then you have this:
http://www.lifeextension.com/Magazine/2017/5/Innovative-Neurotransmitter-Testing/Page-01
MM
Thanks for sharing this link. I was not aware that Life Extension now offers this test. Based on the date it’s a recent addition. I expect they will stop endorsing it once they find it doesn’t correspond with client/patient symptoms, as do most practitioners who use it and then recognize that this test doesn’t reflect what the client is experiencing.