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To discuss this complex
topic, this issue of The Healing Partnership newsletter will carry an
interview with Dr. Bonnet on the subject of pyroluria.
Editor:
Dr. Bonnet, can you define pyroluria for us?
Dr. Bonnet:
Pyroluria is a metabolic disorder in which under conditions of stress a person
becomes functionally depleted of pyridoxine (vitamin B6) and zinc. It was first
identified in the late 1950’s through tests with psychiatric patients in a
psychiatric hospital. Through a specific laboratory test of the patient’s
urine, what has become known as the mauve-factor was identified.
In 1963 Doctors Abram
Hoffer and Humphrey Osmond coined the name ‘malvaria’ for those patients who had
a mauve factor in their urine. Extensive testing showed that the mauve factor
occurred in about one out of three confined in a psychiatric hospital.
Editor:
When and how did you become involved in this research?
Dr. Bonnet:
I joined the research team of Dr. Osmond and Dr. Carl C. Pfieffer at the New
Jersey Neuro-Psychiatric Institute in 1972. By that time Dr. Pfieffer had seen
some astounding results of his experimental research. Particularly in a young
lady, named Sara.
Sara had come to the
Institute in terrible shape. She was fifteen years old at the time, and was
suffering from seizures, chronic insomnia and had bouts of amnesia and
vomiting. She was at the point where she clearly wanted to die. The laboratory
tests showed her urine to have a strong mauve factor and high coproporphyrin
excretion. Her psychiatric rating test (the EWI) clearly showed considerable
perceptive disorder.
Sara was given large doses
of vitamin B6 (up to 1 gm. per day), along with supplementary zinc (160mg) and 8
mg of manganese. She responded immediately. In fact, Sara’s recovery was so
dramatic, she applied to and was accepted not only to college but went on to a
successful modeling career. Today she continues a maintenance dosage of the
vitamin and mineral supplements to prevent a relapse, but leads a healthy, sane
life. Dr. Pfieffer originally called the condition the “Sara syndrome.” Today
it is referred to by the more generic term pyroluria.
My continued study,
research and interest in the topic, stems from my personal diagnosis of
pyroluria. I have maintained a dosage of about 1500mg. of B6 for years. Only
recently, when I expanded my practice to include homeopathic remedies, have I
experienced such a remarkable improvement that I now maintain a dosage of 250mg.
of B6.
Editor:
You noted that initially psychiatric patients were identified as having
pyroluria. Is the problem limited to psychiatric patients?
Dr. Bonnet:
No. In trying to identify its origin we found pyroluria definitely showed
genetic roots. In fact, although the disorder can be inherited form only one
parent, most of the time both parents have the disorder. In fact there is a
better than 50-50 chance of this happening. It also is seen in geniuses. In
fact, both Emily Dickinson and Charles Darwin had all of the classic symptoms of
pyroluria.
Editor:
You raise an important point. What are the symptoms?
Dr. Bonnet:
The diagnosis of pyroluria is fairly easy to make. Symptoms include:
1)
Poor stress tolerance. This is often first noticed as a student
completes high school and leaves homes for the more competitive world of college
or a career. Stress levels skyrocket beyond previous (safe within the confines
of the family) levels. With college students, symptoms are usually seen to be
cyclical in that they increase and decrease with the cycle of the workload
within the semester. Most crises usually surface as the end of the semester
approaches.
2)
A tendency to not be hungry for breakfast, sometimes even experiencing
morning nausea.
3)
Infrequent recall of dreams upon awakening. This does not mean
necessarily being able to relay the dreams, but to remember dreaming.
4)
Pain in the left upper quadrant of the body. This is because the spleen
is congested. B6 is necessary to stabilize the red blood cell membranes and
when a person is deficient in B6, the red cells turn over more rapidly than
normal and that leads to congestion of spleen.
5)
History of mild anemia that doesn’t respond to iron.
6)
A tendency for skin to burn easily in the sun.
Examining the patient is
likely to reveal: white spots on the fingernails; paleness (of complexion); and
crowded incisors.
A word of caution: although
the symptoms seem fairly easy to identify by the patient, it can be dangerous to
self-diagnose and self-treat. Incorrect large doses of B6 can be dangerous and
a proper balance of zinc (generally gluconate) is required.
Editor:
How would the diagnosis be confirmed?
Dr. Bonnet:
Final determination of the disorder requires a urine test. This determines the
Urinary Ehrlich Chromphor (UEC) level.
Considerable care must be
taken in gathering the urine. Due to the fact that the substance we are looking
for is very unstable and quite vulnerable to decomposing, my office adds
ascorbic acid to specimen as soon as the patient voids. The specimen is then
frozen over dry ice. This is critical and must be enforced for a correct
reading. Our lab is likewise extremely careful of temperature when
administering the test.
Editor:
Once the diagnosis has been determined, what is the procedure for treating the
disorder? Will the patient be able to return to or continue a “normal” life?
Dr. Bonnet:
Following usual treatment protocol, the patient starts with a dosage of 500mg.
of the B6. We adjust it upwards by 250mg. every four days until the person
starts to recall dreaming on a regular basis. If they dream too much on the
500mg, we cut back on that dosage. Sometimes if a person is dreaming too much
on even 250mg. it could be an indication that they don’t have pyroluria.
Usually pyroluric people
require doses between 250 to1500mg. Some require up to 2000mg. and there is an
occasional patient that does need more. In the past we always had keep a close
watch on the dosage, especially watching for a more serious side effect,
numbness in the toes, called peripheral neuropathy with pyridoxine (the standard
form of B6). However by adding Pyridoxal-5-Phosphate (P-5-P), the active form of
vitamin B6 we have been able to prevent the peripheral neuropathy and maintain a
much lower amount of vitamin B6. The neuropathy comes about because of an
imbalance between pyridoxine and P-5-P, taking additional P-5-P takes care of
the problem. Hence, it has been a long time since we have seen people with numb
toes.
Editor:
Are there any other symptoms that a patient should report regarding pyroluria?
Dr. Bonnet:
Some pyroluric patients will find they can not handle any level of outside
involvement with people. The stress of these situations is unbearable. In
severe cases, the stress reaches the point that the patient spends their time in
seclusion. The patient might also report blinding headaches, nervous
exhaustion, a change in handwriting and familial dependency. Both Charles
Darwin and Emily Dickinson were known to have these symptoms.
Dramatic personality as
well as physical changes are generally seen when the disorder is properly
treated. The patient will return to a healthy happy life, often finding a job
if they are not working or being promoted if they are employed.
When pyroluria is very
severe, there can be an abnormal (unpleasant sweetish) odor to the person’s
breath. In a psychiatric patient, this usually indicates a breakdown is
pending. The reason for this odor is not currently known, but continuing
research is being conducted.
Frequently gastrointestinal
problems are also noted – particularly irritable bowel syndrome and colitis
(that can be anything from spastic colon to ulcerative colitis). Episodes of
diarrhea and constipation also indicate a lack of B6. Some seizure disorders
can be traced to pyroluria.
One more note, B6 is known as the asthma nutrient. People
with pyroluria will sometimes come down with asthmatic difficulties. We have
also seen increased instances of arthritic disorders as well.
Editor:
Pyroluria, although first identified in psychiatric patients, certainly does not
seem to be limited to that population. You have made it clear why this problem
needs to be diagnosed at your office, where careful patient history and proper
testing of the urine can be handled. Are there any other guidelines for
patients to follow.
Dr. Bonnet:
The most important guideline for any patient to follow is adequate nutrition
and practicing a lifestyle of moderation in all activities (both work and
play). Learn to LOVE your body and take care of it with the proper respect.
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1.
How did you, as a psychiatrist, become interested in nutritional therapy?
Before I attended medical school I had taken a
summer job in the Recreation Dept of the NJ Neuropsychiatric Institute working
with patients. I discovered a group of people who were very sensitive and
intelligent, but were suffering terribly and no one knew how to help them. At
that point I felt a strong sense of vocation. I decided to attend medical
school and make a difference for the people who had inspired me. In medical
school I was deeply influenced by a lecture given by Dr. Carl Pfeiffer. He and
several colleagues had strong evidence that a combination of nutritional based
approaches was the answer to schizophrenia. My traditional based psychiatry
education and residency left me feeling that I was no further ahead then when I
started. While fewer people required long-term hospitalization the shackles
were put on their mind by the drugs as opposed to the walls of the mental
hospital. I was very fortunate to join Dr. Pfeiffer in his exciting research.
2. How long had you practiced using only traditional
talking and pharmaceutical therapy?
Not for very long, after I completed a traditional
psychiatric residency I started a fellowship with Dr. Pfeiffer. He was a
tremendous mentor to me. Under his tutelage I was able to learn the foundations
of Orthomolecular Medicine. Orthomolecular was a term that the late Linus
Pauling, Ph.D. a dual Nobel prize laureate coined to describe the use of
therapeutic dosages of nutrients to treat illness as opposed to pharmaceuticals.
3. Please tell us what exactly you do in your
practice?
My approach involves firstly gathering a very thorough
medical and nutritional history. In my first meeting with a patient I strive to
understand a persons symptoms and their health goals. I set up a treatment
program that involves selected nutritional supplements and homeopathic
remedies. Homeopathy involves prescribing a specific homeopathic medicine
called a “remedy” based on the specific ways a person is experiencing their
symptoms. These symptoms go beyond the typical ones an allopathic doctor would
consider important. I use blood work, urine testing and hair analysis to get a
foundation of where a person is to gain insight of where they need to go.
4. At what point, and why, did you add homeopathy to
the use of vitamins and minerals?
I added homeopathy to my treatment protocol over 15 years
ago. Homeopathy works to rebalance the energies of a person’s body, mind and
emotions. I had a patient whom upon consulting with a colleague of mine felt
that I had covered all the important bases. He recommended the patient consult
a homeopath. The patient improved so dramatically he came back to tell me about
it. At that point I decided to become a 2nd generation homeopath. My
father was the in the last class at Hahnemann medical school to be trained in
homeopathy. The American Medical Association had gained a strong following and
their primary mission in those days was to stamp out any approaches that didn’t
fit with their viewpoints. Fortunately homeopathy gained a strong following in
England, India and other countries around the world and its study is now alive
and well here in the United States and around the world.
5. What improvements do you see in your patients and
to what degree do they recover?
Improvement is often a function of how well a patient
follows the treatment program, but also how timely they communicate with me
about how they are doing: good or bad. I have a special time of the day set
aside for patients so they can talk with me briefly about how they are doing.
When patients use this “calling time” we can work closely at enhancing a
person’s path to wellness.
Generally improvement, to some degree, can be seen within
the first few appointments for most of my patients. I think every practitioner
has their share of dramatic improvements or complete recoveries. However many
of the patients I see have been through the gamut of traditional practitioners
and treatments. Oftentimes we have to try to repair the damage these doctors
have created through the over-prescribing of strong pharmaceutical drugs and
antibiotics. At the same time we have to work very hard to educate our patients
about preventive measures.
6. How long does it take for people to feel a
noticeable improvement and how long for maximum benefit?
Noticeable improvement can be quick but on the other hand
it can be very gradual that a patient doesn’t fully realize how far they have
come in the time they have been coming to see me until we review their
progress. I have patients that have been with me for over twenty years and they
are still improving along the way. Throughout our lives there are continually
new challenges and stresses we all face. Wellness should be an ongoing goal for
all of us.
7. Do people relapse on this approach? If so, how do
the frequency and duration compare with those of talking and pharmaceutical
therapy?
Some patients will relapse when they stop taking their
supplements. However by restarting the treatment program they will often
recover. One of the main underlying factors I screen for is a condition called
pyroluria. Pyroluria is a condition where a person, under extreme stress,
becomes functionally depleted of vitamin B6 and along with it zinc. Pyrolurics
require pharmacological dosages of vitamin B6 and other nutrients to stay in
nutritional balance. Patients with pyroluria must stay on their supplements to
recover and stay well.
Pharmaceutical drugs will manage symptoms to a certain
degree but since they don’t address the underlying causes of illness the
patient’s ability to truly recover is very small. Talk therapy can be very
beneficial in the recovery process, but by itself it has limitations. While I
don’t practice psychotherapy per se, my method of treatment does involve talking
with my patients about subjects and experiences that are often very difficult
for them. One area that I have found enhances psychological wellness is the
process of working a forgiveness affirmation. This involves repeating “I
forgive < a person’s name>” - 70 times in a row for 7 days. This person could
be a family member or another person who has invoked physical or mental harm on
the patient. It is important to remember the process of holding a grudge or not
forgiving someone only harms you, not the other person.
7. Do you combine the nutritional/homeopathic
approach with traditional therapies ever? If so, how do you determine when to
do it?
Yes I do combine treatments. I try to use the best of
everything that is available to help my patients. For example, while St. John’s
Wort works very well for milder states of depression it’s not always as
effective for chronic depression. I will often combine St. John’s Wort with
other supplements like SAMe and the results will be improved, but at times a
prescription anti-depressant might be necessary for the short term. For
patients with schizophrenia correcting underlying factors like: histamine
balance, allergies, heavy metal toxicity, nutrient deficiencies, pyroluria,
candida and so on can make a huge difference.
But, sometimes, low dose medication might be necessary.
These decision are always patient centered. Everyone one of my patients is an
individual – with individual needs. The combination of nutrient therapy and
medication will prevent or reduce the potential side effects of drug therapy.
When patients come in already on medications I don’t as a rule immediately take
them off their current medication. Until I fully understand my patient the
decision to change or stop medication comes later. However, if a patient
strongly feels that they want to stop a medication I will do everything I can to
help them make the transition.
8. Please tell us how food allergies can affect
one’s mental/emotional functioning?
Food allergies are a very complex subject. Food allergies
to gluten (a protein in many grains) and casein (a protein in dairy products)
have a strong link to brain related illnesses like schizophrenia, depression and
autism. Since these are commonly eaten foods it is often difficult for people
to eliminate them 100% from their diet. A food allergy can exhibit itself like
an addiction. For example, a person feels well as long as they eat that
particular food frequently. When they haven’t eaten the food they feel tired,
confused, depressed, withdrawn and so on.
9. How does one know whether one has food
allergies? Must the person give up allergenic foods completely and forever?
Symptoms of food allergies in adults frequently include
tiredness after eating an offending food allergen and in children hyperactivity,
while craving the offending food or foods is most common in both adults and
children.
The typical signs of food allergy are:
* Dark circles under the eyes, which are called “allergic
shiners”
* Puffiness under the eyes, fluid retention
* Chronic swollen glands
The common symptoms of food allergies include:
Gastrointestinal: canker sores, wheat intolerance,
chronic diarrhea or constipation, burning stomach pain, gas
Genitourinary: bedwetting, chronic bladder
infection, lower back pain
Immune: frequent and/or long lasting colds or flu,
problems with ears like: pain, difficulty hearing, excessive wax build-up
Brain: anxiety, depression, hyperactivity,
inability to concentrate, insomnia, irritability, mental confusion, personality
changes, and convulsions
Musculoskeletal: shoulder pain, joint pain, and low
back pain
Respiratory: wheezing, difficulty breathing, and
tightness in chest
Skin: pimples and blemishes, red dry skin patches,
itching, eruption of itchy wheals (raised white patches)
Miscellaneous: irregular heartbeat, edema,
fainting, fatigue, headache, itchy nose or throat, sinus pain, shakiness,
craving of sweets, headaches that are accompanied by disordered vision, vomiting
and light sensitivity.
Food allergies that are fixed such as peanuts and
strawberries, which are common, must be eliminated completely because a person
will always be allergic to them. Functional food allergies are usually foods
that are eaten frequently. Typically if they are eliminated for a period of
time, usually 3 months, they can be added back in and eaten in rotation, only
every 4 days.
10. Why do most psychiatrists and MDs in general not
inquire of patients about their diet and incorporate a nutritional approach?
Most medical schools only require one course in nutrition;
so most physicians have little training or interest to ask their patients about
their diet. In today’s managed care environment most physicians have to see so
many patients per day that they have around five minutes to talk with each one.
This is usually enough time to find out a little about the patient’s problem and
then write a prescription.
The focus of medical school education is based on
diagnosing illness and prescribing drugs to relieve symptoms. The germ theory
of disease is still the primary theoretical orientation that medical schools
espouse. Treating patients through diet and nutrition involves more of a
preventative mindset.
11. Do you see progress being made in this regard?
Fortunately, more and more medical schools are adding
nutrition and prevention to the programs they offer. In my opinion it’s been
way overdue.
12. If someone wishes to try these alternative
therapies, what should he or she do? Does Medicare or Medicaid pay anything
toward it?
They should contact my
office and talk to one of my staff who can explain the procedures for scheduling
an appointment. Medicare picks up most of the initial appointment fees. Some
of the studies that are part of the initial appointment such as the trace
element hair analysis and a specific test I run to screen for pyroluria are not
covered through Medicare. I’m not sure what Medicaid will cover since my office
doesn’t participate with them.
