We have now seen over one hundred clients that had previously been working with other providers for guidance using amino acid therapy. Many of these clients had previous DBS testing completed to help them determine how to optimize their neurotransmitter function. Unfortunately, they did not follow the correct preparation procedure to complete the test and got erroneous results, which then led to erroneous recommendations from their health care providers and sub-optimal resolution of their symptoms. This post will be dedicated to proper preparation for a DBS urine test.
Proper DBS Test Preparation
- Take all amino acids and cofactors as directed. If you missed or altered even ONE dose of amino acids (i.e., NeuroReplete, RepleteExtra, Mucuna 40%, Tyrosine and/or CysReplete) in the 7 days prior to testing DO NOT COLLECT A URINE SAMPLE. Only collect a urine sample after taking your amino acids as directed (i.e, no changes and no missed doses) for at least 7 days.
- Consistency is very important, especially as you begin amino acid therapy – i.e., if you take the morning dose at 9:00 a.m. you should plan to take it every morning within an hour or so of 9:00. This goes for each dose of the day. This is extremely important in the 3-4 days leading up to sample collection. If your dosing schedule varies significantly in the 3-4 days prior to sample collection, DO NOT COLLECT THE SAMPLE. Wait until your dosing schedule is consistent with your recommendations before urine collection to receive accurate results.
- If you have had a major stressor the day you are supposed to collect your urine sample (such as a car accident, unexpected death of family/friend, unexpected crisis, etc.) DO NOT COLLECT A SAMPLE and wait 2 days before urine collection (while continuing to take the amino acids as directed). Abnormal stress can lead to abnormally high levels of neurotransmitter in the urine which provides inaccurate results.
- Females: Do not collect a urine sample during menses; wait until blood flow ceases before collection.
Collection Instructions
- Collect the urine sample after you have been on the amino acids (without missing a dose or changing any of the amino acids) as directed for at least 7 days (i.e., collect the urine sample on the 8th day).
- Empty your bladder 1-2 hours before collecting your urine sample, then drink 16 oz. of water.
- COLLECTION TIME IS CRITICAL: Collect the sample approximately 5-6 hours before your bed time. Normally, this should be around 4-5 PM. NOTE: If your normal bedtime is after 11 PM, write your bedtime on the ‘Additional Notes” section at the bottom of the test requisition form as follows: “I collected my urine sample at (time of collection) PM; my bedtime is (bedtime)”.
- There MUST be at least 4 hours between your previous supplement dose and urine collection to achieve accurate results.
- Collect the urine sample BEFORE your 4-6 PM dose (late-afternoon/early-evening dose) of amino acids.
- Sample collection:
- Begin to void and collect a mid-stream sample of urine in the cup provided.
- Transfer urine sample into small sample tube with pipette provided within 1-2 minutes of urine collection.
- Place cap on sample tube.
- Fill out name/date/time label and apply directly to the sample tube. (Unlabeled samples will not be processed.)
- Invert the sample tube several times and store the sample at room temperature; do not store sample in temperatures higher than 120 degrees Fahrenheit.
- Return the sample on the day of collection; if this is not possible, refrigerate the sample and send the next day in the FedEx box/bag provided. There is a preservative in the urine collection tube.
After completing the urine collection, continue taking your amino acids as directed for the rest of the day. This is extremely important for those that will be conducting a pill stop after completing the DBS test in order to get accurate results.
Testing is Critical to Neurotransmitter and Symptom Optimization
Take your time and review this instructions; if you have questions, contact your health care provider. Getting accurate data from these tests is crucial to your health care provider’s ability to accurately and efficiently provide you recommendations to optimize your neurotransmitter function.
Has anyone else with pre-existing hypertension have blood pressure spikes as a problem taking this protocol? I am on this protocol and I get fairly high B/P readings at times(180/100 but sometimes 150/95) after taking Macuna/Tyrosine doses. I take 24.6 grams of Macuna, 30 grams of Tyrosine per day divided in 4 doses at 8am, noon, 4pm, and 8pm (6.15 gr Macuna, 7.5 grams Tyrosine each dose). CysReplete 6 pills a day (2 pills at 10am,2 pills at 4pm, 2 pills at 10pm). Neuroreplete 8 pills a day (4 at 8am,4 at noon. RepleteExtra 11 pills a day (5 pills at 4 pm, 6 at 7pm). 300 mg B-6 as Pyridoxine HCI per day (at 8am, 2pm, 8 pm). These spikes can occur about 1 hour after taking either the 8am,noon,4pm,and 8pm dose then resolve (go back to 120 or 130 over 80) about 30 minutes later but don’t happen all the time, but quite often. I take one Atenol HCTZ 50mg-25mg and one Fosinopril 20 mg per day divided in half with half taken at 7 am and half at 4pm. Also my blood pressure meter records irregular beats. EKG results say it is not needing treatment. Your thoughts? I am 69 yrs old.
Hi Ernie,
Thanks for the comment/question. This does happen and can ususally be traced back to one of three things: (a) imbalances between dopamine and serotonin, (b) interaction with certain medications, including MAOiS and/or (c) interaction with tyramine-rich foods. You should speak with your provider about these. We always have people taking higher amounts of L-dopa and/or tyrosine severely limit tyramine-rich foods, including: Chocolate, yeast-containing breads (especially sourdough), aged cheeses, smoked/aged/fermented meats, hot dogs, processed lunch meats, fermented soy products/soy sauce, overripe or dried fruits, fermented vegetables, draft beer, wine, bananas, yeast, avocado, chicken/beef liver; click here for a complete list: https://healthyliving.azcentral.com/list-foods-high-in-tyramine-12273868.html.
Hope this helps!
Sincerely,
Dr. Chad
As a follow up question, if tyramine is to be avoided, isn’t it created by the body metabolizing the tyrosine given as part of the protocol?
Hi Ernie,
You are correct; tyramine can be produced from the metabolism of tyrosine. The issue is that tyramine can displace stored monamines (such as dopamine, norepinephrine and epinephrine) from pre-synaptic vesicles.
A large dietary intake of tyramine rich foods (or a dietary intake of tyramine while taking MAO inhibitors or high amounts of L-dopa/L-tyrosine) can cause what is referred to as the “tyramine pressor response”, which is defined as an increase in systolic blood pressure of 30 mmHg or more. This is thought to be due to the displacement of norepinephrine (noradrenaline) from the pre-synaptic neurons by acute tyramine ingestion, which causes vasoconstriction and increased heart rate and blood pressure.
While this response has been noted in less than 5% of the people we have seen using amino acid therapy, it is worthwhile to error on the side of caution when administering high doses of L-dopa (mucuna pruriens) and/or L-tyrosine and avoid tyramine rich foods until each individual’s response can be measured.
I’ll write a blog post specifically about this, as I’ve received a number of requests for more information on this subject; it should be out in January.
Hope this helps!
Sincerely,
Dr. Chad
Have you ever had to have patients stop the protocol (L-dopa/tyrosine as recommended by Dr. Hinz) due to a person having the tyramine pressor response? How would that be accomplished, just quitting protocol cold turkey or gradual withdrawal? The food examples given in your link for avoiding high tyramine foods while on this protocol seems to agree with most other sources. However, with other foods, there seems to be many disagreements from one registered dietitian source to another dietitians source if one can eat this or that, with one saying avoid and another saying the opposite thing. What is a person to believe?
Hi Ernie – we have been able to get any blood pressure imbalances under control with amino acid and dietary changes; I would suggest speaking with your provider to help you get them under control if this is what you are experiencing.
Sincerely,
Dr. Chad