THE ACTIVE INGREDIENT IN MMF

THESE MANAGEMENT PROTOCOLS came from clinical experience and statistical analysis of over two million patient days of de-identified data from over 1,100 medical practices.

DECARBOXYLASE INHIBITORS are known to be effective in the management of L-dopa-induced nausea.³¹ While decarboxylase inhibitors that bind irreversibly to vitamin B6 (B6) and B6-dependent enzymes are of no value in treating disease, they have a powerful ability to bind then deplete B6.³² The serotonin precursor 5-HTP, as found in R&R, through competitive inhibition at the aromatic amino acid decarboxylase (AADC) enzyme, is an effective reversible decarboxylase inhibitor of L-dopa metabolism at the AADC, can manage nausea, and does not deplete vitamin B6.³³

NAUSEA FROM L-DOPA, an active ingredient of mucuna pruriens, usually occurs when the daily dosing value is between 12.0 and 24.0 grams. Experience reveals about 50% of patients experience no nausea when starting the groups on the proper dose of R&R, one tablet per day. One episode of nausea is not significant, but two or more in one day is. Ignoring the warning sign of nausea (no matter how mild it appears), then increasing the daily dose of MMF may induce protracted vomiting. If protracted vomiting does occur, it typically takes the experienced caregiver six to eight weeks to get things back on track and under control. The caregiver will need to be actively involved as soon as possible. The first step in nausea management is to decrease the MMF by 2.4 grams per day and increase the R&R by one tablet per day. Have the patient journal (write down all pills taken with times). Increase the R&R by one tablet for three days. If there is some relief, continue that dose. If no observed relief, increase the R&R daily dosing by one additional tablet per day. Continue adding one tablet every three days until the evaluation of all six R&R dosing levels occurs (1-2-3-4-5-6). With no observed relief on all six daily dosing values, repeat the entire six pill dosing schedule a second time.

NAUSEA MANAGEMENT, Clinical experience reveals two primary etiologies for nausea which may accompany the active ingredient in Mucuna Pruriens, L-dopa. First is an imbalance between serotonin (a hyposerotonergic condition) and dopamine. The second is pre-existing GI pathology which was asymptomatic until dopamine concentrations increased.

Mucuna Pruriens active ingredient L-dopa associated nausea
1-2-3-4-5-6 (twice with journaling)
Gastroenterology referral
Gastroenterology second opinion

Serotonin-dopamine Imbalance drive L-dopa associated nausea.

IF THERE IS NO NAUSEA RELIEF WHEN REPEATED, refer the patient for gastroscopic examination. Over 90% of these patients have GI pathology that did not become symptomatic until the hypodopaminergic condition protocol increased systemic dopamine concentrations. No pathology dominates; it is all over the board. One patient who did not want to have a gastroscopic exam was diagnosed with stomach cancer. Healing of pathology must occur before further MMF optimization can occur.

IF THE GASTROSCOPIC EXAM IS NORMAL, get a second opinion. Unfortunately, many second opinions diagnose pathology not found on the first exam. Healing of pathology is required before further MMF optimization can occur.

WHEN NAUSEA FROM L-DOPA, the active ingredient in Mucuna Pruriens, occurs, decrease the MMF daily dosing to the lowest dose possible, a point where some mild nausea is still present. Some nausea needs to be present to determine the response of nausea to R&R daily dosing adjustments. Therefore, Mucuna dosing not lowered enough when nausea is present will cause the R&R daily dosing changes not to be effective.

THE HYPODOPAMINERGIC CONDITION PROTOCOL SIDE EFFECTS

A PARADOXICAL REACTION is an effect of a chemical substance that is opposite to what would usually be expected. Unlike paradoxical reactions associated with hyposerotonergic conditions, which occur the first week, hypodopaminergic conditions, paradoxical reactions generally occur in the 28.0 to the 38.0-gram range and are marked by symptoms worsening. Therefore, proper management is to increase the MMF daily dosing value by 2.4 grams. Then, if in one-week exacerbation of symptoms continues, increase the MMF a second time by 2.4 gram³⁴

HYPOSEROTONERGIC SIDE EFFECT EXACERBATION Literature notes the side effects of headache, anxiousness, insomnia, and palpitations associated with L-dopa, the active ingredient of mucuna pruriens. Clinical experience with this approach reveals when the daily L-dopa dosing is between 24 and 36 grams per day; these side effects may display. As with any new onset of symptoms, a differential diagnosis must be formulated, including hyposerotonergic condition-induced side effects. If a medical workup of other etiologies is indicated, an empirical trial may occur simultaneously where the R&R is increased by one tablet per day. If in one-week symptoms are still present, add a second R&R per day. When the patient claims they have palpitations, the patient needs a cardiac workup. If there is no tachycardia, chest pain, or shortness of breath associated with the palpitations, demonstrating cardiac findings on workup is rare.^35-41

LONG-TERM HYPOSEROTONERGIC SIDE EFFECTS
A few patients taking L-dopa, the active ingredient of mucuna pruriens on a long-term basis (3 to 7 years), may develop side effects. Literature specifically notes, “The most common side effects in older patients taking levodopa can be confusion, hallucinations, delusions, psychosis, and agitation.” These five things (confusion, hallucinations, delusions, psychosis, and agitation) are specifically listed, in the literature, as an L-dopa side effect, not a disease, still a differential diagnosis needs to be formulated. Proper management of these L-dopa exacerbated hyposerotonergic conditions increases the R&R to level-1 of the hyposerotonergic condition protocol (3 R&R AM and 4 PM). If symptoms are still present in one week, increase to level-2 (3 R&R AM and noon, with 2 R&R Sans at 4 PM). If symptoms are still present in one week, increase to level-3 (3 R&R AM and noon, with 4 R&R Sans at 4 PM). While this problem generally develops after several years, rare cases may occur in the first few months of care.³⁵

LAB TESTING Six weeks after starting the hypodopaminergic condition protocol, submit a specimen to DBS Labs requesting serotonin and dopamine analysis with consult. Testing looks for dopamine fluctuations. Improper management of dopamine fluctuations leads to an inability to stabilize the patient long-term secondary to waxing and waning symptoms. See the hyposerotonergic condition protocol brochure for discussion of renal physiology supporting this testing.

Mucuna Medical Food^TM
Active ingredient L-dopa
Contains no carbidopa.
For the management of hypodopaminergic
conditions when the modified normal diet does
not meet the system’s needs.
Due to the ability to L-dopa to deplete
serotonin and thiol concomitant adminitration
with R&R is recommend.