THE HYPODOPAMINERGIC CONDITION PROTOCOL15-29
AN EMPIRICAL medical foods trial must occur. Before starting medical foods, lab assay with normal results is not reliable when higher than normal serotonin or dopamine is required.
- Scale to weigh Mucuna Medical Food (MMFTM) powder (0.1-gram sensitivity) from CHK.
- Mucuna Medical FoodTM (MMF) from CHK.
- R&RTM from CHK
- Vitamin B6 from CHK
- CysRepleteTM from CHK
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. (Source NeuroResearch Centers databases.)
VITAMIN B6 and L-CYSTEINE are static (one size fits all) dosing ingredients found in R&R. Adequate daily dose is six R&R tablets each day (see R&R product information30). Since the optimal group starting point for managing L-dopa-induced nausea is one tablet of R&R per day, the short-fall in static dosing must be made up by administering additional vitamin B6 and L-cysteine.
THE FIRST WEEK ONLY, administer the MMF three times a day and change to four times a day at the second visit. AT LATER VISITS, if the patient has significan breakthrough symptoms upon rising in the morning, change the MMF dose to five times a day with one dose at 2 or 3 AM when the patient uses the toilet. Do not change MMF dosing to every 2 or 3 hours.
OPTIMAL RELIEF of hypodopaminergic condition symptoms may occur at any MMF dosing level, including 1.8 grams per day (which is very rare). However, most patients require dosing in the 30-to-40-gram range for optimal results. Fifty grams or higher per day has no benefits.
THE FIRST VISIT, inform patients, “If problems occur, stop the nutrients until you consult with me.”
- MMF 0.6 grams three times a day (1.8 grams per day)
- R&R, one pill in the AM
- Vitamin B6, 100 mg twice a day
- CysReplete five capsules per day. Administering less than six R&R per day requires additional L-cysteine.
THE DAILY DOSING OF CYSREPLETE
R + C = 6
Number of R&R pills (R) plus number of CysReplete capsules (C) equals six.
AT THE FIRST 3 VISITS, increase MMF by 1.8 grams per day. It allows the patient to acclimate. Above 7.2 grams per day increase by 2.4 grams per day. Increasing MMF greater than 2.4 grams per week increases the incidence of protracted vomiting, which can take 8 weeks to control.
ONE THING AT A TIME, If side effects (see pages 3 and 4) develop, do not increase the MMF daily dose until the side effect is controlled.
|Mucuna Medical Food|
SECOND VISIT, one week after the initial visit, if no problems, increase the daily MMF dose from 1.8 grams to 3.6 grams per day. Leave all other nutrient dosings in place. If patients understand the need to contact the clinic if side effects (mild nausea) or other problems arise, they may go for two weeks between visits. The patient may increase to 5.4 grams in one week and return to the clinic in two weeks (see orange numbers on the center dosing strip for suggested dosing changes between two-week visits).
IT IS COMMON for patients to get hypodopaminergic condition symptom relief from MMF in the 12.0 to 19.2 grams per day dosing range. Usually, this is partial symptom relief, not optimal symptom relief, but the patient who feels better may believe it is all that needs to be done.
LEAVE ALL DRUGS in place on starting the medical foods. Continue drugs until the caregiver determines otherwise.
HINZ MEDICAL FOODS are intended for the dietary management where a special medically determined nutrient requirements exist the dietary management of which cannot be achieved by the modification of the normal diet alone. These medical foods provide nutritional support specifically modified for the management of the unique nutrient needs that result from the specific disease or condition.29 This product is not intended to diagnose, treat, cure, or prevent any disease.
Many patients obtain a 16-ounce thermos, then place the Mucuna in it with juice, tea, water, whatever they like, and drink 4 ounces four times a day. TSA at airports will allow these thermoses when declared.
Bibliography found at: https://hinzmedicalfoods.com/dopamine
MANAGING NAUSEA CAUSED BY L-DOPA
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 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.
Nausea in the 1.8 to 9.6 gram per day range commonly occurs from drugs, hormones, or other nutrients, very rarely from L-dopa, an active ingredient of MMF.
The 12.0 to 24.0-gram daily dosing range of mucuna pruriens is the most common for nausea from L-dopa, as found in mucuna pruriens.
Nausea in the 26.4 to 50.0 gram per day range occurs commonly from drugs, hormones, or other nutrients, very rarely from L-dopa, an active ingredient of MMF.
|Mucuna Medical Food|
THE HYPODOPAMINERGIC CONDITION PROTOCOL SIDE EFFECTS
The foundation of these side effect management protocols are
clinical experience and statistical analysis of over two million patient days of de-identified data from over 1,100 medical practices.
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 FoodTM
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.
Related topics covered else where:
- Pill Stops
- Nutritional deficiency accompanying Pakrinson’s Disease
- L-dopa induced glutathione (thiol) depletion
- L-dopa induced serotonin depletion Bibliography found at: https://hinzmedicalfoods.com/dopamine
- Too much or too little mucuna looks the same
- Hormone side effect accompanying medical foods