Assessing Risk for Autism: A Brand New Study and Test from GPL


Welcome back to the GPL blog.  I have an exciting announcement: We (GPL) recently conducted a study, and the results demonstrate that the gene ARHGEF6 may play a role in the development of autism.  In the individuals we genotyped, we found that males that had a mutation in this gene are predisposed to develop autism.  Because of this important finding, GPL is now testing for mutations to the ARHGEF6 gene.  Information about this test, the Autism Risk Assessment, including the downloadable brochure can be found here

If you’re a physician with a specialty in pediatric special needs (MD, DO, ND, PA, or NP only) and you’re interested in joining our referral list for ordering and interpreting this new test, please contact your assigned GPL sales representative, send an e-mail to, or call the lab at (913) 341-8949.


The Study:

This study was published in the journal, Hereditary Genetics and can be found online here

The Great Plains Laboratory organized the study utilizing volunteers as well as patient samples from the Autism Genetic Resource Exchange (AGRE), which is a program funded by Autism Speaks. In the study, the researchers genotyped 252 single nucleotide polymorphisms (SNPs) in 35 different genes that had previously been identified as autism risk candidate genes. This study was performed with 247 controls (106 male and 141 female) and 155 patients on the autistic spectrum (134 male and 21 female). They found the most significant marker for autism of the 252 SNPs tested was a genetic variation called rs2295868 in the ARHGEF6 gene on the X chromosome. The odds ratio for males with this SNP was 4.09 with a p value <0.0003, which means nearly 80% would likely develop autism at some point in their lives.  This is higher than any other single SNP previously evaluated for autism risk.  The odds ratio for females (1.02) for the same SNP was not statistically significant and did not indicate that this SNP increased the risk of autism for females.


Since the ARHGEF6 gene is on the X chromosome, this research helps to explain the excess ratio of autism in males, such that males are 4.5 times more affected with autism than females. Males receive an X chromosome only from their mothers while females receive an X chromosome from both their fathers and mothers. Thus, mothers will transmit the affected gene to their sons while both mother and father may transmit the affected gene to their daughters. However, 20% of males with the affected gene do not appear to develop autism, although they may be at risk for schizophrenia and inflammatory bowel disorders. The ARHGEF6 gene SNP was found in 30% of the males with autism spectrum disorders meaning that 70% of cases of autism spectrum disorder in males are due to other causes. A negative result for the ARHGEF6 gene SNP does not rule out a child developing autism from other genes or other non-genetic causes.


Below are some commonly asked questions about the ARHGEF6 gene, along with answers.  If you’re not able to find the answer to your specific question(s) here, please send an e-mail to and either I or one of our other experts will respond to you as soon as possible.


This test is offered exclusively from The Great Plains Laboratory, Inc.  Tests can be ordered through physicians (MD, DO, ND, PA, or NP only) or certified genetic counselors. 

GPL will be building a referral database of physicians who can order and interpret this test.  In the meantime, to find a pediatric special needs physician in your area, visit the Medical Academy of Pediatric Special Needs (MAPS) web site, to find member physicians by state.  Please note these physicians are not guaranteed to be able to order this test.  Physicians will also have their own fees for ordering and interpreting tests.  Please contact them to inquire about fees.

This test is not available in the state of New York. 


Please contact your assigned GPL sales representative, send an e-mail to, or call the lab at (913) 341-8949.


You may seek a genetic counselor through the National Society of Genetic Counselors at or through the American Board of Genetic Counseling at



ARHGEF6 is a gene located on the X chromosome position 26.3 that codes for an enzyme called Guanine Nucleotide Exchange Factor 6. Diseases or non-disease related traits that are transferred through the X-chromosome are termed “sex-linked”. This enzyme is present in the brain, immune system, and the intestine. In the brain, its highest concentration is in the hippocampus CA1 region, which is important for new memory formation. ARHGEF6 is also responsible for normal neuron growth patterns. ARHGEF6 helps to control neurological spine and neurite growth morphologies. Because of its role in neuronal growth, loss of ARHGEF6 activity results in a decrease in the density of cortical pyramidal neurons. These mismanaged growth morphologies can lead to deficits in autophagy (the breakdown and recycling of cellular components) in microglia and impaired synaptic pruning, which have been linked to behaviors similar to those of ASD.

The ARHGEF6 enzyme also plays a role in immunity. It is present in large amounts in the immune system, especially in T-cells. In the intestine it may play a different role. Studies have shown that ARHGEF6 interacts with strains of bacteria that play a role in inflammatory bowel disease.

ARHGEF6’s role in immunity may help explain the link between environmental exposures and the increasing rates of an autism spectrum disorder spectrum disorder. As we are exposed to more toxic chemicals more every day, males with this mutation may be more susceptible to inflammation caused by toxin exposure. Since 20% of males who tested positive for the gene do not have an autism spectrum disorder spectrum disorder spectrum disorder, knowledge about these “resistant” males undoubtedly will help to find out how to protect the 80% of males that are susceptible to the gene.


Males receive an X chromosome from their mothers who have 2 X chromosomes while females receive an X chromosome from both their fathers and their mothers. Thus, mothers will transmit the affected gene to their sons while both fathers and mothers transmit the affected gene to their daughters. 


This mutation is present in about 15% of the population and is present more than twice as often in females than in males because females have two X chromosomes compared to one in males. Our studies so far find no link to the ARHGEF6 mutation and an autism spectrum disorder in females. However our number of female patients was limited. Therefore, no conclusions from this study can be made about how this gene affects human health in females. As we accumulate more data on females we will include it on our website.


Studies have linked many different health issues with ARHGEF6 mutations. In the intestine, mutations in ARHGEF6 have been associated with several types of diseases. ARHGEF6 has been associated with inflammatory bowel disease, ulcerative colitis, and Crohn’s disease. Mutations in ARHGEF6 can cause major structural changes to the brain and have been linked to an autism spectrum disorder spectrum disorder, mental deficiencies, and schizophrenia.



  • Women who are thinking about getting pregnant or who are pregnant

  • Males or females with a history of an autism spectrum disorder in their family

  • Anyone concerned about having a child with an autism spectrum disorder 


If you or child is positive for the ARHGEF6 gene SNP, it is not a definitive diagnosis of an autism spectrum disorder. It simply means there is a greater risk of developing an autism spectrum disorder. There are many things that can be done to potentially counteract various symptoms and common health problems associated with an autism spectrum disorder. The Great Plains Laboratory, Inc. has specialized in these kinds of specialty diagnostics for more than 20 years, and we recommend treatment strategies that are evidence-based and have a high level of efficacy for many patients. We recommend you partner with a healthcare practitioner who thoroughly understands this biomedical approach to an autism spectrum disorder.  You may contact our laboratory to request a list of these kinds of practitioners in your area.

Genetic susceptibility to an autism spectrum disorder may determine who develops this complex disorder, but factors like nutrient deficiencies, food allergies, toxin exposure, and pathogenic intestinal microbial overgrowth strongly influence the severity of symptoms. Yeast (most commonly, Candida) bacteria (particularly Clostridia), and toxins (both metal and non-metal) all have the potential to act as pathogens. Comprehensive laboratory testing can identify the physiological imbalances that contribute to an autism spectrum disorder and point to an individualized treatment approach. Many of the tests are urine tests and can be run on the same urine sample. Treatments are designed to restore the body to balance and optimize function through nutritional support, diet, detoxification, and reduction of toxic environmental influences. For information and resources, go to



An excellent description of the laws in the USA regarding genetic discrimination is found on the website of the National Society of Genetic Counselors:

At the present time, we do not know what safeguards against discrimination based on genetic testing are available in other countries.


Forms that must be completed and submitted are:

  • Test Requisition Form (TRF)

  • Patient/Guardian Informed Consent


  • The sample is collected with a buccal swab which is very similar to a Q-tip®.

  • Rinse your mouth with cold water before you begin collecting your sample and then swallow to remove excess saliva.

  • Collect sample by rubbing the insides of the cheeks of the mouth on all three swabs.

  • Place the swab sleeves containing the dry swabs in the paper envelope included in the kit.

  • Label the envelope with your name and date of sample collection.

  • Ship the test kit back to the laboratory using the shipping mailer provided.

  • More detailed instructions can be found on our website and in the test kits.



Results will be available in about 4 weeks.


Results are kept confidential according to HIPAA requirements and will only be shared with the patient/guardian and designated healthcare practitioner or genetic counselor who authorized the test.  Results are sent via secure portal or secure e-mail. 


Results will only be shared with you as the patient/guardian and healthcare practitioner or genetic counselor who authorized the test. After 60 days, samples will be de-identified in our system and may be used for future research.


In the study by The Great Plains Laboratory, Inc., 80% of males with the ARHGEF6 gene mutation had an autism spectrum disorder while 20% of males with the ARHGEF6 gene mutation did not develop an autism spectrum disorder. Thus, a baby boy with this gene mutation will have four times the risk of developing an autism spectrum disorder compared to a baby boy who is negative for this gene mutation. Since the development of an autism spectrum disorder decreases markedly with age, boys who are positive for this gene mutation would be expected to have decreased risk of an autism spectrum disorder as they age; new development of an autism spectrum disorder is rare after 5 years of age. However, non-autistic men with the ARHGEF6 gene mutation may have a higher rate of depression, colitis, or other bowel disorder.

Males with this gene who produce children do not transfer this gene to their sons but will transfer the gene to all of their daughters. However, our data so far are insufficient to know whether the presence of one or two of the ARHGEF6 gene mutations in female children increases their risk of developing an autism spectrum disorder.



Males who are negative for this gene SNP will not develop an autism spectrum disorder or other illnesses associated with this gene SNP. However, they could develop an autism spectrum disorder or other illnesses due to other untested genetic factors or environmental factors. About 66% of patients with an autism spectrum disorder did not possess the mutant ARHGEF6 gene.


Currently, we have insufficient data to know if females with one or two of the ARHGEF6 gene mutations have an increased risk of developing an autism spectrum disorder or any other illness associated with the ARHGEF6 gene mutations.

Females who have two of the ARHGEF6 gene mutations who bear children have an increased risk of having a boy with an autism spectrum disorder. If a woman with two of the gene mutations (homozygous) is pregnant with a boy child, there is a 100% risk that the boy child will receive the ARHGEF6 gene mutation and an 80% risk that the child will develop an autism spectrum disorder.

Females who have one of the ARHGEF6 gene mutations who bear children have an increased risk of having a boy with an autism spectrum disorder. If pregnant with a boy child, women with one of the ARHGEF6 gene mutations (heterozygous) will have a 50% risk that the boy child will receive the ARHGEF6 gene mutation and a 40% risk that the child will develop an autism spectrum disorder. 

At this time, our data are insufficient to know if women with one or two of the ARHGEF6 gene mutation genes are also at increased risk of having girls with an autism spectrum disorder or other illnesses such as inflammatory bowel disease and depression.


Due to the highly technical and sensitive nature of this test, we ask that you connect with one of our genetic testing experts for any additional questions or concerns.  Please send an e-mail to and one of our experts will respond as soon as possible. 

For a list of references, please visit the Autism Risk Assessment page of our web site here.

If you have any questions about the study or the new Autism Risk Assessment, please contact me at

New Markers for the MycoTOX Profile


Welcome back to the GPL blog.  I have another exciting announcement and that is that we are adding four additional markers to our MycoTOX Profile, which screens for exposure to mycotoxins from mold.  Yet again, our laboratory scientists have shown why we are an industry leader in toxin exposure assessment.  These four new markers will now give us 11 markers on our revolutionary MycoTOX Profile.  These additional markers are also being added at no additional cost.

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Just by ordering the MycoTOX Profile you will get these four new markers in addition to the previous seven markers.  This test can be easily be added to the GPL-TOX (Toxic Non-Metal Chemical Profile) and the Organic Acids Test (OAT), all with just one first morning urine sample. 

Here are the new markers that we will be starting to report today. These four new markers will further help practitioners determine the underlying causes of their patients’ chronic health issues:

Gliotoxin (GTX) is produced by the mold genus AspergillusAspergillus spreads in the environment by releasing conidia which are capable of infiltrating the small alveolar airways of individuals.  In order to evade the body’s defenses Aspergillus releases Gliotoxin to inhibit the immune system.  One of the targets of Gliotoxin is PtdIns (3,4,5) P3.  This results in the downregulation of phagocytic immune defense, which can lead to the exacerbation of polymicrobial infections.  Gliotoxin impairs the activation of T-cells and induces apoptosis in monocytes and in monocyte-derived dendritic cells.  These impairments can lead to multiple neurological syndromes.

Mycophenolic Acid
Mycophenolic Acid (MPA) is produced by the Penicillium fungus.  MPA is an immunosuppressant which inhibits the proliferation of B and T lymphocytes.  MPA exposure can increase the risk of opportunistic infections such as Clostridia and Candida. MPA is associated with miscarriage and congenital malformations when the woman is exposed in pregnancy. 

Dihydrocitrinone is a metabolite of Citrinin (CTN), which is a mycotoxin that is produced by the mold species Aspergillus, Penicillium, and Monascus.  CTN exposure can lead to nephropathy, because of its ability to increase permeability of mitochondrial membranes in the kidneys.  The three most common exposure routes are through ingestion, inhalation, and skin contact.  CTN has been shown to be carcinogenic in rat studies.  Multiple studies have linked CTN exposure to a suppression of the immune response. 

Chaetoglobosin A
Chaetoglobosin A (CHA) is produced by the mold Chaetomium globosum (CG).   CG is commonly found in homes that have experienced water damage.   Up to 49% of water-damaged buildings have been found to have CG.  CHA is highly toxic, even at minimal doses.  CHA disrupts cellular division and movement.  Most exposure to CG is through the mycotoxins because the spores tend not to aerosolize.  Exposure to CHA has been linked to neuronal damage, peritonitis, and cutaneous lesions.

Species of Mold

These new markers are adding to our already revolutionary test. We will now be able to detect over 40 different strains of disease-causing mold.Here is a table that illustrates all of the different mold species that we can now detect:

Myco and Strain Chart.jpg

We are also instituting some new changes to our MycoTOX Profile test report.  We are moving all of the interpretations to the end of the report so that all of the results will fit on the first two pages.  In addition, we are changing the reportable range.  Since we launched this test we have analyzed thousands of samples.  By analyzing those results and comparing them to results from our Organic Acids Test, we now have a better understanding of what could be considered “normal values” for mycotoxins.  On our new report (seen below) you will see two numbers on the bar graph for each marker.  The number on the left is what we consider the maximum safe amount of mycotoxins a patient can have before symptoms may start to appear.  The number on the right is our 75% for our patients.  If your value is above this number then you have more mycotoxins than 75% of patients that have sent in samples.  These should be considered extremely elevated amounts and treatment is highly recommended. 

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Practitioner Training – GPL Academy Practitioner Workshops

I recommend to all practitioners that they attend our training workshops to help better understand how to evaluate the results from our tests, as well as to learn what treatments have been most effective.  Our GPL Academy workshops are great learning experiences.  At these events you can talk to our laboratory experts as well as discuss treatment plans with practitioners that we invite that are experts in their fields.  Please follow this link to find a workshop near you.

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ELISA Versus LC/MS for Mycotoxin Testing


Welcome back to the GPL Blog.  Since we released our new GPL-MycoTOX Profile, we’ve received many questions about what the differences are between the types of mycotoxin testing available, why we use the technology that we do (LC/MS), and why we believe that technology is superior.  I wanted to share our feedback about that with you, including support data in the form of some split sample reports. 

The Difference Between ELISA and LC/MS

MycoTOXLogoMoldy Room.png

ELISA testing is notorious for false positive readings.  ELISA principal is a lock and key activation.  If any molecule fits the lock then the result shows up positive.  One of the criticisms often heard about mold testing is the over-abundance of positive results. The literature backs up this observation with findings that show inferences that cause false positive results.  At Great Plains, we use LC/MS, not ELISA.  LC/MS separates out molecules by their chemical properties and measures their mass, so we get a definitive answer for every sample.  We also use internal standards in every sample to give a definitive quantitative reading. 

Why Creatinine Correction is Important

There are many factors that could influence the value for any urine test, including how recent the exposure was, how much the patient is detoxifying, and how much liquid the patient drank the night before giving the sample.  We are able to correct for the third of these reasons by measuring the amount of creatinine in the sample, which compensates for how diluted the sample may be.  A particular sample one of our practitioner clients asked us about was more concentrated than most (creatinine was 166 mg/dL).  If the value was 80 mg/dL, then the value would have been doubled.  This allows us to mitigate one factor that can cause mycotoxin test values to fluctuate.

We have received a couple dozen results from patients that run a test for mycotoxins from another lab, then have run our test.  We have seen the gamut of results such as their previous test coming back negative and ours is positive (see examples here  – Patient 1 with GPL and Patient 1 with RTL), both tests were positive (see example here -- Patient 2 with GPL and Patient 2 with RTL), and values where the patient was negative on both. 

The Clinical Significance of our Mycotoxin Test and Organic Acids Test

In our experience, no patients are “normal” when it comes to toxins, including mycotoxins.  We see mycotoxin in almost every patient, but we have set our reportable limits to only patients that we feel have abnormal amounts of mycotoxin in order to not alarm patients.  We have followed this up with a study of 50 patients with mycotoxins.  If you look at this file, we did a comparison of patients with mycotoxins to patients without mycotoxins.  We see numerous values elevated on our Organic Acids Test (OAT) in the mycotoxin positive individuals, demonstrating that our test can predict health problems for individuals.  We will soon have more information available about the connection with specific fungal markers on the Organic Acids Test 

Please let me know if you have any questions about our GPL-MycoTOX Profile and we look forward to our continued work with you. 

Matt Pratt-Hyatt, PhD
Associate Laboratory Director

The Connection Between Chronic Inflammation and Disease


Welcome back to the GPL blog.  Today I wanted to talk about the link between inflammation and chronic disease.  The mission of The Great Plains Laboratory is to help those suffering from chronic diseases, and recent studies have shown that most chronic diseases are tied to inflammation.  In this blog post I am going to give a brief synopsis of some of the most common diseases associated with chronic inflammation and what tests we offer that give insight into how to treat these patients.    

Inflammation is a response from the body to assist in the elimination of pathogens and to repair tissue damage from trauma.  Inflammation is a healthy, natural response to cellular stress caused by stimuli perceived as a threat.  It signals the body to bring extra nutrition to sites that are damaged through injury or illness.  Without inflammation proper healing could not occur. While acute inflammation is critical to our well-being, chronic, long term inflammation is damaging to cells and linked to many diseases. Chronic inflammation occurs when the immune system believes there is a threat even when there is no immediate reason for this perceived threat. It is still unclear what causes chronic inflammation but lifestyle factors, genetic factors, and internal stressors have all been implicated.

Recent studies have demonstrated that inflammation is an underlying contributor to most chronic diseases.  Some of the most common of these include cancer, rheumatoid arthritis, Crohn’s disease, depression, stroke, heart disease, and diabetes.   Since inflammation is involved with so many chronic diseases, detecting inflammation is an important aspect to managing patient symptoms. Better still, if the underlying causes of inflammation such as Candida, bacteria, mold, food sensitivities, and environmental toxins are determined, the disease process may be reversed.

Phospholipase A2


We developed the Phospholipase A2 (PLA2) Activity Test to determine if a specific type of inflammation is underlying the patient’s condition.  PLA2 is an enzyme that activates during bacterial infection, cellular trauma, and periods of oxidative stress.  PLA2 activates a cascade of secondary messengers that can lead to cycles of inflammation that can self-perpetuate.  PLA2 metabolizes membrane glycerophospholipids to free arachidonic acid (AA), which is a precursor for the inflammatory signaling molecules, prostaglandins and leukotrienes (Figure 1).  PLA2 is expressed in neuronal tissue and is involved in the degranulation process that releases neurotransmitters from neurons. Research efforts have focused on the role that derangement of normal PLA2 activity plays in the etiology of many chronic illnesses. The specific roles, interactions, and interdependencies of PLA2 have been a major area of interest as it relates to chronic inflammatory conditions, cardiovascular disease, and cancer.  

Measurement of PLA2 is emerging as an important tool for evaluating the chance of cardiovascular disease (CVD), including future stroke, myocardial infarction, heart failure, and other vascular events. Lp-PLA2 appears to be more specific than hsCRP for CVD risk and may also have a pivotal role as a mediator of cardiovascular pathology. In atherosclerosis, PLA2 not only activates macrophages and formation of foam cells, but it also hydrolyzes LDL and HDL, spawning increased numbers of pro-atherogenic small LDL particles, and impairing anti-atherogenic HDL. PLA2 activity may even precipitate bleeding from atherosclerotic plaques.


Because PLA2 is a relatively small enzyme (about 14 KD), it is able to be excreted in urine.  Our enzymatic assay determines how active PLA2 is in the body, which is mediated by phosphorylation of the enzyme.  We have assessed that an activity level of PLA2 activity/creatinine of over 1 results from elevated activity and could be harmful. 


The literature indicates that Cytidine 5-diphospho-choline (CDP-choline or citicoline) attenuates PLA2 through a number of mechanisms. Most notably it repairs membrane potential and reduces lipid peroxidation. These processes essentially prevent new PLA2 from forming by stopping the cycle of inflammation.   Individuals with methylation pathway SNPs may be more susceptible to deficiencies in CDP-choline because it is difficult for them to make phosphoethanolamine, a CDP-choline precursor. Some individuals may have further deficiencies in citicholine due to mutations in their PEMT gene which converts phosphoethanolamine into CDP-choline. Fortunately, this compound is available as a nutritional supplement from New Beginnings Nutritionals and has been used at doses ranging from 500-4000 mg per day in the treatment of patients with a variety of disorders including Parkinson's disease, memory disorders, vascular cognitive impairment, vascular dementia, senile dementia, schizophrenia, Alzheimer's disease (especially effective in those with the epsilon-4 apolipoprotein E genotype), head trauma, and ischemic stroke. A trial in patients with Alzheimer's disease indicated that CDP-choline (1,000 mg/day) is well tolerated and improves cognitive performance, cerebral blood perfusion, and the brain bioelectrical activity pattern. No side effects were noticed except for some mild gastrointestinal symptoms at higher doses. No abnormal blood chemistry or hematology values were found after the use of CDP-choline. Many patients and practitioners are unfamiliar with CDP-choline and may be tempted to use the more commonly prescribed phosphatidyl-choline. These two products cannot be used interchangeably. Phosphatidyl-choline is a glycerophospholipid that PLA2 can use to elicit its inflammatory effects. Individuals with elevations in PLA2 should refrain from supplements containing phosphatidyl-choline and use CDP-choline instead. 

The Organic Acids Test

The Organic Acids Test (OAT) is a comprehensive metabolic assessment of multiple systems in the body.  It is one of our best tools in determining the underlying causes of many chronic diseases.  The OAT test can be useful in the identification of intestinal yeast and bacteria, oxalates, abnormal neurotransmitters, mitochondrial markers, fatty acid oxidation, nutritional deficiencies, detoxification markers, and inborn errors of amino acid metabolism.   

Many of the markers on the OAT can help in the diagnosis of inflammation.  Some of these include markers for Candida and clostridia.  An overgrowth of these pathogenic microbes can lead to disruptions in the gut lining, which can cause inflammation and disrupt the absorption of nutrients.  Candida and clostridia can also produce many different chemical toxins that are absorbed through the intestines.  These toxins can produce confusion (brain fog), thyroid dysregulation, weight gain, acne, drowsiness, irritable bowel syndrome, and insomnia.  There are multiple markers for both Candida and Clostridia.  Some of the most common yeast markers are tartaric, arabinose, and carboxycitric.       


The OAT also has more metabolic markers for clostridia than any other organic acid test on the market.  The OAT is able to identify overgrowth from multiple different strains of clostridia.  This is accomplished by looking at four different markers which include 4-hydroxyphenylacetic, HPHPA, 4-Cresol, and 3-indoleacetic.   These toxins produced by bacteria can lead to inflammation as well as inhibition of neurotransmitter metabolizing enzymes.


One of the best markers for inflammation is the succinic acid marker.  Succinic acid is generated in mitochondria during the tricarboxylic acid cycle (TCA).  Succinic acid is also a signaling molecule which can change gene expression patterns by modulating epigenetic markers in the DNA.  Our data indicates that exposure to environmental toxins can cause inflammation, resulting in accumulation of succinic acid.


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 This may be caused by the inhibition of succinate dehydrogenase, an important enzyme that functions in both the Krebs cycle and complex II of the electron transport chain. In the Krebs cycle, it converts succinate to fumarate. In the electron transport chain, it works with CoQ10 to transfer electrons into the complex III phase of the chain.  Our laboratory compared patients with high values several common environmental toxins on the GPL-TOX test and determined what their average succinic acid values were.  We found that patients with high vinyl chloride, xylene, heavy metals such as lead and mercury, DMP, DEP, and 2,4 D correlated with patients having elevated succinate values (see graph).

One additional marker on the Organic Acids Test for inflammation is quinolinic acid.  Quinolinic acid is a neuroactive metabolite of the kynurenic pathway.  Quinolinic acid is produced from tryptophan through a multi-stage process.  Buildup of quinolinic acid increases stimulation to NMDA glutamate receptors and inhibits the reuptake of glutamate by astrocytes leading to neurotoxicity.  Studies have shown that chronic exposure to quinolinic acid can lead to structural changes such as dendritic beading, microtubular disruption, and a decrease in organelles in neurons.  Quinolinic acid can also increase oxidative stress by inducing NOS activity.  Quinolinic acid further adds to inflammation by causing an increase of expression in the inflammatory response elements TNF-α and interleukin-6. 

Tests for Environmental Toxins

One of the leading causes of inflammation is environmental toxicants, which has been increasing every year since the 1960s.   This increase in toxic burden observed in our patients is one reason why we have put a focus on providing testing for many different sources of environmental toxicants.  We currently offer the GPL-TOX (Toxic Non-Metal Chemical Profile), Glyphosate Test, and metals tests (hair, urine, blood), and we just launched the GPL-MycoTOX Profile, the most sensitive test for mold toxins in the world.  If you have any questions about any of these tests, you may review previous blogs about them here or visit the individual tests information pages on our web site.  


The IgG Food Allergy Test


Testing for food sensitivity has been extremely helpful to many of our patient populations.  The symptoms of food sensitivity can include (but aren’t limited to) austim, ADD, depression, arthritis, fatigue, skin rashes, and gastrointestinal issues.  Our IgG Food Allergy Test is an invaluable tool to determine what role food plays in inflammation in the body. Immunoglobulin G (IgG) is the major antibody found in serum, and our test measures IgG subclasses 1-4.  IgG has a much longer half-life than the transitional IgE antibody.  Whereas IgE can cause acute reactions to food, IgG can cause inflammation that can lead to more chronic health issues.  These IgG reactions can be more subtle and people can live with them for years without realizing what is causing their discomfort.  The degree of severity can differ because of genetics or from exposure to different environmental toxins, which can predispose people to immune responses. 

At The Great Plains Laboratory we offer two different ways to submit samples for IgG food testing – serum and dried blood spot (DBS).  We have validated both of these tests against each other and they provide the same result.  Our test currently looks at 93 different foods along with testing for Candida antibodies. 


At The Great Plains Laboratory, we are very focused on helping patients solve their chronic health problems.  Research shows that inflammation plays a role in most chronic issues.  This is the reason why we have developed so many tests to help pinpoint the root causes of inflammation and to help figure out the best method of treatment.  We hope that we can help as many people in the future live better and longer lives.



A Brand New Urine Test for Mycotoxin Exposure

Welcome back to the GPL blog.  I am very excited to announce our newest test, the GPL-MycoTOX Profile. Mycotoxins are some of the most prevalent toxins in the environment.  Mycotoxins are metabolites produced by fungi like mold, which can infest buildings, vehicles, and foodstuffs.   A majority of mycotoxin exposures are through food ingestion or airborne exposure.   In the EU, 20% of all grains harvested have been found to be contaminated with mycotoxins.

Fungi are able to grow on almost any surface, especially if the environment is warm and wet.  Inner wall materials of buildings, wall paper, fiber glass insulation, ceiling tiles, and gypsum support are all good surfaces for fungi to colonize.  These fungi then release mycotoxins into the environment causing symptoms of many different chronic diseases.  Diseases and symptoms linked to mycotoxin exposure include fever, pneumonia-like symptoms, heart disease, rheumatic disease, asthma, sinusitis, cancer, memory loss, vision loss, chronic fatigue, skin rashes, depression, ADHD, anxiety, and liver damage.  With our new GPL-MycoTox Profile we can identify mycotoxin exposures and make recommendations for detoxification treatments that have been effective. 

Our two primary goals for this test were to design a test that would be more sensitive and accurate than those currently on market as well as more affordable.   We were able to achieve both of these goals with our state of the art liquid chromatography mass spectrometry (LC-MS/MS) technology.  Using this technology, we have a very sensitive test, which is important because mycotoxins can cause serious health issues even in small quantities.  Other mycotoxin testing uses ELISA technology, which relies on antibodies.  Utilization of LC-MS/MS technology gives us a precise identification of all of our analytes, which prevents having false positive errors.  For many of our compounds we are able to detect amounts in the parts per trillion (ppt) which is about 100 fold better than any other test currently available. 

Species of Mold

We are currently measuring eight different mycotoxins in our test, from four types of mold (we are always doing R&D on our tests in the hopes of adding even more markers in the future).  This makes the GPL-MycoTOX Profile the most comprehensive test on the market and it’s the most cost-effective.  Here are the four types of mold we are evaluating:

Aspergillus:  Aspergillus is the most prevalent mold group in the environment.  It has caused billions of dollars in damage to crops and livestock.  The two most common Aspergillus mycotoxins are aflatoxin, ochratoxin, patulin, and fumigillin.  The main target of these toxins is the liver.   These toxins have been found in all major cereal crops including peanuts, corn, cotton, millet, rice, sorghum, sunflower seeds, wheat, and a variety of spices.  They are also found in eggs, milk, and meat from animals fed contaminated grains.  Diseases caused by Aspergillus are called aspergillosis.  The most common route of infection is through the respiratory system.  Aspergillus can cause severe asthma when the mold colonizes the lung, forming a granulomatous disease.

PenicilliumThere are over 200 species of the genus Penicillium that have been discovered.  Penicillium chrysogenum is the most common of these species.  It is often found in indoor environments and is responsible for many allergic reactions.  Penicillium is also a known contaminant in many different food items.  Many different types of citrus fruits can become contaminated with Penicillium, but it can also contaminate seeds and grains.  One reason that Penicillium is such a common infestation is because of its ability to thrive in low humidity.  In the home, Penicillium can be found in wallpaper, carpet, furniture, and fiberglass insulation.  The most common mycotoxin produced by Penicillium is ochratoxin.  Ochratoxin is nephrotoxic, which means that it damages the kidneys.  It is also carcinogenic.      

Stachybotrys:  Stachybotrys is a greenish-black mold.  This mold can grow on materials with high cellulose and low nitrogen content such as gypsum board, paper, fiberboard, and ceiling tiles.  Stachybotrys is known for its production of the highly toxic macrocyclic trichothecene mycotoxins.    Two of the more common mycotoxins produced by Stachybotrys are roridin E and verrucarin.   In addition to these mycotoxins, the fungus produces nine phenylspirodrimanes, as well as cyclosporine, which are potent immunosuppressors. These immunosuppressors, along with the mycotoxin trichothecenes may be responsible for the high toxicity of Stachybotrys

Fusarium:  Fusarium’s major mycotoxins are zearalenone (ZEN) and fumonisin.  Fusarium fungi grow best in temperate climate conditions.  They require lower temperatures for growth than Aspergillus. Fusarium grows worldwide on many different types of grains including corn and wheat.  Exposure to mycotoxins from Fusarium can lead to both acute and chronic effects.  These symptoms can include abdominal distress, malaise, diarrhea, emesis, and death.  ZEN possesses estrogenic effects and has been implicated in reproductive disorders. 


Markers in the GPL-MycoTOX Profile

The strains of mold we’re evaluating can produce several different mycotoxins.  We have developed a test that provides extensive coverage, allowing us to catch most mold exposures. 

Aflatoxin M1 (AFM1) is the main metabolite of aflatoxin B1, which is a mycotoxin produced by different species of the genus Aspergillus. Aflatoxins are some of the most carcinogenic substances in the environment.  Aflatoxin susceptibility is dependent on multiple different factors such as age, sex, and diet.  Aflatoxin can be found in beans, corn, rice, tree nuts, wheat, milk, eggs, and meat.   In cases of lung aspergilloma, aflatoxin has been found in human tissue specimens. Aflatoxin can cause liver damage, cancer, mental impairment, abdominal pain, hemorrhaging, coma, and death.  Aflatoxin has been shown to inhibit leucocyte proliferation. Clinical signs of aflatoxicosis are non-pruritic macular rash, headache, gastrointestinal dysfunction (often extreme), lower extremity edema, anemia, and jaundice. The toxicity of Aflatoxin is increased in the presence of Ochratoxin and Zearalenone.

Ochratoxin A (OTA) is a nephrotoxic, immunotoxic, and carcinogenic mycotoxin.  This chemical is produced by molds in the Aspergillus and Penicillium families.  Exposure is primarily through contaminated foods such as cereals, grape juices, dairy, spices, wine, dried vine fruit, and coffee.  Exposure to OTA can also come from inhalation exposure in water-damaged buildings.  OTA can lead to kidney disease and adverse neurological effects.  Studies have shown that OTA can cause significant oxidative damage to multiple brain regions and the kidneys.  Dopamine levels in the brain of mice have been shown to be decreased after exposure to OTA. 

Sterigmatocystin (STG) is a mycotoxin that is closely related to aflatoxin.  STG is produced from several types of mold such as Aspergillus, Penicillium, and Bipolaris.  It is considered to be carcinogenic, particularly in the cells of the GI tract and liver. STG has been found in the dust from damp carpets.  It is also a contaminant of many foods including grains, corn, bread, cheese, spices, coffee beans, soybeans, pistachio nuts, and animal feed. In cases of lung aspergilloma, STG has been found in human tissue specimens. The toxicity of STG affects the liver, kidneys, and immune system.  Tumors have been found in the lungs of rodents that were exposed to STG.  Oxidative stress becomes measurably elevated during STG exposure, which causes a depletion of antioxidants such as glutathione, particularly in the liver. 

Zearalenone (ZEA) is a mycotoxin that is produced by the mold species Fusarium, and has been shown to be hepatotoxic, haematotoxic, immunotoxic, and genotoxic.  ZEA is commonly found in several foods in the US, Europe, Asia, and Africa including wheat, barley, rice, and maize.  ZEA has estrogenic activity and exposure to ZEA can lead to reproductive changes.  ZEA’s estrogenic activity is higher than that of other non-steroidal isoflavones (compounds that have estrogen-like effects) such as soy and clover.  ZEA exposure can result in thymus atrophy and alter spleen lymphocyte production as well as impaired lymphocyte immune response, which leads to patients being susceptible to disease.

Roridin E is a macrocyclic trichothecene produced by the molds Fusarium, Myrothecium, and Stachybotrys (i.e. black mold).  Trichothecenes are frequently found in buildings with water damage but can also be found in contaminated grain.  This is a very toxic compound, which inhibits protein biosynthesis by preventing peptidyl transferase activity. Trichothecenes are considered extremely toxic and have been used as biological warfare agents. Even low levels of exposure to macrocyclic trichothecenes can cause severe neurological damage, immunosuppression, endocrine disruption, cardiovascular problems, and gastrointestinal distress.

Verrucarin A is a macrocyclic trichothecene mycotoxin produced from Stachybotrys, Fusarium, and Myrothecium.  Trichothecenes are frequently found in buildings with water damage but can also be found in contaminated grain.  This is a very toxic compound, which inhibits protein biosynthesis by preventing peptidyl transferase activity.  Trichothecenes are considered extremely toxic and have been used as biological warfare agents.  Even low levels of exposure to macrocyclic trichothecenes can cause severe neurological damage, immunosuppression, endocrine disruption, cardiovascular problems, and gastrointestinal distress.

Enniatin B1 is a fungal metabolite categorized as a cyclohexa-depsipeptides toxin produced by thefungus Fusarium. This strain of fungus is one of the most common cereal contaminants.  Grains in many different countries have recently been contaminated with high levels of Enniatin.  The toxic effects of Enniatin are caused by the inhibition of the acyl-CoA cholesterol acyltransferase, depolarization of mitochondria, and inhibition of osteoclastic bone resorption.  Enniatin has antibiotic properties and chronic exposure may lead to weight loss, fatigue, and liver disease.

Treatment for Mycotoxin Exposure

Treatment for mold exposure to should include fluid support to prevent dehydration.  The drug Oltipraz can increase glutathione conjugation of mold toxins while inhibiting the toxic effect of P450 oxidation, reducing liver toxicity and promoting safer elimination (PMID: 18286403, 10050868, 7585637).  A diet of carrots, parsnips, celery, and parsley may reduce the carcinogenic effects of mold (PMID 16762476). Bentonite clay and zeolite clay are reported to reduce the absorption of mold found in food (PMID: 16019795, 18286403). Supplementation with chlorophyllin, zinc, A, E, C, NAC, rosmarinic acid, and liposomal glutathione alone or in combination have been shown to mitigate the oxidative effects of mold toxins (PMID:22069658).

Details of the GPL-MycoTOX Profile

The GPL-MycoTOX Profile is a urine test.  The specimen requirement is the first morning urine and 10 ML of urine.  Since this is a urine test a patient can combine this test with many of our other urine tests such as the Organic Acids Test, GPL-TOX (Toxic Non-Metal Chemical Profile), Glyphosate Test, and the PLA2 Test.  We are very excited to have what we believe to be the best and most cost-effective test for mycotoxins available, which will be very helpful in the treatment of many chronic diseases.  To learn more about this test please visit the GPL-MycoTOX Profile test page on our web site, watch the recently recorded webinar about the test, or attend one of our upcoming GPL University Practitioner Workshops.  

New Marker Additions to GPL-SNP1000 DNA Sequencing Profile


The number one goal for The Great Plains Laboratory is to provide the best quality results to our clients.  Our GPL-SNP1000 DNA Sequencing Profile has proven to be a great tool in helping provide personalized healthcare to our clients.  The nine pathways we analyze include: methylation, mental health, oxalate metabolism, drug and environmental metabolism/detoxification, gluten sensitivity, cholesterol metabolism, autism risk genes, and transporter gene.  These are crucial biological pathways, which are at the root of many chronic health conditions.  We are now announcing the addition of nine new markers to our already incredibly comprehensive genetic test:

Dopamine Beta Hydroxylase (DBH)
This is an enzyme that catalyzes the oxidation hydroxylation of dopamine to norepinephrine.  DBH can be inhibited by phenolic compounds including those produced by Clostridium species as well as certain organophosphate herbicides and pesticides.  There are two SNPs that can cause decreased activity of DBH.  These are rs2007153 and rs2283123.  These polymorphisms can lead to an increase in dopamine levels and a deficiency in norepinephrine.  Mental health disorders can result because of the imbalance of dopamine and norepinephrine.  Common symptoms can include depression and anxiety.

Paroxonase 1 (PON1)
This is an important enzyme in the metabolism and elimination of many organophosphorus insecticides (PMID: 13032041) and is located mainly in the liver.  PON1 is important in the reduction of atherosclerosis because of its involvement in the protection of high and low density lipoproteins from oxidation.  Individuals with polymorphisms to PON1 are more susceptible to heart disease (PMID: 8675673).  There are two known polymorphisms that can decrease the activity of PON1 and make the individual more susceptible to pesticide exposure, which are Q192R (rs662) and L55M (rs854560).

Hemochromatosis Protein (HFE)
The hemochromatosis gene HFE (high iron) codes for the HFE protein.   This protein is important for regulating the uptake of circulating iron.  This is done by regulating the interaction between transferrin receptor with transferrin.  SNPs to this gene can cause hemochromatosis, a disorder in which the body loads excess iron, which is autosomal recessive.  This means the patient normally needs two bad copies of the gene in order to exhibit symptoms.  There are three SNPs that can lead to hemochromatosis, rs1800562, rs1800730, and rs1799945.  Patients that are homozygous positive for this SNP should have their iron level measured. 

Vitamin K Epoxide Reductase Complex Subunit 1(VKORC1)
This is an enzyme that is necessary for the reduction of vitamin K 2,3-epoxide to its active form, which is important for clotting.  This enzyme is the primary target for the drug warfarin (Coumadin).  The three SNPs that are associated with warfarin sensitivity are rs9923231 (VKORC1*2), rs9934438, and rs8050894.  These polymorphisms can be used in conjuncture with the genotype of Cyp2C9 in order to accurately dose warfarin.

Tryptophan Hydroxylase 2 (TPH2)
This enzyme catalyzes the first and rate-limiting step in the biosynthesis of serotonin. Mutations to this enzyme have been associated with numerous psychiatric diseases including depression, OCD, bipolar disorder, and suicidal behavior.

Major Histocompatibility Complex DQA1 and DQA8
Patients with SNPs to HLA DQA1 and DQA8 have a higher risk of celiac disease.   The HLA-DQA1 and DQA8 are human leukocyte antigen serotype (also called major histocompatibility complex II). The role of this peptide is to present proteins on the surface of cells for identification purposes. This particular serotype presents proteins belonging to a foreign invader on the cells the macrophages, B cells, and dendritic cells in order to activate the helper T cells of the immune system. Proper presentation is critical for immune system activation against pathogens and may possibly be a mediator of autoimmunity.

UDP Glucosyltransferase 1A1 and 1A8 (UGT1A1 and UGT1A8)
These enzymes are important members of the glucuronidation phase II detoxification pathway.  These enzymes catalyze the addition of a glycosyl group from a nucleotide sugar to a small hydrophobic molecule.  The addition of glycosyl groups results in these molecules becoming more water-soluble and easier to excrete. Some of the target molecules for these enzymes include bilirubin, drugs, hormones, and steroids.

How to Maximize the Benefits of Sauna for Detoxification

by Jessica Bonovich RN, BSN

We have been recommending sauna therapy for detoxification to many of our patients who have high levels of various chemicals found in their GPL-TOX, Glyphosate, or Metals test results.  The fundamental principle that governs detoxification is that heat liberates toxins from fats, which then gets flushed out by the sweat and carried off by the blood to the liver, kidney, and GI tract. Many people are familiar with the Hubbard Protocol for sauna detoxification, which has been shown to be effective for those with serious toxic load issues, and was even used with success on emergency workers who were exposed to chemicals at the World Trade Center 9/11 disaster site.  The Hubbard Protocol is quite intense and requires a great deal of time spent in the sauna on a regular basis.  The sauna detoxification protocol that follows is perhaps more reasonable for the average patient and is designed to maximize detoxification without causing undue stress to the patient.  Sauna should be started after other metabolic supports have been implemented (such as those indicated by the results of the Organic Acids Test (OAT) and GPL-SNP1000 genetic test.

The Case for Sauna Therapy

The use of sauna for liberating toxins from the adipose tissue has been fairly well established as being effective for the treatment of toxicity for many years. The studies that I have read were all published before infrared technology existed.  So, it is safe to say that sauna of any sort is likely to benefit patients with toxicity. Infrared technology claims that it is able to cause a more vigorous sweat at lower temperature, which may create a more comfortable experience for the user (less time needed and at a less high temperature).  Infrared technology also claims that it can penetrate deep within the tissue for effective elimination. While visceral fat (the fat surrounding the organs) is certainly capable of housing toxins, it is the adipose tissue found in the subcutaneous layer that is viewed as the primary culprit for toxin accumulation. To reach the subcutaneous tissue, you simply need heat. Heat can be generated internally. Consequently, exercise is an excellent way to generate heat and burn the fat housing the toxin to begin with. Many patients are too sick to consider this as an option but patients who can tolerate exercise should be encouraged to do so. Better yet, do both exercise and sauna therapy.

 Here is a very thorough article about sauna detoxification, including an interview with Dr. George Yu, who has worked for many years with Gulf War veterans and 9/11 site workers to help them detox with sauna.

Niacin Flushing

Heat helps to destabilize lipophilic compounds just enough so that they can become mobilized by the fluids that are simultaneously released during heat exposure. Some compounds can be liberated directly into the sweat while others will be transported by the blood stream into the liver for metabolization and/or conjugation. The vasodilatation that is induced by heat exposure provides an increased blood flow to these organs.  Nicotinic acid (niacin or niacinamide) can induce flushing in doses above 50 mg which will subsequently increase blood flow to the liver and kidney. It is often used as a part of detoxification protocol because of what is referred to as rebound lipolysis. High dose niacin is used therapeutically to inhibit free fatty acid release, decrease LDL, and increase HDL. This effect is soon compensated for and free fatty acids return to normal and in some cases above normal. The rebound effect varies from study to study but is generally considered mild. It is the release of free fatty acids that also causes the release of toxins in the body. Practitioners are hoping to achieve a greater degree of toxin release through this rebound effect that niacin can have about two hours after administration.

In addition to the rebound lipolysis and vasodilatation, niacin also inhibits oxidation in the vasculature which is an important factor with detoxification. It is worth exercising caution with niacin in patients with diabetes, history of gout, on blood thinners, and who have MTHFR/methylation gene mutations. The rebound effect is associated with insulin resistance in many studies. Patients who are already diabetic tend to have the greatest difficulty with this.  High dose niacin can also cause elevations in uric acid, increased prothrombin time, and decreased platelet counts. It can also cause stress to the methylation pathway because this compound requires methylation to be eliminated. In fact, there are documented cases of hyperhomocysteinemia occurring in patients taking 1000 mg of niacin per day, which is the standard dose for a flush. I typically only recommend niacin as part of the detoxification protocol in patients who have demonstrated their ability to tolerate it or who have minimal risk for methylation pathway disruption.

Further Supporting the Detoxification Process

Heat allows toxins to become reintroduced into circulation and there is an increased potential for oxidative damage. For this reason, I recommend that patients take antioxidants before and after sauna therapy. Liposomal glutathione is an obvious choice because it is not only an antioxidant but an important substrate required for conjugation of many toxic compounds by the liver. I recommend a teaspoon before and a teaspoon after sauna treatment. This equates to approximately 400 mg twice a day. I also recommend taking plenty of vitamins E, A, C, D, and K.

The lipophilic, toxic compounds that find their way to the GI tract should ideally be flushed out through fecal elimination. To ensure the greatest possible chance for this to occur, patients should first and foremost be eliminating bowels every day. To prevent the reabsorbtion of these compounds, bile acid sequesterants and binders can be used and there is evidence to support their use. Bile acid sequesterants are just that - agents that sequester the bile, essentially making it unavailable to bind with other lipids. The prescriptive agent that is most commonly used is called cholestyramine. This agent has a very short half life (6 minutes) and is capable of binding up to 80% of bile in that short time. This short half life also means that taking cholestyramine before sauna will not interfere with the absorption of nutrients at meal time. This is an excellent choice for patients who can tolerate this prescription. Fiber is also capable of binding bile acid, but to a lesser extent. Both soluble and insoluble fibers like lignan, alfalfa, bran, and guar can bind between 10%-30% of bile acids. Cellulose does not effectively bind with bile, so it should not be considered as an option for this particular application. Binders are agents that prevent reabsorbtion by adhering to the toxin itself. Examples of binding agents are bentonite clay and activated charcoal. GI elimination is the only way for the extremely lipophilic, toxic compounds to be eliminated. When doing sauna therapy, any toxic compound in tissue has the potential to be eliminated, so taking these measures to ensure proper elimination via stool is important.

Electrolyte monitoring is an equally important consideration when detoxifying patients. To an extent, the minerals K, Na, Ca, and Mg will be lost during dieresis. Binders used to prevent the absorption of toxins will also prevent the reabsorbtion of certain minerals that are in the gut, so a good multi-vitamin/mineral supplement such as Spectrum Mate should be taken throughout the detoxification process.

Other Factors Impacting Results

The degree that a patient is likely to respond to sauna therapy depends on several things. The amount of toxin accumulated in tissue and the ability of the liver to safely mobilize toxins are two major factors. Toxic compounds that are not conjugated are either extremely hydrophilic or extremely lipophilic (to the extent that they cannot be measured in the urine). Some compounds are more toxic when they have been metabolized and others actually become more stable. The more time exposed to heat, the more toxins will be liberated, but the body can only do and handle so much of this at once. For this reason, I recommend that when patients are in crisis, they start sauna therapy very slowly and work their way up in time spent per session and how often they do sessions, as they become more tolerant.

What Types and Brands of Sauna Are Best?

As previously mentioned, infrared technology claims to have additional benefits over traditional sauna, but there doesn’t seem to be any research directly comparing the two types of saunas.  If infrared rays allow for profuse sweating at lower temperatures than a traditional sauna, then an infrared sauna might provide a more comfortable option (similar results at a lower temperature) for those sensitive to the heat.  If you’re looking for an infrared or other sauna, it is important to consider brands whose wood is not treated with toxic chemicals that will off-gas while in use or that emit large amounts of electromagnetic (EMF) radiation.  Some of the better options for booth-style, wooden saunas are Clearlight and Heavenly Heat.  There are also more portable infrared saunas available that have been shown to be effective and Relax Saunas is a good example.

 If you find purchasing a sauna to be cost-prohibitive, the portable versions are less expensive.  Another option is to find a spa or health club in your area that has a sauna you may use for a particular fee per session or as part of a membership package.  Many integrative healthcare practitioners who are invested in helping their patients detoxify also have saunas in their offices for use.


In summary, patients should be given metabolic supports and be eliminating bowels every day prior to initiating a sauna detoxification program. Heat therapy is effective at removing many toxic compounds from the body and sauna therapy is a passive form of heat therapy. Advise your patients to take antioxidants before and after the heat therapy (liposomal glutathione, if possible). Give binders and bile acid sequesterants prior to heat (sauna) therapy. Make sure that patients remove as much sweat as possible during and immediately after sauna sessions. Monitor your patients’ serum electrolytes. Finally, have patients start with sauna therapy slowly and progress toward longer and more frequent (even daily) sessions until complete elimination of the toxin is observed through testing.


Evidence for sauna treatment:

PMID: 20400489, 2143911, 220089658, 7144634, 20621793, 17234251, 23844383

Evidence in support of fiber and cholestyramine for binding bile acids.

PMID: 956912, 3008573, 30273, 24499150, 17438377

Evidence in support of binders:

PMID: 16019795, 18286403, 22069658, 15781206, 11439224, 17092826, 16095665, 16782537, 17561436, 11245394, 23710148

Bioaccumulation and elimination of toxins:

11572612, 11834080, 17296488, 16924830, 15513954

Niacin flushing:

21386057, 18375237, 18047854, 17996241, 10893322, 4883477, 17368274

Detoxifying Your Body - Water Filtration 101

Jessica Bonovich, RN, BSN

Hello, and welcome back to the GPL Blog.  Today we are talking about water filtration, which is a subject a lot of clients have asked about since we introduced our GPL-TOX test.  What we have seen through our studies, and those of other labs is that many of the toxins assessed by GPL-TOX have been found in many water supplies.  Any treatment plan needs to encompass a plan to prevent re-exposure. 

I recently reached out to over 12 water filter distributors and manufacturers to learn about the best filtration system for removing volatile organic compounds (VOC’s) from water and why. I was very transparent about the needs of our patients and the company I work for. I also reviewed information provided by The Environmental Working Group, who offers this Water Filter Buying Guide.  In addition, I contacted the Industrial Wastewater Management Center, the Department of Natural Resources, NSF Public Health and Safety Organization, and the Environmental Protection Agency.  Here is what I learned:

Carbon Block Filters

Carbon block is the commercially available standard for removing VOC’s. These very small compounds adhere to a surface of carbon (a process called adsorption) but will not be removed through reverse osmosis, ceramic, deionization, ozone, or ultraviolet light filtration. Factors that affect adsorption include the concentration of the compound, surface area, and the contact time between the water and the carbon. Of these factors, filters control the latter two.

The surface area of the carbon refers to the size of the pores in the carbon filter. This is where the “block” comes in. The filtration companies pack the carbons in very tightly which creates a very small pore size. The smaller the pore size the greater the chance of catching very small molecules like the VOC’s. The pore size of carbon block filters is generally measured in microns and ranges from 0.5 up to 1 micron.  This is sometimes also called submicron filtration. These tiny pores also remove lots of other small molecules like bacteria and particulate matter. Our main concern here is the removal of VOC’s because the carbon is the only filtration that will eliminate these compounds. Many other kinds of filters are available to remove the other materials. It’s a bonus but not a big selling point.

The contact time equates to how much water can contact the filter over a given period and directly affects the gallons per minute (gpm) of filtration. Companies intentionally build in methods to restrict the water flow to increase the amount of contact time the water has with the filter. The water restriction lowers the gpm which can slow the water flow. Consumers tend to want higher gpm for greater water pressure but this can affect the removal of contaminants.  The size of the filter also influences the removal. So, if you want high water flow (gpm) you need a larger filter that will handle the larger volume. This will cost you a bit more. If budget is your main concern, low gpm is the priority. Whole house filtration systems are not as effective at removing VOC’s because they are geared toward optimizing the water flow, in other words, fast filtration. The size of the filter needed to overcome the pressure drop on whole house filters is cost prohibitive for most people. Several companies do make carbon block filters for your shower head which is a nice option for reducing the VOC contaminants in your shower water. The under-the-sink and counter top units are often called point of use (POU) filters. The industry standard for good carbon block filters is between 0.5 and 1 gpm. The filter size that is needed to accommodate the larger gpm and still remove VOC’s can be deduced by looking at the performance data sheets that companies provide. This is what people should focus on to determine how robust the filter really is.

Filter Specifications

Understanding filter specifications can be a learning curve in itself. Companies will have third parties test the amount of contaminant coming in (called influent) and the amount going out (called effluent) through a company called NSF. The data sheets do not report the actual effluent, but instead report the “maximum permissible product water concentration” established by the EPA. This number will be the same on all data sheets. This testing is an important factor because we know that the concentration of the compound influences the ability of the filter to adsorb. NSF spikes water samples with a known amount of a compound and then measures the amount that is still in the specimen after filtration. These reports vary considerably and range from very well-organized to quite confusing. Some performance data sheets list these figures as a chart, while others use graphs. The only real difference is the percent reduction. This is the amount that was eliminated during the testing. I have asked multiple companies why they do not provide the actual effluent data and even contacted NSF about this. No one has been able to tell me why they don’t provide the raw data.

Filter Housing Options

Choosing the housing for your filter is the final step. Most of the companies use stainless steel, aluminum, or polypropylene plastic housing. Polypropylene is considered nontoxic by the Environmental Working Group. However, it can be oxidized when exposed to stress like heat and UV.  On top of this, many of our patients have developed severe chemical sensitivity. Once this acute phase has established itself, it can be difficult to predict what the patient will react to. I recommend the stainless steel option to remove any concern about plastic toxicity. Once your water has been filtered, do not store water in a container for more than 24 hours. Without chlorine, the water becomes a target for microbes to take up residency. 

Testing Your Water

Most filtration companies recommend that you have your water tested prior to getting a filtration system so you know exactly what you need. I have focused on single stage filtration designed to remove VOC contaminants. If you have heavy metals or bacterial contamination, you will need a multistage filter that will remove all the other contaminants. To find a laboratory in your area that can test your water, the EPA suggests that you start with your local municipality. I contacted the local water department here in Johnson County, KS to test this theory and they provided me the names of three local laboratories that can test water for contaminants.  Only one of these companies responded to my request and they offered to test for 29 VOC’s for $140.

An acceptable level of contamination has not been established for every chemical compound. The VOC’s that do have a limit are listed on pages 257-533 of this document.  According to the most current information available on the EPA website, municipal water suppliers must test the water for these VOC’s four times per year. If there are no contaminants reported for three years, the municipality can test just once per year. Municipalities can go a step further and apply for a waiver that exempts them from testing any VOC’s for up to six years. If a contamination is found, quarterly monitoring is required. If the municipality does not comply with this, there are no stated penalties or further requirements, which is a bit disconcerting. If you find that your water exceeds any of these standards, you should report this contamination to your state EPA office.  

Final Thoughts

The company (and person) that was the most helpful to me by far on this journey was Ron at All of their filter performance sheets are disclosed here. Individual requirements will vary based on price and available space. If you want my personal opinion for a good filter to remove VOC contaminants, this is a great place to start.


Hello. Welcome back to the GPL-Blog.  My name is Jessica Bonovich, RN, BSN.  I’m the nurse consultant here at The Great Plains Laboratory.  Today I’m going to be discussing oxalates, which are one of the many things that are tested for in the Organic Acids Test (OAT). Oxalates are of particular interest to patients who have pain and in non-verbal children with behavioral issues. Frequently, these individuals are experiencing pain as the result of oxalate crystals precipitating with minerals in tissue, including the formation of kidney stones. The Organic Acid Test is well suited to determine if this is likely occurring. When determining the best course of action we look at the proportion of the oxalate, the metabolite of oxalate, and the patient’s symptoms.

As the nurse consultant at the lab, it is my primary job to review test results with people. and as a result, I see a lot of Organic Acids Tests. Doctors and patients are often surprised to learn that Candida and Aspergillus species can produce oxalates. These species have certain enzymes that allow them to use glyoxalate as a means of making energy (it is an intermediate in their TCA cycle).  Individuals with elevations in Candida or Aspergillus frequently have a subsequent elevation in oxalate metabolites. The degree of elevation may or may not be proportional to the yeast/mold overgrowth and this is an important distinction when evaluating the significance of the markers.  If the elevation is proportional, I can easily point toward yeast as the culprit. If the oxalates are disproportional, it can be related to several other factors.

To some extent, all individuals will obtain oxalates from three sources: liver cells (endogenously), yeast species (exogenously), and food (also exogenous). The reference ranges on our test show the typical accumulation of oxalate metabolites from all three sources.

In humans and in yeast, glyoxalate is the parent compound that can be converted into the three metabolites measured on the Organic Acids Test (OAT): glyceric, glycolic, and oxalic acid (Figure 1).

Figure 1

Figure 1

It can also be converted into glycine which is not measured on the OAT. Individuals with primary, secondary, or tertiary hyperoxaluria have genetic deficiencies in the enzymes that drive these pathways and cause the distinguishing features of the disease. People who are predisposed to stone formation may or may not have deficiencies in these enzymes. The degree to which a person will favor each pathway depends on a number of metabolic factors (including available precursor and pH of the cell). Elevations in all three metabolites can occur because of yeast and endogenous production. Food and Aspergillus on the other hand, produce oxalate in the body directly. So, when these are the source of excess, only oxalate will be elevated on the test.

Patient symptoms are a key component to all of this. It almost goes without saying that we treat the patient and not the number. Low oxalate values do not rule out an oxalate issue and extremely elevated values are not always equated with pain (though the potential certainly exists).  

Let’s get back to the disproportional oxalate scenario. If a patient has mildly elevated yeast and moderately to highly elevated oxalate, what do you think would be the most likely cause?

a.      Endogenous production

b.      Yeast

c.       Food

d.      A combination of b. and c.

The correct answer is d. Food is a direct source of oxalate and the most common cause of disproportionately elevated oxalates. Yeast is contributing to the oxalates in this scenario but is not likely to be the only cause of the elevation. Patients like these should introduce calcium and magnesium supplementation with meals to help bind up excessive oxalates in the food (so they can be eliminated in stool). Many conventional doctors falsely believe that calcium supplementation should be avoided when oxalate stones are a problem. They forget that calcium levels are maintained at precise levels in the blood no matter what the intake is. This is because without calcium, the heart will not pump. So, several mechanisms are in place to ensure adequate levels are maintained at all times. Avoiding calcium is only likely to increase osteopenia and not at all likely to reduce stone formation.

Let’s walk through another scenario. An individual presents with extreme pain in the muscles and history of stone formation. The patient has very elevated Candida and eats a high oxalate diet. All of the oxalate metabolites on the OAT are normal. What is the most likely scenario?

a.      Oxalates are not a problem

b.      Endogenous production

c.       Food and yeast are not a problem

d.      None of the above

The correct answer is d. This is a scenario that I refer to as hidden oxalate toxicity. This patient should have elevated oxalate metabolites.  Based on their history and lab results, oxalates would be expected. It is likely that oxalates are present in the body. However, they are precipitating in tissues before they ever make it into the urine. These patients are usually the most extreme cases of pain. They are also the people who do very well once all of the sources of oxalate have been eliminated. It is important to remember that when patients are in pain, removing oxalates should be done SLOWLY. Otherwise the patients are likely to experience an increase in pain as a result of “oxalate dumping”. When oxalate crystals are already in the tissues, mobilizing them can cause irritation. I recommend that patient introduce therapies one at a time, thoughtfully, over several weeks to months.

Okay, last one. This is a patient with moderately high yeast metabolites, a diet rich in fruits and veggies, and severely elevated oxalate metabolites.  To give this some perspective, the reference range for oxalates is 100 mmol/mol. This patient has close to 1000. The patient has symptoms of yeast overgrowth and fatigue as the chief complaints. What is the most likely cause of the extremely elevated oxalates?

a.      Yeast

b.      Diet

c.       Endogenous production

d.      All of the above

If your answer was d, you are correct. This patient has disproportional oxalates beyond what would be expected in diet. The patient certainly has the potential to accumulate oxalates in the tissues. However, since she is eliminating it effectively, it is not causing her pain at this time. Measures should still be taken to decrease the oxalate burden. We have much more to learn about the tendency for a person to form oxalate crystals.  Several genes (AGXT, GRPHR, and HOGA1) have been implicated (all of which are identified on the GPL SNP1000 test). Even if these genes are not mutated, some individuals still have a tendency toward oxalate stone formation. The high glyoxalate production is only one factor. 

Remediation of high oxalates is a multi-step process. Elimination of yeast is always important and not only because of excessive production. Pathogenic yeast can also cause an imbalance in beneficial bacteria that help to degrade oxalates.  Many studies have demonstrated that oxalobacter can reduce oxalate stone formation (hence the name). As of right now, testing for oxalobacter is available primarily in research settings and supplements are not widely available to the public (though I expect that they will be soon). Fortunately, there are other beneficial bacteria species shown to reduce oxalic acid. Many of these are already available probiotic form. These include Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium breve, and Bifidobacterium lactis all of which are available in Lactoprime and Ther-biotic Complete probiotic formulas.

Awareness of oxalates in food and elimination of those foods highest in oxalate (like spinach, soy, almonds, sweet potatoes, and raspberries) is important. Keep in mind that a low oxalate diet should only be done with the help of a practitioner and only when there is a clear need. The foods that contain oxalate are healthy and provide many nutrients that our bodies need to maintain healthy homeostasis. People forget that the oxalate content alone is not the only factor in oxalate absorption. The oxalate to calcium/magnesium ratio should be taken into account when we consider the potential for oxalate accumulation. If a food has equal amounts of both calcium and oxalate, it is likely that neither one will be absorbed very well. Plenty of bile acid needs to be available to prevent fats from binding with calcium. Both taurine and glycine strengthen bile acid but glycine increases oxalate. Glycine is where our endogenous production of glyoxalate starts. Keep this in mind when you are choosing supplements.

Lastly, sufficient B6 is required to help with the conversion of glyoxalate to glycine in the body. Maintaining sufficient levels of vitamin B6 will help with the endogenous production. However, the active form (P5P) is poorly absorbed.  I recommend that patients in pain start with low doses of pyridoxine hydrochloride (10 mg) and work up to higher doses as tolerated. The upper limit is 100 mg per day. Patients without pain can usually safely start at 50 mg per day.   

Wow, so that was a lot. Oxalates are a topic of much interest in our patient population so I want to be as thorough as possible. If in doubt, call the lab and speak with a consultant. We have lots of experience looking at tests results and can provide insight into the patterns that are occurring on the results.


Finkielstein, V., Goldfarb, D., (2006). Strategies for preventing calcium oxalate stones. Canadian Medical Association Journal , 174 (100). Published online doi: 10.1503/cmaj.051517

Herb, Nutrient, and Drug Interactions. (1st edition). (2008). St. Louis, MO, Mosby, Elsevier

Liebman, M., Costa, G. (2000). Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. Journal of Urology, 163(5): 1565-1659.

Matkovic, V., Heaney, R.P., (1992). Calcium balance during human growth: evidence for threshold behavior. The American Society for Clinical Nutrition, 55(5): 992-996.

Pennistion, K., Nakada, S. (2009). Effect of Dietary Changes on Urinary Oxalate Excretion and Calcium Oxalate Supersaturation in Patients With Hyperoxaluric Stone Formation. Urology, 73(3):484-489.

Physicians Desk Reference for Nutritional Supplements. (2nd edition). (2008). Montvale, NJ: Thomson PDR

Rushton, HG., Spector, M. (1982). Effects of magnesium deficiency on intratublar calcium formation and crystalluria in hyperoxaluric rats. Journal of Urology, 127(3): 598-604.

Poore, R.E., Hurst, C.H., Assimos, D.G., Holmes, R.P. (1997). Pathways of hepatic oxalate synthesis and their regulation. Cell Physiology. 272(1), C289-C294

Shaw, W. (2009). Autism: Beyond the Basics. Self Published, USA.

Weaver, C. (1994). Age related calcium requirements due to changes in absorption and utilization. Journal of Nutrition, 124(8): 1418S-1425S.

Detoxification of Environmental Pollutants

Welcome back to the GPL-Blog.  This month we’ve been discussing how we are exposed to thousands of environmental chemicals on a daily basis, and how GPL can help you determine your toxic load.  We have now expanded our GPL-TOX Profile to measure a patient’s exposure to over 300 chemicals.  We are also the only CLIA-certified lab that performs a test for glyphosate.  Today I’m going to discuss how to prevent exposure to some of these compounds, what treatments have been effective for detoxification, and I’ll give an example of how these treatments can reduce the toxic stress on the body.

The first step to reducing the amount of toxins in your body is to reduce the amount entering your body in the first place.  One of the most important changes people can make is to switch to eating only organic foods.  Most conventional crops are exposed to larger and larger doses of pesticides and herbicides, and by switching to organic you will prevent exposure to hundreds of different organophosphates, 2-,4Dichlorophenoxyacetic acid (2-,4,D), and pyrethroid insecticides. 

The second step is to install some type of high-quality water filtration system in your home.  A lot of the chemicals that we test for have contaminated many public water supplies.   Your options are pitcher filters, faucet filters, reverse osmosis filters, and under-the-counter filters.  The most commonly used and the least expensive are the pitcher filters.  These are easy to use and do remove some chemicals.  Many of these pitcher filters do not remove pesticides, pharmaceutical residues, herbicides, and industrial toxicants.  They do remove mercury, copper, and cadmium.  However, in today’s environment we really need more than that.  Reverse osmosis filters are more expensive, but they do remove a large number of contaminants.  However, they produce a lot of wastewater (50% of all water that goes through the system) and they do not remove organic chemicals, herbicides, or pesticides.  There are several higher quality faucet filters available that do remove pesticides and drug residues.  Finally we have the under-the-counter filters.  These unfortunately are the most expensive, but they are also the best at removing the chemicals that are polluting our water supply.

The third step is to change the products you use on yourself.  Instead of using a plastic cup or water bottle, switch to glass or metal.  Make sure your shampoo, soaps, lotions, and other beauty products are free of phthalates and parabens.  Restrict the use of harsh chemicals for cleaning. Favor gentle cleaning agents such as vinegar, baking soda, citric acid, and antimicrobial oils (tee tree oil). Limit your exposure to cigarette smoke which contains xylene, benzene, and hundreds of other chemicals.  Avoid the use of pesticides and herbicides on the lawn. Make sure you wear shoes when playing in a park because many parks are sprayed with pesticides and herbicides.  Limit the amount of time you or your children spend on playing surfaces produced from ground up tires.  These are just several of the recommendation that could help limit your exposure.  Just be mindful when you are doing anything about what chemicals you could be exposing yourself to. 

Our fourth recommendation is infrared sauna therapy and exercise.  Studies have shown that many of these toxicants are best eliminated through sweat.  Now I suggest that anyone who starts a sauna regimen or exercise regimen do so under a medical practitioner’s care.  I also recommend infrared sauna over conventional sauna because it reaches deeper into the body.  Infrared sauna is useful because it increases the circulation in all of your blood vessels and causes your body to start to release many of the chemicals stored in body fat.  Some of the many chemicals released would be MTBE/ETBE, xylene, vinyl chloride, organophosphates and 2-,4-D.    

There are two particular supplements that people are using to improve detoxification.  The first is glutathione, or its precursor N-acetyl cysteine.  Glutathione is one of the main phase two conjugates that the body covalently bonds to toxicants in order to eliminate them. Certain factors could deplete your glutathione.  These include illness, stress, mutations, diet, or exposure to toxicants.  If you are constantly exposed to toxicants your stores of glutathione could be depleted.  You can check your glutathione levels with the Organic Acids Test that we provide here at GPL.  The second supplement is vitamin B3 (Niacin).  Now I know a lot of people don’t like the flushing experience after taking Niacin.  However, this flushing is from the blood vessels expanding, which is useful in the detoxification process.  At least 50 mg of nicotinic acid is required to induce flushing. Nicotinamide, while identical to nicotinic acid in vitamin activity varies in its pharmacological activity and is not associated with vasodilation. Vasodilatation greatly increases the chances of hypotension which is also be accelerated by the sauna. This type of therapy should only be done under close supervision by a physician. Certain medications are contraindicated while on this therapy (statins in particular can cause serious reactions). Niacin is excreted as methylated pyridones which requires adequate S-adenosylmethionine (SAM). Caution should be used in patients with impaired methylation. The depletion of SAM is thought to be responsible for most of niacin’s adverse affects. Niacin and nicotinamide may also make allergies worse by increasing histamine.

In our work with doctors who have ordered GPL-TOX and our Glyphosate Test, we have started to gather some results for patients that had high environmental toxicant levels.  Here is a result from one patient’s Glyphosate Test (see figure 1):

Figure 1

This patient reported eating an organic diet, but has a high amount of glyphosate.  This patient lives in the Midwest, where it seems glyphosate has contaminated some water supplies.  This patient installed a water filtration system, did several months of infrared sauna treatment, and was then re-tested (see figure 2):

Figure 2

As you can see from these results, this patient was able to decrease the amount of glyphosate in her body by more than half. 

Here are some results from a second patient’s GPL-TOX test.  This patient had high amounts of vinyl chloride and benzene (see figure 3):

Figure 3

This patient started an exercise and infrared sauna regimen.   One important note to remember is to wipe off the sweat regularly, because you don’t want the toxins to reabsorb back into the body.  This patient also started to take regular doses of glutathione.  After three months, we saw drastic results (see figure 4): 

Figure 4

Figure 4

As you can see, this patient went from very high amounts of vinyl chloride and benzene to non-detectable amounts.

The take away from this month’s blog articles is that testing for environmental toxicants is very important because these chemicals can lead to the formation of many chronic diseases. We are exposed to thousands of toxins every day.  The scientists here at GPL have developed tests to measure the most commonly occurring exposures.  With this information and the information obtained through the Organic Acids Test, we can better determine what the underlying cause of many chronic problems is and form plans to solve them.  I hope this was helpful.  Please share your questions, trials, and triumphs with us at

Integrative Medicine for Mental Health (IMMH)

Welcome back to the GPL Blog.  One of my roles at the Great Plains Laboratory is to inform the public that our tests exist, what they do, and what people can do with the information.  One part of this entails going to lots of conferences in our field, which allows me to experience what each has to offer.  I really enjoy the conference experience.  I always come away having met a lot of new and interesting people with lots of great questions and insight, and I always get new bits of information or ideas to implement here at GPL.     

This week I have decided to talk about my favorite conference that I go to every year which is run by Integrative Medicine for Mental Health (IMMH).  In the interest of full disclosure, GPL is affiliated with IMMH and we are very proud to be, as IMMH has built an ever growing and improving annual conference that focuses on multiple aspects of integrative medicine and how they apply to mental health and various neuropsychiatric disorders.   At last year’s conference there were talks on the roles of nutritional deficiencies, food allergies, toxic chemicals, infections, and inflammation in disorders like depression, multiple sclerosis, autism,  Lyme disease,  anxiety, eating disorders, and many more.  In my opinion, anyone that wants to practice integrative medicine would benefit from this conference.  The conference does a solid job of providing offerings that benefit those that are still learning the basics of integrative medicine and to those that have been using it for years, and based on what I’ve seen about this year’s conference so far, I think it will do that better than ever before.  Don’t just take my word for it though.  Here is a review of IMMH 2015 written by Dr. Ira Goodman, Examiner for the American Academy of Anti-Aging Medicine and practitioner of functional medicine: (Click here to read the article)

From my experience and the feedback I get from the attendees at IMMH, the best part of the conference is how all of the speakers use their personal experiences to illustrate how they use different types of testing and how they treat different types of cases.  I personally think that IMMH has some of the best speakers of any conference I attend the whole year.  I know that the IMMH staff goes out of their way to get feedback from the community about what speakers they find the most useful and interesting, and then recruit them to speak.  Having looked through the speaker list for the conference in Washington, DC this coming fall, I can attest that this might be the best group I’ve ever seen.  Since I’ve heard most of these speakers at multiple conferences, having them together in one conference is quite a treat.  For all IMMH 2016 conference details, go to

So, who are some of the speakers that I think you should be excited about?  Well, the first is James Greenblatt, MD.  Dr. Greenblatt is a prominent integrative psychiatrist who will be giving multiple lectures on tools of integrative medicine for mental health disorders.   I’ve seen Dr. Greenblatt speak several times and I’ve heard his webinars.  He is very insightful.  He has published several books about using integrative practices in psychiatry.  His talks at IMMH 2016 will focus on mood and anxiety disorders.  However, his lectures touch upon many tools that practitioners can use to help their patients.  

IMMH 2016 will also feature Kelly Brogan, MD. Dr. Brogan is a holistic women’s health psychiatrist.  She focuses on the root causes of many chronic psychiatric conditions.  She is a great person to follow on Twitter.  She has recently published a book titled A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies and Reclaim Their Lives.  She does an excellent job of explaining the biochemistry issues that can cause anxiety and depression. 

Another highlighted speaker for IMMH 2016 is Daniel Amen, MD - ten-time NY Times best-selling author and popular psychiatrist.  His SPECT brain imaging techniques have helped over 100,000 people.  This technology has allowed many patients to determine the underlying causes of their conditions.  I know of patients whose lives have literally been saved by his work.  The scan technology is useful for ADHD, behavior disorders, depression, anxiety, PTSD, traumatic brain injury, as well has many other diseases.  He is a great speaker who often leaves his audience in tears. 

Finally, IMMH 2016 will be having one of my favorite speakers I’ve ever heard, Terry Wahls, MD.  Dr. Wahls suffers from multiple sclerosis, but through her specific diet and treatment protocol that she created through her research, she has recovered from being wheelchair bound.  Her message is quite powerful.  Dr. Wahls is a professor at the University of Iowa and works in the VA Health System.  Her studies have implications for a number of chronic issues from MS and Parkinson’s to multiple other autoimmune diseases.  She uses many case studies in her talks.  One thing I really like about her presentations is that she has a great protocol, she tells compelling stories, and she has done thorough research that shows why her protocol works. 

Besides these four excellent speakers there are another fourteen expert speakers who will provide you with a variety of new tools to put into your integrative medicine tool box.  There are so many great conversations that occur during the breaks when you can network with fellow attendees, speakers, and exhibitors.  New for this year’s conference, Dr. Kurt Woeller, one of our GPL consultants who is a fixture at IMMH, will be giving a full-day seminar (optional track on day one) on how to integrate the Organic Acids Test into your practice.  Some of the best providers of testing, equipment, and nutraceuticals in the industry are also exhibiting at IMMH.  If you are available from September 29-October 2 and would like to visit the Washington, DC area, I think this is the conference for you.  I hope to see you there! 

Your Body’s Detoxification Pathways

Welcome back to the GPL-BLOG.  Over the past several weeks we’ve been discussing a lot of the environmental toxins that everyone is exposed to on a daily basis.  These toxins must be processed and detoxified.  Most of this is done in the liver through several different processes that include Cytochrome P450 (P450) biotransformation, glutathione conjugation, enzyme hydrolyzing, sulfation, and glucuronidation.

Detoxification is often referred to as a two stage process (phase 1 and phase 2) of metabolism (Figure 1).  Phase 1 metabolism involves the reduction or hydrolysis of the compound (usually caused by the addition of an oxygen molecule).  The addition of oxygen to a compound is referred to as oxidation.  This process is usually performed by the P450 enzymes.

Figure 1

The P450s are a family of enzymes that are found in numerous tissues throughout the body. However, a majority of these are found in the liver.  The P450s are important for the detoxification of many foreign substances, including environmental toxicants and medications.  The P450s are also important in controlling the levels of different molecules produced in the body such as the synthesis and breakdown of hormones, steroids, and multiple other molecules. 

In humans, 58 different P450s have been discovered.  However, only a subset of these is involved in the degradation of xenobiotics (chemicals that come from outside the body).  These enzymes have different substrates, which are determined by the activity pocket of each enzyme.   In regards to detoxification the most important P450s are Cyp1A2, Cyp2A6, Cyp2C9, Cyp2C19, Cyp2D6, Cyp2E1, and Cyp3A4.  Besides detoxification, these enzymes metabolize a majority of medications (figure 2).

Here are some important detoxification enzymes:

Figure 2

Cyp1A2 is important for the metabolism of polycyclic aromatic hydrocarbons (PAHs), which are found in cigarette smoke.  Other substrates include medications, aflatoxin B1, caffeine, and acetaminophen.  The major polymorphism is Cyp1A2*1K, which results in a decrease of activity.

Cyp2A6 is involved in the metabolism of nicotine.  Cyp2A6 is also involved in the metabolism of medications.  The major polymorphic alleles are Cyp2A6*4 and Cyp2A6*9 (which can have between 35% -70% activity depending on if you have one or two polymorphic copies). 

Cyp2C9 is involved with the metabolism of a large number of medications including NSAIDs, warfarin, and tamoxifen.  There are multiple polymorphisms that affect activity of the enzyme. 

Cyp2C19 is involved with the metabolism of multiple medications.  The most common are diazepam, omeprazole, and sertraline.  Cyp2c19 also metabolizes progesterone.   There are two major variants that result in loss of activity.  These are Cyp2C19*2 and Cyp2C19*3.

Cyp2D6 is involved with the metabolism of about 20% of drugs on the market.  It also metabolizes serotonin and neurosteroids.  There are five different polymorphisms that can lead to decreased activity.  Some of the classes of drugs that are metabolized by Cyp2D6 are antidepressants, SSRIs, opioids, and antipsychotics. 

Cyp2E1 is involved with the detoxification of many industrial pollutants, as well as carcinogens.  Cyp2e1 also metabolizes ethanol to acetaldehyde and acetate.  Cyp2e1 is also responsible for bioactivating a number of carcinogens, including cigarette smoke. 

Cyp3A4 is responsible for metabolizing more compounds than most other P450s.  It is responsible for metabolizing sex hormones, caffeine, statins, SSRIs, antifungals, antidepressants, and many other medications.  Some antibiotics can negatively affect its activity. Also, grapefruit and pomegranate juice have been shown to be potent inhibitors. 

Sulfur transferase is a phase 2 enzyme that adds sulfur groups to compounds in order to make them more water soluble and less reactive.  This process is used on a wide variety of toxic molecules including phenols, amines, acetaminophen, and food dyes.  Many chemicals that are able to become airborne are sulfated.  Patients with autism have been found to have impaired sulfation ability, which will make these individuals more sensitive to toxins.

Glutathione transferase is a phase 2 enzyme that catalyzes the conjugation of glutathione to substrates.  The addition of glutathione to toxins prevents these compounds from interacting with proteins in the body and allows them to be excreted via urine or bile.  There are a wide variety of compounds that are conjugated with glutathione.  A partial list includes pesticides, herbicides, carcinogens, acetaminophen, and mycotoxins.   

Glucuronosyltransferase (UGT) is another phase 2 enzyme that is responsible for the glucuronidation of many different toxic chemicals.  This process involves the addition of a glucuronosyl group to substrate molecules making them more polar and more easily excreted by the kidneys. 

Paraoxonase 1 (PON1) is an enzyme that is able to perform paraoxonase activity on substrates.  This enzyme is able to hydroylse and detoxify many different types of organophophate molecules.  PON1 is one of the major pathways that protects people from these types of compounds.  Mutations to PON1 could lead someone to be more sensitive to pesticides.  Infants do not have a lot of PON1 activity.  PON1 becomes active between birth and seven years of age. 

These are the major pathways that you should be aware of when you are thinking about detoxification.  Please see Table 1 to help you understand which pathway is mostly responsible for detoxifying these common toxicants.  Also see Figure 1 to help you understand what you can do to help support type 1 and type 2 detoxification pathways.  Detoxification of compounds by glutathione can be assisted by the supplementation of additional glutathione.  Next week I will discuss some additional methods to help with detoxification.  

Email if you have any questions about this blog post.

Toxic Crumb Rubber: The Dangers Below our Children’s Feet

Welcome back to the GPL Blog.  This month we’ve been talking about toxicity and how the Great Plains Laboratory can help you assess toxic burden.   This week I thought I would talk about a topic that has been getting quite a bit of publicity lately and that is the use of ground up rubber tires for playgrounds and sports fields.

In the last two decades, many playgrounds, soccer fields, and football fields have been replacing their natural surfaces with a synthetic surface of rubber granules made up of ground tires.  Despite the popularity of these types of surfaces many different activist groups have expressed concern that these synthetic materials may be a toxic burden on our children.

In 2006 a commentary was written in Environmental Health Perspectives detailing how little we knew about the material we are having our children play on (Anderson et al, 2006).  In the years since, there have been some insightful studies performed that give clues into how harmful prolonged exposure to these rubber play areas may be.  In 2007, a study from the nonprofit organization Environment and Human Health, Inc. and the Department of Analytical Chemistry at the Connecticut Agricultural Experimental Station produced one of the first reports about chemicals found leaching from artificial surfaces made from rubber tires.  This report indicated that benzothiazole, butylated hydroxyanisole, n-hexadecane, 4-(t-oxtyl) phenol, and zinc was found leaching from the tires.  These chemicals are known carcinogens and neurotoxicants (Brown et al., 2007).

A second report in 2008 in the Journal of Exposure Science and Environmental Epidemiology provided some additional data on the chemicals that could affect children.  The report indicated that the rubber granules have a much higher amount of polycyclic aromatic hydrocarbons (PAHs) than soil.  Zinc and chromium were also found to be much higher in the artificial surfaces than in soil.  The report also stated that although lead was not found to be much higher than in soil the bioaccessibility was much higher (Zhang et al, 2008).  PAHs are known neurotoxic chemicals which have been found in air pollution from fossil fuel combustion.  A recent study published in PLOS One from the University of Columbia discovered a link between PAH exposure and the development of attention deficit and hyperactivity problems (Perera et al., 2014).

So how can we determine if our children are being exposed to these chemicals?  The GPL-TOX profile has two markers that can be used to measure chemicals commonly leached from tires.  These two markers are N-acetyl (3,4-dihydroxybutyl) cysteine (whose parent is 1,3 butadiene) and Phenylglyoxylic acid (whose parent is styrene).   The presence of 1,3 butadieneand styrene in urine have been linked to rubber exposure.  I also recommend doing a hair metals test.  USA Today reported in 2015 that “lead levels high enough to potentially harm children have been found in artificial turf used in thousands of schools, playgrounds and day-care centers.”  By utilizing the GPL-TOX profile and the hair metals test you should be able to determine the amount of tire chemicals your child has absorbed.

In two weeks I will be talking about the detoxification pathways that the body uses to get rid of toxins, and the following week I will discuss which detoxification methods seem to be delivering the best results.  I have been working with several doctors to help develop methods.  I will provide some GPL-TOX results from patients’ pre and post detoxification. 


Email if you have any questions about this blog post.

New Analytes for GPL-TOX

Today is a very exciting day for me.  I really love when we unveil new tests or improved tests.  Today is the latter.  Our scientists have worked very hard to make our tests the best in the industry.  We want to make sure that they can be as useful to the community as possible.  We also strive to make them as affordable as possible.  That is why I’m excited to announce the addition of eight new analytes to the GPL-TOX test at no addition cost.  Just by ordering our GPL-TOX you will get these eight new analytes in addition to the previous analytes and it is still just the one first morning urine sample that is needed.

Here are our new analytes, listed with the parent first and the metabolite we are measuring in parentheses.

Acrylamide N-acetyl-S-(2-carbamoylethyl)-cysteine

Acrylamide can polymerize to form polyacrylamide.  These chemicals are used in many industrial processes such as plastics, food packaging, nail polish, cosmetics, dyes, and treatment of drinking water.    Food and cigarette smoke are also two major sources of exposure.  Acrylamide has been found in foods like potato chips and French fries.  This is because asparagine, an important amino acid for central nervous system function, can produce acrylamide when cooked at high temperature in the presence of sugars.  Foods rich in asparagine include asparagus, potatoes, legumes, nuts, seeds, beef, eggs, and fish, so use caution when cooking these foods at high temperatures.   High levels of acrylamide can elevate a patient’s risk of cancer.  In addition, acrylamide is known to cause neurological damage. 

Acrylonitrile (N-acetyl(2-cyanoethyl)cysteine)

Acrylonitrile is a colorless liquid with a pungent odor.  It is used in the production of acrylic fibers, resins, and rubber.  Use of any of these products could lead to exposure to acrylonitrile.  Smoking tobacco and cigarettes is another potential exposure.  Exposure to acrylonitrile can lead to headaches, nausea, dizziness, fatigue, and chest pains.  The European Union has classified acrylonitrile as a carcinogen.

Diphenyl phosphate

This is a metabolite of the organophosphate flame retardant triphenyl phosphate (TPHP), which is used in plastics, electronic equipment, nail polish, and resins.  TPHP can cause endocrine disruption.  Studies have also linked TPHP to reproductive and developmental problems. 


This chemical is used in the production of rocket fuel, missiles, fireworks, flares, explosives, fertilizers, and bleach.  Studies show that perchlorate is often found in water supplies.  Many food sources are also contaminated with perchlorate.  Perchlorate can disrupt the thyroid’s ability to produce hormones.  The EPA has also labeled perchlorate a likely human carcinogen.  Patients that are high in perchlorate can use a reverse osmosis water treatment system to eliminate the chemical from their water supply.

1,3 butadiene (N-acetyl (3,4-dihydroxybutyl) cysteine)

This is a chemical made from the processing of petroleum.  It is often a colorless gas with a mild gasoline-like odor.  Most of this chemical is used in the production of synthetic rubber.  1,3 butadiene is a known carcinogen and has been linked to increased risk of cardiovascular disease.  Individuals that come into contact with rubber, such as car tires, could absorb 1,3 butadiene through the skin.  The increased use of old tires in the production of crumb rubber playgrounds and athletic fields is quite troubling.  

Propylene oxide (N-acetyl(2,hydroxypropl) cysteine)

This chemical is used in the production of plastics and is used as a fumigant.   Propylene oxide is used to make polyester resins for textile and construction industries.  It is also used in the preparation of lubricants, surfactants, and oil demulsifiers,  as well as a food additive, an herbicide, a microbicide, an insecticide, a fungicide, and a miticide.  Propylene oxide is a probable human carcinogen. 

1-Bromopropane (N-acetyl (propyl) cysteine)

1-BP is an organic solvent used for metal cleaning, foam gluing, and dry cleaning.  Studies have shown that 1-BP is a neurotoxin as well as a reproductive toxin.  Research indicates that exposure to 1-BP can cause sensory and motor deficits.  Chronic exposure can lead to decreased cognitive function and impairment of the central nervous system.  Acute exposure can lead to headaches.

Ethylene oxide ( N-acetyl(2-hydroxyethl)cysteine)

Ethylene oxide is used in many different industries including agrochemicals, detergents, pharmaceuticals, and personal care products.  Ethylene oxide is also used as a sterilizing agent on rubber, plastics, and electronics. 

Chronic exposure to ethylene oxide has been determined to be mutagenic to humans.  Multiple agencies have reported it as a carcinogen.  Studies of people exposed to ethylene oxide show an increased incidence of breast cancer and leukemia.  Caution is needed with ethylene oxide because it is odorless at toxic levels. 

I think these new compounds are going to make the GPL-TOX profile that much more useful.  If you are concerned about your toxic burden, we believe that this test will give you the most comprehensive assessment of your exposure.  I really hope we’ve created a test that can be a useful tool in achieving better health for you and your patients.

More Sources of Information About the Dangers of Glyphosate

More Sources of Information About the Dangers of Glyphosate

GPL was at the Environmental Health Symposium, March 4-6 in San Diego, where we were able to showcase our GPL-TOX Profile and Glyphosate Test with everyone who attended.  The response was rather amazing.  Glyphosate is the primary chemical in RoundupTM and is the world's most widely used herbicide.  Prominent glyphosate researcher, Gilles-Eric Séralini spoke ath the conference on Sunday and did a segment with the local FOX affiliate in San Diego as well.  Click the video to watch

Glyphosate: Trying to Roundup where Your Toxicity is Coming From

Welcome back to the GPL Blog.  This month we’ve discussed the analytes that have been added to GPL-TOX since it launched last year, and we’ve discussed the nine new analytes that we’ve added just this month.   This week I want to discuss another test you can add onto GPL-TOX and that is our Glyphosate Test.  Glyphosate is the active ingredient in Roundup© (there is some controversy on this, but glyphosate tracks with all of the other ingredients).   Roundup© is the most widely used herbicide on the planet (1).   The most recent numbers indicate that over 180 million pounds of it were used in the US in 2007 (followed by Atrazine, one of our new analytes).   

The Great Plains Laboratory Glyphosate Test can be performed on the same urine sample from an Organic Acid Test (OAT) or GPL-TOX. To simplify this process and because we think these tests work well together, we have packaged them into our Enviro-TOX panel, which provides all three tests at a discount. 

So why is measuring glyphosate important?  First of all, there are data indicating that glyphosate is tied to a number of chronic medical conditions (I will expand of this point later).  Second, not everyone has high glyphosate.  Now, I’m not saying that not everyone is contaminated with glyphosate, because I have not seen one patient with an immeasurable amount, but this is t just evidence of how sensitive our test is.  The lower limit of quantification (LLOQ) for our test is 0.38 μg/g of creatinine, so we have a very sensitive test.  Here is an example of our report (Figure 1).

Figure 1

What you will notice from this report is the amount of glyphosate found normalized to creatinine, and then three values.  We have the LLOQ, the 75th percentile, and the 95th percentile.  These percentiles were produced from our own studies, but I have received confirmation from several other scientists that these values seem correct.  If your value is in the 75th percentile this means that 75 out of 100 people would have a value lower than yours.  I generally tell patients that they may want to start a detoxification regimen if their value is higher than 1.8 μg/g creatinine (the 75th percentile). 

Why is testing for glyphosate important?  A recent scientific paper listed Roundup© as one of the most toxic herbicides or insecticides tested (2).  Exposure to glyphosate has been linked to autism, Alzheimer’s, anxiety, cancer, depression, fatigue, gluten sensitivity, inflammation and Parkinson’s (3,4).  The causes for these disorders have been linked to glyphosate’s impact on gut bacteria, metal chelation, and P450 inactivation (5, 6).   

Glyphosate works by inhibiting the synthesis of tryptophan, phenylalanine, and tyrosine in plants. This pathway (called the shikimate pathway) is also how bacteria, algae, and fungi produce the same amino acids. This pathway is not present in humans. So, manufactures of glypohsate claim this compound is “non-toxic” to humans. Evidence is showing that there are human consequences to the wide spread use of this product. The first should be obvious. Humans need to obtain these amino acids from food sources. When food sources have scarce amounts of these amino acids, due to glyphosate use , humans are at risk for deficiency too. Humans also require bacteria to maintain a healthy immune system. Research indicates that glyphosate decreases the amount of good bacteria in the gut such as bifidobacteria and lactobacilli and allows for the overgrowth of harmful bacteria such as campylobacter and C. difficile (7).  Our lab actually has observed this in patients.  We had a female patient who was suffering from depression who did a Glyphosate Test and an OAT.  Here glyphosate results where 2.99 (figure 2), which was over the 95th percentile.

Figure 2

Upon analyzing her OAT we noticed two things.  The first was that her 4-cresol was extremely high (Figure 3).  As I mentioned above, glyphosate exposure decreases the good bacteria and allows C. difficile to invade.

Figure 3

C. difficile produces a toxin called 4-cresol, which we measure in the OAT.  Research has shown that 4-cresol inhibits dopamine beta-hydroxylase (8).  Dopamine beta-hydroxylase converts dopamine to norepinephrine.  In the OAT we measure both homovanillic acid (dopamine metabolite) and vanilymandelic acid (norepinephrine metabolite).  We have observed patients with a high 4-cresol value have elevated homovanillic acid, which indicates an inability to convert dopamine to norepinephrine. The results from our patient mentioned above were consistent with these results (Figure 4). The recommendations for this patient were to treat her glyphosate exposure and to treat her C. difficile infection.   

Figure 4

These results are indicative of why using the OAT and Glyphosate Test together is so valuable.  I hope this information was helpful and that our testing helps you find the best treatment for you or your patients.

Email if you have any questions about this blog post.


2. Mesnage R et al. (2014) Biomed Res Int.  2014:  179691
3. Samsel A and Seneff S. (2013).  Interdiscip Toxicol.  6:  159-184.
4. Samel A and Seneff S. (2015).  Surg Neurol Int.  6:  45. 
5. ShehataAA et al. (2013) Curr. Microbiol.  66:  350-358. 
6. Larsen K. et al. (2014) Int J Toxicol.  33:  307-318. 
7. Clair E. et al. (2012) Curr Microbiol.  64:  486-491. 
8. DeWolf WE jr. (1988)  Biochemistry.  27:  9093-9101.  

Toxic Chemicals and the Increasing Rates of Chronic Illnesses

Toxic Chemicals and the Increasing Rates of Chronic Illnesses

Every day, we are exposed to hundreds of toxic chemicals through products like pharmaceuticals, pesticides, packaged foods, household products, and environmental pollution. As we have become more accustomed to chemical-laden products, and as our environment has become more contaminated, we have been confronted with an accelerating rate of chronic illnesses like cancer, heart disease, chronic fatigue syndrome, chemical sensitivity, autism spectrum disorders, ADD/AD(H)D, autoimmune disorders, Parkinson's disease, and Alzheimer's disease. In this webinar, our lab director, Dr. William Shaw reviewed the common toxic chemicals tested by the GPL-TOX profile, how to prevent exposure to these toxins, and possible treatments.

GPL-TOX: Managing our Toxic Environment

Welcome back to the GPL blog.  I am really excited to be entering our second month of providing what we hope is useful information to the community.  Last month I discussed some of the uses of the GPL-SNP1000 test.  This month we will be discussing environmental toxicants.  Some of the topics covered will be the most prevalent toxicants in our environment, the best way to test for them, and relevant case studies. In the last blog this month I’ll cover some ways to detoxify the body and what tests can determine how well a patient is able to detoxify.

The Great Plains Laboratory introduced GPL-TOX (our toxic organic chemical profile) last July that measures 168 different toxic chemicals.  Our goal was to provide a test that measured as many chemicals as possible for a reasonable price.   These compounds fall into the categories of phthalates, benzene, pyrethrin insecticides, xylenes, styrene, fuel additives, 2,4-Dicholrophenoxyacetic (2,4-D), and organophosphate pesticides. Once a person has been exposed, the chemicals undergo several metabolic changes in the process of elimination and detoxification.  We measure the end products in the urine to determine how much chemical exposure has taken place.  Last October we introduced a test for the toxic compound glyphosate which is the world’s most widely produced herbicide. You have probably heard of it already, as it is the active ingredient in the broad-spectrum herbicide Roundup TM.  

Here at GPL, our scientists are continually working to improve our tests.  Later this month we are introducing eight new analytes to our GPL-TOX test for no additional cost. The new analytes are acrylamide, acrylonitrile, diphenyl phosphate (fire retardant metabolite), perchlorate, butadiene metabolite (carcinogenic component of rubber), dimethyl thiophosphate (pesticide metabolite),  propylene oxideacid and bromopropane.  Even before our recent update, GPL-TOX was one of the most comprehensive toxic chemical tests available.  Next week, I will discuss how all of these new analytes can affect a patient’s health.   This week I am going to provide more details about the analysis and review  a few of our current toxic analytes. I am also going to provide a few examples of case studies.   

To better understand the relevance of GPL-TOX, I’d like to explain the percentiles on our report.  The CDC issues a report of the exposure of many different chemicals to the US population.  Our percentiles are pulled from these reports.  If you are in the 95th percentile, then that means that only 5 percent of the population would have a higher value than yourself.  Since we do not know what the safe amounts are for many of these compounds we recommend reducing levels as much as possible. 

Every year over 1,000 million tons of organophosphates are used in the agricultural industry and in our home gardens.  This is a problem that is affecting us all, because even if we eat exclusively organic food, there is evidence that many of these organophosphates have contaminated the water supply.  The evidence of this has been centered on the increasing prevalence of depression, ADHD, pervasive developmental disorder, and birth defects, linking these toxins to these disorders. GPL-TOX looks at two metabolites related to organophosphates, Dimethylphosphate (DMP) and diethylphoshate (DEP).  Together these two metabolites allow us to track over 151 different organophosphates through urine, including nine of the ten most commonly used organophosphates. 

Another marker that makes GPL-TOX useful is monoethylphlate (MEP), which is a metabolite of phthalate exposure.  Many of us know about the pervasiveness of these compounds, which seem to be found in so many common products.  These products include lubricants, paints, perfumes, children’s toys, gels, and pesticides.  We are seeing many of our sickest patients possessing high values of phthalates.  Some of the symptoms we are seeing are fatigue, depression, ADHD, and arthritis.   

I want to share a couple of case studies to help illustrate what we are seeing.  The first is a painter with arthritis, fatigue, and depression.  The MEP on this patient’s GPL-TOX report came back at 19,110 (see Figure 1), which was ten-fold higher than our 95th percentile.  We recommended a detoxification program to this patient, which many of our patients are using with great success.  I will discuss different means of detoxification in my blog on May 30th, so check back for that.

Figure 1

Figure 1

Here is one more interesting case study.  We have all heard about fracking (the process of injecting liquid chemicals at high pressure far underground, in order extract natural gas or oil) and some of the resulting damage it does to the environment and our water supplies. The results below are from an extremely autistic patient with PANDAS who lives near fracking wells in the summer (see figures 2-4).  This sample was taken months after he was exposed.

Figure 2

Figure 2

Figure 3

Figure 3

Figure 4

Figure 4

These results are pretty alarming.  Obviously not everyone has high values like this, but even if we don’t live near fracking sites, we are exposed to toxic chemicals in our environment more and more every day.  If you do come up high for one or more of these chemicals, there is hope.  On May 30th I will discuss potential treatment options to detoxify the body and recommendations to avoid future exposures.  After treatment and avoidance, I recommend running the test again to make sure that you have sufficiently decreased the toxicants. 

Next week I will talk about the new analytes for the GPL-TOX test and why measuring these particular analytes is important.  In the meantime, stay vigilant about the many chemicals you and your family may be exposed to on a regular basis in every area of your home, from the food you eat and the water you drink, to all your household products.

Email if you have any questions about this blog post.

The Importance of Genetic Testing for Mental Health

Two weeks ago I talked about how we are starting to move into the age of personalized medicine.  Our goal at The Great Plains Laboratory is to determine what factors lead to chronic illnesses and what treatments may help.  Previously I discussed how the Organic Acids Test (OAT) and the GPL-SNP1000 DNA Sequencing Profile work well together to determine both the risk for and causes of many chronic illnesses and how useful these two tests are in helping practitioners develop individualized treatments.  Last week I specifically discussed the DNA methylation pathway, of the GPL-SNP1000.  This week I am going to go over the mental health pathway of the this same test.  I will talk about what genes are most important, some specific polymorphisms to be aware of, how the OAT can help diagnosis these disorders, and what treatments seem to work best. 

The two most important genes in this pathway are MAO-A (monoamine oxidase A) and COMT (catechol-o-methyltransferase) (Please see Figure 1). Both enzymes are required for metabolizing neurotransmitters critical to mental health. Mutations to either one can have serious consequences relating to how we think, feel, and interpret the world around us.

Figure 1

Monoamine oxidase A is important for the metabolism (breakdown) of biogenic amines such as the neurotransmitters dopamine, norepinephrine, and serotonin (figure 2).  Mutations to this gene have also been linked to depression, borderline personality disorder, and bipolar disorder. 


Figure 2


There are two different types of polymorphisms involved with MAO-A.  The first type, which is characterized by rs6323 , causes an increase in activity of the enzyme. Rapid metabolism resulting from this mutation causes depletion in the neurotransmitter. This depletion is directly related to the extent of the enzyme activity which can be determined on the Organic Acid test (OAT) by measuring the production of Homovanillic acid (HVA) and Vanillylmandelic acid (VMA) which are the end products of dopamine and epinephrine metabolism (see figure 1).  Patients who are rapid metabolizers will show an increase of HVA of VMA (Figure 3).  Such patients will have a depletion of these neurotransmitters which leads to multiple neurological diseases including depression. Treatment for these polymorphisms includes supporting the methylation pathway which helps to promote the cofactor required for neurotransmitter synthesis and providing neurotransmitter precursors such as tyrosine, B6 and 5-HTP.

Figure 3

A second type of polymorphism to MAO-A is one that decreases activity (rs72554632,  Gln296X), whichcauses a premature stop codon in the gene..  This polymorphismwill lead to a buildup of neurotransmitters, which can lead to the development of Brunner syndrome.  Brunner syndrome is characterized by a decrease of mental capabilities, increased impulsivity, mood swings, and sleep disorders. These individuals will have a decrease of HVA and VMA metabolites on the OAT. Without the benefit of genetic testing, these results could lead a practitioner to treat with neurotransmitter precursors. Increasing neurotransmitters for individuals with this type of mutation would actually exacerbate the condition. Treatments include decreasing the amine containing foods such as fish, cheese, and fruit, taking progesterone to increase MAO; taking inositol(which reduces 5HT2A serotonin receptor), taking riboflavin (increases MAO activity), or taking ginkgo, which has been shown to decrease aggressiveness in MAO-A deficient patients.

Catechol-O-methltransferase (COMT) is present in the body in two different forms.  The short form is called soluble catechol-O-methyltransferase (S-COMT).  The longer form is called membrane-bound catechol-O-methyltransferase (MB-COMT).   MB-COMT is mainly present in the nerves of the brain, while S-COMT is located in the liver, kidney, and blood.  In the brain, MB-COMT is responsible for degrading neurotransmitters called catecholamines, which include dopamine, epinephrine, and norepinephrine. Therefore the membrane bound form is believed to have a greater affect on mental health, though both forms may be implicated in disease since both are capable of metabolizing catecholamines.

GPL-SNP1000 analyzes six different SNPs for COMT.   Of these, the most extensively studied is a mutation to rs4680 (Val158Met). Despite the many studies available about this mutation, the scientific community is still at odds about the degree to which this mutation causes disease. What is known is that individuals with this mutation have lower activity of the enzyme.  Mutations to COMT will lead to dopamine and epinephrine not being broken down properly, which can be detected by a decrease in the HVA metabolite in the Organic Acids Test.

Figure 4

Interestingly, some individuals may benefit from increased dopamine while others may benefit from less. Dopamine functions differently depending on the area of the brain it is produced in and there are likely other mutation to this gene may also influence its function and expression. These interactions are still being investigated and are why GPL is looking beyond the most common mutation to help inform results.  Conditions associated with these mutations include OCD, depression, and schizophrenia.  Symptomatic patients may benefit from treatment aimed at promoting the enzyme function so that dopamine and epinephrine can be metabolized. This is a SAM dependant enzyme and methylation support can be helpful in patients with this mutation.

Apolipoprotein E (APOE) combines with lipids in the body to form lipoproteins.  Lipoproteins are responsible for packaging cholesterol and other lipids and carrying them through the bloodstream.  Like so many genes in the human body, this is not its only function. The ApoE protein is involved with more than was originally thought. In this case, it has a role in immune expression, cognitive function, and telomere regulation.  There are four different gene versions of APOE called e1 (the double mutant), e2 (rs7412), e3, and e4 (rs429358).  The most common version is e3, the most detrimental is e4

 Mutations to APOE can lead to an increased risk of developing Alzheimer’s disease. People who inherit even one copy of the APOE e4 allele have an increased risk of developing the disease. Certain mutations to this protein impair the ability of the body to phosphorylate NMDA (glutamate) receptors causing a reduction in activity (Glutamate receptors have been implicated in a number of neuropsychiatric disorders including depression, biopolar disorder, schizophrenia, and Autism (PMID: 12404584, 21315104). While this gene is being extensively studied for its role in Alzheimer’s disease, vulnerable patients may also be predisposed to other psychiatric disorders. (PMID: 25751510, 15557508). Patients with certain ApoE mutations may develop cognitive symptoms well before onset of Alzheimer’s disease (  Patients with these polymorphisms should look for early signs of the development of Alzheimer’s disease.  Treatment with estrogen has demonstrated some encouraging results.

The D-amino acid oxidase activator (DAOA) protein (also known as G72) is a 153 amino acid protein that localizes in the brain, spinal cord, and testis.  This protein is located in the endoplasmic reticulum and the mitochondria cellular compartments.   DAOA is a modulator of D-amino acid oxidase (DAO) activity.  If DAO is hyper activated it can result in a decrease in the D-serine level and hypo function of the NMDA receptor.  Overexpression of DAOA has been found in schizophrenics and those suffering from bipolar disorder.  Mutations to DAOA have been linked to a higher incidence of schizophrenia and bipolar disorder. 

It is important to remember that our genes influence our mental health and well being but do not necessarily determine the eventual outcome. There are countless factors that play an equal role in how we perceive the world including diet and lifestyle.   I believe that understanding the most common mutations and their function is very helpful in diagnosing, treating, and preventing different neurological disorders.  Using the GPL-SNP1000 test in combination with the OAT can further help determine the extent to which our genes are being expressed metabolically. The combination of these two tests can help bring about the best chance to achieve emotional health and physical well being.

Email if you have any questions about this blog post.