HELP High Alkiline Phosphate Level

[kim]

Hi all,

 

I received the results of my oldest sons Lab work yesterday afternoon. The office faxed it to me-no call from the Ped.

 

I was really interested in comparing it to my younger sons, which was back about a week ago. There are a couple of out of normal range similarities, but what I'm really concerned about right now is oldest had Alkiline Phosphate level of 364. Reference range is 42-121. I was wondering if anyone had run into this with their labs. From what I read last night, it could be scary, or just due to a growth spurt.

I did'nt really see anything that would directly link it to tic, allergies etc. It seems to be a liver enzyme, or something to do with bone growth. As I said, I did'nt talk to the Ped. and I think if he thought it was something important, he would have called before allowing the office to fax the results, but I think it is definatley something that I need to get to the bottom of.

 

Any input would be appreciated.

 

Kim

[Guest FJ*]

My son used to have an abnormally high alkaline phosphase value, but his physicians never thought it was important. I did some research and found that this high value cold be indicative of a genetic error in a certain enzyme or a B6 deficiency. As it turns out, my son was later diagnosed with pyroluria (for his story, http://brain.hastypastry.net/forums/showth...ighlight=FJ%2A) and the pyroluria treatment called for high doses of B6. Once he started receiving the high daily doses of B6, his alkaline phosphatase values returned to normal.

 

Before suspecting a genetic error, I would encourage you to rule out a chronic or intermittent B6 deficiency, possibly caused by pyroluria.

[kim]

FJ,

 

Thanks for your reply. I am very fimiliar with your sons story and what lengths you went to in finding help for him. It is an amazing story.

 

I'm just wondering if you would still recommend that I have the pyroluria test done, since my sons b6 level shows as 103, expected value is listed between 5-50. The notation says "the elevated pyridoxal phosphate with elevated pyridoxic acid may represent dietary supplementation."

 

He had taken 5 of Bonnies vitamins (25mgs of B6) the night before the test, and we used first morning urine. The test was done through MAYO labs.

 

I was really happy to read your post, as you have said the treatment for pyroluria is very effective. If you still think this is a possibility, I will order the test for both sons right away.

 

Kim

[Claire]

Hi Kim,

 

I am so glad FJ stopped in here--thanks FJ! In case she doesn't check back very often, here is what I found...

 

That sounds like the Great Plains OAT urine test result--we had the same thing. Now I know with pyroluria, excess B6 is excreted in the urine. What I don't know is if it comes out as recognizable B6, so I would love to hear FJ's response.

 

I do know that my son showed no B6 deficiency in that same type of test --nor a zinc deficiency on another test but he had pyroluria. (Later another test showed a zinc deficiency). Especially with your son's recent zinc reading, I think pyroluria is worth at least ruling out. Most people here who took the test showed positive, and it is only $48. We didn't get a doctor signature in advance, just gave his name to the lab, so you don't have to bug your doctor. If the test is borderline/positive, then I do recommend getting him/her involved though.

 

If you do the pyroluria test, I like www.pyroluriatesting.com because if your child is borderline or higher, a Pfeiffer doctor will talk to your doctor on the phone and 'educate them'. The general rule per the lab is that for initial testing, no B6 or zinc for 3 days before the test--simply because they will mask the pyroluria.

 

Claire

[Guest Guest]

Claire,

 

Thanks for reminding me about the lab that does the consult with the Dr.

 

The b6 reading on the MAYO lab result also states Pyridoxal 5 Phosphate. If I remember right isn't this the more "pure form of vit. B? that the body converts the oral vit. to? If this is high-how will supplementing with more help? Or is it that the cells are unable to utilize, due to a difficiency in Zinc/Cal/Mag?

 

Also, I know this is confusing-because I have two sons, but I think you were referring to younger sons zinc, in your last post which was 76.

 

My older son, the one that has this high alkiline phosphate level, has vit B6-P5P level of 103 and zinc of 91(Zinc reading is from Lab corp.) This is also the son who has been taking Bonnie's vit. I had him up to 16 at one time, but have cut him back to 12 for various reasons-illnesses where he couldn't eat, Nuero making me think I was killing him, and the itchy skin problem.

 

Youngest son has taken nothinig but a multi-not a quality brand, and once for about a week, I did give him some cal/mag and b6 combo, just to short term, see the effect. I don't think he had any close enough to the blood work to affect results, however I don't know how long this stuff sticks around.

When I get a chance I am going to post the results of both of their "out of normal" range findings, since this is starting point blood/urine Labs, that ins. and reg Dr. do, it may help others who are just getting started. Who knows maybe we can kick up a common finding at the starting point. Thanks for your input Claire

[Guest Guest]

Claire&FJ,

 

I don't know why this is logging me in as a guest. I can't edit and it won't recoginize my screen name when I try to log in. I guess I'll have to try again later.

 

I have an appt. with the kids Ped at 4:00 today.

 

Kim

[Claire]

Kim,

 

So sorry, you are right, I am getting your son's mixed up. Also, P5P is more absorbable than B6 --Pfeiffer says it is equal to 5X the B6. Other places say double. It isn't purer, just one step further down the chain. My doctor says it doesn't have the yeast aggravating issues that B6 can. However, apparently not everyone can do well with just p5P, it is a trial and error thing.

 

I don't know the other answers, hopefully FJ will stop in. Other than with pyroluria, you need extra B6 or P5P due to the kryptopyrroles themselves depleting the zinc and B6 and taking it out through the urine. However, your child may not have pyroluria at all.

 

Claire

[Guest FJ*]

Kim,

 

I read about your outburst to the neurologist on another post was really cheering for you. I am glad you did it. You are not killing your son with vitamin supplements. In fact, it is the other way around. Medications are potentially much more damaging, but traditional physicians just don't have the appropriate training in nutrition to realize it. So they really ought to keep their mouth shut when some one raises the vitamin topic.

 

As for your B6 question, I don't trust clinical tests that measure vitamin levels directly. To measure functional B6, one needs to have a special type of B6-dependent enzyme test done and even this can be misleading. The only lab that I know does it right is in Canada and it is not easy to get them to accept a sample from the US. I don't have time to go into all the reasons why direct vitamin testing is so unreliable, but it is.

 

Also, as Claire pointed out, the activated B6 form is P5P and some people just are not able to convert ingested B6 into P5P. I have found that my son does better on both supplements, not one or the other. I decided this by trial and error, not a clinical test.

 

Finally, the urinary pyrrole test, though it doesn't measure B6 directly, does capture a host of deficiencies all in one test. Any one who has an elevated urinary pyrrole needs Zinc, B6/P5P, and antioxidants at that minimum. The urinary pyrrole test is inexpensive compared to other tests, individualized for each nutrient. That's why the urine pyrrole test is a good place to start.

 

I will be out of internet contact for the next 12 days, so I won't be able to respond to any more messages for awhile. Good luck.

[kim]

Hi All,

 

I had my appt. with the boys Ped. today and he totally blew off the high alk, phos. level. I'm not saying he's wrong, actually I was relieved to hear that it is not an uncommon level in kids my sons age. BUT i'm not throughly convinced it's that simple either. Thanks to your recommendation Claire, I visited the Autism web site and someone there posted a link to a very compelling article regarding Celiac Diease and high alk. phos. levels. Again, like the TS symptoms, if this is an issue with my kids-it would be mild. They talk about small stature-my boys are really big for their ages, and a whole bunch of really nasty problems, that I don't really see, but if they have a sensitivity, some of the symptoms make sense too. Right back to where I started. We need the testing. On another link she posted, it said kids have a much higher level than adults during puberty. The Ped said they don't worry about it until it hits 500 due to growth factor. I still think the best place to start as FJ said, is with the Pyroluria testing, and the yeast, since one of my biggest concerns is youngest sons horrible diet. I have been holding off on giving him any vits. since I thought it would give a clearer picture for any tests.

Ped will not sign for yeast test I order myself. The neurologist that I had the "falling out" with sent him a letter regarding my dismissal from his practice. This did not help me in getting him on board with anything I'm trying to do. I wish I could use bad words right now, but that won't help I guess so...If anyone knows how I can get yeast tested without a Drs. signature, I'd appreciate it. I am in the process of trying to switch from Health Plus to Blue Cross, I think Claire said they cover some of these tests? Also, I won't have to kiss (oops) I mean I won't need a referral to what ever Dr. I feel is best to help me with all of this. Thanks Tons!

[Claire]

Kim,

 

Lots of the 'celiac symptoms' are just associated with gluten sensitivity. Many (like myself) believe this can be a temporary result of the immune depression. Many more people are gluten sensitive than celiac.

 

If you want to test for it with no doctor's signature, many posters on the Braintalk gluten free/celiac board which I used to visit a lot suggest www.enterolab.com.

It is a $99 stool test that can be done at home. They also had gene tests (for true celiac) and intestinal villi damage, but this is the cheapest route to get results.

 

Another test is to simply remove wheat from the diet, but I don't like doing that unless I know it is an issue--too drastic a change. Best for those who can't justify the cost of the test.

 

If your child has gluten sensitivity, theoretically the Houston Nutriceuticals AFP Peptizade enzyme can allow them to eat wheat. Not everyone though. The best thing in my opinion is to just test these out.

 

At an case, glad your pediatrician wasn't worried about any serious mainstream issue, that must be a relief, regardless of whether you want to pursue more information.

 

Claire

[Caz]

For Kim

 

I was curious when I read your son had a high b6 level show on his blood test. My son too had this, (ref range 30 - 96, his was 120) and I have not been able to make much sense of it, except that the doctor thought that he was unable to activate it into its usable form.. Just this morning, after looking at the enzymes and autism yahoo site that Claire and others talked about I found an article that showed this in its connection to autism. Whilst TS is not autism, I found the conclusions and recommondations intersting. Since we got the b6 blood tests back, we have been doing P5p instead of normal b6, but this refers to it as plp - which I am guessing is the same as p5p

Its a long article, but worth reading.

 

This article by Dr. Steve Austin with commentary by Dr.Alan Gaby was

published this month and I found it really helpful...

A New Understanding of the Use of Megadose Pyridoxine in the

Treatment of Autism

Author: Steve Austin, ND

Reference: Reference: Adams JB, Holloway C. Pilot study of a

moderate dose multivitamin/mineral supplement for children with

autistic spectrum disorder. J Altern Complementary Med

2004;10:1033â€"9.

 

Design: Randomized, double blind placebo controlled intervention trial

 

Participants: Twenty children 3â€"8 years of age with autism

spectrum

disorders (autism, pervasive developmental disorder, or

Asperger’s

syndrome)

 

Study Medication and Dosage: A liquid multi-vitamin/mineral was

administered for three months, which included all essential vitamins

and minerals and 30 mg of pyridoxyl-5-phosphate per ml, with

graduated increasing doses finally plateauing at 1/ml t.i.d. for

every 5 pounds of body weight. Thus, a child weighing 50 pounds would

be given 10 ml t.i.d., or a total of 30 ml per day, which would

contain 900 mg of PLP in addition to high amounts of all the other

vitamins and minerals.

 

Outcome Measures: A parental questionnaire was administered recording

global impressions, sleep patterns, gastrointestinal (G.I.) symptoms,

and psychological symptoms in all subjects. Vitamin B6 serum levels

were also measured at baseline and compared with levels found in

normal children. Vitamin C serum levels were measured at the end of

the trial and compared with those of normal children.

 

Key Findings: Statistically significant improvements in sleep and

G.I. symptoms were found in the group receiving supplements when

compared with those given placebo. No significant differences

occurred in psychological indices. Serum B6 levels were elevated at

baseline (a mean of 75% higher than in the healthy children to whom

they were compared, P<0.0000001). Similarly, vitamin C levels at

completion of the trial were below average levels in those given

placebo (though close to average levels in those given the multi-

nutrient supplement).

 

Practice Implications: Because so many nutrients were supplied to

subjects, we cannot ascribe the clinical improvements observed in

this trial to any particular nutrient. More importantly, the chief

psychological symptoms associated with autism for which parents are

primarily concerned did not improve significantly. Thus, the clinical

findings are neither impressive nor the focus of our interest here.

 

Instead, the exciting part of these findings derives from a new

understand of why autistic children need so much B6 and why it does

not make them sick. For many years, orthomolecular psychiatrists have

used megadoses of B6 (sometimes over a gram per day) in the treatment

of childhood autism based on the findings of 11 double-blind trials

(cited in the current report). Pyridoxine is needed in pathways that

affect amino acid conversions to neurotransmitters. Presumably these

pathways are related to how B6 supplementation improves the severe

psychological deficits associated with autism.

 

What had been lacking previously in this treatment approach was an

understanding of why such megadoses (often 30 mg/kg body weight) were

appropriate for children. Equal amounts of pyridoxine by weight can

induce neuropathies in adults. Yet, despite the lower body weight of

the children who have been subjects in these trials, virtually no

evidence of neurotoxicity has ever emerged.

 

Recent evidence from other reports shows that pyridoxal-5'-phosphate

(PLP) levels are low in autistic children, as are levels of pyridoxal

kinase, the enzyme needed to convert pyridoxal to the active

metabolite PLP. When paired with the findings of this new report

showing highly elevated serum B6 levels in unsupplemented autistic

children, a better understanding emerges that probably explains both

the need for such high doses of B6 in autistic children and why such

doses have not led to toxicity.

 

PLP is the molecule responsible for enzyme activation leading to the

formation of neurotransmitters. The current findings show that

autistic children do not convert adequate amounts of B6 to PLP.

Presumably, because of the inadequate conversion to PLP, serum B6

levels climb while PLP levels remain subnormal. These findings

explain why giant doses of supplemental B6 are needed to override the

metabolic block.

 

In addition to explaining why so much B6 is needed by autistic

children, the current finding of high B6 levels, when paired with

other recent evidence showing abnormally low PLP levels (2003

conference proceedings of the National Autism Society of America,

Pittsburgh, PA, July 16â€"20, 2003), also explains why so little

B6

toxicity has occurred in these children, even when given massive

doses of B6. Presumably, the expected sensory neuropathies have not

occurred with any frequency because the neuropathic side effects are

probably a function of excessive PLP levels, a problem that does not

occur in these children even when given massive doses of B6

supplements.

 

Do these findings suggest that instead of using massive levels of B6

doctors might use lower amounts of PLP instead? (PLP is available as

a separate supplement, albeit at significantly higher cost.) Maybe

so. But if practitioners choose to prescribe PLP instead of B6, they

need to be aware of two challenges. First, the appropriate dosage for

PLP is unknown. The large doses of PLP caused no toxicity in the

current trial, but perhaps this was true only because the trial

lasted for only three months. (The short duration of the trial might

also explain why the PLP supplementation did not result in

psychological improvements -- changes that have consistently been

reported in previous trials using massive doses of B6. Also, by

directly bypassing the just-discovered biochemical blockage, we have

reason to expect that neuropathic toxicity that did not occur with B6

might well eventually be a problem in autistic children given

“too

much� PLP (again, recalling that we don’t know how much

is “too

much�). As a result, practitioners using PLP instead of B6

will

need to watch for sensory losses in the extremities that are not

accompanied by any motor component. (These sensory-only peripheral

neuropathies are the hallmark of B6 toxicity.) If neuropathies do

appear, practitioners will need to reduce the dose of PLP.

Alternatively, pyridoxine may still be administered, given the

positive effects it has been reported to induce in controlled

clinical trials.

 

These new findings are important for yet another reason -- they add

considerable credibility to the pioneering work of Bernard Rimland

and others who, for reasons previously not understood, discovered

years ago that seemingly frighteningly high doses of B6 improve

symptoms of autism without causing toxicity.

 

The vitamin ASD-plex on the Millennium Nutritionals

website has enhanced amounts of B6 and has been yielding positve

results:

http://www.millnut.com/asdplex.shtml

[Claire]

Thanks Caz!

 

Pfeiffer says (I sound like a broken record with that!) that just doing P5P somehow didn't work for lots of kids. That the most effective is usually some combination of the two. So we just do a combo ourselves. (Plus B2 for the P5P).

 

So great to seem some sort of formal analysis! We just compounded a 'basic multivite' with 25 mg of each. Then I will add if needed. In fact, we spent an hour today with a 'basic program' list, and I will compound them. Ka-ching! I am curious as to the cost.

 

Kirkman is interesting. MOST of their multivites now have a ton of B6 and/or P5P (disproportionate amount).

 

Claire

[kim]

Caz,

 

This all gets more confusing by the minute. I assumed maybe he hadn't had a chance to utilize the B6 yet and it was normal to have a high level when supplementing. After reading the article you posted, maybe he can't utilize it. I wonder if someone else could post what there kids blood work shows, and how much they are supplementing with and how close to the blood work it was taken? Maybe the P5P would be a better way to go. I printed the article Claire posted the link to, by William Walsh of Pfeiffer. What interesting reading.

Caz, since you have current blood work handy,(and please anyone else who does) I was wondering if you would mind comparing notes. younger son, has:

High MPV 10.9 Ref range 6.5-10.5 I can't find what this stands for- I asked Ped

and he didn't know, and no I'm not kidding.

#1.Neutrophils 34.2 Low ref. range 41.0-61.0 Low neutrophils-lack of B12 or folic acid or autoimmune diease -Lupus or Aids. Another site said-low count may inicate a compromised immune system, or depressed bone marrow.

#2.Lymphocytes 56.1 high ref. range 32.0-52.0 High lymphocytes-viral infection affecting immune system, some types of leukemia.

#3.WBC low 4.5 ref range 5.0-14.5 I think this said -usually indicates a healthy individual, but I guess I did'nt write this one down.

#4. zinc was 76 range 70-150

#5. B6/ P5P was 48 Expected value 5-50.

 

This son takes a multi vitamin only, cheap kids brand.He's been taking these for a long time, way before I knew any better. He does drink a carnation Instant breakfast every morning that has quite a few vitamins in it, but other than that, his diet is very limited, and not very nutritious.

 

Oldest son:

#1.MPV 12.4 high range 6.5-10.5 Both boys were slightly high here.

#2.Neutrophils 44.7low range 47.0-67.0 both boys were low here however the range listed is different. I have no idea why, same lab.

#3.Basophils 2.3high range 0.0-2.0 Heavily involved in inflamitory response and allergic reactions. (this is the son who has the nightly itching with welts)

#4.alkiline Phosphate 364High Ped. wrote off as "growth spurt"

#5. Under General Chemistry A/G Ratio 2.2High reference range 1.1-1.8 I don't know what this one is either.

#6. zinc 91 limits 70-150

#7. B6 P5p 103 high expected value 5-50

 

This is the son who is currently taking Bonnies Vitamins-approx. 12 per day of TS Plus. I guess after spelling this out here the only two common "out of reference limits", are the MPV and the Neutrophils. If any one cares to comment, great. However, I don't think these are very significant, since there is a wide range of normal for these tests, really curious if anyone knows what the MPV stands for though.

 

kim

 

Kim

[Guest Guest_mmazz]

Hi Kim;

 

I have not embarked upon testing for my son yet. But I did do allot of reading with vitamin books and talking with the storekeep at the healthfood store. I remember reading and hearing that refined sugar intake halts the absorbtion of the b vitamins. Also, many vitamins and minerals work in conjunction with eachother and perhaps something is missing for absorbtion. I know that this is pretty much common knowledge here on this forum, but it is worth saying again. Hopefully the B-6 issue is just a supplement management issue and nothing more. Good luck and remember to take care of yourself!

 

Marie

[Caz]

I have tried to type a response twice, but both times, my post has failed to show up, not sure what is going on with my computer.

 

I check my sons full blood picture, and his neutraphils (?? spelling) and other parts of white cells were all normal. Actually I looked them up on google, and whilst the lab here showed they were normal, his eosiniphils were low as per other labs ref range, as were some others, so I will check it out some more and let you know. His basophils were also low, that is less than .1, so they listed it as 0% - I'm sure this is conencted to histamine.

 

My sons white cell count was 4.9/nl which is within the labs ref range, but different to your ref range, so I guess this depends on which lab you use, but they break the percentages of leukocytes down as percetages of white blood cells, so if wcc is low, then this would affect the ratio etc

 

I guess this just tells us that their immune systems are not running at 100% either that they are fighting viruses or bacterial infections etc

 

I'm planning to spend some time later (kids on school holidays so maybe not) to check this out more.

 

Caz