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Hi to anyone familiar with 23 and me testing!

My son, age 7, has a pandas diagnosis. First flare at age 4 lasted about 5 months, better for 1.5 years then flared again at age 6. Since then I think we've had a few weeks of back to baseline but when he gets sick we're flaring again.

On functional doc's advice I went ahead with 23 and me test to look for underlying methylation issues. I just put the results into 'genetic genie'. I was avoiding any other health info for now as I don't need additional worries, but thought methylation results would be ok. Well, it's telling me he has one heterozygous MTHFR mutation but also MAO-A and COMT mutations. The write up on this second combo is very alarming and says he is prone to 'severe' neurotransmitter imbalances which can create neuropsych symptoms like OCD, mood swings, aggression and depression? Ugh. I don't understand this testing and will meet with the doctor next week but meanwhile if anyone has insight on how this may relate to PANDAS and more importantly if these crummy genetics can be mitigated i would love to hear it. I hold to hope we can beat pandas with ongoing treatment (we are using antibiotics but haven't tried anything else) but this genetic test is a blow to my optimism tonight.

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COMT and MAO degrade adrenaline and to a lesser extent, dopamine. COMT is sometimes called the "warrior/worrier" gene. People who have a normally functioning MAO are calm under pressure, great in a crisis. People who have active or "expressing" COMT mutations have trouble degrading or reducing the levels of adrenaline after they've been faced with a fearful situation. They take longer to come out of a fight/flight/faint response. Having a mutation doesn't necessarily mean it's expressing. But if you have a Pans child, then chances are, this plays a role in some of his responses to stressful situations.

 

The good news is that Dr Yasko's work focuses on ways to manage roadblocks. Niacin - vitamin B3 - helps COMT degrade adrenaline. So supplementing with a little extra niacin (50-100mg) can give more of a "raw ingredient" that COMT needs. In a way, it helps COMT work a little faster, helping people calm down a little faster, a little more "normally". Regular niacin has the unfortunate side effect of causing a temporary, harmless flush for about 20 minutes after you take it. Flush-free niacin avoids that side effect. So you want to make sure you get flush-free niacin. If your son is too young to swallow pills, you can crush one and sprinkle the powder into food. When my daughter was younger, the creme of an oreo was sweet enough to disguise the taste.

 

MAO-A also helps degrade adrenaline and to a lesser degree, dopamine. So MAO plays a role not only in that fight/flight response but also in anger ( when a mutation causes MAO to spin too slowly and you stay rev'ed up with too much adrenaline/dopamine) or depression (if MAO spins too quickly and you end up with too little dopamine). Copper helps MAO degrade adrenaline. Copper is a little trickier to supplement, as too much can cause problems, including a zinc deficiency (zinc is important to the immune system). So if you supplement copper, you don't want to exceed 2mg. You also want to avoid MAO-Inhibitors. Cough medicine, some OTC cold medicines can be MAO-I's.

 

I've found that these "helper" supplements work well in working around the COMT and MAO roadblocks in terms of anxiety and anger. For the most part, I used niacin and didn't try to supplement for MAO issues. Methylfolate and hydroxyB12 supplements can help work around MTHFR issues. But dosing can vary widely. Some people take 800mcg - 5mg of methylfolate. My daughter only needed 67 mcg every other day. More than that made her very bipolarish. So I'd only address one snp at a time and be particularly methodical and slow when it comes to MTHFR.

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