Prescription for Wealth              How to Prosper by Helping Chronically Sick People Get Well Dr. James P.

Blumenthal  NeuroHealth Diagnostics, Inc.2990 S. Sepulveda Blvd., Suite 203Los Angeles, CA, 90064-3973www.NeuroHealthDx.com Florival Publishing CompanyLos Angeles, California2012    Prescription for Wealth:How to Prosper by Helping Chronically Sick People Get Well Copyright 2012  Dr. James P. Blumenthal All rights reserved Florival Publishing Company2990 S. Sepulveda Boulevard, Suite 203Los Angeles CA 90064(310) 445-3350  ISBN: 978-0-9856111-0-1     Prescription for Wealth is dedicated to: Linda, my Muse, my Love, and my InspirationKathy Marks who created the Rx for Wealth conceptRalph White, JJ Virgin, and Mike Mataraza, my friends and coaches who encouraged me to share this with youand to all of the doctors, and patients who have helped me create and improve the PathMAP Profile and the Pathways and Processes ApproachThank you Table of ContentsPrescription for Wealth:              6What makes the difference between striving and struggling?              7Functional Medicine               12Building Blocks and Stumbling Blocks              12The big idea.              13The challenge.              13Pathways And Processes Approach              14Pathways and Processes              17Serotonin/SSRI Example              17The Law of Unintended Consequences              19HRT/Bio-Identical Hormones Example              20In A Nut Shell              23We Need Tools!              27Metabolic control systems              28Correlations               29Cofactors              29Summary Page.              33Neurotransmitters              33Energy production.              39Hilda              43Detoxification Processes              44Hormones.              49Putting it all together:              56Identify the underlying causes of their problems.              56Treat what you find.              56Taking the PathMAP test.              56Assessment              56There are a number of ways that you can proceed therapeutically:              56Custom blended supplements.              57Retesting.              57PathMAP can create unrivaled patient loyalty !              57PathMAP makes YOU the source.              57Bottom Line:              58By providing a turnkey system with.              58PathMAP gives you the three tools your practice needs to excel in today's market.              58Where do we go from here?              59You get to have more fun and make more money in practice when you...              59Start using the PathMAP test...              59Use me as a Resource              60If you are NOT a healthcare provider               60Organic Acids Testing              61Amino Acids Testing              67Minerals/Elements Testing              69Prescription for Wealth: How To Prosper by HelpingChronically Sick People Get WellBy Dr. James P. Blumenthal, DC, DACBN, FACFNAfter more than two decades as a functional medicine doctor, I have learned that you can make a huge difference in a lot of people's lives and make a lot of money in your practice in today's economy. In fact, for doctors like us, there may never be a better time to practice functional medicine than the opportunities in front of us right now. But... you can't do it the 'same old way' that it's been done in the past.Where we are today:·         The economy stinks.·         Unemployment is in excess of 10.6% nationally, and another wave of the recession may be on its way.·         Doctors incomes are down and our expenses are up more than 33% over the past 10 years.·         Our workload and the paperwork required to get paid by insurance companies, has more than doubled since 1998Patients respect and trust for their doctors is in an all time low...20 years ago " Doctor " was the number one most trusted and respected job title... Today, we are number 11 (sanitation workers are number 10!) Patients no longer automatically ask for or blindly follow their doctors recommendations... Now they're checking with the Internet first.Private practice has lost its luster and become a J – O – B for too many doctors. Too many others have gone out of practice in the last five years either because they couldn't make a decent living from it, or because they got burned out from the drudgery.It doesn't have to be like that!!!Some of us...·         Are having the best year of our careers right now!·         Are discovering how much easier and more fun it can be to treat our patients' most chronic and complex issues.·         Are treating our most challenging patients faster and more profitably than ever before.·         Are getting to choose our patients because we're getting more referrals than we can handle.What makes the difference between striving and struggling? Is it.·         Skill?·         Knowledge?·         Luck?·         Location?Is it like the commercial that says "She must be born with it"?Nope.What makes the difference between "just okay" practices and Grrreat! practices?Three things:1.      Systems they create information, save time, and simplify complex tasks.2.      Leveraging your time and money.3.      The Perception the you have something special to offer the patients want and think they can't get somewhere else.In the next few pages, I'm going to share some tools with you that can transform your practice from just okay to Great! by...·         Setting up a system from evaluation through treatment that will make your practice easier, more interesting, and more fun with no extra effort on your part.·         Poising yourself as your communities. "Go - to Expert" for complex, chronic, and challenging patients.·         Freeing-up more of your time and saving your energy while increasing your profits, referrals, and your reputation by effectively treating the patients no one else wants or knows what to do with.We are going to cover some tools that you can automate to:·         Attract a lot of new and interesting patients.·         Easily identify and treat the underlying causes of their most complex problems.·         Create tremendous compliance.·         Inspire your patients to refer everyone they know to you.The difference between success and failure is often doing what others haven't thought of doing. Albert Einstein defined  Insanity as "doing the same thing over and over and expecting a different outcome." If what you are getting from what you have been doing isn't enough (and if it was would you really be here reading this today?)...If you want Outcomes and Income that exceeds what you can reasonably expect from what you are already doing...Then maybe you need to find a new way of being and doing... One that can give you results that areUn – reasonable and Un – expected!!!You get unreasonable, and unexpected results...1.      By doing the unexpected.2.      By doing what no one else is willing to do.3.      By doing what no one else knows how to do.And if you are willing and able to:1.      Do the unexpected.2.      Do what no one else is willing to do.3.      Do it no one else knows how to do.Then you can become as unstoppable as a Force of Nature.Let me tell you a story about Un-reasonableness.:The Spring I turned 16, I was in prep school and I took an extra three week session at the end of the spring semester so that I could take a class that I wouldn't have been able to take during the regular year. The result was that by the time that I got home, everybody else had been out of school for three weeks and all the good summer jobs were taken. I needed a summer job. I needed to be able to make money and one of the things that I really wanted at the end of the summer was to be able to buy a stereo. And not just any stereo. I had seen a Sansui tube type receiver at a secondhand store and I had my heart set on. But like I said all the good summer jobs were already taken. I knocked on doors. I tried family connections. I tried everything I could think of. But all the jobs that I wanted to do were taken. There were no lifeguard jobs available. They were filled. There were no restaurant jobs available. They were filled. There were no jobs working at the Marina or on boats. They were filled. I told my father about the problem I was having finding a job and I asked him what I should do. He said he understood about all the good jobs being taken. After all, the old adage about the early bird getting the worm is often true. He asked me of all the jobs that I could possibly do what I would least like to do. It seemed like a strange question but my dad's a smart guy, so I answered. I listed off a number of things including that I wouldn't want to work on a septic tank truck. He told me he could completely understand that, and that mostly other people probably wouldn't want to work on a septic tank truck either. In fact he bet me that that would be the last place that most people would look go looking for a job. He then gave me the number for the company that cleaned our septic tank at the house and suggested that I call them the next morning.Well, I spent my 16th summer working on a honey-dipper, also known as a septic tank truck. And you know what? At the end of the summer I bought that Sansui receiver, a Dual turntable, and a pair of A-R speakers. I was on Cloud Nine and I couldn't have done it if I didn't only willing to do what everyone else was willing to do. Now I'm not telling you to go work on a honey dipper, but I learned more lessons that summer about what it means to put in an honest day's work that I would've learned doing almost any other job. If you want to accomplish what nobody else does and make when nobody else makes...But you don't need to work on a Honey-dipper or do anything particularly unpleasant to get there.You just need to be able to help the people who nobody else wants or knows how to help.I am going to show you how to do that and how to do it...·         Easier, by working smarter instead of harder.·         Faster, so you will have more time left over to enjoy your family and your life.·         More effectively so you get better patient outcomes.·         With better compliance and more referrals.·         And with greater financial rewards.Beginning with exactly what you already knew when you picked up this book today. If we're going to manage this, then we need a new way to...·         Identify imbalances in our patients metabolic control systems, and understand what is going on behind them.·         Treat the root causes of their problems instead of just suppressing their symptoms.... Because the old ways aren't working for us anymore and it is insane to keep using them when we want a different resultFunctional Medicine Building Blocks and Stumbling Blocks  I frequently travel to lecture to doctor groups around the country. To get to where I am going, I head to the airport and get on a plane, often a Boeing 757 or 767. These are big, powerful pieces of equipment. They're capable of carrying 200 or 300 passengers, almost all of their luggage (except the pieces that you left on the tarmac), and 20 or 30 tons of cargo. They can move down the runway at speeds fast enough to create enough lift to raise a 120 ton piece of equipment 40,000 feet off the ground and move through the air at over 500 nautical miles per hour for thousands of miles. That's a lot of power.! But you know what? If one of the ground crew just takes a 3 foot piece of 4 x 4 and puts it behind one of the wheels while the plane is sitting at the gate, it can't even back away from the gate! It can't even begin the process of moving us and our luggage and all that cargo from one place to another. So often it seems that the problems that our patients are having, the problems that are keeping them from being able to soar are small things like that block that the ground crew puts behind the wheels of the plane to keep it from backing away from the gate. And if we can just identify what those are, then we can treat the underlying problems that are creating our patients' symptoms. It is that easy!The big idea.Functional medicine is based on the premise that the body has an inborn or innate intelligence (a.k.a. "homeostasis") that guides it to write itself, heal itself, and optimize its function... if we can simply remove the obstacles to its performance and provide the building blocks to fuel its systems. The challenge.In order to remove the obstacles and provide the building blocks, we need to know:·         What they are.·         Where they are.·         How to correct them.... for each of our patients as individuals.Two-time Nobel Laureate in Medicine, Albert Szent-Gyorgy said that,"Discovery comes from seeing what everyone else sees and thinking about it in a different way."To successfully treat complex and chronic patients who have "been everywhere" and "tried everything", we need to think about them in a different way than everyone else did who has already tried and failed with them. To treat our most challenging patients we need to understand the root causes behind their symptoms or diagnosis.  To understand those causes, we need to know what is working and what has gone awry in their metabolic control systems:·         Neurotransmitter synthesis and metabolism.·         Hormone synthesis and metabolism.·         Energy production.·         Detoxification. This may sound complicated but we can make it really easy to understand and apply... And your patients are going to describe you as a Genius and as their Hero for helping them when and where other doctors could not!Pathways And Processes ApproachLet's start by looking at things a little bit differently through something that I call the Pathways and Processes Approach.We know that all of biochemistry comes down to              A                                           Bwhere, "A" is a substrate and "B" is a product. This is basically what every reaction looks like.We also know that we can take a pound of "A" and leave it on the counter for days and we would still just have a pound of "A" unless we add something to catalyze or move the reaction forward. We call that something an enzyme. We also know that each enzyme depends on its own subset of cofactors to be able to do its job. Universally, cofactors are vitamins, minerals and amino acids.  So what biochemistry really looks like is simply: enzymeA                                          BCofactors(Vitamins, minerals,amino acids) I tell my patients that the enzymes are like the bus that carries A to B, and the cofactors are like the wheels on the bus. This is a really robust system. Nature, in her infinite wisdom, has provided us with a system which is very powerful and only really has three possible places to break down.1.      We could have not enough substrate "A". This would be like trying t bake a cake without enough flour. In most cases the substrate is going to be an amino acid. The places where we see exceptions to this are in turning essential fatty acids into prostaglandins where typically we're starting with three, six, or nine carbon "essential" fatty acids, in fatty acid metabolism to make energy, where we are generally starting with an even-number fatty acid, and synthesizing steroid hormones where we start with cholesterol.  2.      With enough substrate, there are only two other places for this system to break down. Missing one or more the cofactors (vitamins, minerals, amino acids) prevents the enzyme from working. I tell my patients that it's like having a perfectly good bus that's only missing a few wheels. No matter how good the bus is, if you're missing one or more wheels at bus isn't going anywhere.  3.      Something toxic turns off or "un-couples" the enzyme.  Once we know how reactions work, Pathways are just a series of reactions and they can be understood the same way.                If we know where the substrate is low and which cofactors are deficient, then we will know exactly where to expect enzymes to be compromised and the pathways to be blocked.               Pathways and ProcessesIf we think of metabolic pathways as interconnected Dynamic Processes that make and recycle signaling molecules (neurotransmitters and hormones), produce energy, and clean up its byproducts (detoxification), then we can tell a lot more about where our patients' metabolic control problems are coming from and how to treat them than we can if we just look at one point along a single pathway.Serotonin/SSRI ExampleTake for example the case of one of my patients. Lisa, a 37 year old woman who came in complaining that she was having trouble with her menses, her moods were poor and changeable, she was depressed, and fatigued. Her psychiatrist's first inclination was to put her on a serotonin reuptake inhibitor, or SSRI (Paxil, Prozac, etc.). However, because we had done the labwork, we were able to see what was actually going on in her 'tryptophan to serotonin to melatonin' pathways. We could see where her system is working and where it was impaired, which gave us an entirely different perspective and a much more effective option for treating this lady.                By looking at the example above we can see that she was having problems making serotonin and melatonin because:1.      She did not have enough substrate tryptophan to begin with.2.      She lacked several of the cofactors necessary to run the hydroxylase enzyme to get from tryptophan to 5-HTP.3.      She did not have all the cofactors necessary to run the AADC enzyme to get from 5-HTP to serotonin. We could have given Lisa SSRIs until the cows came home. But that was not going to help her because SSRIs work by blocking the reuptake of serotonin so that it pools until we have enough serotonin to perform its desired functions. Unfortunately, the conventional approach was not only not going to fix any of Lisa's underlying causes, it was also not even going to help her symptoms because she was unable to make enough serotonin to well-up in the first place.  If we think back to our Pathways and Processes Approach, we can see that there were two reasons for this: First, Lisa did not have enough of the tryptophan substrate.  And, even if she had had enough tryptophan to begin with, she wasn't going to be able to convert it to 5-HTP and then on to serotonin since the two enzymes that run those reactions (tryptophan hydroxylase and AADC) weren't working because they were missing several of their cofactors.There was a much more powerful and effective treatment approach available for Lisa. By identifying the building blocks that she was missing and then replacing them (her tryptophan and the cofactors which she was deficient in), we were able to get her own system turned back on and running the way it was designed to do. Interestingly, not only were we able to help improve her menses, her moods, and her fatigue, she also started sleeping more soundly through the night and lost about 7 pounds that she had been unable to get rid of before. The Law of Unintended ConsequencesLisa's case illustrates another powerful aspect of taking the Pathways and Processes Approach called "The Law Of Unintended Consequences". The Law of Unintended Consequences says that any action will provoke other reactions which were not necessarily pre-considered or intended. We see this all the time in pharmaceutical advertising. In most drug ads the first 10 to 12 seconds of a 1 min ad are devoted to the benefits that the company wants to sell you on to get you to use its drug. The remaining 48 to 50 seconds are spent warning you about all the unintended consequences, also known as side effects, that the drug can cause. In my years as a functional medicine doctor and often as the knot at the end of my patients' rope, I have treated countless people who have become victims of this Law and I'll bet you have, too. In functional and natural medicine, we also run into the Law of Unintended Consequences. However, our experience ends up being dramatically different from what happens with drugs. When we provide the body with vitamins, minerals, and amino acids, while we may be intending to restore function in a particular neurotransmitter, hormone, energy production or detox pathway, the body will generally first fix what it thinks is most important, and it will use those nutrients to achieve its desired goals, regardless of what we may be planning. Most of the time, the first thing that our patients' bodies want to do is to start cleaning house and running the detoxification systems because this makes every other system in the body work better. When that happens, we suddenly find that they are sleeping better, have more energy have happier moods, and are able to accomplish more in their daily lives. Something that I have found in my practice and that doctors who use the PathMAP Profile tell me about is that patients will frequently come back when we have used this approach and ask us "How did you know that I was having (some problem) that I never told you about?" One of the great things about how the Law of Unintended Consequences plays out in Pathways and Processes based natural medicine is that it can often make us look even smarter than we are. HRT/Bio-Identical Hormones ExampleHere is another wonderful example of how the Pathways and Processes Approach can help our patients and build our practices.For many of us, gynecology and endocrinology may not be our specialty. In fact they may even seem a bit daunting, so let's look at a little background information on hormones and hormone replacement therapies and how easy it is to take this almost 'ready made market' and improve on the quality of care patients receive and the revenues that our practices enjoy. In 1991, the National Institutes of Health began what was supposed to be a 15 year study of just over 65,500 women to explore the benefits of hormone replacement therapy called the Women's Health Initiative or "WHI". In 2002, NIH stopped its $265 million study 3 1/2 years prematurely because they discovered that conventional hormone replacement therapy (e.g., Premarin, Prempro, etc.) was causing breast, ovarian, uterine and colorectal cancer, heart attacks, stroke, and blood clots in a large number of women. When word of this hit the media, women across the country and around the world started to reassess the dangers posed by conventional hormone replacement therapy. At about that time it was suggested that bio-identical hormone replacement therapy (BHRT) would be a safer alternative. BHRT was expected to sidestep some of the unintended consequences of Premarin, Prempro, and the other horse-urine based hormones because the molecules were significantly closer to our own naturally occurring hormones. Unfortunately, over the decade since the end of WHI, there have been several studies but there has not been much in the peer-reviewed literature that supports the idea that bio-identical hormone replacement therapy is really that much safer than conventional hormone replacement therapy.According to filings with the FDA and SEC, even in light of NIH's findings of the dangers of conventional hormone therapy in the WHI study a decade ago, there were still approximately 12 million prescriptions written in 2011 for over $1.8 billion in conventional hormone replacement drugs. Wyeth still sells over $1 billion in Premarin and recently started selling Aprela. Add to that all of the compounded bio-identical hormones and you have an industry worth somewhere between $2.7 and 5 billion. This represent a tremendous number of women at risk from the current standard of healthcare. It also presents a phenomenal opportunity for you to change the quality of care in your community and to prosper from it significantly, because many of these millions of patients should be coming into your office to be treated naturally, safely and effectively.  JudyLet's consider Judy, a 52 year old menopausal patient who was having difficult symptoms including severe hot flashes both during the day and waking her at night, mood swings, and exhaustion. Judy came to us because her gynecologist was strongly urging her toward hormone replacement therapy. Like many of the women we see, she wanted a more natural and less dangerous solution.When we think about a patient like this, we can use the same Pathways and Processes Approach that we learned above and that we used to help understand the patient with the serotonin deficiency. The substrate for all of the steroid hormones is pregnenolone. First we turn pregnenolone into progesterone and then into aldosterone to regulate our sodium-potassium balance and to help our kidneys recycle water to maintain our hydration. If we have adequate pregnenolone and progesterone to make aldosterone then we hydroxylate them to make cortisol in order to manage stress, inflammation, and immune responses; blood sugar balance; and elasticity of ligaments. If we have enough hydroxy-progesterone and hydroxy-pregnenolone after making cortisol, then we can make androgens: DHEA, androstenedione, and testosterone. Once we have enough androgens then we can make estrogens. To get from hydroxy- pregnenolone and hydroxy-progesterone to the androgens we use an enzyme called lyase that depends on zinc. To get from the androgens to the estrogens we use an enzyme called aromatase that also depends on zinc. If you look at the diagram above, each of the numbers next to an arrow represents an enzyme and each one of those enzymes has a very specific set of cofactors (vitamins, minerals, amino acids) that it depends on. If we know which cofactors are deficient, then we also know which enzymes we can turn on by providing those cofactors. We may also need to add the Substrate. For neurotransmitters, detox pathways and most of energy production the substrates are amino acids. But for the steroid hormones, the main substrate is pregnenolone.In A Nut Shell If you can identify where your patients steroid hormone pathways are being blocked and you provide them with the cofactors nutrients and the substrate pregnenolone, then you can normalize their hormone pathways without putting them at risk from conventional or bio-identical hormones. You will be able to treat your patients' hormone imbalances safely and effectively and they will build your practice magnificently.In Judy's case, we found that she was having trouble producing the substrate pregnenolone because, like many women, she was missing cofactors that run the enzyme that turns cholesterol into pregnenolone. She was also missing cofactors for several of the enzymes that turn pregnenolone into progesterone and aldosterone, and cofactors to hydroxylate pregnenolone and progesterone into cortisol. Since she couldn't make enough pregnenolone to support life sustaining aldosterone and cortisol, it wasn't too surprising that her body was not using what little she had to balance her reproductive system that was already challenged, anyway.So, the first thing we did for Judy was to identify the enzymes and the cofactors that were low by running a PathMAP Profile for her. Then we had a nutraceutical compounding company create a custom blended nutrient powder based on the results of her PathMAP that contained each of the deficient cofactors in slightly super-physiologic doses. We had her take specific doses of her custom cofactor powder and pregnenolone daily. At the end of the first week, she called me and asked what kind of magic we had done. Her hot flashes had settled down about 80%, she was sleeping through the night for the first time in a few years, and she felt tremendously better. After three weeks, Judy's hot-flashes were infrequent and she described them as "occasional warmies". She was also feeling much more energetic and having an easier time staying awake and doing her job at work (the Law of Unintended Consequences serving us again). And then the referrals started. It only takes a few Judys in any practice to get to the point where you can pick and choose the patients you want to see... and there are millions of Judys out there who need our help!And if that is the kind of service you give, can you imagine how thrilled your patients will be? Again and again what doctors have told me is that they love using the PathMAP Profile because they are able to go to places and help with problems that they had never really considered working with beforeWe Need Tools! "You're gonna need a bigger boat!" Sheriff Brody (Roy Scheider), JAWSIf we are going to play at this level, then we need tools that...·         Tell us what is going on.·         Individualize our care for each patient.·         We can easily explain to our patients and sound like we know what we are talking about.We need tools that we can understand...·         Quickly.·         Clearly.·         Unequivocally.Tools that will give us a clear plan of action... without having to spend a lot of time analyzing the data or relearning biochemistry.We need tools you can use with ease and finesse, regardless of whether you are a master of functional medicine or brand-new at it.We need a Metabolic Assessment Profile based on the Pathways and Processes Approach.If we had a Pathways and Processes based Metabolic Assessment Profile we could call it the PathMAP Profile We would want that PathMAP to identify our patients' metabolic imbalances and then show us how to treat them deeply, easily and effectively with very little time needed to assure your patients buy in and compliance. Ideally PathMAP would be so efficient that it would save you hours of time that you could spend with additional patients or even ... with your family.We can create the PathMAP by using three urine-based clinical laboratory tests which have been rigorously assessed over the past 25 to 30 years both in clinical practice and also in the peer-reviewed literature:·         organic acids ·         amino acids ·         minerals or elements testingBy using these three tests, PathMAP would have 115 analytes to measure from. By correlating the analytes which were out of range with the substrates and cofactor deficits that they represent, we could measure for adequate levels ofü      Substrates.ü      Cofactors.and assess the detoxification pathways...So that you can clearly see where your patient's problem is, what is causing it, and how to fix it.Metabolic control systemsMost of the functions of the body are controlled by a very few metabolic control systems. These include:1.      Neurotransmitter synthesis and metabolism.2.      Hormone synthesis and metabolism.3.      Energy production.4.      Detoxification.We are going we are going to look at these systems through the Pathways and Processes Metabolic Assessment Profile (PathMAP)A Tour Through the PathMAP ProfileCorrelations The PathMAP starts by looking at 115 analytes gleaned from the combination of an amino acids profile, an organic acid profile, and a minerals test. By looking at which of the analytes are out of range, either high or low, we correlate those out-of-range analytes with the cofactor (vitamins, minerals, amino acids) deficiencies that would cause them. For example, it is well-established that excess methylmalonic acid results from low vitamin B12 and excess FIGLU is evidence of low folate. High 1- or 3-methylhistidine is evidence of low vitamin E and low 2-oxo-glutaric acid indicates a deficiency of alpha-keto-glutarate.Each enzyme depends on a specific subset of cofactors in each step of each pathway of each reaction of each of the four metabolic control systems:1.      Neurotransmitter synthesis and metabolism.2.      Hormone synthesis and metabolism.3.      Energy production.4.      Detoxification pathways and process.Once we know which cofactors are deficient and which enzymes are impaired, we can clearly identify where and how the pathways that depend on them will be blocked. When we know what our patient is missing that is causing problems, is easy to see what we need to do to get them back into balance and function. CofactorsIdentifying the analytes and correlating them with the cofactors deficiencies that they represent would be a tremendous job if you had to do it for each patient. Fortunately, you don't because we have already identified the analyte imbalances for you that can tell us about deficiencies in 16 vitamins, 12 minerals and 25 amino acids. In addition we've identified the analytes that indicate problems with fatty acid oxidation, yeast and fungus, bacteria, specific toxicities, phase 1 and phase 2 detox imbalances, oxidative stress, and various neurotransmitter problems. This is in addition to the particular reactions and pathways that show imbalances and challenges in the four metabolic control systems.      Summary Page.All of this information might be a lot to wade through if it weren't for the Summary Page. The summary page gives you a concise and complete listing of the pathways that are affected by the various impaired enzymes and cofactor and substrate deficiencies, along with a clear, concise description of therapeutic recommendations that summarize the nutrient deficits, which are causing those pathways to be blocked.NeurotransmittersPathMAP was originally designed to provide very detailed information about the five primary neurotransmitter pathways, including:Ø      Tryptophan to Serotonin to Melatonin.Ø      Tyrosine to Dopamine to the Catecholamines.Ø      Histidine to Histamine: (H1, 2), (H3, 4)Ø      Acetylcholine.Ø      Glutamine to Glutamate to GABA to Krebs Cycle.Not only does PathMAP show you exactly what's going on in the synthesis of these neurotransmitters, it also shows you what's going on in their metabolism. To my knowledge, PathMAP is the only lab test available in the United States, which actually shows you what is going on in the synthesis and metabolism of neurotransmitters and which actually gives you precise, medically legitimate, clinically actionable information about neurotransmitters that you can build a sound treatment plan around.Neurotransmitters control a broad range of autonomic and motors/sensory functions. Some of these include:AlertnessMoods.Excitation.Learning.Focus and attention.Rapid response.Timing and rhythm.Hormonal effects.Sleep.Circadian rhythms.Relaxation.Recall.Resistance to distractibility.Smoothing out motion.Planning and sequencing.Digestion and elimination If we look at some of the pathways what we will see is that everything works stepwise and that we can recognize our Pathways and Processes Approach as we look at the substrates, the enzymes, and the cofactors, which are responsible for each step of synthesis and metabolism (or making and breaking) to assure that we have enough and not too much of each neurotransmitter.        Energy production.One of the most important things that our body does is produce energy, particularly the energy molecule ATP, which runs all of the processes throughout our body. If the energy production system is not working properly, we either manifest the symptoms of all sorts of illness including various mitochondrial dysfunctions or we simply ceased to exist. It would be very difficult to overstate the importance of this system. At the same time, there are very few lab tests that can show us what is going on in these systems at a level that gives us the clinical information to take precise actions to treat our patients. PathMAP was specifically designed to give us precisely that information. And as a result it looks at all four of the primary energy production pathways: Ø      Gluconeogenesis and Glycolysis to synthesize acetyl Co-AØ      Fatty Acid Metabolism to synthesize acetyl Co-AØ      Krebs Cycle, converting acetyl Co-A to ATP.Ø      Oxidative Phosphorylation, perhaps the most vital energy production pathways in the body.Gluconeogenesis begins with the protein glycogen and converts it into glucose by the process of phosphorylation. Glucose is then metabolized into Acetyl Co-A by the sequential action of 10 different enzymes. PathMAP identifies each of those enzymes and each of their cofactors so you can see where gluconeogenesis and/or glycolysis is being impaired.Even-number fatty acids are either converted to acetyl Co-A in four steps, each of which involves its own enzyme with its own set of cofactors, or they are converted to Malonyl Co-A which is then converted into acetyl Co-A by the action of one enzyme which depends on biotin. Once glucose or fatty acids are converted into acetyl Co-A, the acetyl Co-A is run through 10 steps in the Krebs cycle to produce ATP, the energy molecule. Of course, just like all the other pathways, we only need one cofactor or one enzyme to be missing or deficient to stop the Krebs cycle from working. Given the tremendous number of steps, enzymes, and cofactors involved, it is almost unheard of to find someone who does not have some level of impairment in the Krebs cycle. What this means from a therapeutic perspective is that we are almost always in a great position to make a huge improvement in our patients well-being by simply identifying the nutrient cofactors that are missing or deficient and replacing them. In addition to running the wheel of the Krebs cycle to convert acetyl Co-A into ATP, we can go out the bottom of the Krebs cycle from succinyl Co-A into the electron transport chain and oxidative phosphorylation. Oxidative phosphorylation (Ox – Phos) is so important that it has not one, not two, but three redundant pathways that can get us to ATP synthase. It could be argued that this is where the really heavy lifting of energy production takes place. In order to run these three pathways we have four enzymes or, as they are called in ox-phos, Complexes I – IV. More often than not, we see at least three if not all four of these complexes being blocked.This actually brings up an important point. When we are looking at deficiencies and impairments in substrates, cofactors, and enzymes and when we are looking at blockages in the reactions and pathways, we are generally looking at relative rather than absolute deficiencies. For example, if we had no ATP production at all through Krebs cycle or Ox-Phos, we would cease to exist. This is a good illustration of the rule of thumb that whenever we are talking about physiology we are almost always talking about relative rather than absolute balance and function.HildaIt is difficult to overstate the importance of energy production to understanding our patients' symptoms. A good example of this is a lady I will call Hilda. She came in with her son and grandson, who we were treating for autism. Even though I have lived in Los Angeles since 1993, my Spanish is really not that good and Hilda spoke only a little bit of English. After we got her grandson functioning much better, her son asked if there was anything we could do for his mother. At 62, she ached all over, no longer wanted to participate in any of the social activities that she had reportedly enjoyed for years, and had essentially lost the will to live. According to her son, this had been worsening over the past five years.When we ran the PathMAP Profile, it was clear that Hilda was having trouble turning glucose or fatty acids into acetyl CoA. The Krebs cycle enzymes were blocked in multiple places, and all four of the ox-phos complexes (enzymes) were also being blocked.After we got her results back, we had a formula compounded for her and, if I hadn't seen this over and over again, I would have thought it was a miracle. When they brought her grandson in three weeks later, she reported that the pain was gone and she was back to enjoying her friends. Her son added that she had also been singing while working around the house. And to think that this was a woman who only weeks before was ready to give up living! I am grateful for what the PathMAP Profile has done for my practice. I am even happier about what I see it doing for my patients' quality of lifeDetoxification ProcessesWhy do we need to understand detoxification? Because this is one of the most fundamental processes in our body. If detoxification is not working properly, everything else begins to fail... and fail dramatically.There is an old story about the Organs. They were having a meeting one night while their human was asleep. The Brain was bragging about being the most important organ because, without it, the body would have no idea what to do and the other organs wouldn't be able to work in harmony. The Lungs told the Brain that they were even more important because, without oxygen, all of the other organs would die and even the brain wouldn't work. The Heart laughed at the Brain and Lungs and claimed that it was clearly the most important organ because, without it, blood would stop flowing and all of life would cease within minutes. About this time, the colon piped up and said, "Well, I'm important, too." Of course, the Brain and Lungs and Heart laughed at the poor Colon and derided it for its lowly functions and terminus. The Colon was deeply insulted and its feelings were hurt so it went on the strike. Within two or three days, the Brain was experiencing terrible headaches. After a few more days, the Lungs were having problems attaching oxygen to the red blood cells. And after a week and a half, even the Heart was skipping beats. So they all went to the Colon, apologized for their bad behavior and pleaded with it to call off the strike. The Colon relented, opened back up for business, and everyone started working and feeling much better.Although the story talks about the colon, when we look at detoxification we are really talking about the combination of systems. These include Liver cytochrome P450 Detoxification Phases I, II, and III, bile acid production, and antioxidant functions; and elimination of the conjugated toxins through the "emunctories or organs of elimination which include the small and large intestines, kidney and bladder, lungs, and skin.Let's take a tour through Detoxification and review some of its functions. Phase IWe are somewhere between 70 and 80% water by volume. So, it is not very surprising that most of our body's chemistry is water-based chemistry. We particularly use water as a solvent, however many of the wastes and toxins which our detoxification system is responsible for breaking down (metabolizing) and eliminating are not initially water-soluble. The first phase of detoxification is the process of turning non-water-soluble wastes and toxins into water-soluble intermediate forms. Often, these intermediates are actually more toxic than the forms they started as, however they have the benefit of being water-soluble, which means that now we can use our water-based chemistry to metabolize and excrete them.The process of making these non-water-soluble toxins water-soluble is called hydroxylation. If we think of water, which we often write as H2O,  as H+ + 0H- , then basically what happens is that we stick an OH- or a hydroxyl group onto one end of the non-water-soluble molecule which then makes it water-soluble. Hydroxylase, like every other enzyme, has a set of cofactors that it relies on. If we are missing one or more of those cofactors then hydroxylation and Phase 1 of detoxification will fail.  Phase IIOnce we have turned the non-water-soluble toxins water-soluble intermediates, then we need to change or conjugate those toxic and reactive intermediates into forms that we can safely excrete through our organs of elimination without damaging the more delicate parts of those organs, including the brush border of the small intestine and nephrons of the kidneys, the alvioli of the lungs, and structures of the skin.There are six pathways which we use to conjugate those water-soluble intermediates into safe to excrete substances. Each pathway relies on specific amino acid substrates and specific cofactors to eliminate or conjugate particular types of toxins and wastes.Glutathione, in addition to serving as part of Phase 2 conjugation, and superoxide dismutase (SOD) are also the primary antioxidants for the body. Since we go through the steps of identifying functionality in the glutathione clearance pathway, we also identify the cofactors for both forms of superoxide dismutase which are used in the human body. Phase III of DetoxificationOnce the toxins have been conjugated into something safe to excrete, then we need to move those residues from the liver to the emunctories or organs of elimination, so that we can safely excrete them. Bile is composed of bile salts and bile acids. Typically, we move the conjugated residues out of the liver on a stream of bile acids. In total, the body makes five types of bile acids but two of them, taurocholic acid and glycocholic acid, make up about 85% of the bile acids in the body and are the primary ones responsible for moving wastes out of the liver. Bile acids are also responsible for the processes of quenching hydroxyl and peroxynitrate radicals in the stomach and gut and initiating peristalsis (the wavelike motion) in the large intestine, as well as their better-known function of saponifying dietary fats in the duodenum.Detoxification is one of those places where the Law of Unintended Consequences has a tendency to take over. When we run a PathMAP Profile on one of our patients and provide them with their custom-blended nutrients, regardless of our intentions, there is more wisdom in the body's own processes of homeostasis than there is in any healthcare practitioner. I may be intending to improve the messaging molecules (hormones and neurotransmitters) or restore energy production. But the body will usually take the lead and fix what it thinks is most important first. And, usually, its highest priority is housekeeping (aka detoxification). When I first started using the PathMAP guided custom-blended nutrients, patients were initially getting headaches, the runs, and other traditional detox-related symptoms. Since then, we have learned to start at 1/4 or 1/8 dose and titrate up, doubling the dose every 3-5 days until we get to full dose. Now patients are much happier and happy patients comply and refer.Hormones.From knowing when to be awake or asleep and controlling our responses to heat and cold, reproduction and fight or flight, hormones are the messenger molecules that tell our endocrine system how to respond to the environment around us and within us. One of the great opportunities for any functional medicine doctor today is in balancing steroid hormones.  Think back to  Judy's case study on page 21 and you can see an example of the power of balancing hormones. We can use this same process to help boys and girls who are having challenges with puberty and guys who are having erectile dysfunctions and the suite of other symptoms that attract them to drugs like Viagra and Cialis. Sex steroid hormones begin with omega-6, omega-3 , and omega-9 essential fatty acids being metabolized into prostaglandins E1, E2 and E3. All three prostaglandins are necessary to produce cholesterol, the building block from which we form pregnenolone, the substrate for all of the steroid hormones. Pregnenolone gets converted to progesterone, and together they are responsible for making aldosterone, cortisol, and all of the sex hormones. Essential fatty acids.We are designed to convert omega 6 essential fatty acids, including Evening Primrose Oil, Black Currant Seed Oil, and most of the vegetable oils into prostaglandins E1 and E2. We are designed to convert omega 3 fatty acids, including most of the nut and grain oils such as flaxseed oil and walnut oil, and the Omega 9 fatty acids including fish oils, into prostaglandin E3. Prostaglandins E1 and E3 are anti-inflammatory and free radical quenching. Prostaglandin E2 is pro-inflammatory. All three are required for adequate cholesterol synthesis. Because of multiple enzyme cofactor deficits, we are notoriously poor at converting omega 6 fatty has to into prostaglandins E1 and omega-3 fatty acids into prostaglandin E3. In fact this is one of the reasons why I usually encourage my patients who want to supplement prostaglandin E3 that they not try to do it with flaxseed oil, but rather that they take a good form of fish oil since DHA from fish oil is only one step off the prostaglandin E3. The following graphic is a picture of synthesizing prostaglandins from the essential acids. After running hundreds of PathMAP profiles, we found that is highly unusual for someone to not have one or more cofactors missing in the enzymes that convert essential fatty acids to prostaglandins, virtually assuring dysfunction in this part of the system.  Cholesterol.Once we get past the process of prostaglandin synthesis, we move on to the process of producing cholesterol. Making cholesterol is actually a pretty complicated process and we are not going to go into it in-depth here. However it is worth noting that, much different from being the villain that cholesterol has been painted as in much of the medical literature over the last 25 years since the development of statin drugs, cholesterol is one of the most valuable building blocks in our body. Without it, we would cease to exist rather shortly.We rely on cholesterol for several truly essential 'repair and regeneration systems' throughout our body. Some of these include:·         Bile production.·         Bi-lipid membrane production and repair.·         Vascular endothelial repair secondary to free radical damage.·         Myelin production and repair.·         Pregnenolone production for synthesis of mineralo-steroids glucocortico-steroids and sex hormones.We are going to focus on the last of these, the synthesis and metabolism of aldosterone, cortisol, and sex hormones.        PregnenoloneIt all begins with pregnenolone.Cholesterol is converted into pregnenolone by a CP 450 enzyme which depends on niacinamide, iron, sulfur, and oxygen. Pregnenolone is the precursor for aldosterone, cortisol, and the sex hormones. Specifically pregnenolone is metabolized either into progesterone or into hydroxy-pregnenolone by enzymes that depend on niacinamide and iron. Aldosterone.Pregnenolone is converted into progesterone and then, through a couple more steps, is turned into aldosterone. Aldosterone regulates our blood pressure through a number of mechanisms. The three primary systems involved are 1) hydration: aldosterone recycles our body's water; 2) regulating the sodium potassium pump, recycling sodium and discarding the right amount of potassium; and 3) regulating our plasma pH. Since these functions are truly essential to sustain life as we know it, aldosterone gets to make its claim on pregnenolone and progesterone, even before the fight or flight mechanism. Cortisol.If we have enough pregnenolone and progesterone left after making aldosterone, then the next part of survival involves making cortisol. Cortisol is produced and released in response to inflammation, immune system challenges, blood sugar dysregulation, and other existential threats (emotional, thermal, etc.). Basically cortisol regulates virtually all of our autonomic functions and the elasticity of our ligaments. We make cortisol by hydroxylating pregnenolone and progesterone and then converting those products to glucocorticosteroid a/k/a cortisol. Sex hormones.If we have enough pregnenolone and progesterone after we first make enough aldosterone, then make enough cortisol, and we have enough zinc, then we will convert the hydroxy-pregnenolone and hydroxy- progesterone into sex steroids beginning with DHEA and androstenedione, which are then converted into testosterone and the estrogens.While DHEA, testosterone, and estrogen are primarily considered as reproductive hormones, they're also intricately related to neurotransmitter and receptor functions throughout the body.Imbalances, deficiencies, or excesses of hormones should be viewed as evidence of a problem in the preceding pathways that synthesize or the following pathways that metabolize estrogen excesses. Androgen and estrogen excesses can especially be seen as failures in the CP 450 Phase II detox pathways  which are responsible for recycling them.Putting it all together:Bring More Wealth Into Your Life And Your Practice.1.      Welcome the complex and chronic patients who no one else knows what to do with or want to be bothered with.2.      Identify the underlying causes of their problems.3.      Treat them at their core, level and help them get well when no one else has been able to.4.      Enjoy your patients referrals and invite your colleagues to send you the difficult cases.Identify the underlying causes of their problems.The PathMAP Profile can show you where and why these patients pathways are blocked or breaking down and how to get them working properly.Treat what you find.PathMAP will give you the recommendations you need to treat your patients effectively.If you would like us to, we can also guide you to sources that will help you treat them quickly and easily.Taking the PathMAP test.AssessmentThere is enough detailed information in the PathMAP report to enlighten even the most seasoned functional medicine professional.The recommendations are also easy enough to understand and follow so that is clear and accessible for even the newest practitioner.There are a number of ways that you can proceed therapeutically:1.      use the same clinical nutrition regimens which you developed over the years.2.      Use non-nutrient regimens which are within your scope of practice.3.      Use a nutrient powder custom blended to your patient's lab results.Custom blended supplements.Using the third approach, your patient can take all of the necessary nutrients from about a tablespoon a day of custom blended nutrient powder mixed in water or juice instead of taking 12 or 15 different supplements.This case patients money and aggravation, increases their compliance, and greatly simplifies your life. Is there practitioner. It also makes you look even more brilliant in their eyes and make you some money.Retesting.Whichever treatment program you prefer, use it with your patients for about three months based on their lab findings and then retest to see what is working and what needs further attention or change.It is not unusual to get one system up and running again only to have a related system challenged by competitive utilization of the cofactors sometimes a cofactor which was not deficient to begin with will be after a few months of use. Serial testing will uncover and allow you to treat this.PathMAP can create unrivaled patient loyalty !PathMAP makes YOU the source.·         Patients get their test kits from You·         Patients get their test results from You.·         Patients get their custom blended supplements from You (not from the Internet or GNC)·         When PathMAP helps you solve their problems that no one else has been able to figure out, patients give You the credit for being brilliant.·         And they refer their friends and family to You.Bottom Line:By providing a turnkey system with.·         Simple, urine-based tests.·         Clear, concise analysis.·         Unambiguous treatment recommendations.·         Easy, foolproof, affordable, custom blended supplements.It is as easy. Newest associate serve their patients' functional medicine needs with confidence and expertise as it is for the most seasoned doctors among us. You look good, they look good, your patients get great care, you make more money, and your practice and reputation benefit.PathMAP gives you the three tools your practice needs to excel in today's market.1.      Systems that create information, save time, and simplify complex tasks.2.      Leveraging your time and money.3.      Perception that you have something special to offer the patients want/need and cannot get somewhere else.Where do we go from here?You get to have more fun and make more money in practice when you...·         Get more complicated patients well faster.·         Get more referrals and see more patients.·         Get better compliance from everyone you see.·         Increase your reputation and reach.·         Have more time and energy left at the end of your day to do what you worked so hard for.·         Bring the fun back into your practice. Start using the PathMAP test...·         Use PathMAP for your patients with complicated symptoms or diagnostic patterns.·         Use PathMAP for your chronic patients who haven't gotten all the way better despite your best efforts.·         Use PathMAP for your wellness patients who want to be is healthy and whole as they possibly can.·         Use PathMAP for your patience who are facing or been on long-term or heavy-duty drug therapies that are likely to deplete the cofactors... Chemo and radiation; anxiety seizure or psychiatric meds; Bio-identical or conventional hormones; antihistamines, pain killers, statins, or NSAIDs.·         Use PathMAP to improve the healing curve and outcomes for anyone getting ready for surgery Thank you, Dr. Jim Blumenthal, DC, DACBN, DCBCN, FACFNTo order PathMAP Profile test kitsContact us using the above information. We will send you some test kits to start and an account application to confirm that you are a healthcare provider and allow you to order tests for your patientsNeuroHealth Diagnostics, Inc2990 S. Sepulveda Boulevard, Suite 203Los Angeles, CA 90064-3973Toll free: 866-554-5559Phone: 310-445-3350Fax line: 310-445-3351Website: www.NeuroHealthDx.comemail: DrBlu@NeuroHealthDx.comUse me as a ResourceIf you have any questions, please drop me, Dr. Jim Blumenthal, a line at the address above or call me at 310-445-3350. These are also the address and phone numbers for my clinic, Brain Performance Center at theApplied Kinesiology Center of Los Angeleswww.AKCLA.comIf you are NOT a healthcare provider and would like to have a PathMAP Profile runFirst, ask you primary care provider. They already know you best and we will be happy to help them provide you with the test kit, we will walk them through understanding and explaining your test results, and we will guide them toward sources that they can use to fulfill your needs for cofactors and substrates.If your primary care provider is not willing to help you run the PathMAP, then please call us or go on our website, fill out the request form, and we will help you find a doctor who is near you who can and will help you run the test.A Few References for the three urine tests that make up the PathMAP Profile:Organic Acids Testing8-hydroxy-2'-deoxyguanosine (8-OHdG): A critical biomarker of oxidative stress and carcinogenesis.Valavanidis A, Vlachogianni T, Fiotakis C. Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2009 Apr;27(2):120-39.Riboflavin-responsive glutaric aciduria type II with recurrent pancreatitis.Liang WC, Tsai KB, Lai CL, Chen LH, Jong YJ Pediatr Neurol. 2004 Sep;31(3):218-21.Use of fasting urinary methylmalonic acid to screen for metabolic vitamin B12 deficiency in older persons.Kwok T, Cheng G, Lai WK, Poon P, Woo J, Pang CP. Nutrition. 2004 Sep;20(9):764-8.Metabonomics approach to understanding acute and chronic stress in rat models.Wang X, Zhao T, Qiu Y, Su M, Jiang T, Zhou M, Zhao A, Jia W. J Proteome Res. 2009 May;8(5):2511-8.Glutaric aciduria type I and kynurenine pathway metabolites: a modified hypothesis.Varadkar S, Surtees R. J Inherit Metab Dis. 2004;27(6):835-42.Clinical applications of urinary organic acids. Part I: Detoxification markers.Lord RS, Bralley JA. Altern Med Rev. 2008 Sep;13(3):205-15.Clinical applications of urinary organic acids. Part 2. Dysbiosis markers.Lord RS, Bralley JAAltern Med Rev. 2008 Dec;13(4):292-306.Urinary and faecal excretion of metabolites of tyrosine and phenylalanine in a patient with cystic fibrosis and severely impaired amino acid absorption.Van der Heiden C, Wadman SK, Ketting D, et al. Clin Chim Acta. 1971;31(1):133-141.Metabolic acidosis due to D-lactate.Mason PD: Br Med J (Clin Res Ed) 1986, 292(6528):1105-1106.D-arabinitol--a marker for invasive candidiasis.Christensson B, Sigmundsdottir G, Larsson L. Med Mycol 1999, 37(6):391-396.Review article: serotonin receptors and transporters -- roles in normal and abnormal gastrointestinal motility.Gershon MD. Aliment Pharmacol Ther. Nov 2004;20 Suppl 7:3-14.Mitochondrial Dysfunction and Disease.Neustadt J, Integrative Medicine. 2006 June/July 5(3): p.14-20.How to Assess Patient Biochemical and Nutritional Individuality through Organic Acid Testing.Burdette, Cheryl K., Townsend Letter for Doctors and Patients. 2006.Urinary Markers of Intestinal Yeast.Lord RS, Townsend Letter for Doctors. 2003. December (245): p. 96-97Urinary Markers of Yeast Overgrowth.Lord RS, Burdette C, and Bralley JA, Integrative Medicine. 2004. 3(5): p. 24-29.Autistic therapies focused by laboratory data. Part I: Organic Acids.Lord RS, Nutrition Practitioner. 2005. 6(3): p. 1-7.Occupational and lifestyle factors and urinary 8-hydroxydeoxyguanosine.Irie M., Tamae K., Iwamoto-Tanaka N., Kasai, H. Cancer Sci, 2005 Sep; 96(9):600-6.Urine methylmalonic acid measurements for the assessment of cobalamin deficiency related to neuropsychiatric disorders.Gültepe M, Ozcan O, Avşar K, Cetin M, Ozdemir AS, Gök M. Clin Biochem. 2003 Jun;36(4):275-82.3-Hydroxypropionic Acid and Methylcitric Acid Are Not Reliable Indicators of Marginal Biotin Deficiency in HumansDonald M Mock, Cindy L Henrich-Shell, Nadine Carnell, Phyllis Stumbo, Nell I Mock. The Journal of Nutrition. Bethesda:Feb 2004. Vol. 134, Iss. 2; pg. 317, 4 pgsEffects of arginine treatment on nutrition, growth and urea cycle function in seven Japanese boys with late-onset ornithine transcarbamylase deficiency.Nagasaka H, Yorifuji T, Murayama K, Kubota M, Kurokawa K, Murakami T, Kanazawa M, Takatani T, Ogawa A, Ogawa E, Yamamoto S, Adachi M, Kobayashi K, Takayanagi M. Eur J Pediatr. 2006 Sep;165(9):618-24. Epub 2006 May 16.Neopterin and quinolinic acid are surrogate measures of disease activity in the juvenile idiopathic inflammatory myopathies.Rider LG, Schiffenbauer AS, Zito M, Lim KL, Ahmed A, Zemel LS, Rennebohm RM, Passo MH, Summers RM, Hicks JE, Lachenbruch PA, Heyes MP, Miller FW; Clin Chem. 2002. Oct;48(10):1681-8.Catecholamine metabolism: a contemporary view with implications for physiology and medicine.Eisenhofer G, Kopin IJ, Goldstein DS. Pharmacol Rev. 2004 Sep;56(3):331-49.Rate of arabinitol production by pathogenic yeast species.Bernard EM, Christiansen KJ, Tsang SF, Kiehn TE, Armstrong D. J Clin Microbiol 1981, 14(2):189-194.Comparison of antibody, antigen, and metabolite assays for hospitalized patients with disseminated or peripheral candidiasis.Bougnoux ME, Hill C, Moissenet D, Feuilhade de Chauvin M, Bonnay M, Vicens-Sprauel I, Pietri F, McNeil M, Kaufman L, Dupouy-Camet J et al. J Clin Microbiol 1990, 28(5):905-909.Severe illness caused by the products of bacterial metabolism in a child with a short gut.Haan E, Brown G, Bankier A, Mitchell D, Hunt S, Blakey J, Barnes G. Eur J Pediatr 1985, 144(1):63-65.D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms.Uribarri J, Oh MS, Carroll HJ. Medicine (Baltimore) 1998, 77(2):73-82.Human fecal water content of phenolics: the extent of colonic exposure to aromatic compounds.Jenner AM, Rafter J, Halliwell B. Free Radic Biol Med. 2005;38(6):763-772.Host-bacterial mutualism in the human intestine.Backhed F, Ley RE, Sonnenburg JL, et al. Science. 2005;307(5717):1915-1920.Production of amines by bacteria: The decarboxylation of amino-acids by organisms of the groups Clostridium and Proteus With an addendum by Brown, GL.Gale EF.,  MacIntosh, FC,  and White, PB. Biochem J. 1941;35(1-2):66-80.The origin of urinary aromatic compounds excreted by ruminants. 1. The metabolism of quinic, cyclohexanecarboxylic and non-phenolic aromatic acids to benzoic acid.Martin AK. Br J Nutr. 1982;47(1):139-154.Chocolate intake increases urinary excretion of polyphenol-derived phenolic acids in healthy human subjects.Rios LY, Gonthier MP, Remesy C, et al. Am J Clin Nutr. 2003;77(4):912-918.Urinary metabolites of caffeic and chlorogenic acids.Booth AN, Emerson OH, Jones FT, et al. J Biol Chem. 1957:51-59.Hippuric acid as a major excretion product associated with black tea consumption.Clifford MN, Copeland EL, Bloxsidge JP, et al. Xenobiotica. 2000;30(3):317-326.Supplementation with grape seed polyphenols results in increased urinary excretion of 3-hydroxyphenylpropionic Acid, an important metabolite of proanthocyanidins in humans.Ward NC, Croft KD, Puddey IB, et al. J Agric Food Chem. 2004;52(17):5545-5549.Conjugation of benzoic acid with glycine in human liver and kidney: a study on the interindividual variability.Temellini A, Mogavero S, Giulianotti PC, et al. Xenobiotica. 1993;23(12):1427-1433.Production of p-hydroxyhydrocinnamic acid from tyrosine by Peptostreptococcus anaerobius.Lambert MA, Moss CW. J Clin Microbiol. 1980;12(2):291-293.Activity of intestinal microflora in adult coeliac disease.Tamm AO. Biochemical Nahrung. 1984;28(6-7):711-715.Weiner, Debra L. Pediatrics, Inborn Errors of Metabolism. E Medicine 2 Aug. 2001. 2 Jul. 2004Ames, B., Elson-Schwab, I., Silver, E. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms. Am J Clin Nutr 2002;75:616-58.Miller, J., et al. Transcobalamin II 775G>C polymorphism and indices of vitamin B12 status in healthy older adults. Blood 2002;100:718-720.Liebich HM. Gas chromatographic profiling of ketone bodies and organic acids in diabetes. J Chromatogr. 20 (379): 347-66, 1986.Chalmers R., Lawson, A., Organic acids in man. Chapman & Hall, London, 1982.Cyr, D., et al. Stability of HVA and VMA on filter paper. Early Human Development 1997;49:149-152.Duez, P., Kumps, A., Mardens, Y., GC/MS profiling of urinary organic acids evaluated as a quantitative method. Clin. Chem. 1996;42:1609-1615.Fu, X., Iga, M., Kimura, M., Yamaguchi, S., Simplified screening for organic academia using GC/MS and dried urine filter paper: a study on neonatal mass screening. Early Human Development 2000;58:41-55.Fu, X., Kimura, A., Iga, M., Yamaguchi, S., Gas chromatographic-mass spectrometric screening for organic acidemias using dried filter paper: determination of alpha-ketoacids. J. Chromatography B Biomed Science Applications 2001;758:87-94.Greter, J., Jacobson, C., Urinary organic acids: isolation and quantification for routine metabolic screening. Clin. Chem. 1987;33:473-480.Hoffman, G., et al. Quantitative analysis of organic acids in biological samples: batch isolation followed by gas chromatographic-mass spectrometric analysis. Clin. Chem. 1989;35:587-595.Kuhara, T., Diagnosis of inborn errors of metabolism using filter paper urine, urease treatment, isotope dilution and gas chromatography-mass spectrometry. J. 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Med Hypotheses 2002; 59(6): 757-8.Minerals/Elements TestingAssociation between urinary potassium, urinary sodium, current diet, and bone density in prepubertal children.Jones G, Riley MD, Whiting S. Am J Clin Nutr. 2001;73(4):839-844.Tissue zinc levels and zinc excretion during experimental zinc depletion in young men.Baer MT, King JC. Am J Clin Nutr. 1984;39(4):556-570.Occupational Mn parkinsonism: magnetic resonance imaging and clinical patterns following CaNa2-EDTA chelation.[In Process Citation].Discalzi G, Pira E, Hernandez EH, et al. Neurotoxicology. 2000;21(5):863-866.Provocative chelation with DMSA and EDTA: evidence for differential access to lead storage sites.Lee BK, Schwartz BS, Stewart W, et al. Occup Environ Med. 1995;52(1):13-19.Chemical forms of selenium for cancer prevention.Abdulah R, Miyazaki K, Nakazawa M, et al. J Trace Elem Med Biol. 2005;19(2-3):141-150.Recent advances in the nutritional biochemistry of trivalent chromium.Vincent JB. Proc Nutr Soc. 2004;63(1):41-47.Levels of Calcium, Magnesium and Zinc in Urine among Adult Women in Relation to Age with Special Reference to Menopause.Ikeda M, Ezaki T, Moriguchi J. J Nutr Health Aging. 2007 Sep-Oct;11(5):394-401.Moderate magnesium deprivation results in calcium retention and altered potassium and phosphorus excretion by postmenopausal women.Nielsen FH, Milne DB, Gallagher S, Johnson L, Hoverson B. Magnes Res. 2007 Mar;20(1):19-31.  Dr. James P. Blumenthal DC, DACBN, DCBCN, FACFNClinician, Lecturer, Diagnostic Laboratory Director Dr. Blumenthal graduated from Washington University in St. Louis in 1980 and Logan College of Chiropractic in 1993 before moving to Los Angeles to sail, surf, and practice. He has earned Diplomate status from the American Clinical Board of Nutrition and the Chiropractic Board of Clinical Nutrition, the Certified Clinical Nutritionist credential from the International and American Associations of Clinical Nutrition, and Fellow status from the American College of Functional Neurology. Dr. Blumenthal is the founder and chief executive officer of NeuroHealth Diagnostics, Inc.(www.NeuroHealthDx.com), a clinical laboratory dedicated to helping functional medicine doctors understand imbalances in their patients metabolic control systems, and director of the Brain Performance Center and the Applied Kinesiology Center of Los Angeles (www.akcsm.com) where he specializes in the natural treatment of Autistic Spectrum, seizure, and other chronic/complex metabolic and neurological disorders. In addition to several publications, including serving as editor of the Applied Kinesiology Review for the International College of Applied Kinesiology-US from 1996-2000, he lectures nationally and serves as a member of the postdoctoral and continuing education faculties for the ACA Council on Diagnosis and Internal Disorders, several chiropractic colleges, oriental medicine, nursing, and naturopathic boards.He can be reached by phone at 310-445-3350, by “snail mail” at 2990 S. Sepulveda Blvd., Suite 203, Los Angeles, CA 90064-3973, and email at DrBlu@NeuroHealthDx.com .