Optimal Result:
2411.2 - 5047.8 mcg/g.
Vanilmandelate (also known as VMA) is the primary metabolite of norepinephrine and epinephrine (adrenaline). Epinephrine is also called adrenaline, and norepinephrine is also called noradrenaline. They are responsible for the “fight or flight” sensations we experience during periods of stress and anxiety. They are produced in by the nervous system and the adrenal medulla.
Epinephrine and norepinephrine are broken down to VMA (vanilmandelate) by the enzymes MAO and COMT. Vanilmandelate is then excreted in the urine. It can be used as an indirect measure of epinephrine/norepinephrine levels. The adrenal gland makes cortisol and DHEA as well as norepinephrine and epinephrine. When adrenal hormone output is generally low, VMA levels may be low.
Norepinephrine/Epinephrine are made in the brain and in the adrenal medulla.
- Stored in pre-synaptic vesicles to be released immediately on need
- There is no negative feedback loop
- Norepinephrine/Epinephrine cannot cross into or out of the brain
Primary action in the brain or the peripheral tissues is to prepare for fight/flight.
- Brain: alertness, attention, anxiety, vigilance, restlessness
- Periphery: higher blood pressure and heart rate, increases glucose release (via glycogenolysis), diverts blood flow from GI tract to skeletal muscles
It’s lowest levels are in the night and highest levels in the morning unless stimulated.
Norepinephrine/Epinephrine Metabolite, can also reflect genetic mutations and nutrition, neurotransmitter and adrenal problems.
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Vanillylmandelic acid (VMA) can be used to detect neuroblastoma and other tumors of neural crest origin.
References:
- https://www.ncbi.nlm.nih.gov/pubmed/3998066
- https://www.ncbi.nlm.nih.gov/pubmed/15125800
- https://www.ncbi.nlm.nih.gov/pubmed/12834431
- https://www.ncbi.nlm.nih.gov/pubmed/12909458
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821201/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1728136/
- https://www.ncbi.nlm.nih.gov/pubmed/24094641
- https://www.ncbi.nlm.nih.gov/pubmed/16142213
- https://www.ncbi.nlm.nih.gov/pubmed/28757337
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824171/
- https://www.ncbi.nlm.nih.gov/pubmed/12827641
- https://www.ncbi.nlm.nih.gov/pubmed/6723203
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277743/
- https://www.ncbi.nlm.nih.gov/pubmed/11903030
- https://www.ncbi.nlm.nih.gov/pubmed/4925832
- https://www.ncbi.nlm.nih.gov/pubmed/15666839
- https://link.springer.com/chapter/10.1007/978-1-4471-6539-2_5
- https://www.ncbi.nlm.nih.gov/pubmed/15018454
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1459119/
Conditions associated with elevations in urinary vanillylmandelic acid (VMA) include the following:
- Severe anxiety/stress
- Neuroblastoma (a disease in which malignant (cancer) cells form in neuroblasts (immature nerve tissue) in the adrenal glands, neck, chest, or spinal cord.)
- Pheochromocytoma (a rare, usually noncancerous (benign) tumor that develops in an adrenal gland.)
- Other neural crest tumors (eg, ganglioblastoma, ganglioneuroma)
Elevated metabolic by-products of catecholamines—dihydroxyphenylalanine (DOPA), dopamine, norepinephrine, and epinephrine—can be detected in the urine of patients with neuroblastoma and other tumors of neural crest origin. DOPA and dopamine are metabolized into their final product, homovanillic acid (HVA), while norepinephrine and epinephrine are metabolized into vanillylmandelic acid (VMA).
The biochemical pathway is as follows:
- DOPA
- Dopamine
- Norepinephrine → Normetanephrine → VMA and 3-methoxyphenylethyleneglcol (MHPG)
- Epinephrine → Metanephrine → VMA and 3-methoxyphenylethyleneglcol (MHPG)
Ninety percent of neuroblastoma tumors secrete these by-products. Children with dedifferentiated tumors tend to excrete higher levels of HVA than vanillylmandelic acid because these tumors have lost the final enzymatic pathway that converts HVA to vanillylmandelic acid. A low ratio of vanillylmandelic acid to HVA is consistent with a poorly differentiated tumor and indicates a poor prognosis.
In the evaluation of pheochromocytoma, vanillylmandelic acid is now considered the least-specific test for catecholamine metabolites, with a false-positive rate greater than 15%. Measurement of metanephrine, an intermediate metabolite between epinephrine and vanillylmandelic acid, is now considered the most sensitive and specific test for pheochromocytoma. Besides plasma free metanephrines and urine metanephrines, urine or plasma catecholamine tests are also preferred over vanillylmandelic acid testing.
Considerations:
Foods that can increase urinary catecholamines include the following:
Coffee, Tea, Bananas, Chocolate, Cocoa, Citrus fruits, Vanilla
Drugs that can increase urinary vanillylmandelic acid include the following:
Appetite suppressants, Caffeine, Histamine, Imipramine, Insulin, Epinephrine, Levodopa, Lithium, Morphine, Nitroglycerin, Rauwolfia alkaloids, Isoproterenol, Methocarbamol, Sulfonamide, Chlorpromazine
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If Homovanillate (HVA) is low at the same time:
In this case, checking the adrenal glands would be a good idea. Is the HPA axis overactive? Are cortisol levels too high, pushing epinephrine levels up? (and therefore increasing VMA levels)
Other potential causes:
Are you on stimulant medications?
- Amphetamines
- Amphetamine-like meds
- Appetite suppressants like phentermine
- Caffeine (pills or drinks)
- Ephedrine (Sudafed)
- ADHD meds
Are you on dopamine reuptake inhibitors? (risperidone)
Possible tumor of the adrenal medulla? (Pheochromocytoma)
Higher risk for myocardial injury/ dysfunction with elevated cardiac troponin I (Consider age and CVD risk).
If Homovanillate (HVA) is high at the same time:
Possible reasons for a high HVA and high VMA include:
- COMT or MAO mutations that increase dopamine, epinephrine, or norepinephrine levels.
- High levels of or taking Tyrosine, DLPA, Dopamine and/or Macuna supplements (= dopamine precursors)
- Non-selective alpha-blockers for blood pressure (phenoxybenzamine) can increase norepinephrine levels.
- SNRI Medication (Wellbutrin), Tricyclic Antidepressants (amitriptyline)
- Amphetamines/Amphetamine-like medications or drugs, Appetite suppressants (Phentermine), Caffeine (pills or drinks), Ephedrine (ie. Sudafed)
- Parkinson’s medications (Levodopa, carbidopa) will increase dopamine, epinephrine and norepinephrine synthesis.
- Opioids (VMA may be normal)
- Alcohol consumption (increases dopamine, epinephrine, and norepinephrine levels.
- Elevated adrenal output (i.e. cortisol) address the stress
- Inflammation - inflammatory cytokines increase sympathetic output
- Neuroblastic Tumor
- Pheochromocytoma (very high levels of VMA, maybe HVA). Usually also linked to high blood pressure and excessive sweating.
- Neuroblastoma (cancer of the nervous system, often occurs in the adrenal glands).
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Low levels of norepinephrine and epinephrine may be associated with addictions, cravings, fatigue, low blood pressure, low muscle tone, intolerance to exercise, depression, loss of alertness.
The enzymes COMT (methylation) and MAOA are needed to make VMA from norepinephrine. If these enzymes are not working properly, VMA may be low when circulating norepinephrine and/or epinephrine are not low.
If Homovanillate (HVA) is low at the same time:
This suggests that dopamine, norepinephrine, and epinephrine levels are low.
It’s important to look at the cofactors for all of the involved reactions. Could they be low?
- Iron / BH4 / Vitamin B6 / Vitamin B2 / Magnesium / SAMe / Niacin (NAD) / Copper / Vitamin C
- Could there be MAO or COMT mutations that slow down these pathways?
- Low Tyrosine (ie. low protein diet or poor protein absorption)?
- Are your cortisol levels too low? Is your HPA axis “fatigued”?
- Oxidative stress (pushing PEA down other pathways)?
- Fungal/candida infections inhibit Tyrosinase activity (cannot make L-Dopa)
- Glyphosate blocking the Shikamate pathway and depleting/binding co-nutrients (ie. Tyrosine and Tryptophan)?
- Tetrahydrocannabinol (THC) long term use? Possibly suppressive?
If Homovanillate (HVA) is high at the same time:
If dopamine is HIGH and epinephrine/norepinephrine are low or normal, there may be an issue in the conversion of dopamine to norepinephrine.
Cofactors required for the conversion of dopamine to norepinephrine:
- Copper
- Vitamin C
Low copper or vitamin C so DBH enzyme can’t move forward (VMA usually quite low)
- Clostridia difficile (inhibits DBH enzyme so cannlt make VMA)
- Bananas (contain high levels dopamine that doesn’t cross BBB – VMA likely normal)
- Quercetin supplements/foods – turn into HVA in the gut and can show up as artificial high HVA and normal VMA
- Check adrenals – low levels of cortisol too? Then VMA is usually low.
- Tetrahydrocannabinol (THC) use – short term use raises dopamine (VMA may be normal)
- Opioids (VMA may be normal)
- DBH enzyme deficiency (VMA very low) = orthostatic hypotension, exercise intolerance, ptosis of eyelid, psychological/behavior disorders
- Neuroblastic tumor (if HVA are at very high levels)
- Eating a diet super rich in polyphenols (tomatoes, onions, tea) could raise HVA levels in some people.
- Did you eat velvet beans recently? They contain L-dopa and can raise dopamine levels.
Laboratories
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Our database covers over 10,000 biomarkers with clear, simple explanations—so you can finally understand your results and what to do next.
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Enter Your Lab Reports — Always Free
If you'd like to handle inputting your health data into your account, you can do so with our easy-to-use data entry forms. Our user-friendly form is designed to guide you through the quick and easy submission process, making it simple to keep track of your health metrics. This is available to both Complete plan and Unlimited plan members.
Our user-friendly form guides you through a quick, simple submission process, making it easy to enter your health metrics.
Add your results anytime with our easy entry form. It's quick, guided, and helps you stay organized — free for all members.
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View your lab data through easy-to-read graphs and tables. Quickly spot patterns, track changes, and compare results across different dates — all without digging through multiple reports. You can also select and compare graphs of specific biomarkers side-by-side to better understand how they relate and change over time.
See your lab reports in clear graphs and tables. Spot patterns, track changes, and compare results over time — all in one place.
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Export Your Complete Lab History
After collecting lab results from different providers, you can download your entire history combined into a single file. Choose from PDF, Excel, or CSV formats to easily review, share, or get a second opinion—no more juggling multiple reports.
After collecting lab results from different providers, you can download your entire history combined into a single file.
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Data Entry Service for Your Reports
Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest. Complete plan members receive one report entered for free, then $15 per report after that. Unlimited plan members receive ten report entries for free, then $15 per report after that.
Our inclusive service handles the data entry for your lab reports. Just submit your information and we'll take care of the rest.
Securely Share With Anyone You Trust
Whether you're working with a doctor, nutritionist, caregiver, or wellness coach, you can securely share your complete lab history by sending an invite link to anyone you trust. You have full control over who sees your information and for how long, ensuring your privacy and peace of mind at every step.
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Healthmatters is a personal health dashboard that helps you organize and understand your lab results. It collects and displays your medical test data from any lab in one secure, easy-to-use platform.
With a Healthmatters account, you can:
Professionals can also analyze client data more efficiently and save time managing lab reports.
Healthmatters.io personal account provides in-depth research on 4000+ biomarkers, including information and suggestions for test panels such as, but not limited to:
You can combine all test reports inside your Healthmatters account and keep them in one place. It gives you an excellent overview of all your health data. Once you retest, you can add new results and compare them.
If you are still determining whether Healthmatters support your lab results, the rule is that if you can test it, you can upload it to Healthmatters.
While we work with many popular labs, we welcome reports from lots of other places too.
It's as simple as this: if you can get a test done, you can upload it to Healthmatters and we can interpret results from any lab out there. If laboratories can analyze it, we can interpret it.
If you're on the hunt for a specific biomarker, contact us and we'll add it to our database. Anything from blood, urine, saliva, or stool can be uploaded, understood, and tracked with your Healthmatters account.
The Complete Plan ($15/month) is perfect for individuals who want ongoing access to their health data. It includes unlimited lab imports, visual tracking, custom ranges, result explanations, full account exports, and secure sharing — all with a simple monthly subscription. You can cancel anytime and restart your plan whenever you're ready — your data will still be there waiting for you. You can also upgrade to the Unlimited Plan at any time, with the cost prorated based on what you've already paid.
The Unlimited Plan ($250 one-time) is also designed for individuals but offers lifetime access with no ongoing subscription. You'll get all the same features as the Complete Plan, plus a larger initial data entry allowance (10 reports), making it a great choice if you prefer a one-time payment and long-term use without monthly fees.
In short:
There are two ways to add your test reports to your Healthmatters account. One option is to input the data using the data entry forms. The other method is to utilize our "Data entry service."
Our data entry forms offer an easy, fast, and free way for you to input the reports yourself. Self-entry allows you to add an unlimited number of reports at no cost. We make the self-entry process user-friendly, providing dozens of templates that pre-populate the most popular laboratory panels and offering instant feedback on entered values.
For those who prefer assistance, we offer a "Data entry service" to help you input your data. Simply attach an image or file of your lab test results, and a qualified team member from our data entry team will add the results for you.
We support various file types, including PDFs, JPGs, or Excel. This service is particularly useful if you have many reports to upload or if you're too busy to handle the data entry yourself.
Our Data Entry Service is for when you don't want to manually type in your lab results yourself. You simply upload your report (PDF, image, or screenshot), and our trained team enters the information into your Healthmatters account for you — accurately and neatly organized, ready to view in graphs, tables, and timelines.
The $15 per report covers the time and care it takes for a real person to review your file, make sure each result is entered correctly, and double-check for accuracy. This ensures your health data is precise and easy to work with — without you having to spend the time doing it yourself.
Prefer to do it yourself? You can always use our free self-entry tool to add results manually — it just takes a bit more time and attention.
For users on the Complete monthly plan, the first report is entered free of charge, and each additional report incurs a fee of $15.
Unlimited account holders enjoy the entry of ten reports without charge. Subsequent reports are subject to a $15 fee per report.
Additionally, users on the Complete plan can upgrade to a yearly subscription from the account settings. The annual subscription includes a data entry service for five reports.
All professional accounts allow you to import and onboard an unlimited number of clients and their lab results. The distinction between professional plans lies solely in the data entry service.
The Pro Monthly Plus plan is priced at $75 per month and includes a data entry service for five reports each month. Additional reports can be self-entered at no extra cost or, if preferred, you can use our data entry service for an additional fee of $15 per report.
The Pro Monthly plan is priced at $45 per month and does not include a data entry service. Self-entry is free for an unlimited number of reports, and you can opt for the data entry service at a fee of $15 per report.
You also have the option to upgrade to higher monthly or to annual plans, which come with substantial discounts. All upgrades can be done directly from your account.
Simply log in and navigate to your account settings to cancel your subscription. Scroll down to locate the 'Cancel' button at the bottom of the page. Ensure you cancel at least one day before the renewal date to prevent any charges. Once cancellation is requested, the subscription remains active until the conclusion of the current billing cycle.
Our goal has been to make your Healthmatters account as intuitive as possible.
We've crafted multiple ways for you to navigate your data, whether you're glancing at a single report or delving into your historical test reports.
1. Graph View:Dive into a visual journey with our biomarker graphs, showcasing over 40 data points. Combining years of results unveils trends, empowering you to make informed decisions. Our visualization tools make it a breeze to compare and understand changes over time, even if your results are from different labs. A search function and filters simplify the exploration of extensive data, allowing you to focus on what needs attention.
2. All Tests ViewExplore neatly organized reports on a timeline, highlighting crucial details like dates, critical results, and lab/panel names. Each report opens up to reveal in-depth descriptions and additional recommendations for each biomarker. The history of previous results is just a click away, and you can download a comprehensive report for deeper insights. Color-coded and user-friendly, it's designed for easy reading, understanding, and navigation.
3. Table View:For a holistic view of all biomarkers side by side, our table view is your go-to. Results are neatly displayed in a categorized and dated table, ideal for those with an extensive test history. Utilize sorting, filters, and color-coding to enhance your analysis and gain extra insights.
Yes, you can download your information anytime. We offer two easy ways to export your lab data:
This makes it simple to save, back up, or share your health data whenever you need.
Yes, you can print your report. To do so, navigate to "All tests" and open the report you wish to print. You'll find a print button in the right corner of the report. Click on it, and your browser's print window will open. If you prefer to print in a bigger typeface, adjust the scale using the print window settings.
Yes, you can! We highly recommend activating Two-Factor Authentication (2FA) for your account. To do so, please navigate to the "Profile and Security" section of your account, where you will find instructions for activating 2FA.
Yes, you can. When entering values for the biomarker, you will see an "Edit Range" button. Click this button, and you'll have the option to enter a custom range.
A personal account is all about keeping your own lab test results in check. It's just for you and your personal use.
The professional account is designed for health professionals who wish to track and organize their clients' laboratory results.
To learn more about Healthmatters Pro, please refer to the professional page.
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