High levels of vanilmandelate may occur when there are nutritional enzyme inhibitions of the breakdown pathways, inherited low-activity enzymes are present, or if there are high levels of precursors (norepinephrine, epinephrine). Although the breakdown enzymes on both sides of the blood-brain barrier are the same, over 90% of peripheral vanilmandelate comes from the liver metabolism of norepinephrine and epinephrine. Vanilmandelate may be further degraded by sulfotransferase and glucuronidase enzymes in the liver, higher levels may indicate poor detoxification capacity of sulfotransferase and glucuronidation enzymes, which can affect hormone levels; para-hydroxyphenyllactate will be increased if there is inhibition of the sulfotransferase or glucuronidase enzymes.
Increased levels of norepinephrine may indicate systemic inflammation. The herb yohimbine can increase the release of the precursor norepinephrine. A low-sodium diet may increase the excretion of vanilmandelate and 5-hydroxyindolacetate. Inherited high-activity enzyme variations can deplete the neurotransmitters required for normal neurological function and result in higher levels of breakdown products.
1. Increased levels of methylmalonate, quinolinate and pyroglutamate, with decreased levels of cis-aconitate and isocitrate, may also indicate inflammation and poor antioxidant status. Antioxidant supports may include CoQ10, alpha-lipoic acid, vitamins C and E, curcumin, resveratrol, etc. Fresh fruits and vegetables are rich in antioxidant compounds.
2. Liver disorders may also result in increased lactate, adipate, suberate, alpha-ketoisocaproate and hydroxymethylglutarate, while decreasing fumarate, malate, and alpha-ketoglutarate.
3. Low levels of norepinephrine and epinephrine, but high levels of vanilmandelate can occur if there are high-activity breakdown enzymes. Low levels of norepinephrine and epinephrine have been associated with anxiety, depression, fibromyalgia, hypoglycemia, migraines, restless leg syndrome, blood pressure problems and sleep disorders.
4. High levels of norepinephrine and epinephrine have been associated with anxiety, headaches, high blood pressure, arrhythmias, GI symptoms and epigastric pain, irritability, sweating, tremors, insomnia, and increased IgE. High levels of epinephrine have been associated with physical or psychological stress. If indicated, consider supporting the breakdown of norepinephrine and epinephrine with vitamins B2, B3, magnesium. S-adenosylmethionine (SAMe) may be appropriate if there is evidence of problems with methylation. If indicated, consider supporting phase II liver metabolism of vanilmandelate with iron, molybdenum, glycyrrhizin and calcium-D-glucarate.
Low levels of vanilmandelate may occur if there are low levels of precursors (dopamine, norepinephrine or epinephrine), if there are nutritional enzyme inhibitions, or if a low-activity enzyme variant is inherited. Dopamine is either metabolized to homovanillate or converted into norepinephrine and epinephrine. Vanilmandelate is the breakdown product of norepinephrine and epinephrine. The breakdown of peripheral epinephrine and norepinephrine occurs primarily in the liver; low levels of 5-hydroxyindolacetate and vanilmandelate may indicate the presence of a liver disorder. Digestive disorders or protein-calorie malnutrition may result in low levels of precursor essential amino acids. If appropriate, consider supporting either dopamine synthesis or dopamine breakdown into norepinephrine and epinephrine depending upon the patient’s presenting symptoms.
1. Low levels of dopamine will result in low levels of norepinephrine. Low levels of dopamine have been associated with movement disorders (Parkinson’s disease, etc.), but may also present with symptoms of depression, fatigue, poor pain tolerance, reduced sense of pleasure, low libido, cold extremities, and muscle weakness. Low levels of dopamine will likely result in low levels of homovanillate. If indicated, consider supporting dopamine synthesis with tyrosine, vitamin B6, iron (if deficient) and tetrahydrobiopterin (BH4). Oxidative stress may inhibit the conversion of tyrosine into dopamine; consider antioxidant support if indicated. Antioxidant supports may include CoQ10, alpha-lipoic acid, vitamins C and E, curcumin, resveratrol, etc. Fresh fruits and vegetables are rich in antioxidant compounds. Increased levels of methylmalonate, quinolinate and pyroglutamate, with decreased levels of cis-aconitate and isocitrate, may indicate poor antioxidant status.
2. High levels of dopamine may occur if the conversion of dopamine into norepinephrine is inhibited. High levels of dopamine have been associated with the stereotyped behaviors seen in obsessive-compulsive disorder (OCD), attention deficit disorders (ADD), impulsivity, addictive behavior, schizophrenia, and other psychiatric disorders. L-theanine and pycnogenol may be protective if dopamine levels are elevated. High levels of dopamine may, depending upon the site of enzyme inhibition, result in higher levels of homovanillate. If indicated, consider supporting the breakdown of dopamine into norepinephrine and epinephrine with vitamin C and copper. S-adenosylmethionine (SAMe) may be appropriate if there is evidence of problems with methylation.
3. Low levels of norepinephrine and epinephrine have been associated with anxiety, depression, fibromyalgia, hypoglycemia, migraines, restless leg syndrome, blood pressure problems and sleep disorders. If indicated, consider supporting either dopamine synthesis or breakdown as indicated by symptoms.
4. High levels of norepinephrine and epinephrine may occur if their breakdown into vanilmandelate is inhibited. High levels of norepinephrine and epinephrine have been associated with anxiety, headaches, high blood pressure, arrhythmias, GI symptoms and epigastric pain, irritability, sweating, tremors, insomnia, and increased IgE. High levels of epinephrine have been associated with physical or psychological stress. Consider supporting the breakdown of norepinephrine and epinephrine with vitamin B2, B3, and magnesium. S-adenosylmethionine (SAMe) may be appropriate if there is evidence of problems with methylation.
Vanilmandelate is a noradrenalin metabolite.
Nutrient association: Essential amino acids
Vanilmandelate (VMA) and Homovanillate (HVA) are breakdown products from neurotransmitters involved in hormone and nerve impulse transmission, called catecholamines.
Treatments to improve digestion, along with supplementation of tyrosine or phenylalanine, can help improve the ability to keep up with demand for these neurotransmitters.
Vanilmandelate
