QUESTION: I have a pt CBS+ and suox + and wanted some baseline measurements and a means to monitor progress. I got a recommendation to use sulfite urine strips, but I couldn’t seem to find them. Is it acceptable to monitor urine sulfate instead?
ANSWER: Sulfite is the actual Marker. Sulfate sucks as it is post CBS and SUOX. And the SO family often rises for a time with Rx. You can get sulfite urine strips on Amazon.
QUESTION: Ok, So monitoring with sulfite stripes throughout the course of tx, is there a optimal range you found most useful to gauge dosage changes? Would i expect it to change quickly with molybdenum and other cofactor support?
ANSWER: It goes up generally for 1-4 months depending on the backlog (with Mo and B Vit support) till the system is equilibrated then it gets better. If original readings without support are high or high normal Your goal is normal. If not it’s a waste as Sx do not always match sulfite excretion… I almost never use the strips as the sensitivity is low.
QUESTION: My confusion lies in the fact that i wanted to first support cbs/suox before giving GSH or methyl supports and wanted an objective measure to know when it is time to start with supporting methylation (as there are snps there too). In a case like this, if you don’t measure sulfites, do you just give it a couple months and reassess sx and if those sx improve you move on with GSH and/or methyl donors? Right now i’m having this patient avoid methyl donors.
ANSWER: You can sure use sulfite strips and when the sulfite is normal to low normal start the methyl support / GSH. That said I’ve done this thousands of times with no sulfite strips. The only thing you need to do is watch the Sx of over methylation as well as sulfite. Methylation excess is mostly agitation / catecholamine excess; sulfite Sx are headache, itching / skin irritation and some joint pain etc. Of course IF you support methylation AND CBS is working you’ll dump more sulfite. If CBS is slow and you speed that up you’ll dump more sulfite. And, as you mention, sometimes with GSH you’ll provide more sulfite. (Contrary to popular belief Taurine is not an issue here).
As mentioned in the webinar training likely best (and IME best) is to work from the outside in, then do test doses and titrate up. In my experience this is more sensitive than even sulfite measurement. I do the following in a step wise fashion:
1- Support SUOX with 500 mcg Mo BID for 4-8 weeks. Continue that then
2- support CBS with P5P and Magnesium.
3- Continue those two and try GSH (this can be one week from starting CBS support in most folks – but start low (100-500mg test dose IV)
4- slowly add methyl support. All dose titration is in the webinar notes as well.
If you get sulfite or methyl Sx then back off on the latter steps and reinforce (or do for a longer time) the former steps for a few weeks then add Tx on again.
