High ammonia levels

[MR. BMJ]

Here are 2 interesting studies showing higher ammonia levels after ingesting BCAA's, moreso than when consuming whole proteins:

Effects of supplementation with branched chain amino acids and ornithine aspartate on plasma ammonia and central fatigue during exercise in healthy men - PubMed

Supplementation with BCAA and OA is a useful way to improve MCRT during high-intensity exercise and accelerate the elimination of ammonia at the recovery stage after exercise in healthy young men.

pubmed.ncbi.nlm.nih.gov

https://pdfs.semanticscholar.org/9177/0f6f0044c5d10a04a5eceacb53c27fcbe785.pdf?fbclid=IwAR1KhXCyGEfVB5d6JLeXSHuuDIrYhqDKZaGi2XvOvAOrj_V9EJzYnXgM9Hk

Here is also a good read from Lyle McDonald:

 

[nothuman]

I think you are over-reacting to this, especially if you are eating in a hypocaloric state, low carbs, and higher protein(?). Both your BUN and liver enzymes are normal. Higher ammonia comes with the territory I described above. Lactulose, glutamine and citrulline may/will help, but your ammonia levels will rise and fall throughout the day. Foggy headedness can be a result, but unless you have any type of liver disease, I feel you have nothing to worry about.

It's certainly not an overreaction when I can barely function or live a normal life for 2 1/2 years now. I've had to put my life on hold and take a leave at work over this. I'm not worried about dying but I can't continue to live confined to my couch all day the rest of my life in my 30s. I don't know if the high ammonia is the primary issue or if it's exclusively my thyroid. Either way, both need to be addressed until I feel like I can live a normal life again. I'm glad I found out my ammonia is high because now I understand what else is wrong with me.

 

[nothuman]

Here are 2 interesting studies showing higher ammonia levels after ingesting BCAA's, moreso than when consuming whole proteins:

Effects of supplementation with branched chain amino acids and ornithine aspartate on plasma ammonia and central fatigue during exercise in healthy men - PubMed

Supplementation with BCAA and OA is a useful way to improve MCRT during high-intensity exercise and accelerate the elimination of ammonia at the recovery stage after exercise in healthy young men.

pubmed.ncbi.nlm.nih.gov

https://pdfs.semanticscholar.org/9177/0f6f0044c5d10a04a5eceacb53c27fcbe785.pdf?fbclid=IwAR1KhXCyGEfVB5d6JLeXSHuuDIrYhqDKZaGi2XvOvAOrj_V9EJzYnXgM9Hk

Here is also a good read from Lyle McDonald:

Thanks this is a great find. I knew literally zero about ammonia so I appreciate your input

 

[MR. BMJ]

Sorry, I should have been more clear....not saying you shouldn't be concerned of your current lack of functioning, it was more meant toward over-reacting to high ammonia levels as a concern, which can effect it to some degree, but can be common and not life-threatening for those with high protein, low carbohydrate, extreme activity levels, colonic bacterial metabolism, etc. I would bet that it's not the ammonia levels making you feel that way, is what I should have been more clear on...on the over-reaction part...again, assuming you have a healthy liver. If you are low-carb, try raising them some, along with lowering protein a little, while adding in the lactulose, increased water intake, etc. If you feel the same, then it's most likely not from ammonia...though if it improves, it may have been from the ammonia. Like the one article I linked, feeling fatigued can be a complex situation. When I am low carb and high protein, I smell like windex all the time while working out, lol.

 

[nothuman]

Sorry, I should have been more clear....not saying you shouldn't be concerned of your current lack of functioning, it was more meant toward over-reacting to high ammonia levels as a concern, which can effect it to some degree, but can be common and not life-threatening for those with high protein, low carbohydrate, extreme activity levels, colonic bacterial metabolism, etc. I would bet that it's not the ammonia levels making you feel that way, is what I should have been more clear on...on the over-reaction part...again, assuming you have a healthy liver. If you are low-carb, try raising them some, along with lowering protein a little, while adding in the lactulose, increased water intake, etc. If you feel the same, then it's most likely not from ammonia...though if it improves, it may have been from the ammonia. Like the one article I linked, feeling fatigued can be a complex situation. When I am low carb and high protein, I smell like windex all the time while working out, lol.

I agree and that’s the plan I intend to follow. I know I have hypothyroid symptoms but I didn’t realize the ammonia was adding to my cognitive problems as well, which seem far worse than your average brain fog. I think I have a good plan in place to resolve both issues so I can feel great again.

My carbs actually haven’t been too low. I’m definitely dropping my protein for now until further notice.

 

[bananas007]

An ammonia level of 217 is certainly concerning. Patients, at that high of a level could potentially have altered mentation or encephalopathy. I don’t think you can completely blame 217 on a high protein diet. Do you have any tremors or “asterexis”

liver is the first thing one would look at . You can have liver problems with normal liver enzymes. People that have end stage cirrhosis often have normal liver enzymes (nothuman I don’t think you have this but I wouldn’t let normal liver function test fool
You into not pursuing further liver work what was your TBili. What was your INR? Have those been checked?

Next thing ,And this is a shot in the dark , but sometimes too much bacteria in the gut, small bowel overgrowth May cause ammonia elevation. One of the treatment for hyper ammonia , rifaxin is actually an antibiotic that works by killing gut bacteria so less ammonia gets produced. Has something to do with how they ferment or metabolize food in the gut.

after that what I can think of next is some rare genetic disease , That ur missing an enzyme that’s preventing something fromconverting. These diseases are probably harder to diagnose as most GP won’t have much knowledge.

From what I remember you take lots of supps etc. my answer to this would not be throwing massive supps, but backing off on anything you don’t absolutely need. Even green tea extract can cause cirrhosis . I am always nervous about the amount of supps, I have seen people take on here.



Lastly, are you sure it was not a lab error?? Can you have it repeated. That ammonia level is just too high for how healthy you restively are. Did they run someone else’s sample? Did it get run properly? Were there any other major deviations in the chemistry panel that would maybe point to someone else’s blood being mistakenly ran.

 

[nothuman]

An ammonia level of 217 is certainly concerning. Patients, at that high of a level could potentially have altered mentation or encephalopathy. I don’t think you can completely blame 217 on a high protein diet. Do you have any tremors or “asterexis”

liver is the first thing one would look at . You can have liver problems with normal liver enzymes. People that have end stage cirrhosis often have normal liver enzymes (nothuman I don’t think you have this but I wouldn’t let normal liver function test fool
You into not pursuing further liver work what was your TBili. What was your INR? Have those been checked?

Next thing ,And this is a shot in the dark , but sometimes too much bacteria in the gut, small bowel overgrowth May cause ammonia elevation. One of the treatment for hyper ammonia , rifaxin is actually an antibiotic that works by killing gut bacteria so less ammonia gets produced. Has something to do with how they ferment or metabolize food in the gut.

after that what I can think of next is some rare genetic disease , That ur missing an enzyme that’s preventing something fromconverting. These diseases are probably harder to diagnose as most GP won’t have much knowledge.

From what I remember you take lots of supps etc. my answer to this would not be throwing massive supps, but backing off on anything you don’t absolutely need. Even green tea extract can cause cirrhosis . I am always nervous about the amount of supps, I have seen people take on here.



Lastly, are you sure it was not a lab error?? Can you have it repeated. That ammonia level is just too high for how healthy you restively are. Did they run someone else’s sample? Did it get run properly? Were there any other major deviations in the chemistry panel that would maybe point to someone else’s blood being mistakenly ran.

I had ammonia tested one other time about a year ago and it was 72 and I was fasted then. The 217 number from 2 months ago was not fasted. I was equally symptomatic last year, however. To put it into perspective, my cognitive dysfunction is so bad that it prevents me from having any form of social life or be able to go anywhere anymore. It's that bad. Any form of exercise has been completely out of the question for almost a year now. I have had to force myself to take long walks every day as long as I can handle them.

In essence, my life has been effectively over for about a year, with the symptoms beginning 2 1/2 years ago. Whenever my girlfriend goes out, I stay home because otherwise, I am just trying to survive an outing because it's impossible to enjoy anything. Every doctor I've seen has completely failed me, sadly. I feel like I have nobody that can help. I am seeing a liver specialist for the first time Thursday so we will see if he knows what to do.

The other big issue I am also facing is my body temperature is extremely low. Usually below 96F first thing in the morning. It peaks at around 98.1 for a brief moment about 4 hours after I'm up but usually stays in the low 97s. I used different forms of T3 and armour but they only made me feel worse. I believe I overdosed on them when I was supposed to build up slowly. I have been off for almost a month and I plan to re-start at just one grain of armour and stay there for a while.

So I have two major issues that can be causing these problems. I eat an extremely nutrient dense diet, which isn't helping.

You don't feel that my GGT of 11 is enough to clear me from liver disease? Total Bilirubin was 0.8 (0.2-1.0) and Direct Bilirubin was 0.12 (0.02-0.18) if that tells you anything. I have not had INR tested.

I am getting labs re-drawn on Thursday morning for thyroid function, then I have the liver specialist that afternoon.

I strongly doubt that it's a lab error because all my other lab test results that day came back how I would have expected them.

If you have any more input that could be helpful, I'll take anything I can get.

 

[bananas007]

It is not unlikely for people to end up intubated with an ammonia level of 100-150 cause they are obtunded or comatose. So for you to have an cognitive funk at an elevated ammonia level is certainly possible.

I am glad you are seeing a liver specialist. the fact that your bilirubin is normal is also reassuring , but I have a feeling he will want some imaging .

To the best of my knowledge, thyroid and ammonia levels are not related. I think your ammonia level explains most of your symptoms. if i had to guess. now you just have to figure out why they are so high and once lowered i think you should feel better.

 

[bananas007]

fortunately you live in a city, where the best in medicine work. If possible I would also see a geneticist, if the liver checks out. Are cornell doctors covered by your insurance plan?

What all supps are you taking?

 

[bananas007]

what you mention about body temperature is pretty normal. you may be chasing a red herring there.

 

[nothuman]

It is not unlikely for people to end up intubated with an ammonia level of 100-150 cause they are obtunded or comatose. So for you to have an cognitive funk at an elevated ammonia level is certainly possible.

I am glad you are seeing a liver specialist. the fact that your bilirubin is normal is also reassuring , but I have a feeling he will want some imaging .

To the best of my knowledge, thyroid and ammonia levels are not related. I think your ammonia level explains most of your symptoms. if i had to guess. now you just have to figure out why they are so high and once lowered i think you should feel better.

fortunately you live in a city, where the best in medicine work. If possible I would also see a geneticist, if the liver checks out. Are cornell doctors covered by your insurance plan?

What all supps are you taking?

what you mention about body temperature is pretty normal. you may be chasing a red herring there.

Yes, the good about NYC is there are a lot of great hospitals. The bad is that I can't order my own blood tests without a prescription when I feel the need.

I know everyone has a different take on the matter but I have heard thyroid specialists say anything below 97.8-98.2 first thing in the morning signals hypothyroidism. It will be interesting to see where my thyroid numbers are and see how much of my symptoms are related to that compared to my ammonia. The brain issue feels far worse than your typical brain fog that is associated with hypothyroidism. I never once had a TSH higher than 1.6, it's the FT3 that's been low at times.

You're right that I take a lot of supplements. I don't think any one specific one is a direct cause, as I've removed/added things constantly and the symptoms preceded most of the things I take. Still though, there are so many to list. If there are any that you think could be causative, by all means let me know which ones. Curcumin is the only one I've heard could have a rare liver impact and that is the one supplement I have never taken a break from in many years.

I will keep you updated.

Thanks for your help. I appreciate it.

 

[Elvia1023]

I was reading about lactose yesterday actually and ordered some online, just in case I’m unable to secure a prescription on Thursday with a liver specialist. Thanks for the added reading material though. This is excellent and helpful information! I hope it works to lower ammonia even though I don’t think that I have a liver problem.


I’m going to do:
glutamine 20g daily
A combo supplement of arginine/ornithine/lysine
Extra citrulline
Lactulose when I receive it

Just getting back to this and whilst I 100% recommend adding certain supplements I don't think you should just add every supplement you have heard lowers ammonia levels. I know you don't like to hear it but I also think you should literally half your supplement intake. So many things have unknown effects and I would just stick to a certain (much smaller) list of things you think are essential.

I am a fan of glutamine but for you I wouldn't recommend it. It was known as a key player in ammonia detoxification for years but new data suggests it can actually worsen the problem. Here is a study I think you will find interesting...

GLUTAMINE AS A MEDIATOR OF AMMONIA NEUROTOXICITY: A CRITICAL APPRAISAL

Ammonia is a major neurotoxin implicated in hepatic encephalopathy (HE). Here we discuss evidence that many aspects of ammonia toxicity in HE-affected brain are mediated by glutamine (Gln), synthesized in excess from ammonia and glutamate by glutamine ...

www.ncbi.nlm.nih.gov

You also plan to use lysine which has been shown to inhibit several enzymes of the urea cycle so it could potentially worsen ammonia detoxification as well. Nothing is set in stone but this is the problem when adding multiple supplements as they have so many potential different effects it's impossible to know what is going on when you throw so many at an issue. We all do the same though (I have many times) but I just think for you because you write how you have struggled so much for years you have to be extra careful with what you add in. I would personally go with l-citrulline twice daily (4g x 2 to start) and build up the dose and get retested and see how you are and go from there.

 

[Rogue]

Yes, the good about NYC is there are a lot of great hospitals. The bad is that I can't order my own blood tests without a prescription when I feel the need.

I know everyone has a different take on the matter but I have heard thyroid specialists say anything below 97.8-98.2 first thing in the morning signals hypothyroidism. It will be interesting to see where my thyroid numbers are and see how much of my symptoms are related to that compared to my ammonia. The brain issue feels far worse than your typical brain fog that is associated with hypothyroidism. I never once had a TSH higher than 1.6, it's the FT3 that's been low at times.

You're right that I take a lot of supplements. I don't think any one specific one is a direct cause, as I've removed/added things constantly and the symptoms preceded most of the things I take. Still though, there are so many to list. If there are any that you think could be causative, by all means let me know which ones. Curcumin is the only one I've heard could have a rare liver impact and that is the one supplement I have never taken a break from in many years.

I will keep you updated.

Thanks for your help. I appreciate it.

Maybe I missed it, what are your symptoms >?
If you've mentioned it before, please link me.

 

[Rogue]

Yes, the good about NYC is there are a lot of great hospitals. The bad is that I can't order my own blood tests without a prescription when I feel the need.

I know everyone has a different take on the matter but I have heard thyroid specialists say anything below 97.8-98.2 first thing in the morning signals hypothyroidism. It will be interesting to see where my thyroid numbers are and see how much of my symptoms are related to that compared to my ammonia. The brain issue feels far worse than your typical brain fog that is associated with hypothyroidism. I never once had a TSH higher than 1.6, it's the FT3 that's been low at times.

You're right that I take a lot of supplements. I don't think any one specific one is a direct cause, as I've removed/added things constantly and the symptoms preceded most of the things I take. Still though, there are so many to list. If there are any that you think could be causative, by all means let me know which ones. Curcumin is the only one I've heard could have a rare liver impact and that is the one supplement I have never taken a break from in many years.

I will keep you updated.

Thanks for your help. I appreciate it.

Pre-clinical Thyroid issues can affect neuromuscular functions also.

 

[nothuman]

Maybe I missed it, what are your symptoms >?
If you've mentioned it before, please link me.

Pre-clinical Thyroid issues can affect neuromuscular functions also.

Extreme brain dysfunction/fog making it impossible to do life, as well as chronic fatigue. Some dry fingers and heels too (classic hypothyroidism symptoms)

 

[nothuman]

Just getting back to this and whilst I 100% recommend adding certain supplements I don't think you should just add every supplement you have heard lowers ammonia levels. I know you don't like to hear it but I also think you should literally half your supplement intake. So many things have unknown effects and I would just stick to a certain (much smaller) list of things you think are essential.

I am a fan of glutamine but for you I wouldn't recommend it. It was known as a key player in ammonia detoxification for years but new data suggests it can actually worsen the problem. Here is a study I think you will find interesting...

GLUTAMINE AS A MEDIATOR OF AMMONIA NEUROTOXICITY: A CRITICAL APPRAISAL

Ammonia is a major neurotoxin implicated in hepatic encephalopathy (HE). Here we discuss evidence that many aspects of ammonia toxicity in HE-affected brain are mediated by glutamine (Gln), synthesized in excess from ammonia and glutamate by glutamine ...

www.ncbi.nlm.nih.gov

You also plan to use lysine which has been shown to inhibit several enzymes of the urea cycle so it could potentially worsen ammonia detoxification as well. Nothing is set in stone but this is the problem when adding multiple supplements as they have so many potential different effects it's impossible to know what is going on when you throw so many at an issue. We all do the same though (I have many times) but I just think for you because you write how you have struggled so much for years you have to be extra careful with what you add in. I would personally go with l-citrulline twice daily (4g x 2 to start) and build up the dose and get retested and see how you are and go from there.

Well I have been using 10g glutamine for the last two months ever since I got the high ammonia level so now I will have to do more research on it to see if I should continue. Every other link I read says to take it. It's a shame the study you sent if so difficult to understand. I hate when the people who write these papers use such big words and don't convey the message properly.

I started Lysine two days ago so I will have to look into that too.

My blood pressure is very low so I have to be careful as well when it comes to citrulline and arginine. 105/57 is how low it's been lately. Thyroid and cortisol problems are also destroying my quality of life in addition to the ammonia.

 

[SOUR DIESEL]

Thyroid and cortisol problems are also destroying my quality of life in addition to the ammonia.

^^^i think that these may likely be a result of the toxic levels of ammonia
(..i think solving the ammonia issue may go a long way to resolving the other two)

.

 

[nothuman]

^^^i think that these may likely be a result of the toxic levels of ammonia
(..i think solving the ammonia issue may go a long way to resolving the other two)

.

Really? They're connected? I'm very interested in hearing more about what you know about this.

 

[SOUR DIESEL]

Really? They're connected? I'm very interested in hearing more about what you know about this.

^^^hey brother ..my reason for saying that is general

-toxic ammonia levels are "stressful" to the body
-most any "stress" (..chemical, emotional ..whatever) is going to raise cortisol
-cortisol inhibits conversion of T4 to T3 (..body's metabolically active thyroid hormone)
-chronically high cortisol levels can lead to hypothyroidism
-chronically high cortisol levels can also suppress the immune system


-->was talking to a member from another board about something similar fairly recently
..so may have some other things you might be interested in

..just don't have the time to find, collect & post right now ..will be back, or PM you


.

 

[nothuman]

^^^hey brother ..my reason for saying that is general

-toxic ammonia levels are "stressful" to the body
-most any "stress" (..chemical, emotional ..whatever) is going to raise cortisol
-cortisol inhibits conversion of T4 to T3 (..body's metabolically active thyroid hormone)
-chronically high cortisol levels can lead to hypothyroidism
-chronically high cortisol levels can also suppress the immune system


-->was talking to a member from another board about something similar fairly recently
..so may have some other things you might be interested in

..just don't have the time to find, collect & post right now ..will be back, or PM you


.

Thanks. Your line of reasoning makes sense. More than welcome to PM me about it