What is Pyrrole Disorder?
Pyrrole Disorder is an abnormality in biochemistry resulting in the overproduction of a urinary pyrrole called OHHPL (hydroxyhemoppyrrolin-2-one). It was first discovered in the late 1950′s by a team of Canadian researchers lead by Abram Hoffer, MD when they identified a novel compound in the urine of patients with schizophrenia. 
OHHPL produced a lilac-colored (mauve) spot on chromatographic urine testing, and has also been referred to as Mauve Factor. It is both heat- and light-sensitive; therefore, proper collection, transport and testing precautions are required to ensure proper testing.
In the 1960s Dr. Hoffer and colleagues published clinical outcomes of schizophrenic and other mentally ill patients with high urinary pyrrole levels, showing that treatment with high dose niacinamide (the amide form of Vitamin B-3) both normalized the urinary pyrrole level and treated the clinical symptoms characteristic of pyrrole disorder (see below). In the 1970s Carl Pfeiffer, MD showed similar results with high doses of vitamin B6 and zinc, the current treatment of choice.
Vitamin B6, P5P (pyridoxal-5-phosphate), niacinamide and zinc all have important antioxidant roles. Clinical experience at the Pfeiffer Treatment Center in Warrenville, Illinois suggests that an elevated urinary pyrrole may a good biomarker for oxidative stress.
What are the symptoms of Pyrrole Disorder?
The common clinical symptoms in patients with pyrrole disorder are anxiety (fear); poor stress tolerance; sensory hypersensitivity to light, sound, smell and/or touch; mood and emotional liability; social anxiety and/or withdrawal; poor dream recall; and commonly, explosive temper and aggression. Clinical signs are pale skin (china doll appearance), stretch marks, and white spots on the nails due to the commonly concomitant zinc deficiency. An adverse reaction to omega-3 fish oil can be an important piece of the past medical history raising clinical suspicion for the presence of pyrrole disorder.
How is Pyrrole Disorder diagnosed?
Pyrrole disorder is primary a clinical diagnosis, requiring a patient with characteristic clinical symptoms and often a concomitantly elevated urinary pyrrole test result, who responds to appropriate nutrient therapy with improvement in their clinical symptoms. Patients with urinary pyrrole levels of 20 mg/dl or higher often exhibit several of the characteristic clinical symptoms. An intermediate level of 10-20 mcg/dl does not rule out pyrrole disorder because it is response to treatment that confirms the diagnosis.
How is Pyrrole Disorder Treated?
The core treatment of pyrrole disorder is vitamin B6 and/or pyridoxal-5-phosphate (the active form of vitamin B6) along with magnesium and zinc. Vitamin C, vitamin E, and niacinamide are often part of treatment due to their strong antioxidant properties, synergistic metabolic roles, and in the case of niacinamide was originally shown by Dr. Hoffer to be effective as monotherapy in treatment of clinical symptoms and elevated urinary pyrrole levels.
Unlike zinc where proper dosing of zinc is based on zinc levels, adequate dosing of vitamin B6 and P5P are based on resolution of the presenting clinical symptoms. Stress, illness, and injury all exacerbate zinc deficiency and pyrrole disorder; therefore, lifestyle changes, counseling and exercise are all necessary adjuncts to nutrient therapy. In times of severe stress or illness, additional doses of core nutrients (stress dosing) can be helpful in mitigating emergence of clinical symptoms.
Evening primrose oil is also utilised in treatment. Based on work by Bibeus et al. patients with elevated urinary pyrroles had a higher prevalence of low arachadonic acid levels on fatty acid analysis.
Clinical symptoms often return if nutritional treatment is discontinued, suggesting that once pyrrole disorder becomes clinically evident, the need for some treatment will be lifelong.
References:
- McGinnis, WJ. Pyroluria: Hidden Cause of Schizophrenia, Bipolar, Depression, and Anxiety Symptoms.
- McGinnis, WJ et al. Discerning the Mauve Factor, Part 1. Altern Ther Health Med. 2008 Mar-Apr; Vol 14(2): 40-50.
- McGinnis, WJ et al. Discerning the Mauve Factor, Part 2. Altern Ther Health Med. 2008 may-Jun; Vol 14(3): 56-62.
- Pfeiffer, CC. Nutrition and Mental Illness.
Dr Cristina Beer – Medical Practitioner @ The Medical Sanctuary is fully trained in all areas of mental health and pyrrole disorder.