You might have come across the term pyroluria, a somewhat controversial topic buzzing in health discussions for its potential ties to mental health and behavioural issues.

So what exactly is pyroluria?

Put simply, it's when you find an excess of 'pyrroles' (hydroxyhaemopyrrolin-2-one or HPL and kryptopyrroles) in your urine. These pyrolles bind to zinc, B6 and other nutrients in the body and are excreted together via urine. It’s important to note that pyrroles naturally occur in your body as part of the breakdown of your red blood cells. However, when there are high levels of pyrroles in your urine, this can flag to us that you might need further health investigations to understand why this is occuring.

Often, pyroluria is considered when you are experiencing ongoing psychological conditions, due to a link that was first discovered back in the 1950s. More recent research has shed light on several nutrient deficiencies being linked to pyroluria, particularly vitamin B6 and zinc. These nutrients are crucial for various biochemical reactions in the body, including the production of neurotransmitters – those influential chemical messengers shaping your mental well-being.

If you're curious about pyroluria or suspect it might be a factor in your health, keep reading. We'll delve into the telltale signs, potential triggers, and treatment approaches. Plus, we'll explore the ongoing debate on whether pyroluria is a genuine health concern or just a controversial topic.

What are the symptoms of pyroluria?

The symptoms of pyroluria can vary from person to person, but often include anxiety, depression or poor mental health. Individuals diagnosed with pyroluria often discuss having poor dream recall, feeling anxious in social situations, as well as finding it difficult to manage stress.

Other symptoms that can show up in pyroluria include a lack of appetite or fussy eating, getting ‘side stitches’ when exercising, being irritated by tags on clothing or other sensory issues, dry skin, and occasionally nausea. These symptoms often weave together, creating a pattern of anxiety, depletion, and sensitivity to the environment around you. If you're nodding along, it might be time to explore the world of pyroluria.

What causes pyroluria?

The main driver behind pyroluria is understood to be oxidative stress, which occurs when there's an imbalance between harmful molecules called free radicals and the body's ability to control them. Oxidative stress happens when you experience either mental stress - like working hard to meet a deadline and emotional trauma - or physical stress - like exposure to toxins and heavy metals in the environment, deficiencies, viruses and gut issues. In fact, research has found a link between increased pyrrole levels and oxidative stress (1).

Interestingly, there is also an emerging link between pyrroles and ‘leaky gut syndrome’, an inflammatory condition that involves damage to the lining of the digestive tract (3). Leaky gut is also often associated with increased anxiety, so it's a complex dance, and we're here to navigate it.

There has also been some discussion about pyroluria being a genetic condition, although the specific gene has not yet been pinned down. We often see a familial connection in clinic, suggesting that mental and physical stress may be a trigger for this inherited condition.

Enter naturopathic medicine, where we zoom out to look at your whole life story. From testing to treatment, it's about addressing the full picture.

I’ve heard pyroluria is a made up condition - is it real?

Whether pyroluria is a real condition has been highly debated and, ultimately, at The KAN Clinic, we believe it is best to think of pyroluria as a symptom of something deeper - often oxidative stress - rather than a standalone condition.

While your GP may dismiss the condition completely, those diagnosed with pyroluria can experience debilitating physical and emotional symptoms, and can feel a great sense of relief to understand the cause. Sometimes, pyroluria simply represents nutrient deficiencies and can be treated accordingly, with life-changing results.

However, it is often more complicated as pyroluria tends to present alongside other conditions including depression, ADHD, autism and bipolar disorder (3). In fact, urinary pyrroles can be a helpful tool when diagnosing psychiatric conditions to understand the extent of oxidative stress involved (1). This highlights the need to treat each case of pyroluria individually.

How to test for pyroluria

The main test required to diagnose pyroluria is urinary kryptopyrroles, with raised levels confirming the presence of this condition, although due to limitations of this test it is not something we regularly use in clinic. We regularly check blood levels of zinc, copper, and ceruloplasmin and may also run an urinary organic acids test to assess functional B6 levels and other markers (as blood (serum) levels of B6 are unreliable).

Hair Tissue Mineral Analysis, a non-invasive test that examines your hair for mineral levels and also heavy metals such as aluminum and lead, is also an important consideration in pyroluria. Heavy metal toxicity is a common culprit in driving oxidative stress in the body and causing mineral imbalances, which both drive pyroluria.

Given the strong link between gut health and pyroluria, we sometimes also consider stool testing to confirm whether there is inflammation or imbalances in your digestive tract, which may be contributing to your pyroluria diagnosis.

Comprehensive DNA testing may also be utilised on a case-by-case basis.

This is where naturopathy shines, as we don’t take a pyroluria diagnosis at face value - we dive deeper to understand the root cause.

How is pyroluria treated?

Treatment for pyroluria depends on your specific symptoms and test results. Core treatment for this condition includes addressing any nutrient deficiencies or excesses that are found, particularly vitamin B6, zinc, and manganese deficiencies (1) and excess copper. We’ve seen clinically that once clients improve their B6 and zinc levels, their anxiety levels reduce dramatically. This is because these nutrients are so important for the production of neurotransmitters (2). That being said, it’s important not to self-treat, as specific prescriptions and dosages depend on your test results and need to be carefully monitored to avoid toxicity and creating further nutrient imbalances. Simply replenishing zinc and B6 will not treat the root cause.

Addressing both mental and physical stress are extremely important, as these directly contribute to oxidative stress in the body, and as a result, pyroluria.

When it comes to mental stress, it’s important to incorporate sustainable lifestyle practices that help reduce your feelings of stress. We can also support you with herbs and natural supplements to improve your resilience to stress.

Physical stress can be reduced by addressing any heavy metal and nutrient imbalances, supporting digestion and gut health, making lifestyle and dietary changes as necessary - which can sometimes include a reduction in oxalate-rich foods, and through targeted antioxidant therapy. In fact, research shows zinc and Vitamin C can be particularly effective for pyroluria in clients with a reduced sense of taste (4).

So, as you’ll see, pyroluria is not just a nutrient checklist - it’s linked to many aspects of your overall health and needs to be treated in an extremely individualised manner. By working with our team of naturopaths, we can provide access to functional testing and personalised treatment so you can reclaim your health and vitality!

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References

1.Lambert, B., Semmler, A., Beer, C., & Voisey, J. (2023). Pyrroles as a potential biomarker for oxidative stress disorders. International Journal of Molecular Sciences, 24(3), 2712. https://doi.org/10.3390/ijms24032712

2.Ross, K., & VanNortwick, M. (2022). Managing mood-related symptoms utilizing diet, targeted nutrient supplementation, and lifestyle changes: A case series. EXPLORE, 18(5), 591-600. https://doi.org/10.1016/j.explore.2021.09.006

3.Sherwin, A., & Shaw, I. C. (2023). Sixty years of conjecture over a urinary biomarker: A step closer to understanding the proposed link between anxiety and urinary pyrroles. Laboratory Medicine, lmad086. https://doi.org/10.1093/labmed/lmad086

4.Younes, S. (2023). The impact of micronutrients on the sense of taste. Human Nutrition & Metabolism, 200231. https://doi.org/10.1016/j.hnm.2023.200231