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One of the common questions I hear from readers is whether neurotransmitter testing is reliable. The main thing that they’re concerned about is that the brain neurotransmitter levels don’t match what’s in the urine.

This is basically true, to a certain extent. But there is a lot more to this. This is why I still use this test in the clinic with great success for my patients.

What is a neurotransmitter

First, let’s clarify what a neurotransmitter is. A neurotransmitter is a chemical messenger of the nervous system. It signals the communication between the brain and the organs in the body.

Some examples of the neurotransmitters that I often look at to support my patients’ sleep and mood are the calming or inhibitory neurotransmitters serotonin and GABA, and some of the excitatory neurotransmitters such as adrenaline, glutamate, dopamine, and histamine.

These neurotransmitters are found in various body fluids such as in your blood (serum), cerebral spinal fluid, saliva, and urine. Even though they are found throughout the body, these chemical messengers have various functions in the central nervous system (the brain and spinal cord).

The brain has a highly sensitive and protective system called the blood brain barrier, which lets neurotransmitters in and out.

How do neurotransmitters break down and clear out of the body?

Neurotransmitters are produced in the body or come from the food that you eat (for example, tryptophan from protein makes serotonin). They are stored and used and then broken down and cleared out of the body, mainly through urine.

However, before these metabolites (broken-down parts of neurotransmitters or other chemicals in the body) are eliminated, their quantity may be changed. Here are a few reasons why:

  • Some of the neurotransmitters are taken from the blood and filtered through the kidneys. The question is, what if the neurotransmitter metabolism in the kidneys changes the amount secreted in the urine? This study shows that the urine neurotransmitters are more representative of the total output rather than the renal (kidney) output. 
  • Many of the organs in the body are capable of both making and degrading neurotransmitters. This is particularly true of the gut, which contains the enterochroaffin cells. In urine testing we look at serotonin; its broken-down metabolite is called 5-Hydroxyindoleacetic Acid (5-HIAA) and I take into consideration the clinical picture of the patient, which gives me an idea of what would help this person the most.
  • Enzymes such as Monoamine oxidase A (also known as MAO-A) break down neurotransmitters such as dopamine and serotonin. These enzymes run at a certain speed. For example, some people have a genetic mutation where they clear these neurotransmitters faster than other people. These may show an increased release of neurotransmitters in the urine metabolites, which in turn may actually make the person deficient in the said neurotransmitters. All this has to be taken into consideration when looking at these results.

Is urine neurotransmitter testing reliable?

After all this is said, is urine neurotransmitter testing reliable? Yes, but only if the patient’s symptoms and history are taken into account, along with the main neurotransmitter and metabolites and possible genetic influences.

It is true that we need more studies to show the urine neurotransmitter validity, but human studies are considered unethical and hard to perform due to the effect on a person. Here is a paper that looks more in depth at these studies: Urinary Neurotransmitter Testing: Myths and Misconceptions.

These tests often provide guidance to nutritional deficiencies, which often brings immediate relief. Targeted food choices along with supplements can help provide that relief so you can have less of a ruminating or anxious mind and you can fall asleep or stay asleep easier. Check this article out more about what to do if you have anxiety around sleep.

For example, if I see high histamine on the urine test ( read more about histamines in “Benadryl helps you sleep? Here is what to do Instead”) but its broken-down metabolite, N-Methylhistamine, is low, it is telling us that you are not converting properly. It could be a genetic problem or that your body doesn’t make enough SAMe (S-Adenosylmethionine). All this offers incredibly valuable information for the patient’s healing journey.

At the end of the day, as a clinician, I only do tests that are helping me understand what is happening in your body so I can be more ready to help you feel better. If you have questions, click on this link for a free consultation or an initial session (locally in Boulder, Colorado, or all over the world by telemedicine).

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