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    Pyroluria: Fact or Fiction? (2021)

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    Type of Content
    Journal Article
    UC Permalink
    https://hdl.handle.net/10092/102188
    
    Publisher's DOI/URI
    http://doi.org/10.1089/acm.2020.0151
    
    Publisher
    Mary Ann Liebert Inc
    ISSN
    1075-5535
    1557-7708
    Language
    eng
    Collections
    • Science: Journal Articles [1099]
    Authors
    Warren B
    Sarris J
    Mulder RT
    Rucklidge, Julia cc
    show all
    Abstract

    Objective: The term "Mauve factor" (pyrroluria) dates back to 1958 when Dr. Abram Hoffer defined the condition as elevated levels of pyrroles in the urine, currently called hydroxyhemepyrrolin-2-one (HPL). It was suggested that the raised pyrrole levels lead to depletions in zinc and vitamin B<sub>6</sub>, which, in turn, were hypothesized to result in a range of psychiatric disorders, such as schizophrenia, anxiety, and depression. Treatment implications are supplementation with zinc and B<sub>6</sub>. This article aimed to review the scientific literature associating pyrroluria with psychiatric symptoms, explore the validity of HPL testing, explore the role of nutrients as treatment options for pyrroluria, and discuss future research directions. <b><i>Methods:</i></b> A PRISMA review was conducted using search results from electronic databases PubMed, MEDLINE, PsycINFO, EMBASE from inception to February 2020 using the following keywords: hydroxyhemepyryrrolin (HPL), kryptopyrrole (KP), mauve factor, pyroluria, pyrroluria, monopyrroles. Article reference lists were also scanned and included where relevant. <b><i>Results:</i></b> Seventy-three articles were identified of which only three studies identified significantly higher HPL levels in a psychiatric population compared with controls, and there were no placebo-controlled treatment trials directed at pyrroluria. The other 13 clinical studies either showed no association or did not provide adequate data to show group differences in HPL levels. Despite an extensive history of practitioners diagnosing and treating a wide variety of mental health conditions associated with pyrroluria as well as <i>clinical</i> observations of elevated HPL being associated with psychiatric disorders, there was no clear research that showed the following: (1) elevated HPL is robustly associated with increased mental health symptoms, (2) elevated HPL in urine is associated with increased urine excretion of zinc and B<sub>6</sub>, and (3) high-dose zinc and B<sub>6</sub> are an efficacious treatment for mental health problems associated with elevated HPL. <b><i>Conclusions:</i></b> Elevated HPL is a clinically observed, but poorly researched biomarker with unclear associations with mental disorders. Based on current evidence, HPL testing is not recommended as a screening or treatment tool. Further research is required in the following areas: establishment of which specific clinical populations exhibit elevated HPL, validation of the chemistry and validity of testing, and controlled trials to establish efficacy of high-dose zinc and B<sub>6</sub> as treatment of elevated pyrroles.

    Citation
    Warren B, Sarris J, Mulder RT, Rucklidge JJ (2021). Pyroluria: Fact or Fiction?. Journal of alternative and complementary medicine (New York, N.Y.). 27(5). 407-415.
    This citation is automatically generated and may be unreliable. Use as a guide only.
    Keywords
    B6; HPL; kryptopyrrole; mauve factor; pyroluria; pyrroluria; zinc
    ANZSRC Fields of Research
    32 - Biomedical and clinical sciences::3202 - Clinical sciences::320221 - Psychiatry (incl. psychotherapy)
    32 - Biomedical and clinical sciences::3210 - Nutrition and dietetics::321004 - Nutritional science
    42 - Health sciences::4208 - Traditional, complementary and integrative medicine
    Rights
    All rights reserved unless otherwise stated
    http://hdl.handle.net/10092/17651

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