Holistic Adult and Child Psychiatry in Newton, MA

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Judy Tsafrir, M.D.
Tel: 617-965-3020

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My practice is dedicated to healing through integration of heart, mind, body and soul.

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Adventures in Holistic Adult and Child Psychiatry

"One only sees what one looks for, one only looks for what one knows." - Goethe

"I did then what I knew how to do. Now that I know better, I do better." - Maya Angelou

Pyroluria, Mental Health and the Immune System


I never heard the term pyroluria mentioned during my residency in psychiatry, which is kind of crazy, given that it is not at all rare and can profoundly effect mental health. It is a condition found in many people who have serious psychiatric disorders, including severe depression, anxiety, mood swings, explosiveness and violent behavior,  alcoholism, memory problems, attentional problems, academic underachievement, autism spectrum disorders and psychosis. You would think that given how relatively common it is, how debilitating, and how treatable, that it would have been part of the curriculum. But hey, we were not taught a thing about the effect of diet on mental health either.

I first learned about pyroluria from Dr. William Walsh, a biochemist and brilliant pioneer in the field of nutrient therapy for psychiatric conditions. He wrote an excellent book called Nutrient Power: Heal Your Biochemistry and Heal Your Brain. Here is a link to an earlier blog post I wrote in October 2014  inspired by my training with Dr. Walsh.

Pyroluria is also present in people with chronic medical illness, including auto-immune conditions, as it is a general sign of oxidative stress in the body. Many of my readers suffer from poor gut health, and in those individuals, urinalysis may reveal elevated levels of pyrroles. I have pyroluria, as do many of the patients in my psychiatric practice, who are of course, a self-selected group. It is diagnosed by a simple inexpensive laboratory test that measures the level of pyrroles in the urine. The lab that I like is Direct Health in Chicago. Results from 10-20 mcg/dL of pyrroles are considered borderline. Above 20 mcg/dL is considered positive for pyroluria.

Pyrroles are a normal breakdown product of hemoglobin, the molecule that carries oxygen in your blood. When pyrroles are excreted from the body they bind with two nutrients that are essential to mental health, zinc and B6. Individuals with a genetic abnormality that causes elevated production of pyrroles will become relatively deficient in zinc and B6. The combined effect of B6 and zinc deficiency is a disaster for brain function as well as the immune system. B6 is required for the synthesis of three critically important neurotransmitters; serotonin, dopamine and GABA. Zinc is a component of more than 200 enzymes and other special proteins that play a role in cell division and gene expression, insulin regulation, as well as necessary in the maintenance of the blood brain barrier, which prevents harmful chemicals from entering the brain.

Here is Dr. Walsh’s list of some of the symptoms correlated with pyroluria: Poor stress control, sensitivity to bright lights and loud noises, morning nausea, tendency to delay or skip breakfast, very dry skin, pale skin, inability to tan, high irritability and temper, history of underachievement, little or no dream recall, auto immune disorders, white spots on the finger nails, poor growth, coarse eyebrow hair, stretch marks on the skin, severe anxiety and/or depression, fearfulness, obsessions with negative thoughts, delayed puberty, dark or mauve colored urine, affinity for spicy and salty foods, abnormal fat distribution, delicate facial features, extreme mood swings, history of dyslexia, severe inner tension, frequent infections, premature graying of hair, poor muscle development, spleen area pain, joint pain, poor wound healing, psoriasis, tendency to stay up very late, abnormal or absent menstrual periods.

Pyroluria is often found in children who have behavioral dysregulation, attentional problems, learning disabilities and tantrums. Symptoms can be exacerbated when a child has a growth spurt, because growing increases the body’s demand for zinc and B6. With appropriate supplementation, symptoms can improve rapidly. Dr. Walsh said that he was always happy when he tested a kid and found elevated pyrroles, because treatment can make such a dramatic difference so quickly.

If you suspect that you have pyrrole disorder, if you can afford it, and if there is a practitioner in your area, I recommend that you see someone trained by Dr. Walsh to develop a supplement protocol for you. Here is a list of Walsh trained practitioners. Supplements can cause harm if you take an inappropriate dose, or ones that are simply not beneficial for you or an inappropriate combination. They are not simply harmless, and when treatment is initiated, there can be transient increases in anxiety, fatigue, headaches, muscle tension,  itchiness and insomnia, to name a few side effects.

Here is a link to an on-line questionnaire to determine if you are likely to have pyroluria, developed by Trudy Scott, a nutritionist who worked for several years with Julia Ross and is a supporter of the Weston A Price Foundation. Ms Scott wrote a book called “The Anti-Anxiety Food Solution.” and has a website called “Every Woman over 29.”

If you are determined to do it on your own, Trudy Scott suggests a protocol to treat pyroluria. She recommends starting with zinc (30 mg), vitamin B6 (100mg) or P5P (25mg) and evening primrose oil (1300mg), plus a good multi-vitamin (with manganese and no copper) and a multi-mineral and sometimes additional magnesium. She suggests monitoring your B6 level on the basis of dream recall and your zinc level with a zinc status test that is a taste test with liquid zinc.

Here is a great short interview conducted by Sean Croxton of Underground Wellness with Trudy Scott where they discuss social anxiety, introversion and pyroluria.

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