Amino Acid Therapies: Clinical Applications for Depression, Anxiety, Mitochondrial Health and Detoxification
by Dr. Dan Kalish
Amino acids are at the cornerstone of so many biochemical processes, and will therefore play a leading role in most functional medicine protocols you assemble.
To start, every protein in the human body is made from 20 key amino acids. The implications for this are profound: We are talking about almost the entire non-watery part of the body being made up of proteins of some sort. All the organs, all the structural stuff like collagen, the muscles, many hormones like insulin, transport molecules like hemoglobin, every antibody your immune system produces is a protein, all the enzymes that regulate metabolism and detoxification…the list is extensive.
Then there are the non-protein forming roles of various amino acids. For example, you require tyrosine to make dopamine, glycine and taurine to make bile, cysteine, glutamine and glycine to make glutathione (arguably the most important body process in terms of protecting cells from death and us from death). Tryptophan is used for serotonin production and methionine is critical for methylation. Everywhere you look in the list of what could go wrong in the body that leads to diseases and suffering, you find amino acids.
I’ll often design a supplement program with a half dozen or more amino acids for vastly different purposes as an example:
- Tyrosine to boost dopamine 1000 mg 3x day
- Arginine and citrulline to increase nitric oxide 3000 mg daily of each (repairs blood vessels, improves cardiovascular function)
- NAC at 4500 mg daily to boost glutathione
- Free form amino acid powder 8 grams daily away from meals to stimulate mitochondrial biogenesis
And on and on it goes. If you want to break it down on a more systems basis, then I would say we have these systems that are most frequently impacted with amino acid therapy:
- Detoxification – Environmental Health
- Oxidative stress
- Mitochondrial health
- GI Repair (glutamine)
- and the most important, PROTEIN SYNTHESIS (all 20 amino acids required for this)
From a clinical perspective, what you see with the proper use of amino acids is quite exciting. Amino acids tend to impact people in a positive way quickly, which is nice when you are wishing to achieve a palpable improvement in a new patient's condition. Amino acids are generally well tolerated, meaning people don’t react to them poorly very often. They aren’t that expensive. Many of the amino acids are well absorbed in a powder form so for people that don’t like taking a ton of pills this is handy. When you use amino acids to improve neurotransmitter levels like a low dopamine or low serotonin case, the response (assuming you get the dosing right which I’ll admit is pretty hard) is often better than a response they may have experienced in the past using antidepressants.
The challenges amino acid therapy presents, is that you have to run lab tests to know what to do. Many organic acid markers, and of course all the amino acid markers will give you a clear idea where to start. Once you’ve interpreted the labs then the next major hurdle is getting the dosages right. If you underdose someone, it often won’t work at all and everyone gets frustrated, doctor and patient both.
Once in a while, a failure results despite using the right amino acid in the right dose; It just may not be what that person needs the most at the time, or it may be that they are unusually sensitive to supplements in general. It turns out, giving the exact right product at the exact right dose at the wrong time can undermine a program. It’s difficult to get sequencing right, and difficult for me to give an exact sequence for a given case without seeing the labs, but in general you can work through this sequence:
- HPA axis, thyroid hormones, other hormones, mitochondria
- GI issues, microbiome, GI organ dysfunction, GI pathogens
- Detoxification, clearance of chemicals and heavy metals
All three of these require different amino acids:
- HPA axis makes people catabolic so often ffAA work well, thyroid often requires tyrosine (not always) and mitochondrial support can involve a bunch of amino acids depending on your goals there
- GI functional problems are often supported with glutamine to help with GI lining repair, taurine and glycine to help with GB making bile
- Detox pathways require tons of amino acids, methionine, NAC, glutamine, glycine, taurine, couple others
When I see a new patient who has already done a bunch of functional medicine programs with underwhelming results, there are several common mistakes I’ll see frequently in the protocols: One is underdosing, the person is given NAC at 500mg when the starting therapeutic dose is 3,000mg. See that all the time. Or, the person is given too many amino acids. Oftentimes, all of them are indicated, but the wide range of pills just isn’t enough of any one thing to make a difference, so the patient is taking tons of capsules, but none of them are at a sufficient amount.
This leads to a recommendation, which is to choose a limited number of products when designing a new program; Select the most important ones, and be sure each individual product is at its full therapeutic dose. If you design programs this way, you likely won’t be able to use all the products indicated, but that is ok.
If you’ve ever been to a buffet where you pay one price and can eat anything you want. If you try a bite of 27 different foods it just doesn’t work as a meal. Even in a buffet situation, you are better off with a few selections in the right portion to make it work. Same with supplement program design, too many products, all underdosed is not a recipe for success. People end up with no observable benefit, and to make matters worse, if you go to retest these people, their labs won’t have changed much.
One final note: Amino acids need cofactors and coenzymes to work, so anytime you give any amino acids, also give B complex and/or a multi vitamin/mineral product that contains B’s.
If you’re interested in learning more, there are a ton of great books out there. Dr. Richard Lord’s Laboratory Guides to Health is probably the best, but it’s also the most complicated. I’d suggest ordering a half a dozen books that are good sellers these days and reading through them all to get a wider sense of how amino acid therapies can work.