About l-tryptophan disease

What is l-tryptophan disease?

Eosinophilia myalgia syndrome (EMS) is associated with the ingestion of contaminated L-tryptophan, a dietary supplement often sold in health food stores. The contaminant remains unknown. It is a disease of abrupt onset causing severe, disabling, chronic muscle pain, skin symptoms and other neurotoxic reactions . Diagnosis is not easy and depends on finding unusually high levels of eosinophils (circulating white blood cells) over a period of at least six months.

What are the symptoms for l-tryptophan disease?

The symptoms and severity of eosinophilia-myalgia syndrome can vary greatly from one person to another. In most cases, the onset of the disorder is rapid.

The initial symptoms associated with eosinophilia-myalgia syndrome include breathing difficulties such as shortness of breath (dyspnea) and muscle aches, Cramping and spasms. Muscle Pain (myalgia) also occurs and may become progressively worse. Eventually, muscle Pain may become incapacitating making it difficult to walk or perform daily activities. The muscles of the legs, back and shoulders are most often affected. Muscle spasms may be triggered by movement or exercise. Muscle Weakness usually does not occur until later in the course of the disorder.

Additional symptoms that often occur during this earlier phase of eosinophilia-myalgia syndrome include cough, fever, fatigue, joint Pain (arthralgia), swelling due to the abnormal accumulation of fluid (edema), and a sensation of Numbness or tingling, most often in the hands, feet, arms or legs. Affected individuals may also develop a rash that can be extremely itchy (pruritus). This initial (acute) phase of the disorder usually lasts approximately 3-6 months.

After this initial phase, affected individuals experience chronic symptoms that can affect several different organ systems of the body. The skin is the organ most often affected and may slowly swell, thicken and harden (eosinophilic fasciitis). The arms and legs are most often affected. Some individuals develop small areas of hair loss (alopecia).

The central nervous system becomes involved in some cases and can cause decreased feeling (sensation) in the hands, increased sensation (hyperesthesia) in the back and arms or legs, progressive muscle weakness, bladder dysfunction, changes in mood or behavior and cognitive deficits such as memory loss, difficulty concentrating and difficulty communicating. However, the relationship between cognitive deficits or Behavioral changes and eosinophilia-myalgia syndrome is controversial. Some researchers believe these problems arise from severe pain, Depression and disturbances in sleep patterns associated with eosinophilia-myalgia syndrome and not from the direct, underlying effects of the disorder.

Additional symptoms can occur during the chronic phase of eosinophilia-myalgia syndrome although they occur less often than the abovementioned symptoms. Such symptoms include heart (cardiac) abnormalities including Inflammation of the heart muscle (myocarditis), irregular heartbeats (arrhythmias) and palpitations. Some individuals may have gastrointestinal symptoms including nausea, vomiting, Diarrhea and abdominal pain.

Muscle pain, the characteristic finding of the acute phase, also occurs during the chronic phase of the disorder, although it often comes and goes (remission and relapse). Fatigue, which can be profound, also occurs during the chronic phase. Muscle cramps and shortness of breath are also present.

What are the causes for l-tryptophan disease?

Although almost all cases of eosinophilia-myalgia syndrome in the 1989 epidemic were traced back to ingestion of contaminated L-tryptophan manufactured by a single company, namely Showa Denko K.K. (Tokyo, Japan), a large petrochemical company, the precise contaminant causing the disease is still unknown.

There had been isolated cases of EMS diagnosed before the epidemic of 1989 and there have been after, as well. The isolated cases of EMS diagnosed before the epidemic of 1989 were attributed to L-tryptophan dietary supplements. The isolated cases of EMS that are currently being diagnosed are attributed to L-tryptophan or 5-HTP dietary supplements. During the time that L-tryptophan was taken off the market, the closely related dietary supplement 5-hydroxytryptophan (5-HTP) was used as a substitute, and it continues to be so used. The amino acid 5-HTP is found on the metabolic pathway that converts the essential amino acid L-tryptophan to the neurotransmitter serotonin. Because serotonin helps to regulate sleep and mood (among other things), it is thought that ingesting L-tryptophan or 5-HTP, thus purportedly improving sleep and mood, will increase this neurotransmitter.

The National Eosinophilia Myalgia Syndrome Network (NEMSN), for the past several years, has also been receiving reports from people who have developed EMS-like symptoms soon after ingesting manufactured L-tryptophan, 5-HTP, or other products containing L-tryptophan or 5-HTP, such as certain body building products, weight loss supplements, and sleep aids.

What are the treatments for l-tryptophan disease?

There are no peer-reviewed guidelines for the standard of care of EMS patients. Because of the variety and diversity of how EMS manifests, patients are treated based on their individual symptoms.

In the acute phase, patients who have intense muscle pain and cramps may need to limit or avoid strenuous physical activity. Some patients have required hospitalization. In the chronic phase, patients who keep as physically active as possible seem to do better than others.

What are the risk factors for l-tryptophan disease?

Eosinophilia-myalgia syndrome was identified as an epidemic in 1989 after three people in New Mexico were identified with the disorder. The exact incidence of eosinophilia-myalgia syndrome is unknown. One estimate indicates that anywhere from 5,000-10,000 people developed the disorder during the epidemic. Most reported individuals are females and from the United States. However, eosinophilia-myalgia syndrome has been reported in other countries as well including Germany, Canada and the United Kingdom.

Is there a cure/medications for l-tryptophan disease?

Patients may be prescribed muscle relaxants, analgesics, and diuretics to treat symptoms.

High doses of corticosteroids may help reduce inflammation, However, most researchers have concluded that this course of treatment does not reduce the severity or duration of EMS symptoms.

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