Chris Kresser: Well, before we even get into OAT, anemia is absolutely associated with depression. And so if it’s iron-deficient anemia or B12- or folate-deficient anemia, a nutrient-dense diet with organ meats and shellfish could possibly resolve this. I mean, she’s been depressed for 24 years, but we might also assume that she has been anemic for a long time. You know that this anemia is the final stage of iron deficiency and of B12 and folate deficiency, so that when you catch a patient with anemia, you can assume that they’ve been iron or B12 or folate deficient for months, if not years, if not decades before the anemia is actually showing up.
So we know that B12 and folate and iron all play crucial roles in brain health independently, and then we know that red blood cells and the delivery of oxygen to the brain are super important for regulating mood. Okay, so moving on to the OAT results. High yeast and fungal metabolites that can be assigned a fungal overgrowth, especially with high oxalic acid, which it seems is present also. High lactic acid and pyruvic acid, those are more markers for carbohydrate metabolism. So she may not be metabolizing carbohydrates well. Homovanillate levels, or HVA, below the mean, 5-HIAA levels below the mean; those are markers for neurotransmitter metabolism, and when they’re low, dopamine and serotonin levels are low, which could be related to the depression. High quinolinate–5-HIAA ratio, that’s primarily a marker of inflammation. Quinolinate is pro-inflammatory; 5-HIAA is anti-inflammatory. When you have high quinolinate relative to 5-HIAA, it shows that there’s an inflammatory state which is consistent with depression, especially if you consider it from the inflammatory cytokine model perspective. B6 levels below the mean, that could be contributing to anemia, so you’d want to make sure she’s getting plenty of B6 in the diet when you treat the anemia. And then ascorbic acid levels below the mean, as you want to make sure she’s getting enough vitamin C.
So definitely it looks like nutrient deficiency, looks like fungal overgrowth, which you probably would want to address. The carbohydrate issues and the neurotransmitter metabolism issues could be secondary to the GI issues and possibly the anemia. So I wouldn’t address those and the nutrient deficiencies, so I wouldn’t address those right off the bat. But I would address the nutrient balance and gut environment, gut inflammation likely being caused by the fungal overgrowth. And then retest and see where you’re at.