Therapy with micronutrients

Loss of micronutrients in HPU

Since the incorrectly folded heme is toxic to the body, it must be disposed of. This is done by binding vitamin B6, Zinc and Manganese to the defective Haem and excreting the whole complex through the kidney (this complex is measured when HPU is diagnosed).

This solves the problem of toxic Haem, but the body loses important micronutrients that are urgently needed elsewhere. Depending on where the micronutrient deficiency becomes apparent in the body, a variety of symptoms can occur.

Micronutrients – the right ratio is important

Micro nutrients include vitamins, minerals, trace elements, amino acids and fatty acids. Only if all substances are available in a balanced ratio to each other, the metabolism can operate properly.

Deficiencies in minerals can be quickly detected by means of a mineral analysis in whole blood and can be specifically balanced out with food supplements.

Regular blood or urine checks provide clarity

In the course of micronutrient therapy, a micronutrient analysis in the blood and/or urine carried out at least twice a year provides information about existing micronutrient deficiencies. Since some micronutrients in too high doses can have a negative effect on the metabolism, regular checks should not be avoided.

The reference ranges of micronutrients given by the laboratories are often wide. In most cases, the HPUler feels more comfortable in the upper reference range (i.e. with well-filled micronutrient stores) than with low values.


The micronutrient analysis should be performed in whole blood (EDTA or heparin blood, not serum).

A whole blood analysis is more meaningful than a serum analysis because certain metals, such as Zinc and Magnesium, are mainly present intracellularly. Others, however, such as Copper, are enriched in the extracellular space. Whole blood analysis is a measure of the storage status of the cell. It is assumed that an insufficient saturation of a blood cell with, for example, Zinc is also reflected in the cells of the organs.

The mineral analysis in EDTA whole blood records both the intracellularly and extracellularly enriched metals and thus reflects the supply situation of the body with minerals in detail.

In addition to a small blood count (service of the statutory health insurance companies), the following values are available for measurement:

  • Cholesterol
  • Homocysteine in plasma (often elevated in HPU patients with a methylation disorder or a mutation in the MTHFR gene)
  • Sodium in whole blood
  • Phosphate in whole blood
  • Potassium in whole blood
  • Calcium in whole blood
  • Manganese in whole blood
  • Magnesium in whole blood
  • Copper in whole blood
  • Iron in whole blood

Quelle: inflammatio – Labor, Diagnostik und Fortbildungen für Ärzte vom IMD Berlin

Micronutrient therapy in practice

The KEAC research institute recommends the following dosages (per day) of food supplements:

Zinc30 mg
Manganese5 mg
Activated vitamin B6 (P5P)50 mg

The supply of Zinc, Manganese and P5P not only refills existing deficiencies of these vital substances, but also improves the Haem-Synthesis. The reason for this is that some enzymes of the Haem synthesis pathway need P5P as a cofactor in order to function.

Micronutrients can be supplied orally or intravenously as HPU infusions.

ATTENTION: Children under 4 years of age should not take Manganese, as Manganese could possibly have a negative effect on the development of the child’s brain.

Caution for patients with psychosis, anxiety or depression

HPU patients suffering from psychosis, anxiety or depression (current or past) should start therapy very carefully and slowly increase the dosages of the supplements, otherwise side effects such as nausea and exhaustion may occur.

One reason for this is that the body of the HPU patient is on constant alert due to the numerous symptoms, some of which are perceived as life-threatening, such as hypoglycaemia, circulatory problems and allergic reactions. An increase in energy due to micronutrient therapy and hormonal changes can easily turn the increased alert into fear. However, this is only a temporary phenomenon, which can usually be prevented by starting following therapy:

It has proven to be effective to start the therapy with 500 mg Taurine (for breakfast) and to supplement it with 15 mg Zinc after about 10 days. Since Zinc can lead to nausea in an empty stomach, it is best to take it with a warm meal. After about 4 weeks to 3 months (depending on your condition), Manganese and P5P can be introduced in low doses and increased in quantity if well tolerated.

This type of therapy has also proven to be effective in patients with severe irritable bowel symptoms.

“By administering Taurine, small amounts of vitamin-B6 are released for other metabolic processes, so that the body does not open “its floodgates”, but instead starts the conversion slowly”.

Dr. Tina Maria Ritter, graduate biologist and alternative practitioner

(Initial) side effects and their causes

In principle, it has proven to be a good idea to slowly increase the dosage of all micronutrients – in other words, to creep in. Initial side effects such as headaches, nausea or vomiting indicate that the initial dosage is too high.

Dr. Kamsteeg explains the phenomenon in his book “HPU and then” with the readjustment of the hormone cycle. The TSH level, which is usually very low at the beginning of HPU treatment, increases with the intake of HPU supplements. At the same time, an increase in serum gastrin is also observed. The resulting increased production of gastric acid can lead to nausea and vomiting.

Countermeasures: Do not take HPU supplements on an empty stomach. Increase the dose slowly over a period of about 3 weeks.

Intolerance of P5P (active form of vitamin B6)

HPU patients often have a disorder of detoxification phase I. If this phase of detoxification is made possible again to a greater extent by supplementation of vitamin B6 and Zinc, more intermediate products are produced, which must be further metabolised in detoxification phase II. However, if detoxification phase II is also compromised (e.g. the function of glutathione S-transferase), the intermediates of detoxification phase I cannot be further processed. As a result, side effects such as nausea, exhaustion or intensification of the HPU symptoms occur when taking P5P. In this case, detoxification phase II should first be improved.

Complementary micronutrients for HPU patients

B Vitamins

Since a deficiency of other B vitamins can occur if P5P alone is taken, it is recommended to supplement HPU micronutrient therapy with an activated vitamin B complex.


HPU patients often have a higher copper concentration in relation to Zinc. Therefore, a copper-free multi-mineral preparation can be useful, especially at the beginning of HPU therapy. Copper is considered to be the antagonist of Zinc and can prevent the often empty Zinc reserves from being filled up at the beginning of the HPU therapy.

Determining the level of Copper is not easy, as it is present in the body in bound and in free condition. Free Copper can promote inflammatory processes in the body, which in turn increase oxidative stress in the body. Free Copper should therefore not be present in excess.

The copper level in whole blood does not say anything about the ratio of free Copper to bound Copper. For this purpose, the concentration of the copper-binding protein Ceruloplasmin in the blood must be determined and the concentration of Copper in the blood serum (Copper is present in the serum at about 60% and in the cell at about 40%). Using these two values, the laboratory can calculate the ratio of free copper to bound copper.

If the supplementation of copper is necessary, a time-delayed intake of copper in a ratio of 1:10 to zinc is recommended. (e.g. 2 mg copper, with 20 mg zinc intake).


Q10 (as ubiquinol) rapidly provides many HPU patients with more energy. Coenzyme Q10 is required by numerous enzymes as a cofactor and also plays a central role in the respiratory chain of the mitochodria, the body’s energy suppliers.

Vitamin D

Patients with HPU have difficulty storing vitamin D in the liver due to mitochondrial dysfunction. The reason for this is an insufficient supply of cytochrome P-450 monoxygenases. These are the enzymes that store vitamin D in the liver.

Free copper can also combine with vitamin D3 to form complexes and thus lower the vitamin D level.

Vitamin B6

Vitamin B6 is water-soluble and is essential for certain enzymes to operate as a co-enzyme. If it is not present, these enzymes cannot work. Especially enzymes that are needed for the production and metabolism of amino acids and proteins require vitamin B6.

Rich on Vitamin B6

The activation of vitamin B6

In order for vitamin B6 to be able to do its job as a cofactor of enzymes, it must be present in an activated format. This is done by attaching a phosphate group to each of the three inactive forms of vitamin B6: pyridoxal (PL), pyridoxine (PN) and pyridoxamine (PM). The body needs vitamin B2, Magnesium and Zinc for the activation process.

Since many HPU patients have a Zinc deficiency, the activation of vitamin B6 often cannot take place in sufficient amounts. The conversion process can also be disturbed in liver disease, as it takes place mainly in the liver.

In the treatment of HPU, it has therefore proved to be a good idea to compensate the vitamin B6 deficiency with the most important form of the activated vitamin: P5P (pyridoxal 5-phosphate).

“At least in stressful times, a dosage of 50 mg P5P has proven to be effective in practice for adult HPU patients”

Dr. Tina Maria Ritter, Metabolic Disorder HPU, 4th edition 2016, VAK Verlags GmbH

One of the most common complaints of vitamin B6 deficiency are:

  • Tiredness, exhaustion
  • Digestive problems
  • Elevated homocysteine
  • Depressive moods
  • Dermatitis
  • Hair Loss
  • Susceptibility to infection
  • Lack of concentration
  • Headache
  • Reduced muscle mass (muscle atrophy)
  • diseases of the peripheral nervous system (neuropathies)

For detoxification the body needs especially the amino acids glutamine and cysteine. Without sufficient amounts of P5P, these amino acids may also no longer be available in the required amounts. Since they are the starting materials of the gluthation detoxification system, without P5P the detoxification cannot function properly.


Zinc is a real jack-of-all-trades in the human body. The micronutrient is involved in more than 300 enzymatic reactions as a cofactor. Without Zinc, numerous enzymatic reactions cannot take place in the human body. But in the HPU metabolism, Zinc is often wasted in large quantities.

Zinc-rich food

HPU patients permanently lose so much of this important element through the attachment of Zinc to the misfolded, toxic Haem that balancing through food alone is not sufficient.

If you want to support the body with foods that contain zinc in particular, oysters (caution, often contaminated with heavy metals), meat, dairy products, legumes, oat flakes, whole wheat grains and cashews can be used.

“I have made the experience with my patients that Zinc is often better absorbed through a zinc-rich diet than through food supplements. Meat and seafood are particularly suitable for this purpose.”

Kyra Kaufmann, Online Allergy Congress 2019

Meat and fish should be organically farmed or caught in the wild.

Zinc plays an important role:

  • detoxification
  • Hair, skin and nails
  • the production of hormones
  • Protection against free radicals
  • Growth and development of children
  • metabolism of sugar, storage of insulin
  • Sensory Perceptions
  • the synthesis of neurotransmitters

Zinc, like other metals, often cannot be easily absorbed through the intestines. To compensate for a zinc deficiency therefore often requires a lot of patience.

“Adults usually take 30 mg of Zinc per day to compensate for the loss of Zinc through HPU”.

Dr. Tina Maria Ritter, metabolic disorder HPU

A glaring zinc deficiency can also be corrected by a zinc infusion. Due to legal regulations, this may only be administered by a doctor, not by a alternative practitioner.


Like Zinc, Manganese is also used for the excretion of the defective haem, and is thus not available for the HPU patient. The body needs Manganese in smaller quantities than Zinc. It acts as a cofactor of several important enzymes. Manganese is:

  • the structure of amino acids
  • on the degradation of histamine
  • in the production of cholesterol, thyroid and sex hormones, melanin
  • on the formation of collagen
  • on blood clotting
  • the metabolism of carbohydrates and fats

and many other reactions.

In contrast to Zinc, the body replaces Manganese, if it is not available, in some enzymatic reactions with other elements – mostly with Magnesium.

Caution: Children under 4 years of age should not take manganese as a dietary supplement. Manganese could interfere with the child’s brain development.

Manganese competes with Iron for the same transport proteins. As a result, the binding of Manganese to Transferrin is increased in the case of iron deficiency, whereas it is decreased in the case of iron overload.