Pfeifer protocol for Pyrrole Disorder

July 14, 2017

Article by Dr Reinhard Hemm.



10% of us have a metabolic variant where “we” produce higher levels of a breakdown product of blood called Krypto-pyrroles. I say “we” because I recently decided to test myself and not surprisingly came up with an elevated level of Pyrroles which lead to zinc and B6 deficciency. The first time I received a zinc infusion at our clinic I realised that what I had been experiencing were symptoms of zinc deficiency. I felt the haze of irritability, stress and brain fog disappear, I could think clearly as zinc also helps to produce neurotransmitters. I realised that my life leading up to this point could have been much easier if someone had diagnosed me as a child. I hope that this article will lead to many people receiving a timely diagnosis to change their life.


In those of us with elevated levels there is a wide range of severity in symptoms. Children with high Pyrroles tend to be more tired and irritable, may have dark rings under the eyes and have quite pale skin. There is a higher incidence of learning difficulties including dyslexia and ADHD. There may be nausea in the morning and poor appetite, sufferers may routinely skip breakfast. There is a higher incidence of allergies, food intolerance and abdominal pain. Irregular periods, migraines, intolerance to stress, sensitivity to light, sound, odours, depression and schizophrenia are also associated. Patients may have poor dream recall which improves with B6 supplementation, may have white spots on their fingernails which is thought to be due to low zinc levels.


Testing: urine test – second urine of the day. The sample in the test kit has to be taken in a darkened room, wrapped in foil and then frozen while you wait for the courier to pick it up. We use Nutripath Functional Pathology because it is cheaper. It costs $100 and the courier picks it up from your house. The patient must be off all supplements for at least 4 days and the ideal time to take the test is during a period of at least moderate physiological or psychological stress. The test takes about 10 days to return from pathology.


Serum copper and plasma zinc are also of interest in this patient group because once zinc is taken out by the pyrrole-B6 compound this can result in copper overload as zinc usually gets rid of copper via chelation with metallothionine. Zinc also blocks copper absorption when taken orally. Manganese levels are of interest as these can drop with zinc supplementation.


Pfeifer Protocol for treating confirmed Pyrrole disorder


Zinc picolinate – 50 to 100mg/day for an adult – we usually start with a lower dose and the increase to 100. Some people end up on a higher dose. It is possible for plasma zinc levels to drop after initial improvement due to the production of metallothionine which is a natural chelating agent, produced by the liver to take out heavy metals. This process uses a lot of zinc. There is no likelihood of zinc overdose under 200mg in an adult because the presence of pyrroles will continuously flush zinc out via the urine.


B6 50mg/day – this should improve dream recall. We also routinely use the active version of B6 called P5P. Very high doses of B6 can be toxic. Incredibly the Pyrrole molecule irreversibly binds to B6 forming a new molecule which then chelates zinc and takes it out in the urine!


Magnesium – a well absorbed magnesium such as magnesium bisglycinate. Magnesium is not toxic at all but it should be from a reliable quality brand and if large doses are taken this can draw water into the lumen of the intestines and lead to a temporary but relatively harmless bout of loose stools. If this happens, simply reduce the amount you are taking and make sure that you have a good quality magnesium. We do sell magnesium creams and spray on oils for children and people that don’t do well with swallowing tablets or powder. Epsom Salts baths are also an option because Epsom Salts contain magnesium which can be absorbed through the skin.


Evening primrose oil – this contains arachidonic acid which is beneficial for the metabolic variance in pyrrole disorder. Patients don’t do well on fish oil and it may even be inflammatory in this group of patients. Evening primrose oil also has hormone regulating benefits.


Manganese 5mg twice a day: as zinc administration alone reduces manganese levels and therefore, anyone on high doses of zinc long term should be on manganese. Manganese is poorly absorbed so long term regular supplementation is needed. It is needed for regulation of neurotransmitters and cell biochemistry. Deficiency can lead to macrocytosis which is larger than normal red blood cells, something that is commonly seen in B12 deficiency and folate deficiency, manganese deficiency is a much less known cause. Combining manganese with zinc therapy also increases copper extraction which is useful in those with copper overload. Manganese can, on rare occasions, lead to increase in blood pressure in patients over 40. Manganese levels are related to membrane stability and may be of significance in epilepsy. As manganese is poorly absorbed I recommend testing levels in those that are on high doses of zinc for a long time. Some individual cases may need up to several hundred mg of manganese a day to bring whole blood manganese levels up significantly.


Follow up: As pyrrole disorder is genetic, we often test other family members if they have symptoms. Monitoring zinc and manganese levels is important as zinc levels can drop after supplementation is started due to the metallothionine chelation process being triggered. Manganese drops because of zinc supplementation. Long term excessive zinc may also lower copper levels too far. It may also be worth investigating the methylation cycle as 10-20% of the population are under methylators and some of the symptoms overlap with pyrrole disorder.

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