The normal pyrrole (HPL) range is now higher

by sue

Breaking news: the ‘normal’ HPL range is now higher

by Sue Kira, Naturopath & Clinical Nutritionist

Note: This article was released on 27 August 2017 (so not quite ‘breaking news’ now). However the content remains valid.

If you, or someone you know, has a HPL score between 20 to 40, then this information is important.

Extensive research studies in 2017 established that there is need for a significant change in the previous ‘normal’ HPL score for adults. These results were formulated, based on improvements to assay sensitivities, and from consultation with practitioners regarding their clinical observations.

Previously a HPL (pyrrole) adult score of less than 15 or 20 (depending on the lab) was considered normal. The new normal adult reference level is now a HPL reading of less than or equal to 40ug/dl. Thus, the new HPL adult scores are:

  • Normal adult: 40 or less
  • Mild elevation: above 40 and less than 150
  • Moderate elevation: above 150 to 400
  • Severe elevation: above 400 & further haematology (blood tests) advised

The current values for paediatric levels remain the same, which is: HPL]<20ug/dL being normal for children i.e. less than 20ug/dl is normal for kids.

At this stage, I’m not certain what age criteria is used for a child, but in normal naturopathic circumstances, such as for doses of herbals etc, it’s usually less than 12, unless they are large for their age, in which case it could be 8-10 years. Let’s say less than 40kg as a guide, but if I find it’s different I’ll get back to you.

Here is how the new table will look for new reports for adults, along with your specific HPL score.

[HPL]≤40µg/dLNormal adult
40µg/dL<[HPL]<150µg/dLMild elevation
150µg/dL<[HPL]<400µg/dLModerate elevation
400µg≤[HPL]Severe elevation (further haematology advised)

You will notice in any future tests that the reports have some small changes, such as the term ‘Critical Values’ replaced by ‘Reference Ranges’ to make it easier to understand.

So what does this mean for all who thought that they had pyrrole disorder with scores between 20 and 40, the ‘new’ extended normal range?

It simply means that just when you thought that all your symptoms were related to pyrrole disorder, something else might be going on. I can almost hear some of you sighing with relief, while others sigh with despair, particularly when it was so good to know what caused all those horrible feelings and symptoms.

For some, it means, back to the drawing board. But before you throw your expensive supplements into the bin, assess how you have responded to treatment so far.

Do you feel better or worse for the treatment?

The reason I ask this is because there are other biochemical/metabolic disorders and imbalances, many that don’t even have names yet, that just might respond to the same treatment you are using for pyroluria.

Vitamins and minerals such as B6, B12, zinc, magnesium etc are central to many different biological processes that go on in the body. If you are deficient in these nutrients, then supplementation may manage your disorder more efficiently.

However, if supplementation treatment makes you feel worse, which does happen a lot, then it may be worthwhile to be reassessed by your practitioner.

I have seen many clients who felt worse on supplements due to genetic variants that don’t allow methylation processes to work properly. In these cases, even though there were nutrient deficiencies, their bodies could not process high doses (and sometimes low doses) of certain supplements.

In this situation, food is your best medicine – but not just any food. You need foods that are rich in the nutrients required to make methylation processes work more efficiently.

These include folate rich foods such as: leafy greens; zinc rich foods such as seafood, meat and pumpkin seeds etc; B6 rich foods like bananas, meats and more…and the list goes on. Find more information, go to my article Best foods to eat and avoid for pyroluria

While the article is about foods to support pyrrole disorder, be aware that the same foods can help many other metabolic disorders (particularly if this new information about HPL scores suggests you might not have pyrrole disorder).

Yet what if you feel that you still have pyrrole disorder, even though your score was say 35, yet all your symptoms fit the ‘classic picture’ of pyrrole disorder?

It is still possible that you have pyrrole disorder for various reasons. For example, your test results were inaccurate because:

  • the sample was affected by daylight
  • poor transportation if the sample was sent in the post
  • urine was too watered down from drinking lots of water to be able to ‘pee on command’ (usually the watery pee would be noted and you should have been asked for a retest)
  • you just came back from a restful, stress-free holiday and you ate really healthy food

See your practitioner

If you find that you are now within the ‘normal’ reference range, you may not have pyrrole disorder, but rather a condition that has many of the same symptoms such as methylation defects, leaky gut syndrome, heavy metal toxicity etc. 

Or, as mentioned, you may still have pyrrole disorder, but need to be retested. In either case, it’s best to reassess your situation with your health practitioner. Much of this reassessment will depend on that question above, ‘Do you feel better or worse for the treatment?’

My article What is pyrrole goes into more detail to help understand this condition.


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