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The Journal of Orthomolecular Medicine Vol. 15, 1st Quarter 2000

Article

Urine Indican as an Indicator of Disease

J.A. JACKSON, MT(ASCP)CLS, Ph.D., BCLD; H.D. RIORDAN, M.D.; S.S. NEATHERY, MT(AMT)

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Introduction

The urine specimen, although one of the easiest obtained body fluids, is seldom used as a an important diagnostic tool.1,2,3 The results of a complete urinalysis (even if abnormal) are usually only given a cursory glance by the attending physician, while an elevated serum enzyme test will cause the same physician’s eyes to twinkle and the heart to race.

At The Center, the urine sample is a primary diagnostic specimen. Some of the urine tests ordered by The Center’s physi-cians are:

  1. 24-hour urine for pre and post chelation (macro, micro minerals and toxic metals)

  2. Potassium/sodium ratio (dietary intake of these electrolytes).4

  3. Pyrroles (physiological and psychological stress).5

  4. Complete urinalysis and microscopic (where applicable).

  5. Urine vitamin C screen.6

  6. Urine indican (the topic of this paper)

Indican (indoxyl sulfate) is produced by bacterial action on tryptophan in the intestine. Most is eliminated in the feces while the remainder is absorbed, detoxified and excreted as indican in the urine accord-ing to the following reaction:

IndoleOxidized

indoxyl + H2SO4 indoxyl sulfuric acid K+ indican (indoxyl potassium sulfate)

In urine from a patient on a “normal omnivorous diet,” the amount of indican excreted is very small. Indican excretion is increased, however, in patients on a high protein diet. Increased amounts in disease results from putrefactive reactions

  1. Department of Medical Technology, College of Health Pro-fessions, Wichita State University, Wichita, Kansas 67206-0043.

  2. The Center for the Improvement of Human Functioning International, Inc., 3100 N. Hillside, Wichita, Kansas 67219.

and is increased with intestinal obstruc-tion, gastric cancer, hypochlorhydria, bil-iary obstruction, and malabsorptive syn-dromes. Detection of indican in the urine depends upon its decomposition and sub-sequent oxidation of indoxyl to indigo blue and its absorption by chloroform.7 The test requires a visual interpretation of a color formed in the chloroform layer. The BioCenter Laboratory is fortunate in that one of the authors (SSN) has been performing this test for the past 23 years. Results are graded as:

negative (clear or slight blue),

+
1 (baby blue, mint green, yellow),
+
2 (sea blue, grass green, golden brown),
+
3 (indigo or deep blue, dark green, or dark brown)
+
4 (jet black)

At The Center, a negative or + 1 is nor-mal, while +2 or higher are considered toxic and an indication of high levels of bowel putrefaction, problems with intes-tinal integrity, absorption, protein catabolism or other conditions mentioned above. Some laboratories consider a +1 positive. From a physiological and biochemical aspect, indican production, reabsorption and excretion is very similar to that of urobilinogen.

Case Studies

Records from 22 patients who had a urine indican ordered were examined for provisional diagnosis, urine indican and pyrrole results. Any unusual findings were also noted. These results are shown in Ta-ble 1 (p.19) and Table 2 (p.20)

Table 1 shows that 55 percent (10 out of 18 tested), had a “positive” urine indican. As mentioned previously, one diagnostic value of the urine indican test is in de-


Journal of Orthomolecular Medicine Vol. 15, No. 1, 2000

Table 1. Diagnoses, Urine Indican and Pyrrole Results

Age Sex Diagnosisurine indican urine comments (neg,+1, +2, +3,+4 pyrroles <20ng/dL)

5 F allergies, sinusitis+1 29 “0” urine vit. C

5 F allergies, sinusitis (twins)+1 34 “0” urine vit. C

18 F constipation, acne+1 33 none

24 F constipation, irritable bowel +1 10 “0” urine vit. C, syndrome, fatigue elevated Candida albicans antibodies

35 M arthritis, iritis, anxiety, chronic neg 23 none fatigue syndrome, depression

41 M irritable bowel syndrome, +1 32 “0” urine vit. C

52 F constipation, fibromyalgia, neg 8 Yeast 3+ and positive chronic fatigue syndrome, back pain for Entamoebacoli

58 F constipation, allergies, yeastneg. 5 Endolimax nana,

fection, headaches, insomniaelevated Candida albicans and Epstein-Barr antibodies

15 F abdominal pain, fever of +2 68 ASO titer range 4 undetermined origin times normal range

37 F rheumatoid arthritis, psoriasis, +2 18 sedimentation rate fever of undetermined origin 64 mm per hour, low in 6 plasma essential amino acids

47 M post CVA, metastatic cancer +2 23low B2 and B6, elevated Candida albicans antibodies

61 M arthritis, hypertension, allergies, +2 10 “0” urine vit. C, low B2, mitral valve prolapse, tremors elevated Candida albicans antibodies

67 Frheumatoid arthritis, osteoarthritis, +2 26 “0” urine vit. C osteoporosis

23 F gastritis, edema, irritable bowel +3 30 “0” urine vit. C, low syndrome in 9 plasma amino acids

35 F vaginitis, dermatitis, easy bruising +3 45“0” urine vit. C., low in 11 plasma amino acids (4 essential), Iodamoeba-butchlii, Blastocystis hominis

56 M lymphoma, allergies, history of+3 40 Endolimax nana,

hepatitis and intestinal parasitesBlastocystis hominis, elevated Candida albicans antibodies

74 F gastritis, GERD, hypothyroid, +3 15 positive H. pylori anti-depression bodies elevated TSH

83 F constipation, ASHD, mitral valve +3 8 low urine vit. C stenosis, macular degeneration


Journal of Orthomolecular Medicine Vol. 15, No. 1, 2000

tecting food digestion problems (intestinal integrity, absorption, protein catabolism and bowel putrefaction). If we considered +1 as positive, then 83 percent (15 out of 18) of those tested were positive. Two of the pa-tients with a negative indican test were posi-tive for intestinal parasites and Candida overgrowth. Seven of the patients with a +2 or higher were positive for intestinal para-sites, Candida overgrowth, or evidence of protein catabolism problems (low plasma amino acids). It is also interesting to note that of all the patients with a urine indican of +1 or greater, 50 percent had either a zero or low urine vitamin C. None of the patients with a negative urine indican had a low urine vitamin C.

Data from Table 2 (below) showed there was no difference in the amount of indican in the urine of patients and the number of food sensitivities (28% +1, 28% +2, 34% +1, 32% neg), however, the number of patients (four) may be too small to show any type of trend. In summary, at The Center it is believed that the urine specimen offers im-portant diagnostic information, whether it is from a routine urinalysis, 24 hour urine for minerals, urine pyrroles, potassium/so-dium ratio or urine vitamin C screen.

References

  1. Jackson JA: Urinalysis: no longer a stepchild of the laboratory. J Med Tech, 1985; 15(9):256-258.

  2. Jackson JA, Conrad ME: Technical aspects of urine dipstick reagent areas. Amer Clin Prod Rev, 1985; 12: 10-19.

  3. Jackson JA, Conrad ME: Which urinalysis prod-uct to use. Lab Manag, 1988; 11:47-49.

    1. Jackson JA, Riordan HD, Hunninghake, Fougeron

    2. K: The nutritional questionnaire as a diagnos-tic aid. J Orthomol Med, 1998; 13(2): 72-73.
    1. Jackson JA, Riordan HD, Neathery, S, Riordan

    2. N: Urinary pyrroles in health and disease. J Orthomol Med, 1997; 12(2):96-98.
  4. Hunninghake R, Jackson JA, Riordan HD: Mi-graine headaches and food sensitivities in a child. J Orthomol Med, 1992; 7(1):16.

  5. Bradley GM, Densen ES: Examination of urine. In eds. Davidshon I and Henry JB: Clinical di-agnosis by laboratory methods. Philadelphia,

W.B. Saunders Co. 1963, p 76.

Table 2. Urine Indican and the Cytotoxic Food Sensitivity Test
Age/Sex Diagnoses Urine indican Food sensitivity results Comments
(Neg., +1, +2, +3, +4) Neg,, +1 +2 +3 +4
24 F constipation,fatigue, +1 65 15 9 1 0 intestinal parasites negative,
irritable bowel synelevated Candida albicans
drome antibodies. 28% positive
food antigens
37 F fever of undeterm+2 65 16 6 3 0 intestinal parasites negative,
ined origin, rheum28% positive food antigens
atoid arthritis
41 M gastritis, fatigue, +1 59 21 8 2 0 intestinal parasites negative,
allergies, back pain, 34% positive food antigens
irritable bowel
syndrome, mitral
valve proplapse
51 F constipation, headneg. 61 15 13 1 0 intestinal parasites negative,
aches, fibromyalgia, elevated Candida albicans
depression, hypo-antibodies. 32% positive
thyroid, easy bruising food antigens.
irritable bowel syndrome

20


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