Hi, Qwerty.
I reviewed your posted information and lab test data here and on the other site you mentioned. Here are my comments:
In my opinion, you have ME/CFS. Since you are an athlete, it might more properly be called Overtraining Syndrome, which in my opinion is the same disorder after onset.
The reasons I believe that you have this disorder are that you have the elements of the vicious circle mechanism that I believe is characteristic of it, as well as the fatigue, low body temperature, history of anxiety and panic attacks, history of heavy exercise together with calorie restriction, and steroid hormone abnormalities.
Here are comments on your NutrEval panel results:
1. You have glutathione depletion.
There are three markers for this, and all three agree in your case:
a. A drop between citric acid and the next two Krebs metabolites.
b. Low-normal pyroglutamic acid.
c. Low whole blood total glutathione.
2. A functional B12 deficiency.
This is caused by the glutathione depletion. The main marker for it is elevated methylmalonic acid. Yours is high-normal, and would likely be higher were it not for some B-complex vitamin deficienciesB2, maybe B6, and biotin. You also have a high serum B12 level, which is consistent with a functional B12 deficiency.
3. A partial block of methionine synthase.
This is caused by the functional B12 deficiency. This panel doesnt have direct markers for this. Formiminoglutamate (figlu) is a marker for low tetrahydrofolate,
which is a product of this reaction, but your figlu value is not very high, probably because of your low-normal histidine, B2, and perhaps B6, which can mask this marker.
4. Loss of folates from the cells.
The main marker for this is figlu, but as noted above, it appears to be masked. The elevated sarcosine is also consistent with low tetrahydrofolate, and the high ratio of phenylalanine to tyrosine suggests low tetrahydrobiopterin, which would be consistent with low intracellular folates.
In my hypothesis, the above four aspects constitute the core of the pathophysiology of ME/CFS (or Overtraining Syndrome).
In addition, you have markers suggesting intestinal bacterial dysbiosis, yeast infection, and malabsorption by the gut. To get more specific about this and to select treatment for it, you will need to run a comprehensive stool test.
The flow from pyruvate to citric acid is inhibited, making it difficult to use carbohydrates as fuel in the mitochondria. This could be due to deficiencies of lipoic acid, B1, B2 or B3. It's not possible to separate their effects here. Magnesium is another possibility, but other information, below indicates that it is not low.
Because of this impediment, or because of a low carbohydrate diet, your body has moved into partial ketosis as indicated by the elevated BHBA. Fatty acids are being mobilized, but deficiency in B2 or carnitine or both are impeding their use for fuel by the mitochondria, so they are being pushed into omega oxidation, as evidenced by elevated adipic and suberic acids.
The remaining source of fuel for the mitochondria is protein (i.e. amino acids). These are being burned at a higher than average rate, but this rate is limited by deficiency of B2 and maybe B6 (note that the effects of these cannot be separated in this panel, because B2 is needed to convert B6 into its active form, P5P, inside the cells).
The result of the above is that the Krebs cycle is operating at a lower rate than normal, and this is consistent with your fatigue and low body temperature.
The big drop between homovanillic acid and vanilmandelic acid suggests low copper or low vitamin C or both. Low copper was also found in the red blood cells. Low vitamin C would be consistent with low glutathione, because glutathione recycles vitamin C, and it is low.
The vitamin markers indicate that the B-complex vitamins are generally low. B2 and biotin are low for sure, but its not possible to distinguish whether B6 is low, also, or to distinguish between B1, B2, B3, and lipoic acid, at least one of which is low, also.
The detox system is not working well, as evidenced by the high-normal toxin markers.
The elevated tyrosine metabolites are additional markers suggesting low vitamin C or low glutathione or both, and intestinal malabsorption.
The essential amino acids are on mostly on the low side of normal. Given that you have a high protein diet, and that the rate of burning of amino acids is limited by B-vitamin deficiencies, this is probably due to intestinal maldigestion of protein or malabsorption of amino acids.
The low essential amino acids and B-vitamin deficiencies are probably responsible for deficiencies in the nonessential amino acids. Glutamic acid is high, and the glutamine to glutamate ratio is low, perhaps because of a manganese deficiency, which was found in the red blood cells. The high glutamate to GABA ratio could account for the anxiety.
The low alpha-ANBA is likely due to the low glutamine. The good news here is that this shows that you are not an alcoholic!
The low cystathionine is likely due to low B2 (and maybe also B6). This will limit flow into the transsulfuration pathway, which could limit glutathione synthesis, but see below.
The elevated 3-methylhistidine suggests that you are turning over your muscle protein faster than average, which is consistent with burning amino acids at a higher rate than average. The high-normal ammonia and urea also suggest a high rate of burning of amino acids, though ammonia could also be coming from the dysbiotic bacteria in the gut.
Glycine is low-normal to low, and as Valentijn pointed out, this is probably currently limiting the production of glutathione. If you raise glycine, then probably B2 (and maybe also B6) will then limit glutathione synthesis, and then if the partial block in methionine synthase is not lifted, it will eventually be the limiting factor on glutathione synthesis.
The ethanolamine to phosphoethanolamine ratio suggests that your magnesium status is good, which is unusual in ME/CFS. The red blood cell glutathione also looks good.
The high 1-methylhistidine suggests that you eat a lot of poultry and/or fish, and perhaps that you have intestinal permeability (leaky gut), though the absence of food sensitivities argues against the latter.
Your fatty acids panel indicates that you are not converting carbohydrates to stored fat, and that is probably consistent with the high protein diet and calorie limitation you reported. The high tricosanoic acid is consistent with the biotin deficiency and/or the functional B12 deficiency.
Your elongase reactions are not working well, likely because of deficiencies in one or more of the B-complex vitamins, including biotin.
Your selenium could afford to be a little higher. The somewhat elevated red blood cell lead suggests that you have had some exposure to lead (perhaps from old paint flaking off walls). If this exposure has gone on for a long time, you could have considerable lead in your bones, and if so, it takes years to get it out, because you have to wait for the bone to turn over. Getting glutathione back up should help, as it conjugates lead and carries it out of the body.
I believe that the other abnormalities you reported follow from the above-described vicious circle mechanism. For more information on this, I suggest that you view the video or scan the slides (accessible by clicking on the blue print) at this site:
http://iaomt.media.fnf.nu/2/skovde_2011_me_kroniskt_trotthetssyndrom/$%7Bweburl%7D
I think that you would benefit from following the Simplified Methylation Protocol, described elsewhere in this forum.
Best regards,
Rich