You need to appreciate that the first part of the results is from blood, the second part (from nutrient markers onwards) from urine.
High and low results from either source can often have almost the opposite interpretation.
High in blood may mean the substance is not being used in the cell - the pathway involved is slow. Of course it could be that there is an excessive supply, but one can often work out which is which depending on the substance and what is known about intake.
Low in blood could mean the substance is being used excessively. The same proviso holds that it could be lack of supply, but again this can often be worked out knowing intake.
The opposite is the case in urine since here we are dealing with the discards of metabolic pathways. High means that the pathway has been used excessively, low that it is not being used much.
There are some substances where high has a particular meaning. These accumulate when there is a downstream blockage. MMA is a good example, accumulating when a B12 dependant enzyme downstream is not functioning well. Nothing else leads to MMA accumulation so this is diagnostic of B12 deficiency.
Interpretation guides with tests usually point these types of markers.
Also in sequential pathways such as the Kreb's cycle, the pattern of high and low can point to blockages.
Your Kreb's cycle markers could be quite consistent with Fluge and Mella's findings. They were looking at amino acids in blood. The ones that were low, that is, the ones being consumed excessively, were those that didn't enter the Kreb's cycle via PDH, suggesting that PDH was blocked and the body was forced to use other sources of fuel.
Your Kreb's cycle metabolites are in urine. You have plenty of pyruvate so glycolysis is proceeding ok, but it's all downhill from there.
PDH acts on pyruvate to make acetylCoA which then reacts with oxaloacetate to make citrate. You have made a bit of citrate, but not much in comparison with the amount of pyruvate. Most of it is not being used and is accumulating.
Two enzymes are involved between pyruvate and citrate so we don't know which is at fault but, in light of Fluge and Mella's study, it is reasonable to imagine the PDH is not functioning well and that there is not much acetylCoA to make citrate.
Then there is almost a complete blockage at the aconitase enzyme which catalyses the next two steps, leading to almost no formation of cis-aconitate and isocitrate. This is a common source of blockage in the Kreb's cycle since the iron-sulfur clusters needed for enzyme activity are readily oxidised.
You are obviously getting a little input into the cycle beyond this point (presumably from amino acids) since it limps along a bit after this, but essentially the cycle is stuffed.
Join the club.
The very high blood amino acids are puzzling and are maybe saying something about your own particular metabolic problems. Possibly a combination of high intake and low use but the reason for the latter would require a lot more delving.
The low lactate in face of high pyruvate does suggest the LD is not working well.
