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Can anyone help me interpret Genova Metabolic Analysis Profile?

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by pjam24, Jun 5, 2014.

  1. pjam24

    pjam24

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    Hi,

    I'm a new member here. I've had fatigue for a year and no got very far with my doctor. I've had the Genova ASP, CDSA and MAP done. I can understand the first two pretty well I think, but I can't make head nor tail of the Metabolic Analysis Profile. Can people here on the forum help me to understand it? Or can you recommend someone I can send it to who could interpret it?

    Sorry if this is a newbie question that has been covered before.

    Thanks for your help.
     
  2. justy

    justy Senior Member

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    Hi @pjam24 - perhaps if you posted your results up here some folks could come along and tell you what they think? What where your results on the other tests like?

    All the best
    Justy.
     
  3. pjam24

    pjam24

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    Thanks.

    My Adrenal Profile revealed that my morning and bedtime Cortisol level was ok, but the 2 daytime levels were very low and DHEA was very low.

    CDSA showed moderately raised Putrefactive SCFAs, Beta-Glucuronidase, n-Butyrate and Triglycerides. Very high Long Chain Fatty Acids and Fecal Fat. Also some dysbiosis and Giardia for which I've now taken a course of Metronidazole.

    My diet is loosely Primal, moderate carb, and I do eat occasional legumes, rice, oats, fermented dairy or lactose-free dairy. Also Non-organic. I also add a pea protein isolate at breakfast occasionally

    Any help would be greatly appreciated. Many thanks!

    MAP1.jpg MAP2.jpg MAP3.jpg MAP4.jpg MAP5.jpg MAP6.jpg MAP7.jpg
     
  4. Valentijn

    Valentijn Activity Level: 3

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    Elevated 5-oh-indoleacetic acid can (but doesn't always) indicate some serious problems. It might be an indication of tumors, though certainly not always. But you should definitely look into that one with your doctor.

    Most of the abnormalities, including the 5-oh-indoleacetic acid, seem gut related.
     
  5. pjam24

    pjam24

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    Thanks Valentijn,

    I was concerned about the high 5-HIAA reading because of the potential cancer link, so the doc did a further test on that one reading and gave me the all clear. I should have mentioned that I had just been taking Guiafenisen for a nasty chest infection just before sending in the urine samples, so that may explain the elevated 5-HIAA. Sorry for not mentioning that.

    Thanks for highlighting the gut symptoms. I don't know how to understand the Energy Metabolism part, nor the Neurotransmitter Metabolites and Toxins aspects, all of which had some ambers and reds. Any ideas? Thanks.
     
  6. Valentijn

    Valentijn Activity Level: 3

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    The energy metabolism looks fairly normal. It's not really abnormal for certain of the Kreb's Cycle substances to go down to 0, so it's pretty odd that they flag that. And the rest of your neurotransmitter indicators look pretty normal. No idea about the toxins.
     
  7. Leopardtail

    Leopardtail Senior Member

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    The Homovanillic and Mandelvanlic are both low side of okay, they related to Adrenalin and Noradrenalin.
    Given that you also have low cortisol later in the day they are a small concern - do you get hungry, or light headed between meals?
    -- what's your thyroid status like?

    What supplements are you already taking?
    What's your diet like?
     
  8. Leopardtail

    Leopardtail Senior Member

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    @pjam24 are you by any chance on a low carb diet?
     
  9. AkeBono

    AkeBono

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    My two cents:
    CDSA should give you some clue about the real cause - the rest of the results are more or less effects of dysbiosis long term infection. Maybe you can post the CDSA results.

    Usually if giardia is chronic (same with some bacteria) it makes a lot of damage in the gut and malabsorption of critical vitamins and cofactors/minerals. the same with bacterial overgrowth. It could impaire pancreatic function and bile function thus maldigestion / malabsorption.

    In my experience one course of metronidazole is not enough for chronic giardia - in fact is the "treatment of choice" not the very efficient one. Plus in immuno depressed people could give or raise candida. As for the food - you probably know already giardia (and some bacteria) impaires carbs digestion and absorption and let the carbs/starches sit in the gut for other fellows". See also pancreatic insufficiency in the panel.

    Did you have tested the sigA with the saliva or CDSA? Sometimes low sigA due to other factors/infections/stress (generally speaking) make giardia harder to eradicate.
    I'm in a similar situation since many years and just recently found I have H.pylori also.
     
  10. pjam24

    pjam24

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    Thanks Leopardtail and AkeBono,

    To answer your questions:

    I've been pretty grain free for about 2 years. Found gluten wasn't doing me any favours, but also gluten free alternatives still gave discomfort, so just dropped most grains entirely and upped my fats and veggies. I guess that makes me more low-carb, but I do try to eat plenty of fruits and veg, and still have some rice, potatoes, sweet potatoes, beans, and fermented in my diet most weeks. I do get hungry between meals, but usually just take a handful of nuts. Been a bit dizzy since having the fatigue, but thought that was brain fog as it doesn't necessarily seem linked to meals, etc. I used to get low blood sugar symptoms before I dropped grains 2 years ago.

    Thyroid was given all clear by blood test from Doctor, but not had it tested more thoroughly by private tests.

    When the MAP was done, the only supplements I was on was a daily vitamin shake. Since having the tests I've been on Biocare's Mitoguard, Some adrenal supporting herbs, Berberine and Grapefruit and Candibactin for Giardia as well as probiotics.

    Looks like the Giardia has been there for a while as they said it was well established. Maybe picked it up 7 years ago open water swimming in Canada or drinking from streams while hiking in mountains a decade ago, but that's just speculation. Did 7 day course of Metronidazole. Not convinced it worked as started getting some minor symptoms again about 3 weeks later.

    I don't know what sigA is I'm afraid. My wife wondered if I had H. pylori too, but not sure what she based that on.

    Will try to post CDSA a bit later on. Many thanks!
     
    justy likes this.
  11. pjam24

    pjam24

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    Oops, 'fermented' above should say 'fermented oats'!
     
  12. Leopardtail

    Leopardtail Senior Member

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    Pjam,

    When I had a closer look I noticed three things:
    • the possibility of infection
    • B-Vitamin markers that are okay but not ideal
    • Noticeable and linked disruptions the Metabolism of Tryptophan & Vitamin B3 (aka NAD).
    One of the chemicals that is rather high is converted to Vitamin B3 by Ribose. Ribose is derived (rather slowly) from excess Glucose, that in turn is derived (ideally) from fibre or starches. That same chemical disrupts the mechanism that carries Ammonia out of the brain (by converting Glutamate to Glutamine)- the Ammonia could cause your low Neurotransmitter levels. If you rare not producing Glutamine the Ammonia would not enter the Urea cycles and your doctor's standard test would not pick this up.
    Thing to look into below in order I would recommend.

    Andrenal & Possibly Thyroid

    You need to start taking Licorice extract (as mentioned above) ASAP - it helps with blood sugar stability and several causes of brain fog. It may cause very slight stomach upset.

    Vitamin C - this is the major thing for both Adrenals and ME, it spares all kinds of things inside the body, improves immunity, Adrenalin and Noradrenaline production. I strongly disagree with their report on this point. I find it takes min 5g=5000mcg and up to 15g=15000mcg of Vitamin C to keep me feeling well, you seem to be a prime Candiate. Buy this as powder, tablets are vastly more expensive - if you can take yoghurt, mixing it with that protects your teeth, otherwise brush after taking. Your high levels of lipid peroxides indicate high need for Vitamin C too.

    Iodine is vital to every gland in the body not just the thryoid, if things do not pick up, I would suggest supplementing min 1mg=1000mcg per day. If you need to do this you may get detox symptoms. The type of Iodine matters - Potassium Iodide is preferable, any Iodide is okay - there are other forms of Iodine that are cheaper but have more side effects and potential toxicity.

    Iodine can cause detox symptoms. I would not recommend large amounts of Iodine until the other steps have been performed, unless your TSH (thyroid test) was above 2, or there is some other pressing reason.

    B1, B3, Ribose

    Because Ribose is derived from carbs and B1 also comes with carbs - your diet may play a role in several issues here. Low carb can be good, zero-carb definitely isn't
    I would suggest you start by eating small snacks with Carbohydrate between meals (a small amount of sugar would be no bad thing here). Once you get your Ribose up the B3/NAD may well fix itself.

    You can also supplement Ribose but take it after carbs, at meals try vegetable based carbs such as potatoes, sweet potatoes etc.

    If you can't tolerate any grains at all, nor bran you may need to supplement, or find a source of Vitamin B1.

    One question on this : do you know what your SOD function is like?

    B-Vitamins

    I would like to see you taking a good quality active B vitamin supplement (e..g Jigsaw Health is mine). This is in addition to your general multi-vitamin supplement - but don not take them at the same time. Prefer to take your B-Viamins after breakfast and your other a lunch or dinner. These all have Niacinamide, but we just have to live with that.

    Carbs

    Was the low blood sugar verified or worked out from the symptoms?

    There are other issues that can create the impression of low blood sugar that are common in ME.
    Your reactions to Carbs could be downstream if your issues with Adrenalin and Cortisol. You hunger between meals makes this likely. I they still occur (even slightly less with Potatoes & Yams) then I would be even more inclined to thing this. Fixing the Ammonia issue and the Ribose issue may eventually resolve this.

    Make sure you take some carbs in the morning - this will spare your Cortisol a little. Take your carbs in the morning at first, keep the amounts small, and do them in bursts every 90 mins (building up slowly). If you have low blood sugar, a single teaspoon of sugar under your tongue will not cause further low blood sugar.

    Dysbiosis

    Being short of Ribose makes you short of ATP, being short of ATP messes up your immune system, as does high Ammonia (if I am right about that). Whether the possible infection is an inherent problem, upstream of the other metabolic issues, or due to low ATP is high to say at this point.

    One thing worth trying for bugs is Eucalyptus oil. I buy a bottle of the stuff (not the Aromatherapy version) and put a small drop in a cup of water then drink it. Eucalyptus disrupts the cells walls of most microbes. Be warned, it tests foul. You will need to take pro-biotics afterwards though.

    Ammonia
    The biotin mentioned in the report is good advice, it stimulates the urea cycle to get rid of ammonia. I would recommend you follow their guidance.
    If you follow their advice on Vitamin B3 do not use Niacinamide (it contains Ammonia) instead use simple Niacin in a very small dose. If you sort Ribose out, you may not need this though.

    I would be inclined to have a closer look at your Urea cycle and Glutmate/Glutamine levels if things do not improve - this will confirm or disprove my hunch.

    I can't recommend anything more for this until we know how the other things work out.

    I hope that "Novel" of an answer helps.
    Leo
     
    Last edited: Jun 6, 2014
    justy likes this.
  13. pjam24

    pjam24

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    I was asked to post my CDSA results in an earlier post. Here they are along with the ASP to give the full picture. I've since undergone a 7 day course of Metronidazole to treat the Giardia. ASP copy.jpg CDSA1.jpg CDSA2.jpg CDSA3.jpg CDSA4.jpg
     
  14. AkeBono

    AkeBono

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    My two cents again cause not an expert but a sufferer also.

    low DHEA in your context related with chronic infection. If you're not already bedridden its OK you can be back with proper supps. I'm not sure how old is your infection and if you should supplement for DHEA cause some people need it. but usually if the infection/inflammation is solved DHEA and you eat well after it should be back in the normal range.

    Giardia is very common and often overlooked BUT its a common cause of "adrenal fatigue" as is h.pylori.
    Dont laugh now but in my country the doctors tell us everybody has them so dont bother treat them. Better treat the fatigue and depression which is an effect of these. My grandparents died of Hpylori infection complications. So dont bother treating them ...???

    Re- the strep group which they said non-pathogenic i suggest you research more on the net or here. I would not consider them non-pathogenic with this value 4+ especially they are 3 types of strep. two of them are hemolytic - not very good IMO. I've seen several other users here and other forum having problems with strep at this value. I tested positive for strepA in the throat but it can give many other issues in the body including gut. search on the net.
    Could be that strep overgrowth is an effect of long lasting giardia infection but not 100% sure. If giardia impairs carbs digestion and absorption and carbs stay in the gut undigested and strep is fermenting carbs....

    Dont know if theres a relationship between CDSA and your acids profile but it should be. Its a new thing for me also so I cant give you more details for now. Some are related to dysbiosis metabolites directly some to lack of vit/cofactors due to infection. Just search for OAT interpreting guide. i.e.You can check some of your findings here.
    http://drweyrich.weyrich.com/labs/oat.html

    for example:
    4-hydroxyphenylacetic Acid (which is high on your results)
    • Produced by overgrowth of bacteria in the GI tract by metabolizing the amino acid tyrosine.
    • Very elevated values are present in celiac disease, enteritis, and intestinal resection.
     
  15. Leopardtail

    Leopardtail Senior Member

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    I noticed the 4-hydroxyphenylacetic Acid and 2-hydroxyphenylacetic Acid as well. There are also many other indicators of Tryptophan metabolism being disturbed. I noted you each a lot of vegetables in your earlier answer hence there could be several reasons in combination for the high 4-hydroxy:
    1. olive oil in diet,
    2. bugs in your bowels,
    3. low iron
    4. conversion from 2-hydroxy
    The high 2-hydroxyphenylacetic Acid combined with modest NAD indicate possible low ribose (assuming its not genetic). That issue among closely related ones in your profile (modest Adrenaline in a state of infection) imply raised ammonia as does low Glutamate. It would be nice to know your Glutamine level though that would add weight to the possibility. Raised ammonia seriously messes up immunity.

    I did wonder re the Guardia .. how fatigued/exhausted are you, what's the rest of your immunity like?
    is you doctor likely to be at all amenable to medication?

    One other things I noticed was a lot of un-metabolised fat in your faeces, do you know what your level of stomach acid is like? Low stomach acid can prevent digestion of fat, I am not sure what Guardia does there, not my area of expertise.
     
  16. Valentijn

    Valentijn Activity Level: 3

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    @pjam24 - Giardia is a very nasty one, and has a pretty huge impact on the GI tract. Have you been treated for the Giardia?
     
  17. pjam24

    pjam24

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    Thanks for such a thorough response Leo,

    I've been on liquorice root for about 3 months and just started D-ribose 3 weeks ago. Not seen any effect from either so far, but not sure how long they would take? Would the ribose not really help without the B3 anyway?

    To answer your questions:
    I don't know what my SOD function is like? (I don't even know what SOD function is, sorry I'm new to all this)
    How do I find out?

    I haven't had low blood sugar diagnosed and I don't know if I have it as part of the brain fog seems to be a light headed/dizziness occasionally.

    Regarding the 4-hydroxy I do have olive oil regularly and I do have bugs in my intestine, as far as I know my iron is ok. I don't know my Glutamine levels, how would I find out? Is that something I should be supplementing with?

    My immunity was low for about 6 months before I got flu, then post viral fatigue. Colds and sore throats every other week. That has been better since have chronic fatigue for some reason. Using the CFS scales I'd rate my fatigue around 30ish. I can go out for 10 minute walks and get out of the house a few times a week. I could probably work for 5-7 hours per week, but my job is a lot of mental work and meeting people, both of which are affected by brain fog.

    Regarding the fat, my understanding is that the Giardia caused malabsorption of fat, hence the amount in faeces. But I may well have low stomach acid too as my nails are riged. The giardia also steals carbs, so that may cause low blood sugar symptoms.

    My doctor is pretty good and has already given me one course of medication for the giardia.

    Please could you explain the ammonia, glutamine, ribose, B3 part a bit more? I'm not fully understanding what you're saying is happening there or the steps I can take to put that bit right. I understand the rest of the advice you gave, it is all really helpful.

    Thanks again for all your help.
     
  18. pjam24

    pjam24

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    AkeBone: thanks for the points you made about Giardia and the levels of other bacteria. I'll check out the link you gave. That makes a lot of sense and would fit with the upper quadrant abdominal discomfort and distension I'm getting. Is it more antibiotics to treat the bacteria there?

    You mentioned one course of Metronidazole not being enough. We raised that with the doctor, but he said it was fine. What would you recommend from your experience? Thanks again.

    Valentijn: yes, I've been treated for Giardia with a seven day course of metronidazole, plus I've been taking Berberine and Grapeseed extract.
     
  19. pjam24

    pjam24

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    Ps, to everyone who has been helping I really appreciate it. If I'm slow in replying, it's because I'm having to make some pretty big life changing decisions about work due to the fatigue, so having to have lots of meetings with my work partners about it and then lots of conversations with my wife about how we're going to afford to live for the next year or so! Everyone is being very good about it all and very supportive, but trying to sort all that out in the midst of fatigue means I'm being a bit slow at getting back to you after you post all this help. Sorry!
     
  20. Leopardtail

    Leopardtail Senior Member

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    Stomach Acid


    Low stomach acid can cause mayhem and is more common in people with ME. Problems include more bugs and parasites in the bowels, acid reflux, B-vitamin malabsorption, mineral malabsorption. Link to home burp test here.


    Ammonia Stuff

    This is a complex multi-part puzzle.
    1. The 2-hdyroxy that's high in your tests is not nice stuff and can elevate Ammonia levels. Ammonia in turn can lower your production of Adrenalin and Noradrenalin, interfere with your immune system and lower ATP production.
    2. Recycling NAD (that's B3) uses both 2-hdyroxy and Ribose, hence if your short of Ribose your NAD would be a touch low (as per the tests) and your 2-hydroxy high. It's not guaranteed to work but if it does, two birds with one stone so well worth a try.
    3. The Glutmate in your test could be higher. If your brain has Ammonia it converts Glutamate into Glutamine to carry it out of the liver and detox you. The process of recycling the Glutamine back into Glutamate (and getting rid of the Ammonia) does not work if ammonia is high. By testing your Glutamine as well as your Glutamate and comparing the levels we can work out whether you just have low Glutamate, or a urea cycle problem that stopping the regeneration.
    4. Finally turning Niacin (that exact form of B3) into NAD aborbs one molecule of Ammonia. It only takes one extra molecule of ATP as opposed to four for the Urea cycle so it's a possible way of getting things down, but only short term. Again it's two birds one stone, but more chance of side effects hence not doing it first.
    My suggestion would be that you trial other supplements, see what happens and then we can discuss Ammonia and that test if problems continue. Detoxing one lot of Ammonia needs the equivalent four lots of ATP. That's important because if you are Ribose deficient you may have poor ATP and poor Ammonia detox as a results.

    Genova Diagnotics do an Amino Acid test that will tell you about three quarters of your urea cycle, glutamate, Glutamine, and a whole lot more but the other measures above may improve results so better to see what's happening when you had tried the basics. As said though I would deal with what we know, then think about it.

    Blood Sugar

    The hypoglycaemia question was important since the symptoms most people associate with it can be caused by very poor ATP production or slightly reduced oxygen supply to the brain due to low blood volume, a fermenting gut, along with a few other theorised causes. It helps when introducing Ribose to know what's happening very high CFS fatigue can affect insulin metabolism and create a short term reaction when things start to improve. Knowing blood glucose would allows us to work out whether it was a short term glitch and press on, or something else. One can often get blood meter free here at certain clinics, or buy them cheaply, but it would mainly be a 'peace of mind' thing.

    SOD

    SOD is an antioxidant enzyme. This needs a lab test, either a mito function test, or a genetic one. One of the people in the USA needs to advise you on that one - I am only familiar with labs here. If you react badly to the Ribose I would concern myself finding this out. @Hip or @Radio might be able to advise with this one.

    Two things I missed earlier

    To what extent has the Giardia been cleared up? It's not something I have experience of (being from England) I know I need longer courses of antibiotics than most nearly always two weeks rather than one. Pretty much everybody I know what has Giardia in the USA said until it was dealt with progress on other issues was very hard.

    DHEA - being a hormone this is a medical issue, hence I would far rather you get doctors advice. It can affect a very wide variety of functions multliple other hormones are made from it, it's involved in immunity but it's mostly new science. It's very low and worrying, is your doctor skilled enough to understand the interaction of immunity with both Cortisol and DHEA? I know many antifungal medications strain one's adrenal glands but am unsure what the situation is with Giaridia. Many CFS specialsts think one should sort out Cortisol, DHEA and Thyroid first and only then tackle immune problems to avoid side effects of the Herxheimer reaction (aka healing shock)..
     

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