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Lessons from ME/CFS: Finding Meaning in the Suffering
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Help with NutrEval results

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by qwerty42, May 5, 2012.

  1. qwerty42

    qwerty42

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    Hi all,

    New poster here as I'd seen a few people get help with their NutrEval results here.

    Have linked to the file if anyone is any good with them and would be able to take a look I'd thoroughly appreciate it as I'm a bit lost.

    Lead looks high to me and Vit C low which would tie in, but is lead that high a problem with it not being in the red range?

    http://www.4shared.com/get/Qxw1cbZ7/Qwertynutreval.html

    Thank you in advance!
  2. nanonug

    nanonug Senior Member

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  3. qwerty42

    qwerty42

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    Apologies didn't realise I could!

    I can only see how to attach pictures and video, not files such as pdfs?
  4. qwerty42

    qwerty42

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  5. nanonug

    nanonug Senior Member

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    Yep! Next step is to PM richvank and kindly ask him to analyze your results! He's the expert on this stuff...
  6. Valentijn

    Valentijn Activity Level: 3

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    As a very basic observation, supplementing with glycine could correct a few imbalances at once: raising glycine levels, dropping glutamic acid levels, and increasing glutathione levels.

    Basically glycine combines with the glutamic acid and cysteine to form glutathione.

    Glutamic acid is an excitatory neurotransmitter, with pretty unpleasant symptoms when it's too high, so it might be an easy way to fix any problems you're having in that area. And glutathione is pretty essential for quite a few processes.
  7. Valentijn

    Valentijn Activity Level: 3

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    Another thing that's odd is your very high levels of 1-Methylhistidine, but normal anserine (which it comes from), and normal beta-alanine (another byproduct of anserine being broken down). It can be the result of a high-protein diet, but it also sounds like it can result from breaking down your own muscles for fuel.

    Your 3-Methylhistidine is also pretty high, which can also indicate muscle break down. It's possible that your body is breaking down muscle to fuel your Citric Acid Cycle, which shouldn't be happening if you have a pretty normal diet. I had similar results, and eating a bit of protein throughout the day seems to be helping somewhat.
  8. qwerty42

    qwerty42

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    Thank you for those responses guys.

    Glycine seems cheap enough so will see if that starts to help.

    I was wondering if the high lead could be a possible cause?

    I do eat a high protein diet, likely 50% protein so that might account for that as you say.
  9. roxie60

    roxie60 Senior Member

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    Thanks for sharing the results. Look forward to Rich's comments also. What made you get this test? It sure covers a lot. I wonder how much it would vary day to day, flare up to flare up. What is your chief symptom(s)? I always wonder if I could schedule my blood draws for my really bad days (but thn I couldn't get myself there) how the results would compare to an ok day vs bad symp day. Anyone else had his test?
  10. qwerty42

    qwerty42

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    I've been suffering from severe fatigue, dry / gritty, photophobic eyes, low serum testosterone with zero libido or morning erections and middle of the night waking for some time now.

    I'm fairly certain that my symptoms are stemming from elevated reverse T3, rendering my hypothyroid, despite my TSH, FT3 and FT4 looking normal.

    RT3 rises in cases of inflammation - heavy metals, allergies, gut problems, chronic dieting etc to name a few.

    I had always thought mine must have been elevated due to chronic calorie restriction and over exercising (before I got ill a year ago I was a high level amateur athlete and in very good condition) I won't clog this thread with my history but if you are interested it is in this thread on another forum I am on:

    http://forums.realthyroidhelp.com/viewtopic.php?f=5&t=22874&p=183823#p183823



    I've not been able to exercise, have slept 8-10 hours a day and have eaten lots of very good food now though and show no signs of recovery and my RT3 remains high and body temperature low - hence that test to check for underlying causes of inflammation.

    Some other recent results I have:

    December 24 hour salivary cortisol assay

    Sample1: 17.9 nmol/l (12-22)
    Sample2: 5.3 nmol/l (5-9)
    Sample3: 3.4nmol/l (3-7)
    Sample4: 0.5nmol/l (1-3)

    DHEA Mean: 0.87 nmol/l (0.40 - 1.47)
    DHEA : Cortisol Ratio: 3.21 (2-6)

    April 24 hour salivary cortisol assay

    Sample1: 21 nmol/l (12-22)
    Sample2: 10.1 nmol/l (5-9)
    Sample3: 7.8 nmol/l (3-7)
    Sample4: 2.8 nmol/l (1-3)

    DHEA Mean: 1.16 nmol/l (0.40 - 1.47)
    DHEA : Cortisol Ratio: 2.78 (2-6)


    NHS Bloods
    Endocrine

    Testosterone 9.8nmol/l (9-40)
    Cortisol 590 nmol/l (140-500) *
    ACTH 11pmol/l (2.0-11)
    SHBG 20 nmol/l (12-78)
    IGF1 40nmol/l (15-64)
    TSH 1.2 mU/l (0.3 -6.00)
    FT4 15.6 pmol/l (10-22)
    FT3 5.0 pmol/l (2.5-6.5)
    RT3 0.46 pmol/ml (0.14 - 0.54) (This was tested privately, not on the NHS)
    A'dione 3.4 nmol/l (1.0-8.5)
    DHEAS 10.6umol/l (0.3-12.0)
    LH 3.8 U/L (No range given)
    FSH 5.7 U/L (No range given)
    Progesterone 2.6 nmol/l (No range given)
    Oestradiol <50pmol/l (No range given)
    Prolactin 121 mU/l (<350)

    Urea & Electrolytes
    Sodium 142 mmol/L (133 146)
    Potassium 4.2 mmol/l (3.5 5.3)
    Chloride 102 mmol/l (95-108)
    Bicarbonate 29 mmol/l (22-29)
    Urea 7.8 mmol/l (2.5-7.8)
    Creatinine 101 umol/l (50-130)
    eGFR 77 ml/min1.73m^2>60
    Anion Gap 15 mmol/L (6-16)

    CMP
    Total CK 137 U/L (40-320)
    CRP <5 mg/L (<5)
    Total LDH 311 U/L (0-450)
    Albumin 50 g/l (35-50)
    Total Pro 69 g/l (60-80)
    Globulin 19 g/L (19-35)
    Alk Phos'ase 56 U/L (30-130)
    Bilirubin Total 7 umol/l (<21)
    ALT 32 U/L (<35)
    Gamma GT 13 U/L (<50)

    FBC
    HB 14.5 g/dl (13.0- 16.7)
    Haematocrit 40.0 % (39-50)
    Mean Cell Volume 95.5 fl (80-100)
    Platelets 223 x10^9/l (150-400)
    WBC 5.3 x10^9/l (3.5 -11)
    Neutrophilis 2.6 x10^9/l (2.0-7.5)
    Lymphocytes 1.9 x10^9/l (1.0-3.5)
    Monocytes 0.5 x10^9/l (0.2-0.8)
    Eosinophils 0.3 x10^9/l (0.0-0.4)
    Basophils 0.0 x10^9/l (0.0 0.2)
    roxie60 likes this.
  11. richvank

    richvank Senior Member

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    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! :D

    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
    vitamink likes this.
  12. qwerty42

    qwerty42

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    Rich - I want to take the time to reply properly and ask you some questions on that but for now can I just let you know how grateful I am for you taking the time to do that - its more interest than a hell of a lot of Dr's have shown over here in the UK and its really generous.

    My eyes are killing me right now but I'll type up my thoughts and questions hopefully later or tomorrrow.
  13. richvank

    richvank Senior Member

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    O.K., Qwerty. You are very welcome.

    Best regards,

    Rich
  14. DANEL

    DANEL

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    i have tried glutamine and glycine and was having trouble with brain, causing extreme stuppor effects, brain fog, reduced ability to think, etc, I was told I have bad BBB compromise, so these amino acids are hard on me/brain.

    first, can one fix BBB compromise? and how?
    if i can,
    then i could start the glycine and glutamine but i would also have to combine with nac b/c cysteine is very low.
    i am not sure how else to raise glutathione.
    i have high mercury, fungal(from moldy house), bacterial (staph in nose, gut and just removed root canal abscessed teeth and 6 cavitation s due to bacterial mouth infections) and viral (EBV<CMV<HHV6)infections, and blasto hominus parasite and others, whew!
    so trying to detox and chelate.
    dr andy cutler says my glutathione should come up after removal of hg?
    do you believe that here?

    how do i know if i have high glutamic acid?
    was this test blood, stool, urine?
    do you know the cost?

    trying to decide what test to do for the most information, (on disability)
    i have done whole blood, white blood cell nutri from spectra cell labs, animo acid, vit, glucose, glutathione, cysteine, etc, not as extensive as this one,
    great plains, homocysteine, etc

    wonder if this is better than one for methy pathways or both to get the whole picture and which would be best?
    i am looking into the gemo type test

    since TMG has glycine in it, right?
    is it the same and the regular glycine you are talking about?
    it says on bottle it helps convert homocysteine into methionine. i know culter doesn't want us to directly take methionine i believe due to, it is sulfur and can redistribute the hg .
    my homocysteine is high.

    i am not sure what my CFS is from, i guess all the things sited above or/ and a gene mutation.

    if rich's methyl protocol and things like, the tmg, glycine, hg/metals chelation etc if one straightens out do we need to continue taking these aids for live to maintain the correction? or once corrected we can come off? i guess if it is a gene, it is for life
    which is fine, better that this nightmare!

    my diet is not normal or balanced, i can not eat anything but organic meat, no veg, friut, carbs, b/c i can't break it down, my enzymes are all screwed up. the food is like poison to me, even the meat isn't great but better than veg, they really make me sick-this is all so strange

    thanks so much sorry so many questions, but need help
    d
  15. Valentijn

    Valentijn Activity Level: 3

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    It can be tested in the urine, and should be part of any amino acid profile. You said you have had amino acids tested in the past, so it should be in there. It might be called "glutamate" though, instead of "glutamic acid".
  16. nanonug

    nanonug Senior Member

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    I would be very skeptical of that...

    If I were you, I would very much focus on getting rid of these infections. After you fix the infections, there is a very good chance your ME symptoms will miraculously disappear...
  17. DANEL

    DANEL

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    i have high inflammation from high hg/metals, moldy house, fungal bacterial and viral, and parasite infections,
    kinda working on all at the same time.
    chelation cutler, proteolytic enzymes to break up fibrin/biofilm, "killing herbs"( for bacteria, virus, mycoplasma), csm binder , and a huma worm cleanse, low and slow doses.

    my rt3 is also so high started, before protocols was 398 (high range was 350) then moved down on it own to 313-same range, then to 289 last checked without addressing thyroid b/c my adrenals are so depressed, so was working on that as well.
    so i believe this is somewhat straightening out as i reduce the inflammation and opening methy, correct liver phase 1/2 i think, i hope, still pretty sick.

    also low temps. my tsh is normal but have hasimoto , at one time it was graves and also have sojurns
    it is like the whole syst is wacky. but like many of your results are normal but don't feel noemal.

    how much was the test if you don't mind me asking
    i will keep reading thread to see how you are trying to correct this

    have you done stool test? do you have a gut problem?
    RBC mineral test, seems imp for heavy metals i had 6 out of 8 "none detected"
    virus test?
    are you doing any chelation, or protocols to detox, bacteria, mold, etc?

    my neutrophils are low and my lymphocytes are high.
    my ferritin is also high, showing inflammation

    when i take the methyl b12 800mcg and folate acid 800mcg even at 200mcg i gat bad brain fog, wonder if this is from the wrong form of b12 for me, also makes me cry alot/highly emotional from it
    would you know about this?
  18. DANEL

    DANEL

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    the amino acid test was blood from spectra cell labs in houston. it was not urine and i will look again but i don't think it gave me that information, it was not as extensive as this one.
    is there a way someone can help me with some of the questions above?

    i would so appreciate this

    d
  19. DANEL

    DANEL

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    I guess I should have not given too much history-tends to turn people off. but how can someone help if they don't have an idea of what is going on?

    should have just stuck to the questions, then maybe someone could help me with the answers..

    if one has BBB integrity how do you deal with it?
    are there supplements that may help?

    see below..

  20. DANEL

    DANEL

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    Well, it sounds easy.

    you know I have been sick for 7 years, I have been asked to leave dr offices, I was told by family and friends, that I was a hypochondriac, lazy, psychosomatic,
    I was told in a ER I needed a psychiatrist,

    so this is not new to be disregarded,

    but surprising coming from a support group dealing with the very issue I have.

    I do believe my BBB integrity has been compromised,

    I could defend myself by siting several examples, of incidents and supplement situations I have had, but I honestly am too sick to debate this with you.

    You didn't ask me any questions, just made an off cuff comment

    and flipped remark, to JUST "fix" infections



    wish I would have thought of this

    this was a pretty insensitive response

    d

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