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NutrEval Test Results: Help!

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Calico13, Jul 15, 2010.

  1. Calico13

    Calico13

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    Hello I am new here and was told that you might be able to help me interpret these. I have been diagnosed with POTS and adrenal insufficiency. Treating those has not helped me at all, so I asked my doctor to run a NutrEval test to see if I had a possible mitochondrial problem.

    edit: You can view the images of my test here. The guest password is birdladyblog.

    I'd like to get the opinions of what you think these test results mean and what I should do/go from here. I was taking 1000mcg of MethylB12 injections on a daily basis and was also taking 800mcg of Solgar Folate just prior to this. I stopped all supplements 4 days prior as suggested by Genova.

    I'm not sure if I should post just the number results or a PDF of my report.

    I guess I'll post the things that were out of range first and then if you'd like to see the PDF I have that too. Everything else not listed was "normal" and within lab range. Nothing was low except for Omega-3's which isn't a surprise.

    Thank you.

    Cellular Energy/Mitochondrial Metabolites
    a-Ketoglutaric Acid(AKG) 36.5 (0.5-16) H

    Organic Acids
    Methylmalonic Acid 25.9 (<19) H
    Formiminoglutamic Acid 19.5 (<12.1) H

    Essential Amino Acids
    Leucine 100 (30-87) H
    Isoleucine 77 (24-58) H
    Taurine 957 (68-538) H
    Tryptophan 112 (28-111) H

    Nonessential Amino Acids
    Cysteine 149 (21-78) H
    Glutamic Acid 56 (5-21) H
    Proline 18 (2-18) Top of range

    Intermediate Metabolites
    Sarcosine 58 (<48) H
    beta-Aminoisobutyric Acid 354 (22-192) H

    Arachiodonic Acid 23 (15-21%) H
  2. richvank

    richvank Senior Member

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    Hi, Calico13.

    It's difficult to get the whole picture without seeing all the results, but I think there is good evidence that you have a partial methylation cycle block, based on your elevated MMA and Figlu on the organic acids test. Sounds as though you were working on lifting that with the folate and methyl B12. If you want to find out more about this please read my papers at www.cfsresearch.org by clicking on CFS/M.E. and then on my name. If you email your pdf to me at richvank at aol dot com, I'll try to give you more of an overall picture.

    Best regards,

    Rich
  3. Calico13

    Calico13

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    I have been on the daily injections for at least 3 months now along with the folate. I find it pretty hard to believe that my body needs that much B12? My original B12 levels before taking anything was in the low 200's about 3 years ago. I bet my urine MMA was like 3 times the range, but no one checked it at that time. I had complete numbness from the top of my knee cap all the way up to my hip. It felt numb but when also felt like a sunburn at the same time. After about 5 hydro-injections, things started to feel better and then I just got 1 injection every 4 weeks to keep it at bay. Fast forward...The last time I had my serum checked was back in November and it was mid 600's. A few months later I asked my doctor if I could just try daily injections to see what happens and I can't say it's done much of anything. The tingling/numbness I get has been better.

    I got the NutrEval test done figuring that all indicators for B12 and Folate would be skewed due to taking so much of it over the past few months. I decided the test was still worth running because of the other things it tested. I could NOT believe my eyes when I saw that nearly every indicator for B12/B6 and Folate deficiency were high.

    I did a little bit of my own research and I cannot find any instances where urinary MMA stayed high for that long after B12 supplementation UNLESS there was something metabolically wrong like my body can't make the Adeno-form of B12 or if there is another cause for the MMA to be high. I started taking the adeno-form last week and nothing has changed. However I don't know exactly what to expect...lol:Retro tongue: I don't think fixing this will cure me from my issues.

    I have emailed you the PDF. Thanks a lot!
  4. Calico13

    Calico13

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    Just wondering if anyone else who have had any organic acids/amino acid testing done has anything else to add besides the methyl block idea?

    Has anyone had any of the same things elevated too? Do you have POTS? Heat and exercise intolerance?

    Thanks.
  5. richvank

    richvank Senior Member

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    Hi, Calico 13.

    Thank you for sending me your NutrEval pdf. I’ve looked it over, and have some comments to offer. Since my knowledge of your health history and symptoms is limited, there are a few issues that I will not be able to pin down unequivocally.

    First, the results of this panel suggest that your digestive system is in fairly good condition. You appear to be able to absorb proteins and fats pretty well. I gather that you don’t eat a lot of peanuts! It would be helpful to know what your diet is like; i.e. is it more or less balanced, or is it a high protein diet? What are the main protein sources in your diet? Knowing these things would help me to interpret your amino acids levels better.

    It looks as though your glycolysis pathway is working well. Your lactic acid is a little high, and since your citric acid is on the low side of normal, I suspect that you may have a slight deficiency in one or more of the B vitamins or lipoic acid, or mercury may be interfering with the flow of pyruvate into the Krebs cycle.

    The high value for alpha ketoglutaric acid is striking, and there’s a big drop between it and succinic acid in the Krebs cycle. Again, the suspects are low B vitamins or perhaps the elevated mercury.

    Adipic acid is a little high. This could be caused by low carnitine or low vitamin B2 or both. Since you have evidence of a partial methylation cycle block (see below), it’s likely that carnitine is low, because methylation is required to synthesize it, and also because lysine is somewhat low, and that is its precursor. If you tell me that you eat a lot of red meat, I may have to change this interpretation, because red meat contains a lot of carnitine.

    Your vanilmandelic acid is a little low. Since your homovanillic acid is closer to mean normal, this could mean that your body is not able to make norepinephrine from dopamine as fast as normal, and that could be caused by low copper or low vitamin C, both of which are
    possibilities in your case (see below).

    Your whopping values for Figlu and methylmalonic acid are saying that it is very likely that you have a partial methylation cycle block.
    I understand that you were treating for that. You were taking the right stuff (methyl B12 and 5-methyltetrahydrofolate), but your B12 dosage was probably not high enough. As you will see below, you have glutathione depletion. When that is the case, according to my hypothesis, the B12 loses its protection in the cells and is hijacked by toxins. In your case, mercury may be the main one that it hijacking the B12 (see below).

    The somewhat elevated value for 2-hydroxyphenylacetic acid suggests that you may have some bacterial dysbiosis in your gut, but as I wrote earlier, there isn’t a lot of evidence for problems there.

    The elevated alpha ketoadipic acid suggests low vitamin B6.

    Pyroglutamic acid is low-normal, and that suggests low glutathione in the kidneys and/or the intestine.

    You have high levels of several of the essential amino acids, including the branched-chain amino acids and some others. It would be helpful to know whether you have a high-protein diet, but I suspect that this is due to low vitamin B6 status.

    The somewhat elevated 1-Methylhistidine suggests that you eat a lot of chicken. Is that true?

    Your cysteine is high, while your glutathione is low (see below). This is a little puzzling, because cysteine is usually the rate-limiting amino acid for making glutathione. Perhaps the limiting amino acid in your case is glycine, which is low-normal. The elevated glutamic acid is consistent with the elevate alpha ketoglutaric acid, because they are related by reactions. The high ratio of glutamic acid to gamma-aminobutyric acid (GABA) suggests that you may be suffering from some excitotoxicity (can cause insomnia, anxiety, hypersensitivity of the senses, a “wired” feeling). Do you have any of these symptoms?

    The high proline may suggest that your body has difficulty making collagen. Low vitamin C can cause that.

    The elevated beta-aminoisobutyric acid suggests that thymine is being broken down at a higher than normal rate. Thymine is a component of DNA, so this suggests rapid cell turnover or excess production of thymine from uracil. I don’t think the latter is likely because of the condition of your folate metabolism (very high Figlu).
    I think I would need to know more about your health status to interpret this result.

    The elevated sarcosine is consistent with dysfunction of the folate metabolism, which is associated with a partial block in the methylation cycle.

    The low phosphoethanolamine relative to ethanolamine suggests
    low intracellular magnesium. This is consistent with glutathione depletion (see below).

    The low-normal urea together with the low orotic acid suggests that your cells are not burning protein for fuel at a very high rate. This is consistent with your elevated branched-chain amino acids. It also means that you do not have gut bacteria that are producing a lot of ammonia, which is consistent with other markers suggesting that
    there isn’t much bacteria dysbiosis in your gut.

    The low glutamine to glutamate ratio again suggests B vitamins deficiency.

    In your fatty acids analysis, your arachidonic acid is high. That can cause proinflammatory prostaglandins to be produced. Your omega-3 fatty acids index is low. This probably means that you are consuming vegetable oil, and not much flax oil. If I had more information about your diet and your weight history, I could probably do a better job of interpreting this part.

    Getting to the toxic elements, it looks as though you have a mercury issue. Since mercury does not stay in the blood for more that several weeks, your elevated RBC mercury level suggests that you have an ongoing or recent exposure. I’m wondering if you have a significant number of amalgam fillings in your teeth, or if you eat a lot of fish that are near the top of the ocean food chain. It looks as though you are not a smoker. Do you drink water from plastic bottles? That might account for the antimony. It could also be coming from solder in water pipes. Lead sometimes comes from the water system, too. But the mercury is probably the one to focus on, because it could be inhibiting improvement in your methylation cycle function as well as accounting for Krebs cycle issues (above). It also torpedoes glutathione, which is low (see below).

    On the nutrient elements, selenium is clearly low, and it is important in utilizing glutathione to combat oxidative stress, as well as in the conversion of the thyroid hormones from T4 to T3. The elevated mercury could be responsible for the low selenium, because mercury forms a very stable complex with selenium, and takes it out of biochemical availability. Copper is a little low, too, and that is needed for the conversion of dopamine to norepinephrine, as well as in the antioxidant system.

    On the last page, the red blood cell total glutathione is somewhat low, and the lipid peroxides are high-normal. These are consistent with several of the other results, including the low-normal pyroglutamic acid, the elevated markers for a partial methylation cycle block, the low selenium, the low copper, and the elevated mercury. Coenzyme Q-10 is low normal. This is consistent with a partial methylation cycle block, because methylation is needed to make Co Q-10. It’s also consistent with the other markers of oxidative stress, because Co Q-10 is one of the network antioxidants.

    I would say that the overall message from these results is that you have glutathione depletion and a partial methylation cycle block, as well as deficiencies in some of the vitamins and essential minerals.
    Mercury toxicity is an important factor in your case.

    You mentioned that you have diagnoses of POTS and adrenal insufficiency, and you also mentioned some tingling and numbness on your upper leg. You didn’t mention fatigue. Do you also suffer from fatigue?

    I’m not sure why your B12 went so low in the past. Were you a vegetarian? I don’t know your age or whether you were healthy for the first part of your life.

    Normally, when I study a case, I look at the health history and symptoms as described in responses to a lengthy questionnaire, as well as the results from a variety of lab tests. If you are interested in asking me to pursue this further, please email me again.

    Best regards,

    Rich
  6. Calico13

    Calico13

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    Wow wow!! thank you so very much for taking the time to look these over. I hadn't come across anyone who had any clue what these meant, so I was literally on my own trying to interpret them.

    I understand you do not want to reply on this thread again. I hope you don't mind if I answer the questions on here though in hopes that this info can help someone else later on? Forums like this are great informational tools and if my answers could help point someone in the right direction, then that would make me quite happy. :D

    I am 26 yo, female and have been ill since at least the age of 16. My weight has been like a yo-yo ranging from 112 to 140lbs. I got EBV somewhere around 16 and was never the same since then. The most debilitating aspect of my health problems today are the elevated heart rates. I used to have crazy amounts of fatigue, but with the HC that has been A LOT better. When I stand up, my HR goes through the roof; 140's are the norm and 160+'s I see on really bad days or if I just continue to push myself. One time I had a 186 HR and I literally thought I was going to die.

    These high HR's causes me to have fatigue, shortness of breath and I feel like my body is working triple what a normal person's is doing at any time. Everything feels heavy as if I have a 400 lbs weight on my back. I see elderly people doing activities that I could never ever do such as playing volleyball, working in the yard for hours, taking care of their grandchildren (thankfully I have no kids) and doing activities that literally make me feel like I am dying or on the brink of death. It might sound as if I am exaggerating but I am not. :eek:

    Add in a warmer than usual day or a hot room and all of my problems are much much worse. Today I decided to plant 2 flowers in the garden and my HR was 145 and I felt as if I were going to collapse. I just sat down on the ground and waited it all to calm down. Stood up when I could and limped my way back into the house. This is an every day occurrence for me. I've had my heart checked many many times and there is nothing wrong with it physically. It is always just sinus tachycardia which cardiologists and EP care nothing about.

    Last month I went to Cleveland Clinic to have a tilt table test done and my HR's were elevated throughout. I was tachying away at or around 150 for a good 20 minutes and it would have continued on indefinitely. I am not a fainter and my BP's stayed pretty good throughout the test except for a few times it dipped into the low 90's/50.

    It seems like every few years, I get worse and worse. What I think is a bad phase become what I look back on and wish I could have now... Last year around this time is when my POTS got really bad again. I began to have generalized anxiety and weird mental feelings/thoughts. Never before (even though I had POTS for years) had I felt like this. It actually scared me a little and a lot of these feelings are still there, but I have learned to play them down. My thyroid levels are decent, but I have high RT3. Any amount or type of thyroid hormone make me feel so much worse/crazy. My standing HR's get even higher.

    My diet is pretty limited because I have numerous IgG food allergies. I do not eat gluten, wheat, yeast, tomatoes, strawberries and a few other random things. I mostly eat chicken (as you guessed), ground beef, lots of vegetables, salads, rice, potatoes, beans and some chocolate. :Retro tongue: I also limit my dairy intake as I have lactose intolerance, but I still eat butter which doesn't seem to bother my stomach at all. All of the meals, I make myself which isn't easy some days. I haven't eaten out for at least a year or more now. I laughed a little bit about the peanuts because I had just finished eating some apples with peanut butter as I read that sentenced. I don't think I eat a lot of peanuts though. :D My diet is pretty carb heavy as I feel a lot better on that type of diet. I used to have a major aversion to meat, but that's been a little better over past 5 years. When my B12 levels were that low, I was not a vegetarian. In fact, I was probably eating the most balanced diet ever. I was religiously following the carbo metabolic diet type that Dr. Mercola put out a few years back.

    I don't eat a whole lot of red meat. I go through phases where I just get sick of chicken or red meat and then eat a lot of the other one for a bit. :Retro smile:

    The low vanilmandelic acid really threw me for a loop... Just a few weeks prior to this, I found out I have high levels of norepinephrine levels upon standing, which apparently is quite common in POTS. Supine Norepinephrine was 125 and it increased to 613 at the 10 minute mark while on the tilt test. My HR was 133; BP 104/68. I was told that is way too much of an increase upon standing and that 'normal' would have been a doubling not a 5X's increase.

    You asked if I have excitotoxicity feelings and I have to say yes. I never did until about a year ago. I'd worry about real, concrete problems, but now I feel like my mind makes up things to worry about for no reason. :Retro mad:

    I had all of my amalgams out more than 2 years ago. I chelated following Dr. Andy Cutler's protocol until I crashed hard. I was a complete wreck with elevated liver enzymes, neutropenia, elevated eosinophils and a rash all over my body. It was absolutely dreadful. My entire body was shaking and I just couldn't do it anymore and quit after 10 rounds. I was quite shocked to see the mercury that high as well. I know that it doesn't linger in blood for very long...so where is it coming from? I guess I need to suck it up again and chelate more....UGH. :worried:

    Thanks again. I have emailed you for more info.
  7. serg1942

    serg1942 Senior Member

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    Hi Calico 13,

    I'm sorry to read about your history, symptoms, etc. I am just a year older than you, and I cannot avoid feeling sad and also identified with you...

    Just wanted to ask you a question. I am interpreting right now a bunch of tests too, and reading Rich's interpretation of yours has helped me a lot.

    Just wanted to ask you about your levels of aspartate (or aspartic acid), fumarate (or fumaric acid), and malate (or malic acid). I'm not sure if your test measured these compounds. In case they did, would you mind to tell me their levels? --I'm "struggling" with their interpretation, and cause your energy levels seem not to be a big problem right now for you, I am curious in these specific markers, as they are directly related to energy cell production...(Lack of energy is my main issue...).

    On the other hand, when you refer to HC (helping a LOT with energy), you mean Hydrocortisone, rigth? Have you been tested for XMRV?

    Thanks in advance,
    Regards,
    Sergio
  8. Calico13

    Calico13

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    Hey Sergio,

    I took a quick look through the results and the only thing I see tested was Malic Acid. The results to that was 0.9 (<2.4). The units are mmol/mol creatinine. If you have any other questions about results, please let know. I am more than happy to help.

    Yes HC is hydrocortisone. I have not been tested for XMRV. That's something I haven't even looked into at all. There's so many different aspect to look at that I don't know where to go from here...I was really hoping all of my problems were just a nutrient deficiency or just a higher need for a certain nutrient, which I think the NutrEval is sort of showing. I really feel that I have some issue with B vitamins that I just can't seem to figure out. Am I deficient in a mitchondrial enzyme or is something like mercury causing problems in the conversion/enzymes? It's just never ending. Each test brings on more and more questions that I can't ever seem to answer. I'm sure you can understand this!!

    I thought when I got my amalgams out (which was more like 3 years ago when I think about it) that things would get better on their own, but I can say without any doubt things are in fact getting worse on their own...ugh. My problems have evolved over the years though. It went from extreme fatigue (sleeping like 14 hours a day) to leg numbness/tingling, then autoimmune hair loss (alopecia areata), and then severe skin rashes, swollen lymph nodes and weight loss. Most of those issues are completely gone now and now I'm dealing with the intense POTS symptoms and adrenal insufficiency issues.

    Don't get me wrong. I am certainly fatigued. ;) I just don't know if it's the same level as what most people feel on this board. How do you know what is normal when you've been sick for so long? lol I really don't know what a normal person is supposed to be capable of doing during a day. I can only guess based on what I see others do and I definitely can't keep up with others whether they are my age or even older!
  9. serg1942

    serg1942 Senior Member

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    Hi Calico 13,

    Yeah, be sure I understand you, his is a never-ending story. But I have to tell you that for me it is being like a long tunnel with some light at the end, as my progression has been positive during the last 3 years (very far to be “healthy” again though, as I was bedridden for 4 years, and now I can say I am still mostly house-bond…).

    RE: mercury, I have quite a bit knowledge on it, as unfortunately it was the first culprit of my disease, and has had to study it in depth. Also I helped to establish a national Spanish association of people affected by Hg, www.mercuriados.org (I am a board member), so again, this led me to study this subject thoroughly… Ok, this is a long way to tell you that from my own experience, and also from the experience of hundreds of patients, members of our association (no wonder that almost 80% of them suffer from CFS/FM/MCS!!!), I can tell you that, unless in weird cases where you are allergic to mercury (MELISA test), removing your amalgam fillings is just the first step. Normally, the mercury released by the amalgams during years is accumulated mainly in the soft tissues of the body, and although when you remove these fillings, you are eliminating the main source of mercury, the accumulated Hg is still there…

    I think Dr. Cutler’s protocol may work for some people, but not for those with an already evident methylation cycle block. The problem arises when you are also unable to tolerate the supplements intended to restore this basic cycle (as is my case), then, what to do???? Well, I am working on this now! ;-)

    Finally, regarding “what does one feel by being healthy”, Well, I do remember what I could do when I was 21…It seems to me so far away right now…But I do really remember what is to feel just fine, just worrying about silly thing that I don’t care anymore! ;-) Anyway, to compare yourself with other healthy people is also a very good reference…I cannot believe to see my friends doing everything I’d like to do, and that I did once! Well, this is the feeling that must make us continue fighting, don’t you think?

    Ok, Thank you for reviewing your test looking for the markers I asked you for. I sent you a private mail on this regard, but I guess I forgot to press the buttom “send”, as you have not replied, and my “sent messages” folder is empty (too bad!)…So please, tell me if indeed you have not received a PM from me, and I’ll send again.

    Thank you and HEALTH ;-)
    Sergio
  10. Calico13

    Calico13

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    I PMed you back. =)

    I think I had 8 amalgam fillings removed. I'll have to go back through my records and see again because I can't remember right now. The worst part though was my exposures as a child. Yes I was vaccinated too. Ugh. I have a mercury tattoo on my gums from my childhood dentist who didn't believe in using composite fillings or novacaine. He'd always tell us how composites would crumble and didn't last long enough...Which I now know is complete and utter bull. Composites last way longer than amalgams these days. Maybe he was right back then, who knows. I used to scream, kick, whine and cry going to the dentist. It was just awful! I'd spit out bits and pieces of amalgam fillings all the time when I was there. He was a nightmare.

    No other detox protocol really makes any more sense, so I'll have to try it again. I think I was really bad off the first time I did it because I still was not diagnosed with adrenal insufficiency yet.
  11. dannybex

    dannybex Senior Member

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    Hi Calico -- thanks for posting this thread. I've got the NutrEval test kit -- just now trying to raise the $ to pay for it. From my understanding it covers a LOT of bases, so it seems to be worth the money required.

    But I'm curious as to why your doctor wasn't able to help you analyze it. Doesn't Genova provide some sort of explanation/analysis regarding the results? Seems to me they said on their website that they would also consult with docs if they had any questions.

    Thanks in advance,

    Dan
  12. Calico13

    Calico13

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    I did not get any page with any sort of analysis/explanations on it. I know that it says you'll get something, but I called my doctor and they said they got nothing. Perhaps Genova is no longer supplying it ? I really have no idea. Google was pretty helpful with some of the most basic information.

    The doctor that ordered it just did it because I asked him to. He uses Genova for other testing and he was kind enough to order it for me knowing full well he would have no clue on what the results meant. :Retro smile: The receptionist said he would be willing to do some research and help me out, but I'd have to come in for an appointment. He's so booked that wouldn't be until at least October and I am looking to get some help before that.

    I got the test done through the PayAssured program so it only ended up costing me $150. Well worth it. My insurance company wanted to bill me about $1600 for it, but Genova is picking up the tab since I qualified for their program.
  13. Sushi

    Sushi Moderator and Senior Member Albuquerque

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    I had this test too. It is good and like Calico, I got it on the Pay Assured plan for $150. You generally qualify for this if you have decent insurance and you have met your deductible.

    My doc gave me a copy of the "physician's copy." which totaled 27 pages--some of them interpretation.But you still need to look a lot of stuff up if your doctor can't analyse it for you.

    Sushi
  14. serg1942

    serg1942 Senior Member

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    To Calico13

    Hi Calico13,

    Sorry, I didnt have activated the option of keeping my sent messages! Thanks!, I did receive your PM! ;-)

    I have to tell you that your dentist was right:(. Amalgams fillings normally last more, are stronger, and of course cheaper. Also it is required less skill to work with them, so this is one of the reasons why they are still being putting in children, as they move, etcIts a shame!

    I agree with you in that Cutlers protocol is the best among the chelation protocols available. But, I am not sure it is a good idea to follow it without a proper methylation cycle function. This is one of the big questions without answerwhat to do first? Maybe both? Cutler states that it is impossible to detoxify mercury just by supporting the methylaton cycle. Well, he is obviously wrong! I did detoxify LOTS of mercury and other heavy metals just by restoring the methylation cycle.

    The problem is that it seems very difficult for some of us to restore the methylation cycle, so right now Im not sure what we should do first

    I think some infection, maybe XMRV, can be playing an important role hereTime will tell,

    Saluditos,
    Sergio
  15. Calico13

    Calico13

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    I'm going to be getting my blood lactic acid, pyruvic acid, CK and a few other things checked this week or next. First I got to make sure that insurance will cover it and I have to find a lab that can even do them. Apparently the one requires a highly explosive preservative! haha

    When I get the results I'll be sure to post them though. It's it wrong that I'm hoping they show something? :Retro tongue:

    The dentist that removed my amalgams said that composites are much better these days and he's seen them outlast amalgams by many many years. All of the amalgam fillings I had in my mouth, he told me were falling apart and they were only 2 years old. There was even decay underneath them that an x-ray never picked up! I bet that bacteria wasn't helping me...

    Interestingly I never get sick though. Just these stupid chronic problems.
  16. Calico13

    Calico13

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    After doing a little bit more research on my own, having an elevated FIGLu does not mean you need to be taking the active form of folic acid. In fact, it means you desperately need the regular form of folic acid. Now if my homocysteine levels come back high, then it would appear I do need more methyl B12 and methyl folate.

    I have a feeling now after reading about this that my homocysteine levels will be quite low. We'll see though!
  17. dannybex

    dannybex Senior Member

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    Hi Calico,

    I'm still kind of stumped as to why your doctor didn't receive a full report from Genova like the sample one they list on their website:

    http://www.genovadiagnostics.com/index.php?option=com_gpanel&Itemid=2&task=view&nav=doc&id=42 (click on the Sample Report tab on the left hand side)

    If you can't open that, they list several reasons for elevated FIGU:

    "Elevated urine FIGlu can occur with several circumstances. Dietary deficiency of folic acid or [Isevere oxidant stress that limits biologic reduction of folic acid to the THF form can cause this elevation. Histidine as a supplemented nutrient can contribute to urine FIGlu levels, especially if taken in amounts that exceed 50 mg/Kg body weight. Metabolism of folic acid can be impaired if vitamin B12 is insufficient or if its metabolism is disordered. So, elevated FIGlu also can mean that some form of B12 or cobalamin is needed. The enzyme that promotes processing of FIGlu and THF requires pyridoxal 5-phosphate as a coenzyme, and vitamin B6 deficiency also may contribute to elevated FIGlu. Finally, there are rare disorders in purine synthesis that impair normal utilization of folate forms that come from FIGlu and THF.

    Abnormal levels of uric acid, succinylpurines, inosine or adenosine may be investigated if FIGlu levels remain elevated despite folate, cobalamin, pyridoxine and antioxidant therapy.

    Elevated FIGlu can be coincident with homocystinuria and predisposition to cardiovascular disease. In children, elevated FIGlu and folate and/or vitamin B12 dysfunctions may be associated with mental retardation, autism, growth failure and seizures. Folate and/or vitamin B12 insufficiencies can be secondary to gastrointestinal disorders or poor quality diet, and deficiencies of both have been noted in elderly populations."

    Re your comment that you never 'get sick'...'just these chronic problems'...that's classic CFS (or CFIDS) due to the immune system shift. Most of us haven't had a serious cold/sinus infection/fever (a REAL fever) since we became ill. If we did have a normal immune system reaction, like a real decent fever, perhaps our body temp would stay high enough, long enough, to kill off some of the bugs that might be plaguing us. Just a thought...

    d.

    p.s. Thanks for the PayAssured info...unfortunately I don't qualify. :(
  18. Calico13

    Calico13

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    I've been taking so much B12 for the past 3 months, I can't see any way that I'm deficient unless my body has a polymorphism. I'd bet my serum is probably >2000 at this rate, so it has to be either B6 or folic acid (regular form). I'll have to dig up the stuff I read about having to specifically take the folic acid form and not the methyl donor forms to lower FIGU. There was an explanation/reason behind it.

    If you have elevated homocysteine with the elevated FIGU, then you need both the regular folic acid and the THF forms. But if you have normal homocysteine with the elevated FIGU, then the methyl folate won't help to lower the FIGU levels. That's what I was understanding. I have a small handbook my husband just bought that explains the metametrix test. It was like $30 and well worth it.

    Next week I'll know what my homocysteine levels are and then I can go from there. ...Sometimes we get so focused on active forms of vitamins we forget that the regular forms have metabolic and enzymatic use too!
  19. richvank

    richvank Senior Member

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    Hi, Calico13.

    Ordinary folic acid may help to lower your FIGLU level, but it also might not. In order to lower FIGLU, it's necessary to raise tetrahydrofolate (THF). In order to do that with folic acid, your liver has to perform two sequential reactions with the enzyme DHFR (dihydrofolate reductase). If you have inherited a fast form of DHFR, all is well and good. However, if you have inherited a slow form, which has been found in some people with autism, but hasn't been studied in CFS as far as I know, then this conversion might be pretty slow. People vary by a factor of 5 (500%) in the activity of this enzyme. People with a slow form end up with high levels of unreacted folic acid in their blood. Sometimes they get conventional serum folate tests from their doctors, and the high level of folic acid will make the result high, and can be misleading. Meanwhile, they are functionally deficient in folate, because they aren't able to do this conversion very rapidly. Note that normally, the most abundant form of folate in the blood is not folic acid, but 5-methyl tetrahydrofolate. This is also the only form of folate that crosses the blood-brain barrier. Most cell types in the body use the reduced folate carrier to import folate, and folic acid is not a good substrate for this transporter.

    I should mention, though, that Dr. Alan Vinitsky in Maryland does use a protocol that includes folic acid with hydroxocobalamin. He uses a very high dosage of folic acid, though, perhaps because it doesn't convert to the reduced forms of folate very rapidly, especially in some people.

    With regard to homocysteine, we have not found its level to be very predictable in autism and CFS. Some people who have a partial methylation cycle block have low homocysteine, some are high, and some are normal. It may depend on genetic polymorphisms and on the level of methionine that the person has.

    Generally speaking, people who have elevation of both methylmalonic acid and figlu have a partial methylation cycle block, and they are helped by simultaneously taking a relatively high dosage of B12 (hydroxo- or methylcobalamin) with an RDA-like dosage of an active form of folate, either folinic acid or 5-methyl tetrahydrofolate, or both.

    The reason for the high dosage of B12 is that glutathione is depleted, and the B12 is not being adequately protected in the cells, so a lot of it is hijacked by reactions with toxins, and is thus not available to make methylcobalamin and adenosylcobalamin, which are the coenzyme forms of B12 actually used in the biochemistry.

    The reason for the active folate is that when B12 becomes hijacked, folate drains out of the cells into the blood via the socalled "methyl trap" mechanism. The result is that the cells go low in all the forms of folate.

    Best regards,

    Rich
  20. Calico13

    Calico13

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    From what this book states, THF levels do not matter at all for the FIGLu urinary markers. The simple folic acid form's function is to accept a carbon group in the FIGLu reaction. This is all a little too complex to fully understand, but it very plainly says that THF levels have no bearing on lowering or increasing FIGLu levels. You don't need methyl donors to lower FIGLu in the urine and if I am reading this right, it's biologically impossible to use THF to lower FIGLU.

    Also what happens when one has been on high doses of B12 and THF with high FIGLu? Remember my test results are after at least 3 months of following these methylation block protocols, so I'm a little skeptical. Prior to the daily methyl B12 injections, I was taking bi weekly HydroB12 injections. I just don't see any reason for that marker to be high unless I just need regular folic acid.

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