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Can someone help interpretation of NutrEval test please?

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by paulb, Nov 21, 2012.

  1. paulb


    London, England
    Hi, i'm Paul a 37 y.o from London England. You can read the start of ordeal on my profile, but for now, i have been suffering with hashimoto's for 3 years and TPO antibodies are now 1190. I also have parietal cell antibodies, although i am curious about which came first.........i suspect the gut. Throughout my management, Levothyroxine always done the opposite and makes my hypothyroidism worse, maybe a reverse t3 issue? I have also had heart failure symptoms which wax and wane. I did have a adrenal 24hr saliva test done on 2 occasions, the first one was pretty low morning, although this was done after 3 weeks of no thyroid mediaction and could be skewed. The second one a few months later actually showed high cortisol levels. Right now i am taking T3 50mcg split through the day although i still suffer bad fatigue and exercise intolerance.I do tend to feel better late at night. Some of my symptoms are:

    Body hair loss especially legs
    very weak (jelly legs)
    tinnitus in one ear
    sensitive to sudden sounds
    very slow bowel movement (constipation)
    cold and clammy
    Wisdom teeth infections
    No libido
    muscle twitching
    brain fog
    pins and needles in feet legs and sometimes in arms, comes and goes every few days
    Painful tongue, but only when just awakening or falling asleep!?......strange one.

    I also seem to not tolerate pea protein isolate or multicomplex B vitamins, its like my body is struggling to process these things, although i think i need them.

    My TSH fluctuates wildly sometimes 158.53. Only T3 has managed to keep it down lately.

    To be honest the TSH marker does not relate to how i feel, ut probably everyone knows this anyway except local GP doctors.

    I recently had the NutrEval test done, to try and find the route cause, and i would very much appreciate it if someone could maybe find something others couldn,t.

    Initailly i was thinking about the B12 and methyl route being a problem, but MMA and Homocysteine appear normal, although maybe there are other pathways that could affect this. I know this is a very very complex issue, but maybe someone can shed a little light.......treatment for these conditions in the U.K is disgraceful :(

    Here is a link to my results :) https://dl.dropbox.com/s/z0ti3ic9adq065q/Nutreval 1 doc.pdf
  2. Valentijn

    Valentijn Senior Member

    The low B vitamins can cause a ton of problems. A good B-complex (with methylfolate (B9) and methylcobalamin (B12) might help a lot. Same with the elements you're low on, and D3.

    Your Succinic Acid is low in the Krebs Cycle, which could be causing some muscle exhaustion, but everything else in the Cycle looks normal, so you seem to be compensating for or overcoming that problem. The breakdown is somewhere between alpha-ketogltaric acid and succinic acid (there's an intermediate step as well that isn't tested). On the chart it lists the vitamins and minerals involved with the reactions, and a B-complex + multi-mineral supplement would cover those. Because you did test low in some of those vitamins and minerals, supplementing them might fix some symptoms.

    I can't find much on Suberic acid being elevated while other things are normal. My best guess is that you might be metabolizing more fats than normal to compensate for your problem in the Krebs Cycle.

    Your 1-methylhistidine is high because your anserine is high. Your results say this can be ultimately due to zinc deficiency, which you did test low in. So Zinc might fix that. High anserine and low carnosine can also simply indicate you've been eating a lot of poultry.

    In neurotransmitter metabolites, low vanillymandelic acid suggests low levels of epinephrine and norepinephrine. You can get those tested properly with a blood platelet catecholamine test, which can be very useful in getting to the bottom of some symptoms. Deficiencies in these can cause a ton of problems, and can be treated relatively easily.

    The cystine deficiency is interesting, since your cysteine levels are normal. I suppose a protein-folding dysfunction might suggest a cause, but that's rather theoretical. I think there are some threads about it on the forum somewhere.

    Regarding low ornithine, there's been at least a couple studies suggesting that supplementing it can be helpful.

    Supplementing serine looks like a good idea as well, and might fix the other serine metabolites.

    High Omega 9 levels can cause inflammation, so cutting back on those could help, and/or increasing your omega 3 to balance them out, even though your omega 3 levels aren't low.

    To summarize, their recommendations seem pretty good. To keep it simple:
    1) a quality B-complex or multivatimin with the active forms of the B vitamins
    2) a mineral complex, if not included in the multivitamin
    3) a high dose of D3 - the 4,000 IU they recommend sounds reasonable, though I don't think it's sold in that dose - 2,500 or 5000 are usually the options.
    4) Consider getting your catecholamine neurotransmitters properly tested (blood platelet)
    5) Consider looking into supplementing ornithine and serine.
    6) Cut back on omega 9s and/or increase omega 3s
  3. Hey you may want to erase your private information from your test results. More later on your questions.
  4. Body hair loss especially legs
    very slow bowel movement (constipation)
    cold and clammy
    brain fog

    These sound like hypothyroid to me. Hopefully the T3 will be helpful. It sounds like you haven't been on it too long.

    Here's my story. My thyroid antibodies were also extremely high. I went on Armour Thyroid which has T3, which brought it down a lot but they were still like 300. Then I worked with my naturopath. I tested moderately high for lead and mercury. I chelated those out, and also did something called "cleaning off the iodine receptors". The iodine receptors can become clogged with bromide, chloride, and fluoride. I took high dose vitamin C (Bio Energy C buffered with ribose). I also did some very low iodine supplementation. When it was all said and done my labs looked great - antibodies were well within the normal range. This is supposed to have been something of a miracle.

    I think the bromide (used in breads) are banned in the UK, and that you also don't have the fluoride added to the water like we do here. I'm not sure about chlorine, but would guess that is used to sanitize the water there.

    Ok, so you are showing some elevated mercury. So I would at least suggest chelating that out. Be very cautious when chelating. I did a pill called Chelex for 6 months and that worked for me. You'll feel worse as the toxins come out, so start low and go slow. This means start with say 1/8 of a pill and then wait a few days to see how you react. If you can't tolerate it, lower the dose and space it out, don't take it every day. You can try gradually increasing over time as tolerated.

    Also if you have any mercury fillings, you may want to get them removed (very gradually so you don't dump a bunch of mercury into your system). Or just get them out as they go bad, which is what I did. But I only had 4 small ones to deal with.

    When you're chelating, it will also remove minerals, so be sure to be on a good multivitamin/mineral complex. Also make sure your digestion is good so you'll be able to absorb the multivitamin.


    tinnitus in one ear
    sensitive to sudden sounds
    brain fog
    pins and needles in feet legs and sometimes in arms, comes and goes every few days
    Painful tongue, but only when just awakening or falling asleep!?......strange one.

    These sound like B vitamin deficiencies. You're low in folate. You said you're having trouble tolerating B vitamins, can you elaborate on that? Exactly what forms of the vitamins are in your complex? folic acid, cyanocobalamin, methylacobalmin, L-5 methylfolate ????

    Homocysteine can be low, but bad things can still be going on with methylation. Not sure about MMA.
  5. One more thing. The thing with your tongue is making me think of pernicious anemia, which causes B12 deficiency. Read this link: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001595/

    It can also cause shortness of breath during exercise, and hypothyroidism is a risk factor.
  6. nickvalo


    Paul, if you haven't already stumbled across Chris Kresser's discussions on Hashimoto's and using low dose naltrexone (LDN) for it, definitely google it.

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