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Metabolic Analysis Results

RosieBee

Senior Member
Messages
104
Location
UK
Got my results back from the metabolic analysis urine test.

How do these results look to you?

I would be grateful if Rich could take a look.

FIGlu 1.4 (range <1.5)
Methylmalonic acid 0.9 (<1.9)

FIGlu is borderline and MMA is within the normal range.

Does this mean there is no methylation block? I know from previous blood tests that glutathione is very low.

I have been following Rich's simpified protocol for a couple of weeks now (with the supplements he recommends) and have had no start up symptoms. I did feel a little better (from usual malaise) when I switched to taking my morning doses to bed time. I was expecting some reaction to the supplements, but not noticed much difference.

I do have significant mercury levels and I believe mercury toxicity can affect this protocol; I suspended metal chelation with DMSA/ALA (Cutler method) before starting this, and I quite miss it as I usually feel better on chelation. Is it OK to continue with chelation whilst doing the methylation protocol?

I would be grateful for any comments. Many thanks.
 

RosieBee

Senior Member
Messages
104
Location
UK
Help needed interpreting metabolic markers results

I would appreciate some feedback. Should I post the full report? Am I posting this in the wrong place?
 

richvank

Senior Member
Messages
2,732
I would appreciate some feedback. Should I post the full report? Am I posting this in the wrong place?

Hi, RosieBee.

Yes, please post the full report as an attachment, or if that doesn't work, please email it to me at richvank at aol dot com I can usually do a better job if I can see the whole thing.

Best regards,

Rich
 

richvank

Senior Member
Messages
2,732
Hi, Rosie.

I have studied your Metabolic Analysis Profile results. Here are some comments:

You have intestinal bacterial dysbiosis and yeast infection. Comprehensive stool analysis would be required to get more specific about this and to determine what treatment might help.

Your carbohydrate metabolism is low-normal. This could be caused by a low carb diet or to difficulty in absorbing carbs from the gut because of the dysbiosis and yeast infection, or to low magnesium.

You have a mild state of ketosis because of the low carb metabolism. Your cells are calling for fatty acids to be used as fuel, but you appear to be low in carnitine, so that it is difficult for them to enter the mitochondria, and they are going instead to omega oxidation in the peroxisomes. I don't think that an adduct on the gene for fatty acid synthase is causing the elevated adipic and suberic acids. I think it is due to deficiency of carnitine.

Your neurotransmitter metabolites are pretty good.

Your B-complex vitamins status is a little low.

You have glutathione depletion, based on the other measurement you reported, as well as the high-normal pyroglutamic acid and the high lipid peroxides.

You have a low folate status, based on your elevated Figlu.

I do think you have a partial methylation cycle block, based on the high-normal methylmalonic acid, the elevated Figlu, the apparent carnitine deficiency (note that methylation is needed to make carnitine), the apparently low coenzyme Q10 (based on the elevated HMG) (note that methylation is needed to convert HMG to coenzyme Q10), and the glutathione depletion (note that glutathione depletion causes a functional B12 deficiency, and that in turn causes a partial block in the methylation cycle).

Methylmalonic acid by itself is not always a reliable marker for B12 functional deficiency, because it depends on having high enough amino acids levels and high enough P5P, which requires B6 and B2. We don't have amino acids levels for you, but the B-vitamins markers indicate that they are on the low side. So even though methylmalonic acid is not sky-high, I think that everything taken together does point to a partial methylation cycle block.

One could get a more clearcut answer about this from the methylation pathways panel, but I realize that it is more difficult to get this done.

I don't know why you have not experienced anything from the methylation protocol. It is possible that your high mercury levels are blocking enzymes in the sulfur metabolism, including in the methylation cycle. It is also possible that you are low in some of the cofactor vitamins or minerals. B-complex vitamins in particular appear to be candidates. Your magnesium might also be low.

I think it would be O.K. to continue with the Cutler chelation protocol while on the methylation treatment. If you begin to experience exacerbation of symptoms, that would probably be a good sign, and you may need to back off on the chelation again if they become intolerable.

I do think that you will need to identify the issues involved in your digestive system, using stool analysis. Genova Diagnostics offers this type of testing, as do several other labs.

I hope this is helpful.

Best regards,

Rich
 

RosieBee

Senior Member
Messages
104
Location
UK
Thank you very much Rich for that really detailed analysis of my results, I appreciate it very much. I am glad to confirm that I do need to address the methylation cycle as well as gut dysbiosis and yeast infection (yes I am on a low carb diet). Strengthens my resolve.

It is interesting that despite direct supplementation with carnitine (acetyl-L-carnitine), CoQ10 (ubiquinone) , glutathione, B vitamins and many others (oral and transdermal) they are just not getting into the cells. Maybe a result of the digestive problems. I have discontinued quite a few supplements recently because I still read low despite taking respectable quantities.

Recently I have started to have 'fluey' feelings for a day or two for the first time in many years. I imagine this is due to the methylation protocol kicking in at last; It is intermittent though.

Do people find any differences due to the time of day they take various supplements? I am taking my folate at night with most of my other supplements and the Bs in the morning. Maybe should start a new thread with that question.

Thanks again Rich for such a comprehensive and very useful summary.

Rosie
 

rydra_wong

Guest
Messages
514
Rich, you mentioned that methylation is required to make unbiquinol. Is that the only thing necessary to convert ubiquinone to ubiquinol? Because I had an OAT profile that showed low CoQ10 even though I had been supplementing 100mg ubiquinone for 20 years. So either 100mg is too low or I can't convert to ubiquinol. I wondered what is involved in converting ubiquinol -> ubiquinone?

Many thanks for any info.
Rydra
 

RosieBee

Senior Member
Messages
104
Location
UK
Same here Rydra, been taking daily COQ10 100mg for years, up to 300mg for some periods, but readings come back low. I read somewhere recently that ubiquinol may be a better supplement to take than ubiquinone.

Rosie
 

richvank

Senior Member
Messages
2,732
Hi, Rydra and Rosie.

One issue is that Co Q10 is fat-soluble, so to get good absorption from the gut, it is important to take it with some fat. Some of the early research combined it with peanut butter to get better absorption. It's not absorbed very well if no fat is present in the gut with it.

Ubiquinone is the oxidized form, and ubiquionol is the reduced form. These are converted back and forth in the mitochondria, as Co Q10 receives and gives up electrons. Methylation is not involved in this conversion. It's involved in making the basic molecule in a pathway that starts with glucose and passes through hydroxymethylglutarate (HMG). It's the same pathway that goes on to produce cholesterol. The statin drugs, used to lower cholesterol, block HMG CoA reductase, and that's the reason why they also tend to deplete Co Q10.

As people get older, they are not as able to reduce ubiquinone to ubiquinol, so it's preferable to take ubiquinol in that case.

In ME/CFS, the ultimate way to bring Co Q10 up is to fix the methylation cycle partial block, so that it can be made naturally.

Best regards,

Rich
 

aprilk1869

Senior Member
Messages
294
Location
Scotland, UK
I thought I'd post this, this is from Annesse's daughter who wrote the book about Autoimmune diseases and sauerkraut is a big part of the healing protocol.

Hi Guys! Sorry to have gone AWOL for awhile. We have been working on a 2nd edition of the book. Plus, we are being overwhelmed with orders and since we don't have a distributor, we are doing all of the shipping ourselves. We are starting to get our first wholesale orders for the book from other websites so that is exciting. I'll put up a list in a few days of the websites that are going to carry the book.

We are adding a few things to the book, but so you all won't miss anything, I'll post it here also. We thought this info on CoQ10 was way cool. This is what went in the book.

"In addition to carnitine, another critical component necessary for proper function of the mitochondria is Coenzyme Q10 (CoQ10). It acts as an essential cofactor to produce ATP (adenosine triphosphate), which is the currency of energy in the body. To produce ATP, mitochondria need certain essential raw nutrients, such as carnitine and CoQ10. CoQ10 also functions as an antioxidant.

A recent study found that plasma CoQ10 was significantly lower in CFS patients. ( "Coenzyme Q10 Deficiency in ME/CFS" Michael Maes, et al.) It stated, "Up to 44.8% of patients with ME/CFS had values beneath the lowest plasma CoQ10 value detected in the normal controls..."

CoQ10 is a fat-soluble compound synthesized by the body and also consumed in the diet. A report from Iowa
State University lists beef, chicken, pork, and fish as the foods with the highest levels of CoQ10. In a normal person, CoQ10 can be synthesized, but it requires the presence of one of two amino acids we have found lacking in CFS and fibromyalgia; phenylalanine or tyrosine. The Linus Pauling Institute at Oregon State University states, " The biosynthesis of coenzyme Q10 involves three major steps: 1)synthesis of the benzoquinone structure from either TYROSINE OR PHENYLALANINE." Tyrosine is derived form phenylalanine, and phenylalanine is found in high protein foods. Without the abililty to break down high protein food, you would not have the necessary amino acids to produce CoQ10."

http://www.dailystrength.org/groups...-gaining-health/discussions/messages/13548606
 

RosieBee

Senior Member
Messages
104
Location
UK
Thanks Rich and Aprilk869 for the information on CoQ10. Sorry for the slow response, I have not been online for a while.

Interesting about the pathway involving HMG being shared with cholesterol production. My cholesterol levels have been rising despite super-healthy diet (I thought it might be a side-effect of untreated hypothyroidism). I wonder if I have resources diverted away from CoQ10 production into cholesterol production; My coQ10 levels always come back low even when I am supplementing 300mg/day.
 
Messages
7
help with results :)

Hello.... I am in a similar position to RosieBee, before starting the methylation protocol I had the Metabolic Analysis Profile test done, I didn't realise about the methylation panel at the time :(

I have yet to glean any meaningful interpretation of the results so I am still totally clueless as to whether I have issues with methylation or any other factors I need to address to assist with recovery.

I've attached my results and would be hugely grateful if anyone can suggest if there are any issues I need to address... :)

Reading the comments above, I should mention that I was on a low-carb diet at the time.

Thank you :)
 

Attachments

  • Metabolic Analysis Profile Results.pdf
    1.8 MB · Views: 52

richvank

Senior Member
Messages
2,732
Hi, Sleepy.

Thanks for posting your MAP results. I will offer some comments on it. However, please note that when only a MAP is available, there are some uncertainties in the analysis that cannot be resolved from this test alone. Testing costs money, of course, and that limits what can be done in many cases. So we have to work with what we have.

I don't know how long ago this test was run, so I will interpret the results as of the time the urine sample was collected, whenever that was. If it was long ago, things may have changed since then.

The first section of your results indicate that you did have intestinal bacterial dysbiosis, some malabsorption, and yeast infection. To get a more detailed understanding of what is going on in your digestive system, you would need to run a comprehensive stool test.

In the energy section of the report, your glycolysis (carbohydrate metabolism) appeared to be functioning normally, but you were not burning carbohydrates at as high a rate as normal, as indicated by the elevated BHBA. This appears to correspond with your report that you were on a low-carb diet at the time. The elevated BHBA indicates that your energy metabolism was in ketosis, in response to the low availability of carbohydrates. Coupled with this were the somewhat elevated levels of adipic and suberic acids. Ketosis is caused by elevated mobilization of fatty acids and their conversion to acetyl-CoA faster than the Krebs cycle can accept it. The elevated adipic and suberic acids indicate that some of the fatty acids were being pushed into omega oxidation. This could have been due to low carnitine or low B2, or both, but your B2 does not appear to have been extremely low. Low carnitine could be caused by low lysine (an amino acids panel would be needed to determine this) or a methylation deficit, or both.

Looking at the Krebs cycle (Energy Metabolism section), citric acid was a little low-normal, but not too bad. The slight drop from there to cis-aconitic acid suggests that glutathione was somewhat depleted, and this corresponds also to the low-normal pyroglutamic acid in the Toxin section, as well as the high-normal urine lipid peroxides on the next page. Isocitric acid and AKG look good. Succinic is low-normal, suggesting that amino acids were not being burned at as high a rate as normal. This could have been due to low levels of amino acids (we can't know that without an amino acids panel), or to low P5P activity, which depends on adequate levels of B6 and B2. There are indicators (later) that both these were somewhat low. Malic acid was high. This could have been due to low B3 or low coenzyme Q10, or both. Low coenzyme Q10 would be consistent with the elevated HMG and a methylation deficit.

Under Neurotransmitter Metabolites, the low-normal VMA and MPG suggest an abnormality in norepinephrine or epinephrine, or both. It's not possible to get more specific without more data, but it might have been due to low vitamin C or low copper. Low vitamin C would be consistent with low glutathione. The high-normal kynurenic and quinolinic acids suggest deficient P5P activity, which could be due to low B6 or B2 or both. This would be consistent with low B3 production from tryptophan via the kynurenine pathway. The elevated xanthurenic acid in the next section would be consistent with low B6 or B2 or both.

In the Vitamin Markers section, the values are elevated pretty much across the board, and this suggests general deficiencies in the B-complex vitamins. The high-normal FIGLU and MMA
suggest a partial methylation cycle block and depletion of folates. A partial methylation cycle block would be consistent with the indications of low carnitine, low coenzyme Q10, and low glutathione. Note that FIGLU and MMA can be somewhat masked by low amino acids and/or P5P deficiency.

Under Toxin & Detox Markers, the first two indicate exposure to styrene and MTBE and dyfunction of the detox system, which would be consistent with a partial methylation cycle block and low glutathione. The low-normal orotic acid suggests that the urea cycle was not being pushed very hard, and that in turn would suggest that amino acids were not being burned at a high rate, which would also be consistent with the low-normal succinic acid, discussed earlier. Pyroglutamic acid was also discussed earlier.

Under Tyrosine Metabolites, the elevated values are consistent with intestinal bacterial dysbiosis and malabsorption, and since tyrosine is used to make dopamine, norepinephrine and epinephrine, this may be associated with the low-normal VMA and MPG discussed above, though it is not possible to be sure without more data.

As you can see, I've used the words "would be consistent with" quite a few times here. That's because it's all I can say with the limited amount of data. If other tests are run with the MAP, it is possible to reach more definite conclusions.

I hope this is helpful.

Best regards,

Rich
 
Messages
1
Hi All,

This is my first post. I too had the organic acid test performed some time ago (over 2 years) and am going to discuss with my doctor about running the methylation panel. When my results came in my doctor told me that I should be happy because not many results were outside the normal range. The only results marked as low by the lab were citric acid, 2-oxo-glutaric acid and pyroglutamic acid. However, almost every other test was in the low normal range. My doc kind of dismissed the test and said he expected to see many more abonormalities. Didn't seem concerned with all the low-normal results. Only elevated tests were for 3-oxoglutaric and ascorbic acid (been doing vitamin c iv's). Been suffering with CFS for 8 years now and have been on the full methylation protocol for 3 months with some improvements. Anybody have a similar experience with the organic acid testing?

Thanks,
Jim
Based off the the low citric acid, 2-oxo-glutaric acid and pyroglutamic acid do you think I this is evidence of a methylation block?
 

richvank

Senior Member
Messages
2,732
Hi All,

This is my first post. I too had the organic acid test performed some time ago (over 2 years) and am going to discuss with my doctor about running the methylation panel. When my results came in my doctor told me that I should be happy because not many results were outside the normal range. The only results marked as low by the lab were citric acid, 2-oxo-glutaric acid and pyroglutamic acid. However, almost every other test was in the low normal range. My doc kind of dismissed the test and said he expected to see many more abonormalities. Didn't seem concerned with all the low-normal results. Only elevated tests were for 3-oxoglutaric and ascorbic acid (been doing vitamin c iv's). Been suffering with CFS for 8 years now and have been on the full methylation protocol for 3 months with some improvements. Anybody have a similar experience with the organic acid testing?

Thanks,
Jim
Based off the the low citric acid, 2-oxo-glutaric acid and pyroglutamic acid do you think I this is evidence of a methylation block?

Hi, Jim.

It's kind of hard to evaluate without seeing all the results, but if pyroglutamic acid was below the normal range, that is a good indicator for glutathione depletion, and if glutathione is
very depleted, it's pretty certain that there will be a partial methylation cycle block. If you have a lot of low-normal results, you may have deficiencies in some of the essential nutrients, and that can affect the ability to get the methylation cycle going properly. If you send me your results at richvank at aol dot com, I will take a look and give you some comments.

Best regards,

Rich
 
Messages
7
Thank you :)

Thank you so much Dr Rich! Your time and skill in providing such a detailed response is appreciated beyond words!

My test results always amaze me as despite taking truck loads of vitamins I always seem to be deficient.

Since the test I am now supplementing daily with CoQ10, vit C, carnitine, carnosine, tyrosine, B100, activated B3, P5P, inositol + the methylation protocol (+ some others).

Would you recommend taking lysine or anything else?

Which test would be most beneficial - amino acids or methylation panel - how long into the methylation protocol would you advise testing, I am probably on 7-8 weeks at the moment.

On the detox point my phase 1 + 2 both run slowly (the Detoxigenomic test was yet another scantily interpreted set of results I have to fathom!)

Thanks again

Sleepy :)
 
Messages
3
Hi Sleepy,

I was wondering if you found any supplements that really made a difference in your symptoms. I ask because your nutreval test is extremely similar to mine and I was ecstatic to find Rich's incredibly knowledgeable above interpretation of your results (as a proxy for mine :) )

I definitely have methylation issues (I hit the genetic lottery with MTHFR, CBS, COMT, VDR Taq and Fok, MTRR, BHMT, SHMT, NOS) and I also have mercury toxicity. I can't take a B100 because it causes excitement and palpitations, but I can tolerate B1, B2, B6 and B12 individually... I don't tolerate ALCAR or molybdenum. I take magnesium, zinc, Vit C, Vit E, Fish Oil, ph. choline, milk thistle, ACE, chromium, Vit D (I am deficient), benfotiamine, B2, B6, B12.

Just was wondering if you found any magical suppl. that I can try based on your similar nutreval.

Thanks