Learner1
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From the OAT Interpretation Guide for Citric and Cis-aconitic acids:Maybe there is more than one thing that can hit production of this.
If HIGH
Impaired metabolism due to toxic metals (Fl, Hg, As, Sb) OR low cofactors (Fe, GSH—
depleted in oxidative stress); OR high amounts of dietary citric acid; OR metabolic acidosis (if mildly increased cisaconitic acid but markedly increased citric acid).
High Citrate and Cis-aconitate can indicate arginine insufficiency for ammonia clearance
through the Urea Cycle
Consider supplementing with arginine
Rule out toxic metals; glutathione, N-acetylcysteine, Mg, or L-glutamine; consider anti-oxidants; rule out pancreatic insufficiency (can lead to metabolic acidosis from deficient bicarbonate).
If LOW
Low or high pyruvic acid or low acetyl CoA (from fatty acid oxidation)