Metabolic Analysis Profile (Organic Acids)

Complete Evaluation of Key Biomarkers of Metabolism

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Why use the Metabolic Analysis Profile?

The Metabolic Analysis Profile specifically tests for organic acids – compounds in the urine that are produced during daily metabolism. This profile assesses major metabolic areas that may be compromised by common lifestyle and dietary factors, such as nutrient deficiencies, toxicity, bacterial overgrowth, or drug effects. Organic acids testing can indicate the functional need for specific nutrients, diet modification, antioxidant protection, detoxification, or other therapies.

Effective for Patients Experiencing:

Metabolic Analysis Profile testing is effective for patient concerns such as:

  • Mood Disorders
  • Fatigue
  • Digestive Complaints
  • Weight issues/Dietary Guidance

About the Metabolic Analysis Profile

The results and recommendations from the Metabolic Analysis Profile can provide guidance for the development of personalized supplementation, identifying nutritional insufficiences that may be a contributing factor in complex chronic conditions.

The Metabolic Analysis Profile report allows for easy interpretation and clinically actionable results. It includes a Suggested Supplement Schedule that provides personalized recommendations based on test results. The Interpretation-At-A-Glance section of the report provides facts related to nutrient function, causes and complications of their deficiencies, and dietary sources.

The Metabolic Analysis Profile report categorizes test results into major metabolic areas:

  • Metabolic Analysis Markers
  • Cellular Energy & Mitochondrial Metabolites
  • Neurotransmitter Metabolites
  • Vitamin Markers
  • Toxin & Detoxification Markers
  • Tyrosine Metabolism


Clinical Overview

What are Organic Acids?

The Metabolic Analysis Profile specifically tests for organic acids – compounds in the urine that are metabolic byproducts of cellular metabolism.

  • Levels of organic acids in the urine can indicate insufficient cofactor micronutrients for critical enzymes that are needed in metabolic pathways.
  • Dysfunctional or insufficient enzyme activity in metabolic pathways can produce an "enzymatic block," causing the organic acids preceding the block to accumulate and spill into the urine.
  • Traditionally, urinary organic acid assessment is used in neonatal/pediatric medicine to identify genetic inborn errors of metabolism, with severity depending on the degree and type of error.
  • In many cases of genetic inborn errors, the enzymatic defect may be compensated for by high doses of specific vitamin and mineral cofactors and/or dietary interventions. Biochemist Dr. Bruce Ames, an expert in DNA mutations, explains this mechanism:
    • "Our analysis of metabolic disease that affects cofactor binding, particularly as a result of polymorphic mutations, may present a novel rationale for high-dose vitamin therapy, perhaps hundreds of times the normal dietary reference intake (DRI) in some cases … Feeding high doses of the vitamin raises the tissue cofactor concentrations and thereby increases the activity of the defective enzyme." Ames, BN, et al. Am J Clin Nutr. 2002;75:616-58.
  • By assumption, intervention with higher-dose nutrient cofactors may also be effective in cases of decreased enzyme activity due to causes other than frank inborn errors.
  • The metabolic pathways may be compromised in more subtle ways by common lifestyle and dietary factors, such as nutrient deficiencies, toxicity, bacterial overgrowth, or drug effects, and may be associated with symptoms such as:
    • Mood Disorders
    • Fatigue
    • Digestive Complaints
    • Weight issues/Dietary Guidance
  • Based on known metabolic pathways and enzyme-cofactor requirements, organic acids testing with the Metabolic Analysis Profile evaluates:
    • Metabolic Analysis Markers
      • Malabsorption Markers
      • Bacterial Dysbiosis Markers
      • Yeast/Fungal Dysbiosis Markers
    • Cellular Energy & Mitochondrial Metabolites
      • Carbohydrate Metabolism
      • Energy Metabolism
      • Fatty Acid Metabolism
    • Neurotransmitter Metabolites
    • Vitamin Markers
    • Toxin & Detoxification Markers
    • Tyrosine Metabolism

When Should an Organic Acids Profile Be Considered?

Patients with chronic symptoms (especially those eating the standard American diet) or those simply seeking general health or sports-performance optimization may benefit from measurement of organic acids to evaluate specific metabolic pathways and biomarkers of enzyme cofactor need.

Of the 5750 enzymes cataloged in the April 2016 ExPASy ENZYME database, almost 32% (1817 enzymes) require vitamin and/or mineral cofactors. Even with a "good" diet, many people fall short of these critical nutrients. A 2011 analysis of data from the 2003-2006 National Health and Nutrition Examination Surveys (NHANES) found that a significant percentage of Americans (excluding those taking supplements) had usual intakes of many nutrients below the estimated average requirement (EAR).

For instance, the active form of pyridoxine (vitamin B6) is a cofactor in almost 9% of the over 1800 human enzymes requiring a cofactor, affecting pathways involved in amino acid, glucose, and lipid metabolism, as well as the production of hemoglobin and brain neurotransmitters. The NHANES data demonstrated that in adults aged 19 and over (not taking supplements), 15% had usual intakes of vitamin B6 below the EAR. Levels of organic acids associated with B6-dependent pathways may indicate a need for B6 supplementation.

What Advantage Do Organic Acids Profiles Offer Compared to Other Diagnostics?

Dr. Roger J. Williams (the scientist who discovered panthothenic acid, vitamin B5) first coined the term "biochemical individuality" in 1956 to explain genetic variability in disease susceptibility, nutrient needs, and drug responsiveness among otherwise seemingly healthy people. Although practices are changing, the traditional medical model does not currently place emphasis on biochemical individuality. The conventional clinical approach to nutrition-related symptoms does not routinely include utilization of comprehensive nutritional testing through organic acids analysis. When testing is performed, select vitamins are typically assessed in blood to determine if the level is sufficient to meet nutrient requirements based on healthy individuals. Organic acids testing aids in the identification of imbalances occurring in the body that may well precede abnormal findings on conventional serum laboratory panels. Organic acids testing allows greater insight into a patient's biochemical individuality, leading to more targeted therapeutic recommendations.

What Can Clinicians and Patients Expect from Organic Acids Testing?

Organic acids testing with the Metabolic Analysis Profile can indicate the functional need for antioxidants, B-vitamins, minerals, digestive support, diet modification, detoxification, methylation support, or other therapies. The functional nutrient recommendations, based on data generated from the report, identifies subtle impairments in cellular function that may not be apparent on standard serum laboratory work-up. This allows the clinician to make tailored recommendations to enhance other treatments and increase the patients' overall health outcomes and ability to combat chronic illness. Upon request, a Suggested Supplement Schedule for recommended nutrients can be provided to the clinician as part of the report.

The Metabolic Analysis Profile is also a part of the comprehensive NutrEval® FMV and NutrEval® Plasma profiles. The NutrEval is a combination of nutritional tests that not only measures organic acids, but also amino acids, essential and metabolic fatty acids, oxidative stress markers, and elemental markers (both nutrient and toxic elements).

Test Type: Urine Test

Analyte List
2-Hydroxyphenylacetic Acid
3-Hydroxyproprionic Acid
3-Methyl-4-OH-phenylglycol
4-Hydroxyphenylpyruvic Acid
5-OH-Indoleacetic Acid
Adipic Acid
Arabinose
Benzoic
Benzoic/Hippuric Acids Ratio
Cis-Aconitic Acid
Citramalic Acid
Citric Acid
Creatinine
Dihydroxyphenylpropionic Acid
Formiminoglutamic Acid (FIGlu)
Fumaric Acid
Glutaric Acid
Hippuric
Homogentisic Acid
Homovanillic Acid
Indoleacetic Acid
Isocitric Acid
Kynurenic Acid
Lactic Acid
Malic Acid
Methylmalonic Acid
Orotic Acid
Phenylacetic Acid
Pyroglutamic Acid
Pyruvic Acid
Suberic Acid
Succinic Acid
Tartaric Acid
Vanilmandelic Acid
a-Keto-b-Methylvaleric Acid
a-Ketoadipic Acid
a-Ketoglutaric Acid
a-Ketoisocaproic Acid
a-Ketoisovaleric Acid
b-OH-Butyric Acid
b-OH-b-Methylglutaric Acid
CPT Codes  
2-Hydroxyphenylacetic Acid 83921
3-Hydroxyproprionic Acid 83921
4-Hydroxyphenylpyruvic Acid 83921
5-OH-Indoleacetic Acid 83497
Adipic Acid 83921
Citric Acid 82507
Creatinine 82570
Glutaric Acid 83921
Homogentisic Acid 83921
Homovanillic Acid 83150
Isocitric Acid 83921
Lactic Acid 83605
Malic Acid 83921
Methylmalonic Acid 83921
Orotic Acid 83921
Pyruvic Acid 84210
Suberic Acid 83921
Succinic Acid 83921
Vanilmandelic Acid 84585
a-Keto-b-Methylvaleric Acid 83921
a-Ketoadipic Acid 83921
a-Ketoglutaric Acid 83921
a-Ketoisocaproic Acid 83921
a-Ketoisovaleric Acid 83921
b-OH-Butyric Acid 83921
b-OH-b-Methylglutaric Acid 83921
Specimen Requirements
First morning urine collection; one tube of 10ml - needs to be full (samples frozen)