Metabolomix+ : A Non-Invasive Personalized Nutritional Assessment

The Metabolomix+ is a unique combination of nutritional tests that provides an analysis of key nutritional biomarkers. A first morning void (FMV) urine collection, with optional add-on bloodspot finger stick and buccal swab, the Metabolomix+ nutritional test is a non-invasive, patient-friendly way to assess the functional need for antioxidants, B-vitamins, minerals, digestive support, fatty acids, and amino acids. Insights gained from the Metabolomix+ nutritional test allows clinicians to target nutritional therapies to meet the precise needs of their patients.


Metabolomix+ is one of the most comprehensive functional and nutritional assessments available. It is designed to help practitioners identify root causes of dysfunction and provide a systems-based approach to help patients overcome chronic conditions and live a healthier life.

The Metabolomix+ report offers:

  • Nutrient recommendations for key vitamins, minerals, amino acids, fatty acids, and digestive support
  • Functional pillars with a built-in scoring system to guide therapy around needs for methylation support, toxic exposures, mitochondrial dysfunction, fatty acid imbalances, and oxidative stress
  • Interpretation-At-A-Glance pages for patient education
  • Dynamic biochemical pathway charts for clearer understanding

What is a functional nutritional assessment?

Marked accumulation of organic acids in urine can signal a metabolic inhibition or block. The metabolic block may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up, or drug effect.

Enzymes that are responsible for metabolizing organic acids are vitamin and mineral dependent. With this, elevations in organic acids can reflect a functional need for these nutrients on a cellular and biochemical level, even despite normal serum levels.1-5 Recommendations for nutrient supplementation based on elevated organic acid results are generated using a literature-based proprietary algorithm.

Traditionally, urinary organic acid assessment has been 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. Intervention with higher-dose nutrient cofactors may also be effective in cases of decreased enzyme activity due to causes other than frank inborn errors.

* Genova's organic acid testing is not intended for the diagnosis of neonatal inborn errors of metabolism.

Which patients might benefit from functional nutritional testing?

Common clinical indications for testing include:

  • Mood Disorders6,7
  • Mitochondrial Dysfunction8
  • Fatigue9
  • Chronic Stress10
  • Inflammation11

Several diseases are associated with abnormal organic acid, amino acid, and fatty acid levels such as depression, anxiety, cardiovascular disease, neurocognitive decline, diabetes, cancer, anorexia, and many others.12-15

About the Metabolomix+ Profile

The Metabolomix+ 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 Metabolomix+ Profile report categorizes results into several metabolic areas:


  • Organic Acids (urine)
    • Malabsorption and Dysbiosis Markers are metabolites produced by the gastrointestinal microbiome
    • Cellular Energy & Mitochondrial Markers are biomarkers of carbohydrate and fatty acid metabolism, and the citric acid (Kreb's) cycle
    • Vitamin Markers are specific analytes used to assess functional levels of vitamin cofactors
    • Neurotransmitter Metabolites are downstream byproducts of epinephrine, norepinephrine, serotonin and dopamine
    • Toxin & Detoxification Markers relate to certain toxic metabolites and the body's detoxification capacity
    • NEW Oxalate Markers relate to kidney stone formation, oxidative stress and metabolic dysfunction
  • Amino Acids (urine)
    • Essential Amino Acids must be derived from dietary sources
    • Nonessential Amino Acids are synthesized by the body
    • Intermediary Metabolites are byproducts of amino acid metabolism
    • Dietary Peptide Related Markers can indicate incomplete protein breakdown
  • Oxidative Stress Markers (urine) include the oxidative damage markers lipid peroxides and 8-OHdG

  • Essential and Metabolic Fatty Acids - Bloodspot (if selected as add-on profile)
    • Omega 3 Fatty Acids are essential for brain function and cardiovascular health and are anti-inflammatory
    • Omega 6 Fatty Acids are involved in the balance of inflammation
    • Omega 9 Fatty Acids are important for brain growth, nerve cell myelin, and reducing inflammation
    • Saturated Fatty Acids are involved in liproprotein metabolism and adipose tissue inflammation
    • Monounsaturated Fats include omega 7 fats and unhealthy trans fats
    • Delta-6 Desaturase Activity assesses efficiency of this enzyme to metabolize omega 6's and omega 3's
    • Cardiovascular Risk includes specific ratios and the Omega 3 Index
  • Nutrient and Toxic Elements - urine (if selected as add-on profile) assesses 20 toxic and 15 mineral elements
  • Genomics (if one or more of the following SNPs are selected as add-ons)
    • APO E (C112R + R158C)
    • MTHFR Combined (A1298C + C677T)
    • TNF-α
    • COMT (V158M)

    Genova's Methodology

    Urinary organic and amino acids are measured via GCMS, LC/MS/MS and alkaline picrate. Fatty acids are measured via GCMS. Urinary oxidative stress markers are measured using colorimetric, thiobarbituric acid reactive substances (TBARS) and LC/MS/MS. Nutrient and toxic elements are measured using ICP-MS and Kinetic (Jaffe). Reference ranges are age and gender specific and are based on a questionnaire-qualified healthy cohort. Testing is not performed in patients under 2 years old.


    1. Kałużna-Czaplińska J. Noninvasive urinary organic acids test to assess biochemical and nutritional individuality in autistic children. Clin Biochem. 2011;44(8-9):686-691.
    2. Broquist HP, Luhby AL. Detection and isolation of formiminoglutamic acid from urine in folic acid deficiency in humans. Proc Soc Exp Biol Med. 1959;100(2):349-354.
    3. Sun A-l, Ni Y-h, Li X-b, et al. Urinary methylmalonic acid as an indicator of early vitamin B12 deficiency and its role in polyneuropathy in type 2 diabetes. J Diab Res. 2014;2014.
    4. Kwok T, Cheng G, Lai W, Poon P, Woo J, Pang C. Use of fasting urinary methylmalonic acid to screen for metabolic vitamin B12 deficiency in older persons. Nutrition. 2004;20(9):764-768.
    5. Brown R, Thornton MJ, Price J. The effect of vitamin supplementation on the urinary excretion of tryptophan metabolites by pregnant women. J Clin Invest. 1961;40(4):617-623.
    6. Lykouras L, Markianos M, Hatzimanolis J, Malliaras D, Stefanis C. Association of biogenic amine metabolites with symptomatology in delusional (psychotic) and nondelusional depressed patients. Prog Neuro-Psychopharmacol Biol Psych. 1995;19(5):877-887.
    7. Frankenhaeuser M, Lundberg U, Von Wright MR, Von Wright J, Sedvall G. Urinary monoamine metabolites as indices of mental stress in healthy males and females. Pharmacol Biochem Behav. 1986;24(6):1521-1525.
    8. Mitochondrial Medicine Society's Committee on D, Haas RH, Parikh S, et al. The in-depth evaluation of suspected mitochondrial disease. Mol Genet Metab. 2008;94(1):16-37.
    9. Dimmock DP, Lawlor MW. Presentation and Diagnostic Evaluation of Mitochondrial Disease. Pediatr Clin North Am. 2017;64(1):161-171.
    10. Wu H, Jiang K, Gu G, Wu Y, Yu S. [The relationship of occupational stress and the level of some hormone metabolites in urine]. Chin J Indust Hyg Occup Dis. 2014;32(2):83-86.
    11. Jeon SW, Kim Y-K. Inflammation-induced depression: Its pathophysiology and therapeutic implications. J Neuroimmunol. 2017;313:92-98.
    12. Rao TSS, Asha MR, Ramesh BN, Rao KSJ. Understanding nutrition, depression and mental illnesses. Indian J Psychiatry. 2008;50(2):77-82.
    13. O'Connell BS. Select vitamins and minerals in the management of diabetes. Diabetes Spectr. 2001;14(3):133-148.
    14. Harris WS. Omega-3 fatty acids and cardiovascular disease: a case for omega-3 index as a new risk factor. Pharmacol Res. 2007;55(3):217-223.
    15. Spencer SJ, Korosi A, Layé S, Shukitt-Hale B, Barrientos RM. Food for thought: how nutrition impacts cognition and emotion. Sci Food. 2017;1(1):1-8.

    Test Type: Urine Test
    Add-Ons: Urine, Bloodspot, & Buccal Swab
    Turnaround Time: 14 Days

    Analyte List
    2-Hydroxyphenylacetic Acid
    3-Hydroxyproprionic Acid
    4-Hydroxyphenylpyruvic Acid
    5-OH-Indoleacetic Acid
    APOE (Add-on)
    Adipic Acid
    Alpha-amino-N-butyric acid
    Alpha-aminoadipic acid
    Aluminum (Add-on)
    Anserine (dipeptide)
    Antimony (Add-on)
    Arachidic (Add-on)
    Arachidonic (Add-on)
    Arsenic (Add-on)
    Aspartic acid
    Barium (Add-on)
    Behenic (Add-on)
    Benzoic/Hippuric Acids Ratio
    Beta-aminoisobutyric acid
    Bismuth (Add-on)
    COMT (V158M) (Add-on)
    Cadmium (Add-on)
    Calcium (Add-on)
    Carnosine (dipeptide)
    Cesium (Add-on)
    Chromium (Add-on)
    Cis-Aconitic Acid
    Citramalic Acid
    Citric Acid
    Cobalt (Add-on)
    Copper (Add-on)
    Creatinine (Add-on)
    Dihomo-gamma-linolenic (Add-on)
    Dihydroxyphenylpropionic Acid
    Docosahexaenoic (Add-on)
    Docosapentaenoic (Add-on)
    Docosatetraenoic (Add-on)
    Eicosadienoic (Add-on)
    Eicosapentaenoic (Add-on)
    Elaidic (Add-on)
    Formiminoglutamic Acid (FIGlu)
    Gadolinium (Add-on)
    Gallium (Add-on)
    Gamma-Linolenic (Add-on)
    Gamma-aminobutyric acid
    Glutamic acid
    Glutaric Acid
    Glyceric Acid
    Glycolic Acid
    Homovanillic Acid
    Indoleacetic Acid
    Iron (Add-on)
    Isocitric Acid
    Kynurenic Acid
    Lactic Acid
    Lead (Add-on)
    Lignoceric (Add-on)
    Linoleic (Add-on)
    Lipid Peroxides
    Lithium (Add-on)
    MTHFR (C677T and A1298C) (Add-on)
    Magnesium (Add-on)
    Malic Acid
    Manganese (Add-on)
    Margaric (Add-on)
    Mercury (Add-on)
    Methylmalonic Acid
    Molybdenum (Add-on)
    Nervonic (Add-on)
    Nickel (Add-on)
    Niobium (Add-on)
    Oleic (Add-on)
    Orotic Acid
    Oxalic Acid
    Palmitic (Add-on)
    Palmitoleic (Add-on)
    Pentadecanoic (Add-on)
    Phenylacetic Acid
    Platinum (Add-on)
    Potassium (Add-on)
    Pyroglutamic Acid
    Pyruvic Acid
    Rubidium (Add-on)
    Selenium (Add-on)
    Stearic (Add-on)
    Strontium (Add-on)
    Suberic Acid
    Succinic Acid
    Sulfur (Add-on)
    TNF-a (Add-on)
    Thallium (Add-on)
    Thorium (Add-on)
    Tricosanoic (Add-on)
    Tungsten (Add-on)
    Uranium (Add-on)
    Vaccenic (Add-on)
    Vanadium (Add-on)
    Vanilmandelic Acid
    Zinc (Add-on)
    a-Keto-b-Methylvaleric Acid
    a-Ketoadipic Acid
    a-Ketoglutaric Acid
    a-Ketoisocaproic Acid
    a-Ketoisovaleric Acid
    alpha-Linolenic (Add-on)
    b-OH-Butyric Acid
    b-OH-b-Methylglutaric Acid
    CPT Codes  
    1-Methylhistidine 82139
    2-Hydroxyphenylacetic Acid 83921
    3-Hydroxyproprionic Acid 83921
    4-Hydroxyphenylpyruvic Acid 83921
    5-OH-Indoleacetic Acid 83497
    8-OHdG 83520
    Adipic Acid 83921
    Aluminum (Add-on) 82108
    Antimony (Add-on) 83015
    Arachidic (Add-on) 82542
    Behenic (Add-on) 82726
    Cadmium (Add-on) 82300
    Calcium (Add-on) 82340
    Citric Acid 82507
    Creatinine 82570
    D-Arabinitol 84311
    Docosatetraenoic (Add-on) 82726
    Glutaric Acid 83921
    Glyceric Acid 83945
    Glycolic Acid 83945
    Homovanillic Acid 83150
    Isocitric Acid 83921
    Lactic Acid 83605
    Lead (Add-on) 83655
    Lignoceric (Add-on) 82726
    Lipid Peroxides 84311
    Magnesium (Add-on) 83735
    Malic Acid 83921
    Methylmalonic Acid 83921
    Nervonic (Add-on) 82726
    Nickel (Add-on) 83885
    Orotic Acid 83921
    Oxalic Acid 83945
    Pyruvic Acid 84210
    Suberic Acid 83921
    Succinic Acid 83921
    Tricosanoic (Add-on) 82726
    Vanilmandelic Acid 84585
    a-Hydroxybutyrate 83921
    a-Keto-b-Methylvaleric Acid 83921
    a-Ketoadipic Acid 83921
    a-Ketoglutaric Acid 83921
    a-Ketoisocaproic Acid 83921
    a-Ketoisovaleric Acid 83921
    Specimen Requirements
    1 green-top preservative tube - FMV urine (frozen); 1 blue-top amber tube - FMV urine (frozen); 1 green-top tube - FMV urine (frozen); Additional add-ons include 1 bloodspot card; 2 genomic buccal swabs