Collection Pack
Metabolomix+ Collection Pack
A Non-Invasive Personalized Nutritional Assessment

Specimen Type: Urine / Bloodspot / Buccal Swab

Not available in New York state.

Only healthcare providers licensed in their state may order laboratory testing. 

Find a Doctor Provider Login / Order

Discover a New Way to Look at Nutrition!

The only nutritional testing of its kind – combines several methodologies and biomarkers and synthesizes the results.

Metabolomix+ is similar to our comprehensive NutrEval with the advantage of being collected entirely at home.

Dynamic reporting allows for easy interpretation and clinically actionable results.

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.

 

 

Which patients might benefit from functional nutritional testing?

Common clinical indications for testing include:

  • Mood disorders1,2
  • Mitochondrial dysfunction3
  • Fatigue4
  • Chronic stress5
  • Inflammation6

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.7,8,9,10

 

About the Metabolomix+ Profile

The Metabolomix+ Profile report categorizes results into several metabolic areas (see sample report for individual analytes):

  • Personalized Results Overview and Nutrient Need Overview
    • Functional Imbalance Scores in areas of methylation, toxic exposure, mitochondrial dysfunction, fatty acid imbalances, and oxidative stress
    • Nutrient Need Overview with recommendations for antioxidants, B-vitamins, minerals, essential fatty acids, GI support, and amino acids
    • Interpretation-At-A-Glance pages provide nutritional educational support for you and your patient highlighting the function of each nutrient, cause of deficiency, complications of deficiency and food sources of the nutrient
  • Organic Acids (urine)
    • Malabsorption and Bacterial/ Yeast Dysbiosis Markers are metabolites produced by the gastrointestinal microbiome
    • Cellular Energy & Mitochondrial Metabolites are biomarkers of carbohydrate and fatty acid metabolism, and the citric acid (Kreb’s) cycle
    • Neurotransmitter Metabolites are downstream byproducts of epinephrine, norepinephrine, serotonin and dopamine
    • Vitamin Markers are specific analytes used to assess functional levels of vitamin cofactors
    • Toxin & Detoxification Markers relate to certain toxic metabolites and the body’s detoxification capacity
    • 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
      • B Vitamin Markers are involved in biochemical reactions that specifically require B vitamins
      • Urea Cycle Markers are byproducts associated with nitrogen (ammonia) detoxification
      • Glycine/Serine Metabolites are involved in the serine-to-choline pathway and the methylation pathways
    • Dietary Peptide Related Markers can indicate incomplete protein breakdown and meat intake
  • Oxidative Stress Markers (urine) include the oxidative damage markers lipid peroxides and 8-OHdG
COMPONENTS
  • Add-on Essential and Metabolic Fatty Acids Markers (Bloodspot- whole blood)
    • 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
  • Add-on Nutrient and Toxic Elements (urine)  assesses 20 toxic and 15 mineral elements
  • Add-on SNPs (buccal swab) include MTHFR, COMT, TNF-a, and APOE

 

What is a functional nutritional assessment?

Genova’s unique approach to nutritional testing begins by assessing our body’s biochemical pathways. 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.11,12,13,14,15 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.

Maximize your nutrition and improve your health

Nutrition is powerful! A few simple tweaks can make a big difference in your body and how you feel. Nutritional testing can help you identify your unique nutritional needs.

Nutrition is important for every body system. Poor nutrition contributes to many chronic diseases. If you struggle with any of the following conditions or are curious about your nutritional status, nutritional testing may be able to help identify the root cause of your ailments:

  • Depression
  • Heart disease
  • Obesity and Type 2 Diabetes
  • Fatigue
  • Weight issues
  • General dietary guidance
  • Malnutrition (often observed in the elderly)
  • Maldigestion/Malabsorption related to the gut
  • Athletic performance
  • Physical trauma/healing

Genova’s nutritional testing provides a more complete assessment compared to what standard labs offer. Personalized recommendations for amino acids, fatty acids, vitamins, minerals, digestive support, and other nutrients are provided. Testing can also reveal toxic exposures and measure your body’s ability to neutralize those toxins.

The benefits of nutritional balance include healthy weight, mental wellness, disease prevention, and increased energy – if you are ready to feel your best, talk with your healthcare practitioner today about nutritional testing.

The Metabolomix+ can be collected completely in the comfort of your own home. It requires a urine sample and if your practitioner orders add-on testing, a bloodspot finger stick, and cheek swab. We have many resources to help make your testing experience a success. Review the Test Preparation tab to learn more about the collection process.

Important Prep Before Patient Takes Test

Certain medications, supplements, and/or foods may impact test results. Please note that the reference ranges were established based on patients who were taking no medications or supplements. In some instances it is unknown what potential impact a medication may have on test results.

Genova never recommends that patients discontinue medically necessary medications or supplements in order to complete testing.

There may be times when a patient may stay on a medication or dietary supplement during testing in order to evaluate its effectiveness. The recommendation to discontinue any substance is intended to establish a baseline finding. While there are no rigid rules on time frames for discontinuing supplements to establish a baseline, some clinicians choose to discontinue 4 days prior to testing. If you choose to discontinue a medication, a good rule of thumb is to take the biological half-life of the drug times 5 to allow for 'clearance' before testing. With certain medications, the drug itself may have cleared the body, but the effect of the medication may be longer lasting. Below you will find a list detailing the potential interference or influence of certain substances on the biomarkers.

 

Dietary Factor Possible Impact on Results
Artificial sweeteners and MSG Artificial sweeteners and MSG are composed of amino acids which can directly impact measured amino acid levels
Eat your usual diet; avoid over-consuming any single food, extreme diets, or engaging in a rigourous activity (i.e. marathon) Extreme diets and activity may impact certain organic acid biomarkers related to the citric acid cycle, neurotransmitter metabolites, dysbiosis markers, or amino acids
Phenol and flavonoid containing compounds in fruits, vegetables, chocolate, and tea can result in elevation of certain bacterial and fungal dysiosis markers on the organic acids profile
Bananas, pineapple, kiwi, plums, avacado, walnuts, and pecans can result in an elevation of the serotonin metabolite 5-HIAA measured on the organic acids profile
Seafood Seafood containing heavy metals such as mercury and arsenic can result in a transient elevation
Six 8-ounce glasses of fluid Creatinine concentration is influenced by fluid intake
Fasting, water allowed only Reference ranges were set based on an overnight-fasted population. Overnight fasting minimizes influence of a single meal and provides a "steady diet" sample

Medications and supplements may impact results. The discontinuation of any medication is at the discretion of the clinician, only if medically appropriate.

Medications and Supplements Possible Impact on Results
Valproic acid Direct assay interferent for organic acid xanthurenic acid
Acetaminophen Direct assay interferent for multiple organic acids
Berberine HCl Direct assay interferent for organic acids IAA and 5-HIAA
Antibiotics, antifungals, probiotics, digestive enzymes, acid blocking medications May indirectly influence urinary organic acid markers of malabsorption/dysbiosis

Amino acid levels may be impacted by aminoglycoside antibiotics
Amphetamines, centrally acting medications, antidepressants, Anti-Parkinsonian medications May influence urinary organic acid markers of neurotransmitter metabolism1,2
HMG-CoA-reductase inhibitors (statins) and red yeast rice May indirectly increase urinary organic acid B-methylglutaric acid levels
N-Acetyl Cysteine (NAC) Direct assay interferent for cholesterol and triglycerides add-on tests; may lead to falsely low results
Oral contraceptives, estrogen therapy May increase the organic acid quinolinic acid excretion both from altered tryptophan metabolism directly, as well as the indirect functional vitamin B6 insufficiency3
Quercetin May elevate the organic acid homovanillic acid4
Steroids May lower inflammatory neurotransmitter metabolite quinolinic acid, an organic acid
Diuretics May impact creatinine concentration, thus affecting all urinary biomarker measurements
Fibrates May influence fatty acid levels
In some animal studies, fibrates also impact cellular energy metabolites on the organic acids profile
Kreb's cycle and amino chelated supplements (i.e. citrate, malate, succinate, glycinate, threonate, and orotate forms of supplements [magnesium citrate], alpha ketoglutarate, and others) May result in elevations of corresponding Kreb's cycle markers and amino acids
Provocation/chelating agents (i.e. DMPS, DMSA, EDTA, etc.) Reference ranges are based on a non-provoked, non-chelated patient population
Vitamin C May increase urinary excretion of organic acid oxalic acid or lead

Dietary Influences on urinary organic acids:4-16

Urinary Metabolite Common Dietary Sources
Indoleacetic acid High tryptophan intake, green/black tea
Phenylacetic acid Wine/grapes
Dihydroxyphenylpropionic acid Whole-grains, chocolate, coffee, green/black tea, olives/olive oil, citrus fruits (animal studies)
3-Hydroxyphenylacetic acid &
4-hydroxyphenlyacetic acid
Wine/grapes, cranberries, green/black tea, berries, orange juice, grape seed extract
Benzoic acid/Hippuric acid Orange juice, elderberry, huckleberry, food preservative, berries, other flavonoids
Citramalic acid Apples, cranberries, sugar beets
Tartaric acid Wine/grapes, chocolate, food additive/preservative
Malic acid Fruits (apples, pears), vegetables, throat lozenges, syrups, beverages with food preservatives and additives
Homovanillic acid Flavanols including tomatoes, onions and tea
5-hydroxyindolacetic acid Bananas, plantains, kiwi, pineapple, nuts, and tomatoes

Diabetic Patients

Urine glucose is a direct interferent to the lipid peroxides assay. Patients with uncontrolled diabetes and elevated urine glucose may receive a result of 'not reportable, NR' for lipid peroxides. Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors lower blood sugar by disposing of excess glucose via urine.

Urinary Creatinine Levels and Kidney Function

The urine biomarkers are ratioed to urinary creatinine. The urine biomarkers include organic acids, urine amino acids and urine oxidative stress markers. If urinary creatinine is out of range, it can impact the levels of reported urine analytes which are used for nutrient recommendations. The collection instructions recommend not to drink more than six, 8-ounce glasses of liquid (48 ounces) 24 hours prior to sample collection because it can dilute the urine impacting the reported urine analytes. Below are considerations for altered urinary creatinine:

  • Elevated Creatinine: High muscle mass, heavy exercise or increased physical activity, increased protein intake, significant dehydration, and increased renal clearance.
  • Low Creatinine: Poor renal clearance or dysfunction, low muscle mass (i.e. physical inactivity or muscle wasting disease), diluted urine (use of diuretics), malnutrition/protein insufficiency, and hypothyroidism.

We do not recommend urine testing in a patient with known kidney dysfunction, defined by abnormal serum testing.

Pediatric Patients

Testing is not available for children under 2 years old and samples will be discarded. Appropriate reference ranges have not been established for this population. We do not recommend squeezing liquid out of a diaper for sample collection, as this can result in altered concentrations of creatinine and biomarkers. A pediatric urine bag that can be taped to the body is available upon request for appropriate sample collection. While this is not a catheter procedure, instructions for catheterized patients can be followed below with regards to collecting and pooling all urine samples from the child's bedtime to early morning awakening.

Urinary Catheters

It is unknown whether having a catheter placed will affect the results, or whether there will be any interference or decreased viability of the sample owing to this procedure. It is imperative to collect all urine samples from bedtime until early morning awakening. The bladder should be voided before bed. If the patient urinates during the night, the contents of the bag should be emptied into a clean container and refrigerated as soon as possible. This must be done each time urine is collected during the night. This may be inconvenient for the patient but would ensure a more viable sample. Finally, collect the first urine upon waking for the day, and combine that sample with all samples collected during the night. Ensure the combined sample is well mixed before transferring into the labeled tubes.

Pregnant Patients

The reference ranges were not designed for a pregnant population. However, it may be useful to evaluate functional nutritional needs to optimize health during pregnancy, for both the mother and fetus. In pregnancy, the demand for various nutrients increases dramatically. The recommendations offered may reflect that increased nutritional burden. However, because the reference ranges were not established for this patient population, the implementation of nutrient recommendations or botanicals should be in accordance with standard pregnancy recommendations and precautions. Please refer to the link below addressing micronutrient needs during pregnancy and lactation:

References
  1. Grouzmann E, Lamine F. Determination of catecholamines in plasma and urine. Best Pract Res Clin Endocrinol Meta. 2013;27(5):713-723.
  2. Alam N, Wasi N, Naeem S, et al. Methylphenidate increases the urinary excretion of vanillylmandelic acid in rats that is attenuated by buspirone co-administration. Pak J Pharm Sci. 2019;32(2 (Supplementary)):895-898.
  3. Rose D, Toseland P. Urinary excretion of quinolinic acid and other tryptophan metabolites after deoxypyridoxine or oral contraceptive administration. Metabolism. 1973;22(2):165-171.
  4. Combet E, Lean ME, Boyle JG, Crozier A, Davidson DF. Dietary flavonols contribute to false-positive elevation of homovanillic acid, a marker of catecholamine-secreting tumors. Int J Clin Chem. 2011;412(1-2):165-169.
  5. Zamora-Ros R, Achaintre D, Rothwell JA, et al. Urinary excretions of 34 dietary polyphenols and their associations with lifestyle factors in the EPIC cohort study. Sci Rep. 2016;6:26905.
  6. Ward NC, Croft KD, Puddey IB, Hodgson JM. Supplementation with grape seed polyphenols results in increased urinary excretion of 3-hydroxyphenylpropionic Acid, an important metabolite of proanthocyanidins in humans. J Agric Food Chem. 2004;52(17):5545-5549.
  7. Sugimoto N, Forsline P, Beaudry R. Volatile Profiles of Members of the USDA Geneva Malus Core Collection: Utility in Evaluation of a Hypothesized Biosynthetic Pathway for Esters Derived from 2-Methylbutanoate and 2-Methylbutan-1-ol. J Agricul Food Chem. 2015;63(7):2106-2116.
  8. Hulme A. The isolation of L-citramalic acid from the peel of the apple fruit. Biochim Biophys Acta. 1954;14:36-43.
  9. Liu H, Garrett TJ, Su Z, Khoo C, Gu L. UHPLC-Q-Orbitrap-HRMS-based global metabolomics reveal metabolome modifications in plasma of young women after cranberry juice consumption. The J Nutr Biochem. 2017;45:67-76.
  10. Khorassani R, Hettwer U, Ratzinger A, Steingrobe B, Karlovsky P, Claassen N. Citramalic acid and salicylic acid in sugar beet root exudates solubilize soil phosphorus. BMC plant biology. 2011;11(1):121.
  11. van der Hooft JJ, de Vos RC, Mihaleva V, et al. Structural elucidation and quantification of phenolic conjugates present in human urine after tea intake. Analyt Chem. 2012;84(16):7263-7271.
  12. Jacobs DM, Fuhrmann JC, van Dorsten FA, et al. Impact of short-term intake of red wine and grape polyphenol extract on the human metabolome. J Agricul Food Chem. 2012;60(12):3078-3085.
  13. Rios LY, Gonthier M-P, Rémésy C, et al. Chocolate intake increases urinary excretion of polyphenol-derived phenolic acids in healthy human subjects. Am J Clin Nutr. 2003;77(4):912-918.
  14. Henning SM, Wang P, Abgaryan N, et al. Phenolic acid concentrations in plasma and urine from men consuming green or black tea and potential chemopreventive properties for colon cancer. Mol Nutr Food Res. 2013;57(3):483-493.
  15. Feliciano RP, Boeres A, Massacessi L, et al. Identification and quantification of novel cranberry-derived plasma and urinary (poly)phenols. Arch Biochem Biophys. 2016;599:31-41.
  16. Corcuff J-B, Chardon L, El Hajji Ridah I, Brossaud J. Urinary sampling for 5HIAA and metanephrines determination: revisiting the recommendations. Endocr Connect. 2017;6(6):R87-R98.

 

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.

 

 

Which patients might benefit from functional nutritional testing?

Common clinical indications for testing include:

  • Mood disorders1,2
  • Mitochondrial dysfunction3
  • Fatigue4
  • Chronic stress5
  • Inflammation6

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.7,8,9,10

 

About the Metabolomix+ Profile

The Metabolomix+ Profile report categorizes results into several metabolic areas (see sample report for individual analytes):

  • Personalized Results Overview and Nutrient Need Overview
    • Functional Imbalance Scores in areas of methylation, toxic exposure, mitochondrial dysfunction, fatty acid imbalances, and oxidative stress
    • Nutrient Need Overview with recommendations for antioxidants, B-vitamins, minerals, essential fatty acids, GI support, and amino acids
    • Interpretation-At-A-Glance pages provide nutritional educational support for you and your patient highlighting the function of each nutrient, cause of deficiency, complications of deficiency and food sources of the nutrient
  • Organic Acids (urine)
    • Malabsorption and Bacterial/ Yeast Dysbiosis Markers are metabolites produced by the gastrointestinal microbiome
    • Cellular Energy & Mitochondrial Metabolites are biomarkers of carbohydrate and fatty acid metabolism, and the citric acid (Kreb’s) cycle
    • Neurotransmitter Metabolites are downstream byproducts of epinephrine, norepinephrine, serotonin and dopamine
    • Vitamin Markers are specific analytes used to assess functional levels of vitamin cofactors
    • Toxin & Detoxification Markers relate to certain toxic metabolites and the body’s detoxification capacity
    • 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
      • B Vitamin Markers are involved in biochemical reactions that specifically require B vitamins
      • Urea Cycle Markers are byproducts associated with nitrogen (ammonia) detoxification
      • Glycine/Serine Metabolites are involved in the serine-to-choline pathway and the methylation pathways
    • Dietary Peptide Related Markers can indicate incomplete protein breakdown and meat intake
  • Oxidative Stress Markers (urine) include the oxidative damage markers lipid peroxides and 8-OHdG
COMPONENTS
  • Add-on Essential and Metabolic Fatty Acids Markers (Bloodspot- whole blood)
    • 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
  • Add-on Nutrient and Toxic Elements (urine)  assesses 20 toxic and 15 mineral elements
  • Add-on SNPs (buccal swab) include MTHFR, COMT, TNF-a, and APOE

 

What is a functional nutritional assessment?

Genova’s unique approach to nutritional testing begins by assessing our body’s biochemical pathways. 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.11,12,13,14,15 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.

Maximize your nutrition and improve your health

Nutrition is powerful! A few simple tweaks can make a big difference in your body and how you feel. Nutritional testing can help you identify your unique nutritional needs.

Nutrition is important for every body system. Poor nutrition contributes to many chronic diseases. If you struggle with any of the following conditions or are curious about your nutritional status, nutritional testing may be able to help identify the root cause of your ailments:

  • Depression
  • Heart disease
  • Obesity and Type 2 Diabetes
  • Fatigue
  • Weight issues
  • General dietary guidance
  • Malnutrition (often observed in the elderly)
  • Maldigestion/Malabsorption related to the gut
  • Athletic performance
  • Physical trauma/healing

Genova’s nutritional testing provides a more complete assessment compared to what standard labs offer. Personalized recommendations for amino acids, fatty acids, vitamins, minerals, digestive support, and other nutrients are provided. Testing can also reveal toxic exposures and measure your body’s ability to neutralize those toxins.

The benefits of nutritional balance include healthy weight, mental wellness, disease prevention, and increased energy – if you are ready to feel your best, talk with your healthcare practitioner today about nutritional testing.

The Metabolomix+ can be collected completely in the comfort of your own home. It requires a urine sample and if your practitioner orders add-on testing, a bloodspot finger stick, and cheek swab. We have many resources to help make your testing experience a success. Review the Test Preparation tab to learn more about the collection process.

Important Prep Before Patient Takes Test

Certain medications, supplements, and/or foods may impact test results. Please note that the reference ranges were established based on patients who were taking no medications or supplements. In some instances it is unknown what potential impact a medication may have on test results.

Genova never recommends that patients discontinue medically necessary medications or supplements in order to complete testing.

There may be times when a patient may stay on a medication or dietary supplement during testing in order to evaluate its effectiveness. The recommendation to discontinue any substance is intended to establish a baseline finding. While there are no rigid rules on time frames for discontinuing supplements to establish a baseline, some clinicians choose to discontinue 4 days prior to testing. If you choose to discontinue a medication, a good rule of thumb is to take the biological half-life of the drug times 5 to allow for 'clearance' before testing. With certain medications, the drug itself may have cleared the body, but the effect of the medication may be longer lasting. Below you will find a list detailing the potential interference or influence of certain substances on the biomarkers.

 

Dietary Factor Possible Impact on Results
Artificial sweeteners and MSG Artificial sweeteners and MSG are composed of amino acids which can directly impact measured amino acid levels
Eat your usual diet; avoid over-consuming any single food, extreme diets, or engaging in a rigourous activity (i.e. marathon) Extreme diets and activity may impact certain organic acid biomarkers related to the citric acid cycle, neurotransmitter metabolites, dysbiosis markers, or amino acids
Phenol and flavonoid containing compounds in fruits, vegetables, chocolate, and tea can result in elevation of certain bacterial and fungal dysiosis markers on the organic acids profile
Bananas, pineapple, kiwi, plums, avacado, walnuts, and pecans can result in an elevation of the serotonin metabolite 5-HIAA measured on the organic acids profile
Seafood Seafood containing heavy metals such as mercury and arsenic can result in a transient elevation
Six 8-ounce glasses of fluid Creatinine concentration is influenced by fluid intake
Fasting, water allowed only Reference ranges were set based on an overnight-fasted population. Overnight fasting minimizes influence of a single meal and provides a "steady diet" sample

Medications and supplements may impact results. The discontinuation of any medication is at the discretion of the clinician, only if medically appropriate.

Medications and Supplements Possible Impact on Results
Valproic acid Direct assay interferent for organic acid xanthurenic acid
Acetaminophen Direct assay interferent for multiple organic acids
Berberine HCl Direct assay interferent for organic acids IAA and 5-HIAA
Antibiotics, antifungals, probiotics, digestive enzymes, acid blocking medications May indirectly influence urinary organic acid markers of malabsorption/dysbiosis

Amino acid levels may be impacted by aminoglycoside antibiotics
Amphetamines, centrally acting medications, antidepressants, Anti-Parkinsonian medications May influence urinary organic acid markers of neurotransmitter metabolism1,2
HMG-CoA-reductase inhibitors (statins) and red yeast rice May indirectly increase urinary organic acid B-methylglutaric acid levels
N-Acetyl Cysteine (NAC) Direct assay interferent for cholesterol and triglycerides add-on tests; may lead to falsely low results
Oral contraceptives, estrogen therapy May increase the organic acid quinolinic acid excretion both from altered tryptophan metabolism directly, as well as the indirect functional vitamin B6 insufficiency3
Quercetin May elevate the organic acid homovanillic acid4
Steroids May lower inflammatory neurotransmitter metabolite quinolinic acid, an organic acid
Diuretics May impact creatinine concentration, thus affecting all urinary biomarker measurements
Fibrates May influence fatty acid levels
In some animal studies, fibrates also impact cellular energy metabolites on the organic acids profile
Kreb's cycle and amino chelated supplements (i.e. citrate, malate, succinate, glycinate, threonate, and orotate forms of supplements [magnesium citrate], alpha ketoglutarate, and others) May result in elevations of corresponding Kreb's cycle markers and amino acids
Provocation/chelating agents (i.e. DMPS, DMSA, EDTA, etc.) Reference ranges are based on a non-provoked, non-chelated patient population
Vitamin C May increase urinary excretion of organic acid oxalic acid or lead

Dietary Influences on urinary organic acids:4-16

Urinary Metabolite Common Dietary Sources
Indoleacetic acid High tryptophan intake, green/black tea
Phenylacetic acid Wine/grapes
Dihydroxyphenylpropionic acid Whole-grains, chocolate, coffee, green/black tea, olives/olive oil, citrus fruits (animal studies)
3-Hydroxyphenylacetic acid &
4-hydroxyphenlyacetic acid
Wine/grapes, cranberries, green/black tea, berries, orange juice, grape seed extract
Benzoic acid/Hippuric acid Orange juice, elderberry, huckleberry, food preservative, berries, other flavonoids
Citramalic acid Apples, cranberries, sugar beets
Tartaric acid Wine/grapes, chocolate, food additive/preservative
Malic acid Fruits (apples, pears), vegetables, throat lozenges, syrups, beverages with food preservatives and additives
Homovanillic acid Flavanols including tomatoes, onions and tea
5-hydroxyindolacetic acid Bananas, plantains, kiwi, pineapple, nuts, and tomatoes

Diabetic Patients

Urine glucose is a direct interferent to the lipid peroxides assay. Patients with uncontrolled diabetes and elevated urine glucose may receive a result of 'not reportable, NR' for lipid peroxides. Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors lower blood sugar by disposing of excess glucose via urine.

Urinary Creatinine Levels and Kidney Function

The urine biomarkers are ratioed to urinary creatinine. The urine biomarkers include organic acids, urine amino acids and urine oxidative stress markers. If urinary creatinine is out of range, it can impact the levels of reported urine analytes which are used for nutrient recommendations. The collection instructions recommend not to drink more than six, 8-ounce glasses of liquid (48 ounces) 24 hours prior to sample collection because it can dilute the urine impacting the reported urine analytes. Below are considerations for altered urinary creatinine:

  • Elevated Creatinine: High muscle mass, heavy exercise or increased physical activity, increased protein intake, significant dehydration, and increased renal clearance.
  • Low Creatinine: Poor renal clearance or dysfunction, low muscle mass (i.e. physical inactivity or muscle wasting disease), diluted urine (use of diuretics), malnutrition/protein insufficiency, and hypothyroidism.

We do not recommend urine testing in a patient with known kidney dysfunction, defined by abnormal serum testing.

Pediatric Patients

Testing is not available for children under 2 years old and samples will be discarded. Appropriate reference ranges have not been established for this population. We do not recommend squeezing liquid out of a diaper for sample collection, as this can result in altered concentrations of creatinine and biomarkers. A pediatric urine bag that can be taped to the body is available upon request for appropriate sample collection. While this is not a catheter procedure, instructions for catheterized patients can be followed below with regards to collecting and pooling all urine samples from the child's bedtime to early morning awakening.

Urinary Catheters

It is unknown whether having a catheter placed will affect the results, or whether there will be any interference or decreased viability of the sample owing to this procedure. It is imperative to collect all urine samples from bedtime until early morning awakening. The bladder should be voided before bed. If the patient urinates during the night, the contents of the bag should be emptied into a clean container and refrigerated as soon as possible. This must be done each time urine is collected during the night. This may be inconvenient for the patient but would ensure a more viable sample. Finally, collect the first urine upon waking for the day, and combine that sample with all samples collected during the night. Ensure the combined sample is well mixed before transferring into the labeled tubes.

Pregnant Patients

The reference ranges were not designed for a pregnant population. However, it may be useful to evaluate functional nutritional needs to optimize health during pregnancy, for both the mother and fetus. In pregnancy, the demand for various nutrients increases dramatically. The recommendations offered may reflect that increased nutritional burden. However, because the reference ranges were not established for this patient population, the implementation of nutrient recommendations or botanicals should be in accordance with standard pregnancy recommendations and precautions. Please refer to the link below addressing micronutrient needs during pregnancy and lactation:

References
  1. Grouzmann E, Lamine F. Determination of catecholamines in plasma and urine. Best Pract Res Clin Endocrinol Meta. 2013;27(5):713-723.
  2. Alam N, Wasi N, Naeem S, et al. Methylphenidate increases the urinary excretion of vanillylmandelic acid in rats that is attenuated by buspirone co-administration. Pak J Pharm Sci. 2019;32(2 (Supplementary)):895-898.
  3. Rose D, Toseland P. Urinary excretion of quinolinic acid and other tryptophan metabolites after deoxypyridoxine or oral contraceptive administration. Metabolism. 1973;22(2):165-171.
  4. Combet E, Lean ME, Boyle JG, Crozier A, Davidson DF. Dietary flavonols contribute to false-positive elevation of homovanillic acid, a marker of catecholamine-secreting tumors. Int J Clin Chem. 2011;412(1-2):165-169.
  5. Zamora-Ros R, Achaintre D, Rothwell JA, et al. Urinary excretions of 34 dietary polyphenols and their associations with lifestyle factors in the EPIC cohort study. Sci Rep. 2016;6:26905.
  6. Ward NC, Croft KD, Puddey IB, Hodgson JM. Supplementation with grape seed polyphenols results in increased urinary excretion of 3-hydroxyphenylpropionic Acid, an important metabolite of proanthocyanidins in humans. J Agric Food Chem. 2004;52(17):5545-5549.
  7. Sugimoto N, Forsline P, Beaudry R. Volatile Profiles of Members of the USDA Geneva Malus Core Collection: Utility in Evaluation of a Hypothesized Biosynthetic Pathway for Esters Derived from 2-Methylbutanoate and 2-Methylbutan-1-ol. J Agricul Food Chem. 2015;63(7):2106-2116.
  8. Hulme A. The isolation of L-citramalic acid from the peel of the apple fruit. Biochim Biophys Acta. 1954;14:36-43.
  9. Liu H, Garrett TJ, Su Z, Khoo C, Gu L. UHPLC-Q-Orbitrap-HRMS-based global metabolomics reveal metabolome modifications in plasma of young women after cranberry juice consumption. The J Nutr Biochem. 2017;45:67-76.
  10. Khorassani R, Hettwer U, Ratzinger A, Steingrobe B, Karlovsky P, Claassen N. Citramalic acid and salicylic acid in sugar beet root exudates solubilize soil phosphorus. BMC plant biology. 2011;11(1):121.
  11. van der Hooft JJ, de Vos RC, Mihaleva V, et al. Structural elucidation and quantification of phenolic conjugates present in human urine after tea intake. Analyt Chem. 2012;84(16):7263-7271.
  12. Jacobs DM, Fuhrmann JC, van Dorsten FA, et al. Impact of short-term intake of red wine and grape polyphenol extract on the human metabolome. J Agricul Food Chem. 2012;60(12):3078-3085.
  13. Rios LY, Gonthier M-P, Rémésy C, et al. Chocolate intake increases urinary excretion of polyphenol-derived phenolic acids in healthy human subjects. Am J Clin Nutr. 2003;77(4):912-918.
  14. Henning SM, Wang P, Abgaryan N, et al. Phenolic acid concentrations in plasma and urine from men consuming green or black tea and potential chemopreventive properties for colon cancer. Mol Nutr Food Res. 2013;57(3):483-493.
  15. Feliciano RP, Boeres A, Massacessi L, et al. Identification and quantification of novel cranberry-derived plasma and urinary (poly)phenols. Arch Biochem Biophys. 2016;599:31-41.
  16. Corcuff J-B, Chardon L, El Hajji Ridah I, Brossaud J. Urinary sampling for 5HIAA and metanephrines determination: revisiting the recommendations. Endocr Connect. 2017;6(6):R87-R98.

 

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Review information on the Test Preparation tab above for details on how medications and supplements may impact this test.

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