FNMFC Comprehensive Metabolic Functional Profilegnosis-healthcare.com/wp-content/uploads/media_uploads/...Functional Diagnostics Gnosis Laboratories (M) Sdn. Bhd. (577284-A) HQ: 64-1,

Functional Diagnostics

Gnosis Laboratories (M) Sdn. Bhd. (577284-A) HQ : 64-1, Jalan SS15/4, 47500 Subang Jaya, Selangor, Malaysia. Tel: 03-56219177 / 9277 / 9377 Fax: 03-56219077

Comprehensive Metabolic Functional Profile

Cellular Ene rgy Production Markers Methodology : LC-MS/MS

Quintile rankings are a percentile breakdown of population results. These are obtained arranging all the test results in a reference population from lowest to highest. These are then divided into 5 groups of equal numbers. The lowest 20% of results comprise the 1st

quintile. Those results in the next 20% to 40% range are the 2nd quintile, and so forth. The 5th quintile would be the highest 20% of the

results. This percentile ranking by quintile has proved useful in medical research by providing insight as to how test results in

populations might relate to particular illnesses.

Reference Range

2. Suberate ≦6.47

≦6.12 3. Ethylmalonate

4.57

2.06

Carbohydrate Metabolism (B-complex, Cr, CoQ10, Lipoic Acid)

Cellular Energy Production (B-Complex, Mg, CoQ10, Lipoic Acid, Amino acid )

0.23-7.38

2.8-32.8

4. Pyruvate

5. Lactate

≦3.98 6. BHBA

0.655

36.6

�

�

0.889

≦7.27 14. HMG

≦0.79

63-748

29.5-103

38.8-116

0.9-23.7

≦18.7

≦2.00

12. Fumarate

7. Citrate

8. Cis-aconitate

9. Isocitrate

10. AKA

11. Succinate

13. Malate

4.84

0.125

1.03

86.5

72.5

3.67

21.2

1.25

�

�

�

Markers (Nutrient Requirements)

1. ITEM RR Data

Result ug/mg cr.

95% Reference Range

Percentile Ranking By Quintile

20% 40% 60% 80%

Fatty Acid Metabolism (L-Carnitine and B2)

1. Adipate ≦7.25 2.5

Result

ug/mg cr. 95%

Reference Range


20% 40% 60% 80%

Lab No.

Sex / Age

IC No.

Your Ref. No. Patient Tel

Date Receive / Report

Patient Name : SAMPLERefer From :




B-Complex Vitamin Status Makers Methodology : LC-MS/MS

Neurotransmi tter Metabolism Markers Methodology : LC-MS/MS

B-Complex Vitamin Status (B-complex and Biotin)

≦0.2

≦0.88

≦2.13

15. AKIV

16. AKIC

17. AKBM

18. Xanthurenate

19. BHIVA

≦0.63

≦17.0

0.031

0.062

0.078

0.484

10.2

Neurotransmitter Metabolism

(Tyrosine, Tryptophan, 5-HTP, B6)

23. VMA

24. 5-HIAA

25. Kynurenate

22. HVA

0.72-5.96

0.28-5.96

≦1.85

1.54-4.82

26. Picolinate

27. Quinolinate

0.03-0.32

≦8.54

1.4

1.53

1.82

3.85

�

�

0.109

5.51

Methylation Cofactor (B12, B6, Folate, TMG)

20. MMA

21. FIGLU

≦2.83

≦0.38

1.76

0.234

Result ug/mg cr.

95% Reference Range


20% 40% 60% 80%

Result ug/mg cr.

95% Reference Range


20% 40% 60% 80%

Lab No.

Sex / Age

IC No.







Toxicant s and Detoxification Methodology : LC-MS/MS

Gut Dysbiosis Markers Methodology : LC/MS/MS

Result ug/mg cr.

95% Reference Range


20% 40% 60% 80%

Toxicants and Detoxification (Glycine, NAC, Sodium Glucuronate, Taurine,

Magnesium sulfate, Phytochemicals)

28. 2-MetHip

29. Mandalate

≦0.08

≦0.37

30. PGA

31. Glucarate

≦0.44

≦11.0

32. AHBA

33. Pyroglutamate

≦7.37

6.73-27.3

34. Orotate ≦0.90 0.343

0.031

0.187

0.047

6.4

4.88

28.8 �

Gut Dysbiosis Markers (Probiotics, Anti-microbials, Digestive enzyme, S. boulardii)

Yeast / Fungal Markers (Herbal antibiotics, Anti-fungal)

35. Benzoate

36. Hippurate

≦6.97

≦435

37. PAA

38. PPA

≦1.71

≦0.102

39. 4-HBA ≦3.58

40. 4-HPAA ≦25.3

41. IAA ≦7.6

43. Tricarballylate

42. DHPPA

≦1.25

≦1.1

2.78

110

�

0.328

0.0000

0.733

12.2

4.2

0.702

0.062

44. Citramate ≦6.31

46. Arabinitol

45. Tartarate

≦5.82

≦8.40

2.11

3.67

18.8

�

�

Result ug/mg cr.

95% Reference Range


20% 40% 60% 80%

Lab No.

Sex / Age

IC No.







Cellular Energy Production Markers

Stage

1

Cofactor

Inhibitor

Citric Acid Cycles輔酶 Q10

鎂

Stage

2

DIG

ES

TIO

N &

AS

SIM

ILA

TIO

NIN

TE

RM

ED

IAR

Y M

ETA

BO

LIS

M

Oxaloacetate

Succinyl CoA

Acetyl-CoA α -Oxidation

β-Oxidation

Fatty acid Amino Acids

Fats Protein Carbohydrates

#5

Lactate

#6

BHBA

#7

Citrate

#4

Pyruvate

#1

Adipate

#10

AKA

#2

Suberate

Succinate

#11

Iso-citrate

#9

Malate

#13

Fumarate

#12

#8

Cis-aconitate

#3

Ethylmalonate

Mg B-Comp. CoQ10

Arginine

CoQ10

#14

HMG Acetyl-CoA

Stage

3

NADH, FADH2

Energy

ATP

CoQ10

Cholesterol

O2

Electron Transport System

H2O

ELE

CT

RO

N

TR

AN

SP

OR

T

Lab No.

Sex / Age





Neurotra nsmitter Metabolism

Dopamine

Epinephrine

Norepinephrine

Kynurenin

In urine

Niacin

3-amino-3-carboxynuconate

3-OH Kynurenine

Inflammation

Tryptophan

#25

Kynurenate

Xanthurenate

#18

#26

Picolinate

Quinolinate

#27

#23

VMA

#22

HVA

Tyr、、、、

B-Comp.

B6 Mg

Tyrosine

#24

5-HIAA

Tryptophan

Serotonin

Melatonin

5-HTP

Lab No.

Sex / Age





Toxicants and Detoxification

#29

Mandalate

Glutathione(GSH)

#34

Orotate

Glucarate

#31

Hippurate

#36

AHBA

#32

#33

P yroglutamate

GSH Conjugation

Glucuronidation

Glycine Conjugation

Xylene

Styrene

Phase I Detoxification

CYP450 Oxidation

Disposal of ammonia (Urea Cycle)Renal amino acid

Recovery

Phase I Detoxification

Xenobiotics

#28

2-MetHip

PGA

#30

NAC

Banzoate

#35

Fa t - s o l u b l e To x i n s

Polycyclic Aromatic Hydrocarbons

Nitrosamine

Xylene

Paints

Gas

Exhaust gas

Coatings

Varn

ish

De

gre

ase

r St yrene

Paints Cigarette

Plastic bag

Food containers

Varn

ish

Exhaust gas

Rubber products

Cigarette

Hand cream

Tire

BBQ

Hard Cheese

Cured meat

Hot Dog

Salted fish

Areca

Ham

BBeeeerr Cigarette

Lab No.

Sex / Age





Gut Dysbiosis

Benzoate

#35

Hippurate

#36

#37

PAA

#38

PPA

#39

4-HBA

#40

4-HPAA

#41

Clostridia IAA

DHPPA

#42

Citramate

#44

Tartarate

#45

Arabinitol

#46

#43

Tricarballyate

Giardia Lamblia

Preservation in foods (Benzoic acid)

Preservation (4-HBA)

Preservation in cosmetics

Phe-rich foods

Phenylalanine

Tyrosine

Tryptophan

Polyphenol

Polyphenol- rich foods

Tyr-rich foods

Try-rich foods

Clostridia

Candida

Candida

Bacteria

Clostridia

Anaerobic

Bacteria

Joint inflammation

Sugar-rich foods

Grapes, Raisins, Wine, Cream of tartar

Arabinose

Candida

Apples, Plums,

Cherries, Grapes

Aerobic

4R Digestive Health Program:

1R: Remove

Herb antibiotics

2R: Replace

Betaine HCl Pepsin Bromelain Papain

3R: Reinoculate

4R: Repair

Glutamine NAG

Lab No.

Sex / Age





1073 Comprehensive Metabolic Function Profile Summary

Category I: Cellular Energy Marker

Efficient Fatty acid Metabolism: Your test results show reveal optimal ability to metabolize and burn fats.

Inefficient Carbohydrate Metabolism: Your test results reveal inefficiency in your carbohydrate metabolism. This may result in:

·Alcohol, toxic chemical exposure, or anemia ·Hypoxia ·Excessive accumulation of Lactic Acid (e.g., during prolonged

exercise)·Low energy

Inefficient Cellular Energy Production: Your test results reveal inefficiency in your cellular energy production. This is a critical

process that occurs within all cells and sub-optimal energy production may result in:

·Fatigue and lack of vitality ·Ammonia toxicity ·Confusion and poor memory ·Increase oxidative stress ·Accelerated

aging ·Low energy ·Lack of concentration and memory·CoQ10 insufficiency ·Childhood developmental retardation

Category II: B-Complex Vitamin Status Makers

B-Vitamin Efficiency: Your test results show indications optimal B-vitamin status.

Category III: Neurotransmitter Metabolism Markers

Inefficient Neurotransmitter: Your test results show inefficient neurotransmitter, which may result in:

·Mood imbalances and mild depression·Fatigue and lack of vitality ·Increased perception of pain and chronic pain·

Constipation

Category IV: Toxicants and Detoxification

Detoxification insufficiency: Your test results reveal sub-optimal ability to detoxify internal and external chemicals and toxins.

Elevated body burden of toxin may result in:

Styrene exposure ·Increase oxidative stress ·Increased risk for many chronic disease (e.g. heart disease, stroke, and cancer) ·

Lack of concentration and memory

Category V: Gut Dysbiosis Markers

Intestinal Dysbiosis: Your test results Show a dysbiosis or lack of beneficial bacteria, which can result in:

·Intestinal bacteria overgrowth ·Increased risk for many chronic disease (e.g. heart disease, stroke, and cancer) ·Low HCl in

stomach

Detoxification insufficiency: Your test results reveal sub-optimal ability to detoxify internal and external chemicals and toxins.

Elevated body burden of toxin may result in:

·Yeast and other vaginal infections ·Muscle and joint pain

Depending on the result of your test, the nutritional requirements as follows:

� Consider amino acid supplementation。

� Considerα-KG, tyrosine, aspartic acid supplementation。

� Consider glycine, N-Acetyl-L-Cysteine(NAC), taurine, supplementation.

� Consider B2(riboflavin), B5(pantothenic acid), B6(pyridoxine), supplementation.

� Consider Mg, supplementation.

� Consider CoQ10 supplementation.

� Consider betine HCl and pepsin supplementation.

� Consider probiotics and prebiotics supplementation.

� Restricted carbohydrate diet.

� Yeast free diet.

� Avoid excess intake of exogenous sodium benzoate (preserved, packaged foods and some natural ingredient foods): Pickles, Soda,

Lunchmeats, plums, prunes, rhubarb, and cranberries.

� Rule out tartaric acid-containing foods (fruits, especially grapes, raisins or wine; also as “cream of tartar” in some soft drinks &

baked goods).

� Rule out arabinose containing foods (apples, plums, cherries, grapes).

Lab No.

Sex / Age





1073 Comprehensive Metabolic Function Profile Summary

Depending on the result of your test, the food source of nutrients as follows:

Catalog Food Sources

Protein

Protein Egg, milk, corn, pulses, whole grains, oatmeal, peanuts.

Cysteine Peppers, onions, garlic and wheat, poultry, oatmeal, dairy products.

Tyrosine

Meat (fish, chicken, and pork), whole grains (wheat and oats), dairy products (milk, cheese and

yogurt), fruits (avocados and bananas), legumes and nuts (almond, lima beans, sesame seeds)

and pumpkin seeds.

Aspartic acid Meat, sugar beets, oat, avocado and asparagus.

Glycine Soybean, dairy products, egg and meat

Taurine Eggs, seafood (fish, oysters and shellfish), meats and dairy products (milk).

Carbohydrate

Carbohydrate Soybean, nuts, seeds, fish and corn oils.

Vitamin

B2(riboflavin) Liver, whole grains (wheat flour and bread), yeast, milk, egg, nuts (almonds).

B5(pantothenate) Liver and kidney, yeast, egg yolk, broccoli, fish, shellfish, chicken, milk, yogurt, legumes,

mushrooms, avocado, and sweet potatoes.

B6 (pyridoxine) Crude rice, wheat bran, garlic, liver, fish (tuna, salmon, and cod), sunflower and sesame seeds.

Mineral

Mg Green leafy vegetables (e.g., Spinach), unrefined grains and nuts (oat bran and almonds), meats

and milk.

Others

CoQ10 Meat, poultry, fish, soybean, canola oils, and nuts.

Lifestyle & Health:

� Decrease stress (cortisol)–emotional and physical.

� Reduce alcohol consumption.

� Reduce toluene exposure (e.g., paints, paint thinner, perfume, fingernail polish, lacquers, adhesives).

� Maintan a good living habits.

Testing and Treatment Guidelines:

� Adrencortex Stress Profile (#1070).

� Cardiometabolic Health Profile (#807).

� Address any joint inflammation.

� Have a functional medical exam every 3-6 months to make sure that you are getting enough nutrition and activity is recommended.

Lab No.

Sex / Age





With knowledge of a patient's full medical history and concerns, the Comprehensive Metabolic Function Profile laboratory

results may be used to help create an individualized nutrition formula. Based strictly on the results from this test, the

summary table below shows estimates of nutrient doses that may help to normalize nutrient-dependent metabolic functions.

Nutrients listed in this section are normally contained in a multi-vitamin preparation. Customized preparations of the

multi-vitamin/mineral formula shown below may be produced by compounding pharmacies. □ Powder； □ Capsule

Vitamin Dosage Per Day Vitamin Dosage Per Day

Vitamin A (as Vitamin A Palmitate) IU 2500 Vitamin B2 (as Riboflavine 5’ Phosphate) mg 6.25

Vitamin A (as Beta Carotene) IU 5000 Vitamin B3 (as Niacin) mg 50

Vitamin C (as Ascorbic Acid) mg 300 Niacinamide mg 15

Vitamin C (as Ascorbyl palmitate) mg 20 Vitamin B6 (as Pyrodoxine HCl) mg 50

Vitamin D3 (as Cholecalciferol) IU 1000 Vitamin B6 (as Pyrodoxal-5-Phosphate) mg 6.25

Vitamin E (as d-Alpha Tocopherol) IU 75 Folic Acid (as L-5-MTHF) mcg 600

Vitamin E (as Mixed Tocopherols) IU 25 Vitamin B12 (as Methylcobalamin) mcg 800

Vitamin K1 mcg 100 Biotin mcg 400

Vitamin B1 ( as Thiamine Mononotrate) mg 25 Vitamin B5 (as Calcium Pantothenate) mg 25

Vitamin B2 (as Riboflavine) mg 50

Mineral Dosage Per Day Mineral Dosage Per Day

Calcium (as Calcium Carbonate) mg 250 Manganese (as Manganese Glycinate) mg 5

Iodine (as Potassium Iodide) mcg 75 Chromium (as Chromium Picolinate) mcg 200

Magnesium (as Magnesium Glycinate) mg 300 Molybdenum (as Sodium Molybdate) mcg 100

Zinc (as Zinc Picolinate) mg 25 Boron (as Boron Citrate) mg 1

Selenium (as L-Selenomethionine) mcg 50 Sulfate (as Magnesium Sulfate) mg 150

Copper (as Copper AA Chelate) mg 1

Amino Acid & Phytonutrient Dosage Per Day Amino Acid & Phytonutrient Dosage Per Day

Citric Acid mg 500 Glycine mg 500

Malic Acid mg 100 Tyrosine mg 1000

Betaine HCl mg 100 Taurine mg 250

Pepsin (1:10000) mg 20 Calcium-D-glucurate mg 150

CoQ10 mg 30 Milk thistle mg 150

N-Acetyl-L-Cysteine mg 250 Tumeric (curcuma longa) mg 150

OA03

Other suggested products but not included in the Individualized Nutrition Formula.

Nutrient Products Dosage

Herbal bacteriostatic agents Biocidin 2#qd

Probiotics－Saccharomyces boulardii Co-biotic 1#qd

Gastrointestinal restoration Inte-Guard 1#qd

Essential Amino Acid Mixture based on the results of Amino Acid Testing

Lab No.

Sex / Age


Functional Medicine Individualized Nutrition Formula




Comprehensive Metabolic Function Profile

The Comprehensive Metabolic Function Profile is like an emission test performed on your car: the exhaust is examined to see

how efficiently the engine is burning fuel. Similarly, certain compounds in your urine called “organic acids” reveal the efficiency of

your body’s machinery. Many organic acids result from the metabolic pathways, or chemical reactions, your body uses to transform

food into energy, growth, maintenance, and repair of body tissue. Like spark plugs that ignite fuel in a car engine, vitamins and

other essential nutrients are necessary for these chemical reactions that power your metabolic machinery. Thousands of these

reactions occur in your body every second and are the basis of your level of health and vitality.

The figure below illustrates a well-functioning metabolic pathway. Molecule A is converted to Molecule B by the enzyme AB.

Molecule B is converted to Molecule C by the enzyme BC and so on, all the way down the metabolic pathway. Many enzymes

require nutrient co-factors such as specific vitamins and minerals in order to perform their functions in converting one molecule to

another.

If one or more of these specific nutrients are not available in adequate amounts, important reactions cannot occur as well as they

should. The illustration below shows what happens when the nutrient is not present in adequate amounts so that enzyme AB

functions inefficiently. A small amount of Molecule A is converted to Molecule B and the remainder builds up and spills into the

urine. Notice that Molecules C through D downstream are also affected.

Visualize this process as a dam blocking a stream—very little water flowing downstream and an overflow occurring upstream. The

Comprehensive Metabolic Function Profile measures the overflow of certain organic acids in your urine to determine what

blockages may be occurring in your metabolic pathways due to nutrient insufficiencies or other issues.

High levels of many organic acids on your report can indicate which nutrient insufficiencies may be affecting your health. Other

organic acids come from toxins you have been exposed to, and still others show how your body is responding to toxins. When

these are high on your Comprehensive Metabolic Function Profile, you may benefit from therapies that support your body’s

detoxification processes.

Enzyme AB with sufficient

nutrient

Enzyme BC Enzyme BCA B C D

Enzyme AB with sufficient nutrient

Enzyme BC Enzyme CD

Block caused by vitamin insufficiency

In Urine

A B C D

A

Lab No.

Sex / Age





CCoommpprreehheennssiivvee MMeettaabboolliicc FFuunnccttiioonnaall PPrrooffiillee

Category I: Cellular Energy Marker

Carbohydrate Metabolism: B-complex, Cr, CoQ10, Lipoic Acid

4. Pyruvate is aerobic/anaerobic energy production. Low pyruvate indicates impaired production form glycogen (glycogenolysis),

carbohydrates (glycolysis), or protein (gluconeogenesis).

5. Lactate is a product of muscle use, so it is constantly produced in normal daily activity.

High Lactate can cause muscle cramping, fatigue and brain fog. It indicates insufficiency of coenzyme Q10 (CoQ10), a nutrient

that enables the body to use oxygen to generate large amounts of energy. It is important for athletes in order to maintain intense

muscular activity. CoQ10 is also a potent antioxidant helping to slow the aging process and prevent a variety of degenerative

diseases. Risk for certain kinds of heart disease, cancer, and hypertension are increased when CoQ10 is insufficient.

Cellular Energy Production: B-Complex, Mg, CoQ10, Lipoic Acid, Amino acid

7 and 8. Citrate, or cis-aconitate is metabolites of acetyl CoA, precursors of isocitate. Low Citrate, or Cis-aconitate can indicate a

need for essential amino acids, especially arginine.

10. Alpha-ketoglutaric Acid (AKA) is metabolite of isocitrate, also glutamate; precursor of succinate. Low AKA can be caused

by weakness of isocitrate dehydrogenase, the citric acid cycle enzyme that forms it from isocitric acid. This enzyme requires

vitamin B3 as NAD, magnesium and manganese, and it is strongly inhibited by aluminum. Alpha-ketoglutaric acid is a

scavenger of amino groups and ammonium ions in the body. Adding an amino group to alpha-ketoglutaric acid results in

glutamate formation.

11. Succinate is used in the body’s metabolic pathway that generates cellular energy–the Citric Acid Cycle. This cycle critically

supports organ maintenance and neurological function. High succinate may occur if succinate dehydrogenase is weak or

rate-limited. This enzyme requires ferrous iron (Fe+2) and vitamin B2 as FAD, and is inhibited by excessive levels of malonate.

If α-ketoglutarate is elevated along with succinate, malate, and fumarate, you may need additional CoQ10, a nutrient that

enables the body to use oxygen to generate large amounts of energy.

Category III: Neurotransmitter Metabolism Markers

Neurotransmitter Metabolism: Tyrosine, Tryptophan, 5-HTP, B6

23. Vanilmandelate(VMA)is norepinephrine metabolite. Low VMA indicates your body is not making enough of epinephrine

and norepinephrine neurotransmitters. Symptoms associated with this condition are depression, sleep disturbances, anxiety and

fatigue. Treatments to improve digestion, along with supplementation of tyrosine, can help improve the ability to keep up with

demand for these neurotransmitters.

Lab No.

Sex / Age





25. Kynurenate is tryptophan catabolism and precursor to quinolinate.(see #27). High kynurenate indicates an insufficiency of

vitamin B6, especially when xanthurenate (see #18) is high. Vitamin B6 deficiency symptoms are consistent with fatigue,

irritability, GI distress, neuritis and neuropathy.

Category IV: Toxicants and Detoxification Makers

Detoxification: Glycine, NAC, Sodium glucuronate, Taurine, Magnesium sulfate, Phytochemicals

33. Pyroglutamate is product of gamma-glutamyl pathway required for renal amino acid recovery and small intestinal amino

acid absorption. High Pyroglutamate indicates the body is using up glutathione to keep from losing amino acids. Glutathione is

important for protection of cells from oxidation. Various amino acids, especially methionine and glycine, can help rebuild total

body glutathione. Pyroglutamate elevation can also indicate a glycine insufficiency; supplementation with this amino acid may

be indicated.

Category V: Gut Dysbiosis Markers

Gut Health: Probiotics, Anti-microbials, Digestive enzyme, S. boulardii

35. Benzoate is produced by intestinal bacteria. High Benozate: It can also occur in the urine because of exposure to foods that

contain benzoate as a preservative, such as pickles and lunchmeats. The amino acid glycine and vitamin B5 are required to

eliminate benzoate from your body. When benzoate is high, regardless of the source, these nutrients will help to lower the level.

Yeast / Fungal Markers: Probiotics, Antibiotics, Anti-fungal agent

45.Tartaric Acid is breakdown product of hyaluronic acid, also contained in certain foods. Widely distributed in fruits, tartaric

acid is particularly high in grapes, raisins, and in wine. It may also be found in some soft drinks and baked goods (as "cream of

tartar").

High Tartaric Acid: The elevation of tartaric acid may be due to recent ingestion of higher than usual amounts of some of these

foods. Aside from dietary sources, elevated urine tartrate can be the result of (intestinal) yeast overgrowth. Elevations also may

be possible joint inflammation, leading to release of hyaluronic acid.

46. Arabinose is breakdown product of hyaluronic acid, also contained in certain foods. High Arabinose: Elevations may be

indicate ingestion of arabinose-rich foods (apples, plums, cherries, grapes), and in juices made from these fruits. Elevations also

may be possible joint inflammation, leading to release of hyaluronic acid. A finding of high arabinose, without dietary intake of

the above-mentioned fruits, suggests a stool analysis or other tests/examinations for Candida overgrowth.

*** The above suggestions are for doctor’s reference only ***

Lab No.

Sex / Age


Documents

FNMFC Comprehensive Metabolic Functional Profilegnosis-healthcare.com/wp-content/uploads/media_uploads/...Functional Diagnostics Gnosis Laboratories (M) Sdn. Bhd. (577284-A) HQ: 64-1,