Great Plains Lab Report – an Example

A reader forwarded me a copy of their results. As usual, I like to go thru it via a blog post. The report gives good information but in the context of CFS/IBS we may be approaching the edge of what we can do with it (i.e. no studies, etc). Here goes….

First item, I am in general very happy with their presentation of information, as shown below.

gtreat

 

Organic Acids Test  – Nutritional and Metabolic Profile

The following were all in the normal range:

  • Glycolytic Cycle Metabolities
  • Mitochondrial Markers – Krebs Cycle Metabolites
  • Mitochondrial Markers – Amino Acid Metabolities
  • Pyrimidine Metabolites – Folate Metabolism
  • Ketone and Fatty Acid Oxidation
  • Indicators of Detoxification
  • Mineral Metabolism

Mitochondrial markers being normal excludes one set of hypothesis about CFS for this patient. See these PubMed articles where CFS patients were found to have mitochondrial issues.

Yeast and Fungal Markers

The following were high:

  • Citramalic (~ 96%ile)
  • Tartaric Acid – very high (3x high normal range)
  • Arabinose – high (2x high normal range)

My read would be to take prescription  Metronidazole/Flagyl  (people responded well to it according to the surveys) or other anti-fungal medications. For herbs  Cistus Incancus is one of many choices.

In short — evidence that a subset have issues here — but a lack of followup studies.

Bacterial Markers

  • Hippuric – very high 4x high normal range
    • “Hippuric acid is a normal component of urine and is typically increased with increased consumption of phenolic compounds (tea, wine, fruit juices).” [source] – other sources are exposure to high levels of toluene.
      • Mulder TP, Rietveld AG, van Amelsvoort JM.
        Consumption of both black tea and green tea results in an increase in the excretion of hippuric acid into urine. Am J Clin Nutr 2005;81:256S-260S.
      • Clifford MN, Copeland EL, Bloxsidge JP, Mitchell 10.
        LA. Hippuric acid as a major excretion product associated with black tea consumption. Xenobiotica 2000;30:317-326. Li C, Lee MJ, Sheng
  • 4-Hydroxybenzoin ~ 98%ile

What I could find:

Lab’s Recommendation: “High hippuric acid (Marker 10) may derive from food, GI bacterial activity, or exposure to the solvent toluene. …. Bacterial overgrowth can be treated with natural anti-bacterial agents and/or probiotics (30-50 billion cfu’s) that include Lactobacillus rhamnosus.”

Actions: None beyond the above

Clostridia Bacterial Markers

Three markers were in the normal range, only one was outside

  • HPHPA – 96%ile
    • “(HPHPA) was found in higher concentrations in urine samples of children with autism compared to age and sex appropriate controls and in an adult with recurrent diarrhea due to Clostridium difficile infections… a value 300 times the median normal adult value,”[2010]  – reader value is no where need this
    • “After oral vancomycin treatment, urinary excretion of HPHPA … decreased markedly, which indicated that these compounds may also be from gut Clostridium species.”[2016]
      • If the reader was taking any Clostridium probiotics, this could account for the slightly high reading.

Lab’s Recommendations: “Treatment with Metronidazole or Vancomycin is almost 100% effective in killing parent Clostridia organisms but not their spores. At least three months of probiotic therapy is recommended after antimicrobial treatment due to spore formation by Clostridia species. Clostridia overgrowth can sometimes be controlled by supplementation with Lactobacillus rhamnosus GG (Culturelle) or Saccharomyces boulardii. Phenalalanine or tyrosine supplements should be avoided because of the possibility of conversion to HPHPA or other toxic byproducts.”

Actions: Not sufficiently high to warrant 3 months of antibiotics (which will cause other side effects)

Oxalate Metabolites

  • Oxalic – 98%ile

Lab’s Recommendations: “…. are also byproducts of molds such as Aspergillus and Penicillium and probably Candida.  ….Elevated oxalate values with a concomitant increase in glycolic acid may indicate genetic hyperoxaluria (type I), whereas increased glyceric acid may indicate a genetic hyperoxaluria (type II). Elevated oxalic acid with normal levels of glyceric or glycolic metabolites rules out a genetic cause for high oxalate. However, elevated oxalates may be due to a new genetic disorder, hyperoxaluria type III.
Organic ”

Actions: Resolve the Candida/Fungal/Yeast and then get retested.

Neurotransmitter Metabolites

  • Quinolinic / 5-HIAA Ratio — very high ( 5-HIAA was near bottom of range — hence the high ratio). 5-HIAA is a metabolite of serotonin which is typically low in CFS [2015] [2004]

Lab’s Recommendations: ” Supplementation with the precursor 5-HTP (5-hydroxytryptophan) at 50-300 mg/day may be beneficial. Supplementation with tryptophan itself may form the neurotoxic metabolite quinolinic acid, however, 5-HTP is not metabolized to quinolinic acid. Excessive tryptophan supplementation has been associated with eosinophilia myalgia syndrome. ”

Actions: Consider d-ribose — if does result in improvement of symptoms. Taking tryptophan has no improvement for CFS [2010] [2014]

 

Nutritional Markers

  • Pantothenic (Vitamin B5) – High

Lab’s Recommendations: “High pantothenic acid (B5) (Marker 52) indicates high recent intake of pantothenic acid. Pantothenic acid is an essential B vitamin. Since some individuals may require very high doses of pantothenic acid, high values do not necessarily indicate the need to reduce pantothenic acid intake.”

Actions: None suggested

  • Ascorbic (Vitamin C) – Low

Lab’s Recommendations: “Ascorbic acid (vitamin C) levels below the mean (Marker 54) may indicate a less than optimum level of the antioxidant vitamin C. Suggested supplementation is 1000 mg/day of buffered vitamin C, divided into 2-3 doses.”

Actions: Follow the labs — nothing specific for CFS is reported. However, do not get from orange juice as it may increase Hippuric levels further [2014]

Amino Acid Metabolites

Many(5) values were zero at bottom of normal range.

Lab’s Recommendations: “Low values for amino acid metabolites (Markers 62-74) indicate the absence of genetic disorders of amino acid metabolism. These markers are deamination (ammonia removed) byproducts that are very elevated only when a key enzyme has low activity; slight elevations may indicate a genetic variation or heterozygous condition which may be mitigated with diet or supplementation. Low values are not associated with inadequate protein intake and have not been proven to indicate specific amino acid deficiencies.

Actions: Consider supplementation with those listed in this post. Alternatively visit http://www.hmdb.ca/ and see what they suggest for each. For example for having zero 3-Hydroxyisovaleric acid  “Levels may also be increased from prolonged consumption of raw egg-whites (PMID: 16895887 , 9523856 , 15447901 , 9176832 )(OMIM: 210210 , 253270 , 600529 , 253260 , 246450 , 210200 , 238331 ).”

Bottom Line

Apart from address Fungal/Yeast issues – there does not seem to be any actionable items beyond the existing lab recommendations.

For other CFS patients — the results will likely vary greatly because of the variation in the microbiome shifts.