0290 Cardio/ION Profile

Transcription

1 Ordering Physician: Metametrix 1234 Main St. Anywhere, GA Accession Number: Order Number: G Reference Number: Patient: Age: 51 Date Collected: Report Date: Telephone: Fax: Reprinted: Comment: Sex: 4/3/13 Date Received: 4/4/13 Female Date of Birth: 02/05/1962 4/16/ /17/ Cardio/ION Profile

2 Ordering Physician: Date Received: 4/4/2013 Date Reported: 4/16/2013 Cardiovascular Health Profile - Serum, Plasma & Erythrocytes Lipoprotein Factors Methodology: Automated Chemistry, Immunometric Assay,Competitive Immunology, HPLC, ICP-MS Reference Limits Total Cholesterol 394 H < 200 mg/dl HDL Cholesterol 105 >= 50 mg/dl LDL Cholesterol (Direct) 275 H < 130 mg/dl Triglycerides 74 < 150 mg/dl Lipoprotein (a) 45 H <= 37 mg/dl Lipoprotein Ratios LDL/HDL 2.6 <= 3.3 Total/HDL 3.8 <= 4.5 Chronic Inflammatory Markers Male Female LDL/HDL Total/HDL LDL/HDL Total/HDL Risk (*) xAverage xAverage xAverage xAverage *Adapted from the Framingham Heart Study Ferritin ng/ml Fibrinogen mg/dl c-reactive Protein (HS) 2.1 <= 3.0 mg/l Cardio CRP value (mg/l) CHD Risk Level * If the cardio CRP concentration exceeds 10 mg/l after repeat <1 Low testing, the patient should be evaluated for noncardiovascular 1-3 Average etiologies. >3 (up to 10)* High Other Important Indicators Insulin µiu/ml Testosterone 30 <= 51 ng/dl Sex Hormone Binding Globulin nmol/l Free Androgen Index (calc.) 2.3 <= 4.6 Magnesium Oxidant Stress Factors % Reference Interval Homocysteine 10.8 H nmol/ml Coenzyme Q mg/l alpha-tocopherol mg/l gamma-tocopherol mg/l 1.72 Lipid Peroxides 0.70 <= 2.60 nmol/ml ppm Fibrinogen performed by Southern Clinical Laboratory 405 West Pike St.,Suite A Lwrenceville, GA Lab Director: Dr. Robert David Page 1

3 Total Cholesterol Triglycerides Lipoprotein (a) LDL/HDL Total/HDL Ferritin Fibrinogen c-reactive Protein (HS) Coenzyme Q10 alpha-tocopherol gamma-tocopherol Lipid Peroxides Homocysteine Magnesium Insulin Free Androgen Index (calc.) Better Negative Effect on Cardiovascular Health Worse Most of the nutritional and metabolic measurements included in the Cardio/ION profile are associated to some degree with your cardiovascular health. However, those shown on the previous page of this report are ones that most strongly and specifically affect your cardiovascular health. Some factors are favorable for cardiac health when they are high, while others should be low. The chart above helps you to see where the most significant abnormalities are; the longest bars on the chart show the most abnormal results on a scale of increasing negative effects on cardiovascular health. The "Cardiovascular Index" chart below shows your test results with all of the factors summarized as a single index. Depending on your results, some steps that your doctor may want you to take to improve your cardiovascular health are shown in the tables of recommendations at the end of these pages. It is important that you follow your doctor's instructions to achieve the lowest index. Cardiovascular Index = All Factors Favorable All Factors Unfavorable These guidelines are intended as a starting point for the clinician who requested the test and are based only on the laboratory results included in this report. Final recommendations should be implemented by the clinician with consideration of medical history and current clinical observations. These tests are not intended for the diagnosis of specific disorders. Page 2

4 Ordering Physician: Date Received:04/04/2013 Date Reported: 04/16/2013 Amino Acids 20 Profile - Plasma Methodology: High Performance Liquid Chromatography Ranges: Ages 13 and over. Essential Amino Acids Limiting Amino Acids Lysine Methionine Tryptophan µmol/l % Reference Interval Branched Chain Amino Acids Isoleucine Leucine Valine Other Essential Amino Acids Phenylalanine Histidine Threonine Conditionally Essential Amino Acids Arginine Taurine Glycine Serine Page 3

5 Ordering Physician: Date Received:04/04/2013 Date Reported: 04/16/2013 Amino Acids 20 Profile - Plasma Ranges are for ages 13 and over. Functional Categories Vascular Function µmol/l Arginine Taurine 49 Methodology: High Performance Liquid Chromatography % Reference Interval Neurotransmitters and Precursors Phenylalanine Tyrosine Tryptophan Glutamic Acid Taurine Sulfur Amino Acids (Glutathione - related) Methionine Taurine Urea Cycle and Ammonia Detoxification Arginine Citrulline 17 L Ornithine Glutamine Asparagine Aspartic Acid Ratios Phenyalanine/Tyrosine Glutamic Acid/Glutamine Tryptophan/LNAA* *Large neutral amino acids (Leu+Ile+Val+Phe+Tyr) <= Page 4

6 Ordering Physician: Homocysteine Assay - Plasma nmol/ml Date Received: 4/4/2013 Date Reported: 4/16/2013 Methodology: Competitive Immunoassay 95% Reference Interval Homocysteine 10.8 H Page 5

7 Ordering Physician: Date Received: 4/4/2013 Date Reported: 4/16/2013 Nutrient & Toxic Elements Profile - Blood Methodology: Inductively Coupled Plasma /Mass Spectroscopy 95% Reference Interval Nutrient Elements Erythrocytes (packed cells) 1 Potassium 3,157 3,055 2,426-4,472 ppm 44 2 Magnesium ppm 44 3 Calcium* ppm Plasma Zinc 1, Copper 773 L Whole Blood Selenium 0.21 Toxic Elements Whole Blood 45 7 Aluminum Arsenic < Cadmium < Lead Mercury , , <= 140 <= 13.7 <= 1.50 <= 36 <= 13.8 ppb ppb ppm ppb ppb ppb ppb ppb *Relevant to membrane permeability, not nutritional status. Toxic metals are flagged high when the result is above the 95% Reference Interval. for whole blood toxic elements that are within normal limits do not rule out metal accumulation in other tissues. This can be evaluated with urinary porphyrin or urine elements tests. Page 6

8 Ordering Physician: CoEnzyme Q10 Plus Vitamins Profile - Serum Date Received: 4/4/2013 Date Reported: 4/16/2013 Methodology: High Performance Liquid Chromatography mg/l 95% Reference Interval Coenzyme Q alpha-tocopherol gamma-tocopherol Vitamin A 0.82 H β-carotene Lipid Peroxide Assay - Serum 6 Methodology: High Performance Liquid Chromatography nmol/ml 1.72 Lipid Peroxides 0.70 <= 2.60 DNA/Oxidative Stress Marker Assay - Urine Ranges are for ages 13 and over. ng/mg creatinine Methodology: LC/Tandem Mass Spectroscopy, Colorimetric Hydroxy-2-deoxyguanosine 2.0 <= 7.6 Vitamin D Profile - Serum ng/ml Methodology: LC/Tandem Mass Spectroscopy Reference Interval 8 25-Hydroxyvitamin D 56.3 Sufficient Optimal 9 25-Hydroxyvitamin D Hydroxyvitamin D Total 25-Hydroxyvitamin D is considered the best assessment of vitamin D status. The test reflects vitamin D from all sources (diet, supplements, and sun exposure). A 2011 Endocrine Society Clinical Practice Guideline suggested vitamin D deficiency be defined as < 20 ng/ml, insuffuciency as ng/ml, and sufficiency as ng/ml.¹ The Vitamin D Council has proposed ng/ml as optimal, and 100 ng/ml as an upper limit.² 25-Hydroxyvitamin D3 is from sun exposure, vitamin D-rich foods, or vitamin D3 supplements. 25-Hydroxyvitamin D2 is only from fortified foods or supplements. 1. Holick MF, Binkley, NC, Bischoff-Ferrari, HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. July 2011, 96(7): Vitamin D Council Conversion factors: nmol/l = ng/ml x 2.5 ng/ml = nmol/l x 0.4 * <DL = less than detection limit Page 7

9 Ordering Physician: Date Received: 4/4/2013 Date Reported: 4/16/2013 Fatty Acids Profile - Plasma Ranges: Ages 13 and over. µmol/l Methodology: Capillary Gas Chromatography/Mass Spectrometry 95% Reference Interval Polyunsaturated Omega Alpha Linolenic (18:3n3) 18 L Eicosapentaenoic (20:5n3) 10 L Docosapentaenoic (22:5n3) 11 L Docosahexaenoic (22:6n3) 32 L Polyunsaturated Omega ,669 5 Linoleic (18:2n6) 642 L 821-2, Gamma Linolenic (18:3n6) Eicosadienoic (20:2n6) 5.1 L Dihomogamma Linolenic (20:3n6) Arachidonic (20:4n6) Docosadienoic (22:2n6) <0.23 <= Docosatetraenoic (22:4n6) Polyunsaturated Omega Mead (20:3n9) 2.9 <= 8.3 Monounsaturated Myristoleic (14:1n5) Palmitoleic (16:1n7) 28 L Vaccenic (18:1n7) 26 L , Oleic (18:1n9) , Eicosenoic (20:1n9) 2.6 L Nervonic (24:1n9) <1.1 L Page 8

10 Ordering Physician: Fatty Acids Profile - Plasma Date Received: 4/4/2013 Methodology: Capillary Gas Chromatography/Mass Spectrometry Ranges: Ages 13 and over. Saturated 95% µmol/l Reference Interval Capric (10:0) 4.8 H Lauric (12:0) Myristic (14:0) , Palmitic (16:0) , Stearic (18:0) Arachidic (20:0) Behenic (22:0) Lignoceric (24:0) Hexacosanoic (26:0) <0.27 <= 0.43 Odd Chain Pentadecanoic (15:0) 7.8 <= Heptadecanoic (17:0) 9.7 <= Nonadecanoic (19:0) 0.91 <= Heneicosanoic (21:0) 32 Tricosanoic (23:0) Trans <0.38 < <= 0.74 <= Palmitelaidic (16:1n7t) <0.4 <= Total C:18 Trans 35 <= 59 Ratios LA/DGLA EPA/DGLA AA/EPA 21 H Triene/Tetraene <= Page 9

11 Ordering Physician: Date Received: 4/4/2013 Date Reported: 4/16/2013 Organix Comprehensive Profile - Urine Ranges: Ages 13 and over. Nutrient Markers mcg/mg creatinine Methodology: LC/Tandem Mass Spectroscopy, Colorimetric 95% Reference Interval Fatty Acid Metabolism (Carnitine & B2) Adipate 1.0 <= Suberate 1.0 <= Ethylmalonate 2.1 <= 6.3 Carbohydrate Metabolism (B1, B3, Cr, Lipoic Acid, CoQ10) Pyruvate <DL* <= L-Lactate β-hydroxybutyrate <DL* <= 9.9 Energy Production (Citric Acid Cycle) (B comp., Q10, Amino acids, Mg) Citrate 618 H Cis-Aconitate Isocitrate a-ketoglutarate <= Succinate 15.5 H <= Fumarate 0.64 H 0.59 <= Malate 0.7 <= Hydroxymethylglutarate 2.5 <= 5.1 B-Complex Vitamin Markers (B1, B2, B3, B5, B6, Biotin) a-ketoisovalerate 0.18 <= a-ketoisocaproate 0.05 <= a-keto-β-methylvalerate 0.08 <= Xanthurenate 0.10 <= β-hydroxyisovalerate 3.4 <= 11.5 Methylation Cofactor Markers (B12, Folate) Methylmalonate 0.8 <= Formiminoglutamate <DL* <= 2.2 Page 10

12 Ordering Physician: Date Received: 4/4/2013 Date Reported: 4/16/2013 Methodology: LC/Tandem Mass Spectroscopy, Colorimetric Organix Comprehensive Profile - Urine Ranges: Ages 13 and over. Cell Regulation Markers mcg/mg creatinine 95% Reference Interval Neurotransmitter Metabolism Markers (Tyrosine, Tryptophan, B6, antioxidants) 22 Vanilmandelate 1.0 L Homovanillate 1.4 L Hydroxyindoleacetate Kynurenate <= Quinolinate <= Picolinate Oxidative Damage and Antioxidant Markers (Vitamin C and other antioxidants) p-hydroxyphenyllactate 0.19 <= Hydroxy-2-deoxyguanosine 2.0 <= 7.6 (Units for 8-Hydroxy-2-deoxyguanosine are ng/mg creatinine). Toxicants and Detoxification Detoxification Indicators (Arg, NAC, Met, Mg and antioxidants) Methylhippurate H <= Orotate 0.16 <= Glucarate 1.1 <= a-hydroxybutyrate 0.2 <= Pyroglutamate Sulfate 938 L 958 2, ,988 Page 11

13 Ordering Physician: Date Received: 4/4/2013 Date Reported: 4/16/2013 Organix Comprehensive Profile - Urine Methodology: LC/Tandem Mass Spectroscopy, Colorimetric Ranges: Ages 13 and over. mcg/mg creatinine Compounds of Bacterial or Yeast/Fungal Origin Bacterial - general Benzoate 5.2 H <= Hippurate 8 <= 1, Phenylacetate <DL* <= Phenylpropionate <DL* <= p-hydroxybenzoate 0.6 <= p-hydroxyphenylacetate <DL* <= Indican 5 <= Tricarballylate 0.56 <= 1.41 L. acidophilus / general bacterial D-Lactate <= 4.3 Clostridial species 45 3,4-Dihydroxyphenylpropionate <DL* <= 0.05 Yeast / Fungal D-Arabinitol 12 <= 73 Creatinine = 200 mg/dl * <DL = less than detection limit ** >LIN = greater than linearity limit Page 12

14 ION Analyte Pattern Analysis A multi-analyte report can provide greater insight about health risks and special nutrient needs. Patterns of abnormalities can reinforce the degree of significance indicated by a single measurement. Analytes from the various profiles in the ION report are combined below into categories associated with clinical/metabolic conditions. The categories included cover the most common areas of concern relevant to these profiles. Above each thermometer are listed the analytes used to calculate the degree of significance. An H or L appears when the patient result is in the fifth quintile (80%) of the population. An additional X next to an analyte indicates that the patient result is outside the 95% reference interval for that analyte. The thermometer advances to the right as the number and severity of relevant abnormalities increases. The longer the filled bar, the greater the degree of significance or likelihood that a health threat may exist in that category. The preceeding laboratory reports provide the detail upon which these thermometers are based. Cardiovascular System Arginine Homocysteine H Calcium Magnesium CoQ10 a-tocopherol Lipid Peroxide 8-OHdG AA/EPA H Low significance Fatigue Isoleucine Leucine Phenylalanine Valine Magnesium CoQ10 Adipate Suberate AKG Succinate H Malate Xanthurenate MeMalonate FIGLU Low significance Metabolic Syndrome (Syndrome X) Magnesium Palmitic Stearic AHB BHB BHiVal Low significance Mental/Emotional Tryptophan Tyrosine Magnesium EPA L DHA L Xanthurenate MeMalonate FIGLU VMA L X 5-HIA Low significance Page 13

15 ION Analyte Pattern Analysis Intestinal Bacterial Metabolites PhAc PhProp pohbenz pohphac Indican Tricarb D-Lactate 3,4-DHPP Low significance Intestinal Yeasts / Fungal Metabolites D-Arabinitol Low significance Digestion/Absorption Arginine Histidine Isoleucine Leucine Lysine Methionine Phenylalanine Threonine Tryptophan Valine Selenium Low significance Toxic Exposure Aluminum Arsenic Cadmium Lead Mercury Palmitelaidic C18TrFa Citrate H Cis-Aconitate Isocitrate Quinolinate 2-MeHipp H Orotate Glucarate Low significance Detoxification Impairment Methionine Glycine Serine Taurine Glutamine Pyroglutamate Sulfate L Benzoate H Low significance Page 14

16 ION Analyte Pattern Analysis Oxidative Stress/Antioxidant Insufficiency Taurine Selenium Lead Mercury H a-tocopherol g-tocopherol Vitamin A b-carotene Lipid Peroxide 8-OHdG pohphlac Sulfate L Low significance Mitochondrial Functional Impairment Magnesium CoQ10 Adipate Suberate Ethylmalonate Pyruvate L-Lactate AHB BHB Low significance Succinate H Fumarate H Malate Amino Acid Insufficiency Arginine Histidine Isoleucine Leucine Lysine Methionine Phenylalanine Threonine Tryptophan Valine AKG Succinate H Sulfate L Low significance Essential Fatty Acid Insufficiency AA ALA L LA L X GLA DGLA Palmitoleic Triene/Tetraene EPA L DHA L Low significance Disordered Methyl Group (Single carbon) Transfer Homocysteine H Pentadeca Heptadeca Nonadecanoic Tricosanoic Xanthurenate MeMalonate FIGLU Kynurenate Low significance Page 15

17 ION Analyte Pattern Analysis Disordered Tryptophan Metabolism Tryptophan Xanthurenate 5-HIA Kynurenate Quinolinate Indican Low significance Abbreviation 2-MeHipp 5-HIA 8-OhdG AA/EPA AHB AKG akbmeval akicap akival ALA a-tocopherol BHB BHiVal C18TrFa CoQ10 DGLA DHA 3,4-DHPP EPA Analyte Name 2-Methylhippurate 5-Hydroxyindoleacetate 8-Hydroxy-2-deoxyguanosine Arachidonic (20:4n6)/Eicosapentaenoic (20:5n3) a-hydroxybutyrate a-ketoglutarate a-keto-ß-methylvalerate a-ketoisocaproate a-ketoisovalerate Alpha Linolenic (18:3n3) alpha-tocopherol ß-Hydroxybutyrate ß-Hydroxyisovalerate Total C:18 Trans Coenzyme Q10 Dihomogamma Linolenic (20:3n6) Docosahexanoic (22:6n3) 3,4-Dihydroxyphenylpropionate Eicosapentaenoic (20:5n3) Abbreviation FIGLU g-tocopherol GLA Heptadeca Hcys HVA HMG LA MeMalonate Pentadeca PhAc PhProp phbenz phphac phphlac Total C:18 Tricarb Triene/Tetraene VMA Analyte Name Formiminoglutamate gamma-tocopherol Gamma Linoleic (18:3n6) Heptadecanoic (17:0) Homocysteine Homovanillate Hydroxymethylglutarate Linoleic (18:2n6) Methylmalonate Pentadecanoic (15:0) Phenylacetate Phenylpropionate p-hydroxybenzoate p-hydroxyphenylacetate p-hydroxyphenyllactate Total c:18 Trans Tricarballylate Mead/Arachidonic Ratio Vanilmandelate Page 16

18 Supplement Recommendation Summary With knowledge of a patient's full medical history and concerns, the ION Profile laboratory results may be used to help create an individually optimized nutritional support program. 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. Customized Vitamin and Mineral Formulation Nutrients listed in this section are normally contained in a multi-vitamin preparation. "Base" amounts may be used to ensure health even when no abnormalities are found. Customized preparations of the multi-vitamin/mineral formula shown below may be produced by compounding pharmacies. Base Daily Amounts Units Added Vitamin A B-Carotene 2500 IU 5500 IU Vitamin C 250 mg 500 mg Vitamin D 400 IU Vitamin E (Mixed Tocopherols) 100 IU 200 IU Vitamin K* Thiamin (B1) 100 mcg 5 mg Riboflavin (B2) 5 mg 10 mg Niacin (B3) 25 mg Pyridoxine (B6) 15 mg 50 mg Folic Acid (or 5-Methyl-THF) 400 mcg 500 mcg Vitamin B12 50 mcg 800 mcg Biotin 100 mcg 600 mcg Pantothenic Acid (B5) Calcium Citrate Iodine* 25 mg 500 mg 75 mcg Magnesium 250 mg 200 mg Zinc 15 mg Selenium 100 mcg 50 mcg Copper 1 mg 2 mg Manganese* Chromium Molybdenum* Boron* 5 mg 200 mcg 25 mcg 1 mg * Nutrients with an asterisk are not modified based on the ION test results. MM02 Page 17

19 Other Items Indicated for Individual Supplementation Various conditionally essential nutrients and other potentially beneficial interventions appear in this section only if relevant abnormalities are present. These ingredients are not included in the customized vitamin formula on the previous page. Amino acids listed on this page result from functional markers of individual amino acid insufficiency and do not reflect amino acids measured in plasma. Item Amount Arginine 500 mg Coenzyme Q10 60 mg Fish Oil 6 gm Glycine 3000 mg N-Acetylcysteine 400 mg Page 18

20 Ordering Physician: Customized Free-Form Amino Acids The table below shows a customized amino acid formula based on the results of your laboratory profile. The formula is optimized by adding amounts shown in the Grams Added column according to the relative positions of results found. Directions: Adults mix 1 and 1/2 measuring teaspoon (5g) in juice or water 2 times daily between meals as a dietary supplement, or as directed by a health care provider. Children under 12 years old: 3/4 teaspoon 1-2 times daily between meals. Children under 5 years old: Use 1/4 teaspoon, 1-3 times daily; adjust for body weight. Grams Added % of Formula Active mg/day L-Arginine HCl (80% active) L-Histidine HCl (74% active) L-Isoleucine L-Leucine ,133 L-Lysine HCl (80% active) L-Methionine L-Phenylalanine ,266 Taurine L-Threonine L-Tryptophan L-Valine Pyridoxal-5-phosphate Alpha-ketoglutaric acid Total grams added 9 Base Formula amount 291 Total Weight 300 L-5-Hydroxytryptophan This formula is intended to optimize essential and conditionally essential amino acid intake. Other non-essential amino acids can be produced in human tissues. Pyridoxal-5-phosphate (an active form of vitamin B6) and alpha-ketoglutaric acid are key factors needed for the body's utilization of amino acids. The formula may be ordered as a powder that dissolves easily in beverages or may be added to foods such as applesauce. Other forms of supplemental dietary protein or amino acids may need to be restricted while using your customized formula. If enhanced energy levels prevent sleep, avoid bedtime use. This formula is provided as a starting point that may guide decisions about medical treatment based on the test results. It is derived only from the laboratory results included in this report. Final recommendations should be based on consideration of the patient's medical history and current clinical condition. In addition to the above customized amino acid formula, this patient may benefit from further use of single amino acids, as evidenced by profiles other than plasma amino acids. See the category, "Other Indicated Nutrients" on your Supplement Recommendation Summary Page. Page 19