009: Complete Metabolic Profile: Coach Al’s Experience (Podcast)

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complete metabolic profile http://pursuitathleticperformance.com/complete-metabolic-profile/

Today we have an extensive and unique view into the experience and results of a Complete Metabolic Profile (CMP).

Coach Al recently did the testing using the Design for Health CMP program. In this podcast, Coach describes why he did the CMP, what he learned from it, what changes he’s made, and how it has impacted his training, his nutrition and his well being.

We now have the CMP available to our athletes and clients. (Click here for more information.) Designs for Health (DFH) only makes their products available through health care practitioners, so this is not a program you can buy off the shelf or sign up for at your local GNC. DFH produces the Detox program we offer; we’ve got a great deal of experience with them and their products and have 100% confidence in the quality.

What the CMP Tells You
The CMP allows us to further explore ways we can help our athletes enhance their overall health status and sport performance.  It is a cutting-edge testing protocol that goes way beyond the typical “blood test” to look in detail at an individual’s unique metabolic and nutritional needs.

 The systems of the body work together, not in isolation. There are many complex and unique pathways and reactions in the body that aren’t always as they might first appear. Looking in detail at many of these processes is one valuable aspect of the CMP.

 From simple urine and blood spot samples collected by the individual, the CMP essentially provides a “road map” that recognizes the unique interactions of all systems of the body, and among other things, can point to:

  • metabolic blockages in specific pathways that may lead to disease, poor performance, or lack of desired adaptation to training
  • insufficient essential nutrient status, such as vitamin, mineral, enzyme, or essential fat
  • digestive system abnormalities

Any of these elements may reveal the root cause of any of a variety of symptoms, such as:

  • little or no energy for daily tasks or training
  • poor endurance / less than optimal endurance
  • poor sleep or an inability to sleep soundly
  • an inability to lose body fat / maintain lean body mass
  • plateaued fitness and performance
  • inability to absorb or process fuels or energy supplements during training
  • GI problems on the racecourse 

This “road map” allows for specific targeted use of vitamins, minerals, and other essential nutrients, correcting nutritional imbalances, and avoiding slow AND costly trial and error. The goal is to find the perfect, individualized, balanced nutritional support for optimal health and superior performance.  

Coach Al's CMP Experience and Results:
Because of the value of this kind of testing, and because I am also an athlete who wants to perform my best, (and because I’m a bit of a science geek!), I knew the first person who would do this testing protocol would be me. I was very curious to know whether my present nutrition and dietary habits and regimen, as well as my EFA and vitamin supplement strategy, was on target. Am I getting what I need? Am I performing and adapting as well as I can? Am I getting too much of some things and not enough of others? All important questions to answer.  No more guess work for me!

I generally feel good, with adequate energy and reasonably good sleep patterns. I am pretty lean and feel I perform well relative to my present fitness level. Despite the belief that things are  “okay,” I do believe that things like energy levels, body-fat percent, and overall productivity, can always improve.  I thought to myself, "Who knows? There might just be something I’m missing in the way I eat or in my daily approach with eating and nutrition."

To think of it another way, so many of us (including me) have basically taken a “throw it against the wall and hope it sticks” approach to supplements, because previously there has been no good way to look at these kinds of things in detail. It was about time for me to find out for sure where things might be a bit off. Maybe I really could have even MORE energy, be leaner, and blast my fitness and performance to an even higher level! So I decided to jump in and make the testing happen.  I’d be a good guinea pig.

 I did my required 8 hour fast, collected the urine and blood spot samples as indicated by the testing kit provided by DFH, and sent it all off via FedEx to the laboratory in Georgia.  

About a week after receiving my package, the results of my testing were returned back to us. In the following, I’d like to share some bits and pieces about what was reported and what I have learned about MY unique nutritional status.

Some additional basic background:

 Among other things, he CMP looks at organic acid status.  This is much like looking at the exhaust on your car to see how efficiently the engine is burning fuel.  These compounds called organic acids reveal the efficiency of the body’s cellular engine.

 The general categories that the test measures include:

  • B-Vitamin Insufficiency
  • Cellular Energy
  • Neural Function
  • Detoxification
  • Dysbiosis
  • Oxidative Stress
  • Polyunsaturated Omega-3
  • Polyunsaturated Omega-6
  • Trans Fat
  • Compounds of Bacterial Origin
  • Food Antibody Reactions

Let's dive into the results!


 B-Vitamin Insufficiencies
Insufficiency of B-vitamins tends to be common since they are not stored as efficiently in the body as are other vitamins. B-vitamins are involved in many critical processes including energy production, digestion, and muscle/nerve function.[1] These are obviously of particular importance for any athlete hoping to perform at their very best!

All of the compounds that have been placed in this category (Metametrix lab / DFH) are metabolic intermediates in the degradation of amino acids (protein). As a result, when looking at the list of intermediates tested for, you won’t see the typical “B-Vitamins” listed that you might expect.

 “B-vitamin insufficiencies result in slower rates of the required reactions necessary for tissue health, growth, and vitality. Because of the specificity of individual enzymes utilizing the vitamin-derived coenzymes, discrete patterns of elevated excretion of specific intermediates signal functional deficiencies of individual vitamins.”[2]

 Even modest B-vitamin insufficiencies can compromise energy production, leading to poor acid secretion and digestive disturbances.[3]

 Coach's results:

  • No abnormality was found here with B-vitamin status.  
    • There were ranges from somewhat lower to somewhat higher in some of the nine B-vitamins tested for with Xanthurenate being lowest (less than 20th percentile) and B-Hydroxyisovalerate being highest (95th percentile). 

Cellular Energy
According to the DFH Patient Guide, “this category measures compounds that relate most directly to how efficiently your cellular engines (mitochondria) produce energy.  Obviously, inadequate energy production at the cellular level can and will impact your body’s ability to perform at a high level and might have a dramatic impact on a wide range of health issues.

The most efficient way to make energy (ATP) from fatty acids is by B-oxidation in the mitochondria. Carnitine and B2 are needed to shuttle these fatty acids across the mitochondrial membrane.

Three Fatty Acid metabolism markers (dicarboxylic acids) are looked at in the CMP: Adipate, Suberate, and Ethylmalonate. Elevation of any of these markers indicates a metabolic block. In a nutshell, when these compounds are high in the urine, it tells us that fats are not getting into the mitochondria, thus leading to a decrease in energy production and trouble with “burning” fats.

 If any of you recall, carnitine has received a lot of press in popular media as being a weight-loss supplement for this very reason. In theory, once carnitine levels are restored, fats are “burned” and people can lose weight and enjoy improved energy levels.

 Carnitine is known as a “non-essential metabolic cofactor that can be synthesized from the essential amino acid, L-lysine. Because of dietary or digestive limitations of available lysine or increased carnitine demand (which can happen for those participating in endurance exercise), carnitine requirement may exceed capacity for synthesis in some folks. Therefore carnitine is in the category of conditionally essential dietary components.[4]

 Coach's results:

  • Suberate levels were found to be high. Adipate was low, and Ethylmalonate was moderate.
    • Carnitine is needed/required to move fatty acids into the mitochondria for beta-oxidation (conversion into energy).  When insufficient levels of carnitine or B2 slow down this process, other parts of the cell machinery take over, and the results are elevated suberate.
    • Since our body produces much of its necessary energy via burning of fatty acids, it is logical to assume that energy status, as well as muscle and brain functioning will suffer if this pathway is blocked.
    • Note: “When carnitine is inadequate to keep up with demand, the degradation of fatty acids takes place through an alternate, less efficient pathway known as “omega-oxidation” (as opposed to the beta-oxidative pathway mentioned earlier). Suberate is a product of incomplete oxidation in the omega-oxidation pathway.”[1]

Coach’s “take home”: I was really surprised to find that carnitine was low. Red meat is thought of as a good source; I usually have red meat 1-2x per week.

 Carnitine deficiency is indicated for those who have difficulty losing weight or burning fat as a fuel source, which I would say does not describe me at all. Clearly, there is more for me to learn in this area.

  • Interestingly, B-Hydroxybutyrate and Fumerate levels were on the low side, below the 20th percentile.
    • Low levels of fumerate can indicate a general amino acid insufficiency,[2]e.g. low daily protein intake.

Coach’s “take home 2”:
There were a few other results from the test which did indicate that I’m probably not getting enough protein in my diet on a daily basis. I’ve boosted my intake of eggs, lean meats, and added DFH's Amino Acid Synergy, which is a good source of essential aminos and BCAAs in particular. For those who would like a little more background on amino acids:

“Amino acids are one important component of food that serves as the building blocks of protein.

Think of it this way: protein is really much of the dry matter you have left if you were to take out all the water from the body, and makes up much of the body’s structure. This structure is constantly being replaced so that with the passing of each year, the body essentially has a whole new structure.

Would you believe that the lining of the small intestines is replaced every three days! These structures are modeled on the food eaten day in and day out in the preceding year.  The old saying: “we are what we eat,” is true, and this is particularly the case with amino acids, the building blocks of protein.”[3]


Neural Function
According to the DFH Patient Guide, this “category relates to neurotransmitters, the chemicals your nervous system uses to function and communicate with your body.

Coach's results:

  • No abnormalities were found with neurotransmitters.
  • However, 5-Hydroxyindoleacetate was on the high end in the 95th percentile.
    • High levels may indicate an increased utilization and breakdown of serotonin (a neurotransmitter).
    • Dietary intervention would include increased protein intake and on consumption of foods high in tryptophan (an essential amino acid), as the neurotransmitter serotonin, is synthesized via tryptophan hydroxylase.[4]
    • Picolinate was on the very low end, below the 20th percentile.
      • For what its worth, high protein diets seem to cause an increase production of picolinate.
      • Abnormalities with these can relate to symptoms of mental, emotional, or behavioral problems. 

Coach’s “take home”:
No cause for real concern here, as all levels fell within acceptable ranges. Of note, it would seem that a slightly below optimal protein intake would therefore cause slightly lower levels of picolinate. And if protein is low, tryptophan would also be low, which would again point to a slightly below optimal level of dietary protein on a daily basis.


Detoxification
We know that part of the body’s job is to rid itself of environmental toxins and even certain chemicals it itself creates. The detoxification process is very important for our health! Somewhat like a backed up sewer, an impaired detox system can lead to an assortment of problems, such as headaches, insomnia, nausea, sensitivities to certain food items or other chemicals, and other chronic health issues. 

The CMP looks at nine specific compounds which are organic acids, all of which are significant markers of exogenous or endogenous toxin accumulation in the body.

Coach's results:

  • Of these nine compounds, one was shown to be high: Pyroglutamate.
  • Pyroglutamate (along with a-Hydroxybutyrate and Sulfate) is associated with the body’s use of glutathione, an amino acid (there they are again!) critical for removing toxins (that is also a very powerful antioxidant).
    • Elevated pyroglutamate levels indicate the body is using up glutathione to keep from losing amino-acids.
    • Pyroglutamate elevation can also indicate a glycine insufficiency.

Coach’s “take home”:
What appears to be indicated here is glutathione “wasting.” According to the Lab’s website:

“Pyroglutamate is seen as a glutathione-wasting marker. Pyroglutamate is a product of the gamma-glutamyl cycle (GGC) in the renal tubules. This cycle functions to recover amino acids and glutathione. When this pathway is disrupted, either by toxicant effects, lack of ATP, or genetic polymorphisms of the cycle enzymes, pyroglutamate is released.” [5] 

What does it tell me: this is another obvious reference to my apparently inadequate amino acid/protein intake on a daily basis. I’m getting the message loud and clear.


Dysbiosis
This is the condition of having microbial imbalances on or within the body. This can happen anywhere on the body, but typically is discussed in terms of the digestive tract. All of the compounds in this category normally appear in urine in very low levels. However, unfriendly intestinal micro-organisms can manufacture them in relatively high quantities.

When found in high amounts in the urine, any of these compounds can indicate an overgrowth of a certain species of bacteria or yeast. Symptoms of dysbiosis can range anywhere from gas, bloating, constipation or diarrhea. 

Coach's results:

 All compounds were in the normal range with the exception of Indican.

    • Indican, like the other toxic products measured in this portion of the CMP, can indicate the overgrowth of unfavorable bacteria.
    • “Because the upper bowel is sparsely populated with bacteria, indican is present in urine at low levels in health. An elevated level of urinary indican is an indication of upper bowel bacterial overgrowth. Such an overgrowth was reported for some patients with adult celiac disease.”[6]
    • “The interpretation of indican results is complicated by impaired protein digestion, which increases the tryptophan available for bacterial action. Even patients with normal intestinal bacterial populations can show increased postprandial indican excretion when they fail to digest dietary protein. The relationship between increased indican and incomplete digestion might be utilized as a measure of protein digestive adequacy.”[7]

Coach’s “take home”:
I haven't to this point in time, taken a pro-biotic; It would appear I need to UP my intake of them, to improve the amount of favorable organisms to balance intestinal bacteria.  When one reads through the above notes, one cannot but help to again draw a correlation with inadequate protein intake as a possible factor.  Adding DFH's Pro-biotic Synergy to my daily supplement routine.


 Oxidative Stress
We know the excessive formation of free radicals (harmful chemicals produced from energy production AND to fight infection) can be dangerous to our health. Sustained inflammatory responses cause increased production of these free radicals. When local antioxidant protection fails to keep free radicals in check, there is threat of damage to cell membranes, enzymes, proteins, and even DNA.[8]

8-Hydroxy-2’-deoxyguanosine (8-OHdG) is a product of oxidative damage by free radicans to DNA; the 8-OHdG test tells you if you have enough antioxidants in your system. High levels are sometimes associated with toxic exposure, cancer, diabetes, aging, liver disease, and smoking.

 Coach's results:

  • My level of 8-OHdG was slightly elevated, nearing the 90th percentile. The number kept it slightly below the threshold range indicating specific intervention would be recommended.   

Coach’s “take home”:
I did take this slightly elevated number as a sign that I could benefit from increasing the amount of anti-oxidants in my diet, and perhaps consider some supplementation also. Presently I do not supplement at all. My daily intake of vegetables and fruits and whole foods normally considered good sources of antioxidants is high.


Polyunsaturated Omega-3/Omega-6
Looking in detail at essential fatty acid status is important for assessing overall health status. It can be powerful in predicting potential weaknesses or imbalances that will impact health status greatly.

Achieving the optimal balance of essential fatty acids minimizes inflammation and is necessary for proper nervous system functioning, and brain development. To put it simply, the activity of every cell in your body is compromised when fatty acids are deficient.

The CMP looks at blood spot levels of fatty acids, which reveal circulating levels in plasma as well as long term balance in the tissue. By examining whole blood it is possible to gauge how well your body is utilizing the fatty acids you consume.[9]

Eleven different markers are examined in the CMP. EPA, DHA, LA, GLA, DGLA, AA, Trans Fatty Acids, as well as four different ratios: LA/GLA, AA/EPA, EPA/DGLA, and an index of EPE/DHA.

Coach's results:

  • Polyunsaturated Omega 3: No abnormalities were found.
  • Polyunsaturated Omega 6: No abnormalities were found.
  • Trans: No abnormalities were found.
  • Ratios: No abnormalities were found.

Coach’s “take home”:
Looks like my present strategy is working well. Thanks, DFH OmegaVail Marine!  


 Bloodspot IgG Food Antibodies
What is left beyond assessing the status of vitamins, neurotransmitters, detoxification, microbial balance, and essential fatty acids or amino acids? Food sensitivities.

The CMP bloodspot IgG4 Food Antibodies Profile offers a non-invasive alternative to a blood draw in determining IgG food reactions. Responses to 30 different foods are tested, and responses are categorized by severity from borderline to mild, moderate, or severe on the report. Common offending foods are milk, corn, wheat, eggs, tea, juices, and breads.

Coach's results:

  • The test showed a “mild” potential reaction to dairy/milk.

Coach’s “take home”:
I have sometimes had reactions in the past when drinking milk, such as dry mouth, or an increase in nasal discharge. This now makes sense to me. No other foods have seemed to cause those reactions. Since taking dairy out of my diet, I believe I feel less bloated, and experience less of the previously mentioned symptoms.  Do I miss cheese? Oh yeah. But I know the benefits will outweigh the potential negative reactions. And as time goes on, I should be able to add these foods back in slowly, being careful to see how I react.


 Summary
I’m personally very happy to have gone through this CMP testing process. There are many aspects of this test which were new to me; I’ve learned a great deal researching and learning along the way.

The fact remains that looking simply at vitamin status doesn’t tell the whole story. Similarly, throwing every known supplement against the wall (and down the throat) at substantial cost, doesn’t necessarily address the very specific needs I, or any of you, might have.

Since I received the results of the test, I’ve begun taking daily supplements to address the imbalances gleaned from the CMP. As you would probably guess, the DFH PurePea protein powder is an essential ingredient in my daily smoothies!  In addition:

  • Probiotic Synergy: http://papstore.dfhealthestore.com/probiotic-synergy-60-sphere.html
  • Daily carnitine (500mg): http://papstore.dfhealthestore.com/carnitine-synergy-120.html
  • Complete Multivitamin: http://papstore.dfhealthestore.com/complete-multi-copper-iron-free.html
  • Amino-D-Tox: http://papstore.dfhealthestore.com/amino-d-tox-90-vegetarian-capsules.html
  • Amino Acid Synergy: http://papstore.dfhealthestore.com/amino-acid-synergy-120.html


We hope you enjoy our podcasts and find them useful for your training and racing. Any questions? Hit us up in the comments, or on Facebook. Let us know of any topics you would like us to cover too.

Be great!

Coach Al and Kurt

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[1] http://metametrix.com/files/learning-center/leifm/book-Laboratory-Evaluations-in-Molecular-Medicine.pdf, pg.7
[2] Designs For Health “Patients Guide,” pg 5
[3] http://www.metametrixinstitute.org/post/2010/10/18/Weighty-Matters-Benefit-From-Targeted-TRIAD.aspx
[4] http://en.wikipedia.org/wiki/Tryptophan
[5]
http://www.metametrixinstitute.org/post/2010/05/17/organix-step-5-detoxification.aspx

[6] http://metametrix.com/files/learning-center/leifm/book-Laboratory-Evaluations-in-Molecular-Medicine.pdf. Pg36
[7] Ibid
[8] Designs For Health “Patient Guide.”
[9] Designs For Health “Patient Guide.”

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