Nutritional Biochemistry Quiz

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Questions and Answers

What is the primary use of testing methylmalonic acid (MMA)?

To assess iron storage capacity

To determine serum calcium levels

To measure vitamin D levels

To evaluate vitamin B12 deficiency (correct)

Which of the following statements about serum ferritin is true?

It is a measure of vitamin D levels.

It only reflects recent dietary intake.

Optimal ranges vary by age and gender. (correct)

It is less accurate than serum iron testing.

What is the optimal serum vitamin D3 level range preferred by many practitioners?

50-75 nmol / L

100-150 nmol / L (correct)

75-100 nmol / L

150-200 nmol / L

Why is serum calcium testing generally limited in its interpretation?

It is under strict homeostatic control. Signup and view all the answers

Which essential fatty acid (EFA) ratio should typically be increased according to specialized labs?

Omega 6 to 3 ratio Signup and view all the answers

What does a high level of C-reactive protein (CRP) generally indicate?

Ongoing inflammation in the body Signup and view all the answers

What is the primary function of testing for organic acids in nutrition?

To evaluate cellular nutrient status Signup and view all the answers

What condition is most commonly associated with elevated methylmalonic acid levels in urine?

Vitamin B12 deficiency Signup and view all the answers

What is the primary benefit of Organic Acid Testing (OAT)?

It offers an overview of metabolic function and weaknesses. Signup and view all the answers

Which of the following factors can affect the interpretation of OAT results?

The diet eaten before the test. Signup and view all the answers

What type of metabolites are grouped under indicators of detoxification in OAT?

Metabolites linked to environmental toxins. Signup and view all the answers

Which organic acids are particularly analyzed for their balance within glycolysis?

Lactate and pyruvate. Signup and view all the answers

What should practitioners primarily use for interpreting OAT results?

The interpretive guide provided by the lab. Signup and view all the answers

In OAT, what does a result being out of range typically indicate?

A pathway that may need support or further investigation. Signup and view all the answers

Why is it important to consider context when interpreting functional tests like OAT?

Because results can be influenced by various lifestyle factors. Signup and view all the answers

Which metabolic pathways do OAT markers typically reflect?

Nutritional function and Krebs Cycle activity. Signup and view all the answers

What is a major challenge in interpreting OAT results?

It requires specific interpretation guides that vary by lab. Signup and view all the answers

Which metabolic markers might suggest dysbiosis in OAT?

Bacterial metabolites and neurotransmitter metabolites. Signup and view all the answers

What key elements should be considered when interpreting functional tests for SIBO?

Clinical symptoms, stool test findings, and other digestive indicators Signup and view all the answers

What is the purpose of reference ranges in lab testing?

To provide a measure of proximity to the mean within a population sample Signup and view all the answers

How can variations in reference ranges occur?

Variations can occur based on age, gender, ethnicity, and laboratory differences Signup and view all the answers

What should you do if a lab result is within the reference range but near the cut-off, and the client exhibits symptoms?

Consider that function may still be affected despite being within the reference range Signup and view all the answers

Which of the following companies provides direct-to-patient testing?

Medichecks Signup and view all the answers

Which of the following is a common use of Organic Acid Testing (OAT)?

To assess the impact of genetic problems on metabolic pathways Signup and view all the answers

What type of information can the numbers in an OAT report provide?

They give a quick reference for vitamin levels. Signup and view all the answers

What is one reason practitioners incorporate OAT markers into nutritional panels?

To provide a comprehensive view of multiple metabolic functions Signup and view all the answers

Which vitamin is specifically mentioned as commonly observed in OAT results?

Vitamin C Signup and view all the answers

In the context of case studies in nutrition, what should be identified and written based on OAT findings?

Key findings along with aims and recommendations Signup and view all the answers

What does a low level of catecholamine metabolites in an OAT suggest?

Possible genetic methylation SNPs Signup and view all the answers

Which aspect of health could be analyzed using results from an OAT?

Neurotransmitter function Signup and view all the answers

How are the results of an OAT placed for interpretation?

On a scale showing deviation from the mean Signup and view all the answers

What is one way to address findings presented in an OAT report?

By focusing on optimizing nutrient status Signup and view all the answers

What might be a likely outcome of combining OAT with Genetic Testing?

Identifying specific metabolic dysfunctions Signup and view all the answers

What is the primary difference between 'reference ranges' and 'optimal ranges' in testing?

'Reference ranges' are used for diagnostic purposes while 'optimal ranges' indicate a need for support. Signup and view all the answers

Which of the following is a benefit of functional testing?

It can quantitatively measure a client’s progress. Signup and view all the answers

When interpreting functional tests, which aspect is essential for understanding the results?

The dietary patterns adhered to by the person. Signup and view all the answers

What should practitioners always request from clients regarding blood test results?

Even 'normal' results for optimal functioning assessment. Signup and view all the answers

What is a common downside of functional tests?

They are difficult to communicate results to clients. Signup and view all the answers

Which blood test result level does conventional medicine consider sufficient for Vitamin D?

Above 50 nmol / L Signup and view all the answers

What does the interpretation of a functional test rely heavily on?

The context of the client's symptoms at the time of testing. Signup and view all the answers

In what way can functional testing enhance a client's health plan?

By uncovering deeper understanding of imbalances. Signup and view all the answers

Why is it important to look for patterns in functional tests?

Because single markers are less relevant for overall health. Signup and view all the answers

Which of the following techniques can help in communicating functional test outcomes?

Translating complex results into simpler terms for clients. Signup and view all the answers

What role do microbiomes play in relation to health and disease?

They can influence the risk of developing certain diseases. Signup and view all the answers

Which method has improved the availability and accuracy of testing for gastrointestinal microbiomes?

Developments in stool testing methodologies. Signup and view all the answers

What does the term 'commensal' refer to in microbiome terms?

Microbes that coexist with the host and are beneficial. Signup and view all the answers

Which of the following best defines 'pathobiont'?

Microbes that pose a threat to health under specific circumstances. Signup and view all the answers

How does the microbiome depend on cultural, dietary, environmental, and familial factors?

They can influence the types and balance of microorganisms present. Signup and view all the answers

What is the significance of Hippocrates' quote, 'All disease starts in the gut'?

It emphasizes the potential connection between gut health and various diseases. Signup and view all the answers

What is the primary concern when pathogenic microbes invade the microbiome?

They can cause harm and affect the host's health. Signup and view all the answers

What might stool testing help identify regarding gut health?

Possible increased intestinal permeability or inflammation. Signup and view all the answers

What does a high level of zonulin family peptide indicate?

Severe intestinal permeability Signup and view all the answers

Which type of bacteria is considered a significant indicator of gut health?

Bifidobacterium Signup and view all the answers

What is a possible consequence of a diet lacking diversity?

Decreased microbial diversity Signup and view all the answers

What could indicate severe pancreatic insufficiency?

Amylase levels below 100 µg/g Signup and view all the answers

What factor can negatively impact gut barrier function?

Heavy metal exposure Signup and view all the answers

What is one of the signs of immune response in the gastrointestinal tract?

Increased antimicrobial peptides Signup and view all the answers

What dietary pattern could adversely affect the levels of beneficial gut bacteria?

FODMAP diet Signup and view all the answers

Which statement about commensal bacteria is true?

Diversity in the microbiota is a key indicator of health. Signup and view all the answers

Which bacteria is specifically associated with hydrogen sulphide gas production?

Desulfovibrio spp. Signup and view all the answers

What criteria should be considered when assessing pathobiont bacteria?

The context of commensal bacteria and host markers Signup and view all the answers

What type of testing can help indicate the presence of small intestinal bacterial overgrowth (SIBO)?

Breath test Signup and view all the answers

What is a characteristic feature of Helicobacter pylori in terms of its presence in the host?

Can exist in a commensal state Signup and view all the answers

What indicates a potentially pathogenic strain of Helicobacter pylori?

Presence of virulence factors Signup and view all the answers

Pathobiont bacteria can become pathogenic under which circumstance?

When the terrain of the host changes Signup and view all the answers

What type of stool testing provides results as either negative or positive?

Faecal antigen testing Signup and view all the answers

Which symptom might indicate raised levels of certain gas-producing bacteria?

Gassy symptoms Signup and view all the answers

What does the scale in an OAT report indicate?

How far the result is from the mean average Signup and view all the answers

Why might practitioners use OAT alongside genetic testing?

To see impacts on pathways from suspected genetic problems Signup and view all the answers

What could a low indication of vitamin C status in an OAT report suggest?

Optimizing vitamin C status may be necessary Signup and view all the answers

What information do OAT markers provide when incorporated into nutritional panels?

They reflect specific metabolic pathways being evaluated Signup and view all the answers

What is the focus of interpretations based on OAT results?

Understanding clinical presentations and recommendations Signup and view all the answers

How are the results in an OAT report presented for interpretation?

Using a numeric scale against median values Signup and view all the answers

What does a practitioner typically identify when analyzing OAT findings in a case study?

Key findings, aims, and recommendations Signup and view all the answers

What role do OAT markers have in relation to multi-methodology nutritional panels?

They provide additional metabolic insights alongside other methodologies Signup and view all the answers

What are potential health concerns for a client with multiple courses of antibiotics and hormonal treatments?

Nutritional deficiencies Signup and view all the answers

What is a common diet change noted in the client's case, though not always followed consistently?

Mediterranean diet Signup and view all the answers

Which of the following conditions is associated with the need for organic acid testing?

Chronic fatigue Signup and view all the answers

What aspect of the client's menstrual health changed since her latest IVF treatment?

Irregular periods Signup and view all the answers

Which of the following features of the client's vaginal health is reported?

Slight soreness after intercourse Signup and view all the answers

What is one role of organic acids measured in organic acid testing?

Assessing mitochondrial activity Signup and view all the answers

Which of the following is a possible symptom shared by the client due to her health status?

Unusual fatigue Signup and view all the answers

What lifestyle change has the client considered to improve her health during fertility treatments?

Reducing caffeine intake Signup and view all the answers

Study Notes

Methylmalonic Acid (MMA)

MMA is a more accurate indicator of B12 status than serum B12
MMA can be tested in serum and urine
Vitamin B12 deficiency is the most common cause of elevated MMA in urine

Serum Ferritin

Serum ferritin is a more accurate indicator of iron storage than serum iron
Optimal serum ferritin levels vary with age, gender, and other factors, but generally fall in the range of 30-100 ug/L

Vitamin D3

Optimal Vitamin D3 levels are over 75 nmol/L
Many practitioners prefer Vitamin D3 levels between 100-150 nmol/L

Serum Magnesium

Serum magnesium testing may only show a severe deficiency
Consider testing cellular magnesium levels for a more accurate assessment

Serum Calcium

Typically used for assessing kidney or hormonal problems
Rarely shows deficiencies due to strict homeostatic control

Essential Fatty Acids (EFAs)

Specialized labs can test the omega-3 to 6 ratio and blood levels of all EFAs
A high omega-6 to 3 ratio may indicate a need to increase intake of linoleic acid (LA) found in sesame seeds and decrease consumption of arachidonic acid found in meat

C-Reactive Protein (CRP)

CRP is a marker of inflammation
Normal CRP range is unspecified in provided text

Organic Acid Testing (OAT)

OAT provides a comprehensive overview of metabolic function, revealing areas of biochemical weakness
OAT can guide the development of a naturopathic care plan by identifying specific areas requiring attention
OAT can be challenging to interpret and requires use of specific guides provided by the lab
The test results are influenced by diet at the time of testing
OAT does not directly measure vitamin levels, relying on functional assessment instead

OAT Metabolite Groups

OAT examines various metabolite groups associated with different aspects of function, including:
- Nutritional function
- Detoxification and elimination
- Amino acid metabolism
- Krebs Cycle function
- Bacterial metabolites
- Glycolysis
- Neurotransmitter metabolism
- Oxalate metabolism
- Environmental toxin exposure

Interpreting OATs

Interpret OAT results by analyzing the deviation of an individual’s results from the mean
Focus on organic acids that fall outside the expected range within their respective pathways to guide nutritional support
Every lab provides a thorough interpretive guide that is essential for interpretation, even by experienced practitioners
OAT results are a snapshot in time and should be interpreted with context, including symptoms, dietary patterns, and other relevant factors

OAT in Clinic

OAT can be purchased as a standalone test or integrated into larger nutritional panels
OAT results can be combined with genetic testing results to identify potential interactions between genetic predispositions and metabolic pathways
Examples: Low catecholamine metabolites in OAT may coincide with methylation SNPs in genetic testing

Sample Report:

OAT reports display headings indicating the metabolic pathways being assessed
Numerical data provides a quick reference to interpretation, highlighting areas requiring attention
The results are represented on a scale showing deviation from the mean
Interpretation guides provide clinical recommendations and treatment strategies based on the OAT results

Functional vs. Conventional Testing

Conventional testing can provide functional insights by analyzing how closely parameters fall to the edge of the reference range
Functional testing focuses on optimal ranges for maintaining homeostasis, unlike diagnostic reference ranges used in conventional testing
Functional testing can uncover deeper imbalances and provide a more comprehensive understanding of a client's health
Functional testing results should be interpreted with the client’s symptoms, dietary patterns, activity levels, and other relevant factors in mind
Functional testing can be expensive and may be challenging to interpret
Functional testing results may not be readily understood by medical doctors

Functional Testing Benefits:

Uncovers deeper imbalances for a more tailored approach to health
Supports a more targeted and effective naturopathic treatment plan
Provides quantitive assessment of client progress, enhancing accountability

Functional Testing Downsides:

Often expensive due to private provider reliance
Requires careful interpretation and analysis
May be difficult to communicate results to medical doctors

Functional Testing Context:

Interpreting functional tests requires understanding the underlying context, including:
- Symptoms at the time of testing
- Dietary patterns
- Activity levels
- Any factors that may have influenced the results

Rule of 3:

Apply the rule of 3 for functional testing, using multiple data points to confirm findings:
- Clinical symptoms
- Test results (e.g., microbial findings in stool tests)
- Additional relevant markers indicating imbalances

Reference Ranges

Established through measuring a population sample and defining the mean and standard deviation
Reference ranges and units may differ between labs and countries, so retesting should be done with the same lab
Reference ranges can vary by factors such as age, gender, and ethnicity
Always consider the pattern of results and the context, even if results fall within the reference range but near the cutoff

Testing Companies:

Student accounts with functional medicine testing companies provide access to interpretive guides, technical calls, and clinical resources
Major functional testing companies include: Genova, Invivo Healthcare, Regenerus, Cambridge Nutritional Sciences, Biolab UK, Functional Dx
Direct-to-patient testing options include: Thriva and Medichecks

Microbiome overview

Microbiomes are complex microbial ecosystems found in and on all multicellular organisms with different areas known as niches (e.g., GI, vaginal, oral, skin, urinary etc)
Microbiome balance can play a role in health and disease and is key in relation to the concept of the terrain
Microbiome science is constantly changing at a rapid rate
The microbiome is dependant on cultural, dietary, environmental, and familial aspects

Gastrointestinal Microbiome

"All disease starts in the gut" — Hippocrates
Emerging microbiome science supports Hippocrates' statement in many ways
Newer methodologies in testing have enabled stool testing to gradually become much more available and accurate
Stool tests can be used to optimize a diet for a healthful microbiome, ascertain if there is possible increased intestinal permeability, look for the presence of inflammation, gas-producing bacteria, or in some cases pathogenic microbes

Commensal Bacteria

Commensal microbes live in harmony with the host and provide a benefit to us
Pathogenic microbes possess certain evolutionary advantages to invade our microbiome at a cost to our health
Pathobiont microbes live with us and normally don’t pose a problem unless there is clear opportunity
Diets lacking diversity, over-eating, antibiotic usage, and chronic conditions can impact commensal bacteria levels in an adverse way
Diversity in gut bacteria is a major indicator of health

Host Markers

Zonulin family peptide (produced by epithelial cells when the GI tight junctions are open) is a marker of intestinal permeability
High levels of Zonulin in a stool test ( > 100 µg / g) may be raised in severe intestinal permeability and celiac disease

Gas-Producing Bacteria

Some bacteria are known for their ability to cause gas, and can sometimes be implicated in ‘gassy’ symptoms or SIBO
Methane production is associated with Methanobrevibacter smithii
Hydrogen sulfide gas production is associated with Desulfovibrio spp and Bilophila wadsworthia
Many bacteria are hydrogen-producing

Pathobiont Bacteria

Pathobiont bacteria are bacteria that only become pathogenic when there is an opportunity (e.g. if the terrain changes)
It is important to compare the abundance of pathobiont bacteria in relation to the commensal bacteria and host markers
Avoid ‘blaming and shaming’ bacteria just because they are present
Remember — pattern and context

Helicobacter pylori

Many people carry a level of commensal strains of H. pylori
Other, more pathogenic strains of H. pylori can carry ‘virulence factors’, allowing them to turn infectious, adhering to and damaging the gastric mucosa
The presence of H. pylori doesn’t always equal disease; read alongside symptoms and markers such as calprotectin and FIT
Faecal antigen testing for H. pylori is reported as negative or positive
Faecal PCR tests for H. pylori will always show some amount of H. pylori
Look for a higher-than-expected amount or presence of virulence factors in faecal PCR tests

Case Exercise A (Maxi)

Maxi is a 37-year-old female who works in marketing
She has been trying to conceive for 4 years and has had several miscarriages
Maxi has had multiple courses of antibiotics and hormonal interventions associated with IVF
She is getting frequent colds and feels generally run down
Maxi is experiencing vaginal soreness after intercourse, prolific grey and fishy smelling vaginal mucus, irregular periods, mild bloating, and anxiety
Maxi is on a Mediterranean diet, but doesn't stick to it
Maxi is taking a pre-conception care multivitamin with methylated B vitamins and a probiotic containing Lactobacilli