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Question: A question on urinary lactate, pyruvate, and Krebs Cycle metabolites
When the NAD+ sensitive steps of the citric acid cycle are being inhibited, that could be hypoxia, it could be high-intensity exercise, it could be taking metformin or berberine, it could be having a complex 1 disorder, and of course, I would sort of measure this against symptoms. So if you feel great, I wouldn't overinterpret this. But if you have something that feels like messed up energy metabolism, then I think it's best correlated with a deficiency in the respiratory chain, whether that's driven by oxygen, by increased demand, through high-intensity exercise, through taking complex 1 inhibitors like metformin or berberine, or through having a genetic complex 1 disorder. Thiamine is possible but if it's thiamine deficiency, then you should also see elevations in alanine as well. So I would get a plasma amino acids test, and then you could also look at the thiamine level in the blood and you could look at... HDRI has an erythrocyte transketolase activity test, and it's listed as ETKA on their requisition form.
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DISCLAIMER: I have a PhD in Nutritional Sciences and my expertise is in performing and evaluating nutritional research. I am not a medical doctor and nothing herein is medical advice.