Adipic Acid, together with Suberate and Ethylmalonate are all functional markers for deficiency of carnitine.
Carnitine is needed to move fatty acids into the mitochondria where they are converted to energy using vitamin B2.
If carnitine is sufficient long-chain fatty acids go through beta-oxidation in the mitochondria.
When insufficient levels of carnitine or vitamin B2 slow down this process, other parts of the cellular machinery take over and make adipic acid and suberate.
A similar block in another pathway causes high ethylmalonate. Since most of our bodies’ energy is produced from the burning of fatty acids, our muscles and brain suffer when this cellular energy pathway is blocked. Anything that interferes with the normal fatty acid oxidation may reveal high levels of these metabolites.
Value may be elevated in:
- Fasting, ketosis or metabolic acidosis.
- Excessive intake of adipic acid-containing foods such as Jell-O, especially if suberic acid is not elevated.
- Increased intake of foods containing medium chain triglycerides such as coconut oil.
- Functional deficiency of the fat-transporting molecule carnitine which may prevent entry of long chain fatty acids into mitochondria, leading to incomplete fatty acid oxidation. Consider supplementation with 500 to 1000mg L-Carnitine TID (CI with certain thyroid medications); or L-Lysine 1000mg QD to TID (precursor to carnitine); also consider SAMe, Vitamin B6, Mg, Vitamin C, Fe, niacin, and adequate protein intake.
- Mitochondrial dysfunction. Consider Vitamin B2 100mg BID.
- Genetic deficiencies of fatty acid metabolism.
- Genetic disease multiple acyl dehydrogenase deficiency.
- Environmental toxins.
- Periodic mild weakness.
- Recurrent infections.
- Sweaty-feet odor.
- Reye syndrome (inhibition of FA oxidation associated with aspirin, viral infections, and genetic mutations).
- Isolated high values of adipic acid only (i.e. not suberic) may be found in patients with ADD, lethargy and seizures.
Slightly elevated levels may result from ingestion of gelatin or other food additives containing adipic acid. Elevated levels suggest issues with fatty acid metabolism. Consider carnitine supplementation.
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