Optimal Result: 10 - 36 mmol/mol creatinine.

Citric acid, cis-aconitic acid, and isocitric acid are the first three metabolites in the Krebs Citric Acid energy production cycle, which operates in the mitochondria of your cells. 

Citrate, cis-Aconitate (and Isocitrate) are involved in both energy production and removal of toxic ammonia.

High levels can indicate ammonia toxicity. Chronic loss of these valuable compounds can contribute to loss of organ reserve and disturbances in neurological function. If they are low they can indicate a need for essential amino acids, especially arginine.

Nutrient association: Arginine, Iron

References:

- Medline.gov - Arginine [L]

What does it mean if your Cis-Aconitic Acid result is too low?

Possible causes:

Low or high pyruvic acid or low acetyCoA (from fatty acid oxidation).

What does it mean if your Cis-Aconitic Acid result is too high?

Possible causes:

- Impaired metabolism due to toxic metals (Fl, Hg, As) 
- OR low cofactors (Fe, GSH—depleted in oxidative stress)
- OR high amounts of dietary citric acid
- OR metabolic acidosis (if mildly increased cisaconitic acid but markedly increased citric acid).
- Low glutathione
- High amounts of dietary citric acid
- Metabolic acidosis (if mildly increased cis-aconitic acid but markedly increased citric acid)
- High levels can indicate ammonia toxicity or arginine insufficieny.
- An elevated level of this organic acid may be an indication of poor supplies or metabolism of amino acids. A clinical sign is fatigue.
- If elevated with orotate, isocitrate and citrate, suspect hyperammonia.
- High Citrate and Cis-aconitate can indicate arginine insufficiency for ammonia clearance through the Urea Cycle.

Additional investigations:

- Comprehensive Urine Elements Profile

- Functional Liver Detoxification Profile

- Complete Digestive Stool Analysis

Treatment considerations:

- Rule out toxic metals

- Glutathione-

- Consider supplementing with arginine and possibly cysteine.

Some foods high in argininer are:

- Pumpkin seeds

- Sesame seeds

- Dried walnuts

- Almonds

- Pine nuts

- Soy beans

- Chickpeas

- Seaweed

(Do not take L-arginine if you have had a recent heart attack.)

Additional investigations:

- Comprehensive Urine Elements Profile
- Functional Liver Detoxification Profile
- Complete Digestive Stool Analysis
- Rule out toxic metals and check for iron deficiency

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