Optimal Result: 0 - 3.6 mmol/mol creatinine.

Citramalic Acid is a metabolite of yeast or anaerobic bacteria, including Clostridia.

Citramalic acid is an analog of malic acid. The structure of citramalic acid is similar to the structure of malic acid except it has an extra CH3 group on it. It can inhibit the production of malic acid. Citramalic acid has been found to be a byproduct of Saccharomyces yeast species, as well as Propionibacterium acnes.

What does it mean if your Citramalic result is too high?

If your citramalic acid is elevated it could mean that there is yeast or anaerobic bacterial overgrowth.

Elevated citramalic acid is produced mainly by Saccharomyces species or Propionibacteria overgrowth.

With a chemical structure very similar to that of malic acid, citramalate may cause metabolic interference with malate. This is of concern because malic acid has extra-mitochondrial functions, as with the "malate shuttle" for carrying reducing equivalents (protons) into the mitochondria. While the metabolic interference aspect is uncertain, the presence of citramalate in the urine indicates intestinal dysbiosis. Not formed in human tissues, citramalate may be formed by anaerobic bacteria such as clostridia, as well as by yeast/fungi. A stool analysis with bacteriology or microbiology is suggested.

Additional investigations:

Citramalic acid is a general indicator of excess yeast in your system. In order to determine if this is due to normal flora (Saccharomyces) or imbalanced flora, consider a comprehensive stool analysis and GI Effects test. 

Treatment considerations:

- Antifungals or antimicrobials

- Yeast free diet

- Probiotics: High-potency multi-strain probiotics may help rebalance GI flora.

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