Optimal Result: 320.2 - 3375.5 nmol/mg Creatinine.

Fumarate (together with Succinate and Malate) is used in the body’s metabolic pathway that generates cellular energy – the Citric Acid Cycle. This cycle critically supports organ maintenance and neurological function. Fumarate is also a product of the urea cycle. Much like vitamin D, fumaric acid is formed by the body, in the skin, during exposure to sunlight.

What does it mean if your Fumaric Acid result is too low?

Low levels of Fumarate can indicate a general amino acid insufficiency.

Nutritional Considerations:

Low levels of fumarate have been correlated with lower levels of: Tyrosine and/or Phenylalanine, B6, B2, Arginine, Essential Amino Acids and CoQ10.

Clinical Observation:

Use of malic acid supplements (such as magnesium malate) often can help short term as the underlying cause of the low result is clinically determined.

Possible Interfering Factors:

Diet low in protein or insufficient in essential amino acid balance. Use of acid blockers that decrease assimilation/breakdown of ingested protein.

Clinical Considerations:

Some individuals with low level of fumarate may have an increased exacerbation of psoriasis. Low levels may correlate with increased fatigue and sense of low energy to perform daily functions. May wish to look at confirmatory tests for possible low iron status, such as ferritin, TIBC, Total Iron, Transferrin. Can be symptomatic of poor conversion of phenylalanine to tyrosine or altered urea cycle metabolism.

Important Clinical Note:

Since Phenylalanine and Tyrosine feed into the CAC pathway via fumarate, supplementation with these two amino acids may be particularly indicated for individuals with lower mood, since the catecholamine pathway (dopamine, epinephrine, norepinephrine) is also fueled by these amino acids.

What does it mean if your Fumaric Acid result is too high?

- Check levels and intake of amino acids that flow into the Krebs cycle: tyrosine and phenylalanine.

- Evaluate B-complex status.

- In chronic kidney disease in those with type 2 diabetes, urinary fumaric acid and malic acid predicted progression of disease.


Excess urea cycle function can generate high levels of fumarate, because fumaric acid is one of the urea cycle products.

Higher levels of these compounds in urine indicate inefficiencies in energy production.

Possible causes:

- Impaired metabolism due to low B3

- May be secondary to high pyruvate or lactate

- Yeast overgrowth

Additional investigations:

- Vitamin and Mineral Analysis

- Comprehensive Urine Elements Analysis

- Adrenal Hormone Profile

- Complete Digestive Stool Analysis

Treatment considerations:

- Consider B3 supplementation, unless secondary to high pyruvate or lactate

- Rule out/address yeast overgrowth

If α-ketoglutarate is elevated along with succinate, malate, and fumarate, you may need additional CoQ10, a nutrient that enables the body to use oxygen to generate large amounts of energy.

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