• Deficient substrate for energy production
• Impaired production from glycogen (glycogenolysis), carbohydrates (glycolysis), or proteins (gluconeogenesis)

Additional investigations if low:

• Urinary Amino Acids
• Vitamin & Mineral Analysis
• Adrenal Hormone Profile

Treatment considerations if low:

• Gluconeogenic amino acids (e.g. L-alanine, glycine, L-serine)
• B6, Mg
• Correct glucose/insulin imbalances
• Adrenal support if required
• Consider Ca pyruvate supplementation

Elevated by a number of nonspecific factors, including vigorous exercise, bacterial overgrowth of the GI tract, shock, poor perfusion, B-vitamin deficiency, mitochondrial dysfunction or damage, and anemia, among others. High pyruvic acid indicates the possibility of an inborn error of metabolism increases as the value exceeds 100 mmol/mol creatinine.

• Impaired metabolism due to cofactor insufficiencies or toxic metals (As, Pb, Hg, Cd)
• Muscle injury
• Severe adrenal insufficiency (impaired conversion of pyruvate to alanine)

Additional investigations if high:

• Vitamins & Minerals Analysis
• Comprehensive Urine Elements Profile
• Adrenal Hormone Profile

Treatment considerations if high:

• Supplement cofactors (B1, B2, B3, B5, Mg, Lipoic acid)
• Remove toxic metals
• Adrenal support if required