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INDIVIDUAL OPTIMAL NUTRITION TM

Clinician Guide
 4855 Peachtree Industrial Blvd. Norcross, GA 30092 800-221-4640 Fax 770-441-2237 www.metametrix.com
10040101403
The ION™ Profile reports over 100
analytes that provide insight into
your patient’s metabolic status. The
ION report is designed to assist your
interpretation of the data and to
help educate your patient about the
significance of the measurements. There
are three components of the ION report:
the Clinician Guide, the Patient Guide,
and two sets of laboratory data with
supplement recommendations and
pattern analysis charts.

I. The Clinician Guide

A. Designed to assist with interpretation of abnormal results,
it contains:
1. Quick Reference Table to Clinical Interventions and Metabolic
Associations
Each analyte is arranged in the sequence used on the laboratory

reports. It helps plan appropriate interventions quickly and uses

appropriate levels of explanation for patient understanding and

compliance.

2. Figures of Biochemical Pathways

Sometimes a diagram is the best explanation of a metabolic

marker abnormality. The pathway diagrams show relationships

between the measured compounds (in red letters) and nutrients or

neurotransmitters.

B. Inserted into the Clinician Guide booklet are the customized

(loose) pages that contain:
1. ION laboratory test results
2. ION Analyte Pattern Analysis
3. Your Supplement Recommendation Summary

II. The Patient Guide

A. Written primarily to explain how the lab results can predict
special needs.
B. Extra copies of the loose sheets are provided for your patient as
you see fit.
 Quick Reference to Clinical Interventions and Metabolic Associations

Amino Acids Potential Intervention Metabolic Association

If High*:
1. Arginine Mn Nitric oxide (endothelial relaxation), urea cycle
2. Histidine — Histamine/glutamic acid formation (Fig. 2)
3. Isoleucine B6, Check for insulin insensitivity Branched-chain amino acids - muscle cells
4. Leucine B6, Check for insulin insensitivity Branched-chain amino acids - muscle cells
5. Lysine α-Ketoglutarate, Niacin, B6 Carnitine synthesis
Methyl group donor & glutathione
6. Methionine B6, α-KG, Mg, SAM
formation
7. Phenylalanine. Iron, Vitamin C, Niacin, Low Phe diet Catecholamine synthesis (Fig. 5)
8. Threonine. B6, Zn Biosynthesis or glycine synthesis
9. Tryptophan. Niacin, B6 Serotonin & kynurenin pathways (Fig. 3)
10. Valine. B6, Check for insulin insensitivity Branched-chain amino acids - muscle cells
11. Glycine. Folate, B6, B2, B5 Biosynthesis and detoxification (Fig. 6)
12. Serine. — Biosynthesis and detoxification (Fig. 6)
13. Taurine. Vit. E, Vit. C, ß-Carotene, CoQ10, Lipoate Neurotransmitter, antioxidant, bile acid
14. Tyrosine. Cu, Iron, Vitamin C, B6 Catecholamine synthesis (Fig. 5)
15. Asparagine. — Urea cycle
16. Aspartic Acid. Mg, Zn Excitatory neurotransmitter, urea cycle
17. Citrulline Citrulline, Mg, Aspartic acid Urea cycle
18. Glutamic Acid. Niacin, B6 Excitatory amino acid
19. Glutamine α-KG, B6 Amino group transport
20. Ornithine. Mg, α-KG, B6 Urea cycle

Homocysteine
21. Homocysteine B6, Folate, B12, Betaine Endothelial dysfunction

*If Low: The most frequent finding of low levels of plasma amino acids is generally corrected by using balanced or
custom mixtures of essential amino acids. See the individualized recommendations for each case.
Erythrocyte Minerals Potential Intervention Metabolic Association
Nutrient Elements If Low:
1. Calcium N/A Membrane Ca ++ pump defect
2. Chromium Cr Insulin target cell binding
3. Copper Cu Detox pathways/Thyroid, Melanin
4. Magnesium Mg ATP energy transfer
5. Manganese Mn Biosynthetic pathways
6. Molybdenum Mo Xanthine oxidase
7. Potassium Fresh fruit & vegetables Neuromuscular function
8. Selenium Se Antioxidant protection
9. Vanadium V Cholesterol, triglycerides
10. Zinc Zn Cofactor for numerous enzymes

Toxic Elements If High:

11. Aluminum Avoidance Lung
12. Cadmium Zn Kidney
13. Lead Ca Bone
14. Mercury Se CNS/Brain

2.
Antioxidant Profile Potential Intervention Metabolic Association
Serum Vitamins If Low:
1. Coenzyme Q10 CoQ10 Mitochrondrial energy production

2. Vitamin A. Vit. A Vision, DNA protection

3. Vitamin E. Vit. E Membrane antioxidant

4. ß-Carotene ß-Carotene Vitamin A precursor

Oxidative Damage Markers If High:

5. 8-Hydroxy-2’-deoxyguanosine Antioxidants DNA oxidative damage

6. Lipid Peroxides Antioxidants Membrane oxidative damage

Plasma Fatty Acids Potential Intervention Metabolic Association

L = LOW H = HIGH
1. Alpha linolenic (ALA) L Flax oil Essential fatty acid

2. Eicosapentaneoic (EPA) L Fish oil Eicosanoid substrate

3. Docosapentaneoic L Fish oil Nerve membrane function

4. Docosahexaneoic (DHA) L Fish oil Neurological development

5. Linoleic (LA) L LA-rich oils* Essential fatty acid

6. Gamma linolenic (GLA) L GLA-rich oils* Eicosanoid precursor

7. Eicosadienoic L Omega-6-rich oils* DGLA precursor

8. DGLA L DGLA-rich oils* Eicosanoid substrate

9. Arachidonic (AA) H Reduce red meats Eicosanoid substrate

10. Docosadienoic H Dietary fat restriction Peroxisomal activation, weight gain

11. Docosatetraenoic H Dietary fat restriction Peroxisomal activation, weight gain

12. Mead H Check triene/tetraene ratio Essential fatty acid deficiency

13. Myristoleic H Essential fatty acids Essential fatty acid deficiency

14. Palmitoleic H Essential fatty acids Essential fatty acid deficiency

15. Vaccenic L Olive oil Membrane fluidity

16. Oleic L Olive oil Membrane fluidity

17. 11-Eicosenoic L Olive oil Membrane fluidity

18. Erucic L Peanut oil Nerve membrane function

19. Nervonic L Fish and canola oils Nerve membrane function

20. Capric L Carnitine, B2, B3 Acyl carnitine transferase

21. Lauric L Carnitine, B2, B3 Acyl carnitine transferase

Hypertriglyceridemia, hyperinsulinemia, acyl

22. Myristic H Lipid-lowering agents
carnitine transferase
Hypertriglyceridemia, hyperinsulinemia, acyl
23. Palmitic H Lipid-lowering agents
carnitine transferase
Hypertriglyceridemia, hyperinsulinemia, acyl
24. Stearic H Lipid-lowering agents
carnitine transferase

25. Arachidic H Lipid-lowering agents Impaired peroxisomal oxidation

26. Behenic H Lipid-lowering agents Impaired peroxisomal oxidation

*Evening primrose, black currant, or borage oils

3.
 Plasma Fatty Acids Potential Intervention Metabolic Association

L = LOW H = HIGH

27. Lignoceric H Rape or mustard seed oils Peroxisomal oxidation

28. Hexacosanoic H Rape or mustard seed oils Peroxisomal oxidation

H Check markers for Vit. B12 carnitine,

Propionate accumulation,
29. Pentadecanoic biotin, and intestinal bacterial
Omega oxidation
overgrowth
H Check markers for Vit. B12 carnitine,
Propionate accumulation,
30. Heptadecanoic biotin, and intestinal bacterial
Omega oxidation
overgrowth
H Check markers for Vit. B12 carnitine,
Propionate accumulation,
31. Nonadecanoic biotin, and intestinal bacterial
Omega oxidation
overgrowth
H Check markers for Vit. B12 carnitine,
Propionate accumulation,
32. Heneicosanoic biotin, and intestinal bacterial
Omega oxidation
overgrowth
Propionate accumulation,
33. Tricosanoic —
Omega oxidation

34. Palmitelaidic H Eliminate hydrogenated oils Eicosanoid interference

35. Total C18 Trans Isomers H Eliminate hydrogenated oils Eicosanoid interference

36. LA/DGLA H Zinc, Magnesium, Vit. B6 ∆6 desaturase, Zinc insufficiency

37. ALA/EPA H Zinc, Magnesium, Vit. B6 ∆3 desaturase, Zinc insufficiency

H Black currant oil

38. EPA/DGLA Eicosanoid imbalance
L Fish oil

39. AA/EPA (Omega-6/Omega-3) H Fish oil Eicosanoid imbalance

40. Triene/Tetraene Ratio (Mead/AA) H Essential fatty acid-rich oils Essential fatty acid deficiency

41. Sat./Unsat. H Dietary unsaturated oils Membrane fluidity, sterol synthesis

Urine Organic Acids Potential Intervention Metabolic Association

If High:
1. Adipate L-Carnitine, Vitamin B2 Fatty acid oxidation (Fig. 7)

2. Suberate L-Carnitine, Vitamin B2 Fatty acid oxidation (Fig. 7)

3. Ethylmalonate L-Carnitine, Vitamin B2 Fatty acid oxidation (Fig. 7)

4. Pyruvate Vitamins B1, B3, B5, Lipoic acid Anaerobic energy production (Fig. 7)

5. Lactate CoQ10, Vitamins B1, B3, B5, Lipoic acid Anaerobic energy production (Fig. 7)

6. β-Hydroxybutyrate Chromium, Vanadium Ethanol and glucose oxidation

7. α-Hydroxybutyrate NAD, Niacin Glucose uptake

Citric Acid Cycle Intermediates,

8. Citrate* Arginine, Essential amino acids Aerobic energy production (Fig. 7),
Renal ammonia clearance

9. Cis-aconitate* Arginine, Iron “

10. Isocitrate* Arginine, Magnesium, Manganese “

11. α-Ketoglutarate* Vitamins B1, B3, B5 “

12. Succinate* CoQ10, Vitamin B2, Magnesium Mitochondrial oxidation (Fig. 7)

*A pattern of low levels may indicate need for essential amino acids.

4.
Urine Organic Acids Potential Intervention Metabolic Association
13. Fumarate* CoQ10 Mitochondrial oxidation (Fig. 7)

14. Malate* CoQ10 Mitochondrial oxidation (Fig. 7)

15. Hydroxymethylglutarate (HMG) CoQ10 CoQ10 synthesis (Fig. 7)

16. α-Ketoisovalerate Vitamins B1, B3, B5, Lipoate Branched-chain amino acid catabolism

17. α-Ketoisocaproate Vitamins B1, B3, B5, Lipoate Branched-chain amino acid catabolism

18. α-Keto-β-methylvalerate Vitamins B1, B3, B5, Lipoate Branched-chain amino acid catabolism

19. Xanthurenate (XANTH) Vitamin B6 Tryptophan catabolism (hepatic) (Fig. 3)

20. β-Hydroxyisovalerate Biotin Isoleucine catabolism

21. Methylmalonate (MMA) Vitamin B12 Odd-chain fatty acid catabolism

22. Formiminoglutamate (FIGLU) Folic acid Histidine catabolism (Fig. 2)

23. Vanilmandelate (VMA) Essential amino acids Epinephrine, Norepinephrine catabolism (Fig. 5)

24. Homovanillate (HVA) Essential amino acids Dopamine catabolism (Fig. 5)

25. 5-Hydroxyindoleacetate (5-HIA) Essential amino acids Serotonin catabolism (Fig. 3)

26. Kynurenate (KYN) Vitamin B6 Tryptophan catabolism (Fig. 3)

27. Quinolinate (QUIN) Antioxidants (Vit. C, Vit. E, Lipoic acid) Tryptophan catabolism (macrophage) (Fig. 3)

28. p-Hydroxyphenyllactate Antioxidants (Vit. C, Vit. E, Lipoic acid) Pro-oxidant and carcinogen

29. 8-Hydroxy-2’-deoxyguanosine
Antioxidants (Vit. C, Vit. E, Lipoic acid) DNA oxidation product
(8-OHdG)

30. 2-Methylhippurate Avoidance of xylene Hepatic Phase II conjugation

31. Orotate Arginine, Magnesium Urea cycle

32. Glucarate Toxicant (xenobiotic) avoidance Detox. liver enzyme induction

N-acetyl-cysteine (NAC),
33. Pyroglutamate Renal amino acid recovery
Glutathione, Lipoic acid
N-acetyl-cysteine (NAC),
34. Sulfate (if low) Detox. & anti-oxidant functions
Glutathione, Lipoic acid
Hepatic Phase II conjugation and intestinal
35. Benzoate Glycine, Pre + Probiotics and Antibiotics
bacterial overgrowth
Hepatic Phase II conjugation and intestinal
36. Hippurate Glycine, Pre + Probiotics and Antibiotics
bacterial overgrowth

37. Phenylacetate Pre + Probiotics and Antibiotics Intestinal bacterial overgrowth

38. Phenylpropionate Pre + Probiotics and Antibiotics Intestinal bacterial overgrowth

39. p-Hydroxybenzoate Pre + Probiotics and Antibiotics Intestinal bacterial overgrowth

40. p-Hydroxyphenylacetate Pre + Probiotics and Antibiotics Intestinal bacterial overgrowth

41. Indican Pre + Probiotics and Antibiotics Intestinal bacterial overgrowth

42. Tricarballylate Pre + Probiotics and Antibiotics Intestinal bacterial overgrowth

43. D-Lactate Antibiotics + avoidance of acidophilus Intestinal bacterial overgrowth

44. Dihydroxyphenylpropionate
Pre + Probiotics and Antibiotics Intestinal bacterial overgrowth
(DHPP)

45. Tartarate Pre + Probiotics and Antifungals Intestinal yeast overgrowth

46. Citramalate Pre + Probiotics and Antifungals Intestinal yeast overgrowth

47. Arabinitol Pre + Probiotics and Antifungals Intestinal yeast overgrowth

5.
 Biochemical Pathways

The figures in this section show metabolic pathways involving amino acids, vitamins, and metabolic markers that
were measured in the ION profile. You may use them to help explain the significance of your patient’s results and
demonstrate the importance of nutrients to cell function and health. You can follow the arrows to see how one
metabolic compound converts into the next within these specific parts of the delicate and complex network of
chemical reactions that are happening in your patient’s body. Providing insight into this most inner aspect of your
patient’s health is what the ION report is designed to do.

Figure 1. Methylation Cofactor Markers - Vitamin B12

Odd-chain fatty acids

Marker of functional Vitamin B12

Propionyl-CoA
Methylmalonic acid

Methylmalonyl-CoA

Methylmalonyl-CoA Mutase
B12

Succinyl-CoA

Figure 2. Methylation Cofactor Markers - Folic Acid

L-Histidine
Marker of functional folic acid

Formiminoglutamic acid

Glutamate Formiminotransferase

Folate

Glutamic acid

6.
7
Figure 3. Tryptophan Pathways in Vitamin B6 Deficiency and Inflammation

Serotonin Mood enhancement,

L-Tryptophan 5-Hydroxyindoleacetic acid sleep promotion
Serotonergic receptor activation

Kynurenine Kynurenic acid Markers of B6 deficiency

NMDA receptor antagonist

3-Hydroxykynenine Xanthurenic acid

B6

Quinolinic acid Product of (viral) inflammation

 Neurodegeneration
NMDA receptor agonist

Figure 4. Relationships of Vitamins and Sulfur-containing Amino Acids

Methionine
ATP

Folate
ADP B12
Betaine

SAM Homocysteine
S-Adenosylmethionine
Serine B6

SAH
S-Adenoslyhomocysteine
Cystathionine

Glutamate Glycine α-Ketobutyrate

NADH

Glutathione Cysteine NAD+

B6 α-Hydroxybutyrate

Taurine

7
8.
 Figure 5. Neurotransmitters from Amino Acids

Biopterin Biopterin
Fe+++ Fe+++
Phenylalanine Tyrosine DOPA
P5P
O2 H2O O2 H2O

CO2
Cu+++ Urinary
Dopamine Homovanilate
O2
I2
Ascorbate
Cu+++
Thyroid Hormone Melanin
SAH H2O

Epinephrine Norepinephrine

SAM

Vanilmandelate

Figure 6. Metabolism of Glycine and Serine

Acetylcholine
(Brain)

Threonine
Choline
(Fat Metabolism)
B6
Proteins
Body Functions
B6 Purines DNA, RNA blood formation
Porphyrins growth
Folate Glutathione repair
Serine B6 Glycine digestion
Glycocholate
Hippurate and other brain
detoxification
hepatic phase II
B6
conjugates

Glucose

Citric Acid Cycle

8.
 Figure 7. Central Energy Pathway

Digestion FATS CARBOHYDRATES PROTEINS

and
STAGE I

Assimilation

Fatty Acids, Gycerol Glucose & Other Sugars Amino Acids

Cholesterol
Keto Acids
Adipate Carnitine Pyruvate Lactate
B1, B2, B3, B5, Lipoate
Suberate B1, B2, B3, B5, Lipoate
Ethylmalonate
Intermediary Acetyl CoA
Metabolism ß-Hydroxybutyrate

Asp Oxaloacetate Citrate

Citric Acid Cycle
B3 cis-Aconitate
STAGE II

Malate Cysteine, Fe ++ Glu

His
Isocitrate Arg
Tyr Pro
Fumarate B3, Mg, Mn Gln
Phe
B2 α-Ketoglutarate
Succinate B1, B2, B3, B5, Lipoate
Mg Succinyl-CoA
Ile
Val
Electron Transport NADH Met
and
Oxidative
STAGE III

NADH
Phosphorylation Dehydrogenase

Coenzyme Q10 ADP + Pi

Cytochromes
Hydroxymethylglutarate ATP Energy for muscle and
nerve function and for
O2 H2O building new tissue
Note: Vitamin & mineral requirements for
cofactors are shown in light blue box. Compounds Reported in IONTM Profile are Printed in Red
Elevations of metabolites before these steps
indicate functional deficit of the nutrients.

9.