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1. Glucose is generally metabolized into pyruvate. and it then enters the Citric acid cycle(Krebs cycle or TCA cycle) via a dehydrogenase enzyme.
2. In anaerobic condition. pyruvate is metabolized into lactate dehydrogenase(LDH) which convert pyruvate into lactate, vice versa
   1. $$ \text{Pyruvate} + \text{NADH} + \text{H}^+ \rightarrow \text{Lactate} + \text{NAD}^+ $$
   2. $$ \text{Lactate} + \text{NAD}^+ \rightarrow \text{Pyruvate} + \text{NADH} + \text{H}^+ $$
   3. Both processes need the NAD+ which is made by Vitamin B3(Niacin)
3. To metabolize both Lactate and pyruvate into acetyl-CoA (which is called pyruvatd dehydrogenase complex, PDC) needs Vitamin B1(thiamin), B3(Niacin), B5(Pantothenic acid), and Lipoic acid.
   1. If not sufficient pyruvate and Lactate may build up and become elevated.
   2. $$ \text{Pyruvate} + \text{CoA} + \text{NAD}^+ \rightarrow \text{Acetyl-CoA} + \text{CO}_2 + \text{NADH} $$
   3. The coenzymes mentioned above all work together tightly coordinated manner.
      1. Thiamin converted into thiamine pyrophosphate(TPP) - decarboxylation of pyruvate
      2. Niacin is a precursor for NAD+
      3. Pantothenic acid is a component of Coenzyme A(CoA)
      4. Lipoic acid acts as a cofactor for the dihydrolipoyl transacetylase component of the PDC. it facilitates the transfer of the acetyl group to CoA and also helps in the regeneration of enzyme complex.
   4. Also the CoQ10 is not involve the LDH and PDC process but is recommended for high Urine lactate.
      1. which is to support mitochondrial function, enhance energy metabolism, provide antioxidant protection, and may help reduce symptoms associated with metabolic dysfunction.

Lipoprotein -> Fatty acid -> beta-oxidation in the mitochondria, which is carnitine carnitine-dependent step.
- If not, <u>Adipate and Suberate</u> are produced outside the mitochondria by peroxisomes.
- <u>Ethylmalonate</u> is a byproduct of the breakdown of butyrate. which can be accumulated by carnitine deficiency.
- Carnitine is biosynthesized from the amino acid lysine.
- The Vitamin B2(Riboflavin) is essential because it is the precursor to the coenzymes FMN and FAD which are crucial for the beta-oxidation of FA, the electron transport chain, and overall energy production.

- Fatty acid -> Fatty Acyl-CoA / Acetocetate <-> Acetyl CoA -> Citric cycle -> ATP

- So if these 3 organic acids are detected high in urine, L-lysine (if Low, 500mg tid), L-carnitine (500-1000mg TID), Vitamin B2(Riboflavin)(100mg TID) is recommended