Specialist Testing · Deeper Investigation
Metabolomix+
Comprehensive Nutritional Profile
When a standard organic acids test gives you the metabolic pathway picture but the clinical story asks for more — Metabolomix+ adds amino acid status and oxidative stress markers from the same first-morning urine collection, with an optional blood-spot add-on for fatty acid balance.
What Metabolomix+ Is
Metabolomix+ is Genova Diagnostics' comprehensive nutritional and metabolic urine test. It is not simply an organic acids test with a different name — it combines three analytical layers that no standard OAT provides in one collection: organic acid metabolites, amino acid precursors and breakdown products, and oxidative stress indicators. A fourth layer, fatty acid balance, is an optional add-on measured from a finger-prick blood spot rather than urine.
Where a standard OAT answers the question what are my metabolic pathways doing, Metabolomix+ answers the deeper question: why are they doing that, and what nutritional substrate is missing or depleted that's causing it. The amino acid layer, and the fatty acid add-on where it is ordered, are the difference — they give you the raw material picture alongside the pathway dysfunction picture.
For a stand-alone organic acids test, the Mosaic OAT is usually what I use. Metabolomix+ is the organic acids test in the TDG Five-Test Programme, and the one I choose for more complex cases — neurodivergent presentations, significant gut problems, or where the clinical picture is more complex — where nutritional depletion, neurotransmitter precursor deficiency, fatty acid imbalance, or chronic oxidative stress need to be quantified alongside metabolic pathway findings.
Clinical positioning
Metabolomix+ is the standard organic acids test in the TDG Five-Test Programme. Outside the programme, the Mosaic OAT is usually the first choice, and Metabolomix+ is ordered when the presentation suggests neurodivergence, significant gut problems, nutritional depletion, eating disorder history, or chronic fatigue where the amino acid picture (and, with the add-on, the fatty acid picture) adds material clinical value.
What It Measures — Three Layers Plus a Fatty Acid Add-On
Each analytical layer of Metabolomix+ answers a different clinical question. Understanding what each layer adds is the key to knowing when to order it.
- Krebs cycle / energy production markers
- Neurotransmitter metabolites (HVA, VMA, 5-HIAA, kynurenate, quinolinate)
- Yeast and fungal metabolites (arabinose, citramalic, tartaric)
- Clostridia markers (HPHPA, 4-cresol)
- B-vitamin functional status (methylmalonate, xanthurenate, pyridoxate)
- Detoxification and oxidative stress markers
- Mitochondrial dysfunction indicators
Equivalent to the standard Mosaic OAT — this layer alone provides the metabolic pathway picture most practitioners use the OAT for.
- Essential amino acids (tryptophan, phenylalanine, methionine, lysine, leucine/isoleucine/valine)
- Neurotransmitter precursors (tryptophan → serotonin; tyrosine → dopamine/noradrenaline)
- Glutamate / GABA balance (excitatory/inhibitory ratio)
- Sulphur amino acids (cysteine, taurine, homocysteine pathway)
- Protein digestion markers (hydroxyproline, 3-methylhistidine)
- Urea cycle function (arginine, citrulline, ornithine)
Critical for ADHD, anxiety, depression, autism spectrum, eating disorder recovery — any presentation where neurotransmitter precursor status is clinically relevant.
- Omega-3 status (EPA, DHA, DPA)
- Omega-6 status and arachidonic acid load
- Omega-3:6 ratio (inflammatory balance)
- Trans-fatty acid markers
- Saturated and monounsaturated fatty acid balance
- Elongation and desaturation enzyme function (delta-6 desaturase activity)
Fatty acid imbalance is mechanistically relevant to ADHD (DHA and neuronal membrane function), cardiovascular risk, chronic inflammation, and mood disorders. Not measurable on any urine OAT, including the base Metabolomix+; it needs the Fatty Acids add-on.
- 8-OHdG (8-hydroxy-2'-deoxyguanosine) — DNA oxidative damage
- Lipid peroxidation markers
- Antioxidant capacity indicators
- Glutathione pathway status
- Coenzyme Q10 functional indicators
8-OHdG is the gold-standard marker of oxidative DNA damage — elevated in chronic disease, environmental toxin exposure, and accelerated ageing. Not available on standard OATs.
The ADHD and Anxiety Case for Metabolomix+
For neurodevelopmental presentations — ADHD, anxiety, autism spectrum, developmental delays — Metabolomix+ provides a level of mechanistic detail that no other single urine test matches. The reason is the combination of organic acid and amino acid layers that bear directly on neurotransmitter function, with fatty acids (including DHA) available through the blood-spot add-on:
Key markers for neurodevelopmental presentations
HVA : VMA Ratio
Homovanillic acid to vanillylmandelic acid — the dopamine:noradrenaline metabolite ratio. The core ADHD marker. Low HVA relative to VMA indicates reduced dopamine turnover. Mosaic OAT and Metabolomix+ both measure this; it's the anchor marker for ADHD pattern recognition.
Tryptophan pathway
Tryptophan → 5-hydroxytryptophan → serotonin (via 5-HIAA) vs tryptophan → kynurenine → quinolinate (neuroinflammation). The IDO pathway diversion is measurable here. Low 5-HIAA with high quinolinate = serotonin depletion driven by neuroinflammation, not dietary intake.
HPHPA (Clostridia)
3-(3-hydroxyphenyl)-3-hydroxypropionic acid — the Clostridia marker that inhibits dopamine-beta-hydroxylase, the enzyme that converts dopamine to noradrenaline. Elevated HPHPA with low HVA is the gut-brain ADHD pattern. Interventions targeting Clostridia can shift the neurotransmitter picture without medication.
DHA status
Docosahexaenoic acid is the structural fatty acid of neuronal membranes and synaptic vesicles. Low DHA impairs neurotransmitter release kinetics. ADHD research consistently shows lower DHA in affected individuals. On Metabolomix+ it needs the Fatty Acids add-on (finger-prick blood spot); no urine organic acids test measures it.
Glutamate : GABA
The excitatory/inhibitory balance. Elevated glutamate relative to GABA is the biochemical correlate of anxiety, sensory sensitivity, and difficulty with emotional regulation. Direct amino acid measurement gives you this — the OAT organic acid markers are proxies; the amino acid panel is the direct measure.
Phenylalanine status
Phenylalanine → tyrosine → DOPA → dopamine. If phenylalanine is low or conversion to tyrosine is impaired (tetrahydrobiopterin cofactor issue), the entire catecholamine synthesis pathway is rate-limited upstream. This shows in the amino acid panel as low phenylalanine or high phenylalanine with low tyrosine.
Who This Test Is For
Outside the TDG programme, Metabolomix+ is not the default OAT choice for every presentation. It is the right test when the clinical picture specifically benefits from the amino acid, fatty acid, or oxidative stress layers — which means the following presentations:
🧠
ADHD and Neurodevelopmental
Adults or children with diagnosed or suspected ADHD, autism spectrum, or developmental delays where neurotransmitter precursor status, fatty acid balance, and the gut-brain connection (HPHPA, Clostridia) are clinically relevant. The combination of HVA:VMA ratio, tryptophan pathway, DHA status (with the fatty acid add-on), and HPHPA makes this the most mechanistically complete single test for these presentations.
😰
Anxiety, Depression, Mood Disorders
Where the serotonin and GABA picture needs more than the standard OAT proxies can give. The direct amino acid measurement of tryptophan, 5-hydroxytryptophan, GABA, and glutamate alongside the inflammatory diversion of tryptophan via the quinolinate pathway gives the full neurotransmitter substrate picture.
🍽️
Eating Disorder Recovery
Restriction and compensatory behaviours create profound amino acid depletion — particularly the essential amino acids and the sulphur amino acids. Refeeding without understanding the specific depletion pattern risks under-correcting the most critical deficits. Metabolomix+ maps the full amino acid status alongside the organic acid markers of mitochondrial and neurotransmitter function.
⚡
Complex Chronic Fatigue
When the standard OAT shows mitochondrial pathway dysfunction and the clinical picture suggests profound nutritional depletion — the Metabolomix+ amino acid layer (and the fatty acid add-on, if ordered) help show whether CoQ10 precursor availability, carnitine status, and omega-3 balance are contributing to the energy production failure. CoQ10 functional indicators and 8-OHdG together give a more complete mitochondrial picture.
🔥
Chronic Inflammation Investigation
The 8-OHdG oxidative DNA damage marker and lipid peroxidation indicators place the Metabolomix+ alongside the standard OAT organic acid findings to give an oxidative stress picture. For clients with chronic inflammatory conditions, autoimmune presentations, or post-viral syndrome where oxidative load is mechanistically central.
🌿
Post-COVID / Post-Viral Recovery
The tryptophan-to-quinolinate IDO pathway diversion seen in post-COVID syndrome is measurable on the standard OAT. Metabolomix+ adds the amino acid precursor picture (is tryptophan actually available?) and the oxidative stress markers (is ongoing oxidative damage measurable?) — together these give a more complete post-viral metabolic picture than the OAT alone.
Metabolomix+ vs Standard OAT — What's Different
| Marker category |
Mosaic OAT |
DSL OAP |
Metabolomix+ |
| Organic acid metabolites (full panel) |
✓ Full |
✓ Full |
✓ Full |
| Neurotransmitter metabolites (HVA, VMA, 5-HIAA) |
✓ |
✓ |
✓ |
| HPHPA / Clostridia markers |
✓ |
✓ |
✓ |
| Yeast / fungal metabolites |
✓ |
✓ |
✓ |
| B-vitamin functional markers |
✓ |
Partial |
✓ |
| Amino acid profile (full direct measurement) |
✗ |
✗ |
✓ Metabolomix+ only |
| Neurotransmitter precursors (direct) |
✗ |
✗ |
✓ Metabolomix+ only |
| Fatty acid balance (omega-3/6, DHA, EPA) |
✗ |
✗ |
✓ Add-on (blood spot) |
| 8-OHdG (oxidative DNA damage) |
✗ |
✗ |
✓ Metabolomix+ only |
| Glutamate / GABA (direct measurement) |
✗ |
✗ |
✓ Metabolomix+ only |
| Collection method |
First-morning urine |
First-morning urine |
First-morning urine (+ blood spot for fatty acid add-on) |
| Client fee (Nordic) |
£318 |
£224 |
£419 |
When to choose Mosaic OAT instead
For most clinical presentations — gut dysbiosis investigation, standard metabolic pathway assessment, hormone metabolism, general fatigue — the Mosaic OAT provides everything needed at a lower client cost (£318 vs £419). Metabolomix+ earns its additional cost specifically when the amino acid, fatty acid, or oxidative stress layers are clinically relevant. If unsure, start with the Mosaic OAT and order Metabolomix+ if the clinical picture after the first test indicates the deeper nutritional picture is needed.
Available Add-Ons
Two optional add-ons are listed below. Urine Elements uses the same first-morning urine collection; the Fatty Acids panel needs a finger-prick blood spot. Each adds a specific analytical layer for presentations where that data is clinically relevant.
Fatty Acids Panel (+£51)
Extends the lipid analysis to include a detailed breakdown of individual omega-3 and omega-6 fatty acid species, saturated and monounsaturated fatty acid balance, trans-fatty acid markers, and desaturation enzyme activity indicators. Most clinically relevant for ADHD presentations (DHA:EPA ratio and neuronal membrane function), cardiovascular risk profiling, and chronic inflammatory conditions where the specific fatty acid species driving inflammation need to be identified. The base Metabolomix+ does not include fatty acids. This add-on is how they are measured, from a finger-prick blood spot collected at home.
Urine Elements (+£100)
Measures a comprehensive panel of essential and toxic elements in urine — including heavy metals (lead, mercury, arsenic, cadmium, aluminium) and essential mineral excretion patterns (zinc, copper, magnesium, selenium, molybdenum). Urine elements reflect recent exposure and current renal excretion rather than long-term tissue burden — for that picture the Hair Tissue Mineral Analysis (HTMA) is the appropriate test. The Urine Elements add-on is most relevant when acute or recent toxic metal exposure is suspected, or when mineral excretion abnormalities may be contributing to enzyme dysfunction identified in the organic acid or amino acid layers.
Clinical note on add-ons
Urine Elements uses the same first-morning urine collection as the base test. The Fatty Acids add-on needs a finger-prick blood spot, a small extra step. The question is whether the additional data materially changes the clinical protocol. In most cases the base Metabolomix+ panel provides what is needed. Add-ons are best selected when a specific clinical presentation — heavy metal exposure history, or fatty acid status in ADHD — makes the additional markers directly relevant rather than generally interesting.
How It Works — The Process
1
Initial consultation and test selection
We discuss your health history, current presentation, and goals. If Metabolomix+ is the right test for your specific clinical picture, we confirm this in the consultation and arrange the test kit. If a standard OAT or a different test is more appropriate, we'll identify that too — the right test for your specific situation, not a default protocol.
2
Test kit collection and instructions
The Metabolomix+ kit is sent directly to your home address. Collection is a single first-morning urine sample — the instructions are clear and the collection takes under five minutes. The kit includes a prepaid return envelope to the Genova laboratory. No clinic visit required.
3
Laboratory analysis — 10 to 14 days
Genova processes the sample across each analytical layer ordered. The report is delivered to the practitioner portal as a detailed PDF with reference ranges, interpretive comments, and the results presented in integrated format. Turnaround is typically 10–14 days from sample receipt at the laboratory.
4
Results interpretation consultation
We review the full report together — not just which markers are out of range but what the pattern across the layers means clinically. The amino acid, oxidative stress and (if ordered) fatty acid findings are interpreted alongside the organic acid metabolites to build a coherent clinical picture. This integration across layers is where Metabolomix+ delivers its most distinct value.
5
Clinical protocol development
Based on the integrated findings we develop a targeted nutritional, dietary, and lifestyle protocol. For ADHD and neurodevelopmental presentations this will typically include neurotransmitter precursor support, fatty acid intervention, and gut-focused work if the Clostridia and yeast markers are significant. For fatigue presentations it will address the mitochondrial, oxidative, and nutritional depletion picture in sequence.
Pricing and Ordering
Metabolomix+ — Genova Diagnostics via Nordic Laboratories
Base test fee (client price)
£419
Add-on: Fatty Acids panel
+£51
Add-on: Urine Elements
+£100
Results interpretation consultation
£145
Base test plus interpretation
£564
Add-ons are selected at the time of ordering and added to the base test fee. Urine Elements measures toxic and essential elements in urine — useful when heavy metal or mineral excretion is clinically relevant. Urine Elements uses the same urine collection; the Fatty Acids add-on needs a finger-prick blood spot. Prices correct at July 2026 — confirm current pricing when ordering.
How Metabolomix+ Fits the Wider Investigation
Metabolomix+ is most powerful when interpreted alongside other test findings rather than in isolation. It is one layer of a clinical investigation, not a complete picture on its own.
Combined with the GI-MAP stool test, the Metabolomix+ organic acid Clostridia and yeast markers make clinical sense — the GI-MAP identifies the organisms in the colon, the OAT layer identifies their systemic metabolic impact. The amino acid findings from Metabolomix+ show whether gut dysbiosis has depleted neurotransmitter precursors to a clinically significant degree.
Combined with blood chemistry from a Regenerus blood panel, the fatty acid findings (when the add-on is ordered) add context to the cardiovascular risk picture — particularly when lipid markers are raised and the omega-6 load needs to be understood.
Combined with the DUTCH Plus hormone test, the OAT layer's cortisol-related organic acid markers and the oxidative stress findings from 8-OHdG together give a complete HPA-mitochondrial picture for chronic stress and fatigue presentations.
Is Metabolomix+ the right test for your presentation?
Book an initial consultation to discuss your health history and current picture. We'll identify whether Metabolomix+, the standard OAT, or a different investigation is the right starting point — and build a testing plan around your specific clinical needs.
Book a Consultation
Explore the Five-Test Programme
A note on test selection
Metabolomix+ is a powerful test in the right context. It is not a better version of the standard OAT for all clients — it is a more specific tool for specific presentations. Part of what we do in an initial consultation is identify the right tests for you rather than applying a standard protocol. The TDG approach is to test specifically, interpret clinically, and intervene on the basis of what the testing actually shows.