Organic Acids Testing 




Organic acids are chemical compounds excreted in the urine of mammals that are products of metabolism. Metabolism is the sum of chemical reactions in living beings by which the body builds new molecules and breaks down molecules to eliminate waste products and produce energy. Organic acids are organic compounds that are acidic. Organic acids are substances in which carbon and hydrogen are always present but which may also contain the elements of oxygen, nitrogen, sulfur, and phosphorus as well.

The names of most organic acids contain the suffix –ic, followed by the word “acid” such as lactic acid. Every organic acid has one or more conjugate bases named with the suffix –ate. Thus, the conjugate base of lactic acid is lactate. Many times, the name of the organic acid and its conjugate base(s) are used interchangeably when discussing physiology and biochemistry, such as lactate or lactic acid. The most common chemical groups associated with organic acids are carboxylic acids which are present in the conjugate base form at neutral pH, 7.0, the pH of the inside of most living cells. Organic acids with one carboxylic acid have one conjugate base while some organic acids may have two or three carboxylic acids and two or three conjugate bases.


Many genetic disorders are caused by the production of an inefficient enzyme that reacts at a slower than usual rate, resulting in an accumulation of a metabolic intermediate. More than 50 phenotypically different organic acidemias are now known since the oldest known disease, isovaleric aci­demia, was described in 1966. An organic acid is any compound that generates protons at the prevailing pH of human blood. Although some organic acidemias result in lowered blood pH, other organic acidemias are associated with organic acids that are relatively weak and do not typically cause acidosis. Organic acidemias are disorders of intermediary metabolism that lead to the accumulation of toxic compounds that derange multiple intracellular biochemical pathways including glucose catabolism (glycolysis), glucose synthesis (gluconeogenesis), amino acid and ammonia metabolism, purine and pyrimidine metabolism, and fat metabolism. The accumulation of an organic acid in cells and fluids (plasma, cerebrospinal fluid, or urine) leads to a disease called organic acidemia or organic aciduria.

Clinical presentations of organic acidemias vary widely and may include failure to thrive, intellectual development disorders, hypo- or hyperglycemia, encephalopathy, lethargy, hyperactivity, seizures, dermatitis, dysmorphic facial features, microcephaly, macrocephaly, anemia and/or immune deficiency with frequent infections, ketosis and/or lactic acidosis, hearing, speech, or visual impairment, peripheral neuropathy, sudden cardiorespiratory arrest, nau­sea and coma. Many organic acidemias are associated with slight to marked increases in plasma ammonia. Some organic acidemias may be chronic and present in the first few days of life. In others, such as medium-chain acyl dehydrogenase deficiency, a child might appear completely normal until a potentially fatal episode of cardiorespiratory arrest.

Many other non-genetic factors can also alter human metabolism. Toxic amounts of the drug acetaminophen and other toxic chemicals can use up a key molecule, glutathione, that helps the body detoxify, leading to the overproduction of the organic acid pyroglutamic acid. Tumors of the adrenal gland called pheochromacytomas can cause the overproduction of the neurotransmitter epinephrine, resulting in marked increases in its metabolite, vanillylmandelic acid (VMA). Genetic diseases of the mitochondria, the cell’s energy source, as well as toxic chemicals that disrupt mitochondrial function cause elevation of succinic acid.  Succinic acid is a key intermediate of both the Kreb’s cycle and the electron transport chain that generates adenosine triphosphate (ATP), the currency for most of the body’s energy transactions.

A number of organic acids directly or indirectly indicate deficiencies of critical vitamins such as vitamin B12, pantothenic acid, biotin, and others. One of the most important uses of the organic acids test is as an indicator of dysbiosis, an abnormal overgrowth of yeast and bacteria in the intestinal tract. Some of these bacterial byproducts from the intestine enter the bloodstream and may alter the metabolism of neurotransmitters such as dopamine.

Organic Acids Test (OAT)
Nutritional & Metabolic Profile


The Organic Acids Test (OAT) offers a comprehensive metabolic snapshot of a patient’s overall health with 76 markers.  It provides an accurate evaluation of intestinal yeast and bacteria. Abnormally high levels of these microorganisms can cause or worsen behavior disorders, hyperactivity, movement disorders, fatigue and immune function. Many people with chronic illnesses and neurological disorders often excrete several abnormal organic acids in their urine. The cause of these high levels could include oral antibiotic use, high sugar diets, immune deficiencies, acquired infections, as well as genetic factors.

Our Organic Acids Test also includes markers for vitamin and mineral levels, oxidative stress, neurotransmitter levels, and is the only OAT to include markers for oxalates, which are highly correlated with many chronic illnesses.

If abnormalities are detected using the OAT, treatments can include supplements, such as vitamins and antioxidants, or dietary modification. Upon treatment, patients and practitioners have reported significant improvement such as decreased fatigue, regular bowel function, increased energy and alertness, increased concentration, improved verbal skills, less hyperactivity, and decreased abdominal pain. The OAT is strongly recommended as the initial screening test.

The Microbial Organic Acids Test (MOAT) is ideal for a follow-up to the OAT and is often recommended by practitioners looking for a specific abnormality, to monitor certain microbial imbalances, or to assess treatment efficacy.

The Organic Acids Test report includes:

Markers for Krebs Cycle abnormalities, neurotransmitter levels,
nutritional deficiencies, antioxidant deficiencies, yeast and
Clostridia overgrowth, fatty acid metabolism, oxalate levels,
and more.


■ Understand vitamin and hormone metabolism
■ Determine capacity to generate energy
■ Evaluate intestinal wall integrity
■ Assess performance of the central nervous system
■ Evaluate muscle function
■ Reveal excessive levels of gastrointestinal (GI) yeast
■ Reveal excessive levels of GI bacteria
■ Detect nutritional or antioxidant deficiencies
■ Determine problems in fatty acid metabolism
■ Identify oxalate imbalances

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Urine: 10 mL of first-morning urine before food or drink is suggested. Patients should avoid apples, grapes (including raisins), pears, cranberries, and their juices 48 hours prior to specimen collection. Avoid arabinogalactan, echinacea, reishi mushrooms, and ribose supplements for 48 hours before collection.


Glycolysis: Elevations may result from infection, exercise,
or B vitamin deficiency. Very high levels may result from
genetic metabolic disorders.

Krebs cycle: Abnormalities may result from nutrient
deficiencies, microbial overgrowth, or glutathione (GSH)
synthesis deficiency.

2-oxoglutaric: Regeneration of amino acids to remove excess
ammonia may result in low levels.

Neurotransmitters: Metabolites of dopamine,
norepinephrine, adrenaline, and serotonin are measured.
Abnormalities may result from stress or poor detoxification,
toxic metal exposure, and rarely, specific tumors. Low levels
may be associated with mood disorders or depression.

Pyrimidines: Slight elevations may occur from folic acid
deficiency. Significant elevations can indicate possible
genetic disorders.

Fatty acids: Elevations can result from ketogenic diets
or fasting, intake of medium-chain triglycerides, carnitine
deficiency, diabetes, or genetic disorders.

Toxic indicators: Abnormalities can result from a deficiency
of glutathione, poor ammonia detoxification, or the ingestion
of aspartame or salicylates.

Vitamin indicators: Abnormalities involving B12, B6, B5, B2,
CoQ10, absorbic acid, biotin, and ascorbic acid are measured.

Amino acids: High elevations are associated with possible
genetic errors in metabolism. These markers are deaminated
by-products of amino acids themselves. Low levels do not
indicate inadequate protein intake.

Slight elevations of valeric acid analogs may indicate a greater
requirement for thiamine (B1).

3-Methylglutaric or 3-methylglutaconic Acid:
Elevated levels indicate a reduced capacity to metabolize
leucine. Small elevations may accompany impairment
of mitochondrial function.

3-Hydroxyglutaric Acid: Elevations indicate a deficiency
in the enzyme involved in the breakdown of lysine
hydroxylysine and tryptophan.

Phosphate: Low phosphate is primarily associated with
vitamin D deficiency. Individuals consuming a low grain diet
may have lower phosphoric acid compared to those on a
conventional “Western Diet.” More rarely, hypoparathyroidism
may be involved.


“After identifying a low serotonin level on an Organic Acid Test (a hallmark functional medicine test), A severely depressed and suicidal man began taking 100mg of 5htp twice a day (5htp is the direct precursor to serotonin). After 2 days, he said his depression virtually disappeared and he was no longer suicidal. I love when I can identify a biochemical glitch and someone can have such a profound emotional turn around.”

–Dr. Josh Friedman of Integrative Psychotherapy of Omaha

“The Organic Acids Test has brought new meaning to my specialized practice in women’s health. This test has allowed me to investigate more deeply the chronic issues that contribute to female related conditions like PMS, uterine fibroids, endometriosis, chronic UTIs and vulvodynia. I have had a great deal of success in treating complicated PMS cases that didn’t respond to typical female hormone balancing therapies. Since utilizing the OAT, it has provided me with a variety of information to determine the underlying cause of female related issues. Some of the markers that I find valuable for women’s health issues are the bacterial and yeast metabolites, oxalates, B vitamins, vitamin C, and pyroglutamic acid. I have been so impressed by this test that I can’t help but want to spread the word about its uses for various women’s health conditions!”

–Jennifer, N.D.

Organic Acids: Autism

The following markers are highly correlated with autism:

• Yeast and bacteria (especially arabinose, citramalic acid, tartaric acid, HPHPA, 4-cresol, and DHPPA)
• Oxalates (specifically oxalic, glyceric, and glycolic acids)
• Mitochondrial function (including succinic, fumaric, malic, 2-oxoglutaric, aconitic, and citric acids)
• Neurotransmitter function (HVA, VMA, HVA/VMA ratio, and quinolinic acid)
• Nutritional markers relevant to autism treatment such as vitamins B6 and B12, and markers for detoxification

Eliminating yeast overgrowth can be an effective method of reducing autistic symptoms. Microbial overgrowth can be measured by urinary organic acids analysis of yeast and bacteria metabolites. The test also helps to identify indicatorsof methylation problems associated with autism. Many children on the autism spectrum have an overgrowth of certain Clostridia species, which produce compounds such as HPHPA (3-(3-hydroxyphenyl)-3-hydroxypropionic acid) and 4-cresol. HPHPA and 4-cresol may disrupt dopamine metabolism by interfering with the enzyme, dopamine beta-hydroxylase. HPHPA is a potent toxin with profound neurological effects in autism, which can cause moodiness, tantrums, extreme anxiety, aggression, self-injurious behavior, and digestive problems.