Know Your Body Better: Here’s What Organic Acid Testing Can Reveal

As a functional medicine practitioner, I’m always doing detective work. When someone is experiencing unexplained symptoms, from fatigue and brain fog to bloating or pain, my job is to find that explanation and then treat the root cause. 

Often, there is more than just one cause. Multiple different factors contribute to chronic symptoms and chronic illnesses, and the more we can understand about how everything in the body is interacting, the better equipped we are to restore overall health and well-being. 

I use a number of different tools to solve these puzzles (depending on the case), and one of them is the organic acid test (OAT). Let’s explore how this test works, what it can reveal, what it can’t reveal, and other key things you need to know. 

What is the Organic Acid Test (OAT)? 

The organic acid test is a urine test that measures the end products of numerous metabolic processes and biochemical reactions that occur in your body every day. These metabolic byproducts, or organic acids, give us a window into how your metabolism is operating. 

Your body produces organic acids when it metabolizes food, supplements, medications, and toxins, and when performing numerous functions like energy production, detoxification, and synthesis of neurotransmitters. Some gut microbes also produce organic acids. 

Because your body doesn’t reabsorb these organic acids, they get flushed out in your urine, providing a helpful snapshot of internal activity and metabolic pathways. 

What Can the OAT Test Reveal?

The OAT test gives us clues and direction as to how your metabolism is operating, where there may be imbalances, and what some of the underlying contributors to chronic illness or symptoms might be. It helps us ask more specific questions and put pieces of the puzzle together. 

Some of the most helpful areas the test explores include: 

Yeast & Fungal Overgrowths and Gut Health

While organic acid testing doesn’t provide a complete breakdown of what’s going on in your gut microbiome (comprehensive stool testing is better for that), it can identify a number of key imbalances and microbial overgrowths pointing to dysbiosis. These include overgrowths of Candida and other yeasts, strains of the bacterial species Clostridia, and fungi. These imbalances are linked to concerns including gastrointestinal symptoms, changes in neurotransmitter activity, and mood changes. 

There is ongoing research into the link between Candida and Clostridia overgrowths and behavioral or mood changes, particularly in patients with autism spectrum disorder (ASD). (1, 2) Other markers found on the OAT including HPHPA and oxalates may also contribute to these patterns. 

Mitochondrial Function

The OAT looks at a number of markers of mitochondrial dysfunction and stress (which can happen due to toxic overload, chronic stress, and/or nutrient depletion). Organic acid testing is one of the best ways to analyze mitochondrial function, which is a component of many different kinds of chronic disease. 

Metabolic Efficiency

This refers to how well your body processes carbohydrates, fats, and proteins. The OAT gives us insight into glucose metabolism, fatty acid metabolism, and inefficiencies that may be creating energy deficits and other issues. 

Oxalate Metabolites

Elevated oxalates can occur as a result of high dietary intake, yeast overgrowth, or mold exposure. OAT testing is helpful in cases of potential oxalate sensitivity, because it helps us assess not just whether oxalates are high but what might be underlying the issue (e.g. yeast or mold), so that we can tailor interventions accordingly. Oxalate issues have been linked to chronic pain, fatigue, and other health concerns. (3) 

Methylation & Detoxification 

Methylation is crucial for detox, gene regulation, and neurotransmitter function. The OAT can point to poor absorption of B12, folate, B6, and B2, key nutrients for proper methylation. Organic acid testing also looks at glutathione precursors and the presence of oxidative stress to help determine how well your body is metabolizing toxins. 

Neurotransmitter Metabolites

The OAT provides insights into levels of key neurotransmitters including dopamine, serotonin, and norepinephrine. Imbalances can be related to conditions including ADHD, depression, and anxiety. OAT testing looks at activity of the enzyme DBH (dopamine beta-hydroxylase), which has been linked to Parkinson’s disease, Alzheimer’s, and other neurological disorders. (4) 

In cases like Clostridia overgrowth, which impacts norepinephrine production, we can see the gut-brain connection in action with organic acid testing.  

Mold Exposure

Organic acid testing looks at markers associated with mold toxicity, including from Aspergillus. It won’t show you the mold problem directly, but it gives us information on how your body is responding to mold exposure and how it may be impacting your health. 

Other Markers

A few other things we can look at with an organic acid test include (this is not a complete list): 

• Some nutritional deficiencies including vitamin D, B vitamins, and CoQ10 
• Salicylate metabolism
• Metabolism of folate via pyrimidine metabolites
• Amino acid metabolites
• Antioxidant status and other nutritional markers

Who Should Consider Organic Acid Testing? 

There are several different instances in which I would recommend organic acid testing. It’s often very helpful when someone is experiencing chronic symptoms or a chronic illness and conventional tests haven’t uncovered a good reason why. 

With some tests, we’re looking for something specific. For example, a breath test for SIBO or a zonulin test to detect leaky gut. With organic acid testing, we’re getting a diverse picture of so many different inner workings of the body. It can help point us to things we may not have even had a reason to suspect. 

So, it’s very helpful in investigating complex health problems. But it can also be useful when someone is just looking to get a baseline or more information about where they stand metabolically. 

While many different patients with different concerns or goals can benefit from an OAT test, there are a few conditions and symptoms where it may be especially helpful. These include: 

• Chronic fatigue syndrome; fibromyalgia 
• Brain fog and fatigue 
• Autism spectrum disorder (5) 
• ADHD 
• Autoimmune conditions 
• Food sensitivities
• Neurological conditions including Parkinson’s 
• Mood imbalances 
• Chronic pain 

What Are the Limitations of the OAT Test? 

It’s always important to understand what a test is useful for, and what it isn’t. The organic acid test doesn’t provide specific diagnoses. It’s a screening tool that gives us clues, but it doesn’t provide all the answers. 

And, while it does look at many different markers that point to different kinds of imbalances, there are a number of important drivers of chronic disease that OAT tests don’t test for directly. These include inflammation, intestinal permeability, parasites, specific food sensitivities, and many nutrient deficiencies. Other tests may be necessary to get a more complete picture depending on your individual health profile. 

Organic acid levels also tend to change quickly when our inputs change: a shift in diet or a new supplement can make a big difference. This can be a positive thing, particularly when it comes to retesting during or after a protocol. 

But it also gives us another reason to be very intentional about when, why, and how we run the test. If you just came back from a vacation where you were eating a totally different diet than usual, your results might not reflect how your body normally operates. 

Finally, I think it’s very important to only do this test with a practitioner (ideally a functional medicine practitioner) who is familiar with it and knows how to interpret the results (and what to do next).

How To Do the Test 

There are a few different companies that offer organic acid tests. They all work essentially the same way, but some look at more markers than others (this is usually reflected in the cost of the test) and their lab testing methods may vary. 

To do an organic acid test, you’ll get a test kit from your provider and collect a urine sample at home. Your sample should be your first morning urine, before you’ve consumed any food or drink. You’ll freeze your sample and then send it directly to the lab via courier (shipping documentation and everything you need comes with your test kit).

There are a few specific foods and supplements that may need to be temporarily avoided prior to collection, as they can skew your test results. Your practitioner can also help determine if any medications you’re taking may interfere with the accuracy of your results. 

Turnaround time is usually a few weeks, and then a report will be sent to your provider. 

Finding Clues About Your Health

Organic acid testing doesn’t give us all of the answers (no single test does), but when done with a knowledgeable functional medicine practitioner, it can provide us with several helpful clues and point us in the direction of what to do next. 

If you’re interested in pursuing organic acid testing or want to learn more about our personalized approach to wellness, please reach out to schedule a consultation with our telehealth functional medicine clinic.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

Sources

• Gokay, O. E., & Sibel, B. (2023). Might the fungus Candida albicans be a risk factor for autism? A meta-analysis study. African Health Sciences, 23(4), 230-235.
• Kandeel, W. A., Meguid, N. A., Bjørklund, G., Eid, E. M., Farid, M., Mohamed, S. K., … & Hammad, D. Y. (2020). Impact of Clostridium bacteria in children with autism spectrum disorder and their anthropometric measurements. Journal of Molecular Neuroscience, 70(6), 897-907.
• Lorenz, E. C., Michet, C. J., Milliner, D. S., & Lieske, J. C. (2013). Update on oxalate crystal disease. Current rheumatology reports, 15(7), 340.
• Ghosh, A., Biswas, A., Sadhukhan, T., Das, S. K., & Ray, J. (2014). Role of Dopamine β Hydroxylase (DBH) in Parkinson’s disease patients of Indian population. Molecular Cytogenetics, 7(Suppl 1), P122.
• Chen, Q., Qiao, Y., Xu, X. J., You, X., & Tao, Y. (2019). Urine organic acids as potential biomarkers for autism-spectrum disorder in Chinese children. Frontiers in cellular neuroscience, 13, 150.