Organic Acids Test (OAT)

NUTRITIONAL & METABOLIC PROFILE

The Organic Acids Test (OAT) offers a comprehensive metabolic snapshot of a patient’s overall health with over 70 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 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.

Characterization

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.

Measurement

Almost all organic acids used for human testing are measured by a combination of gas or liquid chromatography linked with mass spectrometry. Organic acids are most commonly analyzed in urine because they are not extensively reabsorbed in the kidney tubules after glomerular filtration.  Thus, organic acids in urine are often present at 100 times their concentration in the blood serum and thus are more readily detected in urine.  This is why organic acids are rarely tested in blood or serum. The number of organic acids found in urine is enormous.  Over 1,000 different organic acids have been detected in urine since this kind of testing started.

Modalities

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, mental and/or developmen­tal retardation, 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 blood stream and may alter the metabolism of neurotransmitters such as dopamine.

Complete Evaluation of Key Biomarkers of Metabolism

The Metabolic Analysis Profile specifically tests for organic acids – compounds in the urine that are produced during daily metabolism. This profile assesses major metabolic areas that may be compromised by common lifestyle and dietary factors, such as nutrient deficiencies, toxicity, bacterial overgrowth, or drug effects. Organic acids testing can indicate the functional need for specific nutrients, diet modification, antioxidant protection, detoxification, or other therapies.

The Metabolic Analysis Profile report categorizes test results into major metabolic areas:

Metabolic Analysis Markers

Cellular Energy & Mitochondrial Metabolites

Neurotransmitter Metabolites

Vitamin Markers

Toxin & Detoxification Markers

Tyrosine Metabolism

Metabolic Analysis Profile testing is effective for patient concerns such as: Mood Disorders, Fatigue, Digestive Complaints and, among others, Weight issues/Dietary Guidance

Timing

Patients with chronic symptoms (especially those eating the standard American diet) or those simply seeking general health or sports-performance optimization may benefit from measurement of organic acids to evaluate specific metabolic pathways and biomarkers of enzyme cofactor need. Of the 5750 enzymes cataloged in the April 2016 ExPASy ENZYME database, almost 32% (1817 enzymes) require vitamin and/or mineral cofactors. Even with a “good” diet, many people fall short of these critical nutrients. A 2011 analysis of data from the 2003-2006 National Health and Nutrition Examination Surveys (NHANES) found that a significant percentage of Americans (excluding those taking supplements) had usual intakes of many nutrients below the estimated average requirement (EAR). For instance, the active form of pyridoxine (vitamin B6) is a cofactor in almost 9% of the over 1800 human enzymes requiring a cofactor, affecting pathways involved in amino acid, glucose, and lipid metabolism, as well as the production of hemoglobin and brain neurotransmitters. The NHANES data demonstrated that in adults aged 19 and over (not taking supplements), 15% had usual intakes of vitamin B6 below the EAR. Levels of organic acids associated with B6-dependent pathways may indicate a need for B6 supplementation.

Comparative Analysis

Dr. Roger J. Williams (the scientist who discovered panthothenic acid, vitamin B5) first coined the term “biochemical individuality” in 1956 to explain genetic variability in disease susceptibility, nutrient needs, and drug responsiveness among otherwise seemingly healthy people. Although practices are changing, the traditional medical model does not currently place emphasis on biochemical individuality. The conventional clinical approach to nutrition-related symptoms does not routinely include utilization of comprehensive nutritional testing through organic acids analysis. When testing is performed, select vitamins are typically assessed in blood to determine if the level is sufficient to meet nutrient requirements based on healthy individuals. Organic acids testing aids in the identification of imbalances occurring in the body that may well precede abnormal findings on conventional serum laboratory panels. Organic acids testing allows greater insight into a patient’s biochemical individuality, leading to more targeted therapeutic recommendations.

Conclusion

Metabolic Analysis Profile testing is effective for patient concerns such as: Mood Disorders Fatigue Digestive ComplaintsWeight issues/Dietary Guidance and More

The results and recommendations from the Metabolic Analysis Profile can provide guidance for the development of personalized supplementation, identifying nutritional insufficiencies that may be a contributing factor in complex chronic conditions.

The Metabolic Analysis Profile report allows for easy interpretation and clinically actionable results. It includes a Suggested Supplement Schedule that provides personalized recommendations based on test results. The Interpretation-At-A-Glance section of the report provides facts related to nutrient function, causes and complications of their deficiencies, and dietary sources. Levels of organic acids in the urine can indicate insufficient cofactor micronutrients for critical enzymes that are needed in metabolic pathways.Dysfunctional or insufficient enzyme activity in metabolic pathways can produce an “enzymatic block,” causing the organic acids preceding the block to accumulate and spill into the urine.Traditionally, urinary organic acid assessment is used in neonatal/pediatric medicine to identify genetic inborn errors of metabolism, with severity depending on the degree and type of error. In many cases of genetic inborn errors, the enzymatic defect may be compensated for by high doses of specific vitamin and mineral cofactors and/or dietary interventions. Biochemist Dr. Bruce Ames, an expert in DNA mutations, explains this mechanism:

“Our analysis of metabolic disease that affects cofactor binding, particularly as a result of polymorphic mutations, may present a novel rationale for high-dose vitamin therapy, perhaps hundreds of times the normal dietary reference intake (DRI) in some cases … Feeding high doses of the vitamin raises the tissue cofactor concentrations and thereby increases the activity of the defective enzyme.” Ames, BN, et al. Am J Clin Nutr. 2002;75:616-58.

Modus Operandi

Urine: 10 mL of first morning urine before food or drink is suggested. Patient 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 12 hours before collection.

For more details, schedule a consult

 

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