What an Organic Acids Test (OAT) Measures and Why It Is Helpful for Mold Patients

by Dr. Susan Tanner, MD

Of all functional medicine tests that are available, hands down, the most helpful to me as a clinician is the Organic Acids test done through first morning urine.  When results are paired with a patient’s specific history and the whole picture is interpreted, no other diagnostic gives as much “bang for the buck” as the Organic Acids test, in my opinion.

What Is an Organic Acids Test (OAT)?

An Organic Acids test is not one that you will routinely see in traditional or allopathic medicine, and I think it is a shame, as it has so much to offer.  First, the test is done from urine, so there no need to draw blood. The patient then submits the sample through FedEx to the lab directly; therefore, there is no need for the patient to wait for an appointment to go ahead and get the ball rolling.  What is amazing is just how much insight into the inner works of the body this “simple” urine test can give. 

What Are Organic Acids?

Organic acids are the byproducts of metabolism of every cell in the body.  Metabolism is the biochemical process that reflects cell growth and reproduction. Thus, healthy cellular metabolism provides energy to the whole body.  As each cell does its metabolic job, certain substances called organic acids are released and then excreted by the individual through the urine. By looking at the levels of these excreted acids and the ratios between them, many physical conditions and health symptoms can be explained and corrected.

What Does an Organic Acids Test Tell You?

A full organic acids profile reports over 70 different excreted acids; each with its own significance.  The sheer amount of information provided makes an OAT not an easy test to understand. In fact, it has taken me well over 15 years of experience with clinical study to be able to interpret and fully utilize the guidance that it provides.  Additionally, research on organic acids continues, and more subtle changes are continually recognized to be helpful in predicting certain illnesses before they occur or in understanding why some conditions have failed to improve despite the patient undergoing “the right” treatment.

Understanding OAT Results

The first page of the test results on an OAT is reflective of 18 different acids produced by yeasts, molds, and non-desirable bacteria residing in the small intestine.  Depending on results, mold and mycotoxin exposure, yeast overgrowth, and SIBO/SIFO (small intestinal bacterial/fungal overgrowth) can be diagnosed.  Furthermore, the presence of an overgrowth of certain types of clostridial bacteria may be identified which are hugely disruptive to the immunity of the gut but also to the metabolism of some of the brain chemicals. If there are elevations suggesting mold exposure, then proceeding on with urine mycotoxin-specific testing and mycotoxin testing in the home can and should be done. (Note: Some of my really informed patients sometimes even come to me having done testing with the EC3 Mold Plates prior to the OAT test, so they know their fungal load in their home beforehand.)

The second page of the test looks more at metabolites produced by the mitochondria of the cells. Elevations in these acids demonstrates not only deficiencies in certain B vitamins, coenzyme Q10, glutathione, and other nutrients, but can give a good indication of if the body is or has been under significant oxidative stress.  We know by now that oxidative stress leads to disease in some form or fashion.  When the damage is severe, the need for intervention is even more urgent.  While some oxidative stress may be entirely genetic in origin, identification of environmental or other stressors and appropriate treatment can mitigate many situations before they become dire.

On the organic acids test that I use, there are eight reported levels that reflect the balance of neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin) which effect mood and mental health in the brain.  There have been many depressed or anxious patients who have been helped by seeing exactly how these neurotransmitters are being broken down in the body and, if medications are needed, which ones may be more likely to be helpful.

The next section of the test looks at how well fatty acids are used for energy and at nutritional markers.  If there are imbalances here it usually reflects specific needs for various vitamins such as B12, B6, Vitamin C, Biotin, and more.  Evaluating vitamin needs by urine with excreted organic acids is much more accurate than by using blood levels in my opinion.  Blood levels indicate what is in circulation at a given time but not what is being taken up and utilized by the cells themselves.  Cellular metabolism of vitamins and nutrients determines how you think, act, and feel and is extremely important.

Finally, several metabolites can be present on an OAT that show the ability of the body to detoxify itself through liver function.  Where and what these metabolites are can suggest the things that may have caused the detoxification issues in the first place. Thus, before beginning any detoxification plan or regimen, it is a good idea to look at if and how well detoxification is working in the first place.

Finally, the level of phosphoric acid in the urine quite accurately reflects vitamin D, magnesium, calcium, and vitamin K status. This section of the OAT can be a signal of a poor diet or of nutrient absorption issues. So, while I can only provide a brief overview of the test, I think you can already see that it can provide tremendous value for both patient and practitioner.  As I mentioned, it takes a lot of time and experience to learn the nuances of the results but digging in can really help to figure out the “why” behind many symptoms.

How is an OAT Used to Inform Treatment?

Application of OAT results is usually done in a stepwise fashion; this is where the art of medicine comes in.  Most practitioners will agree that dealing with issues in the small intestine, the gut, must come first.  However, if there is evidence of environmental mold/mycotoxins triggering the symptoms, the patient must make finding a safe, mold-free space, even if it is only temporary the first intervention. Like I stated earlier in this article, the findings in the OAT, when paired with a urine mycotoxin test and reviewed by a skilled practitioner can really elucidate a mold/yeast problem in the digestive system vs. a more systemic mold toxicity issue that also has a gut dysbiosis piece. The two conditions, while often related, can be dissimilar and require different interventions. In the case of mold toxicity triggered by environmental mycotoxin exposure, the patient will need to address their air first, and the mold toxins they are breathing into their body. Once clean air and mold-free living conditions are established, then all treatment and interventions will work much better and have better results. Additionally, if there is evidence of oxidative damage to the cells, such that they are not functioning efficiently and no obvious source of the damage is present, then other testing may be recommended such as genetics, a heavy metal assessment, and/or testing for other toxic or environmental pollutants.

Where Can a Patient Get an Organic Acids Test?

There are several labs that offer this test. I have used many over the years but find Great Plains Laboratory offers the most comprehensive OAT with consistent test results such that I trust the process. The implications of the results with the Great Plains OAT are well-documented as well.  Additionally, Genova and US BioTech offer organic acid testing with slight differences and nuances as to what is tested and how results are measured and presented.

Because an OAT is a lab done by functional and integrative medical practitioners when looking for root causes to illnesses, it is not usually standard of care or a fully insurance-covered diagnostic as of yet. Thus, most of the time, this test is considered an out-of-pocket expense. In my opinion, though, as I stated in the beginning of this article, the information gleaned from an OAT and its usefulness towards informing further testing and treatment is invaluable, especially for those patients who have had all of the “standard” bloodwork and labs, but who still do not have answers about what is causing their health issues.

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