- OAT + Amino Acids Urine Test — The Great Plains Laboratory, Inc
- ORGANIC ACIDS TEST
- AMINO ACIDS URINE TEST
- CLINICAL USEFULNESS:
- SPECIMEN REQUIREMENTS
- CPT CODES
- Organic Acids-Metabolic Profile (Test Code 4016) – NutriPATH Integrative and Functional Pathology Services
- Common Conditions:
- Organic Acids Test — The Great Plains Laboratory, Inc
- How are organic acids measured for medical reasons?
- How are organic acids tests used for the treatment of diseases?
- SPECIMEN REQUIREMENTS
- A New Generation of Organic Acid Testing: Pushing the Limits of Detection with New Technology
OAT + Amino Acids Urine Test — The Great Plains Laboratory, Inc
The Great Plains Laboratory, Inc. is now offering the Organic Acids Test and Amino Acids Urine Test as a combination. This combo test is an excellent option if your insurance company doesn't reimburse for the standalone Amino Acids Urine Test. Below is an overview of the tests:
ORGANIC ACIDS TEST
The Organic Acids Test offers an accurate evaluation of intestinal yeast and bacteria.
Abnormal toxic levels of these microorganisms can cause or worsen behavior disorders, hyperactivity, movement disorders, affect energy levels and immune function.
Many people with chronic illnesses and neurological disorders often excrete one or more abnormal organic acids in their system. The cause of these toxic levels include: oral antibiotic use, high sugar diets, immune deficiencies, and genetic factors.
If abnormalities are detected in the Organic Acids Test, treatment can include supplements, vitamins, antioxidants and dietary modification.
Upon treatment, patients and physicians have reported significant improvement such as decreased fatigue, regular bowel movements, increased energy and alertness, increased concentration, improved verbal skills, less hyperactivity, and decreased abdominal pain.
Patent # 5,686,311 for specific Organic Acids Test compounds: Certain uses of the compounds arabinose, citramalic, tartaric, 3-oxoglutaric, carboxycitric, 3,4-dihydroxyphenylpropionic (DHPPA), and 3-(3-hydroxyphenyl)-3-hydroxypropionic (HPHPA) acids in their application to autism in the Organic Acids Test and Microbial Organic Acids Test are protected by USA patent 5,686,311 granted November 11, 1997.
AMINO ACIDS URINE TEST
The Amino Acids Urine Test offers important clinical data on metabolic, nutritional, and neurological disorders.
The test analyzes 40 amino acids and provides a detailed explanation of the possible causes and consequences of detected abnormalities, along with nutritional information.
Amino acid imbalances are frequently underlying factors in disorders such as ADD, depression, Tourette syndrome, tic disorder, OCD, seizures and others.
- Because the OAT and Amino Acids Test quantitate different markers for assessing GI function, detoxification capacity, and certain nutritional deficiencies, together they provide a more in-depth evaluation of overall nutritional status and digestive sufficiency.
- Sampling for the two tests at the same time strengthens the usefulness of the single tests.
- The tests show a total of 115 markers (75 OAT metabolites and 40 amino acids combined).
- Along with a physician's clinical assessment, a treatment plan can be designed from the two tests, including nutritional supplementation, treatments for dysbiosis, and indications for genetic testing.
- Simple testing — urine is collected at home and mailed to the lab.
Organic Acids Test:10 mL of first morning urine before food or drink is suggested. Patient should avoid apples, grapes (including raisins), pears, cranberries and their juices 24 hours prior to specimen collection.
Avoid arabinogalactan, echinacea, reishi mushrooms, and ribose supplements for 12 hours before collection.
Amino Acids Urine Test: 25 mL of of first morning urine before food or drink is required for the random collection.
Organic Acids-Metabolic Profile (Test Code 4016) – NutriPATH Integrative and Functional Pathology Services
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The organic acids test is a simple urine test that looks at biomarkers from various metabolic pathways. These biomarkers give an overview of several major systems in the body and an analysis of nutritional deficiencies in the body. The organic acid test is a nutritional test providing insights into the body’s cellular metabolic processes.
Organic acids are metabolic intermediates that are produced in pathways of central energy production, detoxification, neurotransmitter breakdown, or intestinal microbial activity. Marked accumulation of specific organic acids detected in urine often signals a metabolic inhibition or block.
The metabolic block may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up or drug effect.
The Organic Acids metabolic test is the preferred test used in clinical practice as many functional medicine practitioners believe the metabolic panel provides remarkable data about a patient from one simple urine collection kit.
This test assess a wide range of cellular and physiological processes including intestinal dysbiosis, energy production, nutrient cofactor requirements and neurotransmitter metabolism.
By evaluating organic acid levels and pinpointing the metabolic dysfunctions occurring at the cellular level, a comprehensive, customised treatment strategy can be tailor-made for each individual patient.
This test is the single most comprehensive test in evaluating:• Citric acid cycle abnormalities• B-group vitamin utilisation• Neurotransmitter abnormalities• CoQ 10 sufficiency• Amino acid insufficiencies• GUT Dysbiosis• Yeast infestation• Nutritional deficiencies
• Fatty acid metabolism
• Fatigue• Mood changes• Blood sugar dysregulation• Weight gain• Nausea• Multiple chemical sensitivity• Bloating, gas and distention• Joint pain• Acid reflux• Autoimmune disorders
Liquid chromatography–mass spectrometry (LC-MS/MS)
Organic acids for Bacterial dysbiosis, Yeast & fungal dysbiosis, Citric acid cycle metabolites, Ketone/fatty acid metabolites, Cofactor sufficiency markers, Neurotransmitter metabolites (HVA, VMA, 5HIAA)
NutriPATH practices in the usual practitioner-referral system for pathology laboratories.Patients are highly recommended to seek the supervision and guidance of a qualified healthcare practitioner for the interpretation of any lab results and associated information. NutriPATH can offer assistance in locating a suitable practitioner
Find a Practitioner
Registering with nutripath is simple and easy. Licensed healthcare practitioners may begin the process of opening an account here.
Healthcare practitioners can log in to their unique client portal to submit test request, order inventory materials, download patient results, and have access to other clinical support tools.
NUTRIPATH offers more tests than any other integrative medical laboratory. With more than 200 tests available, it is the anti-aging and integrative medical practitioners’ one-stop-shop with assessments that investigate endocrine, gastrointestinal, immunological, genomic, metabolic and nutritional balance.
Organic Acids Test — The Great Plains Laboratory, Inc
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.
How are organic acids measured for medical reasons?
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.
How are organic acids tests used for the treatment of diseases?
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 blood stream and may alter the metabolism of neurotransmitters such as dopamine.
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 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.
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 48 hours before collection.
A New Generation of Organic Acid Testing: Pushing the Limits of Detection with New Technology
Shaw, William Ph.D
More than 50 phenotypically different organic acidemias have been discovered since the first known disease of this type, isovaleric academia, 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 relatively weak organic acids that 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 academia, or organic aciduria.
Although this technology has commonly been used for diagnosing genetic disease in children, genetic diseases in adults have also been detected with it.
New applications of organic acid testing include detection of factors in psychiatric disorders, mitochondrial disease and dysfunction, and exposure to a wide variety of toxic chemicals from the environment, and assessment of inflammation due to overproduction of quinolinic acid from tryptophan.
Testing now includes markers for the following metabolites:
- Krebs Cycle
- Amino acid Metabolism
- DNA, RNA metabolism
- Neurotransmitter metabolism
- Organophosphate metabolism
- Yeast, fungal markers
- Markers for beneficial bacteria
- Oxalate markers for kidney stones, genetic disease
- Specific marker for ammonia toxicity
- Markers of fatty acid catabolism
- Metabolic diseases causing autism spectrum disorders
- Dry cleaning solvents
- Vinyl chloride
- Specific Clostridia marker
- Specific mitochondrial disease markers
- Vitamin deficiency markers
- Phosphate marker of bone function
- Marker for glutathione precursor
- Genetic screening with extremely sensitive markers
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 detected in urine with greater accuracy and precision than with blood samples.
The number of organic acids found in urine is enormous: over 1000 have been detected since this kind of testing started 25 years ago. The challenge of dealing with so many compounds led to the use of gas chromatography-mass spectrometry (GC/MS) to analyze these complex body fluids.
With GC/MS, organic acids are chromatographically separated on the basis of their polarity and volatility and then bombarded by an electron beam that fragments the eluting molecules in a characteristic pattern. The patterns, or spectra, are stored by a computer system and then compared with known spectra that are compiled in a spectral “library.
” The software then compares an unknown spectrum to all the spectra on the hard drive and prints out those with the best fit. Since a single organic acid analysis generates over 1000 spectra, and each spectrum may consist of 600 ions, the software must be optimized to analyze the data in the most efficient and clinically relevant manner.
Recently, the Great Plains Laboratory Inc.
increased the sensitivity of this technology by approximately 1000-fold with the use of new triple-quadrupole MS technology so that a large number of toxic compounds can be measured at levels of micromoles/mole creatinine compared with urine compounds, such as vanillylmandelic (VMA), which is measured at levels of millimoles/mole creatinine.
The scope of organic acid testing has been markedly widened by commercial laboratories such that it can monitor physiological changes in nongenetic diseases and offer tremendous help in diagnosis and treatment of most chronic illnesses. Some examples are given below:
An adult with a movement disorder and bilateral temporal arachnoid cysts by brain imaging was found to have very elevated glutaric acid, indicating the presence of the genetic disease glutaric aciduria type 1.
1Symptoms of this potentially fatal disorder include headaches, ataxia, memory loss, and many other neurological effects.
Treatment with high doses of carnitine may be helpful in relieving symptoms in such cases, and of course such information is important for genetic counseling.
High levels of urine oxalates in an adult with frequent kidney stones led to a closer examination of the patient's dietary history. The patient ate a large spinach salad with pecans almost every day.
Spinach is one of the foods highest in oxalates, and all nuts are high in oxalates as well. Treatment is directed at reducing dietary oxalates as well as calcium citrate and vitamin B6 supplementation.
After organic acid testing, a child with autism was found to have very high values (more than four times the upper limit of age-appropiate normals) of the catecholamine metabolites VMA and HVA, indicating a possible neuroblastoma. Follow-up imaging near the spine confirmed the presence of a previously undiagnosed neuroblastoma, ly saving the child's life.
Another child thought to have autism had very low amino acids, and the neurologist recommended high doses of amino acid supplements, which made the child severely ill.
Organic acid testing revealed a massive excretion of methylmalonic acid, indicating that the child had methlmalonic aciduria, a severe genetic disorder. Treatment of this disorder requires extensive supplementation with vitamin B12 and a low-protein diet.
Continued amino acid supplementation or a high-protein diet might have been fatal.
A person with severe depression was found to have low amounts of the serotonin metabolite 5-hydroxy-indoleacetic acid, which is derived from tryptophan. Depression is associated with decreased brain serotonin. However, the tryptophan metabolite by an alternate pathway, quinolinic acid, was much higher.
Quinolinic acid is associated with inflammation such as arthritis and is considered to be neurotoxic, with a probable role in Parkinson's syndrome, Alzheimer's disease, Huntington's disease, and schizophrenia.
2,3 The condition eosinophilia myalgia syndrome (EMS), associated with excessive tryptphan intake, is probably not due to tryptophan itself but to the inflammatory effects of its major metabolite quinolinic acid. Quinolinc acid administered by itself generated all of the symptoms of EMS.
4,5 This research indicates that various conspiracy theories about contaminated tryptophan batches as the cause of EMS are unnecessary and probably wrong. 100% pure tryptophan at high enough doses will produce significant quantities of toxic quinolinic acid and EMS in susceptible individuals.
Administration of 5-hydroxytryptophan (5-HT or 5-HTP) is a much safer option than tryptophan since 5-HT cannot be converted to the neurotoxic quinolinic acid, whereas only about 1% of tryptophan is converted to serotonin.6 Both the serotonin metabolite and quinolinic acid are measured by organic acid testing (Figure 1).
I recently proved that the dibiosis marker 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), the predominant dihydroxy-phenylpropionic acid isomer in urine measured in the organic acid test, is due to a combination of human metabolism and the metabolism by a group of Clostridia species, including but not limited to C. difficile.
7 The same article indicates that 3,4-dihydroxyphenylpropionic acid (DHPPA) is a marker for beneficial bacteria in the gastrointestinal tract such as Lactobacilli, Bifidobacteria, and E. coli.
The exception is one species of Clostridia orbiscindens that can convert the flavonoids luteolin and eriodictyol (which occur only in a relatively small food group that includes parsley, thyme, celery, and sweet red pepper) to DHPPA. The quantity of C. orbiscindens in the gastrointestinal tract is negligible (approximately 0.
1% of the total bacteria) compared with the predominant flora of Lactobacilli, Bifidobacteria, and E. coli.7 DHPPA is an antioxidant that lowers cholesterol, reduces proinflammatory cytokines, and protects against pathogenic bacteria.
Outdated literature has referred to HPHPA as due to dietary origin based mainly on conjecture, but this conjecture was clearly disproved by my 2010 article which indicates that the metabolite is abolished by the antibiotic metronidazole.
8 DHPPA, a different isomer, has been claimed to be a metabolite of Pseudomonas species, but the literature indicates that this compound is formed by the in vitro action of these species on quinolone, a component of coal tar – a substance missing from the diet of virtually all humans.9
HPHPA has been one of the most useful clinical markers in recent medical history. Treatment of individuals with high urinary values with metronidazole, vancomycin, or high doses of probiotics has led to significant clinical improvements or remissions of psychosis, tic disorders, seizures, autistic behaviors, hyperactivity, chronic fatigue syndrome, and obsessive compulsive behavior.
One of the newest aspects of organic acid testing is the screening for 74 different toxic chemicals in the environment by testing their organic acid metabolites. Solvents such as benzene, toluene, styrene, and others may be present for only short periods in body fluids and may also be lost in transit due to their volatility, but their metabolites are very stable.
Using this screening technique, most metabolites of different organophosphates and pyrethrins can be measured as well as trichloroethylene, tetrachloroethylene, and vinyl chloride.
Phthalates, an extremely toxic group of compounds implicated in infertility and abnormal sexual development in both males and females, can be measured by their metabolite phthalate, a specific chemical entity.
The chemical structure of phthalic acid (or phthalates) is nearly identical to quinolinic acid.
A toxic effect occurs when phthalic acid competitively inhibits the reaction by which quinolinic acid is converted to the beneficial coenzyme NAD.
High concentrations of phthalic acid or quinolinic acid may be associated with increased toxicity due to phthalate blockage of NAD formation and potential mitochondrial dysfunction due to deficient NAD for mitochondrial energy production.
One of the most important advances in the organic acid test is the addition of a biochemical marker, tiglylglycine, as a specific indicator for mitochondrial dysfunction.11 Mitochondrial dysfunction has been implicated in Parkinson's and Alzheimer's syndromes, diabetes, autism, chronic fatigue syndrome, aging, and many others.
Tiglylglycine has been shown to be elevated in the urine in mitochondrial disorders involving defects of complexes I, II, III, and IV, protein complexes attached to the mitochondrial membrane that are involved in energy production.
In addition to mutations in mitochondrial or nuclear DNA, mitochondrial dysfunction may also be due to exposures to toxic chemicals such as organophosphates and the solvent trichloroethylene.
The advantage of the organic acid test is that if a mitochondrial dysfunction is detected, a number of different toxic chemicals implicated in mitochondrial damage can be reviewed to find the potential cause.
Trichloroethylene has been found as a contaminant in the municipal water supply of many cities in both the US and Canada, and is used as a degreaser military bases and as a common solvent throughout the chemical industry. Mitochondrial disorders can be treated with a cocktail of nutritional substances including coenzyme Q10, carnitine, riboflavin, and others, when chemical exposure is not detected. If toxic chemicals are found, treatment with the Hubbard protocol can be highly successful for the removal of a wide array of toxic substances.12
- 1. Martinez-Lage J et al. Macrocephaly, dystonia, and bilateral temporal arachnoid cysts: glutaric aciduria type 1. Childs Nerv Sys. 1994;10(3): 198-203.
- 2. Guillemin GJ et al. Quinolinic acid in the pathogenesis of Alzheimer's disease. Adv Exp Med Biol. 2003;527:167-176.
- 3. Stoy N et al. Tryptophan metabolism and oxidative stress in patients with Huntington's disease. J Neurochem. 20015;93:611-623.
- 4. Silver RM et al. Scleroderma, fasciitis, and eosinophilia associated with the ingestion of tryptophan. N Engl J Med. 1990;322(13):874-881.
- 5. Noakes R, Spelman L, Williamson R. Is the L-tryptophan metabolite quinolinic acid responsible for eosinophilic fasciitis? Clin Exp Med. 2006;6(2):60-64.
- 6. Shah GM et al. Biochemical assessment of niacin efficiency among carcinoid cancer patients. Am J Gastroenterol. 2005;100:2307-2314.
- 7. Shaw W. Increased urinary excretion of a 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), an abnormal phenylalanine metabolite of Clostridia species in the gastrointestinal tract, in urine samples from patients with autism and schizophrenia. Nutr Neurosci. 2010;13(3):1-10.
- 8. Kumps A, Duez P, Mardens Y. Metabolic, nutritional, latrogenic, and artifactual sources of urinary organic acids: a comprehensive table. Clin Chem. 2002,48:708-717.
- 9. Shukla OP. Microbial transformation of quinolone by a pseudomonas sp. Appl Environ Microbiol. 1986;51(6):1332-1342.
- 10. Fukuwatari T et al. Phthalate esters enhance quinolinate production by inhibiting alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarbocylase (ACMSD), a key enzyme of the tryptophan pathway. Toxicol Sci. 2004;81:302-308.
- 11. Bennett M et al. Tiglylglycine excreted in urine in disorders of isoleucine metabolism and the respiratory chain measured by stable isotope dilution GC-MS. Clin Chem. 1994;40(10):1879-1833.
- 12. Shaw W. The unique vulnerability of the human brain to toxic chemical exposure and the importance of toxic chemical evaluation and treatment in orthomolecular psychiatry. J Orthomol Med. 2010;25(3).