Organic Acids Test (OAT): Interpreting Results!

Hi friends!

As mentioned in my previous blog post, I wanted to post and review the results of my organic acids test (OAT) that I did right before clearing SIBO (May 2019).

This test is quite valuable, as it gives you an analysis of 48 markers (possibly more depending on which lab you do your test with). The key of course is properly interpreting the results, so that you reap the full value of the test!

If you take a quick look at some of the below screenshots of my test results, you’ll notice the marker names are very “technical” and not exactly user-friendly, unless you’re some sort of health professional. Actually, funnily enough, my naturopath also needed a bit of help from Genova (the supplier of my test) to break down the results for me!

So in essence, this test is not the easiest to understand, but with a bit of time (or maybe a lot, it took me several hours to go through this myself, honestly) and help from your health care professional, it should make sense and paint a great picture of your health. With this information, it will be easier to know where to focus on, treatment-wise.

In summary, the results for me personally, revealed a very big and significant issue with my B vitamins. Mainly stemming from a protein malabsorption issue, despite eating adequate amounts of meat.

Now, if you are anything like most people who have SIBO, having issues with malabsorption is not shocking or rare. However, because I eat quite a lot of meat every day, I would never have suspected protein would be an issue for me. I assumed it was only plants and fiber that I wasn’t breaking down well (they seemed to bloat me the most). Because of this unexpected result, I really believe in the value of testing and getting hard data, when trying to solve your health issues! Playing the guessing game will not only cost you more time and energy, but potentially a lot of frustration and money (supplements aren’t cheap, amiright?).

Having a deficiency in B vitamins can cause a whole host of issues, including your dopamine production, energy, mood, and can even lead to increased levels of toxic build-up, such as ethylmalonate (you’ll see more on this below).

I reference and use a website (healthmatters.io) frequently throughout this post that I found extremely helpful in interpreting my test results! I recommend checking them out. All you need to do is copy and paste your marker name into their search bar, and read their explanation below.

If you do not have a healthcare professional to work with when interpreting this test, then healthmatters.io as a resource is a great tool! I suggest simply writing down each marker and its explanation, based on your result (whether it is in the high or low range). Then as you go along, you will begin to see a pattern or connections, which can help you to decide which areas to focus on, and/or which dietary or supplement regimen to start.

As always, I recommend working with a healthcare professional, but I also understand that is simply not always viable for everyone (due to financial or geographical reasons). Under those circumstances, I think it's important to be able to provide as much resource and information to others, to empower us to sort out our own health issues 🙂

I plan on having another OAT test done soon, as this one was done almost a year ago, now. I am in a much better place, health-wise (but still not 100%), so I am very curious to see how things have changed and be able to adjust my health protocol accordingly!

If you want to see more details on my test results, or want to have help understanding your own test, please continue reading below, where I break down most of my results. Maybe some of your results overlap with mine and it will benefit you to understand the break-down I go through 🙂

My Organix Test Results

Fatty Acid Metabolism markers

3 – Ethylmalonate (3), together with Adipate (1) and Suberate (2), gives information about your ability to process fatty acids!

Suberate, Adipate, and Ethylmalonate elevations can indicate that you may need additional carnitine and/or vitamin B2 to assist your cells in converting fats into energy efficiently

Anything that interferes with the normal fatty acid oxidation may reveal high levels of these metabolites.

For my specific results, ethylmalonate is the only one marker in this category that is going into the range of being too high.

Adipate, Suberate, and Ethylmalonate elevations indicate metabolic blocks. Carnitine is needed to move fatty acids into the mitochondria where they are converted to energy using vitamin B2 (riboflavin).

When insufficient levels of carnitine or vitamin B2 (riboflavin) slow down this process, other parts of the cellular machinery take over and make adipate and suberate. A similar block in another pathway causes high ethylmalonate

Ethylmalonate, which comes from the breakdown of butyrate, has a carnitine-dependent pathway and can accumulate with an insufficient amount of carnitine. Dietary fat, carbohydrate, and protein are all broken down to produce energy using pathways that require vitamin B2 (riboflavin).

Dietary fat, carbohydrate, and protein are all broken down to produce energy using pathways that require vitamin B2 (riboflavin). If you do not have sufficient riboflavin, compounds such as succinate, adipate, suberate, and ethylmalonate are found high in urine.

Riboflavin is a B vitamin (B2) and due to malabsorption in my case (I eat plenty of meat, eggs), my naturopath suggested I take Amino Replete, by Pure Encapsulations! It contains essential amino acids, which could help with the deficiencies.

It's important to fix this issue, as high levels of ethylmalonate can act as an acidogen and a metabotoxin. An acidogen is an acidic compound that induces acidosis, which has multiple adverse effects on many organ systems.

A metabotoxin is an endogenously produced metabolite that causes adverse health effects at chronically high levels. Ethylmalonic acid is an organic acid. Abnormally high levels of organic acids in the blood (organic acidemia), urine (organic aciduria), the brain, and other tissues lead to general metabolic acidosis.

In adults, acidosis or acidemia is characterized by headaches, confusion, feeling tired, tremors, sleepiness, and seizures”.

One of my biggest symptoms with SIBO were extreme fatigue – seriously, I would sleep for 10-11 hours a night, wake up tired, and needing a nap later in the afternoon – and brain fog (not a great thing to have as a University student who also worked full time!).

Having these results helped make sense of my symptoms, validated them, and also gave me a clearer path to take on how to fix it!

Carbohydrate Metabolism markers

There are two main components to give attention to, in this criterion:
5- L-Lactate and ß-Hydroxybutyrate (6) are in the high end of the spectrum

According to Healthmatters.io (https://healthmatters.io/understand-blood-test-results/l-lactate) high L-Lactate “indicates insufficiency of coenzyme Q10 (CoQ10), a nutrient that enables the body to use oxygen to generate large amounts of energy.

It is important for athletes in maintaining intense muscular activity. CoQ10 is also a potent antioxidant and may help to slow the aging process and prevent a variety of degenerative diseases. Risk for certain kinds of heart disease, cancer and hypertension are increased when CoQ10 is insufficient.

When both L-Lactate and pyruvate are high, there may be insufficient lipoic acid, a type of B-vitamin.

So again, B vitamins are missing (despite eating more than enough meat every day!! A pattern is forming)

6 – ß-Hydroxybutyrate:

According to Healthmatters.io, high levels of b-Hydroxybutyrate can signal that your body is producing ketones, or is in a state of ketosis.

This one is a bit tricky to understand in some cases, as it can be caused by a couple of factors.

1 – If you are eating a low-carb diet, naturally, your body will go into a state of ketosis (when your cells do not get a steady supply of sugar from dietary carbohydrate, they begin to burn fat instead, and ketones are a by-product of this mechanism).

Based on the way I was eating (paleo), it is entirely possible that I was in ketosis without intending to be. It could also be possible that I was eating enough carbs to not be in ketosis, but if there were any digestive disturbances (well, there definitely were, thanks SIBO!), it's possible that I was simply not digesting and/or absorbing them correctly, resulting in ketosis.

Unfortunately at this point in time, i was not tracking my calories or macros (I only began doing that about 6 months later, to help myself gain back sibo-lost weight), so it's difficult to know for sure what was going on here.

If you know for sure that you are eating an adequate amount of carbs to not be in ketosis, yet you still have high levels of ß-Hydroxybutyrate on an OAT test, it is recommended to supplement with the following:

chromium
vanadium
lipoic acid (ALA)

Note on lipoic acid: If you have, or are uncertain that you have heavy metal toxicity, specifically mercury, it is ill-advised to be taking ALA (According to the Andy Cutler protocol), due to its ability to chelate (in simple terms, detox) mercury.

Taking ALA willy-nilly, without the proper protocol (such as the Andy Cutler protocol) is something I would strongly advise against, just based on the research and personal experience I have with ALA. It can make you feel much much worse, instead of better. ALA affects those with mercury in a very different way than those without it!

2 – Second possible factor to having high levels of ß-Hydroxybutyrate is insulin issues. Having high levels of ß-Hydroxybutyrate can be a sign of insulin resistance. The risks associated with insulin resistance is type 2 diabetes.

Getting to the root cause of this insulin/glucose dysregulation is important to avoid developing type 2 diabetes among other issues. There are various root causes that can cause your body to be insulin resistant, such as stress, excess body weight, diet too high in sugar/carbs, lack of exercise.

Energy Production markers

For the energy production markers, I don’t recall my naturopath saying too much about this (I don’t have much in my notes), except for point 7, 8, 9, where she suspected malabsorption, due to the fact that I do eat a sufficient amount of protein, yet the values are on the low end.

This is likely because none of them are in the full “danger zone” on the spectrum, however to me, none of them look optimal, either, except for point 14 (Hydroxymethylglutarate).

By the way, it really bugs me when doctors tell you that your tests look “normal”, when really we want optimal! Most of these markers are “normal”, but that doesn’t necessarily mean they aren’t bordering on “at risk”, or aren’t worthy of giving any attention to.

When doing my own research (because in case you haven’t discovered this by now, you will need to do a lot of it yourself!), many of these markers are on the “at risk” spectrum.

For example, point 7 (citrate), is low. Normal, yes, but at risk of being abnormal!

Point 11 (Succinate) was quite low, and when evaluated, it seems to be a lack of leucine or isoleucine – essential amino acids. So again, taking a supplement in an easily digestible form (such as the Amino Replete mentioned above) would likely be beneficial here.

B-Complex Vitamin Markers

There is a decent amount to cover in this section, so I will break it down again by marker:

15 – a-Ketoisovalarate:  <DL = This means the value was too low to be detected. When looking this value up on Healthmatters.io, it says “Possible low B6; OR secondary to low branched-chain amino acids”. Low B vitamins seem to be a trend in some of my other results, so this makes sense to me.

a-ketoisocaproate: Result (0.06) falls under the “At Risk” category on the spectrum. Healthmatters says “Possible low B6 or secondary to low branched-chain amino acids”.

In case you aren’t familiar with what “branched chain amino acids” are, they are also known as BCAAs – a group of three essential amino acids: leucine, isoleucine, and valine. Our bodies cannot produce these on their own so it must come from food (like meat or eggs).

Again, since I consume plenty of animal protein, this doesn’t make sense and could be a sign of malabsorption or if you have an issue with your MTHFR gene (I did a DNA test and submitted to SelfDecode and my MTHFR gene is “bad” or not working properly).

Here is a snapshot of my MTHFR gene report from SelfDecode

Because this gene or enzyme is responsible for creating methylfolate, if your MTHFR gene is less active (due to a genetic mutation), it can cause issues within the body.

According to my SelfDecode report: Methylfolate helps eliminate levels of homocysteine, a toxic amino acid. A build-up of homocysteine has consequences on our health, such as worsened inflammation (we have enough of that with sibo and/or leaky gut going on!), oxidative stress and accelerates aging.

It can also contribute to heart disease, increase depression and anxiety, and impaired cognition !

Essentially, if you do have a low acting MTHFR gene, it can lead to deficiencies and health issues, and therefore it is recommended to supplement with a B-complex, which contain mixed forms of folate (methylfolate and folinic acid).

The best form of methylfolate, based on my research, is “Quatrefolic (6S)-5-methyltetrahydrofolat”. This is according to this website, check it out for more details.

If you want to find out if you have a mutation with your MTHFR gene, sign up at SelfDecode  !

17 – a-keto-b-methylvalerate: DL = Again, too low to pick up on the test!

Vitamins B1 , B2 , B3 , B5 , and lipoic acid are needed for this dehydrogenase to function properly. If these nutrients are insufficient, the keto acids may build up in the urine (I did have high ketones showing up in my test earlier on under ß-Hydroxybutyrate).

I need to supplement a good B-complex! I also cannot supplement with lipoic acid (ALA) because I have mercury toxicity, and this can act as a chelator/binder. This must be done carefully with proper scheduling if you are mercury toxic (if interested in more info on this subject, check out the Andy Cutler protocol or join their Facebook group to get started).

18 – Xanthurenate: My result is on the higher side of the spectrum.

Check out this great explanation by Healthmatters:

High levels can indicate an insufficiency of B6, a vitamin critical for all protein metabolism. Use of medications (e.g., oral contraceptives, anti-hypertensives, and bronchodilators) and exposure to tobacco smoke, pesticides, and other agricultural products can all contribute to insufficiency of vitamin B6.

Symptoms of vitamin b6 deficiency:

Changes in mood, such as irritability, anxiety and depression, confusion, muscle pains, low energy, or fatigue (check, check and check!)

Treatment options:

Foods high in B6 include pinto beans, avocado, pistachios, sesame and sunflower seeds. Supplementation may be advised.

19 – B-hydroxisovalerate: This marker is related to Biotin. Mine is right in the middle, so nothing to be concerned about at this time.

If your results are too high, you may want to consider supplementing with Biotin or addressing dysbiosis (if you are ruling out other possibilities, it might mean you have malabsorption from SIBO or other dysbiosis).

Symptoms of low biotin include:
hair loss
skin rash
dermatitis
immune deficiencies
gait disturbances
tremor
muscle weakness

20 – Methylmalonate: Although my results are not overwhelmingly high, because I have some of the symptoms that come with high Methylmalonate (which signals low B12), I will keep an eye on this one for when I re-test.

Symptoms associated with high Methylmalonate / low B12:

– Fatigue,

– poor memory,

– brain fog,

– unsteady gait,

– numbness, tingling,

– and depression

For now, I will continue to supplement with a good B-Complex, and take Amino Replete.

21 – Formiminoglutamate:

Formiminoglutamate (FIGLU) is a functional marker of insufficiency of folic acid, another B-vitamin, and is a compound made from the amino acid histidine.

My results are right in the middle, but again since I have the mutated MTHFR gene, have taken contraceptives for long periods of time (I have since went off them to try and regain my health) and have some of the symptoms of low folic acid (persistent fatigue, weakness, lethargy, irritability), I will also be keeping an eye on this one for the re-test, as well as continue with the supplements!

Neurotransmitter Metabolism Markers

22 – Vanilmandelate: This marker is for the “fight or flight mode”, and depending on how low or high this and Homovanillate are, it can mean different things. I would suggest checking out Healthmatters’ website for details!

My results, because Vanilmandelate is somewhat low, and Homovanillate is low, it could mean that dopamine, norepinephrine, and epinephrine levels are low.
I also have symptoms associated with low levels of epinephrine and norepinephrine, such as:

anxiety.
depression.
changes in blood pressure.
changes in heart rate.
low blood sugar, or hypoglycemia.
migraine headaches.
problems sleeping.

I have since taken measures to reduce stress and deal with emotional/childhood trauma that has put me in the “fight or flight mode” for years on end.

Things such as:
Quitting my job (toxic and stressful environment is no good for anyone)
Meditation
Taking time for myself and the things I enjoy (reading, taking a bath, drawing, playing with my cats, seeing friends, baking)
Therapy. I have partaken in CBT therapy for a few years off and on, but have recently opted for EMDR therapy. An evidence-based approach to trauma.
Exercise
Getting enough sun each day
Eating well

23 – Homovanillate: Take a look at HealthMatters' great explanation:

Homovanillate (aka Homovanillic Acid) is a dopamine metabolite.

Low Homovanillate indicates low levels of dopamine. Symptoms associated with this condition are depression, sleep disturbances, inability to deal with stress, and fatigue (you know me too well, healthmatters!).

Possible causes:

– Low precursors/neurotransmitters (phenylalanine, dopamine, noradrenalin)

– Low cofactors (B2, B3, B6, Mg or Fe)

– Impaired methylation

Treatment considerations:

Treatments to improve digestion, along with supplementation of tyrosine or phenylalanine (again, amino acids!), can help improve the ability to keep up with demand for these neurotransmitters.

– L-tyrosine & B6

– B2, B3 or Fe if low

– Support methylation (methionine/SAMe, B6, B12, folate, Mg)

Personally, this one makes sense and doesn’t surprise me. I suffered from depression and anxiety, and terrible quality sleep for a long time.

24 – 5-Hydroxyindoleacetate:
5-Hydroxyindoleacetic acid (5HIAA) is a breakdown product of serotonin that is excreted in the urine.

What does it mean if your 5-Hydroxyindoleacetate result is too low?
Low 5-HIAA indicates inadequate production of serotonin. 

Symptoms include:
Constipation
Depression
Fatigue
Insomnia
Attention deficit and behavioral disorders

90% of serotonin is produced in the gut. Makes total sense that many with gut issues also suffer from the symptoms associated with low serotonin levels.

Lower levels of 5-HIAA may mean you have:

– Depression

– Migraines

What does it mean if your 5-Hydroxyindoleacetate result is too high?
High 5-HIAA can be caused by SSRI medication, 5-HTP supplementation, increased release of serotonin from the central nervous system, digestive system or platelets. Very high 5-HIAA levels can ironically indicate a tryptophan deficiency, as this may cause an increased conversion of tryptophan to serotonin.

There are some guidelines you might want to follow before doing the OAT test, to avoid any false positive/negative results.

These things include:
One should also avoid caffeinated beverages such as tea and coffee or caffeinated foods for 48 hours before and during specimen collection.

Certain medicines can raise or lower your 5-HIAA levels.

Eating certain foods containing serotonin can raise 5-HIAA levels.

Strenuous exercise can also raise your 5-HIAA levels.

Check out Healthmatters for more details!

25 – Kynurenate:
You may have high levels of Kynurate and xanthurenate in your urine if you have a B6 deficiency.

26 – Quinolinate:

High levels of quinolinate are associated with increased oxidative stress. Significant elevations in one or more of these compounds could indicate a strong need for other antioxidants as well. Supplementing with Vitamin E may be useful. It works to remove harmful molecules that degrade the fatty acids that make up cell membranes.

According to Healthmatters:

High levels might be associated with mental illness, ALS, alzheimer's and depression. Studies have demonstrated that quinolinic acid may be involved in many psychiatric disorders, neurodegenerative processes in the brain, as well as other disorders such as mental illness, ALS, alzheimer's and depression.

Increased levels of quinolinic acid have also been detected in Lyme patients with central nervous system inflammation.

The following substances have been proven to lower levels of quinolinic acid:

Sulforaphane

Selenium

Melatonin

Theanine

Green Tea Polyphenols

Curcumin + Piperine

Since my levels are high, I am supplementing with Vitamin E, derived from Sunflowers, rather than Soy as I am intolerant to soy.

Vitamin E helps reduce inflammation and protect you from molecules that degrade
the fatty acids that make up cell membranes. It is a great antioxidant, as well as Vitamin C. I take high amounts of Vitamin C (about 4 grams a day, but take until your bowel tolerance) to protect myself from oxidative stress caused by mercury toxicity.

Working on your gut health and clearing any dysbiosis will be one step to reducing the inflammation that is causing high levels of quinolinic acid to be produced and shown in your urine.

There may be other causes as well that are worth investigating. I would recommend re-testing and doing another OAT test after clearing the dysbiosis, to see if your levels have decreased into optimal range.

27 – Picolinate:

Picolinate is a neurotransmitter metabolism marker and is produced under inflammatory conditions.

If your Picolinate is low, and your quinolinic acid is high: symptoms may show as mental, emotional, and behavioral problems. Low Picolinate levels can be caused by excessively high fish oil intake.

If your Picolinate is high: elevations can be caused by inflammatory processes induced by the immune system. High protein diets can increase production of picolinate whereas polyunsaturated fatty acids divert the flow through the kynurenin pathway to quinolinate.

You may want to consider:
Lowering your protein intake
Increase fatty acids
Supplement with antioxidants such as vitamin C and/or E

Oxidative Damage and Antioxidant markers

28 – p-Hydroxyphenyllactate: is a marker of cell turnover
My result is in the low end, but if yours is on the high end of the spectrum, it may be indicative of oxidative stress. In that case, an antioxidant such as vitamin C or E might be considered.

29 – 8-Hydroxy-2-deoxyguanosine: 8-hydroxy-2-deoxyguanosine measures the oxidative impact to DNA. 8-hydroxy-2-deoxyguanosine levels will be high if your total antioxidant protection is inadequate.

Under certain circumstances, the balance between the damaging chemicals and protective mechanisms can be upset, resulting in a condition termed “oxidative stress”. High levels reflect high oxidative stress to the cells.

My results are okay, but if yours are high, consider supplementing with Vitamin C, E, lipoic acid (please see my above warning on Lipoic Acid) and NAC, and consuming berries, due to their phenolic compounds, and green tea.

Detoxification Indicators

30,31,32 – all low for toxin markers

33, 34, 35 – detox markers – may need amino acids for 34, so again protein malabsorption issue showing up again.

Bacterial/Yeast markers

Since I did the OAT test right around the time I became SIBO-free, it makes sense none of my bacterial markers are elevated or abnormal. I wish I had done the test earlier, would have loved to see how it looked before treatment!

Thanks for taking the time to go over these results with me! I know it is a bit overwhelming and confusing at first, but I am confident that with some time and reading, you will figure your results out, too!

As always, feel free to leave a comment or send me an email, if you are struggling with your test interpretation. I will do my best to help you out!

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