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.
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.
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.
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