Overview
Organic acids are cellular byproducts produced through metabolic processes. They provide a "metabolic snapshot" of nutritional status, metabolic efficiency, microbiome balance, detoxification capacity, and neurotransmitter function. The OAT is often used as a comprehensive first-line screening tool when the root cause of symptoms is unclear.
When to Order
- Unclear etiology of chronic symptoms (excellent first-line screening test)
- Autism spectrum disorders (ASD) — Candida/Clostridia markers, oxalates, HPHPA
- Mood disorders (ADHD, anxiety, depression) — neurotransmitter metabolites
- Chronic fatigue — mitochondrial markers
- Suspected fungal/yeast overgrowth — often missed by conventional culture
- Chronic pain — oxalate markers
- Cognitive decline (Parkinson's, Alzheimer's risk assessment)
- Mold illness — assess mitochondrial dysfunction and oxidative stress
- Pediatric patients with behavioral concerns
Mosaic OAT Categories (76 analytes)
1. Gastrointestinal Microbial Markers
Yeast/Fungal Overgrowth Markers
| Marker | Interpretation |
|---|
| Citramalic Acid | Yeast metabolite — Candida, Saccharomyces |
| 5-Hydroxymethyl-2-furoic Acid | Candida/Aspergillus metabolite |
| 3-Oxoglutaric Acid | Yeast/fungal overgrowth |
| Furan-2,5-dicarboxylic Acid | Aspergillus metabolite |
| Furancarbonylglycine | Aspergillus metabolite |
| Tartaric Acid | Candida marker — also found in grapes/wine |
| Arabinitol | Primary Candida marker — invasive candidiasis |
| Carboxycitric Acid | Yeast metabolite |
Clinical Pearl: Elevated tartaric acid with arabinitol strongly suggests Candida overgrowth. Rule out recent grape/wine consumption for tartaric acid.
Bacterial Overgrowth Markers
| Marker | Interpretation |
|---|
| Hippuric Acid | Benzoate metabolism, toluene exposure |
| 2-Hydroxyphenylacetic Acid | Bacterial metabolite |
| 4-Hydroxybenzoic Acid | Bacterial metabolite |
| 4-Hydroxyhippuric Acid | GI bacterial overgrowth |
| DHPPA (3,4-Dihydroxyphenylpropionic Acid) | Beneficial Clostridia — polyphenol metabolite (good) |
| 4-Hydroxyphenylacetic Acid | Clostridia metabolite |
Clostridia-Specific Markers
| Marker | Interpretation |
|---|
| HPHPA (3-(3-Hydroxyphenyl)-3-hydroxypropanoic Acid) | C. difficile and pathogenic Clostridia — dopamine analog that blocks dopamine β-hydroxylase |
| 4-Cresol | C. difficile marker — toxic to colonocytes |
Clinical Pearl: HPHPA is particularly significant in autism, ADHD, and behavioral disorders. It mimics dopamine but blocks conversion to norepinephrine, potentially contributing to aggression, mood instability. Treatment: targeted antimicrobials + high-dose probiotics (esp. Saccharomyces boulardii).
2. Oxalate Markers
| Marker | Interpretation |
|---|
| Glyceric Acid | Oxalate precursor |
| Glycolic Acid | Oxalate precursor |
| Oxalic Acid | Primary oxalate marker — kidney stones, joint pain, vulvodynia |
Clinical Pearl: High oxalates can cause chronic pain, kidney stones, and mitochondrial dysfunction. Cross-reference with Aspergillus markers (Aspergillus produces oxalates). Also consider dietary sources (spinach, almonds, chocolate, sweet potatoes). Low oxalate diet + calcium citrate with meals to bind oxalates.
3. Mitochondrial/Energy Markers (Krebs Cycle)
| Marker | Pathway | HIGH Indicates |
|---|
| Lactic Acid | Glycolysis | Anaerobic metabolism, mitochondrial dysfunction, exercise |
| Pyruvic Acid | Glycolysis → Krebs entry | CoQ10, B1, B2, B3, lipoic acid need |
| Citric Acid | Krebs cycle | Substrate accumulation — mitochondrial stress |
| cis-Aconitic Acid | Krebs cycle | Glutathione depletion, mitochondrial stress |
| Isocitric Acid | Krebs cycle | B3 need, mitochondrial dysfunction |
| 2-Oxoglutaric Acid | Krebs cycle | B1, lipoic acid need |
| Succinic Acid | Krebs cycle | CoQ10, B2 need |
| Fumaric Acid | Krebs cycle | Mitochondrial stress |
| Malic Acid | Krebs cycle | Mitochondrial stress |
| Hydroxymethylglutaric Acid (HMG) | Fatty acid/ketone metabolism | CoQ10 synthesis issue |
Functional Interpretation Pattern:
- Multiple elevated Krebs cycle markers = mitochondrial dysfunction → assess CoQ10, B vitamins, lipoic acid, L-carnitine
- Elevated pyruvic + lactic acid = poor glucose metabolism → assess B1 (thiamine), lipoic acid
- This section is critical for mold illness patients (mycotoxins damage mitochondria)
4. Neurotransmitter Metabolites
| Marker | Neurotransmitter | Interpretation |
|---|
| Homovanillic Acid (HVA) | Dopamine metabolite | LOW: low dopamine (depression, low motivation). HIGH: high dopamine turnover |
| Vanilmandelic Acid (VMA) | Norepinephrine/Epinephrine metabolite | LOW: adrenal insufficiency. HIGH: stress, pheochromocytoma |
| HVA/VMA Ratio | Dopamine/NE balance | HIGH ratio: dopamine β-hydroxylase (DBH) insufficiency — can't convert dopamine to NE |
| 5-Hydroxyindoleacetic Acid (5-HIAA) | Serotonin metabolite | LOW: depression, insomnia, carb cravings. HIGH: carcinoid (rare) |
| Quinolinic Acid | Tryptophan/kynurenine pathway | HIGH: neuroinflammation, B3 deficiency, phthalate exposure |
| Kynurenic Acid | Neuroprotective tryptophan metabolite | Balance with quinolinic acid matters |
Clinical Pearl: The HVA/VMA ratio is clinically powerful. An elevated ratio suggests the body can make dopamine but can't convert it to norepinephrine (DBH deficiency). This is associated with copper deficiency, vitamin C deficiency, and has been implicated in neurodegeneration. Support with copper (if deficient), vitamin C, and address Clostridia (HPHPA blocks DBH).
5. Nutritional Markers
| Marker | Nutrient Assessed | HIGH Indicates Deficiency In |
|---|
| Methylmalonic Acid | Vitamin B12 | B12 deficiency (more specific than serum B12) |
| Pyroglutamic Acid | Glutathione | Glutathione depletion, oxidative stress |
| 2-Methylhippuric Acid | Xylene detox capacity | Environmental exposure |
| 2-Hydroxyhippuric Acid | Aspirin/salicylate metabolism | Salicylate sensitivity |
| Orotic Acid | Ammonia metabolism | Urea cycle dysfunction, arginine need |
| β-Hydroxyisovaleric Acid | Biotin | Biotin deficiency |
| Ascorbic Acid | Vitamin C | — |
| 3-Hydroxy-3-methylglutaric Acid | CoQ10 synthesis | CoQ10 need |
| Xanthurenic Acid | Vitamin B6 | B6 deficiency |
| Kynurenic Acid | Vitamin B6 | B6 need (along with xanthurenic acid) |
| Formiminoglutamic Acid (FIGLU) | Folate | Folate deficiency |
| Phosphoric Acid | Mineral status | Phosphate metabolism |
6. Detoxification Markers
| Marker | Interpretation |
|---|
| Pyroglutamic Acid | LOW glutathione → impaired detox |
| 2-Hydroxybutyric Acid | Oxidative stress, glutathione depletion |
| Orotic Acid | Ammonia detox issue |
| Glucaric Acid | Phase II liver detox activity |
7. Amino Acid Metabolites
Various markers related to amino acid metabolism indicating protein digestion, absorption, and metabolic pathway function.
Comparison: Top 3 OAT Tests
| Feature | Mosaic OAT | Genova Organix® | US BioTek |
|---|
| Analytes | 76 | 51 | 36 |
| Yeast/Fungal markers | ✅ Extensive | ✅ Some | ❌ |
| Clostridia markers | ✅ HPHPA, 4-Cresol | ✅ Some | ❌ |
| Oxalate markers | ✅ | ✅ | ❌ |
| Neurotransmitter markers | ✅ | ✅ | ✅ Limited |
| Mitochondrial markers | ✅ | ✅ | ✅ |
| Nutritional markers | ✅ | ✅ | ✅ Limited |
| Detox markers | ✅ | ✅ | ✅ |
| Cost | $$$ | $$ | $ |
| Best For | Most comprehensive, ASD, mold | Visual report, mitochondrial focus | Budget-friendly screening |
Cross-References to Other Labs
| OAT Finding | Cross-Reference With |
|---|
| Elevated yeast markers | GI-MAP Candida species, stool culture |
| Elevated Clostridia markers | GI-MAP Clostridia class, C. difficile toxins |
| Low neurotransmitter metabolites | DUTCH VMA/HVA, comprehensive neurotransmitter panel |
| Elevated oxalates | GI-MAP Aspergillus, dietary assessment, kidney function |
| Mitochondrial dysfunction | MycoTOX (mycotoxin exposure), heavy metals panel |
| Elevated MMA | Serum B12, homocysteine, methylmalonic acid (blood) |
| Low glutathione (high pyroglutamic) | 8-OHdG (DUTCH), NutrEval oxidative stress |
| Elevated quinolinic acid | Environmental toxin panel (phthalates), CRP/inflammatory markers |
Clinical Pearls
- Fasting matters: First morning void, fasted, for most accurate results
- Supplements affect results: Decide whether to test ON or OFF supplements based on clinical question
- Diet affects results: Recent fruit intake elevates tartaric acid; meat affects hippuric acid
- Mold + OAT combo: The Myco-Metabolic Panel (MycoTOX + OAT) is powerful for mold illness — shows both exposure AND mitochondrial damage
- Antibiotic history matters: Recent antibiotics dramatically alter microbial markers
- Pattern recognition > individual markers: Look for clusters of elevated markers in the same pathway rather than individual outliers
- Repeat every 3-6 months to monitor treatment effectiveness