Organic acid test (OAT) has gained popularity among many functional health experts in recent years. But do they give more bang for your buck compared to conventional tests ordered by doctors? How well are they backed by science and scientific research? Will an OAT provide valuable insight into how your body is working, or will it just be money down the drain? We’ve done the research — read on to learn what we’ve discovered.
What is the Organic Acid Test?
Organic Acid Test, popularly known as OAT, measures the levels of organic compounds in urine that are produced in the body as a part of many vital biochemical pathways.
A defect in a particular pathway can result in either accumulation or lowered levels of its byproducts. Thus, measuring the levels of these markers can help to identify which metabolic process is compromised.
Abnormal levels of organic acids not only signal issues with the metabolism, but excessive amounts of some organic acids can harm the body, which is why people with inborn metabolic disorders often need lifelong treatment.
Legitimate Use
Doctors will order an organic acids test to check for RARE inborn genetic defects of metabolism, most often in newborns. It’s frequently ordered as a follow-up for a positive newborn screen result, as recommended by American College of Medical Genetics and Genomics [1].
These tests are highly specialized and among the most complex tests performed in many laboratories. Performing the tests and interpreting the results requires highly trained and qualified health practitioners (American Board of Medical Genetics and Genomics or other relevant medical board-certified laboratory director) [1].
Usually, abnormal levels of a single organic acid can point to multiple anomalies. That’s why doctors will use a combination of markers to narrow down the potential root cause. They will focus on the overall pattern, rather than on individual abnormalities [1].
Furthermore, a characteristic abnormal organic acid profile is not always sufficient to establish a diagnosis. Confirmation by other tests is often required [1].
Unsanctioned Use
In recent years, some labs have started offering this test to the general public and many alternative practitioners started recommending it in their practice.
OAT testing has expanded to include “the diagnosis” of non-genetic conditions such as nutritional deficiencies or environmental exposure to toxins, which are then “treated” with supplements.
This type of testing also often includes another category of organic acids that are produced as a result of microbial activity (bacteria and yeast) in the gut that can supposedly uncover gut dysbiosis.
It’s important to know that there isn’t much scientific support for this kind of testing. That’s one of the reasons conventional medicine doesn’t recognize them as useful.
But we didn’t take that at face value. We did the legwork and combed the studies to find out which of these tests have been studied, and whether they were useful and informative. Read more about that below.
What Proponents Say
Abnormal OAT profile has been seen in people with some chronic illnesses (such as diabetes, fatigue, kidney disease) and neurological disorders (such as autism, Alzheimer’s disease, ADHD) [2, 3, 4, 5, 6, 7, 8, 9, 10].
Proponents state that prioritizing the treatment by dietary intervention or tailoring the need for specific nutrients may significantly improve clinical outcomes.
What Skeptics Say
Many skeptics say that OAT is a scam. It will set you back around $250 or more, and you will likely not be any better off for doing it.
They say that there’s no evidence these tests provide any useful information. They can’t be relied upon for the diagnosis of any non-genetic conditions. Furthermore, using them in an unsanctioned way can be misleading.
Are OAT Ranges Legit?
In many cases, likely not.
Many of the markers used in OAT have not been studied well enough to understand what ranges in healthy populations are compared to ranges in those with certain diseases.
Read more about how normal ranges are established here.
Which of The OAT Markers Are Reliable?
To find out which parts of the OAT test can be useful, and which are just nonsense, we delve into the science and look into each of the markers in isolation in the following posts:
- OAT: Mitochondrial Markers
- OAT: Nutrient Deficiencies & Methylation
- OAT: Detoxification & Oxalates
- OAT: Neurotransmitters
- OAT: Amino Acid Metabolites
- OAT: Yeast & Bacteria
We’ll summarize the gist of them here.
Mitochondrial, Carb & Fatty Acid Metabolites
Most of these markers are mainly used to diagnose rare genetic disorders, and there’s likely no benefit to testing them for any other reasons.
There are many other tests that doctors can use to evaluate your overall health that are reliable and backed up by plenty of studies and actual science.
Among these markers, there are 3 that doctors may actually use, depending on one’s signs, symptoms, medical history, and other test results. They are:
- Lactic acid – used to check for disturbances in blood pH (lactic acidosis)
- Citric acid – used in people with or at risk of kidney stones
- Ketone bodies – used to check blood sugar control in diabetes or confirm ketosis on keto diets
Nutrient Deficiencies & Methylation
Some of the nutritional markers tested as a part of OAT may point to valid nutrient deficiencies, mainly: methylmalonic acid, pantothenic acid, methylcitric acid, and uracil/thymine.
However, in all of these cases, blood tests are more reliable and your doctor is likely to order them for confirmation.
Detoxification and Oxalates
While testing oxalate is relatively common practice, testing other “detoxification“ markers is of rather limited value and unlikely to be of benefit, unless your doctor is screening for inborn metabolic disorders or you’re exposed to significant amounts of toxic chemicals in your workplace or environment.
Neurotransmitter Metabolism
Testing neurotransmitter metabolites in urine can’t tell you what’s going on in the brain. Doctors test these metabolites in specific cases to diagnose tumors (of the adrenal gland or carcinoid tumors) or to check for rare genetic disorders.
Apart from that, these metabolites respond to certain diets and may be affected by underlying issues such as inflammation. However, testing them has no clear use or benefit.
Amino Acid Metabolites
Amino acid metabolites are used to help diagnose rare genetic disorders, and don’t really seem to have a purpose beyond that.
Yeast and Bacterial Metabolites
Markers of yeast and bacterial overgrowth are the most exciting part of the organic acid test (OAT). Mainly because we are just beginning to understand our microbiome and the effect it has on our bodies and metabolism. However, this also means that these markers are experimental — no clinical studies have verified or validated their use and their ranges.
While there are studies that have linked most of these markers to yeast and bacterial overgrowth, they are few and small in scale. Much larger and well-designed research is needed to establish how useful and informative testing each of these markers is in the general population.
Many of these markers can increase due to causes other than microbial overgrowth, including certain foods and metabolic disorders. Therefore, results should be interpreted with caution by a qualified medical professional. Your doctor will interpret your results in conjunction with your signs, symptoms, medical history, and other test results, and they will order further tests if needed.
Bottom Line: Is OAT Useful Or A Hoax?
The truth is probably that most people don’t require this test and will not benefit from getting it.
Many of the markers in this test are useless for the majority of people.
Then again, particular markers found in this test are legitimately used to help diagnose some non-genetic conditions. However, you could probably get those markers tested, if needed, for less than $250.
Keep in mind that:
- Many organic acids require the collection of 24 hr urine in order to provide accurate information (i.e. OAT test has lower accuracy).
- Most organic acids are indirect or non-specific markers and can be falsely elevated due to benign conditions. That is why they should never be relied upon in isolation. Doctors will always use a combination of markers to get a picture of the underlying cause.
- Often, urinary levels do not reflect the levels in tissues. This is especially the case for neurotransmitters metabolites.
If in doubt whether to get this test done, weigh the pros and cons with your doctor.
