The Organic Acids Test: Focus on Energy, Nutrients and Detoxification

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm launching into the second podcast on interpreting the organic acids test, a test that I use with a lot of my clients that can tell you about your gut health, in particular with regard to Candida and mold, bacterial overgrowth, and overgrowth of Clostridia, as well as oxalate levels your production of energy from carbohydrates, fatty acids, and protein, your neurotransmitter levels, nutrient levels of the B vitamins, vitamin C, CoQ10, and NAC, and detoxification markers. Last time I focused on the gut stuff, oxalates, and neurotransmitters, which was episode 74 from June 7th, 2022. So if you missed that one, you may wanna go back and listen first to that one and then listen to this one. Today I'll be focusing on energy production, nutrient levels, and detoxification markers. And to listen to this podcast and have it make any sense at all, you should find the link to the Organic Acids Test PDF from the show notes or go to my website, HighDesertHealthCoaching.com/the-perfect-stool, or just go to the main website and find the link to the podcast page. And there towards the bottom, you'll find a link to download a copy of the test that I'm going to be talking about today so you can see what I'm referring to. But before I get started, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebook called Finding Your Root Cause Through Stool and Organic Acids Testing when you sign up. If you haven't yet done my quiz on which stool or functional medicine test could help you uncover your root cause, you can find a link in the show notes and take that. Now onto the show. So I'm going to jump right back into the test, noting briefly that this is the Great Plains Organic Acids Test, and there's another from Genova called the Organics that some practitioners use. On some of these sections, the Organics does have one or two advantages over the Great Plains OAT, one of which is that it lists the nutrients at the top of each section that are involved, such that if there's an issue, you know what to supplement with, although dosages, timing, etc. aren't given. So I'll mention those nutrients as we go along. And I do want to forewarn you that I'm going to be using a lot of big sciency words, and not to get intimidated, just have the sample OAT test open and glean what you can from what I'm saying. And if at some point you take the OAT or already have one of your own, you can re-listen and key in on the markers that you have elevated or low and listen to the specifics and then dig further. So we're jumping first to page 3, and you can find this test in the show notes if you missed the intro, and markers 22 and 23, lactic and pyruvic, under glycolytic cycle metabolites. The glycolytic cycle, also known as glycolysis, is the metabolic process that converts glucose, which you get primarily from eating carbohydrates, into pyruvic acid, which is turned into something called acetyl-CoA, which then enters the Krebs cycle to produce energy. This process is a sequence of 10 reactions that are catalyzed or helped along by enzymes. Those enzymes require cofactors, which are nutrients like B vitamins, for example, that are necessary for those reactions to take place. So when pyruvic is high on the organic acids test, as it is in this test, it means that the pyruvic acid isn't converting into acetyl-CoA. Which when it gets bad enough indicates insulin resistance. So this is an early sign of a diet that's likely too high in sugar and refined carbohydrates. Interventions at this point are usually dietary, like eliminating all added sugars and white carbs and increasing protein or fat. And then in terms of supplement support, you're looking at alpha lipoic acid, which helps stabilize blood sugar, and the B vitamins, in particular B1, also known as thiamine, B2 or riboflavin, B3 or niacin, and B5 or pantothenic acid. But it's best to take a B complex whenever you're taking B vitamins because they work together synergistically. Chromium can also be useful if you're dealing with blood sugar dysregulation, both on the hypoglycemic side, meaning low blood sugar, a sign of which is dizzy spells and shaking when your blood sugar drops, and the hyperglycemic side, which means high blood sugar and is typical of type 2 diabetes and also characterized by blood sugar highs and then crashes in which you feel exhausted. High lactic, number 22, can be from vigorous exercise because when oxygen is in short supply, pyruvic acid is converted to lactic acid through an anaerobic process, leading to sore muscles, like after you've lifted too many weights or done something new to your muscles. Lactic acid can also be elevated from bacteria overgrowth in the GI tract. B vitamin deficiencies like I described before. They can lead to blood sugar dysregulation, mitochondrial dysfunction or damage, and anemia, among others. There can also be genetic reasons, but the numbers are generally much higher, like above 300 mmol/mol creatinine when you start suspecting that. Pyruvate can also be elevated for the same reasons as well, with possible genetic causes over 100 mmol/mol creatinine. If you have enzyme issues that are genetic, you can also see neurological problems and seizures. If lactic is high but pyruvic isn't, it's more likely to point to anemia, zinc deficiency, but also can be from excess alcohol or toxic metal exposure. And if either is high because of the lack of energy production, CoQ10 is also a helpful supplement to help with energy. The next section, mitochondrial markers, Krebs cycle metabolites, or markers 23 through 29, are markers of the metabolites of the Krebs cycle, also known as the citric acid cycle or TCA, tricarboxylic acid cycle, which is the intermediate step in the creation of energy from food and which takes place inside our mitochondria, which are in all of our cells. If you Google the Krebs cycle and pull up an image, that might be helpful in following along with what I'm saying. So as I mentioned above, glucose from carbohydrates converts to pyruvic acid and then to acetyl-CoA. That's just one of the potential ways of creating acetyl-CoA, and I'll talk about more later. But acetyl-CoA enters into the Krebs cycle, and then there are all these chemical reactions that happen so that acetyl-CoA is converted into citrate, which is the oxidized form of citric acid when it loses its hydrogen. And by the way, these markers on the Genova Organics form of the test are all listed, listed in the -ate form, like citrate. Whereas on the Great Plains Oat, they're all listed in the -ic form, like the acid form, that is like citric. So then citrate is converted into cis-aconitate, and the corresponding marker on the Great Plains Oat is aconitic, which is converted to isocitrate, which is on the Organics but not on the Great Plains Oat, and then converted to alpha-ketoglutarate, which is the same as 2-oxoglutaric acid on the Great Plains Oat. I know this is very confusing. Which is then converted to succinate, then fumarate, and then malate. And there's a few steps in between that I didn't mention, but that's the cycle of the citric acid or Krebs cycle. And one of the byproducts of the citric acid cycle is NADH, which is then fed into the electron transport chain through a process called oxidative phosphorylation, which is the final step in the creation of energy or ATP, also known as adenosine triphosphate. Now, forgive me if I have anything not quite right in this description, as I was a French literature major in college and I've had to do a lot of catch-up in my chemistry chemistry and biology to understand this stuff. But the long and short of it is each of these markers on the oat can indicate if there's a break in the process of the creation of energy in our mitochondria, or a problem with it entirely, like there's just not much of it going on because your mitochondria have collapsed and been destroyed by oxidative stress from toxins, or not enough antioxidants in support of them and to help detoxify the toxins, like vitamin C and E. So if you see one of these markers elevated, it could also be because of a missing cofactor or nutrient in the process. So for example, to convert isocitrate to alpha-ketoglutarate, you need B3 or niacin, magnesium, and manganese. So if one of those is missing, you'll have excess isocitrate because the conversion isn't taking place and it's building up. Or to convert succinate to fumarate, you need B2, also known as riboflavin. So if you're short on that, you'll see succinate elevated because the conversion isn't taking place.. So that's the general background of how to look at it. And then a deficiency of CoQ10 or its active form ubiquinol is also a common problem when there are breaks in the citric acid cycle. So specifically getting down to the individual markers, high succinic can be from a deficiency of B2, CoQ10, also from bacterial degradation of unabsorbed glutamine supplementation, or from heavy metal or other toxic exposures and mitochondrial dysfunction. It's also possible to have a genetic issue with an enzyme, but in any case, low levels of succinate or succinic indicate a need for supplementation of the amino acids leucine or isoleucine. Elevated fumaric can be from a defect in the enzyme fumarase that catalyzes the conversion to malate, a defect in mitochondrial function, or impaired Krebs cycle function. Symptoms will be fatigue and weakness. You can support it with the addition of CoQ10, NAD+, which is a derivative of niacin or vitamin B3 called nicotinamide adenine dinucleotide. Also the addition of nicotinamide, another form of B3, the amino acid L-carnitine, riboflavin or B2, biotin or B7, and vitamin E. Elevated MALLC can point to the need for more niacin or CoQ10. Hyperinsulinism, which impedes weight loss. And again, this represents a break in the citric acid cycle. So again, you'll see fatigue and weakness. When 2-oxoglutaric, also known as alpha-ketoglutarate, is elevated, if it's not from supplementation, it can be due to vitamin deficiencies such as B5, also known as pantothenic acid, or FAD, which is flavon adenine dinucleotide, which is derived from riboflavin and thiamine, or from under eating. And symptoms of this would be fatigue or reduced stamina. Now, if you see citric, fumaric, and 2-oxoglutaric acids simultaneously elevated, it strongly suggests mitochondrial dysfunction. Then when aconitic is elevated, it could be a mitochondrial disorder or additional need for reduced glutathione, which is your master antioxidant. Low levels aren't significant or problematic unless you see multiple Krebs cycle metabolites low. Now, if you see all or most of these markers very low, this indicates mitochondrial collapse. Which means that there are not that many mitochondria. In this case, you'll want to give free-form amino acids or protein powder to stimulate the growth of new mitochondria, which is done at a particularly high dosage at one time to stimulate something called mTOR. But this is a complex topic that would require probably an entire podcast on it alone. Then citric can be elevated from the intake of citric acid-containing foods, intestinal yeast that produces citric acid, amino acid deficiencies of taurine and methionine, problems with the citric acid cycle, ammonia toxicity, which can be from H. pylori or other bacterial overgrowth, as well as poor protein absorption or a lack of glutathione, our master antioxidant. You may also see pyroglutamic values low along with this, which is in the detoxification section, marker 58, in which case you know that you should supplement with either NAC, N-acetyl cysteine, an antioxidant that increases the glutathione reserves in the body, or glutathione itself. Preferably in some format like liposomal or trisomal, which are more absorbable, but at minimum in the reduced glutathione format. And note, when I say low pyroglutamic values, I actually mean high because it's an inverse marker. But in general, when there are multiple high markers in the Krebs cycle, you're looking at supplementing with CoQ10, magnesium, amino acids, and the B vitamins, and then figuring out if there's an underlying cause for the dysfunction, like gut health issues or toxins like heavy metals, environmental chemicals, or mold. The next section, markers 30 through 32, are mitochondrial markers of amino acid metabolites. Markers 30 and 32 will be increased if there's a reduced ability to metabolize the amino acid leucine, which can be genetic or a mitochondrial disorder. In any case, supplementing with CoQ10, niacin, L-carnitine, the B vitamins, and vitamin E may be helpful. So in these cases, I usually look at a multivitamin with high B vitamins like my favorite MultiPerk Lifeguard, which you can find in my FullScript Dispensary, plus a CoQ10 or ubiquinol supplement, ubiquinol being the active form of CoQ10. Slight elevations in marker 31, 3-hydroxyglutaric, may indicate mitochondrial dysfunction, while high elevations are usually from genetic issues. The next section, 33 to 40, the neurotransmitters, I covered in my earlier podcast, episode 74. So I'm gonna jump right to 41 and 42, the pyrimidine metabolites, folate metabolism. The pyrimidines are one of two chemical compounds that cells use to make the building blocks of DNA and RNA. So elevated uracil, or marker 41, may indicate a defect in folic acid metabolism, which is present in about 10% of children with autism, or a folate deficiency. If it's elevated for a client, I just make sure they're getting a good quality multivitamin or B complex with the active form of folate, not folinic acid or folic acid. Acid, which many people have genetic issues metabolizing. So I look for the active forms of folate, which might be listed as methylfolate, L-methylfolate, 5-methylthiofolate, L-5-MTHF, or 5-MTHF. Slightly elevated thiamine isn't significant, but very high values on thiamine have been associated with inflammatory diseases and cancer. And elevated thiamine along with elevated pyrimidines has been associated with a genetic disease that causes seizures and autism. Then the next section, ketone and fatty acid oxidation, markers 43 through 49, is one of my favorites. I like this section because if there are issues here with elevated markers, it's one of the quickest and easiest fixes that usually has a dramatic effect on how people are feeling. So fatty acids, like carbs, must be converted into acetyl-CoA to be brought into the Krebs cycle to create energy, and this process is called beta oxidation. Now to do this, you need two things: the amino acid L-carnitine and vitamin B2, or riboflavin. And this is where I often see issues in vegetarians, vegans, or people who only eat chicken and fish or just seafood. Carnitine is plentiful in red meats like beef and lamb. So for example, 4 ounces of ground beef has 87 to 99 milligrams of carnitine, 4 ounces of steak 56 to 162, but 4 ounces of chicken breast only 3 to 5, 4 ounces of codfish 4 to 7, and a glass of milk 8. Pork is sort of on the moderate range with 31 milligrams per 4 ounces, and lamb is the highest with 180 grams in 4 ounces of lamb filet. So over time on a restricted diet, carnitine will become depleted and then you aren't bringing fats into the Krebs cycle to, to be burned for energy. Instead, they're getting stored as fat. So this can lead to weight gain and low energy, muscle aches, weakness, recurrent infections, migraines, age-related cognitive decline, and in extreme cases, dementia. And because you don't have fats to supply energy when carbs are quickly digested, which usually happens in about 2 hours, they have blood sugar highs and lows. So you'll usually see a blood sugar high followed by a crash and symptoms like nausea, confusion, or hypoglycemia. Of course, all this can happen to a meat eater as well who has a deficiency of B vitamins, which could be from dietary— if there's just not enough meat consumed, there's malabsorption, like with certain gut issues like Crohn's disease, ulcerative colitis, or celiac, low stomach acid. So when proteins aren't getting broken down properly into amino acids, or it can be from excessive exercise, like when training for endurance sports or alcohol abuse. But since B2 is most plentiful in dairy foods, fortified foods like oats and breakfast cereals, meats, and nuts, if you're on a gluten-free vegan diet eating no processed foods, you could end up deficient in both carnitine and B2. So issues in this area are relatively easy to fix with the addition of L-carnitine or its active form acetyl-L-carnitine. I usually use the former when there are physical issues like fatigue or weight loss resistance, and add the latter if there are brain issues like memory issues or age-related cognitive decline or brain fog. And all that I was talking about with regard to burning fatty acids for energy applies specifically to markers 45, 46, 48, and 49. And those also can be elevated because of fasting or high intake of coconut oil or MCT oil. Some of the other markers like 3-hydroxybutyric and acetoacetic acids can also be elevated because of a ketogenic or very high-fat diet. So it's important to ask about diet before jumping to the conclusion that someone has a defect in their fatty acid oxidation. Those two can also be elevated because of prolonged fasting, protein malnutrition, a B12 deficiency, pulmonary infections, and a severe Candida overgrowth in the GI tract. But overall, generally, the more markers that are high in this section, the higher I think of raising carnitine dosing. I try to find the 1,000 milligram pills to reduce the quantity people have to take. So like 3,000 milligrams a day in 3 doses is ideal, best on an empty stomach like all amino acids. It smells and tastes gross, so it's best to do it in pill format rather than in a powder. You can go up to 5,000 milligrams a day if you're not getting results at lower doses, or add in 2,000 milligrams a day of acetyl-L-carnitine if you have the brain symptoms too, as it easily crosses the blood-brain barrier and helps increase acetylcholine, which is an important neurotransmitter for learning, memory, and general cognition, which can help with Alzheimer's, as a severe depletion of acetylcholine is associated with Alzheimer's. Of course, as with any markers, very high levels can indicate a genetic issue. And for adipic in particular, gelatin and other junk foods may have adipic acid as an additive, causing an elevation. The next section, nutritional markers, markers 50 to 57, indicate deficiencies in different B vitamins, which are listed by each one, vitamin C, CoQ10, and NAC. This is all pretty intuitive with low markers for most of them indicating deficiencies, generally flagged if it's below the mean. Except that some of them are inverse markers and have an asterisk, which means that a high value indicates a deficiency, which is the case for B12 methylmalonic, which is much more sensitive and will show up earlier than a blood test for B12, B2 glutaric, CoQ10, 3-hydroxy-3-methylglutaric, and biotin methylcitric. Deficiencies of different vitamins can have a variety of causes, but for B12, for example, a vegan diet Pernicious anemia and gut issues are common causes. For B6, low values are associated with high oxalates and low neurotransmitters, but those are not causes per se and are more likely the result of having low B6. I often see marker 52, pantothenic, elevated, which is a marker of B5. It can be from recent supplementation but isn't of concern if it's high or necessarily indicate a need to reduce it. But if values are more than 20 times the upper limit of normal, there could be a genetic issue with conversion of B5 in a disease called pantothenate kinase-associated neurodegeneration. In mild variants of this disease, psychiatric illnesses such as schizoaffective disorder, hallucinations, obsessive-compulsive disorder, speech defects, and depression are common. Generally, I assume that more severe manifestations of these types of genetic orders are uncovered with regular doctors because of the early onset of severe symptoms. Also, high glutaric acid for B2, which is one of the inverse markers, so high means low, Besides meaning low B2, can also be because of a lack of carnitine, so the B2 isn't getting used as it should, or because of celiac disease. Supplementing with both riboflavin and CoQ10 is helpful when glutaric is elevated. Next is ascorbic acid, or vitamin C, which when elevated usually isn't a concern as it usually means you're supplementing with it, and low levels are pretty typical if supplementation is stopped prior to testing, dietary intakes are inadequate, which is the case for most people given the nutrient levels in our foods have decreased so markedly with the advent of modern agriculture and transport practices. So if you get a low level, it is good to supplement with vitamin C. The only concern would be with someone with high oxalates or history of kidney stones as ascorbic acid or vitamin C could convert to oxalic acid, increasing the risk of kidney stones and other symptoms of high oxalates, which I discussed in episode 74. With normal levels of oxalic acid, vitamin C supplementation shouldn't be an issue. Then I've never virtually never seen the marker for CoQ10, 3-hydroxy-3-methylglutaric acid, or HMG, to be high. And again, this is an inverse marker, so high means low levels of CoQ10. But one reason that it may be high is the use of statins, which decrease HMG and CoQ10. If you're on a statin, you should be taking CoQ10 preventatively. Very high levels would point to a genetic disorder. Then biotin deficiency marked by high methylcitric acid, I've also never seen. But causes could be dietary deficiencies, dysbiosis, or excessive intake of raw egg whites. Again, very high levels could be from genetic causes. I'll also note that I've only seen one OTE in which someone didn't show up as deficient in B6. So I'm not sure if there's a test error there, or all people with gut issues have low B6, which is not unlikely because gut issues can inhibit absorption, or whether there's a population-level deficiency issue. But just to let you know that I've observed that as well as have other mentors of mine in the functional medicine community. But I do tend to recommend B vitamins to almost everyone I work with in any case, so I typically choose one with high B6 for a time. Now, it is possible to overdo B6, and symptoms of that are a lack of muscle control or coordination, skin lesions, heartburn, nausea, photosensitivity, numbness, and reduced ability to sense pain or extreme temperatures. So I don't recommend a super high B6 supplement indefinitely, and when I say super high, I'm talking 100 to 200 milligrams a day. But usually 6 months, if you see a low level, then retesting is ideal or move to a more reasonable dose like 25 to 50 milligrams a day. And finally, I just wanna say that I've also never seen N-acetylcysteine or NAC not in range, so it's not a terribly useful marker. The next section on detoxification usually alerts us to the need for NAC supplementation. So let's just jump there. So this section, indicators of detoxification, are markers 58 to 61. Help you understand how well your liver is clearing toxins from your body. The first marker, 58-pyroglutamic, is a metabolite of glutathione, which is our body's master antioxidant, and one of its roles is to bind toxic compounds in the liver. High levels, meaning a lack of glutathione because it's an inverse marker, are usually due to toxic exposures like acetaminophen toxicity or other toxins, genetic disorders, the metabolic effects of certain antibiotics, or the path to mitochondrial failure from oxidative stress. You can supplement with NAC or N-acetyl cysteine to support phase 2 detoxification, which will increase glutathione and bring this into the normal range. Sometimes other components of glutathione are missing though, like glycine or glutamine, or you need other sulfur amino acids to support phase 2 detoxification like taurine, methionine, and cysteine. So you may need to add those as well, or just take free-form amino acids that contain them all, or just supplement with liposomal glutathione, which is the preferred form. If glutathione is low, you should usually also supplement with magnesium. If you're just going off the OTE results, you can check the Krebs cycle markers, and if they're low, meaning mitochondria have collapsed and given up, and you're feeling tired, depressed, or have chronic fatigue, you'll need both magnesium and glutathione or its precursors. There's also an issue if this marker is very low, which means your body's working really hard to get rid of toxins. So you should supplement with NAC or glutathione in this case as well. The next marker, 2-hydroxybutyric, is also an inverse marker, and high values indicate either methylation defects or toxic exposures. Again, this points to the need for glutathione or NAC supplementation. It can also be elevated due to genetic SNPs in the methylation pathway or deficiencies of methyltetrahydrofolate, the active form of folate, methyl B12, the active form of vitamin B12, or betaine. Or it could be elevated due to the onset of diabetes or from excessive alcohol use. And again, sometimes genetic issues show up here, but this is less common. The next marker, urotic, is another one I really like because it's usually an easy fix. It gets elevated when ammonia levels are high from either drug toxicity to the liver bacterial overgrowth, particularly H. pylori, GI bleeding, or inborn errors of the urea cycle, which is our process for ammonia metabolism, like a CBS mutation. So when you eat protein, you need to get rid of the nitrogen. But if you have a problem with your urea cycle and you can't do that efficiently, you end up with a buildup of ammonia, which can be because of faulty enzymes due to very common genetic issues with the urea cycle. Some symptoms of hyperammonemia are headache, fatigue, confusion, poor concentration, loss of muscle control, and food intolerances. So to help the urea cycle function, what you do is take high doses of L-arginine, which pushes the cycle and helps clear out the ammonia. Next to last marker I'll mention is 2-hydroxyhippuric, which is elevated from aspartame consumption, high salicylates like an aspirin, and also an additive to personal care products and naturally occurring in many fruits and vegetables. Some people have a sensitivity to salicylates. So if you've tried everything else diet-wise and this is high, it could be a salicylate sensitivity. It can also be elevated from overgrowth of certain bacteria in the gut that convert the amino acids tyrosine or phenylalanine into salicylic acid. The remaining markers under amino acid metabolites are rarely elevated and mostly point to genetic issues, so I'm not gonna discuss them much here. And finally, under mineral metabolites, phosphoric acid is also rarely off because phosphates are common in processed foods. But if it is low, it could point to a vitamin D deficiency. Okay, so I know all of that was a bit much. Just look for some tidbits of information that you can use and don't stress if most of it was gibberish. If you do wanna see the podcast in written format, just go to HighDesertHealthCoaching.com and sign up for my newsletter. You'll get an email when I put out the transcript of the podcast in a week. And if you're dealing with either gut issues or mental health issues or chronic all-over body problems or energy issues, the good news is, is that this stuff is quite fixable. And the Organic Acids Test is often a great way to start to uncover what's going on underneath. And I work with clients using this test to reveal these issues and the root causes and educate you on how to fix them. So if you wanna talk to me about what you've been dealing with and see if you think I can help, you can set up a free 30-minute breakthrough session with me through the link in the show notes., and I can let you know if I think I can help you and about my 5-appointment gut or autoimmune healing program, and you can decide if that seems like a good fit for you. Or you can just sign up for single appointments. Links to those are in the show notes. And if you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my gut healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, or find me on Twitter, Instagram, or Pinterest. Links for those are all in the show notes. Thanks for joining me today. I'm just wishing you all a perfect storm.