The Organic Acids Test: Focus on Gut, Oxalate and Mental Health Markers

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm going to be introducing you to a test that I use a lot with my clients called the Organic Acids Test, and I'll be explaining the markers on the test that can tell you about your gut health, excess oxalates, your mental health, and give you some insight into how to interpret this test. And then in a future podcast, I'll finish it off to discuss the other markers on the test that address your detoxification status, energy production, and more. So to listen to this podcast effectively, I would recommend that you go to my website, HighDesertHealthCoaching.com/ThePerfect— oh no, it's the-perfect-stool. Or just go to the main website and press the main 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. I'll also put a link in the show notes to it directly. 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 my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet 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 on to the show. So the Organic Acids Test is a test I use with most of my clients because in addition to giving insight into gut health issues and having the only reliable marker of invasive candidiasis, it also offers insight into bacterial overgrowth in the gut, other fungal overgrowth markers of mitochondrial health and energy production from all the macronutrients that's carbs, fats, and protein, detoxification markers, markers of excess oxalates, B vitamin markers, vitamin C and CoQ10 status, and the state of your neurotransmitters, which are serotonin, dopamine, epinephrine or adrenaline, and norepinephrine or noradrenaline, and others. So it's an amazing test to get a read on what's going on in someone's body and where problems could be arising. It's also a urine test that can be done at home and can be ordered in most states without a doctor's order, So that makes it easy and accessible. So as far as I know, it's primarily offered by two labs, Great Plains and Genova. The Genova one is called the Organix with an X, but the markers on each of them are a little bit different. And I generally prefer the Great Plains one because it includes oxalates, which aren't on the Organix, and it has many more markers for fungi, including environmental molds. So a little history on this test as I first understand it. So one of my mentors on how to interpret this test, Dr. Daniel Kalish, shares this history in most of his videos. He's been working for years with Richard Lord, PhD, to learn about this test and other tests and how to interpret them, and just to pass on Dr. Lord's complex understanding of the body and nutrition. And I've taken a course with videos and webinars from both of them on amino acids and B vitamins. But basically, Richard Lord, in addition to developing the GI Effects test, another very common stool test, was the first person to think of taking these organic acids tests, which are normally given to infants to make sure they don't die in the first few days or weeks of life due to certain genetic SNPs or single nucleotide polymorphisms, also known as gene mutations, and apply them to adults. So while an infant with a homozygous form of a certain gene, meaning two copies of a mutation, might have extreme effects ranging from severe disabilities to death, adults who are heterozygous, meaning just one copy of a mutation, or who only have one polymorphism impacting a given condition because multiple genes can impact certain conditions. That adult might have much more mild effects that only come to light when there are environmental factors at play like a poor diet, lifestyle, or just the effects of aging. The organic acids are metabolic byproducts in the urine, meaning end products of digestion by you or your microbes. The markers on the test point to the ways in which gut health or other root cause issues can cause dysfunction in the body at the cellular level. I generally recommend this test to clients also struggling with complex issues like autoimmunity, fatigue, brain fog, or mental health problems, or who show symptoms of systemic Candida infections like sugar cravings, a white coating on their tongue, or recurrent yeast infections. So now, if you skipped the intro, now is the moment to pause the podcast and follow the link in the show notes or go to HighDesertHealthCoaching.com /the-perfect-stool and open up the link for the Episode 74 Organic Acids Sample Test. I'm going to be going through the test and highlighting some of the markers and their meanings, so it won't make a lot of sense unless you're looking at it too. So the first set of markers, numbers 1 through 9, are for yeast and fungal metabolites. The primary one to determine if someone has invasive candidiasis is number 7, arabinose, which is the only fungal marker on the organics. Version of the test. This is the Great Plains version of the test I'm interpreting. I will generally recommend taking action on that if someone's symptomatic and it's above the yellow and orange bars, which represent one standard deviation around the mean, which is the black line in the middle. So if someone isn't symptomatic but has a number near the top of the range, like in this example, I will— I'll let it go. But if someone had a bacterial dysbiosis or SIBO and had a high marker on arabinose like this, I'd make sure that I educated them on antimicrobial products that covered both bacteria and yeast, like most herbal products do. Another set of markers that are different from the Candida markers are the furans 2, 4, and 5. These 3 are markers of Aspergillus, which is typically an environmental mold. So when I see those elevated, I recommend mold testing in someone's house. And then number 6 can point to Candida or Aspergillus. Then number 9, tricarbolic, is associated in particular with fumonisins, which are toxin produced by the fungus F. verticilioides, which come from corn products contaminated with the omnipresent toxin. So generally, when I see that elevated, I suggest people reduce corn-based products in their diets other than fresh corn. In this case, eating organic probably doesn't matter as it's an equal opportunity toxin. So I'll go briefly over the remaining fungal markers. Number 1, citromalic, can point to elevated Saccharomyces species or propionibacteria overgrowth. Although one of the most common probiotics, and one I use a lot, is called Saccharomyces cerevisiae subspecies boulardii, S. boulardii for short, and some people can actually have an immune reaction to that strain.

And then number 3, 3-oxoglutaric, is also a marker of yeast overgrowth.

That's one I commonly see elevated. And 8-carboxycitric is a general yeast/fungal marker. Then the next section is the bacterial markers. So the first 4, 10 through 13, when elevated, point to bacterial overgrowth characteristic of SIBO or small intestine bacterial overgrowth. And in combination with SIBO symptoms like bloating, constipation, diarrhea, or soft stool, elevated markers here are a good indication of SIBO since I generally don't put much stock in breath testing. But of course, when you see that, it's best to get a stool test so you know if there are other things at play like parasites or specific pathogenic bacteria like enteroinvasive E. coli or H. pylori, for example. Because if you just treat with antimicrobials, when you choose the wrong ones, you can leave someone with an overgrowth of something even more dangerous. The other thing about these first 4 markers is that they are also metabolites of fruits and vegetables and their polyphenols in the urine. So if they're really low, that's also not great because it means that someone isn't eating the proverbial rainbow as they should be. Polyphenols feed the good gut bacteria, so you want to see some moderate to higher level of them. Within the normal range. And then the last marker, DHPPA, is a marker of Lactobacilli, Bifidobacteria, and beneficial strains of E. coli. So elevations here are not generally concerning. The final section on microbes is specific to species of Clostridia that can be pathogenic. Now, there's a whole range of Clostridia, many of which are not just beneficial but essential to healthy gut function. So there's the class of bacteria Clostridia, which consists of many known butyrate producers, including the genuses Eubacterium, Roseburia, Butyrovibrio, Coprococcus, Ruminococcus, and Clostridium. So you see there's the genus Clostridia, or Clostridium in the singular, and the class Clostridia.

Butyrate producers like Clostridia are essential to healthy barrier function in the colon and for keeping it anaerobic and feeding the colonocytes, or the cells lining the colon. But there are pathogenic Clostridia as well, under the genus Clostridium, like C. difficile, which which is responsible for almost 500,000 cases of acute chronic diarrhea and almost 30,000 deaths a year in the US. So marker 17-4-CRESL is a marker specific to overgrowth of C. difficile, but also another Clostridium called C. scatologenes. However, if you don't have symptoms like diarrhea, your C. diff is likely still being kept in check by other bacteria, but it's an important consideration in picking antimicrobials because you don't wanna start killing off other bacteria that are keeping it in check before reducing it. But when this marker is elevated, it impacts an enzyme called dopamine beta-hydroxylase, or DBH, in the brain, which converts dopamine to norepinephrine, which will show up later in the test as elevated homovanillic acid, or HVA. And high urine values of 4-Cresol are associated with the most severe clinical symptoms in autism, multiple sclerosis, neurotoxicity, hallucinations, and other neurological and psychiatric disorders., but at lower levels can show up as symptoms of low norepinephrine, like anxiety, depression, ADHD, memory problems, headaches, sleeping problems, low blood pressure, and low blood sugar. Then marker 15, 4-hydroxyphenylacetic acid, can be a marker of various types of Clostridia overgrowth, as in SIBO, but also a marker of any type of small bowel disease, or possibly elevated because of celiac disease. Then marker 16, HPHPA, is indicative of another group of Clostridia overgrowing, which can cause a derangement in neurotransmitter balance. So I often see issues with neurotransmitters like dopamine and serotonin off when this marker's high. And the same is also true for 4-Kressel. And then finally, marker 18, 3-indoleacetic acid, is elevated when another group of Clostridia is overgrown. And very high amounts of this metabolite, which is derived from tryptophan, can indicate that there's a depletion of tryptophan, which would normally be needed for other physiological functions. And tryptophan is the precursor to serotonin, our feel-good hormone. Which when it's too low leads to anxiety and depression and problem sleeping because serotonin is the precursor to melatonin. So you can see how bacteria and yeast can start to impact your health and your mental health, and this test really shows you the connection between them. So the next page of the test shows the Krebs cycle, or the citric acid cycle, which is a cycle by which your body produces energy. And so it's showing you all the conversions here between the different organic acids that are on this test. And when you have high levels of these organic acids, what you're seeing are breaks in that cycle and hence in the production of energy. But we'll talk about that more in the next podcast on the organic acids test. Then below that is a model of the amino acids being turned into the catecholamine neurotransmitters, which are dopamine, epinephrine, and norepinephrine. So you see how phenylalanine, an essential amino acid, meaning that you have to get it from food, is converted to tyrosine, which then converts to dopa and then to dopamine. Then that converts to norepinephrine and epinephrine. And you see to the side of the arrow going to the, to norepinephrine, the enzyme that catalyzes the conversion, dopamine beta-hydroxylase, which I just mentioned earlier, and the nutrients necessary for that conversion, which are copper and vitamin C. And then the metabolite of norepinephrine and epinephrine is vanillemandelic acid, or VMA, and the metabolite of dopamine is homovanillic acid, or HVA. And we'll look more closely at all this when we get to the neurotransmitter section. Okay, so the next page, page 3, starts with the oxalates. And you can see here that there are two oxalate markers that are officially high. And I just want to point out that once you see the orange/yellow bar reduced in size to the left like that, and the scale then ends closer to the middle, you know the levels are so high they're off the chart. So then you should look at the scale and the number you got on the test to get a sense of exactly how high they are. Like, is it double or is it 10 times the top of the scale? So oxalic acid, or oxalates, are naturally occurring compound in plants, and they're especially high in berries, nuts, legumes, and dark green leafy vegetables like spinach. So when I see someone put down on their intake form that they eat a green smoothie each morning, I'm always thinking, yikes, that could be an oxalate issue. Oxalates are also produced as waste by our bodies as well as coming from our diet. And if the oxalates bind to calcium in our digestive tract, it will be pooped out and it won't cause an issue. But often as people try to eat healthier, they fill up on high oxalate foods and eliminate dairy, and then they start to get these issues like urinary tract infections or UTIs. Because oxalates are little crystals that can make cuts in your urinary tract. They can also deposit crystals in your joints, causing joint pain, be deposited in your bone and cause osteoporosis, be deposited in the kidney and form kidney stones, be deposited in the eyes and cause cuts and pain, and in the muscles, blood vessels, brain, and heart and cause problems in all those places. They can contribute to muscle pain and fibromyalgia, and oxalate deposits in the breast tissue have also been associated with breast cancer. Another source of high oxalates can be a bile acid deficiency because bile is what helps break down fats. So when it's deficient, the excessive undigested fatty acids in the diet will be poorly absorbed and they'll bind to calcium, preventing it from binding to oxalate and eliminating it. And then high oxalates in the GI tract can also reduce absorption of calcium, magnesium, zinc, and other essential minerals. So oxalic marker number 21 is the primary marker of excess oxalates in the diet, but can also be elevated due to dysbiosis from Aspergillus, penicillium, and possibly Candida, or from high doses of vitamin C. However, my favorite oxalate expert, Susan Owens, believes that it's the other way around, that actually high oxalates can cause elevations in Candida and bacteria. And then there can also be genetic causes of high oxalates. So the other two markers, glycolic and glyceric, if they're low, they rule out genetic causes for high oxalates. And while oxalates are best known for causing kidney stones, I see a lot of clients who have what I believe to be oxalate-related problems that have never had a kidney stone. Some of those common manifestations I see in my practice are UTIs, joint pain, and interstitial cystitis, or frequency with, or urgency with urination. Then high glyceric acid, number 19, may be due to microbial sources such as yeast, in particular Aspergillus, Penicillium, and Candida, or due to dietary sources containing glycerol or glycerin, or due to genetic factors. Then high glycolic acid, number 20, can also be from overgrowth of fungi and yeast in the GI tract, including Aspergillus, Penicillium, and Candida, again from dietary sources of glycerol or glycerin, and from a wide variety of bacteria. And glycolic acid can also come from fruits and veggies. So according to Susan Owens, when glycolic is elevated, you should look for B6 deficiency due to ongoing infections like gut infections, because your body will create endogenous or internal oxalates if you have a lack of B6. So if you're concerned about oxalates and how to lower them correctly, And mind you, stopping all high oxalate foods suddenly is not the way unless you want to suddenly have an oxalate dumping event where oxalate crystals start coming out of your body everywhere. I'll put a link in the show notes to Susan Owens' website, lowoxalate.info. There's also a Facebook group called Trying Low Oxalates. So for now, I'm gonna skip down to the neurotransmitters and save the energy production markers for another podcast. So we're gonna skip to the bottom of page 3 and marker 33, HVA. This is your marker of dopamine. When this marker is very high, it means you're going through some type of high emotional or internal stress and using up lots of neurotransmitters. When it's below the mean, it indicates your dopamine production is low, and this will happen with long-term antidepressant usage, especially if it's an SSRI or selective serotonin reuptake inhibitor, because serotonin and dopamine compete for resources in the body, and SSRIs increase serotonin. It can also happen when you're protein deficient because you need phenylalanine, which converts to tyrosine to make dopamine, and that's an amino acid. So long-term vegan or vegetarian diets can lead to a dopamine deficiency. You can also have issues with missing cofactors like vitamin B6 that are necessary for dopamine production. And then chronic stress can lead to this, but it can also be a genetic issue. So when dopamine is very low, you'll see profound fatigue or physical exhaustion, difficulty concentrating, compulsive behaviors, loss of satisfaction, addictions, cravings. Sensation-seeking behaviors, including pain-inducing behaviors like cutting or use of drugs, sex addictions, or food compulsions, sugar cravings, you know, because eating sugar temporarily causes a dopamine rush. And then low dopamine has also been linked to Parkinson's, restless leg syndrome, and ADHD. The next marker, VMA, is indicative of low levels of epinephrine and norepinephrine. Because they're converted from dopamine, there are similar root causes and symptoms of low levels. With the addition of a lack of SAMe, or SAM, adenosylmethionine, a well-known supplement used for depression, which is needed for the conversion of epinephrine and norepinephrine to VMA. Common genetic polymorphisms in the MAO and COMT, or COMPT, genes can also cause a reduction in VMA. And then VMA values that are below the mean but which are much lower than HVA values are usually due to issues with an enzyme called dopamine beta-hydroxylase, or DBH, which I already mentioned a couple times due to the Clostridium metabolites HPHPA for Kressel or 4-hydroxyphenylacetic acid, which we saw in the first section, or also the mold metabolite fusaric acid, the one that comes from moldy corn. So again, you see how the bacteria and fungi interact with neurotransmitters and can cause mental health issues. There are also certain pharmaceutical drugs that can lead to low HVA values, as well as consuming aspartame or deficiencies of the cofactors vitamin C and copper. If you have low VMA due to Clostridium metabolites or genetic DBH deficiency, you should not take supplemental L-phenylalanine or L-tyrosine or L-dopa. The next marker, 35, represents that ratio of the two above. So if it's high, you can see there are conversion issues from dopamine to norepinephrine and epinephrine. Again, this points to a lack of cofactors like vitamin C or copper, or the other issues I mentioned above. The next marker, 36, or DOPAC, is an intermediate in the metabolism of dopamine. And when it's elevated, it can be from supplementing with L-phenylalanine, L-tyrosine, or L-dopa, or because of factors that inhibit the DBH enzyme, as I mentioned above. Because if you go back to the image on the bottom of page 2, you'll see that the DBH enzyme is helping convert dopamine into epinephrine and norepinephrine. And if it's sluggish, then the dopamine will be shunted off to DOPAC, which converts to HVA. So that's one way to see if DBH is likely an issue. Then 37, the HVA/DOPAC ratio will tell you if that final conversion is off, which can point to a lack of SAMe needed for the conversion or sluggish COMT enzyme, which catalyzes the conversion. Then markers 38 to 40 are all about tryptophan metabolism. And tryptophan is an essential amino acid that is the precursor to serotonin. So when you see 5-hydroxyindoleacetic acid or 5-HIAA high, that's marker 38, it means you're using up a lot of serotonin, which can deplete your tryptophan stores. And tryptophan is needed for the formation of all proteins in the body except collagen and can be caused by stress or SSRI usage. So levels below the mean may indicate low serotonin production related to long-term tyrosine usage or usage of ADHD medications, antidepressants, recreational drugs, or just tryptophan deficiency from a long-term vegan or vegetarian diet, poor absorption and/or missing cofactors, or an inherited deficiency. So when you're low on this marker, you'll see anxiety, panic attacks, insomnia, chronic pain, and digestive imbalances and constipation because serotonin is involved in moving the intestines, assimilation and absorption of nutrients, particle transport, and fluid discharge in the GI tract. Also, serotonin is, is released as you eat and it is nature's natural appetite suppressant. So low levels will increase food cravings and lead to overeating and weight gain. Then marker 39, quinolinic, points to faulty tryptophan metabolism where tryptophan is being diverted into the kynurenate pathway way because of stress or infections, and where it can eventually turn into quinolinic acid, which is neurotoxic, meaning it kills brain cells. This will lead to decreased serotonin and all the symptoms that go along with that. So the most common source of infections causing high quinolinic are viral, parasitic, fungal, or bacterial infections in the gut or body in general. And the second most common sources of inflammation are chemicals and heavy metals impacting the liver, as well as autoimmune disorders. There's a diagram of this on page— the top of page 7. High levels of quinolinic acid have been implicated in Alzheimer's, autism, Huntington's disease, stroke, dementia, depression, and schizophrenia. High levels are also highly correlated with the degree of arthritis impairment. Then marker 40, kynurenic, will be elevated if you're inflamed, are defending against a pathogen, or are deficient in B6, and the result will be a decrease in serotonin. Kynurenic is also produced in the liver, so if it's low from the liver, that points to vitamin B6 deficiency. But if it's low because the brain and stress, it points to neuroinflammation. So if you see both kynurenic and quinolinic high, you know there's inflammation impacting the brain. Then you need to find the source of the inflammation. However, if you see low B6 on marker 51 and high kynurenate below quinolinate, it's likely a low B6 problem, not neuroinflammation. So I know that was all a mouthful and an earful, so I'm going to finish the remaining oat markers in another podcast. But that gives you a great insight into how the oat can show you how bacterial and fungal infections in the gut or dietary issues can lead to mental health and physical health issues. So if you're dealing with either gut health issues or mental health issues or chronic all-over body problems, the good news is that this stuff is quite fixable. 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 want to talk to me about what you've been dealing with and see if I think I can help, you can set up a free 30-minute breakthrough session with me through the link in the show notes. I can let you know if I think I can help you and tell you 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 a single appointment. Links for 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 HighDesertHeliCoaching.com, or find me on Twitter, Instagram, and Pinterest. And links for everything is in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.