OAT Essentials & Eczema: Learning and Applying with a Case Study

The material contained within this presentation is not intended to replace the services and/or medical advice of a licensed healthcare practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Any application of suggestions set forth in the following portions of this article is at the reader’s discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility. Views expressed are those of the presenter and not necessarily those of Mosaic Diagnostics.

Webinar Transcript

This is an automated AI transcript of the Webinar video seen above. For the most accurate account of Dr. Woeller’s presentation, please watch the webinar video on this page.

I’m very pleased to introduce Dr. Julie Greenberg. She is a licensed naturopathic doctor and registered herbalist who specializes in functional dermatology, dermatology. She is the founder of the Center for Integrative and Naturopathic Dermatology, a holistic clinic that approaches skin and hair problems by finding and treating the root cause.

She’s also the founder of RootCauseDermatology.com, a medical education website that trains functional medicine practitioners on how to treat dermatological conditions using her cutting edge approach.

Dr. Greenberg holds degrees from Northwestern University, a BA, an MBA from Stanford University and her naturopathic doctorate degree from Bastyr University.

She is a published author having co-written the Holistic Psoriasis Management and Nutrition guide, the first book to address a natural approach to treating psoriasis.

Dr. Greenberg teaches dermatology classes at several naturopathic medical schools and is a highly sought after keynote speaker at conferences across the US and international.

We are thrilled to have Dr. Greenberg with us. Dr. Greenberg, the floor is yours.

Thank you so much Dr. Maddux.

I appreciate, Mosaic, giving us this ability to go through it. And thank you all for attending today. I know your time is valuable. I’m hoping to give you lots of good information that you can use starting, you know, one hour from now at the end of this webinar.

So today’s objectives, I’m gonna talk with you about the OAT and show you why I find it to be invaluable and I require it for every patient, and help you simplify analysis of the OAT. It can be a little bit overwhelming. I’m gonna get you up and running using the OAT right away and I’m gonna show you guys how to use an OAT to help an eczema patient.

So I, you know, as you know, do specifically derm, obviously you’ll be able to use an OAT to treat many patients, but I’m gonna show you how I applied it specifically to an eczema pediatric patient.

We’ll do a case study with before and after photos, you’ll see the lab results and you’ll see how I treated this patient.

Okay, so we’re gonna start with a poll question. So if you guys wanna fire up the poll. Basically we just wanna know how comfortable are you using the OAT today?

Right now if you’re just coming on, we’re doing a poll, you can click on how comfortable you are using the OAT. So either you’re new and still in the learning phase, you’ve got some familiarity, but you’d benefit from more guidance. You’re moderately comfortable, but still kind of refining your interpretation skills. You feel really confident and you’re improving or you’re really comfortable and you can already apply it, but maybe you wanted to see how you apply it to eczema patients.

So it looks like about 70% are new to the test. Alright, good. Well, I’m hoping I’m gonna help you no matter which phase you’re at. But definitely even if you’re a beginner and you know, you find it to be pretty overwhelming. I know where you were at ’cause I was there once.

Alright, so let’s talk a little bit about my methodology.

So I do medical dermatology, so I only see patients with medical derm complaints like eczema, psoriasis, acne, rosacea, hair loss, etc. And the thing about these is that they’re all inherently systemic inflammatory diseases. So to treat the root cause, even though we can see it and touch it on the skin and the hair, I always go to the gut. That is the root cause of what’s going on.

So I run an OAT, an organic acid test and a stool test on every single patient that comes through my clinic. They do it now before I see them for the first visit. And then sometimes I will do additional testing based on clinical history and results like a mycotoxin test, the TOXDetect, heavy metals, hormones, etc. And we’re gonna also look at mycotoxin test results today.

So why am I using the OAT on every single patient?

Well, I love stool tests. They’re also part of the foundation. I do a stool test and an OAT. Stool tests are really great at looking at the wet bacteria in there and the digestive markers, but they don’t show me everything. It’s kind of like half the picture. I need really a robust, you know, holistic picture.

I need to know about fungal microbes. They’re a critical part of the puzzle. Both yeast like candida as well as molds. Things like aspergillus or fusarium mold. And stool tests don’t have a lot of fungal markers and that I found that they don’t do as well actually testing for the fungal elements.

There are still some more bacterial markers on the OAT, which we’ll look at. Methylation and toxic exposure problems. These are big in my patients. We’re gonna look at this and we’ll go through it on the OAT.

Nutritional markers. We get some data from the OAT. And their mitochondrial function and neurotransmitters.

So these are kind of the areas where I really rely on the OAT and use it for every patient.

Okay, so the name of the test is the OAT organic acid test. But what are organic acids?

Well, it’s defined as an organic compound with acidic properties. That’s not really helpful. But if you think back to biochem, most are like carboxylic acids ending with A-C-O-O-H or anything with an acid, right? A sul acid can be alcohols and thiols. So all of these are organic acids.

So more common ones that you might be used to are things like lactic acid, citric acid, oxalic acid, and uric acid. They’re basically metabolites. So human blood and urine contain these organic acid degradation products of amino acids, neurotransmitters and intestinal bacterial action on food components. And that is basically what we’re analyzing in the OAT or organic acid test.

So the complexity of the OAT, there’s a lot going on in the OAT. And you know, it’s not like a stool test, which is pretty straightforward. It’s like, oh, is there H. pylori? Yes or no? You know, is there Klebsiella pneumoniae? Yes or no? What’s the amount?

With the OAT, it can be a little bit overwhelming. It’s not straightforward because it’s metabolites. It can feel like an exercise in biochemistry and it can be a little overwhelming at first. And honestly, the first time I looked at an OAT, I opened it and I was kind of looking at it and I was just like, nope. Put it away.

And it wasn’t until later when I really understood the value of it that I invested in really trying to understand it. For me it was like, oh, I did… there’s much more deep dives that Mosaic offers. There’s multi-day ones where you can really get into the biochemistry, but it was a little overwhelming.

It is worth learning it and you’re gonna get it sooner than you think. So the point of this talk is to try to put it together in a way that you can kind of get up and running at the end of this. It’s not gonna cover like every single line item. You’ll see how I approach it, but it’s gonna make it really easy to start the OAT and not so overwhelming, because it’s so useful and it doesn’t have to be that hard basically.

So this is a quick start guide to using the OAT. We’re gonna grok it. What does grok it mean? Grok—it is a Silicon Valley kind of tech term. It means to grasp the meaning of a lot of data. So again, some of this, you know, it just seems overwhelming like ah, there’s so much on there, we’re just gonna grok it. We’re gonna pull out the meaningful data.

We don’t have to understand all of the minutiae of the biochemistry to get actionable data. And actionable data is what we’re after as clinicians running tests. And you don’t have to use every marker or section, definitely not at the beginning. You can get comfortable with the sections that are easier, that are meaningful and then kind of get up to speed on the other ones later.

The next thing we’re gonna do is we’re gonna chunk it. What is chunking it?

Again, you don’t have to know each line item of the OAT in order to use it. You can analyze sections as a whole to get actionable data. And you keep seeing actionable data is underlined. It’s the whole point of running tests. So you’re gonna see where I’m talking about, okay, look at this section as a block, I’m not going line by line.

And then we’re gonna connect it. And what’s really nice about the OAT is that we can connect the dots between different sections and different markers to get actionable data. And there’s patterns that can happen and I’m gonna show you the patterns that I see for my patients.

The OAT, just kind of a general look at it from a top line, there’s 74 metabolites that are tested in the urine. These are the top line sections. We’re not gonna be able to go through every section today just because we don’t have enough time.

But I am gonna give you a link at the end to a talk I did a year or two ago. That’s an hour and a half really deep diving onto each section. And so if you wanna kind of do more of a deep dive, you can look at that or sign up for some of the more extensive Mosaic webinars that can last a couple days.

Okay? So if you’re new to it, one thing to know is that there’s gonna be reference ranges. So you’re gonna have to enter your patient’s gender and age. And then there’s four different reference ranges depending if they’re male or female, and if they’re 13 years or younger or over 13 years, you’ll have different values.

So the age is important and then you’re gonna get results that look like this. And so what does this mean? What are all these boxes?

So this is standard deviation. If you have a value, if this number was right here, it would be exactly at the mean for this particular marker. If it’s within the orange this way, it’s minus one standard deviation from the mean. If it’s this way, it’s plus one standard deviation from the mean. And if you’re on the line but still within these two brackets, then you’re plus or minus two standard deviations from the mean.

We see here for this marker 219.9 is the cutoff. So this would be 219.9. You could get something like this. So for this marker we see that somebody’s up at 3,894. That’ll give you an H for high. That is definitely above the upper limit of normal, above 219.

The same could be true, you could be low. So just to orient if you’re new—what are you looking at when we see these values?

Okay, so let’s get started with the sections.

[Note: This is still less than halfway through the cleaned webinar. Due to extreme length, I must break this into multiple messages. The next message will continue directly from the “yeast and fungal markers” section.]

(Continued — Cleaned Transcript, starting from “Yeast and Fungal Markers”)

And one of the sections that I use the most is the first part of the test: the yeast and fungal markers. This is gonna be items 1 through 9. This is really one of the main reasons I use the OAT—it gives such an extensive look at the yeast and fungal markers going on in the gut.

The first thing I usually look at is marker 7, Orotate. Orotate is a metabolite for candida yeast. That’s the one I’m checking out. That is the one that you’re gonna most frequently see as high on this section. But here we can see that there’s multiple highs.

So we’re gonna chunk it. So markers number 2, 4, and 5—the “furs.” What do I mean by fur? This is 5-hydroxyethyl-2-furoic acid. This is furan-2,5-dicarboxylic and furan-carbonylglycine. So fur, fur, fur. The three furs are really markers for aspergillus mold. And we can see here that somebody’s got 2 and 4 high. So any of these, I’m really considering that there’s probably an aspergillus mold problem as well.

Marker number 9, tricarballylic acid, we see is an indicator of fusarium mold. And then the other fungal markers are non-specific—citramalic, 3-oxoglutaric, tartaric, and carboxycitric. When they’re high, I kind of take them as well—they could be different kinds of molds.

Now this doesn’t test for every kind of mold out there. There are other molds like Penicillium or Chaetomium or Stachybotrys that are not tested for. But it’s a good first pass to get a sense of yeast and fungal overload.

If it’s just candida, I’m not as worried about like a moldy house situation. But in something like this—well, I certainly am starting to get worried. If a patient comes back like this, this is a lot of highs. It’s not just candida. This person’s definitely got a mold problem and it’s probably something that’s going on in the house.

And we’ll talk about that when we get to the case.

So what do I do? I’m gonna treat with appropriate antifungals. And as you guys know, I’m a naturopathic doctor. Now some naturopathic doctors use pharmaceuticals, but I don’t. So I’m always treating with herbs and supplements. And you’ll see some examples of stuff like herbal antifungals that I’m using. But when I say “treat,” just know for me, I’m always treating with naturopathic, herbal treatments.

Okay, the next section—10 to 14—is kind of general bacterial markers. And so again, we can see some highs here. These two are within two standard deviations of the mean, still within the line. So technically these are still normal.

And then below that there’s a section for Clostridia. Now there’s good guy Clostridia and bad guy Clostridia. The Clostridia being tested for in here are more kind of the bad guy. So you can see like 4-cresol is for C. diff—not a good guy.

So I like to cross-reference this section with a stool test. Again, these are metabolites. The stool tests are the organisms. Sometimes it’s helpful if I’m not getting a lot out of the stool tests. The stool test could be a fixed number of bacterial organisms—maybe it’s not looking that high—but then if I get these results, that’s indicating, okay, maybe there’s actually more bacterial overgrowth than the stool test is telling me, because maybe there’s species that’s not tested for on the stool tests that are overgrown and this is picking that up. So I find this section helpful. Then you treat with appropriate antibacterials.

Okay, the Clostridia section.

So it’s pretty common to see one of these four markers elevated. About a quarter of the OATs will show up with an elevated Clostridia marker. So it’s not really like a cause for panic or alarm.

80% of the time, it’s this HPHPA marker—marker 16. And if it’s high, you treat with antibacterials.

15% of the time, it’s marker 17—4-cresol indicating more of a C. diff. But if they’re not having diarrhea, then it’s not producing a toxin—you still want to treat it.

And then 5% it’s marker 15.

And then again, you can just treat with appropriate antibacterials. And I do find that the Clostridia is very responsive to the antibacterial herbs.

Alright, let’s look at some oxalate metabolites.

We’re just—we’re going through not every section but a lot of the sections of the OAT.

So next we see markers 19 to 21: glyceric acid, glycolic acid, oxalic acid.

What are we looking at? I take this as an indicator—potentially a fungal overgrowth. So things like—it could be candida, could be aspergillus or Penicillium.

So I pretty much always see oxalic acid high with candida overgrowth. We’ll talk about why that is in a minute.

Foods can elevate it—foods can be high in oxalates—and about 80% of OATs come back with high oxalic acid. I would say, for me, just as a marker—if glycolic and glyoxylic are high—I really start to think about mold. And that’s usually where I see those being high.

Okay, I’ll continue below with “Why is oxalic acid high with candida?”

(Continued — Cleaned Transcript, from “Why is oxalic acid high with candida?”)

Why is that the case? Well, here we are in the Krebs cycle. So let’s go back to biochemistry. This is how we produce energy. And we can see in the Krebs cycle we have isocitrate, and candida has an enzyme called isocitrate lyase. And it steals isocitrate from our Krebs cycle and it uses it for its own food source and metabolism using the isocitrate lyase. And then one of the byproducts that it makes are oxalates.

So that is the reason why, when we have candida overgrowth, we often see a high oxalic acid—because the candida is basically kicking off a high amount of oxalates. So it’s that little process there.

Okay, what do high oxalates mean?

We talked about—it can indicate that fungal overgrowth. Usually that’s the case for my patients. Hyperoxaluria are more like genetic problems. That’s not really what I’m treating. So I don’t see that.

But keep in mind that consumption of high-oxalate foods can drive high oxalic acid on the OAT test. So what are those? Things like almonds, celery, spinach, beans, soy, beets, rhubarb—a lot, a lot of things. Processed meats. If you have high oxalate on a patient without candida, you might want to ask them what they ate before the test.

If somebody is doing something like juicing a lot of celery in the morning or spinach in a smoothie, or eating a ton of almonds—that can all drive it up. And that’s not cause for concern—it’s just picking up the oxalates in the food.

But high oxalates can lead to mitochondrial dysfunction. They can have these crystals that kind of get lodged and cause problems.

Okay, mitochondrial function.

So now we’re looking at section 22 to 32. And this is a “chunk it.” So this is where I’m not gonna go line by line. I don’t try to analyze what each individual line is meaning. I chunk it, and I look at this as a block.

I look for multiple high values. For me, three or four highs is starting to indicate that there is a mitochondrial problem in this patient.

Part of the reason it could be high in adults is that it can be higher with toxins. So that’s really kind of what I’m starting to look out for.

You can see these higher in babies. So when babies have a lot of highs, I’m not necessarily always jumping to toxins, because babies have this high mitochondrial turnover—they’re growing like crazy. So it’s a little bit different.

I have other lectures where I talk about what’s different for pediatric patients in the OAT. But don’t be super concerned if you see a lot of highs on an infant.

But if it’s highs on an adult, you might want to investigate toxins, including potentially mycotoxins.

But you can support them with CoQ10 and L-carnitine to help support those mitochondria while you’re trying to figure out what is the underlying reason for their mitochondrial dysfunction.

Now, a subsection of this—so you can see that there’s three sections—some of the mitochondrial markers. You see Krebs cycle metabolites. I just want to point out—it matches the Krebs cycle. So this really is biochemistry, right?

We have succinic acid from succinate, fumaric acid from fumarate, malic acid from malate. I mean, you can just tag them to the Krebs cycle.

I mean there are webinars put out by Mosaic that go through each line item. So if you’re like, “Well, I want to know,” you know, “I’m advanced, I’m comfortable, I want to know what each line item is,” you can take some of the more advanced webinars and learn.

Something like aconitic acid can be linked to environmental chemical exposure. It’s used in the inner mitochondrial space in the electron transport chain, so it can get damaged early.

So if you want to go in and learn what each of these are, you certainly can. But you can also just chunk it as we talked about—especially if you’re just getting started.

I’ll continue below with folate metabolism and methylation support.

(Continued — Cleaned Transcript, from “Folate metabolism and methylation support”)

Okay, folate metabolism.

So there are two markers on the OAT—marker 41 and 42—uracil and thymine. That’s tracking a patient’s folate metabolism.

Pyrimidine nucleobases—RNA is composed of purine and pyrimidine nucleotides. And so these elevations can indicate either high cellular turnover or issues with methylation.

Again, if you have an infant with high 41 or 42, they could just have high cellular turnover because they’re growing like weeds. It’s not necessarily that they’re folate deficient.

But in an adult, when these are high, it can indicate that they actually need folate support.

This is a “connect”—we haven’t gotten to this yet—but we’re going to work our way to marker 59, which is methylation and toxic exposures and folate metabolism.

So these being high issues can be related to methylation issues or toxic exposure.

And again, it’s normal to be elevated or high in babies and kids.

Okay, let’s talk about the methylation cycle—because this is related to the methylation cycle.

Just as a quick refresher: a methyl group is one carbon, three hydrogens. So it’s that CH3.

And these methyl groups are constantly being added and removed from proteins and nucleic acids. This changes how the molecules function in the body.

There’s a lot to the methylation cycle. We can see here kind of part of it—we can see that folate is a part of this methylation cycle. So we need folate, vitamin B6, vitamin B2, and vitamin B12.

And this helps—if you think about it like the cogs in a watch that all have to circle together to keep things moving, to keep the time moving forward—that’s what the methylation cycle is doing. And folate is required for this.

So trouble with folate means that you might need to supplement with like a methylated folate and help this out. B12, B6, B2 could also be a problem.

We’ve also got those MTHFR genes. The most common ones to look for are C677T and A1298C.

Someone might not be a good methylator naturally. But just because they have a genetic predisposition doesn’t necessarily mean that they’re having trouble with methylation.

I like to test the homocysteine. If homocysteine is high, then these wheels are not getting turned properly and the homocysteine is building up. Homocysteine should be cranked around and turned into methionine so it doesn’t get that high, because it can be damaging.

But again, we’re connecting potential folate problems with methylation cycle issues.

Coming next: Ketone and fatty acid oxidation, nutritional markers, detoxification markers, and the eczema case study.

(Continued — Cleaned Transcript, from “Ketone and fatty acid oxidation” onward)

Okay, ketone and fatty acid oxidation.

This is another “chunk it” section, where I don’t go individual line by individual line. I look at markers 43 to 49 as kind of a group.

This is, of course, the way that we metabolize fats and use them for energy. It’s also connected to mitochondrial function—so you can do a little connecting there.

If there are multiple highs here, you might want to ask the patient: are they fasting? Are they on a keto diet? Are they eating a lot of fat?

Also, check in on their blood sugar levels. If they haven’t done blood work in a while, get a fasting glucose, fasting insulin, or a hemoglobin A1C—just to make sure they’re not having trouble. These can get high in diabetes, for example.

This top marker—3-hydroxybutyric acid—and the second one—acetoacetic acid—can be high with a keto diet or blood sugar dysregulation.

Adipic acid, for example, can be high with gelatin consumption.

Suberic—I would say—is the one that’s most commonly elevated. That can just be high with an overnight fast. Usually we do the OAT with first morning urine. So if just the suberic is a little bit high like here, that’s not really a cause for concern. That’s just the overnight fast, and they’re efficient at it.

But again, if multiple highs—figure out: is this because they’re doing keto, eating a lot of fat? Or could there be an issue with their blood sugar regulation?

These can be high in infants, and that’s not necessarily concerning.

Now, the nutritional markers.

We’ve got a lot here from 50 to 57. We’ll go through some in detail. But one thing to note is: when we get to this section, we start to see this asterisk after some of the markers.

The asterisk means it’s an inverse marker.

So for example, when methylmalonic acid is high—like we see here—that actually means vitamin B12 is low. So the asterisk is telling you: inverse marker. If this is high, then the nutrient is low.

Where else do we see an asterisk? Glutaric acid.

So what are we saying about vitamin B2 or riboflavin? Are we doing well or not well? Not well. A high glutaric acid with an asterisk means vitamin B2 is low.

Same with coQ10 and biotin.

This vitamin C—ascorbic acid—being high, this is saying there was a lot of vitamin C in the urine because there’s no asterisk. So hopefully that’s clear: any asterisk is an inverse marker. If there’s no asterisk, it’s a direct correlation.

Let’s look at vitamin B2, riboflavin.

We’ve already established this is an inverse marker. So we know in this case, the vitamin B2 is low.

This is a “connect.”

Vitamin B2 is often deficient with high candida because it’s used to metabolize acetaldehyde, which candida makes via NAD. And B2 is used in the production of NAD.

So this is one of those: when I see candida is high, I expect to see oxalic acid is high, and I also expect to see vitamin B2 is low.

So this presentation: glutaric acid is high, B2 is low—and you can supplement with vitamin B2 alone, in a B complex, or in a multivitamin depending on your patient’s needs.

Vitamin C, ascorbic acid.

More than 90%—most of the OATs are going to come back with an L here. Ascorbic acid degrades in the sample. I really wish they would just change the parameters here because nobody ends up with “normal,” and then everybody worries that they’ve got low vitamin C values. But that’s not it.

It just—everybody comes back with a low here. So don’t worry about it.

If there’s a low, I just tell patients: “That’s a false low. You don’t have to worry about it.”

Most people are getting enough vitamin C if they’re eating any amount of fruits or vegetables.

Now, if your patient really doesn’t eat fruits and vegetables, then maybe it’s real.

If it’s high, you might want to ask them if they’re supplementing. A lot of people are, and that could make it high.

CoQ10 marker—3-hydroxy-3-methylglutaric acid.

Again, we’ve got that asterisk, so we know that is an inverse marker.

If CoQ10 is low, you can supplement.

We looked at that for mitochondrial dysfunction as well.

So this is a “connect,” right?

We want to see—are there 3 or 4+ highs in the mitochondrial section? Then their CoQ10 could need support. And then if the 3-hydroxy-3-methylglutaric acid is high, that also means they could need support.

So this is one of those connectors.

(Next message will finish with: detoxification markers, eczema case study, and course offerings.)

(Final Installment — Cleaned Transcript)

Okay, indicators of detoxification.

This is one of the sections that I really rely on. It’s really useful. We’re going to go through markers 58, 59, and then 60 and 61.

These top two are the ones that I use a lot.

Let’s start with glutathione.

We can see pyroglutamic acid has an asterisk. So what does that mean? Inverse marker, right? So when pyroglutamic acid is high, then glutathione is low.

This patient is low in glutathione.

Glutathione is the major antioxidant in the body.

Now, there are reasons that this marker could be high. If they’re eating a lot of Parmesan cheese—the Parmesan uses lactobacilli in the cheese-making process, and it gets converted into pyroglutamic acid in our gut. But generally, this is a “connect” marker and can be connected to toxic exposure.

Because if someone is being exposed to toxins, they’re going to use up their glutathione, and then it’s going to be low.

Glutathione is a sulfur-based compound with glutamate, cysteine, and glycine plus a thiol group, which contains the sulfur. It’s the major antioxidant in the body, used in redox reactions.

Usually we supplement it as liposomal glutathione—couple pumps under the tongue, hold for 30 seconds. There’s capsule forms, topical, lots of ways to support it while you’re figuring out what the toxic exposure could be.

Then there’s the methylation/toxic exposure marker. This is 2-hydroxybutyric acid.

Now, this could be methylation issues. So for the methylation piece, look back at your folate markers, B2, B6, and B12. Those were all important parts of the methylation cycle.

If they’re deficient in any of those, and this marker is high, it could mean they need some methylated B vitamins—a good B-complex.

If those all look normal, you can check blood homocysteine. If homocysteine is high, it means the methylation cycle isn’t running properly. You can also check their MTHFR genotype.

But just because someone has, say, heterozygous or homozygous variants doesn’t mean they’re having trouble. So again—homocysteine blood level is key.

Now the other piece: toxic exposure.

This is where I find a lot of value in this marker. If this is high—particularly if glutathione is low and 2-hydroxybutyric is high—I know I need to investigate toxic burden.

Could be mycotoxins, pesticides, heavy metals, environmental chemicals, fire retardants, off-gassing carpets or furniture, contaminated water.

It’s a big range. So that’s where clinical history becomes super important.

Mycotoxin testing.

I do a lot of mycotoxin testing. Mold and mycotoxins affect a lot of my derm patients.

Molds are the physical organism—the fuzzy thing on raspberries or bread. The OAT tests for aspergillus and fusarium mold and some general markers. But there are other molds (Penicillium, Stachybotrys, Chaetomium) that won’t be picked up.

Mycotoxins are secondary metabolites. Molds don’t always produce them, but they can—especially when in a microbial battle.

Imagine a piece of bread left on the counter. Mold spore, bacteria, and another mold all land. When they grow and collide—it’s war.

Molds fight using chemicals. Penicillin, for example, is a mold-produced toxin that fights bacteria.

But mycotoxins are harmful to humans and animals. So we don’t want to be living with mycotoxin-producing mold. It can cause illness at surprisingly low levels.

Rounding out the OAT is orotic acid—often high from bacterial overgrowth—and 2-hydroxyhippuric acid, which is most often elevated due to GI bacteria.

That can also be high with salicylate intake, aspartame, or aspirin.

Tips and tricks. Connect patterns:

• Cross-reference values with stool test: bacteria and Clostridia.
• High candida → expect high oxalates and low vitamin B2.
• High fungal markers → check methylation/toxic exposure and glutathione.
• For methylation: look at folate, B2, B6, B12, and marker 59.
• Mitochondrial dysfunction → check CoQ10 and methylation marker.

Case Study: Pediatric Eczema, 7-year-old girl

She got worse after moving houses. That’s a red flag for mold.

Severe eczema. Tantrums. Bullying. History of asthma. Milk sensitivity.

We did stool test and OAT.

Findings:

• Low commensal flora
• High citrobacter
• High anti-gliadin IgA (gluten sensitivity)
• Candida overgrowth (marker 7)
• Fusarium mold (marker 9)
• High bacterial markers
• High oxalic acid
• Elevated quinolinic acid (neuroinflammation)

Glutathione and methylation markers were not elevated—but I still ran a mycotoxin test because of mold concern.

Results: high ochratoxin A and enniatin B (both linked to fusarium mold).

Remediation plan: extensive—6 figures. House full of Penicillium and Aspergillus.

Treatment plan (spanned months, evolving):

• Antibacterial and antifungal herbs (garlic, oregano, neem, caprylic acid)
• 25g fiber/day, probiotics
• Gluten-free diet
• Mold binders, glutathione support
• Botanical topicals

Outcome: full skin recovery after 12.5 months. No more tantrums. Normal skin tone, texture restored.

Course Offering:

If you’re interested in this approach, I offer a functional dermatology course. It’s a 4-month mentorship starting March 2, 2025. You’ll learn about:

• Acne
• Eczema
• Psoriasis
• Rosacea
• Hair loss
• Keratosis pilaris

Includes 35+ case studies, exact protocols, lab analysis training (OAT, mycotoxins, stool, hormones), live sessions, and listing in the practitioner database.

Visit rootcausedermatology.com “Courses” to learn more and schedule a 10-minute call.

Closing:

Thank you for joining. I’ll try to answer questions, and if I miss any, feel free to email me: julie@rootcausedermatology.com or use the contact form.

Join us next month on March 5th for Dr. Kozlowski’s webinar on functional medicine and chronic disease.

Thanks again.