The Organic Acids Test with a Focus on the Bacterial Metabolite Section


Kurt Woeller, DO, FMAPS


Digestive bacterial markers on the Organic Acids Test (OAT) do not typically get as much attention compared to the clostridia toxins such as 4-Cresol and HPHPA. However, there are some important clinical considerations to pay attention to when markers in the Bacterial Metabolite section of the OAT show up elevated.

Q: Can the Hippuric levels be an indicator of mold mycotoxins? 

A: Not that I am aware of.


Q: Can Hippuric acid result from Lyme and other co-infections – bartonella, mycoplasma. i.e. Is this a non-discriminate marker? 

A: I am not aware of any information showing these infections directly generating hippuric acid. 


Q: What was it that indicates bacterial overgrowth? 

A: Elevated levels within the Bacterial Marker section of the Organic Acids Test, particularly markers #10 – #13.


Q: High level of vanilmandelate can be due to ochratoxin? 

A: Ochratoxin A is a known inhibitor of phenylalanine hydroxylase which could lead to low dopamine. Low dopamine could lead to low homovanillic acid (HVA). Low vanillylmandelic acid (VMA) is often seen with dopamine beta-hydroxylase (DBH) inhibition by clostridia bacterial toxins. A mycotoxin from fusarium mold called fusaric acid is a DBH inhibitor. 


Q: My DC interpreted my high bacterial markers as bacterial overgrowth and suggested I avoid probiotic supplementation. However, I don’t have any signs of overgrowth in small intestines, and there are so many benefits to probiotics. What would you suggest? 

A: The elevated bacterial markers on the Organic Acids Test (OAT) are often benefitted with probiotic use. Each person is different with regards to their reactivity to probiotics. For example, some people with small intestine bacterial overgrowth (SIBO) do not tolerate probiotics early on in their treatment, but this does not mean everyone needs to avoid probiotics who have elevated OAT bacterial markers.


Q: If hippuric acid is elevated, should I tell patients not to drink coffee for 3 days? So, it can be ruled out and hone in on toluene as the cause of elevation and not from coffee? 

A: It is more than coffee consumption that could generate high hippuric. There are lots of vegetables and fruits containing chlorogenic acid that get converted into hippuric acid. My recommendation is to follow the directions in the organic acids test urine collection instructions. It will provide a list of foods to avoid.


Q: Any significance of extra low hippuric acid? 

A: Not entirely sure. Maybe it could be linked to poor glycine conjugation and/or very low consumption of chlorogenic and/or benzoic acid containing foods?


Q: Could high 4-hydroxyhippuric also be due to eating daily blueberries? 

A: Yes


Q: Does high tartaric and arabinose come from mold? Can it resolve with probiotics? 

A: High tartaric is associated with aspergillus mold. Arabinose is linked to candida. Probiotics may be helpful in improving diversity of the microbiome which can help against overgrowth of fungus. However, it typically requires more than just probiotics to reduce or eliminate overgrowth of fungal species in the digestive system for many people. For example, the use of antimicrobial botanicals and/or prescription antifungals like Nystatin may be necessary. 


Q: Do you find many issues in these bacterial markers in cases of atopic dermatitis? I have a case of a 14-month-old with severe eczema, and hadn’t yet considered an OAT for him, but now, I might. 

A: This condition can certainly be linked to underlying digestive problems and toxins. I would strongly recommend doing an OAT, as well as a comprehensive digestive stool analysis, and food sensitivity assessment. There may be more tests needed, but these are a good place to start. 


The material contained within this article and webinar 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 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.

Kurt Woeller DO

About the Author

Kurt Woeller, DO, FMAPS

Kurt N. Woeller, DO, FMAPS, is a Doctor of Osteopathic Medicine, integrative and functional medicine physician, and biomedical Autism Treatment Specialist in clinical practice for over 25 years.

Dr. Woeller is the education director and main course developer for his Integrative Medicine Academy (https://integrativemedicineacademy.com), an online academy for health professionals. He is also the Organic Acids Test (OAT) seminar creator and presenter for Mosaic Diagnostics Laboratory (formally Great Plains Laboratory’s GPL Academy) Mosaic EDGE seminars and has been involved in monthly educational webinars for GPL/Mosaic Diagnostics, and other organizations for over a decade.

His private practice, Sunrise Functional Medicine (https://mysunrisecenter.com), focuses on specialized diagnostic testing and treatments for individuals with complex medical conditions like autism, autoimmune, gastrointestinal, certain neurological disorders, and other chronic health conditions. Dr. Woeller is a Fellow of the Medical Academy of Pediatric Special Needs (MAPS).

He has served as a clinical consultant for various laboratory companies, i.e., Great Plains Laboratory, BioHealth Laboratory, providing health practitioner education regarding functional and integrative medicine.

You can follow Dr. Woeller for ongoing education articles and videos through his Substack at https://drwoeller.substack.com/ and his YouTube channel for Integrative Medicine Academyhttps://www.youtube.com/@integrativemedicineacademy. Finally, listen to Dr. Woeller’s latest health professional interviews through his Functional Medicine Doc Talk Podcast – https://functionalmedicinedoctalk.com.