Organic Acids Test (OAT)

Organic Acids Test (OAT) banner-like image in all white - MosaicDX

A Nutritional and Metabolic Snapshot

Organic acids are products of the body’s metabolic pathways. Evaluation of these downstream metabolites from various metabolic pathways provides insight into important areas related to gut health, mitochondrial dysfunction, neurotransmitter status, indicators of detoxification and macronutrient breakdown and nutritional status. This makes organic acid testing a valuable tool to assess the functional need for essential nutrients, diet modification, antioxidant protection, detoxification, and other therapies.

The Organic Acids Test (OAT) provides a comprehensive nutritional and metabolic snapshot of an individual’s overall health. The OAT measures 76 organic acids from one easy to collect urine sample.

Urine
Turnaround Time: 1-2 weeks

Turnaround times are estimates. Detailed order tracking is available in the MosaicDX Portal.

Organic Acids Test (OAT)
* Available in English, Japanese, German, Polish, French, Italian, Korean, Portuguese, Spanish, Hungarian, Chinese

Discover the Power of Organic Acids Testing

Join Dr. Kurt Woeller at our upcoming OAT Fundamentals Workshop!

Elevate your expertise in the Organic Acids Test (OAT) by joining our comprehensive one-day fundamentals seminars. Designed to equip you with the essential knowledge and skills to master the OAT delving into OAT interpretation, clinical application, disease conditions, and OAT patterns.

Qualified practitioners can register today at MosaicEDGE and receive a sample OAT as part of registration. CME Available.

Descriptive image for OAT (Organic Acids Test) - MosaicDX

What Patients Might Benefit from the OAT?

The OAT provides useful information about how well an individual’s metabolic pathways are functioning. Revealed imbalances may provide guidance around the underlying contributors to both symptoms and disease states – with improvement of associated symptoms and overall health when clinically addressed.

Symptoms and diseases associated with nutritional deficiencies and other metabolic imbalances:

  • Anxiety
  • Autism Spectrum Disorders
  • Depression
  • Diabetes
  • Digestive Disorders
  • Fatigue
  • Fibromyalgia
  • Gastrointestinal dysbiosis
  • Insulin resistance
  • Neurological Disorders
  • Obesity
  • Optimizing health
  • Psychological Disorders
  • Vulvodynia

Details

Why Run an Organic Acids Test (OAT)?

The Organic Acids Test (OAT) is a simple and efficient way to assess a number of metabolic pathways providing insight into imbalances and nutrient needs. The OAT can provide insight into a wide range of conditions, making it valuable for individuals who are experiencing complex chronic conditions.

The OAT test report is organized into clinically useful categories including:

  • Intestinal Microbial Overgrowth markers evaluate for candida activity, clostridia bacteria toxins, potential mold exposure, and imbalance in the gut microflora.
  • Oxalate Metabolites provide insight into oxalate levels being generated by organisms within the system or via dietary contributions.
  • Glycolytic Cycle Metabolites and Mitochondrial Markers (Krebs Cycle and Amino Acid Metabolites) evaluate for metabolic efficiency (e.g., use of glucose and amino acids for energy generation) and mitochondrial dysfunction.
  • Neurotransmitter Metabolites evaluate for phenylalanine, tyrosine and tryptophan metabolism which are linked to neurotransmitter status and quinolinic acid production.
  • Pyrimidine Metabolites & Ketone and Fatty Acid Oxidation markers give insight into folate status and cellular turnover, as well as mitochondrial utilization of fatty acids for energy production.
  • Nutritional Markers provide insight into the sufficiency of essential vitamins, antioxidants, and metabolic pathway co-factors.
  • Indicators of Detoxification assess for the presence of oxidative stress via markers of glutathione sufficiency and methylation versus transsulfuration function.
  • Amino Acid Metabolites may suggest functional nutrient need or be reflective of genetic metabolic dysfunction if a consistently, persistently elevated level of a particular analyte is noted.
  • The Mineral Metabolism marker provides insight into dietary intake of phosphate and can give insights into Vitamin D levels.

Learn More About the Organic Acids Test: Explore FAQs

Analytes

The OAT measures 76 organic acids from one easy to collect urine sample.

See full list of markers below:

  • Citramalic Acid
  • 5-Hydroxymethyl-2-furoic Acid
  • 3-Oxoglutaric Acid
  • Furan-2,5-dicarboxylic Acid
  • Furancarbonylglycine
  • Tartaric Acid
  • Arabinose
  • Carboxycitric Acid
  • Tricarballylic Acid
  • 2-Hydroxyphenylacetic Acid
  • 4-Hydroxyphenylacetic Acid
  • 4-Hydroxybenzoic Acid
  • 4-Hydroxyhippuric Acid
  • Hippuric Acid
  • 3-Indoleacetic Acid
  • Succinic Acid
  • HPHPA (Clostridia marker)
  • 4-Cresol (C. difficile)
  • DHPPA (beneficial bacteria)
  • Glyceric Acid
  • Glycolic Acid
  • Oxalic Acid
  • Lactic Acid
  • Pyruvic Acid
  • 2-Hydroxybutyric
  • Fumaric Acid
  • Malic Acid
  • 2-Oxoglutaric Acid
  • Aconitic Acid
  • Citric Acid
  • Homovanillic Acid (HVA)
  • Vanillmandelic Acid (VMA)
  • HVA/VMA Ratio
  • 5-Hydroxyindoleacetic Acid (5-HIAA)
  • Quinolinic Acid
  • Kynurenic Acid
  • HVA/DOPAC Ratio
  • Dihydroxyphenylacetic (DOPAC)
  • Uracil
  • Thymine
  • 3-Hydroxybutyric Acid
  • Acetoacetic Acid
  • 4-Hydroxybutyric Acid
  • Ethylmalonic Acid
  • Methylsuccinic Acid
  • Adipic Acid
  • Suberic Acid
  • Sebacic Acid
  • Methylmalonic Acid (Vitamin B12)
  • Pyridoxic Acid (Vitamin B6)
  • Pantothenic Acid (Vitamin B5)
  • Glutaric Acid (Vitamin B2-Riboflavin)
  • Ascorbic Acid (Vitamin C)
  • 3-Hydroxy-3-methylglutaric Acid (Vitamin Q10-CoQ10)
  • N-Acetylcysteine (Glutathione precursor and chelating agent)
  • Methylcitric Acid (Vitamin H-Biotin)
  • Pyroglutamic Acid
  • Orotic Acid
  • 2-Hydroxyhippuric Acid
  • 2-Hydroxyisovaleric Acid
  • 2-Oxoisovaleric Acid
  • 3-Methyl-2-oxovaleric Acid
  • 2-Hydroxyisocaproic Acid
  • 2-Oxoisocaproic Acid
  • 2-Oxo-4-methiolbutyric Acid
  • Mandelic Acid
  • Phenyllactic Acid
  • Phenylpyruvic Acid
  • Homogentisic Acid
  • 4-Hydroxyphenyllactic Acid
  • N-Acetylaspartic Acid
  • Malonic Acid
  • 3-Methylglutaric Acid
  • 3-Hydroxyglutaric Acid
  • 3-Methylglutaconic Acid
  • Phosphoric Acid

Sample Reports

The OAT test report is organized into seven clinically useful categories including:

  • Intestinal Microbial Overgrowth – Evaluates for invasive candida, clostridia bacteria toxins, potential mold exposure, and imbalance in the gut microflora
  • Glycolytic and Mitochondrial Metabolites – Evaluates for mitochondrial dysfunction
  • Neurotransmitter Metabolites – Evaluates for phenylalanine, tyrosine and tryptophan metabolism linked to neurotransmitter status and quinolinic acid production
  • Pyrimidines and Fatty Acids – Evaluates for folate metabolism, as well as fatty acid metabolism problems which can contribute to mitochondrial dysfunction
  • Oxalates
  • Nutritional Markers
  • Amino Acids
  • Body’s Capacity to Detoxify

Test Prep and Instructions

MosaicDX offers patient-friendly sample collection kits that simplify testing. Our kits include visual, step-by-step instructions for test preparation and sample collection, personalized shipping cards, and pediatric collection bags if needed. With MosaicDX, patients can easily collect samples for testing with confidence and accuracy.

Patient Resources

Assets for practitioners to support patients in understanding organic acids and MosaicDX’s OAT, enhancing their patients’ comprehension, decision-making, and overall health journey.

Gain crucial insights on integrating the OAT in your practice from Kurt Woeller, DO.

This webinar, hosted by Kurt N. Woeller, D.O., is specifically designed to provide practitioners with a basic understanding of the Organic Acids Test. Whether you are new to the field or simply require a refresher, this lecture is an ideal introduction to the OAT.

OAT Organic Acids Test logo

Frequently Asked Questions

•Organic acidic products of cellular metabolism that are excreted in urine (in mammals)

oProduced by living organisms including humans, bacteria, and fungi

oEvaluation of these downstream products of metabolic pathways provides insight into potential nutrient deficiencies, inflammation, toxicity, and other imbalances that could be contributing to clinical complaints

•Origins of Organic Acid Testing

oTo rule out rare Inborn Errors of Metabolism (IEM)- usually in infancy

oElevations of these organic acids (OA) reflect dysfunction in specific metabolic pathways

§Accumulation of these toxic metabolites can by life-threatening

§Symptoms observed in the newborn period include poor feeding and weight gain; nausea and vomiting; neuromuscular issues (e.g., poor tone, seizures); and susceptibility to infection

Use of OAs have evolved from investigating IEM to providing insight into functional metabolic imbalances.

The ordering process for MosaicDX tests starts with your healthcare practitioner assessing your symptoms and recommending the most appropriate test.

Once a test has been recommended, collection kits can be conveniently ordered and delivered straight to your doorstep. If you already have a collection kit, you can register your test and begin the process at your convenience.

It is important to carefully follow the collection instructions and include all required information about yourself and your specimens when registering your test. When your specimens are collected, you can use the prepaid shipping materials provided in your kit to ship them to MosaicDX. Your results will be accessible online via the MosaicDX portal. We recommend scheduling an appointment with your healthcare practitioner to discuss your results and develop a plan for your healthcare

If you are located outside of the U.S., our customer service team can assist you in finding a distributor in your country. In countries where a distributor is not required, you can place an order through our international patient ordering site. Please note that all international shipping costs must be paid prior to shipping the kit.  

The following tests provide valuable insight into metabolism, nutrient needs, food sensitivities and metal toxicity.

The Organic Acids Test by Mosaic Diagnostics evaluates levels of oxalates in urine. Oxalate (and its acid form, oxalic acid), is an organic acid that is primarily derived from three sources: the diet, fungus (such as Aspergillus and Penicillium), possibly Candida, and also human metabolism. Oxalic acid is the most acidic organic acid in body fluids and is used commercially to remove rust from car radiators. Antifreeze (ethylene glycol) is toxic primarily because it is converted to oxalate in the body. Two different types of genetic diseases are known in which oxalates are high in the urine, hyperoxalurias type I and type II, which can also be determined from the Organic Acids Test. 

Foods especially high in oxalates are often foods thought to be otherwise healthy, including spinach, beets, chocolate, peanuts, wheat bran, tea, cashews, pecans, almonds, berries, and many others. People now frequently consume “green smoothies” in an effort to eat “clean” and get healthy, however, they may actually be sabotaging their health. The most common components of green smoothies are spinach, kale, Swiss chard, and arugula, all of which are loaded with oxalates. These smoothies also often contain berries or almonds, which have high amounts of oxalates as well. Oxalates are not found in meat or fish at significant concentrations. Daily adult oxalate intake is usually 80-120 mg/d. A single green smoothie with two cups of spinach contains about 1,500 mg of oxalate, a potentially lethal dose. 

High Oxalate Food List

Fruit
Vegetables
Blackberries 
Beans (baked, green, dried, kidney)
Leeks
Blueberries
Beets
Okra
Carambola
Beet greens
Olives
Concord grapes
Beet root
Parsley
Currents
Carrots
Peppers (chili and green)
Dewberries
Celery
Pokeweed
Elderberries
Chicory
Potatoes (baked, boiled, frieds)
Figs
Collards
Rutabaga
Fruit cocktail
Dandelion greens
Spinach
Gooseberry
Eggplant
Summer squash
Kiwis
Escarole
Sweet potato
Lemon peel
Kale
Swiss chard
Orange peel
 
Zucchini
Raspberries
 
 
Rhubarb
 
 
Canned strawberries
 
 
Tamarillo
 
 
Tangerines
 
 
Fats, Nuts Seeds
Dairy
Misc.
Nuts
Chocolate milk
Chocolate
Nut butters
Soy cheese
 
Sesame seeds
Soy milk
 
Tahini
Soy yogurt
 
Soy nuts
 
 
Drinks
Starch
Dark or “robust” beer
Amaranth
Wheat bran
Black tea
Buckwheat
Wheat germ
Chocolate milk
Cereal (bran or high fiber)
Whole wheat bread
Cocoa
Crisp bread (rye or wheat)
Whole wheat flour
Instant coffee
Fruit cake
Hot chocolate
Grits
Ovaltine
Pretzels
Soy drinks
Taro

External sources of oxalates include ethylene glycol, the main component of antifreeze. Antifreeze is toxic mainly because of the oxalates formed from it. In addition, some foods also contain small amounts of ethylene glycol. Vitamin C (ascorbic acid or ascorbate) can be converted to oxalates but the biochemical conversion system is saturated at low levels of vitamin C so that no additional oxalate is formed until very large doses (greater than 4 g per day) are consumed. The high correlation between arabinose and oxalates indicate that intestinal yeast/fungal overgrowth is likely the main cause for elevated oxalates in the autistic spectrum population. The deposition of oxalates in critical tissues such as brain and blood vessels, the oxidative damage caused by oxalate salts, and the deposition of oxalate mercury complexes in the tissues.

Almost all organic acids used for human testing are measured by a combination of gas or liquid chromatography linked with mass spectrometry. Organic acids are most commonly analyzed in urine because they are not extensively reabsorbed in the kidney tubules after glomerular filtration. Thus, organic acids in urine are often present at 100 times their concentration in the blood serum and thus are more readily detected in urine. This is why organic acids are rarely tested in blood or serum. The number of organic acids found in urine is enormous. Over 1,000 different organic acids have been detected in urine since this kind of testing started.

Use of organic acids to provide insight into functional metabolic imbalances has evolved from historic diagnostic testing to investigate inborn errors of metabolism (IEM).

While the OAT is not designed specifically to diagnose classically defined IEMs, persistent marked elevations in OAs noted on the profile may indicate an undiagnosed underlying metabolic pathway defect. As such, further clinical investigation via an individual patient’s clinical presentation and the results of complementary laboratory tests may be warranted to guide more specific testing.

IEM are a class of inborn errors of metabolic pathways that are marked by accumulation (and usually toxic) organic acid metabolites in blood (i.e., organic acidemias) and increased excretion of organic acids in urine (i.e., organic acidurias). While individual IEMs are rare that typically become apparent clinically during the newborn period or early infancy, though milder – and even asymptomatic – forms may emerge in adolescence and adulthood.

Because of the life-threatening metabolic disturbances (acidosis and ketosis) that are associated with IEMs, an entire field of preconception and postnatal screening has arisen. Current newborn screening includes assessment of 34 core conditions which allows for early treatment intervention should a positive finding result.

The OAT or MOAT is typically not affected by antibiotics or antifungal medications, unless they contain certain fruits like apples, grapes, pears, or cranberries. However, it’s important for both the patient and practitioner to consider the purpose of the test when deciding whether to avoid these medications. For instance, if the practitioner is interested in evaluating the effectiveness of a particular therapy, it may be acceptable for the patient to continue taking the medication during the test. On the other hand, if the patient wants to determine their metabolic condition without any influence from medication, it’s advisable to discontinue the antibiotics or antifungals for a period of 1-2 weeks before the test. 

The Microbial Organic Acids Test (MOAT) is ideal for a follow-up to the OAT and is often recommended by practitioners looking for a specific abnormality, to monitor certain microbial imbalances, or to assess treatment efficacy.

Yes, it is possible to conduct multiple urine tests using a single urine sample, provided that the volume requirement for each test is met. The urine collection container typically holds around 50 mL of urine. However, for timed and 24-hour urine tests, a specialized collection jug or bag is necessary. 

Different states have regulations that define the scope of practice for practitioners. It is the practitioner’s responsibility to abide by these rules. Check with your state board of health to determine any restrictions related to laboratory testing. Please note, Mosaic Diagnostics does not offer testing in New York. 

Once you have opened your account, you have the options of ordering kits to stock in your office or drop-ship kits directly to your patients through your MosaicDX portal.   

Watch our short tutorial videos on how to conveniently  

Already have a kit? Watch this video on how to place an order for your patient using a kit from your inventory.   

To ensure optimal results, it is recommended to ship urine specimens to the laboratory immediately after collection as they start degrading in quality soon after. In case immediate shipping is not possible, here are some guidelines for specimen stability: Urine samples can be stored in the refrigerator for up to 5 days, and for extended periods in the freezer. This applies to all urine tests performed at MosaicDX, except for the Kryptopyrrole test, for which urine must be frozen immediately and received within 24 hours of collection for accurate results. 

Please refer to your test’s specific Test Preparation and Instructions for more information regarding the potential effects of medications, foods, and supplements on this test. 

You make also consult your healthcare provider prior to making any changes to your medications.

Visit the payment information page for an overview of payment options and procedures along with insurance coverage overview.

NOTE: Insurance coverage for testing is based on several factors such as the type of procedure, diagnosis, and insurance policy guidelines. Patients are encouraged to contact their insurance company to check for coverage and to provide the procedure codes (CPT codes) and diagnostic codes (ICD-10 codes). The CPT codes can be found on the billing information page, while ICD-10 codes are provided by the practitioner.

Mosaic Diagnostics offers written interpretations within test reports and complimentary consultations with our clinical educators for qualified practitioners. To schedule a consultation, simply sign in to your MosaicDX account and book a consultation online. 

We encourage all patients to discuss results with your practitioner.

Our Resources tab also contains educational materials that you may find useful, we also offer MosaicEDGE workshops for qualified practitioners to better understand the fundamentals of lab testing.

MosaicDX offers pediatric collection bags with adhesive tape for pediatric patients who have not been toilet trained. These bags can be used to collect urine from infants or young children. To request pediatric collection bags, please contact our Customer Service team

Together they provide necessary information about mycotoxin burden, nutritional need, mitochondrial function and detox capability in one, easy, urine sample.

Mold OvergrowthOrganic Acids Test:
GI tract invasive growth of metabolites of mycotoxins – aspergillus and fusarium
MycoTOX Profile:
Toxicity can happen independently or simultaneously with growth and colonization
Mycotoxin Potential ExposureX – 2 metabolites metabolite indicators aspergillus and fusariumX – 20 tests
Mycotoxin Toxic BurdenX
Mycotoxin Specific InfoX
Nutritional NeedX
Mitochondrial functionX
Detox capabilityX

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Clinical References