Download Top 25 Organic Acid Markers Worksheet worksheet Download our free printable worksheet covering the 25 most clinically relevant organic acid markers, organised by metabolic category for quick reference during consultations. Download worksheet Key Takeaways Organic acids test interpretation reveals metabolic dysfunction, nutrient gaps, and microbial imbalances from a single urine sample Focus on marker patterns across categories rather than isolated high or low values for accurate clinical decisions Microbial overgrowth markers like HPHPA and arabinose help identify gut dysbiosis that standard stool tests may miss Neurotransmitter metabolites such as HVA, VMA, and 5-HIAA guide targeted mood and cognitive support protocols Integrating organic acids test results with patient history and other labs produces the most actionable treatment plans Organic acids test interpretation is one of the most valuable skills a practitioner can develop for functional and integrative care. This urine-based test measures over 70 metabolic byproducts, offering a snapshot of energy production, nutrient status, gut health, and neurotransmitter balance. However, the sheer volume of data on an organic acids test report can feel overwhelming without a structured approach.In this guide, you will learn how to interpret the key marker categories, identify clinically significant patterns, and translate organic acids test results into actionable treatment plans. Whether you run a primary care practice, a wellness clinic, or an integrative medicine centre, understanding these markers gives you deeper insight into your patients' biochemistry.What Is an Organic Acids Test?An organic acids test (OAT) measures small molecules produced during cellular metabolism. These compounds are filtered by the kidneys and excreted in urine, making the test non-invasive and straightforward to collect. For example, when the body breaks down glucose for energy through the Krebs cycle, it produces intermediates like citric acid, succinic acid, and malic acid. Similarly, gut bacteria and yeast produce their own organic acids as metabolic byproducts.The most widely used panels, such as the MosaicDX OAT (76 analytes) and the Genova Organix (51 analytes), group results into categories including mitochondrial function, microbial overgrowth, neurotransmitter metabolites, and nutrient needs. As a result, a single organic acids test provides a broad metabolic overview that blood tests alone cannot replicate.In addition, organic acids testing has moved beyond its original role in screening for inherited metabolic disorders. Functional medicine practitioners now use it routinely for patients presenting with chronic fatigue, mood disorders, digestive complaints, and unexplained symptoms. According to Lord and Bralley (2008), the clinical utility of urinary organic acids has expanded significantly as research links specific markers to nutrient cofactor deficiencies and microbial overgrowth.Why Organic Acids Test Interpretation Matters in Clinical PracticeAccurate organic acids test interpretation transforms raw data into clinical decisions. Without a structured approach, practitioners risk either overlooking significant findings or over-treating isolated abnormal values.For instance, a single elevated marker might reflect a temporary dietary influence. However, when multiple markers within the same metabolic pathway are abnormal, this pattern points to a genuine dysfunction. Therefore, pattern recognition is the cornerstone of effective organic acids test interpretation.Furthermore, organic acids testing offers functional insight that standard blood panels miss. Serum B12 levels can appear normal even when intracellular B12 is insufficient. In contrast, methylmalonic acid on the OAT rises when B12 is functionally deficient, providing a more accurate clinical picture. Pro Tip Always compare organic acids test results against the patient’s symptom picture. A marker that falls within the reference range but sits at the high or low extreme may still be clinically relevant when correlated with symptoms. Key Marker Categories in the Organic Acids TestUnderstanding the major categories is essential for efficient organic acids test interpretation. Most panels organise markers into five or six groups that reflect distinct metabolic pathways. The chart below illustrates how markers are distributed across these categories. Organic Acids Test: Key Clinical Categories – Source: Pabau Microbial Overgrowth MarkersMicrobial markers reveal yeast, fungal, and bacterial overgrowth in the gastrointestinal tract. These are among the most clinically actionable findings on the organic acids test.Arabinose and tartaric acid are key yeast overgrowth markers. Elevated arabinose, in particular, strongly correlates with Candida colonisation. On the bacterial side, HPHPA (3-(3-hydroxyphenyl)-3-hydroxypropionic acid) indicates Clostridia species overgrowth, while 4-cresol specifically reflects Clostridioides difficile activity.Conversely, DHPPA serves as a marker of beneficial bacterial metabolism. Low DHPPA suggests the patient may have reduced populations of health-promoting gut flora. In most cases, practitioners address microbial overgrowth through antimicrobial protocols followed by targeted probiotic support.Mitochondrial and Energy Production MarkersThe Krebs cycle intermediates form the backbone of energy assessment on the organic acids test. Citric acid, succinic acid, malic acid, fumaric acid, and 2-oxoglutaric acid each represent a step in the cycle. When several of these markers are simultaneously elevated or depleted, the pattern suggests mitochondrial dysfunction or nutrient cofactor deficiency.Pyruvic acid and lactic acid provide additional context. Elevated pyruvate often indicates impaired conversion to acetyl-CoA, which requires adequate thiamine (vitamin B1), lipoic acid, and coenzyme Q10. Similarly, elevated lactic acid points to anaerobic metabolism or mitochondrial stress.As a result, practitioners interpreting these markers should consider supplementation with B-complex vitamins, CoQ10, magnesium, and alpha-lipoic acid when patterns suggest energy production bottlenecks.Neurotransmitter MetabolitesOrganic acids test interpretation includes indirect assessment of neurotransmitter function through downstream metabolites. Homovanillic acid (HVA) reflects dopamine turnover, while vanillylmandelic acid (VMA) indicates norepinephrine and epinephrine metabolism. The HVA-to-VMA ratio provides clinically useful information about catecholamine balance.5-Hydroxyindoleacetic acid (5-HIAA) measures serotonin metabolism. Low 5-HIAA may correlate with mood disturbances, sleep issues, or carbohydrate cravings. Meanwhile, quinolinic acid and kynurenic acid reflect tryptophan metabolism through the kynurenine pathway. An elevated quinolinic-to-kynurenic acid ratio suggests neuroinflammation and potential excitotoxicity. Pro Tip When you see elevated quinolinic acid alongside low 5-HIAA, tryptophan is likely being shunted away from serotonin production and towards the inflammatory kynurenine pathway. Address inflammation first before supplementing serotonin precursors. Nutrient Status MarkersSeveral organic acids serve as functional indicators of vitamin and mineral status. Methylmalonic acid is the gold-standard functional marker for vitamin B12 deficiency. Formiminoglutamic acid (FIGLU) reflects folate status, while xanthurenic acid indicates vitamin B6 insufficiency.In addition, pyroglutamic acid serves as a reliable marker for glutathione deficiency. Glutathione is the body's primary intracellular antioxidant, and elevated pyroglutamic acid signals increased oxidative stress or impaired detoxification capacity.These markers are particularly valuable because they reflect functional nutrient status at the cellular level, rather than simply measuring circulating blood levels. Consequently, organic acids test interpretation often reveals nutrient insufficiencies that standard blood panels miss entirely.Detoxification and Methylation MarkersDetoxification markers assess the body's capacity to process and eliminate toxins. Pyroglutamic acid, as mentioned, indicates glutathione demand. Additionally, markers related to the methylation cycle, such as methylmalonic acid and formiminoglutamic acid, overlap with nutrient assessment.Oxalic acid deserves special attention in organic acids test interpretation. Elevated oxalates may result from yeast overgrowth (Candida produces oxalates), vitamin B6 deficiency, or excessive dietary oxalate intake. High oxalic acid levels have been associated with kidney stone risk, joint pain, and vulvodynia.Furthermore, ethylmalonic acid and adipic acid reflect fatty acid oxidation capacity. Elevations in these markers suggest the body is struggling to burn fat for energy, potentially due to carnitine or riboflavin deficiency. “Since integrating functional lab testing into our workflow, we have been able to offer truly personalised wellness protocols. The ability to track metabolic markers over time and document results digitally has transformed how we deliver care and communicate findings to our clients.” Sarah Lomas CEO, Sarah Lomas Step-by-Step Organic Acids Test InterpretationCollecting and Preparing the SampleThe organic acids test requires a first-morning urine sample for optimal accuracy. Patients should avoid apple juice, grape juice, and foods high in arabinose for 24 hours before collection. In addition, certain supplements, particularly high-dose B vitamins, should be paused 48 hours prior to testing to avoid skewing results.Most laboratories provide a collection kit with preservatives and clear instructions. Using digital intake forms to send pre-test preparation instructions ensures patients follow the protocol correctly, which directly improves result reliability.Reading the Results ReportStart by scanning for markers flagged as high (H) or low (L) by the laboratory. However, resist the urge to address each abnormal marker individually. Instead, group the flagged markers by metabolic category and look for patterns.For example, if citric acid, succinic acid, and malic acid are all elevated, this cluster points to a Krebs cycle bottleneck rather than three unrelated problems. Keeping thorough patient records allows you to compare results across multiple tests and track improvement over time.Identifying Clinically Significant PatternsThe most reliable organic acids test interpretation focuses on patterns rather than isolated values. Here are three questions to guide your analysis: Are multiple markers within the same pathway affected? If so, the pathway itself likely needs support. Do the findings correlate with the patient's symptoms? An elevated quinolinic acid matters more in a patient with depression than in one with no mood complaints. Are upstream or downstream markers also abnormal? For instance, elevated pyruvic acid (upstream) alongside elevated lactic acid (downstream) strongly suggests impaired mitochondrial conversion. Common Patterns and What They SuggestUnderstanding recurring patterns accelerates organic acids test interpretation in daily clinical practice. The following patterns appear frequently:Yeast overgrowth pattern: Elevated arabinose, tartaric acid, and oxalic acid occurring together. This combination strongly suggests gastrointestinal Candida overgrowth and warrants antimicrobial intervention alongside dietary oxalate reduction.Mitochondrial dysfunction pattern: Multiple elevated Krebs cycle intermediates combined with high lactic acid and pyruvic acid. This pattern indicates the energy production machinery is under stress. Consider CoQ10, B-complex, magnesium, and alpha-lipoic acid as foundational support.Neurotransmitter imbalance pattern: Low 5-HIAA with elevated quinolinic acid suggests tryptophan is being diverted from serotonin synthesis into the inflammatory kynurenine pathway. Address systemic inflammation and consider pre and post care protocols that include anti-inflammatory support.B-vitamin depletion pattern: Elevated methylmalonic acid (B12), xanthurenic acid (B6), and formiminoglutamic acid (folate) appearing together indicate broad B-vitamin insufficiency affecting multiple metabolic pathways. Pro Tip Create a clinical template in your practice management system that maps each common organic acids pattern to its first-line interventions. This saves interpretation time and ensures consistency across practitioners in multi-provider clinics. Integrating Organic Acids Test Results Into Treatment PlansEffective organic acids test interpretation does not end with identifying patterns. Translating findings into personalised treatment plans is where clinical value is realised.Start by prioritising the most symptomatic findings. If a patient presents with chronic fatigue and the test reveals mitochondrial dysfunction markers, address energy production first. If gut symptoms dominate and microbial overgrowth markers are elevated, begin with antimicrobial support.In addition, use measurements tracking software to monitor key markers across follow-up tests. Tracking trends over time is far more informative than a single snapshot. For example, declining arabinose levels over three months confirm that an antifungal protocol is working.When communicating results to patients, avoid overpromising based on biomarker data alone. As outlined in our guide on interpreting biomarkers without overpromising, frame results as clues that guide clinical decisions rather than definitive diagnoses.Furthermore, document all findings and treatment rationale in the patient's record. Using lab management software to store and organise results streamlines this process and supports continuity of care across appointments.How Practice Management Software Supports Lab-Based CareClinics that routinely order organic acids testing benefit enormously from digital workflows. Manually tracking dozens of markers across multiple patients quickly becomes unmanageable.A comprehensive primary care EHR system allows you to store lab results digitally, set follow-up reminders, and compare results across test dates. Additionally, capture forms can standardise how practitioners document their organic acids test interpretation, ensuring nothing is missed.For clinics offering functional medicine services, integrating lab workflows into your practice management platform reduces administrative burden and improves the patient experience. Patients appreciate receiving clear, documented summaries of their results alongside personalised recommendations. Expert Picks Want to interpret biomarkers responsibly? Read our guide on interpreting biomarkers without overpromising to patients. Building a preventive care workflow? Explore the best primary care EHR systems for managing lab-based patient care. Struggling with clinical documentation? Learn how faster, safer clinical notes can streamline your practice. Frequently Asked Questions What does an organic acids test measure? An organic acids test measures over 70 metabolic byproducts in urine, including markers for energy production, gut microbial overgrowth, neurotransmitter metabolism, nutrient status, and detoxification capacity. It provides a broad metabolic overview from a single non-invasive sample. How do you interpret organic acids test results? Effective organic acids test interpretation focuses on patterns rather than isolated values. Group flagged markers by metabolic category, look for clusters within the same pathway, and correlate findings with the patient’s symptoms and clinical history before designing interventions. What is the most common organic acids test? The MosaicDX Organic Acids Test (OAT) measuring 76 analytes is the most widely used panel in functional medicine. The Genova Organix (51 analytes) and Diagnostic Solutions OAp are also popular alternatives with slightly different marker profiles. What do elevated organic acids mean? Elevated organic acids typically indicate a metabolic bottleneck where enzymatic function is impaired, nutrient cofactors are deficient, or microbial overgrowth is producing excess metabolites. The clinical significance depends on which markers are elevated and whether they form a recognisable pattern. How should patients prepare for an organic acids test? Patients should collect a first-morning urine sample and avoid apple juice, grape juice, and high-arabinose foods for 24 hours before testing. High-dose B-vitamin supplements should be paused 48 hours prior. Following the laboratory’s collection kit instructions ensures accurate results. Can organic acids testing detect gut issues? Yes. Organic acids testing includes microbial overgrowth markers such as arabinose and tartaric acid for yeast, HPHPA for Clostridia bacteria, and DHPPA for beneficial bacterial activity. These markers can reveal gut dysbiosis that standard stool cultures may miss.
