Gone are the days when healthcare professionals’ treatment practices were based on the infrequent assessment of functional test or pathology markers that are used to diagnose disease. Introducing organic acid tests to your diagnostic toolbox will help you to identify the root cause of your patients’ poor health and treat them without having to use potentially harmful chemicals.

Unless you are working in the field of paediatrics, organic acids are often forgotten when you leave university and start working with patients. The significance of organic acid levels has been known since the 1960s when Dr Richard Lord was obtaining his PhD. However, they are seldom incorporated into mainstream medical practices.

When a baby is born their heel is pricked and a small amount of blood is drawn to test for genetic abnormalities in metabolism that could be fatal. Similar genetic abnormalities in metabolism can present in adults but are seldom investigated because they present as chronic diseases which have established diagnostic tests and treatment regimes. Organic acid tests look a little deeper to establish the root cause of the problem.

Organic Acids Produced During Metabolism

To refresh your memory, organic acids are compounds formed during the metabolism of dietary carbohydrates, fats and proteins. The term “organic” refers to the carbon that forms the backbone of their structure; “acid” refers to the fact that they are weakly acidic, can donate a hydrogen ion and have a pH value of less than seven. 

Organic acids may also contain sulphur, phosphorus, oxygen and nitrogen. When these elements combine in various combinations they create hundreds of different compounds. More than one thousand organic acids have been identified in urine samples.

The functions of organic acids include the generation of cellular energy and the support of cell function through a variety of chemical pathways. They are an essential piece of the metabolic puzzle. When genetic mutations that have an impact on metabolism occur, the ability to use certain organic acids is diminished, affecting the efficiency of important chemical pathways. The result is often chronic disease.

Testing For Organic Acids In The Urine

While organic acids are present in the blood, they are excreted in the urine. A urine analysis test is more useful than a blood test because they are more concentrated in the urine. The test results are grouped according to function.

#1 Fatty Acid Metabolism

The organic acids adipic acid, suberic acid and ethylmalonic acid provide information about a person’s ability to metabolise fatty acids. Long-chain fatty acids are metabolised inside the mitochondria provided there is sufficient carnitine to transport them across the membrane. If there is insufficient carnitine the long-chain fatty acids are processed outside the mitochondria where adipic acid, suberic acid and ethylmalonic acid are produced.

#2 Energy Production

To investigate energy production we look at α-ketoglutaric acid, succinic acid, lactic acid, fumaric acid and malic acid.

Vitamins B1, B2, B3 and B5, and lipoic acid are required for the function of a dehydrogenase enzyme for the metabolism of α-ketoglutaric acid. When α-ketoglutaric acid levels are high there may be an indication for one or more of these B-complex vitamins.

Succinic acid, lactic acid, fumaric acid and malic acid are other functional markers that may indicate that the body is incapable of the efficient production of energy from CoQ10.

#3 B-Vitamins Methylation Cofactor

Methylmalonic acid and formiminoglutamic acid are organic acid indicators of Vitamin B12 and folate status. A deficiency of these vitamins is associated with many diseases including anaemia, cardiovascular disease and chronic fatigue.

High levels of methylmalonic acid can indicate a need for supplementation with vitamin B12.

The synthesis of formiminoglutamic acid relies on the amino acid histidine. Folate is required to maintain optimum levels of histidine. Increased amounts of urinary formiminoglutamic acid can indicate a folate deficiency.

#4 Oxidative Damage Status

High urinary levels of 4-hydroxyphenylacetic acid and 8-hydroxy-2′-deoxyguanosine are associated with increased oxidative stress. They indicate a strong need for an increased intake of antioxidants.

#5 Toxicants and Detoxification

2-methylhippuric acid, orotic acid and glucaric acid are indicators of exposure to environmental toxins. Chemicals that may increase urinary levels of these organic acids include xylene, pesticides, herbicides, fungicides, petrochemicals, alcohol, pharmaceutical compounds and toxins produced in the gastrointestinal tract.

Your Patients Will Benefit When You Introduce Organic Acid Testing To Your Practice

Organic acid tests take the guesswork out of establishing the root cause of your patients’ health conditions. They provide the information that makes it possible for them to support the natural chemical pathways involved in the metabolism of dietary carbohydrates, protein and fat; returning the body to optimum function. When you understand the effects of inherited metabolic disorders, you are able to treat them more effectively and prevent and manage chronic disease. 

By using appropriate tests to unravel your patients’ metabolic pathways you can reveal their unique Metabolic Signatures.

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