InstalabOAT
Should you take a OAT test?
This test is most useful if any of these apply to you.
77 Biomarkers Included
- Citramalic AcidA small acidic molecule found in urine that is thought to come mostly from gut microbes, used as a window into what is growing in the digestive tract.
- 5-Hydroxymethyl-2-furoic AcidA small molecule found in urine that forms when your body breaks down a compound created in sugar-rich foods during cooking, baking, and roasting.
- 3-Oxoglutaric AcidA small molecule from your body's main energy-making cycle, measured in urine to give clues about how well your cells are producing energy.
- Furan-2,5-dicarboxylic AcidA small molecule found in urine that scientists are studying as a possible signal of microbial activity in the gut, though its meaning in the human body is not yet well understood.
- FurancarbonylglycineA small waste molecule found in urine that forms when the body processes a compound called furan, which can come from certain foods and may also be produced by gut microbes.
- Tartaric AcidA small molecule found in urine that scientists are studying as a possible signal of microbial activity in the gut, though its meaning in the human body is not yet well understood.
- ArabinoseA small sugar molecule found in urine that is sometimes attached to larger sugar chains called glycans, and whose levels can shift in certain cancers and other conditions.
- Carboxycitric AcidA small molecule that appears in urine as part of how your body processes food and energy, sometimes reflecting the activity of bacteria living in your gut.
- Tricarballylic AcidA small molecule made by gut bacteria from compounds in your diet, which shows up in urine and may reflect what is happening in your gut microbiome.
- Hippuric AcidA small molecule made in your liver when gut bacteria break down plant compounds from fruits, vegetables, tea, and coffee, which is then filtered into urine.
- 2-Hydroxyphenylacetic AcidA small acid made when your body and gut bacteria break down certain proteins, showing up in urine as a marker of how this metabolism is running.
- 4-Hydroxybenzoic AcidA small organic acid found in urine that mainly reflects how much of certain preservatives, called parabens, your body has recently broken down and is excreting.
- 4-Hydroxyhippuric AcidA small molecule that shows up in urine after your gut bacteria break down certain plant compounds in your diet.
- DHPPAA small molecule found in urine that your body and gut bacteria make after you eat whole-grain wheat or rye.
- 4-Hydroxyphenylacetic AcidA small molecule found in urine that comes from how your body breaks down a building block of protein called tyrosine and from how gut bacteria process certain foods.
- HPHPAA substance made by certain gut bacteria from amino acids, then filtered out into your urine, where its level can hint at how active those bacteria are in your gut.
- 4-CresolA small molecule made by gut bacteria when they break down a protein building block called tyrosine, which your body then processes and passes out in urine.
- 3-Indoleacetic AcidA small molecule made when gut bacteria break down the amino acid tryptophan from food, which then passes through your blood and into your urine.
- Glyceric AcidA small acidic molecule produced during the body's normal breakdown of sugars and the amino acid serine, normally cleared from the bloodstream by the kidneys in tiny amounts.
- Glycolic AcidA small organic acid produced when your body breaks down certain proteins and collagen-related building blocks, and that shows up in urine where it can hint at kidney stone risk, rare inherited conditions, or toxic exposures.
- Oxalic AcidA waste molecule that the body cannot break down further, made by the liver and absorbed from food, which the kidneys must flush out before it crystallizes.
- Lactic AcidA small molecule produced when cells break down sugar for energy, appearing in urine as a signal of how your body is handling metabolic stress and how your kidneys are processing the load.
- Pyruvic AcidA small energy-related molecule found in urine that reflects how your body is using sugar and fuel to make energy.
- Succinic AcidA small molecule made inside your cells during normal energy production that ends up in urine when your body's metabolism is under stress or out of balance.
- Fumaric AcidA small acid your body makes during cellular energy production, which can show up in urine when that process is disrupted or when certain parts of the kidney are stressed.
- Malic AcidAn organic acid your cells make while turning food into energy, which can show up in your urine when that energy-making process is disrupted or when certain inherited conditions are present.
- 2-Oxoglutaric AcidA small molecule made inside your cells as part of how they turn food into energy, which then shows up in urine and reflects how well that energy system is running.
- Aconitic AcidA small organic molecule from your body's main energy-making cycle that shows up in urine, where its level offers a window into how well your cells are producing energy and how your kidneys are handling these byproducts.
- Citric AcidA small molecule in urine that binds calcium and helps stop it from clumping into kidney stones, with levels that also reflect your body's acid-base balance.
- 3-Methylglutaric AcidA small molecule found in urine that signals problems with how your cells produce energy or break down certain amino acids.
- 3-Hydroxyglutaric AcidA small acid in your urine that builds up when your body cannot properly break down certain protein building blocks, mainly because of a rare inherited enzyme problem.
- 3-Methylglutaconic AcidA small organic acid found in urine that can signal problems with how cells produce energy or break down certain building blocks of protein.
- Homovanillic Acid (HVA)A small molecule found in urine that your body makes when it breaks down dopamine, a chemical your brain and certain glands use as a signaling messenger.
- Vanillylmandelic Acid (VMA)A small molecule found in urine that is the main breakdown product of adrenaline and noradrenaline, the chemicals your body releases during stress or that some tumors produce in excess.
- HVA / VMA RatioA comparison of two breakdown products in urine that shows whether the body is leaning more on dopamine signaling or on adrenaline-type signaling.
- Dihydroxyphenylacetic Acid (DOPAC)A breakdown product of dopamine, a brain-signaling molecule, that shows up in urine and can reflect how the body processes dopamine in the kidneys and nervous system.
- HVA / DOPAC RatioA comparison of two dopamine breakdown products in urine that gives an indirect read on how your body is processing this important brain chemical.
- 5-Hydroxyindoleacetic Acid (5-HIAA)A waste product your body makes when it breaks down serotonin, a signaling molecule active in the gut, brain, and blood vessels.
- Quinolinic AcidA breakdown product of the amino acid tryptophan that builds up when your body is under inflammation or metabolic stress.
- Kynurenic AcidA small molecule made when your body breaks down the amino acid tryptophan, with levels in urine reflecting how your immune system, brain chemistry, and energy metabolism are interacting.
- UracilA small molecule produced when your body breaks down the building blocks of DNA and RNA, which can leak into urine when this recycling pathway is disrupted.
- ThymineA small chemical building block of DNA that shows up in urine when cells repair damaged DNA or break down certain chemotherapy drugs.
- 3-Hydroxybutyric AcidA small energy molecule your liver makes from fat when carbohydrates run low, with the amount leaving your body in urine reflecting how much you are burning fat for fuel.
- Acetoacetic AcidA ketone body made by the liver when the body burns fat for fuel, with its presence in urine signaling that fat-based energy production is high.
- Ethylmalonic AcidA small acid found in urine that signals trouble in how your body breaks down certain fats for energy.
- Methylsuccinic AcidA small acid found in urine that builds up when the body has trouble breaking down certain fats and amino acids for energy.
- Adipic AcidA small molecule found in urine that signals how your body is breaking down fat when its main fat-burning system is under stress.
- Suberic AcidA small fat-derived molecule that shows up in urine when your body burns fats through a backup route, often because the main fat-burning system inside your cells is overwhelmed or impaired.
- Sebacic AcidA medium-chain fatty acid byproduct your body makes when it burns certain fats for energy, measured in urine to reflect how your cells are processing those fats.
- Methylmalonic AcidA small acid in urine that signals how well your body is using vitamin B12 to break down certain fats and proteins.
- Pyridoxic AcidA breakdown product of vitamin B6 that your body sends out through urine, used to track recent vitamin B6 intake and how fast your body is burning through this vitamin.
- Pantothenic AcidA B vitamin (vitamin B5) measured in urine, where the amount you pass each day mirrors how much of this nutrient your body is taking in and using.
- Glutaric AcidA small waste molecule made when your body breaks down certain amino acids and fats, found at low levels in everyone's urine but much higher when specific metabolic pathways are blocked or disrupted.
- Ascorbic AcidA vitamin in the urine that mostly reflects how much vitamin C your body is absorbing from food and supplements compared to what your kidneys can hold onto.
- 3-Hydroxy-3-methylglutaric AcidA small acid molecule that appears in urine when the body's leucine breakdown and ketone-making machinery is disrupted, often pointing to inherited metabolic or mitochondrial problems.
- N-Acetylcysteine (NAC)A small sulfur-containing molecule that appears in urine and reflects either intake of N-acetylcysteine supplements or the body's processing of sulfur-based compounds tied to its main internal antioxidant system.
- Methylcitric AcidA waste molecule your body builds up when it cannot properly process certain building blocks from protein and fat, used to detect rare inherited disorders that block this part of energy metabolism.
- Pyroglutamic AcidA small molecule made when your body breaks down and rebuilds glutathione, one of your cells' main damage-protection systems, and it shows up in urine when that recycling process is under stress.
- 2-Hydroxybutyric AcidA small molecule made when the body breaks down certain amino acids and produces its main built-in antioxidant, glutathione.
- Orotic AcidA small molecule made by your body when it builds new genetic building blocks, and one that normally appears in very low amounts in urine.
- 2-Hydroxyhippuric AcidA small organic acid found in urine that forms when your liver and gut bacteria break down aspirin-like compounds and certain plant chemicals from food.
- 2-Hydroxyisovaleric AcidA small acid that shows up in urine when your body breaks down the amino acid leucine, reflecting how well a vitamin-dependent step in that pathway is working.
- 2-Oxoisovaleric AcidA small acid molecule made when your body breaks down a building block of protein called valine, which appears in urine and can reflect how well your body is handling protein metabolism.
- 3-Methyl-2-oxovaleric AcidA small acid your body produces when it breaks down isoleucine, one of the building-block proteins from food.
- 2-Hydroxyisocaproic AcidA small molecule made when your body breaks down the amino acid leucine, which can also be produced by certain gut bacteria.
- 2-Oxoisocaproic AcidA breakdown product of the amino acid leucine that shows up in urine when the body is processing more leucine than it can clear or when leucine breakdown is disrupted.
- 2-Oxo-4-methiolbutyric AcidA small molecule made when your body breaks down the amino acid methionine, measured in urine as part of broader organic acid testing.
- Mandelic AcidA small molecule that appears in urine when the body breaks down certain industrial chemicals you have inhaled, swallowed, or absorbed through your skin.
- Phenyllactic AcidA small acid molecule made when your body breaks down the amino acid phenylalanine, with extra contributions from gut bacteria and certain fermented foods.
- Phenylpyruvic AcidA breakdown product of the amino acid phenylalanine that shows up in urine when the body cannot process phenylalanine the way it normally should.
- Homogentisic AcidA small molecule formed when your body breaks down two common amino acids, found in urine in very small amounts unless an inherited enzyme problem causes it to build up.
- 4-Hydroxyphenyllactic AcidA small organic acid that appears in urine when your body, or your gut bacteria, break down the amino acid tyrosine.
- N-Acetylaspartic AcidA small molecule made mostly in brain cells that shows up in urine, where it can signal rare inherited diseases or shifts in how the body handles energy and amino acids.
- Malonic AcidA small organic acid your body produces while processing fats and energy, which can spill into urine when a specific metabolic pathway is blocked.
- 4-Hydroxybutyric AcidA small acid found in urine that comes from the body's normal breakdown of a brain signaling chemical, and is also the same substance as the recreational drug GHB.
- Phosphoric AcidA mineral measured in urine that reflects how much phosphate your body is taking in from food and how your kidneys are handling it.
- CreatinineA waste product made by your muscles that your kidneys filter out and send into your urine, used to judge how well your kidneys are working and to standardize other urine measurements.
About OAT
A single morning urine sample contains hundreds of small molecules your body has discarded after running its biochemistry overnight. The Organic Acids Test (OAT) reads dozens of those molecules at once and uses the pattern to ask a different question than blood testing usually asks: not what is circulating right now, but what is leaving the system, and why.
This panel is exploratory rather than a routine adult screen. It was developed inside functional medicine to surface patterns in cellular energy production, gut microbial activity, neurotransmitter turnover, and detoxification demand that standard bloodwork is not designed to see. Standardized cutoffs and outcome studies for general preventive use are still limited, so results are best read as hypotheses to investigate, not diagnoses.
What This Panel Reveals
The clinical story this panel tells covers several distinct domains at once. Each domain is read by a small cluster of markers, and the value of doing them together is that the clusters cross-check each other. The American College of Medical Genetics and Genomics (ACMG) treats organic acid analysis as a first-tier laboratory test for inborn errors of metabolism, and the same chemistry underlies the broader functional read offered by this panel.
Cellular energy and the Krebs cycle
Inside every cell, a chain of reactions called the Krebs cycle (also known as the citric acid cycle) burns fuel into the molecule that powers everything you do. When that chain gets backed up, intermediates spill into urine in characteristic patterns. The panel measures most of the cycle's main intermediates along with lactic and pyruvic acids, the upstream feeders that accumulate when oxygen-dependent metabolism is sluggish. A study of pediatric primary mitochondrial disease found increased urinary cis-aconitate, fumarate, and succinate compared to controls. Backlogs at specific steps can point to nutrient cofactor shortages, mitochondrial inefficiency, or impaired energy production.
Gut microbial fingerprints
Bacteria and yeast leave behind chemicals that humans do not make, and many of them pass straight into urine. The panel reads several of these. One group reflects beneficial bacterial activity and microbiome diversity. Hippuric acid, for example, has been associated with greater gut microbial diversity and consumption of polyphenol-rich foods including coffee, whole grains, and fruit, and with lower odds of metabolic syndrome. Another group is read as overgrowth signals: HPHPA (3-(3-hydroxyphenyl)-3-hydroxypropionic acid) and 4-cresol are reported alongside Clostridia activity, arabinose alongside Candida fermentation, and several furan and tartrate compounds alongside fungal byproducts. The panel cannot identify which species are present, but it can show whether the chemistry of microbial output looks balanced.
Neurotransmitter turnover and neuroinflammation
The panel measures urinary breakdown products of dopamine, norepinephrine, and serotonin, plus two compounds from the tryptophan-to-NAD (nicotinamide adenine dinucleotide, a key energy molecule) pathway that rise during neuroinflammation. Urine values do not directly mirror brain levels, but elevations and depressions can track high-volume turnover or shifted balance. In a systematic review of human studies, urinary quinolinic acid rose during acute physiological stress and in several chronic inflammatory conditions. The catecholamine metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) are also used clinically to screen for catecholamine-producing tumors in children. That diagnostic use is separate from how the markers are read inside this panel.
Fatty acid burning and B-vitamin demand
When fat oxidation runs cleanly, only small amounts of the intermediate dicarboxylic acids should appear in urine. Elevations of adipic, suberic, and sebacic acids are sensitive but nonspecific signals of impaired mitochondrial beta-oxidation of fatty acids. The panel also reports the two main ketones the body makes when it shifts toward fat fuel. Alongside these, several markers reflect the working demand on individual B vitamins. Methylmalonic acid in urine is one of the earliest and most specific signals of cellular vitamin B12 deficiency, with the urine-to-creatinine ratio limiting the effect of kidney function on the value. Pyridoxic acid covers B6, pantothenic acid covers B5, and glutaric acid covers riboflavin and lysine handling.
Detoxification and glutathione
Pyroglutamic acid, also called 5-oxoproline, rises when the body is recycling glutathione under high demand and glycine availability falls behind. Pyroglutamic acidosis from blocked glutathione regeneration has been documented in patients with septic shock. 2-Hydroxybutyric acid, orotic acid, and the salicylate-related markers complete the read on cleanup throughput. A urinary creatinine value is reported alongside everything else so each result can be normalized to how dilute or concentrated the sample is.
How to Read Your Results Together
No single marker on this panel is diagnostic on its own. The interpretation rule is to look for clusters that agree. A scattered elevation on one marker with everything else normal is usually background variation. A cluster of elevations within one domain is what the panel is built to find.
| Pattern | What It Suggests |
|---|---|
| Elevated arabinose, citramalic, and tartaric acids | Yeast or fungal fermentation pattern; warrants further gut workup before assuming Candida overgrowth |
| Elevated HPHPA, 4-cresol, and 4-hydroxyphenylacetic acid | Clostridia-associated microbial pattern; consider stool testing to confirm |
| Elevated Krebs cycle intermediates with high lactic and pyruvic acid | Cellular energy bottleneck or B-vitamin cofactor shortage; check B1, B2, B3, and coenzyme Q10 (CoQ10) status |
| Elevated methylmalonic acid with normal serum vitamin B12 | Functional B12 deficiency at the cellular level despite a normal blood number |
What to Do with Your Results
The decision pathway depends on which domain lit up. A microbial pattern is worth pairing with a stool test before any antimicrobial or antifungal treatment, because urine chemistry alone cannot prove which organism is responsible. A mitochondrial or Krebs cycle pattern is worth pairing with serum B vitamins, homocysteine, and a measure of insulin resistance, since cofactor deficiencies and metabolic disease both push the same intermediates upward. A functional B12 signal from urinary methylmalonic acid is worth confirming with serum vitamin B12 and homocysteine before starting supplementation.
For neurotransmitter and neuroinflammation markers, the most useful next step is usually clinical: a structured review of sleep, mood, stress load, and any medications that affect catecholamine or serotonin handling, rather than treatment aimed at the urinary number itself. For fatty acid oxidation markers, a fasting state at collection alone can produce the same elevations as a real defect, so a clean repeat under non-fasting conditions is the cheapest next move.
Retesting cadence depends on what you change. After a meaningful intervention (antimicrobial protocol, targeted nutrient repletion, change in fueling strategy), a repeat at three to six months is the shortest interval that will show a real shift. Without an intervention, annual retesting is reasonable for tracking and pattern recognition.
When Results Can Be Misleading
Urine concentration drives everything on this panel. A dehydrated morning sample will push most analytes upward, and a very dilute sample will pull them down. The creatinine value on the report is the correction factor, but extreme values on either end make the whole panel harder to read.
Diet in the 24 hours before collection matters. Foods rich in benzoates, polyphenols, or salicylates shift hippurate and related microbial markers. Bananas, walnuts, pineapple, tomatoes, and avocados can falsely raise 5-hydroxyindoleacetic acid (5-HIAA), the serotonin metabolite. L-dopa medications can falsely raise HVA and VMA. A fasting collection inflates ketones and dicarboxylic acids, while a recent course of antibiotics or antifungals can flatten the gut microbial section for weeks afterward.