InstalabOAT
Urine Test
See an early, exploratory map of how your gut microbes and cellular energy may be shaping your fatigue and brain fog.
4.9 (4,545 reviews)
Tested by Mosaic Diagnostics
Physician-reviewed results
Results in under 1 week
How it works
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Explained with clear next steps, no medical jargon
Should you take a OAT test?
This test is most useful if any of these apply to you.
Living With Unexplained Fatigue
You feel drained in a way routine bloodwork hasn't explained, and you want an exploratory look at your cellular energy pathways.
Dealing With Ongoing Gut Symptoms
You have bloating or digestive issues and want early clues about how your gut microbes may be behaving.
Tracking Mood and Focus Changes
You want an exploratory read on how your gut and metabolism may connect to shifts in your mood and concentration.
Curious About Functional Testing
You like tracking your own biology and want a wide, pattern-level snapshot you can retest and follow over time.
What's included
77 biomarkers included
- Metabolic2
- 3-Hydroxybutyric AcidA ketone your body makes when burning fat for fuel, reflecting fuel-source shifts.Why it mattersElevation usually reflects fasting, low-carb eating, or heavy fat reliance rather than disease.
- Acetoacetic AcidA second ketone that, with 3-hydroxybutyric acid, shows how much you are running on fat.Why it mattersA high level signals ketone production from fasting, carbohydrate restriction, or uncontrolled blood sugar.
- Liver5
- N-Acetylcysteine (NAC)A sulfur compound tied to glutathione building, read within the panel's antioxidant section.Why it mattersIts level offers an exploratory clue to sulfur and antioxidant pathway activity, often influenced by supplements.
- Pyroglutamic AcidA marker of glutathione turnover, the body's main internal antioxidant system.Why it mattersA high level may reflect strain on glutathione, the body's key detox antioxidant.
- 2-Hydroxybutyric AcidAnother marker of glutathione demand and oxidative stress, complementing pyroglutamic acid.Why it mattersElevation is read as a sign of increased oxidative or metabolic stress on antioxidant pathways.
- Orotic AcidA marker of the urea cycle, the body's ammonia-clearing pathway.Why it mattersA high level can point to a urea-cycle issue affecting ammonia handling, warranting follow-up.
- 2-Hydroxyhippuric AcidA minor hippuric-acid relative the panel groups with its bacterial and detox markers.Why it mattersAn elevated level may reflect microbial activity or aspirin and salicylate intake, so context matters.
- Kidney4
- Glyceric AcidA precursor-pathway marker that helps distinguish the source of a high oxalate result.Why it mattersElevation with high oxalate can point toward a metabolic rather than dietary oxalate source.
- Glycolic AcidAnother oxalate-pathway marker used with glyceric and oxalic acid to interpret oxalate status.Why it mattersA high level alongside oxalate helps flag a possible internal overproduction pathway.
- Oxalic AcidAn acid that can form kidney stones, with dietary, metabolic, and microbial inputs feeding it.Why it mattersA high level may reflect diet, gut or yeast activity, or oxalate handling, and relates to kidney-stone risk.
- CreatinineNot a disease marker but the yardstick every other value is measured against, correcting for urine dilution.Why it mattersAn unusual creatinine can distort the whole panel, since all results are expressed relative to it.
- Electrolytes1
- Phosphoric AcidA urine acid reflecting mineral and acid-base balance, tied to diet and bone metabolism.Why it mattersAn abnormal level mostly reflects diet and mineral balance rather than a specific disease.
- Nutrients24
- UracilA building block of genetic material whose urine level reflects nucleic-acid and folate-related metabolism.Why it mattersAn abnormal level can flag folate or B-vitamin issues or, rarely, an inherited metabolic disorder.
- ThymineAnother genetic-material building block, paired with uracil for nucleic-acid metabolism.Why it mattersElevation with uracil may reflect altered pyrimidine metabolism, an exploratory or rarely inherited signal.
- Ethylmalonic AcidA marker the panel links to short-chain fat metabolism and possible cofactor needs.Why it mattersAn elevated level may reflect a hiccup in short-chain fat breakdown, an exploratory metabolic signal.
- Methylsuccinic AcidA companion to ethylmalonic acid that reflects short-chain fatty-acid handling.Why it mattersA high level, alongside ethylmalonic acid, may point to strained fat oxidation.
- Adipic AcidA byproduct of a backup fat-burning route the body uses when normal fat metabolism is impaired.Why it mattersElevation can suggest reliance on this backup route, though a fatty or ketogenic diet also raises it.
- Suberic AcidA related backup fat-burning byproduct that, with adipic and sebacic acid, flags reliance on this pathway.Why it mattersA high level supports a pattern of increased backup fat metabolism, best read with adipic acid.
- Sebacic AcidThe longest of the backup fat-burning markers, rounding out the panel's fatty-acid view.Why it mattersElevation with adipic and suberic acid strengthens a signal of altered fat metabolism, though diet can raise it.
- Methylmalonic AcidA functional marker of vitamin B12 status, a vitamin needed for nerves and red blood cells, at the cellular level.Why it mattersElevated methylmalonic acid suggests a functional B12 shortfall even when blood B12 looks normal, though kidney disease and dehydration can also raise it.
- Pyridoxic AcidA breakdown product of vitamin B6, used to gauge how well supplied this enzyme cofactor is.Why it mattersAn abnormal level is read as a clue to vitamin B6 status, best confirmed with a blood B6 test.
- Pantothenic AcidReflects vitamin B5, a building block of the body's main energy-carrying molecule.Why it mattersAn unusual level is interpreted as a clue to vitamin B5 status, an exploratory nutrient signal.
- Glutaric AcidA marker the panel links to riboflavin-dependent fat metabolism and, at extremes, a rare disorder.Why it mattersA markedly high level warrants ruling out glutaric acidemia, a rare inherited condition.
- Ascorbic AcidVitamin C appearing in urine, offering a rough read on vitamin C intake and status.Why it mattersA low level may hint at low vitamin C intake, though recent diet strongly drives this value.
- Methylcitric AcidA marker linked to vitamin B12-dependent metabolism and, at high levels, a rare organic acidemia.Why it mattersMarked elevation warrants ruling out a rare inherited disorder of B12-dependent metabolism.
- 2-Hydroxyisovaleric AcidA branched-chain amino-acid byproduct that adds to the panel's amino-acid metabolism view.Why it mattersElevation may reflect altered branched-chain amino-acid handling or a related cofactor need.
- 2-Oxoisovaleric AcidA branched-chain amino-acid intermediate reflecting how these amino acids are processed.Why it mattersA high level, at extremes, can flag a rare disorder of branched-chain amino-acid breakdown.
- 3-Methyl-2-oxovaleric AcidAnother branched-chain amino-acid intermediate completing that cluster.Why it mattersMarked elevation with related markers warrants ruling out maple syrup urine disease, a rare condition.
- 2-Hydroxyisocaproic AcidA leucine-derived byproduct adding depth to branched-chain amino-acid assessment.Why it mattersAn abnormal level reflects altered leucine metabolism, an exploratory nutrient and metabolic signal.
- 2-Oxoisocaproic AcidA leucine intermediate grouped with the branched-chain amino-acid markers.Why it mattersA high level, at extremes, can contribute to flagging a rare amino-acid disorder.
- 2-Oxo-4-methiolbutyric AcidA methionine-pathway intermediate linked to sulfur amino-acid metabolism.Why it mattersAn abnormal level reflects altered methionine handling, an exploratory metabolic clue.
- Mandelic AcidA marker linked to solvent exposure and phenylalanine metabolism.Why it mattersA high level may reflect styrene or solvent exposure or metabolic shifts, so context is needed.
- Phenyllactic AcidA phenylalanine byproduct that can reflect both microbial activity and amino-acid metabolism.Why it mattersElevation may reflect microbial or metabolic handling of phenylalanine, and at extremes prompts further testing.
- Phenylpyruvic AcidA phenylalanine intermediate that at high levels is a classic marker of a rare inherited disorder.Why it mattersA markedly high level should prompt evaluation for phenylketonuria (PKU).
- Homogentisic AcidA tyrosine breakdown product; grossly high levels are a hallmark of a rare inherited disorder.Why it mattersA very high level warrants ruling out alkaptonuria, a rare genetic condition, with confirmatory testing.
- 4-Hydroxyphenyllactic AcidA tyrosine byproduct with both microbial and liver-related inputs.Why it mattersElevation can reflect microbial activity or liver processing of tyrosine, and is useful in specific disorders.
- Neurological11
- Homovanillic Acid (HVA)The main breakdown product of dopamine, and the panel's central marker of dopamine turnover.Why it mattersOnly a small share of the body's HVA comes from the brain, so it reflects whole-body, not brain, dopamine activity.
- Vanillylmandelic Acid (VMA)A breakdown product of adrenaline-type signals, reflecting stress-hormone turnover.Why it mattersUrinary VMA mainly reflects liver processing and body-wide activity, not brain norepinephrine status.
- HVA / VMA RatioA ratio comparing dopamine and adrenaline-pathway breakdown to suggest balance between them.Why it mattersA skewed ratio is read as a possible tilt in catecholamine metabolism, an exploratory rather than diagnostic signal.
- Dihydroxyphenylacetic Acid (DOPAC)Another dopamine breakdown product that, with HVA, refines the dopamine-turnover picture.Why it mattersAn abnormal level adds detail to dopamine metabolism but, like HVA, largely reflects peripheral sources.
- HVA / DOPAC RatioA ratio comparing two dopamine breakdown products to hint at how dopamine is processed.Why it mattersA shifted ratio suggests a change in the dopamine-breakdown route, interpreted only exploratorily.
- 5-Hydroxyindoleacetic Acid (5-HIAA)The main breakdown product of serotonin, the panel's window onto serotonin turnover.Why it mattersUrinary 5-HIAA reflects body-wide serotonin, largely from the gut, not brain serotonin status.
- Quinolinic AcidA tryptophan-pathway product tied to inflammation, part of the panel's neuro-inflammation view.Why it mattersElevation may reflect systemic inflammation shifting tryptophan metabolism rather than a direct brain measure.
- Kynurenic AcidA protective tryptophan-pathway product that, with quinolinic acid, shows how tryptophan is routed.Why it mattersAn abnormal level reflects systemic tryptophan-pathway shifts, often inflammation-related, not brain activity.
- N-Acetylaspartic AcidA brain-enriched compound the panel reads within its neurological markers.Why it mattersA very high level, rarely, points to a specific inherited neurological condition.
- Malonic AcidA marker of fat-synthesis and mitochondrial handling; grossly high in a rare disorder.Why it mattersA very high level should prompt evaluation for the rare condition malonic aciduria.
- 4-Hydroxybutyric AcidA marker that at high levels signals a specific rare inherited disorder.Why it mattersA markedly elevated level warrants evaluation for SSADH deficiency, a rare condition.
- Microbiome18
- Citramalic AcidAn acid the panel groups with its proposed yeast and fungal fermentation markers.Why it mattersElevation is read as possible yeast or bacterial overgrowth, a link that is exploratory, not confirmed.
- 5-Hydroxymethyl-2-furoic AcidA furan-derived acid the panel associates with fungal activity and certain dietary intake.Why it mattersA high level is interpreted as possible fungal overgrowth, though diet can also raise it.
- 3-Oxoglutaric AcidAn acid included among the panel's proposed fungal-metabolism markers.Why it mattersElevation is treated, exploratorily, as a possible yeast-related signal.
- Furan-2,5-dicarboxylic AcidA furan-family acid the panel reads as a fungal or dietary marker.Why it mattersA high level is interpreted as possible fungal activity, with diet a common confounder.
- FurancarbonylglycineA furan byproduct grouped with the panel's fungal and microbial markers.Why it mattersElevation is read as a possible microbial or dietary signal, exploratory in meaning.
- Tartaric AcidAn acid the panel treats as a proposed yeast-fermentation marker, since human cells make little of it.Why it mattersA high level, beyond dietary sources like grapes and wine, is read as possible yeast overgrowth, exploratorily.
- ArabinoseA sugar-alcohol byproduct the panel reads as a proposed marker of gut yeast activity, extrapolated from research on invasive fungal infection.Why it mattersElevated arabinose is read as possible gut yeast activity, though its validated evidence is for invasive candidiasis in hospitalized patients, not wellness overgrowth.
- Carboxycitric AcidAn acid the panel includes among its yeast and fungal fermentation markers.Why it mattersA high level is interpreted, exploratorily, as possible fungal overgrowth.
- Tricarballylic AcidAn acid linked to gut microbial activity and certain mold-related dietary exposures.Why it mattersElevation may reflect microbial metabolism or dietary mold exposure, so it is nonspecific.
- Hippuric AcidA joint product of gut microbes and your liver that reflects both microbial activity and dietary plant intake.Why it mattersIt sits at the crossroads of diet, gut microbes, liver, and kidney, so an abnormal value rarely points to one cause.
- 2-Hydroxyphenylacetic AcidA bacterial byproduct of amino-acid breakdown the panel uses as an exploratory gut-activity marker.Why it mattersElevation is read as increased bacterial protein fermentation in the gut, a nonspecific exploratory signal.
- 4-Hydroxybenzoic AcidA microbial phenolic byproduct included among the panel's bacterial dysbiosis markers.Why it mattersElevation is interpreted, exploratorily, as increased gut microbial phenol production.
- 4-Hydroxyhippuric AcidA phenolic marker combining gut microbial and host processing, complementing hippuric acid.Why it mattersA high level suggests a shift in microbial phenol metabolism that can corroborate other bacterial markers.
- DHPPAA phenolic acid the panel reads as reflecting gut bacterial metabolism of plant compounds, including beneficial flora.Why it mattersAn abnormal level is interpreted as a shift in gut bacterial activity, though its clinical meaning stays exploratory.
- 4-Hydroxyphenylacetic AcidA phenol-family acid from gut bacterial metabolism of tyrosine, adding to the panel's microbial section.Why it mattersA high level suggests altered bacterial tyrosine metabolism, sometimes seen alongside other overgrowth markers.
- HPHPAA urinary byproduct linked to certain Clostridia bacteria; it anchors the panel's exploratory picture of bacterial activity in the gut.Why it mattersA markedly high level suggests possible Clostridia overgrowth, which functional frameworks link, exploratorily, to mood and behavior changes.
- 4-CresolA byproduct of gut bacteria breaking down the amino acid tyrosine, and one of the better-studied microbial urine markers.Why it mattersElevated 4-cresol reflects shifts in gut bacterial protein metabolism and can change with antibiotics or microbiome shifts.
- 3-Indoleacetic AcidA byproduct of gut bacteria breaking down tryptophan, contributing to the microbial metabolism picture.Why it mattersAn abnormal level reflects changes in bacterial tryptophan handling in the gut, an exploratory signal.
- Mitochondrial12
- Lactic AcidA product of burning sugar without enough oxygen, a classic signal of energy-metabolism stress.Why it mattersElevated urinary lactic acid can suggest cells are leaning on backup, less efficient energy production.
- Pyruvic AcidThe fuel molecule feeding the energy loop; paired with lactic acid, it shows how sugar is being used.Why it mattersAn abnormal level, especially with high lactic acid, suggests strain converting sugar into usable energy.
- Succinic AcidA mid-loop energy intermediate that is also a gut-microbe product, tying the energy and microbial pictures together.Why it mattersElevation may reflect a stall in the energy loop or microbial input, and rose in a small Parkinson's study.
- Fumaric AcidA late energy-loop intermediate that helps locate where energy production may be strained.Why it mattersAn unusual level suggests a possible block later in your cells' energy loop.
- Malic AcidA near-final energy-loop intermediate, completing the panel's view of the energy pathway.Why it mattersAn abnormal level points to a possible disruption near the end of the energy loop.
- 2-Oxoglutaric AcidA key energy-loop intermediate, also called alpha-ketoglutarate, reflecting mid-loop flux.Why it mattersAn abnormal level suggests a possible bottleneck in the energy loop at this step.
- Aconitic AcidAn early energy-loop intermediate that adds detail to how smoothly your cells turn fuel into energy.Why it mattersAn abnormal level points to a possible step-specific slowdown in the cellular energy loop.
- Citric AcidThe entry point of your cells' main energy loop; it anchors the panel's mitochondrial energy section.Why it mattersA markedly abnormal level suggests possible strain or a bottleneck in cellular energy production worth exploring.
- 3-Methylglutaric AcidA marker the panel links to energy-cofactor pathways and, at extremes, rare disorders.Why it mattersA markedly elevated level warrants evaluation for a rare inherited metabolic condition.
- 3-Hydroxyglutaric AcidA marker that, at high levels, is a hallmark of a specific rare inherited disorder.Why it mattersA very high level should prompt testing for glutaric acidemia type 1.
- 3-Methylglutaconic AcidA marker tied to mitochondrial function and, at extremes, rare inherited conditions.Why it mattersMarked elevation warrants evaluation for a rare mitochondrial or metabolic disorder.
- 3-Hydroxy-3-methylglutaric AcidA marker tied to a CoQ10 cofactor pathway and, at extremes, a rare metabolic disorder.Why it mattersA very high level should prompt evaluation for a rare inherited metabolic condition.
Overview
About OAT
You feel tired, foggy, or somehow off in a way your standard bloodwork does not explain. The Organic Acids Test, or OAT, takes a different route. It reads the chemical leftovers your body sends into your urine after it burns fuel, processes nutrients, and lives alongside its gut microbes.
Each leftover is a clue about one specific chemical step happening inside you. Read as a set, they sketch a wide, exploratory picture of your metabolism that no single measurement can give. This is a research-and-wellness tool, not a diagnosis, and that framing matters for how you use it.
What This Panel Reveals
The panel is best understood as several stories told at once. Rather than one organ, it looks at how your gut microbes, your cellular energy machinery, and your nutrient pathways are behaving, using urine because it is easy to collect and carries these small molecules in measurable amounts.
The gut and yeast markers make up the largest group. Many of these acids are produced partly by microbes living in your intestine. When certain yeasts such as Candida or certain bacteria such as Clostridia species become more active, they can leave behind distinctive acids that pass into urine. One bacterial marker, HPHPA, has been reported at high levels in small studies of people with behavioral and psychiatric conditions, and it dropped after an antibiotic in one case report. Treat these as hypothesis-generating signals, not proof of overgrowth. The yeast markers warrant extra caution, since their published validation comes from severe invasive fungal infections in hospitalized patients, not from gut yeast in otherwise healthy people.
The energy markers track your cells' main power plant. Compounds from the Krebs cycle (your cells' central energy-producing loop) plus lactic and pyruvic acid are read as indirect signs of how smoothly you turn food into usable energy. In disease-specific human studies, patterns of these urinary acids have tracked strained or suppressed cellular energy metabolism, though this has been shown in defined conditions rather than as a general wellness screen.
The remaining groups cover fuel and nutrients. Backup fat-burning byproducts (adipic, suberic, and sebacic acid) can rise when normal fat metabolism is strained. Ketones reflect fat-based fuel use. Vitamin-linked markers such as methylmalonic acid (a functional vitamin B12 signal) and pyridoxic acid (a vitamin B6 signal) hint at how well certain nutrient pathways are supplied, and glutathione-related markers reflect your internal antioxidant system.
How to Read Your Results Together
The value of this panel is in the pattern, not any single number. A lone elevated acid means little. Combinations across groups are what point you toward a question worth chasing with a validated test. Here are patterns worth recognizing, all exploratory rather than diagnostic.
| Pattern | What it may suggest (exploratory) |
|---|---|
| High yeast markers (like arabinose) plus a high bacterial marker (like HPHPA) | Possible gut microbial imbalance worth confirming with validated stool or breath testing |
| Several elevated energy-cycle acids with high lactic and pyruvic acid | Possible strain on your cells' energy production, best interpreted with symptoms and standard labs |
| High methylmalonic acid with a normal blood B12 | A possible functional B12 shortfall at the cellular level, once kidney issues and dehydration are ruled out |
| Elevated adipic, suberic, and sebacic acid together | A shift toward backup fat metabolism, though a fatty or ketogenic diet can also raise these |
What to Do with Your Results
No single OAT value diagnoses anything, so the next step is confirmation, not treatment. If gut markers stand out, a validated stool panel or a breath test for small intestinal bacterial overgrowth (extra bacteria in the small intestine, called SIBO) gives firmer ground. If the nutrient markers stand out, a blood vitamin B12, folate, or homocysteine test corroborates them. Energy-related patterns are best discussed with a clinician who can weigh your symptoms and standard labs.
Serial tracking is where this panel earns its place. Because a single spot urine varies day to day, one result is a snapshot, not a stable baseline. If you make a change, retest under similar conditions after about three to six months and watch whether the pattern moves in the direction you wanted, rather than reading any one value in isolation.
When Results Can Be Misleading
Some confounders shift the entire panel at once. Because every value is expressed relative to creatinine (a marker used to correct for how dilute your urine is), anything that changes your creatinine, including a meat-heavy diet, body size, or sex, can nudge every result. In one study, a diet-independent compound read 26% lower after creatinine adjustment simply because meat eaters excrete more creatinine.
Hydration, recent diet, and normal biological variation also move many of these acids together, and spot urine samples correlate only moderately with full-day excretion. Your kidneys and liver process many of these compounds too, so reduced kidney function, dehydration, or thyroid disease can raise markers such as methylmalonic acid even when your vitamin status is fine. An abnormal result reflects your whole system on that day, not one isolated pathway. This is why the panel works best as a repeated, pattern-level screen interpreted alongside a clinician.