The nutritional markers in an organic acid test assess functional levels of key vitamins and cofactors, especially B12, folate, B6, and nutrients essential for energy, detox, and brain health.

 

In an Organic Acids Test (OAT), the nutritional markers section evaluates metabolites that reflect vitamin and nutrient status, especially those needed for mitochondrial function, detoxification, neurotransmitter synthesis, and amino acid metabolism.

Key Nutritional Markers Measured:

Here’s a breakdown of common nutritional markers in the OAT and the nutrients they reflect:

What These Markers Help Assess:

• Vitamin Deficiencies (especially B-complex, C, CoQ10)

• Methylation Support Needs (B12, folate, B6)

• Mitochondrial Function

• Neurotransmitter Synthesis

• Detox Pathway Support

Alex’s Results: 

Lab Tech comment: 

• Low or BDL 4-pyrodoxic acid, ascorbic acid, pantothenic, and N-acetylcysteine may be suggestive of a deficiency/insufficiency in these micronutrients. 
• Elevated glutaric acid, methylcitric acid, 3-hydroxy-3-methyl-glutaric acid, 3-hydroxypropionic acid, mevalonic acid, and xanthurenic acid are suggestive of corresponding micronutrient marker deficiency/insufficiency. A low level is insignificant.

Dr Lindenberg’s comment: NAC and B6 are low, but B5 is high.

1. 3-Hydroxy-3methyglutaric acid (Coenzyme Q10)    4.23(result) L / 15 – 49 (range)

3-Hydroxy-3-methylglutaric acid is a functional marker for CoQ10 status and mitochondrial performance—elevated levels may signal a need for CoQ10 support.

• MG is an intermediate in the mevalonate pathway, which is crucial for:

  • Cholesterol synthesis

  • Coenzyme Q10 (ubiquinone) production

• It reflects the body’s ability to produce CoQ10 endogenously (within cells).

• Interpreted alongside other markers like:

  • Succinic acid

  • Fumaric acid

  • Lactic acid

  • Pyruvate

  • Methylmalonic acid

Coenzyme Q10 is a compound that helps generate energy in your cells. CoQ10 is naturally found in the body, with the highest levels in the heart, liver, kidney, and pancreas. It helps generate energy in cells by making the antioxidant adenosine triphosphate (ATP), which is involved in cell energy transfer, and serves as an antioxidant to protect cells against oxidative stress.

 

2. Pantothenic Acid (Vit B5)                                              4.49 (result)  H / <4.4 (range)

Pantothenic acid (vitamin B5) is essential for producing coenzyme A, which drives energy metabolism, fat processing, and hormone production—deficiency can impair mitochondrial and neurological function.

Vitamin B5 is necessary for making coenzyme A (CoA), which is involved in:

• The Krebs cycle (for ATP/energy production)

• Fatty acid synthesis and oxidation

• Hormone and cholesterol synthesis

• Acetylcholine (neurotransmitter) production

In Organic Acids Testing (OAT):

Pantothenic acid levels are typically inferred through elevated or altered metabolic intermediates, such as:

 

3. NAC (N-Acetyl-Cysteine / Glutathione Cycle)        BDL (result)  / <0.13 (range)

N-Acetylcysteine is a glutathione precursor that supports detoxification, antioxidant defense, and neurological balance—especially when oxidative stress or toxicity is present.

• NAC is a supplemental form of the amino acid cysteine, and acts as a precursor to glutathione (GSH)—the body’s master antioxidant.

• Glutathione is made from cysteine + glutamate + glycine and is essential for:

  • Detoxifying toxins, heavy metals, and drugs

  • Reducing oxidative stress

  • Supporting immune function and mitochondrial health

In the Context of Organic Acids Testing:

NAC is not always tested directly, but its function and impact can be inferred from other related markers, including:

 

4. 4-Pyridoxic Acid and Xanthurenic acid (Vit B6)     BDL (result)  / <3 or <4 (range)

4-Pyridoxic acid reflects vitamin B6 utilization—low levels suggest deficiency, while high levels may point to excess intake or increased demand.

• 4-Pyridoxic acid is the end product of vitamin B6 (pyridoxine) metabolism, formed in the liver.

• It reflects how the body uses and breaks down B6, particularly the active form, pyridoxal-5′-phosphate (P5P).

• Often reviewed along with:

  • Xanthurenic acid (another B6-dependent metabolite)

  • Kynurenic / Quinolinic acid

  • Neurotransmitter metabolites like 5-HIAA and HVA

• 💊 Vitamin B6 Forms:

  • Pyridoxine (common in supplements)

  • P5P (pyridoxal-5′-phosphate) – active form, often better tolerated

 

5. Ascorbic acid (Vit C)                                                 0.07 / < 81.45

Ascorbic acid in the OAT reflects vitamin C status—low levels suggest increased need for antioxidant support, while high levels usually indicate recent supplementation.

Ascorbic acid is a water-soluble antioxidant that plays a key role in:

• Neutralizing free radicals

• Regenerating other antioxidants (e.g. vitamin E)

• Supporting immune response

• Collagen synthesis for skin, bones, and blood vessels

• Iron absorption and utilization

• Neurotransmitter production (dopamine to norepinephrine conversion)

Assessed alongside:

• Glutathione markers (e.g., pyroglutamic acid)

• Oxalate metabolites (vitamin C can convert to oxalates if taken in excess)

• Other antioxidant markers (e.g., CoQ10, vitamin E status indirectly)

 

6. Methylmalonic acid (Vit B12)                                0.56 (result) / <3.6 (range)

Methylmalonic acid is a sensitive marker for vitamin B12 deficiency—elevated levels reflect impaired B12-dependent energy metabolism and methylation.

Methylmalonic and B6 are directly involved with the function of the CBS enzyme and indirectly involved with MTHFR, BHMT and SHMT. When B12 is low, MMA levels in the blood and urine increase.

• MMA is produced during the breakdown of certain amino acids and fatty acids.

• Vitamin B12 is required as a cofactor for the enzyme methylmalonyl-CoA mutase, which converts methylmalonyl-CoA to succinyl-CoA (a Krebs cycle intermediate).

• Without sufficient B12, MMA accumulates in the blood and urine.

• Often evaluated alongside:

  • Homocysteine (not part of OAT but relevant for B12)

  • Methylcitric acid (may rise when B12 is low)

  • 3-Hydroxypropionic acid and glutaric acid (to rule out B7 or B2 deficiency)

Blood Vit B12    1164(result) 165 – 698 (range) (2016) / 898 (result) >221 (range) (2018)

 

7. 3-Hydroxypropionic acid (Biotin – Vitamin B7)

3-Hydroxypropionic acid is a functional marker of biotin status—elevations may indicate biotin deficiency, mitochondrial stress, or gut imbalances.

• 3-Hydroxypropionic acid (3-HPA) is a short-chain hydroxy acid produced during:

  • Propionic acid metabolism

  • Branched-chain amino acid breakdown (like valine)

• It accumulates when there is dysfunction in biotin-dependent carboxylase enzymes, particularly:

  • Propionyl-CoA carboxylase

  • Methylcrotonyl-CoA carboxylase

• Often assessed alongside:

  • Methylmalonic acid (B12)

  • Lactic acid / Pyruvic acid (B1, B3)

  • Xanthurenic acid (B6)

  • FIGLU (Folate)

Why Biotin Matters:

• Acts as a coenzyme in key carboxylation reactions

• Essential for:

  • Fatty acid synthesis

  • Gluconeogenesis

  • Amino acid catabolism

• Deficiency can lead to:

  • Fatigue

  • Hair loss

  • Dermatitis

  • Neurological issues

 

8. Glutaric acid (Riboflavin – Vitamin B2)

Glutaric acid is a marker of riboflavin (B2) and mitochondrial function—elevations may indicate B2 deficiency or impaired energy metabolism.

• Glutaric acid is a dicarboxylic acid that results from the breakdown of lysine, hydroxylysine, and tryptophan.

• Its accumulation often signals impaired fatty acid and amino acid oxidation, which relies on B2-dependent enzymes in the mitochondria.

• Riboflavin’s Roles:

  • Required for:

    • FAD and FMN coenzymes (crucial for mitochondrial respiration)

    • Glutathione recycling (antioxidant defense)

    • B6 and folate metabolism

    • Activation of other B vitamins

Often interpreted alongside:

• Succinic acid

• Lactic acid

• Other dicarboxylic acids

 

9. Methylcitric acid (Biotin)

Methylcitric acid elevation suggests impaired biotin-dependent metabolism and may reflect biotin or B12 deficiency, or mitochondrial stress.

• Methylcitric acid is formed when propionyl-CoA (from amino acid and fat breakdown) is mistakenly incorporated into the Krebs cycle in place of acetyl-CoA, producing this abnormal metabolite.

• This misstep often occurs when biotin-dependent enzymes are not functioning properly.

• Often interpreted alongside:

  • 3-Hydroxypropionic acid (biotin marker)

  • Methylmalonic acid (vitamin B12 status)

  • Krebs cycle intermediates (e.g. citric acid, succinate)

 

10. Mevalonic acid (Q10)

Mevalonic acid reflects activity in the cholesterol and CoQ10 synthesis pathway—elevated levels may indicate a block in CoQ10 production or statin effects.

• Mevalonic acid is a key intermediate in the mevalonate pathway, which produces:

  • Cholesterol

  • Coenzyme Q10 (ubiquinone)

  • Dolichols and other important isoprenoids

• This pathway begins with acetyl-CoA and is heavily regulated by HMG-CoA reductase—the same enzyme targeted by statin drugs.

 

11. Xanthurenic acid (Vit B6)

Xanthurenic acid elevation suggests vitamin B6 deficiency or functional impairment, reflecting disrupted tryptophan metabolism.

• Xanthurenic acid is produced during the kynurenine pathway of tryptophan metabolism, a process that requires vitamin B6 as a cofactor.

• When vitamin B6 is deficient or its activity is impaired, tryptophan metabolism is disrupted, leading to accumulation and excretion of xanthurenic acid.

• Interpreted alongside:

  • 4-Pyridoxic acid (another B6 marker)

  • Kynurenic acid and Quinolinic acid (related to tryptophan metabolism)

  • Neurotransmitter metabolites

 

PLEASE NOTE: ANY VIEWS REGARDING THE RESULTS ARE MY UNDERSTANDING AND DO NOT SERVE AS PROFESSIONAL ADVICE. THE TREATMENT RECOMMENDATION IS STRICTLY RELATING TO ALEX’S RESULTS AND NOT MEANT FOR SELF-TREATMENT. ALWAYS SPEAK TO YOUR HEALTHCARE PROVIDER BEFORE STARTING ANY TREATMENTS.