by Dr. Joseph Debé
Whether you are struggling with a chronic disease or feel great and want to function at peak efficiency, you can benefit from a urinary organic acid analysis. The unparalleled range of important information it provides makes it the single most valuable test in healthcare today. But don’t ask your conventional medicine doctor to run an organic acid analysis on you or he’ll look at you like you have two craniums. Organic acid analysis falls into the realm of “alternative medicine” and most conventional doctors are not familiar with it.
Organic acids are compounds produced within the body in the course of metabolism. Metabolism is the totality of biochemical reactions taking place to “run” your body. Organic acid analysis gives us insight into our metabolism. Our state of metabolism determines our state of health and is the result of an interplay of our genes, diet, thoughts, beliefs, lifestyle and other environmental factors.
Forty-seven organic acids are measured from a morning urine specimen. The laboratory’s test report groups the organic acids into three general areas: 1. nutrient markers, 2. cell regulation markers, and 3. toxicants and detoxification. Each of these areas is further subdivided.
Under nutrient markers, we have: fatty acid metabolism, carbohydrate metabolism, energy production, B-complex vitamin markers, and methylation cofactor markers.
Cell regulation markers has two categories of organic acids: those reflecting neurotransmitter metabolism and those associated with oxidative damage and antioxidant markers.
Under toxicants and detoxification we have detoxification indicators and four sections related to dysbiosis, which means a state of imbalanced ecology within the intestinal tract. We get specific information about dysbiosis related to bacteria, l.acidophilus, clostridia and yeast. We each have hundreds of species of bacteria and yeast residing in our intestinal tracts. These organisms number about 100 trillion and their collective metabolism has a tremendous effect on our metabolism.
An organic acid analysis can reveal an individual’s metabolic strengths and weaknesses. What we see with this test is the end result of an interplay of the individual’s genetic make-up and environmental and lifestyle factors. The first use of urinary organic acid analysis was to detect inborn, or genetic, errors of metabolism in infants. A newborn that has a severe genetic error may totally lack a specific enzyme. This is seen by extreme elevation of the corresponding organic acid that is normally metabolized or broken down by the enzyme. These extreme cases of genetic errors are very serious and usually result in early death. Probably the most widely known inborn error of metabolism, Phenylketonuria, is alerted to on food products like Equal, which contain the amino acid phenylalanine. People who lack the enzyme to metabolize phenylalanine must go to great lengths to avoid consuming it. For their bodies, phenylalanine is toxic. There are other genetic errors of metabolism that exist in different degrees of severity. In milder genetic variants, an individual’s enzyme may be less efficient. Enzymes catalyze biochemical reactions in the body, converting one compound to another. Enzymes need coenzymes, vitamins and minerals, in order to work. At a given tissue concentration of a vitamin, one person’s enzyme will be less active than that of another individual if it is not efficient in binding the vitamin. The end result is impairment in metabolism signified by build-up of one biochemical and lowered levels of its breakdown product. In genetic errors of metabolism, in which the enzyme is not missing but simply does not bind efficiently to its vitamin coenzyme, it has been found that metabolism can be pushed toward normalcy by greatly increasing the concentration of the vitamin - mega dosing the vitamin. This is the power of personally tailored nutrition and is a concept that applies to everyone. Individuals with a particular genetic variation require 500 times more vitamin B6 for normal enzyme activity and metabolism than do people who do not have the variant! A study published in Science in 2001, found an average of 14 different variations per gene that could be inherited from one’s parents. It has been estimated that in total, the human genome may consist of 500,000 to 1.5 million variations! Therefore, all of us have some enzymes that are inefficient. In order to overcome this, we need to supplement with more of the vitamin or mineral cofactor that powers the enzyme. I personally was found, by organic acid analysis, to have less than optimal levels of vitamin B6 for proper metabolism, even though I was already supplementing with in excess of 50 times the recommended dietary intake. Mild genetic weaknesses become more pronounced with aging. Organic acid analysis can reveal a person’s metabolic Achilles’ heel, leading to proper treatment to strengthen that weak link in physiology. The essential nutrients that can be found lacking by organic acid analysis include the minerals chromium, magnesium, vanadium, and manganese; the amino acids arginine, aspartic acid, glutamine, glycine, taurine, tyrosine, and tryptophan; and vitamin C and the entire B vitamin family.
Organic acid analysis can reveal need for a variety of other types of nutrients. Many of these nutrients are very popular today and are taken in supplemental form by millions of people who learn about some purported beneficial effect. These nutrients include Coenzyme Q10, alpha lipoic acid, NADH, carnitine, glutathione, acidophilus, and others. The results of an organic acid analysis may reveal that an individual has an overgrowth of acidophilus. In this case, supplementing acidophilus can be harmful. Organic acid analysis is also valuable for assessing nutrients like Coenzyme Q10 that are basically non-toxic. One of my patients was spending hundreds of dollars a year on Coenzyme Q10 supplements. Organic acid analysis showed us that his body did not need any additional Coenzyme Q10; his body was making enough of its own to maintain healthy metabolic function. Another patient heard of the health benefits of Coenzyme Q10 and had been taking a daily supplement for several years prior to consulting me. I ran an organic acid analysis, which revealed he was very deficient in Coenzyme Q10. The 60 milligrams of Coenzyme Q10 he was supplementing was supplying only a fraction of what his body needed.
Organic acid analysis gives us information about an important biochemical process called methylation. Specifically, this test measures the status of three key nutrients involved in methylation: folic acid and vitamins B6 and B12. Methylation refers to the transfer of methyl groups (one carbon bound to three hydrogen atoms). Methylation occurs billions of times in the body each day and is essential for health. Methylation plays a role in detoxication, phospholipid and DNA synthesis and repair, as well as genetic expression. Methyl groups are strategically placed on certain genes to inactivate them. Every cell in the human body has the genetic information to produce every other type of cell. The thing is that most of the genes are not active. Methyl groups silence the genes that should not be active in a given cell at a given time. This is obviously critical for good health. Some of the genes within our cells are tumor promoters. Proper methylation keeps these genes silenced. When methylation is lacking, these tumor promoter genes become active and trouble begins. Cancer cells have been found to be lacking in methylation. Methylation also plays a role in dopamine and serotonin metabolism. Not surprisingly, folic acid deficiency is a consistent finding in depression. Methylation also plays an important role in detoxication of a variety of compounds, including environmental toxins (such as mercury, lead, arsenic and tin), medications, and some of the body's own hormones. Estrogens are detoxified through methylation. Inadequate methylation causes potentially toxic build-up of estrogens in the body, which increases risk to breast, prostate and other cancers. Other conditions of estrogen excess, such as uterine fibroids and endometriosis, are also more likely to occur and be more severe. Histamine, epinephrine (adrenaline), and norepinephrine are also detoxified by methylation. Inadequate methylation therefore potentially worsens allergy and stress-related symptoms. Methylation is critical for the detoxication of homocysteine, which, like blood cholesterol, is directly associated with cardiovascular disease. In a recent study of people who had their atherosclerotic (clogged) coronary arteries treated by balloon angioplasty, homocysteine levels were measured. Half of the study participants were supplemented with folic acid and vitamin B12. At the end of the study, homocysteine levels and coronary artery clogging were again evaluated. The group that received folic acid and B12 had lower homocysteine levels and less blood vessel clogging. High homocysteine levels do more than damage arteries. Conditions associated with elevated homocysteine levels include coronary artery disease, heart attack, stroke, deep vein thrombosis, peripheral vascular disease, miscarriage, birth defects, depression, sensorineural hearing loss, osteoporosis, cancer, arthritis, dementia, Alzheimer's disease, Parkinson's disease, and complications of diabetes.
Organic acid analysis also evaluates carnitine status. Carnitine is a compound that is manufactured within the body and transports fatty acids into the part of the cell (mitochondria) where they are burned for energy. When carnitine levels are suboptimal, difficulty with weight loss is among the consequences. Three organic acids are measured that tell us about the degree of carnitine insufficiency.
A person’s ability to metabolize carbohydrates is also seen with this test. Insulin resistance is one of the impairments of carbohydrate metabolism revealed by organic acid analysis. Insulin resistance refers to inefficiency of this important blood sugar-regulating and anabolic hormone. Insulin resistance contributes to obesity and diabetes, and is probably responsible for more ill health than any other metabolic factor in industrialized nations. It is treated with diet, lifestyle, nutritional supplements, exercise, stress reduction, weight loss and medication.
Carbohydrate and fatty acid metabolism are part of the process of converting our food into energy. The organic acid analysis gives us further insight into this critical aspect of metabolism. All bodily functions are powered by the release of energy as chemical bonds in food are broken down. With organic acid analysis, we actually get a glimpse into the workings of the mitochondria of cells, where 95% of the body’s energy is produced, as food and oxygen are combined to produce ATP and other energy compounds. Organic acids are produced in the series of biochemical steps called the citric acid cycle that turns food into energy. Low levels of these particular organic acids indicate deficiencies of precursor compounds like amino acids, which come from dietary protein. Elevations of these organic acids reveal metabolic blocks due to various nutrient deficiencies, toxicity, inflammation, or insulin resistance. Fatigue is not the only consequence of impaired cellular energy production. All organs and bodily functions require energy. Therefore, any condition (including aging) may be impacted by poor cellular energy production. Targeted treatments result from analyzing the individual’s pattern of organic acid abnormalities.
The organic acids related to neurotransmitter metabolism give us information about the balance of epinephrine, norepinephrine, serotonin and dopamine. Imbalances are seen in cases of anxiety, depression, stress, insomnia, schizophrenia, attention deficit and behavioral disorders, carbohydrate craving, constipation, obesity, chronic fatigue syndrome, and addictions. Elevation of a particular organic acid is associated with inflammation that may be impacting the brain. Inflammation can result in neuron (brain cell) degeneration and death, and plays a role in different neurological conditions, including Alzheimer’s disease.
Free radical damage to DNA is also revealed with this test, by measurement of an organic acid called 8-OHdG. Damage to DNA can predispose to cancer cell formation. Elevations of 8-OHdG are seen in a variety of chronic conditions including elevated blood cholesterol levels. Fifty percent of the 8-0HdG measured comes from the brain. Neuropsychiatric conditions such as ADHD, Down’s syndrome, schizophrenia, depression and autism are associated with increased free radical damage. Organic acid analysis measures another compound, which is involved in regulation of cell growth. Its elevation is associated with growth of malignant cells, including breast cancer cells. Very high doses of vitamin C help to lower this compound.
Organic acid analysis gives us insight into the body’s toxin exposure and its ability to rid itself of toxins. Several factors determine toxicity: the potency of the toxin, its concentration, and the capacity of the body’s detoxication system to eliminate the toxin. Toxins interrupt the body’s normal metabolism and physically damage the body’s tissues. According to a paper published in Clinical Chemistry in 1996, the symptoms of chronic poisoning include fatigue, sleep disturbances, gastrointestinal distress, allergy symptoms, headaches, confusion, and anxiety. I believe that almost any symptom can be caused by toxicity. Environmental toxins, such as xylene, and endogenous (made within the body) toxins such as ammonia, are detected by this test. Ammonia toxicity can result from some combination of genetic predisposition, nutrient deficiencies, and excess dietary protein.
Another important source of ammonia toxicity revealed by organic acid testing is overgrowth of bacteria within the intestinal tract. This is a common condition often resulting from overuse of antacids and antibiotics. Thirteen organic acids produced by different strains of bacteria, parasites, and yeast living within the intestinal tract are tested. When there is an overgrowth of one of these unfriendly organisms, its metabolic waste products build-up beyond normal levels, are absorbed from the intestines into the blood, and then are excreted in the urine. An elevated urinary level of organic acids produced by intestinal organisms is an extremely accurate indication of overgrowth and dysbiosis within the intestinal tract. These organic acids from bacteria, yeasts, and parasites are toxic to human physiology. They poison our metabolism, upset the immune system and can produce a wide range of ill effects. These include symptoms like digestive disturbances, fatigue, chronic pain, skin rashes, autoimmune conditions, and malabsorption and malnutrition resulting in weight loss and even osteoporosis. Additionally, a long list of mental-emotional symptoms can be caused by intestinal dysbiosis, including: “brain fog”, confusion, anxiety, depression, memory impairment, seizures, and autism. Adverse symptoms from eating certain foods or taking certain nutritional supplements can result when organisms in the intestinal tract feed on them, proliferate, and produce toxic waste products. Overgrowth of intestinal yeast can result in autointoxication from alcohol formation. This condition can produce lowered levels of vitamins B1, B2, B6, magnesium, and zinc. Treatments to kill off the unfriendly organisms are often necessary. This can be done with herbs or medication. It is often helpful to supplement with strains of normal beneficial bacteria such as lactobacillus acidophilus and Bifidobacteria, in order to physically displace the unfriendly organisms from binding sites on the intestinal wall. These “friendly” bacteria also produce natural antibiotics, which are toxic to some of the unfriendly organisms. Normalizing any impairment in digestion or absorption is also critical, as undigested and unabsorbed food particles become food for bacteria and yeast within the intestines. Digestive enzymes and supplemental hydrochloric acid are necessary in many cases.
Organic acid analysis gives a wealth of information about the adequacy of the body’s detoxication system and its overall toxic burden. Five different major detoxication pathways are assessed with this test. The body has to detoxify and eliminate not only byproducts of intestinal organisms, foreign chemicals like pesticides, but also its own biochemicals like estrogens, which become toxic at a certain concentration. The detoxication reactions are dependent upon nutrients, especially amino acids and B vitamins. Test results lead to tailored treatments, including nutrient supplementation and toxin avoidance.
The organic acid analysis test report includes a personalized supplement recommendation chart. Based upon the test results, a computer-generated list of needed nutritional supplements and their daily dosage is given. A custom compounding pharmacy can produce a personalized nutritional supplement powder based upon this information, in order to make supplementation more convenient. Rather than taking multiple pills from different bottles, a scoop of powder is mixed with water or juice.
Organic acid analysis is valuable in autism, depression, anxiety, mood disorders, ADHD, developmental delay, learning disorders, dementia, Alzheimer’s disease, seizures, cancer, cardiovascular disease, chronic fatigue and chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, chronic pain, inflammatory disorders, gastrointestinal symptoms, every degenerative disease, and the aging process. It’s almost pointless to list specific conditions that would benefit from organic acid analysis because, due to the fundamental information it provides about an individual’s metabolism, people with any condition can benefit. It is critically important to understand that alterations in metabolism precede the development of symptoms and disease states. Therefore, this test is also ideal for people who are healthy and want to fine-tune their metabolism to achieve peak performance and delay and prevent degenerative conditions.
I’ll leave you with a quote from the textbook, Laboratory Evaluations in Molecular Medicine: “Instead of tests that measure nutrient concentrations, abnormal concentrations of organic acids in urine provide functional markers for the metabolic effects of vitamin inadequacies, toxic exposure, neuroendocrine activity, and intestinal bacterial overgrowth. The ultimate tool for laboratory evaluation in nutritional medicine is a simple, sensitive test that can reveal evidence of functional inadequacy of specific nutrients. The promise of such a tool is found in profiling of organic acids in urine.”