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The Organic Acids Test is unlike any other test in functional medicine. Where blood panels give you a snapshot of what is circulating in your body right now, organic acids reveal what is happening inside your cells — how your mitochondria are producing energy, whether gut organisms are releasing toxins, how your neurotransmitters are being broken down, and which nutrient deficiencies are impairing your metabolism at the biochemical level. When every other test comes back normal and you still feel terrible, this is often where the answers are.
This is exactly the situation the OAT was designed for. Standard bloodwork assesses only certain aspects of your biochemistry. The OAT can show how well fuel is being converted into cellular energy, reveal fat-metabolism intermediates, indicate whether a hidden candida overgrowth may be releasing neurotoxic byproducts, identify whether oxalates may be contributing to pain, and show whether your B vitamins are being utilized at the cellular level even if serum levels look adequate.
Organic acids are the byproducts of these deeper metabolic processes — and measuring them in urine gives us a window into cellular function that no standard blood test can provide. I use the OAT when clients present with complex, multi-system symptoms that have resisted explanation — and it consistently reveals patterns that change the entire direction of the treatment plan.
Understanding the Test
Organic acids are chemical compounds produced as byproducts of metabolism — the downstream products of your cells burning fuel, gut organisms breaking down food, your liver detoxifying chemicals, and your nervous system synthesizing and degrading neurotransmitters. They are excreted in the urine at concentrations up to 100 times higher than in the blood, making urine the ideal medium for measuring them.
When metabolic pathways function efficiently, organic acids are processed and excreted at expected levels. When enzymatic function is impaired, when nutrients cofactors are deficient, when gut organisms are overgrowing, or when toxins are blocking pathways — organic acids accumulate abnormally. Those abnormal accumulations show up in the urine as a detailed map of where the problems are.
The OAT by Mosaic Diagnostics measures 76 organic acid markers across seven major categories — all from a single first-morning urine sample collected at home. The analysis uses gas chromatography linked with mass spectrometry, the gold standard for organic acid measurement. I use the OAT as both a first-line test for clients with complex multi-system complaints and as a deeper investigation when initial bloodwork raises questions that need cellular-level context.
Because the OAT covers fungal and bacterial markers, I often use it alongside the GI Map stool test or as a complement to it. Together, they provide a more complete picture of gut inflammation available through functional testing.
The Seven Categories This Test Covers
The OAT does not specialize — it covers the breadth of cellular metabolism at once. This is what makes it so clinically powerful for complex cases. Here is what each category assesses and why it matters.
Markers of yeast, mold, bacteria, and Clostridia species — the metabolic byproducts these organisms release when they overgrow in the gut. Many of these compounds are neurotoxic and can cross the gut-brain barrier, directly affecting mood, cognition, and behavior.
Intermediates of glucose, fatty acid, and amino acid metabolism involved in cellular energy production. Abnormal patterns here reveal impaired mitochondrial function — the most common and most overlooked cause of persistent fatigue, exercise intolerance, and brain fog.
Dopamine, serotonin, and norepinephrine and epinephrine pathway metabolites — the breakdown products that reveal how these neurotransmitters are being produced, utilized, and cleared. Abnormal patterns directly explain anxiety, depression, ADHD, OCD, and mood instability. It is important to interpret this portion of the OAT alongside additional lab testing, such as methylation, copper/zinc, and pyrrole status.
Direct and indirect biomarkers reflecting exposure to environmental toxicants, heavy metals, mold toxins, and markers of glutathione depletion and oxidative stress. Elevations point to toxic burden that is overwhelming the body's detoxification capacity.
Metabolites reflecting methyl group cycling, glutathione production, and the nutrients that drive both methylation and detoxification pathways. These markers complement the Methylation Profile SAM/SAH test by showing functional methylation demand from a different angle.
Direct and indirect biomarkers reflecting functional demand for B vitamins, antioxidants, CoQ10, biotin, and other metabolic cofactors. Critically, these reveal functional deficiencies — nutrients being consumed faster than they are supplied — even when serum levels appear adequate on standard bloodwork.
Oxalates are organic acids derived from diet, fungal organisms (including Candida and Aspergillus), and human metabolism. Elevated oxalates are highly correlated with many chronic conditions and cause significant pain, kidney stress, and mitochondrial dysfunction when they accumulate in tissues.
What the OAT Finds That Other Tests Cannot
Standard bloodwork measures what is circulating in your blood at a single point in time. It is a snapshot of your body’s inputs and outputs — not a picture of what your cells are actually doing with what they receive. This is a fundamental limitation that leaves the most important metabolic questions unanswered.
Organic acids exist in urine at concentrations up to 100 times higher than in serum. They are the downstream byproducts of what happens inside cells — which means they reveal metabolic problems far upstream of where standard tests detect them.
A critical example: serum B12 can appear completely normal while a person has a severe functional B12 deficiency at the cellular level — because the serum level reflects how much B12 is present, not how much is actually being utilized. Methylmalonic acid, an OAT marker, rises when B12 is functionally deficient at the cellular level regardless of what the serum level shows. This distinction changes the clinical picture entirely.
The same principle applies to virtually every nutrient and pathway the OAT assesses. It does not ask what is in your blood — it asks what your cells are actually doing. That is the information that drives genuinely personalized treatment.
Concentrations circulating in serum or plasma at the time of the blood draw — a real-time snapshot of inputs and outputs
Whether nutrients in the blood are being absorbed and used by cells — serum B12 can be normal while cells are functionally deficient
Whether metabolic enzymes are working — impaired enzymes cause organic acid buildup that blood tests cannot detect
Neurotoxic compounds released by gut yeast, bacteria, and fungi that affect brain chemistry — invisible to all standard blood panels
Whether mitochondria are producing ATP efficiently — the most common cause of persistent fatigue has no blood test equivalent
The downstream metabolic byproducts of all of the above — at cellular resolution, 100x more concentrated than serum, from a single urine sample
Conditions the OAT Most Commonly Clarifies
The OAT is particularly valuable for conditions where the root cause is metabolic, microbial, or nutritional — and where standard testing has repeatedly come back “normal” without explaining the symptoms. These are the presentations where I reach for it most often.
Neurotransmitter metabolite markers on the OAT frequently reveal abnormal serotonin or dopamine pathway function, elevated Clostridia toxins that disrupt GABA production, or mitochondrial dysfunction impairing the energy supply the nervous system needs to regulate itself.
Neurotransmitter and microbial categoriesWhen antidepressants have not worked or have stopped working, the OAT frequently reveals the reason — impaired tryptophan-to-serotonin conversion, B6 or folate functional deficiency disrupting neurotransmitter synthesis, or gut dysbiosis producing compounds that compete with neurotransmitter production.
Neurotransmitter and nutrient categoriesDopamine pathway metabolite abnormalities, elevated Clostridia byproducts that interfere with dopamine metabolism, mitochondrial dysfunction impairing prefrontal cortex energy supply, and high oxalates disrupting brain function — all visible on the OAT, all invisible to standard bloodwork.
Microbial, neurotransmitter, and mitochondrial categoriesMitochondrial dysfunction is the most clinically significant and most underdiagnosed cause of persistent fatigue — and it has no reliable blood test equivalent. The OAT's Krebs cycle and fatty acid oxidation markers reveal exactly where the energy production bottleneck is occurring.
Mitochondrial categoryThe OAT was originally developed in the context of autism research. Elevated Clostridia metabolites, Candida byproducts, oxalates, and mitochondrial markers appear consistently in ASD profiles. The test remains one of the most clinically useful tools for identifying the biochemical contributors to ASD symptoms.
Microbial, mitochondrial, and oxalate categoriesThe OAT detects Candida and fungal organisms through their metabolic byproducts in urine — a more sensitive and comprehensive assessment than standard stool culture, which frequently misses yeast at lower levels. Arabinose and tartaric acid are among the key Candida markers measured.
Microbial and oxalate categoriesOxidative stress markers, glutathione depletion, methylation dysfunction, and gut dysbiosis — all captured on the OAT — are documented drivers of autoimmune activity. The test frequently reveals the biochemical context in which autoimmune conditions develop and persist.
Toxic exposure and methylation categoriesSerotonin-to-melatonin conversion markers, Clostridia toxins disrupting sleep regulation, and nutrient deficiencies impairing the synthesis of sleep-related neurotransmitters are all captured on the OAT — giving a biochemical explanation for insomnia that sleep studies cannot provide.
Neurotransmitter and microbial categoriesHigh oxalate levels are strongly associated with fibromyalgia, muscle pain, and joint pain — oxalate crystals deposit in soft tissue and cause significant inflammation. The OAT is one of the only tests that directly measures oxalate load and identifies whether dietary or fungal oxalates are the primary driver.
Oxalate and mitochondrial categoriesOAT vs. Standard Testing
The OAT is not a replacement for bloodwork — it is a different lens. Here is exactly what each approach can and cannot reveal.
Sample Collection and Requirements
The OAT requires a first-morning urine sample — collected before eating, drinking, or taking supplements. This is the most concentrated collection of the day and gives the most accurate baseline picture of overnight metabolic activity.
Dietary preparation matters significantly. Several foods and supplements can interfere with specific markers and produce false elevations that would alter the interpretation. Apples, grapes, cranberries, and certain herbal supplements must be avoided for 48 hours before collection. You will receive a thorough preparation protocol before the collection day to ensure the results we receive are accurate and actionable.
The sample must be frozen. Organic acids degrade at room temperature, so the collected urine must be frozen for at least four hours before shipping. The kit includes instructions and appropriate shipping materials to ensure the sample arrives at the lab in good condition.
Note for New York residents: Mosaic Diagnostics does not offer testing in New York due to state regulations. If you are based in New York, please let me know during your consultation and we will discuss alternative options.
How It Works
The entire OAT process happens at home — no blood draw, no clinic visit. Here is what it looks like from your first call to your personalized treatment plan.
We spend 20 minutes talking through your symptoms, history, and health goals. I will let you know whether the OAT is the right starting point — or whether other testing should come first or alongside it based on your situation.
After sign-up, we complete a full intake session. I order your Mosaic Diagnostics OAT kit, which is mailed directly to your home with collection materials and the full preparation protocol.
On a Monday through Thursday morning, you collect your first-morning urine sample following the protocol, freeze it for at least four hours, then ship it to Mosaic Diagnostics in the provided packaging. Results return within two to three weeks.
Once results are in, I build your starting treatment plan based on the patterns across all seven categories. We review the full 76-marker report together — I translate every relevant finding into plain language and build your targeted nutrition, supplement, and lifestyle protocol. We meet monthly with updates.
years in practice
Why Work With Samantha
The Organic Acids Test generates a detailed 76-marker report that is genuinely complex. Without clinical experience interpreting it — and without the broader context of a client’s full biochemical picture — it is easy to over-treat individual markers in isolation and miss the more important patterns that run across categories.
I have used the OAT as a core part of my practice for many years. What I have learned is that the most important information in the report is often not the most dramatic-looking number — it is the pattern across multiple categories that points to the root cause. A cluster of elevated microbial markers alongside imbalanced neurotransmitter metabolites and mitochondrial dysfunction tells a very different story than any single marker in isolation.
You will receive a thorough preparation protocol — because proper preparation is essential for accurate results, and I want your test to give us the most useful clinical information possible.
Common Questions
The Organic Acids Test (OAT) by Mosaic Diagnostics measures 76 organic acid markers in a single first-morning urine sample. Organic acids are the byproduct compounds of cellular metabolism — produced when your cells produce energy, when gut microorganisms break down food, when your liver detoxifies chemicals, and when your nervous system synthesizes and degrades neurotransmitters. Because organic acids accumulate in urine at concentrations up to 100 times higher than in blood, urine testing reveals metabolic activity that blood tests cannot detect. The OAT covers seven major categories: microbial overgrowth, mitochondrial health, neurotransmitter metabolites, toxic exposure, methylation and detoxification, nutrient needs, and oxalate metabolites.
Clostridia are a genus of bacteria that naturally inhabit the gut in small amounts. When they overgrow, they produce metabolic byproducts — including HPHPA and 4-cresol — that are highly neurotoxic. These compounds inhibit dopamine beta-hydroxylase, the enzyme that converts dopamine to norepinephrine, disrupting the entire catecholamine system. Elevated Clostridia markers on the OAT are strongly associated with ADHD, autism spectrum disorder, OCD, tic disorders, and severe behavioral dysregulation. They are one of the most clinically significant findings the OAT produces — and they are completely invisible to standard stool tests and blood panels.
The OAT includes methylation and detoxification markers that provide one dimension of methylation assessment — specifically functional demand markers and glutathione status. The Methylation Profile SAM/SAH test, on the other hand, directly measures the actual SAM and SAH molecules and their ratio, which is the most precise real-time measure of methylation cycle efficiency. The two tests are complementary: the OAT shows whether methylation demand is high and glutathione is depleted, while the SAM/SAH profile tells you exactly how well the methylation cycle is meeting that demand. I often use both together for clients where methylation is a central concern — particularly those with depression, anxiety, OCD, ADHD, undermethylation or overmethylation.
Both — it depends on your symptom picture. For clients with complex multi-system symptoms involving fatigue, mood, cognition, gut, and pain simultaneously, the OAT’s breadth makes it an excellent first-line test that immediately identifies the major categories of dysfunction to address. For clients who have already done targeted testing (thyroid panel, copper/zinc, methylation profile) and still have unexplained symptoms, the OAT provides the cellular-level context that fills in the gaps. I will advise during your consultation which approach makes the most clinical sense for your specific situation.
The OAT is a specialty functional lab test and is not typically covered by insurance. It is an out-of-pocket cost. During your free discovery call I can walk you through current pricing. The comprehensiveness of the OAT — 76 markers across seven systems from one collection — often makes it more cost-effective than ordering multiple narrower tests to cover the same clinical ground. I will help you prioritize based on your symptom picture and budget.
Standard bloodwork measures what is circulating in your blood at the time of the draw — concentrations of hormones, nutrients, and other molecules at one point in time. It does not tell you whether those nutrients are being utilized by cells, whether gut organisms are releasing toxins that affect your brain chemistry, whether your mitochondria are producing energy efficiently, or what your neurotransmitter pathways are doing at the metabolic level. The OAT measures the downstream byproducts of all of those processes. It is not a replacement for bloodwork — it is a different and complementary lens that reveals what is happening inside cells rather than just what is circulating in the blood.
Oxalates are organic acids derived from three sources: your diet, fungal organisms (particularly Candida and Aspergillus), and your own metabolism. In small amounts they are harmless. In excess, oxalic acid is the most acidic organic acid in body fluids — it forms crystals that can deposit in soft tissue, joints, and the kidneys. High oxalates are strongly associated with fibromyalgia, widespread muscle pain, kidney stones, vulvodynia, and mitochondrial dysfunction. Many foods considered healthy — spinach, beets, almonds, berries, tea — are extremely high in oxalates and can be a significant contributor. The OAT identifies both the level of oxalates and gives clues about whether their origin is primarily dietary or fungal.
The OAT requires a first-morning urine sample collected before eating, drinking, or taking supplements or medications. You collect on a Monday through Thursday morning to ensure overnight delivery to the lab. For 48 hours before collection, avoid apples, grapes, raisins, pears, cranberries and their juices, arabinogalactan, reishi mushrooms, echinacea, and ribose supplements — these can falsely elevate certain markers. Avoid glutathione, activated charcoal, and bentonite clay for 3 days before collection. Wait 48 hours after finishing antibiotics. After collecting, freeze the sample for at least 4 hours before shipping in the provided packaging. I walk every client through this protocol before their collection day to make sure everything goes smoothly.
Unfortunately Mosaic Diagnostics does not offer the OAT in New York due to state laboratory regulations. If you are a New York resident, please mention this during your discovery call. We can discuss whether there are alternative labs that offer comparable organic acid testing in your state, or whether starting with other tests in my panel makes more sense as a first step. This is not an insurmountable barrier — it just requires a different path.
Mosaic Diagnostics does offer international testing in many countries. Collection kits can typically be shipped internationally and returned with appropriate frozen sample packaging. International availability and shipping requirements vary by country. Please mention your location during your discovery call and I will confirm whether the OAT is available to you or whether we should consider a comparable alternative for your region.
Schedule your free 20-minute discovery call with Samantha. We will talk through your symptoms, your history, and whether the Organic Acids Test is the right next step — or which combination of tests gives you the most complete picture.