Organic Acid Testing Review – Uncover Your Metabolic Road Blocks

Organic Acid Testing Review

By Dr. Justin Marchegiani

Organic acids are made by your metabolism. They come from amino acids or proteins essentially. They can give us a window underneath the hood what’s happening with B vitamins, with methylation, with detox, with neurotransmitters, mitochondrial function, how you’re generating energy from proteins, fats, and carbohydrates, etc. Watch this video and learn more what are the five big root cause of organic acids.

Today’s video’s going to be on organic acid testing. We’re going to dive in deep to a patient’s lab. Also, we’re going to go over organic acids- how to look at them, testing-wise and what they actually mean from the inside out.

Organic Acids

So off the bat, organic acids are made by your metabolism. They come from amino acids or proteins, essentially. They can give us a window deeper under the hood of what’s happening with B vitamins, with methylation, with detox, with neurotransmitters, mitochondrial function, how you’re generating energy from proteins, fats and carbohydrates, neurotransmitters, oxidative stress. It even can look on fungus and bacterial overgrowth. So it gives us a good window of what’s happening underneath the hood.

Now, we will look at tests. Actually look at the summary of abnormal findings and go through what everything means.

Why organic acids go out of balance?

  1. Poor diet
  2. Malabsorption
  3. Stress
  4. Toxicity
  5. Genetic (MTHFR)

Out-of-Balance Organic Acids

Poor diet

This can be poor macronutrients, proteins, you’re on a low-fat diet, a very high amount of carbohydrates with insulin resistant or could be just poor quality of food. Lots of toxins, chemicals, inflammatory food as well. So make sure that your diet is on  point.


This could be low stomach acid or enzymes. You could have infections infections like SIBO or bacteria or parasitic infections, and could even be food allergies as well. Including sensitivity followed by leaky gut, etc.


This could be emotional stress such as relationship, financial issues, family, friends issues, work issues. It can also be too much exercise, very high amount of physical exercise or even too little. And it also could be sleep – poor sleep. Sleep really helps recharge and reinvigorate you for the next day and repair also.


Toxins whether it’s from round up or pesticides, glyphosate, heavy metals and environmental stressors like mold or mycotoxins or even EMF.


There is an MTHFR, SNP issue or just need certain higher levels of other nutrients like magnesium or B6. Everyone’s a little bit different.

So now knowing that, let’s dig in. So off the bat, you can see this patient’s lab test a lot of things are popping up. Issue with fatty acids, issues with carbohydrate, energy. The big thing off the bat is amino acids,amino acids, amino acids. Carnitine’s actually made from methionine and lysine free-form aminos, tyrosine neurotransmitter issues.


Some issues with amino acids seen on lab tests

Issues with Amino Acids in Lab TestsThis means that neurotransmitters are more burnt out. And the big thing I’m seeing is stress and/or malabsorption. When you see amino acids like this go crazy off the chart, that’s definitely an issue – lower brain amino acids and obviously, gut issues.

In this patient, we have other lab tests in this patient but there’s infections present as well, which is setting up for that area number two which is the malabsorption issue. We’re seeing nutrients not quite present at optimal levels and just the pattern we’re seeing really tells us a strong  malabsorption going on. Persons diet’s already good, pretty good. Malabsorption is definitely present and with that, stress definitely becomes an issue. Also, sleep and all that we are working on that with the adrenals in diet and lifestyle;but malabsorption is definitely present.

So let’s go look at the nitty-gritty of the lab testing here. We like the patient to be somewhere between the top part of the first and the bottom part of the fourth. This is what I call the sweet spot that we like right in the middle. This is like the field-goal post we want to kick the ball right through for that field goal. When organic acids go high or low, there’s essentially imbalances in those intervention or companion nutrients.

Demand or Depletion Issue

You can see the Carnitine for the Ethyl Manolate. You can see that Mandelate, the companion nutrients, Tyrosine. So if these organic acids go high or low, it means either a demand or depletion issue. So when organic acids go high, there’s a massive demand issue. That means the body needs that nutrient at a higher amount than what is present.

So my analogy to the patients and that’s like you’re making $1 million a year but you’re spending $2 million a year. You’re making a lot of money but you are spending too much. Your budget needs to get rained in. That’s the big five things we talked about earlier. And then on the depletion side of now your organic acids are low. That’s typically from chronic stress of those big five issues, more chronic longer-term issue. It’s like you’re making $1000 a year, but you’re spending 10,000. One, you’re not making that much to begin with. Number two, you’re spending way more than what you’re making, anyway. So it’s going to be impossible to get ahead.

So we have to work on getting to the big five of why that is the case. When you see organic acids high or low, they mean different things, but low is more depleted; high is more demand. They both mean that those intervention nutrients need to be supported and addressed. And obviously, the underlying big five stressors need to be looked at- which in this case, is definitely going to be malabsorption and stress.

Low Amino Acids

You can see this person here, a little bit high in the Ethyl Malonate, which we talked about – means Carnitine, we saw the L – lactate. So you can see if we draw a sweet spot here, we’re very low in this area. And that’s another marker for amino acids. So the amino acids are very low and you can see some of these are two-tailed, some are one. So if you were to do like a Beta Hydroxy Butyrate, well there’s no left area that’s low. But if you go down below, under energy production, there’s definitely red on the right and left of Citrate, Cis-Aconitate and Isocitrate.

So that means we have two-tailed here and only one tail below. That matters is that we have, let’s say Malate is low, that’s important to know. But it’s more important that if Isocitrate is low because it’s actually a red area. It’s two-tailed, there’s a high and a low versus just a high.

So on that note, we can see with the above that’s amino acids, lower amino acids. You can see the mitochondria. Here’s our sweet spot. If we only have two organic acids in the sweet spot, we definitely have these two were low, but these three above are more important because there is no red area to the left down there.

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Low B Vitamins

But we can see the mitochondria and how we’re generating energy is severely depleted and again this one of this patient’s chief issues is fatigue and you can see five areas in the bad left area and you can see three are very low. So definitely a depleted mitochondria, for sure. B vitamins, nothing’s flagged high but you can see we’re definitely in the low area. We’re definitely in that first quintile, and if you go back here, you can see B complex vitamins are part of what’s needed to drive the citric acid, Krebs cycle, warrior mitochondria. Essentially all the same name here for this.

So B vitamins definitely in the lower side. Methylation, a little bit in the lower side. I get more concerned when these go higher with Methylmalonate goes higher, it means we’re depleting a lot of B-12. When B12 isn’t present, Methylmalonate goes high. So it’s definitely part of this sequelae of this low B vitamin symptomatology we’re seeing. Lower energy means lower B vitamins.

Low Vanilmandelate

Neurotransmitters, you can see this person is low in Vanilmandelate, which means lower adrenaline. Lower adrenaline so their ability to regulate stress and adapt to stress is going to be thwarted and maybe some anxiety too, pretty possible or inability to focus When you have not enough adrenaline or dopamine, you typically lose that ability to focus longer and the time there. Homovanilate, 5-Hydroxyindoleacetate, that’s serotonin and dopamine, those are okay. Kyunurenate, it’s a little bit low. It’s a marker for B6, Quinolinate and Picolinate are markers for brain inflammation. Look okay but definitely the adrenaline markers are lower. Oxidative stress look pretty good. I’m fine with these being low because, you know, less oxidative stress, stress or internal rusting.

Low Detox

Detox, you can see, very much on the low side and again this didn’t even get flagged on the summary page of this. It’s important because if you’re just getting this test on your own, you’re like, “fine detox look no problems”- wrong. There is a massive polar shift to the left, which tells me there’s a severe depletion, remember. Lower organic acids depletion on the left section. Sulfate, the only one in the middle. This is sitting right on the fence of being low. Right on the fence being low gets flagged at 28. That’s 29- that’s a big marker for sulfur amino acids and glutathione precursors. So definitely an issue. They’re having a harder time to bring those nutrients on board to make the glutathione and to make all the phase 2 and phase 1, literally toxifying support.

High Indican

And in gut bacteria, it’s got one that’s high down here and the one that’s borderline. Indican is on the higher side that means not quite digesting protein well. Inability to digest proteins in putrefaction happening and just higher amounts of bad bacteria. And as you can see here this is what gets flagged when it’s 5% in the top 5%-1.41 It gets into the red .73, 1.41 and reach the top 5% of the reference range. Top 5% in this patient here. 1.84. So we don’t just look at it when it’s high, that’s very high. A lot of gut bacteria dysbiosis and some putrefaction  are happening, meaning not quite digesting protein. And that makes sense because when we go back to the protein on the summary page, a lot of amino acids were low and then yeast and fungus looked okay.



So if we go back here to the summary page, high and low organic acids mean something. We already talked about that. Depletion on the low-end demand in the high-end. The big five tend to be the driving factors why this go out of balance. Diet, malabsorption stress, sleep, toxicity and genetics. Genetics being MTHFR, and we’ll see that with high amounts of Methylmalonate and/or formiminoglutamate but again, this is a quick video just to give you some insight of how we’re looking at how we’re interpreting this test. And we put this test together to look at body system three and we have to look at the other two body systems, and maybe even blood work. And obviously, a full diet and lifestyle review so we can get a complete picture of what’s happening under your metabolic.

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The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.