OAT: Mitochondrial, Carb & Fatty Acid Metabolites

OAT: Mitochondrial, Carb & Fatty Acid Metabolites

Organic acid test (OAT) has gained popularity among many functional health experts in recent years. A large part of the test looks at metabolites involved in energy production, including those involved in carbohydrate and fatty acid metabolism and mitochondrial markers. But how informative are these markers? Read the article and judge for yourself. What is the Organic Acid Test?

Organic Acid Test, popularly known as OAT, measures the levels of organic compounds in urine that are produced in the body as a part of many vital biochemical pathways. It’s used to check for RARE inborn genetic defects of metabolism, most often in newborns.

A defect in a particular pathway can result in either accumulation or lowered levels of its byproducts. Thus, measuring the levels of these markers can help to identify which metabolic process is blocked or compromised .

However, OAT has been increasingly available as a pricy, direct-to-consumer test recommended by many alternative practitioners. In this article, we will break down the science behind testing for the glycolytic cycle, mitochondrial or Krebs cycle, and fatty acid metabolites. Read on to find out which ones are actually worth testing.

Glycolysis is the first step in glucose metabolism (breakdown of sugar) producing pyruvate and some energy (ATP). This step takes place in the absence of oxygen. Pyruvate, then, enters mitochondria and is converted into acetyl CoA, which is then metabolized in the Krebs cycle to produce more energy in the presence of oxygen.

Pyruvic acid is created in the metabolism of carbs, proteins, and fats. It is one of the intermediate compounds our body uses to convert food into energy [ 1 ].

Apart from its role in energy metabolism, pyruvic acid is also an antioxidant and helps decrease inflammation [ 2 ].

When mitochondrial functions are compromised due to low oxygen supply or other factors, glycolysis becomes the major source of energy, producing more pyruvate. Excess pyruvate has an escape route where it is converted to oxaloacetate and lactic acid [ 3 ]. Thus, pyruvate levels are usually evaluated with levels of lactic acid and other organic acids.

A pyruvic acid test can tell you if there is a lack of oxygen in your body or issues with your blood vessels. A lactic acid (lactate) test, however, is more reliable and much more often used for these purposes.

These can increase pyruvate levels: Rare inborn disorders — very high pyruvate levels can point to inborn metabolic disorders due to genetic mutations [ 16 , 17 , 18 ]

Since pyruvate levels can increase due to various causes, they are not particularly informative, unless they are used to check for rare metabolic disorders. If your levels are elevated, work with your doctor to find out why and to treat the underlying cause.

Elevated urine pyruvate levels are used to screen for rare metabolic disorders. They can also increase due to various other health issues, which is why a doctor will interpret them together with other tests, your signs, symptoms, and medical history.

Lactic acid is produced in the body as cells convert food (glucose) into energy. It gets used and removed quite efficiently, and therefore the blood and urine levels are normally low [ 19 , 20 ].

Larger amounts of lactic acid are produced by the muscles, brain, and other tissues when there is not enough oxygen . This process is known as the anaerobic (= without oxygen) metabolism of glucose. This often happens during exercise, for example. Some gut bacteria also produce lactic acid [ 19 , 20 ].

Lactic acid gets broken down in the liver and kidneys and can accumulate in the body when it is produced faster than it can be removed [ 19 , 20 ].

Lactic acid in excess can lower the pH of the blood and cause what is known as lactic acidosis. A lactic acid test is often ordered when a person has signs of low oxygen (hypoxia) and lactic acidosis such as [ 19 ]: Shortness of breath

Rapid breathing




Muscle weakness

Abdominal pain

Higher lactic acid levels can be caused by many different factors and conditions, including: Strenuous exercise — when there is an imbalance between oxygen delivery and energy requirements in the muscles [ 21 , 22 , 23 , 24 , 25 , 25 ]

Gut bacterial dysbiosis, found in short bowel syndrome and after gastric bypass surgery [ 32 , 33 , 34 , 35 , 36 , 37 ]

Conditions that decrease blood flow or oxygen supply to the tissues, such as bleeding (hemorrhage) and anemia [ 49 , 50 , 51 , 52 , 53 ]

Exposure to toxins such as cyanide (found in bitter almonds), carbon monoxide, toluene, or the pesticide fenaminosulf [ 56 , 57 , 58 , 59 , 60 ] Alcohol intoxication, including ingestion of ethanol, propylene glycol, ethylene glycol, and alcohol-containing products such as hand sanitizer [ 61 , 62 , 35 , 63 , 64 ] Severity and symptoms of lactic acidosis can vary widely depending on which metabolic pathway is not functional and can range from severe neurological degeneration in newborns (Leigh syndrome) and early death to relatively normal life with episodes of vomiting, nausea, and generalized weakness [ 86 ].Since there are so many different things and conditions that can cause an increase in lactic acid, some of them life-threatening, it’s very important that you don’t try to self-diagnose! Work with your doctor to find out what’s causing elevated lactic acid and to treat any underlying condition.Following the treatment regimen your doctor prescribes will help decrease lactic acid back to normal.Elevated urine lactic acid levels are used to screen for rare metabolic disorders. They also increase due to various other health issues, and can cause lactic acidosis, which is a life-threatening condition. Work with your doctor to find the cause and treat any underlying condition!Krebs cycle (also called tricarboxylic acid or TCA cycle) is the center for energy production from carbohydrates, fats, and proteins. The cycle consists of a series of reactions, with […]

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