Why It's Impossible to Treat Chronic Gut Dysfunction at the Bacterial Level — Layer 2: The Mitochondrial Data Tells You Exactly Where the Engine Is Failing

What the Organic Acids Test actually measures The Organic Acids Test (OAT) is a urine test, most commonly run through Mosaic Diagnostics or Great Plains. It measures about 75 different small molecules that your body produces as it burns fuel, builds neurotransmitters, and processes waste. When specific organic acids are elevated or suppressed, they tell you precisely where your metabolism is backed up &#8212; which enzymes are struggling, which cofactors are missing, which pathways are blocked. Most practitioners run the OAT to look for yeast and mold markers. That is the least interesting thing it measures. The OAT is the most direct non-invasive window we have into mitochondrial function &#8212; which means it is the most direct window into what is happening inside your gut cells. Here&#8217;s what it shows in my patients: Ethylmalonic acid &#8212; elevated. What this is: a small organic acid that accumulates when a mitochondrial enzyme called short-chain acyl-CoA dehydrogenase (SCAD) cannot keep up with its work. What SCAD does: it is the first enzyme in the pathway that burns short-chain fatty acids &#8212; including butyrate, which is a 4-carbon fatty acid &#8212; for energy. What elevated ethylmalonic acid means: your colonocyte has butyrate sitting there, ready to be burned, but the enzyme that&#8217;s supposed to burn it is failing. This is the chemical equivalent of yo