Teresa says, “How often do you use organic acids testing? It seems like stool or SIBO testing would give all the info we need. Is there an example where OAT would give us the info that the other two do not?”
Chris: Yes. OAT, I guess we’re talking specifically about microbial organic acid testing, so thanks for making that distinction because obviously there are other organic acids that reveal problems that are not necessarily specifically related to the gut like methylmalonic acid as a marker for active B12 and formiminoglutamic acid as a marker for folate deficiency and some of the markers for mitochondrial issues. In terms of the microbial organic acids, sometimes we see a patient who has pretty high d-arabinitol levels, for example, and d-arabinitol is, if you search for it in the peer-reviewed literature, you’ll find references to it as a marker for invasive candidiasis, and it has some research behind it. Sometimes we do see patients who don’t test positive for fungal overgrowth in the stool but do test positive for d-arabinitol in the urine, and that can be a marker of a fungal overgrowth. Also, d-lactate, as I mentioned, and indican are being considered as alternative markers of bacterial overgrowth in the small intestine, but there is not quite enough research on them to validate that yet. But if somebody has d-lactate, indican, and other markers of bacterial dysbiosis biopsies on the organic acids panel, and their stool and breath tests are normal, then I would probably pay attention to that. As you know, breath testing is not 100 percent accurate. No testing is 100 percent accurate, but breath testing for SIBO on particular is somewhat problematic. Stool testing, while it’s come a long way and is really good at detecting, I think, pathogens like parasites, pathogenic bacteria, etc., is not necessarily where we want it to be for just detecting the overall health of the microbiome. I think the organic acids can be helpful there.