Dr. Amy Nett: I’m assuming that you’re talking about the Organix Comprehensive. Just to clarify, the two major companies here are Great Plains and Genova. Those are the two major companies that we do urine organic acid testing through, and in the course, we’ve talked about the Genova Organix Dysbiosis primarily, but I think we did mention that we normally go through Great Plains if we’re working with kids, particularly if they’re on the spectrum. There are more markers for clostridia and yeast. I think your question here is whether or not you want to use and/or promote the Urine Organix Comprehensive. That’s kind of the assumption I’m going to make when I answer it.
As we talked about in the gut testing section, there are some really valuable markers for yeast overgrowth and bacterial overgrowth, and one of the reasons we layer in so many different tests is because no test is perfect. If you have a patient and you strongly suspect SIBO but their breath test comes back completely normal, you might want to do the Urine Organix Dysbiosis Test to see if there are markers there that might lead you or push you in the direction of treatment. That would be one place to look. For kids on the spectrum—kids with developmental issues, I should say—I’m more inclined to do the organic acids test, get an idea of what’s going on with the gut. So, yes, one reason is just to layer in additional understanding, additional testing for what’s going on with the GI tract because again, as we’re looking at it, the GI tract and the health of the gut and the microbiome is one of the major factors in terms of overall health, so it might have a role there.
If you’re talking about the Genova Organix Comprehensive, we won’t be going over that in the course, but that test includes markers for things like peripheral neurotransmitter metabolism. It includes formiminoglutamic acid and methylmalonic acid. Those can be markers that might indicate inadequate or low levels of B12 or folate, so you might expect impaired methylation if you see those. The peripheral neurotransmitter metabolism markers, I think I mentioned. You can look at HVA, VMA, kynurenate. What’s the other one that I really like? Oh, quinolinic acid. Those help give you an idea as to whether or not there’s a lot of inflammation in the body. I think I’m going to say this incorrectly, but high… it’s either VMA or HVA can be a clue that there might be a metal toxicity. That test also has markers for carbohydrate metabolism, fatty acid metabolism and utilization, and I think what we’ve talked about, too, in this course is even with the Dysbiosis, that a urine organic acids test probably has the most variability, and I often tell patients, “If you were to take this test maybe every day for two weeks, we would probably see eight different results, ten different results, something like that. There’s going to be variation depending on what people eat.” So I never use the organic acids test alone in isolation. I use it to complement other tests, and I never use just one marker in a category to send me down a pathway. If I see one marker of abnormal neurotransmitter metabolism, I don’t get too excited about it. If I see only one marker of impaired mitochondrial function, I don’t get too excited. But if someone comes back with, let’s say, four markers out of range in the detoxification section, like there are a few markers for detox capacity, then that tells me something’s going on and I want to dig a little bit deeper. What I often do with the urine organic acids, if I’m doing a lot of testing on someone, like let’s say someone’s coming to the clinic and we decide we’re going to do gut testing, metals testing, methylation testing, hormone and adrenal testing, I don’t see a lot of need for doing the organic acids test there because the urine organic acids test isn’t going to send me in any other direction if I’m already digging pretty deep into metals toxicity, that sort of thing. But if I have a patient who’s kind of not too specific in their presentation, we’re not sure where to go, then I might do something like a stool test, a SIBO breath test, a urine organic acids test, maybe a hormone profile, and depending on how that urine organic acids test comes back in addition to the other pieces, that might be an indication to me that either I need to dig a lot deeper, or if it comes back really clean, then I might say, OK, let’s first focus a lot more on diet and lifestyle rather than necessarily digging into heavy metal toxicity or something like that.
That’s a long way of saying I think we still need to figure out the best way to use the urine organic acids test. I use it as big-picture overview, a lot of markers out of range. It’s going to send me down a direction of looking into other things but doesn’t normally affect my specific treatment plan. Again, I think Chris orders it more consistently than I do right now. He’s still using it mostly for the bacterial and yeast markers. I think he said when he first started practice he was kind of playing whack-a-mole with all those markers because if you look on it, it’ll suggest all the nutrients and that sort of thing you should add, which we just didn’t find successful. When I first started training with him, I think we were doing custom vitamin formulas to match that, and I’m just not sure that that makes sense. It’s sort of a big-picture overview, and hopefully that helps. And I agree. It’s a complementary test. It’s never the one and only you’ll use, but depending on the clinical picture, the other tests you’re doing, it might play a role in terms of guiding you on where to go.