Ten Organic Acid Biomarkers That Reveal Clues to Patient Wellness

Organic Acid Testing with DUTCH 

Organic acid tests (OATs) are a popular tool to evaluate health. Organic acids are compounds the body makes that influence the pH of cells. Each cell in the body requires a specific acid-base balance to ensure it’s communicating and metabolizing appropriately.  

OATs and Cellular Health 

The way the body metabolizes compounds can offer information on nutritional status, the levels of neurotransmitters (like dopamine) in the body, gut dysbiosis, and more severe disease states. 

Most organic acids require metabolism through the Krebs cycle or the electron transport chain (ETC) to complete the steps the cell needs to function. Each step requires a certain amount of functionality to ensure optimal health.  

DUTCH testing allows for evaluation of nutritional and neurotransmitter levels, as well as gut dysbiosis or imbalance. Let's walk through the ten organic acid biomarkers evaluated on the DUTCH Test to learn more about their importance for monitoring overall health. 

Methylmalonate (MMA) 

Also known as methylmalonic acid, MMA levels elevate when the body is not getting enough vitamin B12, specifically the adenosyl form of B12. Vitamin B12 is an important nutrient for cognition, nerve function, stress management, energy, and mood.  


This marker may be elevated when the body has low levels of vitamin B6. Xanthurenate has also been seen with decreased insulin sensitivity, oxidative stress, and can bind with iron—causing DNA damage. 


Referred to as KYNA in some literature, is a by-product of tryptophan.  

When kynurenate is elevated, it is usually due to:  

  • inflammation, as inflammation causes the pathways to divert to kynurenate instead of tryptophan.  
  • low serotonin, because tryptophan is diverted to kynurenate and does not make the tryptophan-to-serotonin conversion. 
Checmical pathway from tryptophan to kynurenine to quinolinate

Certain inflammatory compounds such as lipopolysaccharides can cause inflammation, triggering the production of kynurenate. We can also see elevated kynurenate as neuroprotective, suggesting that there is something causing neuroinflammation as well. When xanthurenate and kynurenate are both elevated it is more indicative of vitamin B6 deficiency, as we can also see kynurenate elevations with low levels of vitamin B6. 


This marker is like MMA in that b-hydroxyisovalerate is elevated when the body is deficient in biotin. Biotin is an important nutrient for skin and hair growth. Symptoms associated with low biotin (elevated b-hydroxyisovalerate) may be hair loss, cracks in the skin along the lips, dry skin, eczema, or rashes. Biotin supplementation can be helpful to replete these levels. It may also be helpful to include an overall B-complex as the B vitamins work synergistically for overall repletion status. 


Also known as quinolinic acid, this marker suggests neuroinflammation, but may also be present with phthalate exposure, and generalized inflammation. Quinolinate levels increase in disease states like ALS, Huntington’s disease, motor neuron disease, and depression. 

Quinolinate is a precursor to NAD through tryptophan metabolism. NAD reduces the effects of oxidation and is an important molecule that cells depend on for energy. There is a delicate balance between activation of quinolinate to help fight off toxins, and too much quinolinate (if the body is not able to sufficiently fight off toxins or regenerate healthy cells). Quinolinate is an important factor in evaluating inflammation and inflammatory response in different cell types. 


Indican is produced by the body. When this marker is elevated in the urine it is suggestive of gut dysbiosis or imbalance. Indican is also a tryptophan by-product. Indican levels elevate when the body is unable to break down proteins efficiently, and when the gallbladder and/or pancreas are not meeting the enzyme production demands to break down food well. Indican itself is not a sufficient marker to know what types of treatment may be needed, but it is an indicator that further work-up should be completed to understand what is happening in the gut.  

Three New Organic Acid Biomarkers are now available on every DUTCH Complete and DUTCH Plus report! Download the fact sheet for complete details of how to interpret
b-Hydroxyisovalerate, Quinolinate, and Indican.


In a DUTCH report, this marker can be low or high. Research supports that when pyroglutamate is high there is need for glutathione. When pyroglutamate is low, this suggests that glutathione levels are still not quite optimal and may need more support from precursors to help create glutathione. Glutathione is a potent antioxidant which helps cells stay healthy and clean by removing toxins. 

Homovanillate (HVA) 

HVA is a dopamine metabolite. When this marker is elevated, it is because there is significant release of dopamine. This may be from foods, increased stress response, or anxiety. Low levels of HVA may be associated with low mood, depression, decreased pleasure, and cravings.  

Vanilmandillate (VMA) 

VMA is a metabolite of epinephrine and norepinephrine. Epinephrine is associated with the body’s stress response. Therefore, when VMA is elevated, this is usually in response to increased stress. Low levels of VMA may be associated with fatigue and long-term stress response.  


This marker is known as the “oxidative stress” marker. Oxidative stress refers to cellular damage or DNA damage. The body needs healthy and robust cells and DNA. Cell-signaling influences blood sugar, hormone production, detoxification, the creation of new cells, etc. 

Oxidation is like aging. If cells age too quickly, the body is unable to heal and recover well. Elevated 8-OH-dG is associated with many disease states including high cortisol and some cancers.Learn more about oxidative stress and how why it's so integral to patient health with our in-depth 8-OH-dG fact sheet.

OATs and Patient Evaluation 

When evaluating patient health, there may be a difference between pathology (true disease states) and the “gray area”. The gray area is where traditional lab testing may not detect irregularities in OATs biomarkers—leaving providers without suggestions to help and support their patients.  

At DUTCH, we are committed to evaluating all areas of health and metabolism, including the gray areas. OATs testing offers a broader scope of evaluation to ensure all systems are operating efficiently. Identifying imbalances in sex hormones and adrenal function is necessary for optimal health evaluation.  

The OATs included with the DUTCH Test provide a comprehensive view of possible hormone and metabolite imbalances or deficiencies that can influence overall health, energy, and quality of life. Take organic acid testing seriously and choose the lab that goes beyond the traditional markers. 

Our complete Organic Acids Test information sheet explains more about using these biomarkers to evaluate patient wellness. Download the information sheet below.