This is a continuing series of blogs looking at OATS results and autism. The goal is to filter out items that are relevant to autism. The series is not intended to do a full explanation of the OATS test. The OATS test is not autism specific but general health (often IBS/FM/CFS focuses).
Remember that our knowledge is constantly changing (unfortunately most MDs knowledge of the literature is stale). In going thru the literature, remember what is reported is the result of a group and may not apply to a specific child with autism. Each child has difference symptoms and thus different microbiome dysfunction.
The purpose of the literature review is to identify items that are recognized as autism associated and to know what to follow up on with your medical professional.
This article, A Metabolomics Approach to Screening for Autism Risk in the Children’s Autism Metabolome Project [2020] is worth a read.
Panel A
Glyceric
Nothing found
Glycolic
A low value is seen here and in disagreement with the literature
- Other metabolites increased are 3,4-dihydroxybutyric acid, glycolic acid and glycine, cis-aconitic acid; phenylalanine, tyrosine, p-hydroxyphenylacetic acid, and homovanillic acid [2014]
Oxalate
A high value is seen here and in agreement with the literature
- Children with ASD demonstrated 3-fold greater plasma oxalate levels compared with reference and 2.5-fold greater urinary oxalate concentrations [2012]
- Low oxalate diets have been tried with no published results [2020]
Lactic
Appears to be connected to anxiety. High levels are associated with brain fog and loss of executive function with other conditions. Child is high.
- Brain lactate as a potential biomarker for comorbid anxiety disorder in autism spectrum disorder-reply [2015]
- The relationship between lactate level and the repetitive behavior domain of the Autism Diagnostic Interview-Revised was statistically significant. [2020] See this post for possible ways to reduce..
Pyruvic
Child is upward trending. The literature refers to the ratio being high, and in this case, the ratio appears to high. An appropriate goal would be to reduce lactic acid.
- Higher Lactate Level and Lactate-to-Pyruvate Ratio in Autism Spectrum Disorder [2020]
- A significant elevation was observed in the levels of NO, MDA, protein carbonyl, and lactate to pyruvate ratio in the plasma of Omani autistic children as compared to their age-matched controls. [2012]
Panel B
Succinic
We see low values, the literature reveal that this may be connected to some SNPs in some.
- Bi-allelic Mutations in ALDH5A1 is associated with succinic semialdehyde dehydrogenase deficiency and severe intellectual disability [2020] [2020]
- Succinic Semialdehyde Dehydrogenase Deficiency Presenting as Autism Spectrum Disorder [2016]
- Safety and efficacy of oral DMSA ( dimercapto succinic acid ) therapy for children with autism spectrum disorders: part B – behavioral results [2009] “DMSA had significant improvements on all the assessment measures.”
- “DMSA greatly increased the excretion of lead, substantially increased excretion of tin and bismuth, and somewhat increased the excretion of thallium, mercury, antimony, and tungsten. ” [2009]
Fumaric
Skipping – not abnormal and nothing clear in the literature.
Malic
This person is high. Nothing found in the literature.
2-Oxoglutaric
This person is slightly low.
This lead to a single study from [2011]: “Significant differences were found between the autistic children and the control group in organic acids: 2-oxoglutaric, isocitric, citric, 4-hydroxybenzoic, 4-hydroxyphenylacetic, hippuric, adipic, suberic (all with p<0.05).”
There was also “The ASD group had higher levels of phenylactic acid but decreased amounts of aconitic acid, phosphoric acid, 3-oxoglutaric acid, and carboxycitric acid compared to TD children. ” [2019]
Aconitic
This person is low.
This was also found low in the last study “decreased amounts of aconitic acid” [2019] and contrary results in ” Interactions among diet, intestinal flora and genes may explain such findings… Other metabolites increased are 3,4-dihydroxybutyric acid, glycolic acid and glycine, cis-aconitic acid; phenylalanine, tyrosine, p-hydroxyphenylacetic acid, and homovanillic acid are all involved in the tyrosine pathway leading to neurotransmitter cathecolamine.” [2014]
Citric
This person is slightly low.
“Three of 7 patients demonstrated abnormalities in citric acid metabolites, bacterial metabolism, and fatty acid oxidation markers. ” [2015] This implies abnormalities may only occur in a subset.
3-Methylglutaric
This person is slightly elevated.
” Metabolomic analysis of urinary organic acids revealed that three metabolites, 3-hydroxy-3-methylglutaric acid (P = 0.008), 3-methyglutaconic acid (P = 0.018), and ethylmalonic acid (P = 0.043) were significantly elevated in individuals with ASD.” [2020]
3-Hydroxyglutaric
Nothing found in the literature. Person is in normal range.
3-Methylglutaconic
Nothing found in the literature. Person is in normal range.
Bottom Line
We have done another section of the OATS report. Correcting by diet or drugs some of these shifts is another level of analysis; one that too-often there is little information on.
One known example: Pyruvic-Lactate ratio can be addressed by reducing the amount of lactic acid (i.e. no Lactobacillus probiotics, reducing food that produce lactic acid – milk, yogurt). It may also require 16s microbiome tests to determine which lactate producing bacteria are present (list here)