Five Gastroenterologists And Not One Stool Test

By: Dr. Matt Lewis, D.C., DACBN, CFMP®

I recently had a patient whom spent twenty years with chronic GI complaints, visiting greater than five gastrointestinal specialists. In that span of time, not one of the GI specialists ordered a stool test. I found that surprising and too common. The patient found it frustrating!

Can you imagine having a gut issue for over twenty years and no one thought to perform a stool test?

This particular patient had already been through a series of tests including endoscopy, colonoscopy and abdominal sonogram, due to abdominal pain, reflux symptoms and inconsistent bowels ranging from hard or dry stools to watery diarrhea. To be fair, the tests she  had were able to screen for a variety of conditions including celiac, h-pylori infection, gastritis, polyps, colon cancer, and esophagitis to name a few.

However, the patient was told there was no pathology (this basically means your not dying and we can’t find what’s wrong, so you must be ok). The patient was happy to hear she had no pathologies and unhappy with the proposed solution. She was offered  prescription Bentyl and after trying it for several months was unsatisfied with the results.

In my Tampa clinic I use a few different labs to test for GI problems. One such test is the GI Map test provided by Diagnostic Solutions Lab. Here are some of the highlights of this test.

Finding Microorganisms

The GI map tests uses a method for amplifying the DNA material of various bacteria, viruses, parasites and protozoa in the stool. The technique is termed  qPCR (A quantitative polymerase chain reaction). The benefit of qPCR is confirming the presence of DNA material for each tested microorganism present within the stool sample and assigning a specific quantity. Since we all live with various microorganisms in our gut and throughout our bodies it’s normal for many organisms to be present. However, when certain microorganisms are able to grow, either pathogenic or opportunistic in large numbers this can create clinical symptoms and persistent inflammation in the GI tract.

Clinical symptoms may include, nausea, vomiting, loose stools, bleeding, mucus, or abdominal pain. This is usually found in acute infections. For some with chronic GI inflammation the symptoms can vary including, chronic gastritis, bloating, constipation, abdominal discomfort, belching, gas, chronic bad breath and undigested food in the stools.

Assessing Healthy Gut Flora

Healthy gut flora are the good guys (microorganisms) that beneficially colonize the digestive tract. This would be analogous to the probiotics a patient may take. In reality, we all have a unique microbiome (universe of microorganisms inhabiting our bodies). That sounds terrible, but it’s really great! These good guys help us to make vitamins, digest food, reduce inflammation, support production of happy chemicals like serotonin and boost immune function. I appreciate that the GI map test shows what good microorganisms are colonized in our gut, along with the bad ones that can be present.

The GI Map test includes looking at levels of bifidobacteria and lactobacillus among other healthy bacterial flora. The doctor and patient can see if there is a good balance and make clinical decisions about what probiotics may be most helpful if the balance of good bacteria is to low, or if the bad bacteria is overgrowing. This imbalance of gut bacteria is termed dysbiosis.  

Having  healthy levels of good bacteria or the opposite (dysbiosis) is a product of lifetime dietary habits, history of antibiotic use, antacid or proton pump inhibitor use, previous infections, travel, drinking soda, sweetener use, stress levels, exposure to water damaged buildings, hospital stays, and much more. A holistic approach to gastrointestinal health is to unwind the lifetime of stress to the digestive system.

Inflammation Markers

If you read about health, then you know what inflammation is. It’s probably the most important method used to combat a variety of acute and chronic triggers to our immune system. However, we don’t want it hanging around. I often check inflammatory markers like hsCRP, ESR, Homocysteine, and Uric Acid that are often missing from patients previous lab work and can provide valuable insight as to the level of inflammation systemically.

Typically it’s a simple CBC and Metabolic Chemistry that is  run without paying attention to inflammation. In a more thorough approach when inflammatory lab markers are ordered they may still be negative. In this case be maybe looking in the wrong place!

If the inflammation is in the digestive tract, why not look there?

By examining the stool we are able to gain valuable information so the patient can start healing. We can see markers for inflammation that are sensitive, reliable and are local to the GI tract. If levels of calprotectin, beta-glucuronidase, or zonulin are elevated inflammation is confirmed. If sIgA (secretory immunoglobulin A)  levels are high or low this speaks to an immune response and inflammation as well. sIgA is the primary immunoglobulin used by the immune system in all mucus membranes, (gut mucosa, lung, sinus, bladder, vaginal) with large quantities in the gut. This is a first line defense against invading microorganisms and controlling internal immune responses.

Low levels indicate that the patient is immunocompromised or is struggling with a chronic infection (a finding I often see in my patients who have rather normal lab findings from previous physicians).

Calprotectin is a marker that can distinguish between IBS (irritable bowel syndrome) or IBD (irritable bowel disease). Aggressively high levels can indicate IBD, an autoimmune response possibly colitis or Crohn’s. It can also be moderately elevated in response to an infection, food allergy or other insult to the digestive system. Listening to the patient and asking for clues on the initial paperwork helps me to identify what the problem might be. Then after treatment we can check the markers again and see what kind of progress we are having. If a referral is warranted I can now send the patient back to the GI specialist with additional information that can be helpful in finally obtaining a more complete diagnosis and adequate treatment. I often find that the holistic approach will resolve most of the GI complaints and help manage those with a chronic organic disease. By having a stool test we can know better what the actual diagnosis is and for many patients that alone can reduce anxiety and a pathway to healing.

Leaky Gut

Zonulin is a protein made by the body, indicating that the lining to the digestive tract is breaking down, this is what is termed as “leaky gut”. If the gut becomes porous, LPS a bacterial toxin can pass into the bowels and upregulate the immune system, causing all kinds of nasty symptoms.

Often I see this presenting as anxiety, brain fog, fatigue, and weakened immune function. Overtime the leaky gut can cause LPS overstimulation to the immune system leading to autoimmunity, attention deficit, and a chronic inflammatory response. We call this “Brain on Fire”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660627/

Small Intestinal Bacterial Overgrowth And Poor Detoxification

Beta-glucuronidase can be elevated when there are challenges with phase 2 detoxification or over exposure to persistent environmental toxins. This may indicate the need for liver cleansing or support with herbals and finding the source of toxins. High levels can also indicate dysbiosis or small intestinal bacterial overgrowth (SIBO). In that case, seeking out the cause of overgrowth and treating for SIBO may be indicated. Other considerations are poor detoxification of estrogen metabolites coming from either contraceptives, hormone replacement therapy, internal sources of estrogen elevations or environmental exposure to xenoestrogens., found personal care products. The source of toxins is often associated with exposure to a water damaged building and the range of inflammagens found within. See my blog on biotoxin and mold illness for further discussion. http://doctormattintampa.com/mold-its-usually-not-allergy-its-a-biotoxin-illness-named-cirs/

Additional Markers

GI Map is comprehensive. It also looks at markers to assess pancreatic function (elastase). Elastase is an enzyme only made by the pancreas to support digestion. Low levels of elastase may indicate pancreatic insufficiency, cystic fibrosis, or simply insufficient acid production in the stomach due to infection, prescription medication or other causes.

The stool is checked for fat levels. High levels indicate poor absorption of necessary fats and may indicate celiac disease, gluten sensitivity, gallstones, or low acid in the stomach (the opposite of what most doctors are treating for when they prescribe proton pump inhibitors like nexium, prilosec, and omeprazole).

Red blood cell quantities are also measured indicating upper GI bleed potentially causing anemia or possibly coming from hemorrhoids. The quantity of red blood cells can help distinguish where the bleeding is coming from or how serious the condition. Higher elevations can indicate the need for colonoscopy to rule out polyps or colorectal cancer.

Treatment for Gastrointestinal Health

In summary, stool testing provides a window into the interplay between microorganisms, environment, diet, previous antibiotic or proton pump inhibitor use, good bacteria, immune function, brain function and symptoms of gastrointestinal health. In holistic medicine it has long been said that the gut is where health starts and where health fails. Knowing your stool test results can help you and your clinician gain a better insight into what the appropriate diagnosis is, what is causing the problems, and inform treatment decisions.

Using stools tests has helped many of my patients not only monitor treatment but return to a happy and healthy life without nagging gut symptoms all the time.

In my Tampa holistic medicine practice patients start by filling their functional medicine analysis. http://mattlewisdc.livingmatrix.com/self_register_patients/new

This tells me your health story before you arrive at the clinic. You may also receive a copy of the analysis at your visit for your reference.

If you would like to be seen in my office please fill out your analysis today and proceed to schedule using our online calendar. /http://doctormattintampa.com/schedule-an-appointment/

If you would like more information please read about my practice here.  http://doctormattintampa.com/understanding-my-personal-approach-to-doctoring/

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