Testing For The Root Cause Of Your Digestive Problems

This article originally appeared on Healevate.

Nothing says good morning quite like pooping into a toilet hat and transferring part of that specimen, using a spoon, into a test tube. While this might sound a little gross on the surface, it can tell you a lot about your health.

The condition of your gut and how well you can absorb, utilize, and eliminate nutrients represents the foundation of health in your body. Digestive symptoms manifest as anything from brain fog, fatigue and acne, to diarrhea, gas, and bloating. The symptoms are vast and can be confusing, so clearly knowing what you’re looking for helps.

Symptoms of Digestive Problems

Understanding your symptoms can be a useful guide for choosing the correct test.

GI: Gas, bloating, belching, stomach pain, constipation, diarrhea, undigested food particles or fat in stool, gurgling in stomach, acid reflux, malabsorption, cankers, altered motility or gastroparesis, and food sensitivities or allergies.
Immune: Allergies, asthma, chronic sinus infections, frequent infections such as urinary tract infections, Candida overgrowth, and autoimmune conditions.
Liver: Poor detoxification, recirculation of toxins and hormones from bacterial deconjugation, increased or decreased bile production, and pain under the lower right ribs.
Skin: Itching, hives, acne, rosacea, rashes, eczema, psoriasis, and dermatitis.
Musculoskeletal: Joint pain, muscle pain, and fibromyalgia.
Brain and Mood: Headache, fatigue, neuropathy, brain fog, inability to focus, irritability, anxiety, depression, ADD/ADHD, lack of coordination or balance, and poor memory.
Hormones: Fatigue, poor temperature control, weight gain or weight loss, poor sleep quality, food cravings, poor blood sugar regulation, and hormone imbalances.

Which Test Do I Choose for Digestive Problems?

Choosing digestive tests can be a daunting task, especially when the symptoms seem to be coming from everywhere in your body. Starting off with the basics and expanding from there is always a good way to proceed when doing any testing.

The first thing to consider is if the symptoms suggest an acute infection, such as parasites or food poisoning. If this is the case, then testing to identify the organism is best. This usually involves a stool test and/or blood testing.

If your symptoms are chronic or more vague, then approaching tests with a broader scope can more easily pinpoint the root causes (there are often many). Dysbiosis, malabsorption, nutrient depletion, and GI dysfunctions like increased or decreased transit time often occur together.

When using this approach, the first goal is to identify and eliminate all pathogens, because if they’re present, you’ll have dysbiosis. Next, identifying the composition of the gut flora and checking immune and gut function will help direct treatment in the healing and rebuilding phases.

Occasionally, things don’t go like you want them to and further testing is warranted. Some companies offer specialty tests for food sensitivities or allergies (like celiac), detoxification, specific toxin testing, and hidden infections. We’ll get to these types of tests later on.

Digestive Testing

General tests can be completed by lab companies such as LabCorp or Quest, as well as specialty labs:

  • Stool testing (1- or 3-day)
  • Serum blood testing for infections such as bacteria or yeast
  • Antibody or antigen testing for certain bacteria, yeast, or viral infections

Functional tests are more in-depth than standard digestive tests. They’re provided by specialty labs and often require a practitioner to request them for you:

  • Organic acids dysbiosis profile
  • Comprehensive digestive stool analysis (CDSA)
  • Intestinal permeability
  • Lactose intolerance breath testing
  • SIBO (small intestinal bacterial overgrowth) breath testing

Stool Testing

Stool testing is just what it sounds like—an examination of your stool for good and bad organisms, toxins, and the presence of blood.

Typically, stool tests incorporate a stool culture of common bacteria, microscopic analysis for yeast, fungi, parasites, and blood cells, and sometimes testing for toxins that organisms excrete, such as the Shiga toxins (E. coli) or Clostridium difficile toxins A and B.

Additionally, most of the functional/specialty labs do antibody tests for hard-to-identify organisms, such as Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica, and Helicobacter pylori as a part of their normal stool testing.

One of the big differences is that some labs offer one-day tests while others offer three-day tests. The benefit to three days’ worth of samples is that there’s a greater chance of identifying elusive GI organisms.

That’s not the whole story, though. While most labs rely on traditional methods to identify organisms, some labs offer PCR-based testing, which means they’re using DNA to identify and only require one sample.

Standard stool testing is offered by traditional lab companies. Expanded stool testing is offered by specialty labs such as BioHealth Laboratory, Genova Diagnostics, and Doctor’s Data. DRG Laboratory offers PCR-based stool testing.

Serum Testing for Infections

Serum testing requires a blood draw, and the sample will be used to identify any organisms in your bloodstream. This may happen if you’ve had a systemic illness that may have spread from another area, such as the digestive or urinary tracts.

Bacteria, yeast, and other fungi are often identified in this manner. Yeast is especially important to consider here, because it’s opportunistic and will go beyond the limits of the GI tract in people with compromised immune function or co-infections.

This test is most likely to be conducted through a standard lab, at a hospital, or through your doctor’s office. It’s not something offered through specialty labs.

Antibody or Antigen Testing for Infections

Antibody testing is similar to serum testing in that it offers another means of identifying sometimes hard-to-locate organisms. Antibody testing can be done on blood or stool. When you have an infection, your body mounts an immune attack and creates antibodies against that specific organism’s antigen (the protein your body identifies as foreign).

Antibody tests measure your body’s immune response to an organism. This type of testing lets you know that there was an organism present at some moment in time, but it won’t necessarily tell you if it’s active, since antibodies can remain elevated even after the intruder is eliminated.

Similarly, antigen testing can identify the presence of an organism. Performing a stool antigen test for H. pylori is a preferred method, as it’s less invasive than other methods and is both sensitive and specific for active infection.

Antibody and antigen testing can be run through standard labs, as well as via BioHealth Laboratory, Genova Diagnostics, Doctor’s Data, and DRG Laboratory.

Organic Acids Dysbiosis Profile

Urinary organic acids measure the byproducts of your metabolic processes. Specifically, it’s measuring the metabolites produced by the bacteria and yeast living in your gut. This is a simple and non-invasive test, since it requires only a urine sample.

Intestinal bacterial overgrowth and yeast infections will cause elevated metabolites, and they’re also useful in assessing carbohydrate and protein malabsorption.

Urinary organic acid testing is available through Great Plains Laboratories and Genova Diagnostics.

Comprehensive Digestive Stool Analysis (CDSA)

Comprehensive digestive stool analysis is another way to evaluate the health of the GI tract. Using microbial growth-based cultures, biochemical assays, and microscopic evaluation, this thorough test assesses the status of beneficial and pathogenic microorganisms, including aerobic and anaerobic bacteria, yeast, and parasites. Specific analysis includes:

  • Identification of pathogenic bacteria, parasites, and fungi, and levels of beneficial bacteria
  • Protein, carbohydrate, and fat absorption via elastase and chymotrypsin levels, as well as the presence of meat and vegetable fibers and fats
  • Inflammatory markers including lactoferrin, lysozyme, eosinophil protein x, calprotectin, and the presence of mucus or blood cells
  • Immune function via sIgA levels (secretory IgA)

Many of these markers can also be tested as smaller profiles or individual tests. The full test is offered by Genova Diagnostics and Doctor’s Data, while DRG Laboratories can do a pared-down version with their stool PCR testing.

Intestinal Permeability Testing

This test provides a method for verifying the presence of increased intestinal permeability, also called leaky gut. Leaky gut allows food particles, toxins, and products of dysbiosis to enter the bloodstream, where an immune response mounts and inflammation is produced. It’s implicated in many conditions, from IBS to autoimmunity.

One version of the test, the Lactulose-Mannitol test, requires you to drink a solution of the sugars lactulose and mannitol. The degree of permeability is assessed by the amount of sugar recovered in urine.

An updated version of permeability testing called Intestinal Antigenic Permeability Screening assesses IgA, IgM, and IgG antibody reactions to bacterial endotoxins (LPS) that have entered the bloodstream. It also measures the tight junction proteins zonulin and occludin that break down in leaky gut, as well as a cell structure component called actomyosin. This test may more specifically show the route of gut barrier damage.

Genova Diagnostics and Doctor’s Data offer Lactulose-Mannitol testing. Cyrex Labs has the Array 2: Intestinal Antigenic Permeability Screening.

Lactose Intolerance Breath Testing

Lactose intolerance is one of the most common food intolerances in the US. Consumption of dairy that causes gas, bloating, diarrhea, and abdominal pain is an indication for this type of test. Inability to break down the dairy sugar lactose because of a lack of the digestive enzyme lactase or intestinal irritation results in lactose malabsorption and digestive symptoms.

This test requires you to drink a lactose solution and then take breath samples over a period of several hours. It measures the amount of hydrogen and methane produced when undigested and absorbed lactose is fermented by gut bacteria.

Genova Diagnostics offers this test.

SIBO Breath Testing

Small intestinal bacterial overgrowth (SIBO) occurs when large amounts of bacteria are present in the small intestine, where there are normally very few. The small intestine is where absorption largely takes place, so there’s little need of bacteria.

The symptoms are similar to lactose intolerance, because the bacteria are fermenting undigested foods (especially carbohydrates) and producing methane or hydrogen. Bloating, gas, abdominal pain, diarrhea, and constipation are classic symptoms.

During this test, you consume solution of glucose or lactulose, and then breath samples are taken over a period of 2-3 hours. The test measures the amount of hydrogen and methane produced when undigested and unabsorbed lactose is fermented by gut bacteria. High methane is associated with constipation, and high hydrogen levels correlate with diarrhea.

Genova Diagnostic and Commonwealth Labs both offer this test.

Summary

There’s certainly no shortage of digestive testing for you to explore. If you don’t get answers from basic tests, perhaps it could be time to consider more functional testing. Many of the tests referenced above can be ordered through Direct Labs, and can shed much light on the root causes of your health symptoms- and like G.I. Joe used to say, knowing is half the battle.

Save

When to Test for Blood Sugar and Metabolic Imbalance

This article originally appeared on Healevate.

To tell you that sugar is bad for you would be beating a horse that’s long been dead. We all get it by now. But what exactly does it do that’s so bad?

For starters, it’s a major source of inflammation, tissue destruction, brain degeneration, cardiovascular disease and depression.

Elevated blood sugar literally causes damage everywhere in the body and impacts other hormones, compounding this effect. What’s even worse is that it sets the stage for metabolic syndrome, diabetes and cardiovascular disease.

Low blood sugar doesn’t get as much press, since it doesn’t cause as much damage, but the downstream effects on other hormones are no less important.

Getting your blood sugar and metabolic hormones (such as insulin and cortisol) back in check is essential for reversing inflammation, aging, and many disease processes. Since blood sugar regulation reflects many disorders of metabolism, understanding the symptoms is the first step.

Symptoms of Imbalanced Blood Sugar and Metabolic Hormones

The symptoms of hypoglycemia (low blood sugar) include:

Brain/mood: Lightheadedness, jitters, fainting, dizziness, confusion, headaches, irritability, sadness, blurred vision/double vision, anxiety, hyperactivity, lack of focus.
Energy: Fatigue, weakness, energy surge post-meal or snack, feeling like you’re going to crash when you don’t have food, excessive hunger.
Hormonal: Hormone imbalances, especially low cortisol.
Metabolic: Sweating.

The symptoms of hyperglycemia (high blood sugar) include:

Brain: Brain fog, irritability, difficulty focusing and concentrating.
Neurological: Neuropathy, paresthesia, pins and needles, tingling.
Energy: Lethargy, feeling sleepy post-meal, fatigue.
Skin/hair/eyes: Dark patches of skin on neck, elbows, armpits, and knees (acanthosis nigricans), skin tags, wounds that won’t heal, loss of hair.
GI: Nausea, vomiting, stomach pain, fruity scent to breath, dry mouth.
Metabolic: Increased thirst and urination, rapid heartbeat, shortness of breath, high blood pressure, abdominal fat, high cholesterol or triglycerides, fatty liver.
Hormonal: Hormone imbalances including estrogen, testosterone, and cortisol, PCOS.

How Can I Test for Blood Sugar and Metabolic Hormone Imbalance?

Testing for blood sugar and metabolic hormone imbalance is more straightforward than other types of testing.

The goal is to find out if your blood glucose levels—and the hormones related to blood sugar management and metabolism—are functioning properly.

This can be determined with an initial set of tests that assess blood sugar levels and management, as well as hormone regulation. After initial testing is completed, additional testing may be warranted. If you find that you have elevated blood sugar with poor blood sugar management, evaluating inflammation, lipids, and cardiovascular markers is an important secondary step.

Blood Sugar and Metabolic Testing

Initial testing:

  • Glucose tests: Fasting glucose, 2-hour glucose tolerance test, hemoglobin A1C, and fructosamine.
  • Insulin tests: Fasting insulin and C-peptide.
  • Hormone tests: Adiponectin, leptin, and cortisol.

Secondary testing:

  • Inflammatory tests: Homocysteine, CRP, ApoB, Lp(a)
  • Lipid tests.

Glucose Testing

Fasting glucose (FBG) is the initial test completed when screening for blood sugar abnormalities and diabetes. It measures the levels of glucose in the blood after a period of fasting for at least 8 hours. FBG tells you if your blood sugar is high or low and can reflect metabolic imbalance. Blood glucose levels are largely dependent on 3 factors:

  1. The ability of the pancreas to produce appropriate amounts of insulin, as well the cells having the appropriate response and sensitivity to insulin.
  2. The liver’s storage and breakdown of glycogen (the storage form of glucose in muscles and the liver to be used later as energy).
  3. Adrenal hormone function (cortisol, epinephrine), which also impacts control of blood sugar levels.

Fasting glucose can also be measured daily at home with a glucometer.

A 2-hour glucose tolerance test (GTT) is done to assess how efficiently your body responds to glucose. This test requires an initial fasting blood draw followed by consumption of a 75 mg glucose drink. Two hours later, a second sample is drawn.

Normally, after you consume sugar, your body detects your high blood sugar, which causes the pancreas to release insulin so the sugar can be cleared from your blood and stored. The second measurement should be normal. If you have impaired glucose tolerance or insulin resistance, the blood sugar level will remain high.

Hemoglobin A1c (HbA1c) measures glycated hemoglobin, or glycohemoglobin, in the bloodstream. Glycohemoglobin is formed when circulating glucose combines with the hemoglobin in your red blood cells (RBCs).

RBCs have a lifespan of 120 days, so the amount of glycated (also called glycosylated) hemoglobin is directly proportional to the amount of glucose present in the bloodstream during that period of time.

The process of glycation is irreversible, so the greater the concentration of glucose in the blood, the more it will attach to the RBCs. HbA1c is used to monitor long-term glucose control and assist with the management of high blood sugar.

Fructosamine, similar to HbA1c, forms when glucose binds to serum proteins. Fructosamine levels represent the total amount of glycated protein in the blood. This is an irreversible glycosylation process reflecting the average lifespan of serum proteins—about 14 to 21 days. It’s used to monitor blood sugar control, but it’s less common than HbA1c.

Insulin Testing

Insulin is the hormone secreted by the pancreas in response to glucose in the bloodstream that facilitates the transport of sugars into your cells.

Fasting insulin levels are measured after a minimum of 8 hours without food to detect insulin resistance, as well as high or low blood sugar.

If the pancreas doesn’t produce adequate insulin or the body loses its sensitivity to insulin (insulin resistance), blood sugar will be elevated, while fasting insulin will be low because of the lack of insulin production and high with insulin resistance.

C-peptide levels reflect how much insulin the pancreas is producing. High levels of C-peptide indicate increased insulin production, usually in response to high blood glucose levels or insulin resistance.

This test is useful for monitoring treatment of hypoglycemia and diabetes, since it only measures the body’s insulin production. It can also be helpful in distinguishing between Type I (autoimmune) and Type 2 (metabolic) diabetes, the diagnosis of insulinomas (insulin-producing tumors), and when autoantibodies are produced against insulin. Because of this, C-peptide levels can be difficult to measure.

Metabolic Hormone Testing

Adiponectin is a hormone produced by adipocytes (fat cells) that promotes proper metabolism of sugars (carbohydrates) and fats (triglycerides). It also influences the body’s response to insulin.

High levels are beneficial and indicate efficient cellular energy production. Low levels are associated with metabolic syndrome, obesity, diabetes, and cardiovascular disease.

Leptin is largely produced by fat cells and works in a feedback loop with the brain to regulate appetite and satiety. When sufficient amounts of food are consumed, leptin signals to the hypothalamus, telling the body it’s no longer hungry. Low leptin should signal hunger, and high leptin should signal satiety. The level of leptin you have directly reflects your total body fat.

Leptin deficiency isn’t common, but leptin resistance, much like insulin resistance, definitely is. It reflects the body’s decreased sensitivity to the hormone, resulting in increased production. Even though there are adequate amounts of leptin, hunger is still present since the signal isn’t getting to the brain efficiently.

Cortisol is a hormone produced by the adrenal glands that literally impacts the entire body by decreasing inflammation, regulating the stress response and circadian rhythms, and controlling blood sugar.

If blood sugar is high, cortisol stimulates the storage of sugar in the liver as glycogen. If you have cortisol dysregulation (adrenal fatigue or excess cortisol), your normal regulatory functions don’t occur properly, resulting in blood sugar dysregulation.

Cortisol follows a natural rhythm, peaking in the morning and falling throughout the day. Measuring this curve is best achieved through a salivary or dried urine cortisol test with four measurements.

Metabolic Inflammatory Testing

Homocysteine is an amino acid produced as an intermediate product in the metabolism of the amino acids methionine and cysteine (the process is called methylation).

If methylation doesn’t occur properly due to a lack of key nutrients like B12, B6, and folic acid, or because of a genetic mutation (MTHFR), homocysteine levels can rise in the blood.

Elevated homocysteine is associated with an increased risk of Alzheimer’s, cardiovascular disease, and stroke, since it directly damages the lining of the blood vessels. People with poor blood sugar regulation and diabetes are at an increased risk for elevated homocysteine.

C-reactive protein (CRP) or high sensitivity CRP (hsCRP) is an acute phase reactant protein produced mostly in the liver in response to inflammation. Elevated CRP is highly associated with metabolic syndrome, diabetes, high blood pressure, and cardiovascular disease, as they share the common root cause of inflammation.

Apolipoprotein B (ApoB) is a protein involved in fat metabolism and is a component of low density lipoproteins (LDL), also known as “bad” cholesterol. Elevated levels are associated with insulin resistance, high cholesterol, atherosclerosis, and heart disease.

ApoB100 is an even more specific marker, as only one molecule of ApoB100 attaches to each LDL particle, allowing for the total number of lipoproteins in circulation to be quantified. ApoB100 is a better marker of cardiovascular risk than LDL.

Lipoprotein a (Lp(a)) consists of an LDL particle bound to the protein apoA. Levels of Lp(a) have a significant genetic component, and levels remain relatively constant over your lifetime. Elevated Lp(a) is a risk factor for cardiovascular disease.

Lipid Testing

Lipid testing determines whether or not a person’s cholesterol-carrying proteins are healthy or not. The standard lipid panel that measures LDL (low density lipoprotein), HDL (high density lipoprotein), and triglycerides measures total serum lipid numbers only. It can be a good general marker of cardiovascular disease (CVD) risk, especially when viewed with other biomarkers such ApoB and Lp(a).

Elevated levels of LDL and triglycerides, especially when taken in the context of other biomarkers, are associated with an increased risk of CVD, as is low HDL. This test is available through LabCorp and Quest and in expanded profiles from Spectracell, Genova Diagnostics, and Doctor’s Data.

Lipoparticle protein testing provides a more accurate assessment of your cholesterol and cardiovascular risk, as it measures the particle numbers and density. When considering each lipoprotein, size does matter. For example, LDL particles can be small, medium, or large, and the amount of cholesterol within the particles varies widely. Smaller particles are more predictive of cardiovascular disease and plaque buildup, since they can penetrate the arterial walls where the larger particles can’t.

Remnant lipoproteins (RLP) and intermediate density lipoproteins (IDL) are also associated with increased CVD risk. Large, buoyant HDL (HDL2) corresponds to a decreased risk of CVD. LabCorp and Quest offer this and call it VAP testing. Spectracell calls it Lipoparticle Protein Testing, and Genova has the CV Health Profile.

All testing that we’ve discussed can be done through Direct Labs, who has contracts with the traditional and newer labs. If you’re experiencing any of the symptoms mentioned earlier in this article, it could be worthwhile to get some simple testing done so you can know where you stand and make corresponding changes, if and where necessary.

Save