Diagnostic Stool Analysis
Table of Contents:
Digestive Stool Analysis: Testing
As discussed previously, the gut is a very important mechanism in the maintenance of immune system health. Given that 80% of the immune system surrounds the gut, dysfunction in this organ can directly affect the immune system. The gut dysfunction can then lead to the development of the other drivers of AD.18-23 As we are seeing more every day, it is a central mechanism for much of chronic disease. When someone has diarrhea, constipation, gastroesophageal reflux disease (GERD), bloating, flatulence, foul-smelling stools, nausea, abdominal pain, undigested food in their stool, and bloody stools it is easy to see the functional issues with the gut. But a person may have none or minimal gut symptoms and still have a very dysfunctional gut. This is why eight out of ten people with celiac disease never get diagnosed. Despite having an AD attacking the small intestine, 80% of celiac patients have minimal or no gut systems.33
When the gut is disrupted, food is not digested well, and the nutrients absorbed into the body are compromised. These nutrients are the basic building blocks the body uses for essential daily function. The gut is called the “second brain.” The way research is going, the gut may turn out to actually be the “first brain.” But let’s stick with the gut as the second brain for now. The gut makes items the brain needs to function such as the neurotransmitters serotonin and GABA.96 Ninety percent of serotonin for example is made in the gut.96 Now' this is not made completely altruistically by the gut for his good friend the brain. The gut uses serotonin itself for purposes such as the regulation of gut motility. Serotonin is knowm for its effect on mood, but it also has a significant impact on the immune system, sleep, diabetes mellitus, autism spectrum disorder, Parkinson’s, and Alzheimer’s disease.96 Thus, disrupted production of serotonin by the gut w'ould affect gut motility, mood, sleep, and the immune system all at once.96
The gut is a vital organ for detoxification.26 Most toxins have to leave the body through defecation. This includes not only the environmental toxins such as lead and mercury but also internally generated toxins such as old, toxic estrogen metabolites.26 Every cell in our body makes toxic byproducts of metabolism that must be cleared from the body. It is vitally important to be able to clear toxins from the body efficiently and the gut is the primary organ of detoxification. An inability to clear old, toxic estrogens from the body can be one of the causes of estrogen dominance (i.e., too much estrogen compared w'ith progesterone). Estrogen dominance is a big driver of menstrual pain, heavy flows, premenstrual syndrome, PMDD, fibroids, endometriosis, ovarian cysts, and fibrocystic breast disease.97 Insomnia and anxiety may be impacted by estrogen dominance as well. Many of these can create debilitating pain, and estrogen dominance is such a big driver of ad.18-2022-98"101 This is one reason why more women acquire ADs than men.97
Digestive Stool Analysis: Interpretation
The gut is a huge central mechanism in immune system dysregulation and the associated pain. Information received by the use of a digestive stool analysis is so helpful, and most of it is typically unavailable through hospital or local lab testing (Figure 6.9). Pancreatic elastase levels inform us if the pancreas is still able to produce this important enzyme. It can drop for a variety of reasons including if the pancreas is having to work hard to make higher than ideal levels of insulin due to insulin resistance.102 Or perhaps even fasting insulin levels have dropped below ideal on their way
FIGURE 6.9 Digestive stool analysis.
from pre-diabetes to full-blown diabetes. As we discussed earlier, when the important hormone triad of cortisol, thyroid, and insulin/blood sugar is disrupted, insulin resistance will be the result. As cortisol and thyroid are correcting, the insulin resistance and pancreatic elastase production can self-correct.
Fecal fats and fecal protein products are reported. If too high, our body is not digesting them well in order to obtain the nutrients we need to power up our bodies.
Inflammation markers calprotectin, EPX and Sig A are tested. Elevation of calprotectin indicates inflammation and that the patient is moving towards colon cancer and the ADs, such as ulcerative colitis and Crohn’s disease.103 If this number hasn’t normalized by the first recheck, a person needs to be referred for colonoscopy. An elevated EPX means some of the foods that are being consumed by the person are having a negative impact on the gut.104105 High Sig A means intestinal permeability issues. A low Sig A means that the person has lost the protective mucosal membrane separating the intestinal wall from the contents of the gut.104105
Short-chain fatty acids (SCFAs), including n-butyrate. When n-butyrate is low, so much inflammation is produced that a person has an increased risk of colon cancer.104-105 The good bacteria in the gut should make these important SCFAs.104-105
When beta glucuronidase levels are higher than ideal, this means toxicity.104-105 When elevated, this also raises the risk of colon cancer.104-105 Also, when this marker is high, estrogens that need to leave the body are reactivated and reabsorbed into the body, contributing to the estrogen dominance issue.104-105 The good bacteria should make an enzyme to break beta glucuronidase down and keep levels optimal.104105 When the beta glucuronidase level is low, this tends to indicate tolerance issues with carbohydrates, including blood sugar issues.104-105
Along with a look at overall intestinal microbiome diversity, the population abundance of at least three very important good bacterial numbers are tested specifically. Levels go from no growth (NG) to 4+; 4+ for each is ideal. Bad bacterial numbers are given as well. Certain bad bacteria are only problematic when they reach levels of 4+. Some are quite problematic even at low numbers and need to be totally removed from the gut if it is ever going to heal. Mold is very similar to the bad bacteria but tends to be very hard to find and diagnose. One of the popular digestive stool analysis companies looks for microscopic mold spores, and this tends to help greatly with identifying the presence of problematic amounts of mold.
Digestive Stool Analysis: Treatment
There are a couple of different testing companies to use for digestive stool analysis. Some people like one, other people like the other. Several issues noted on testing tend to be the most important to treat and then the body will often take care of all the other areas itself.
Pancreatic elastase (enzymes): This should be >500. If lower, start digestive enzymes 1-2 capsules before each meal, or apple cider vinegar, 2 teaspoons before meals. If high protein products or fecal fats are found in the stool analysis, the patient is not digesting these nutrients well and the treatment suggestions above may be helpful.
Three different inflammation markers are tested.
If calprotectin is high, this is quite concerning. As mentioned before, a person is moving towards diseases such as ulcerative colitis, Crohn’s disease, and colon cancer.103 Simply treating what is found in the rest of our overall testing will work to eliminate this high number. If, upon retesting 3 months after treatment initiation, calprotectin is not yet in the ideal range, then the person will need to have a colonoscopy.106-107
EPX: When this is high, it suggests food is bothering the gut. Avoiding the offending foods should drop this number by the next retest. If it is still high, the patient either needs to do better with avoiding offending foods already identified or some additional foods may be problematic and need to be removed from the diet as well. Sometimes, empirically, some foods may need to be removed for a while. An example could be lectin-containing foods or the nightshade family of foods.
Sig A: If high, it suggests intestinal permeability disorder. If low, it suggests the patient has lost the protective membrane that separates the gut wall from the gut contents. If at the time of the retest, perhaps 3 months later, a very low result has now changed to a high result, this is good. The protective membrane has been reestablished, but the intestinal permeability disorder still needs to be corrected. For all these issues, L-glutamine powder needs to be used, on an empty stomach, at 3 to 5 grams TID. This is the best primary agent to use in this situation.
Short-chain fatty acids (SCFAs) and n-butyrate: They should be produced by the good bacteria in the gut. If low, the good bacteria are not doing their job. If n-butyrate is very low, you may want to wait and see if the intestinal microbiome improves enough to self-correct this by the next retest. Or use a butyric acid supplement to start correcting immediately. This important nutrient and its role in the health of the whole body will be discussed further in a minute.
Beta glucuronidase: This tends to self-correct as the good bacteria should make an enzyme to break it down. If they don’t start doing this work by the first retest, consider calcium D-glucarate supplementation. Or possibly add a combination insoluble/soluble fiber supplement to bind up the toxins until they can be cleared from the gut and help to feed the good bacteria as a “prebiotic,” food for the good bacteria.
Good bacteria: The ideal is 4+ of each and 4+ of all as a good balance, which is so important. High-quality probiotics will always be needed just as vitamin D will always be needed. Which probiotic to use will vary.
Using antibiotics can be quite problematic due to the negative impact on the intestinal microbi- ome, particularly as they will need to be used for an entire month if the offending bacteria is to be cleared completely. Potentially using probiotics 2 hours after each dose of an antibiotic and continuing the probiotic for at least 2 weeks after antibiotic treatment can minimize the negative impact no matter when we use these medicines.
A quick review is needed of two very important components required for optimal gut health and the body as a whole: vitamin D and vitamin D receptors (VDRs),63 more specifically, their impact on the intestinal microbiome and overall body inflammation and health. The intestinal mucosa has so many vitamin D receptors. This tells us how important vitamin D is for the gut.63 VDRs need vitamin D available in the gut in order to function properly. But VDRs need probiotics and n-butyrate for upregulation of the vitamin D receptor sensitivity. All the vitamin D in the gut may not help the situation if the VDRs are dowmregulated. This is why oral vitamin D optimization, probiotics, and n-butyrate supplementation will be an excellent way to decrease inflammation in the gut, reestablish the intestinal microbiome, and clear even inflammatory bowel disease as well as flares of celiac disease.63 It will also decrease inflammation in the body as a whole, thus addressing chronic pain problems and chronic disease in general.63