Time to dig into stool testing! The GI Map from Diagnostic Solutions Lab is my preferred stool test, so that’s the one I’m going to be using images for and will be referring to throughout this newsletter. You can apply the concepts I discuss to all stool tests though. If you’re wondering where you can get a stool test, there are companies that allow you to order on your own and send her results, but I haven’t found one of those that I really like. To get a GI Map, you have to order through a practitioner, which is what you want anyway so they can help you understand your results and what actions to take. If you’re unsure of whether or not you should look further into your gut health, check out this post. I breakdown how to know if your gut needs support. As always, this is just general information and is not meant to be prescriptive. Always talk with your provider about your health concerns before making any changes.

We have a lot to cover, so I’m going to jump right into the test. When it comes to a GI map, the test is broken up into different sections. The first section is for pathogens and looks at bacterial pathogens, parasitic pathogens, and viral pathogens. You will see that when nothing shows up for a pathogen, it will say <dl, which means below the detectable limit. This is good! We don’t want to see pathogens show up. Then you will notice that there is a bacterial pathogen that is yellow and some that are red. Yellow means they are present and it is a red flag, but they are not technically elevated levels. Red means they are out of the reference range and are present in excess. When we see bacteria pop up in this section, we do want to eventually eradicate. More on this in a bit! The majority of these pathogens are from contaminated food and drinking water.

H. Pylori

The next section of the test is exclusively for H. pylori. The GI Map is known for how sensitive it is when testing H. pylori. They even look at virulence factors and whether or not the type of H. pylori present will be resistant to different strains of antibiotics. Diagnostic Solutions Lab has a test just for H. pylori as well. H. pylori is a potentially dangerous infection typically found in the stomach and can lead to an increased risk for ulcers and cancer. It can also be found in the upper gastrointestinal tract and liver. H. pylori thrives in stomach acid and is a very common root cause behind acid reflux.

You will see on the results above this person has high levels of H. pylori that are above the reference range as well as many virulence factors. The virulence factors give us a bit more insight into how severe the type of H. pylori infection can be. For example, the babA virulence factor has been shown to have more severe clinical outcomes than other virulence factors and cagA is an H. pylori strain that is associated with an increased risk of gastric cancer. You may see normal levels of H. pylori on your GI map and wonder if you should try to eradicate. I think this really depends on the person. If someone has symptoms of H. pylori like reflux, bloating, digestive upset, constipation, etc. then I may recommend treating as if the H. pylori were high, but if they don’t have any symptoms, then I often don’t treat it.

Beneficial Bacteria

The next section of the test looks at our beneficial bacteria. You will see it breaks it down into commensal bacteria and bacterial phyla, which dominate our digestive health from our mouth to our colon. They somewhat recently updated the look of their test reports to reflect the colors below. I think this is helpful for understanding whether you have optimal or high or low levels of beneficial bacteria. It’s not quite as simple as a high or low. The green indicated the optimal range, which is where we ideally want to be for all of our bacteria. While this is our beneficial bacteria, you still don’t want high levels. Both high and low levels of beneficial bacteria would indicate some dysbiosis or imbalance of bacteria.

I often see low levels of beneficial bacteria on GI maps, which is when we want to think about three major areas:

1. Digestion: if we can’t breakdown our food properly then those bacteria cannot be fed.
2. Prebiotic food intake: we need to eat prebiotic and resistant starch rich foods in order to feed these beneficial bacteria. This includes cooked and cooled potatoes/rice, oats, beans/legumes, cooked apples, cooked greens, raw carrots, etc.
3. Other gut imbalances: other overgrowth in the gut will impact the balance of good bacteria. For example, parasites and overgrowth of bacteria change the pH and environment in the gut. This makes it harder for your beneficial bacteria to thrive.

I am often asked what type of probiotic someone should take, but unless you’ve seen their gut bacteria, it’s hard to know exactly what they need. Many times I still would rather focus on eating certain foods than taking a specific probiotic. I always focus on digestion, which we will talk about at the end of the test since they have some helpful markers for them.

Opportunistic Bacteria

This section of the test is looking at types of bacteria that aren’t necessarily pathogenic, but can be harmful when they overgrow. For example, you are going to see Bacillus spp. on pretty much every GI map. It’s not necessarily a bad thing unless it’s present in high amounts. When that happens, it is an indicator that there could be some poor digestive function, possibly small intestinal bacteria overgrowth (SIBO), or constipation happening. Enterococcus faecalis and faecium on the other hand are known toxin producers. They are associated with chronic fatigue and UTI’s so I am usually pretty mindful if these show up for someone. They also have a high natural resistance to antibiotics making it easier for them to overgrow.

Morganella spp may produce histamine and can migrate to the urinary tract and cause problems for many. The Klebsiella spp. can also produce histamine. When we have high levels of most of these bacteria it is a sign of inflammation in the gut. It’s also a sign that there is likely some poor digestive function. While this is not a test for SIBO, high levels of many of the opportunistic bacteria is very common with SIBO.

The inflammatory and autoimmune related bacteria section of this can sound scary, but they are just bacteria that are researched in association with certain types of autoimmune conditions. They are not indicators that an autoimmune disease is present. Citrobacter and prevotella are associated with rheumatoid arthritis. Klebsiella pneumoniae resides in the oral cavity and respiratory tract and is often high after long-term antibiotic use. It is associated with Crohn’s and Ulcerative Colitis.

When we see a lot of overgrown bacteria in these sections, this is a big red flag to look further at digestion, stomach acid production, and gut motility. Most often, these people will need some sort of digestive support like digestive bitters. You do want to get to the root cause of poor digestion though, which is often related to our thyroid and chronic stress.

Fungi/Yeast

The next section is measuring fungi and yeast. Candida spp is high for this person. This is a sub-species of Candida and is not Candida Albicans. This shows that this person has yeast overgrowth since levels are elevated, which we would want to address. Oftentimes, we want to address yeast first and take extreme approaches with a Candida diet, but that never solves the problem long term and gets to the root of why you have Candida in the first place. Candida is the last thing to grow, so when we see that we have to think about what in this person’s gut created a beneficial environment for Candida to grow and how can we fix that. Cutting out sugar and carbs doesn’t do that. It also doesn’t actually get rid of the Candida.

Candida Albicans is very opportunistic and can grow quickly. It’s associated with fatigue, brain fog, weight gain, cravings, bloating, vaginitis, and IgA damage. Getrichum is a fungus found in soil, water, air, sewage, plants, cereals, and dairy products. It is considered to be a normal part of the human microflora, but we don’t want it to overgrow. Microsporidium is a bit more problematic. It is a spore forming parasitic fungi, which means it is harder to eradicate and can come with severe symptoms like diarrhea, weight loss, abdominal pain, nausea, and vomiting. Finally, Rodotorula is like candida and is very opportunistic and can overgrow quickly. It is most often seen in those that are already immuno-compromised.

The GI map also tests for viruses but will only detect active infections and not past ones, so if you’ve had EBV or Cytomegalovirus and are wondering why it didn’t show up, then that would indicate it’s not a current infection.

Parasites

The section everyone has been waiting for! The GI map tests for a handful of parasites. Here is a quick breakdown of what we are looking at:

• Blastocystis Hominis: this is a common parasite that the CD considers to be non-pathogenic but it can do some damage and disrupt the immune system quite a bit through issues like IBS< bloating, and recurrent Candida overgrowth. It’s also associated with Hashimoto’s and is often seen with H. pylori.
• Chilomastic Mesnili: also considered to be non-pathogenic but is associated with other parasites. You will often see this one paired with another parasite.
• Cyclospora spp: can cause diarrhea and often lasts 6 weeks but it can be a chronic infection as well.
• Dientamoeba Fragilis: this is another very common and very small parasite.
• Endolimax Nana: this is often a primary infection and can cause calcium to leach from the bones. It has been associated with autoimmunity, malabsorption, brain fog, and chronic fatigue.
• Entomoeba coli: this parasite inhabits the large intestine. It is not very problematic, but still something we don’t want in our gut.
• Pentatrichomonas Hominis: usually acquired from fecal contamination of food or water and can cause irritation to the intestinal lining as well as diarrhea.

You will notice the GI map also looks at different types of worms.

Intestinal Health

My favorite section of the GI map! As a practitioner, I learn so much about someone when I review this section. It really helps bring the all of your test results together and can help you best understand the next steps.

Digestion

Let’s start with the digestion section. This includes steatocrit and elastase:

• Steatocrit measures undigested fat in the stool. Ideally, we don’t have any undigested fat, but technically less than 15% is considered normal. I would not call this optimal though. When I see 5% or higher it is a big red flag and something I like to address. You would want to look at whether or not your stool floats, if it does that’s a sign you’re not digesting fats well. Then you need to apply this to your health history. If you don’t have a gallbladder, you may need some sort of fat digestion support. Sometimes that is digestive bitters, lipase enzyme supplements, or oxbile. The exactly type of support will depend on the person. If you do have a gallbladder and are still struggling, you may want to try something like taurine, which helps make bile salt.
• Elastase measures pancreatic enzyme production. Low levels are an indicator that you likely need digestive support. You will see on this test it’s less than 200 is low, but ideally you want them over 500. I like using bitter foods and digestive bitters to support enzyme production. Sometimes we need to add digestive enzymes in, but these will not improve your own production of enzymes long-term. They are an okay short term solution, but it’s important to understand why production is low. This is often related to chronic stress, blood sugar dysregulation, and possibly inflammation.

GI Markers

Onto the next section! B-Glucuronidase is the next marker and is another important one. This is an enzyme that breaks the bond between hormones, toxins, and glucuronic acid. We need to package of hormones and toxins nicely so they easily leave the body. This enzyme breaks up that package. This enzyme is also used to digest carbohydrates. This marker on the GI map is actually measuring the enzyme activity, not the levels of the enzyme itself. This enzyme is produced by cells in the liver, kidney, and intestines and is also produced by certain gut bacteria.

B-Glucuronidase Producing Bacteria:

• Bacteroides fragilis,
• Bacteroides vulgatus,
• Bacteroides uniformis,
• Clostridium paraputrificum,
• Clostridium clostridioforme,
• Clostridium perfringens,
• Escherichia coli,
• Eubacterium,
• Peptostreptococcus,
• Ruminococcus,
• Staphylococcus

When we have high levels of B-glucuronidase it can be a sign the body is having a hard time detoxing hormones and toxins and is associated with estrogen dominance. Things you want to consider if you have high levels:

• Bacterial overgrowth (see list above)
• High fat and high protein diets without adequate fiber can lead to high levels
• I’ve also seen high levels after coming off the birth control pill

The next measurement is occult blood, which is measuring blood in your stool. When this is present it indicates the presence of microscopic blood. This can be due to an ulcer or lesion or may be something more serious. It can also be elevated if you collect your sample during menstruation.

Immune Section

• Secretory IgA measures our immune system. When we have low levels this means are immune system is depleted. This often happens when we have a long history of gut health issues and/or chronic health issues. The immune system has been working so hard for so long that eventually it gets depleted and is no longer functioning probably. This increases our risk for infection and inflammation and is often seen in those that have histamine issues. On the other hand, if SigA levels are high, that is a sign of an active infection that your body is trying to get rid of. Typically you will have overgrowth, parasites/pathogens/yeast when levels are high. Eradicating those infections can help avoid burn out of the immune system. When SigA levels are low, you may have overgrowth that isn’t showing up on your GI map.
• Anti-Gliadin IgA measures your body’s reaction to one of the proteins in gluten (gliadin). You need to compare this number to your Secretory IgA. If you have a low Secretory IgA, then this marker can look low and may not be accurate. If you have a normal or high Secretory IgA, then you can read this accurately.
• Eosinophil Activation Protein is a protein released by activated eosinophils, which can lead to cell damage. The protein plays a significant role in a variety of inflammatory and mast-cell mediated issues in addition to fighting pathogens, particularly viral infections. High levels of this protein on a GI map are associated with inflammation and and tissue damage.
• Calprotectin is a marker for gastrointestinal inflammation. High levels show that the GI tract is inflamed. This is one marker that can change pretty quickly, even on an hourly basis, so unless it is very high, I don’t draw a ton of conclusions from it.

Understanding Next Steps

It can be easy to see high levels of parasites, pathogens, or yeast and immediately want to eradicate, but it’s important to take a step back and look at digestion, immune system function, and detox. You always want to have detox support in place before starting a gut protocol. You also want to make sure your immune system can even handle a gut protocol. I often see low SigA levels along with poor digestion and low beneficial bacteria. These all go together and would want to be addressed first before you start trying to get rid of anything. Otherwise, you likely will not tolerate the protocol and can even feel worse.

Step one will always be support digestion as needed. Then you’d want to have some sort of liver detox support in place. I like using milk thistle, castor oil packs, and the Biotoxin binder from Cellcore. From there, you have to prioritize. If you have a low functioning immune system, utilizing something like colostrum or MegaIgG2000 is a great option. It’s hard to eradicate if your immune system isn’t working properly. If you have a lot of inflammation and infections, prioritizing eradicating that overgrowth typically utilizing herbs (depending on what the overgrowth is) is important, but you still need to support digestion and detoxification.

I have two podcast episodes that talk about how to support gut health which can also be a great place to start!

• Gut Health 101
• How to have healthy digestion

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