Clinical Interpretation of a Functional Stool Test with Dr. Ben Weitz: Rational Wellness Podcast 451

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Clinical Interpretation of a Functional Stool Test with Dr. Ben Weitz.  

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Podcast Highlights

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

Podcast Transcript

Dr. Weitz:  If you’re looking for clinically useful insights, not wellness hype, then this is the place for you. Welcome to the Rational Wellness Podcast, the podcast for functional and integrated practitioners who want to practice with greater clarity and precision. I’m Dr. Ben Weitz, and each week I sit down with the leading clinicians, researchers, and lab innovators to explore the science lab testing and clinical reasoning behind modern root cause medicine.  This is a show focused on practical evidence informed insights that you can actually use in patient care. Please subscribe to the Rational Wellness Podcast on Apple, Spotify, or YouTube. Please tell your friends and colleagues and if you could give us a ratings and review on Apple or Spotify. We would certainly appreciate it.  Finally, to access the show notes and the full transcript, please go to my website, drweitz.com. 

Today we’re going to discuss how to interpret a functional medicine type stool test to give us a better picture of gut health. Now, there’s various reasons for looking at gut health. We’re talking about the health of the gastrointestinal tract, including the balance of microbes in the microbiome.  Gut health is important for overall health. It can play a role in autoimmune diseases. It plays a role in brain health. It plays a role in cardiovascular health, and of course it plays a role in gut symptoms like stomach pain, constipation, diarrhea gas and bloating, nausea, et cetera. There’s a whole series of symptoms that are common in patients who have gut disorders.

Now when you have a patient who has gut symptoms, things like diarrhea, constipation, stomach pain first of all, you want to make sure you rule out the more severe pathologies, things like stomach cancer, colon cancer Crohn’s disease, ulcerative colitis. Intestinal blockages, intestinal paralysis, very severe pathogenic infections, et cetera.  So if you want to make sure of this, a, you’ve gotta take a very careful history and b, to be on the safe side, have the patients see a conventional gastroenterologist, and if needed, they’ll end up being recommended to get a colonoscopy or an endoscopy, colonoscopy from the bottom up, endoscopy from the [00:03:00] top down, possibly some sort of scan or ultrasound to see what’s going on.  Once you’ve ruled out serious pathology, then understanding the gut is an important part of that, besides history, besides other testing, like SIBO breath testing and organic acids testing, et cetera, is to look at a functional medicine type stool test. Now, why do we say functional medicine type stool test?

Because if your patient is sent for a stool test by their conventional gastroenterologist and they go to LabCorp request, typically it’s gonna be a very limited test that’s gonna look at some specific number of pathogens, serious pathogens, parasites, things like h [00:04:00] pylori. Et cetera, and it’s not gonna look at the, not only do you want to look at those things, but you also want to look at the microbiome, the commensal bacteria, the keystone species, the bacteria that are normally present in the gut, but can be overgrown, which we call dysbiosis.  You won’t get many measures of the functional status of the gut, how the gut is functioning as far as its ability to keep toxins out, which is markers for leaky gut and markers for pancreatic enzymes and for inflammation, et cetera, et cetera. You may get a few of those, but a comprehensive stool test that we find in the functional medicine world is going to give you all of that. And so we’re going to walk through a comprehensive stool test so you can get a better [00:05:00] idea and hopefully everybody will glean at least one or two things to help them better interpret one of these tests to help their patients.  So one of the tests we like to use in the office is the GI Map stool test from Diagnostic Solutions. So I’m going to pull a sample up from the website and then walk through some of the, give you some insights of things that I’ve learned along the way.

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So this is the first page of the GI Map stool test.  And this lists serious bacterial, parasitic, and viral pathogens. If any of these infections are in the acute stage, they can be very serious, life-threatening infections. C difficile if it’s in the acute stage and the person’s having multiple rounds of bloody, watery diarrhea throughout the day, C Difficile needs serious medical attention. Heavy antibiotics, possibly a stool transfer, a fecal microbial transplant. But most of the patients I’ve seen in my office, when they did have an elevation of something like c diff, [00:08:00] it was typically because it was now in a chronic stage and those patients didn’t need acute life-saving interventions.

So let’s go on to the second page. So on this page, one of the microbes that we see is something called h pylori, which is a bacteria that lives in the stomach. It’s known to be a cause of ulcers. And when Helicobacter pylori, H. pylori is elevated this can be a player in stomach pain and gut health, typically, depending upon where it’s growing in the stomach.  If h pylori is elevated and there are certain virulence factors, it could lead to ulcers and can be a very serious condition. However, a lot [00:09:00] of people argue about this whole H. Pylori hypothesis, including there’s a very famous book called Missing Microbes, in which the author argues that h pylori is actually a commensal bacteria and really should be present in the gut and is very protective.

And we go into all the different aspects. But while on the one hand, H. Pylori increases the risk potentially for. For bleeding ulcers and even for possibly stomach cancer. It reduces the risk if it’s present of esophageal cancer and has other beneficial effects. So it’s a complicated story. Generally it’s thought that if you see h pylori, especially if there is [00:10:00] elevation of several ence factors, and some of these virulence factors matter more than others.

So two that have been cited in the literature is being important are Cag A, and Vac A. So when we see elevations of h pylori and we think they might be playing a role, number one, we have to consider the fact that typically h pylori will lead to a decrease in hydrochloric acid. So this can be a factor in being able to break down and digest your food.  So we may want to supplement with hydrochloric acid. There are several products on the market that contain a mixture of digestive enzymes along with some HCL. That is one way to do it. You can also use herbal bitters that can stimulate digestive enzymes hydrochloric acid and or bile to be secreted.[00:11:00]

Now, the next section here is the commensal bacteria. This is. Some of the important species that make up the microbiome. Now, obviously there’s a very limited number of types of species shown here. While we know there are thousands that exist in the microbiome, these are some of the more important ones and the three that are known as keystone species are Akkermansia, Faecalibacterium prausnitzii, and Roseburia. And if those are low, that is very problematic for the overall health of the microbiome because they’re important producers of some short chain fatty acids like butyrate, which also provide fuel for the overall gut and for the health of the other [00:12:00] bacteria.  So we want to look at this to see is it generally low? Is it fairly high? So if it’s low, that means the person has a depleted microbiome, and we’re gonna really need either at some point, maybe at the beginning, maybe after we’ve gone through a killing phase of. Really beefing up the microbiome. And if we see a particular species, like in this test, we see Akkermansia muciniphila is not even detectable.

That’s one that we really need to boost up. And fortunately we do have akkermansia supplements on the market that we can use as part of our rebuild and re inoculate phase of gut care. So this page here, this looks at a bunch of bacteria that are generally found [00:13:00] in the microbiome, but if they’re found in higher levels than normal, then they are said to be overgrown or dysbiotic.

And so here you see strep, staph, and pseudomonas are all. Overgrown and to get good balance in the microbiome, we would typically wanna lower some of these. The next section here has DesulfaVibrio and Methanobrevibacter.  I believe the reason why these two were called out as somewhat separate is because these are two bacteria that have been known to be involved in a condition called SIBO or small intestinal bacterial overgrowth. So Methanobrevibacter is a type of microbe that’s actually [00:14:00] called an it’s not a bacteria, it’s actually a archaia and methanogens are known to cause IMO or what we used to call methane sibo.

DesulfaVibrio is one of the bacteria that’s been shown to cause hydrogen sulfide SIBO. Now, technically, according to Dr. Pimentel’s criteria and others, you cannot use a stool test to diagnose sibo. But if one or both of these are high, it might give you some idea that there might be SIBO. And when we see low detectable levels, that means there’s basically very little of it and you don’t need to worry about it.  But even if it’s not called out in red, like you can see Methanobrevibacter here is listed as 9.97 E six. So it’s below the reference range, but it’s still above detectable levels, and that could be significant depending upon the patient.  So we see some of these bacteria there are actually been shown in the literature to be specifically related to autoimmune and other inflammatory conditions.  So, for example, Klebsiella has been shown in some literature to be associated with an autoimmune condition known as ankylosing spondylitis. So does that mean if we reduce Klebsiella, if it’s overgrown, that will prevent or treat. That particular condition. Well, we don’t have enough research to show that’s the case, but if it’s [00:16:00] overgrown, it certainly would not be a bad idea to reduce it, to create balance in the microbiome.

So this test also looks at fungi of which the most important species are the various forms of candida. Which is a yeast or fungus that grows throughout the digestive track anywheres along the route. This stool test is basically measuring what we find in the colon, but candida can be growing in the mouth, in the throat anywheres along the digestive track, and candida can definitely be a serious player in various gut symptoms.

So if there is candida, we definitely want to work on reducing it. And this can be done with a specific type of anti candida diet that’s low in carb, in sugar, and high glycemic carbs. And [00:17:00] there are specific herbal formulas that target candida and other yeast. There, there are prescription medications a number of antifungals on the market that can be used as well.

Stool tests are not the most sensitive for a candida, so. If we suspect candida, we might wanna do an organic acids test, which might give us a better hint that there’s a fungal overgrowth and fungus can create SIBO like symptoms. And there’s actually a separate condition called sifo or small intestinal fungal overgrowth.

We still do not have a breath test that can diagnose it. Given that the stool test is not that accurate, we’re in a bit of a [00:18:00] diagnostic dilemma. So a number of practitioners do use organic acids tests that can give you an indication of whether candida may be overgrown. Now, on this page of the GI Map, we see some parasites, and these are not all that uncommon.

So we see proteasomes. Some of these, like, blastocystis hominini and D. Fragilis are questionable whether they’re truly pathogenic. But there, there is enough research to think that if they are found and they can be reduced, it generally will improve the health of the microbiome. Some of the others we know for sure are are bad players in the gut.

Certainly all the worms are and the amoeba. So then we [00:19:00] have these markers for intestinal health. So the first one is steatocrit, and that’s basically fat in the stool. So if that’s elevated, you’re not breaking down fats. So that means either you don’t have enough lipase and fat digesting enzymes, or you don’t have enough bile, which bile is a substance secreted by the liver into the gallbladder and then squirt it out into the small intestine. When you consume a fatty meal and without enough bile, you won’t be able to break down your fats and you can supplement with bile. Typically ox bile, and it can be part of a digestive enzyme supplement, or it can be taken separately.  And using herbal bitters can often stimulate bile production on its own. Elastase is a measurement of pancreatic enzymes. So if your elastase is under 500, I know this test says under 200, but in the functional medicine world, we generally think anything under 500 is less than optimal. The patient would usually benefit from taking some digestive enzymes.

Beta glucuronidase is a measurement of how well you’re metabolizing and excreting your estrogen. So if it’s elevated, you’re not secreting your estrogens properly. And this can be a problem because if they don’t get excreted, they get reabsorbed and this can increase. The likelihood of estrogen dominance and problems related to too much of the wrong kind of [00:21:00] estrogen.

This test looks at occult blood. Then we look at some markers for immune system function, including secretory, IGA. So this is an overall measure of the gut immune health. If this is under 500, this is definitely a problem. And we like to supplement with immunoglobulins such as the SBI protect product to increase secretory IGA.  There’s a number of other products on the market that also do a good job for this.

Antigliadin IgA is an indication of that patient not being able to utilize gluten and forming an immune antibody response to the protein found in wheat. So this demonstrates, if it’s elevated, gluten sensitivity or allergy.

Eosinophil activation protein like calprotectin are both indicators of inflammation in the gut.

And we can also add on a gluten peptide, which is another indicator of gluten sensitivity and zonulin, which is a marker for leaky gut. If the patient has leaky gut, it means when you’re in the second or third phase of gut repair, you wanna make sure you heal that leaky gut with the right types of nutrients.

I think most of our patients who have gastrointestinal problems are liable to have leaky gut, but it’s nice to get a measurement to show that’s the case for [00:23:00] sure. And over here they looked at h pylori antibiotic resistant genes, so you might know which antibiotics are not liable to work. In your particular case with your h pylori.  And we also have some other antibiotic resistant genes. So if you decide to use prescription antibiotics like Ciprofloxin, Vancomycin, you’ll know if you have one of these antibiotic resistant genes, that antibiotic is less likely to be effective. So that’s pretty much, some of the key points that you can glean off a GI Map stool test, so I will talk to everybody next week.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star readings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine.  If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.