Stool Testing

Question 1

Commensal

Answer 1

Microbes that live in harmony with the host (us) and provide a benefit to us.

Question 2

Pathogenic

Answer 2

Microbes that possess certain evolutionary advantages to invade our microbiome at a cost to our health.

Question 3

Pathobiont

Answer 3

Microbes that live with us and normally don’t pose a problem unless there is clear opportunity. Many well known bacteria fit this picture, e.g.,
Prevotella copri , Klebsiella spp., Staphylococcus aureus.

Question 4

Gram Negative Bacteria

Answer 4

Bacteria that possess an outer cell wall, normally rich in lipopolysaccharides (LPS).

Question 5

LPS

Answer 5

The major component of gram negative bacteria which have the ability to induce inflammation and immune responses.

Question 6

What is Metabolic
Endotoxaemia?

Answer 6

An immune response that becomes a
sub clinical, persistent, low grade
inflammation because of increased
circulating endotoxins (LPS)’.

Normally happens in conjunction with
poor GI barrier integrity.

Can be a risk factor for many chronic
diseases such as insulin resistance,
diabetes, CFS, autoimmunity.

Question 7

Calprotectin

Answer 7

A protein made by leukocytes when they have migrated to and are active in the GI wall. It is a marker of inflammation.

Flagged as high over 50 µg / g. Between 50‒175 is ‘mid range inflammation ’. The elevation is triggered by damage to the epithelial lining in worst case scenarios IBD, ulcers, cancer , but in most scenarios, relates to pathogens, NSAIDS etc.

Question 8

Eosinophil Protein X

Answer 8

• Normal range: <1.1 mcg / g; Moderate:
  1.1 - 4.6 mcg / g; High : >4.6 mcg /
• Raised with intestinal inflammation and in cases of food allergies, parasites, colitis.

Question 9

Beta
glucuronidase:

Answer 9

• Elevated often due to dysbiosis and a western diet in red meat / animal protein.
• When high it can interfere with oestrogen excretion (= ↑ circulating oestrogen)

Question 10

Pancreatic elastase (PE-1)

Answer 10

• Normal range: 200-500 µg / g.
• < 200 µg / g need digestive support.
• Exocrine (digestive) pancreatic insufficiency: 100-200 µg / g.
• Severe insufficiency: insufficiency:<100 µg /

Question 11

Faecal fats

Answer 11

• ↑ levels suggest fat maldigestion associated with pancreatic insufficiency, SIBO, hypochlorhydria .
• ↓ levels seen in low fat diets.

Question 12

sIgA (secretory IgA)

Answer 12

• Low sIgA (<100 µg / g) ― correlates with chronicity. ↑ susceptibility to GI infections. Always identify why (e.g. chronic stress
• High sIgA (<750 µg / g) ― upregulated immune response (e.g., acute GIT infection ) when testing.

Question 13

Beta-defensin 2

Answer 13

High > 62ng / g might be a sign of the immune system responding to a breach by microbes , or due to GI inflammation e.g., UC.

Question 14

Zonulin family peptide

Answer 14

• High > 100 µg / g ― may be raised in severe intestinal permeability (e.g., due to poor nutrition, heavy metals, drugs, alcohol, dysbiosis) and coeliac disease.
• Note ― even if it is 0, it does not rule out other modes of ‘intestinal permeability.’ The patterns of microbes can also be clues to intestinal permeability.

Question 15

Short chain fatty acids (SCFAs)

Answer 15

• SCFAs are by products of bacterial fermentation of fibre. The most common being butyrate, propionate and acetate.

Question 16

Mucin degrading bacteria

Answer 16

• Akkermansia muciniphila is an important mucin degrading bacteria but equally plays a protective role to the mucosal barrier.
  Absent levels are a risk factor for metabolic endotoxemia patterns of disease (obesity, insulin resistance, autoimmunity).
  Note low FODMAP diets can lower Akkermansia spp.
• Ruminococcus gnavus R.gnavus or R.torques in high amounts, coupled with low diversity, has been proposed as a mechanism for autoimmune disease.
• Absence of diversity in Bacteriodes sub groups can cause the bacteria to become more mucin degrading.

Question 17

Gas producing bacteria

Answer 17

• Methanobrevibacter smithii associated
  with methane gas production.
• Desulfovibrio spp. and Bilophila wadsworthia associated with hydrogen sulphide gas.