Testings and Diagnosis Flashcards
Name 3 benefits of functional testings?
- Helps to uncover a deeper understanding of imbalances to help inform a naturopathic plan.
- Can make a plan more targeted and effective.
- Allows to quantitatively measure a client’s progress, which benefits the client as they can clearly see improvements.
Name 3 downsides of functional testings
- Functional tests are provided privately, and so can be expensive. Always ask yourself: is the test likely to change the outcome / the plan you create?
- They can sometimes be challenging to read and interpret.
- As they are not diagnostic, it can be difficult to communicate results to medical doctors.
- It’s only a snapshot in time => they can be impacted by medication, food, supplements. Put the test results in context.
Which rule to apply with functional testings?
The rule of 3 - The presence or absence of a marker does not necessarily equate to disease
What are the 3 forms of microbes
- Commensal — microbes that live in harmony with the host (us) and provide a benefit to us.
- Pathogenic — microbes that possess certain evolutionary advantages to invade our microbiome at a cost to our health.
- Pathobiont — microbes that live with us and normally don’t pose a problem unless there is clear opportunity. Problematic if there in high amount and with not a lot of commensal bacteria.
What is a gram negative bacteria ?
Gram negative bacteria — bacteria that possess an outer cell wall, normally rich in lipopolysaccharides (LPS). Can interact quite strongly with our immune system.
What are LPS ?
LPS — the major component of gram-negative bacteria which have the ability to induce inflammation and immune responses. LPS have a fat component – immune system can recognise them and react. LPS in the digestive system is fine, but if we get LPS fragment in the rest of the body we get immune reaction, an inflammatory reaction. When looking for chronic diseases you can look for high load of LPS in the system.
What are comprehensive digestive stool analysis (CDSA) useful for?
Stool testing is a good way of getting a comprehensive snapshot of digestive function and the GI microbiome at a given time
Helpful when working with GI complaints or for more chronic systemic illnesses in which poor GI function might be relevant. This includes the consideration of metabolic endotoxemia
What is Metabolic Endotoxaemia?
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
What two markers can CDSA evaluate?
- Microbial markers such as commensal bacteria, pathogenic bacteria, parasites, pathobiont microbes, mycology, sometimes worms (these are often best seen visibly in the stool).
- Host markers — markers made by the human host such as immune, digestive, inflammation, intestinal permeability and occult blood.
How to interpret a CDSA?
look for correlations of the symptoms + microbes + host markers
looking at a relationship between the individual person and their microbes. In the context of the symptoms.
Reference ranges in the microbiome are hard to ascertain as there is a large range of normal, so don’t panic if something is in or out of range — look at the whole pattern.
Host marker = Calprotectin - what does it indicate ? What is a high level?
Calprotectin:
A protein made by leukocytes (WBC) when they have migrated to and are active in the GI wall. It is a marker of inflammation.
It is raised when there is inflammation at the gut wall. When a little raised could be linked to NSAIDS, high alcohol before the test, IBS, pathogen at the time of test. When High could be because there is damage at the GIT wall, IBD, Cancer, ulcers.
- 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. Calprotectin is 250 and above for IBD.
Host marker = Eosinophil Protein X - what does it indicate ? What is a high level?
Normal range: <1.1 mcg / g; Moderate: 1.1–4.6 mcg / g; High: >4.6 mcg / g.
* Raised with intestinal inflammation and in cases of food allergies, parasites, colitis. Look at the calprotectin as well if raised.
Host marker = beta glucoronidase - what does it indicate ? Why can it be elevated?
Beta-glucuronidase:
An enzyme made by some intestinal bacteria.
Can be made by human and bacteria incl. E. coli.
Elevated — often due to dysbiosis and a western diet ↑ in red meat / animal protein. Associated with a higher risk of cancer.
* When high it can interfere with oestrogen excretion (= ↑ circulating oestrogen).
High from bacteria means dysbiosis.
Host marker = Pancreatic elastase (PE-1): - what does it indicate ? What is a low level?
Pancreatic elastase (PE-1):
Proteolytic enzymes excreted by the pancreas that do not breakdown in the GIT. Correlate with levels of amylase, trypsin etc.
- Normal range: 200–500 μg / g.
- < 200 μg / g — need digestive support – pancreatic enzyme secretion Is struggling. Could be stress, low Hcl, SIBO as can deconjugate pancreatic elastase.
- Exocrine (digestive) pancreatic insufficiency: 100–200 μg / g.
- Severe insufficiency: <100 μg / g – we want to know why? How do I increase pancreatic elastase?
Host marker = faecal fats: - what does it indicate ? What is a low level? what is a high level?
Faecal fats:
Rough measure of fat in stool. Low accuracy as it changes with diet and testing type.
- ↑ levels suggest fat maldigestion — associated with pancreatic insufficiency, SIBO, hypochlorhydria. Is the client struggling to digest fat? Floating frothy foul smelly stools. Look for the symptoms in stool chart.
- ↓ levels — seen in low fat diets.
Host marker = SIgA: - what does it indicate ? What is a low level? what is a high level?
sIgA (secretory IgA):
Secreted by mucosal tissue ― provides first line of immune defence in the GI mucosa.
- Low sIgA (<100 μg / g) ― correlates with chronicity. ↑ susceptibility to GI infections. Always identify why (e.g. chronic stress). The person needs immune system support -> Vit A, D, Zinc.
- High sIgA (<750 μg / g) ― upregulated immune response (e.g., acute GIT infection) when testing. You’re reacting to either a pathogen or a food allergy or intolerance. Will come with calprotectin, a nasty pathogen and sIGA together!
Host marker = Beta-Defensin 2: - what does it indicate ? what is a high level?
Beta–defensin 2:
Antimicrobial peptides produced by the GI wall when breached. Made by epithelial cells and stored in the mucosal membrane.
- 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.
Host marker = Zonulin: - what does it indicate ? what is a high level?
Zonulin family peptide:
A peptide produced by epithelial cells when the GI tight junctions are open.
- 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, diabetes, other chronic autoimmune patterns.
- 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.
What are commensal bacteria healthy markers x3?
- One of the major indicators of health in the microbiota of humans is diversity.
- In the commensal markers, check for:
‒ Plenty of diversity (check that all bacteria are accounted for).
‒ Good levels of short-chain fatty acid producers (next slide).
‒ Good levels of Bifidobacterium (check that it is taking up more space than E. coli – if E. coli is too high can predispose to IBS type symptoms) and Lactobacilli.
what can negatively impact commensal bacteria health?
Diets lacking diversity (e.g., junk food diet, SAD diet, low-FODMAP diet)
over-eating
antibiotic usage
chronic conditions
Name 3 SCFA ? What are SCFA? What is their main functions x3 ?
- SCFAs are by-products of bacterial fermentation of fibre (or prebiotics). The most common being butyrate, propionate and acetate.
- The epithelial cells of the colon use butyrate as their main fuel source — maintaining the intestinal lining.
- SCFAs can also affect appetite and modulate inflammation.
What can cause low SCFA?
Low SCFAs — caused by antibiotic use, low fibre diets, diarrhoea
What is associated with low mucosal integrity?
mucosal barrier sit on top of the epithelial barrier
Low mucosal integrity can be associated with local symptoms such as ulcers, IBD and gastritis, but can also be associated with too much cross-talk between the gut microbiota and immune system, resulting in metabolic endotoxemia (i.e., a different type of increased intestinal permeability).
What can cause low mucosal integrity?
The presence of high levels of mucin-degrading bacteria
Low diversity of commensal bacteria
High gram-negative bacteria
What are the 3 mucin degrading bacteria to look for on a stool test?
Akkermansia muciniphila is an important mucin-degrading bacteria but equally plays a protective role to the mucosal barrier. But a proliferation of those starved from fibre and can survive by eating the mucosal barrier that then can become too thin. Absent levels are a risk factor for metabolic endotoxemia patterns of disease (obesity, insulin resistance, autoimmunity).
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
What are the gas producing bacteria ? x2
What diet promotes them?
- Some bacteria are well known for their ability to cause gas, and can sometimes be implicated in ‘gassy’ symptoms or SIBO.
- Methanobrevibacter smithii — associated with methane gas production. Sometimes associated with Constipated dominant type IBS.
- Desulfovibrio spp. and Bilophila wadsworthia — associated with hydrogen sulphide gas. A little bit of it is healthy.
==> love high sat fat diet
What are pathobionts bacteria and how to interpret them if present on a stool test?
- Pathobiont bacteria are bacteria that only become pathogenic when there is an opportunity (i.e. if the terrain changes).
- It is important to compare an abundance of them in relation to the commensal bacteria and host markers.
- Avoid ‘blaming and shaming’ bacteria just because they are present. Remember — pattern and context.
