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Patients Gut Health Assessment

A recent explosion of scientific research worldwide is providing new insights into the importance of the gut as “the gateway to good health” and giving new meaning to the phrase “you are what you eat.” This neglected organ has been subject to increasing scrutiny as technological advances are revealing just how central it is to our overall health. In fact, the root cause of many seemingly unrelated chronic health complaints may be discovered by simple tests that assess the health of the gastrointestinal tract.

THE PROBLEM

Your abdominal pain, aching joints, fatigue, headaches, diarrhea, anxiety, or even depression could equally well reflect one of several conditions. This can make diagnosis and treatment difficult. When the cause of symptoms is unknown, a “one-size-fits-all” approach to treatment (e.g., anti-inflammatory medications, antibiotics) may bring temporary relief but before you know it the symptoms return, and you are back to square one. This can put you on a never-ending merry-go-round of medications and procedures, without any real promise of a cure….

THE SOLUTION

You might think that your aches, pains, itches, tummy troubles, and tiredness are just part of getting older. You may have grown used to these symptoms as part of your “new normal.” But it is now possible to find out what’s beneath certain chronic ailments, as the first step toward lasting relief.

Scientists are discovering that chronic health problems may be related to the balance of bacteria and other micro-organisms living inside your intestines (collectively called the gut “microbiota” or “flora”) and the health of your gut lining. From these research findings, Salveo Diagnostics, Inc. is generating new tools that will help your physician assess the health of your digestive system, with the potential for a long-term resolution.

WHAT IS THE GUT MICROBIOTA AND WHY IS INTESTINAL PERMEABILITY IMPORTANT?

Our guts are complex ecosystems containing trillions of micro-organisms (mostly bacteria, and collectively called the “gut microbiota” or “gut flora”) that help regulate our immune systems, digest our food, make vitamins, and protect us from toxins and pathogens. The gut lining, or single-cell thick “intestinal mucosa,” forms a barrier that allows nutrients from digested food to enter the bloodstream but keeps bacteria, toxins, and undigested food out.

Certain triggers (e.g., poor diet, imbalanced gut flora, or certain medications) can cause inflammation and increased intestinal permeability (“leakiness”) to foreign substances. This is an important and overlooked cause of many chronic diseases, as outlined below.1-3

Autoimmune Diseases
Increased intestinal permeability can cause the immune system to overreact to foreign substances that leak through, creating inflammation in various tissues, e.g., the joints (rheumatoid arthritis), skin (eczema or psoriasis), and pancreas (type 1 diabetes).

Irritable Bowel Syndrome
Uncovering the root cause of chronic abdominal pain, constipation, diarrhea, and bloating, whether it be hypersensitivity to certain foods or inflammation due to a bacterial infection, is the first step toward finding permanent relief.

Anxiety & Depression
The state of our gut flora has a major influence on our state of mind, affecting our ability to handle stress.4 Stress hormones such as cortisol can in turn cause gut inflammation, nutrient deficiencies, and metabolic disturbances that may directly affect the nervous system.5

Hormone Imbalances, Obesity, & Type 2 Diabetes
Feeling rundown, with weight loss or gain, is often the result of gut inflammation. Excess dietary sugar, exposure to toxic chemicals, imbalanced gut flora, and stress may all contribute. Hormones important for regulating thyroid function, energy levels, and blood sugar are all affected by gut health.6

Ulcerative Colitis and Crohn’s Disease
In genetically susceptible individuals, the immune system may overreact to certain triggers in the gut (e.g., bacteria, foods, medications, or stress) leading to periods of severe inflammation and abdominal pain, with increased intestinal permeability and diarrhea.7

 A PATH TO SYMPTOM RELIEF
With our scientifically supported gut health tests, along with an easy-to-follow lab report and clinical interpretation, we can help you and your doctor more effectively tackle the underlying cause of your chronic condition and restore you (and your gut) to a state of good health.

Stool Tests

F/B Ratio

Firmicutes and Bacteroidetes are the most common types of bacteria that live in the human gut. When they are in the right balance with each other, they help us digest our food, strengthen our immune system, and make vitamins that keep us healthy. The F/B ratio can tell us when the gut bacteria are out of balance (called “dysbiosis”) due to gut inflammation, food allergies, infections, or certain medications. Eating lots of fresh fruits and vegetables and cutting down on high-fat, high-sugar, processed foods can help keep your gut bacteria happy and your F/B ratio optimal.

Short-Chain Fatty Acids

Short-chain fatty acids (SCFAs) are produced by friendly bacteria in your gut, when they break down fiber from fruits and vegetables that you’ve eaten. These SCFAs, especially n-butyrate, help to keep your intestines healthy, make sure that you have regular bowel movements, and protect the gut from inflammation, infections, and even colorectal cancer. The amount of SCFA depends largely on the balance of your gut bacteria and the amount of fiber that you eat. If your SCFA levels are low, your doctor may suggest specific foods or supplements that will help.

Calprotectin

Calprotectin is a small protein produced by a type of white blood cell, the neutrophil. Neutrophils are key players in the immune system and are called in to fight infections where there is inflammation in the body. The amount of calprotectin present in your stool tells your doctor if there is inflammation in your intestines, and how severe it is. It is a useful test for helping distinguish between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Calprotectin may also detect inflammation due to an infection, food sensitivities, medications that can irritate the gut lining, or colorectal cancer. This test may be used to check whether your gut is healing well in response to treatment.

Secretory IgA

Secretory IgA (sIgA) is the main antibody found on mucus membranes in the body that are exposed to the outside world, such as those in the nose and lungs (from breathing in air), and lining the gut (from eating and drinking). sIgA is an important part of our immune system that protects the body at these sites from harmful bacteria or viruses that could get in and make us sick. Optimal levels of sIgA keep the gut lining strong and healthy, and are a sign of a strong immune system that can help ward off infections.

Eosinophil-Derived Neurotoxin

Eosinophil-derived neurotoxin (EDN) is a protein that is released by another type of white blood cell, the eosinophil, when the gut lining is damaged. Eosinophils play an important role in protecting the body against harmful bacteria and the development of food sensitivities. The EDN result is a way of assessing one kind of gut inflammation. Increased levels of EDN measured in the stool have been associated with food allergies and sensitivities, defense against parasites, inflammatory bowel disease, chronic diarrhea, gastroesophageal reflux disease (GERD), excessive alcohol intake, and bowel cancer.

Pancreatic Elastase

When food is being digested in the intestines, digestive fluids are released by the pancreas that help break down carbohydrates, fats, and proteins. Pancreatic elastase is an enzyme secreted by the pancreas that can be measured in the stool (feces) as a marker of how well your pancreas is functioning. When pancreatic elastase levels are low, the body has a harder time breaking down fats which can result in oily, pale, loose, or watery stools, as well as other symptoms such as bloating after a meal, abdominal discomfort with gas, heartburn, undigested food in the stool, nausea, weight loss, and bone pain. Your doctor may prescribe certain medications and offer dietary advice to help your digestion.

Zonulin

Zonulin is a protein that acts as a “gatekeeper” in your gut lining, controlling what substances can pass through into the bloodstream by the opening and closing of tiny pores. If zonulin levels are high, and these pores are left open for too long, toxins and undigested food particles may sneak into your bloodstream and cause health problems. Zonulin levels can be increased by things like candida (intestinal yeast), bacteria, gluten (from wheat), and parasites in the gut. The amount of zonulin in your stool (feces) can indicate whether you have these breaks or openings in your gut lining that need to be repaired.

iFOBT

The iFOBT (immunochemical fecal occult blood test) is a noninvasive test (nothing enters the body). This test detects hidden (occult) blood in the stool (feces). Such blood may come from anywhere along the digestive tract. Hidden blood in the stool is often a warning sign that a person has colorectal disease, including colon cancer, but it may also be present due to stomach ulcers, bleeding gums, or hemorrhoids. If the results are positive, your doctor may recommend further tests to see where the blood is coming from.

Yeast Culture

While the microbes in your gut are mostly bacteria, everybody carries some fungal or yeast species too — normally a much smaller component. In healthy individuals, these fungi cause no problem. However, when the gut flora is upset by antibiotics, chemotherapy, or immunosuppressive drugs, or the immune system is compromised, certain fungi/yeasts can overgrow and this imbalance can contribute to chronic disease symptoms. The yeasts and fungi present in the gut flora (Saccharomyces and Candida being the two most prevalent in stool samples of healthy individuals) are influenced by diet and interactions with other microorganisms that are also present. This Salveo Diagnostics test detects the amount of yeast in the stool and can differentiate Candida from non-Candida species with high accuracy. 

Gastrointestinal Pathogens

Intestinal parasites, pathogenic bacteria, viruses, and yeasts can be a significant source of gastrointestinal (GI) illness. If the immune system does not manage to clear them or keep them in check, they may start to cause symptoms such as diarrhea, abdominal cramps and/or discomfort, nausea, vomiting, and fever. The Salveo Diagnostics Gastrointestinal Pathogens Test identifies the 22 most common pathogenic causes of infectious gastroenteritis, so that the right treatment can promptly aid recovery. We also test for antigens to H. pylori and Blastocystis species, two other potential causes of GI illness.

Serum Tests

Anti-Candida IgG, IgM, IgA

Candida albicans (C. albicans) is a yeast that can be found in the body as part of the normal microflora. How much Candida you have is regulated in part by your immune system and in part by the other bacterial and fungal species that are present. An overgrowth of Candida in the gut can be the result of an imbalance between the good and bad bacteria and/or depleted immune system, due to prescription medications, toxic agents, age, or ongoing chronic disease. Symptoms such as bloating, constipation, diarrhea, fatigue, headaches, and memory issues can be a warning that you may be suffering from CandidaIf the immune system is unable to keep the Candida in check, it may leak through the gut lining and trigger the production of antibodies (IgG, IgM, and IgA) that circulate in the blood (from which we can measure them). The presence of anti-Candida antibodies can help guide your treatment.

Celiac Disease           

Anti-tTG Antibodies (IgG, IgA)
Anti-DGP Antibodies (IgG, IgA)

Celiac disease is the one of the most prevalent autoimmune diseases; however, estimates suggest that only 17% of U.S. cases are currently diagnosed. Untreated celiac disease can cause inflammation and malabsorption in the intestines, leading to possible nutrient deficiencies. Early diagnosis coupled with nutritional therapy can improve quality of life and prevent life-threatening complications. 

Patients should consider being tested for celiac disease if they have a family history or gastrointestinal (GI) symptoms such as chronic diarrhea, a diagnosis of irritable bowel syndrome (IBS), abdominal pain/bloating after eating, or unplanned weight loss. Other symptoms of celiac disease include anemia, bone and skin diseases, and elevated liver enzymes. Undetected celiac disease can increase the risk of developing autoimmune disease, GI cancers, and non-Hodgkin’s lymphoma. 

Amylase

Amylase is an enzyme made in the body that assists in the breakdown of carbohydrate-based, starchy foods. Blood amylase tests can be used to diagnose acute pancreatitis or other disorders of the pancreas. Increased amylase levels can also occur with gallbladder inflammation, kidney or liver disease, celiac disease, diarrhea, alcoholism, eating disorders, and/or inflammatory bowel disease. Low levels of amylase may indicate damage to the pancreas and may impair the digestion of carbohydrates. 

Lipase 

Lipase is an enzyme made in the body that helps to break down fatty foods so they can be absorbed in the intestines.  Blood lipase tests can be used to diagnose acute pancreatitis or other disorders of the pancreas. Elevated lipase levels can also be seen in patients with type 2 diabetes, peptic ulcer disease, hepatitis C, kidney or liver disease, inflammatory bowel disease, and an inflamed gall bladder. Low levels lipase may indicate damage to the pancreas and problems with proper digestion of fats.

Vitamin D (D2+D3)
Vitamin D is a fat-soluble vitamin that is produced when the skin is exposed to sunlight.  Vitamin D3 occurs naturally in a few foods (e.g., oily fish, egg yolks, butter, and beef liver) and in fortified dairy and grain products. It is very important to bone and muscle integrity and has recently been discovered to have a significant role in gut health. Adequate vitamin D levels are protective against colorectal cancer, inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS) by way of their effect on the immune system. Vitamin D deficiency has been linked to chronic autoimmune conditions such as type 1 diabetes, systemic lupus erythematosus, celiac disease, multiple sclerosis, asthma, IBD, food allergies, and rheumatoid arthritis.

Prealbumin

Prealbumin is a protein made in the liver that is responsible for carrying vitamin A and thyroid hormone around the body. The measurement of prealbumin can indicate protein depletion or malnutrition when evaluating nutritional status in a variety of chronic inflammatory conditions.  Serum prealbumin levels decline following 3-5 days of very low nutrient intake.  Certain conditions such as oxidative stress, diabetes, infection, malignancy, thyroid disease, and chronic heart disease can cause a reduction in prealbumin, whereas serum prealbumin levels may be elevated with kidney disease, oral contraceptive use, corticosteroid therapy, underactive thyroid, and high-dose non-steroidal anti-inflammatory drugs (NSAIDs). Monitoring prealbumin levels may help in optimizing treatments for chronic inflammatory diseases.

hs-CRP

C-reactive protein (CRP) concentration is measured in the blood to assess the presence of inflammation or suspected infections, and for monitoring response to treatment. It is made in the liver in quick response to the onset of inflammation or injury anywhere in the body and is also important in protecting against infections.  The high-sensitivity CRP (hs-CRP) immunoassay can help detect low-grade chronic inflammation. Increased serum CRP levels are linked to obesity, insulin resistance, and high cholesterol, and are a strong predictor of cardiovascular disease, heart attacks, and strokes. Serum CRP is also one of the best markers (along with fecal calprotectin) for assessing the inflammation in inflammatory bowel disease (BD). It can help in differentiating between irritable bowel syndrome (IBS) and IBD, evaluating response to therapy, and predicting a relapse.

References

  1. Bischoff SC, et al. Intestinal permeability—a new target for disease prevention and therapy. BMC Gastroenterology 2014;14:189.
  2. Carding S, et al. Dysbiosis of the gut microbiota in disease. Microb Ecol Health Dis 2015;26:26191.
  3. Sekirov I, et al. Gut microbiota in health and disease. Physiol Rev 2010;90:859–904.
  4. Sanders L. Microbes can play games with the mind. ScienceNews 2016;189(7):23.
  5. Almond M. Depression and inflammation: examining the link. Curr Psychiatr 2013;12(6):25–32.
  6. Patterson E, et al. Gut microbiota, obesity, and diabetes. Postgrad Med J 2016;92(1087):286–300.
  7. Bellaguarda E, et al. IBD and the gut microbiota—from bench to personalized medicine. Curr Gastroenterol Rep 2015;17:15.
  8. Turnbaugh PJ, et al. The human microbiome project. Nature 2007;449:804–810.
  9. Bäckhed F, et al. Host-bacterial mutualism in the human intestine. Science 2005;307:1915–1920.
  10. Mowat AM, Agace WW. Regional specialization within the intestinal immune system. Nat Rev Immunol 2014;14:667–685.

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