Gut Health Assessment

Firmicutes/Bacteroidetes Ratio Test Summary

Description/Background Information

A healthy gut microbiota is vital to our wellbeing—it helps to establish and maintain our immune system, fend off opportunistic pathogens, extract nutrients and energy from foods we cannot digest (e.g., dietary fiber), produce vitamins, and stimulate communication between the gut and brain.1-5The beneficial end-products of fiber fermentation are short-chain fatty acids (SCFAs), which nourish the gut lining and regulate food intake, inflammatory tone, and insulin signaling.1,6 Microbiota diversity is dependent on both diet and colonic transit time, and may confer resilience to stress.2,7 Overall microbial composition affects the structural integrity of the gut lining and, although influenced by our genetic background and maternal flora, also reflects what we eat.5,8

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Short Chain Fatty Acids Test Summary

Description/Background Information

Humans lack the enzymes needed to break down the bulk of dietary fiber and other indigestible complex carbohydrates (e.g., cellulose, resistant starch, and oligosaccharides). Such food components are instead fermented by bacteria in the colon to produce short chain fatty acids (SCFA), primarily n-butyrate, acetate, and propionate. These beneficial SCFA have immunomodulatory and anti-inflammatory properties, provide energy to nourish the colonic epithelial cells and intestinal microbiota, and exert numerous positive effects on gut homeostasis:1-7

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Calprotectin Test Summary

Description/Background Information

Calprotectin is a small calcium- and zinc-binding protein that derives mainly from neutrophils, constituting 60% of the cytosolic protein.1 Active inflammation in the gut that induces neutrophil influx into the mucosa will eventually disrupt the mucosal architecture, allowing neutrophils (with their cytosolic calprotectin) to leak into the intestinal lumen and be excreted with the feces.2 Fecal calprotectin (fCal) has been shown to correlate with the severity of intestinal inflammation, and is a sensitive biomarker of inflammatory bowel disease (IBD).3,4

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Eosinophil-Derived Neurotoxin (EDN)(Eosinophil Protein X; EPX) Test Summary

Description/Background Information

Measurement of eosinophil-derived neurotoxin (EDN; also called eosinophil protein X or EPX) is the preferred method for sensitive, noninvasive assessment of intestinal eosinophilic activity, commonly associated with intestinal parasites and food allergies—both IgE-mediated (e.g., food anaphylaxis or protein-induced enteropathy) and non-IgE dependent (e.g., celiac disease).1

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Secretory IgA Test Summary

Description/Background Information

Secretory IgA (sIgA) is the primary antibody in mucous membranes in humans, which are the entry point for most foreign antigens (e.g., in the nose, lungs, and gut lining). It therefore plays a critical role in mucosal immunity—the protection and homeostatic regulation of mucosal epithelia.1,2  Upon exposure to microbial or other antigens, sIgA is synthesized in B-lymphocyte-derived plasma cells and transported across the mucosa by the polymeric immunoglobulin receptor (pIgR) into external secretions (e.g., tears, saliva, and mucus lining the gut).1-3

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Pancreatic Elastase Test Summary

Description/Background Information

A healthy pancreas is vitally important for digestion of our food and absorption of nutrients. After a meal, hormonal and neural signals stimulate the production of pancreatic secretions, typically 1-2 liters per day, into the duodenum.1

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Zonulin Test Summary

Description/Background Information

Zonulin – the “GateKeeper” of Intestinal Permeability

The intestinal wall—the single-cell-thick layer of epithelial cells lining the inside of the gut—is the largest barrier between the human body and the outside world. Maintaining control of this barrier is crucial for regulation of the immune system and protection against pathogens. There are two routes from gut lumen to the bloodstream—across the enterocyte brush border via transporters (the “transcellular” route, as in absorption of most nutrients), or through gaps between the cells (the “paracellular” route, through which ions, water-soluble molecules, and occasional microbes passively flow). The paracellular route is finely controlled by intricate protein “gates” called tight junctions.1-3 These dynamic structures open and close in tune with dietary state, physical activity, hormonal and neural signals, and inflammatory mediators.4,5

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Immunochemical Fecal Occult Blood Test Summary

Description/Background Information

Fecal occult blood is defined as the blood contained in feces that is hidden or not visibly apparent. It can be a late symptom of inflammatory mucosal damage to the intestine from multiple potential causes, including inflammatory bowel disease (Crohn’s disease or ulcerative colitis), diverticulitis, peptic ulcers, polyps, or colorectal cancer (CRC).1 Inflammatory bowel conditions may lead to CRC if left untreated.

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Gastrointestinal Pathogens Test Summary

Description/Background Information

The Gastrointestinal (GI) Pathogen Test is a new multiplex molecular diagnostic assay to simultaneously detect and identify 14 bacterial, viral, and parasitic pathogens that are responsible for the vast majority of infectious gastroenteritis.1

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H. pylori Test Summary

Description/Background Information

Helicobacter pylori, or H. pylori as it is more commonly known, is a ubiquitous bacterium which is estimated to be present in 40–50% of the world’s population.1Prevalence and incidence of H. pylori infection differs by geography and race. In the United States, H. pylori prevalence is 60% in Hispanics, 54% in African Americans, and 20% in Caucasians.2

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Yeast Culture Test Summary

Description/Background Information

While the human microbiota is made up mostly of bacterial species, everybody carries some fungal species too — a much smaller component of the microbiota, separately referred to as the “mycobiota.”1,2 In healthy individuals, these fungi cause no problem. However, when the gut microbiota is upset by antibiotics, chemotherapy, or immunosuppressive drugs, or the immune system is compromised, certain fungi can become opportunistic and pathogenic.

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Antinuclear Antibodies Test Summary

Description/Background Information

Immune system dysregulation can lead to autoantibodies directed against a variety of intracellular antigens, such as chromatin (dsDNA and histones), nuclear/nucleolar proteins, centromeres, RNA, cytoplasmic organelles, and cell membrane components.1,2 These “antinuclear antibodies” (ANA) are often present in patients with autoimmune (rheumatic) diseases and their detection can aid in diagnosis of suspected cases.

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Anti-Candida Antibodies Test Summary

Description/Background Information

Candida albicans (C. albicans) is a benign yeast commonly found on mucosal surfaces of the human body (e.g., mouth, digestive system, urogenital tract, and skin). Transmitted from mother to infant during birth, it forms part of the commensal gastrointestinal “mycobiota” in approximately half of the world’s population.1 The colonization and amount of Candida and other yeast species in the gut is regulated by interactions with the host’s immune system and the intestinal microbiota. A fine balance between resistance to fungal overgrowth (release of pro-inflammatory signals) and tolerance (release of anti-inflammatory signals, to prevent mucosal damage caused by the immune response) is required to maintain a healthy gut microbial community.2,3

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Celiac Disease Antibodies Test Summary

Description/Background Information

Celiac disease (CD), or gluten-sensitive enteropathy, is an autoimmune disorder characterized by chronic inflammation of the small-intestinal mucosa in response to ingested gluten (the storage protein of wheat, rye, and barley) in genetically predisposed individuals.1 In this condition, undigested gliadin peptides—the toxic component of gluten—leak through the intestinal barrier, where they are deamidated by tissue transglutaminase (tTG) to form deamidated gliadin peptides (DGP), triggering an inflammatory immune reaction in the process.

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Lipase and Amylase Test Summary

Description/Background Information

Lipase and amylase are two enzymes produced by the body to help with digestion of food: amylases catalyze the breakdown of carbohydrates—such as starch, glycogen, and other polysaccharides—into simple sugars, while lipases catalyze the hydrolysis of dietary fats (triglycerides) to free fatty acids and glycerol. Human serum amylases derive mainly from the pancreas and salivary glands. Lipases are found mainly in the pancreas, gastrointestinal tract, and saliva, and are essential for the intestinal absorption of fats.1,2

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Vitamin D [25(OH)D] Test Summary

Description/Background Information

Vitamin D is a fat-soluble vitamin produced in the skin upon exposure to sunlight. It is essential for strong bones and muscles as it regulates intestinal and renal absorption of calcium and phosphate, and ensures that serum levels of these minerals remain optimal.1,2 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. Vitamin D2 is derived from ergosterol, a sterol present in fungi, and is not normally present in the human body.3

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Prealbumin Test Summary

Description/Background Information

Prealbumin, so-called because it migrates ahead of albumin during electrophoresis of human plasma, is a glycoprotein synthesized mainly in the liver, the choroid plexus of the brain, and the pancreas.1 Otherwise known as transthyretin, prealbumin acts as a carrier protein for thyroxine (T4) and retinol-binding protein 4 (RBP4), by which it transports vitamin A throughout the body.2In humans, prealbumin carries about 15% of the serum T4.3

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High-Sensitivity C-Reactive Protein Test Summary

Description/Background Information

C-reactive protein (CRP) has long been recognized as the blood-based biomarker of choice for evaluating inflammatory conditions or suspected infections.1,2Synthesized in the liver in response to pro-inflammatory cytokines, CRP is an acute-phase reactant whose level in human serum can increase 1000-fold within 48 hours after the onset of inflammation, infection, or tissue injury.1 It is also a modulator of innate immunity and plays an important role in host defense against invading pathogens.1

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