If you've ever experienced the pain, discomfort, and inconvenience of digestive issues, you know firsthand how these symptoms can disrupt your day-to-day life. In naturopathic medicine, we see gut health as a central place to support the body’s overall well-being: our digestion is the center of nutrient assimilation, it impacts nervous system regulation, hormone balance, and immune health, and affects the health of every other system in the body including skin and metabolic issues. So, if something is off with digestion, it’s important to treat the root cause as soon as possible.
If you're grappling with gut-related concerns, you may have heard about the benefits of running a ‘comprehensive gastrointestinal panel’. (Sometimes these are referred to by many names including a ‘microbiome test’ or a ‘specialty’ or ‘functional stool panel’. There are many different names because there are many different test options.) Overall, comprehensive GI tests provide valuable insights into your gut health, but are they right for you and are they worth the investment? Let's explore.
Understanding Comprehensive GI Tests and Their Process
Comprehensive GI Tests primarily examine the composition of beneficial and harmful bacteria in your gut, determine the presence of pathogenic and opportunistic species, look for immune and inflammatory markers, and assess the overall functionality of your digestive system. But, unlike a blood draw, these tests may involve a bit more effort.
Typically, you receive an at-home kit that instructs you how to collect a stool sample and send it back to the lab for testing. It's only natural to feel a bit hesitant about this process, but the results can provide a wealth of information about how to treat symptoms and improve your health.
Who Should Consider a Gut Microbiome Test?
There are a wide variety of gut tests available for people with gastrointestinal issues or those whose symptoms may be linked to gut health. These tests are beneficial if you're dealing with persistent bloating, diarrhea, gassiness, constipation, or if you've already been diagnosed with a GI disorder like Crohn's disease, ulcerative colitis, irritable bowel syndrome, or celiac disease.
These tests can also be highly informative if you've suffered from GI issues for an extended period without a clear dietary connection. In other words, if you maintain a healthy diet but still grapple with GI symptoms, microbiome tests can provide valuable insights.
In addition, given the importance of gut health to the overall health of the body and so many other organ systems, often functional GI testing can be very helpful in other conditions as well. For example, most patients with autoimmune conditions should examine their gut because a compromised microbiome can impact susceptibility to autoimmune flares. Gut microbiome or comprehensive functional GI testing can be helpful for assessing and treating skin conditions like eczema, dermatitis, or psoriasis because there's a close link between the digestive tract and the skin, and our dietary choices significantly influence skin health.
What Can You Discover from a Gut Microbiome Test?
If you decide to opt for comprehensive GI testing, you may receive insights about the following categories of information:
The Balance of Beneficial Bacteria: We have learned so much more about what contributes to a healthy, protective gut microbiome in the past 3-5 years than we have known for a very long time. From gut microbiome tests we are able to apply some of the most recent research to better understand how to support optimal health and metabolism in the ecosystem of gut bacteria. For example, we know that it’s not just the presence of certain protective organisms that support health, but it’s also determining the overall diversity of healthy organisms that impacts vitality and resilience in the digestive tract. We also know that certain species of protective bacteria are specifically helpful just because of the metabolic byproducts that they produce. We know that eating enough dietary fibers feeds certain bacteria that then turn around and produce short-chain fatty acids, such as butyrate. Short-chain fatty acids are protective to the colon and we want to make sure that you’re able to support a gut ecology that has them in abundance.
Imbalances in Microbial Species, including:
Pathogenic Species: Occasionally and surprisingly, gut microbiome testing reveals the presence of bacterial species characterized as frank pathogens. Whether left over from a recent travel history, food poisoning incident, or over-talomg an immune-suppressed gut lining, pathogenic bacteria can be responsible for confusing cycles of symptoms and inflammation.
Parasites: Conventional tests often screen for species under the microscope whereas comprehensive GI tests are often DNA-based meaning they are much more likely to detect the presence of many different species.. Parasites are more common than people often realize. Frequent exposures may occur through various water sources, wilderness exposures, children and animals, and infections such as Blastocystis hominis and Dientamoeba fragilis causing symptoms like cyclical nausea and stomach discomfort.
Yeast: An excessive presence of yeast, particularly Candida albicans, can contribute to symptoms like fatigue after eating, constant sugar cravings, persistent acne, bloating, weight gain, and brain fog.
Opportunists: This category encompasses both "potentially pathogenic" and pathogenic bacteria. Potentially pathogenic bacteria only become problematic when they proliferate. In contrast, pathogenic bacteria like salmonella can be harmful even in small quantities.
Immune and Inflammatory Markers
The Immune System at the Level of the Gut Lining: Testing for immune markers reveals whether the immune system is overactive or underactive. Specific inflammatory markers like Secretory IgA can tell us about the activity of the immune response and whether it’s inflamed or suppressed. In conjunction with all the other test results and history, we may be able to tell if there’s an allergic reactivity at play, inflammatory processes, or if fungus, mold, or a parasite is causing trouble.
Calprotectin: Calprotectin is a conventional gastroenterology test correlated with highly inflammatory states such as inflammatory bowel disease (IBD) and colon cancer. Elevated levels necessitate consultation with a GI specialist for further evaluation. (Comprehensive GI Testing is not a replacement for colonoscopy but can help determine how to support the GI tissues returning to balance.)
Testing for Overall Digestive Capacity
Digestive Enzyme Secretions: Comprehensive GI panels can screen for the levels of enzymes secreted by the digestive system such as pancreatic elastase and steatocrit. These levels should be present in appropriate amounts; insufficient levels might indicate malabsorption issues and reveal deeper causes of ongoing digestive issues.
How Do Gut Microbiome Results Influence Treatment?
The wealth of information that these tests provide allows us to tailor treatment to each patient with specificity and clarity. There’s often a palpable level of relief that comes with obtaining these kinds of results and walking through the interpretation together. Patients often feel validated at having their results explained to them in a way that connects their symptoms with numbers on the report with corrective treatments.
The context of the each case determines whether comprehensive GI testing should be paired with other conventional gastroenterology tests (such as a colonoscopy, or endoscopy, or other tests). While some patients with chronic GI conditions have already had extensive conventionall workups, other patients with more mild or moderate symptoms may not have had extensive testing completed.
In my practice, I often recommend complementing comprehensive GI testing with in-person physical assessments of the abdomen. This physical assessment is a more subtle form of diagnosing and treating patterns in the abdomen; it draws from western biomedicine, naturopathic functional medicine, and east Asian medicine and can be very helpful for clarifying patterns. This type of assessment can also look at disturbances in the gut-brain axis.
Whatever the case may be, it’s best to pursue gut microbiome testing under the guidance of a healthcare professional who can help you select the appropriate GI test for you, help interpret the results, and determine treatment steps in the context of your overall health. Self-diagnosis, inaccurate test selection, and inappropriate treatment are all risks to be aware of.
To Test or Not to Test: When to Delay or Skip Comprehensive GI Testing
Comprehensive GI Testing can assess people for many underlying causes of digestive complaints. However, patients who have poor dietary habits may want to delay testing and try working on foundational nourishment changes first. So, if your diet primarily consists of processed and inflammatory foods, you may do best to prioritize dietary improvements before immediate testing.
In some cases, making dietary modifications yourself can alleviate GI issues. More often than not however, patients arriving in my practice are typically exhausted from trying to troubleshoot their issues, trial different dietary changes, and still experience ongoing confusing symptoms. Testing is often extremely helpful in these scenarios.
How often should you undergo a comprehensive GI test?
These tests are not inexpensive, typically ranging from $200 to $400. However, on a positive note, the information gleaned from the test results can provide clarity in the overall therapeutic direction that may save time and money otherwise lost to guesswork that not uncommonly adds up to weeks, months, and years of prolonged symptoms
In addition, once you test, you do not often require frequent repeat testing. In many cases, we conduct the testing, analyze and interpret the results, establish a treatment plan and once we observe improvement, there's no immediate need for further testing.