Digestive Stool Analysis and Hepatic Detoxification Analysis

I. Comprehensive Digestive Stool Analysis

This is a test, which requires a stool sample. It is designed to highlight the efficiency of the gastrointestinal function in terms of digestive markers, absorption, metabolic markers, immunology, microbiology, and dysbiosis. The test will accurately measure the adequacy of digestion and how well the individual patient is able to break down proteinaceous and complex carbohydrate fibers and the levels of short-chain fatty acids, such as valerate and butyrate, which are essential short chain fatty acids that are required to maintain normal metabolic activity of the cells that line the gastrointestinal tract. It also measures the adequacy of enzymes, such as chymotrypsin, and the ability of the digestive process to breakdown and absorbs fats. It will provide an accurate measure of total fecal fat, short chain fatty acids, long chain fatty acids, and cholesterol.

The test will measure the microbiology of the stool sample and determine representative ratios of beneficial bacteria (including lactobacillus, bifidobacter and E. Coli) to unfriendly bacteria, which may contribute to an overall unhealthy ecology. Such unhealthy bacteria may include, but are not limited to, gamma strep, hemolytic E. coli, Enterobacter cloacae, and bacillus.

The test includes a mycology component and will check for various types of parasitic presences, such as hafnia, Blastocystis, and giardia. The stool analysis also looks at metabolic markers, which determine the efficiency of cell function, turnover and maintenance of normal cell architecture as well as an immunology screen measuring fecal secretory IgA (sIgA).

II. Comprehensive Hepatic Detoxification Profile

This is a test that is a true assessment of a functional liver analysis. In many instances, physicians speak of functional liver tests, which are really tests that measure liver cell enzymes, such as SGOT and SGPT. However, these are not true functional tests. They are actually measures of cell damage that may occur in such disease processes as hepatitis infection or hepatic cirrhosis.

In this test, the patient will ingest a small amount of caffeine, acetaminophen, and aspirin. The metabolic by-products of each of those medicines will be quantitatively measured in the serum, urine, and saliva.

There are actually two phases of hepatic detoxification that are designed and carried out by our bodies to break down toxic products that are developed by our own endogenous metabolism or are brought into our body by our environment and diet. The first phase is an enzyme-mediated system that is called P450 that can be up regulated as needed. Certain medicines, such as seizure medicines and alcohol, can increase the activity of this particular type of enzyme. The phase two pathways involved conjugation to less toxic molecules to render a toxin soluble so that it can be excreted. Such processes would include glutathione conjugation, sulfation to make, for example, acetaminophen sulfate, glucuronidation, and glycination that would be involved in the salicyluric acid cycle.

A problem occurs when there is an imbalance in the relative rates and efficiency of detoxification with these pathways. For example, if a person could adequately metabolize toxins through the phase one pathways but certain aspects of phase two pathways were deficient or non-functioning, toxic intermediate molecules would build up or bottleneck beyond the liver\'s capacity to break down those molecules. If such a situation occurs, then, those toxic molecules can have far-reaching effects that may adversely impinge on the efficiency of the central nervous system, respiratory system, immune system, or endocrine system.

The purpose of this test, then, is to determine the relative efficiency of an individual patient\'s detoxification system. From that information, we can suggest nutritional protocols that would be helpful in supporting those areas that are deficient.

III. Intestinal Permeability Analysis

The intestinal permeability test requires a urine sample. It is a test whereby a patient is given oral doses of lactulose and mannitol, which are two sugars that are not metabolically active in the body. They are absorbed and excreted in the urine. Mannitol is very easily absorbed. Lactulose is only partially absorbed in a normal situation. However, in patients who have altered intestinal permeability, where a low-lying state of chronic inflammation is present in the small bowel, patients tend to be more likely to experience symptoms of recurrent infections, food allergies and sensitivity, alterations in gastrointestinal function, irritable bowel syndrome, dermatologic conditions, colitis, autoimmune diseases (such as rheumatoid arthritis, ankylosing spondylitis, eczema) and other immune-mediated disorders. This syndrome has been noted to be commonly present in HIV infection and various types of cancers.

From the urine sample supplied in this test, the relative level of inflammation in the small bowel can be determined. If it is significantly altered this, of course, can contribute to some of the pathologies noted above, and adversely effect the body as a whole.

Fortunately, there are some very simple nutritional approaches to help modify this particular metabolic limitation that can be specifically aimed at correcting intestinal permeability (leaky gut syndrome). The nutritional protocols for approaching this problem are somewhat lengthy in duration of treatment. However, in our clinical experience, they have shown great promise.

Dale Guyer, M.D.