Functional Testing

USE: THIS TEST IS USEFUL FOR MONITORING PANCREATIC FUNCTION IN CASES OF POOR DIGESTION OR SUSPECTED MALABSORPTION

Pancreatic exocrine insufficiency (EPI) is a reduction in pancreatic digestive enzymes or enzyme activity that can lead to poor digestion and malabsorption. Clinical symptoms may not occur until about 90% of the exocrine function of the pancreas has been reduced. Some patients may have mild to moderate EPI, which may not be associated with signs of poor digestion and/or malabsorption

Signs and symptoms of pancreatic insufficiency include:

• Diarrhea
• Steatorrhea
• Malodorous feces
• Swelling
• Excess flatulence
• Abdominal discomfort
• Weight loss

Pancreatic exocrine insufficiency may be secondary to:

• Cystic fibrosis
• Chronic pancreatitis
• Pancreatic resection
• Autoimmune pancreatitis
• Gallstones
• Tumor / pancreatic cancer
• Gastrointestinal surgery (e.g., gastric bypass, pancreatic resection)

Other clinical factors associated with pancreatic insufficiency with unclear mechanisms include:

• Celiac disease
• Inflammatory bowel disease (IBD)
• Zollinger-Ellison syndrome
• Aging
• Excessive alcohol consumption
• Overgrowth of bacteria in the small intestine (SIBO)
• Smoke
• Obesity
• Vegan/vegetarian diets
• Diabetes

Pancreatic elastase 1 (PE-1) is a digestive enzyme secreted exclusively by the pancreas. Measurement PE-1 in feces provides information about pancreatic exocrine function. PE-1 is highly stable and does not degrade during passage through the gastrointestinal tract.2 Fecal PE-1 levels are a good reflection of pancreatic production of elastase, as well as other pancreatic enzymes, such as amylase, lipase, and trypsin. PE-1 is not affected by transit time, although copious aqueous stool samples may cause PE-1 to be falsely low at dilution.

HOW TO INTERPRET THE RESULT

• > 200 ug / g= Normal exocrine pancreatic function
• 100 to 199 ug/g= Mild to moderate exocrine pancreatic insufficiency (EPI)
• <100 ug / g= Severe pancreatic insufficiency

PE-1 is related to the gold standard test for pancreatic insufficiency, the secretin test (Biochemical test for evaluation of pancreatic function consisting of pancreatic juice sampling by duodenal probing after intravenous injection of secretin).

Low PE-1 levels correlate with the gold standard morphologic test for chronic pancreatitis, namely endoscopic retrograde cholangio-pancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP).

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it

USE: THIS TEST IS USEFUL FOR EXAMINING ANY ALTERATIONS IN DIGESTIVE PROCESSES OR BACTERIAL FERMENTATION OF FOOD PROTEINS

Food proteins that are not digested or absorbed in the small intestine can be fermented by bacteria in the colon to produce protein degradation products, also called short-chain putrefactive fatty acids. This test can measure the concentration of three short-chain fatty acids (SCFA)-valerate, isobutyrate and isovalerate, which are bacterial products given by protein fermentation.

Methodological considerations

The results of this test on protein breakdown products should be considered in light of other data such as the patient’s lifestyle, other fecal biomarkers, as well as profiles of commensal bacteria. Bacteria ferment protein to produce putrefactive short-chain fatty acids. They also ferment fiber to produce other short-chain fatty acids (e.g., butyrate, acetate, and propionate). Dysbiosis can cause imbalances in the processes described above.

In the literature, imbalances in short-chain fatty acids (from both protein fermentation and fiber) are associated with multiple conditions, including:

• Colorectal cancer
• Depression
• Overgrowth of bacteria in the small intestine (SIBO)
• Antibiotics
• Increased protein consumption
• Diverticulosis
• Celiac disease
• Autism
• Gastrointestinal bleeding
• Chronic pancreatitis, steatorrhea

Causes of high levels of protein fermentation products include:

• Exocrine pancreatic insufficiency
• Protein-rich diet
• Small intestinal bacterial growth (SIBO)
• Low gastric HCL (hypochlorhydria, use of proton pump inhibitors)
• Some types of dysbiosis
• Gastrointestinal bleeding

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it

USE: THIS TEST IS USEFUL FOR EXAMINING ANY ALTERATIONS IN DIGESTIVE PROCESSES OR ABSORPTION OF DIETARY FAT

Fecal fat analysis tests several types of lipids including triglycerides (TG), long-chain fatty acids (LCFA), phospholipids, cholesterol, and total fecal fat. Fecal fat is used clinically as a surrogate marker for poor digestion and fat malabsorption. Total fecal fat is derived from the sum of lipid analytes. Total fecal fat is usually dominated by long-chain fatty acids, which has the highest concentration among the four fats.

Because fecal fat concentrations are measured without knowing the amount of fat ingested by the patient, all test results must be contextualized with the patient’s diet.

Methodological considerations

Triglycerides (TGs) and cholesterol make up most of our dietary fat intake; TGs are broken down to form the long-chain fatty acids LCFA. The fate of dietary fatty acids depends on their size. Smaller fatty acids passively diffuse through the enterocyte wall and are absorbed. In contrast, the uptake mechanisms of LCFAs is mediated by transporters.

• Triglycerides: an increase in fecal TGs means poor digestion
• LCFAs: increased fecal LCFAs are often indicators of malabsorption
• Cholesterol: fecal cholesterol can come from several sources: diet, bile and intestinal secretion. Our daily fecal cholesterol excretion may exceed our cholesterol intake. Therefore, fecal cholesterol should not be used alone as a parameter to determine poor digestion or malabsorption.
• Phospholipids: fecal phospholipids can be derived from diet, bile, epithelial cell breakdown, and bacterial cell membranes. Diet is unlikely to be a dominant contributor to the fecal phospholipid pool. Phosphatidylcholine (FC) is the major phospholipid in bile and accounts for 90% of intestinal mucus; this phospholipid is generally hydrolyzed and absorbed from the small intestine. An increase in fecal phospholipids may be due to mucosal cell turnover, malabsorption, or bile.

Causes of poor fat digestion:

• Pancreatic exocrine insufficiency (EPI)
• Bile salt insufficiency
• Use of pump inhibitors (PPIs) and hypochlorhydria. PPIs increase the secretion of most pancreatic enzymes but reduce the secretion of cholipase. Pancreatic cholipase is secreted as a pro-protein and requires proteolytic enzymatic activation. A deficiency in cholipase production or activation can cause poor fat digestion, even if pancreatic lipase is normal or increased.
• Bacterial proliferation in the small intestine (SIBO) due to:
• Acidic pH of the small intestine (impaired production or function of digestive enzymes in the small intestine)
• Deconjugation of bile acids

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it

USE: THIS TEST IS USEFUL FOR MONITORING EXOCRINE PANCREATIC FUNCTION (DIGESTIVE FUNCTION)

Chymotrypsin is one of several digestive enzymes secreted by the exocrine portion of the pancreas. In particular, it is a protein-digesting enzyme that may be useful when monitoring pancreatic exocrine function in patients with normal stool transit time.

Unlike PE-1, chymotrypsin did not correlate with the secretin test, although it did with respect to the 72-hour fecal fat test

Methodological considerations

• Chymotrypsin is a noninvasive biomarker of pancreatic (i.e., digestive) exocrine function. It is influenced by exogenous supplementation, making it an ideal marker for monitoring dose adequacy
• Altered intestinal transit can affect chymotrypsin. Protease degradation may result in higher levels of chymotrypsin in response to diarrhea and lower levels in response to slow transit time.

Causes of poor fat digestion:

• Low chymotrypsin levels(<0.9U/g) in the presence of normal transit time are indicative of exocrine pancreatic insufficiency. Low chymotrypsin may also result from slowed transit time (constipation)
• High levels of chymotrypsin(> 26.8 U/g) are indicative of rapid transit time (diarrhea) or may be due to excessive pancreatic enzyme supplementation.

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it

USE: THIS TEST IS USEFUL FOR MONITORING DIGESTIVE FUNCTION OR SUSPECTED MALABSORPTION

In this test, meat and plant fiber residues are examined in feces to identify the efficiency of digestive processes and/or possible malabsorption processes when used in conjunction with clinical symptom presentation and other biomarkers, such as Pancreatic Elastase. This repeated test over time may be useful for monitoring the progression and efficacy of ongoing therapies

Methodological considerations

• Meat and plant fiber are digested in the upper gastrointestinal tract, so the presence of these food fragments are indicative of poor digestion and malabsorption or increased intestinal transit (diarrhea)
• The presence of meat fibers or some types of plant fibers in the feces suggests incomplete digestion (e.g., pancreatic insufficiency, hypochlorhydria)
• High levels of fiber or undigested material may also result from inadequate chewing or hypermotility

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it

USE: THIS TEST IS USEFUL FOR EXAMINING THE COMPOSITION OF THE GUT MICROBIOTA, THE PRESENCE OF IMBALANCES THAT ARE THE CAUSE OF DYSBIOSIS, AND PARAMETERS RELATED TO METABOLIC AND DIGESTIVE FUNCTION

Chronic constipation, diarrhea, abdominal discomfort, and bloating are symptoms attributable to irritable bowel syndrome or IBS.

Many scientific studies suggest that both local and systemic health problems may begin as imbalances in gastrointestinal function. Some of the consequences of an imbalance in gastrointestinal health are:

• Maldigestion
• Malabsorption
• Irritable bowel syndrome (IBS)
• Bacterial overgrowth in the small intestine (SIBO)
• Impaired immune function
• Overgrowth of bacteria/fungus
• Chronic dysbiosis

Imbalanced diet, allergies, poor digestion, parasites, yeasts, bacterial imbalances and inflammation can all contribute to the onset of IBS. Identifying some of these abnormalities through gut microbiota testing allows the following specialist to prepare a therapeutic strategy to improve your symptoms

WHAT DOES THE TEST ANALYZE?

The gut microbiota test is done on stool and depending on the laboratory where it is performed is able to provide an informative and flexible screening of gastrointestinal function. This test is able to evaluate:

• Digestion/Absorption:
  • Chimotrypsin
  • Short-chain putrefactive fatty acids
  • Meat and vegetable fibers
  • Fecal fats
• Gut metabolic markers
  • Beneficial short-chain fatty acids (SCFAs) with n-butyrate
  • n-butyrate
  • Beta-glucuronidase
  • pH
  • SCFA distribution
  • Fecal lactoferrin
  • Macroscopic examination (color, mucus)
  • Occult blood
• Quantitative expression of microorganisms
  • Eubiotic/protective bacteria
  • Saprophytic/ opportunistic bacteria
  • Fungi (e.g., Candida and Aspergilli)
  • Pests

WHEN SHOULD MICROBIOTA TESTING BE CONSIDERED?

The test can reveal important information regarding microbiological imbalances and other metabolic markers that underlie many common symptoms such as gas, bloating, abdominal pain, diarrhea, and constipation. Fecal lactoferrin and occult blood provide information about potential intestinal inflammation.

WHAT ADVANTAGE DOES MICROBIOTA TESTING OFFER OVER OTHER DIAGNOSTIC TOOLS?

Very often the causes that trigger IBS are not detected by conventional tests. Endoscopic tests such as gastroscopy or colonoscopy are invasive examinations and while valuable in detecting the presence of any pathological conditions (mucosal inflammation, stenosis, diverticula, polyps, tumors), in cases of IBS they are often negative. Stool microbiota analysis represents a noninvasive test that offers an easy way to provide physicians, nutritionists, or other therapists with valuable information about gastrointestinal imbalances.

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it

USE: THIS TEST IS USEFUL FOR DETECTING THE PRESENCE OF PARASITES IN THE INTESTINES

Comprehensive parasitological testing is a stool test that assesses the presence of parasites. This stool test can help reveal the hidden causes behind acute or chronic conditions that develop from parasitic infections or dysbiosis. Comprehensive parasitology stool testing is ideal for patients with sudden changes in bowel function pattern, especially those who have traveled abroad or camping.

Susceptibility to parasitic infections

It is generally assumed that travel to a Third World country or the occasional camping trip is an opportunity to become infected with parasites. The truth is the combination of long world travel, increased immigration with people from countries with high parasite prevalence rates, daycare centers (and other sources of easy transmission): anyone living in modern Western countries is potentially susceptible. In fact, diarrheal diseases (both bacterial and parasitic) are the world’s leading cause of morbidity and mortality.

Pathogenicity of parasites

Various organisms are increasingly recognized for their potential pathogenicity. For example:

• Giardia lambliaisamong the leading causes of intestinal parasitic infection in modern countries. Only a few decades ago it was not considered pathogenic
• Cryptosporidium, a known pathogen in animals, has only recently been identified as a human pathogen
• Blastocytis hominisisthe most frequently observed fecal parasite. Its level of pathogenicity continues to be controversial

Pathogenicity, in general, seems to vary depending on the parasite itself, the susceptibility of the host, and the microbiological environment in which the parasite lives.

Parasitic symptoms of infection

The most common symptoms of parasite infection are.

• Diarrhea
• Abdominal pain
• Flatulence
• Anorexia
• Weight loss
• Fever
• Shivers
• Blood or mucus in the stool

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it

USE: THIS TEST IS USEFUL FOR MONITORING THE STATE OF FUNCTIONING OF THE BODY’S MAJOR METABOLIC AND ENERGY PATHWAYS BY ENABLING THE IDENTIFICATION OF NUTRITIONAL, VITAMIN AND MINERAL MICRODEFICIENCIES

Metabolomics testing is a nutritional test that provides information on organic acids in urine and insight into the body’s cellular metabolic processes. The test allows for the identification of metabolic blocks that can be treated nutritionally and integratively, thus allowing for the tailoring of interventions that maximize patient responses and lead to better patient outcomes.

Metabolomics testing is ideal for patients who may suffer from:

• Weight problems
• Sleep abnormalities
• Depression
• Chemical sensitivities
• Fatigue and weakness
• Brain fog, drops in concentration
• Dysbiosis and malabsorption
• Fibromyalgia and autoimmune diseases
• Hormonal imbalances

WHAT ARE ORGANIC ACIDS?

Organic acids are metabolic intermediates produced in the pathways of central energy production, detoxification, neurotransmitter degradation, or gut microbial activity. A marked accumulation of specific organic acids detected in urine often signals metabolic inhibition or blockage. Metabolic blockade may be due to nutrient deficiency, hereditary enzyme deficiency, toxic accumulation, or pharmacological effect. Many of the biomarkers are markers of intestinal bacterial or yeast proliferation.

The comprehensive metabolomics test profile provides vital patient information from a single urine sample. This nutritional test of organic acids is useful for determining:

• Vitamin and functional mineral status
• Amino acid deficiencies such as carnitine and NAC
• Oxidative damage and the need for antioxidants
• Detoxification capacity of phase I and phase II
• Vitamin requirements of functional B complex
• Neurotransmitter metabolites.
• Mitochondrial energy production
• Sufficiency of methylation processes
• Status of lipoic acid and CoQ10
• Markers for bacterial and yeast overgrowth

WHAT ARE THE BENEFITS OF METABOLOMICS TESTING?

Comprehensive-The metabolomics test is a nutritional test that contains one of the most comprehensive lists of biomarkers in the industry. By including nutritional markers such as quinolinate, D-arabinitol and 8-hydroxy-2’deoxyguanosine, the test is of great value.

Innovative Method-The LC / MS-MS method, also used to screen infants for metabolic disorders, requires very little sample preparation and processing. This technology provides greater stability, accuracy and sensitivity in measuring organic acids at low levels for optimal test results.

Single urine sample-A single early morning urine collection is easy for patients, ensuring greater patient compliance.

Would you like more information about how to perform this test and what information it can give about your health status? Contact me and we can schedule a brief 15-minute free consultation to talk about it