3 Gut Health Tests You Can Start Ordering Today for Your Patients

Gut health is a cornerstone of functional medicine, influencing everything from digestion to mood and the immune system. Understanding the state of a patient's gut health can unlock clues to various health conditions, ranging from digestive disorders like irritable bowel syndrome to systemic issues such as fatigue and anxiety. 

Choosing the right diagnostic tools can be overwhelming, especially for practitioners who are new to functional medicine. This article aims to simplify this task by focusing on three key gut health tests: GI-MAP®, GI Effects®, and GI360®. These tests are vital tools in diagnosing and managing patients with gut-related issues. Let's explore how these tests work and why they are essential additions to your functional medicine toolkit.

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Understanding the Importance of Gut Health

The gut is often referred to as the body's "second brain," a testament to its role in maintaining overall health and well-being. Beyond its primary function in digestion and nutrient absorption, the gut plays a pivotal role in several other critical areas, including immune function and the prevention of chronic diseases.

Role in Overall Health

The gut is a powerhouse of microbial activity, which significantly influences the body's immune response. A healthy gut flora promotes a robust immune system, helping to ward off infections and reduce inflammation, a common precursor to many chronic conditions. Gut health is intimately linked to the body’s ability to prevent and manage diseases such as type 2 diabetes, obesity, and heart disease, indicating its role in holistic health maintenance.

Common Gut Health Issues

Poor gut health can manifest in numerous ways, impacting much more than digestion. Here are some common symptoms and conditions related to gut health issues:

• Irritable Bowel Syndrome (IBS)
• Autoimmune Diseases (e.g., Crohn's disease, ulcerative colitis, ankylosing spondylitis)
• Mental Health Disorders (e.g., anxiety, depression)
• Chronic Fatigue
• Food Intolerances
• Small Intestinal Bacterial Overgrowth (SIBO)
• Gastroesophageal Reflux Disease (GERD)
• Changes in bowel movements (constipation, diarrhea, or both)
• Bloating

The Top 3 Gut Health Tests You Can Start Ordering Today for Your Patients

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1. GI-MAP® Test

The GI-MAP® (Gastrointestinal Microbial Assay Plus) test utilizes DNA-based technology to analyze the microbiota present in the gut. 

What It Measures: 

The GI-MAP® test from Diagnostic Solutions offers a comprehensive analysis of the gut microbiome by measuring the following key components:

• Pathogenic Bacteria: Detects harmful bacteria, including Campylobacter and Clostridium difficile (Toxin A & B)
• Parasites: Identifies parasites such as Cryptosporidium and Entamoeba histolytica‍
• Fungi/Yeasts: Measures the presence of fungi and yeasts, including Candida spp. and Geotrichum spp.
• Beneficial Bacteria: Assesses health-promoting bacteria like Akkermansia muciniphila and Bacteroides fragilis.‍
• Inflammatory and immune markers, including markers such as Calprotectin and Secretory IgA (sIgA), to evaluate gut inflammation and immune function.

 A complete list of what the GI-MAP® test measures can be found here.

Clinical Applications: 

The results of the GI-MAP® test can have profound implications for the treatment plans of patients with various gastrointestinal issues. Here’s how the results can be used in clinical practice:

• Dietary Changes
  • Addressing Imbalances: Tailor diets to address microbial imbalances, such as increasing prebiotics to boost beneficial bacteria like Bifidobacteria and Lactobacilli.
  • Elimination Diets: Implement elimination diets to remove foods that cause inflammation or sensitivities, as indicated by markers like Anti-Gliadin sIgA.

• Probiotic Supplementation
  • Restoring Balance: Based on the GI-MAP® results, specific probiotic supplements can be recommended to restore balance to the gut microbiota, such as Lactobacillus.
  • Supporting Recovery: After treatment for pathogenic infections, probiotics can help re-establish a healthy microbiome, which is crucial for preventing a recurrence of symptoms and further infections.

• Antimicrobial Therapies
  • Targeted Antibiotic Use: Pathogenic bacteria like C. difficile or harmful parasites can prompt the use of targeted antibiotics or antiparasitic medications. The GI-MAP® test's antibiotic resistance genes panel can further assist in choosing an effective treatment, reducing the trial and error often associated with antibiotic prescriptions.
  • Antifungal Treatments: If fungi such as Candida spp. are identified, antifungal therapies can be precisely administered to curb overgrowth and alleviate symptoms associated with yeast infections.

How to Order and Interpret

Ordering the GI-MAP® test and interpreting its results are crucial steps in effectively utilizing this tool in your clinical practice. Here’s a simple guide to facilitate the process through Rupa Health.

• Find the GI-MAP® test listed under the gastrointestinal category. You can also select any add-ons, such as the Zonulin test if needed for a more comprehensive assessment. After selecting the test, you can order the test kits to be shipped either directly to your clinic or your patient’s home. 

• The patient will collect their stool sample using the kit provided by Rupa Health. The kit comes with detailed instructions to ensure that the sample is collected correctly. Once the sample is processed, the results will be available through Rupa Health’s portal. 

• The GI-MAP®® report will include various sections detailing the presence of pathogens, the balance of beneficial and harmful bacteria, markers of inflammation, and more. Familiarize yourself with the layout and the significance of each section.

• Correlate the findings with the patient’s symptoms and medical history. The presence of specific pathogens, for instance, should be considered in the context of the patient’s clinical presentation. Look for imbalances in the flora, signs of inflammation, or digestive issues that match the symptoms reported by the patient, and schedule a call with the lab to gain further insights from one of the staff clinicians. All of these steps will help guide your therapeutic decisions.

2. GI Effects® Comprehensive Stool Profile

This advanced stool test provides an extensive evaluation of digestive health and nutrient absorption. It is engineered to provide a deep dive into gastrointestinal function using an integrated array of testing methodologies, including PCR (polymerase chain reaction), stool culture, and microscopic examinations. This comprehensive approach can help you diagnose and manage a wide array of digestive disorders effectively, supporting patients’ overall health and well-being.

What It Measures: 

• Digestive Enzymes: The test analyzes markers such as Pancreatic Elastase-1, which indicates exocrine pancreatic function and protein and fat breakdown products. 

• Gut Inflammation Markers: GI Effects® includes key inflammatory markers like calprotectin, differentiating inflammatory bowel diseases such as Crohn's disease and ulcerative colitis from irritable bowel syndrome. Other markers, such as Eosinophil Protein X and Fecal Secretory IgA, offer insights into allergic responses, infections, and overall immune function within the gut.

• Levels of Beneficial and Pathogenic Microbes: This test provides a detailed look at the gut microbiome, identifying both beneficial commensal bacteria and harmful pathogens. It measures metabolic indicators such as short-chain fatty acids and beta-glucuronidase, which are critical for understanding the metabolic functions performed by gut bacteria. Additionally, it assesses the presence of specific pathogens through bacterial and mycology cultures and sensitivities, as well as parasitology.

Clinical Applications: 

The GI Effects® Comprehensive Stool Profile is a valuable diagnostic tool that is important in identifying and managing digestive health issues. Here's how it helps in clinical settings:

• Diagnosing Digestive Issues: The test can distinguish between types of gastrointestinal conditions, such as IBD versus IBS, based on inflammation markers. It also identifies infections from bacteria, fungi, or parasites, which can direct specific treatment options.

• Adjusting Diets: Analysis of the gut microbiome can lead to personalized dietary recommendations to enhance the growth of beneficial bacteria and suppress harmful ones. If digestive enzyme levels are low, the test may suggest dietary modifications or supplements to aid digestion.

• Enhancing Nutrient Absorption: The test can guide dietary strategies to improve nutrient absorption and overall digestive health by pinpointing malabsorption issues through the presence of undigested fats and proteins in the stool.

How to Order and Interpret

Rupa Health simplifies the process of ordering specialized lab tests like the GI Effects® Comprehensive Stool Profile from Genova Diagnostics. Here's a step-by-step guide on how to order this test and effectively utilize its results in a clinical setting:

• Choose the appropriate test version (1-day or 3-day collection) based on your clinical assessment of the patient’s needs. In cases of no/low suspicion, a one-day sample will likely be adequate; providers should order the three-day collection kit for high suspicion.
• Rupa Health will notify you once the test results are ready. You can access the detailed report through your Rupa Health dashboard. The test results will come with a detailed report that explains the findings. Review these in the context of the patient’s overall health, symptoms, and medical history.
• Based on the test results, develop a personalized treatment plan that may include dietary modifications, supplementation (e.g., probiotics, digestive enzymes), and possibly medication to address identified pathogens or inflammatory processes.

3. GI360®™ Test

The GI360®™ test is an advanced stool analysis tool that offers a comprehensive look at the gut microbiome using state-of-the-art PCR technology, along with culture-based methods, sensitive biochemical tests, and microscopy. This test is useful in identifying and evaluating pathogens, viruses, parasites, and bacteria that could contribute to gastrointestinal symptoms and diseases in patients. By examining the DNA of gut microbiota, the GI360®™ test provides insights into over 45 specific factors linked to dysbiosis and various chronic illnesses.

What It Measures: 

The GI360® test is designed to examine a broad range of gut-related parameters, which include:

• Gut Bacteria: It assesses beneficial commensal bacteria and harmful pathogens like Helicobacter pylori, and also performs bacterial cultures to guide antibiotic treatment.
• Parasites: The test detects common and obscure parasites using PCR and microscopy, ensuring a thorough parasitological assessment.
• Fungi: Identifies disruptive fungal organisms, including yeasts, through KOH preparations and culture techniques.
• Digestive Markers: Measures enzymes and markers like pancreatic elastase and calprotectin to evaluate digestive function and inflammation, which help differentiate conditions like IBD from IBS.

Clinical Applications: 

The GI360®™ test’s comprehensive scope of analysis provides critical insights that can significantly enhance patient care. Here’s how this test can be applied clinically:

• Inflammatory Bowel Disease (IBD): By measuring markers like calprotectin and lactoferrin, the test can help differentiate between IBD and less severe inflammatory conditions such as IBS, guiding appropriate therapeutic interventions.
• Infections: Detecting specific pathogens, including bacteria like Helicobacter pylori and parasites such as Blastocystis spp., enables targeted antimicrobial treatments.
• Dysbiosis: Analysis of bacterial and fungal communities assists in identifying imbalances that may contribute to conditions like small intestinal bacterial overgrowth (SIBO) and candidiasis.

• Dietary Modifications: Information on the presence of digestive enzymes and gut flora composition can guide dietary recommendations to improve gut health and overall digestion.
• Probiotic and Prebiotic Therapy: Understanding the microbial landscape of the gut enables practitioners to recommend specific probiotic strains and prebiotic fibers that can help restore microbial balance.
• Pharmacologic Interventions: Identifying pathogenic bacteria and their antibiotic sensitivities, as well as inflammatory markers, helps craft precise pharmacologic strategies that are more likely to be effective.

How to Order and Interpret

To order and use the GI360® test effectively in your clinic, follow these steps and guidelines:

Patient Preparation:

• Patients should avoid antibiotics, antiparasitics, antifungals, probiotic supplements, proton pump inhibitors, and bismuth for two weeks before the test. Additionally, aspirin and other NSAIDs, digestive enzymes, laxatives, activated charcoal, betaine HCl, and antacids should be stopped two days prior to beginning sample collection.
• The GI360® requires a three-day stool sample collection, which can be done consecutively or within seven days. Instruct patients to follow the kit's detailed instructions for each day's collection method and storage, ensuring samples are not contaminated with urine or water and are stored correctly before shipping.

Collecting and Storing Samples:

• The GI360® test requires a three-day stool sample collected over consecutive days or within a week. Proper collection and storage are critical for accurate results. Samples should be stored as instructed—typically refrigerated or frozen—until shipped.
• Provide clear instructions on collecting and storing the samples using the materials provided in the test kit.

Interpreting Test Results

• Understanding the Report: The GI360® test results include a Dysbiosis Index (DI) and standard deviation scoring from the normobiotic reference, providing a clear view of the gut microbiota's health. This detailed report will help you identify imbalances in gut bacteria, the presence of pathogens, and other digestive issues.
• Clinical Application: Use the insights from the test to discuss potential digestive issues and imbalances with your patients. The data can guide the development of personalized treatment plans, including dietary changes, supplementation, or medication.
• Follow-up Testing: Consider retesting based on the initial results and treatment outcomes. Retesting should be scheduled no sooner than three weeks after treatment to avoid detecting remnants of dead pathogens, ensuring the accuracy of the follow-up results.

Integrating Gut Health Testing into Practice

Integrating gut health tests such as GI-MAP®, GI Effects®, and GI360® into clinical practice can provide invaluable insights into patients' gastrointestinal health. Here's how to effectively incorporate these tests based on patient symptoms and history, interpret their results, and determine follow-up actions.

When to Order Tests

1. GI-MAP®:

• Symptoms indicative of dysbiosis, such as chronic diarrhea, constipation, bloating, and gas.
• Autoimmune disorders: to explore potential gut-related triggers.
• Unexplained systemic issues, such as fatigue, headaches, and skin conditions, which could be rooted in gut health.

2. GI Effects®:

• Chronic gastrointestinal symptoms like persistent indigestion, stomach pain, or irregular bowel movements.
• Inflammatory Bowel Diseases (IBD): when Crohn's disease or ulcerative colitis is suspected.
• Nutrient absorption issues as indicated by unexplained deficiencies or general malnutrition.

3. GI360®:

• Complex digestive disorders where multiple factors, including bacteria, fungi, and parasites, might be involved.
• Post-infection recovery to assess the gut environment following a known gastrointestinal infection.
• Evaluation of Gut-Brain Axis: for patients with neurological symptoms potentially linked to gut health.

Interpreting Results

• Functional Imbalance Scores: These scores help identify key areas of concern, such as digestion, inflammation, and microbial balance. High scores in specific areas like dysbiosis or inflammation guide clinical focus and intervention strategies.
• Pathogen Detection: The presence of specific pathogens such as bacteria, viruses, and parasites can pinpoint the causes of symptoms and guide antimicrobial treatment choices.
• Biomarker Insights: Levels of beneficial and opportunistic bacteria, as well as markers for gut barrier integrity and immune response (e.g., calprotectin, sIgA), provide a comprehensive view of gut health and its systemic impacts.

Follow-up Steps

1. Additional Testing:

• Further microbial analysis: If initial tests indicate dysbiosis or pathogen presence, more detailed microbial analyses might be required.
• Nutrient and metabolic assessments: These should be considered, especially if malabsorption or maldigestion is suggested.
• Allergy and intolerance tests: If food sensitivities are suspected.

2. Referrals to Specialists:

• Gastroenterologists: For advanced diagnostic interventions like colonoscopies or to manage complex cases of IBD.
• Nutritionists or dietitians: To devise dietary interventions based on the test findings.
• Integrative medicine specialists: For a holistic approach to treatment that may include botanicals, probiotics, and lifestyle changes.

3. Initiating Treatment Protocols:

• Dietary modifications: Tailored diets to promote beneficial bacteria and reduce inflammation.
• Probiotic or prebiotic supplementation: To restore microbial balance.
• Antimicrobial treatments: Targeted therapy against identified pathogens.

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Key Takeaways

• Understanding and assessing gut health is crucial in functional medicine, as it impacts digestion, immune function, and overall well-being.
• These diagnostic tools are essential for assessing patients' gut health, offering unique insights into gut microbiota, inflammation, and digestive function using advanced DNA-based and other biochemical testing technologies.
• Results from these tests can guide targeted treatments such as dietary changes, probiotic supplementation, and antimicrobial therapies, improving the management of conditions like IBD, SIBO, and dysbiosis.
• Utilizing these tests in functional medicine helps craft personalized treatment plans based on detailed gut health profiles, thus enhancing overall patient care and addressing complex gastrointestinal and systemic health issues.