Please click on the test links given below to see more detail, collection instructions, sample reports etc...
After a detailed review (Feb 20) of the gut tests available - no easy task, I can tell you! - I have listed the DD GI360 as my main gut test. I can still do the DD CSAP3 (a bit cheaper than the new one because it doesn't include the extensive PCR testing, but still very useful), the Genova CDSA or the GI-MAP if you wish, but I think the GI360 supercedes all of those.
Essentially, it covers PCR and MALDI-Tof types of testing for bacteria, yeasts (inc candida), parasites and some key gut viruses, but also uses microscopy and culture to confirm things.
It gives you useful clinical information on inflammation levels, malabsorption, short chain fatty acids (important for food sensitivity, infections etc), leaky gut, blood presence and SIgA (the gut immunity and food 'safety' marker) and also gives you an idea of what natural and antibiotic remedies any 'baddies' found are most sensitive to - in your particular case.
You can see full details here, including a sample report and collection instructions. You have the option of doing 1, 2 or 3 day collections - I always prefer at least 2, preferably 3, because parasites hide and we've more chance of finding them then! You return samples to the UK lab for onward forwarding to the US. You can do this test from Europe as well as the UK.
If you wish, you can add-on Zonulin (a leaky gut marker) and/or H pylori - see the add-ons in the test menu. If you wish to test the microbiome only (ie look for pathogens, check progress of them) without the stool markers, you can do that with the GI360 Essentials. If you wish to check the markers (ie. the inflammation, SCFAs, absorption etc) but not the microbiome, you can do that using Stool Chemistry.
You get a detailed report with your results, but if you need more help, you can order a Test Report and I'll explain the results in more detail and advise a way forward for you.
Candida. Candida and yeasts are generally covered in the comprehensive tests above. But, if your test comes up negative and you still suspect it OR you simply want a candida test done OR you want to double-check if a positive finding is a significant one, I would look for a SAPS positive candida. Everyone has a level of candida in their gut. The question is whether it has changed to the mycelial form, which is when it becomes pathogenic (ie needs treating). There is only one lab who looks for that, and they also include a moulds check too - BTS Candida SAPs Stool Test. Very useful. See in Tips below for what supplements to stop before the test and collection instructions here.
SIgA. This is a measure of mucosal immunity (ie in the gut, sinuses, vaginal areas etc). Put simply, if your SIgA (secretory IgA) level is too low, you will find it very difficult to fight off 'baddies' like yeasts and bacteria. You then need to work to raise your levels first. If your SIgA is high, it suggests an acute problem somewhere - usually inflammation, infection or a sensitivity to something (eg. a food intolerance). SIgA is measured in the stool tests but you can do it separately too. Do BTS SIgA Stool test if you suspect a gut problem, or Genova' SIgA Saliva Test if you have problems elsewhere. See the Bowel Factsheet above for a link to an article I've written on SIgA generally.
For SIBO, I use the Aero Diagnostics SIBO Breath test mainly because that's all they do and I really like their report, which is one of the clearest I've found. This breath test can be done using glucose or lactulose and both are good with different experts recommending either or both. Alison Siebecker, the SIBO guru, tends to recommend lactulose so I will order that unless you ask specifically for glucose in comments on your order. You can see collection instructions including a video and the patient preparation instructions here. This test is returned to the UK lab for onward shipping.
For info, the ingredients of the lactulose substrate is: 10 g lactulose (and less than 1.6 g galactose, less than 1.2 g lactose, and 1.2 g of other sugars). Also contains FD&C Yellow No. 6, purified water, USP and wild cherry flavoring. A minimal quantity of sodium hydroxide, NF is used to adjust pH when necessary. (not dairy free) And the glucose: DEXTROSE, HYDROUS, POWDER, USP. Synonyms: Corn sugar; Dextrosol; Glucose, monohydrate (not grain free)
There is also a new type of SIBO test from good-old Cyrex now - Cyrex 22. This is very different to the breath test in that it is looking for antibodies to bacterial cytotoxins released in SIBO rather than the gases we produce. It also looks for evidence to see if the cytotoxins have caused a leaky gut. You can see more info on this sheet here.
In terms of leaky gut, a lot of the time you can assume it is present because of the case and just treat. However, I have found sometimes it can help you find what is causing the leaky gut specifically. For example, if an LPS marker comes up on the results for Cyrex Number 2, it is far more likely to be a bacterial infection problem than it is food sensitivity. Can help with the detective work. More on the Cyrex 2 test here, and please note the sample needs centrifuging! I also find it useful as a progress marker, but sometimes prefer the cheaper Biolab PEG test for that. If fewer larger molecules are getting through, then you are getting less leaky. Nice and simple. You can see collection instructions here. You might find this blog post useful: Should You Test For A Leaky Gut?
Helicobacter Pylori is a useful addition to the comprehensive tests above and I have listed a DD CSAP3 with H Pylori for you to make life easier (and slightly cheaper, always good!) and it is included in the GI-MAP for a molecular check. Or, it can be done via Doctors' Data H Pylori stool test or Genova's H Pylori Breath Test. Both are effective. H pylori is the most common gut infection and very linked to acidity (eg. GERD, acid reflux), chronic stomach pain and ulcer problems. See also the new GastroPanel below for a more comprehensive test if your issues are stomach rather than bowel based.
For pancreatic function, that's included in the above gut tests but you can also do just pancreas elastase separately in a stool test too. Here is an info sheet from Genova but they no longer do it apart from in the CDSA, so I do the same with BTS - cheaper too :)
Clostridia is tested for in the gut screens above. However, the lab will look for and report on the presence of any clostridia found, but you need to do further tests then to see what strain of clostridia it is as there are loads. If your symptoms fit, do further testing with the Comprehensive Clostridium test. This is a stool culture but they will also do a DNA check if any C. Diff is found as this helps determine if it is a pathogenic type.
Note that you can also use functional testing for gut problems, see Metabolic & Functional Tests, which helps identify whether there are any clues to what's going on in the body - are there any markers suggesting gut issues?
Most of the issues so far have concentrated on the intestine; the small and large bowels, but what about the stomach? I have now managed to get a GastroPanel which is being reliably used as a kind of pre-gastroscopy, if you like. GastroPanel® is a blood test, which provides information on the status of your stomach mucosa, possible helicobacter pylori infection or lack of acid in your stomach, also known as achlorhydria or hypochlorydia. The test can also estimate the risk of developing vitamin-B12 or micronutrient deficiency. It measures four antibody markers to pepsinogens, gastrin and Helicobacter pylori and the test comes with a report on what the specific mix of results on your report means. You can read much more about it here, see a sample report here and a different one here and also review a pretty technical interpretation guide here if you are that way inclined. The sample does NOT need to be centrifuged, frozen or stablised as the lab does whole blood samples for us. You will be asked to contact the lab for FedEx details to onward ship to Finland - this is included in the price. You can see collection instructions here and you fill in a form to say if you are on anti-acid meds etc so the results can take that into account.
Testing Hints & Tips:
Q: Why do you like the Doctors' Data GI360 so much?
There are many gut tests. The reason I went for this one is that it is really comprehensive and uses PCR/DNA testing as well as MALDI-TOF analysis so you're likely to find more 'baddies' if they're there, plus a really useful raft of stool chemistry markers that allow me to see patterns causing eg. food sensitivity, or reasons for poor detoxification, why you can't fight off infections well etc. It looks for actual fibres of veg and protein in the stool and includes a carbohydrate malabsorption check as well as fat. It also has lysozyme, a good inflammation marker the others don't have (they all have inflammation markers but this is an extra in the Doctor's Data version). It also includes occult blood (an important bowel cancer test) and a consistency check, which the others don't. Bonus: it's cheaper both to buy and to return to the lab.
Q: Why do you do a 3 day version? Can I do 1 or 2 days?
I have chosen to offer the 3 day version, although I can do 1 or 2 days if you prefer. The reason I have gone for 3 is that parasites hide and it is best to have a 3 day sample to give yourself the best chance of finding them. One tip: if you wish to make sure parasites are found, some practitioners suggest you 'purge' your bowel eg. using Vitamin C, magnesium or something from your health shop/pharmacist (not salt or castor oil) on the 3rd day so you get a 'clear-out' if you like. Then use that for your third day sample. Yum!
Q: Sadly, I don't go to the loo that often. What if it takes me several days to get the three samples?
I asked the lab this for someone who was taking 9-10 days to get the three samples, which is about the limit really I would say. They advised: The samples need to be with us within 4 days of the LAST day – the chemistry tube (frozen) and the parasites (preservative) keep them viable. The culture tube on the last day is the most time sensitive.
Q: Any advice on stopping supplements etc?
For gut tests, my standard advice is to do the following unless you are monitoring yourself on them - please be led by your health professional and the specific instructions in your test kit/on the lab sites; these are my general tips:
Please make sure you stop taking any probiotics (bacteria eg. acidophilus) at least 5 days before doing the test.
For candida, stop any form of anti-fungal (eg caprylic acid, oregano, garlic etc) at least a week before. The official advice from BTS is: You should stop taking all anti-fungal supplements at least a week before you take your sample (e.g. caprylic acid, garlic capsules, grapefruit seed extract, oregano oil). Two days before you take your sample avoid fungi-food eg. camembert, brie, stilton, kefir, kombucha and stop taking any probiotics for 5 days before the sample is taken. Natural probiotic yoghurt is fine.
For parasites, stop taking any anti-parasitics at least a week before and it is best to do a 3 day sample so we have the best chance of finding anything; they hide!
For the pancreatic function test, this will be affected by any pancreas meds and pancreatic enzyme products, including glandulars.
The SIgA and leaky gut tests will be affected by any supplements designed to assist them eg beta glucans, glutamine, saccharomyces boulardii etc, so stop these a few days before unless you are monitoring yourself on them.
Immune-suppressant medication may affect the inflammatory markers, specifically Calprotectin and Eosinophil-Protein X, though the labs cannot predict exactly how these medications may impact the test results. They say: "We never recommend patients discontinue medically prescribed medications in order to do testing. With regards to medicines in general, we cannot know for certain how long a specific dosage will impact test results. Patients on regular medications can continue during testing to see how they are impacting. However if the medication is temporary they may choose to wait until the medication course has been completed." Wise words.
Medication / supplement considerations for the GI-MAP, they say: 3 days before taking your sample, consider stopping • Anti-inflammatories • Steroids. 24 hours before taking your sample, consider stopping Vitamin C >250mg/d • NSAIDS • IBS medication. Note: Steroid cream: shower before & ensure all washed off • Long term antibiotics can be continued • Long term probiotics can be continued.
Q: What's the difference with the Genova CDSA and DD CSA?
They are both excellent tests. I think the DD one is probably better for finding baddies because they use MALDI-TOF techniques. The CDSA is probably better for analysing bile flow if that is a concern and I like the clear report and analysis you get with this test. Horses for courses. You can't really go wrong with either test. Just compare the two to make sure you are covering what you want to test.
Q: Do I have to return my samples to the US for Doctor's Data etc?
No, although many of these tests are actually run in US or European labs, all Doctor's Data, Breathtrackers, Genova, BTS and Cyrex samples are returned to the UK lab for onward drop-shipping, which saves a lot of time and money!