Which Stool Test is Best?

Hippocrates famously said that all disease begins in the gut, and 2,500 years later, those words still ring true. When taking a deeper dive into our patients' health, the gut is often the first place we look for more information. But with so many different stool tests available, how do you choose the right one? 

Why Do a Stool Test?

First, let’s consider what we’re trying to achieve with a stool test. The first priority is to identify any significant, overt barriers to health. This can include the presence of overt pathogens such as parasites, as well as any markers that may precipitate a GP referral; for example,  elevated calprotectin, or the presence of occult blood. If there are more significant pathogenic issues or red flags to consider, these are best ruled in or out at the outset of investigations. Considering the finer details of the microbiome and the abundance or lack of beneficial bacteria in a more in-depth way can then be undertaken as step 2. To work this way, we need a first-line stool test.

The GI-MAP

The GI-MAP (click here for a sample report) is a microbiome-focused stool test that was designed to detect key microbes that may contribute to pathogenicity. The GI Map was therefore designed to be a first-line stool test - meaning that it allows us to see if there are overt potentially pathogenic issues to address such as C.Difficile or Giardia. Red-flag markers including Calprotectin, Steatocrit and Occult Blood are also reported.  When symptom analysis matches with key findings on the GI Map, medical consideration (or a medical referral by complementary healthcare practitioners) can then be given.

The GI-MAP is a specialised tool for illuminating hidden gut issues like parasites, worms, H. pylori, viruses, and other gut infections that may be playing a role in chronic conditions. There's a link to histamine with the recent addition of desulfovibrio spp. It also tests for indicators of digestion, absorption, inflammation, and immune function, rounding out a clinically relevant picture of what is going on in the gut.

The GI-MAP uses quantitative polymerase chain reaction (qPCR) technology to detect parasites, bacteria and fungi by targeting the specific DNA of the organisms tested. The advantage of quantification is that we can evaluate the extent of infection - we can see the level of infection, so we can thereby evaluate our own therapeutic intensity with more confidence..

Gut Healing Protocols: A Clinical Flow with the GI-MAP

Any gut healing protocol worth its weight will be organised in a way that systematically and comprehensively addresses any barriers to health. This means that things need to be addressed in the correct order.

Colabs’ founder Louise Carder discusses her approach to gut health that she has developed over 15 years in practice. Starting with a thorough investigation of the underlying causes of the symptoms is key to getting the information she needs to make her protocols truly personalised. Louise uses the GI-MAP as a first-line stool test for this because it offers a highly-sensitive analysis of a range of pathogens. 

Louise finds it particularly useful that the GI-MAP quantifies H.pylori with great sensitivity. It also tests for the virulence factors. Virulence factors are genes that may be found within the genome of H. pylori, and are related to higher incidence of pathology such as ulcers.  Virulence Factors such as the toxins H.pylori produce to optimise its habitat can lead to a deeper, more significant pathology.  If upper gastrointestinal root causes such as H.pylori are not corrected, they may continue to have downstream effects, potentially sabotaging any gut healing work you may do with a patient, so the H.pylori section is a clinically valuable part of the test. Armed with the information from the GI-MAP alongside careful symptom analysis, antimicrobials may then be used, or, with medical consideration, short-term triple medication antibiotic treatment. The GI Map is currently the only stool test that delivers Virulence Factor information. If H.pylori has been proven to be a client’s key issue, it is possible with Colabs to retest this as an individual marker at a later stage, rather than repeating the entire GI Map test. 

Alongside consideration of potential pathogens, it is also important to consider the intestinal barrier. Markers on the GI-MAP such as Anti-Gliadin and Zonulin (an add-on marker) are important to assess potential risk of intestinal permeability. If further investigation is needed, the Colabs Intestinal Permeability Panel is a great option. Louise will then move her patients to a maintenance protocol. At this point, a microbiome-focused stool test is recommended, to support optimising the microbiome.

The most common imbalances found on the GI Map test are:

• Imbalance of commensal and dysbiotic/overgrowth flora
• Presence of potential pathogens such as E.Coli, Giardia, Blastocystis hominis  
• Indications for SIBO/post-infectious IBS with dysbiosis and presence of a triggering bacterial species such as campylobacter, salmonella found, perhaps alongside an associated bacteria such as Citrobacter (if these are found then the IBS Smart test can be considered as a next-step test)
• Presence of H.pylori (frequently alongside parasites- if stomach acid levels are suppressed by H.pylori there can be an increased risk of minor parasites)
• High steatocrit (often accompanied by low elastase), indicating possible fat malabsorption
• High or low SIgA (high reflecting a current requirement for additional protection in the gut lining, and low indicating an exhaustion of this process/sub-optimal adrenal function or perhaps if very low an inherited deficiency of IgA - see our article on SIgA for more.)

New Test: NL850 Gut Microbiome - Screening

Colabs’ new specialised test microbiome panel offers a comprehensive analysis of the GI microbiome. Not only are individual microbes assessed, but a composition graph gives relative percentages of each species. Charts are then provided to show whether levels fall below or are reported above reference values. Click here to see a sample report.

More in-depth clinical work can be undertaken based on the results of this panel to support microbial balance in terms of species diversity and relative percentages.  This is best done when microbial and terrain issues are some way to being resolved/supported and time has been given for restoring the delicate balance of components that comprise the gut lining, so that re-seeding or optimising flora balance has the maximum opportunity for success.

In summary, once the key clinical aspects have been resolved, such as the pathogen/medically significant markers, and lining work has begun, then we can start looking into a gut-microbiome screening in greater detail. Sometimes, the microbiome will swing somewhat back into balance after the heavy lifting of first phase actions, which is why we recommend splitting the two out and testing the microbiome when sufficient time has been given to see what the system is capable of doing on its own. Just as we need to stage our interventions, we also need to stage our testing for optimal clinical flow.