stomach pain

Why IBS sufferers should do comprehensive stool testing

Susan Hunter Digestive Health Leave a Comment

It’s not common practice for doctors or gastroenterologists to use comprehensive stool testing to look into the functional problems that are causing the signs and symptoms of irritable bowel syndrome (IBS).

Often people with IBS are experiencing debilitating bloating, abdominal pain and changes in bowel movements and they are after some answers about the cause of those signs and symptoms.

What many people don’t know is that there are stool tests available that can provide you with valuable information about the functional problems in the gut that are causing and/or contributing to their experience of IBS.

Know your gut bugs

With all of the research being done into the gut microbiome we are learning so much about the role specific strains of bacteria in our gut have on our health. This knowledge can be applied to our individual gut microbiome.

These stool tests, also known as comprehensive stool tests, can report what gut bacteria counts look like in the colon. The concentration and diversity of the gut’s ecosystem provides us with important  information that is required to work out how to get a person’s gut health back on track.

A good quality comprehensive stool test will provide you with a snapshot of the composition of bacteria in your gut. What is undergrowing and needs pre- and probiotic treatment, as well as what is overgrowing and requires eradication.

Quite often it is overgrowths of bacteria like E.coli, Bacteroides spp., Clostridium spp. and Desulfovibrio that are actually the cause of digestive problems and are reducing numbers of the good bugs – they’re crowding out the good guys. They are also stopping other good bugs from flourishing in their place, which is the way to achieve digestive harmony.

What does a comprehensive stool analysis tell you?

Not only do we learn about the bacterial terrain in the large bowel when we do a comprehensive stool test. We also learn about how we are absorbing our food, how our immune system is engaging with our gut and vice versa and whether we are providing our gut bugs with the right fuel sources via our diet.

Some stool analyses test digestive enzyme capacity and the gut’s ability to breakdown fats, carbohydrates and protein. This provides valuable information about how much of what is being eaten is being absorbed and assimilated.

Inflammatory markers in the bowel can also be tested and provide valuable information about the extent of mucosal damage in the gut as well as the possibility that a patient may have undiagnosed Coeliac disease, Crohn’s disease, Ulcerative colitis, allergies and/or parasites.

Another useful piece of information you can glean from these tests if the distribution of short chain fatty acids (SCFA) in the gut. Beneficial SCFA’s are the stuff that’s produced by your gut bacteria when resistant starches and fiber are fermented by them. You want lots of SCFA because they are protective to the gut by doing cool jobs like protecting intestinal barrier function, providing fuel for gut cells and regulating colonic absorption of water and electrolytes amongst other things.

Commensal gut bacteria anaerobically ferment resistant starch and dietary fiber (including prebiotics) to produce the beneficial short-chain fatty acids (SCFAs) acetate, propionate, and butyrate.127 In particular, n-butyrate is the obligate fuel source for colonocytes, and inadequate levels are associated with disordered colonic health.128,129 In the gut, short-chain fatty acids:

  • Maintain intestinal barrier function
  • Provide fuel for colonocytes (n-butyrate)
  • Regulate colonic absorption of water and electrolytes
  • Salvage unabsorbed carbohydrates
  • Support commensal bacteria SCFA levels are influenced by many factors

Not only are gut bacteria tested for but using culturing techniques yeast overgrowth and parasite infections can also be detected.

Who wouldn’t want to know all of this amazing information when they are struggling with gut problems? These informative tests are a great way to get people with IBS well again. By understanding what is happening internally we can then correct the functional problems identified.

Which stool test then?  

When spending the money on a stool test it’s best to go with a reputable lab because it is more likely to be accurate. The last thing you want to do is base your gut treatment on false information. Labs that are tried and trusted for accurately reporting bacteria levels in the bowel are Genova Diagnostics and Ubiome. Both are labs based in the US that use PCR technology; i.e. Polymerase chain reaction, a molecular technique that looks for bacteria and parasite at their DNA level in the stool meaning results are very accurate and sensitive, unlike the old method of microscopy.  

Genova’s GI Effects gives you the added bonus of also testing the above mentioned digestive inflammatory and short chain fatty acid markers, as well as parasites and yeasts (on micrcoscopy only for these two). They also report 24 of the better known and researched bowel bacteria species using the PCR technique.

The ubiome is a more limited test that only looks at commensal bacteria but lots of them! It is also using PCR technology so the results are accurate. It’s good to keep in mind that all testing has it’s shortcomings and may miss detecting some bacteria but these two labs do well at capturing the gut bacteria picture.

Each individual has their own unique bacteria counts and that’s why a blanket approach to treating gut problems does not work for all. Individualised treatment is ideal and worth doing if you can.

Susan Hunter
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