Dr. Emily Chan ND
Are you experiencing some bloating, gas, stools that vary in consistency, and some occasional abdominal discomfort? It seems that your symptoms are worse after eating, but difficult to pinpoint what foods make it worse. Sometimes you eat one thing and sure it made you feel sick, but the next time you eat that same food, nothing happens. Do you have IBS? Do you have a more serious disease like Ulcerative Colitis? Do you have Leaky Gut? Perhaps you have not had much success in getting the help you need and want to get to the bottom of what is going on.
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Most stool tests that your MD will perform include fecal occult blood. This test looks for any blood in the stool. Another stool test they often perform is a parasite test. This checks for parasites such as Giardia, Cryptosporidium, Blastocystis, and Entamoeba. They may examine the stool for worms or eggs. Most patients will have a normal stool test, meaning they do not have parasites or blood.
But what if there are issues in the intestinal tract that can be tested in the stool that show other problems such as inflammation, which have nothing to do with blood in the stool or parasites? These tests are generally not offered in your routine office visit but may be offered by a doctor who practices integrative medicine.
In Depth Stool Testing
There are 2 tests that will be covered in this article that test for the level of inflammation in the gut. They are Calprotectin and Eosinophil Protein X (EPX). Before we discuss these two tests it is important to understand how inflammation and the immune system work in the body.
When there is an elevation of inflammation found in the intestinal tract, it is very certain intestinal permeability (leaky gut) is increased. Inflammation destroys the lining of the intestinal barrier, the one cell layer that separates the stool from the immune system. 70% of the immune system live in the walls of the intestinal tract. The immune system includes white blood cells, such as neutrophils, basophils, monocytes, lymphocytes, and eosinophils. When inflammation sets off leaky gut, the undigested food particles in the stool are more easily exposed to the immune cells. The immune cells see the foods as foreign and attack. This is how food allergies start. Therefore measuring inflammation in the gut is important in getting to the bottom of the symptoms mentioned at the beginning of this article.
Calprotectin is a protein secreted by neutrophils. When this is elevated it means that neutrophil activity is increased. Neutrophils tend to fight bacteria and Lymphocytes tend to fight viruses. When Calprotectin levels are increased, it is an indication of increased inflammation.
- Calprotectin can be helpful in ruling out more serious inflammatory bowel diseases (IBD) such as Crohn’s disease or Ulcerative Colitis. If a patient has IBS symptoms and a calprotectin level less than 50mcg/g, it is highly unlikely they have a serious inflammatory bowel disease. A Calprotectin level greater than 120mcg/g indicates more serious inflammation.
- A slightly elevated level of Calprotectin 50-120mcg/g may indicate Small Intestinal Bacterial Overgrowth SIBO. Remember Calprotectin is a protein secreted by neutrophils and neutrophil activity is elevated with pathogenic bacteria? Elevated calprotectin may also indicate dysbiosis in the gut.
- Patients with colon cancer or taking NSAIDS may also have increased Calprotectin.
Eosinophil Protein X (EPX)
EPX is a protein that is released when eosinophils degranulate (burst). Eosinophil levels can be elevated in the presence of allergies, parasites and cancer. Eosinophils are also released when the intestinal barrier is damaged. Therefore Eosinophil Protein X is a good marker to assess how badly the intestinal barrier is damaged (leaky gut).
- Eosinophil protein X is great for tracking a decrease in food allergies/sensitivities after an elimination diet has been implemented. Generally, there will be a reduction in EPX after 3 months of eliminating food allergens.
- EPX levels should be less than 1 mcg/g in a healthy individual. EPX levels greater than 2 may suggest a parasitic infection or food allergies.
- EPX levels greater than 4 mcg/g may indicate more serious auto-immune inflammatory disease in the gut.
While there is no specific test that directly measures for leaky gut, other than a biopsy of the intestine; stool analyses of inflammatory markers are helpful as an alternative to the more invasive biopsy. As explained earlier the process of inflammation destroys the gut lining, therefore the higher the levels of Calprotectin or EPX the more severe intestinal permeability occurs. Leaky gut is how food allergies start and identifying this issue with these markers may help a patient’s ability to stop developing more food allergies and perhaps heal and be able to tolerate more foods in the future after treatment.
These tests may be helpful in distinguishing between IBS and more serious IBD. Finally, these tests may be helpful in determining if the cause of the GI symptoms are more bacterial in origin (elevated Calprotectin), or parasitic/allergic in origin (elevated EPX). I’ve found these tests helpful in getting to the bottom of what is going on in a patient and more specifically treating them. They are also useful to track improvement.
Dr. Emily Chan ND received her doctorate of Naturopathic Medicine from Bastyr University. She is a board-licensed naturopathic doctor and founder of Modern Integrative Medicine. She currently practices in San Diego, CA and consults around the world. Dr. Chan specializes in chronic medical conditions that have an impaired body memory component to them. She integrates the immune/nervous system and physiological relationships in treating her patients. She is published in medical journals, and magazines. She is a speaker, and has presented at medical conferences training doctors, and has appeared on television. She also authors and teaches health, and body memory reprogramming courses. You can contact her at http://www.modernintegrativemedicine.com
YouTube: Dr. Emily Chan ND https://www.youtube.com/user/DrEmilyChanND