Diagnosing the Gut after Organic Acid Test results

[Journeyman]

Hi Folks,

Recently I had an Organic Acids Test (OAT) done by Great Plains Labs per the thread here: http://forums.phoenixrising.me/inde...lts-are-in-insights-sought.48762/#post-805072

and I've done some further investigation into what the results might indicate about my gut health. It appears that both the elevated markers and my symptoms are indicative of gut dysbiosis. Specifically Small Intestinal Bacterial Overgrowth (SIBO) which causes IBS type symptoms.

I'm now at a crossroads as to what to do and I'm keen to get any ideas or suggestions on where to from here. On the one hand it seems I should go and get a Hydrogen/Methane breath test to confirm whether I do indeed have SIBO, and thus also identify what my dietary options are (perhaps dairy isn't bad for me??) and on the other hand my OAT results could indicate a parasitic infection such as Giardia. Where a stool analysis would be required to distinguish the two.

So I woke up this morning prepared to call various local test providers about a Comprehensive Digestive Stool Analysis (CDSA) but then thought I better look into what Giardia actually is. The key thing I found was that even with stool analysis its often not detected, and a stool analysis is an exorbitant $600 here in Australia (pending further checks) So ok, perhaps I have cryptosporidium... but like Giardia the treatment is a certain type of antibiotic (suspect it might even overlap with Giardia) - Flagyl.

So given the cost and potential 'nothing found' outcome of a stool analysis I'm now only really considering the hydrogen/methane breath test to confirm/rule out SIBO, but time is a factor too. I've got only 3 more weeks break before an intense period of study commences and so I'd rather try the natural treatment for SIBO (which the OAT results suggest I have already) and then be in tip top shape health wise and financially for study...

What if I commence a low FODMAP diet (this seems the best option to address SIBO) straight away rather than getting either the stool or breath testing done.... Will I regret it in the future? Am I missing something? From what I gather the SIBO is effectively an inbuilt carbohydrate metabolism problem which will still manifest in the breath test regardless of whether I commence the diet now before testing at some point in the future, but then I also read that being on the diet may result in a false negative test result if its tested in the future...

Keen to get your suggestions...

Regards

Journeyman

 

[kangaSue]

The key thing I found was that even with stool analysis its often not detected, and a stool analysis is an exorbitant $600 here in Australia (pending further checks) So ok, perhaps I have cryptosporidium.

Ask your G.P. about getting a Faeces PCR test. It's bulk-billed for Healthcare Card holders and covers the major nasty things that uses a stool analysis to determine it.
http://www.qml.com.au/IamaDoctor/TestingGuide/NewTestingInnovations/FaecalMultiplexPCR.aspx

 

[alicec]

So I woke up this morning prepared to call various local test providers about a Comprehensive Digestive Stool Analysis (CDSA) but then thought I better look into what Giardia actually is. The key thing I found was that even with stool analysis its often not detected,

As@kangaSue has just indicated, you could ask your doctor to order a faecal multiplex PCR test which is done by a number of pathology companies and is available on the PBS.

This test is much more sensitive than CDSA but detects only the specific organisms tested for. These are 10 major enteric pathogens including Giardia.

This would be a cheap way of ruling out the ten organisms.

As for the other possibilities, unfortunately there are no ideal gut tests. CDSA tests are very limited and in my opinion far too expensive for the little useful information they provide.

Their measurements of things like SCFAs, pancreatic enzymes, fat, fibre etc can give useful information about digestive efficiency and a broad indication of gut bacterial activity, but the culture based analysis is pretty useless.

It is simply selecting out aerotolerant organisms which can be cultured easily. These are the minor components of the gut. The vast majority of the gut inhabitants are totally missed by the test.

DNA based tests give a far more accurate picture of what is really going on in the gut but it is early days in knowing how to interpret the information obtained.

Recently one of the companies offering microbiome testing has added a specific test based on organisms which have the most known about. It needs to be ordered by your doctor and results will be provided to the doctor. It could be worth thinking about.

They offer in parallel complete microbiome testing which you can order yourself and also need to interpret yourself, just like 23andme.

Breath tests might be helpful but there are problems with them also.

I would be cautious about claims about dysbiosis markers on OAT tests. These are the least reliable aspects of the tests. We simply don't know a lot about some of the claims made for the markers.

Elevation of a number of markers in combination with obvious gut symptoms could be a flag to do more investigation, but elevation of a few markers in isolation may not mean much. You would need to look much more closely at each of the markers and how much is really known about its association with dysbiosis.

 

[Journeyman]

Ask your G.P. about getting a Faeces PCR test. It's bulk-billed for Healthcare Card holders and covers the major nasty things that uses a stool analysis to determine it.
http://www.qml.com.au/IamaDoctor/TestingGuide/NewTestingInnovations/FaecalMultiplexPCR.aspx

Thats brilliant @kangaSue and so provided I find a willing referring dr theres not even any out of pocket expense??? There must be some costs?? The next trick will be finding a Dr who is willing to submit the test which I could only justify by showing them the OAT.... seems unlikely but worth a try... did you have to get a functional medicine Dr to make the referral??

 

[kangaSue]

did you have to get a functional medicine Dr to make the referral??

Just my normal G.P.

The next trick will be finding a Dr who is willing to submit the test which I could only justify by showing them the OAT....

It's reasonable to ask any G.P. to run this test if you have some unexplained gastrointestinal symptoms going on.

theres not even any out of pocket expense??? There must be some costs??

There is a cost but you've already paid it, income tax. PBS covers it all.

 

[Journeyman]

As@kangaSue has just indicated, you could ask your doctor to order a faecal multiplex PCR test which is done by a number of pathology companies and is available on the PBS.

This test is much more sensitive than CDSA but detects only the specific organisms tested for. These are 10 major enteric pathogens including Giardia.

This would be a cheap way of ruling out the ten organisms.

As for the other possibilities, unfortunately there are no ideal gut tests. CDSA tests are very limited and in my opinion far too expensive for the little useful information they provide.

Their measurements of things like SCFAs, pancreatic enzymes, fat, fibre etc can give useful information about digestive efficiency and a broad indication of gut bacterial activity, but the culture based analysis is pretty useless.

It is simply selecting out aerotolerant organisms which can be cultured easily. These are the minor components of the gut. The vast majority of the gut inhabitants are totally missed by the test.

DNA based tests give a far more accurate picture of what is really going on in the gut but it is early days in knowing how to interpret the information obtained.

Recently one of the companies offering microbiome testing has added a specific test based on organisms which have the most known about. It needs to be ordered by your doctor and results will be provided to the doctor. It could be worth thinking about.

They offer in parallel complete microbiome testing which you can order yourself and also need to interpret yourself, just like 23andme.

Breath tests might be helpful but there are problems with them also.

I would be cautious about claims about dysbiosis markers on OAT tests. These are the least reliable aspects of the tests. We simply don't know a lot about some of the claims made for the markers.

Elevation of a number of markers in combination with obvious gut symptoms could be a flag to do more investigation, but elevation of a few markers in isolation may not mean much. You would need to look much more closely at each of the markers and how much is really known about its association with dysbiosis.

I gave Nutripath a call and one of their staff explained the difference between the various CDSA 1-5 test options they've got. The CDSA1 is actually quite impressive, even if it would seem poor given the 1-5 scale. It tests a lot of the major bacteria and FWIW if you throw an extra $50 at it they will do the test using the DNA PCR method (applies to all their CDSA options) so that might be useful for anyone who is actually going to get the test done.

I've decided against it after reading about the unreliability of stool tests in detecting bugs and likewise for the Hydrogen breath testing used to detect SIBO. I know having followed a low FODMAP diet for just 5 days now that I've definitely got SIBO (symptoms have improved noticeably). I've ordered a range of herbal antibiotics for the same cost as getting the stool test done, and this way I'm not wasting time getting a test done to confirm what I've otherwise isolated to be the almost certain cause of my malaise in spite of a near perfect methylation protocol and heavy metal toxicity almost certainly ruled out (don't have a bad reaction to a strong ALA in spite of taking it for 2 years)
I plan to follow this kind of protocol but using another pairing of herbal antibiotics rather than the Candibactan options (they're too $$$ for me)
https://sexysibo.blogspot.com.au/2015/04/treating-sibo-with-herbal-antibiotic.html

Cheers

Journeyman