Should You Test For A Leaky Gut?

test iconWell, yes and no. Let me explain. In fact, let SCD Lifestyle explain as they’ve just done a useful post on it, so it saves me time! Their post was about a webinar which has now gone, but some of the points in the post are useful anyway.  I have been asked my views on it by a few of you so thought I would share them more widely!

Is Leaky Gut Testing A Waste Of Time and Money?

In essence, they suggest you could better spend your money elsewhere and assume you have a leaky gut. I agree with that and have said it many times.

BUT, it can be very useful to test your leakyness so you can monitor progress. I went through a time when I was saying the same thing but found people wanted to test sometimes anyway, if only to see on paper if the gut or brain barrier had been affected in some way and they weren’t going mad. Also, it can really help to see that damage coming down, even when you can’t feel anything getting better yet – and that has happened quite a few times so far. I did Cyrex 20 for migraine, for example, as I wanted to see if my blood brain barrier was breached and how badly, for example. It sort of helps to see something on paper even though I suspected it.

The other thing is that the Cyrex 2 especially can give you a good idea of what might be causing the leakyness. A case in point was just last week.

I had a patient do the Cyrex testing as I have set it out in the Gluten Plan and the Gluten Testing page. In essence, the results suggested they have gut and blood-brain barrier loss of integrity, plus thyroid autoimmunity, caused most likely by bacterial infection rather than food or gluten specifically.

How can we tell it is likely bacterial rather than food, you ask?

Well, in Cyrex 2, the permeability test, we found a high LPS score which shows bacterial endotoxins most likely causing leaky gut rather than food because results from Cyrex 3 and 4 showed no food antibodies positive, Cyrex 20 showed blood brain barrier integrity loss. Ergo more likely to be infection than food. That’s not to say food might not be involved – the tests are not infallible and it may be that this person doesn’t have an antibody reaction to food. That’s when you would double-check with something like the ALCAT tests.

So, sometimes you can see it is useful to test – it certainly gives this person somewhere to focus treatment: on hunting down and dealing with bacterial infection.

That said, SCD make a good point and I agree in that I always ask: will having a test change the treatment? If not, is it worth it to know? In this case, would the person have been taking anti-bacterial treatment as part of a gut healing protocol anyway? Maybe. But would it not be more beneficial to try and discover what the bacterial problem is and target is specifically? Possibly. It’s always a judgement call, isn’t it?

I do agree that no leaky gut test yet exists that is 100% reliable but these are the best we have and can help when you use them correctly.

What about the PEG test, or lactulose/mannitol?

Basically, there are two main ways of testing leaky gut currently. You can either look at absorption of molecules, as in the PEG and L/M test OR you can now look at antibodies – immunological damage to the barrier structures and proteins – as in the Cyrex 2 permeability test. The two are completely different: apples and pears, and you cannot compare them.

Generally, I have found the PEG test very useful in people as a progress marker. The PEG test is looking to see what size molecules are getting through the gut barrier – larger ones shouldn’t be getting through, quite simply, and you should see the number coming down if you are healing.

The more well known lactulose/mannitol test is similar in that it is measuring absorption and molecules getting through really. I avoid it in TGF world, though, because it is derived from corn and dairy most of the time. PEG is an inert synthetic substance: OK, not great for you but not a food allergen at least.

The Cyrex 2 is an antibody test, looking for immunological markers and, as I have explained above, can be quite useful in our detective work.


The Strategy for Healing

The second part of the SCD post is also useful in that it describes the approach to so-called ‘tough cases’. In effect, diet alone will not do it. Again, I agree with that. They have even caught up now and advise an AIP diet, healing supplement protocol and working on your stress. Recognise that? It’s the Gluten Plan and strategy advised on the TGF site! Nuff said.

For more on leaky gut and the healing protocols, it’s all in the Gluten Plan – I haven’t had a chance yet to pull that section out and do a leaky gut factsheet for you. Never enough time! But it is all there for you, I promise.

Thanksgiving and Test Sample Returns

Just a quick note to remind you that it is Thanksgiving for our US friends on Thursday 27th November. Please bear in mind US labs will be closed on that day so don’t send any samples back to arrive then, eg Cyrex, Neuroscience. Thanks.

Which Lab Tests Are Best?

It’s really interesting sometimes to see how other practitioners are working in-clinic because it helps me to see how I am doing. Am I up on the latest thinking? Have they found something I haven’t etc etc? That’s how we all learn: by sharing information.

A very useful interview on lab testing from functional medicine practitioner Chris Kesser came out recently, which gave me the chance to see if I have the right lab tests available for you all. The upshot is that I am doing a lot of the same things, with a few UK tweaks, so that’s heartening.

Obviously, lab testing is very much dependent on the specific person, but, as Chris says in this useful interview, there are definite trends and things you look for in most cases. He chooses to do a LOT of testing and I’m not sure that all of it is needed but, as he says, he sees very sick people.

Anyway, I thought it might be useful for now to set out the tests he mentions for ease for you, and give a few comments as I go along, as always!


Which Lab Tests Do You Need?

The first point I would make is an important one. Always think before you have a test done: what is the point of having it done? (Are you clear what you want?) What do you want to find out? (Do you know this particular test will give you the answer to your question specifically? ie. is it the right test?) And will the result affect your treatment or approach? If the answer is no to this last one, why are you doing it?! Sometimes, of course, it might be that you simply want to see something on paper – or your family do! – and that is a valid reason for testing. It’s entirely your choice and I am here to help you, but those are important questions to ask yourself so you get the best out of your tests.

OK, that said, here are my comments on testing that is helpful for many people.

Basic Workup

Chris start off with a basic work up for all patients, which I will come back to another time – I’m trying to put together a cost-effective way of doing the test I would do. Here, though, are some of the areas of tests he mentions in case it helps you. Incidentally, I have put some of this and more in the new Test FAQ pages I have been building for you on the shop site – have you seen them under Test FAQ? So far, I have pages on Gut, Allergy & Intolerance, Nutrient, Metabolic and Hormone tests – most have a quick overview guide and then some FAQ as they come up.


The Gut PlanGut Tests

Chris says he does three standard tests for the gut: a stool test, a breath SIBO test and urine amino acids.

I was particularly pleased to hear he and I have come to the same conclusions about which is the best stool test – the DD CSAP3  - and he has not been thrown by all the PCR GI Effects testing hoo ha either. I think there is much more research to be done on that method and, like him, I prefer the DD one.

For SIBO testing, we can’t get the Genova one he refers to, which is US only, but this SIBO Breath Test is just the same. You also get an indicator in the main stool test above.

In terms of the amino acid testing, this is a way of functionally testing the body to identify any areas of the body that might need attention. Chris uses Genova’s Organix Comprehensive, which is the traditional US one. I can do that if needed, but actually I prefer the cheaper version of the Metabolic Analysis one , which is more than sufficient for most needs.


hormone womanHormone Tests

He does Biohealth’s 201, which is the same as the standard Adrenal Test I do almost daily it seems! Sometimes, he also does Complete Hormones, a fabulous if pretty expensive test which can be very useful in difficult hormone cases. I find that the Rhythm Plus, Rhythm, or Male Hormones is a plenty complex enough for most people!


test iconMethylation Tests

Here, again, we are in happy agreement. I have lost count of the number of people who have had genetic tests done, like 23 and me etc, and have based their whole protocols on finding methylation SNPs without actually checking functional methylation ability. Just because you have the genetic pattern, does not make the actual condition so. That’s why I have both tests on the system and encourage both where possible.

My tests match his. You can do a Methylation Gene Test and a Methylation Functional Panel. Also, experts like Dr William Walsh consider body histamine levels a good indicator for methylation status and you can also get an idea from the Metabolic Analysis test I mentioned above. You can see more about Dr Walsh’s recommended tests here.


Immunological and Food Intolerance Tests The Barrier Plan

Chris uses the Cyrex panels here. Mainly, 3, 4, 5 and 7, sometimes checking leaky gut with 2 (more on each below, don’t worry…).

My comments on that with regard to food intolerance are that he is only looking for antibody reactions there and it is well known that some people don’t show antibodies and have other types of reaction going on. Antibodies is certainly a place to start and the Cyrex ones are good, but can be a bit limited as the foods list is not very long in panel 4.

Number 3 is a given for gluten related disorders – which MANY people don’t suspect but have.

Number 4 is used for finding cross-reactive foods if the person is positive on number 3, but I would also extend the list to other antibody tests like this one, which tests 96 foods for the three main antibodies (but has to be sent to the US) or this one which tests the most common antibody, IgG. And, I would include an ALCAT check for a really proper check.

Cyrex 5 is an autoimmunity screen. Very useful and I wish more people would do it.

Cyrex 7 is a neurological screen, and I have just added that to the shop.

Cyrex 11 is the new chemical sensitivity screen. Very useful and just added to the shop too.

I also do Cyrex 20, the blood-brain barrier test, a good deal for people with neurological disorders like behavioural, mood, migraines and motor/movement disorders like ataxia, restless legs etc.

In terms of leaky gut, I agree partly with what he says. 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 Number 2, it is far more likely to be a bacterial infection problem than it is food sensitivity. Can help with the detective work. I also find it useful as a progress marker, but sometimes prefer the cheaper PEG test for that. If fewer larger molecules are getting through, then you are getting less leaky. Nice and simple.


mineralsNutrient Tests

Again, we are in agreement here. Partly. Chris rates the Nutreval, and so do I. He also rates the very expensive ION profile. This is £1000! Eek. Actually, I have most of the elements of that on the shop separately and will pull together what is needed specifically for the person. Sometimes, though, someone might want to do the whole lot. Maybe I should put it on the shop! Ask if you require it.

I also like the ONE test (as opposed to ION, rather confusingly!), which is a smaller version of the Nutreval but often gives people a good indication of what’s going on. The thing in common with these are that they include amino acid metabolic testing (like the Metabolic Analysis above) to find functional problems with nutrient use in the body rather than measuring actual levels in cells, if you see what I mean.

That said, I have found over time it is very useful to see the red cell levels of the various minerals, especially magnesium and zinc. For most people, however they test, I usually want to see Vitamin D status, the vitamin levels, especially of B6 and B12, and often like an Anaemia Profile, (one that includes red cell folate and active B12 preferably like that one) depending on the case.

There are tons of things to test here and various methods of doing so. I need to find some time to extend the Nutrient testing FAQ for you as this is a complex field. If in doubt, go for those three above, the ONE or Nutreval to give you the most clues.

Heavy metal testing. This again is incredibly confused as there are several ways of looking. Chris says he uses Quicksilver’s method which measures different types of mercury. Their general metal test, though, seems to be from whole blood.

You can do a whole blood test from Genova or you can do a combined red cell nutrients and whole blood heavy metals test, which is much better value. I told you it was complicated!

In case it helps, here is what I have said so far in the Nutrient Test FAQ on heavy metal testing for you:

What’s the best way to test heavy metals?

This is not an easy question as each test type has pros and cons. Here is a useful summary for you:

The hair test is a 3-4 month recent history of exposure to the elements.  It gives an idea of what the body is possibly holding onto in tissues.

Fecal metals will give an indication of ongoing daily exposure from eg. dental amalgams. It also gives an idea of how well your liver/bile flow is getting rid of them.

Urine generally helps you find if there is an overall high retention of heavy metals in the body. You can do this chelated or un-chelated, but many experts prefer a chelated challenge test for validity of results. 

Blood testing is most effective to check an acute, or ongoing exposure to the metals. You can do this in whole blood or red blood cells. Red cells show what’s in the cells at the current time. 

In essence, I prefer blood testing unless you are on a chelation programme which would then require urine testing. If you want a quick idea, a hair test can give an indication if heavy metals, especially mercury, might be something you need to look at further. It tells you if levels were high about 3-4 months ago as that’s how old the hair is when you test it. If you want to know if levels are currently high in the body, I would then choose blood or urine. 

Phew, lot of info there for you. I hope it at least gives you some idea of what areas are important to look at and how you might go about doing so. I have actually written a lot of stuff about the various key areas in chronic health issues in the Gluten Plan with testing and protocol information in there. Eventually, when I get a chance, I need to pull the various sections out of that plan and put it into a kind of Chronic Health Plan instead – all the info’s there; it’s just called the Gluten Plan as that was the focus when I was doing the research and writing! Always more to do ;)

Anyway, thanks to Chris for giving me the incentive to pull that together for you. I hope it helps with the testing minefield!


Are Acid Meds Behind The Rise In Allergy?

This is a great piece which goes some way to explaining why I am always wittering on about low stomach acid. It’s making the point that suppressing stomach acid leads to poorer digestion and to larger protein fragments in the gut, which all leads to a higher allergy risk. Interesting. In fact, most people on antacid medication in my clinical experience have the opposite problem. It’s confusing because low stomach acid can often look symptomatically exactly the same as high stomach acid. Always worth checking.

Stomach Acid 3DRead the factsheet on hypochlorydia/low stomach acid here for more info. And here’s the piece for you:

Why Is the Incidence of Food Allergies Rising in Both Adults and Children?

 Immunoglobulin E (IgE)-mediated food allergies–the allergies that can cause anaphylaxis–have historically been relatively rare. In the past, they typically were seen in children, who tend to outgrow them by adulthood. Recently, however, the incidence of these allergies in children has risen, and the reactions increasingly are sustained into adulthood. Furthermore, new-onset food allergies and anaphylaxis in adults are now being seen, something virtually unheard of a mere 20 or 30 years ago. So what factors are contributing to this onslaught of allergic disease?

One powerful shift promoting adult-onset food allergy is the relatively new, global use of acid-blocking therapy such as proton pump inhibitors (PPIs) and H2 blockers. Numerous studies demonstrate this association, including one completed in 2005 by Untersmayr and colleagues.1 In this trial, 152 adults were given either a PPI or H2 blocker for 3 months and IgE responses to 19 foods were measured at the end of the trial. Amazingly, a greater than 10-fold rise in the incidence of food allergy was seen in the study group as measured by IgE response, and most of these food allergies were de novo, or new-onset reactions. Some participants with existing allergies experienced an increase in intensity of the reaction as a result of the PPI or H2 blocker. In a significant subset of the volunteers, the reactions continued long after the acid blocker was stopped. Not surprisingly, a control group demonstrated no significant change in IgE food allergy incidence.

The mechanism of this reaction is straightforward: Acid blockers inhibit the digestion of protein in the stomach. When the stomach does not predigest protein for the intestine, the pancreatic and brush border enzymes found there do not perform as well, resulting in larger protein fragments that are sometimes absorbed. Larger protein fragments are more antigenic than small ones; therefore, they are more likely to generate an allergic response.

Source: IFM Journal Nov 14.

To read the full study, see here:

  1. Untersmayr E, et al. Anti-ulcer drugs promote IgE formation toward dietary antigens in adult patients. FA SEB J. 2005 Apr;19(6):656-8. Epub 2005 Jan 25. (Link to free full text: click here)

Women Smokers: Stop Before Middle Age!

Great piece in The Lancet for you today showing that if women stop smoking before they hit middle-age, preferably well before, they can reverse 97% of the damage done and live another 10 years on average! The researchers did a prospective study on well over a million women and concluded:

Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater.

Stopping before age 40 years (and preferably well before age 40 years) avoids more than 90% of the excess mortality caused by continuing smoking; stopping before age 30 years avoids more than 97% of it.

That’s huge. Have you stopped yet?!

Have a read:

The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK.

Sign Up For The Free Meditation Today Before It Goes!

Just to let you know that the free meditation programme I recommended here will start disappearing today. Each day’s meditation is up for five days and it is day five today so Day 1 in the series will go sometime today. If you’ve not started, I suggest you do so today before they go – it’s a goodie :)


Arsenic in rice

Arsenic in rice