At the time of your appointment, I would like to see a current (within the past three months) CBC (complete blood count) and CMP (complete metabolic panel) and a urinalysis. Ideally, I would also like to see a full thyroid panel, a full iron panel, with ferritin, serum B12, and serum magnesium.
Please send me copies of any additional testing or procedure reports from the past 5 years. If you do not have these handy, I will have you fill out a release of records and I can request these directly from your provider. The initial intake is an on-boarding appointment – this is our information gathering appointment, where we will discuss your history, symptoms, treatments, labs and procedures. It is okay if you do not have everything in hand at the time of this appointment. I need these in hand for our second call, which is the call that we will discuss your assessment and plan.
In addition to the labs that you have in hand, there may be additional testing that I will want to see that will allow me to target neutraceutical therapies. Addressing SIBO is complicated. I don’t want to guess at what is going on internally. It is better to test than guess. When armed with the right information, your program will become that much more targeted and effective.
I recommend the following testing on a case by case basis. You do not need to have these in hand prior to your intake session.
The following labs are available through my office:
SIBO Lactulose Breath Test If there is an overgrowth of organisms in the small intestine, they produce hydrogen or methane that diffuses across the intestinal lining, into the blood and then the gases are expelled out through your lungs. During this test, you will be given a sugar solution and then asked to breath into a tube at 20 minute increments. Hydrogen and methane production are measured at ppm (parts per million) at each 20 minute interval from baseline, for 90 minutes to two hours (depending on the lab test). This test requires a one day dietary prep.
Assess for Candida (yeast)
Candida is a yeast infection in the digestive tract. Humans have many species of yeast, including Candida albicans living in your large intestine. New studies are shedding light on a new diagnosis SIFO – Small Intestinal Fungal Overgrowth.
Testing is tricky. Yeast does not survive transit from the bowel into feces. Stool testing is one option, yet, if they are only relying on culturing yeast; taking live yeast and culturing it on a petri dish to see if it is there and grows, then they will miss the diagnosis. A better test is microscopic examination of a stool test, collected over three days.
Yeast will not appear in stool on a daily basis. Collecting over three days, will lead to a more accurate lab test result. Clinically I have seen many three day stool tests, showing ‘negative’ for yeast culture and ‘many’ yeast present under daily microscopic examination. This is clearly a positive yeast/ candida lab that would have returned a negative reply if culturing was the only assessment.
Organic Acid Profile testing of urine is another way to test for yeast. This looks at metabolites in your urine that would be present if an invasive yeast issue were present in the digestive tract.
GI Effects Test -3 Day Collection, by Genova Diagnostics is my go to test, along with the Lactulose Breath Test for SIBO. This is a three day collection that looks at:
- Commensal flora, imbalanced flora and pathogenic flora
- Microscopic evaluation of parasites: giardia, cryptosporidium and yeast
- Cultures yeast and does a microscopic yeast evaluation of each day
- Secretory IgA: this is secreted by your mucosal lining and represents the first line of immune defenses of the GI mucosa. Low levels are a risk factor for SIBO and repeat SIBO infections. Knowing that this is low will allow this to be addressed during phase II of treatment.
- Fat Stain: are you absorbing and digesting fat
- Lactoferrin: this is high with an inflammatory bowel disease and not IBS/ SIBO
Clostridium difficile stool culture: this is a pathogenic bacteria that causes a host of issues and mimics SIBO symptoms. This is not included on the digestive stool analysis.
Additional Breath Tests:
Some practitioners also utilize a fructose intolerance and lactose intolerance breath test. I do not start with these tests. To quickly address gut symptoms, I recommend immediately implementing a low fermentable eating plan. During SIBO/ SIFO treatment, fructose and lactose are removed. Post treatment we will then challenge (test) these foods to see if they cause digestive distress.
I feel that we can save money by forgoing these tests:
- Fructose Intolerance Breath Test
- Lactose Intolerance Breath Test