I had a patient come in to see me the other day who had had diarrhea for two years – yes, TWO YEARS! It started randomly, totally out of the blue, and she her whole life had suffered every since. She had to plan her social life around it – what social life she had left, that is; and she had lost a lot of weight. Not being into allopathic medicine, and not knowing a whole lot about natural medicine, it took her a while to figure out where to go and who to see. I love evaluating undiagnosed digestive issues – it’s like a mystery to solve, but more often than not there is an underlying cause that can be identified using functional testing.
In looking at a situation like this, there are a few key things that I would evaluate to try to find the root cause of what is going on. Very rarely do I run this panel of tests and look into these possibilities and not find out what’s going on. She was desperate for answers by this point, so she was happy to do all of these tests to try and find a solution to her problem:-
Evaluating Undiagnosed Digestive Issues
- The first thing I would test for is intestinal parasites. Given the sudden onset of symptoms, and the chronicity of the diarrhea, a gut bug of some kind could be quite likely. All it takes it to eat at a restaurant where one of the workers did not practice good hygiene, and ta-da, a parasite such as Giardia, Cryptosporidium or Blastocystis might take hold. Even parasites that are not always considered pathogenic like Entamoeba histolytica could potentially cause problems in some people. I also tested her through a panel that included Helicobacter pylori, even though that is a bacteria of the stomach and usually presents somewhat differently – but we were on a mission to rule everything out. The test I used was BioHealth Diagnostics’ stool test for parasites and H. pylori. This test will also report bacterial imbalances in the gut, which are important to know about, even though I don’t typically find them to be the primary culprit.
- Candida – yeast overgrowth can cause a myriad of digestive issues. I have written extensively about Candida because it is so common. Candida occurs naturally in our gut, it is supposed to be there – it’s when it gets overgrown that it becomes a problem. Candida overgrowth happens easily in someone who takes a lot of antibiotics, eats a lot of sugar, or has some other inflammatory situation going on that leaves the intestines in a compromised state (such as parasites or gluten intolerance). I chose the urine Microbial Organic Acid Test by Great Plains Lab for this.
- Food sensitivities – I definitely wanted to assess for food sensitivities or intolerances in this case, just to see if there was anything in the diet that could be triggering problems. Food sensitivities are different from full-blown food allergies, so they can be harder to identify – the reactions can take up to 3 days to come on, so they’re less obvious. Food sensitivities can change over time based on other stressors in the gut, leakiness of the gut, nutritional status and other causes of inflammation. We did the Great Plains Lab IgG food sensitivity test, which just required a simple finger stick. It will check for 95 different foods.
- Gluten intolerance – gluten intolerance is a different thing to a food sensitivity. In food sensitivities, we’re looking at general IgG reactions to foods – meaning, it’s an immune response, but not necessarily auto-immune. Gluten intolerance is auto-immune, and so there are different tests for that than the IgG foods (which we do by finger stick test). I sent this patient to Enterolab to do this test, as I have found their stool testing to be more sensitive than standard gluten intolerance blood tests. I have also seen gluten intolerance come on after parasitic infections – somehow the parasite causes enough distress to the gut to trigger the gluten problems. I worked with a guy at a gym in Australia many years ago who had an acute Giardia infection, and ended up with full-blown celiac disease, when he had been able to tolerate gluten just fine his whole life. He lost a ton of weight and went from big strong bodybuilder to fairly emaciated and malnourished in a short space of time, with chronic diarrhea being a central symptom.
- SIBO – I decided to run the SIBO test on this patient too, just to be really complete. Testing for SIBO is not a perfect science, but given that we were wanting all the information, it was worth running. I used Genova’s SIBO test, which is a hydrogen breath test. One drinks a solution of lactulose, then blows into a pouch and the gas levels are measured by the lab. Small intestinal bacterial overgrowth can mimic symptoms of lower intestinal issues, including diarrhea and malabsorption.
I am pretty confident that this panel of testing will get to the bottom of it (so to speak). It’s kind of a lot for the patient to co-ordinate, given most collections will be done at home, but she was excited to have a direction, a plan, and to find an underlying cause. Once results are back, I’ll write another post about what we found and what we’re doing to address it.
I love functional medicine testing for this exact reason – it can help in evaluating undiagnosed digestive issues as well as many other health issues that may otherwise be quite mysterious.