About Intestinal Dysfunction Symptoms, Testing & Support
Many with Lyme disease and tick-borne infections have intestinal dysfunction caused by the illness or using antibiotics. Symptoms and signs of intestinal dysfunction include:
- intestinal and abdominal bloating and gassiness,
- constipation,
- loose stools,
- diarrhea,
- undigested food, and
- abdominal cramping.
In this article I lay out a screening and testing approach I use with my patients at Marty Ross MD Healing Arts. While the focus of this article is about tests and a screening questionaire, I also provide care regimen ideas through links to other articles on this site or limited recommendations here.
Note, this article does not address constipation. Some people that have methane producing small intestinal bacteria overgrowth (SIBO), which I describe below, can have constipation as a key part of that diagnosis. Addressing SIBO can improve the constipation. In the future, I plan to write an article about constipation.
First – Intestinal Yeast Overgrowth
Too many yeast in the intestines can occur before addressing Lyme. But addressing Lyme with herbal and prescription antibiotics can kill good intestinal bacteria, leading to intestinal yeast overgrowth and intestinal dysfunction.
Don’t Trust The Tests – A Yeast Questionnaire is Best
Testing for yeast has many problems and is often not correct. These tests include
- stool studies to see if there are large quantities of yeast,
- blood tests to see if someone has antibodies against yeast, and
- urine tests to see there are excessive organic acids, like arabinose, produced by yeast.
Because these tests are not reliable, I use a yeast screening tool. This tool looks at risk factors for yeast and intensity of yeast symptoms. In my experience, I find improvements in intestinal dysfunction when I address intestinal yeast overgrowth with antimicrobials when a score is over 140.
Yeast Care Steps
See Kills & Prevents Yeast: A Brief Guide for care ideas.
Why Yeast Testing Is Not Accurate
Stool studies often do not show excessive yeast when someone has a screening score of 140 or higher. Yet, I usually find great benefit in addressing yeast in these situations. That is why I say stool studies are not accurate.
Yeast normally live in healthy amounts in our intestines. Usually intestinal yeast do not lead to intestinal dysfunction because other germs and bacteria in the gut keep the yeast under control. Because yeast live in the gut normally, they can trigger the immune system to make antibodies. Detecting yeast antibodies in the blood does not mean yeast are growing too much. It just means the immune system has seen the yeast even at healthy levels.
Yeast do make organic acids, like arabinose and tartaric acid that get absorbed into the blood. These are then cleaned out by the urine where they can be detected. However, there are no studies that validate whether elevated organic acid tests in the stool truly mean that someone has increased intestinal yeast. In addition, there are no studies that show if too many yeast always produce excessive organic acids like arabinose or tartaric acid. So – these tests are not reliable.
Next Up – SIBO
Too many bacteria living in the small intestines can trigger gassiness and bloating. This condition is called Small Intestine Bacterial Overgrowth (SIBO). It can sometimes lead to poor food digestion too. If a person has a normal yeast screening score and is gassy or bloated – or is cared for intestinal yeast, but does not improve – then it is time to test for SIBO.
The SIBO Tests
There are two ways to test for SIBO. One is to have a culture of your small intestines. If too many bacteria grow, then a person has SIBO. An intestine specialist has to perform this test using a scope which is passed through the mouth into the intestines. Because of cost and comfort issues, this test is often not done.
The easiest way to test is called a SIBO Breath Test. It is not as exact as the test above. In the breath test a person swallows lactulose or glucose sugar water. Then, over a two or three hour time period you collect breath samples. If a person’s breath contains high amounts of hydrogen or methane, the test is positive. This test can be performed at home. In my practice, I use the test kit from Genova Diagnostics.
The downside to the SIBO Breath Test is it only finds up to 70 percent of people that have the illness. So you could have a negative test, but still have the condition. For this reason, the small intestine culture is much more accurate.
SIBO Therapy Steps
Read Small Intestinal Bacterial Overgrowth (SIBO) in Lyme Disease for care regimen steps.
When All Else Fails – Comprehensive Stool Analysis
Think of getting a comprehensive stool analysis if the yeast questionnaire is negative or if addressing yeast does not correct cramping, loose stools and/or constipation. Get a SIBO test done too while doing a comprehensive stool analysis if you have lots of gassiness and bloating in addition to cramping, loose stools and/or constipation after caring for intestinal yeast overgrowth.
Genova Diagnostics, Doctor’s Data, GI Map, and Great Plains Lab all offer a comprehensive stool analysis. For this test, you collect a sample of stool and then send it to the lab for evaluation. The lab will look for
- parasite and bacterial infections that should not be there,
- amounts of common bacteria and parasites that should be there,
- calprotectin,
- pancreatic elastase,
- beta-glucuronidase, and
- zonulin.
If testing shows you have a parasite or a bacterial infection, address these with the appropriate herbal or prescription antimicrobial based on the infection.
About Calprotectin
Calprotectin is an inflammatory chemical that is present in Crohn’s Disease and/or Ulcerative Colitis.
Steps to Adress Elevated Calprotectin
If Calprotectin is elevated, you should see a GI specialist to have a colonoscopy evaluation of your intestines to see if you actually have one of these conditions.
About Elastase
Elastase is an enzyme made by the pancreas. If it is low, it means your pancreas is not making enough digestive enzymes. Lack of digestive enzymes leads to poor digestion and loose stools with cramping. A cause of this can be dysfunction of the intestinal skin (epithelium) caused by imbalance of good intestinal bacteria. Healthy intestinal epithelium signals the pancreas to make pancreatic digestive enzymes. This imbalance in healthy bacteria is called intestinal dysbiosis.
Steps to Address Elevated Elastase
The regimen for pancreatic insufficiency includes probiotics and pancreatic enzymes.
- For information about how to use probiotics see Your Guide to a Healthy Intestinal Microbiome—Even on Antibiotics.
- For pancreatic enzymes I like to use Similase by Integrative Therapeutics 2 pills before meals 3 times a day.
About Beta-glucuronidase
Beta-glucuronidase is an enzyme made by unhealthy bacteria. It breaks off water soluble chemicals that liver detoxification places on fat-based toxins. These now water soluble toxins mix with stool and then get pooped out. But excessive beta-glucuronidase breaks the water soluble group off these toxins. These fat-based toxins then get reabsorbed back into the bloodstream. So elevated Beta-glucuronidase means you have intestinal dysbiosis.
Steps to Address Elevated Beta-glucoronidase
The care regimen for elevated beta-glucuronidase is probiotics and killing any bacteria pathogens or infections that show up in the stool studies with an appropriate antimicrobial targeting those germs. For information about how to use probiotics see Your Guide to a Healthy Intestinal Microbiome—Even on Antibiotics.
About Zonulin
Zonulin is a chemical made by intestinal epithelium when there is dysbiosis or in reaction to gliadin found in wheat. Zonulin causes gaps to develop between intestinal cells – leading to leaky gut syndrome. In leaky gut syndrome gaps in the intestinal barrier allow partly digested food, toxins, and allergens to reach immune cells that line the intestines triggering allergy and inflammatory chemical production – including cytokines. So increased Zonulin can indicate leaky gut syndrome. However, there is a question about the accuracy of this test. It is possible to have leaky gut syndrome while having normal zonulin. And the test at times may falsely determine zonulin even when it is not present.
Steps to Address Leaky Gut Syndrome
See Your Guide to a Healthy Intestinal Microbiome—Even on Antibiotics for more information.
Watery Stools Only
If your main problem is watery stools with cramping, get a stool test for Clostridium difficile (C. diff) toxin. This test is run by a regular lab. C. diff is a bacteria that lives in healthy amounts in the intestines. At times when a person is on antibiotics or has been on antibiotics, this germ can grow too much releasing a toxin that causes cramping and watery diarrhea.
Steps to Address C. Difficile
For more information see C. Difficile Diarrhea.
Disclaimer
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