August 15, 2025 • 60 mins
Today, we’re diving into a hot topic that many of you have asked about: gut health testing. There are so many testing options out there claiming to provide answers for your digestive issues — from food sensitivity panels to comprehensive stool tests. But how many of these are actually validated, and which ones are just burning a hole in your wallet?
Whether you’re wondering about IgG food sensitivity testing, the GI-MAP stool test, or hydrogen/methane breath testing, we cover it all — plus, we share our professional take on what’s truly worth your time and money when navigating IBS and gut symptoms.
⏱️ Chapters:
- (0:00) — Episode Teaser
- (0:43) — Welcome to the Gut Fit Nutrition Podcast
- (1:36) — Today's Episode & Our Guest
- (1:52) — Andrea's Background & Career Journey
- (6:15) — Setting the Stage: Gut Health Testing Overview
- (6:49) — IgG Food Sensitivity Testing & Why It’s Misleading
- (14:02) — Food Anxiety, Elimination Diets & Gut–Brain Connection
- (21:08) — GI Map Testing: Popular but Problematic
- (31:12) — H. pylori & Fecal Elastase: When Testing Makes Sense
- (37:03) — Pancreatic Insufficiency, IBS Overlap & Enzyme Therapy
- (42:38) — Celiac Screening (TTG IgA) & Why It’s Essential
- (45:49) — Hydrogen & Methane Breath Tests: SIBO & IMO
- (53:01) — Elemental Diets as an Alternative Approach
- (56:44) — Overrated vs Underrated Gut Health Tests
- (59:16) — Outro & Listener Invitation
👤 Today’s Guest: Andrea Hardy RD
Andrea Hardy is a registered dietitian from Calgary, Canada where she runs a multi-disciplinary digestive health practice called Ignite Nutrition. She specializes in gut health & gastrointestinal diseases and is recognized in the media as Canada’s Gut Health Expert. She is passionate about translating science into ‘easy to digest’ information to support a healthy gut. She has spoken on the TEDx stage, as well as internationally about digestive health.
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👩🏻💻 RESOURCES & LINKS MENTIONED: ⤵️
📌 Why I Don’t Recommend Commercial Stool Tests (Aka Microbiome Testing) Just Yet
📌 What the Science Says: This Dietitian's Honest Thoughts on Food Sensitivity Blood Tests
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
I've seen physicians recommend it, I've seen dietitians
recommend it. And the problem is, is and and
like I post about it on Instagram the other day and a
dietitian had said, you know, I respectfully disagree because
this test has helped people. That's not how science works.
We need to validate the test because a lot of times with GI
(00:22):
diagnosis that are functional, the trajectory is as people get
better over time. So like we can't just treat
people and be like, oh, it was the treatment that made them
better. We need scientific evidence to
tease out, you know, placebo effect, natural disease
trajectory, all of these sorts of things that result.
In improvement, welcome to the Gut Fit Nutrition Podcast, the
(00:45):
show where we dive deep into theworld of gut health, nutrition,
and fitness to help you unlock your best self from the inside
out. I'm your host Lee Morado, a
registered dietitian, gut healthexpert, long distance runner,
and movement enthusiast on a mission to empower you with
science backed whole body strategies to fuel your body,
heal your gut, and thrive in your active life.
(01:06):
Whether you're here to finally break free from IBS and
digestive symptoms, optimize your fitness performance, or
learn how to support your gut health with natural strategies,
you're in the right place. Each week, we'll explore topics
like conquering digestive symptoms, building a gut
friendly lifestyle, enhancing endurance and strength
performance, and more. So grab a cup of your favorite
gut friendly tea and settle in, because we're about to get gut
(01:29):
fit together. Today we're diving into a hot
topic that many of you have asked about, gut health testing.
There are so many testing options out there claiming to
provide answers for your digestive issues, from food
sensitivity panels to comprehensive stool test.
But how many of these tests are actually validated and which
(01:49):
ones are just going to burn a hole in your wallet?
To help me unpack the science and the hype, I'm joined by my
colleague and fellow gut health dietitian, Andrea Hardy.
Andrea is based in Calgary, AB, and her clinic, Ignite
Nutrition, specializes in helping people with IBS and
digestive concerns cut through the noise, understand their
symptoms, and feel empowered in their gut health journey.
(02:10):
She's passionate about helping people make informed choices,
especially when it comes to testing.
What are you wondering about? IgG food sensitivity testing,
the GI map stool test, celiac testing or SIBO, AKA hydrogen
methane breath testing. We cover it all.
Plus, we share our professional take on what's truly worth your
(02:31):
time and money when navigating IBS and gut symptoms.
Let's get into it, OK? Hello Andrea, welcome to the
show. Hey, thanks for having me.
I'm so excited to be having thisconversation with you about, you
know, all of these GI tests and what works, what doesn't, what
we should be saving our money on.
So yeah, it'll. Be definitely, yeah, definitely.
(02:53):
I know I asked my audience what would be interesting and this
was the, the top topic in terms of gut health tests.
Just to go through the, the mostcommon ones that people talk
about and what what people should be focusing on and what
they should probably skip and not waste their money on.
So super excited just to introduce yourself.
Do you want to tell us a little bit more about you, where you're
(03:14):
located, and who you help currently?
Sure. So I'm Andrea Hardy.
I'm a registered dietitian. I have a Canada wide private
practice called Ignite Nutritionwhere I have a team of amazing
GI dietitians. I'm a psychologist to help
people with GI disorders. And then in addition to that, I
do a lot of media speaking and science communication through
(03:38):
Instagram at Andrea Hardy Rd. And my ultimate goal is really
to help connect people with sound nutrition science,
especially in the field of gastroenterology.
I struggle with GI issues myselfand I just feel like, you know,
a lot of times it's taboo, It's hard to talk about, and there's
(03:59):
a lot of misinformation out there that we need to tackle as
well. Definitely.
And I know you also help other practitioners as well as I've
been in your professional or your GI support supervision
group. Yeah, we do a lot through gut
Ed. It's just gut dash Ed dot.
Com. And we do help a lot of
(04:20):
dietitians with continuing education.
We have some amazing free resources.
We have the guidebook, which is like we are slowly adding a
whole bunch of GI topics. I think we probably have like 8
or 9 GI topics that are fairly well-rounded in there right now.
So SIBO, IBSIBDILS, diarrhea, wekind of cover it all right now.
(04:40):
Yeah, and the monthly journal club as well.
Yeah, recently very excited for that too.
So yeah, awesome. Cool.
And what, what got you into, I guess digestive health and made
you want to focus on this as a, as a dietitian, right?
My background really was actually working in acute care.
(05:01):
So I spent a lot of time workingin ICUCVICU, liver transplant,
all of which has significant overlap with GI.
And then I worked in oncology. Again, significant overlap with
GI because chemo, radiation, surgery all impact the GI tract
for a lot of cancer patients. As I was working in the
(05:23):
beginning of my career, I was struggling myself with irritable
bowel syndrome. And I'm the type of person that
needs to know everything about everything.
So when I was diagnosed, I really dove into the research
and then my colleagues would come to me and ask me, this was
like when the low FODMAP diet was just coming out, my thoughts
on it, how I would implement it,all of these sorts of things.
So I moved and when I moved to anew city, instead of working in
(05:46):
acute care, I started a private practice knowing that there's so
many people to help with GI. It was so underserved 10 years
ago. Actually, it's my business's 10
year anniversary next week. So yeah, it's exciting.
And yeah, so we've had 10 years of GI care and trying to get the
message out about digestive disorders, which has really just
(06:06):
exploded the last 10 years. It's top of everybody's mind
when it comes to health. Yeah, definitely.
Gut health is a very trendy topic these days.
And as you said, a lot of good, like a lot more research out
there and good information, but a lot of misinformation too.
So which we will dive in for today.
So let's talk about gut health testing.
(06:27):
So we have sort of five on our list and I guess we'll just go
through each of them. We can talk about what the tests
do and sort of what conditions that they may test for and then
sort of our thoughts based on the current research and whether
they're either underrated. So something you maybe should
consider or overrated, somethingmaybe to skip or use with
(06:49):
caution. So the first one we'll go
through is IgG testing. So these are like the food
sensitivity blood tests, I thinkis like a common term that
people would maybe recognize them.
You know, here in Ontario, we have life labs.
I've seen like posters for thesetests in the lab and then I
think a lot of like naturopathicdoctors recommend them.
(07:11):
I haven't seen many dietitians, but essentially what they test
for IgG antibodies in the blood and they claim to help you
identify different food intolerances or sensitivities.
So essentially, what are your thoughts on these tests?
I know mine but. Yeah, right.
I'm sure we are of the same mind, but you know, Ige testing
(07:36):
is not evidence based and here'swhy.
So as we go through these tests,I think it's really important to
have some context around tests that are offered outside of
conventional medicine. Some have evidence, some have
evidence that is poorly done. In the case of IgG testing, this
is an example and some completely lack evidence, but at
(07:59):
the end of the day, you're paying money to try to find a
solution to something you're struggling with.
So I have so much empathy there.You're, you know, probably have
gone down the conventional medicine route and just either
haven't been heard or feel like the solutions don't resonate
with you or they haven't worked.And so it makes sense that
you're seeking an answer. And a lot of times these tests
(08:21):
over promise. And this is definitely the case
with IgG testing saying, you know, your digestive issues,
your health issues, your fatigue, your, you know,
whatever is because you have food sensitivity that can't be
diagnosed in a traditional manner.
So pay us $500, we'll tell you what you can and can't eat and
we'll make you all better. So with the IgG testing, I think
(08:47):
it's important to understand what IgG is and it really is an
antibody that is produced when the immune system responds.
And so the immune system responds in two different ways.
1 is in a reactive way, in a defensive way like we would see
with Ige mediated allergies and then one is in a recognition
(09:08):
kind of way. And the science is a little bit
out on IgG, but we know there's different types of IgG where
some response, you know, reactively and then where it
responds to recognize. And it's really hard to tease
that out. And it hasn't been validated
(09:28):
that measuring IgG response is going to tell you what you're
intolerant to versus what your immune system is recognizing.
Because your immune system is kind of like, you know,
cataloging things as it comes in.
It's like safe, unsafe, safe, unsafe.
IgG is part of that recognition system.
And so just simply producing IgGdoesn't necessarily tell us what
(09:51):
your immune system's actually doing.
I think what's also important torecognize is that certain foods
are more antigenic, meaning thatthey elicit a bigger immune
response than other foods. And that's not necessarily a bad
thing. Those antigenic foods are those
top priority allergens. Wheat, dairy, soy, eggs, all are
(10:14):
more antigenic. Your immune system is inherently
going to, you know, do a little bit more work in identifying
those proteins. So you're going to get an IgG
response. And so when patients bring me
these burritos, of course, a lotof times the most antigenic
foods are high because their immune system's like, hey, yeah,
(10:36):
we recognize these. They're the foods you consume
regularly, and we're recognizingthem.
But the way that these tests getinterpreted is you eat these
foods all the time. No wonder you're so sick.
Just cut them out. You'll feel better.
And so it's very validating for people to get the results and be
like, oh, no wonder I'm so sick.These are such common foods.
(11:00):
I eat them all the time. And so it's very easy to like,
feel like this test is the rightanswer as well.
When we cut out things like wheat, dairy, eggs, soy, what
are we left with? We're left with exactly Whole
Foods that you have to cook fromscratch.
(11:20):
It's going to be, you know, typically a very simple diet.
It's going to require you to overhaul your diet, put more
attention into your diet. And inherently, people could
feel better by doing this because they're overhauling
their diet. They're choosing more Whole
Foods that they're making from scratch.
(11:41):
And it could have nothing to do with these tests at all or the
results of these tests at all. And of course, a lot of those
foods inherently tend to be higher in Fodmaps when we're
talking about dairy, wheat and soy, specifically the nuts and
seeds, some of the legumes, moreantigenic.
So I do wonder, you know, is cutting out those foods just
(12:02):
reducing the overall on map loadfor a lot of these people
resulting in symptom? Improvement.
Yeah, that's a good point too. And I think just the process of
like using these tests, I think they're typically recommended to
like and say by a natural healthpractitioner to do the test.
And then you cut out all the foods that it says you're
(12:22):
sensitive for. I think they usually do like 4
weeks, you eliminate them and then one by one you test them
back in. That can be quite challenging if
there's like 20 to 30 foods on that list.
And I've had a lot of people whohave gotten the test done and
they kind of thought about it and then they gave up on it
because it's just too complicated and restrictive to
(12:44):
even follow. So I think even from that
approach too, it can be hard to actually like implement the
results. And like you said too, is it if
they do end up implementing it, is it actually just your diet
quality is improving? It's similar with like someone
trying the Paleo diet or Whole 30 where yeah, they're eating
like a lot more single ingredient nutrient dense foods.
(13:05):
So you're probably feeling better as a result of that and
cutting out a lot of more, you know, more processed foods in
your diet. So it can be hard to tell what
what's actually helping in the situation.
So, and do you need a $400.00 test to to do that?
And then, you know, is there anyfear about adding those foods
back in? Because it certainly happens
(13:25):
with any other elimination diet is if you feel better cutting
out those 20 to 30 foods, are you going to hesitate
introducing adding them back in and end up on an extremely
unnecessarily restrictive diet that impacts your food
relationship, impacts your social life, impacts, you know,
how you feed you and your family.
(13:46):
So there's a lot of considerations there that I
think are often missed when we look at implementing A
restrictive diet to solve a health problem.
Yeah, yeah, that's a good point too.
Even in the case of IBS, like, you know, it's quite common for
people to feel anxious just about eating.
So if you're feeling nervous about eating a certain food,
that can actually just impact the gut brain connection and a
(14:08):
sense can make you actually react to the food just because
you're feeling more more anxiousor more nervous about having it.
So whether it's the food or it'ssort of what's going on in your
body and you're just reacting ina sense that can occur too.
Once we, you know, start blindlycutting out all these foods and
you know, start worrying about every little thing that we eat,
which is not a fun place to be in either.
(14:30):
So. And it's not a fun place to be
in. And also down, you know,
$400.00. Yeah, like with your money.
And if you have the opportunity,work with a dietitian to figure
out, you know, what your symptoms are going or what's
going on with your symptoms and then evaluating like an actual
strategic evidence based plan tohelp resolve those.
(14:51):
Sometimes nutrition's the answer, sometimes it's actually
not. So having somebody really take a
critical look at that can help you on the right path.
Yeah, exactly. And with the, I think the other
issue too is with these tests isa lot of people say that they or
they think that they're testing for allergies.
I think there's like a common thing to sort of use allergy
(15:12):
intolerance and sensitivity likeinterchangeably when they're
actually different. So allergy is a, is an Ige
modulated reaction, which refersto like an actual allergy.
And that one is a, an immune response versus a food
intolerance could be IgG, but it's actually a response of like
(15:32):
your digestive tract. So either you lack an enzyme to
break down a certain food, like in the case of lactose
intolerance you lack lactase enzyme, then you may get
bloating, gas etcetera when you consume like milk or yogurt, but
it's not an immune mediated response.
Although you said like the IGIGGcan like be more antigenic to
(15:54):
the immune system, but it's not like an immune response.
I get a little bit tripped up inthe science there, but.
Yeah, yeah, for sure. And I mean, ultimately, you
know, when it comes to food intolerances and sensitivities,
there's so much we need to learn, and there's a lot that's
poorly understood. And we need to be careful about
(16:15):
predatory tests that profit off of pathologizing what might be a
normal immune response. Yeah, I have people that, you
know, have noted they feel better on their restrictive IgG
supported diet. And when we get into it, we
(16:37):
realize, you know, you've cut out a lot of Fodmaps and maybe
fructose is actually the problemor your diet qualities change,
or how frequently you've eaten has changed, how you prepare
your food has changed. So there's so many other factors
that might lead to you feeling better that could be considered
to reduce how restrictive the diet is.
(16:58):
Yeah, exactly. And it could be hard to
backtrack a little bit from that.
I think once you've cut out so many foods, like you said, then
people can be anxious to add them back in.
But as we would say from a whole, maybe skip these tests
and work with a dietitian so that you could have a plan to
identify what's going on withoutneeding to be so restrictive, at
(17:21):
least at the at the onset. Like some restriction may be
necessary, like if there is, youknow, a suspected intolerance or
allergy. But usually upfront, it's
probably not where we would start with anyways for someone
to cut out a bunch of. So yeah, I wanna say that even
in the case of like intolerances, I guess if we
(17:43):
think about like what may be driving the intolerances, there
may be like an immune connectionthere.
I was thinking about even in terms of like histamine
intolerance where we know it caneither be caused by is it DAO
like enzyme being low, which canoccur from I think different
like conditions etcetera. Or there may be like sort of an
(18:03):
overabundance of histamine production, I think which can
occur in like SIBO, which then there may be like an over
activation of the immune system.But you're still like low in
that sort of enzyme that helps breakdown histamine.
So that all to say, I was tryingto say that with an intolerance,
it's not I mean mediated, but there may be something deeper
going on that like involves the immune system.
(18:26):
Is that right? I don't know if I.
Sort of yeah, exactly. That's exactly it is OK.
Especially, you know, post COVIDinfections we see mast cells
behaving badly. So these are, you know, the best
cells that house a lot of immunemediated chemicals.
(18:47):
And when they release those immune mediated chemicals, they
result in symptoms that are allergic.
Like we know that people with IBS have a higher presence of
mast cells in their GI tract that contributes to visceral
hypersensitivity. We know that people with IBS
tend to have a microbial profilethat's more likely to cause
(19:09):
excess histamine production in the gut.
So all this to say, you're right, intolerance may have an
overlapping component with an immune mediated reaction.
And I think, you know, again, with this test, it's, it hasn't
been validated. They've, they've tried poorly.
(19:30):
I would say to go back and validate it with some studies
that are well designed and kind of like already have a
predetermined conclusion in mind.
Like they don't go into the science experiment curious with
a hypothesis. You can tell they've kind of
gone in with like, I'm going to prove this test works because
that's the goal of this study, you know, so.
(19:52):
It's not where we want to start with.
Science. No, exactly.
So I think, you know, at this point we can't measure your IgG
response to dietary, you know. Dietary proteins or components
or foods and use it in a diagnostic process 'cause it
hasn't been validated. We don't fully understand IgG
(20:17):
and you know the different typesof IgG and we're not good at
measuring those things, so skip it.
Yeah, and it would be amazing ifwe did have a, you know, a blood
test that could tell us all the foods that we were intolerant
to. But yeah, as you said, the
science just isn't there even in2025 S hopefully at some point,
(20:37):
but for now it's a pass. And then if someone were to be
considering or wondering how do I actually diet like understand
or, you know, investigate my food intolerances.
The gold standard that we still have is a structured elimination
diet and then a reintroduction diet, which suggests to do with
a dietitian so that you can do it properly and know what to, to
(21:00):
look for and be able to, you know, isolate or remove
additional variables so that we're not conflicting the
results as well. Yeah, which FODMAP, low FODMAP
diet is an example of that too. All right, so let's get into the
GI map test as our second. So I like to talk about this
(21:23):
one. I actually have a blog that I, I
think I published it maybe threeyears ago.
And it's definitely like the best performing blog on my
website. And I get a lot of like positive
emails around it and then other people that I get some sort of
angry emails about my my statements in that article.
Yeah, it's definitely something that I have not recommended in
(21:44):
practice. I've also never done it myself.
I think it's a past. But what are your thoughts on
this? Yeah, this one for me is a path
or like pass, don't do it. Because similarly to IgG
testing, the evidence just isn'tthere.
So like, I feel like as dietitians, we can't have it
both ways. We can't just use the science
(22:06):
when it's convenient for us and ignore the science when it
doesn't serve us. Unfortunately, we have to look
at it all, even if it irritates us and you get crazy comments on
your blog. So the ultimate thing is this,
you know, with the explosion andmicro site.
So GI map is a microbiome test where they measure a variety of
(22:26):
different microbes in your stooland they kind of like rate them
in this like super pretty print out of, you know, too much, too
little, the right amount. They also look at fecal
elastase, which is a validated test that we'll get into.
But there's a few other components of this test.
I've seen physicians recommend it.
(22:47):
I've seen dietitians recommend it.
And the problem is, is, and likeI post about it on Instagram the
other day and a dietitian had said, you know, I respectfully
disagree because this test has helped people.
That's not how science works. We need to validate the test
because a lot of times with GI diagnosis that are functional,
(23:12):
the trajectory is as people get better over time.
So like, we can't just treat people and be like, oh, it was
the treatment that made them better.
We need scientific evidence to tease out, you know, placebo
effect, natural disease trajectory, all of these sorts
of things that result in improvement.
So we can't just say like, you know, oh, I did this and this
(23:33):
person got better. Therefore it must be valid.
I always tell the story. One time I thought I got drunk
because I drank 2 beers outside a soccer stadium and it turns
out they were not alcoholic. Like, our brains are really
powerful things. About 30% of, you know,
interventions in a study are, you know, we get a 30% placebo
(23:56):
response or no SIBO response in the case of, you know, my
alcohol. But ultimately, you know, we
can't just go off of anecdote when it comes to these tests.
So GI map, it's really unfortunate because microbiome
science is exciting, but we haven't validated, you know,
(24:19):
clinical ranges for these microbes.
So when we think of our gut microbiome, we want to think of
it like a big forest, whole bunch of trees and animals and
it's really an ecosystem. And when we think of that
ecosystem, there might be, you know, things that exist in that
ecosystem that if they got out of balance might cause harm.
(24:42):
But in a functioning ecosystem could exist without actually
causing any issues. For example, E coli, you can
have E coli existing in your stool and it not be pathogenic
or not 'cause disease when it gets out of, you know, balance.
And there's certain types of E coli that you would get
(25:02):
infection. So the fact is, is we don't know
what a healthy microbiome looks like.
Each of these microbes would need really thorough scientific
research to determine what a reference range is.
And it just hasn't been done. So you can't just, you know,
(25:23):
measure a microbe and decide that you know, between like, you
know, 1 is bad and 10 is good. And the closer you, you get to
like, you know, 10 is, is better.
So we just, we don't have the research to really say that
those numbers are meaningful andthat they represent a normal
healthy gut. And then we certainly don't have
(25:45):
data to say that if you do XY and Z, if you take these
supplements that I'm now sellingyou, these microbes are going
to, you know, go away or improveor what have you.
Yeah. So the issue with the test too
is that they, I believe with theGI map, they come up with their
own parameters. Like it's just based on their
own numbers that they came up with in their own studies, which
(26:08):
is a big red flag. Like if someone is selling a
test to diagnose something, for them to come up with like just
their own data and their own parameters around what is good
and bad is definitely a red, redflag for sure.
And then, yeah, to that point aswell, I think like a lot of
times people are told to take this again from like natural
(26:29):
health practitioners, then they get the results back and then
they're given, you know, prescriptions for hundreds or
thousands of dollars of supplements to help fix the, you
know, the issues that this test comes back with.
But to your point, do we actually have the the research
that tells us, you know, what what is wrong?
Like, you know, what is the issue with your results?
And then how do we fix that? We just don't have that data
(26:51):
yet. So in a sense, people are still
sort of guessing on how to, you know, treat the results from
these tests exactly. And I mean the, there's been
like, I don't know if it's 60 minutes or whatever, but
ultimately someone I remember sent their GI sample to like 3
different of these microbiome, you know, test studies and all
(27:15):
the results were different. Like the reality is, is your
microbiome fluctuates day-to-day.
What my microbiome looks like today is probably different than
what it's going to look like tomorrow based off what I eat
and everything else but sleep, stress, all of these things.
And even in this one sample, they got a whole variety of
results because, you know, there's human error involved.
(27:38):
There's supplement sample contamination.
Like you're not in a lab doing this sample in a way that's
structured. All of these companies are, you
know, hopefully following best practice, but we don't really
know what that is. So you know, you might have a
diagnosis with GI map one day and then a week later you might
(27:59):
not actually meet their diagnostic criteria, right.
It's just it's, it's too variable to use unfortunately
right now as a tool to diagnose and treat the data for
diagnosis, we don't have the data for treatment.
Again, we're pathologizing your stool when you're struggling
because you would do this test when you're struggling with
(28:20):
something, whether that's, you know, floating or fatigue or
diarrhea or what have you. And it can feel really
validating to get this test. It can feel really validating to
get solutions and then you mightget better based on those
recommendations. So again, it's another source of
validation that doesn't necessarily provide us like good
clinical data. Right.
(28:41):
Because you could have inherently gotten better over
time. You could have made changes that
would have gotten you better without doing these tests.
Yeah. And for those listening that
haven't done or looked into the GI map test, essentially you put
like a little hammock on your toilet and you poop into it and
then you mail it into the lab. So as you said, like it's a lot
(29:03):
different doing it in the comfort of your home home versus
in a lab where they're able to, you know, keep things controlled
and more sterile etcetera, whichcan also impact the results.
So various issues with this testalso about you saying that that
it can change like day-to-day orweek to week.
I think also it's important to recognize like the your stool
(29:25):
won't look the same sort of throughout like your as it moves
through your intestinal tract oryour GI tract versus what you
actually poop out. So what you know the end result
is may not actually like match what it is sort of when it's
still in your body, which is also an issue too if we're using
that for. Results.
Yeah, there's some really cool news, science coming out, but
(29:47):
it's literally, you know, in thephase of exploration where
they're able to sample the microbiome throughout your
entire GI tract, which is reallycool.
And I can see that, you know, people are going to try to
capitalize on this and, you know, it's gonna turn into like
another GI map, but. Hopefully we can use that.
(30:10):
I'm sure it'll be AI powered as well.
Right. What is it?
Yeah. Yeah.
So it's not, we know it's not a validated test for IBS or SIBO
cannot which we'll get more intothe, the testing for SIBO
Candida I think is another one that people use to say and help
(30:33):
them identify that they had Candida overgrowth.
But the issue with that one likeyou said with E coli is that
Candida also naturally exists inyour intestinal tract.
And so just because you have presence of it in your stool or
a certain amount doesn't necessarily mean that you have a
Candida or fungal overgrowth. So another issue with that one
(30:55):
there. I was reading though the one
yeah, you mentioned fecal lastase and then also H pylori.
I wasn't too sure where I landedon that one.
They, I saw some sources say it could be helpful to detect like
presence of it. But what were your thoughts
around H pylori and the GI? Map, yeah, I need to re look at
it. I don't actually remember what
(31:16):
they're measuring in the GI map around H pylori, but I actually
we can use stool as a method of diagnosing H pylori.
Right. So it could be they could be
using the validated test. I wouldn't be surprised if they
were. I assume they were if they, you
know, they are, if they're, you know, using things like people
last days. So it could be helpful in that
(31:39):
case. My concern is, is like, you
know, who's prescribing you thistest?
Are they capable of diagnosing? Because I'm not, I'm a dietitian
and I can't diagnose you with anything, but I can, you know,
advocate to your physician to take a medical look and make
those decisions. Do you have a medical provider
(31:59):
that can diagnose that's overseeing the use of this test?
It's a big question. You don't want to just be
diagnosed Willy nilly by somebody who can't diagnose
legally and shouldn't be diagnosing doesn't have the
skills to diagnose. So yeah, if you are using it for
fecal last days in H pylori one,why don't you do the cheaper
individual tests if you're living in the US, I'm sure it's
(32:22):
much cheaper to do those separately than it is to the GI
map. It's in Canada.
Get it through a physician that can diagnose as opposed to
paying for an entire GI map to do to validated tests.
And frankly, it's very rare thatI would ever suggest to a
physician to do a fecal elasticsand H pylori at the same time
(32:42):
because the symptomology is so different.
You know, like if you have H pylori or if I suspect you have
H pylori, I'm going to tell the doctor this person has XY and Z
symptoms. Have they been tested for blah
blah, blah, blah, blah? If not, would you consider it
fecal elastase? Same thing, totally different
set of symptoms that I would present to the physician and
(33:04):
request a test. If they thought it was
appropriate, they might move. Ahead, right.
Yeah. So better to do more targeted
testing than just consider this GI map test that claims to look
at everything but really doesn'tproperly look at anything.
Because test sensitivity and specificity varies.
(33:24):
Like with the H pylori stool testing, it's sensitivity and
specificity. I know it's lower, so it's not
100%. So they could falsely diagnose
you with H pylori or they could miss diagnosing H pylori.
So we want to take it in the context of symptoms, not just
Willy nilly test everything in everybody.
(33:47):
Yeah, exactly. It's a good point and it makes
me sad too when I see people like recommended or they pay for
this test before really trying anything else.
Like even in the case of IBS, weknow that it can be really well
managed with dietary and lifestyle changes, you know,
which will get you a lot more results than doing a test and
taking a bunch of supplements, which really just won't, you
(34:09):
know, kind of mask the actual issues there.
So again, too, that's why it's. Yeah.
Accurate diagnosis. Right.
Yeah, exactly. So many issues with this test.
Yeah, I'm not a fan and I know Isent you the other day like a
yeah, a very popular gut health dietitian who said it was one of
the tests that every person withgut issues should run.
(34:33):
But yeah, you. Struggle with that sentiment.
Yeah. It just doesn't make sense at
this point. Yeah, I think it's like
anything. You can't really say that
there's one thing that everyone should do.
I mean maybe drink more water, but then again some people are
already drinking lots of water so maybe not.
(34:53):
Like reflux worse for people. Yeah, yeah, yeah.
It's interesting. I think as providers, 'cause I
assume dietitians listen to yourpodcast, we really need to
address some of our own biases in, you know, offering these
tests because we really want to help people.
And so if this test is sold to you and you're not super
(35:16):
confident in dissecting the science, you're like, this test
could help my patient, why wouldn't I do it?
And then they do present all this data that isn't, I've
combed through it. It's not research.
It's just, you know, pieced together again, cherry picking
to validate, you know, their particular stance on measuring
each of these microbes. So I think sometimes we need to
(35:39):
just take a step back and realize people want, you know,
people don't like the diagnosis of the irritable bowel syndrome.
They feel like it's not real. So they're looking for, you
know, these root causes. And this GI test can feel really
validating when in fact it, you know, is muddying the waters,
(35:59):
over complicating things and notnecessarily providing people
appropriate, you know, solutionsto their symptoms, let alone,
you know, the results of these tests.
Yeah, that's a good point too. And even as you said, like with
IBS, we know that they're like the microbiome profile is a lot
less diverse and less resilient.So probably if they were to do
(36:22):
these tests, if you had IBS, it's going to show you that
maybe there's low levels of yourhealthier bacteria.
But do we need like an $800 testto tell you that you should, you
know, you try to eat more, more diversity, try to improve your
diet to help improve your microbiome.
There's lots of things that you can do that we know can help
with improving the microbiome profile that are low cost or you
(36:44):
know, that you can fit into youreveryday.
Do you need to do a $800 test totell you that can save that
money for, you know, groceries and all the other stuff?
Vacation where your ideas will be so much better because too
relaxed. Yeah, exactly.
OK, We can talk about GI map allday, but hopefully we'll move
on. So the next one is the Ficola
(37:05):
last days. Yeah, so we kind of touched on
this, but fecal elastase is a valid test and it kind of loops
back to GI map because they do do fecal elastase.
So fecal elastase is really a measure of elastase is an enzyme
produced by your pancreas to help in digestion.
And sometimes if you're experiencing symptoms of
(37:26):
diarrhea, you know, fat malabsorption, the doctor may
order a fecal elastase to see how much of this elastase is in
your stool. If it's low, it could mean that
you have pancreatic exocrine insufficiency.
So basically your pancreas isn'tproducing enough enzymes to
properly digest. And the concern with this is, is
(37:47):
malnutrition in really severe cases that you might have issues
with fat soluble vitamins, thoseof those and then you know, you
might actually malabsorb nutrition like macro nutrients
as well, especially with the volume of diarrhea some patients
experience. So that test can be helpful in
determining what further work upis needed because usually
(38:10):
pancreatic exocrine insufficiency is associated with
other health conditions. Cystic fibrosis is the big one.
Most people with cystic fibrosiswill be diagnosed at a very
young age, but also diabetes, pancreatic cancer, chronic
pancreatitis, you know, structural abnormalities with
your pancreas that you might have been born with, pancreas
(38:31):
division. All of these things can
contribute to pancreatic exocritinsufficiency.
So they'll look into getting a proper diagnosis for you.
What is the cause of your pancreas not producing enough
enzyme And then treat that plus typically enzyme replacement
therapy. Yeah.
And even yeah, in the case of IBS too, I'm sure you've seen it
(38:52):
a lot, but someone may get diagnosed with diarrhea dominant
IBS or IBSD, which do present with more loose stools.
And then the symptoms of IBS like abdominal pain and
bloating, but with exocrine pancreatic insufficiency, it can
like mimic the symptoms of IBSD.So you do get a lot of like
abdominal pain, very frequent loose stool, difficulty like
(39:14):
absorbing fats, so maybe more greasy stool, fatigue, which can
overlap. So even in the case of
someone's, you know, been diagnosed with IBSD or they
think they have IBS but it's notreally getting better even with
like low FODMAP diet or sort of trying the, you know, common IBS
management strategies, then it could be helpful to test for it
to rule it out and then get the proper treatment for it.
(39:38):
Yeah. And it is a simple test.
It is a relatively inexpensive test and you're right, it should
be looked at. I believe it's like do you
remember? I don't know the exact
statistic, but it's quite a large portion of people with
chronic diarrhea that have EPI or PEI.
It's like. Yeah, I'd have to look at maybe.
(39:59):
10% or 5% but. I'd have to double check, but
it's actually, it's not just like a small minuscule amount of
people with, you know, undiagnosed chronic diarrhea.
It's, it's a pretty good chunk. So if your chronic diarrhea is
not responding to standard intervention, then it should
absolutely be considered. And that's again, where like we
(40:21):
or I or other dietitians might advocate to your physician
because we spend more time with you typically than your
physician. So we can say this is what's
going on, why we think this testmight be valuable.
And then the treatment for it islike prescription strength
digestive enzymes. So Creon is a common one here in
Canada, which is not a somethingyou would typically give to like
(40:43):
an IBS patient unless you suspected that they had EPI.
Sure. Yeah, you can do over the
counter enzymes. That's such a good point.
I think a lot of people think they can just pick up any
digestive enzyme blend they findin like the natural health
section. But that's like, I was going to
make like a silly reference, butlike, yeah, it's such a small,
(41:05):
miniscule dose of what you wouldneed to overcome what your
pancreas is not doing for you. Yeah.
And I'd like to say like sometimes people take those over
the counter enzymes and are like, I feel better.
It doesn't mean you have extra and pancreatic insufficiency.
Lots of those enzymes contain like alpha galactosidase, which
(41:25):
helps to breakdown galactolidosaccharide sounded
like beans and nuts and some grains and or they contain
lactase or again ties back to the placebo effect.
Doing something typically can help people feel better.
So yeah, we just want to be cautious and drawing
conclusions. Your pancreas might be a OK.
(41:46):
Yeah. And so back to the point about
the GI map test, it does claim to test for fecal elastase, but
you could always start with the one that you can do through your
doctor, your medical team, whichwill cost a lot less and give
you more targeted result of investigation, so.
Yeah, I'm getting like AGI work up right now due to some issues.
(42:10):
I think fecal last days was like$40 lab here in Mexico where I
live, which I assume is probablycomparable in the US.
Canada, you don't pay for your blood work anyways.
So yeah, yeah, but it's. So much less expensive on you on
the healthcare system than doingJMAP so.
(42:30):
Exactly, and the next test wouldbe TTGIGA or Celiac screening.
Yeah. So this is a blood test where
we're measuring TTGIGA, which isa antibody that's produced by
those with celiac disease as a result of inappropriate immune
(42:53):
response or an autoimmune response to the protein found in
wheat, barley and rye, which is gluten as a protein.
And so what's important about this test is you actually have
to have consumed wheat for the test to have validity.
So it's a really important part of working out any sort of GI
(43:15):
diagnosis. If you're experiencing things
like diarrhea, bloating, even Constipation, fatigue, ruling
out celiac disease should be like, you know, the very first
step that people take. A good chunk of celiac disease
is asymptomatic. So you might not have intestinal
symptoms. You might have extra intestinal
(43:36):
symptoms like fatigue, like vitamin deficiencies that are
unexplained, low iron. And so celiac screen is really
important. That means that it's the first
step in diagnosing celiac disease.
It's sensitivity or ability to accurately diagnose people with
celiac disease isn't 100%, so a follow up if your symptoms
(44:01):
require for their follow up would be a biopsy as the gold
standard. I think previously here in, in,
I know in Ontario we had to pay for the celiac blood testing.
But I think maybe as of two years ago, well, they started
with like a pilot project to make it free.
And then I think they've continued it.
(44:23):
So now people don't have to pay for the celiac testing if they
meet the criteria, which I thinkbefore was a little bit of a
deterrent. It was like $100 and some people
didn't want to pay for it. But even in the case of of, you
know, IBS or, or determining if you have IBS, it is important to
rule out celiac disease first because a lot of the symptoms
(44:45):
can overlap. And then if you want to, you
know, with IBS, maybe try a lower FODMAP diet or some people
do want to try gluten free. It's much better to rule out
celiac first while you're still eating gluten before you go to
cut it out because it can be difficult then to add it back in
if you're feeling better but still having symptoms, it is
(45:06):
important to rule it out initially.
And yeah, I was reading on this,I think it was Celiac Canada
website. But the typical symptoms are
diarrhea, pain, weight loss. However, they now say like a lot
of patients can present with atypical symptoms.
So anemia is 1, osteoporosis, oral ulcers, Constipation.
(45:28):
So not just diarrhea, but not having bowel movements as well,
infertility and neurological problems.
So a lot of symptoms, but it canpresent in different ways.
So it is important to rule it out.
And then let's get into the lastTest.
So the hydrogen and methane breath test, what are your
thoughts on on this one? This one is like a use
(45:51):
judiciously test. So hydrogen and methane breath
testing measures hydrogen and methane that you expire or
breathe out when you're given a specific substrate.
So we use Lactulose or glucose, you can assume that and then it
allows you consume that like fasted not eating, and then your
(46:15):
microbes go to work and break that down.
You shouldn't have too many microbes high up in your
intestine, in your small bowel, and you should have lots of
microbes to digest that substrate in your colon.
And so this test is used to diagnose small intestinal
bacterial overgrowth or intestinal methanogenic
(46:35):
overgrowth. Done.
Really, the only way your body can produce hydrogen or methane
is through microbes. So it's like a direct
measurement. It's not like you're producing
hydrogen and methane any other way.
So it's a very direct test. The problem with this test is
that the sensitivity and specificity, meaning ability to
positively or accurately diagnose someone who's positive
(46:58):
or rule out somebody who's actually negative, is less than
perfect for so many reasons. In particular, how quickly your
GI tract moves and how your bodyabsorbs the substrate if you're
using glucose, because your bodywill absorb it.
So it's not a perfect test. However, it can be a really
helpful test in determining who is best going to respond to
(47:22):
antibiotics. So if you have a positive
hydrogen and methane breath test, you're more likely to
adequately respond or have an improvement with antibiotic
treatment for that SIBO or IMO. So as dietitians here, but a lot
of people might not know this isrifaximin is an antibiotic
(47:44):
that's approved for treating irritable bowel syndrome,
diarrhea. It's also the antibiotic we've
used to treat SIBO. However, people with IBSD who
haven't had a hydrogen and methane breath test, it doesn't
work all of the time and sometimes needs multiple rounds.
People with the hydrogen and methane breath test that's
(48:04):
positive, they're more likely torespond to that rifaximin.
So I like hydrogen and methane breath testing if I have a
patient who has irritable bowel syndrome overlapped with what I
think is SIBO, to better determine who is going to best
respond to antibiotics because they're expensive, they're hard
to access, and it really validates the potential use of
(48:25):
those antibiotics when other options for IBS management have
failed. Yeah.
And the, yeah, I know I've seen,I think it's similar to the GI
map test, but it's recommended alot online.
The online gut health space, I think it was, I don't know if
I've seen as many posts about it, but I think a couple years
ago SIBO was getting a lot of attention and there were a lot
(48:47):
of posts saying like at least 50% or 50 to 80% of people with
IDs have SIBO. So you should be tested for it
and you should be treating it, which is not necessarily true.
I mean, even now we know there'stwo different types of SIBO.
So there's SIBO, which is small intestinal bacterial overgrowth,
which refers to having more bacteria in your small bowel,
(49:08):
which technically most of our microbiome is housed in our
large bowel. We shouldn't have much microbes
in our small bowel. So if there are more microbes
there, it can cause issues. And then in the case of
intestinal methanogen overgrowth, that's a growth of
not a bacteria, but microbe known as methanogens, which can
occur throughout both the large and small, but also two types
(49:30):
which can present in different symptoms, diarrhea,
Constipation, etcetera. But to your point that it may
lack in specificity and sensitivity, it might not be the
best test to just jump to if you're having IBS symptoms.
Might be good to maybe trial some of the strategies for IBS
1st and see how you respond and then working with your medical
(49:51):
team based on, you know, lookingat your clinical symptoms and
how you're responding, then maybe considering doing the
test. Yeah, I totally agree, because
it's not a perfect test. So in the context of, you know,
really thinking about what the trajectory will look like for a
patient who has a positive test,it's hard, it's expensive.
(50:11):
It's, you know, we don't want tounnecessarily recommend
antibiotics. We want to make sure that our
intervention actually has an impact, especially when that
intervention holds risk. So because the test isn't
perfect, that's why I always tryto manage those symptoms prior
(50:34):
to jumping to the hydrogen and methane breath testing as
opposed to, like you said that like first line approach.
Because the test is so for example, TTGIGA that we just
talked about has a sensitivity and specificity in the high 90s,
meaning that like very few people are wrongly diagnosed or
(50:54):
missed. Hydrogen and methane breath
testing is like depends on what study you look at, but it can
range like, you know, 40 to 60% sensitivity, meaning we're
missing the other 40 to 60%. And then the specificity can be
quite high actually. So we're not wrongly diagnosing
people, but it's still not, you know, high 90s, it's, you know,
(51:17):
80s. So you don't want to be wrongly
diagnosed either. Yeah, exactly.
And similar to the celiac testing where you need to be
eating gluten for a period of time before to get the right
results with the hydrogen methane breath testing, like
there's certain supplements you have to stop beforehand and then
the day before you're supposed to essentially do like a low,
(51:39):
low fiber, very bland diet and then fast for at least 12 hours
before. So even just how well you
actually, you know, committed and implemented the, the prep
for it can influence the resultstoo.
And I think the other factor toois also Constipation.
Like if someone is backed up andthere's stool back up, that can
actually muddy the the results too.
(52:01):
So different things could be going on and then the access of
it is difficult to like. And there's one private clinic
here in Toronto that I sometimeshave people get their doctor to
refer them to. But there's not a lot of options
for like in lab testing versus there are like home tests that
you could order. But it's similar with the GI map
(52:22):
test that like it's harder to control things when you're doing
it at home and that can impact the results too.
So it's, yeah, while you said it, it could be, you know,
helpful in certain cases. There's definitely things that
aren't perfect with it all around unfortunately, but.
Yeah, access is hard. And most importantly like we
need a doctor to diagnose and treat when we're, you know,
(52:43):
thinking about using these tests.
Otherwise it's for not. So, you know, we want to make
sure we have a a physician on board that understands SIBO and
IMO and is willing to provide anintervention based on the
results too. Exactly.
Yeah. Just to the point of about
(53:04):
responding to antibiotics, I know more recently there was a
study that came out looking at the elemental diet, so is that
similar as well? Using the breath tests can help
us predict who will respond better to an elemental diet for
SIBO. Yeah, I assume so.
So this study was interesting inthat the a good chunk of the
(53:25):
participants, this wasn't like their first time being diagnosed
with placebo or Ivo. That's a good point.
You know, they might have failedantibiotics or they might have
had two rounds of it. It wasn't really disclosed.
You know, did they not respond to antibiotics?
Did they relapse? Have they done a couple rounds?
(53:45):
Like it was very unclear, but what was interesting is is you
know, it had a very good response rate where people had a
negative test after doing elemental diet.
So an elemental diet is really drinking formula kind of like,
you know, you think of it kind of like Ensure, but it's
completely broken down, meaning it's not going to be accessible
(54:08):
to microbes after it hits your stomach.
It's going to be rapidly absorbed higher up in the small
bowel. So those microbes essentially
get starved out and then there'sa few other mechanisms in which
it might improve your bowel symptoms.
And you do this for two weeks. So no food, just this elemental
diet for two weeks. And I think it was about 80% of
people had a positive response where they ended up having a
(54:31):
negative hydrogen and methane breath test post, especially
those with just hydrogen. They were very good responders.
Methanogens are way harder to treat and manage.
So yeah, then methanogen group kind of stuck around or had more
likely not gone into remission. All patients reported really
(54:51):
great symptom response, which isgreat.
And they were measuring in the people that had methane positive
tests, they were measuring like daily methane levels in both
breath. So pretending to hold like a
little breath tube because it's cute or also in the stool as
well. So the methanogens in the stool
dropped. So I'm excited about this
(55:13):
because it provides people an alternative option that doesn't
rely on antibiotics. I think the perception from
physicians will be safer or higher safety profile.
But it's expensive and psychologically it's really hard
to do. Not consuming food for two
(55:36):
weeks, just formula. Yeah.
So that's kind of the tricky part.
Most of my patients like that have done elemental diets seem
to like handle it well for like the first, but if they have
recurrence SIBO, they're like, Idon't think I can do that again.
That was so hard. So depending on how severe the
symptoms are, like it's like with other things, sometimes
(55:58):
we're willing to try more to feel better.
Yeah. But yeah, it is quite expensive.
I think the MBIOTA one, which iswhat the one that was in the
study that you're referencing, Ithink it's 750US for two weeks.
Yeah, we created a little chart actually of all the elemental
formulas on the market and then the price so that people
(56:20):
understood. So that's available on like
Ignite Nutrition if you've Googled palatable elemental
diet. And then it's also available on
Gut Ed for dietitians as well. Cool.
So we put it in both places so that people could utilize it
with your patients to determine because that's a lot of money.
(56:41):
A lot, a lot of money, so. It's it's cool.
So recap our test options. So I've put in the underrated,
underrated category fecal elastase, TTGIGA or celiac
screen. And then I added hydrogen
(57:02):
methane breath test because I feel like although it's been
talked about a lot, I think it'sstill underrated from the aspect
of what it can help with, although it's not a perfect
test. Would you?
Agree, Underrated in conventional medicine and
overrated in more of like an alternative medicine space.
So we just got to like. Yeah, that's again more
tradition. OK, this is a little bit of both
(57:24):
true and then overrated. Definitely GI map and the IgG
testing. Yeah, yeah, overrated and.
We agree. We're in agreeance.
No arguments over over these tests.
Cool. OK, well, we definitely talked
through a lot. I think each one of these tests
could have been an episode on its own, but it's all good.
(57:47):
Great. Always come back to it.
Yeah. Anything else you want to add to
the? You know, most of these things
actually, like if people are looking For more information, I
think we have blog posts on every single one of these tests
or the diagnosis associated withthese tests on Ignite
nutrition.ca. So lots of good resources there.
(58:10):
And for dietitians either, you know, obviously Lee has great
stuff on her podcast. I also have a podcast called
Let's Get Real. It hasn't been running in a
while, but the episodes are still relevant and good.
And then got that for dietitiansas well, both free and paid
continuing education there. So could you?
Yeah. So I will link.
I will link to those in the shownotes.
(58:32):
And then I guess if someone wants to get in touch with you,
you don't currently do counseling anymore.
I don't. OK, my team does.
I have an amazing team and you can find the medic night
nutrition.ca cool. And they're Canada wide.
Yeah, cool. There's a couple.
Provinces. We don't practice in Quebec and
Manitoba, but we're everywhere else.
(58:55):
Cool. OK.
Awesome. Well, thanks Andrea.
This is a great discussion. If anyone is listening and has
any thoughts, comments, even their own experiences, you can
pop them below. And yeah, I'm sure there'll be
some light bulb moments for our listeners today.
Thank you for having me. That's a wrap for today's
(59:15):
episode. Thank you so much for listening
and being a part of our community here.
If the Gut Fit Nutrition podcastis giving you value, helped your
digestion and fitness, made you rethink how you approach your
gut health, consider leaving a review on Apple, Spotify, or
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If you have questions for my listener Q&A episodes, you can
submit them as a comment on thisepisode or send me an e-mail at
(59:39):
lee@leemorado.com. For more digestible IBS gut
health and fitness tips, be sureto follow me on Instagram at Lee
Morado under score Rd. and to apply for coaching, shop the
resource suite or grab a freebie, visit
gutfitnutrition.com. Thanks for tuning in.
We'll be in touch soon.
I've seen physicians recommend it, I've seen dietitians
recommend it. And the problem is, is and and
like I post about it on Instagram the other day and a
dietitian had said, you know, I respectfully disagree because
this test has helped people. That's not how science works.
We need to validate the test because a lot of times with GI
(00:22):
diagnosis that are functional, the trajectory is as people get
better over time. So like we can't just treat
people and be like, oh, it was the treatment that made them
better. We need scientific evidence to
tease out, you know, placebo effect, natural disease
trajectory, all of these sorts of things that result.
In improvement, welcome to the Gut Fit Nutrition Podcast, the
(00:45):
show where we dive deep into theworld of gut health, nutrition,
and fitness to help you unlock your best self from the inside
out. I'm your host Lee Morado, a
registered dietitian, gut healthexpert, long distance runner,
and movement enthusiast on a mission to empower you with
science backed whole body strategies to fuel your body,
heal your gut, and thrive in your active life.
(01:06):
Whether you're here to finally break free from IBS and
digestive symptoms, optimize your fitness performance, or
learn how to support your gut health with natural strategies,
you're in the right place. Each week, we'll explore topics
like conquering digestive symptoms, building a gut
friendly lifestyle, enhancing endurance and strength
performance, and more. So grab a cup of your favorite
gut friendly tea and settle in, because we're about to get gut
(01:29):
fit together. Today we're diving into a hot
topic that many of you have asked about, gut health testing.
There are so many testing options out there claiming to
provide answers for your digestive issues, from food
sensitivity panels to comprehensive stool test.
But how many of these tests are actually validated and which
(01:49):
ones are just going to burn a hole in your wallet?
To help me unpack the science and the hype, I'm joined by my
colleague and fellow gut health dietitian, Andrea Hardy.
Andrea is based in Calgary, AB, and her clinic, Ignite
Nutrition, specializes in helping people with IBS and
digestive concerns cut through the noise, understand their
symptoms, and feel empowered in their gut health journey.
(02:10):
She's passionate about helping people make informed choices,
especially when it comes to testing.
What are you wondering about? IgG food sensitivity testing,
the GI map stool test, celiac testing or SIBO, AKA hydrogen
methane breath testing. We cover it all.
Plus, we share our professional take on what's truly worth your
(02:31):
time and money when navigating IBS and gut symptoms.
Let's get into it, OK? Hello Andrea, welcome to the
show. Hey, thanks for having me.
I'm so excited to be having thisconversation with you about, you
know, all of these GI tests and what works, what doesn't, what
we should be saving our money on.
So yeah, it'll. Be definitely, yeah, definitely.
(02:53):
I know I asked my audience what would be interesting and this
was the, the top topic in terms of gut health tests.
Just to go through the, the mostcommon ones that people talk
about and what what people should be focusing on and what
they should probably skip and not waste their money on.
So super excited just to introduce yourself.
Do you want to tell us a little bit more about you, where you're
(03:14):
located, and who you help currently?
Sure. So I'm Andrea Hardy.
I'm a registered dietitian. I have a Canada wide private
practice called Ignite Nutritionwhere I have a team of amazing
GI dietitians. I'm a psychologist to help
people with GI disorders. And then in addition to that, I
do a lot of media speaking and science communication through
(03:38):
Instagram at Andrea Hardy Rd. And my ultimate goal is really
to help connect people with sound nutrition science,
especially in the field of gastroenterology.
I struggle with GI issues myselfand I just feel like, you know,
a lot of times it's taboo, It's hard to talk about, and there's
(03:59):
a lot of misinformation out there that we need to tackle as
well. Definitely.
And I know you also help other practitioners as well as I've
been in your professional or your GI support supervision
group. Yeah, we do a lot through gut
Ed. It's just gut dash Ed dot.
Com. And we do help a lot of
(04:20):
dietitians with continuing education.
We have some amazing free resources.
We have the guidebook, which is like we are slowly adding a
whole bunch of GI topics. I think we probably have like 8
or 9 GI topics that are fairly well-rounded in there right now.
So SIBO, IBSIBDILS, diarrhea, wekind of cover it all right now.
(04:40):
Yeah, and the monthly journal club as well.
Yeah, recently very excited for that too.
So yeah, awesome. Cool.
And what, what got you into, I guess digestive health and made
you want to focus on this as a, as a dietitian, right?
My background really was actually working in acute care.
(05:01):
So I spent a lot of time workingin ICUCVICU, liver transplant,
all of which has significant overlap with GI.
And then I worked in oncology. Again, significant overlap with
GI because chemo, radiation, surgery all impact the GI tract
for a lot of cancer patients. As I was working in the
(05:23):
beginning of my career, I was struggling myself with irritable
bowel syndrome. And I'm the type of person that
needs to know everything about everything.
So when I was diagnosed, I really dove into the research
and then my colleagues would come to me and ask me, this was
like when the low FODMAP diet was just coming out, my thoughts
on it, how I would implement it,all of these sorts of things.
So I moved and when I moved to anew city, instead of working in
(05:46):
acute care, I started a private practice knowing that there's so
many people to help with GI. It was so underserved 10 years
ago. Actually, it's my business's 10
year anniversary next week. So yeah, it's exciting.
And yeah, so we've had 10 years of GI care and trying to get the
message out about digestive disorders, which has really just
(06:06):
exploded the last 10 years. It's top of everybody's mind
when it comes to health. Yeah, definitely.
Gut health is a very trendy topic these days.
And as you said, a lot of good, like a lot more research out
there and good information, but a lot of misinformation too.
So which we will dive in for today.
So let's talk about gut health testing.
(06:27):
So we have sort of five on our list and I guess we'll just go
through each of them. We can talk about what the tests
do and sort of what conditions that they may test for and then
sort of our thoughts based on the current research and whether
they're either underrated. So something you maybe should
consider or overrated, somethingmaybe to skip or use with
(06:49):
caution. So the first one we'll go
through is IgG testing. So these are like the food
sensitivity blood tests, I thinkis like a common term that
people would maybe recognize them.
You know, here in Ontario, we have life labs.
I've seen like posters for thesetests in the lab and then I
think a lot of like naturopathicdoctors recommend them.
(07:11):
I haven't seen many dietitians, but essentially what they test
for IgG antibodies in the blood and they claim to help you
identify different food intolerances or sensitivities.
So essentially, what are your thoughts on these tests?
I know mine but. Yeah, right.
I'm sure we are of the same mind, but you know, Ige testing
(07:36):
is not evidence based and here'swhy.
So as we go through these tests,I think it's really important to
have some context around tests that are offered outside of
conventional medicine. Some have evidence, some have
evidence that is poorly done. In the case of IgG testing, this
is an example and some completely lack evidence, but at
(07:59):
the end of the day, you're paying money to try to find a
solution to something you're struggling with.
So I have so much empathy there.You're, you know, probably have
gone down the conventional medicine route and just either
haven't been heard or feel like the solutions don't resonate
with you or they haven't worked.And so it makes sense that
you're seeking an answer. And a lot of times these tests
(08:21):
over promise. And this is definitely the case
with IgG testing saying, you know, your digestive issues,
your health issues, your fatigue, your, you know,
whatever is because you have food sensitivity that can't be
diagnosed in a traditional manner.
So pay us $500, we'll tell you what you can and can't eat and
we'll make you all better. So with the IgG testing, I think
(08:47):
it's important to understand what IgG is and it really is an
antibody that is produced when the immune system responds.
And so the immune system responds in two different ways.
1 is in a reactive way, in a defensive way like we would see
with Ige mediated allergies and then one is in a recognition
(09:08):
kind of way. And the science is a little bit
out on IgG, but we know there's different types of IgG where
some response, you know, reactively and then where it
responds to recognize. And it's really hard to tease
that out. And it hasn't been validated
(09:28):
that measuring IgG response is going to tell you what you're
intolerant to versus what your immune system is recognizing.
Because your immune system is kind of like, you know,
cataloging things as it comes in.
It's like safe, unsafe, safe, unsafe.
IgG is part of that recognition system.
And so just simply producing IgGdoesn't necessarily tell us what
(09:51):
your immune system's actually doing.
I think what's also important torecognize is that certain foods
are more antigenic, meaning thatthey elicit a bigger immune
response than other foods. And that's not necessarily a bad
thing. Those antigenic foods are those
top priority allergens. Wheat, dairy, soy, eggs, all are
(10:14):
more antigenic. Your immune system is inherently
going to, you know, do a little bit more work in identifying
those proteins. So you're going to get an IgG
response. And so when patients bring me
these burritos, of course, a lotof times the most antigenic
foods are high because their immune system's like, hey, yeah,
(10:36):
we recognize these. They're the foods you consume
regularly, and we're recognizingthem.
But the way that these tests getinterpreted is you eat these
foods all the time. No wonder you're so sick.
Just cut them out. You'll feel better.
And so it's very validating for people to get the results and be
like, oh, no wonder I'm so sick.These are such common foods.
(11:00):
I eat them all the time. And so it's very easy to like,
feel like this test is the rightanswer as well.
When we cut out things like wheat, dairy, eggs, soy, what
are we left with? We're left with exactly Whole
Foods that you have to cook fromscratch.
(11:20):
It's going to be, you know, typically a very simple diet.
It's going to require you to overhaul your diet, put more
attention into your diet. And inherently, people could
feel better by doing this because they're overhauling
their diet. They're choosing more Whole
Foods that they're making from scratch.
(11:41):
And it could have nothing to do with these tests at all or the
results of these tests at all. And of course, a lot of those
foods inherently tend to be higher in Fodmaps when we're
talking about dairy, wheat and soy, specifically the nuts and
seeds, some of the legumes, moreantigenic.
So I do wonder, you know, is cutting out those foods just
(12:02):
reducing the overall on map loadfor a lot of these people
resulting in symptom? Improvement.
Yeah, that's a good point too. And I think just the process of
like using these tests, I think they're typically recommended to
like and say by a natural healthpractitioner to do the test.
And then you cut out all the foods that it says you're
(12:22):
sensitive for. I think they usually do like 4
weeks, you eliminate them and then one by one you test them
back in. That can be quite challenging if
there's like 20 to 30 foods on that list.
And I've had a lot of people whohave gotten the test done and
they kind of thought about it and then they gave up on it
because it's just too complicated and restrictive to
(12:44):
even follow. So I think even from that
approach too, it can be hard to actually like implement the
results. And like you said too, is it if
they do end up implementing it, is it actually just your diet
quality is improving? It's similar with like someone
trying the Paleo diet or Whole 30 where yeah, they're eating
like a lot more single ingredient nutrient dense foods.
(13:05):
So you're probably feeling better as a result of that and
cutting out a lot of more, you know, more processed foods in
your diet. So it can be hard to tell what
what's actually helping in the situation.
So, and do you need a $400.00 test to to do that?
And then, you know, is there anyfear about adding those foods
back in? Because it certainly happens
(13:25):
with any other elimination diet is if you feel better cutting
out those 20 to 30 foods, are you going to hesitate
introducing adding them back in and end up on an extremely
unnecessarily restrictive diet that impacts your food
relationship, impacts your social life, impacts, you know,
how you feed you and your family.
(13:46):
So there's a lot of considerations there that I
think are often missed when we look at implementing A
restrictive diet to solve a health problem.
Yeah, yeah, that's a good point too.
Even in the case of IBS, like, you know, it's quite common for
people to feel anxious just about eating.
So if you're feeling nervous about eating a certain food,
that can actually just impact the gut brain connection and a
(14:08):
sense can make you actually react to the food just because
you're feeling more more anxiousor more nervous about having it.
So whether it's the food or it'ssort of what's going on in your
body and you're just reacting ina sense that can occur too.
Once we, you know, start blindlycutting out all these foods and
you know, start worrying about every little thing that we eat,
which is not a fun place to be in either.
(14:30):
So. And it's not a fun place to be
in. And also down, you know,
$400.00. Yeah, like with your money.
And if you have the opportunity,work with a dietitian to figure
out, you know, what your symptoms are going or what's
going on with your symptoms and then evaluating like an actual
strategic evidence based plan tohelp resolve those.
(14:51):
Sometimes nutrition's the answer, sometimes it's actually
not. So having somebody really take a
critical look at that can help you on the right path.
Yeah, exactly. And with the, I think the other
issue too is with these tests isa lot of people say that they or
they think that they're testing for allergies.
I think there's like a common thing to sort of use allergy
(15:12):
intolerance and sensitivity likeinterchangeably when they're
actually different. So allergy is a, is an Ige
modulated reaction, which refersto like an actual allergy.
And that one is a, an immune response versus a food
intolerance could be IgG, but it's actually a response of like
(15:32):
your digestive tract. So either you lack an enzyme to
break down a certain food, like in the case of lactose
intolerance you lack lactase enzyme, then you may get
bloating, gas etcetera when you consume like milk or yogurt, but
it's not an immune mediated response.
Although you said like the IGIGGcan like be more antigenic to
(15:54):
the immune system, but it's not like an immune response.
I get a little bit tripped up inthe science there, but.
Yeah, yeah, for sure. And I mean, ultimately, you
know, when it comes to food intolerances and sensitivities,
there's so much we need to learn, and there's a lot that's
poorly understood. And we need to be careful about
(16:15):
predatory tests that profit off of pathologizing what might be a
normal immune response. Yeah, I have people that, you
know, have noted they feel better on their restrictive IgG
supported diet. And when we get into it, we
(16:37):
realize, you know, you've cut out a lot of Fodmaps and maybe
fructose is actually the problemor your diet qualities change,
or how frequently you've eaten has changed, how you prepare
your food has changed. So there's so many other factors
that might lead to you feeling better that could be considered
to reduce how restrictive the diet is.
(16:58):
Yeah, exactly. And it could be hard to
backtrack a little bit from that.
I think once you've cut out so many foods, like you said, then
people can be anxious to add them back in.
But as we would say from a whole, maybe skip these tests
and work with a dietitian so that you could have a plan to
identify what's going on withoutneeding to be so restrictive, at
(17:21):
least at the at the onset. Like some restriction may be
necessary, like if there is, youknow, a suspected intolerance or
allergy. But usually upfront, it's
probably not where we would start with anyways for someone
to cut out a bunch of. So yeah, I wanna say that even
in the case of like intolerances, I guess if we
(17:43):
think about like what may be driving the intolerances, there
may be like an immune connectionthere.
I was thinking about even in terms of like histamine
intolerance where we know it caneither be caused by is it DAO
like enzyme being low, which canoccur from I think different
like conditions etcetera. Or there may be like sort of an
(18:03):
overabundance of histamine production, I think which can
occur in like SIBO, which then there may be like an over
activation of the immune system.But you're still like low in
that sort of enzyme that helps breakdown histamine.
So that all to say, I was tryingto say that with an intolerance,
it's not I mean mediated, but there may be something deeper
going on that like involves the immune system.
(18:26):
Is that right? I don't know if I.
Sort of yeah, exactly. That's exactly it is OK.
Especially, you know, post COVIDinfections we see mast cells
behaving badly. So these are, you know, the best
cells that house a lot of immunemediated chemicals.
(18:47):
And when they release those immune mediated chemicals, they
result in symptoms that are allergic.
Like we know that people with IBS have a higher presence of
mast cells in their GI tract that contributes to visceral
hypersensitivity. We know that people with IBS
tend to have a microbial profilethat's more likely to cause
(19:09):
excess histamine production in the gut.
So all this to say, you're right, intolerance may have an
overlapping component with an immune mediated reaction.
And I think, you know, again, with this test, it's, it hasn't
been validated. They've, they've tried poorly.
(19:30):
I would say to go back and validate it with some studies
that are well designed and kind of like already have a
predetermined conclusion in mind.
Like they don't go into the science experiment curious with
a hypothesis. You can tell they've kind of
gone in with like, I'm going to prove this test works because
that's the goal of this study, you know, so.
(19:52):
It's not where we want to start with.
Science. No, exactly.
So I think, you know, at this point we can't measure your IgG
response to dietary, you know. Dietary proteins or components
or foods and use it in a diagnostic process 'cause it
hasn't been validated. We don't fully understand IgG
(20:17):
and you know the different typesof IgG and we're not good at
measuring those things, so skip it.
Yeah, and it would be amazing ifwe did have a, you know, a blood
test that could tell us all the foods that we were intolerant
to. But yeah, as you said, the
science just isn't there even in2025 S hopefully at some point,
(20:37):
but for now it's a pass. And then if someone were to be
considering or wondering how do I actually diet like understand
or, you know, investigate my food intolerances.
The gold standard that we still have is a structured elimination
diet and then a reintroduction diet, which suggests to do with
a dietitian so that you can do it properly and know what to, to
(21:00):
look for and be able to, you know, isolate or remove
additional variables so that we're not conflicting the
results as well. Yeah, which FODMAP, low FODMAP
diet is an example of that too. All right, so let's get into the
GI map test as our second. So I like to talk about this
(21:23):
one. I actually have a blog that I, I
think I published it maybe threeyears ago.
And it's definitely like the best performing blog on my
website. And I get a lot of like positive
emails around it and then other people that I get some sort of
angry emails about my my statements in that article.
Yeah, it's definitely something that I have not recommended in
(21:44):
practice. I've also never done it myself.
I think it's a past. But what are your thoughts on
this? Yeah, this one for me is a path
or like pass, don't do it. Because similarly to IgG
testing, the evidence just isn'tthere.
So like, I feel like as dietitians, we can't have it
both ways. We can't just use the science
(22:06):
when it's convenient for us and ignore the science when it
doesn't serve us. Unfortunately, we have to look
at it all, even if it irritates us and you get crazy comments on
your blog. So the ultimate thing is this,
you know, with the explosion andmicro site.
So GI map is a microbiome test where they measure a variety of
(22:26):
different microbes in your stooland they kind of like rate them
in this like super pretty print out of, you know, too much, too
little, the right amount. They also look at fecal
elastase, which is a validated test that we'll get into.
But there's a few other components of this test.
I've seen physicians recommend it.
(22:47):
I've seen dietitians recommend it.
And the problem is, is, and likeI post about it on Instagram the
other day and a dietitian had said, you know, I respectfully
disagree because this test has helped people.
That's not how science works. We need to validate the test
because a lot of times with GI diagnosis that are functional,
(23:12):
the trajectory is as people get better over time.
So like, we can't just treat people and be like, oh, it was
the treatment that made them better.
We need scientific evidence to tease out, you know, placebo
effect, natural disease trajectory, all of these sorts
of things that result in improvement.
So we can't just say like, you know, oh, I did this and this
(23:33):
person got better. Therefore it must be valid.
I always tell the story. One time I thought I got drunk
because I drank 2 beers outside a soccer stadium and it turns
out they were not alcoholic. Like, our brains are really
powerful things. About 30% of, you know,
interventions in a study are, you know, we get a 30% placebo
(23:56):
response or no SIBO response in the case of, you know, my
alcohol. But ultimately, you know, we
can't just go off of anecdote when it comes to these tests.
So GI map, it's really unfortunate because microbiome
science is exciting, but we haven't validated, you know,
(24:19):
clinical ranges for these microbes.
So when we think of our gut microbiome, we want to think of
it like a big forest, whole bunch of trees and animals and
it's really an ecosystem. And when we think of that
ecosystem, there might be, you know, things that exist in that
ecosystem that if they got out of balance might cause harm.
(24:42):
But in a functioning ecosystem could exist without actually
causing any issues. For example, E coli, you can
have E coli existing in your stool and it not be pathogenic
or not 'cause disease when it gets out of, you know, balance.
And there's certain types of E coli that you would get
(25:02):
infection. So the fact is, is we don't know
what a healthy microbiome looks like.
Each of these microbes would need really thorough scientific
research to determine what a reference range is.
And it just hasn't been done. So you can't just, you know,
(25:23):
measure a microbe and decide that you know, between like, you
know, 1 is bad and 10 is good. And the closer you, you get to
like, you know, 10 is, is better.
So we just, we don't have the research to really say that
those numbers are meaningful andthat they represent a normal
healthy gut. And then we certainly don't have
(25:45):
data to say that if you do XY and Z, if you take these
supplements that I'm now sellingyou, these microbes are going
to, you know, go away or improveor what have you.
Yeah. So the issue with the test too
is that they, I believe with theGI map, they come up with their
own parameters. Like it's just based on their
own numbers that they came up with in their own studies, which
(26:08):
is a big red flag. Like if someone is selling a
test to diagnose something, for them to come up with like just
their own data and their own parameters around what is good
and bad is definitely a red, redflag for sure.
And then, yeah, to that point aswell, I think like a lot of
times people are told to take this again from like natural
(26:29):
health practitioners, then they get the results back and then
they're given, you know, prescriptions for hundreds or
thousands of dollars of supplements to help fix the, you
know, the issues that this test comes back with.
But to your point, do we actually have the the research
that tells us, you know, what what is wrong?
Like, you know, what is the issue with your results?
And then how do we fix that? We just don't have that data
(26:51):
yet. So in a sense, people are still
sort of guessing on how to, you know, treat the results from
these tests exactly. And I mean the, there's been
like, I don't know if it's 60 minutes or whatever, but
ultimately someone I remember sent their GI sample to like 3
different of these microbiome, you know, test studies and all
(27:15):
the results were different. Like the reality is, is your
microbiome fluctuates day-to-day.
What my microbiome looks like today is probably different than
what it's going to look like tomorrow based off what I eat
and everything else but sleep, stress, all of these things.
And even in this one sample, they got a whole variety of
results because, you know, there's human error involved.
(27:38):
There's supplement sample contamination.
Like you're not in a lab doing this sample in a way that's
structured. All of these companies are, you
know, hopefully following best practice, but we don't really
know what that is. So you know, you might have a
diagnosis with GI map one day and then a week later you might
(27:59):
not actually meet their diagnostic criteria, right.
It's just it's, it's too variable to use unfortunately
right now as a tool to diagnose and treat the data for
diagnosis, we don't have the data for treatment.
Again, we're pathologizing your stool when you're struggling
because you would do this test when you're struggling with
(28:20):
something, whether that's, you know, floating or fatigue or
diarrhea or what have you. And it can feel really
validating to get this test. It can feel really validating to
get solutions and then you mightget better based on those
recommendations. So again, it's another source of
validation that doesn't necessarily provide us like good
clinical data. Right.
(28:41):
Because you could have inherently gotten better over
time. You could have made changes that
would have gotten you better without doing these tests.
Yeah. And for those listening that
haven't done or looked into the GI map test, essentially you put
like a little hammock on your toilet and you poop into it and
then you mail it into the lab. So as you said, like it's a lot
(29:03):
different doing it in the comfort of your home home versus
in a lab where they're able to, you know, keep things controlled
and more sterile etcetera, whichcan also impact the results.
So various issues with this testalso about you saying that that
it can change like day-to-day orweek to week.
I think also it's important to recognize like the your stool
(29:25):
won't look the same sort of throughout like your as it moves
through your intestinal tract oryour GI tract versus what you
actually poop out. So what you know the end result
is may not actually like match what it is sort of when it's
still in your body, which is also an issue too if we're using
that for. Results.
Yeah, there's some really cool news, science coming out, but
(29:47):
it's literally, you know, in thephase of exploration where
they're able to sample the microbiome throughout your
entire GI tract, which is reallycool.
And I can see that, you know, people are going to try to
capitalize on this and, you know, it's gonna turn into like
another GI map, but. Hopefully we can use that.
(30:10):
I'm sure it'll be AI powered as well.
Right. What is it?
Yeah. Yeah.
So it's not, we know it's not a validated test for IBS or SIBO
cannot which we'll get more intothe, the testing for SIBO
Candida I think is another one that people use to say and help
(30:33):
them identify that they had Candida overgrowth.
But the issue with that one likeyou said with E coli is that
Candida also naturally exists inyour intestinal tract.
And so just because you have presence of it in your stool or
a certain amount doesn't necessarily mean that you have a
Candida or fungal overgrowth. So another issue with that one
(30:55):
there. I was reading though the one
yeah, you mentioned fecal lastase and then also H pylori.
I wasn't too sure where I landedon that one.
They, I saw some sources say it could be helpful to detect like
presence of it. But what were your thoughts
around H pylori and the GI? Map, yeah, I need to re look at
it. I don't actually remember what
(31:16):
they're measuring in the GI map around H pylori, but I actually
we can use stool as a method of diagnosing H pylori.
Right. So it could be they could be
using the validated test. I wouldn't be surprised if they
were. I assume they were if they, you
know, they are, if they're, you know, using things like people
last days. So it could be helpful in that
(31:39):
case. My concern is, is like, you
know, who's prescribing you thistest?
Are they capable of diagnosing? Because I'm not, I'm a dietitian
and I can't diagnose you with anything, but I can, you know,
advocate to your physician to take a medical look and make
those decisions. Do you have a medical provider
(31:59):
that can diagnose that's overseeing the use of this test?
It's a big question. You don't want to just be
diagnosed Willy nilly by somebody who can't diagnose
legally and shouldn't be diagnosing doesn't have the
skills to diagnose. So yeah, if you are using it for
fecal last days in H pylori one,why don't you do the cheaper
individual tests if you're living in the US, I'm sure it's
(32:22):
much cheaper to do those separately than it is to the GI
map. It's in Canada.
Get it through a physician that can diagnose as opposed to
paying for an entire GI map to do to validated tests.
And frankly, it's very rare thatI would ever suggest to a
physician to do a fecal elasticsand H pylori at the same time
(32:42):
because the symptomology is so different.
You know, like if you have H pylori or if I suspect you have
H pylori, I'm going to tell the doctor this person has XY and Z
symptoms. Have they been tested for blah
blah, blah, blah, blah? If not, would you consider it
fecal elastase? Same thing, totally different
set of symptoms that I would present to the physician and
(33:04):
request a test. If they thought it was
appropriate, they might move. Ahead, right.
Yeah. So better to do more targeted
testing than just consider this GI map test that claims to look
at everything but really doesn'tproperly look at anything.
Because test sensitivity and specificity varies.
(33:24):
Like with the H pylori stool testing, it's sensitivity and
specificity. I know it's lower, so it's not
100%. So they could falsely diagnose
you with H pylori or they could miss diagnosing H pylori.
So we want to take it in the context of symptoms, not just
Willy nilly test everything in everybody.
(33:47):
Yeah, exactly. It's a good point and it makes
me sad too when I see people like recommended or they pay for
this test before really trying anything else.
Like even in the case of IBS, weknow that it can be really well
managed with dietary and lifestyle changes, you know,
which will get you a lot more results than doing a test and
taking a bunch of supplements, which really just won't, you
(34:09):
know, kind of mask the actual issues there.
So again, too, that's why it's. Yeah.
Accurate diagnosis. Right.
Yeah, exactly. So many issues with this test.
Yeah, I'm not a fan and I know Isent you the other day like a
yeah, a very popular gut health dietitian who said it was one of
the tests that every person withgut issues should run.
(34:33):
But yeah, you. Struggle with that sentiment.
Yeah. It just doesn't make sense at
this point. Yeah, I think it's like
anything. You can't really say that
there's one thing that everyone should do.
I mean maybe drink more water, but then again some people are
already drinking lots of water so maybe not.
(34:53):
Like reflux worse for people. Yeah, yeah, yeah.
It's interesting. I think as providers, 'cause I
assume dietitians listen to yourpodcast, we really need to
address some of our own biases in, you know, offering these
tests because we really want to help people.
And so if this test is sold to you and you're not super
(35:16):
confident in dissecting the science, you're like, this test
could help my patient, why wouldn't I do it?
And then they do present all this data that isn't, I've
combed through it. It's not research.
It's just, you know, pieced together again, cherry picking
to validate, you know, their particular stance on measuring
each of these microbes. So I think sometimes we need to
(35:39):
just take a step back and realize people want, you know,
people don't like the diagnosis of the irritable bowel syndrome.
They feel like it's not real. So they're looking for, you
know, these root causes. And this GI test can feel really
validating when in fact it, you know, is muddying the waters,
(35:59):
over complicating things and notnecessarily providing people
appropriate, you know, solutionsto their symptoms, let alone,
you know, the results of these tests.
Yeah, that's a good point too. And even as you said, like with
IBS, we know that they're like the microbiome profile is a lot
less diverse and less resilient.So probably if they were to do
(36:22):
these tests, if you had IBS, it's going to show you that
maybe there's low levels of yourhealthier bacteria.
But do we need like an $800 testto tell you that you should, you
know, you try to eat more, more diversity, try to improve your
diet to help improve your microbiome.
There's lots of things that you can do that we know can help
with improving the microbiome profile that are low cost or you
(36:44):
know, that you can fit into youreveryday.
Do you need to do a $800 test totell you that can save that
money for, you know, groceries and all the other stuff?
Vacation where your ideas will be so much better because too
relaxed. Yeah, exactly.
OK, We can talk about GI map allday, but hopefully we'll move
on. So the next one is the Ficola
(37:05):
last days. Yeah, so we kind of touched on
this, but fecal elastase is a valid test and it kind of loops
back to GI map because they do do fecal elastase.
So fecal elastase is really a measure of elastase is an enzyme
produced by your pancreas to help in digestion.
And sometimes if you're experiencing symptoms of
(37:26):
diarrhea, you know, fat malabsorption, the doctor may
order a fecal elastase to see how much of this elastase is in
your stool. If it's low, it could mean that
you have pancreatic exocrine insufficiency.
So basically your pancreas isn'tproducing enough enzymes to
properly digest. And the concern with this is, is
(37:47):
malnutrition in really severe cases that you might have issues
with fat soluble vitamins, thoseof those and then you know, you
might actually malabsorb nutrition like macro nutrients
as well, especially with the volume of diarrhea some patients
experience. So that test can be helpful in
determining what further work upis needed because usually
(38:10):
pancreatic exocrine insufficiency is associated with
other health conditions. Cystic fibrosis is the big one.
Most people with cystic fibrosiswill be diagnosed at a very
young age, but also diabetes, pancreatic cancer, chronic
pancreatitis, you know, structural abnormalities with
your pancreas that you might have been born with, pancreas
(38:31):
division. All of these things can
contribute to pancreatic exocritinsufficiency.
So they'll look into getting a proper diagnosis for you.
What is the cause of your pancreas not producing enough
enzyme And then treat that plus typically enzyme replacement
therapy. Yeah.
And even yeah, in the case of IBS too, I'm sure you've seen it
(38:52):
a lot, but someone may get diagnosed with diarrhea dominant
IBS or IBSD, which do present with more loose stools.
And then the symptoms of IBS like abdominal pain and
bloating, but with exocrine pancreatic insufficiency, it can
like mimic the symptoms of IBSD.So you do get a lot of like
abdominal pain, very frequent loose stool, difficulty like
(39:14):
absorbing fats, so maybe more greasy stool, fatigue, which can
overlap. So even in the case of
someone's, you know, been diagnosed with IBSD or they
think they have IBS but it's notreally getting better even with
like low FODMAP diet or sort of trying the, you know, common IBS
management strategies, then it could be helpful to test for it
to rule it out and then get the proper treatment for it.
(39:38):
Yeah. And it is a simple test.
It is a relatively inexpensive test and you're right, it should
be looked at. I believe it's like do you
remember? I don't know the exact
statistic, but it's quite a large portion of people with
chronic diarrhea that have EPI or PEI.
It's like. Yeah, I'd have to look at maybe.
(39:59):
10% or 5% but. I'd have to double check, but
it's actually, it's not just like a small minuscule amount of
people with, you know, undiagnosed chronic diarrhea.
It's, it's a pretty good chunk. So if your chronic diarrhea is
not responding to standard intervention, then it should
absolutely be considered. And that's again, where like we
(40:21):
or I or other dietitians might advocate to your physician
because we spend more time with you typically than your
physician. So we can say this is what's
going on, why we think this testmight be valuable.
And then the treatment for it islike prescription strength
digestive enzymes. So Creon is a common one here in
Canada, which is not a somethingyou would typically give to like
(40:43):
an IBS patient unless you suspected that they had EPI.
Sure. Yeah, you can do over the
counter enzymes. That's such a good point.
I think a lot of people think they can just pick up any
digestive enzyme blend they findin like the natural health
section. But that's like, I was going to
make like a silly reference, butlike, yeah, it's such a small,
(41:05):
miniscule dose of what you wouldneed to overcome what your
pancreas is not doing for you. Yeah.
And I'd like to say like sometimes people take those over
the counter enzymes and are like, I feel better.
It doesn't mean you have extra and pancreatic insufficiency.
Lots of those enzymes contain like alpha galactosidase, which
(41:25):
helps to breakdown galactolidosaccharide sounded
like beans and nuts and some grains and or they contain
lactase or again ties back to the placebo effect.
Doing something typically can help people feel better.
So yeah, we just want to be cautious and drawing
conclusions. Your pancreas might be a OK.
(41:46):
Yeah. And so back to the point about
the GI map test, it does claim to test for fecal elastase, but
you could always start with the one that you can do through your
doctor, your medical team, whichwill cost a lot less and give
you more targeted result of investigation, so.
Yeah, I'm getting like AGI work up right now due to some issues.
(42:10):
I think fecal last days was like$40 lab here in Mexico where I
live, which I assume is probablycomparable in the US.
Canada, you don't pay for your blood work anyways.
So yeah, yeah, but it's. So much less expensive on you on
the healthcare system than doingJMAP so.
(42:30):
Exactly, and the next test wouldbe TTGIGA or Celiac screening.
Yeah. So this is a blood test where
we're measuring TTGIGA, which isa antibody that's produced by
those with celiac disease as a result of inappropriate immune
(42:53):
response or an autoimmune response to the protein found in
wheat, barley and rye, which is gluten as a protein.
And so what's important about this test is you actually have
to have consumed wheat for the test to have validity.
So it's a really important part of working out any sort of GI
(43:15):
diagnosis. If you're experiencing things
like diarrhea, bloating, even Constipation, fatigue, ruling
out celiac disease should be like, you know, the very first
step that people take. A good chunk of celiac disease
is asymptomatic. So you might not have intestinal
symptoms. You might have extra intestinal
(43:36):
symptoms like fatigue, like vitamin deficiencies that are
unexplained, low iron. And so celiac screen is really
important. That means that it's the first
step in diagnosing celiac disease.
It's sensitivity or ability to accurately diagnose people with
celiac disease isn't 100%, so a follow up if your symptoms
(44:01):
require for their follow up would be a biopsy as the gold
standard. I think previously here in, in,
I know in Ontario we had to pay for the celiac blood testing.
But I think maybe as of two years ago, well, they started
with like a pilot project to make it free.
And then I think they've continued it.
(44:23):
So now people don't have to pay for the celiac testing if they
meet the criteria, which I thinkbefore was a little bit of a
deterrent. It was like $100 and some people
didn't want to pay for it. But even in the case of of, you
know, IBS or, or determining if you have IBS, it is important to
rule out celiac disease first because a lot of the symptoms
(44:45):
can overlap. And then if you want to, you
know, with IBS, maybe try a lower FODMAP diet or some people
do want to try gluten free. It's much better to rule out
celiac first while you're still eating gluten before you go to
cut it out because it can be difficult then to add it back in
if you're feeling better but still having symptoms, it is
(45:06):
important to rule it out initially.
And yeah, I was reading on this,I think it was Celiac Canada
website. But the typical symptoms are
diarrhea, pain, weight loss. However, they now say like a lot
of patients can present with atypical symptoms.
So anemia is 1, osteoporosis, oral ulcers, Constipation.
(45:28):
So not just diarrhea, but not having bowel movements as well,
infertility and neurological problems.
So a lot of symptoms, but it canpresent in different ways.
So it is important to rule it out.
And then let's get into the lastTest.
So the hydrogen and methane breath test, what are your
thoughts on on this one? This one is like a use
(45:51):
judiciously test. So hydrogen and methane breath
testing measures hydrogen and methane that you expire or
breathe out when you're given a specific substrate.
So we use Lactulose or glucose, you can assume that and then it
allows you consume that like fasted not eating, and then your
(46:15):
microbes go to work and break that down.
You shouldn't have too many microbes high up in your
intestine, in your small bowel, and you should have lots of
microbes to digest that substrate in your colon.
And so this test is used to diagnose small intestinal
bacterial overgrowth or intestinal methanogenic
(46:35):
overgrowth. Done.
Really, the only way your body can produce hydrogen or methane
is through microbes. So it's like a direct
measurement. It's not like you're producing
hydrogen and methane any other way.
So it's a very direct test. The problem with this test is
that the sensitivity and specificity, meaning ability to
positively or accurately diagnose someone who's positive
(46:58):
or rule out somebody who's actually negative, is less than
perfect for so many reasons. In particular, how quickly your
GI tract moves and how your bodyabsorbs the substrate if you're
using glucose, because your bodywill absorb it.
So it's not a perfect test. However, it can be a really
helpful test in determining who is best going to respond to
(47:22):
antibiotics. So if you have a positive
hydrogen and methane breath test, you're more likely to
adequately respond or have an improvement with antibiotic
treatment for that SIBO or IMO. So as dietitians here, but a lot
of people might not know this isrifaximin is an antibiotic
(47:44):
that's approved for treating irritable bowel syndrome,
diarrhea. It's also the antibiotic we've
used to treat SIBO. However, people with IBSD who
haven't had a hydrogen and methane breath test, it doesn't
work all of the time and sometimes needs multiple rounds.
People with the hydrogen and methane breath test that's
(48:04):
positive, they're more likely torespond to that rifaximin.
So I like hydrogen and methane breath testing if I have a
patient who has irritable bowel syndrome overlapped with what I
think is SIBO, to better determine who is going to best
respond to antibiotics because they're expensive, they're hard
to access, and it really validates the potential use of
(48:25):
those antibiotics when other options for IBS management have
failed. Yeah.
And the, yeah, I know I've seen,I think it's similar to the GI
map test, but it's recommended alot online.
The online gut health space, I think it was, I don't know if
I've seen as many posts about it, but I think a couple years
ago SIBO was getting a lot of attention and there were a lot
(48:47):
of posts saying like at least 50% or 50 to 80% of people with
IDs have SIBO. So you should be tested for it
and you should be treating it, which is not necessarily true.
I mean, even now we know there'stwo different types of SIBO.
So there's SIBO, which is small intestinal bacterial overgrowth,
which refers to having more bacteria in your small bowel,
(49:08):
which technically most of our microbiome is housed in our
large bowel. We shouldn't have much microbes
in our small bowel. So if there are more microbes
there, it can cause issues. And then in the case of
intestinal methanogen overgrowth, that's a growth of
not a bacteria, but microbe known as methanogens, which can
occur throughout both the large and small, but also two types
(49:30):
which can present in different symptoms, diarrhea,
Constipation, etcetera. But to your point that it may
lack in specificity and sensitivity, it might not be the
best test to just jump to if you're having IBS symptoms.
Might be good to maybe trial some of the strategies for IBS
1st and see how you respond and then working with your medical
(49:51):
team based on, you know, lookingat your clinical symptoms and
how you're responding, then maybe considering doing the
test. Yeah, I totally agree, because
it's not a perfect test. So in the context of, you know,
really thinking about what the trajectory will look like for a
patient who has a positive test,it's hard, it's expensive.
(50:11):
It's, you know, we don't want tounnecessarily recommend
antibiotics. We want to make sure that our
intervention actually has an impact, especially when that
intervention holds risk. So because the test isn't
perfect, that's why I always tryto manage those symptoms prior
(50:34):
to jumping to the hydrogen and methane breath testing as
opposed to, like you said that like first line approach.
Because the test is so for example, TTGIGA that we just
talked about has a sensitivity and specificity in the high 90s,
meaning that like very few people are wrongly diagnosed or
(50:54):
missed. Hydrogen and methane breath
testing is like depends on what study you look at, but it can
range like, you know, 40 to 60% sensitivity, meaning we're
missing the other 40 to 60%. And then the specificity can be
quite high actually. So we're not wrongly diagnosing
people, but it's still not, you know, high 90s, it's, you know,
(51:17):
80s. So you don't want to be wrongly
diagnosed either. Yeah, exactly.
And similar to the celiac testing where you need to be
eating gluten for a period of time before to get the right
results with the hydrogen methane breath testing, like
there's certain supplements you have to stop beforehand and then
the day before you're supposed to essentially do like a low,
(51:39):
low fiber, very bland diet and then fast for at least 12 hours
before. So even just how well you
actually, you know, committed and implemented the, the prep
for it can influence the resultstoo.
And I think the other factor toois also Constipation.
Like if someone is backed up andthere's stool back up, that can
actually muddy the the results too.
(52:01):
So different things could be going on and then the access of
it is difficult to like. And there's one private clinic
here in Toronto that I sometimeshave people get their doctor to
refer them to. But there's not a lot of options
for like in lab testing versus there are like home tests that
you could order. But it's similar with the GI map
(52:22):
test that like it's harder to control things when you're doing
it at home and that can impact the results too.
So it's, yeah, while you said it, it could be, you know,
helpful in certain cases. There's definitely things that
aren't perfect with it all around unfortunately, but.
Yeah, access is hard. And most importantly like we
need a doctor to diagnose and treat when we're, you know,
(52:43):
thinking about using these tests.
Otherwise it's for not. So, you know, we want to make
sure we have a a physician on board that understands SIBO and
IMO and is willing to provide anintervention based on the
results too. Exactly.
Yeah. Just to the point of about
(53:04):
responding to antibiotics, I know more recently there was a
study that came out looking at the elemental diet, so is that
similar as well? Using the breath tests can help
us predict who will respond better to an elemental diet for
SIBO. Yeah, I assume so.
So this study was interesting inthat the a good chunk of the
(53:25):
participants, this wasn't like their first time being diagnosed
with placebo or Ivo. That's a good point.
You know, they might have failedantibiotics or they might have
had two rounds of it. It wasn't really disclosed.
You know, did they not respond to antibiotics?
Did they relapse? Have they done a couple rounds?
(53:45):
Like it was very unclear, but what was interesting is is you
know, it had a very good response rate where people had a
negative test after doing elemental diet.
So an elemental diet is really drinking formula kind of like,
you know, you think of it kind of like Ensure, but it's
completely broken down, meaning it's not going to be accessible
(54:08):
to microbes after it hits your stomach.
It's going to be rapidly absorbed higher up in the small
bowel. So those microbes essentially
get starved out and then there'sa few other mechanisms in which
it might improve your bowel symptoms.
And you do this for two weeks. So no food, just this elemental
diet for two weeks. And I think it was about 80% of
people had a positive response where they ended up having a
(54:31):
negative hydrogen and methane breath test post, especially
those with just hydrogen. They were very good responders.
Methanogens are way harder to treat and manage.
So yeah, then methanogen group kind of stuck around or had more
likely not gone into remission. All patients reported really
(54:51):
great symptom response, which isgreat.
And they were measuring in the people that had methane positive
tests, they were measuring like daily methane levels in both
breath. So pretending to hold like a
little breath tube because it's cute or also in the stool as
well. So the methanogens in the stool
dropped. So I'm excited about this
(55:13):
because it provides people an alternative option that doesn't
rely on antibiotics. I think the perception from
physicians will be safer or higher safety profile.
But it's expensive and psychologically it's really hard
to do. Not consuming food for two
(55:36):
weeks, just formula. Yeah.
So that's kind of the tricky part.
Most of my patients like that have done elemental diets seem
to like handle it well for like the first, but if they have
recurrence SIBO, they're like, Idon't think I can do that again.
That was so hard. So depending on how severe the
symptoms are, like it's like with other things, sometimes
(55:58):
we're willing to try more to feel better.
Yeah. But yeah, it is quite expensive.
I think the MBIOTA one, which iswhat the one that was in the
study that you're referencing, Ithink it's 750US for two weeks.
Yeah, we created a little chart actually of all the elemental
formulas on the market and then the price so that people
(56:20):
understood. So that's available on like
Ignite Nutrition if you've Googled palatable elemental
diet. And then it's also available on
Gut Ed for dietitians as well. Cool.
So we put it in both places so that people could utilize it
with your patients to determine because that's a lot of money.
(56:41):
A lot, a lot of money, so. It's it's cool.
So recap our test options. So I've put in the underrated,
underrated category fecal elastase, TTGIGA or celiac
screen. And then I added hydrogen
(57:02):
methane breath test because I feel like although it's been
talked about a lot, I think it'sstill underrated from the aspect
of what it can help with, although it's not a perfect
test. Would you?
Agree, Underrated in conventional medicine and
overrated in more of like an alternative medicine space.
So we just got to like. Yeah, that's again more
tradition. OK, this is a little bit of both
(57:24):
true and then overrated. Definitely GI map and the IgG
testing. Yeah, yeah, overrated and.
We agree. We're in agreeance.
No arguments over over these tests.
Cool. OK, well, we definitely talked
through a lot. I think each one of these tests
could have been an episode on its own, but it's all good.
(57:47):
Great. Always come back to it.
Yeah. Anything else you want to add to
the? You know, most of these things
actually, like if people are looking For more information, I
think we have blog posts on every single one of these tests
or the diagnosis associated withthese tests on Ignite
nutrition.ca. So lots of good resources there.
(58:10):
And for dietitians either, you know, obviously Lee has great
stuff on her podcast. I also have a podcast called
Let's Get Real. It hasn't been running in a
while, but the episodes are still relevant and good.
And then got that for dietitiansas well, both free and paid
continuing education there. So could you?
Yeah. So I will link.
I will link to those in the shownotes.
(58:32):
And then I guess if someone wants to get in touch with you,
you don't currently do counseling anymore.
I don't. OK, my team does.
I have an amazing team and you can find the medic night
nutrition.ca cool. And they're Canada wide.
Yeah, cool. There's a couple.
Provinces. We don't practice in Quebec and
Manitoba, but we're everywhere else.
(58:55):
Cool. OK.
Awesome. Well, thanks Andrea.
This is a great discussion. If anyone is listening and has
any thoughts, comments, even their own experiences, you can
pop them below. And yeah, I'm sure there'll be
some light bulb moments for our listeners today.
Thank you for having me. That's a wrap for today's
(59:15):
episode. Thank you so much for listening
and being a part of our community here.
If the Gut Fit Nutrition podcastis giving you value, helped your
digestion and fitness, made you rethink how you approach your
gut health, consider leaving a review on Apple, Spotify, or
wherever you're getting your podcasts.
If you have questions for my listener Q&A episodes, you can
submit them as a comment on thisepisode or send me an e-mail at
(59:39):
lee@leemorado.com. For more digestible IBS gut
health and fitness tips, be sureto follow me on Instagram at Lee
Morado under score Rd. and to apply for coaching, shop the
resource suite or grab a freebie, visit
gutfitnutrition.com. Thanks for tuning in.
We'll be in touch soon.
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