Uncovering Hidden Gut Issues: Tests Beyond IBS Diagnosis | Episode 33

In this episode of The Health Pulse Podcast, we tackle the often frustrating diagnosis of Irritable Bowel Syndrome (IBS)—a label that names your symptoms but rarely explains them. Instead of settling for generic treatment, we explore how functional gut testing can uncover what’s really driving your digestive issues.

Learn how tests like comprehensive stool analysis, SIBO breath testing, and food sensitivity panels can identify hidden causes like bacterial overgrowth, parasites, delayed immune responses, and leaky gut—conditions that standard evaluations often miss.

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Disclaimer: The information provided in this podcast is for informational purposes only and should not be considered medical advice. The content discussed is based on research, expert insights, and reputable sources, but it does not replace professional medical consultation, diagnosis, or treatment. We strive to present accurate and up-to-date information, medical research is constantly evolving. Listeners should always verify details with trusted health organizations, before making any health-related decisions. If you are experiencing a medical emergency, such as severe pain, difficulty breathing, or other urgent symptoms, call your local emergency services immediately. By listening to this podcast, you acknowledge that The Health Pulse and its creators are not responsible for any actions taken based on the content of this episode. Your health and well-being should always be guided by the advice of qualified medical professionals.

Episode Transcript

Nicolette (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.

Rachel (00:24):
So that gnawing feeling right in your gut, the bloating
that just pops up, cramps, thoseyou know, endless bathroom
issues.
Or maybe it's the opposite,just feeling stuck.

Mark (00:37):
It's such a common story.

Rachel (00:38):
It really is and for so many people, it ends up with
this label IBS irritable bowelsyndrome.
Yeah, ends up with this labelIBS irritable bowel syndrome.

Mark (00:44):
Yeah, and while getting any kind of label can feel like
a relief at first the IBS one itoften brings more frustration
than clarity, doesn't it?

Rachel (00:53):
Totally, because it doesn't really tell you why.

Mark (00:55):
Exactly.
Ibs is huge, affects maybe 10,15% of adults across the world.
But and this is key, it's nottechnically a disease.
Well, it's a collection ofsymptoms.

Rachel (01:05):
So your gut feels awful, totally valid.
But the diagnosis itself isn'tthe root cause.

Mark (01:10):
Precisely.
It's like your phone batterykeeps dying fast.
The diagnosis is phone notholding charge.
Okay, great, but why isn't itholding the charge?
Is it the battery, the software, something else?

Rachel (01:20):
Right and with IBS and standard medical practice, they
do rule out the really seriousstuff, which is crucial,
absolutely essential first step,but then you're often left just
managing, trying to cope withthe symptoms without knowing
what's actually driving them andthat's the real kicker.

Mark (01:34):
You might have had scopes, blood tests and they say
structurally everything looksfine.

Rachel (01:40):
Your gut looks healthy.

Mark (01:42):
But your experience, it's anything but Bloating.
Pain, urgency, that gap betweenhow it looks and how it feels,
that's classic IDS territory.

Rachel (01:52):
And because it's symptom-based, the advice can
feel well pretty genericsometimes yeah.

Mark (01:58):
Try more fiber, avoid trigger foods.
Maybe some medication fordiarrhea or constipation.

Rachel (02:03):
Which can help sometimes .

Mark (02:05):
Sure, symptom relief is important.
But if you don't know why, somemedication for diarrhea or
constipation which can helpsometimes.
Sure, symptom relief isimportant, but if you don't know
why you have the diarrhea orwhy you're bloated, it feels
like you're just putting outsmall fires instead of finding
the source.

Rachel (02:14):
Exactly Just treating the branches, not the root.

Mark (02:16):
So the big question we're kind of digging into today is
what if we could go deeper?
What if there are ways touncover the reasons your gut is
out of whack beyond that initialIBS workup?

Rachel (02:26):
Okay, I'm intrigued because that sounds like moving
from guessing to actuallyknowing.

Mark (02:31):
That's the goal.
We're going to explore some ofthese modern gut testing options
, tools that can potentiallyshine a light on what's really
happening in there.

Rachel (02:38):
All right, let's do it.
Where do we start?

Mark (02:40):
A really valuable starting point is comprehensive stool
analysis.
Now most people might have hada very basic stool test, looking
for one specific bug, maybeRight, like for C, diff or
something after antibiotics.
Exactly.
But these functional stoolpanels, you might hear names
like GI map or GI effects.
They go way, way beyond that.
They give you a much richerpicture of the entire gut

(03:02):
environment.

Rachel (03:03):
OK, so richer how?
What are these tests actuallylooking for, that the standard
ones miss?

Mark (03:08):
Well, think of it like mapping the ecosystem.
They look at the balance ofyour gut bacteria.
Are the beneficial microbesthriving or are opportunistic
ones starting to take over thatimbalance?
That's dysbiosis.

Rachel (03:20):
OK, so the overall bacterial community.

Mark (03:22):
Yeah, and, crucially, they also screen for specific
unwanted guests, things likeparasites that might be hiding
out or used overgrowth candidais a common one even viruses or
specific bacterial toxins.

Rachel (03:35):
Wow, okay, so not just is there an infection, but a
detailed roll call of who'sliving in there and if they're
playing nice.

Mark (03:43):
You got it, and it doesn't stop with the microbes.
These panels also give us cluesabout how well your digestion
is actually working.

Rachel (03:49):
Like what.

Mark (03:50):
Like they measure elastase .
That tells us about yourpancreatic enzyme output.
Are you making enough enzymesto break down food properly?

Rachel (03:59):
Ah, okay, if not, that could definitely cause issues.

Mark (04:02):
For sure.
They also often measure fat inthe stool, which can show if
you're having trouble digestingand absorbing fats.

Rachel (04:08):
Makes sense.
Undigested food equals troubledown the line.
What else?

Mark (04:12):
Inflammation markers, but specifically gut inflammation,
things like calprotectin orsecretory IgA.
These show if there'sirritation or immune activation
happening right there in theintestinal lining.

Rachel (04:23):
So not just general body inflammation, but gut-specific.

Mark (04:26):
Correct, and some panels even look at something called
beta-glucuronidase.
High levels might suggestissues with detoxification
pathways even how your bodyhandles hormones like estrogen.

Rachel (04:36):
That is A lot of information from one sample, so
bring it back to the person withIBS.
How does knowing all thisactually help?

Mark (04:46):
It helps because it allows for targeted action Instead of
just saying eat better.
If we see, say, a parasite, wecan target that parasite.

Rachel (04:54):
Okay.

Mark (04:54):
If there's clear dysbiosis , specific probiotics or
prebiotics might be recommended.
If enzyme levels are low, youmight need digestive enzyme
support.
If fat digestion is off, maybesupporting bile flow is key.

Rachel (05:09):
So it moves from guesswork to a much more
strategic plan based on what thetest actually shows is going on
.

Mark (05:15):
Exactly.
It's about personalizedinsights leading to personalized
interventions.

Rachel (05:19):
All right, that sounds incredibly useful.
Now, another term that pops upconstantly with IBS is SIBO.

Mark (05:24):
Ah yes, sibo, Small intestinal bacterial overgrowth.

Rachel (05:27):
What exactly is that and how does it fit into the IBS
picture?

Mark (05:30):
Okay, so SIBO is basically bacteria in the wrong
neighborhood.
Your large intestine is meantto have tons of bacteria.
They do important jobs likefermenting fiber.

Rachel (05:38):
Right, that's normal.

Mark (05:39):
But the small intestine that's primarily for digesting
and absorbing nutrients.
It's not supposed to be teemingwith bacteria.
Incebo bacteria that should bein the large intestine have
migrated up into the smallintestine.

Rachel (05:52):
Okay, so they've moved upstream to where they shouldn't
be in large numbers.

Mark (05:56):
Precisely.
And when those bacteriaencounter carbohydrates you've
eaten sugars, starches in thesmall intestine they do what
bacteria do.

Rachel (06:03):
They ferment them.

Mark (06:04):
But too early and in the wrong place.

Rachel (06:06):
Exactly this premature fermentation produces gas,
hydrogen methane, sometimeshydrogen sulfide, right there in
your small intestine.

Mark (06:14):
And that causes the symptoms.

Rachel (06:16):
That can absolutely cause many classic IBS symptoms,
especially that rapid onsetbloating after eating, maybe
within 60 to 90 minutes.
Also excessive gas, abdominaldiscomfort and it can swing
bowel habits either towardsdiarrhea or constipation.

Mark (06:31):
Okay, the timing thing is interesting feeling bad
relatively quickly after a meal.
So how do you figure out ifSIBO is the culprit?

Rachel (06:38):
The main tool is a breath test.
It's non-invasive.
You drink a specific sugarsolution, usually lactulose or
glucose.

Mark (06:45):
Then, over the next two to three hours, you breathe into a
series of collection tubes atset intervals.

Rachel (06:50):
And they measure the gases in your breath.
How does that work?

Mark (06:53):
Yeah, they measure the levels of those gases produced
by the bacteria.
Hydrogen and methane are thestandard ones.
If those gases risesignificantly within the first
90, 120 minutes, it suggestsfermentation is happening too
high up in the small intestine.

Rachel (07:07):
Indicating SIBO.

Mark (07:09):
Correct.
High hydrogen is often linkedmore with diarrhea or mixed
symptoms.
High methane that's frequentlyassociated with constipation,
because methane can actuallyslow down gut motility.

Rachel (07:19):
And you mentioned hydrogen sulfide.

Mark (07:21):
Yes, newer testing can also measure hydrogen sulfide.
High levels might be linked todiarrhea.
Urgency foul-smelling gas,maybe even things like body
aches.
It adds another layer to thepicture.

Rachel (07:32):
It's pretty amazing.
You can detect that just frombreath.
And you said SIBO is prettycommon in IBS.

Mark (07:36):
It's thought to be a major driver.
Some studies suggest SIBO mightbe underlying maybe 50 or even
70 percent of IBS cases,particularly IBSD, the diarrhea
type, and IBSM, the mixed type.

Rachel (07:48):
Wow.
So identifying and actuallytreating the SIBO could
potentially resolve IBS for alarge chunk of people.

Mark (07:55):
It can make a massive difference for many.
Yes, instead of just managingthe downstream symptoms, you're
addressing an upstream causebacteria fermenting where they
shouldn't be.

Rachel (08:05):
OK, another really important potential avenue.
Let's shift gears a bit to food.
Everyone with gut issues knowsfood plays a role, but it gets
confusing when standard allergytests are negative.

Mark (08:16):
That's a really common scenario and it's where we get
into the territory of foodsensitivities, which are
different from allergies orintolerances.

Rachel (08:24):
Can you break that down?
Allergy, intolerance,sensitivity, what's the
difference?

Mark (08:29):
Sure.
A classic food allergy involvesan IgE immune response, usually
rapid and potentially severethink hives, swelling,
anaphylaxis.

Rachel (08:37):
The immediate, obvious ones.

Mark (08:39):
Right.
A food intolerance typicallydoesn't involve the immune
system directly.
It's often about lacking anenzyme like lactase.
A food intolerance typicallydoesn't involve the immune
system directly.
It's often about lacking anenzyme like lactase.
For lactose intoleranceSymptoms are digestive but not
immune mediated.

Rachel (08:50):
Got it Like lactose intolerance, causing gas and
diarrhea.

Mark (08:54):
Exactly.
Food sensitivity, however, isthought to involve other parts
of the immune system, maybe IgGor IgA antibodies or other
cellular reactions, and,crucially, the reactions are
often delayed.

Rachel (09:05):
Delayed, how delayed.

Mark (09:07):
They can occur anywhere from a few hours up to maybe 48,
even 72 hours after eating thefood.

Rachel (09:16):
Ah, okay, that makes it so much harder to connect the
dots between eating somethingand feeling lousy later?

Mark (09:18):
Absolutely.
You eat something on Monday andthe headache, brain fog,
bloating or even joint paindoesn't hit until Tuesday or
Wednesday.
It's really tricky to pinpointwithout some help.

Rachel (09:29):
So this is where food sensitivity testing might come
in, when standard allergy testsare clear, but you still suspect
food triggers.

Mark (09:35):
Exactly, especially if you've already tried removing
the big common culprits likegluten, dairy, and you're still
reacting, or if you have thosedelayed symptoms or systemic
symptoms beyond the gut, likefatigue, skin issues, mood
changes.

Rachel (09:47):
What kind of tests are we talking about here?
I hear about IgG tests a lot.

Mark (09:51):
IgG antibody panels are one type.
They measure IgG antibodylevels to a wide range of foods.
There are also IgA panels,sometimes combined with IgG.
Another approach is mediatorrelease testing, or MRT, which
looks at how immune cells reactto food extracts.

Rachel (10:08):
Okay, and how helpful are these tests really?
I know there's some controversyaround them.

Mark (10:12):
That's a really important point.
These tests aren't perfect andthere is debate about their
clinical utility.
A positive IgG result doesn'tautomatically mean you'll react
badly to that food if you eat it.
Immune reactivity doesn'talways equal clinical
intolerance.

Rachel (10:26):
So it's not a simple test says avoid this, eat that
situation.

Mark (10:30):
Not necessarily on its own .
However, they can be a usefultool, especially when
interpreted in context.
If someone has known gut issueslike dysbiosis or particularly
leaky gut- Leaky gut.

Rachel (10:41):
OK, we need to talk about that.

Mark (10:43):
Right.
In that context, elevatedantibodies might indicate foods
that are currently challengingthe immune system or crossing a
compromised gut barrier.
They can help guide a targetedelimination diet.

Rachel (10:53):
So use the test results as clues to design a more
focused elimination andreintroduction plan, ideally
with professional guidance.

Mark (11:01):
Exactly.
It's not usually the finalanswer, but it can help narrow
down the suspect significantlyrather than just guessing or
trying to eliminate huge foodgroups indefinitely.

Rachel (11:11):
OK, that makes sense.
A tool in the toolbox Usethoughtfully.
Now you mentioned leaky gut.
Let's dive into that.
What exactly is leaky gut?

Mark (11:20):
So leaky gut is the more common term for what's
scientifically known asincreased intestinal
permeability.
It means the lining of yoursmall intestine, which is
supposed to be a reallyselective barrier.

Rachel (11:30):
Like a tight security checkpoint.

Mark (11:32):
Perfect analogy.
It should let nutrients throughinto your bloodstream, but keep
out things that don't belong,like undigested food, particles,
toxins, microbes In leaky gut.
The gatekeepers, these tightjunctions between the intestinal
cells, become looser, morepermeable.

Rachel (11:47):
So the barrier gets leaky, allowing stuff to slip
through.

Mark (11:51):
Precisely Partially digested food, bacterial
fragments like LPS toxins thatcan pass through this
compromised barrier and enterthe bloodstream where they
shouldn't be.

Rachel (12:00):
And I'm guessing the body doesn't like that.

Mark (12:02):
Not at all.
Your immune system sees thesethings as foreign invaders and
mounts a response.
This can trigger inflammationnot just locally in the gut, but
potentially systemicallythroughout the body.
This can trigger inflammationnot just locally in the gut, but
potentially systemicallythroughout the body.

Rachel (12:13):
Ah okay, so leaky gut isn't just a gut problem.
It could drive other issues.

Mark (12:18):
Yes, it's increasingly recognized as a potential root
cause or contributing factor inIBS itself, certainly in food
sensitivities, but alsopotentially linked to autoimmune
conditions, skin problems,fatigue, mood disorders.
The list is growing.

Rachel (12:34):
Wow, okay.
So how do we know if thisbarrier is compromised?
Are there tests for leaky gut?

Mark (12:39):
Yes, functional medicine labs offer tests to assess gut
barrier integrity.
One common marker is zonulin.

Rachel (12:45):
Zonulin.

Mark (12:46):
Yeah, zonulin is a protein that actually regulates those
tight junctions.
High levels of zonulin in theblood or stool can suggest the
junctions are more open,indicating increased
permeability.

Rachel (12:55):
Okay, so high zonulin equals potentially leaky gut.

Mark (12:58):
What else?
Another key marker is LPSlipopolysaccharide.
That's part of the outermembrane of certain bacteria.
Finding significant levels ofLPS antibodies in the blood
suggests that bacterialcomponents are crossing the gut
barrier and triggering an immuneresponse systemically.

Rachel (13:15):
Because normally LPS should stay inside the gut.

Mark (13:18):
Exactly.
Its presence in the bloodstreamis a sign the barrier is
breached.

Rachel (13:23):
Are there other markers they look for?

Mark (13:24):
Sometimes tests will also look for antibodies against
these structural proteins of thetight junctions themselves,
like occludin and clodin.
If your body is makingantibodies against these
proteins, it suggests there'sdamage to the gut lining
structure.

Rachel (13:38):
Okay, actual structural damage markers.

Mark (13:41):
And secretory IgA, which we mentioned with stool tests,
can also be relevant here.
It's the gut's first line ofimmune defense.
Very low levels might indicatea weakened defense, while very
high levels could signal ongoingimmune activation and stress in
the gut.
Both can be linked topermeability issues.

Rachel (13:57):
So if that barrier breaks down, it makes sense why
someone might suddenly react tofoods they used to tolerate fine
or develop these wider symptomslike fatigue or joint pain
alongside their IBS.

Mark (14:08):
Absolutely.
It creates a situation ofheightened immune reactivity and
potential systemic inflammation, often fueled by things
crossing that leaky barrier.
Assessing and addressing gutpermeability can be a crucial
piece of the puzzle for manypeople with chronic digestive
and systemic symptoms.

Rachel (14:26):
It really feels like we're getting layers deeper than
just irritable bowels.
Okay, so we've covered stooltests, sibo, breath tests, food
sensitivity panels, leaky gutmarkers.
What if someone's exploredthese, or their practitioner has
, and they're still struggling?
Are there other stones to turnover?

Mark (14:43):
Yes, definitely For complex or persistent cases or
when other symptoms areprominent, there are further
investigations that can bereally valuable.

Rachel (14:50):
Like what.

Mark (14:51):
Well, we touched on pancreatic elastase in stool
tests.
If that's consistently low, itpoints towards exocrine
pancreatic insufficiency, or EPI.
Basically, the pancreas isn'tmaking enough digestive enzymes.
That needs specific support andcan definitely mimic IBS.

Rachel (15:06):
Okay, so ruling out EPI is important.
What else?

Mark (15:09):
Liver and bile function, especially if symptoms like
bloating or fatty stools seemworse after fatty meals.
Standard liver enzymes ALT, ast, ggt can give clues and
sometimes specific tests forbile acids are used.
Poor bile flow really hampersfat digestion.

Rachel (15:27):
Right and poor fat digestion can cause a lot of gut
upset.

Mark (15:30):
Absolutely.
Then there's the organic acidstest, the OAT.

Rachel (15:34):
You mentioned that briefly.
What does it show again?

Mark (15:35):
It's a urine test that gives a really broad snapshot of
your metabolism.
You can indicate potentialyeast or fungal overgrowth
markers that might not showclearly on stool tests.
It also looks at markers fornutrient absorption,
mitochondrial function, how yourcells make energy, b vitamin
status, even neurotransmitterbyproducts.

Rachel (15:52):
Wow, so that casts a really wide net.
When might that be useful?

Mark (15:55):
It can be helpful when symptoms are complex, maybe
involve fatigue, brain fog, moodissues alongside the gut stuff,
or if there's suspicion ofcandida overgrowth or issues
with energy productioncontributing to the overall
picture.

Rachel (16:09):
OK, and lastly, what about just standard blood
markers for inflammation, likeCRP or ESR?
Do they play a role in figuringout IBS?

Mark (16:18):
Well, ibs itself isn't defined as an inflammatory bowel
disease like Crohn's or colitis.
So typically major inflammatorymarkers like CRP and ESR might
be normal in straightforward IBS.

Rachel (16:30):
But they're still worth checking.

Mark (16:31):
Yes, because they help confirm that it is more likely
functional IBS rather thanunderlying IBD, which requires
very different management.
Also, sometimes you might seemildly elevated markers or high
ferritin, which isn't just ironstorage but also an acute phase
reactant.

Rachel (16:46):
Meaning it can go up with inflammation.

Mark (16:48):
Exactly Seeing.
Those might hint at low-gradesystemic inflammation or
oxidative stress that could beplaying a role, even if it's not
full-blown IBD.
It adds context, especially ifother tests haven't pinpointed a
single cause or if there arelots of extraintestinal symptoms
.

Rachel (17:02):
It really underscores that IBS isn't just one thing,
and figuring it out sometimesrequires looking beyond the gut
itself.

Mark (17:09):
It really does.
The body is interconnected andgut health impacts and is
impacted by so many othersystems.

Rachel (17:16):
So, wrapping this all up , if you're listening and you've
been handed that IBS diagnosis,maybe felt dismissed or like
it's just something you have tolive with.

Mark (17:24):
Yeah, if it feels more like a label than an actual
explanation, please know you aredefinitely not alone in feeling
that way.
It can often feel like a catchall when initial tests don't
show something obvious.

Rachel (17:36):
But and this is the hopeful part we've explored
today just because thosestandard tests look normal
doesn't mean nothing's wrong.

Mark (17:43):
Absolutely not.
It might just mean theinvestigation hasn't gone deep
enough, hasn't looked at thefunctional aspects, the
microbiome balance, thedigestive processes, the barrier
integrity, potential overgrowthlike SIBO.

Rachel (17:55):
And these modern functional tests the stool
analyses, breath tests,sensitivity panels, permeability
markers they offer thepotential to move beyond that
frustrating guesswork.

Mark (18:06):
Exactly.
They provide data, real,objective information that can
help uncover why your gut isstruggling.
Is it dysbiosis?
Is it SIBO?
Is it leaky gut Allowing foodreactions?
Is it poor enzyme function?

Rachel (18:17):
Finding those potential root causes then allows for much
more targeted, effectivestrategies.

Mark (18:22):
That's the goal.
Your symptoms are real, theyare valid and the data from this
kind of deeper testing matters.
It can empower you and yourpractitioner to create a plan
and a genuine healing andunderstanding, not just symptom
chasing.

Rachel (18:35):
Moving from just seeking relief to actually building
resilience and health withconfidence.

Mark (18:41):
Beautifully put.
It's about getting answers andtaking informed action.
So we have a final thought foryou, the listener, to ponder,
Reflecting on everything we'vediscussed today.
The microbiome mapping, SIBO,food reactions, leaky gut does
one of those areas particularlyresonate with your own IBS
journey?
Is there a piece of this puzzlethat feels like it might hold a
key clue for you, Somethingworth exploring further?

Nicolette (19:08):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
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Stay informed, stay healthy andwe'll catch you in the next
episode.