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Thursday, June 22 2017

The History of Stool Testing

There is an ever-increasing number of medical journals and scientists that are discussing the gut and specifically the connection of the stool to understand why chronic pain, chronic illness, and autoimmune disease is so prevalent in the U.S.  In the past twenty-five years, I have seen many changes take place in the technology of stool analysis.

The research around stool testing continues to expand its confidence in the relationship between aberrant findings on stool tests and the names of conditions we commonly hear from friends and family such as:

  • Allergies
  • Depression
  • Acne
  • ADD
  • Autism
  • Arthritis
  • Hashimoto’s Thyroid
  • Crohn’s Disease
  • Eczema,
  • and many others… 

This newer testing goes far beyond the typical and limited medical versions that looks for blood or parasites in the stool. 

Some of the novel new approaches were to microscopically identify abnormal parasites, bacteria, and yeast in stool and to measure different species of beneficial bacteria such as Lactobacillus, Bifidobacteria, and E Coli.  The identification of potentially harmful organisms was mainly through staining and culturing techniques, microscopic analysis and antigen testing.  A more recent type of testing called Polymerase Chain Reaction or PCR, can detect DNA or RNA of any kind of organism including virus’, and anaerobic bacteria, something that was impossible to do prior.  PCR testing can identify pathogens that could never be isolated by traditional testing.  This test is remarkably sensitive to finding microbes in a stool test because of PCR’s ability to find DNA fragments of pathogens without clinicians needing to see it.  These fragments tell us that the pathogens are there.  Previously, with antigen testing we only knew that a patient had exposure to the pathogen without knowing if the pathogen was an active infection or not.  Another advantage is the ability to quantify the amount of the pathogen.  Previously, a lab technician would need to see the pathogen and based on the amount that they saw in the stool sample would quantify it as rare, moderate, or heavy infestation.  Today with PCR testing, labs have computers count the DNA fragments in relation to the overall fragments to give an accurate quantification of how much of the pathogen is there.  F.D.A. guidelines have determined what amounts of these pathogens are acceptable so any deviation from that is considered abnormal. 

Dysbiosis and its associated problems

Dysbiosis is the infestation of any organism such as parasites, bacteria, fungi, or viruses causing stress to our overall state of health.  If combined with intestinal permeability or what is commonly called leaky gut syndrome, some possible outcomes can be expected.  Recent research has shown the following dysbiotic organisms and their autoimmune and pathological relationships.  Here are some examples:

Klebsiella Pneumonia, Citrobacter, Proteus, Prevotella, Bacteriodes, S. Pyogenes

Anklylosing spondylitis, Rheumatoid Arthritis, General arthritities




Graves’ Disease, Hashimoto’s Thyroid


PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with streptococcal infections.


Systemic Sclerosis (Scleroderma)

Campylobacter Jejuni

Guillian Barre Syndrome

E. Coli, Proteus

General autoimmune problems



To further illustrate this idea of bacterial connection to a specific illness, a study was done on wild mice where they introduced one foreign bacteria called H. Helmiticus.  This caused irritable bowel disease in the mice and an increase of an inflammatory chemical, IL 17.  They then introduced another bacteria, B. Fragilis which neutralized the H. Helmiticus and increased an anti-inflammatory chemical IL 10, which suppressed the IBD and IL 17. 

Professor Alan Ebringer in the U.K. has found that there is a strong Rheumatoid Arthritis (R.A.) connection to Proteus Mirabilis in the upper urinary tract.  His group has done ground breaking work on establishing specific amino acid patterns of between the Proteus hemolysin and R.A. associated HLA-DR molecules as well as the Proteus urease enzyme and hyaline cartilage (a specific collagen found in the small joints).  What this means is that they have found molecular mimicry between the Proteus bacteria and a type of HLA (human leukocyte antigen) that is on the surface of small joints.  This results in an autoimmune trigger when an infection of Proteus occurs.  The body attacks the joints thinking it is attacking Proteus.  

Diagnostic Solutions Laboratory

In the past year, I switched from a well-respected lab doing microscopic stool testing to PCR testing done by Diagnostic Solutions Laboratory.  In addition to the PCR testing they do, they have several intestinal health tests that give added information to enhance their reports:

Elastase-1:   This is a digestion marker for enzymatic breakdown of proteins.

Steatocrit:     This is a digestion marker for fat.

Calprotectin:This is a marker for colonic inflammation.  The resulting score can differentiate between irritable bowel syndrome (I.B.S.) and irritable bowel disease (I.B.D.)

Secretory IgA: Is an antibody protein that helps maintain barrier protection.  It increases in an acute infection and lessens with chronic infections and stress.

Anti-Gliadin IgA: A marker for gluten sensitivity in the stool that is more sensitive than blood antibodies.

b-Glucuronidase: A chemical given off by certain species of bacteria. It is also found to be elevated by 1.7 times in those with colon cancer.  It also interferes with a detox pathway that breaks down estrogen.  This can result in elevations in estrogen and an increased likelihood of estrogen dependent cancers. 

Zonulin:  Is a protein that prevents permeability of the intestinal barrier cells.  Elevated zonulin is a sign of “leaky gut syndrome”. 


If you would like to see a sample report from their lab click here


If you think you or someone you know would benefit from having this test done, please let me know and stool kits can be picked up at my office.  The price for the test depends on insurance coverage, and can vary depending on the tests that are chosen to be performed.  I can discuss this with you by phone or email.

Posted by: Dr. Goldstein AT 10:39 am   |  Permalink   |  0 Comments  |  Email

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