Dr. Jennifer Kessmann breaks down the GI-MAP stool test, which measures gut bacteria, parasites, viruses, and markers like zonulin and calprotectin. The test identifies dysbiosis, inflammation, and malabsorption, with results shaped by diet, antibiotics, and stress. She explains what each finding means and how to support beneficial bacteria like Akkermansia.
Chapters
Hello and welcome to the GI-MAP discussion. Good evening. I hope you're having a good night or day or whatever's going on. I want to go through this quickly in just a superficial format so that you and I could spend more time together on your particular results. This is the GI-MAP test, which is one of the stool tests that I use to evaluate what's going on in your microbiome. The microbiome can have many different things, as you'll see through this report. Sometimes it's overgrown, sometimes it doesn't have enough of the good bacteria, and so therefore it's undergrown, and that is the reason that you're having inflammation or problems. So there's lots of different things, and it's important to check in on your microbiome from time to time if you're— especially if you're having immune system issues or having gut issues. So this test is the GI-MAP, and it is done by what we call the PCR reaction. The PCR reaction clones the bacteria in a way, scientific way, and so you get an amplified specimen. And this is, of course, just a sample report. But I want to just kind of go through the different sections and give you some super— some information so that you can look at your report and and think of any questions that you might have for our meeting together. This first page is pathogens. And the entire page— usually these bacteria are not supposed to be in the stool. And when you see them, it is concerning. So for a potential pathologic infection, and therefore it's called pathogen page. But you'll see things that commonly cause food poisoning. C. difficile is commonly caused through antibiotics. O157 is sometimes considered the hemorrhagic E. coli. These are found in fast food sometimes. And then Shigella, Salmonella, most people have heard of those. Giardia is a parasite that sometimes I will see, and it flies under the radar. And people sometimes are symptomatic, but sometimes they're not. And it is important to not carry Giardia. Thank you. to lower inflammation in the gut. And then finally, viruses. So hopefully your first page is negative. And if not, we'll certainly discuss it. This next page is H. pylori. And H. pylori on this particular test is overrepresented, in my opinion. Usually most people have a positive and detectable level in the stool, but it's not at a high level. And it also does not have these virulence factors. So usually these will be negative on most of my patients' specimens. A lot of people believe that this test overrepresents Helicobacter in the stool, and therefore I do not always treat this because we really do not know if it's in the stomach based on these report— this report. So when Helicobacter is able to grow in the stomach, it usually means that the immune system is impaired and also that you may not have enough stomach acid in your stomach. I have seen where people do some treatment with me through protocols that I customize for every single report. I've seen Helicobacter go from positive to negative with a lot of correction in the microbiome as well, with just a few supplements and diet changes sometimes. That's a possibility as well for you. This next section is considered normal bacteria flora. And these are normally found in the gut. And the new reports have, like, a scale. And ideally, you'd like to see the normal bacteria kind of going straight down the middle in the green. And often, there is 1 or 2 that are off. These last 2 are considered really beneficial— Akkermansia and this Prausnuna. Those are both associated with lower incidence of autoimmunity when you have effective levels. OK. You can purchase Akkermansia for $100 a bottle, or you can grow what hopefully is in your gut. If you have low levels, you can grow them by eating a healthier, higher fiber, partially cooked, and lots of berries. And cranberries and pomegranates are said to encourage the growth of Akkermansia. Now be careful with the berry family, as you know. If you've been working with me, those can have high oxalates. And also, some of them are nightshades if they have seeds. So keep it a small to moderate amount. And frequently feed your Akkermansia throughout the week if you can. The next 2 are— we usually look at in generalities. And if you have high levels, that would be considered an overgrowth. If you have low levels, that could be representative of an undergrowth. And then different foods will— Propagate these different categories. These are also— this is sort of the overlying phyla where these bacteria up above fall below. Next, we have the dysbiotic or overgrowth bacteria. When you see a lot of red here, I usually think of dysbiosis, which is usually supported through an unhealthy diet with sugar or maybe a lot of antibiotics in the past or even a lot of stress can trigger dysbiosis. Constipation is another big cause of dysbiosis because it will allow these bacteria to overgrow in the gut. Makes sense. Sometimes when that happens, you can back up the bacteria into the small intestine and you can get what's called SIBO. Although it's not specific for SIBO, it is an indication that perhaps there's a pathologic overgrowth process that might involve the small intestine when you see a lot of high bacterial counts in this category. Certain bacteria like Pseudomonas are more pathogenic and can create what we call biofilms in the gut. Biofilms in the gut are— the bacteria do something that we call quorum sensing. Quorum sensing means that they send messages to each other to say that it's safe to grow, and they form a little protective barrier together, and they all get together and create a muck of mass inflammation in the gut. When you have certain bacteria at high levels, you might need to think about biofilm disruption. That would be something that we could also discuss. There's many ways to do that. When you're trying to get rid of bacteria, we often would like to use biofilms. Biofilm breakers. If you have good bacteria already and you don't have a lot of overgrowth, then biofilm breakers would not be encouraged for you because you have good bacteria, we just need to perhaps optimize something else. This next category are bacteria that are found associated with autoimmune. Now, it does not mean that you will get autoimmune or that you have autoimmunity, but we have studies that show that when you have things like Klebsiella that might be associated with autoimmunity, such as ankylosing spondylitis or other— many other different forms— Citrobacter and You know, these things can be associated with Crohn's, but probably, you know, they just increase inflammation, which also promotes autoimmunity. And so I think that when you have overgrowth in any of these, it could contribute to any kind of autoimmune or immune dysfunction, perhaps. But remember, this is just a single day in your stool also, and I forgot to mention that. So it doesn't mean that, you know, Klebsiella is always overgrown. It could mean that on this particular day, Klebsiella was a little bit high. So that's one other caveat with this test. Fungi and yeast, these are Candida. These are all under the category of fungi and yeast. This will always be present in the gut. They try to target a zone where normal is a little higher for this Candida so that they don't target Candidal overgrowth that's not really a problem. Problem, if that makes sense. So it's really sometimes hard to interpret, but if you have a lot of Candida symptoms and you have a positive Candida test in the stool, perhaps that is part of the reason that you have inflammation going on in your gut. This next one is 2 viruses that may show up when the immune system is really compromised. You may have CMV or EBV show up in the gut. But I honestly have not seen that, and I've ordered this test hundreds of times. The next 2 categories are parasites and worms, and I would also say that I don't see a lot of positives here. There's some controversy as to whether or not some of these are pathogenic or not. And then we get down into the other markers, and this part can be very interesting. If we didn't see anything up above, we might something here. So steatocrit is looking at the fat in the stool. So ideally you want that to be less than 15% or less than detectable limit. And then elastase, you want it to be greater than 200, and that is your enzymes, or one enzyme that is coming from the pancreas. Now if you haven't been eating, if you, you know, have been sick or, you know, something like that, some of these markers will be changed. And, and always, you know, we have to consider the clinical situation that is happening with you when we interpret this Beta-glucuronidase— and this person had a high level of beta-glucuronidase. Beta-glucuronidase is something that the bacteria in the gut make to reabsorb toxins and reabsorb different things into the bloodstream. And so if you have high estrogen, this is something that I really like to look at, because if you have high beta-glucuronidase and have high estrogen in your blood, then something called calcium D-glucarate might be Ideal for you. Also, if you're struggling with toxins or you're having difficulty detoxing, you have high beta glucuronidase. You may want to consider calcium D glucarate as well. Now, high beta glucuronidase can shift with correction of the microbiome. So it's possible that you can lower this through changing and encouraging healthier bacteria in the gut. The next test is the occult blood, and you want this to be negative. Of course, if it's positive, it could mean inflammation. It could mean a stomach. ulcer, and anything, and even including a GI malignancy or colon cancer most commonly. So if you have a positive occult blood, we need to repeat that, and then you probably need further evaluation or workup if there's not a clear explanation. It's important also to do this test when you're not on your cycle, and also, you know, try to avoid red meat for a few days before the test as well. These 2 tests, this is looking at the reaction to wheat. This can trigger inflammation. Some people think they're gluten-free or wheat-free, and then we do this test and we see a really high antibody. When I see that, I usually think that they may be getting secretly exposed to gluten unknown to them. It's a good opportunity to reevaluate things and maybe do a diet diary, thinking about all of the different potential exposures. Sauces and, you know, sandwich meats are 2 things to really think about, and anything where they might be adding gluten or gliadin or any wheat product to the, to the recipe. Calprotectin is a marker for inflammation, and it often will be high, and it can be even in the thousands when you have something like ulcerative colitis and Crohn's. If you see a low level, um, you know, 200 or less, it usually is not diagnostic of anything, but rather it's just showing a little bit of inflammation, which could be from all of the categories— stress, foods, toxins, dysbiosis, bad microbiome, all of the above. Zonulin is sort of related to calprotectin, but it basically is a marker in the gut for leaky gut. When the gut is irritated from whatever reason, and all of the above qualify, as well as any food allergy or stress or just, I mean, I sometimes even think of popcorn seeds just going through and just kind of creating a leaky gut situation that could contribute to an elevated zonulin. Zonulin is very common for it to be positive, but it's important for it to be negative because if you can really heal up the gut and not have all of these microbleeds, and there it's microscopic, you know, what we're talking about. But if you can heal up the gut and get your zonulin to be in the normal range, sometimes that can allow you to tolerate more things and just kind of have a better overall state of health with lower inflammation. And then finally, they include, if people are considering doing antibiotics for Helicobacter, they do include the antibiotic resistance markers for the positive Helicobacter tests. So hopefully, I look forward to going over your results with you, and I hope this video was helpful. And please, yeah, send any questions and write down your questions so that when we meet, we can go through those. Have a great rest of your day. Thank you.
