Lab Testing
I recommend checking your Inflammatory markers throughout the year at regular intervals so you can track your progress. What gets measured gets managed. What gets managed can improve.
Your lived experience and quality of life is most important. Keeping a regular journal is helpful because we often forget how good things are until they sometimes turn sour. Heck, I can’t even remember what I had for breakfast yesterday!
The Crohn’s Disease Activity Index (CDAI) and Simple Clinical Colitis Activity Index (SCCAI) are useful tools to consider using. They access disease activity in Crohn’s and Ulcerative Colitis. For children, consider the Pediatric Crohn’s Disease Activity Index(PCDAI ) or Pediatric Ulcerative Colitis Activity Index (PUCAI).
It’s helpful to pair the lived experience with clinical lab testing as sometimes what’s going on deep inside our bodies are not easily felt, and sometimes they are felt too late and a flare-up is imminent. I’d love for you to stay in long term remission and never experience a flare-up again!.
For clinical results, at the very least, I recommend calprotectin checked every 3 or 4 months.
Order Your Lab Tests From Home
Inflammatory markers to track include Calprotectin, a stool test that measures inflammation in the gastrointestinal (GI) tract, C-Reactive Protein which is a blood test marker to test inflammation in the body, and Sed rate, also known as erythrocyte sedimentation rate ( ESR) which is also a blood test used to test inflammation in the body and help monitor the status of inflammation, progression or decline.
Recent research shows EBV or Epstein-Barr Virus activation may be responsible for 60% of IBD cases and flare-ups. For this reason, I’ve included EBV testing below for your convenience.
Your Doctor can order these tests for you or you can order directly using the One Great Gut account at Ultra Lab Tests. This is the first company that not just lets patients order their own labs (and receive the results), but also allows you to submit your receipts to your insurance for billing! Please be sure to check with your insurance, as each company has different rules.
Here are the direct links to the tests at Ultra Lab Tests for your convenience:
– Sed Rate by Modified Westergren (ESR)
Useful in differentiating inflammatory and neoplastic diseases and as an index of disease severity. CRP is also useful in monitoring inflammatory disease states.
– Calprotectin, Stool
– Calprotectin, Stool – Canada
Indicator of inflammation specifically in the GI track. Clinical Significance Used to diagnose inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, or to differentiate IBD from irritable bowel syndrome (IBS).
– C-Reactive Protein Cardiac (hs-CRP)
Also useful in predicting risk for cardiovascular disease
Lactoferrin, Quantitative, Stool
This is an Enzyme-Linked Immunosorbent Assay (ELISA) for measuring concentrations of fecal lactoferrin, a marker for leukocytes. An elevated level is an indicator of intestinal inflammation. The test can be used as an in vitro diagnostic aid to distinguish patients with active inflammatory bowel disease (IBD) from those with noninflammatory irritable bowel syndrome (IBS).
Lactoferrin, Qualitative, Stool
The Lactoferrin IBD-CHEK® is a qualitative (QL) Enzyme Linked Immunosorbent Assay (ELISA) for measuring concentrations of fecal lactoferrin, a marker for leukocytes. A positive level is an indicator of intestinal inflammation. The test can be used as an in vitro diagnostic aid to distinguish patients with active inflammatory bowel disease (IBD) from those with non-inflammatory irritable bowel syndrome (IBS).
Fecal Globin by Immunochemistry (InSure®)
The fecal occult blood test is an immunochromatographic fecal occult blood test that qualitatively detects human hemoglobin from blood in fecal samples. This is a useful screening aid for detecting primarily lower gastrointestinal (G.I.) disorders that may be related to iron deficiency anemia, diverticulitis, ulcerative colitis, polyps, adenomas, colorectal cancers or other G.I. lesions that can bleed. It is recommended for use by health professionals as part of routine physical examinations and in screening for colorectal cancer or other sources of lower G.I. bleeding.
Fecal Globin by Immunochemistry (InSure®), Medicare Screen
The fecal occult blood test is an immunochromatographic fecal occult blood test that qualitatively detects human hemoglobin from blood in fecal samples. This is a useful screening aid for detecting primarily lower gastrointestinal (G.I.) disorders that may be related to iron deficiency anemia, diverticulitis, ulcerative colitis, polyps, adenomas, colorectal cancers or other G.I. lesions that can bleed. It is recommended for use by health professionals as part of routine physical examinations and in screening for colorectal cancer or other sources of lower G.I. bleeding.
Epstein-Barr Virus (EBV) Antibody Panel
Includes: Epstein-Barr Virus VCA Antibody (IgM), Epstein-Barr Virus VCA Antibody (IgG) and Epstein-Barr Virus Nuclear Antigen (EBNA) Antibody (IgG)
Epstein-Barr (EBV) Comprehensive Panel
For the most comprehensive look at your biomarkers for Epstein-Barr (EBV)
EBV-VCA IgG/IgM (viral capsid antigen) – A positive IgG means you’ve had or currently have the infection; A positive IgM means the virus has been reactivated.
EBV-EBNA IgG (nuclear antigen): A positive test result is usually associated with past infections.
EBV-EA-D IgG (early antigen): A positive EA IgG may mean you have an active or reactivated infection.
The Epstein-Barr EBV Early Antigen D Ab IgG test that will let one know if the virus is actively replicating.
Another good company to use is True Health Labs who offer more specialized testing. TrueHealthLabs, founded in 2009, was created by a Doctor to make lab testing directly available to those who are uninsured, underinsured, whose doctor refuses to order tests and those who simply want to make their own healthcare choices. Your results will be sent to you via encrypted email. Turnaround times are usually 3-4 business days, however, more complex tests can take 14+ business days. TrueHealthLabs saves you 20-80% off lab tests by negotiating directly with CLIA certified labs. With a very high trust rating from thousands of users I am a fan.
They conveniently accept HSA +FSA Accounts, too!
Some of these tests are more expensive than your usual test, and that is because they give specific insight into certain lab markers that other labs are not able to see. For example, the last time I tested my
pro-inflammatory IL2-TH1 with lab corp they were only able to tell me that I was under 31.2. Not exactly helpful!! CytoDx, seen below, will show you IL2-TH1 with greater granularity, and since we would like it to be below 12, this further shows that the <31 from the other lab is not very useful information.
Antibodies to Saccharomyces cerevisiae
These are found in approximately 75% of patients with Crohn’s disease, 15% of patients with ulcerative colitis, and 5% of the healthy population. High antibody titers increase the likelihood of disease, especially Crohn’s disease, and are associated with more aggressive disease. As the inflammation in Crohn’s disease is focused at the gut mucosa, most patients have IgA antibodies to S cerevisiae and half of these also have IgG antibodies. A minority of patients have only IgG antibodies to S cerevisiae.
TH1 TH2 Cytokine Test – Basic
For those with a confirmed autoimmune condition, the Th1 Th2 test is possibly the most important test. The test points out imbalances in the immune system by looking at cytokines, proteins that the immune system relies on to communicate. Bad communication results in complications for those with autoimmune conditions. The information this test provides helps your doctor develop a strong and effective treatment plan for you, especially when seeking alternative medicine support.
The immune system works like a seesaw. On one side you have Th1 cytokines that initiate the first line of defense. On the other side, you have Th2 cytokines which help produce antibodies to protect you from future invasions. However, when one side goes up, the other side goes down. This can contribute to a weak immune system and potentially promote autoimmune issues. Running this test will help to understand where the imbalance is. Because certain botanicals used in natural medicine can boost Th1 cytokines and Th2 cytokines, this test can help you and your doctor develop an effective plan to help balance a weak immune system and turn the volume down on autoimmune attacks.
TH1 TH2 TH17 Cytokine Test – Advanced aka CytoDX
This test is more detailed than the above with readings including
- Inflammatory Cytokines- Th1
- INF Gamma: Th1
- IL-1 beta: Th1
- IL-2: Th1
- IL-6: Th1 and Th2
- IL-7: Weak Th1
- IL-8: Weak Th1
- IL-12 p70: Th1
- IL-17A: Th17
- IL-18: Weak Th1
- TNF alpha- Th1
- Anti-Inflammatory Cytokines- Th2
- IL-4: Th2
- IL-5: Th2
- IL-10: T-regulatory cells
- IL-13: Th2
- IL-15: Weak Th2
TH17 Test
New studies show that an increase in a particular type of white blood cell, called Th17 cells, can trigger and determine the severity of autoimmune conditions. Monitoring Th17 levels can help you and your doctor better treat the condition.
Health Check Plus Vitamin D
The Health Check Plus with Vitamin D is perfect for the yearly physical or to monitor diet and lifestyle improvements. Health Check Plus with Vitamin D tests for all the body’s major systems including markers for the heart, kidneys, thyroid, immune system, and liver and more. The panel also screens for anemia, inflammation, infections, diabetes, hypoglycemia, minerals, and vitamin D deficiency. The cost of this test at your doctor’s office or hospital will cost you approximately $1000 plus the cost of the appointment. Running this test before seeing your doctors (check with him/her to see if they want to run additional tests) will save you $700. It makes lab testing affordable for the whole family, even if you have insurance.
Bacterial Organic Acids Test + Amino Acids by Great Plains Labs
The Organic Acids Test (OAT) offers a comprehensive metabolic snapshot of your overall health with 76 markers. It provides an accurate evaluation of intestinal yeast and bacteria. Abnormally high levels of these microorganisms can cause or worsen behavior disorders, hyperactivity, movement disorders, fatigue, and even immune function.
Many with chronic illnesses like Crohn’s Disease and Ulcerative Colitis, or even neurological disorders often excrete several abnormal organic acids in their urine. The Organic Acids Test also includes markers for vitamin and mineral levels, oxidative stress, neurotransmitter levels, and is the only OAT to include markers for oxalates, which are highly correlated with many chronic illnesses.
Check out this testimonial from Dr. Friedman who uses the OAT in his practice to help someone who was depressed and suicidal:
“After identifying a low serotonin level on an Organic Acid Test (a hallmark functional medicine test), A severely depressed and suicidal man began taking 100mg of 5htp twice a day (5htp is the direct precursor to serotonin). After 2 days, he said his depression virtually disappeared and he was no longer suicidal. I love when I can identify a biochemical glitch and someone can have such a profound emotional turnaround.”
With depression and suicidal ideation sometimes present in those with IBD, Crohn’s, and Colitis, the OATS test could be a test to significantly help.
Bacterial Organic Acids Test(MOAT) by Great Plains Labs
The Microbial Organic Acids Test (MOAT) is included in the Organic Acids Test (OAT) and indicates the metabolites produced by yeast and bacteria. Elevated test values are related to yeast or bacterial dysbiosis.
This test reports 21 metabolites (including creatinine) such as markers for beneficial bacteria, harmful bacteria, Clostridia species, Candida species, yeast and fungal metabolites, and general markers of dysbiosis.
The MOAT is ideal for follow-up to the OAT and may be recommended by practitioners looking for a specific abnormality, to monitor certain microbial balances, or to assess treatment efficacy. We strongly recommend the full OAT as the initial screening test.
As much as 80% of the population in the United States is estimated to have low vitamin D levels. Emerging studies show that low vitamin D is associated with an increase cause of death from ALL causes. Low vitamin D is also associated with autoimmune diseases and overall immune health.
Vitamin D is crucial for proper immune function. Research is emerging that optimal levels of vitamin D (40ng/ml+) may be able to help prevent upper respiratory infections like the flu and common colds.
One fascinating aspect of Vitamin D is it upregulates the production of Cathelicidins. Cathelicidins are peptides that kill viruses, bacteria, and fungi. Often those with IBD, Crohn’s and Colitis have sub-optimal absorption from foods leaving Vitamin D levels low. Also, many of us work indoors, lack sun exposure in the winter, or live in climates where sun exposure is infrequent allowing Vitamin D levels to drop to potentially dangerous levels. Over 70% of the population have suboptimal Vitamin D levels. PMID: 19737226 -PMID: 19895218
Studies show that Vitamin D supplementation dose needs to be higher in patients with inflammatory bowel disease[R] We recommend checking your Vitamin D levels at least four times a year, seasonally, and supplementing from the One Great Gut Dispensary as needed.
Vitamin D 1,25 Dihydroxy Active Form
Vitamin D from our diet and sun exposure must be converted into its active form 1, 25 dihydroxy vitamin D. High or low levels of 1, 25 dihydroxy vitamin D and have negative impact in the cardiovascular, neurological, and immune systems.
It is recommended to test dietary/sun vitamin D levels ( 25 hydroxy vitamin D ) in combination with this test in order to deficiencies and/or conversion issues.
Natural Killer Cell(CD56) And Regulatory T-Cell (CD25) Profile
This test determines your Natural Killer Cell and Activated T-Cell Profile including Absolute and Percentage CD3, Absolute and Percentage CD3 CD25 (Regulator T-Cells), Absolute and Percentage CD3 CD56, (Natural Killer Cells), CBC with Differential and Total Lymphocyte Count. Assess changes in T-lymphocyte surface markers that may indicate immune stimulation. Natural killer (NK) cells are large granular lymphocytes that mediate MHC-unrestricted cytotoxicity against virus-infected and malignant cells and manufacture a number of cytokines following stimulation of the immune system. The combination of IL-2 and T-cell markers can be used to assess the state of activation of T cells. NK cells are responsible for the destruction of virally infected cells, tumor cells, and antibody-dependent cellular cytotoxicity.
Glucose 6 Phosphate Dehydrogenase (G6PD)
G6PD deficiency is a hereditary condition in which red blood cells break down (hemolysis) when the body is exposed to certain foods, drugs, infections or stress. High dose Vitamin C IV is growing in popularity and helpful for many, however, contraindicated for those with a G6PD deficient as it could lead to death. We recommend that everyone know their G6PD status just in case a high dose Vitamin C is every desired. For example, it’s being reported that some hospitals in China are using high dose Vitamin C IV to treat covid19, and it’s been used to treat cancer and other conditions such as fatigue and infections for years, it is not approved by the U.S. Food and Drug Administration (FDA) for the treatment of cancer or any other medical condition.
Basic CD4 CD8 Ratio Test
The CD4 CD8 ratio profile helps assess the immune system in detail. This test is crucial for patients who are suspected of having a compromised immune system as seen in autoimmune conditions and HIV.
Epstein-Barr Early Detection Test
To detect the early presence of the Epstein Barr Virus, the causative virus in Mononucleosis (Mono). Epstein Barr (EBV) Early Detection Test (IgG D Antigen)
Epstein Barr Profile Mono Test
To detect the presence of the Epstein Barr Virus, the causative virus in Mononucleosis (Mono).
Ebstein Barr Virus VCA (Viral Capsid Antigen) Antibody IgM
Ebstein Barr Virus VCA (Viral Capsid Antigen) Antibody IgG
EBV Nuclear Antigen Antibody, IgG
I recommend to run the Th1 Th2 test along with this CD4/CD8 ratio test if you have any concerns with an autoimmune condition like Crohn’s or Colitis.
Stool Microbiome Testing
BiomeFx by Microbiome Labs is an innovative stool test that utilizes the most advanced technology and evaluates novel, functional markers of the microbiome. This is a new test released in 2020, check out a sample report here. Microbiome Labs testing requires a practitioner account that we have set up for your convenience. Use onegreatgut code or just click on this link.
GI-Map by Diagnostic Solutions Laboratory
This is the preferred gold standard by many Functional Naturopathic doctors. The GI-MAP (Microbial Assay Plus) is unique in the field of comprehensive stool testing. It relies exclusively on quantitative polymerase chain reaction (qPCR) technology to detect parasites, bacteria, fungi, and more, by targeting the specific DNA of the organisms tested.
GI-MAP by Diagnostic Solutions for those that live in Canada
These Stool Microbiome Tests allow for personalized treatment plans and informative retests. Consider running these labs twice a year so you know where you are with your microbiome and can make adjustments as necessary. Staying on top of your health decreases the chances of a flare-up occurring that could take a while to reverse. Some conditions that may warrant microbiome testing are: Autoimmune diseases IBS/IBD Digestive complaints, diarrhea or constipation, brain fog, skin problems, like acne and psoriasis, mood disorders, depression, and anxiety, diabetes, and weight loss issues. The GI-MAP is commonly used in infants and children and can provide insight into conditions related to Attentional Deficit Hyperactivity Disorder, Autism, and digestive complaints.
Every purchase from these lab test companies will allow the One Great Gut Foundation to get closer to curing IBD Crohn’s and Colitis. So you can invest in your health and build a healthier world through our initiatives, at the same time!
I hope this has been helpful for your health journey!
References
- Vnitr̆ní lékar̆ství (Vnitr Lek): Czech and Slovak Society of Internal Medicine – Kojecký V, Matouš J, Zádorová Z, Gřiva M, Kianička B, Uher M Vitamin D supplementation dose needs to be higher in patients with inflammatory bowel disease: an interventional study.
https://www.ncbi.nlm.nih.gov/pubmed/31487989 - Journal Of Crohn’s and Colitis – Vitamin D Inhibits Pro-Inflammatory T Cell Function in Patients With Inflammatory Bowel Disease – Schardey J, Globig AM, Janssen C1, Hofmann M, Manegold P, Thimme R, Hasselblatt P https://www.ncbi.nlm.nih.gov/pubmed/31051495
- Journal Of Crohn’s and Colitis – Vitamin D Decreases Hepcidin and Inflammatory Markers in Newly Diagnosed Inflammatory Bowel Disease Paediatric Patients: A Prospective Study – Moran-Lev H, Galai T, Yerushalmy-Feler A, Weisman Y, Anafy A, Deutsch V, Cipok M, Lubetzky R, Cohen S. – https://www.ncbi.nlm.nih.gov/pubmed/30840757
- Journal Of Crohn’s and Colitis – The Effect of Vitamin D on Intestinal Inflammation and Faecal Microbiota in Patients with Ulcerative Colitis. Garg M, Hendy P, Ding JN, Shaw S, Hold G, Hart A. – https://www.ncbi.nlm.nih.gov/pubmed/29726893
- Journal Of Crohn’s and Colitis – Lower Vitamin D Status May Explain why African Americans Have Poorer Outcomes than Non-African Americans After Surgery for Crohn’s Disease.
- 1Dobnig H, et al. Independent association of low serum 25-Hydroxyvitamin D with all cause mortality. Archives of Internal Medicine. 2008 Jun 23:168:1340-1349.
- Vitamin D and prevention of breast cancer: Pooled analysis. The Journal of Steroid Biochemistry and Molecular Biology Volume 103, Issues 3-5, March 2007, Pages 708-711
Note: Originally published in July 2019, this article has been revised and updated for accuracy and thoroughness.
