Episode 333: Functional Stool Testing: What It Is & How to Know If You Need It
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If you have obvious GI symptoms going on (digestion, bloating, gas, heartburn, acid reflux, loose stools, diarrhea, constipation, or sluggish bowels) you might want a stool test. But there are some non obvious conditions that also have a GI component, such as autoimmune diseases, hormonal imbalances, and skin conditions, that would also benefit from results of a stool test. Learn about functional stool testing, what it is, how you know if you need it and how it can help you.
Interested in having your stool test analyzed by Team FN? Sign up for The Gut Panel - our new offer designed to give you more insight as to what your root cause may be. Limited to 10 spots!
In this episode:
Non-obvious signs that something is going on with your gut health [5:44]
How functional stool tests differ from conventional GI labs [11:27]
Specific things that a stool test can show you [15:38]
Importance of stool testing with autoimmunity [20:04]
The most important thing to consider when getting a stool test [27:52]
When to forego the basics and jump into a stool test [31:33]
Resources mentioned:
The Gut Panel (Only 10 spots available!)
LMNT Electrolyte Replenishing powder (Use code FUNK get a free sample pack with any purchase!)
Qualia Mind (Get up to 50% off and an extra 15% off your first purchase with link + code FUNKS)
Organifi supplement powder (save 20% on your order with code FUNK)
Ned Natural Remedies (get 20% off your order with code FUNK)
Learn more about Gut Health & Functional Nutrition
Related episodes:
332: Coffee Enemas: The Whys, Whats and Hows
245: Our Favorite Functional Labs
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Erin Holt [00:00:02]:
I'm Erin Holt, and this is the Funk'tional Nutrition Podcast, where we lean into intuitive functional medicine. We look at how diet, our environment, our emotions, and our beliefs all affect our physical health. This podcast is your full bodied, well rounded resource. I've got over a decade of clinical experience, and because of that, I've got a major bone to pick with diet culture and the conventional healthcare model. They're both failing so many of us. But functional medicine isn't the panacea that it's made out to be either. We've got some work to do, and that's why creating a new model is my life's work. I believe in the ripple effect.
Erin Holt [00:00:39]:
So I founded the Funk'tional Nutrition Academy, a school and mentorship for practitioners who want to do the same. This show is for you if you're looking for new ways of thinking about your health and you're ready to be an active participant in your own healing. Please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment. I would love for you to follow the show, rate, review, and share because you never know whose life you might change. And of course, keep coming back for more. Hello, my friends. Welcome back. Let's just keep the poop talk going, shall we? Last week, we talked about coffee enemas, and today we're going to talk about functional stool testing, what it is and how to know if you need it.
Erin Holt [00:01:28]:
It's a question that I get over and over again, and honestly, sometimes it's not even a question. It's not a question that people know to ask because they're not even aware that this tool or this resource exists. It kind of reminds me of that story where two young fish are swimming in the ocean and an older fish says, hey, guys, how's the water today? And one of the younger fish looks at the other one and says, the hell is water? It's like we cannot see beyond what we know. So if all you've ever had at your disposal is conventional medicine tools, then you might not even know other tools are available. If you're someone who has already had your gut tested by a gastroenterologist, but you still have lots of gut symptoms, or unresolved IBS or unchecked autoimmune issues, hey, it might be time for another test. Or if you feel like you've tried everything and you're not getting the results with your health that you want, this might be a really great tool for you. So the intention of today's show is to tell you about another test that is available to you, a comprehensive stool analysis or a functional stool test. Now, practitioners, this is an episode that you might want to share with your clients or your patients to help them understand what a functional stool test is and how it might differ from other tests that they can get from their doctors.
Erin Holt [00:02:50]:
So what we're going to get into today is why you would even need a functional stool test. How they're different from the test that you're gastroenterologist or doctor might run. What specifically a functional stool test would show you and how it would help you. Like cool. It's going to show us the data, but it's also going to really help you feel better, here's how. And then how you can get one of these stool tests. And the most important thing to keep in mind, if you order one or you have someone order one for you, I cannot express this enough. You want to stay to this point in the show because it's crucial.
Erin Holt [00:03:23]:
It is clutch. And I'm going to be making a big announcement. I'm offering something that we've never done before here at TFN. Despite people asking me for years, we're finally doing it because now we have the bandwidth to do it. So let's start things off by talking about why you would order a functional stool test. Like why should you even care about this episode to begin with? Now, it might make sense that if you had obvious GI symptoms going on, you might want a stool test. So this would be poor digestion, bloating, gas, heartburn, acid reflux, loose stools, diarrhea, constipation, or sluggish bowels. And you've attempted the basics because a lot of what we just talked about, it can be due to poor diet.
Erin Holt [00:04:07]:
It could be due to not getting enough variety, not getting enough fiber in your diet. It could be due to lack of hydration. It could be due to a sedentary lifestyle. So you want to make sure you're eating well, you're moving your body, you're drinking the fluids, all of that. And if you still have GI symptoms that persist despite the obvious interventions, then a stool test would be a great option for you. Hey, if you haven't downloaded our free Digestive Guide yet, be sure to do that. Cause that can also help walk you through the basics. Head to thefunktionalnutritionist.com/digestion.
Erin Holt [00:04:37]:
You can also catch that in the show notes as well. So those are some reasons that you might wanna stool test. Also, multiple food sensitivities and reactions. If you feel limited in what you can eat, you're down to only a few foods. You're just reacting to more and more and more foods. That's an indication that it's more of an immune system situation. And we really want to see a stool test to figure out what is going on. And just a heads up, this might surprise you, but food sensitivities, especially multiple food sensitivities, are rarely a root cause.
Erin Holt [00:05:11]:
Usually they're an indication that something else is going on. And we want to see a stool test to figure that out. And then finally, IBS. Either diagnosed IBS or suspected IBS. The diagnostic pathway for IBS or irritable bowel syndrome starts with recurrent abdominal pain associated with altered bowel movements. So if your tummy hurts a lot and you kind of alternate between constipation and diarrhea, that's when you might want to start thinking about IBS. IBS diagnosis is basically a collection of symptoms. So we want to understand what is driving those symptoms.
Erin Holt [00:05:44]:
Whether you have the diagnosis or just suspect it, we still want to understand what is causing those symptoms. Just receiving an IBS diagnosis doesn't uncover the root causes. It doesn't tell us what contributing factors led up to the symptoms. And without that information, it's hard to alleviate the symptoms a lot of the time. So it's pretty straightforward that, hey, if you've got some of those gut symptoms going on, hey, you might want a stool test to look at your gut. But some non obvious things that might surprise you, conditions like hashimoto's, endometriosis, or PCOS. I pretty much always want to see a stool test in those situations. It's very, very common to have a gut component to those conditions.
Erin Holt [00:06:27]:
Same deal with autoimmune disorders. Again, whether that's diagnosed or suspected, there's almost always a GI component to an autoimmune condition. Skin issues, things like acne or eczema, psoriasis, chronic rashes. We want to see what's happening in the gut for sure. And then even hormonal imbalance, especially PMS, heavy bleeding, like heavy menstrual cycles, tender breasts, fibroids, some of the more estrogen dominant symptoms. I really like to see a stool test because it's going to help us understand whether or not we're effectively clearing estrogen out of the body or not. And if we're not, it can indicate why we're not, which is a really big deal when it comes to hormones. So all of the things that I just listed are all signs that something bigger is going on with your gut. 70% to 80% of the immune system lives in your gut.
Erin Holt [00:07:26]:
Inflammation in the gut can lead to inflammation anywhere else in your body. I mean, I'm sure you've seen the hippocrates quote before all disease begins in the gut. This is why gut health truly does affect everything. And that's really why I like to highlight some of the non obvious stuff, because, let's say you received a Hashimoto's diagnosis. I recently talked to two people, back to back who received hashi diagnosis. But you're not like, oh, my tummy hurts, right? I have a bellyache, or like, maybe my poop is fine. I go to the bathroom every day.
Erin Holt [00:07:56]:
No big deal. You probably wouldn't assume that you need to test your gut via a stool test, but in fact, you probably really do, because so much of the immune system resides there. And Hashimoto's is an imbalance of the immune system. It's autoimmune disorder. Now, if you have some of the issues from the first list, the obvious gut issues, you may have gone to your doctor, who may have sent you to a gastroenterologist. Or even if you've been diagnosed with an autoimmune or chronic condition, you may have partnered with a gastroenterologist or GI doc. A friend of mine has two autoimmune conditions, RA being one of them. And she has told me countless times, oh, my gastro already tested my gut.
Erin Holt [00:08:37]:
She said that to me a bunch. My gastroenterologist already tested my gut. She loves her gastroenterologist, which is like chef's kiss. Good work out there. Not everybody has a great experience, so she has an awesome one. And she's consistently, consistently told me, he's already tested my gut. And of course, my questions, coming from more of a root cause functional background, is, oh, great. What does that mean? What test or test that they specifically run? What were they looking for, and what did they find? And how does that tie into what your symptoms are? I always like to kind of get to the root of the root and ask a lot of questions.
Erin Holt [00:11:27]:
So there are different tests that your gastroenterologist might run. And to be clear, I am not suggesting any of these tests are wrong or bad at all. They're very useful. You know, we say bless up to modern medicine. So grateful to have it. They're just different than the comprehensive stool analysis that we reference and run here in the functional medicine space.
Erin Holt [00:11:57]:
Okay, so we're looking at different things. So let's talk about some labs or testing that your GI doctor might. Run an endoscopy. Pretty common. So that's looking at the esophagus, the stomach, the duodenum. They're going into the mouth, and they're using a camera to see what's going on in your upper GI tract. Colonoscopy is same, but the other end. So they're looking in the colon, in the rectum.
Erin Holt [00:12:23]:
Most of us are pretty darn familiar with the colonoscopy. It's really good practice to get that done, especially once you hit a certain age. Just last year, I had to pick somebody up from their first colonoscopy, and, whoo. It was a wild time. They were drugged up to the nines. I will never forget it. It was so, so funny. Anyway, don't sleep on your colonoscopies.
Erin Holt [00:12:46]:
And then, of course, there's imaging tests, like ultrasound, a CT scan, MRI, and this is looking at more of the organs and the soft tissues to make sure that there's no tumors or inflammation or abnormalities there. There can be biopsies done. So this is pretty common with an endoscopy, where they're taking tissue samples just to make sure that there's no cancer or other pathogens or diseases, and a breath test they can run. And this is getting more and more common in conventional medicine. I'm so grateful for that. SIBO, small intestinal bacterial overgrowth. This is a overgrowth of bacteria in your small intestine, and it is diagnosed through a breath test. So this is a test that we run in our practice, but you can also get this through a gastroenterologist, which is wonderful and different than a stool test.
Erin Holt [00:13:35]:
I will say that because what we're looking at in with a SIBO breath test is the small intestine, and what we're looking at with the stool test is the large intestine, the colon. So two different areas of the gut. And I just say that because, let's say you've gotten a SIBO breath test and it was negative. I always have our clients actually send it to us so we can see it even if we're not running the test. Like, let me just see it, because there's a lot of misinterpretation I found with SIBO tests. So let's say your SIBO test is negative. It doesn't mean I. That you won't still find issues on a stool test.
Erin Holt [00:14:08]:
So this is actually another great indication that you would be a good fit for a stool test if you have a lot of GI symptoms. But your SIBO test was negative, like, get a stool test, because looking at a different part of your gut. And then, of course, from your doctor or GI doc, you can get a stool test there. This is a culture stool test. And this is really more looking at common pathogens, parasites, things that would cause diarrhea, campylobacter, E. Coli. Like I said, parasites. So this is kind of used for more acute infections versus chronic ongoing stuff.
Erin Holt [00:14:44]:
So let's say you went on a trip and you came back and you're like, ever since I've been back for my trip, my stomach is like super funky, or you got food poisoning or something like that. That's kind of what this test is screening for. But if your issue has been going on for a year, two years, three years, like you've just had ongoing GI issues, it's probably not going to be super useful or helpful in that scenario. So I want to make it clear that the comprehensive stool analysis, the functional stool test that I am talking about here, that we reference and run in a functional medicine space, is different than the culture stool test that your doc would run. Again, both have utility. We're just looking for different things. So those are some of the gut tasks that you would find in conventional medicine. Now, let's tuck and roll into the functional stool test that we run.
Erin Holt [00:15:38]:
There's different options. The company that we work with is Diagnostic Solutions. So we run a GI Map. I have tried different stool tests. This is the one that consistently gets us the best clinical results. We've run hundreds of them. So in our opinion, it is one of the better ones, just because we consistently get our clients very, very good clinical outcomes and clinical results using it. So different stool tests are going to use different technology.
Erin Holt [00:16:06]:
The GI Map uses quantitative PCR. You don't have to worry too much about that. It's essentially detecting DNA for specific organisms. And that's really what its aim is to do. It's to measure clinically relevant organisms. And this helps to guide treatment. And it's quantitative, so we can see actual numbers, and that helps us to see with treatment, are they increasing? Are they decreasing? Ideally, we want the good ones to increase and the bad ones to decrease. So that's why we find it to be a very clinically relevant tool, which is very different than other at home stool tests, like Viome, for example, which is just looking at more.
Erin Holt [00:16:49]:
So the overall microbiome, the overall ecosystem, it's not really looking for pathogens or things to treat like the GI Map is. And so if you have ongoing issues, GI or otherwise, you want to know what the problem is. So then we can fix it. So what the GI Map looks for specifically is, like I said, pathogens. So this might be bacteria, it might be fungus, yeast, it might be viruses, it might be parasites. We get to see all of them opportunists, which are not necessarily bad bacteria, but it's just that when there's an imbalance in the ecosystem, that is the microbiome, these opportunists will take the opportunity to overgrow. And when they overgrow in some people, they can cause disease, inflammation, they can kind of run amok. We want to keep these guys in balance so they don't have the opportunity to overgrow.
Erin Holt [00:17:44]:
We also are looking at H. Pylori in seven different virulence factors. So H. Pylori is a pretty common infection in the stomach. 50% of the population has H. Pylori. Here's the deal. Only 2% develop gastric cancer.
Erin Holt [00:17:59]:
But this is a pretty serious thing, gastric cancer, we know. And so the positive virulence factors can show the genetic potential for an H. Pylori strain to go on to cause disease. And it really helps the clinician guide a treatment plan. We can determine, okay, do we go after this aggressively or not? One of the criticisms of the GI Map is that it over reports pathogens due to the technology used. And I would agree that it takes a pretty skilled clinician to be able to look at a stool test and determine, okay, do we treat this or do we not treat this? We'll get into that a little bit more later. But with, with H. Pylori, there's a lot of different factors that we would be looking at.
Erin Holt [00:18:43]:
So if somebody has symptoms, let's say they have upper GI discomfort, heartburn, and they have a positive H. Pylori on their stool test, and they have a positive virulence factor, I would be more keen to treat that H. Pylori. If they have a family history of gastrointestinal cancer, then absolutely. So we're looking at H. Pylori. We're looking at the virulence factors. We're also looking at the good guys, the good buggies, the beneficial bacteria, because those have to be nice and robust for us to have overall gut health, to prevent leaky gut, to have overall good immune function.
Erin Holt [00:19:18]:
We can look at Akkermancia. If you listen to the podcast, you know, I'm a big fan of Akkermansia. We can look at the short chain fatty acid and butyrate producers. So these are big fancy words to say, like, hey, things are running really well. Things look good. But if these guys are low, then we want to create a treatment plan and an approach to help to regrow them out. We're looking at specific bacteria that can contribute to inflammation, diarrhea, loose stools, abdominal pain, constipation.
Erin Holt [00:19:48]:
We can look at histamine producing bacteria. So if you've got histamine issues, mast cell activating bacteria. So we can actually see specific strains that correlate with some of these symptoms. What I really love about this test is we also can see bacteria and viruses associated with autoimmunity. So there are certain bacteria that can essentially activate, turn on, or even exacerbate the autoimmune process. So if somebody's coming to me with autoimmunity, I already said I want to see a GI Map. I want to see a stool test, no question. And I am looking for any of these bacteria that might be part of the autoimmune process.
Erin Holt [00:20:31]:
And what's really interesting is that GI symptoms are actually less common when these bacteria are elevated. So, like I was saying, you don't want to just do a stool test when you have funky guts and tummy troubles. You definitely want to do it if you have a more chronic ailment going on as well.
Erin Holt [00:23:19]:
Like I said earlier, we can see yeast overgrowth markers. We can see parasite markers. We can see worms on a stool test. That's always one of my favorite things when I got to tell somebody they have a worm. That's neat.
Erin Holt [00:23:53]:
We can also see digestive capacity, so digestive enzyme levels. It can tell us if you're actually breaking down your food or not. We can see if you're breaking down your fat or not. How it shows us is if there's fat in the stool, that tells us that your body is not absorbing the fat that you're eating. We shouldn't see fat in the stool. So that's a big marker. We can see immune response. So it looks at secretory iga.
Erin Holt [00:24:15]:
That's like the bouncer at the bar. That's the guy that's going to kind of prevent all the other bad guys from getting in. So if that's low, we definitely need to do some immune rehabilitation. And if this marker is high, that it's telling us, hey, something is activating the immune system in real time, and it needs your attention right now. Your immune system is mounting a reaction against something. And so we look at that marker, and then we look at the rest of the test to determine what could be going on here. We can also see some allergy markers, inflammation markers, a detox marker. So this is one of my favorite things to look at with hormone symptoms, beta glucuronidase.
Erin Holt [00:24:54]:
If that is, is elevated, then we're really not effectively clearing estrogen out of the body. So when I'm just looking at a hormone test, a DUTCH test, for somebody with hormone symptoms, especially those estrogen dominant symptoms, I almost always wish I had a gut panel to go with it, because we know that hormones are reacting to what's going on in the body, and the gut can be a large part of that whole hormonal picture. So one test really does give us an incredible amount of data, which is why I think a stool test is a super valuable investment. It's an investment that I make for myself. Once a year, I like to do an annual stool test. Now, that's great. The data is great, but how does the data actually help us? It gets us answers to longstanding symptoms. You can stop playing guessing games with your gut health.
Erin Holt [00:25:46]:
You can see and know what's going on. So you can actually treat the root and the treatment, depending on what's going on, it might be specific dietary changes, it might be lifestyle suggestions, it might be supplements. There might be a kill protocol where we're using herbs and nutraceuticals to address some of the bacterial overgrowth. I don't like to be super heavy handed with this, so we want to use discretion and bring this in when necessary. But it's nice because it gives us, we have an alternative to harsh antibiotics. So, for example, if you tested positive and conventional medicine for H. Pylori, one of the go to treatments is triple antibiotic therapy.
Erin Holt [00:26:29]:
You're getting hit with three different antibiotics where we can use herbs and nutraceuticals for the same effect with less devastation to the microbiome. And think about it like this. The symptoms are really the way that your body is communicating to you. Symptoms are like saying, hey, something is off here. Your body is telling you something is off. So when you address the root, the body doesn't have to yell anymore. It can go into recovery and repair mode. You can address the root, you can fix the root, and the body can go into self healing mode, which is really where it wants to be, and it's where we want it to be as well.
Erin Holt [00:27:04]:
Now, I did mention earlier that some of the controversy with GI Map is that it, people say that it can over report pathogens. It's picking up things that might not be there, and that's because PCR is very sensitive, so it can detect low levels of something where another test may show up as negative. Now, if you're a practitioner, this is something to really keep in mind so you're not over treating somebody's gut. This is something we break down in FNA, in the Funk'tional Autrition academy. Unfortunately, I think it's pretty commonplace with functional medicine to do that, to just kind of see a stool test and go gangbusters treating every imbalance lab marker. That's not really the approach that we want to take. I've said this a hundred times before. If I've said it once, it's not just the test.
Erin Holt [00:27:52]:
It is the interpretation of the test. And that is the critical piece that I want you to understand as a consumer or as somebody who would be thinking about purchasing or ordering a stool test or having your practitioner order it. The interpretation of the test is as important as the data itself, as the lab results itself. So it's not just about getting your hands on a GI Map. It's also about who is interpreting this and how are they conveying that data from the test. It's the clinician, the experience of the clinician that's going to help discern, is this finding on the test clinically relevant? Is this something that we should address or do we not need to worry about it? And I think if a practitioner has sort of a kill all the things mentality, then running a GI Map could potentially set you up to overtreat. And I think this is something that we should all be very, very aware. Now, I personally do love the GI Map because it shows the problems to fix.
Erin Holt [00:28:53]:
It's less of an overall microbiome test. Like, here's your overall ecosystem, like a Viome, and it's more of a pathogen test. It's assessing. Hey, what's wrong here? So it's so nice to be able to use this stool test and show our clients, hey, here's your problem. Like to be able to point to the issue. It's so validating for a client when they've been suffering for so long to see what the issue actually is. But we also don't want to forget about overall pattern assessment in critical thinking, which is exactly why we are rolling out our new offer, the Gut Panel. We wanted to give our audience more access to this data.
Erin Holt [00:29:32]:
We wanted to give you more access to this lab with a trained expert reviewing it. Remember, that is the key critical component. When you work with my team, you're getting experience. We have seen hundreds and hundreds of these labs. We know what we're looking for, and we know how to pair the data from the lab with the symptom that you're experiencing to let you know, like, hey, this is clinically relevant. Like, this is a big deal. And so this is why we're offering it to our entire audience right now.
Erin Holt [00:30:01]:
Up until this point, for, like, seven years, we've only ever offered a stool test to our one to one clients, and now we're opening it up to everybody right before the holidays, full little holiday treat. I will say that due to bandwidth, I can only open up ten spots. So I am assuming, since we've never done this before, I'm assuming that they will sell out by the end of the week. So if you're listening to this and you know you want in, I would head to the website right now. It's the funktionalnutritionist.com/gutpanel. I'll link it up in the show notes as well. So you'll get the GI Map that I just discussed, plus you'll get in depth interpretation from either myself or someone on my team. So if this is the first time you're learning about a functional stool test, or if you've known about it in the past and you've just been like, stool test curious, your next question might be like, okay, when is a good time to invest in a lab like this? And I would go back to the list at the beginning of this episode.
Erin Holt [00:31:01]:
If you're dealing with any of those. Great time. Great time to do a stool test again after you've attempted the basics. I usually, if you are like, okay, I am eating the standard american diet. I'm not moving my body. I'm inside all day. I'm sitting down all day. Like, get some of the basics.
Erin Holt [00:31:19]:
Do some of the lifestyle stuff that we talk about on this podcast all of the time. Start there. You don't need to start with the stool test. Start with the basics. If you're like, dude, I got the basics on lock then, and I'm still dealing with these issues, then get a stool test. Now, there is a caveat to that, and that is if you are a data driven dame. Meaning, I don't know. I just coined that.
Erin Holt [00:31:42]:
I like the alliteration. What can I say? But if you know that you need to see stuff on paper to really make the change, then that is like, the one caveat where I'm like, all right, you can forego the basics and just get the stool test. A recent client shared with us after she received her gut panel. She said, I knew there was something going on with me. Once I saw the test results, I can now understand what is going on in my body. It's just so clarifying. And it was the data that was the impetus for her to start actually making the changes. Look, she knew all of the basics to do, but she wasn't really consistent with them.
Erin Holt [00:32:19]:
It was the gut panel that helped her be more accountable to herself because she saw the data, and she was like, oh, before, she didn't really know what was wrong. So it was kind of hard for her to uphold the consistency. So I pretty much always say, start with the basics, start with the foundations before you start doing functional lab testing of any variety. But that is the one caveat to the rule, is if you love data, and it's data that helps you make the change. All right? So that is why I love functional stool tests for chronic GI and immune stuff. Chances are it does go beyond what your doctor or your GI specialist has looked at. That is not a problem.
Erin Holt [00:32:58]:
It's not a dig against your doctor or your GI specialist. It's just a different tool. It's a different set of tools. You can almost consider a stool test like this, a second set of eyes after your healthcare providers have told you that everything is normal, because it's not normal to feel shitty all the time. You know, whoever needs to hear this, listen up. Come back to me if you drifted off. If you're multitasking, it's not normal to feel shitty all the time, right? This is quality of life that we're talking about, the quality of your life. You deserve to feel better than shitty, okay? You deserve that for yourself.
Erin Holt [00:33:35]:
And there's solutions to feel better. But in order to know what the solutions are, we need to know what the problem is. And so this type of testing can help us help you feel better. So if you're into the Gut Panel, like I said, we've got ten available. Is one of them yours? Would love to see your poop. Okay, send me your poop. I'll check you next week. Thanks for joining me for this episode of the Funk'tional Nutrition podcast.
Erin Holt [00:34:07]:
If you got something from today's show, don't forget to subscribe, leave a review, share with a friend, and keep coming back for more. Take care of you.
