Lab Testing to Assess Malasborption and Leaky Gut

Dr. Justin Marchegiani

Today’s gonna be a video where we actually go over a real live patient’s lab test and we’re gonna be looking for malabsorption. Again a lot of people that come to see me, there tend to be some kind of chronic stress issue where eventually that stress has affected their gut and essentially they’re no longer able to maximize the absorption of a lot of the nutrients coming into their body.

So we’re going to look at a few different lab tests here, some cutting-edge stool test looking at specific DNA technology as well as some organic acid testing that we’ll look at these various organic acids which are metabolites from protein that have various companion nutrients that give us a window into how other nutrients in the body are doing, and we can see malabsorption and stress based on that pattern. So let’s roll up our sleeves and dig in.


So we’re already on this first test here. This is called the GI-MAP. Now in this test it’s a PCR which stands for polymerase chain reaction DNA test and it’s going to look at various infections, whether it’s pathogen, bacteria, various parasitics, various viral infections H. pylori. It will look at bacterial overgrowth. You can see that this patient, this person has actually low beneficial bacteria. So you can see lactobacillus is a beneficial flora along with bifidobacter is also a beneficial probiotics. So off the bat you can already see the person has low beneficial bacteria. That’s automatically starting to make me feel like there is a dysbiosis. Dys– meaning out of balance, –biosis meaning bacteria.  So out of balance regarding bacteria, typically more bad stuff than good. We already know the bacteria that’s good is low, right?

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So let’s go to the next page. So off the bat looking at potential autoimmune bacteria we look pretty clean but look up here. We already some dysbiotic flora showing up. So we have Pseudomonas species and Staphylococcus species. Now off the bat, that theory on page one regarding the dysbiosis we already know is present because we can see it here based on the Pseudomonas and the Staphylococcus. Go down a little bit further. Look at this. We got the trifecta. Wooh! Blasto, Dientamoeba fragilis and Endolimax nana. Then we go a little lower, there’s also candida. So we got a bacterial overgrowth. We have 3 parasitic infections, not one, but two, but three—Blasto, Dientamoeba fragilis and Endolimax nana. We have candida albicans and we have low beneficial bacteria, and if we don’t add any more insult to injury, we also see low levels of enzymes. This is important.

The more stressed your gut is, the more stressed your adrenals and your blood sugar and sleep is, the more put your body into a fight or flight, the more that shuns your body from being able to adequately produce enzymes and you can see it right here, looking at the various compound, Elastase, which gives us a pretty good marker of what’s coming out of the pancreas. So Elastase is low, low pancreatic output, and we also see low SigA, which is the localized immune system in the gut, and that kind of makes sense. How’s your immune system going to be when 70-80% of it is in the GALT and MALT, which is in the stomach and the small intestine, when you got 3 infections—3 major parasitic infections, a candida overgrowth, low beneficial flora, and 2 dysbiotic bacterial overgrowths, right? And then we also can’t break down our food well, so you see this sets us up for the perfect storm in functional medicine world. That’s why we look at the gut because most people they would be passed and they wouldn’t have this deep assessment to figure out what’s happening under the hood.

So now on top of that, kind of go back to page one in summary again, we saw low beneficial flora there and then we saw very high amounts of dysbiotic bacteria here, and then we saw Blasto infection, Dientamoeba fragilis, Endolimax nana, high levels of Candida, and again these tests aren’t the best for picking up candida and the best clinical indicators like jock itch or fungal nails or thrush, coated white tongue or itchy rectum or itchy anus, dandruff—those types of things are telltale signs of fungus and we actually have it on the test, too. Also the low localized immune system and the low levels of enzyme.


The Organic Acids Test

So let’s switch gears and go to the organic acid test because this will give us a window into other companion nutrients that’s going on in the body. So down the list we go, so this is the summary page. So real quickly about organic acids, organic acids can go high or go low. High organic acids, my analogy is it’s like making a million dollars a year but spending two. You’re still a million bucks in debt. It’s a lot of debt, versus someone on the low side—a lower organic acids that’s like making 10 thousand a year, but you’re spending 20. Yeah, so you have a lot less in the supply side which is kind of important. So typically lower organic acids mean it’s a longer type of chronic issue, where higher means it’s more of an acute issue in this typically a little bit more resiliency there. So high and low, both are signs of deficiency. Don’t let the high fool you. High still means there’s essentially a functional deficiency based on the high demand. So high and low, the sweet spot’s kind of in the middle and again organic acids are metabolites from protein. So what that means is the proteins are metabolized to various organic acids and these organic acids have various companion nutrients that they essentially are symbolic of. So like various things like suberate may be symbolic of carnitine or homovanillate or vanilmandelate may be symbolic of adrenaline or dopamine level. So various organic acids have their companion nutrients. So high or low, we would look to that companion nutrient as a source of solution and the big five are always gonna be:

  1. Diet
  2. Malabsorption, digestion or food allergens—gut issues basically.
  3. Emotional stress and/or sleep.
  4. Toxicity.
  5. Genetics like MTHFR, genetic individuality with certain nutrients, MTR, COMT, vitamin D receptor issues.

So all those things are going to be at step number five with the genetic factor. So going back in here real briefly. This person, what do we see, right? They already had this test over here with all of the infections. What do I think when I see infections? I always think potential malabsorption.

Let’s go look at that now. Low free form amino acids, low amino acids. Going to the neurotransmitter section, more low amino acids, very low, that means this is a long-term type of situation happening here. Low serotonin, low dopamine, low amino acids, low amino acids, and we keep on scrolling down here. So you can see, the moral of the story here is malabsorption. Malabsorption and if we go to each section—I don’t want to go too deep into this test because it can be quite an episode going through it, but look at carnitine, fatty acid, everything’s low. Look at the energy production. Everything skewed into that first quintile. Look at the L-lactate, low amino acids, look at the B vitamins. Everything’s low. Look at methylation, low. Look at neurotransmitters, everything’s low. Not bad with the oxidative stress. Detox low-high. Bacteria wasn’t that bad. So this organic acids test missed the bacteria even though we had a whole bunch pop up here. That’s why we always want to do multiple tests to help have a safety net in case we missed something.


Treating Malabsorption with Functional Medicine

So going back here, what’s the take home? The take home is with functional medicine assessments that are holistic and broad spectrum with a clinician that has a knowledge base, we can pick up infections that drive dysfunction in the body. Now when we see things like low amino acids like that, what does that mean to me? What does that mean to the person at home watching this video? It means we’re in a catabolic state of physiology. Our body is breaking down faster than we are building up. Our body has to take in nutrients and has to be able to digest it, assimilate it, utilize it and get it into the bloodstream then actually use it. And that’s what’s happening here, but we have a malabsorption. We have lower amino acids because gut stress creates malabsorption. So got to fix the root cause from a diet perspective, a stress perspective, we have to support the adrenals, but also fix the underlying gut issue that’s driving that malabsorption.

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Now with this person here, we may have to do a couple of rounds of gut killing to really get things cleaned up because there’s a lot of different things happening with these infections. So if you have a chronic issue, we got to look deeper at the gut, got to look at the malabsorption and the nutrients under the hood. If you feel like you have an issue that kind of resembles this and you wanna look deeper under the hood at what could be the potential cause, we need a holistic approach. So click and subscribe. Click onscreen and reach out, and schedule a consult with myself.