Gut treatment using the Metametrix GI Effects test

Many doctors, including Peterson, Cheney, Guyer, Myhill and de Meirleir advocate working on the gut and trying to get it into balance. This is not an easy enterprise. De Meirleir says that it takes months to redress the grievances of a dysfunctional gut. This is a slow rebuilding process and it takes time.

Dietary changes have been seen as essential to bringing the gut into line, particularly changes that involve avoidance or elimination. Many items need to be restricted or given up, depending on the specifics of the patient. Often this will involve cutting out white flour, sugar, caffeine, soy, dairy, wheat, tobacco, and alcohol. Adding fresh organic vegetables, low carbohydrates and lean meats along with bottled water is seen as a step in the right direction Many people do not want to constrict themselves in this way and make these substitutions, as they are already giving up so much with this disease. It takes a special type of patient to do this - especially as the results are not immediately or readily apparent.

One of the chief weapons in trying to control and alter the gut is the diagnostic stool analysis (CDSA). In the US, stool tests are done by Metametrix, Genovas, and Diagnostechs. In Europe the chief test is the fecal microbial analysis at RedLabs BE. Each of these tests have their particular advantages, which the reader can explore. Dr. Guyer uses the Metametrix. Dr. Vrchota uses Genovas. Rich van Konynenburg recommends the Diagnostechs. My patient has been using the Metametrix test for the past three years.

The first set of items - Predominant Bacteria (Obligate anaerobes and Facultative anaerobes) – are an important set of markers of the health of the immune system. “They provide colonization resistance against potentially pathogenic organisms, aid in digestion and absorption, produce vitamins and SCFA’s and stimulate the GI immune system.” Dr. Guyer says that these items should be on the right of the graph. If the little dots are to the left, this indicates that the item is low, and that it needs to be raised. Unfortunately, there is nothing that can be directly done to elevate these items or to bring them into a more normal range.

Bacteroides sp. along with Bifidobacteria sp. should be highest. The information about Clostridia sp., Prevotella sp. and Mycoplasma sp. is confusing, to say the least. Prevotella is one of the three bad boys that shows up on de Meirleir’s list, along with Enterococcus and Streptococcus. Prevotella can be lowered by taking oxbile or Creon (suggested by de Meirleir). Oxbile can be supplemented by itself, or as part of a pancreatic enzyme such as GNDL digestive Enzyme.

Two items that are key to good gut ecology are Lactobacillus and Bifidobacter. These two items are often very low in CFS patients. A low number of these two is a good indicator that the bad boys are in control. The patient can attempt to raise these items with Probiotics. There are many Probiotics available on the market. Some are seen as better than others. Treatment has to be personalized, and trial and error comes into play.

VSL #3 is seen as a quite good and well-researched probiotic. It is ordered on the internet. Culturelle, available in grocery stores and pharmacies, is also well researched, and has the advantage of being D-Lactate free. D-Lactate producing Lactobacillus and Bifidobacter probiotics are seen as a problem for CFS patients. Custom Probiotics makes a D-Lactate free combination of Lacto and Bifido. Harry, who runs Custom Probiotics, seems happy to talk about the advantages of his products, which he has designed himself. Mutaflor makes a probiotic that is seen as providing great benefit. This product can be purchased in Germany and shipped to America. De Meirleir and Cheney both use this product. Recently, Dr. Alan Logan on Cort Johnson’s most valuable site, has been promoting Align, a bifidobacterial probiotic. Align has a small amount of sugar in it, and is also D-Lactate free. Dr. Guyer recommends Allergy Research’s Russian Immune for boosting the immune system.

There is continuing research into various probiotics and their relationship to particular illnesses and to health in general. For instance. there is a probiotic in development that supposedly eats oxalates, for those of you that have that particular problem.

So it would be prudent to keep reading about probiotic research and keep in mind that it might also be useful to rotate probiotics.

One recipe for making gut ecology improvement might be this:

GNDL digestive Enzyme
Custom Probiotics, D-lactate free
Culturelle GG
Mutaflor
Russian Immune
Symbiotics Colostrum
Align
Glutagenics

Opportunistic Bacteria emerge for various reasons: lowered immunity, poor diet, parasites and so forth. Among these bacteria are Klebisella sp. and Citrobacter sp. They are identified and dealt with directly with anti-microbials or herbs.

Pathogenic Bacteria come next and include four items, including helicobacter pylori.

The Yeast/Fungi section will report on Candida. Candida is reported on the intensity of its presence, with various stages being indicated. Candida seems to plague CFS/ME patients. (Some people think candida is a cause of some CFS/ME.) Candida can be dealt with in several ways. The first way is through an anti-Candida, low-glycemic index, hypoglycemic diet. Information on this diet can be found is various places on the internet. Dr. St. Amand’s recommendations are particularly valuable. High candida can also be attacked by prescription drugs Nystatin and Diflucan - but the treatments often need to be repeated. Diet needs to be dealt with in a stringent fashion, and probiotics used to increase the proportion of good bacteria.

The Metametrix test identifies parasites in the gut. These can range from Hookworm and pinworms to a host of other parasites. Specific identification allows for specific treatments. Some of the most common parasites are listed in the Metametrix interpretative guide.

Adiposity index elevation is associated increased caloric extraction from food, whatever that means.

Beneficial SCFA (short chain fatty acids) are seen as wanting to be up in the normal range. “Production of SCFA in the intestinal lumen plays an important role in the maintenance of the intestinal barrier.” Low total SCFA and low n-Butyrate are seen as not being good. “Presence of short chain fatty acids and n-butyrate are essential for the health of the colon. In general, high normal levels of these could mean that there is an optimal fiber intake and a balanced bacterial population.”
These items are signs of intestinal health if they are present in the mid to upper normal range. Butyrate can be supplemented.

Propionate invites further questions for CFS/ME patients. Dr. Alan Logan wrote this: “Writing in the journal Physiology and Behavior (2004), these researchers showed that intestinal lactic acid, both L-lactate and D-lactate, as well as another potentially brain toxic fermentation product called propionate, were all involved in the behavioral disturbances.” So the picture with propionate is confusing.

Lactoferrin is a marker for gut inflammation and need to be treated if present.

Under Immunology, Fecal sigA is low - due to stress or high - resulting from immune response. Anti-gliaden sigA elevation is associated with gluten sensitivity.

Additional tests are self-descriptive and include ph, which seems to want neither to be too low or too high.

Digestion includes Elastase 1, which should be over 500. Low elastase 1 is associated with pancreatic insufficiency. High Triglycerides indicate malabsorption, and are high digestive fibers.

The last category is Absorption.

This Metametrix test provides a great deal of information. Much is known about the gut, but much is unknown. It is beginning to dawn on doctors that the gut might have something to do with immune function and chronic illness. In this Patient Advocates estimation, certain parts of the test are more important than others, particularly since there are treatments that can bring improvement. Certainly identifying pathogens, high enterococcus, high streptococcus, high prevotella, inflammation, low good bacteria can all point towards various treatments, diet, pharmaceuticals, probiotics, and herbs, that can bring improvement to the gut ecology.

And then there is the idea about biofilms that fills the CFS forums these days. What effect biofilms have on gut ecology is another story for another day.

Comments, corrections, suggestions, additions, and/or clarifications are welcome.