Testing to help your Crohn’s disease and ulcerative colitis symptoms

Sometimes underlying issues may be affecting your health and your IBD. There are a range of tests available to help discover what these could be. In this article Greg Williams explains the different types of testing available and what they are looking for.

It can be frustrating when medication, surgery, diet and lifestyle changes aren’t helping your inflammatory bowel disease (IBD) symptoms. Quite often there is something else going on and we have to look deeper inside someone’s body to truly understand the cause. 

To do this, there are a range of really advanced tests available, many of which are relatively unknown but can be very effective in identifying underlying causes.

Some of these tests are provided for free on the NHS (for those who live in the UK) and, whilst these can sometimes be effective, they often aren’t advanced enough, or interpreted in the correct way, to help someone to beat their symptoms.

This article covers some of the testing options that are available that your doctor almost certainly hasn’t run.

The results of these tests, assuming they are interpreted correctly, then enable personalised plans to be developed to make a significant difference to your health – including energy levels, digestive issues and pain reduction.

Some of the tests include:

Stool test

This is a comprehensive stool test (done at home) that checks for the presence of pathogens such as parasites, and bacterial imbalances.  These can be very common in people with IBD because of the weakened immune system and addressing them is absolutely critical as they can wreak havoc on your digestive system potentially causing, amongst other things, frequent urgent bowel movements, fatigue, reflux, bloating, and pain.

The test is a three day stool test (meaning samples are taken over a three day period). This is because pathogens can very easily be missed when using just one sample. 

In particular, a good quality stool test can check for:

Your doctor may have given you a stool test in the past but it was almost certainly a one day test that uses relatively poor testing methodologies to assess the results (and, therefore, would have very likely missed things of importance). 

The doctor is also only looking for very specific things and will often miss items of extreme significance.  For example, a doctor’s stool test is generally looking for certain parasites only.  However, if you have a parasite that isn’t on their list (a parasite is basically a bug living inside of you, and is dependent on you for its survival), or if you have some dysbiotic bacteria or yeast overgrowth, the doctor would not pick this up, even though it is adversely affecting your health.

For someone with digestive health issues a comprehensive stool test can almost always be the single most important test you can first do.

Organic acid test

This simple urine test looks at a huge range of markers (over 70) and, in particular, can indicate intestinal yeast and bacterial problems, as well as nutrient deficiencies, oxidative stress, and neurotransmitter levels.  

Many people with chronic illnesses (such as IBD) often excrete several abnormal organic acids. The cause of these high levels could include oral antibiotic use, high sugar diets, immune deficiencies, acquired infections, as well as genetic factors. If abnormalities are detected then appropriate protocols (including supplements, or dietary changes) can be put in place to address them.

Intestinal permeability (“leaky gut”)

Leaky gut is also known as ‘intestinal permeability’ and is very heavily linked with autoimmune conditions such as Crohn’s disease or ulcerative colitis. 

The small intestine both helps to absorb nutrients from the foods we eat, as well as acting as a barrier against excessive absorption of things such as bacteria and toxins. When a gut is ‘leaky’, undigested food particles and things such as parasites, bacteria, fungi and toxic wastes (that would normally be eliminated), are allowed to pass through the intestinal barrier into the blood stream. These will then be recognised by the body as an invader and the immune system will attack it, resulting in a large number of symptoms. These symptoms will be different in each person but would potentially be skin irritation, increased food sensitivities, urgent bowel movements, aching joints, and fatigue.

In a “leaky gut” test you drink a sugary solution (at home) that contains molecules called lactulose and mannitol. The test measures the ability of these sugar molecules to pass through the intestinal lining by checking the level of these molecules in a urine sample that you provide the following morning.

This test isn’t necessarily the first port of call for someone with IBD. That’s because if someone is still experiencing symptoms, or are reliant on medication to remain in remission, then it is almost certain they currently have a leaky gut and working to resolve that is more important than confirming its presence through a test. 

However, it can be a very important test to use once someone is in drug free (or minimal medication) remission. In these cases, an annual or bi-annual test can be worthwhile as it can provide a warning sign of if your health is slowly worsening  (it’s been shown that a gut may be ‘leaky’ up to a year prior to the onset of symptoms).

Adrenal stress indicator

This is a saliva test that can be done at home. Four saliva samples are taken throughout the day which measure the effectiveness of your adrenal glands and check for steroid hormone imbalances, both of which are critical for overall health, especially energy (low energy is a common symptom in people with IBD). 

The test shows markers for a number of important hormones including cortisol (a very important hormone for energy), progesterone, testosterone, DHEA, and oestrogen. As well as giving a much greater insight into energy levels, sex drive and muscle building/fat burning ability, this can be a really important test for women who suffer with PMT.

Food sensitivity testing

There are a variety of food sensitivity tests on the market, all which use their own testing methodology (though all have inherent inaccuracies). The most accurate ones would generally take a blood sample.

Personally, I am not a huge fan of food sensitivity testing because it is generally very inaccurate. Additionally, a lot of someone’s food sensitivities exist because their gut is in bad way. Over time, as the gut heals (through diet and lifestyle changes, and putting in protocols based on the results of the tests mentioned above), the majority of someone’s food sensitivities will go away. This is a really important place to get to as you don’t want to be on a restricted diet forever.

The most accurate way to work out the foods you are currently sensitive towards is done through an elimination and reintroduction diet, whereby you remove the commonly problematic foods from your diet for a period of time (preferably at least 30 days) before reintroducing the foods, one by one, in a structured way, and assess how your body reacts to those foods. 

Vitamin D

Vitamin D deficiency is a huge problem in the world today and is heavily linked with autoimmune conditions such as Crohn’s disease and ulcerative colitis. This test, which requires a simple finger prick blood test, done at home, can quickly highlight if you have a deficiency, and to what extent. The symptoms of a vitamin D deficiency can be wide ranging but can include fatigue, muscle pain, frequent colds, and joint pain.

This is a test which can be done on the NHS via a blood test and in many cases, especially when you have a diagnosed condition, your doctor will be willing to give you this test for free - so just ask!

Doctor’s testing

The tests described above are almost always much, much more advanced than the standard tests that an NHS doctor would have access.  Because of this they come at a cost. However, doctors do have access to certain tests that MAY be beneficial, including the ability to check for certain parasites (though as mentioned above they will often miss things of extreme significance), iron, vitamin B12 and vitamin D deficiencies, as well as coeliac disease.

Whether or not your doctor is responsive to doing them is, unfortunately, just pot luck and will depend on your doctor and your current health.

How and where to get testing done

The majority of these tests you will need to pay for. The test kits and analysis are carried out by specialist labs but to access them you need to go through a registered practitioner (such as a nutritionist). This also ensures you get someone who is experienced in interpreting the results. When choosing a practitioner ensure they have experience in working with clients who have taken these tests and that they have worked with other people with IBD.

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