This test is performed to identify abnormal intestinal microflora, but does not directly assess abnormal digestion/absorption, inflammation or other specific aspects of gastrointestinal health. The test is typically performed as a follow up after treatments initiated as a results of the Comprehensive Stool Analysis with Parasitology.
The ability to access intestinal ecology through stool culture techniques (which include comprehensive bacteriology and yeast cultures to identify the presence of beneficial flora, imbalanced flora including Clostridium species and dysbiotic flora), combined with detection of infectious pathogens and visual evaluation for the presence of parasites, is an important step in identifying imbalances in intestinal microflora.
A good balance of beneficial microflora has been known to be associated with health benefits since the turn of the century. At that time Metchnikoff drew attention to the adverse effects of dysbiotic gut microflora on the host and suggested that ingestion of fermented milks ameliorated what he called “autointoxication”. He proposed that the consumption of large quantities of Lactobacillus species would reduce the number of toxin-producing bacteria and result in better health and increased lifespan. 1
Over the past 90 plus years there has been extensive scientific research demonstrating that a good balance of Lactobacilli, Bifidobacteria and beneficial E. coli bacteria are important to the functional health of the gut, and as a consequence, to the whole organism. The benefits identified include inhibition of microbial pathogens, 2 prevention and treatment of antibiotic associated diarrhea, 3 prevention of travelers’ diarrhea, 4 reduction of lactose intolerance symptoms, 5 reduction in serum cholesterol levels, 6,7 enhancement of the immune system, 8 and inhibition of the proliferation of Candida albicans. 9,10 Research has shown that improved biological value of food can be achieved through the activity of Lactobacilli and Bifidobacteria which have been reported to produce folic acid, niacin, thiamin, riboflavin, pyridoxine, biotin and vitamin K. 11
The mechanisms by which these benefits are derived are not yet fully understood. However, research suggests that some of the beneficial effects may be due to the following activities of beneficial bacteria:
Release of substances antagonistic to enteropathogenic microorganisms such as lactocidin, lactobicillin, and acidolin
Competition with pathogens for adhesion receptors
Production of lactase
Production of short chain fatty acids (SCFAs) such as butyrate, propionate, and acetate
In a healthy balanced state of intestinal flora the beneficial bacteria make up a significant proportion of the total microflora. However, in many individuals we see an imbalance of beneficial bacteria and an overgrowth of non-beneficial or even pathogenic microorganisms (dysbiosis). This can be due to a variety of factors including: daily exposure to chemicals in our drinking water that are toxic to friendly bacteria; the use of antibiotics; chronic consumption of highly processed foods ( low in fiber, high in sugar) and high stress levels. Patients may present with chronic symptoms such as irritable bowel syndrome, autoimmune diseases (e.g. rheumatoid arthritis), fatigue, chronic headaches, and allergies to a variety of foods.
Bacterial sensitivities to a variety of prescriptive and natural agents are provided when pathogenic bacteria are cultured. This provides the clinician with important and specific clinical information to help plan an appropriate treatment protocol.
1 Metchnikoff, E. The Prolongation of Life. 1907, Heinemann
2 Fuller R. Probiotics in human medicine. GUT, 1991;32:439-442
3 Sittonen S, Vapaatalo H, Salminen S, et al. Effect of Lactobacilli GG yogurt in prevention of antibiotic associated diarrhea. Ann Med. 1990;22:57-59
4 Oksanen P, Salminen S, Saxelin M, et al. Prevention of travellers’ diarrhea by Lactobacillus GG. Ann med 1990;22:53-56
5 Kim H and Gilliland S. Lactobacillus acidophilus as a dietary adjunct for milk to aid lactose digestion in humans. J Dairy Sci. 1983;66:959-966
6 Tahri K, Crociani J, Ballongue J and Schneider F. Effects of three strains of bifidobacterial on cholesterol. Letters Applied Microbiology. 1995;21:149-151
7 Klaver F and Van Der Meer R. The assumed assimilation of cholesterol by Lactobacilli and Bifidobacterium bifidum is due to their bile salt- deconjugating activity. Applied and Envir. Micro. 1993;1120-1124
8 Peridgon G, Alvarez M, et al. The oral administration of lactic acid bacteria increases the mucosal intestinal immunity in response to enteropathogens J. Food Prot. 1990;53:404-410
9 Elmer G, Surawicz C, and McFarland L. Biotherapeutic agents – a neglected modality for the treatment and prevention of intestinal and vaginal infections. JAMA 1996; 275(11):870-876.
10 Fitzsimmons N and Berry D. Inhibition of Candida albicans by Lactobacillus acidophilus: evidence for involvement of a peroxidase system. Microbios. 1994; 80:125-133
11Noda H, Akasaka N and Ohsugi M. Biotin production by Bifidobacteria.J Nutr. Sci. Vitaminol. 1994; 40:181-188.
Infection with yeast species can cause a variety of symptoms, both intra- and extra- gastrointestinal, and may escape suspicion as a pathogenic agent in many cases. Controversy remains as to the relationship between Candida infection and episodes of recurrent diarrhea. 1 However, episodes of yeast infection after short-term and long-term antibiotic use have been identified in patients with both gastrointestinal and vaginal symptoms. 2
There is some evidence linking yeast infections with more chronic extra-gastrointestinal conditions. Studies suggest that the production of antibodies against Candida Albicans may contribute to atopic dermatitis in young adults. 3 Other studies have identified the potential role of candidiasis in chronic fatigue syndrome. 4
Identification of abnormal levels of specific yeast species in the stool is an important diagnostic step in therapeutic planning for the patient with chronic gastrointestinal and extra-gastrointestinal symptoms.
Yeast sensitivities to a variety of prescriptive and natural agents are provided when yeast is cultured at any level. This provides the clinician with useful clinical information to help plan an appropriate treatment protocol.
1 Nolting S, Stanescu Siegmund A, Schwantes PA. Candida and the gastrointestinal tract. A medical-research evaluation. Fortschr Med . 1998;116(6):22-8.
2 Goulden V, Glass D, Cunliffe WJ. Safety of long-term high dose minocycline in the treatment of acne. Br J Dermatol . 1996;134(4):693-5.
3 Savolainen J, Lammmintausta K, Kalimo K, Viander M. Candida albicans and atopic dermatitis. Clin Exp Allergy . 1993;23(4):332-9.
4 Cater RE 2 nd . Chronic intestinal candidiasis as a possible etiological factor in the chronic fatigue syndrome. Med Hypotheses . 1995;44(6):507-15.
According to Dr. Hermann R. Bueno of the Royal Society of Tropical Medicine and Hygiene in London, “parasites are the missing diagnosis in the genesis of many chronic health problems, including diseases of the gastrointestinal tract and endocrine system.” 1
While parasitic infection may be an underlying etiological factor in several chronic disease processes, doctors often do not consider the potential for parasitic involvement because signs and symptoms of parasitic infection often resemble those of other diseases. Moreover, it has been shown that parasite testing is a reasonable approach to the detection of causative agents for chronic gastrointestinal disorders. 2
Most Americans are inclined to believe that parasitic infection is a rare and exotic occurrence, limited to those who have traveled to distant, tropical lands. However, for a number of reasons, there has been an increase in the incidence of parasitic infection in this country. Reasons for this increase include the following: 3
Contamination of the water supply
Increased use of day care centers
Increased travel to, and visits from residents of countries where parasitic infection is endemic
Consumption of exotic and uncooked foods
The “sexual revolution”
Signs and symptoms of parasitic infection vary from one individual to another. The more common signs and symptoms are: constipation, diarrhea, bloating, gas, symptoms of irritable bowel syndrome, arthralgias, myalgias, anemia, increased allergic reactions, skin lesions, agitation and anxiety, difficulty with sleep, decreased energy, malnutrition and decreased immune function.
Infection can occur by four different pathways. These routes include contaminated food or water, insect vectors, sexual contact, and passage through the skin and nose. A thorough patient history will help assess the possibility of parasitic infection and the need for appropriate testing to confirm the suspicion. 4
Definitive diagnosis can be difficult because the life cycle of some parasites allows them to escape detection in standard tests. Interfering factors such as barium, bismuth, enemas, and antimicrobials such as antibiotics may further complicate detection of parasites in the stool. 5
1 Gittleman AL. Guess What Came to Dinner: parasites and your health . Garden City Park: Avery Publishing Groups Inc. 1993. p. ix.
2Zdero M, Cabrera G, Ponce de Leon P, et al. Parasitosis in an adult population with chronic gastrointestinal disorders. Acta Gastroenterol Latinoam . 1997;27(2):67-73.
3 Gittleman AL. Ibid. pp. 9-10.
4 Ibid., pp. 22-3
5 Ibid. p.93
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