How Does The Lactulose And Mannitol Test Work
Well, you simply consume 2 types of non-metabolized sugar, one with large molecules and one with small molecules , and then your urine is analyzed to see which sugars passed through your system1.
If the lactulose find their way into your urine, your gut may be considered overly permeable, ie leaky.
Given its specialist focus it is considered the #1 test for leaky gut.
If you are interested in getting this test, its quick and easy to order and as you can see non-invasive and very simple to do. Even more conveniently, it can be ordered straight to your home and is very affordable in terms of testing, with prices starting from around $179.
True Health Labs offers the lactulose mannitol test at this price .
Is There A Test For Leaky Gut
While diagnosis is incredibly difficult as mentioned, there is one specific test that some physicians will use in order to test intestinal permeability. The test is called the mannitol and lactulose test. Both of these are water-soluble molecules that the body cannot use. Mannitol is easily absorbed by people with healthy intestinal linings, whereas lactulose is a larger molecule, and thus is only slightly absorbed. A person is instructed to drink a solution containing both of these molecules, and then their urine is collected for six hours. The amount present in the urine reflects how much was absorbed by the body a healthy test will display high levels of mannitol, and low levels of lactulose. If high levels of both are found, it indicates increased intestinal permeability. If low levels of both are found, it indicates general poor absorption of all nutrients .
It is important to note that this test is an indicator of small intestine permeability, and cannot definitively diagnose leaky gut with full certainty. Most physicians steer clear of this test, as they do not believe it is very reliable. Additionally, since increased intestinal permeability is a symptom of many other diseases, it should not be used to necessarily diagnose leaky gut syndrome, as this could prevent a patient from receiving treatment for a more serious condition they may have. Seeking the advice of a gastroenterologist is recommended, as they specialize in digestive health and the GI tract.
Engage In Cardiovascular Exercise
Finally, move your body! It has been proven that cardiovascular exercise helps with the transportation of oxygen throughout your body and digestive system.
This supports the bacteria in your digestive system especially the n-butyrate generating beneficial bacteria. 150 minutes of heart rate increasing exercise is recommended.
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Testing Options For Intestinal Permeability
So if you look at the research, there are a number of different tests that have been used to define or identify intestinal permeability. And some of these are more common than others, but Im just going to mention a few different ones and then Ill tell you what we use in our practice and what I recommend.
So the first is the lactulose/mannitol permeability assay, and this uses molecules, sugars, long-chain sugars called oligosaccharides, and Ill explain a little bit more about it in a moment.
The second is an antigenic permeability screen, and this looks at antibodies to particular antigens like lipopolysaccharides and then also antibodies to endogenous molecules like actomyosin and occludin and zonulin. So these are proteins that the body produces in the gut that help to regulate tight junction permeability and the structure of the gut and determine whether the gut is permeable or not.
But in terms of clinical practice and whats readily available and whats been most validated by the scientific research, the lactulose/mannitol test and the antigenic permeability screen, I think, are the two most useful tests.
Putting A Stop To Leaky Gut
- By Matthew Solan, Executive Editor, Harvard Men’s Health Watch
Leaky gut gets blamed for everything from everyday stomach issues to pain to anxiety, yet it is one of the most mysterious ailments to diagnose and treat.
Part of the reason for this medical mystery is because the gut is such a vast and complex system. Science continues to find new ways that the gut can influence everything from heart health to keeping our brains young, says Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment with Harvard-affiliated Massachusetts General Hospital. There is much we know about leaky gut in terms of how it affects peoples health, but there is still so much that is unknown.
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What Happens When The Gut Is Leaky
When the intestinal cells and connecting proteins are damaged by any of these triggers, the gaps between them grow bigger, allowing substances to travel across the intestinal lining that wouldnt usually be able to get through such as bacteria, protein, indigestible fibers, and complex sugar molecules. It also means that sugars that should get digested by enzymes produced by the intestinal cells wont be digested or absorbed well.
And it is not just the intestinal cells that are affected in leaky gut. The proteins in the tight junctions are also damaged causing them to release a protein called actomyosin into the bloodstream.
There is a common misconception that the causes and symptoms of leaky gut are the same for everyone and that you either have it or you dont. I find that Leaky Gut is actually a spectrum from mild to severe that can affect everyone in unique ways. In other words, the pieces of your puzzle may be different from others when it comes to finding the root cause.
Keep in mind that there are trillions of cells that make up the lining of the wall of the small intestines. The degree to which they are damaged determines the extent of leaky gut symptoms and how they will affect you. For some people, leaky gut will be associated with higher than normal levels of certain proteins in the blood and/or a hormone that opens up the spaces between intestinal cells called zonulin.
Inflammatory Bowel Disease Eg Crohns Disease Ulcerative Colitis
The link here with leaky gut is quite clear and as mentioned above, studies are increasingly revealing the growing link between leaky gut and autoimmune disorders such as IBD.
Said differently, if you have IBD, you likely have leaky gut.
There is no chicken and the egg problem here. Unsurprisingly then, there is also a strong connection between people who suffer with IBS and leaky gut27.
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Tests For Leaky Gut Syndrome
A number of tests can help identify direct and indirect signs of a leaky gut, but no single test will give you an absolute answer.
Physicians should test when appropriate and let the results inform but not drive their clinical decisions, says Leo Galland, MD, an internist in New York City and director of the Foundation for Integrative Medicine. I see a lot of patients who get overtested, and their health-care practitioner follows the test results blindly, he says. As a patient, find a practitioner who you feel really listens to your experience and takes a thorough medical history.
Here are some of the most valuable tests.
Lactulose/mannitol test is the most common and only direct test of a leaky gut. The premise is simple. You ingest two types of sugar: one has large molecules and the other has small molecules. A healthy gut will pass the small molecules into the bloodstream to be excreted by the kidneys. The larger sugar molecules should stay in the gut. Presence of the larger molecules in the urine is indicative of a leaky gut.
Hydrogen methane breath test helps determine if your gut has a bacterial overgrowth. Most bacteria give off methane and hydrogen, which you expel in your breath. Presence of these gasses can indicate a serious overgrowth. Halitosis is not a sure sign of a leaky gut but it might be one indication.
Illustrations by Kotryna Zukauskaite
Thoughts to share?
How To Test Blood For Leaky Gut
The easiest way to test for leaky gut is through a urine test , but there are a few ways you can investigate leaky gut through taking a blood sample. These include:
Serum zonulinThis is one of the proteins that regulates tight junctions in the intestines. If zonulin levels are high in the blood , it suggests that your gut is more permeable than it should be.
There are a couple of issues with this test. Firstly, zonulin levels naturally fluctuate, so one reading may not be reliable.28 Secondly, the specificity of the testing method is variable, which means you can get false positives.
Zonulin antibodiesWhen zonulin is released into your blood, your immune system responds by making antibodies. Measuring these antibodies can therefore indicate the level of zonulin. This test is considered to be more accurate than serum zonulin, but its also more expensive.
Other antibody markersIf your gut is leaky, other substances such as LPS , occludin and actomyosin can find their way into the bloodstream.29 Again, your immune system produces antibodies, which can then be detected in a blood sample. Like zonulin antibodies, this is a pricey way to test for leaky gut.
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Can You Treat Leaky Gut
You can, but the approach is similar to diagnosing a broken car, says Dr. Fasano. You dont know the exact problem until the mechanic lifts the hood, looks around, and tries different things there is not a simple, direct approach to fixing the problem, he says. Its the same with leaky gut. We have to try different strategies to see what helps.
Your first step is to share your symptoms with your doctor. If leaky gut is a possibility, he or she can try several strategies to help relieve symptoms and reduce inflammation. The most common is to review your diet and eliminate known dietary causes of inflammation, such as excessive consumption of alcohol and processed foods, and to explore whether you have any food sensitivities for instance, to gluten or dairy. In theory, reducing inflammation from your diet like this also may rebuild the gut lining and stop further leakage, says Dr. Fasano.
The best way to protect yourself from leaky gut is to invest more in your overall digestive health, he adds. This means being more attentive about following a gut-healthy diet that limits processed foods and high-fat and high-sugar foods, and includes enough fiber. Sticking to a regular exercise program also can strengthen your digestive system. For example, studies have suggested that taking a 15-to 20-minute walk after a meal can aid in digestion. Your gastrointestinal system is complex, but caring for it doesnt have to be, says Dr. Fasano.
But Things Are Changing Tests Are Becoming 10x More Useful
Some companies are actually starting to deliver plain English results and most of all, tell you what you should do with the results they find!
I mean, imagine receiving a letter in a language you couldnt speak or understand and now, finally having a translator convert it to plain English!
i.e. instead of just sending you a complex and bewildering list of strains in your gut, they are now sending you individualized recommendations and lifestyle tips to improve your gut health and thus intestinal permeability.
This changes everything.
Unfortunately, there are dozens of companies out there offering what they say are the most advanced tests. But most are delivering nothing of the kind.
Ubiome and Biohm are 2 interesting testing companies Im keeping my eye on, because the data they produce is solid. However, the actionable takeaways they offer in the results they send back are still quite limited.
Thryve is doing interesting work too, but I feel their testing service is a loss leader for their follow up products. So Im not totally sold on them.
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Leaky Gut: Symptom Or Disease
It is important to note here that leaky gut is not a recognized medical condition.
In fact, it has been the victim of an ugly debate in the medical and scientific community for a while now.
As recently as five years ago, a large percentage of the medical community argued that leaky gut was a completely made-up condition.
Today, the discussion has moved on ever so slightly. Many doctors and researchers agree leaky gut exists. Now, there is a debate as to whether it is a symptom or a cause of disease.
What does this mean?
Well, it means the whole thing is a bit of a scientific chicken-or-egg situation.
Many scientific studies show that people with undiagnosed digestive conditions and those who are in relapse for chronic diseases are more likely to test positive for the leaky gut than those whose conditions are under control. This has led some researchers to suspect that leaky gut is a symptom of these conditions not being managed. They think the gut conditions are causing damage to the gut lining, leading to increased intestinal permeability, and then to a leaky gut.
Others argue that leaky gut is a condition in-and-of-itself. Researchers in this camp suspect that the toxins allowed to move through a leaky gut cause digestive disorders to develop in the first place.
Lets look at an example: celiac disease.
We explored the debate around how leaky gut in great detail in our article Is Leaky Gut Real?. If you want a deep dive, take a look.
What Is Leaky Gut
Leaky gut or leaky gut syndrome is something that many people have heard of but the name sounds quite vague, the official name in all of the research is Intestinal Permeability.
Leaky gut or Intestinal Permeability can bring up images of food particles, toxins and other waste matter from the intestines leaking into the rest of the body, and depending on your imagination this can seem quite dramatic and serious .. which it can be for your long term health.
From the moment you start chewing your food the digestion processes starts, chewing your food well is important as it makes it easier to digest in the stomach, and even the process of chewing and the activation of saliva sends messages further down the digestive tract to stimulate the release of digestive enzymes.
Once the digested food passes from the stomach to the small intestine it is further broken down into simple sugars, amino acids and fatty acids that are small enough to pass through the intestinal wall and into the bloodstream. These nutrients are the building blocks for cells and provide energy to keep us going through the day.
But for some people this intestinal barrier becomes more permeable, rather than small tight junctions that only let the essential nutrients into the body, larger undigested food molecules are allowed to enter the bloodstream leading to what is known as leaky gut.
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What Is The Best Lab Test For Leaky Gut
Are you looking for the best lab test for leaky gut? The large majority of my patients have been to at least a few other doctors before they enter my office, many have been to specialists and as such, they have lab work that I can review. When people tell me that their labs are normal, with confidence I can assure them that likely someone didnt scrutinize the labs enough and that I will probably find a few things that will at least suggest a direction to go without spending more money on advanced labs often seen in functional medicine. Most people want a SIBO test or stool test, but they are often overlooking in my opinion, the best lab test for leaky gut.
Before we get to the best lab test for leaky gut, lets discuss the difference between functional lab analysis and pathological or conventional lab analysis. To do this, lets use the example of a common headache. Most people with frequent headaches dont have any abnormal lab values. Though, we know something is going wrong, overreacting or under functioning if you get headaches frequently. This means that further investigation needs to occur and more scrupulous inspection may benefit the patient.
A Path Toward A Healthier Gut
Although it is unusual to hear the term “increased intestinal permeability” in most doctors’ offices, alternative and integrative medicine practitioners have worked on gut healing as an initial step to treat chronic diseases for decades. Other cultures around the world often recommend specific diets to make people feel better. Even in the United States, it is common to see people changing their diets after getting sick. A common initial step some practitioners take is to remove foods that can be inflammatory and could promote changes in the gut flora. Among the most common are alcohol, processed foods, certain medications, and any foods that may cause allergies or sensitivities. In my practice, I often see patients improve significantly when they start eating a healthier diet.
Controversy still exists on whether leaky gut causes the development of diseases outside the gastrointestinal tract in humans. However, it is always a good idea to eat a nutritious, unprocessed diet that includes foods that help quell inflammation , which may, at least in theory, help to rebuild the gut lining and bring more balance to the gut flora. This recipe could make you feel better, without any side effects. It is definitely worth a try.
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What Do The Results Of A Lactulose Mannitol Test Mean
In the results of your lactulose mannitol test, you will usually see three numbers.
Your test results will be shown on a graph. The graph will highlight the normal reference range to 1 standard deviation . This is where 68% of the population would have their levels.
Then it will show a 2 SD. This expanded range is where 95% of the population would have their levels.
If your results fall within 1 SD, it is very likely that you have normal intestinal permeability and digestive function.
If they are within 2 standard deviations, it is still very likely you have normal permeability and digestive function. But, if you are in the 2 SD range and are having digestive symptoms a follow-up test would be a solid idea.
If your results fall outside 2 SD, you almost certainly have increased intestinal permeability or other digestive abnormalities.
Note: The exact cutoffs for normal levels for each of these numbers will change depending on which laboratory is doing the test.