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RESEARCH. TECHNOLOGY. RESULTS.
INTERPRETIVE GUIDE
GI-MAP ® – Unparalleled DNA-Based Stool Testing
Our mission: to deliver innovative, accurate and clinically relevant diagnostic testing in a timely and cost-effective manner
“At Diagnostic Solutions Laboratory, we’re not content with the range of clinical testing currently available to practitioners. We believe that every patient should achieve optimal health, and we’re driven to give clinicians the tools to do so. Our mission, therefore, is to use our resources to bring the most advanced, innovative, and clinically relevant testing to healthcare providers worldwide.”
Tony Hoffman
President and CEO
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INTRODUCTION
The Gastrointestinal Microbial Assay Plus (GI-MAP®) is an innovative clinical tool that measures gastrointestinal microbiota DNA from a single stool sample with state of the art, quantitative polymerase chain reaction (qPCR or real-time PCR) technology.
The GI-MAP was designed to detect microbes that may be disturbing normal microbial balance or contributing to illness as well as indicators of digestion, absorption, inflammation, and immune function. The following guide may be useful for understanding the nature of each of the microorganisms found on the GI-MAP, as well as clinical implications and treatment guidelines.
GI-MAP® INTERPRETIVE GUIDE
HOW TO READ THE REPORT
GI-MAP quantifies bacteria, fungi, viruses, and parasites using qPCR. This is a leap forward from older methodologies that report only positive or negative. Results are reported as colony forming units per gram of stool (CFU/g). One CFU is roughly equivalent to one microorganism (or one cell). Results are expressed in standard scientific notation. A reported result of 3.5e7 is equivalent to 3.5 x 107 CFU/g, which equals 35,000,000 CFU/g, or 35 million CFU per gram of stool.
Figure 1. The normal reference range for C. difficile, Toxin A is 0–1,000 CFU/g. The patient’s result is very high at 1.21 x 105, or 121,000 CFU/g.
Reference ranges were developed using known positive, diseased samples to construct cut off values that distinguish disease-causing amounts of pathogenic and opportunistic microbes. Reference ranges for the pathogens were correlated with an FDA cleared assay for GI pathogens. The GI-MAP is capable of detecting as low as 0.1 cell per gram of stool.
Table 1. Scientific notation; a basic reference table.
| 1.0e1 | 1 X 101 | 10 | Ten |
| 1.0e2 | 1 X 102 | 100 | One hundred |
| 1.0e3 | 1 X 103 | 1,000 | One thousand |
| 1.0e4 | 1 X 104 | 10,000 | Ten thousand |
| 1.0e5 | 1 X 105 | 100,000 | One hundred thousand |
| 1.0e6 | 1 X 106 | 1,000,000 | One million |
Table 2. Clinical Approach — The Five “R” Treatment Protocol. The 5R Protocol is a widely accepted clinical guideline to treating pathogens and imbalances in the GI microbiota and restoring health to the gastrointestinal tract. Re-test patients with the GI-MAP in 3–6 months to monitor progress and make changes to the treatment protocol as needed.
diagnosticsolutionslab.com PATHOGENS
| REMOVE Using a course of antimicrobial, antiviral, antifungal, or antiparasitic therapies in cases where these organisms are present. It may also be necessary to remove offending foods, gluten, or medication that may be acting as antagonists. | Antimicrobial | Broad-spectrum antimicrobial herbs including: berberine, caprylic acid, garlic oil, oil of oregano, uva ursi, olive leaf extract |
| Antibiotics | Research the recommended antibiotic for the specific microbe present. Avoid medications to which the microbe is thought to have resistance. | |
| Antifungal | Caprylic acid, garlic oil, oil of oregano, olive leaf extract | |
| Antiparasitic | Black walnut, garlic oil, oil of oregano, Artemisia (wormwood), berberine, goldenseal, gentian root extract, quassia bark extract, citrus seed extract | |
| Antiviral | Olive leaf extract, purified silver, cat’s claw, monolaurin, osha root (Ligusticum porteri), vitamin A, vitamin C, vitamin D, reishi mushrooms, Echinacea, zinc | |
| REPLACE In cases of maldigestion or malabsorption, it may be necessary to restore proper digestion by supplementing with digestive enzymes. | Digestive support | Betaine hydrochloride, apple cider vinegar, herbal bitters, ox bile, lactase, pancreatic enzymes (amylase, lipase, protease), pepsin |
| REINOCULATE Recolonization with healthy, beneficial bacteria. Supplementation with probiotics, along with the use of prebiotics helps re-establish the proper microbial balance. | Probiotics | Lactobacillus acidophilus‚ Bifidobacterium bifidum‚ Bifidobacterium longum‚ Lactobacillus rhamnosus‚ Bifidobacterium breve‚ Lactobacillus casei‚ Saccharomyces boulardii |
| Prebiotics | Beta-glucan, fiber, inulin, pectin, xylooligosaccharides, galactooligosaccharides, larch arabinogalactans | |
| REPAIR Restore the integrity of the gut mucosa by giving support to healthy mucosal cells, as well as immune support. | Immune Support | Colostrum, immunoglobulins, S. boulardii |
| Intestinal Barrier Repair | L-Glutamine, aloe vera extract, deglycyrrhizinated licorice, marshmallow root, okra, N-acetyl glucosamine, quercetin, S. boulardii, slippery elm, zinc carnosine, vitamin A, essential fatty acids, B vitamins | |
| REBALANCE Address whole body health and lifestyle factors so as to prevent future GI dysfunction. | Support Consideration | Sleep, diet, exercise, and stress management |
SOURCES OF EXPOSURE AND RE-INFECTION FDA recommendations
To effectively treat infections and prevent reinfection, exposure should be identified and eliminated. Most exposure to pathogens occurs via fecal-oral transmission, most often due to use of contaminated water sources or improper hand hygiene. This may include drinking contaminated water, eating raw foods washed in contaminated water or harvested (e.g. shellfish) in contaminated water, or improper handwashing.
To remove microorganisms from food, the FDA recommends first washing your hands, running cool water over fruits and vegetables, while rubbing or scrubbing, and then letting them dry out before eating. During treatment, consider all possible sources of fecal transmission: romantic partners, children (especially if in diapers or not toilet-trained), sheets, towels, water source to the home, etc…
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