Fecal zonulin testing for gut health
One of my favorite tests that we run at Tendwell as part of the comprehensive functional medicine assessment is a stool analysis. We generally recommend Vibrant Wellness’ Gut Zoomer 3.0. This stool test looks at digestive enzyme levels, inflammatory markers, pathogens, and the total gut microbiome, among other things. One of these other things is a fecal zonulin test. This is a diagnostic test that measures the levels of zonulin in a person's stool sample. Zonulin is a protein that regulates the permeability of the intestinal barrier. What does this mean? It means that zonulin controls the openings between the cells of the intestinal lining, allowing nutrients to pass through while preventing the entry of harmful substances.
Increased levels of zonulin have been associated with a condition known as "leaky gut syndrome" or increased intestinal permeability. In the case of increased intestinal permeability, the tight junctions between the cells of the intestinal lining become loose, allowing bacteria, toxins, and other substances to leak into the bloodstream. This can potentially trigger an immune response and contribute to various health problems, especially autoimmune conditions.
Fecal zonulin testing aims to assess the integrity of the intestinal barrier by measuring the concentration of zonulin in the stool. The test involves collecting a stool sample, which is then analyzed in a laboratory to determine the zonulin levels. The results can help evaluate the extent of intestinal permeability and may provide insights into actions we can take to correct this situation to prevent potential gut-related issues.
Fecal zonulin has been a topic of interest in the context of inflammatory bowel disease (IBD), which includes conditions like Crohn's disease and ulcerative colitis. IBD is characterized by chronic inflammation of the gastrointestinal tract and is believed to result from an inappropriate immune response against the gut microbiota in genetically susceptible individuals.
Zonulin, a protein involved in the regulation of intestinal permeability, has been proposed as a potential marker and contributor to the pathogenesis of IBD. Studies have shown that zonulin levels can be quite elevated in the intestines of individuals with IBD, suggesting an association between increased intestinal permeability and the development or progression of the disease.
In IBD, we know the integrity of the intestinal barrier is compromised, allowing the entry of bacteria, antigens, and toxins into the intestinal wall and triggering an immune response. Zonulin is believed to play a role in this process by modulating the tight junctions between intestinal cells. Elevated levels of zonulin may contribute to increased intestinal permeability, leading to the translocation of harmful substances and promoting inflammation in the gut.
It's important to note that fecal zonulin testing is not widely used in routine clinical practice. This is not a test you will get at a typical primary care office or even a conventional gastroenterologist’s office. The concept of "leaky gut syndrome" or more accurately increased intestinal permeability and the clinical significance of measuring zonulin levels are still subjects of debate among some medical professionals. Some researchers and many in integrative medicine believe that increased intestinal permeability and elevated zonulin levels play a key role in certain conditions like autoimmune disorders, inflammatory bowel disease, and certain allergies. I certainly do. Re-establishing intestinal barrier function is a key strategy to prevent the autoimmune process.
You may be asking yourself what are the triggers of increased intestinal permeability?
· Food antigens/other components
· Stress
· Infection—viral, bacterial, fungal
· Dysbiosis--SIBO
· Intestinal inflammation—IBS, IBD
· Many diseases
· Impaired digestion--low stomach acid, insufficient digestive enzymes
· Toxins--Pesticides, BPA, glyphosates
· Nutritional insufficiencies
· Increased uptake of food antigens
· Malabsorption/Malnutrition
· Increased uptake of toxins and lipopolysaccharides
· Various medications
Make an appointment to talk to a functional medicine practitioner at Tendwell today and find out more or become a member and unlock your best health.
References:
Szymanska E, Wierzbicka A, Dadalski M, Kierkus J. Fecal Zonulin as a Noninvasive Biomarker of Intestinal Permeability in Pediatric Patients with Inflammatory Bowel Diseases-Correlation with Disease Activity and Fecal Calprotectin. J Clin Med. 2021 Aug 30;10(17):3905. doi: 10.3390/jcm10173905. PMID: 34501351; PMCID: PMC8432014.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432014/
Heidt C, Kämmerer U, Fobker M, Rüffer A, Marquardt T, Reuss-Borst M. Assessment of Intestinal Permeability and Inflammation Bio-Markers in Patients with Rheumatoid Arthritis. Nutrients. 2023 May 19;15(10):2386. doi: 10.3390/nu15102386. PMID: 37242269; PMCID: PMC10221762.
