Functional & Integrative Medicine Ltd, 77 Austin St, PO Box 19033, Onekawa, Napier 4146 NZPh 0800 439 633 Fax 0800 439 630 support@fxmed.co.nz www.fxmed.co.nz

Based on the Treatment Strategies provided by Sharon Erdrich MHSc [Hons], NZRGON, Dip Nat, Dip Med Herb.

SIBO Seminar 2017

SIBO SOLUTIONSFxMed Booklet

CONTENTSProduct

Treatment Objectives Chart

Atrantil — KBS Research

Berbercap — Thorne Research

Berberine-500 — Thorne Research

Betaine HCL/Pepsin — Thorne Research

Bio-Gest — Thorne Research

Candicidal — Xymogen

Critical Digestion — Enzyme Science

Curcumin — Ayush Herbs

EnteroMend — Thorne Research

Enzyme Defense Pro — Enzyme Science

Happy Belly — Metabolic Maintenance

MotilPro — Pure Encapsulations

NAC — Pure Encapsulations

Neem Plus — Ayush Herbs

Prescript-Assist Pro — Researched Nutritionals

Sacro-B — Thorne Research

Functional Testing for SIBO

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2.

Berbercap (200mg) – Broad-spectrum immune and GI activity

• Helps maintain a healthy immune response.• Helps maintain the body’s normal intestinal flora.• Biofilm disruptor activity.• Eradicate bacterial overgrowth – hydrogenic bacteria.• Promotes healthy respiratory mucus membranes.

Berberine-500 – Supports a healthy balance of normal bacteria in the intestines.

• Anti-microbial effect against bacteria, fungi, viruses, yeast, protozoans and helminthes.

• Biofilm disruptor activity.• Eradicate bacterial overgrowth – hydrogenic bacteria.• Higher amount for maintenance of healthy glucose

metabolism.• Supports healthy lipid levels.• Provides cardiovascular support.• Contains 500mg of Berberine HCl per capsule.

Atrantil — NEW!– Daily support and balance for the digestive system

A patented nutraceutical and a vital component of any Methanogenic SIBO Protocol, this product facilitates the elimination of unwanted methane producing bacteria from the small intestine that can cause bloating, abdominal discomfort and changes in bowel habits. Atrantil works by calming the gut with M. Balsamea Willd extract (peppermint), then Quebracho extract (flavonoid) binds to the hydrogen that the bacteria use as fuel to produce methane gas. The Conker Tree saponins (natural antibacterial) also reduce abundant methane by binding to the reductase enzyme in the weakened archaebacteria – stopping methane production.

• These 3 active ingredients work synergistically to reduce the incidence of bloating, abdominal discomfort and changing bowel habits (constipation & diarrhoea) either due to SIBO or the consumption of gas forming foods.

• Atrantíl can increase cellular support to promote a healthy gut.

• New research shows that the problems start with methane producing archaebacteria. When left untreated, these out-of-place bacteria feed off the foods you eat and create methane gas, this leaves you bloated and uncomfortable. Atrantíl breaks the cycle naturally restoring good digestion.

3.

Betaine HCl & Pepsin – For improved protein digestion

• For optimal stomach acidity.• Promotes protein breakdown and absorption.• Benefits individuals with occasional indigestion.• Thorne provides hydrochloric acid and pure pepsin from a

porcine source, which is pure, undiluted and lactose-free.

Bio-Gest – Broad spectrum digestive aid

• For individuals needing more than HCI – a blend of hydrochloric acid (HCI), pepsin, pancreatin and ox bile.

• Promotes digestion of proteins, carbohydrates, and fats.• Ox bile added to promote fat digestion.• Benefits individuals with occasional indigestion.

Critical Digestion - High potency digestive enzyme formula

Enzyme supplementation works with our digestion to lessen symptoms associated with impaired digestion. Contains patented Thera-blendTM enzymes: multiple strains of enzymes that work in various pH levels and demonstrate unmatched performance and speed in digestion of proteins, fats, fibers and carbohydrates in addition to promoting an optimally functional GI tract.

• High potency formula comprised of digestive enzyme, probiotics and nutraceuticals.

• Soothes occasional indigestion, gas and bloating.• Supports nutrient absorption and also improves HCL

availability in the upper GI.• 1 billion active probiotic cultures per capsule.• Vegetarian enzyme.

4.

Candicidal– Natural Support for GI Balance

The complementary blend of ingredients is formulated to support against microbial insult, support gastrointestinal function, and moderate oxidative and inflammatory activities. Contains Origanox™ WS, phenolic-rich ingredient extracted from the edible herb Oregano ‘Origanum vulgare, as well as herbs to support digestion and a healthy GI system.

• Supports healthy microbial balance.• Supports gastrointestinal health.• Provides nutrients that support antioxidant and anti-

inflammatory activity.• Eradicate bacterial overgrowth – hydrogenic bacteria.

5.

Curcumin – A potent herbal anti-inflammatory and powerful antioxidant.

Curcuma longa (Turmeric) has a long history of use in Ayurvedic medicine as a treatment for inflammatory conditions.

• Anti-biofilm activity.• Supports a healthy inflammatory and metabolic response

already within a normal range. • It is known to have important antioxidant properties, to

support the body’s natural detoxification and liver function, and to support healthy brain tissue.

• Best in combination with NAC for treatment of SIBO.

Enzyme Defense Pro – Proteolytic enzymes to support healthy immune function

• High potency proteolytic enzymes targeting cells that are dead, damaged or do not belong.

• Has shown to help disrupt biofilm formation.• Critical support for immune health.• Nattokinase NSK-SD blend and Serratiopeptidase – vascular

and circulatory health.• Includes Vitamin D3 and L-Lysine.

EnteroMend – Intestinal Health Support

A unique formula combining the mucosa-protective effects of L-Glutamine with highly absorbable botanical complexes to provide a great-tasting orange-vanilla powder for maintenance of a healthy intestinal tract.

• Meriva® and Casperome® (curcumin and Boswellia phytosomes) – enhanced absorption and to help maintain an already healthy inflammatory response in the GI tract.

• DaltonMax 700® – a unique 200:1 – potency aloe extract that soothes the mucus membranes of the GI tract.

• Sunfiber® – promotes healthy flora, butyrate levels and bowel regularity.

• L-Glutamine – provides fuel for the cells of the intestines for support of colonic permeability.

6.

MotilPro – Promotes GI motility

An advanced gut signalling support formula, supporting serotonergic and cholinergic neurotransmission in the GI tract, as serotonin and acetylcholine are the principal neurotransmitters that stimulate GI motility.

• 5HTP and Activated B6 – stimulates enteric neurons through activation of 5HT4 receptors.

• Acetyl-l-carnitine – supports autonomic neuronal health and encourages neurotransmission of signals to encourage healthy motility.

• Ginger – modulates serotonin signalling, supports gastric emptying, intestinal transit, healthy visceral sensation and upper GI comfort.

Happy Belly – To reduce harmful microbes and parasites

Happy Belly provide a variety of pharmacological actions that help to resolve dysbiosis and improve GI health. Caprylic acid, berberine, black walnut, garlic, and olive leaf have shown antibacterial, antimicrobial, antifungal, anti-parasitic, antiviral, anti-diarrhoeal activities as well as beneficial effects on the GI tract and metabolism of the host. • Multiple modes of action thereby showing synergism,

biofilm disruption, and are less likely to cultivate resistance in pathogenic organisms.

• Integrative and functional medical practitioners can use Happy Belly as part of an antimicrobial regimen protocol for gastrointestinal repair.

• The proprietary blend of herbs has shown a long history of human medicinal use suggests low risk of adverse side effects and may be used alone or in conjunction with prescription antibiotics or antifungals.

• Recommended for the treatment of microbial imbalance, yeast overgrowth and parasites.

NAC – Liver support, detoxification and immune support

N-Acetyl-l-Cysteine (NAC) is a sulphur-containing amino acid, and is the precursor of the amino acids L-cysteine and glutathione.

• Powerful free radical scavengers.• Mucolytic action as well as providing powerful nutritional

support to cells as an antioxidant.• Inhabits biofilm formation and destroys developed biofilm.• Enhances glutathione production and plays a role in heavy

metal detoxification.• Effective in promoting normal liver detoxification.

Neem Plus – Immune and Skin Support

Has shown anti-biotic, anti-viral, anti-fungal and anti-bacterial properties, which supports the immune system and promotes healthy skin.

• Contains Azadirachta indica (Neem) – immune promoting properties.

• Emblica officinalis (Amla) – Antioxidant and adapatogenic properties.

• Tinospora cordifolia and Rubia cordifolia – immuno-supportive effects.

• Terminalia chebula (Haritaki) – mild laxative for occasional constipation and digestive aid properties.

• Terminalia belerica – digestive and liver support.• Eradicate bacterial overgrowth – hydrogenic bacteria.

Prescript – Assist Pro – Broad spectrum probiotic

High potency, clinically researched probiotic containing 30 plus soil based probiotics. These probiotics found in the soil were naturally available in our diet before our current farming techniques including pesticides, herbicides and other chemicals.

• Promotes a healthy response to gut-related issues and provides beneficial bacteria during prolonged antibiotic treatment.

• pH resistant micro flora.• Vegan, dairy free, does not require refrigeration.

Sacro-B – Beneficial yeast for the GI Tract

• Supports growth of beneficial intestinal flora.• Increases secretory IgA (sIgA) the body’s first line of defense

in the GI tract. • Enhances gut immunity and helpful for occasional diarrhea.• Numerous studies show Saccharomyces boulardii supports

the gastrointestinal system.

7.

The Comprehensive Stool Analysis (CSA) with Parasitology by Doctors Data Inc.

A non-invasive diagnostic assessment that helps pinpoint the causes of GI symptoms and chronic systemic conditions, and measures key markers of digestion, absorption and inflammation. It allows practitioners to evaluate the status of beneficial and imbalanced commensal bacteria, pathogenic bacteria, yeast/fungus and parasites (worms, eggs, larva and protozoa (including Giardia and Cryptosporidium). In relation to SIBO the CSA test - bacteriology culture will show a good indication of large intestine bacterial population. Also shows markers for fat malabsorption which often results from SIBO +/- low grade inflammation.It measures the following:

• Elastase (pancreatic exocrine sufficiency), fat, muscle and vegetable fibers, and carbohydrates — giving important information regarding the efficiency of digestion and absorption.

• Biomarkers such as lysozyme, lactoferrin, calprotectin, WBC’s and mucus. These markers can be used to differentiate between inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS). Lactoferrin is only markedly elevated prior to and during the active phases of IBD, but not with IBS. Monitoring fecal lactoferrin levels in patients with IBD can therefore facilitate timely treatment of IBD.

• Secretory IgA (sIgA) — the only bona fide marker of humoral immune status in the GI tract. sIgA is normally present in the GI tract, where it prevents binding of pathogens and antigens to the mucosal membrane, therefore it is essential to know the status of sIgA in the gut.

• RBC’s — may be associated with a parasitic / bacterial infection or inflammatory condition such as Ulcerative Colitis / Colorectal Cancer / Anal fistulas / Haemorrhoids.

• Occult Blood — Free haemoglobin (released when RBC’s are lysed).• pH is largely dependent on the fermentation of fibre by the beneficial flora of the gut (Short chain fatty acids).

A low pH makes the environment unsuitable for pathogens including bacteria and yeast.• Yeast — Indicates the presence of fungi such as Candida albicans. • Comprehensive Parasitology x 3 (3 day collection) considered the ‘gold standard’ by Gastro-Enterologists.

• Also available is the Comprehensive Stool Analysis (CSA) which tests the same species and intestinal biomarkers as the ‘CSA with Parasitology’, but without detecting parasites.

• Practitioners can also order just ‘Parasitology’ (without the ‘comprehensive’) which does not report other flora – useful as a re-test if only parasites were the issue.

LAB #: F000000-0000-0PATIENT: Sample PatientID: P0000000000 Doctor's Data, Inc.SEX: MaleDOB: AGE: 4

CLIENT #: 12345DOCTOR:

3755 Illinois Ave.St. Charles, IL 60174 U.S.A.Comprehensive Stool Analysis / Parasitology x3

SHORT CHAIN FATTY ACIDSWithin Outside Reference Range

% Acetate 5140 - 75 %

% Propionate 259 - 29 %

% Butyrate 209 - 37 %

% Valerate 4.60.5 - 7 %

Butyrate2.0

0.8 - 4.8 mg/mLTotal SCFA’s 9.9

4 - 18 mg/mL

INTESTINAL HEALTH MARKERSWithin Outside Reference Range

Red Blood Cells NoneNone - Rare

pH7.0

6 - 7.8 Occult Blood Neg

Neg

MACROSCOPIC APPEARANCEAppearance Expected

ColorBrown

BrownConsistency Soft Formed/Soft

©DOCTOR’S DATA, INC. ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 CLIA ID NO: 14D0646470 MEDICARE PROVIDER NO: 148453

0001953

Short chain fatty acids (SCFAs): SCFAs arethe end product of the bacterial fermentationprocess of dietary fiber by beneficial flora in thegut and play an important role in the health of theGI as well as protecting against intestinaldysbiosis. Lactobacilli and bifidobacteria producelarge amounts of short chain fatty acids, whichdecrease the pH of the intestines and thereforemake the environment unsuitable for pathogens,including bacteria and yeast. Studies have shownthat SCFAs have numerous implications inmaintaining gut physiology. SCFAs decreaseinflammation, stimulate healing, and contribute tonormal cell metabolism and differentiation. Levelsof Butyrate and Total SCFA in mg/mL areimportant for assessing overall SCFA production,and are reflective of beneficial flora levels and/oradequate fiber intake.

Red Blood Cells (RBC) in the stool may beassociated with a parasitic or bacterial infection,or an inflammatory bowel condition such asulcerative colitis. Colorectal cancer, anal fistulas,and hemorrhoids should also be ruled out.pH: Fecal pH is largely dependent on thefermentation of fiber by the beneficial flora of thegut.Occult blood: A positive occult blood indicatesthe presence of free hemoglobin found in thestool, which is released when red blood cells arelysed.

Color: Stool is normally brown because ofpigments formed by bacteria acting on bileintroduced into the digestive system from theliver. While certain conditions can causechanges in stool color, many changes areharmless and are caused by pigments in foodsor dietary supplements. Consistency: Stoolnormally contains about 75% water and ideallyshould be formed and soft. Stool consistencycan vary based upon transit time and waterabsorption.

LAB #: F000000-0000-0PATIENT: Sample PatientID: P0000000000 Doctor's Data, Inc.SEX: MaleDOB: AGE: 4

CLIENT #: 12345DOCTOR:

3755 Illinois Ave.St. Charles, IL 60174 U.S.A.

Comprehensive Stool Analysis / Parasitology x3

DIGESTION /ABSORPTION

Within Outside Reference Range

Elastase 440 > 200 µg/mL

Fat Stain Few None - Mod

Muscle fibers None None - Rare

Vegetable fibers Rare None - Few

Carbohydrates Neg Neg

INFLAMMATION

Within Outside Reference Range

Lactoferrin 2.6 < 7.3 µg/mL

Calprotectin* 68 10 - 50 µg/g

Lysozyme* 271 <= 600 ng/mL

White Blood Cells None None - Rare

Mucus Neg Neg

IMMUNOLOGY

Within Outside Reference Range

Secretory IgA* 39.7 51 - 204 mg/dL

Comments:

Date Collected: 01/28/2015 *For Research Use Only. Not for use in diagnostic procedures.Date Received: 01/30/2015 Methodology: Elisa, Microscopy, Colormetric,Date Completed: 02/06/2015 Gas Chromotography, ph Electrode©DOCTOR’S DATA, INC. ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 CLIA ID NO: 14D0646470 MEDICARE PROVIDER NO: 1484530001953

Elastase findings can be used for the diagnosisor the exclusion of exocrine pancreaticinsufficiency. Correlations between low levelsand chronic pancreatitis and cancer have beenreported. Fat Stain: Microscopic determinationof fecal fat using Sudan IV staining is aqualitative procedure utilized to assess fatabsorption and to detect steatorrhea. Musclefibers in the stool are an indicator of incompletedigestion. Bloating, flatulence, feelings of“fullness” may be associated with increase inmuscle fibers. Vegetable fibers in the stool maybe indicative of inadequate chewing, or eating“on the run”. Carbohydrates: The presence ofreducing substances in stool specimens canindicate carbohydrate malabsorption.

Lactoferrin and Calprotectin are reliablemarkers for differentiating organic inflammation(IBD) from function symptoms (IBS) and formanagement of IBD. Monitoring levels of fecallactoferrin and calprotectin can play an essentialrole in determining the effectiveness of therapy,are good predictors of IBD remission, and canindicate a low risk of relapse. Lysozyme* is anenzyme secreted at the site of inflammation inthe GI tract and elevated levels have beenidentified in IBD patients. White Blood Cells(WBC) and Mucus in the stool can occur withbacterial and parasitic infections, with mucosalirritation, and inflammatory bowel diseases suchas Crohn’s disease or ulcerative colitis.

Secretory IgA* (sIgA) is secreted by mucosaltissue and represents the first line of defense ofthe GI mucosa and is central to the normalfunction of the GI tract as an immune barrier.Elevated levels of sIgA have been associatedwith an upregulated immune response.

LAB #: F000000-0000-0

PATIENT: Sample Patient

ID: P0000000000 Doctor's Data, Inc.

SEX: MaleDOB: AGE: 4

CLIENT #: 12345DOCTOR:

3755 Illnois Ave.St. Charles, IL 60174 U.S.A.

Comprehensive Stool Analysis / Parasitology x3

PARASITOLOGY/MICROSCOPY *PARASITOLOGY INFORMATION

Sample 1

None Ova or Parasites

Sample 2

None Ova or Parasites

Sample 3

None Ova or Parasites

GIARDIA/CRYPTOSPORIDIUM IMMUNOASSAY

Within Outside Reference Range

Giardia intestinalis Neg Neg

Cryptosporidium Neg Neg

Comments:

Date Collected: 01/28/2015

Date Received: 01/30/2015

Date Completed: 02/06/2015

©DOCTOR’S DATA, INC. ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 CLIA ID NO: 14D0646470 MEDICARE PROVIDER NO: 148453

0001794

Intestinal parasites are abnormal inhabitants of the gastrointestinal tract that

have the potential to cause damage to their host. The presence of any parasite

within the intestine generally confirms that the patient has acquired the

organism through fecal-oral contamination. Damage to the host includes

parasitic burden, migration, blockage and pressure. Immunologic inflammation,

hypersensitivity reactions and cytotoxicity also play a large role in the morbidity

of these diseases. The infective dose often relates to severity of the disease

and repeat encounters can be additive.

There are two main classes of intestinal parasites, they include protozoa and

helminths. The protozoa typically have two stages; the trophozoite stage that is

the metabolically active, invasive stage and the cyst stage, which is the

vegetative inactive form resistant to unfavorable environmental conditions

outside the human host. Helminths are large, multicellular organisms. Like

protozoa, helminths can be either free-living or parasitic in nature. In their adult

form, helminths cannot multiply in humans.

In general, acute manifestations of parasitic infection may involve diarrhea with

or without mucus and or blood, fever, nausea, or abdominal pain. However

these symptoms do not always occur. Consequently, parasitic infections may

not be diagnosed or eradicated. If left untreated, chronic parasitic infections

can cause damage to the intestinal lining and can be an unsuspected cause of

illness and fatigue. Chronic parasitic infections can also be associated with

increased intestinal permeability, irritable bowel syndrome, irregular bowel

movements, malabsorption, gastritis or indigestion, skin disorders, joint pain,

allergic reactions, and decreased immune function.

In some instances, parasites may enter the circulation and travel to various

organs causing severe organ diseases such as liver abscesses and

cysticercosis. In addition, some larval migration can cause pneumonia and in

rare cases hyper infection syndrome with large numbers of larvae being

produced and found in every tissue of the body.

One negative parasitology x1 specimen does not rule out the possibility of

parasitic disease, parasitology x3 is recommended. This exam is not designed

to detect Cryptosporidium spp, Cyclospora cayetanensis or Microsproridia spp.

Giardia intestinalis (lamblia) is a protozoan that

infects the small intestine and is passed in stool

and spread by the fecal-oral route. Waterborne

transmission is the major source of giardiasis.

Cryptosporidium is a coccidian protozoa that

can be spread from direct person-to-person

contact or waterborne transmission.

*A trichrome stain and concentrated iodine wet

mount slide is read for each sample submitted.

LAB #: F000000-0000-0

PATIENT: Sample Patient

ID: P0000000000

Doctor's Data, Inc.

SEX: Male

DOB: AGE: 4

CLIENT #: 12345

DOCTOR:

3755 Illinois Ave.

St. Charles, IL 60174 U.S.A.

Comprehensive Stool Analysis / Parasitology x3

BACTERIOLOGY CULTURE

Expected/Beneficial floraCommensal (Imbalanced) flora

Dysbiotic flora

3+ Bacteroides fragilis group1+ Beta strep, not group A or B

4+ Bifidobacterium spp.2+ Citrobacter freundii complex

NG Escherichia coli1+ Citrobacter freundii complex,isolate 2

NG Lactobacillus spp.2+ Enterobacter cloacae complex

NG Enterococcus spp.3+ Gamma hemolytic strep

1+ Staphylococcus aureus

NG Clostridium spp.

NG = No Growth BACTERIA INFORMATION

YEAST CULTURE

Normal flora

Dysbiotic flora

No yeast isolated

MICROSCOPIC YEAST

YEAST INFORMATION

Result: Expected:

None None - Rare

Comments:

Date Collected: 01/28/2015

Date Received: 01/30/2015

Date Completed: 02/06/2015

©DOCTOR’S DATA, INC. ADDRESS: 3755 Illinois Avenue, St. Charles, IL 60174-2420 CLIA ID NO: 14D0646470 MEDICARE PROVIDER NO: 148453

0001793

Expected /Beneficial bacteria make up a significant portion of the total microflora in a healthy & balanced GI tract. These beneficial bacteria have many

health-protecting effects in the GI tract including manufacturing vitamins, fermenting fibers, digesting proteins and carbohydrates, and propagating anti-

tumor and anti-inflammatory factors.

Clostridia are prevalent flora in a healthy intestine. Clostridium spp. should be considered in the context of balance with other expected/beneficial flora.

Absence of clostridia or over abundance relative to other expected/beneficial flora indicates bacterial imbalance. If C. difficile associated disease is

suspected, a Comprehensive Clostridium culture or toxigenic C. difficile DNA test is recommended.

Commensal (Imbalanced) bacteria are usually neither pathogenic nor beneficial to the host GI tract. Imbalances can occur when there are insufficient

levels of beneficial bacteria and increased levels of commensal bacteria. Certain commensal bacteria are reported as dysbiotic at higher levels.

Dysbiotic bacteria consist of known pathogenic bacteria and those that have the potential to cause disease in the GI tract. They can be present due to a

number of factors including: consumption of contaminated water or food, exposure to chemicals that are toxic to beneficial bacteria; the use of antibiotics,

oral contraceptives or other medications; poor fiber intake and high stress levels.

Yeast normally can be found in small quantities in the skin, mouth, intestine and mucocutaneous

junctions. Overgrowth of yeast can infect virtually every organ system, leading to an extensive array

of clinical manifestations. Fungal diarrhea is associated with broad-spectrum antibiotics or

alterations of the patient’s immune status. Symptoms may include abdominal pain, cramping and

irritation. When investigating the presence of yeast, disparity may exist between culturing and

microscopic examination. Yeast are not uniformly dispersed throughout the stool, this may lead to

undetectable or low levels of yeast identified by microscopy, despite a cultured amount of yeast.

Conversely, microscopic examination may reveal a significant amount of yeast present, but no yeast

cultured. Yeast does not always survive transit through the intestines rendering it unvialble.

The microscopic finding of yeast in the stool is

helpful in identifying whether there is

proliferation of yeast. Rare yeast may be

normal; however, yeast observed in higher

amounts (few, moderate, or many) is abnormal.

* Aeromonas, Campylobacter, Plesiomonas, Salmonella,

Shigella, Vibrio, Yersinia, & Edwardsiella tarda have

been specifically tested for and found absent unless

reported.

8.

Functional Testing for SIBO

For additional information, please request FxMed’s Functional Testing Reference Catalogue or contact FxMed’s Technical Support Team to book in a skype training on either of these tests on 0800 439 633 or techsupport@fxmed.co.nz

9.

Organic Acids Test (OAT) by The Great Plains Laboratory

The Organic Acids Test (OAT) measures organic acids in a urine sample. It offers a comprehensive metabolic snapshot of a patient’s overall health. The test includes 70 metabolite markers that can be very useful for discovering underlying causes of chronic illness. It provides a unique profile into:

• Intestinal Microbial overgrowth (yeast and fungal markers, bacterial and clostridia bacteria markers).• Cellular energy status, neurotransmitter metabolism, nutrient deficiencies and detoxification. • In regards to SIBO provides information of bacterial overgrowth indicated by levels of hippurate,

4-Hydroxybenzoic, and other bacterial metabolites.

The Great Plains Laboratory, Inc.Requisition #:

Patient Name: Physician:

Date of Collection: 4/21/2015

Indicator of Fluid Intake

89

76

mg/dL

*Creatinine

*The creatinine test is performed to adjust metabolic marker results for differences in fluid intake. Urinary creatinine has

limited diagnostic value due to variability as a result of recent fluid intake. Samples are rejected if creatinine is below 20

mg/dL unless the client requests results knowing of our rejection criteria.

Example of Elevated Value

Explanation of Report FormatThe reference ranges for organic acids were established using samples collected from typical individuals of all ages with no known

physiological or psychological disorders. The ranges were determined by calculating the mean and standard deviation (SD) and

are defined as + 2SD of the mean. Reference ranges are age and gender specific, consisting of Male Adult (>13 years), Female

Adult (>13 years), Male Child (<13 years), and Female Child (<13 years).There are two types of graphical representations of patient values found in the new report format of both the standard Organic

Acids Test and the Microbial Organic Acids Test. The first graph will occur when the value of the patient is within the reference (normal) range, defined as the mean plus or minus

two standard deviations.

The second graph will occur when the value of the patient exceeds the upper limit of normal. In such cases, the graphical

reference range is “shrunk” so that the degree of abnormality can be appreciated at a glance. In this case, the lower limits of

normal are not shown, only the upper limit of normal is shown.In both cases, the value of the patient is given to the left of the graph and is repeated on the graph inside a diamond. If the value

is within the normal range, the diamond will be outlined in black. If the value is high or low, the diamond will be outlined in red. Example of Value Within Reference Range

Organic Acids Test - Nutritional and Metabolic Profile Page 5 of 10

The Great Plains Laboratory, Inc.Requisition #:

Patient Name: Physician:

Date of Collection: 4/21/2015

Metabolic Markers in Urine

Reference Population - Females Age 13 and Over

(mmol/mol creatinine)Patient Value

Reference Range

Indicators of DetoxificationGlutathione

23-

58

3310

23

Pyroglutamic ä

3.0- H

59

1.80.03

3.0

2-Hydroxybutyric ä

Ammonia Excess

0.33-

60

0.540.06

0.33

Orotic

Aspartame, salicylates, or GI bacteria

1.5≤ H

61

1.3

1.5

2-Hydroxyhippuric

ä A high value for this marker may indicate a Glutathione deficiency. Amino Acid Metabolites

0≤

62

0.420.00

2-Hydroxyisovaleric

0.40≤

63

2.1

0.40

2-Oxoisovaleric

0.49≤

64

0.87

0.49

3-Methyl-2-oxovaleric

0≤

65

0.480.00

2-Hydroxyisocaproic

0.47≤ H

66

0.37

0.47

2-Oxoisocaproic

0.10≤

67

0.16

0.10

2-Oxo-4-methiolbutyric

0.18≤

68

0.21

0.18

Mandelic

0.17≤

69

0.20

0.17

Phenyllactic

0.48-

70

1.90.20

0.48

Phenylpyruvic

0.04≤

71

0.360.04

Homogentisic

0.72≤

72

0.80

0.72

4-Hydroxyphenyllactic

1.5≤

73

3.0

1.5

N-Acetylaspartic

3.0≤

74

9.7

3.0

Malonic

Mineral Metabolism

2 638-

75

5 0001 000

2638

Phosphoric

Organic Acids Test - Nutritional and Metabolic Profile Page 4 of 10

The Great Plains Laboratory, Inc.

Requisition #:

Patient Name:

Physician:

Date of Collection: 4/21/2015

Metabolic Markers in Urine Reference Population - Females Age 13 and Over (mmol/mol creatinine)

Patient

Value

Reference Range

Pyrimidine Metabolites - Folate Metabolism

5.1≤40 9.7 5.1Uracil

0.22≤41 0.56 0.22Thymine

Ketone and Fatty Acid Oxidation

19≤ H42 3.1 193-Hydroxybutyric

9.5≤43 10 9.5Acetoacetic

0.34≤44 4.8 0.344-Hydroxybutyric

1.4-45 2.80.44 1.4Ethylmalonic

2.1-46 2.20.10 2.1Methylsuccinic

2.0-47 3.80.04 2.0Adipic

0.80-48 2.20.18 0.80Suberic

0.19≤49 0.24 0.19Sebacic

Nutritional Markers

Vitamin B12

2.0≤50 2.3 2.0Methylmalonic ä

Vitamin B6

5.1≤51 34 5.1Pyridoxic (B6)

Vitamin B5

1.3≤52 10 1.3Pantothenic (B5)

Vitamin B2 (Riboflavin)

0.29-53 0.360.04 0.29Glutaric ä

Vitamin C

0.44- L54 20010 0.44Ascorbic

Vitamin Q10 (CoQ10)

22-55 390.17 223-Hydroxy-3-methylglutaric ä

Glutathione Precursor and Chelating Agent

0.17≤56 0.28 0.17N-Acetylcysteine (NAC)

Biotin (Vitamin H)

1.9-57 2.70.19 1.9Methylcitric ä

ä A high value for this marker may indicate a deficiency of this vitamin.

Organic Acids Test - Nutritional and Metabolic Profile Page 3 of 10

The Great Plains Laboratory, Inc.

Requisition #:

Patient Name:

Physician:

Date of Collection:

4/21/2015

Metabolic Markers in Urine

Reference Population - Females Age 13 and Over

(mmol/mol creatinine)

Patient

ValueReference Range

Oxalate Metabolites4.6

-

19

7.00.77

4.6

Glyceric

46

-

20

11716

46

Glycolic

69

-

21

1016.8

69

Oxalic

Glycolytic Cycle Metabolites12

≤

22

48

12

Lactic

4.4

≤

23

9.1

4.4

Pyruvic

Mitochondrial Markers - Krebs Cycle Metabolites

5.3

≤

24

9.3

5.3

Succinic

0.51

≤

25

0.94

0.51

Fumaric

0.95

-

26

1.80.06

0.95

Malic

49

≤H

27

35

49

2-Oxoglutaric18

-

28

286.8

18

Aconitic

706

≤H

29

507

706

Citric

Mitochondrial Markers - Amino Acid Metabolites

0.35

≤

30

0.76

0.35

3-Methylglutaric8.8

≤H

31

6.2

8.8

3-Hydroxyglutaric2.2

≤

32

4.5

2.2

3-Methylglutaconic

Neurotransmitter Metabolites

Phenylalanine and Tyrosine Metabolites3.3

-

33

3.60.80

(dopamine)

3.3

Homovanillic (HVA) 2.0

-

34

3.70.46

(norepinephrine, epinephrine)

2.0

Vanillylmandelic (VMA) 1.6

-

35

1.80.16

1.6

HVA / VMA Ratio

Tryptophan Metabolites

1.5

≤

36

4.3

(serotonin)

1.5

5-Hydroxyindoleacetic (5-HIAA) 2.4

-

37

3.90.85

2.4

Quinolinic

1.4

-

38

2.20.17

1.4

Kynurenic

1.6

-

39

2.00.42

1.6

Quinolinic / 5-HIAA Ratio Organic Acids Test - Nutritional and Metabolic Profile

Page 2 of 10

Requisition #:

Patient Name:

Physician:

Date of Collection:

Patient Age:F

52

Patient Sex:

Time of Collection:

Print Date:

4/21/2015

04:30 AM

04/29/2015

Metabolic Markers in Urine

Reference Population - Females Age 13 and Over

(mmol/mol creatinine)

Patient

ValueReference Range

Intestinal Microbial Overgrowth

Yeast and Fungal Markers

0.90

≤

1

3.6

0.90

Citramalic

5.4

≤

2

14

5.4

5-Hydroxymethyl-2-furoic 0

≤

3

0.33

0.00

3-Oxoglutaric

10

≤

4

16

10

Furan-2,5-dicarboxylic 0.88

≤

5

1.9

0.88

Furancarbonylglycine 1.5

≤

6

4.5

1.5

Tartaric

88

≤H

7

29

88

Arabinose

0.36

≤

8

29

0.36

Carboxycitric

0.33

≤

9

0.44

0.33

Tricarballylic

Bacterial Markers

622

≤H

10

613

622

Hippuric

0.55

-

11

0.660.06

0.55

2-Hydroxyphenylacetic1.0

≤

12

1.3

1.0

4-Hydroxybenzoic8.2

-

13

170.79

8.2

4-Hydroxyhippuric0.21

≤

14

0.38

0.21

DHPPA (Beneficial Bacteria)

Clostridia Bacterial Markers

25

≤H

15

19

(C. difficile, C. stricklandii, C. lituseburense & others)

25

4-Hydroxyphenylacetic 271

≤H

16

208

(C. sporogenes, C. caloritolerans, C. botulinum & others)

271

HPHPA

42

≤

17

75

(C. difficile)

42

4-Cresol

2.8

≤

18

11

(C. stricklandii, C. lituseburense, C. subterminale & others)

2.8

3-Indoleacetic

Testing performed by The Great Plains Laboratory, Inc., Lenexa, Kansas. The Great Plains Laboratory has developed and determined the

performance characteristics of this test. This test has not been evaluated by the U.S. FDA; the FDA does not currently regulate such testing.

Organic Acids Test - Nutritional and Metabolic ProfilePage 1 of 10

Functional & Integrative Medicine Ltd, 77 Austin St, PO Box 19033, Onekawa, Napier 4146, NZPh 0800 439 633 Fax 0800 439 630 support@fxmed.co.nz www.fxmed.co.nz

Please call our Technical Support Team on 0800 439 633 if you have further questions or email support@fxmed.co.nz