Articles

Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

How to Heal Your Gut Without Lab Tests: Your Action Plan

Written by Dr. Michael Ruscio, DC on February 12, 2023

Written by Dr. Michael Ruscio, DC on February 12, 2023 — Reviewed by Dr. Hannah Hamlin

• Labs Tests Aren’t the End-All-Be-All|
• How to Heal Your Gut Without Lab Tests|
• Find Your Diet|
• Supportive Supplements|
• Fight Off Pathogens|
• When Gut Tests Are a Good Idea|
• Start Your Journey Today|

Dealing with symptoms of an unhealthy gut or other health concerns makes turning to functional health lab tests for answers seem like the logical next step. But the high price point, often required doctor’s signature, and hard to interpret results are enough to make you ask, are they really always necessary? 

Fortunately, no. Today I’m covering one part of the hotly debated topic of functional health gut testing, and why you often don’t need a stool analysis, breath test, or food allergy panel to heal your gut. In fact, I often see that a simple diet reset, targeted supplements like probiotics and fiber, and occasionally some hard-hitting antimicrobials to balance the gut biome are what most of my patients need to feel better.

This isn’t to completely knock lab testing for your gut. Many people receive long-awaited answers for their elusive health symptoms from these tests — I happened to fall into this camp with my own health journey. That being said, I’ve seen countless patients fall victim to the pervasive myth that they are always necessary to heal, often spending hundreds (if not thousands) of dollars on these often cumbersome tests. 

Furthermore, the over-reliance on these tests in the functional health field has the potential to act as a hindrance to your health, by delaying treatment and masking a successful recovery with their sometimes ambiguous or hard-to-interpret results (even practitioners get bogged down here). But to put it frankly, lab tests aren’t always required — at least not as your first, or even second, or third, step. 

Many times your symptoms and listening to your body can be used in lieu of lab testing, making your treatment far more individualized than going over a lab result could. I’ll be covering the 3 main steps to healing your gut without lab tests, why labs are only part of the picture, and what to do when these steps aren’t enough. 

Lab Tests Aren’t The End-All-Be-All of Gut Health

Getting your digestive tract into shape is the crux of overall health, and you can often get there without the need for functional health lab testing (or with minimal testing). Unfortunately, when lab testing is used as the pinnacle of guiding diagnosis and treatment, it can create anxiety for the patient surrounding the results of the test. 

A positive lab test may give relief in the moment, as it provides an “answer” to symptoms, but can backfire later on when the symptoms have resolved but the test is still positive. Alternatively, a negative result in someone with significant symptoms can be devastating, leaving them thinking there are no answers and regretting a time-consuming and expensive test. 

Patients (and practitioners) often believe that it’s hard to address your symptoms when you don’t have the help of labs to tell you what is really going on. And while labs should guide a fourth of the treatment, there are several ways we can start to shift medicine’s lab-directed paradigm to one that’s more patient-focused.

First, treatment responses can often take the place of labs and be used as diagnostics in themselves. You can learn so much by listening to your body and how it responds to different therapies, then use that information to guide further treatment. For example (and as I will discuss in more detail shortly), using an elimination diet over a food allergy panel as a far more accurate way to discover your food sensitivities. 

Second, you don’t always need to know what’s happening in your gut to start addressing it, as many gut-healing therapies are effective for a wide array of conditions. Anti-inflammatory diets, probiotics, and a healthy lifestyle can benefit nearly everyone with a chronic health condition.

As a quick caveat, there are times when gut health tests are necessary, especially when it comes to screening and diagnostic labs for more serious conditions, like inflammatory bowel disease. I cover this topic and some of the issues with functional health testing at the end of this article.

How to Heal Your Gut Without Lab Tests: Your Action Plan

The Great-in-8 Action Plan from my book, Healthy Gut, Healthy You, outlines this complete process in-depth and has other great information on how to heal your gut without lab tests. This article will cover a few of the fundamentals of this plan today, which don’t involve any expensive or cumbersome testing. In fact, I specifically designed it to cut out the hassle of unnecessary lab tests, too many expensive supplements, or restrictive dieting. 

Here’s a quick glance into some of the gut-healing therapies included in The Great-in-8 Action Plan:

• Start a short-term liquid diet
• Build a whole foods elimination diet
• Discover probiotic supplements
• Utilize natural antimicrobials
• Find the right balance of fiber and prebiotics
• Enjoy a non-restrictive lifestyle

But today, I’ll be focusing on the first few the fundamentals of a healthy digestive system.

Step 1) A Total (but Simple) Diet Reset

There are two parts to a gut-healing diet: a liquid gut reset and an elimination diet. A gut reset works to quickly calm an unhealthy gut by giving it a rest. I use an elemental diet, which contains all the daily nutrients your body needs in a pre-digested form. 

Using this total meal replacement over two to four days can be a tremendous help in lowering inflammation and intestinal permeability, rebalancing the microbiome, and reducing your symptoms. 

These benefits are probably why research shows elemental dieting to be a worthwhile option for reducing symptoms of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) [1, 2, 3], and can help with the dysbiosis seen in small intestine bacterial overgrowth. An elemental diet is a great example of why you don’t need to wait on a lab test to start your healing, as it is beneficial for a broad array of gut conditions. 

If you are seeing great improvement after a few days, feel free to move on to an elimination diet. However, those with more severe symptoms may stay on it for 1-2 weeks to help correct a significant gut issue like IBD, Celiac disease, or even small intestine bacterial overgrowth (SIBO). For these more severe cases, I recommend getting supervision from your doctor or us at the clinic to ensure that you are getting enough support to completely address your condition. 

Once you have completed your elemental “fast”, it’s time to move on to the second phase, finding your elimination diet. 

Finding Your Elimination Diet

Elimination diets are a great (and more accurate) way to find your individual food sensitivities without relying on expensive food allergy panels. A 2015 study found that no food sensitivity test, including IgG testing, is scientifically validated, and the most accurate way to determine food sensitivities was through symptom response to removing and reintroducing foods [4].  

Though they all aim to reduce inflammation by removing your unique food triggers, not all elimination diets are created equal. Some are highly restrictive, like the autoimmune protocol (AIP) diet, and some are very targeted in what they remove, like the low FODMAP diet. 

We recommend starting with the least restrictive option possible, which is styled after the Paleo diet. The Paleo diet is anti-inflammatory in nature, as it removes the common triggers of gluten-containing whole grains, dairy, sugar, and processed foods. If removing these foods gives you symptom relief, it’s a pretty good sign you had an intolerance or sensitivity to one of those foods (which you’ll be able to pinpoint during the reintroduction phase).

We have several articles that outline how to build and follow an elimination diet protocol, but here are other common elimination diets that I often see to be successful in reducing patients’ symptoms:

• Low FODMAP diet: Removes certain carbohydrates and fibers that can feed an underlying imbalance in the microbiome (like in SIBO).
• Autoimmune protocol (AIP): Styled after the Paleo diet, but more restrictive as it removes a broader array of foods that can trigger an immune response, such as peppers and nuts.

Low histamine diet: Can be combined with other elimination diets or used on its own, and removes foods that are high in histamine or trigger histamine release.

Most importantly, if your chosen diet doesn’t seem to touch your symptoms after 2-3 weeks, it’s probably time to move on to the next option, and can even clue you in as to what is going on with your gut. For example, if you don’t fully respond to a Paleo diet, but have significant improvement in your symptoms on a low FODMAP diet, it’s a pretty good idea that you have some gut dysbiosis and can redirect your focus and efforts.

Most people feel at least 30% better after finding their right elimination diet. Though some experience a full recovery, while others may not see much of an improvement. If you still have symptoms after trying out a few different elimination diets.

Food Reintroduction

I go through the process of how to properly reintroduce foods after an elimination diet in more detail here. It’s best to take this step slowly and give your body time to respond to the foods. It can take a few days to see symptoms after eating inflammatory foods, so try to introduce them one at a time, over 2–4 days.

If a certain food leads to a symptom, leave it out of your diet for now. It doesn’t mean you need to cast it aside forever, but you may need a little more time to heal before trying to introduce it back into your diet. If you don’t respond poorly to a food you previously eliminated? Start eating it again and enjoy a non-restrictive diet! 

Step 2) Support with Supplements

If a diet reset alone doesn’t seem to resolve gut concerns, probiotics are a great next step. Probiotics are another great example of why you don’t need lab tests to heal your gut, as they are widely beneficial for most gut complaints (and no lab test can predict if you will see benefit). 

They are composed of billions of good bacteria and other microorganisms that have numerous benefits for your gut health. They lower intestinal inflammation, balance your biome and immune system, fight off pathogens, and heal a leaky gut barrier [5, 6, 7, 8, 9, 10, 11, 12, 13]. It’s due to their profound healing effects on the digestive tract that these microbes help with so many other symptoms and conditions including:

• Diarrhea [14, 15, 16, 17]
• Constipation [18, 19, 20, 21]
• Gas and bloating [22, 23, 24, 25, 26]
• Irritable bowel syndrome (IBS) [19, 23, 27, 28, 29]
• Inflammatory bowel disease (IBD) [30, 31]
• Diverticulitis (32)
• Brain fog and overall health (33) (34) (35)
• Autoimmune diseases [36, 37, 38, 39]
• Seasonal allergies [40]

I tend to see patients have the best results when combining multiple types of probiotics that I’ve broken down into three distinct categories:

1. Bifidobacterium/ Lactobacillus blend
2. Soil-based (Bacillus spp.)
3. Saccharomyces boulardii (a healthy yeast)

Individually, these organisms can work wonders for your health, and combining them likely offers the maximum health benefits you can get from probiotic supplements. Taking a separate supplement for each of these categories will work fine, but if you want to take them all in one go, you can find our Triple Therapy probiotic sticks on our online store. 

When used judiciously, other supplements that target specific functions of the digestive tract can be transformative for those with lingering symptoms. Ones that occasionally deliver top results when used appropriately are:

• Betaine HCl: Replace low stomach acid, often seen in chronic gastritis, heartburn, and acid reflux.
• Digestive enzymes: Break down food and help prevent malabsorption, especially in exocrine pancreatic insufficiency. 
• Prokinetics: Increase gut motility — a slow gut transit underlies constipation and can be responsible for dysbiosis like SIBO

My book goes into more detail on when these may be a good choice for you, or you can always book a consult with one of our qualified healthcare practitioners at The Ruscio Institute for Functional Health. 

Assess Your Stomacid Acid Level with Betaine HCl

Using betaine HCl is a great example of why you don’t need a lab test for insight into your symptoms. Betaine HCL is used as a stomach acid replacement for those with low levels, often due to PPI use or autoimmune gastritis. Low stomach acid is a cause of many gut issues as it can lead to downstream issues like bacterial overgrowth and decreased nutrient absorption, which cause a whole host of issues [41, 42, 43, 44, 45]. 

However, the test for detecting HCl levels is done under general anesthesia where a pH monitor is placed at the bottom of the esophagus to sense when acid refluxes up from the stomach. Unfortunately, this test often doesn’t detect low stomach acid, the more frequent cause of acid reflux, regurgitation, and heartburn. 

This is a prime example of where the reliance on lab tests can go horribly wrong, subjecting the patient to a highly invasive, expensive, and likely unhelpful test. While there are more accurate labs to check your stomach acid levels, like gastrin, pepsinogen, and antibody testing, you can easily see if your symptoms will respond without the need for tests. 

Betaine HCl works quickly and effectively, but should never be taken on an empty stomach. For the best results, see the following:

1. Start with 1-3 capsules, taken just before a meal.
2. If you have improvement in your symptoms, continue to take it while you heal your gut.
3. If you have no improvment after 1-2 weeks, low stomach acid may not be the cause of your symptoms.
4. If you have worsening of your symptoms, or notice burning in your upper abdomen, discontinue the supplement.

In some cases, labs are a good idea, like when your symptoms are severe or your labwork shows anemia. Lab testing at this stage is an effective way to figure out what is behind your symptoms.

Step 3) Fight Off Pathogens and Rebuild Your Gut Biome

Pathogens and gut microbiota imbalances can lead to poor digestive health and chronic health symptoms, and some common ones that I come across in my practice are (but not limited to) SIBO, fungal overgrowth, H. pylori, and parasites. 

Fortunately, you don’t need a stool analysis or breath test to see if you will benefit from dysbiosis-directed treatments. If dietary changes and targeted supplements didn’t give you complete relief, antimicrobials are a logical next step. Antimicrobials are a special class of supplements that contain botanicals and other compounds that can kill off pathogens and restore balance to the microbiome. 

Oil of oregano is a strong antimicrobial that contains the compounds carvacrol and thymol, which can reduce IBS symptoms by 75% [46]. This goes to show that even conditions that aren’t directly known to be caused by infection seem to benefit from microbiome-balancing herbs.  

You should always consult with your doctor before taking antimicrobials. Once you’re in the clear, you can begin taking this gut-balancing botanicals, which sometimes can take up to 1-2 months for your symptoms to start improving. If they do get better with antimicrobials you likely had gut dysbiosis. However, worsening of symptoms can also be indicative of a good response, due to bacterial die-off. 

If you do experience the latter, your unwanted reaction should start to level out in a week and improve thereafter. If your symptoms persist or worsen after a week, you may be having a bad reaction to the antimicrobials themselves and should discontinue.

You may benefit from taking antimicrobials cyclically if you don’t feel better after a 2-month course. If you still have significant symptoms that aren’t resolved after a few cycles, it may now be beneficial to talk to your practitioner about functional health or other testing to see what could be contributing. You can also pick up where we left off in my book, Heathy Gut, Healthy to explore other DIY options and the rest of the Great-in-8 Action Plan to address stubborn symptoms. 

When Lab Testing for Your Gut is a Good Idea

There are two general categories of gut health tests: standard screening and diagnostic labs and specialized functional health testing. 

The former is one you typically don’t want to skip, especially when recommended by your doctor. Annual bloodwork is a good idea for staying on top of your health and can help detect more serious gut health issues like inflammatory bowel disease and colon cancer. Regular bloodwork is a great way to screen for these conditions but isn’t diagnostic. 

Instead, if you have symptoms and/or screening labwork that is signalling a serious gastrointestinal condition, it’s often followed up with targeted tests:

• Fecal calprotectin (an inflammatory marker for the GI tract)
• Fecal occult blood test (FOBT)
• Colonoscopy
• Upper GI endoscopy
• MRI or cat scan imaging

If your doctor recommends these as your next step, it’s typically in your best interest to complete them. However, the above tests generally fall outside the scope of “functional health testing,” which constitutes more elective tests like:

• Bacterial overgrowth breath tests: used to detect intestinal dysbiosis, as in small intestine bacterial overgrowth (SIBO).
• Food allergy panels: used to assess for food allergies or sensitivities, and to guide elimination diets.
• Stool analysis testing: used to detect pathogenic bacteria, parasites, yeast, amoebas, and signs of inflammation and malabsorption. 

These tests may be a good idea when you have made changes to your diet and lifestyle and tried targeted supplements with little to no relief. I discuss the controversy surrounding functional medicine lab tests on my podcast, but I’ll briefly touch on why I don’t immediately jump to these tests for healing your gut.

The Pitfalls of Functional Health Testing

Foremost, the ability of functional health tests to accurately detect a diseased state is highly variable, with some being more helpful, like exocrine pancreatic and bile acid malabsorption tests [47, 48], and others not so much (we’re looking at you, food sensitivity panels).

But the main trouble with many of these tests is that positive (or negative) lab results don’t always correlate with symptoms, and many people who feel better still show “positive” lab results. Unfortunately, these cases can lead to unnecessary anxiety and further treatments, even when you’re symptom-free.

The truth is, we don’t know the exact role that many of these tests play in gut health. This is highlighted in the case of a stool microbial test which can “map” or identify your gut microbiome, but has little indication as to what the results actually mean. 

For example, a 2022 study found that probiotics improved the severity of eczema symptoms in children, and the benefits continued even after stopping the supplement. However, their microbiomes remained unchanged on stool analysis, making it a poor indicator of eczema recovery [49]. 

Everyone has a highly unique gut flora, and while certain trends in microbial composition are associated with various health conditions, it doesn’t mean they are clinically meaningful and certainly shouldn’t be used diagnostically [50].

Ambiguous results aside, relying on these tests is often expensive, as most aren’t covered by insurance companies and cost hundreds of dollars. Furthermore, waiting on test results can cause an unnecessary delay in your treatment and recovery.  

In summary, if it’s your annual blood work, a work-up for a serious gut condition, or once all other treatments have failed to resolve your symptoms, lab tests are probably a good idea. Otherwise, most gut health tests are an unnecessary, expensive, and sometimes invasive first step. It’s time to put the myth to rest that labs are the end-all-be-all of your health and dive directly into treating yourself today.

How to Heal Your Gut Without Lab Tests: Start Your Journey Today 

Lab testing can often delay your treatment and be an unnecessary expense. Though they certainly have their time and place, you can learn how to heal your gut without lab tests. 

Elemental and elimination-based diets, and balancing your gut biome with beneficial bacteria, antimicrobials, and prebiotics are a great approach to DIY gut healing that doesn’t require a doctor’s order. For the full breakdown of the Great-in-8 Action Plan, my book, Healthy Gut, Healthy You, can help.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.