What’s Inside This Episode?

• Spotting the Hidden Signs: Why so many practitioners miss gut imbalances—and how you can avoid the same mistakes.
• The Secret in Blood Work: How to decode routine CBC and comprehensive blood panels to uncover gut dysfunction.
• Cracking the Organic Acid Code: Learn how these metabolic markers reveal fermentation issues, nutrient gaps, and more.
• Mastering Stool Tests: Get the inside scoop on identifying inflammation triggers.
• Beyond the Basics of Gluten: Advanced tests that reveal gluten sensitivities many practitioners overlook.
• Exposing Leaky Gut: Cutting-edge strategies for assessing intestinal permeability and its ripple effects on overall health.

Resources and Links

• Download the Transcript here.
• Download our FREE Workshop The Nutritional Gems Hidden in Your Blood and How to Get the Most Critical Tests (Even if Your Doctor Won’t Order Them For You)
• Join the Next-Level Health Practitioner Facebook group for community support and free resources.
• Reserve your spot for ReInvent 2025 to explore gut health’s intersection with brain, metabolic, and skin health.
• Learn more about testing strategies at INEMethod.com for advanced health practitioner training.
• Check out other episodes of ReInvent Healthcare on gut health here.

Dr. Ritamarie Loscalzo’s Bio

Dr. Ritamarie Loscalzo is a leading expert in functional health, specializing in nutritional endocrinology and root-cause approaches to systemic imbalances. With over three decades of clinical experience, she is the founder of the Institute of Nutritional Endocrinology, where she trains practitioners to integrate advanced testing, nutrition, and lifestyle strategies into their practices. Dr. Ritamarie’s mission is to empower practitioners and self-healers to uncover the root causes of health challenges and achieve transformative results.

Together, let’s rewrite the rules of healthcare by addressing the root causes and empowering true wellness!

Transcript

Dr Ritamarie (0:43)

So today we’re going to review what I’ve found in over 33 years of clinical experience to be the top five categories of tests that actually help us to identify gut imbalances and contribute to systemic health conditions, even when nobody’s really looking there. So the categories are the routine blood markers, which is the CBC and blood chems that most doctors run as part of the annual exam.

Organic acid tests, which we can run as parts of various functional tests. Stool tests, which is everybody’s favorite, the messy stool test, it gives us lots of great information, obviously, about what’s going on in the gut. Gluten intolerance tests, and we’re not just talking a transglutaminase or simple tests for celiac, we’re looking at a lot of other markers that can be utilized to determine if a person is intolerant to gluten or one of the protein constituents of gluten.

And finally, intestinal permeability tests, because we know, leaky gut is the common name for it, but if we have food particles, we have undigested particles, we have toxins, we have other things going through the protective lining of the gut that’s supposed to filter that out and getting into the bloodstream, that can be contributing to a lot of systemic conditions. 

So let’s look at some of the blood markers. So why is it important to look for these? Well, it’s there. We see this every day. Most doctors are running these tests, just typical CBC and blood chems. And it’s important to look there because it’s right there before our eyes. We don’t have to spend a lot of extra money. It’s usually covered by insurance. And you know, we can find things if you know what you’re looking for. And it’s probably not the stuff you were taught in medical school. So what markers?

Well, I like to look at BUN and creatinine. I know those are kidney markers, but when they’re high, they usually do indicate a lack of filtration in the kidneys. But when they’re low, a lot of times that means that there’s not either enough protein in the diet or there isn’t enough absorption of protein or there might be muscle wasting. So we want to determine that. But if there’s not enough protein in the diet, we have a malabsorption problem. We want to know that.

Dr Ritamarie (02:54)

So we don’t go by any one of these, we go by the composite of these and how these various markers interact with each other. So when we have low BUN or creatinine, that clicks off a little ticky mark in the head that says, okay, let’s look for other signs of malabsorption. So then we look at protein, albumin and globulin in the A/G ratio. And this can be related to, again, lack of good protein in the diet, but also malabsorption, something going on in the GI tract that’s affecting the absorption of protein.

Dr Ritamarie (03:28)

When the albumin and globulin ratios are off, that can sometimes lead us to think that there’s an intestinal permeability, right? And globulin is related to immunoglobulins, which is a sort of infectious type process that the immune system is fighting. So we really want to look carefully whenever we see that albumin-globulin ratio off.

Dr Ritamarie (03:48)

If we’re looking at the white blood cell counts, and we’re seeing high eosinophils or high basophils, that can indicate that there’s some sort of an allergic or histamine type reaction going on in the gut, it could be anywhere else in the body as well, but oftentimes we look there. We also look to see if there’s parasites, indications of parasites, because oftentimes when there’s parasites, we see an elevation of the basophils. 

If we see a high or a low white blood cell count, that can often mean that there is something going on. Usually we think about high white blood cell count as an infectious, acute infectious process, and low white blood cell count as possibly a chronic infection process or a chronic immune, like an autoimmune condition. So if we’re seeing this, we want to start looking because sometimes these aren’t the overt types of infections.

They’re actually subtle, and it could be a dysbiosis in the gut that’s causing the white blood cell counts to be high or low. And oftentimes it’s not significant. It’s not usually outside of the lab range. It’s usually outside of the optimal range. And again, as astute functional practitioners, we need to be thinking about all the possible causes of these things that are out of balance.

Finally, we look at ferritin and iron, right? And if those tend to be low, so if the ferritin is low and the iron is low, it could be that we have a malabsorption going on, and we’re not absorbing the iron from the food. I mean, of course it could be a diet that’s devoid of these things, but usually more often than not, we’re thinking of it in terms of a malabsorption type problem. So these are some of the little sneaky clues that come up on just a regular old blood test. So we want to be aware of this, before we even think about running some special tests.

The other piece I like to look at is what’s called organic acid. What are those? They’re metabolic intermediary products that are floating around in the bloodstream and then get in the urine. The organic acid tests are generally a urine test. And we look to see, are there high organic acids? 

Dr Ritamarie (5:55)

And we’re looking at a particular pathway, a high level of a metabolic acid, an organic acid may mean that the pathway that converts it downstream to the next step in the process is not working properly. It could be a co-factor problem. It could be a malabsorption of particular nutrients, vitamins and minerals are generally there, but amino acids as well. So again, like in the blood chem, we’re seeing signs that maybe amino acids are not getting absorbed, not getting protein to be digested well, which of course is a gut test.

So the tests that I like to use are either what used to be called Great Plains Labs. They changed their name to Mosaic Labs, and they have just an organic acid test. They call it the OAT test. But there are other labs, I think the company that makes Diagnostic Solutions that makes the GI map test, they also have an organic acid test. I think that Vibrant America has an organic acid test. 

So then there’s Genova’s tests, the Metabolomix and the Nutrival, which have a whole section on organic acids. So it doesn’t matter where you run them through, most of the markers are the same. There’s of course always going to be a slight difference from one lab to the other. But the specific areas that I’m looking at here, yeah, you can look at Krebs cycle metabolites, you can look at detox, but in particular, I like to look at the byproducts of intestinal fermentation. 

So we might see some dysbiosis markers. We might see things like Arabinose, which is a marker for Candida overgrowth. And that marker can indicate a Candida overgrowth either in the gut or a systemic Candida overgrowth.

Dr Ritamarie (7:34)

Elevations in D-lactate can be found on organic acids and D-lactate is a byproduct of lactate fermentation, lactate digestion. And oftentimes people with a SIBO problem would have elevations in this D-lactate. We also are going to see hyporheic acid which can be a sign of bacterial overgrowth. So if somebody has bacterial overgrowth either in their large intestine or in their small intestine like a SIBO or a SIFO, then that’s something that we want to be looking at as well.

Dr Ritamarie (8:04)

The thing I would caution you when you’re looking at these, is not to just jump to the conclusion that the person has dysbiosis. Certain foods can cause elevations of these things. So if you read the test results, there’s a very excellent guide, an interpretation guide that comes with these tests. But you can see that you want to ask a person if they ate certain foods that might contribute to elevations here. And usually when they’re taking the test, the instructions will tell them, avoid this fruit, this food, or this food.

Dr Ritamarie (8:34)

So when I use organic acid tests, I’m not using it in isolation. Just like any test, I’m not using it in isolation. But I may see some markers on the blood tests that indicate that there’s some gut dysbiosis going on. I might be going by symptoms. It’s really a matter of looking at the whole composite. So let’s look at everybody’s favorite, which is the stool tests. 

So some of the tests that do stool analysis are the GI Effects from Genova, the GI Map from Diagnostic Solutions, and then the Gut Zoomer from Vibrant America. And we’re looking at the stool itself. We’re looking at a collection sample. Oftentimes it’s a three-day sample, especially if we’re looking for parasites, because sometimes they’re tricky, and they hide, and we need to have multiple days worth.

So we run these tests, people collect their stool, they’re given a little bit of liquid to mix it with like a preservative, and then they send it off to the lab. There’s a lot of things we can find out here. 

We can look at the microbial content of the intestine. We can look at whether there’s yeasts or parasites, various bacteria that should be there in small amounts as commensals that may be an overgrowth. We look at the normal flora. We look if they have the right quantities of their bifidobacter and their lactobacillus species and other things like that. So we’re looking to see how does it rank. And there’s little markers and sliders that tell you where that person lies.

Dr Ritamarie (9:58)

And there’s interpretation guides which really help you to see where the problem might lie. In some cases, it’s a matter of providing the right natural flora to crowd out the abnormal. And sometimes if it’s serious enough and there’s high enough levels and the organisms are pathogenic enough, we want to kill them.

So it’s going to be up to you and the person that you’re working with because killing them off can be problematic in that it can cause symptoms like a Herzheimer reaction in people as those organisms are dying off. So it’s really important to look there. But in addition to the microbes, we see inflammatory markers. So if somebody’s complaining about a lot of irritation and pain in their gut, and even if they have bleeding stools and urgency, we want to be looking at the inflammatory markers. 

So the certain levels of inflammatory markers are acceptable, but when they get too high, that can indicate an inflammatory bowel disease. So we want to be able to look at this carefully and make sure we don’t miss that and just tell somebody, hey, you have IBS and have them go on their way when in reality they have a more dangerous inflammatory autoimmune condition happening. We look at markers of digestion, there’s pancreatic elastase, there’s signs of

undigested food particles in their stool. We also look at short chain fatty acids, because those are so important for maintaining the integrity of the intestinal lining. For example, somebody comes in and they’re complaining of IBS like symptoms, know, that gotta go, can’t go, gotta go, can’t go, urgency, that kind of stuff and irritation and inflammation. We may think it’s just IBS and we can treat it as IBS.

This test can give you a little bit more clues as to whether there’s inflammation happening down yonder and that it’s a more serious effect or an autoimmune. So it makes you look more carefully at some of the other factors. So it’s a really important piece to be looking at.

Dr Ritamarie (11:56)

Now let’s look at some of the gluten intolerance tests. And a lot of people in conventional medicine just think poo poo, gluten intolerance, it’s just the latest fad. But in reality, a small percentage of the population has actual celiac disease where there’s damage to the intestinal lining from the autoimmune process. But a lot of people have non-celiac gluten intolerance. And that can be contributing to all sorts of problems, malabsorption, maldigestion, pain, and irritation in their gut. So we want to be looking at this. 

And it’s not enough to just run a test for transglutaminase in the stool or in the blood, it’s really a good idea to be looking more carefully and more in depth. So let me tell you about some of the tests that I like to use.

Dr Ritamarie (12:43)

So there’s a test called the Wheat Zoomer by Vibrant America. There’s another test called the Cyrex Array test. And I think it’s array 1, 2, it might be 3 or 4. They have several different arrays, but it’s a Cyrex test. And they’re both blood tests that test for the presence of all sorts of antigens, not just anti-gliadin, not just anti-transglutaminase, but there’s a whole bunch of beta transglutaminase and alpha and all sorts. 

There’s at least 20 different antigens that they’re testing for.  I’ll give you an example of somebody I’m working with that has been off of gluten, as far as she knows, for decades, who discovered that she had celiac, very full-blown celiac, and has been off of gluten for a long time.

But when we ran her GI, the Gut Zoomer test, it showed that she had some gluten antibodies. And if you haven’t been exposed in over 20 years, you’re unlikely to have those antibodies. So we start to trace down, is there a hidden source of gluten out there? Then we run the Wheat Zoomer, which goes into more detail, so we can figure out what is actually going on there. And we see a whole bunch of other different fractions of gliadin antibodies and other antibodies related to gluten intolerance. 

In addition, the Wheat Zoomer has a whole section on intestinal permeability. Cyrex has a separate test that you can do for intestinal permeability. And we’re going to talk about that in a moment. But basically you go look at this test and you can tell, is there zonulin antibodies, is there actin, myosin, LPS, because these things should not be getting into the bloodstream if we have an intact intestinal lining. 

So this is really important to help people who have been up till this point told it’s all in your head, it’s not a gluten thing, and they’re given all kinds of medications, but they’re not ever taught how to avoid the thing that’s causing it. So I really like doing these tests. Do I run them on everybody? No, I mean, there’s certain situations that you’re going to run into when you’re looking for a hidden source of some sort of gut infection. 

Dr Ritamarie (14:59)

So let’s finish up with intestinal permeability. Back in the day before some of these newer labs came about, the way that we tested for intestinal permeability is we did a test from lactulose and mannose. And they’re basically sugars that you would drink and then we look for signs of that coming out in the urine. 

And it’s a crude test. One of the sugars shouldn’t go into the bloodstream and one of them should. And we look at the ratios of those that they come out. Now we have more sophisticated tests for intestinal permeability. Cyrex has Array 2, which tests for the zonulin, the actin, the myosin, and LPS and looks for the specific antibodies to those. Same thing with the Wheat Zoomer that has all of that incorporated into that test. 

It’s really a combination of two of the Cyrex labs. When we look at that, we get an idea that, okay, this person has a gut that’s not filtering what it should be filtering. It’s allowing things to pass through that shouldn’t get into the bloodstream. So is it a full blown out confirmation that this person has leaky gut? We can estimate that it is intestinal permeability.

We have tight junctions between the cells in the intestine and those tight junctions should be pretty tight. And when they get loose, because there’s inflammation in between, that’s when we start to see intestinal permeability. So do we have to do all of these tests? Of course not. But these are things that are at your disposal when you’re trying to understand what’s going on. 

I personally take the approach that we don’t need to run a hundred tests on everybody. We definitely look at the blood chemistry because everybody has them. We can get some signs in there, and we look at symptoms. We look at how they are feeling. Now, if this is a person who has been around the block a few times, who has tried this and tried that and seems to be doing all kinds of leaky gut protocols and whatnot, we want to do some more advanced testing to see are there particular microbes that we’re having trouble eradicating?

Dr Ritamarie (17:08)

Are there particular imbalances in the gut flora? Is there lack of diversity in the gut flora? So there’s a lot of things that we can test, and we can tell when we do some of these tests. But I’m not by any stretch implying that you need to run all of these tests on everybody. But I want you to know that you have these at your disposal and that when you’re scratching your head trying to understand what’s going on with this person or why they’re not responding well to the typical approach to cleaning up the microbes and getting good flora in there and eating fermented foods and all, then you have a bunch of tests that you can tell what’s really going on.

Dr Ritamarie (17:46)

So we’ve covered a lot. We’ve covered a bunch of different categories of tests. Like I said, we don’t need to run all these tests on everybody, but it’s an awakening for you to be able to help people when they’ve been trying so many things and not finding the underlying causes. So I recommend that you keep these in your back pocket, that you use them appropriately as you need, and stay tuned. 

Dr Ritamarie (18:11)

Stay tuned to other episodes where I’m going to explore in more depth on the lining of the intestine and intestinal health and gut permeability and all that and its relationship to metabolic health and hormone balance. So stay tuned for that. Check the show notes, the description, we have a link there to a three-day live event for health practitioners that we’re doing in January, 2025.

If it’s already passed then when you’re listening to this, then you can find more information in the description and in the show notes on how you can get access to recordings. We are looking forward to sharing with practitioners all the implications and all the interactions between gut health, brain health, metabolic health, skin health, and so much more.

Dr Ritamarie (18:56)

So I want you to really get that we are the future of healthcare. We are the change makers. We need to keep in mind that our goal is to get to the root causes and stop trying to suppress symptoms. That’s the old way. The new way is to help people get to the root causes, correct the root causes and achieve the kind of help they deserve. And we can do this. 

I’ve dedicated my life to empowering people to get to the root causes, to empowering and training health practitioners to use this new medicine, which is not really medicine at all. It’s just a matter of empowering people to take charge of their health.

So if you’re ready to take your practice to the next level, go visit us at INEMethod.com. And if you want to learn more about testing strategies, be sure to visit the show notes for important links. Together, let’s continue the movement to Reinvent Healthcare. And until next time, shine on.