The use of functional laboratory testing in a case of Runner’s Diarrhoea

This article first appears in Nutrition Practitioner Journal vol 12, issue 1 Spring 2011

Angela Walker BScNut.Med. mBANT NTCC CNHC


Functional Laboratory tests are an extremely useful tool for the nutrition practitioner who takes a functional model approach. This case study involves an amateur runner with digestive issues, often referred to as ‘Runners Diarrhoea’ (RD), that were inhibiting her ability to train for a marathon. Digestive disturbances including RD are relatively common amongst long distance runners, yet the underlying causes remain unclear. Prior to presenting at my clinic, various nutritional strategies had been trialled, all unsuccessful in resolving RD. The use of functional laboratory tests enabled identification of underlying imbalances and a targeted digestive and nutrition support programme, which led to significant improvement in the RD.



Runners Diarrhoea (RD) is characterized by frequent, loose bowel movements during or immediately after a run. It is most common in long-distance or marathon runners1. While it is a relatively common problem amongst runners, the aetiology is not fully understood.


In one study at an event of 119 competitors 81% of responders had gastrointestinal symptoms, 61% reported lower gastrointestinal symptoms2. In a larger survey of 707 marathon runners, over 1/3 experienced an urge to defecate during and immediately after running3. A pubmed search for ‘Runners Diarrhoea’ brings up only 29 articles. Of course it may be that the term is too colloquial, but at least one author reviewing the topic has stated that very little is available in the literature compared to other ailments experienced by endurance athletes and given the prevalence.4

While a precise understanding of the aetiology remains elusive a number of potential underlying causes have been proposed, these are summarise in Table 1. Effects of increased sympathetic activity, dehydration, nutritional factors, hormonal changes and underlying infection or dysbiosis and the main areas which are thought to lead to RD.

Table 1 Proposed etiology of Runners Diarrhoea

Mechanism Effect
Increased sympathetic activity 1: reduced splanchnic blood flow (by up to 80%)5,6 Intestinal mucosa dysfunction7

  • Malabsorption (and hence evacuation)
  • Cellular injury necrosis and erosions leading to bloody stool
  • Increased membrane permeability
Increased sympathetic activity 1: suppresses parasympathetic activity Reduced parasympathetic activity means decreased gut tone, accelerating transit time3
Increased sympathetic activity 2: triggers release of gastrin & motilin3 Directly contributes to diarrhoea when exercise intensity is high 3
Nutritional Factors 1; sports drinks with glucose concentration in excess of 7 to 10% cause increase osmotic pressure in gastrointestinal (GI) tract drawing water into tract and creating diarrhoea3 “Dumping Syndrome” 3
Nutritional Factors 2: High dietary intake of fibre and high glycemic index foods can have same effect on osmotic pressure in GI as above3 “Dumping Syndrome”3
Hormonal changes 1. Cortisol, adrenalin & noradrenaline may all be elevated after marathon 4


Exact effect unknown, but GI symptoms may be correlated with lower post race cortisol and or noradrenaline and higher potassium levels 4
Hormonal Changes 2. Elevation of certain gut hormones including Vasoactive Intestinal Peptide (VIP), gastrin and secretin. All believed to provide increased metabolic support of increased fuel demands4 Effect of these hormones may also be as vasodilation and increased motility4
Consider infections3 and consider that RD can signify a “stress test for the colon”.8 Hypothesis is that aerobic exercise can stress colon to the stage where is reveals an underlying disorder, imbalance or infection.
Dehydration. Exacerbates reduced blood flow 1,3

Electrolyte and fluid imbalance can cause irritation to colonic smooth muscle and mucosa.3

Effect of persistent pounding in a long distance race causes churning in intestine9 Stool liquefies
NSAIDS3 Can contribute to GI bleeding, can be used inappropriately by athletes3


Case background

Sally is a 31 year-old Caucasian female of a slim, light build.


Sally was hoping to train for a marathon and was regularly running a 12k circuit, however on most training runs she experienced a cramping pain that would come in waves after approximately 30 minute, she would feel the need to defecate, would have to stop and experienced diarrhoea. If she ran first thing in the morning on an empty stomach there would be no digestive problems, but this was unrealistic for every training run and the problem was inhibiting her from training for a marathon. Her primary health concern was to resolve these digestive issues so that she could pursue her running ambitions.


Sally was referred to me by a chiropractor, he had already worked with her to optimise hydration and to improve diet, adding whole grains, fruit, vegetables and including a good protein source with meals. He had also ordered an IgG4 assay which showed only a mild positive for crab. Timing of meals had been explored and a small snack of seeds 2 hours included before each run. Non of these strategies improved the RD symptoms.


Health History (key points)

Sally had suffered (self diagnosed) Irritiable Bowel Syndrome (IBS) during her 20’s. She had experience pain and cramps after meals. These issues improved as she started to exercise and eat more frequently.

Skin problems (acne) had persisted for a number of years leading to two courses of Roaccutane 7 and 5 years previous to the consultation. Prescribed the antibiotic Minocin since 2006 for acne. Prescribed Yasmin birth control pill for skin in 2006.

Insomnia on and off since early teens, still persisted at times and didn’t sleep well.


Current Digestive Health

Bowel movements 2 or 3 times a day and rarely constipated. They could be loose or formed, colour varied, occasional mucous. On occasion she had a cramping pain in middle of stomach and to right hand side and passed mucous. Whilst running, before onset of RD, pain was experienced in the same location (i.e. middle and right hand side) and described as a ‘grinding’.


Current Medications

Minocin (Minocycline antibiotic) and Yasmin (combination birth control pill)


Current Diet & Lifestyle

  • Breakfast: Cereal with milk, plus two pieces of fruit
  • Lunch: salad with tinned tuna
  • Dinner: salad with salmon or fish cakes.
  • Fruit as snacks
  • Caffeinated drinks daily and alcohol two or three times a week

Sally experienced more bloating with salad-based meals. Sally was quite conscious about low fat foods and as a result essential fatty acid sources were limited as no oils or dressings used with salads.


As already noted, she ran 12K three times a week and had a stressful and demanding job in Public Relations.


Other assessments

A zinc taste test was undertaken during the initial consultation: furry tongue, dry taste, reasonably strong after a few seconds, but not described as metallic.


Laboratory Evaluations

As previously stated an IgG 4 test of 30 foods ordered by the referring clinician revealed only a mild response to crab.


Having reviewed the case history, we ordered a comprehensive stool test that uses PCR technology to identify microbes by DNA. The rationale for this was to identify underlying imbalance within the GI tract.


A blood spot fatty acid test was also ordered. Early studies on acne indicated lower levels of linoleic acid in the skin surface lipids of sufferers10. Coupled with the low dietary fat intake and knowing the role of essential fatty acids in the gastric epithelium, an assessment of fatty acid levels was felt to be important.


Test Results

Figure 1: Stool Test Result

Figure 2: Fatty Acid test result


Summary of abnormal findings

  • H Pylori
  • Yeast
  • Blastocystis
  • Klebsiella
  • Elevated anti-gliadin sIgA
  • Low Pancreatic Elastase
  • Low levels of linoleic and gamma linolenic acids


Interpretation of the case under the Functional Model

(This section will focus only on the most relevant aspects of this case)


Digestion/absorption / Elimination

Occasional mucous stool and on-going loose stool suggest a degree of digestive imbalance.

Helicobacter pylori is a bacterium that primarily affects the stomach inhibiting normal proliferation of the gastric mucosal cells, furthermore, it can release bioactive factors that inhibit the ability of the parietal cells to produce hydrochloric acids (HCl)11. Normal secretion of gastrin, which stimulates release of HCl from parietal cells and stimulates gastric motility may also be inhibited. H.pylori could have been asymptomatic, but given the presence of some bloating it was felt to be relevant in this case and possible that the H pylori infection could be inhibiting normal digestive potency, therefore inhibiting optimal absorption.


Fecal pancreatic elastase is considered an accurate measure of pancreatic enzyme output12. Combined with the presence of H pylori and its inhibition of stomach acid, it would appear that Sally’s digestive potency is reduced, this may be contributing to bloating after certain meals, loose stools, low nutritional status as well as RD.


Despite long term (4 year) use of an antibiotic, the predominant bacterial populations were good on the test results. However opportunistic bacteria (Klebsiella) yeast and the parasite Blastocystis were present, indicating a dysbiotic state. Stool studies to investigate for parasites, pathogenic and opportunistic bacteria is suggested as part of a comprehensive assessment of RD 4 (see Table 1). Furthermore, one hypothesis is that aerobic exercise can stress the colon to the extent that underlying imbalances or disorders can be revealed 3. This interpretation may apply in the current case; a dysbiotic state, while not creating symptoms in every day life, but the symptoms are revealed once stressed from an extended run.

Anti Gliadin sIgA is a marker for gluten sensitivity and is elevated in the test results. Gliadin is known to induce zonulin release, opening up the tight junctions on the intestinal epithelium, increasing intestinal permeability 14. While gluten remains in the diet there will be a continued irritation to the gastrointestinal tract.

Toxic by products of bacterial and yeast overgrowths create and additional toxic load for the liver (15,16). These can also contribute to intestinal hyperpermeability.

Inflammation & Defense

Inflammation markers on the test are low but it could be expected that continued exposure to gluten from the diet as well as toxic by products from yeast and bacteria and presence of parasites would create an inflammatory state. Inflammation is involved in the pathogenesis of acne 17,18. The laboratory testing has identified low Linoleic and Gamma Linolenic acid levels, given their role in membrane phospolipids, eicosanoids 19, and connection to acne5, re-establishing these levels will be important to improve gastric epithelial function and reduce skin inflammation.

A key role of the essential fatty acids is cellular membrane structure and fluidity 19, in this capacity they are also involved in cell receptors. Table 1 described the possible factors involved in RD, which include hormone imbalance. Optimising cell receptor function, via the required essential fatty acids may therefore be of benefit.
Structure and repair

As has already been mentioned, the essential fatty acids have a key structural role, in particular the omega 6 fatty acids may have a restorative effect on the intestinal epithelial cells through the COX pathways 20. The fact that these are depleted will have implications for optimal digestive function.


Nutrition Programme

The NICE guidelines for H Pylori treatment is a 7 day course consisting of proton pump inhibitor (PPI) with two antibiotics either metronidazole 400mg and clarithromycin 250mg OR amoxicillin 1g and clarithromycin 500mg 21. However these protocols are not always effective and come with concerns regarding antibiotic resistance 22,23. Given the ongoing antibiotic use and in discussion with Sally, a botanical approach was first tried for H Pylori.

A tailored 4 R programme with additional essential fatty acids:

  • Digestive enzymes before each meal
  • Botanical anti microbial formula 2 caps bid (per 2 caps: tribulus terrestris 24 400mg , sweet wormwood 25 300mg, caprylic acid 25 300mg, berberine 25 200mg, grape seed extract 26 200mg, barberry 27 100m, bearberry (cranberry) 21 100mg, black walnut 100mg). (30 days in total)
  • Botanical formula to target H Pylori 2 caps bid (Vitamin C 28 500mg, Deglycyrrhizinated licorice DGL 29 1500mg, Mastic Gum 30 1000mg, Methylmethioninesulfonium “vitamin U” 200mg, Zinc-carnosine 31 75mg) (30 days in total)
  • Oil of Oregano to target yeast 32 30mg pd
  • Gamma Linoleic Acid 500mg pd
  • Gluten Free diet
  • Sally was coached to introduce more variety (fresh fish rather than tinned), wider range of vegetables, less raw salad, inclusion of seeds and nuts each day as well as for salad dressings. The need to continue phasing a small snack 2 hours before each run and to maintain hydration was empahsised. She was also coaching to chew more thoroughly.


4 week follow up

  • Week 1 of programme: no different, possibly worse
  • From week 2 onwards, definite improvement. Still experienced ‘feeling’ but no need to stop run
  • Skin felt clearer
  • Bowel movements more solid.
  • All of the improvements were despite an extremely stressful period at work.

Ceased botanical formulas & oil of oregano. Continued with rest of programme


Follow up test results

Figure 3: Microbial Profile Result

Summary of findings:

  • H Pylori, Yeast & Blastocystis no longer present
  • Predominant bacteria all low (mainly in 2nd quintile), due to the anti-microbial botanical formulas used, which will have a non-discriminatory effect on gut microflora.
  • Parasites (taxonomy unknown). The test sensitive and often traces of parasite are identified with taxonomy unknown, this generally means the parasite is not likely to be a human pathogen and is probably transient.33


Follow Up Consultation (2 months)

  • Sally described improvement as 80 to 90%. She hasn’t had to stop any runs at all for a bowel movement, although has had ‘the feeling’ in her stomach. Planning to run half marathon later in the year.
  • Daily bowel movements and digestive function improved
  • Skin improved and noticeably smoother
  • Gluten avoidance is 100% during week but only 90% at weekends
  • Energy levels improved but would like to have more energy


Revised nutrition & supplement programme

The maintenance strategy is to support the natural defences from pathogenic bacteria, yeasts and parasites. The programme goals are to re-establish healthy microflora population, support gut immune defences and epithelial function.

Comprehensive Bifidobacterium strains 30 billion CFU’s per day

  • Prebiotic formula of chicory inulin, oligofructose, larch arabinogalactan and purified yeast beta-glucan. 5g per day. Prebiotics can help healthy populations of bifidobacterium (and other comensal probiotic strains) to flourish34 beta glucans may also have an immune supportive role against bacterial and parasitic challenges. 35
  • Continue to avoid gluten. Recommended a digestive enzyme which includes Glucoamylase to support gluten digestion for use at weekends when needed
  • Essential fatty acid blend of omega 3, 6 & 9
  • A multi vitamin and mineral was added



The stool test revealed significant dysbiosis. Parasites, pathogenic bacteria, opportunistic bacteria don’t always lead to symptoms. In this case, although a history of digestive issues and (certainly from a nutritional therapy perspective) below optimal current daily digestive function existed, the symptoms weren’t bothersome for the client until they intensified during high intensity running resulting in RD. Once the gut dysbiosis improved, evidenced by the follow up stool test, the symptoms improved by 80 to 90%. The hypothesis that aerobic exercise can stress the colon and reveal underlying imbalances would appear to be a valid interpretation in this case. The client is very happy with her progress and we are continuing to work on the maintenance programme to enable her to successfully pursue her marathon ambitions.






1. Mayo Clinic. Runner’s Diarrhea. How can I prevent it? Available from: [Accessed September 2010]

2. Worobetz & Gerrard (1985) Gastrointestinal symptoms during exercise in Enduro athletes: prevalence and speculations on the aetiology. NZ Med. J. 98 (784) pp 644-6

3. Keeffe et al (1984) Gastrointestinal symptoms of Marathon Runners. Western Journal of Medicine. 141 (4) pp 481-484.

4. Ho (2009) Lower Gastrointestinal distress in endurance athletes. Current Sports Medicine Reports 8 (2) pp 85-91

5. Cohen et al (2006): Marathon-Induced ischemic colitis why running is not always good for you. Am J Emerg Med. Feb 27 (2) pp 255

6. King & Avery (2010): Marathon Induced Colitis. Available from [Accessed 21st March 2011]

7. Ho (2009) Lower Gastrointestinal Distress in Endurance Athletes. Current Sports Medicine Reports 8(2) pp 85-91

8. Swain (1993) Exercise-induced diarrhea: when to wonder. Medicine and Science in Sports And Exercise Vol. 26(5) pp 523-526

9. Simon & Kennedy (2004) Gastrointestinal Problems in Runners. Current Sports Medicine Reports 3 pp 112-116

10. Downing, D.T. Stewart, M.E. Wertz, P.W. and Strauss, J.S. (1986) Essential fatty acids and acne. Journal of American Academy of Dermatology 14(2 Pt 1); 221-5

11. eMedicine. Helicobacter Pylori Infection. Available from [Accessed 21st March 2011]

12. Takeda et al (2002) Fecal elastase-1 test: clinical evaluation of a new noninvasive pancreatic function test Rinsho Bylori (article in Japanese) 50(9) pp 893-8.

13. Swain (1993) Exercise-induced diarrhea: when to wonder. Medicine and Science in Sports And Exercise Vol. 26(5) pp 523-526

14. Lammers et al (2008) Gliadin induces an increase in intestinal permeability and zonulin release by binding to the chemokine receptor CXCR3. Gastroenterology. 135(1) pp194-204.

15. Lord & Bralley (2008) Laboratory Evaluations for Integrative and Functional Medicine. 2nd Ed. Metametrix Institute

16. Thomas Sult (2005) Clinical Approached to Gastrointestinal Imbalance. Textbook of Functional Medicine. Ed Jones & Quin. Institute for Functional Medicine.

17. Webster (2002) Acne vulgaris. BMJ 325 pp475-9

18. Cordain (2005) Implications for the Role of Diet in Acne. Semin Cutan Med Surg 24 pp 84-91

19. Calder & Grimble (2002) Polyunsaturates fatty acids, inflammation and immunity. European Journal of Clinical Nutrition Vol 56 (Sup3) pp 14-19

20. Ruthig & Meckling-Gill (2001) N3 and n6 fatty acids stimulate restitution by independent mechanism in the IEC-6 model of intestinal wound healing. Journal of Nutritional Biochemistry 13 pp 27-35

21. Dyspepsia: Managing dyspepsia in adults in primary care. August 2004. Available from [Accessed 15th November 2010]

22. Fuccio et at 2008. Treatment of Helicobacter pylori infection. BMJ 2008; 337



Help to save Alternative Medicine Review

Please read the follow appeal from Andy Bralley CEO of Metametrix on what we need to do to save Alternative Medicine Review (AMR).

AMR has been dedicated to providing timely, fact-based, and clinically relevant research articles, literature reviews, monographs, abstracts, and editorials for the practicing health care practitioner.

Unfortunately, AMR is no longer able to continue with free subscriptions and is asking for your support to continue publishing AMR.

Will you subscribe to Alternative Medicine Review?

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They need at least 3,500 subscriptions to continue publishing AMR. This is not just their journal, it is yours and mine. AMR has supported the advancement of our community for many years; now they need our support. Join me and an increasing number of our colleagues in making a difference for a trusted source of information in the practice of alternative medicine.

Thank you,

J. Alexander Bralley, CEO
Metametrix Clinical Laboratory

Toxicity Evaluations

I’m off to Atlanta this weekend for the Metametrix Conference on Toxicity. A brilliant line of of speakers Walter Crinnion, Todd LePine, Richard Lord and Alexander Bralley.

Click here for more details

Will be reporting back and running our own toxicity assessment workshops later in the year.

In the mean time, any questions you’d like to pose to any of the speakers think of me as your mouthpiece and send a message via twitter@_NutritionGeeks on on the form

Study shows effect of early Bisphenol A exposure on behaviour and function in children

A study published in Pediatrics last year demonstrated that early, fetal exposure to Bisphenol A (BPA) was associated with anxious and depressive behaviour in their children, especially girls.

BPA was measured in urine samples of 244 mothers at 16 and 26 weeks of gestation and then in their children and 1, 2 and 3 years of age. Behavior and executive function were measured by using the Behavior Assessment System for Children 2 (BASC-2) and the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P).

BPA was detected in >97% of the gestational (median: 2.0 μg/L) and childhood (median: 4.1 μg/L) urine samples. With adjustment for confounders, each 10-fold increase in gestational BPA concentrations was associated with more anxious and depressed behavior on the BASC-2 and poorer emotional control and inhibition on the BRIEF-P. The magnitude of the gestational BPA associations differed according to child gender; BASC-2 and BRIEF-P scores increased 9 to 12 points among girls, but changes were null or negative among boys. Associations between childhood BPA exposure and neurobehavior were largely null and not modified by child gender.

The researchers concluded that gestational BPA exposure affected behavioral and emotional regulation domains at 3 years of age, especially among girls. Clinicians may advise concerned patients to reduce their exposure to certain consumer products, but the benefits of such reductions are unclear.

Clincians have a further option, to screen for BPA exposure for patients in that population group using the Metametrix Bisphenol A Urine Profile. This profile is available in the UK and Europe from Nutrition Geeks, please contact us at for further information.

Study: Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children, Braun et al 2011 Pediatrics Vol. 128 No. 5 November 1, 2011
pp. 873 -882 (doi: 10.1542/peds.2011-1335)

Angela Walker BSc Nut Med mBANT CNHC registered
Technical Advisor, Nutrition Geeks

Clinician under the Spotlight: Sue Simmons

Our first featured clinician for 2012 is Sue Simmons, a Nutritional Therapist and Autism specialist.

NG: Tell us a bit about yourself: how long have you been in practice, where did you train?

SS: I’ve been in practice as a Nutritional Therapist for 8 years and have specialised in the field of children and young adults with Autistic Spectrum Disorders (ASD) for the last 5 years.  I did my Nutritional Therapy training with Plaskett Nutritional Medicine College which became part of Thames Valley University.  I then went across the to US for 3 years running to do the Defeat Autism Now! Clinician’s training and to attend their annual conference.

NG: What was the first lab test you ran and what did you learn from it?

SS: My first experience of a lab test was as a consumer when a practitioner I consulted regarding my son suggested a Mineral Sweat Patch test to identify mineral deficiencies.  My son was diagnosed with Autism in 1996 and it was his positive reaction to dietary changes that led me to study Nutritional Therapy; I needed to learn more to understand how to help him.

NG: What’s your favourite test panel and why?

I’ve always used comprehensive stool analysis with parasitology with my patients but have recently been converted to the benefits of the DNA analysis used in Metametrix Gastrointestinal Effects Profile.  Many ASD children are non-verbal or have limited speech and understanding of questions, so functional testing is essential.

NG: Is there one intervention, dietary, supplement or lifestyle that you think delivers most change for your clients?

SS: Finding the right therapeutic diet is key, whether it is Gluten/casein/soya/corn Free, Feingold, Specific Carbohydrate, Low oxalate or GAPS.  Supporting the patient’s parent to implement the diet effectively so that it is nutrient rich and avoids preservatives and other undesirable substances is essential.  A lot of the gluten-free products in supermarkets leave a lot to be desired.

NG: Who is your favourite educator or guru in the nutrition or functional medicine field?

SS: In my specialist area, Dr Daniel Goyal is a great educator for parents and practitioners alike.  He is straight talking and is not afraid to ruffle a few feathers.  For me personally, my mentor and fellow Nutritional Therapist, Jean Muscroft has been an inspiration.

NG: What’s the best advice you’ve ever received?

SS: One of the Defeat Autism Now! Clinician’s training sessions was titled ‘Have I done everything I can for this patient?’ and this phrase has stuck in my mind.  It leads me to review case files and think strategically about my therapy plan for the patient.  It also makes me consider whether it is in the patient’s best interest to refer them to on to another specialist.

NG: What’s the secret of your success?

SS: Having a personal connection with autism makes me passionate about the subject and this motivates me immensely.  I also believe that investing in the very best continuous professional development pays dividends to both your patients and your practice.

NG: How do you switch off after a busy day in clinic?

SS: Going for a run by the river Thames with The Killers playing on my ipod does it everytime.

Find out more about Sue’s work at

Nutrient and Toxic Elements*

Selecting the right specimen to measure nutrient and toxic elements* can be a bit of a minefield. What specimens are most relevant for nutrient and toxic elements for an individual case? For many elements, the likelihood is that no one specimen is optimal, as each specimen has its own strengths and weaknesses and often multiple specimens are more appropriate for the most comprehensive assessment.

When it comes to the toxic elements, the question is often asked, should specimens be taken with or without a challenge? Metametrix have recently change the reference ranges on the urine so that ranges are now provided for both challenged / chelated and non challenged specimens, providing clinicians with even more data to make their clinical judgements.

The Metametrix interpretation guide offers more detail on specimens all element assessments and provides a concise yet comprehensive overview of both; definitely recommended as a read and a great reference point.

The interpretation guide as well as new sample test reports with the new reference ranges can be found at under Improved Metametrix Elements Profiles

Angela Walker BSc Nut Med mBANT CNHC registered
Technical Advisor, Nutrition Geeks




* The definition here of elements is the form of the chemical element found in the human body, either nutrients (i.e. minerals) or toxic metals, usually complexed to proteins or other biological macromolecules.


Clinician under the Spotlight: Matt Lovell

This month we’re featuring sports nutrition guru and author of the Palm Sized Plan and a Fist full of Food, Matt Lovell:

NG: Tell us a bit about yourself: how long have you been in practice, where did you train?

ML: My parents inspired my passion for food,  my mother cooking me food when she got back from work, and talking to me about it. My father – an acupuncturist and healer – showing me the power of food, herbs and the mind in terms of healing the body. Oh and Bruce Lee!

After a degree in political philosophy at Bristol, I couldn’t keep away from the health and fitness arena and qualified as a personal trainer, eventually running my own company in the city. This led to developing my other passion, nutrition, training at the Institute of Optimum Nutrition. I started working with the England Rugby Team in 2002 and was part of Clive Woodward’s team that lifted the world cup, I still work with England rugby as well as Tottenham football club and was recently asked to lead the Loughborough site English track and field team into the 2012 Olympics – co running the nutrition programme with Glenn Kearney. I have my own elite performance based company, based in London.

NG: What was the first lab test you ran and what did you learn from it? What’s your favourite test panel and why?

ML: I ran an ASI because I felt like I had adrenal fatigue – it came back positive which was a relief as I like many people like to have reasons and number to work out why I’m getting symptoms. I learned a lot about how to treat adrenal fatigue and thyroid issues along the way – self taught and based on my personal experiences. This has helped me enormously with other people suffering from adrenal fatigue and thyroid problems. Athletes commonly knock the HPA axis off tilt through pushing themselves in training.

NG: Is there one intervention, dietary, supplement or lifestyle that you think delivers most change for your clients?

ML: It has to be learning to train properly and learning to sleep properly! Most people don’t train! Or even lift weights. It should be one of the 10 commandments.

NG: Who is your favourite educator / guru in the nutrition or functional medicine field?

ML: Dr Eric Serrano

NG: What’s the best business / practice advice you’ve ever received?

ML: You cannot help everyone.

NG: What’s the secret of your success?

ML: I have a code of conduct, a principle centred approach to life and the way I practice. It’s to do with my company symbol and it means; Free, cheerful, hardy and god fearing. I’ve evolved these to mean; free to evolve and be creative in my programming, cheerful as successful athletes are happy athletes, hardy is my warrior code of conduct I stick to when things get tough – which they do and god fearing is nature respectful which means sustainable, natural, organic and things like that.

NG: Who are you client base?

ML: 50% elite rugby, but also Triathlon, golfers, track and field – boxers, UK bob sleigh – basically all kinds of athletes, both professional and recreational.

NG: How do you switch off after a busy day in clinic?

ML: I take sedatives 🙂 I actually use a variety of things a chinese herbal tincture containing schinandra, astragalus, Siberian ginseng and rhodiola – it makes you totally calm and horny! Awesome for performance.  I also use magnesium, glycine,  inositol and glutamine – this tastes sweet so it helps with sugar craving and also addiction…..

Mostly I get home and the kids will generally be laughing a lot and if not then I make them laugh this is the best medicine.

Find out more about Matt’s work at

Stool Testing FAQ’s

Clinicians often ask us about sensitivity markers when yeast or bacteria are found on a stool test, so with the help of Metametrix we’ve put together some FAQ’s to help:

Q: When is sensitivity testing provided:

A: Sensitivity testing done when a yeast, fungi or opportunistic bacteria are identified on a stool test. Sensitivity testing is not performed for parasites or pathogenic bacteria.

Q: I’ve got a positive yeast result on my stool test, but the sensitivity page is blank, reporting “Unable to determine sensitivity to pharmaceuticals and botanicals due to the lack of growth of fungi / yeast in vitro”.

A: We identify the yeast /fungi by DNA. If something is found we do sensitivity testing by growing the yeast/ fungi in culture and then testing specific anti-fungal agents against it to see what may slow growth or kill the organism. Yeast are very difficult to culture (grow), they have specific preferences for nutrients, oxygen and pH, and all labs struggle with this issue. If it will not grow in vitro we cannot perform the sensitivity testing.

You will note that most labs utilizing culture as their means of identifying yeast also employ a visual or microscopic report of yeast for this very reason. Again, labs struggle to grow yeast. So they may tell you there is yeast present by microscopy but because it did not grow they cannot ID the yeast or provide a sensitivity report.

In the case that the yeast does not grow and no sensitivity report is available a product that contains a blend of known anti-fungal botanicals or pharmaceuticals like Fluconazole or Nystatin are commonly used.

Q: What about pathogenic bacteria – when the sensitivity page is blank for these, is it for exactly the same reason?

A: The pathogenic bacteria are mostly anaerobes (grow without oxygen) and therefore culturing them would be very costly (you must create anaerobic conditions to grow them). Regardless of what method is used to ID them, DNA or EIA tests you still have the same issue when performing a sensitivity test: labs must grow it. The recommended practice is to refer to a PDR or another reference for treatment options and dosages.

Q:  Why are sensitivities tests not conducted for parasites?

A: There are no commercial labs culturing parasites. The reasoning is twofold. First, they are very difficult to grow in vitro. Researchers can get them to grow and have for studies but at a high cost. The second reason is that unlike bacteria and even yeast to a smaller extent, protozoa evolve very slowly and therefore effective treatment options have remained the same for decades.

For more information on DNA Microbial Comprehensive Stool Testing in the UK

Clinician under the Spotlight: Heidi Bohrn

It was great to see so many clinicians at our conference last month. Consistently the feedback from these events is that, on top of the fabulous clinical insights, clinicians really enjoy the network opportunities and the chance to learn and grow from each other. We thought we could help maintain those sharing opportunities with a new feature “Clinician under the Spotlight’. Stepping up to be the first one under the spotlight is Heidi Bohrn.

NG: Tell us a bit about yourself: how long have you been in practice, where did you train?

HB: “My name is Heidi Bohrn (NT dip CNM mBANT AFMCP) and I have been practising as a nutritional therapist over the past 2 years. I studied at the College of Naturopathic Medicine in London and have conducted further studies via The Functional Medicine University as well as recently completing the AFMCP-UK course run by The Institute for Functional Medicine. I became interested in nutrition after being diagnosed with M.E, after 5 years of suffering with the debilitating illness I turned to nutrition and supplements to get myself better and have never looked back since. I am very happy to pronounce that I’m symptom free since turning to the powers of nutrition. Like many people in this profession I want to enlighten as many people as possible as to how food really does make an impact on people’s health and their overall wellbeing.  I am also a zest4life practitioner where I run weekly weight loss health seminars to the local community.”

NG: What was the first lab test you ran and what did you learn from it?

HB: “When at college studying, I released that I definitely wanted to take a more scientific approach in identifying underlying causes as I feel you can be more targeted in your treatment plan and you gain more compliance from your patients. My first test was a cardiovascular panel for one of my case study which so happened to be my mother. She had been suffering from high blood pressure and didn’t want to go onto statin’s. The test allowed me to be so targeted that within 6 weeks her blood pressure went from 168/80 to 139/80, even my teacher was surprised at such results.”

NG: What’s your favourite test panel and why?

HB: “For me it has to be the Metametrix Comprehensive Stool Test (Gifx), I find I am ordering a least 2 of these tests a week. Time after time I find positive results for pathogenic invaders; this is a must for anyone who is suffering from any digestive disorders. I really find this test so useful, it covers the whole spectrum of pathogens including H. Pylori and this is one key areas that I feel other stool tests are lacking. This stomach bacteria seems to rife in the UK and from once my patients have addressed their H. Pylori we find that lots of their symptoms seem to disappear, even symptoms that are not even related to digestive function such as high blood pressure and heart murmurs . I find this test to be so much more precise in picking up parasites as it tests the DNA rather than the culture that other tests analyse.”

NG: Is there one intervention, dietary, supplement or lifestyle that you think delivers most change for your clients?

HB: “To me balancing out blood sugar levels via a low GL diet is quick, effective and doesn’t cost your patient the earth. Installing clients with a low GL food protocol such as eating 3 times a day and eating protein with each meal is such an easy and cost effective way for patients to see many benefits.  Not only weight loss, but other health benefits such as better mood, less cravings, reduced PMS, reduce blood sugar markers, an increase of energy and the elimination of acid reflux are all benefits that can be gained from the installation of this healthy eating plan. I am a big advocate of a dietary plan as it integral to the Zest4life plan designed by Patrick Holford, which I teach on a regular basis.”

NG: Who are your favourite educators / gurus in the nutrition or functional medicine field?

HB: “Such a tough question…with so many experts to draw inspiration from I really would find it impossible to pick just one. However I do love experts who provide clinical expertise and deliver material in such a fashion that it can be immediately implemented into working practises so I would have to say that I’ve always been impressed with experts such as Dr Weatherby, Kara Fitzgerald and from IFM -Kristi Hughes and Mark Hyman.”

NG: What’s the best business / practice advice you’ve ever received?

HB: “Always start with digestion. They say the seed to good health starts in the gut and from a clinical view point this has been proven for me. When I first started my treatment plans I was all over the place, I was trying to fix all symptoms at once and not focus on being targeted.  I now initially focus on digestion and then (un)surprisingly a lot of the other areas of concern tend to calm down, for me it the quickest way to make an immediate impact on your client. Immediate success obviously helps with client retention and from once your client returns you can then focus on deeper routed health concerns.”

NG: What’s the secret of your success?

HB: “Keep learning!  In our profession you can never stop learning, we are in a sector where new research is becoming available on a daily basis and you need to be up to date with your research and protocols. I love to learn from the experts and believe it has allowed me to grow as a practitioner very quickly!”

NG: How do you switch off after a busy day in clinic?

HB: “I live in a beautiful village set in rural area just on the outskirts of greater London, so I try and go for a walk each night to switch off. I think it is important to cut yourself off from work as what we do can tend to be quite demanding. I also try not to see clients at the weekend as this is my time that I reserve for my family because without them I would not be able to help others.”

Find out more about Heidi’s clinic from her Alternative Nutrition.

Who should we feature next? Send your nominations (or nominate yourself) to

Angela Walker BSc Nut Med mBANT CNHC registered
Technical Advisor, Nutrition Geeks


The low down on Organix technology

We’re often asked about the differences are between laboratory testing methods and machinery used by Metametrix and some of the other laboratory companies. Its a great question to ask and so we wanted to share something from Dr Bralley, which we think does a great job at explaining the technical differences and the effects these have on the lab tests. There are links provided to a summary table and copy of the article mentioned

“Hi Don, Attached is a brief summary comparison of the two types of analytical techniques used to measure and report organic acids [download copy here]. We started years using GC/MS years ago when we pioneered the use of organic acid testing in integrative/functional medicine. In that sense you could say we have the most experience in the field, having introduced and written the book on this test. The reason it is so popular is that everyone realized how much useful information there is in this test after we came out with it. Everybody has pretty much copied us since.

We were attracted to the tandem mass spec methodology because of its robustness and flexibility, even though the equipment is significantly more expensive. We are very insistent on quality around here. This technology allows us to offer other compounds in the report that other labs do not have. These include 8-hydroxy-2-deoxyguanosine, a well documented marker of oxidant stress and damage to DNA. No other lab offers this in their profiles since it would add considerable additional cost. Also, we include D-Lactate, an important marker of gut dysbiosis. The LC/MS-MS (Liquid chromatography / Tandem mass spectrometry) allows us to report this. It cannot be done using the GC/MS methodology. Again, a value added service other labs don’t provide. We also are the only lab to report out the well documented Candida albicans marker, D-arabinitol. This is very useful to clinicians as it provides a reliable yeast overgrowth marker, again at no additional cost.

Finally, I would like to comment on the scientific inaccuracy some labs are perpetuating. This is the reporting on the “supposed” yeast dysbiosis markers of tartarate, citramalate and arabinose. I challenge anyone to find any support for these compounds as markers of yeast overgrowth in the medical literature. It simply does not exist and labs that say these are markers, I have no respect for. In fact, we published a paper in Clinical Chemistry on tartarate about this error. [download copy here]”
J. Alexander Bralley, Ph.D.
CEO – Metametrix Clinical Laboratory
3425 Corporate Way
Duluth, GA 30096 USA