Labcorp Stool Test Results And Questions

[powerofpositivethinking]

I posted this in the thread I've been keeping on my gluten-free journey but wanted to post it here as well to get some input. 

 

Earlier this week I got my LabCorp results from a fecal fat test that my GI wanted done since my Vitamin K is still low.  Thankfully, it was the test where I only had to give one sample vs a 72-hour bucket of fun   It did come back that my neutral and total fats in my stool are both increased.  I've been playing phone tag with the GI's office, and I did call to confirm the supplements I'm taking since they wanted to make sure I wasn't taking Alli or something that definitely would cause fat malabsorption.  They called again today, but didn't leave a message this time, so I'll call again Monday.  

 

This is what LabCorp's site says in reference to the test:  Increases in neutral fat are commonly associated with pancreatic exocrine insufficiency. Increase in stool total fats (neutral fats, soaps, and fatty acids) is likely to be associated with small bowel disease.

 

I keep reading about pancreatic exocrine insufficiency in regards to cystic fibrosis.  Can it also be related to celiac?  I don't want to change anything about my diet until after talking to the doctor and possibly getting more tests completed, but for fat malabsorption, should I be looking to follow a low-fat diet and starting to take pancreatic enzymes?  I know I need to eat some fat or my Vitamin K supplements won't be absorbed well.

 

Any input is much appreciated!

 

 

[nvsmom]

I do not know much about the pancreas and fat absorption... I'll get that disclaimer out of the way now.    But I think if you have a tough time digesting fats, then you would need to consume more fats to give your body what it needs, and it does need fat.  I wouldn't cut fat unless it is causing health problems. Not absorbing fat would be like not absorbing a certain vitamin - a person would take more until the body is working better... I think.

 

Pancreatic enzymes might be a good thing to look into.... I hope someone else chimes in with some wisdom - I've got nothin' here.

[Gemini]

Pancreatic insufficiency is most definitely associated with Celiac. Your small intestine sends out messages to your pancreas, calling for digestive enzyme when needed to break down food. When your small intestine becomes damaged and villi flatten or are destroyed, it can no longer send for the help it needs to break down your food. This can reverse when the small intestine heals but if you have Celiac, that means the gluten-free diet.

I have a good article on this but it's on my computer at work and I won't be there until Monday. I had this myself and always have had trouble digesting fats. It has gotten much better since I went gluten-free. The pancreas can actually atrophy in places because it's not able to function.......sort of like a muscle that does not get used. You may or may not get back 100% of its function BUT that is not something to freak about. With high fat meals/foods, I take a digestive enzyme and have no problems with the meal. I have not been able to eat lamb again because lamb is a higher fat meat and I just can't digest it. No biggie, there is plenty of other good protein sources I can eat with no problem.

One way to look to see if this could be a problem is your stools will become lighter in color and bulky, plus they tend to float. High fat content will do this. I will look up the article on Monday and post it. It is not a common condition in general but because of the nature of Celiac, it can happen as a result of malabsorption.

[1desperateladysaved]

Enzymes have been very useful for me with my celiac.  The enzymes help to break down your food until the villi heal enough to do their job of telling the pancreas to fire.  My functional medicine nurse has told me this.  I would recommend (as one who has been helped by enzymes) looking into enzymes for this purpose and see if they would help you.

 

D

[GFinDC]

You could also try taking some Betaine HCL when you eat greasy foods.  It turns into hydrocloric acid in the stomach.  The digestive enzymes are a good idea too.  If you take both, look up the suggestions for taking them.  I think they say to take the enzymes 30 minutes after eating.  Prolly the Betaine at the beginning of the meal.  But you should do some research on it yourself to be sure.  The timing of when to take the Betaine and the enzymes is important, they say.

[NoGlutenCooties]

Just wanted to add that you want to make sure the digestive enzyme has lipase in it - that's the enzyme that breaks down fat.

I agree with the others that a low-fat diet isn't really a good idea (not that you should overdose on fat though either).  Your body needs good fats.

 

This is the digestive enzyme I use:  Open Original Shared Link

[powerofpositivethinking]

thanks, everyone!  

 

I've also come across that it could be gallbladder related as well, but I'm skeptical.  I had a family member who had her gallbladder taken out at a young age, but she also was in so much pain.  I had a gallbladder/liver ultrasound last year that came back normal, and I don't have any pain in my gallbladder area.  I have never gotten the HIDA scan.  I get discomfort very occasionally in the lower right quadrant near my naval where I believe my colon is.  I mentioned this to both my GP and GI, but they both did the poking and prodding test and didn't feel anything abnormal.  I have a feeling it's related to constipation.  

 

I had blood work done at the same time as the stool test and my white blood cell count was normal as were my liver tests and bilirubin levels, and through researching it seems they would be elevated if I had gallstones.

 

Before I stopped gluten, I bloated from my stomach down below my naval, but now when I bloat I've noticed it's usually just a little above my naval and below.  

 

My stool is never what I deem a strange color.  Not to be TMI, but it's usually a lighter brown, almost the color of peanut butter.  Honestly, since I was a big C sufferer, I'm just excited that I go most days!  

[IrishHeart]

 Not to be TMI, but it's usually a lighter brown, almost the color of peanut butter.  Honestly, since I was a big C sufferer, I'm just excited that I go most days!  

 

That's a good poop color! no worries.

 

The advice offered by my pal Gemini earlier in the thread is exactly what I was going to write (and I love when she comes on before me because then I can just say this)

 

Yeah! what she said. 

[powerofpositivethinking]

it's like deja vu reading these studies because they all say weight loss and the big D as symptoms of pancreatic insufficiency  <---not for this girl    It reminds me of when doctors say you can't have celiac if you're not emaciated and having the big D.  I'm one of those overweight mostly reformed big C types.

 

Other things align with what I've been reading and that I have personally experienced: stool that sticks to the bowl after flushing or frothy stools but I only get that one on occasion.  When I had to increase my fat for the test I did notice a bit of abdominal swelling/bloating, and that is listed as a symptom.  It seems that the back discomfort, not shooting pain, I get sometimes can be related to the pancreas.  I was blaming it on coffee 

 

Something that did not make me happy to read, "Patients usually will present for evaluation when <10% of exocrine pancreatic function remains, which results in lipid malabsorption."

 

On the very positive side: "In contrast, decreased production of pancreatic lipase without glandular destruction is associated with Celiac sprue, Crohn’s disease, and Shwachman–Diamond syndrome."

 

That silver lining is always important 

 

Open Original Shared Link

 

 

Here comes some thinking out loud, but if anyone wants to offer input, I will gladly take it!  I wrote previously, "Before I stopped gluten, I bloated from my stomach down below my naval, but now when I bloat I've noticed it's usually just a little above my naval and below."  

 

Since gluten is a protein, and proteins are fully broken down in the stomach by enzymes, I think that's what accounted for the full on belly bloat to below the naval.  My stomach kept trying to digest it, but it just wasn't happening so I bloated up and had GERD as a result.  Meanwhile I've been gluten-free, but as noticed last week I bloated but only around my naval and not my stomach with increased fat in preparation for my test.  Since fat mixes with enzymes in the duodenum, but my enzymes are apparently MIA then the undigested fat is passing through the rest of my digestive system intact which in turn is irritating my system and causing bloat below the stomach.  Does that sound like a reasonable explanation?  

 

TIme to give my brain a rest.  Night all!

 

EDIT:  Gemini, I meant to add that if I would have went back and reread the WGO guidelines on celiac disease that I actually gave my GI a copy of, right under the section labeled "persistent symptoms" is pancreatic insufficiency clear as day.  Definite oversight on my part 

 

Open Original Shared Link

[powerofpositivethinking]

ok so the doctor said pretty much what I thought he would say but actually didn't mention a thing about the gallbladder.  He said we can do a CT/MRI of the pancreas and small bowel, and that the malabsorption can happen from celiac itself or pancreas problems.  He also said something I didn't think about because the fat isn't being broken down initially then it can't get absorbed anyway by the small intestine.  

 

I'll call tomorrow and make a follow-up appointment, but is anyone familiar with the fecal elastase test for pancreatic function?  On LabCorp's site it says the specimen stability is 14 days, so if they already have my sample from the previous test, do you think they can use the same sample to run the fecal elastase test?  Anyone know how reliable this test is for pancreatic insufficiency?

 

I've never had a CT or MRI involved, so I'm not sure exactly what they will show.  Will it just show if the pancreas is inflamed, or will it actually be able to see the part of where the enzymes should be released from?  

 

Regardless of whatever results I get, I am going to try digestive enzymes.  

 

Thanks for any input!

[kareng]

I bet they didn't keep any extra stool sample they had left. But the doctor can fax them an order to do the test on the left- over and find out.

[powerofpositivethinking]

I was able to get the fecal elastase done, but I had to give another sample    Yesterday I had a follow-up appointment for the fat malabsorption tests and was hoping they'd have the elastase results, but the results hadn't been reported yet.  He admitted that when I called and asked for the test he had to look it up because he had never ordered it for a patient, but that it seemed like a valid test for pancreatic insufficiency.  He looked at pictures I had done last year and said he didn't see any pancreatic inflammation, so I am no longer getting the CT scan which I'm perfectly fine with since it involves radiation.  He did make the comment that I teach him things, which made me super happy because he did complete his residency at Harvard, and I've only heard that they're a hard school to get accepted 

 

I gave him these two papers, and after a quick read, he thought the second one was good:

Open Original Shared Link

Open Original Shared Link

 

I don't think he realized the connection between celiac and the pancreas either, and that with gluten intake it makes the pancreas work harder and harder until it says it has had enough.  I asked about pancreatic enzymes, and he seemed to be under the impression that they had to be taken long-term, but I said that wasn't what I had read when it comes to the correlation between celiac and pancreatic insufficiency since as I wrote earlier glandular destruction is not associated with celiac, so he said he would definitely look into it.  It seems the pancreas just needs a jump start from all the abuse it has taken.

 

I wish I would have printed this one out since the conclusion clearly states, "Fecal elastase-1 is useful in identifying exocrine pancreatic insufficiency in adult celiac patients with diarrhea. Our longitudinal data suggests that pancreatic enzyme supplementation could be discontinued in a substantial proportion of patients as symptoms improve."

Open Original Shared Link

 

Anyway I'm waiting for the elastase results, and he said possibly I might have the capsule endoscopy done as well.  Happy Friday everyone!!

[powerofpositivethinking]

wanted to come back and update with my results.  I had another GI appointment yesterday and did get diagnosed with severe exocrine pancreatic insufficiency from the fecal elastase testing.  Anything below 100 indicated severe insufficiency, and I had a 72.  After I get other testing completed, which will include the capsule endoscopy this week, then I will begin taking Creon.  

[IrishHeart]

"Fecal elastase-1 is useful in identifying exocrine pancreatic insufficiency in adult celiac patients with diarrhea. Our longitudinal data suggests that pancreatic enzyme supplementation could be discontinued in a substantial proportion of patients as symptoms improve."

 

.....suggests to me that you may not need to take the supps forever.

 

Most celiacs have some level of pancreatic insufficiency upon diagnosis but that reverses in time..

[powerofpositivethinking]

that's what I'm hoping will happen 

 

 

"Fecal elastase-1 is useful in identifying exocrine pancreatic insufficiency in adult celiac patients with diarrhea. Our longitudinal data suggests that pancreatic enzyme supplementation could be discontinued in a substantial proportion of patients as symptoms improve."

 

.....suggests to me that you may not need to take the supps forever.

 

Most celiacs have some level of pancreatic insufficiency upon diagnosis but that reverses in time..

[IrishHeart]

that's what I'm hoping will happen 

 

here's where your username comes in super - handy 

[nvsmom]

here's where your username comes in super - handy 

LOL  

 

I took Creon for about 6 months too.

[powerofpositivethinking]

I've got to admit on this one I'm a little scared, but to those around me, I've been keeping myself super upbeat, so that my family and friends don't worry.  On the thread where I've been writing down my testing journey https://www.celiac.com/forums/topic/99439-need-help-with-tests-results-please/page-9, I had a fasting blood sugar level of 100, and I was given other blood work to get taken yesterday.  I realized the one test was the HGB A1C test for diabetes.  Quite honestly the thought of having diabetes scares me, and I've shared a lot of the other testing things with family and friends, but I've only shared this part with two friends because I don't want to worry my family unless I find out I actually have it, and that's my same thought process with getting gene tested for cystic fibrosis.  Really I just want to get the capsule endoscopy and hear the GI say we found damage in your small intestine so all of this is celiac related. 

 

Since the elastase testing means my pancreas is functioning at less than 10%, the sooner I start those enzymes the better.  I've been doing a lot of research on exocrine pancreatic insufficiency, and although this isn't a definite result, this is the best statement I've found relating to diabetes and EPI, "Enzyme replacement therapy might have an impact on glucose metabolism since it can reduce the insulin requirement and contribute to improved control of the glucose metabolism, but the evidence is contradictory[^{Open Original Shared Link,Open Original Shared Link}] as improvement of glucose metabolism was not seen in all studies[^{Open Original Shared Link,Open Original Shared Link}]."

 

Open Original Shared Link

 

Hopefully I'll have those blood test results in a few days

 

here's where your username comes in super - handy 

 

Nicole, did you notice a big difference after taking Creon?

 

 

LOL  

 

I took Creon for about 6 months too.

[IrishHeart]

Hon, Blood glucose levels may  fluctuate with celiac disease (UNdXed or in the beginning)

 

 Mine has been as high as 107 in the past, then down to 68, now it lingers around 80 or so. I'm good.  

And yes, they tested me every which way for diabetes. 

 

What I am trying to tell you is...MOST of this will regulate after a while off gluten.

 

You are worrying yourself sick about things that may very well normalize the longer you are off gluten.

[nvsmom]

 

Nicole, did you notice a big difference after taking Creon?

 

To be honest, not really... But I'm not really sure what sort of symptom improvements I was supposed to experience with that.  Then again, I don't think I am the best at connecting the dots when it comes to stomach issues so it could have helped.

 

I never did have any tests done that showed I should have been on them in the first place. I just went along with it because I figured it wouldn't hurt.

 

I hear you about the diabetes worry. Over the last year my blood glucose numbers have taken a huge jump, and I am eating better than I was before going gluten-free so it's incredibly frustrating for me. I've been gluten-free for almost two years so that made no difference for me. I am firmly prediabetic right now. My fasting blood glucose (FBG) is usually over 100 and after a glucose tolerance test it went over 170. The only time my blood glucose falls below 100 is a couple of hours after eating carbs (my BG spikes high then drops fast) or if I have eaten very low carb (less than 50g of carbs/day) for a few days. I know I need to change my diet, give up all sugar and starchy food, but it's very very hard. I found going gluten-free much easier.  

 

Good luck with that HbA1c!

[GottaSki]

Hi Positive Thinking!!!

 

I have to agree with Irish on this one -- I had sugar, pancreatic, liver, kidneys and more with fluctuating variances for the last five years prior to diagnosis PLUS at least 18 months gluten-free....all of them were within normal ranges by two years.

 

I think you are at a year gluten-free if I remember correctly - too lazy to scroll up - while it is important to follow up on all these items and supplement and/or add medication if necessary, I think you'll find the next six months to one year will provide less scary numbers on all of your serology.

 

The only other thing I'll suggest, if you are eating quite a bit of processed gluten-free items - limit them to treats and increase the whole foods - you may already be doing this, but it never hurts to remind folks

 

Hang in there

[cyclinglady]

Wow! I am keeping my fingers crossed about the pre-diabetes thing. I was hoping that it might be related to celiac disease, but was not able to find any research on it. I am eating to my meter and I found that my body does not like carbs. I started testing only because I have a genetic anemia and that affects the Hba1c test and I did not want to wait another three months for a re-test. I am glad to hear that Irish and Lisa's labs have improved so much after a sustained gluten-free diet.

There is a benefit though to the low carb, high fat diet though.....a smaller dress size. No need to purchase formal wear for my upcoming cruise. I am glad that I did not get rid of those smaller clothes! But it would be nice to have a gluten-free cupcake every once in a while.

Based on this information, I am going to wear my new smaller Capri pants but store the older larger ones. I might be able to eat potatoes once again!

[GottaSki]

Yep...my funky variances with my labs is what finally got attention -- well that and I was a huge ball of inflammation that couldn't function

[IrishHeart]

Yep...my funky variances with my labs is what finally got attention -- well that and I was a huge ball of inflammation that couldn't function

 

Same here. I was always all over the place, the WBC, RBC, BG, ferritin, even the thyroid panels.  Wonky and funky. (could be a good name for an alternative band...) My BP was 80/50...that's soooo NOT normal....anyhoo..

 

Everything in me is NORMAL now.  For the first time in my life.

 

also Cycling lady, said...

 

"But it would be nice to have a gluten-free cupcake every once in a while." 

 

 

 

FOR a low carb gluten-free cupcake....I'd visit Elana's pantry  because every girl deserves a cupcake.

[GottaSki]

and my BP that is historically low -- was skyrocketing...it is back in normal headed to low, but it took some time.

 

All this is to say it MAY just take time, but investigation is good while you wait.  It's the worry and stress that you should try to avoid...I know...not easy.

 

Edited to add...hubby who always had my back, but was never quite certain that things were as bad as I said...first time I said my BP was elevated and docs suggested meds to alleviate such...said and I quote:

 

"What the f$#%, you have always had low blood pressure in the years i have known you -- do i need to talk to this f$#%ing doctor?"

 

lol...I can laugh now...but should illustrate to anyone reading along...those of us with a lifetime of undiagnosed celiac causes the "medical acceptable data" to worsen until everyone says.....say it with me:

 

What the BLANK is going on here?