How accurate would you say the Diagnostic Solutions GI-MAP stool test is? I have a patient with a zonulin level of 505, [and] normal is 107. Could I use this value and their symptoms to develop a treatment plan?

Great question. We’re using the GI-MAP. We’ve been evaluating it for the past year. There are a lot of things I like about it, but there are some ongoing questions I have about it, as well. I hope part of the value of this course [is that] you get to benefit from some of our experiences. We have five clinicians and thousands of patients, and we do things like split samples for tests that we’re evaluating where we’ll send a sample from the same patient on the same day but labeled differently to check for reproducibility. We’ve done that with the Diagnostic Solutions GI-MAP test once, and the results didn’t give me a lot of confidence, so we’re in the process of doing it again to see if that was a fluke. We’re working with the lab to try to address what might have happened there. Zonulin, both fecal zonulin and serum zonulin, from the research I’ve done are not very accurate markers, so I don’t pay a lot of attention to them. I will be talking about that further in the intestinal permeability section of the course and also whether testing for intestinal permeability is even useful in a clinical setting. But if that’s the only thing that was elevated or out of range, I wouldn’t have a ton of confidence in assembling a treatment plan on that basis alone, Daniella.