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Urinary Indican test – what is this?

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The Urinary Indican (or Obermeyer) test is an accurate, simple and efficient screening tool for the presence of dysbiosis (bacterial imbalance) in the gut.  This can lead to excessive metabolic toxicity that can trigger an inflammatory response and compromise optimal wellbeing.

HOW DOES THE TEST WORK?

Tryptophan, an amino acid, is converted to indole that is excreted in faeces; but putrefaction by dysbiotic bacteria in the gut, converts indole to indican, which is then transported to the liver and converted to indoxyl, which is subsequently transported to the  kidneys for excretion in the urine. The test detects the presence of indicans in the urine (also known as indoxyl suplhate and indoxyl glucuronate).

The test can be affected by high protein diets or insufficient protein digestion.

SOME CAUSES OF A POSITIVE INDICAN TEST:

A positive test result could indicate:-

  • Dysbiosis
  • Small intestinal bowel overgrowth of anaerobic bacteria (SIBO)
  • Hypochlorhydia (insufficient stomach acid)
  • Protein maldigestion (or high protein consumption)
  • Intestinal mucosal permeability (due to damage from infection, toxic or reactive exposure, or nutritional deficiency)
  • Coeliac disease
  • Pancreatic insufficiency
  • Malabsorption
  • Bile duct obstruction or intra-hepatic biliary obstruction such as gall stones
  • Inflammatory bowel disease
  • Intestinal mucosal damage (‘leaky gut’)
  • Nutritional deficiencies
  • Irritable bowel syndrome
  • Diverticulosis
  • Intestinal infections
  • Auto-immune disease
  • Excessive use of antibiotics
  • Liver dysfunction

SYMPTOMS OF GASTROINTESTINAL TOXICITY MAY INCLUDE:

  • Constipation, diarrhea, irritable bowel symptoms
  • Bloating, flatulence (offensive), indigestion
  • Fatigue
  • Muscle aching or weakness, joint aches/pains
  • Allergies, food sensitivites and/or intolerances
  • Skin disorders such as acne, eczema and psoriasis
  • Mood swings, poor memory, recurrent headaches
  • Poor immune function
  • Thrush, tinea, recurrent urinary tract infections
  • Depression and/or anxiety
  • Weight gain

COMMON MICRO-ORGANISMS FOUND TO CONTRIBUTE TO POSITIVE INDICAN TESTS INCLUDE:

Salmonella, Shigella, Campylobacter jejuni,yersinia enterocolitica, Citrobacter freundi, Citrobacter diversus, Klebsiella pneumoniae, Pseudomonas aeruginosa, some strains of Escherichia coli, Staphyloccocus aureus, some strains of bacteriodes, Clostridium difficile, candida albicans, other candida species etc

REQUIREMENTS FOR A URINARY INDICAN TEST:

  • No alcohol within 24hrs before the test.
  • No iodine or bile supplements taken in high doses 3 – 4 days prior to testing (these create a false positive test).
  • Kelp & other supplements (e.g Bladderwrack herbal tincture) high in iodine should be avoided for three days before taking urine sample.
  • A meal with some protein to ensure adequate amounts of tryptophan (required for an accurate test result) should be eaten the night before the sample is taken – but not in excess.
  • Appointments need to be made for this test.
  • Specimen does not need to be any more than 20 ml urine.
  • Collect your first urine specimen of the morning, mid-stream in the clean specimen container. It is important to use first morning urine as indican levels can reduce throughout the day.
  • Urine sample should be refrigerated until arrival at consultation.
  • Testing and review of results takes approximately 15 mins.

WHAT HAPPENS NEXT?

The urinary indican test is the first step in determining whether you have a bacterial imbalance, i.e. your good/bad bacteria are out of balance. If the test shows a strong positive and you have severe gut symtoms, then the next step is usually a Complete Digestive Stool Analysis (CDSA) to ascertain which bacteria are out of balance and if any other parasites or yeast/fungi are present in the gut. An additional or subsequent test is the Intestinal Permeability (IP) test, which indicates if the dysbiotic bacteria have damaged the gastrointestinal wall lining. Damage to the gastrointestinal wall lining affects absorption, your optimal health and can lead to Leaky Gut Syndrome.

HOW CAN NATUROPATHY HELP YOU?

After a thorough review of all test results, health history, current symptoms and health goals, a personalised program of detoxification and repair will be discussed with you.

This would most likely include:

  • reducing toxic exposure through dietary, environmental and lifestyle changes
  • reducing inflammatory load and stabilising the digestive system & supporting organs (liver, gall bladder, kidneys)
  • renewing and repairing the lining of the digestive tract
  • improving digestive function
  • neutralising reactive metabolites, e.g. lipopolysaccharides (LPS)
  • removing unwanted bacteria, metabolic waste, fungal and parasitic overgrowths
  • rebalancing the opportunistic ‘bad’ bacteria with healthy ones
  • supporting the body to eliminate toxins more effectively

References –  

http://www.cfma.com.tw/%E5%B0%BF%E6%B6%B2%E6%9C%89%E6%A9%9F%E9%85%B8%E7%9A%84%E5%88%86%E6%9E%90%E8%88%87%E6%87%89%E7%94%A8Clinical%20Applications%20of%20Urinary%20Organic%20Acids.%20Part%202.%20Dysbiosis%20Markers.pdf

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2009.01370.x/full

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