Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.

Evidence: CAG IBS guideline (Moayyedi P 2025 · sources last checked 2026-08-20

Reference tool — not medical advice. Thresholds, targets, and first-line agents differ by guideline body and change over time — switch the lens to compare. Clinician judgement, dosing/monitoring, contraindications, and live coverage always required. Runs entirely in your browser — no data is collected.

Gut “dysbiosis” guide

An evidence-honest guide to gut “dysbiosis” — which is NOT a validated diagnosis. The tool leads with naming the real condition and ruling out red flags, then lets you toggle a professional lens (conventional / dietetic / naturopathic / TCM) to see each approach’s options, honestly evidence-graded, as adjuncts — never replacements. Commercial microbiome tests are not clinically actionable.

Guideline lens

Presentationchoose one

Red flags

Prior workupchoose one

Safety flags

⚠ 'Dysbiosis' is not a validated diagnosis

There are no validated diagnostic criteria, and commercial stool 'microbiome tests' are not clinically actionable. Name and treat the REAL condition (IBS/IBD/celiac/SIBO/C. difficile). Complementary approaches are ADJUNCTS, never replacements.

Lens

Conventional — deliberately skeptical of the 'dysbiosis' framing; name the real diagnosis

Notes

  • • 'Dysbiosis' is not a validated standalone diagnosis and commercial stool microbiome tests are not clinically validated (inconsistent, not actionable) — don't spend money or make decisions on them. Name and treat the real condition instead. 'Leaky gut syndrome' is not a recognized diagnosis.
  • • NEVER delay workup of red flags (weight loss, bleeding, anemia, nocturnal symptoms, family history of CRC/IBD/celiac, new onset at age ≥50, dysphagia, persistent vomiting) — investigate first.

Suggested drug classesLens: Conventional. 'Dysbiosis' is not a validated diagnosis — complementary approaches are adjuncts, not replacements, and never delay red-flag workup.

Select the presentation and check for red flags to begin.

Switch the lens: the conventional lens is deliberately skeptical of the “dysbiosis” framing; the dietetic lens is where the evidence is comparatively strongest; naturopathic/TCM options are mostly weak/traditional-use with safety flags.

Should I be tested?

Last reviewed 2026-09-23

Patients sometimes ask about testing for related labels after seeing a naturopathic doctor or researching symptoms themselves. This section is static, reviewed content — not generated at runtime — covering the testing questions that come up alongside gut “dysbiosis”.

Small intestinal bacterial overgrowth (SIBO)

Clinical diagnosis — no single test

Also called: SIBO, small intestinal bacterial overgrowth, bacterial overgrowth

Patients raise SIBO after an ND-ordered breath test, or after researching causes of bloating and gas that persist despite standard IBS treatment. SIBO is a real, recognized cause of these symptoms in specific patient groups; breath testing is genuinely imperfect, which is a fair thing for a patient to have concerns about either way (false negatives and false positives both occur).

Raises suspicion

  • • Persistent bloating, gas, diarrhea, or malabsorption in a patient with a recognized risk factor: prior bowel or gastric surgery (especially with loss of the ileocecal valve), scleroderma, diabetes with autonomic neuropathy, or small bowel diverticulosis
  • • Symptoms that persist despite standard, guideline-based IBS management

Does not raise suspicion

  • • Routine bloating or gas in a patient with typical IBS and no specific risk factor: SIBO breath testing is not a first-line or routine test in this setting
  • • PPI use alone, without other risk factors or persistent symptoms

Red flags

  • • Weight loss, GI bleeding, iron-deficiency anemia, nocturnal symptoms, family history of colorectal cancer, IBD, or celiac disease, or new onset at age 50 or older: these need red-flag GI work-up first, before any breath test

Who to test

  • Persistent symptoms with a recognized SIBO risk factor, or symptoms unresponsive to standard IBS management, after red flags are excluded: SIBO breath test (lactulose/glucose hydrogen, ± methane, 3-gas) (Situation-specific)Lactulose or glucose hydrogen breath testing (with methane) is the practical option; it is imperfect, with both false positives and false negatives, and results should be interpreted alongside the clinical picture, not treated as definitive on their own
  • Diagnostic uncertainty where malabsorption is suspected: Fecal calprotectin (Situation-specific), Ferritin (Standard), Complete blood count (CBC) (Situation-specific)Helps exclude inflammatory bowel disease and identify nutrient deficiency consistent with malabsorption, alongside SIBO testing

More likely instead

  • • IBS
  • • Acid reflux
  • • FODMAP sensitivity
  • • celiac (if not yet excluded)

Counselling script

“If you have a specific risk factor, like prior bowel surgery, or symptoms that haven't responded to standard IBS treatment, a SIBO breath test is a reasonable next step. It isn't a perfect test, so a positive or negative result needs to be read alongside how you're actually doing, not taken as the final word either way. If red-flag symptoms like bleeding or weight loss are present, those get worked up first.”

Chart snippet (OSCAR-safe plain text)

Concern discussed, not tested

Concern re: small intestinal bacterial overgrowth (SIBO) discussed, raised by patient or ND.
Discriminating features: prior bowel surgery, scleroderma, diabetic autonomic neuropathy, or symptoms unresponsive to standard IBS care; reviewed.
Red flags: absent.
Assessment: breath testing is an imperfect but reasonable option given the risk-factor profile; test performance limitations discussed.
Plan: lactulose or glucose hydrogen breath test considered; red-flag work-up prioritized if any red flag present.
Ref: ACG SIBO guideline 2020; North American breath testing consensus 2017.
Patient given info page: https://dysbiosis.ajaxharwoodclinic.com/patient
Revisit if: red-flag features develop, or symptoms do not improve despite treatment.

Testing ordered

Concern re: SIBO discussed.
Discriminating features: recognized risk factor or treatment-refractory IBS-type symptoms present; red flags absent.
Assessment: breath testing indicated; result to be interpreted alongside clinical picture given known false-positive and false-negative rates.
Plan: lactulose or glucose hydrogen breath test ordered.
Ref: ACG SIBO guideline 2020; North American breath testing consensus 2017.
Patient given info page: https://dysbiosis.ajaxharwoodclinic.com/patient
Revisit if: symptoms persist regardless of test result, or red-flag features develop.

Revisit if

  • • Red-flag features develop
  • • Symptoms persist despite a negative test or despite treatment of a positive test
  • • New risk factor (e.g. bowel surgery) arises

References

  1. 1. American College of Gastroenterology. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth (2020)ACG guideline defining diagnostic criteria and optimal testing methods for SIBO
  2. 2. North American Consensus (multi-society expert panel). Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus (2017)North American consensus noting a lack of standardization in breath test indications, methodology, and interpretation
Evidence notes

Tag rationale: BORDERLINE, decided as B. SIBO is a real, mechanistically clear condition with ACG diagnostic guidance [1], which argues for A. It is tagged B instead because the practical diagnostic test (breath testing) is acknowledged by its own consensus statement to lack standardization [2], and the reference-standard test, jejunal aspirate and culture, is invasive and rarely performed in practice, so in real clinical use no single accessible test reliably settles the diagnosis the way, for example, celiac serology does. This is exactly the kind of borderline call the brief asks to escalate to Dr. Yu: reasonable physicians could tag this A (a defined condition with guideline-based testing) or B (no test that reliably settles it in practice). Host is 'dysbiosis' per batch instruction, since this will render as a section of the existing ahc-dysbiosis tool; red-flag wording is deliberately matched to ahc-dysbiosis/lib/classes.ts 'red-flag-workup' for consistency across the two records.

Intestinal parasites

Defined testing criteria

Also called: intestinal parasites, gut parasites, parasitic infection, ova and parasites

Patients raise intestinal parasites after travel, after a wellness panel suggests it, or because chronic GI symptoms have been attributed by an ND to an undiagnosed parasitic infection. Parasitic infection is a real, testable, treatable cause of GI symptoms in patients with a genuine exposure; it is a much less likely explanation without one, and testing without any exposure history rarely finds anything.

Raises suspicion

  • • Persistent diarrhea, generally lasting more than one to two weeks, especially with a relevant exposure: recent travel to an endemic area, new immigration or refugee status, daycare attendance or close contact, exposure to untreated well water, or a known outbreak
  • • Eosinophilia on a blood count
  • • Diarrhea in an immunocompromised patient
  • • A prior history of parasitic infection with new or recurring symptoms

Does not raise suspicion

  • • Chronic fatigue, bloating, or brain fog without diarrhea or a relevant exposure history
  • • A commercial 'wellness panel' stool test flagging parasites in an asymptomatic patient with no exposure history

Red flags

  • • Weight loss, GI bleeding, iron-deficiency anemia, nocturnal symptoms, family history of colorectal cancer, IBD, or celiac disease, or new onset at age 50 or older: needs red-flag GI work-up alongside, not instead of, parasite testing when exposure history is present

Who to test

  • Persistent diarrhea with a relevant exposure history: Stool ova and parasites (O&P) (Situation-specific)Note the specific exposure (travel destination, well water, daycare contact, outbreak) on the requisition, since it guides which organisms the laboratory looks for
  • Eosinophilia, or diarrhea in an immunocompromised patient: Stool ova and parasites (O&P) (Situation-specific), Complete blood count (CBC) (Situation-specific)

More likely instead

Counselling script

“If you've traveled somewhere parasites are common, drunk untreated water, or have ongoing diarrhea lasting more than a week or two, a stool test for parasites is a reasonable and useful thing to do. Without a specific exposure like that, this test rarely finds anything and usually isn't the right next step. Tell us about any relevant travel or water exposure, since it helps the lab know what to look for.”

Chart snippet (OSCAR-safe plain text)

Concern discussed, not tested

Concern re: intestinal parasites discussed, raised by patient or ND.
Discriminating features: persistent diarrhea, relevant travel or water exposure, eosinophilia, or immunocompromised status; reviewed.
Assessment: exposure history reviewed to determine testing yield.
Plan: stool ova and parasites ordered if exposure history present; red-flag GI work-up considered in parallel if red flags present.
Ref: Public Health Ontario parasitology testing instructions.
Patient given info page: https://dysbiosis.ajaxharwoodclinic.com/patient
Revisit if: symptoms persist despite negative testing, or new exposure occurs.

Testing ordered

Concern re: intestinal parasites discussed.
Discriminating features: persistent diarrhea with relevant exposure history present.
Assessment: stool ova and parasites testing indicated.
Plan: stool ova and parasites ordered, exposure details noted on requisition.
Ref: Public Health Ontario parasitology testing instructions.
Patient given info page: https://dysbiosis.ajaxharwoodclinic.com/patient
Revisit if: symptoms persist despite negative testing, or a new exposure occurs.

Revisit if

  • • Symptoms persist despite negative testing
  • • A new relevant exposure occurs
  • • Red-flag GI features develop

References

  1. 1. Public Health Ontario. Enteric Parasite Microscopy (Kit and Test Ordering Instructions) (2026)Public Health Ontario stool ova and parasites testing is for microscopic detection of enteric apicomplexans, helminths, or microsporidia, guided by exposure history noted on the requisition
Evidence notes

Tag rationale: A, not borderline. Intestinal parasitic infection is a well-defined, microscopy-confirmed diagnosis with clear exposure-based testing criteria [1], and this record agrees with the linked ova-and-parasites test record. Host is 'dysbiosis' per batch instruction; red-flag wording matches ahc-dysbiosis/lib/classes.ts 'red-flag-workup' for consistency with the existing app this will become a section of.

Popular labels: what they mean

"Candida overgrowth" / systemic candidiasis

Not a recognized medical diagnosis

Also called: candida overgrowth, yeast overgrowth, systemic candida, candidiasis hypersensitivity syndrome, chronic candidiasis

'Candida overgrowth' or 'systemic yeast' is a popular explanation, often from an ND or wellness source, for fatigue, bloating, brain fog, and sugar cravings. Candida is a real, normal part of the gut microbiome, and can cause genuine, well-defined infections in specific settings (oral or vaginal thrush, or invasive candidiasis in immunocompromised patients); the broader 'systemic overgrowth causing chronic symptoms' construct is not a validated diagnosis, and a randomized trial of antifungal treatment for it found no benefit over placebo.

Raises suspicion

  • • This label itself has no validated discriminating features for the chronic 'systemic overgrowth' claim. Recurrent oral thrush, vaginal candidiasis, or signs of invasive infection in an immunocompromised patient are real, separate diagnoses and should be assessed on their own terms, not as 'systemic candida.'

Does not raise suspicion

  • • Fatigue, bloating, brain fog, or sugar cravings attributed to candida
  • • A positive candida IgG/IgA/IgM antibody test: this reflects normal past exposure, not overgrowth or illness
  • • A commercial stool or microbiome report flagging candida as elevated

Red flags

  • • Weight loss, GI bleeding, iron-deficiency anemia, nocturnal symptoms, family history of colorectal cancer, IBD, or celiac disease, or new onset at age 50 or older: needs red-flag GI work-up, not candida-directed treatment
  • • Signs of invasive infection in an immunocompromised patient (fever, systemic illness): needs urgent assessment as its own diagnosis

Who to test

  • Everyone presenting with this concernCandida IgG/IgA/IgM antibody testing has no validated use for diagnosing 'candida overgrowth' as a cause of chronic symptoms; a randomized trial of antifungal treatment for this presentation showed no benefit over placebo. Recurrent thrush or suspected invasive candidiasis are separate, real diagnoses worked up on their own.

More likely instead

Counselling script

“Candida antibody blood tests don't diagnose 'systemic overgrowth,' since a positive result just shows your body has met this normal yeast before, which almost everyone has. A randomized trial actually tested antifungal treatment for these symptoms and found it worked no better than placebo. Your symptoms are real, so let's look for a more likely, treatable cause instead.”

Chart snippet (OSCAR-safe plain text)

Concern discussed, not tested

Concern re: 'candida overgrowth' discussed, raised by patient, ND, or a commercial stool/microbiome report.
Discriminating features for a genuine candida infection (thrush, invasive disease): absent.
Assessment: 'systemic candida overgrowth' as a cause of chronic symptoms is not a validated diagnosis; candida antibody testing does not support this construct.
Plan: no candida antibody testing ordered; alternative causes of symptoms discussed.
Ref: Dismukes et al. NEJM candidiasis hypersensitivity trial 1990.
Patient given info page: https://dysbiosis.ajaxharwoodclinic.com/patient
Revisit if: features of a genuine candida infection (recurrent thrush, signs of invasive disease) develop.

Revisit if

  • • Recurrent, genuine thrush or vaginal candidiasis develops: assess and treat as its own diagnosis
  • • Signs of invasive infection in an immunocompromised patient
  • • Red-flag GI features develop

References

  1. 1. New England Journal of Medicine (Dismukes et al.). A randomized, double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome (1990)— older guidelineRandomized double-blind trial finding nystatin did not reduce systemic or psychological symptoms significantly more than placebo in patients diagnosed with candidiasis hypersensitivity syndrome
Evidence notes

Tag rationale: C, not borderline. [1] is flagged older_than_10y (1990), but it remains the standard-cited RCT evidence against the 'candidiasis hypersensitivity syndrome' construct and no more recent trial revisiting this specific claim was located in this session; this is recorded as a gap rather than treated as settled by newer evidence. Distinguished explicitly from real candida diagnoses (thrush, invasive candidiasis) so the label is not used to dismiss genuine infection. Host is 'dysbiosis' per batch instruction; red-flag wording matches ahc-dysbiosis/lib/classes.ts 'red-flag-workup' for consistency.

"Leaky gut syndrome"

Not a recognized medical diagnosis

Also called: leaky gut syndrome, leaky gut, intestinal permeability, increased gut permeability

'Leaky gut syndrome' is a popular explanation, often from an ND or wellness source, for fatigue, brain fog, joint pain, or autoimmune-type symptoms, on the theory that a permeable gut lining lets toxins and undigested food into the bloodstream. Increased intestinal permeability is a genuine, measurable phenomenon in specific diseases (such as celiac disease and IBD); 'leaky gut syndrome' as its own standalone diagnosis explaining a broad range of symptoms is not accepted by gastroenterology, and the commercial tests marketed to diagnose it are not reliable.

Raises suspicion

  • • This label itself has no validated discriminating features. Increased permeability is a feature of specific diagnosed conditions (celiac disease, IBD, active infection); when those conditions are suspected, work them up directly on their own pages rather than testing for 'leaky gut' in isolation.

Does not raise suspicion

  • • Fatigue, brain fog, bloating, or joint pain attributed to leaky gut
  • • A commercial lactulose/mannitol urine test or serum zonulin level marketed as a 'leaky gut' test
  • • A wellness or ND report describing 'intestinal permeability' as the root cause of unrelated symptoms

Red flags

  • • Weight loss, GI bleeding, iron-deficiency anemia, nocturnal symptoms, family history of colorectal cancer, IBD, or celiac disease, or new onset at age 50 or older: needs red-flag GI work-up, not permeability testing

Who to test

  • Everyone presenting with this concernLactulose/mannitol urine testing and serum zonulin have no validated clinical use for diagnosing 'leaky gut syndrome' or explaining nonspecific symptoms; commercial zonulin assays have been shown not to reliably detect the protein they claim to measure. If celiac disease or IBD is suspected, test for those directly.

More likely instead

Counselling script

“Gut permeability is a real, measurable thing in specific conditions like celiac disease, but 'leaky gut syndrome' as its own diagnosis explaining a wide range of symptoms isn't accepted by gut specialists. The zonulin and permeability tests sold for this haven't been shown to reliably measure what they claim to. Your symptoms are real, so let's look for a specific, treatable cause instead, including checking for celiac disease if that hasn't been done.”

Chart snippet (OSCAR-safe plain text)

Concern discussed, not tested

Concern re: 'leaky gut syndrome' discussed, raised by patient or ND.
Discriminating features for celiac disease or IBD: absent.
Assessment: 'leaky gut syndrome' is not a recognized standalone diagnosis; commercial zonulin and lactulose/mannitol testing lack validated clinical use for this purpose.
Plan: no permeability testing ordered; celiac serology considered if not previously done; alternative causes discussed.
Ref: Ajamian et al. zonulin assay study 2019.
Patient given info page: https://dysbiosis.ajaxharwoodclinic.com/patient
Revisit if: features of celiac disease, IBD, or another specific GI condition develop.

Revisit if

  • • Features of celiac disease or IBD develop
  • • Red-flag GI features develop
  • • Symptoms persist despite reassurance: reassess for depression, IBS, or another cause

References

  1. 1. Monash University / The Alfred Hospital (Ajamian et al.). Serum zonulin as a marker of intestinal mucosal barrier function: May not be what it seems (2019)Commercial zonulin assays used to support 'leaky gut' claims do not detect the actual zonulin protein
Evidence notes

Tag rationale: C, not borderline as a standalone diagnosis, though the underlying physiology (intestinal permeability exists and is measurable in specific diseases) is real and should not be conflated with the invalid broad claim; this distinction is made explicitly in why_this_comes_up and who_to_test. Host is 'dysbiosis' per batch instruction; red-flag wording matches ahc-dysbiosis/lib/classes.ts 'red-flag-workup' and its 'avoid-microbiome-tests' class, which already states 'leaky gut syndrome' is likewise not a recognized diagnosis, for consistency with the existing app this will become a section of.

Guidelines

References

  1. [1]CAG IBS guideline (Moayyedi P, et al. 2019 — red flags) + AGA (low-FODMAP CPU 2022; probiotics guideline 2020 — against for most GI); FDA FMT safety communications; van Nood NEJM 2013 (FMT for recurrent C. diff). Commercial microbiome tests not clinically validated (Lancet Gastroenterol Hepatol 2025). link
  2. [2]Dietetic evidence: low-FODMAP (Chey AGA CPU 2022); fermented foods RCT (Wastyk, Cell 2021); prebiotics meta-analysis (Wilson AJCN 2019 — no IBS benefit); Mediterranean/NU-AGE (Ghosh, Gut 2020). link
  3. [3]NCCIH — probiotics usefulness/safety (weak/insufficient for broad claims; infection risk in vulnerable). Berberine (MSK About Herbs — CYP/P-gp interactions; pregnancy contraindication). 'Leaky gut' review (Lacy, Gastroenterol Hepatol 2024). link
  4. [4]TCM: Cochrane herbal-medicine review (Liu 2006 — 'premature to recommend'); NCCIH TCM safety (adulteration, heavy metals); Health Canada recalls of adulterated TCM products; herb-drug interaction review (Tsai, PLoS One 2013). link