The authors have developed a Gut Dysbiosis Score (Table 3) to make the CDSA more useful.

Interpretation of Gut Dysbiosis Score (Refers to Table 3)

Excess meat or vegetable fibers or triglycerides (one point each) suggest mal- digestion. This is a common effect of bacterial overgrowth but can also con- tribute to its cause.

Excess cholesterol or fatty acids (one point each) is indicative of malabsorp- tion; bacterial overgrowth produces this by interfering with micelle forma- tion.

Low concentrations of butyrate or SCFA (two points each) indicate insuffi- cient anaerobic fermentation of soluble fiber. This may result from a low fiber diet deficiency of Bifidobacteria.

High concentrations of butyrate or SCFA (two points each) is indicative of increased anaerobic fermentation.

Alkaline stool pH (two points) often accompanies a low butyrate. When it is associated with a normal butyrate it signifies increased ammonia production, reflecting a diet high in meat or excessive urease activity of intestinal bacte- ria. Bacterial cultures can provide more direct evidence of dysbiosis. The most common finding is:

A lack of Lactobacillus or of E.Coli on stool culture (3 points each) High levels of uncommon or atypical Enterobacteriaceae or of Klebsiella, Proteus or Pseudomonas, may reflect small bowel overgrowth of these organisms (score 1 point for each.)

Total Score-7 points or more is always associated with clinical dysbiosis; 5-6 is probable dysbiosis; 3-4 is borderline. There are rare cases in which a score less than 3 occurs in a dysbiotic stool. These cases are usually under treatment at the time the stool is obtained. In severe cases abnormal blood tests may be found. There may be erythrocyte macrocytosis, low circulating vitamin B12 or hypoalbuminemia. Urinary excretion of essential amino acids may also be low, signifying impaired assimilation of dietary protein.

Discussion
Based on available research and clinical data, we now believe that there are four patterns of intestinal dysbiosis: putrefaction, fermenta- tion, deficiency, and sensitization.

Putrefaction
This is the classic Western degenerative disease pattern advanced by Metchnikoff. Putrefaction dysbiosis results from diets high in fat and animal flesh and low in insoluble fiber. This type of diet produces an increased concentration of Bacteroides sp. and a decreased concentra- tion of Bifidobacteria sp. in stool. It increases bile flow and induces bacterial urease activity(1). The alterations in bacterial population dynamics which result from this diet are not measured directly by the [Comprehensive Digestive Stool Analysis (CDSA)]. The changes occur primarily among anaerobes, but the effects are measured in an in- crease in stool pH (partly caused by elevated ammonia production) and in bile or urobilinogen and possibly by a decrease in short chain fatty acids, especially in butyrate. Epidemiologic and experimental data implicate this type of dysbiosis in the pathogenesis of colon can- cer and breast cancer(6). A putrefaction dysbiosis is accompanied by an increase in fecal concentrations of various bacterial enzymes which metabolize bile acids to tumor promotors and deconjugate ex- creted estrogens, raising the plasma estrogen level(6). Putrefaction dysbiosis is corrected by decreasing dietary fat and flesh, increasing fiber consumption and feeding Bifidobacteria and Lactobacillus prep- arations.