These Nutripath tests look at gut barrier function and digestion. Faecal zonulin and the lactulose mannitol test are marketed for leaky gut, but the common zonulin assays may not measure zonulin itself and the permeability test is mainly a research tool. A CDSA reports digestion markers, microscopy and microbes. Pancreatic elastase is the best validated of the group, and a low result points to pancreatic insufficiency that needs a GP. Verified practitioners can order all of them through Vively.
| Test type | Measured in a stool or urine sample |
|---|---|
| Nutripath code | 2023, 2011, 2003, 2004, 2006, 2008, 2024, 2014 |
| Sample and collection | Stool kit, or a urine kit with a sugar drink for the permeability test, collected at home and posted to Nutripath |
| Preparation | Eat as usual for stool tests and avoid starting new probiotics, antibiotics or digestive enzymes beforehand where the prescriber agrees. The permeability test needs an overnight fast. |
| Turnaround | 3 to 5 business days depending on the test (Nutripath estimates: zonulin, secretory IgA and pancreatic elastase 3 to 5, intestinal permeability and the CDSA levels 5). Allow extra days for postage. |
| Available through | Nutripath test ordered through Vively. You need to be a verified practitioner to refer it. |
| Pricing | Pricing in your practitioner account |
| Results | PDF report from Nutripath, filed in your client’s record and app beside their blood results |
Only practitioners can order this test. Ask your naturopath, nutritionist or dietitian whether they use Vively.
What do these gut barrier and digestion tests measure?
The tests fall into three groups: markers sold as measures of gut barrier function, a broad stool analysis, and specific markers of digestion and gut immunity.
Zonulin was described as a protein that loosens the junctions between gut cells. Nutripath measures it in stool by immunoassay.
The client drinks lactulose and mannitol, then collects urine. More lactulose passing through, relative to mannitol, is read as higher permeability.
Level 1 covers microscopy, parasites and culture of beneficial and dysbiotic bacteria and yeasts. Level 2 adds short chain fatty acids, beta glucuronidase and pancreatic elastase. Levels 3+ and 4+ add markers such as secretory IgA, H. pylori antigen and M2 pyruvate kinase.
Secretory IgA is the main antibody in the gut lining. Pancreatic elastase is an enzyme from the pancreas that passes into stool largely unchanged, so it reflects how much enzyme the pancreas makes.
| Nutripath test | Code | Sample | Turnaround |
|---|---|---|---|
| Zonulin | 2023 | Stool | 3 to 5 business days |
| Intestinal Permeability Test | 2011 | Urine | 5 business days |
| Comprehensive Digestive Stool Analysis (CDSA), Level 1 | 2003 | Stool | 5 business days |
| Comprehensive Digestive Stool Analysis (CDSA), Level 2 | 2004 | Stool | 5 business days |
| Comprehensive Digestive Stool Analysis (CDSA), Level 3+ | 2006 | Stool | 5 business days |
| Comprehensive Digestive Stool Analysis (CDSA), Level 4+ | 2008 | Stool | 5 business days |
| Secretory IgA | 2024 | Stool | 3 to 5 business days |
| Pancreatic Elastase 1 | 2014 | Stool | 3 to 5 business days |
How do you order a zonulin, permeability or CDSA test through Vively?
- Get verified. You need to be a verified practitioner to refer tests. Practitioners with a recognised qualification or membership (ATMS, NHAA, ANTA, Dietitians Australia, NSA, CMA or Ahpra registration) can request free practitioner access.
- Build the order. Log in to the practitioner platform, choose the Nutripath test and add any blood tests or the $99 Baseline Health Check to the same order. Pricing shows in your account, and either your client or your practice can pay.
- Client collects at home. Nutripath sends your client the collection kit once the order is placed. Your client follows the kit instructions (a stool sample for zonulin, CDSA, secretory IgA and pancreatic elastase, or, for the permeability test, a sugar drink taken after an overnight fast followed by a timed urine collection) and posts the sample back to Nutripath in the packaging provided.
- Review the report. Nutripath’s PDF report is filed in your client’s record and app, next to their blood results, ready for the follow-up consult.
See every Nutripath test you can order on the Nutripath tests page.
Order a zonulin, permeability or CDSA test with your client’s blood tests
Free access for verified naturopaths, nutritionists and dietitians. Order Nutripath tests and blood pathology in one place, and see every result in your client’s record.
What can these tests tell you, and what can they not?
Pancreatic elastase is well validated. Zonulin and permeability testing are not ready to guide treatment, and a CDSA mixes well established findings with less certain ones.
Researchers found that a widely used commercial zonulin assay detects other proteins, such as properdin, rather than the zonulin precursor it was meant to measure (Scheffler et al., 2018). Treat zonulin results with caution.
Increased permeability is seen in coeliac disease and inflammatory bowel disease, but leaky gut is not a diagnosis on its own. The lactulose mannitol test is a research tool, and methods and cut-offs vary between labs (Camilleri, 2019).
Parasites, blood in the stool and pancreatic elastase have clear meaning. Bacterial culture counts and dysbiosis scores have no agreed healthy range, and organisms such as Blastocystis are often found in people without symptoms.
A result below 200 micrograms per gram suggests exocrine pancreatic insufficiency, and below 100 suggests severe insufficiency (Toouli et al., 2010). It is the most widely used pancreatic function test, but it can miss mild insufficiency, and a low result needs a GP (Löhr et al., 2017).
How do these tests fit with blood work?
Gut barrier and digestion problems show up in blood as poor absorption. Order a few blood markers in the same order to see whether nutrition is affected.
- ReferLow pancreatic elastase with low vitamin D, weight loss or oily stools
A pattern of fat malabsorption. Refer to the GP, who may arrange imaging and enzyme replacement.
- ReferBlood in the stool, raised calprotectin or low ferritin
Signs of inflammation or bleeding. Refer to the GP before any gut protocol.
- CheckRaised zonulin or permeability with low iron, B12 or folate
Check for coeliac disease with the GP, while the client still eats gluten, before treating the gut barrier.
- ContextNormal blood work and an unremarkable CDSA
Supports a functional picture. Work on diet, fibre, stress and bowel habits rather than repeating stool tests.
What can affect gut barrier and stool results?
- Antibiotics, probiotics, antifungals and laxatives in the weeks before collection
- Watery stools, which dilute pancreatic elastase and can give a falsely low result
- Pancreatic enzyme supplements, which do not change pancreatic elastase but do change fat and food remnant findings
- NSAIDs, alcohol and hard exercise before a permeability test
- Diet in the days before, which shifts short chain fatty acids and culture results
When should you refer the client to their GP?
- Pancreatic elastase below 200 micrograms per gram
- Blood in the stool, rectal bleeding or black stools
- Unexplained weight loss, night time diarrhoea or iron deficiency
- Parasites or pathogens that need prescription treatment
- Suspected coeliac disease or inflammatory bowel disease
How should a client prepare for a stool or permeability test?
Copy or print this to send to your client. Follow the instructions in the Nutripath kit if they differ.
Preparing for your gut test
- For a stool test, eat as you normally do in the days before.
- Ask your practitioner whether to stop probiotics, digestive enzymes or laxatives before you collect. Don’t stop antibiotics or other prescribed medicines without asking your doctor.
- Collect the stool sample as the kit instructions say, and post it back early in the week so it isn’t in the post over the weekend.
- For the permeability test, fast overnight, collect the first urine sample, drink the sugar solution from the kit, then collect your urine for the time the instructions give.
- Avoid alcohol, anti-inflammatory medicines and hard exercise the day before a permeability test, if your doctor agrees.
- Your practitioner will receive the report and go through it with you.
What does the zonulin, permeability and CDSA report look like?
Nutripath publishes sample reports on its website. They open in a new tab.
- Zonulin sample report (PDF)
- Intestinal Permeability Test sample report (PDF)
- Comprehensive Digestive Stool Analysis (CDSA), Level 1 sample report (PDF)
- Comprehensive Digestive Stool Analysis (CDSA), Level 2 sample report (PDF)
- Comprehensive Digestive Stool Analysis (CDSA), Level 3+ sample report (PDF)
- Comprehensive Digestive Stool Analysis (CDSA), Level 4+ sample report (PDF)
- Secretory IgA sample report (PDF)
- Pancreatic Elastase 1 sample report (PDF)
How do practitioners use these tests with clients?
Start with the question you need answered. For oily stools, weight loss or suspected malabsorption, pancreatic elastase answers it well. For possible infection or parasites, a CDSA level with microscopy fits. Zonulin and permeability results are best kept as background, and should not be the main reason for a long protocol. Rule out coeliac disease and inflammatory bowel disease with the GP first, and retest only when the result would change what you do.
Zonulin, intestinal permeability and CDSA FAQs
Can a naturopath, nutritionist or dietitian order a zonulin or CDSA test through Vively?
Yes. You need to be a verified practitioner to refer it. Add the Nutripath kit to an order in the Vively practitioner platform, on its own or with blood tests. Pricing shows in your account. No account yet? Request free access.
Does a zonulin test diagnose leaky gut?
No. Leaky gut is not a recognised diagnosis, and research has found that the commonly used zonulin assays may not measure zonulin itself. Use the result with caution and look for conditions with clear tests, such as coeliac disease.
Which CDSA level should I order?
Level 1 covers microscopy, culture and parasites. Level 2 adds short chain fatty acids, beta glucuronidase and pancreatic elastase. Levels 3+ and 4+ add markers such as H. pylori antigen, secretory IgA and M2 pyruvate kinase. Choose the lowest level that answers your clinical question.
What does a low pancreatic elastase mean?
A result below 200 micrograms per gram suggests the pancreas is not making enough digestive enzymes. Watery stools can give a falsely low result. Refer the client to their GP, who may confirm it and consider enzyme replacement.
How long do these results take?
Nutripath estimates 3 to 5 business days for zonulin, secretory IgA and pancreatic elastase, and 5 for intestinal permeability and each CDSA level, from when the lab receives the sample. Allow a few extra days for postage.
References
- Scheffler L, Crane A, Heyne H, et al. Widely used commercial ELISA does not detect precursor of haptoglobin2, but recognizes properdin as a potential second member of the zonulin family. Frontiers in Endocrinology. 2018.
- Camilleri M. Leaky gut: mechanisms, measurement and clinical implications in humans. Gut. 2019.
- Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterology Journal. 2017;5(2):153-199.
- Toouli J, Biankin AV, Oliver MR, Pearce CB, Wilson JS, Wray NH. Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations. Medical Journal of Australia. 2010;193(8):461-467.
- Nutripath. Zonulin, intestinal permeability, CDSA, secretory IgA and pancreatic elastase, test codes 2003 to 2024. nutripath.com.au, and CDSA sample reports, checked 20 October 2026.