Clinical Service · Gut Health

Gut Health & Microbiome Testing

At SPOKEmed, gut microbiome testing is used as a root-cause diagnostic tool - not a standalone add-on. For women who have struggled to lose weight despite consistent effort, the gut microbiome is often an overlooked contributor to chronic disease and metabolic dysfunction.

Testing is ordered and interpreted by Michelle Middleton, PA-C, and results directly inform the personalized treatment plan you receive as part of our broader weight management and metabolic health program.

Clinical Services

What Gut Microbiome Testing Evaluates

Gut microbiome testing at SPOKEmed uses a DNA-based stool analysis powered by quantitative polymerase chain reaction (qPCR) to evaluate the trillions of bacteria, fungi, parasites, viruses, and other microbes living within the digestive tract. This method detects the genetic material of each targeted organism - enabling precise identification and quantification of gut microbiota that culture-based tests often miss.

The test does not catalog microbiome composition alone - it also measures markers of digestion, intestinal barrier integrity, immune function, and gastrointestinal inflammation. Findings are interpreted by Michelle Middleton, PA-C alongside your symptoms, medical history, laboratory results, and lifestyle factors. Results are never reviewed in isolation.

The Method

qPCR

Quantitative PCR detects microbial DNA in stool, so we know which organisms are present, at what levels, and whether those levels represent a clinical concern - far beyond presence/absence panels.

What The Test Identifies

Conditions & Patterns the Test Can Detect

The analysis evaluates multiple domains of gut health simultaneously, including:

  • Bacterial pathogens and opportunistic overgrowth

  • H. pylori and its virulence factors

  • Fungal and yeast overgrowth, including Candida

  • Parasitic organisms

  • Levels of beneficial and commensal bacteria

  • Dysbiosis - imbalance in bacterial types and microbial diversity

  • Mucosal immune function e.g., secretory IgA

  • Digestive function markers e.g., pancreatic elastase

  • Intestinal barrier integrity & permeability markers associated with leaky gut

  • Hormone metabolism & detoxification markers e.g., beta-glucuronidase

  • Overall microbial balance & diversity

Gut microbiome imbalance has also been associated with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and other chronic health conditions with a gastrointestinal component.

Who This Service Is For

Symptoms That May Indicate a Gut Microbiome Imbalance

This service is appropriate for adults presenting with digestive issues or other symptoms that may have a gastrointestinal root cause.

Perimenopause & Menopause

Women in perimenopause and menopause are particularly affected by gut microbiome changes. Hormonal shifts during this stage can disrupt microbial balance, worsen digestive issues, and contribute to weight gain and metabolic dysfunction that does not respond to standard interventions.

  • Persistent bloating, gas, or abdominal discomfort

  • Constipation, diarrhea, or irregular bowel function

  • Reflux or digestive dysfunction

  • Food sensitivities or intolerances

  • Unexplained fatigue or low energy

  • Skin concerns - eczema, acne, rosacea

  • Difficulty losing weight despite consistent effort

  • Mood changes, brain fog, or anxiety

  • Chronic inflammation or elevated inflammatory markers

  • Metabolic challenges disproportionate to lifestyle & treatment

How It Works

The Testing Process at SPOKEmed

  • Initial Consultation

    Michelle reviews your health history, symptoms, goals, medications, and lifestyle to confirm that microbiome testing is clinically appropriate.

  • At-Home Sample Collection

    The lab ships the kit to your home - collection container, preservative, and prepaid return shipping. No lab visit required.

  • Laboratory Analysis

    The sample is processed using qPCR technology, measuring microbial abundance plus digestive, inflammatory, immune, and barrier markers.

  • Results & Treatment Plan

    Michelle prepares a personalized PDF summary and schedules a follow-up to review findings and your plan.

    Results typically ready ~3-4 weeks after the lab receives your sample; review within 1-2 weeks.

What's Included

Service Structure & Pricing

Full Gut Health Testing Service

$899

Everything required to complete testing and review your individualized treatment plan.


Depending on case complexity and scheduling, the results analysis and plan review may be combined into one visit or conducted as two separate visits. All necessary consultations are included.

The Service Includes
  • At-home microbiome test kit and laboratory processing

  • Clinical interpretation of all results

  • Personalized PDF summary with findings & recommendations

  • One results review consultation to discuss findings & next steps

  • A practical daily implementation routine

SPOKEmed operates on a direct-pay model and does not accept insurance. Gut microbiome testing may qualify for HSA or FSA reimbursement depending on your individual plan and eligibility.

Clinical Approach

How SPOKEmed Interprets & Acts on Results

Michelle applies a personalized, root-cause framework to every set of results - integrating microbiome findings with your symptoms, labs, history, lifestyle, and goals. No single protocol is applied uniformly.

Remove

Step 01

Address pathogens, microbial overgrowths, or identified triggers - such as H. pylori, opportunistic bacteria, yeast overgrowth, or dietary contributors - based on your individual GI-MAP findings.

Replace

Step 02

Support digestion and nutrient absorption when indicated, including addressing markers of low pancreatic elastase, fat malabsorption, or digestive insufficiency.

Reinoculate

Step 03

Restore a healthy microbiome by rebuilding beneficial bacteria through dietary strategies, prebiotic-rich foods, and targeted probiotic recommendations individualized to your findings - not a generic formula.

Repair

Step 04

Support the intestinal barrier and gut lining using nutrition, lifestyle interventions, and targeted supplementation when markers indicate intestinal permeability, inflammation, or impaired mucosal health.

Rebalance

Step 05

Address sleep quality, stress, physical activity, blood sugar regulation, circadian rhythm, and hormone balance - all factors that influence how a microbiome supports long-term gut health and metabolic function.

Dietary Protocols

Nutritional Frameworks Applied After Testing

Dietary recommendations are individualized and microbiome-based - informed by GI-MAP findings, your clinical presentation, and lifestyle. No single dietary protocol is applied to all patients.

The strategy is selected by integrating lab findings with your full clinical picture - part of a broader plan that also addresses sleep, stress, hormones, physical activity, and metabolic health.

  • Anti-inflammatory whole foods diet as a foundational approach

  • Targeted elimination & structured reintroduction for suspected food sensitivities

  • Low-FODMAP protocol for bloating, gas, and IBS symptoms

  • Mediterranean-style eating for microbiome diversity & metabolic health

  • Reduced sugar & refined carbohydrate protocols for yeast overgrowth, dysbiosis, or insulin resistance

  • Higher fiber & prebiotic-focused nutrition when beneficial bacteria are low

  • Digestive support protocols for malabsorption or low pancreatic elastase

Precision Medicine Integration

Complementary Testing Available at SPOKEmed

When clinically appropriate, Michelle may recommend additional diagnostics alongside microbiome testing to provide a more complete picture of contributing factors.

DUTCH Hormone Testing

A urine-based test measuring estrogen, progesterone, cortisol, and testosterone - and how the body metabolizes them. Used when hormonal imbalances may contribute to fatigue, weight gain, sleep disruption, mood changes, or digestive dysfunction. Hormones and gut health are closely connected.

3X4 Genetics Testing

A DNA test evaluating genetic variants related to methylation, detoxification, inflammation, hormone metabolism, and cardiometabolic health. Used to explain why patients respond differently to the same diet, lifestyle, or treatment - and to support individualized protocols.

SIBO Breath Testing

A non-invasive breath test for small intestinal bacterial overgrowth - bacteria proliferating in the wrong part of the digestive tract, causing bloating, gas, constipation, or diarrhea. Ordered when symptoms suggest it, since the GI-MAP alone cannot definitively diagnose SIBO.

Comprehensive Metabolic Blood Work

Markers for inflammation, insulin resistance, thyroid function, nutrient status, liver function, and cardiovascular risk. Used to correlate GI-MAP findings with overall metabolic and systemic health.

Testing is selected based on individual presentation. The goal is to combine microbiome findings with hormonal, genetic, and metabolic data to identify root causes and develop a strategy designed for your specific biology.

Clinical Context

Gut Microbiome Testing for Patients on GLP-1 Medications

Microbiome testing is not routinely ordered for all patients in the SPOKEmed GLP-1 Weight Management Program. It may be considered case-by-case when a patient presents with persistent gastrointestinal symptoms - bloating, constipation, reflux, diarrhea, or food sensitivities - or when metabolic challenges appear disproportionate to lifestyle efforts and medical treatment.

The purpose in this context is to gather additional information about the GI environment, microbial balance, digestive function, and inflammatory markers that may be influencing treatment outcomes. Findings may guide personalized recommendations intended to complement - not replace - the GLP-1 treatment plan.

GLP-1 medications remain the primary clinical tool within the SPOKEmed Weight Management Program. Microbiome testing, when appropriate, is an additional diagnostic layer to better understand factors affecting your overall health and response to treatment.

Michelle Middleton, PA-C, Founder, SPOKEmed
Image: patient lifestyle / clinical detail
Patient Results

What Patients Have Experienced

"

One patient came to SPOKEmed with persistent bloating, chronic inflammation, poor sleep, and difficulty losing weight despite a healthy lifestyle. She had previously seen a gastroenterologist and undergone conventional testing - including endoscopy - without a clear explanation.

Gut microbiome testing identified Helicobacter pylori as a potential contributor. Because H. pylori may be present in low concentrations or outside areas sampled during endoscopy, it is not always detected conventionally. The GI-MAP's PCR-based method detects microbial DNA in stool, offering a different diagnostic lens.

Michelle developed a personalized plan using targeted nutritional and supplement interventions. Follow-up testing confirmed resolution of H. pylori, and the patient reported significant improvements in bloating, digestion, sleep, and energy - describing weight maintenance as more manageable once the underlying gut issue was addressed.

Individual results vary. Outcomes cannot be guaranteed.

Service Availability

Telehealth Care, Available Across the U.S.

SPOKEmed is a telehealth practice and can work with patients located anywhere in the United States. Michelle Middleton, PA-C is licensed to prescribe medications in Florida and New York. Patients outside those states may still access consultation, microbiome testing, and personalized treatment planning - with the understanding that prescription-based interventions require Florida or New York licensure.

The practice is based in Jupiter, Florida and primarily serves women in Florida. Sample collection is completed at home - the kit is shipped directly to you, with no clinic visit required regardless of location. Health coaching services are available nationwide without restriction.

This service is available to both male and female patients. Eligibility is based on health concerns, symptoms, goals, and clinical appropriateness.

Please Note

The test may not be appropriate if you are currently taking antibiotics or antiparasitic medications, have recently completed colonoscopy prep, or are experiencing severe acute GI symptoms requiring emergency evaluation. These factors are reviewed during the initial consultation.

Michelle Middleton, PA-C, Founder, SPOKEmed
Image: Michelle Middleton, PA-C portrait
About The Provider

Michelle Middleton, PA-C

Michelle is a Physician Assistant-Certified (PA-C), the founder of SPOKEmed, and the sole licensed clinician responsible for all patient consultations, diagnostic interpretation, and treatment planning at the practice. She has over a decade of experience as a Physician Assistant.

Her advanced continuing education spans gut health, microbiome research, hormone optimization, metabolic medicine, obesity medicine, precision medicine, and longevity. All test results are reviewed and interpreted directly by Michelle - not delegated to a third-party platform or automated report system.

Get Started

Schedule a Gut Health Consultation

If you are experiencing persistent digestive symptoms, unexplained weight management challenges, or metabolic concerns not resolved through conventional evaluation, advanced microbiome testing may provide answers standard testing has not.

  • Call or Text

    (561) 823-0040

  • Email

    support@spokemed.com

  • Hours

    Mon, Wed, Thu 8:30am-5pm · Tue 7:30am-3pm

  • Direct Access

    All patients receive Michelle's personal cell for questions between appointments.

Initial Consultation

$60

Michelle reviews your health history, current symptoms, and goals to determine whether gut microbiome testing is the right next step for your situation.

Common Questions

Frequently Asked Questions

Find out what's really going on

Answers Standard Testing May Have Missed

Book a consultation with Michelle to review your symptoms, explore advanced microbiome testing, and discover what precision medicine can do for your gut and metabolic health.