Yuck! Who likes to think about, let alone talk about, poop? In our office, I talk about bowel habits and regularity with each of my patients. Why? Because it is a great indicator of what is happening inside the body and poor GI health is often at the root of chronic health conditions. In other words, having a healthy digestive system is crucial for achieving optimal health.
So, what really is normal? Do you ‘go’ every day? Once a week? Several times a day? Conventional medicine doctors have been trained that constipation is defined as moving your bowels less than three times per week and/or hard painful stools. A better indication of a healthy gut is actually going one to three times per day. Many patients accept their lack of regularity as ‘normal for them.’ It is important for you to understand that our bodies were designed to ‘detox.’ Having regular, daily bowel movements is a means of eliminating toxins and waste. Constipation (best defined as not going at least once daily) contributes to toxins and waste sitting idle in our bowels, leading to their reabsorption into the blood stream and disruption of the normal bacterial balance. Inflammation ensues and chronic diseases of all types are associated with poor bowel health.
Talking about poop is not the most glamorous topic, however, it is a very important one. Constipation is the most common digestive complaint in the United States, outnumbering all other chronic digestive disorders. Physicians write over one million prescriptions for constipation each year and over $700,000 dollars are spent annually on laxatives. As unpopular as this topic may be to discuss, it is clearly a tremendous health concern.
Let’s talk a little anatomy and physiology. Your GI tract involves everything from your mouth to your anus. Food is chewed and digestion begins in your mouth with chewing and salivary enzymes. As foods travel to the stomach and small intestines, they undergo further digestion. Most nutrients (vitamins, minerals, sugars, amino acids, fatty acids, etc.) are absorbed in the small intestines. Once food moves through and into the large intestines (bowels), water is absorbed from the digested food to form your stool. Muscle contractions, known as peristalsis, push the poop towards the rectum where it collects and is ready for elimination. At this point much of the water has been absorbed and the stool is in solid form.
WHAT CAUSES CONSTIPATION? Here are the most common causes:
• Dehydration – Our bodies require adequate water intake in order to help ‘flush’ the system.
• Poor Diet (lack of fiber, junk food) – Fiber adds bulk and holds onto water to help move stool through the colon. Fiber also binds toxins and keeps them from absorbing into the bloodstream. Foods high in sugar and lacking nutrients negatively impact our bowel health.
• Thyroid Disease – Hypothyroidism (under-functioning thyroid) is a very common cause of constipation. More information of hypothyroidism is found in here.
• Nutritional Deficiencies (particularly magnesium) – Healthy nutritional status is critical for optimal health. Enzymes, energy metabolism and therefore motility are tightly regulated by certain nutrients. Not eating well or having poor bowel health with inadequate absorption of nutrients can significantly impact your ability to have regularity.
• Sedentary Lifestyle – If you sit, you don’t poop! Plain and simple! You’ve got to move!
• Use of Medications That Interfere With Bowel Motility. Many pharmaceutical agents (opiates, anti-depressants, antacids, iron, and others) can cause poor motility and dehydration and lead to constipation.
• Food sensitivities. Food sensitivities are a very common problem. As your body struggles to digest these foods that are causing inflammation, constipation is a common side effect. Gluten and dairy are the most common culprits, but food sensitivities can be caused by any number of foods. The best way to evaluate for these sensitivities is to do an elimination diet. Obtaining the direction of a Functional Medicine practitioner can provide the guidance you need to determine these health concerns. Specialized blood testing for food sensitivities is available at Vine Healthcare.
• Dysbiosis (abnormal GI bacteria). Disruption of the normal gut flora can lead to yeast overgrowth, intestinal permeability (known as ‘leaky gut’), and inflammation. There are actually over 100,000,000 organisms in the GI tract (10X more than the number of cells in our body) Yikes! We are actually more ‘bug’ than human and the balance of these organisms is critical! Constipation is a common side effect of unhealthy ‘bugs.’
• Chronic Neurologic Conditions. Multiple Sclerosis, Parkinson’s, spinal cord injury, and other health conditions that impact neurologic function can lead to poor motility and constipation.
• Bowel Obstruction/Partial Bowel Obstruction. While these are not the most common causes of constipation, a partial (or complete) bowel obstruction caused by a mass (such as a colon/rectal cancer or large polyp), narrowing of the colon/rectum from surgery or chronic inflammation, or twisting of the bowels must be considered. If any of these conditions are concerns, immediate medical attention should be sought.
DON’T BE “FOS” (Full of Stool):
• Drink Plenty of Water! Make sure to drink at least ½ your body weight in filtered ounces of filtered water per day. Drink more on hot, sweaty days and on those days you are exercising.
• Stop Eating Junk and Add More Veggies and Fiber to Your Daily Regimen! This should be pretty obvious and is important to overall good health, not just to your bowels. There different types of fiber to add into your diet. Soluble fiber and insoluble fiber as well as resistant starch.
o Soluble fiber, found in apples, carrots, nuts, lentils, beans, etc., are just that….They are soluble. When they come in contact with liquid they dissolve. Soluble fibers swell in liquid, make you feel full, slow the absorption of sugar, and encourage healthy bacteria in your GI tract to multiple by feeding these friendly ‘bugs.’ Healthy flora leads to normal bowel motility.
o Insoluble fibers, found in many vegetables and the skins of fruits and veggies, support intestinal health another way – by absorbing water, making the stool more bulky. They help keep you regular.
o Resistant starch is type of starch that acts like a fiber. It is ‘resistant to digestion’ and much like insoluble fiber, it traps water, adds bulk, and helps with regularity. Resistant starch is similar to soluble fiber as well. It helps feed and promote growth of healthy bacteria that live in your lower intestines.
o Most foods contain a mixture of these different types of fiber.
• Avoid Pro-Inflammatory Foods! Stay away from those foods that we know are inflammatory – gluten, corn, soy, dairy, sugar, and processed/junk foods. Dairy is inherently constipating, especially if you have lactose intolerance. Consider an elimination diet to identify what other foods might be inflammatory for you (known as food sensitivities or even food allergies that you are unaware you have). We place every patient we have on some form of an ‘elimination diet’ on their journey to optimal health.
• Start Taking Probiotics and Eat Lacto-Fermented Veggies. If the flora in your colon is imbalanced, it is critical to restore the bacteria to a healthy balance. Bifidobacter and Lactobacillus species are found in probiotics and fermented foods and they help to ensure adequate bacterial counts. Foods like kimchi and sauerkraut not only help to provide probiotics, but they also provide beneficial enzymes. When taking a probiotic, look for a product that has at least 25 billion CFUs of Lactobacillus and Bifidobacter strains.
• Make Sure You Eat Healthy Fats Daily! Avocado, avocado oil, olives, olive oil, coconut and coconut oil, nuts, seeds, fatty fish, flax oil, and fish oil are all excellent options. Healthy fats help to lubricate the GI tract.
• Evaluate Your Medications! Are they all necessary? Research the side effects. Does the benefit outweigh the side effects? Always speak with your physician/practitioner before you decide to stop a medication. Find out if there are other options for you if the drug is necessary for your health.
• Get Your Thyroid Checked! If thyroid disease is a concern, discuss this with your medical provider and make sure to get a comprehensive thyroid evaluation performed. Thyroid dysfunction can negatively impact bowel health.
• Sleep! Sleeping is our ‘healthy reset’ button. You need to get at least 8 hours of sleep per night for optimal hormonal and physiologic functioning.
• Regular Exercise! A mixture of weight training, aerobic activity, and plyometrics help bowel motility by revving up metabolism and stimulating the intestines.
• Go When You Gotta Go! Don’t hold it in! Ignoring the urge to go can give the bowels the signal to ‘hold’ and slow down peristalsis.
• Increase Digestion! Chew your food! Chewing initiates the production of saliva which then begins the digestion process. Also, consider adding in a digestive enzyme supplement that contains amylase, lipase, and proteases, at a minimum. Adding organic apple cider vinegar before meals can help aid digestion as well.
• Create a ‘Bathroom Routine.’ You need to set aside time every day, preferably in the morning, for 10-20 minutes to sit quietly on the toilet to re-train your gut and nervous system to relax. Deep breathing exercises would be helpful.
• Squat! No, I don’t mean exercise squats…although these are quite helpful and you should probably be doing these anyway. The ideal position to be in when you evacuate your bowels is in a squatting position. This doesn’t exactly sound pleasant, as most of us can’t see ourselves ‘squatting’ over the toilet. This is why we carry a type of stool (pun unintended), called a Squatty Potty, in our office. It helps to keep your feet elevated and almost in a squatting position while sitting on the toilet.
• Don’t Rely On Laxatives or Colonics! You don’t want to do anything that your body becomes dependent on. An occasional colonic may provide some benefit (although healthy flora can be wiped out), but if you require one to ‘clear out,’ there is a problem!
• Get Scoped! If you have a family of colon cancer or are concerned about a partial bowel obstruction or anatomic problem, a colonoscopy is an important (albeit, not the most pleasant) evaluation. Discuss this with your doctor.
• Get a Massage! Better yet, massage can be performed on yourself at home. Lie down on your back and place your palms on your abdomen. Make small clockwise motions around your bellybutton, applying light pressure with your fingertips. Make larger and larger circles and move from the lower right part of your belly up to your right rib cage – over to your left rib cage and down to the lower left quadrant of the abdomen. Do this for at least 5 minutes. A different technique involves the help of another person. If you lie on your back have someone else take their palms and slip them under your low back until they reach your spine. Then they gently lift up and pull their hands out with gentle upward pressure. Repeating on the opposite side of the low back is necessary.
• Take Magnesium! We always want to address underlying root problems and not just treat symptoms. Almost 80% of the US population is magnesium deficient. Magnesium helps the bowels and its musculature relax as well as aids in muscle contraction. This improves bowel regularity. Start with 100 mg of magnesium per day and increase to desired result, not to exceed 1000 mg per day. You want at least 1-2 bowel movements per day. Back off if diarrhea develops. Do not use magnesium if you have kidney disease, without the direction of your medical provider. I prefer the form, magnesium citrate, taken at bedtime along with some fluid.
• Replace Nutrient Deficiencies! Other than magnesium, there are many nutrient deficiencies that can contribute to poor bowel health. Specialized nutrient blood testing can be done to determine which specific ones you are deficient in. Vitamin C is also a common nutrient deficiency. It is a powerful antioxidant but it also has laxative effects. It can be used to soften stool. We typically recommend a buffered vitamin C powder titrated to bowel tolerance (before diarrhea develops). Remember, addressing root issues are our goal…not just treating the symptoms!
There’s no reason to suffer with constipation! Don’t accept your ‘twice a week’ bowel habits as normal, either! You might actually find you feel a bit lighter, actually like eating, and can enjoy life a bit more.
If you’d like help uncovering and addressing root, underlying issues, we’d love to partner with you to achieve optimal health. While our office is in Indiana, we help patients from all over the country and outside the U.S.
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