Category Archives: Constipation

Do Slow Guts Need Loved?

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Three and one-half years ago I started skeptically experimenting with alternative health ideas to fix my gut.  I feel a little “out there,”–yes, I do– but I can’t argue with success that exceeds Miralax, Metamucil, and Smooth Move Tea.  You can read Part 1, Part 2, and Part 3 of my slow-to-stop gut story if you feel so inclined.  Okay.  Here we go.  Welcome to The Fites Medical Funnies, where nothing is intended to be used for medical advice and any appealing ideas should be run by your favorite healthcare practitioner.  Because yoga and gargling could be dangerous.

Alone Time First Thing in the Morning

The gut makes a large movement when we wake up in the morning, before we’ve even eaten anything.  I’ve found that if my gut is going to eliminate, it’s going to do so early in the morning when I’m sitting alone quietly.  If I hear my husband get up to shower, if I shower,  or if I decide to start breakfast early, the game is over for the day.  Rarely, if I get some time in the afternoon to sit and check email or something and the kids are quietly playing in the basement or outside–and Mars aligns with the moon– then, my gut may relax enough to move.

This tells me my gut can work and bring about normal defecation.  This also tells me that my sympathetic tone is VERY strong and easily over-rides the parasympathetic control of my gut. The sympathetic nervous system is what gets the body geared up and ready to go.  It is described as the system that kicks in “when you’re running from an ax-murderer.”  Your parasympathetic control is the “rest and digest” control system.  I’d say, in general, my sympathetic control system predominates my life.

Bottom-line:  The parasympathetic nervous system promotes defecation.  My sympathetic tone responds quickly to any perceived task, even if it’s as simple as saying “good-bye” to my husband in the morning or changing into clothes for the day.  (Yeah.  I know.  I’m working on it.)  Getting up before everybody in the house wakes up and sitting quietly promotes movement of my gut.  It’s almost a necessity in the equation.

Ileocecal Valve Massage, Gargling, and Gagging

Hey.  This may be whacko at its finest, but it’s cheap, safe, and easy to do.  About seven months ago, I started thinking about something called small intestinal bowel overgrowth (SIBO) hard.  If a person has SIBO, constipation can be an outcome, particularly if the “bacteria” make extra methane.  I suspect I have a mild case of SIBO but have never tested myself for SIBO because 1) it’s one more test 2) nobody in my area tests for methane predominant SIBO that I know of 3) there’s no good treatment for it 4) I’d already tried the treatment for it a few years ago (and it helped a little with bloating but not for long) and 5) my symptoms were/are not that significant to me (and my constipation has been life-long and I feel it led to my SIBO rather than SIBO causing it).

But, I thought, if I have SIBO, the only way I’m going to get that better is if my ileocecal valve (a “valve” which separates the small intestine from the large intestine) is opening and closing the way it should.  AND if my vagal tone (parasympathetic tone)  to the gut is promoting sweeping forward and peristaltic motions as it should be.  With my long-term history of constipation, I figured this indicated that my gut does not sweep forward like it ought to, allowing bacteria to migrate up inappropriately through the ICV to the small intestine, leading to my middle-aged SIBO symptoms.  To get my gut moving forward better and to stop the retrograde flow of bacteria, I felt I needed to work on my ICV and my vagal tone.

Mmm.  Yes.  You following this crazy?  So, with some internet research, I decided to rub my ICV.  (It’s in the right lower quadrant, kind of above the hipbone but over a bit toward the belly button.)  This usually ended up being about 2-3 times a day:  when waking up in the morning, when going to bed at night, and during the day if I could steal a second to lay flat.  I noticed that my ICV was actually quite tender, like a sore muscle or “trigger point.”  I also noticed that my gut started gurgling and growling after massaging the ICV.  Just for the heck of it, I then, after massaging my ICV continued to massage the colon around.  Really.  You can find this all on the internet.

Okay, if rubbing ICVs and colons is not cutting edge enough for you, I proceeded to work on vagal tone.  When I brushed my teeth, I would stimulate the gag response five times and call that enough.  I would also then gargle water at the end.  When I showered, I’d also gargle and try to gargle periodically through the day, for example when I’d use the bathroom.  Gargling and gagging stimulate the vagus nerve.

I’ve been doing this for quite some time now, and I get no immediate response.  None.  But I’ve kept doing them at least once a day for about six months.  My SIBO does seems much improved, and my gut is moving a lot better.  This could be so many things, but these are easy things to do and try.  I have nothing to lose in trying these things.  Obviously, you shouldn’t throw up your food or hurt yourself gagging.  Duh.

Bottom-line:  These are simple things to try.  My ICV is rarely sore anymore, but it does seem when the bloating flares again, it is more sore.  Whatever.  I’m going to keep this routine going longer.

Core Exercise

I have a very weak core due to having a pretty large umbilical hernia and diastasis recti from having four kids.  During the summer, I thought, “I’m going to fix this hernia.” and I tried a program called MuTu at the recommendation of a friend.  I liked it a lot, and my core definitely got stronger.  Could this have contributed to GI improvement?  Maybe so.  Don’t know.  I haven’t done the exercises for three months now, and my gut kept on working.  I have exercised plenty in the past (and continue to do so), so I don’t feel like exercise in general moves my gut.

Changing Perception

Over the last four years, I’ve observed that my food intolerances and gut do better when I’m less stressed.  I’m a pretty intense person, and I walk around looking for stuff to do, even if it’s just folding a blanket nicely on the couch.

If my vagus nerve and parasympathetic nervous system are going to function optimally to help me get off of all supplements for my gut, then I’m going to have to do some major brain rearranging.  My brain has to stop sometimes and/or I have to learn that I don’t need to always listen to my busy brain.

In light of this, I have a good friend who teaches therapeutic, problem-focused type yoga.  It was time to sign up for some individual work.  Like with acupuncture, when I quietly worked with her on breathing, stretching, awareness of body and thoughts, meditation and learned some of the techniques she taught, my tummy would sit there and rumble during the class.  It’s like my gut is singing, “Hel-loh-oh.  I like this stuff.”

Bottom-line:  I’ve been doing this yoga/meditation/self-awareness jazz for about four months.  The last two of those four months were completely normal bowel movements.  Is it the acupuncture?  The K2?  The butyrate?  The resistant starch?  The gargling?  The yoga.  The mediation?  Who cares!  I’ll take it.

Loving My Body’s Limitations

So I read about this woman who cured her autoimmune disease by choosing to love it.  Yes, my brain sang “Hoakie.” (Singing loudly is supposed to stimulate the vagus, too.)  But I’m in a place where I’ve tried it all, and I’m totally game to try something that’s free, painless, and completely safe!  So for a time, I would lay in bed as I woke up or went to sleep or at my yoga lessons, and I’d tell my colon it was doing a good job.  That it had a hard job digesting and moving all that food under the conditions I gave it.  That we, the rest of the body, would do whatever it took to help the colon do its job better.  And even if it never did its job any differently, we loved it as a part of this wonderful body.  We told it thank you.  We told it good job.  We quit telling it sucked.  It was broken.  It was harming the rest of the body.  It needed fixed.  It was ugly and gross and dysbiotic.

Did it work?  Well, not directly.  But whatever.  I tried it for a month.

Bottom-line:  Worked for some other chic but not for me.  But it still was a very nice thing to do for my colon.  And why not be nice?  I think it was worth a try.

Diet

What do I eat?  My diet is usually pretty clean, and I’ve tailored it over the last three and 1/2 years with an elimination diet to where I feel the best.  I started with GAPS diet and have branched my diet out (or unbranched it, in the case of some GAPS allowed foods I avoid eating).  I try to avoid completely adhering to dogma now (for example, never eating legumes or dairy or sugar or grains for the theory of it) and instead prefer to use close scrutiny (which usually leaves me avoiding legumes, dairy, most grains, and sugar for the reality of it! 🙂 ).  I eat lots of vegetables, both cooked and uncooked–all kinds.  I eat meat about once a day, sometimes twice–to satiety.  I eat a lot of seafood, and also lamb, beef, and pork.  I eat fruit about once a day, about 1-2 servings unless it’s summer and something I love is in season.  My gut now likes nuts and moves fine and actually very well on them, but my headaches don’t like them.  So I have to go easy on nuts and seeds, even though I seem to think that things like hemp, seed-based granola bars, etc promote gut movement for me.  Potatoes and rice seem to go well for me, especially when eaten cooked and cooled, and I make a point to try to eat either cold rice, cold potatoes, or green banana daily for resistant starch.

Besides the rice, I don’t eat many grains.  My gut always slows for a few days after I try to re-introduce gluten, so I keep it off the menu.  As far as dairy, I don’t eat it much, but for a time, I seemed to be doing fine with sheep and goat cheese and my homemade yogurt from a local Jersey cow.  I don’t eat eggs unless they’re long-cooked in something, and even then I use extreme caution.

I’ve played around with carbohydrate levels, fat levels, protein levels, calories, raw foods, all cooked foods.  Baby, I’ve tried it.  I seek out the freshest, most stable fats I can find to use, usually fresh olive oil and drippings from cooking meats that I save.  I usually eat organic, but it’s not usually a deal-breaker.

There is NO doubt in my mind that my diet change plays a HUGE role in relieving my constipation.  And I think a good elimination diet is nothing short of miraculous.  I know my gut would not be moving if I hadn’t watched, listened, and felt closely.

Closing

I’m in a good place now, and it has taken three and 1/2 years.  Maybe doing it my way took longer, but when I tried to ask for help, of both conventional and alternative providers, it cost a lot of money and didn’t make my gut work much better.  So this is where I am.  Don’t use my story as medical advice.

If you’re still reading, I think you must have a vested interest in constipation.  Good luck to you.  If my symptoms flare up again, I’m not worried.  There’s a few more tricks out there to try when I’m no longer nursing.  But no matter what, my gut can now move with the simple help of magnesium.  This ought to save me from a colectomy, and for that, anyone can be truly grateful.

Terri

Maybe Slow Guts Need Poked

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Everyone tells you its simple.  Everyone tells you, “Oh, if you’d only try this, then…”

You don’t know whether to feel stupid or insulted and mad.  Then, rashly, you fork out money to try X, Y, or Z sometimes–which fails–and then you feel stupid AND mad.

I’ve got today’s post and one more on my personal story on severe, chronic, idiopathic constipation.  I’m not here to tell you it’s simple or even that I know what I’m talking about when it comes to constipation.  My blog is not for medical advice anyhow.  (It’s to make you wonder what kind of person would type about this.  Is she normal?  Or not normal?  Hmmm…)  If you missed them, I wrote this post first and this post second in my personal update series on trying to cure my refractory, lifelong constipation.

512px-Tea_in_different_grade_of_fermentation

Smooth Move Tea and Laxatives

A few years ago I went to a gastroenterologist for my constipation.  She recommended that I stop the magnesium preparation that I was taking and sip Smooth Move Tea (a senna product). I didn’t like this recommendation so I didn’t do it.  I’d tried senna products before, and they never worked for me.  I felt the doctor clearly wasn’t listening to my story, so I found a different doctor.  I mean, I’d told her I had given up pizza and bread and ice cream to try to beat my severe, chronic constipation–did she really think that sipping a simple tea was going to work?  Like she blew me off, I blew her off and did not try that blasted tea.  Last year, however, after having the baby, my constipation had some bad spells.  So I decided to get off my high horse and try the stupid tea.  The tea did nothing but cause severe cramps. (Point: Patients usually know their bodies.)  I also tried some other OTC laxatives, but they also did nothing but cause cramps and create no bowel movement.

Bottom-line:  These products don’t work well for me.  They never have, and they still don’t.  I get terrible cramping and little to no bowel movement.  To get a bowel movement, I have to take like 12 or more pills of whatever.  I’d better stick to giving up pizza.

Herbs and Spices

I use a lot of herbs and spices when I cook, both fresh and dried.  I’ve tried increasing these over the last several months.  Nothing has seemed to jump up and shout that it is making my gut move specifically.  But they taste good and have many great properties.  Could they be doing slow magical work?  Sure.  I’ll keep using my herbs and spices:  turmeric, Ceylon cinnamon, cardamom, fresh-pressed garlic allowed to sit ten minutes, coriander, allspice, nutmeg, saffron, fresh cilantro, fresh parsley, rosemary, and so on and so forth.

Bottom-line:  Herbs and spices are worth adding in for overall health even if they don’t clearly seem to make a definable difference in my GI motility.

Diverse Fiber

I’ve read some fascinating anecdotes about people who tanked up on diverse fibers and reversed their GI, SIBO, and food issues.  (Fiber is a VERY complex term.  Please consider reading about it here.)  Fiber in the forms of legumes, Metamucil, and whole grains has never worked for me.  But as I’ve researched, I’ve come to find that I’m not needing the “skin” fiber of foods that I thought I needed for bulk–or even “soluble” or “insoluble” fiber.  There are other, less definable, carbohydrates that the bacteria in our guts may chomp on to produce by-products that stimulate and repair the gut.  So I devoted a couple of months to trying high dose “fibers”:  glucommannan (cramping), FOS/inulin/beta glucan (no change), psyllium (no increase in movement but more bulk), and oatmeal/blueberry/potato starch smoothies three times a day (no change).  I had no significant set-backs from these attempts, but I still needed tons of magnesium.

The “fiber” that seems to do me best is resistant starch “fiber” via green bananas (in smoothies), cold cooked rice (as in rice salad), and cold cooked potatoes (great over a salad topped with vinaigrette).  I also occasionally pop a bit of raw potato.  I do feel these “fiber” foods help me if consumed daily.

Also, over the summer I inadvertently upped my raw vegetable intake with delicious Israeli-inspired salads a good friend taught me to make.  Raw vegetable intake at the beginning of my journey killed my bloating problems.  Not anymore.  Once a gut’s environment is improved, I think raw vegetables and fruits are important.  Maybe the addition of these salads helped.

Bottom-line:  I can’t be 100% sure, but I do think that the resistant starch foods eaten daily and the salads play a role in the recent progress of my gut.  (And these are amazing salads!  Not the kind boring ones I used to make.)  The powders and supplements I tried didn’t work for me. (Too easy.)

Triphala

I tried some triphala.  No luck.  Nothing bad.  But nothing improved, and although it is listed as safe in some places for nursing (and other places not), I thought my baby had looser stools when I titrated up the dose.  So I ditched triphala.

Essential Oils

Oh man.  I love the way these smell.  Some people swear success in helping their constipation with essential oils.  I’ve tried two different times and no go for me.

 

Acupuncture

Japanese_kudabariI told a medical school friend, who is married to another medical school friend, that I was trying acupuncture for my gut.  She laughed and jokingly said, “I won’t tell Jeff that you’re trying that.  He’d never let me talk to you again…”

Anyhow, I have received acupuncture now for about 5 months (with some quite extended breaks for traveling).  When those tiny needles poke me, you can hear my gut start rumbling.  It’s a little embarrassing.  Sometimes after a treatment, I will have to go to the bathroom.  Usually not.  However, in the several months of acupuncture I’ve had, my gut has improved. The acupuncturist I go to only does acupuncture, but he draws on chiropractic, ancient Chinese medicine, Ayurvedic principles, and kinesiology.  When we first started, I asked him, “So, do you think you’ll be able to fix me?”  He was super honest and said, “Well–you’ve had this a long time–but we can try.”  I love that answer!  I have the utmost respect for what he does, but I do have to say it feels like “voodoo” at its finest to a conventional doctor.

I think that acupuncture has been a piece of the progressive improvement of my gut (but only as a part of the plan).  For the first 6 weeks, treatments were weekly.  Then, he spaced it to every two weeks.  And then slowly we are stretching it out further.  It does seem to help.  On the down side, it is not cheap.  In fact, it’s expensive.  Some insurances pay for acupuncture, but mine does not.

Here are some links to check out about acupuncture and constipation:

Efficacy of acupuncture for chronic constipation: a systematic review.:  This is an abstract to a positive Chinese study on acupuncture for constipation.

Use acupuncture to treat functional constipation: study protocol for a randomized controlled trial :  Here is a full-text summary of the study protocol for the above-linked study, in case you want to take it to your acupuncturist to see what points were used.  🙂

Acupuncture for functional constipation: protocol of an individual patient data meta-analysis : And here it looks like the British Medical Journal is gearing up to explore acupuncture for functional constipation.

Bottom-line:  Acupuncture definitely seemed to add some motility to my gut.

Closing

I will try to wrap up this long story in the next post which will cover things like yoga, acceptance, meditation, getting up early, and my favorite topic–diet.  It seems like a lot of stuff to try–and it is–but I know these things will impact my marriage, my parenting, and my life forever.  Here is a funny thought:  I am a better person because of my constipation.  Oh, my.  Did I just type that?Insane.

I appreciate the comments you’ve all left.  And I like to hear of people doing well and what and who they used to achieve that.  Have a super week.

Terri

 

 

 

 

Slow Guts Need Tenacity

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256px-Pieter_Lastman_-_Jonah_and_the_Whale_-_Google_Art_ProjectTenacity.  Word for the day.  Word for a season.  Word for life.  I can hear mom’s voice even now, “Oh, Terrrr-rrrri.  You have a one-track mind.”  She said it like it was a bad thing!  Pshaw.  But, tenacity got her to buy me some black parachute pants; I think it’s restoring my gut too.  I’ve worked very hard to get this gut moving.  Very.  I’ll be laying out all that I can think of that I tried and how I think it affected my gut and me.  There is no ONE thing that worked for my colon regularity and stool consistency.  Geesh.  What would I have to write about if it was that easy?  I’ve turned down more cookies, cakes, and cheese platters than you can even imagine.  I’ve made myself go to bed early more than I’ve ever made my kids go to bed early.  I’ve attacked my gut on all fronts that I can.  Tenacity.

I’m starting out by writing about the supplements I’ve tried.  That does NOT mean that the supplements are the most important.  Just that I’m postponing talking about acupuncture and gargling and chakras.  I’ve already mentioned vitamin K2 in the last post.  These posts will just keep rolling.  So let’s continue.  Don’t use this as medical advice.  It’s my story.  If it gives you ideas to try, talk about them with your doctor.  Be SAFE.

Iodine

I’ve taken iodine for about two years now. I don’t have much in the way of a reliable iodine source in my diet, so I supplement. Iodine comes to a conventional diet via egg yolks, dairy, seafood, and iodized salt.   Iodine didn’t seem to have any particular impact on MY constipation, although other people have reported to me that when they started taking iodine it did seem to improve their constipation; I experienced other positive benefits from taking iodine. I was able to have my thyroid labs followed to make sure I was safely supplementing. Hypothyroidism (low thyroid) causes constipation. I was never categorized as hypothyroid. However, iodine supplementation did slowly drive my TSH down over time, which was medically interesting to watch.

Bottom line for me: Iodine did not seem to make my constipation better, but it helped other things for me. I think that a TSH needs periodically checked and symptoms need closely monitored if a person is going to take iodine.  In case you’re counting, this is the second supplement I take routinely.

Probiotics and Probiotic Foods

I’ve tried dozens of probiotics. Not A DOZEN—but DOZENS. There is no probiotic that makes my motility improve directly. I’ve tried soil based. I’ve tried VSL. I’ve now tried the Japanese kind. I’ve tried Klaire Labs. I’ve tried pickles, pickle juice, sauerkraut, sauerkraut juice and kimchi. I’ve made my own fermented pickles, sauerkraut, and beets. I’ve tried 24 hour homemade yogurt. I’ve tried homemade coconut yogurt. Tenacity.  There is one probiotic source I haven’t tried, but I’d like to try: Mutaflor. It has studies showing it helps constipation. However, it’s only available in certain countries, and the USA isn’t one of them.

Probiotics aren’t the “cure” for my STC.  I’ve tried many kinds, and I’ve tried driving up the doses.  Tenacity.  In fact, for a couple of months this summer, I even stopped probiotics completely!!!!  I suffered no ill GI effects and my gut still moved! Why did I stop them? I think that I have a mild case of small intestinal bowel overgrowth (SIBO).  (Why not test?  1) I already eat a tailored diet.  2) Things are improving.  3)  I’ve tried antibiotics before for it, and it came right back.  And now, I won’t take antibiotics because I’m nursing.  4)  My case isn’t that bad.)  I now waffle between probiotics and no probiotics.

What is SIBO?  This is where the bacteria from the colon track up into the small intestine in larger numbers and/or with different species than those that should be there. It leads to significant bloating, distention, bowel movement changes, fatigue, and other symptoms. There is a dispute in the SIBO arena about whether one should take probiotics with this disorder. Having no vested interest and an open mind, I could see both sides. So since I’d tried probiotics like crazy for years, I thought I’d try without. (Another aside: I have not always had SIBO symptoms. They started at about age 35. I think it was a result of chronic non-movement of my gut.  I think to effectively treat SIBO, a person HAS to address the underlying issues.)

Bottom-line for me: I tried coming off my probiotic. My gut still moved off the probiotic! However, my gut also moved normally for a couple of months before I got pregnant a couple of years ago and I was ON a probiotic. So for my body, I’m not yet sure whether it prefers a probiotic or not.  LOTS of people swear by probiotics for constipation.  I have been trying to utilize normal portions of Bubbie’s pickles, Bubbie’s sauerkraut, and eating my home-grown produce.

Butyrate

Butyrate has kick-started my gut twice in my life now. In 2013, I started taking it after a big dose of magnesium and immediately I had normal bowel movements daily. I then titrated up resistant starch using potato starch (which leads to natural butyrate production) and came off of the butyrate pills. I then titrated up food sources of resistant starch (green bananas, plantains, cooked and cooled potatoes and rice, raw potato and sweet potato sparingly) and stopped the powder forms of resistant starch.

BINGO. I thought I was a diet-controlled constipetic and the story was over! (I always told God I was going to stop blogging when my constipation was cured.  Never tell God what to do or what you think YOU’RE going to do.  Instead, when you hear “Jump.” from the Big Man, you say, “How high?”  Got it?) But I got pregnant in 2013 and I’ve been chasing GI rainbows ever since. Finally, late this summer of 2015, I decided to get back on butyrate. I took a good dose of magnesium to try to propel that butyrate deep into my intestines (just in case that would help, you know).  BAM.  My gut has been doing pretty well since then. Knock on wood. And I’m working on building back up my food sources of resistant starch again and working on other areas I’ll elaborate on through these posts (like stress management, core strength, etc). THIS IS NOT A SIMPLE QUICK-FIX JOURNEY. You want that? Go somewhere else.  Tenacity.

I KNOW butyrate does NOT work for all people. They’ve told me. More people have told me that butyrate did NOT help them than people have told me that butyrate DOES help them. I’d like to also point out that during pregnancy and post-partum, my gut kind of stopped working and I was on high dose magnesium. Butyrate did not work at this time—even though this summer I tried again and it did! This leads me to suspect that hormones play a huge role in constipation—which I already suspected and this simply pounded into my heat that I need to make sure and learn about this (and hopefully write it up too—although I must say the other day in my research, I saw a new review article that was downplaying hormones…).

Many people write to ask what butyrate I take. I simply tell this as part of my story. Listen. I do not support this brand, other than it has worked best for me out of all the ones I’ve tried. I don’t pretend to think this brand or even butyrate will help you. Heck, it may even set YOU back, while it sets me forward.  I use Body Bio Mag-Cal Butyrate 600 mg (two three times daily, usually, but not always with a meal). If you decide to try this, flash it to your doctor so he/she can make sure it’s going to be fine for you. A commenter, Vicki, has noted that Body Bio has received some reprimands. You may read about this by scrolling down to the comments and looking for an interchange between Vicki and me.  Sometimes, I have a strange feeling that some bottles work better than others.  I don’t know, though.  I have NO proof of that.

Bottom-line: Butyrate has some good evidence supporting its role in promoting gut motility.  I have many posts on that in my butyrate series.  Some people have tried it and found that it helped their food intolerances and gut motility. Others have tried it without success—and with a loss of hard earned cash.  If your’e counting, this is the third, and final, supplement that I currently take routinely.

Magnesium (Natural Calm)

What did I take during pregnancy and post-partum when hormones gripped my gut so tightly? I took three tablespoons of Natural Calm magnesium citrate in a tall glass of water nightly–every night. This is WAY too much magnesium. I am well aware that most of us are magnesium deficient, but this is a lot much! One electrolyte at a high dose is not good for the other electrolytes and their balances.  So even though this got things moving (diarrhea), this is not a good place to live for the rest of my life if I can help it.  Tenacity.

I tried some different forms of magnesium because the taste of this, although the unflavored is really okay, is becoming repulsive after four years or so of using it. The other forms, both topical and oral types of magnesium, just don’t work. And Epsom salts bath, although relaxing, don’t do anything at all for my GI.  This is the only brand of magnesium that has worked for me.  Again, I’ve no vested interest in this supplement, and I’m not saying it will work for you.

At my best right before pregnancy and also the last two months now, I was able to get off of the magnesium.  I still had/have to use it about once a week, and usually at a much lower dose– a heaping tablespoon.  But I only use it when I skip a day or things are too hard.

Bottom-line: Calm magnesium citrate now can keep my gut going (although with diarrhea) through thick and thin. Before I changed my eating and lifestyle four years ago, high dose magnesium did not work. So the fact that it works is great! But I still want off of it entirely! I am currently down to about once a week.  So I guess, if you are a nickel and dime counter, we would call this 3 and 1/2 regular supplements—since I only have to take it as needed and this only about once a week now.

Closing

I am going to stop now.  I have LOTS more to say.  You will be so bored by the time I finish.  You’ll think I talk and think about nothing but moving GI tracts. But, finish I will.  Tenacity.  Get those parachute pants.

Terri

Click here for Slow Guts Need Care, the first post in this series.

 

Slow Guts Need Care

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“Colectomy rates for constipation are rising, are associated with significant morbidity and do not decrease resource utilisation, raising questions about the true benefit of surgery for slow transit constipation… (1)”

Whew!  From second chakras to acupuncture to triphala, I have been taking this alternative medicine front by storm to cure my slow gastrointestinal (GI) transit.  If all conventional medicine has to offer is a colectomy, then there is no shame in yoga and Squatty Potties.  Where do I stand?  Pretty good.  Pretty good.  Not yet cured.  Definitely have some ups and downs, but overall, my gut has totally reversed itself.  Knock on stinking wood.  Or incense sticks–or something–just so my gut doesn’t fall back again.  (Which those with this problem know is quite easily possible.)

Constipation isn’t talked about.  But it should be.  Colons are cut out because of it (seriously–see opening quote).  And people go to the ER for it (quite embarrassing, quite).  Not to mention hemorrhoids and anal fissures and horrible cramping (ouch).  Sometimes all it takes is simple diet maneuvers to get things back on track.  Other times, like in my case, it takes exploring your sanity and motivation.  (For the record, I am completely sane.  I ask my husband and friends every day.  Although I question some of my friends–so maybe you ought to wonder about me…Which brings me to the necessary disclaimer that this is only my story.  It is not medical advice.  You should absolutely discuss anything you try for your health with your doctor.  I am not your doctor.  I quit that jazz for Oz and its Munchkins.)

My History

I’m going to take a few posts to lay out what I do or have tried for my slow transit.  Let me briefly get you up to speed on my gut history.  I’ve had constipation all of my life.  As long as I can remember.  It worsened, just like the medical texts said it would, every decade of my life.  Until I was pooping once a month WITH Miralax, fiber, and a probiotic.  (Magnesium simply did not work at all.)  This was about age 35, and I had to start cranking on the stimulant medicines (which until this point I had only used as needed for the most part).  Not only was this ineffective, the high doses led to ouchy cramping.  I knew something else had to be done, so I turned to the halls of the internet clinic (because my doctors didn’t have any good answers for me–I mean, how could they?  I didn’t have any for myself!) after I quit working to homeschool my kids and I had “time.”

Now I must say, there have been three times, each lasting a mere few months, in my life where I have had what I feel are completely normal people bowel movements with little to no use of supplemental pills or powders. Once in my twenties after being treated for ulcer type symptoms with a PrevPac (involves amoxicillin and clarithromycin). Second time was two years ago just before getting pregnant.  Pregnancy and lactation proceeded to undo the hard-earned success I had achieved using diet, lifestyle changes, and focused supplementation. Finally, the third time I feel my gut has been reliable has been the last few months.  So, here I am with about daily Bristol 4 stools.  I’ll admit, I’m nervous going to bed each night, wondering, “Will I go tomorrow?”  Thinking the next day will be the beginning of the end of my GI success.  Unless you have a very bad problem with constipation, you may simply just not get this.   But I’m hoping if that’s you, I lost you at the first paragraph.

Getting to the Details

I have tried A LOT of stuff.  Since pregnancy and nursing, it has been focused on things that are safe to my baby.  I am still nursing, so I am still careful about what I try.  Let’s get started with more of my story.  There is a lot to write, and I will break it up.  If you have severe constipation and you expect a quick-fix, you may need to reset your expectations.

I am going to start with the supplements I take or have taken.  Some I don’t even take for the constipation, but I have to wonder about the role they play in my gut progress.  I only have room to cover vitamin K2 in this post.  MUCH more to come.  And, please, supplements really need to pass the approval of your doctor.

Vitamin K2

Briefly about:  Vitamin K2 is a relatively recent health-related discovery. It helps shuttle calcium where it’s supposed to go, whether we’re talking about shuttling it TO the bones or shuttling OUT of the heart blood vessels where it doesn’t belong. Getting enough vitamin K2 in our modern diet is tough for anyone because our meat, egg and dairy sources are not eating what they would eat if turned out of the pen. Vitamin K2 is present in the egg yolks of birds who eat worms, seeds, and other things they peck at in nature; the fat of grass-grazing animals; liver; and the milk-fat products of grass-grazing animals (butter and full-fat milk). It is also formed by bacterial action on milk-fat when cheese is being made or by bacterial action when natto (from soybeans) is being made. One last rich source is fish eggs. Vitamin K2 is a fat-soluble vitamin, and therefore likes to be in fat and is best absorbed when eaten with fat.

My story:  I started taking vitamin K2 because I realized with my dairy and egg intolerance, I was not getting any K2 to support my bones, blood vessels, and gums/teeth. (Vitamin K2 plays a large role in the structure and health of the oral region.) (Aside:  Vitamin K2 is supplemented in conventional chickens and so it is a source of vitamin K2; I strangely can’t eat chicken either.) I don’t know if vitamin K2 has helped my STC or not as an individual agent. However, it is a supplement I have taken daily for the last four months or so.

Is there research that may lend itself to the idea that vitamin K2 may be helping my gut move forward? I found an abstract in which bone morphogenetic protein 2 (BMP2) helped improve slow transit constipation. Vitamin K2 does impact BMP 2:

Mol Med Rep. 2015 Nov;12(5):6547-54. doi: 10.3892/mmr.2015.4297. Epub 2015 Sep 7. Bone morphogenetic protein 2 regulates the differentiation of nitrergic enteric neurons by modulating Smad1 signaling in slow transit constipation. Liu X1, Liu S2, Xu Y3, Liu X4, Sun D1.

 

And then here is a connection linking vitamin K2’s effect on BMP 2, a vitamin K dependent protein:

Oman Med J. 2014 May; 29(3): 172–177. doi: 10.5001/omj.2014.44PMCID: PMC4052396. Vitamin K Dependent Proteins and the Role of Vitamin K2 in the Modulation of Vascular Calcification: A Review. Margueritta S. El Asmar,1 Joseph J. Naoum,2 and Elias J. Arbid2,*

Bottom line for me: Vitamin K2 modulates BMP2. BMP2 may help slow transit constipation. MAYBE my vitamin K2 supplement is helping my slow transit. (Big question mark.)

Closing

Next post will have lots more.  It’s a long, long story.  Eat right.  Sleep right.  Look up the second chakra.  Love your gut.  Question your sanity.  Keep going.  🙂

Terri

 

 

  1.  Aliment Pharmacol Ther. 2015 Dec;42(11-12):1281-93. doi: 10.1111/apt.13415. Epub 2015 Oct 1. Colectomy for constipation: time trends and impact based on the US Nationwide Inpatient Sample, 1998-2011. Dudekula A1, Huftless S2, Bielefeldt K1,3.

Digestive Link Sharing

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Fall leavesThere are so many helpful, fascinating topics I really want to get a chance to read on and summarize for my blog posts.  Writing and explaining helps solidify the information in my mind and hopefully the summarized information helps some readers too.  Sadly, I just can’t keep up with all that I want to do in a timely fashion.  So today I’m going to share three links which have been shared with me that some readers may be interested in.  Eventually, I’d like to read and summarize on the methanogens and progesterone links.  But, honestly, I can see it may take me a year to do it.

Link ONE is about how certain microorganisms in the gut make methane which then slows the intestinal transit leading to chronic constipation.  This may lead to the idea that a breath test could be diagnostic and certain antibiotics helpful.

Methanogens in Human Health and Disease
http://www.nature.com/ajgsup/journal/v1/n1/full/ajgsup20126a.html

Link TWO is about the effect of progesterone and prostaglandins on women’s colons.  Women with chronic constipation and slow transit have been found to have abnormal levels of prostaglandins and cyclooxygenases in their colons.  When researchers applied progesterone to colon cells from women without constipation, they were able to bring about the abnormal levels seen in cells from constipated colons.  So there is clearly a role between progesterone, prostaglandins, and chronic constipation. 

Chronic constipation in women linked to prostaglandins
http://www.modernmedicine.com/modern-medicine/news/modernmedicine/welcome-modernmedicine/chronic-constipation-women-linked-prostag?page=full

Link THREE is about an online, digestive conference coming up.  It is free.  There are some good speakers involved who are on the cutting edge, or at least reading up on the cutting edge, of digestive health.  The speakers are from a wide variety of backgrounds, some MDs and some not.  Usually something like this is a good place to listen, generate ideas, and then verify ideas with research or run them by your doctor.

The Digestion Sessions
http://digestionsessions.com/

Closing

Information is key.  Help your doctor help you by learning the new information out there.  Your doctor is like a good coach.  They have strong knowledge and experiences, but they’re trying to orchestrate many, many players all day long.  There is no way on God’s great earth doctors can ever keep up on all of the new information.  Print off credible articles, highlight important information in it which you think applies to you, and then say, “Hey, Doc.  I found this article about my problem.  Could we try it for me or do you think it’s a bad idea?”

Thank you Ashwin, Nishka, and Toni for the links.  I can’t wait to delve into them more.

 

Terri

What Role Could Constipation Be Playing in Your Child’s Bed Wetting and Bowel Habits?

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Miralax (polyethylene glycol)Someone sent me a link, “What Every Parent Should Know About Bedwetting, Accidents, and Potty Training,” relating constipation to bedwetting, and I found it a good read.  Constipation is prevalent in our society, and kids are not exempt.  The author of the article is a physician, specifically a pediatric urologist, who deals with urinary issues in children day in and day out.  He feels that constipation–which can be difficult to diagnose in children because they leak liquid stool around hard, large impeding stools in the rectum, appearing to have diarrhea instead–is a leading cause of urinary problems in kids.  He also, like me, is frustrated at the medical community’s blasé “just take Miralax and eat fiber” treatment of constipation.

“Constipation is a distasteful subject. No one wants to talk about it.”

As distasteful as it is, constipation is a health condition that needs talked about.  Headaches.  Back aches.  Tooth aches.  Poop aches.

I had a child who used Miralax daily and still had constipation issues.  She would sit on the toilet screaming and crying for her “poop medicine” as I stood there trying to decide whether or not to torture her further with a suppository.  Traumatized by constipation issues, we decided to figure out what was causing constipation problems.  We eventually found that complete dairy elimination cured her constipation.   We next undertook a complete overhaul of our family’s diet, providing foods to help her GI tract recover a good barrier so the foods she ate wouldn’t cause her problems anymore.  Luckily we succeeded, and on the way we learned the importance of proper fuel and the devastation caused by improper fuels–and how each body is unique.

I believe, unlike my conventional medicine colleagues, that bowel habits are a good indicator of health.  Band-Aids won’t help a festering wound, and Miralax won’t really change chronic constipation.  Causes and good treatments for constipation and urinary issues should be sought.  Sometimes it’s as simple as feeding your kids real food. Or identifying a sensitivity to gluten or dairy, even minute quantities.  Or incorporating probiotics or probiotic foods.  Treatment may require more diligence with a bowel retraining program or an elimination diet.  But I am confident that constipation can be improved, especially in young children.

I encourage you to check out “What Every Parent Should Know About Bedwetting, Accidents, and Potty Training” written by Dr. Steve Hodges. Click on the blue texted excerpts below to go there.:

 

“Reality: Most children wet the bed because their rectums are clogged with poop. The hard, bulging poop mass presses against the bladder, compromising its capacity and irritating the nerves feeding it… The most rigorous studies ever conducted on childhood wetting were led by Sean O’Regan, a kidney specialist drawn to the topic because his 5-year-old son wet the bed every night. A test called anal manometry showed his son’s rectum was so stretched by stool that the boy couldn’t detect a tangerine-sized air balloon inflated in his bottom…

Ultimately, O’Regan’s Canadian research team tested several hundred children with enuresis, encopresis, and recurrent UTIs. Virtually all were, like O’Regan’s son, stuffed with poop. When their rectums were cleaned out with enemas, the wetting, soiling, and infections stopped… A couple years back, I tracked down Dr. O’Regan, now retired and living in Arizona. I asked him why he thought his research, compelling as it was, never made a splash.

He told me: ‘Constipation is a distasteful subject. No one wants to talk about it.'”

If you have kids who have urinary issues or constipation, check it out.

Nothing on my blog should be construed and used as medical advice.  But I do hope it makes you think and start asking questions.

Health to you and yours–

Terri

The Unglorious Call to Action

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IntestineThat is a personal problem.  Not a medical problem.

Here’s the poop.  No.  No.  I mean scoop.  My call to nutritional voodoo was, well, to say the least, not a glorious one.  Other nutritional blog hosts–oh such extraordinary, amazing recovery stories from horrible illnesses like multiple sclerosis and ulcerative colitis.  Motivating and inspiring us all to higher eating!  My issue–hmmm.  Right.  Not so inspiring.  Considered by the uninformed to be a personal problem, not a medical problem.  Ah, well.  Even if I arrived in Nutritional Nirvana via a clumsy fall on my derriere, I am here all the same.  My gut is working.  And the pursuit of that goal is pretty much what started this blog.

My History

I’m a 39 year-old female.  I have had chronic constipation all of my life.  Although not a common issue, I can remember twice in high school when I had horrible stomach cramps prompting me to head to the nurse’s office.  On the way, the visceral pain overcame me, and I passed out leaning against the lockers in the hall.  As a sixteen year-old girl I did not make the connection between constipation and these symptoms.  Neither did anyone else!  “You just need to eat more.”  Mmm-kay.  It never dawned on me that my gut was trying to move against a brick and it hurt!  I thought bricks were normal.  I mean, nobody talks about bowel movements at 16!  (I suppose I’m not supposed to talk about them ever.  But since I’m a medical doctor, no orifice or function makes me blush.)

Each decade, my GI function worsened, and I did finally realize in pharmacy school that my gut was abnormal.  The next ten years brought rounds of different fiber preparations (I can make darn tasty desserts with Metamucil wafers), docusate, milk of magnesia, magnesium supplements, suppositories, Miralax, yogurt, probiotics, prunes, shredded wheat (half a box a day), and finally, despite my attempts to only use them sparingly, daily stimulant laxative became required.  Mind you, even with those stimulant laxatives which were needed at doses which would kill a normal human being, my bowel movements still only occurred about every five to ten days and still were not easy to pass.  My gut was slowing down from slow to stop and becoming refractory to everything I knew to try.  I visited several doctors through the years and I always got the same answer:  more fiber and water.  Got a colonoscopy.  Pretty negative.  Got checked for low thyroid and celiac disease.  Negative.

I decided to think outside of the box and took to the wilderness of internet medicine.  Talk about crazy.  How do some of these people say these things without a license?  Guess I’m glad they can because it tipped me off in the right direction, and I embarked on the odd diet called GAPS (at least that founder has a medical license)–before I knew about Paleo which sounds way cooler than GAPS.  (Ha!  Ha!  I actually have landed on a diet which has no name but uses the templates of several diets.)  GAPS helped me identify food intolerances and taught me how to eat a nutrient dense diet.  It got my gut usually responding again to high dose magnesium (Natural Calm), but I don’t think high dose magnesium is good to take for the rest of my life.  So my endeavors persisted.  My goal is NO supplement for my constipation.  For myself, I try to use supplements as a bridge to achieve my health goals.  Once my health goal is achieved, I’d like to try to maintain it with food choices if I can.  However, I recognize there are conditions which will require lifelong dependence on medicines and/or supplements, not to mention declining content of certain nutrients in our food sources.

Achieving Success

This week I’ve lived large, taken a chance, and dropped the magnesium which sustained me through pregnancy.  My gut is working daily!  Back in November 2013, my gut was also working very well daily, and I was set to write this post back then.  I had started butyrate (butyric acid), and although it isn’t supposed to make it to the colon, it worked like a charm on my gut.  My GI tract moved daily and even my stupid food intolerances seemed diminished just in time for Thanksgiving.

But I hate supplements (please know that I do take some). I wanted to allow my body (I consider those bacteria in my gut to be part of my body.) to make its own butyrate, so  I tried to incorporate green bananas, green plantains, cold potatoes, occasional bites of raw potato and sweet potato, some legumes, and potato starch slurried up in water each night to get my own gut bacteria to make butyrate.  Things were going great.  Just great!  I was able to stop my butyrate and still have the same effects.  Wow.  Wow.  Wow.

Then, we were blessed with pregnancy.  Let me rephrase that.  We were blessed with a baby.  Pregnancy is no sleigh ride with jingle bells. (Increased constipation has always been in an issue in pregnancy.  This time was much better.  There was a time at about 14 weeks along where my gut completely stopped and nothing I did made it move.  I got worried, but after a couple of weeks, that lifted and magnesium helped again.)  However, I worked through all the food and supplement aversions and stomached magnesium, which I needed again every single day in excessive doses.  I bid “good-bye” to butyrate and resistant starch foods, which sounded disgusting during this time.  I delivered in July a beautiful, healthy girl.

About two weeks ago, I decided it was again time to get rid of that excessive magnesium and all that it was probably doing to my calcium balance.  Besides that, the magnesium didn’t always work daily.  I decided to take butyrate again and started incorporating resistant starch foods into my diet.  Would the experiment work for me again?  I was nervous since I had proclaimed success with butyrate in fall of 2013.  What if it failed?  I would have reported it, you know.  But I would have felt very stupid because I never want to lead anyone astray.  The experiment for me has successfully repeated itself.  Now all that needs to happen is to continue the resistant starch foods and see if I can taper myself off of the butyrate supplement.

Closing

So you see, mine is not the most glorious nutritional conversion story there is.  But it’s real.  It has convinced me that eating a nutrient dense diet, excluding inflammatory foods, and supporting the body’s bacterial flora is key to health and curing disease.  I am pretty much 100% convinced that this experiment would never have worked two and one-half years ago in the gut that I had then.  I’ve worked very hard and tried a lot of things to rehabilitate my broken colon.  In the next post, I am going to list what I feel has been most important for getting my gut peristalsis in working order.  I will report what worked for me.  Don’t assume that what works for me will work for you.  I want to make sure you seek the advice of your doctor; I don’t want you to overlook serious health conditions because you’ve given up on conventional medicine.  Don’t use my story as medical advice.  That it is not.  This is my story.

~~Terri
Photo credit:

Originally from en.wikipeida.  Author Dflock.  Now public domain.

Butyrate Series, Part 7

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Introduction:

We have made it to butyrate supplements.

Diet-wise, I follow the GAPS diet with modifications resembling a Paleo Diet/Autoimmune Paleo Diet –with some low carb stints thrown in to try to achieve my health goals.  I don’t have any lofty goals of looking like a runway model or movie star.  I’m still a little young to be much scared about cancer.  I don’t hang out with a fitness crowd to bring out my competitive inner edge.  My labs and ideal body weight have always checked out ideal.

I started the GAPS diet for exceptionally severe, idiopathic constipation and tweaked it here and there based on my research.  The symptoms I have changed include headaches, chronic allergy symptoms, fatigue, dry eyes, strange premature hot flashes, and I could go on.  My gut improved, but I still thought it could work better.  Several months ago, I started following some leads on nerve regeneration in the gut, and they lead me to butyrate.  I decided I would try an oral butyrate supplement, despite the researchers all saying a delayed release product was probably necessary.  If, by some chance, oral butyrate helped me, I would then focus on tweaking my diet some more to obtain butyrate naturally through food.  I was amazed when oral butyrate worked for me, particularly as I didn’t even choose a sustained release formulation.  If I stopped butyrate, my symptoms returned.  When I resumed it, my symptoms resolved.  So I’ve been working to try to increase forms of fiber and resistant starch that I tolerate–I’ve defined these in previous butyrate posts.

Ways I see to increase butyrate:

1. Eat foods with butyrate (butyrate-containing foods), like high fat dairy products such as butter. (Part 4)
2. Eat foods that your bacteria can make butyrate from (butyrate-producing foods), like fiber and
resistant starch.

3. Take butyrate supplements.
4. Take butyrate producing probiotics and prebiotics.

A bit about butyrate production.

Aside from the pharmaceutical industry, butyric acid is also used in the manufacture of plastics, varnishes, disinfectants, perfumes, and cosmetics. (Butyric acid and butyrate are interchangeable terms for our conversation.)  The American Food and Drug Administration has even approved it as an additive to food, beverages, and flavorings in the form of tributyrin. (1)  You’ll see more on tributyrin below.  (Humorous:  I also found it is used in fish bait: Carp Fishing Pellets.  Nice.)

The organic structure of butyrate is simple. It is just four connected carbons saturated with hydrogens with a carboxylic acid on the end of the chain. The manufacture of butyric acid is mainly from chemical synthesis using crude oil extracts. Crude oil extracts provide cheap, readily available ingredients. Butyrate can be extracted from butter, but the process is reportedly more difficult and expensive. Another way to obtain butyrate is through bacterial fermentation (the way we naturally get it from resistant starch and fiber in our colons). Bacteria are given the appropriate matter, and they ferment it to make butyrate. The fermentation method interests manufacturers because of the growing interest in “natural” sources for foodstuff. (1)  Butyric acid itself is a bit corrosive, and in supplements it will be found as a salt form.

My concerns with oral butyrate supplementation–and supplements in general.

My concerns with oral butyrate supplements are not unique to butyrate; they are the same concerns I have with supplements in general. Butyrate seems to have a pretty good track record. I mean, as I mentioned above, it’s even approved by the FDA for flavorings. But any time I take a supplement I ask myself a battery of questions. Could there be impurities, such as heavy metals? What is the proper dose? Does the supplement contain the amount of active ingredient it says it does? What if people take enormous amounts? Should there be a concern with unopposed supplementation? (What I am thinking of here pertains to “ratios.” For example the ideal ratio of calcium to magnesium supplementation. Or the ideal omega-3 to omega-6 ratio.) What are the side effects?

Butyrate seems pretty non-toxic as long as the manufacturer’s dosing guidelines are adhered to.  One study found that escalating doses in mice lead to kidney swelling– in humans the equivalent dose would be 7-8 grams in humans.  (2, 3)  To put it into perspective, the butyrate supplement I tried recommends a dose of up to 3.6 grams.  Another study specifically points out that in vitro, butyrate has positive effects until a certain point at which it has an opposite, detrimental effect:

“We conclude that the effect of butyrate on the intestinal barrier is paradoxical; i.e. whereas low concentrations of butyrate may be beneficial in promoting intestinal barrier function, excessive butyrate may induce severe intestinal epithelial cell apoptosis and disrupt intestinal barrier.” (4)

And finally, here is a nice toxicology report on butyric acid from the Environmental Protection Agency,  “Screening Information Data Sets” (SIDS). The report was accumulated for the SIDS Initial Assessment Meeting, referred to as the SIAM, in 2003.  It goes over just about anything you’d want to know about butyric acid, from its different uses to its stability in water to its effects on rats and their fetuses. For those interested in the toxicity profile as it at least relates to rats, scroll down a ways. It will talk about effects on male rats, female rats, pregnant rats, developing fetuses, chromosomes, etc. (5)

What are some commonly available butyrate supplements?

I Googled some supplements, and I will list those that I found. By listing them, I am not recommending any of them!  (Neither am I dis-recommending any of them.)  I’m simply listing in one spot just about all the supplements I could find and available consumer reviews.  If you think butyrate may be right for you, run it by your favorite healthcare provider. Maybe print off a couple of the studies I’ve linked to in my article and the EPA report above to help the provider understand toxicity, perhaps highlighting the sentences of interest to facilitate quick reading for them. I’m not in the situation to recommend anything, but I am happy to share my own personal experiences and research that I’ve come across.

Keep in mind the success of butyrate supplementation is going to vary from person to person. The pills will release their contents differently because of inter-individual differences in the pH of a person’s gut and transit time.  These supplements are salts, and the butyrate provided by these supplements will probably be absorbed very early in the GI tract, perhaps offering no benefit. There are other forms of butyrate used out there but not over the counter. I will mention them later.

P.S.:  Thank Amazon for the photos.  I didn’t realize the links came with photos.  Well, that saves you from my very bad drawings and “bubble-gum” photos.  (Sorry.  “Bubble-bum” is the word my dad used to describe the music I listened to as a kid.)   Rest assured this is still a hobby; I make no money from it.

• BodyBio/E-Lyte Butyrate 600 mg (Calcium/magnesium complex): This one has five reviews you can read on Amazon. The reviews revolve around fibromyalgia, collagenous colitis, excess ammonia, and multiple food sensitivities.

http://www.amazon.com/BodyBio-E-Lyte-Butyrate-600-caps/dp/B0016NHCGA/ref=pd_sbs_hpc_1

• BodyBio/E-Lyte 600 mg (Sodium Butyrate): This one also has five reviews on Amazon, around cancer, bipolar, substance addiction, and more nebulous issues. Quite interestingly enough, this also has medium chain triglycerides in it!

http://www.bodybio.com/main/products/sodiumbutyrate_qa.htm

http://www.amazon.com/BodyBio-E-Lyte-Sodium-Butyrate-caps/dp/B0058A9SF0/ref=pd_sbs_hpc_2

• BodyBio/E-Lyte 500 mg (Sodium-Potassium Butyrate): One review regarding autism.

http://www.amazon.com/BodyBio-E-Lyte-Sodium-Potassium-Butyrate-Capsules/dp/B0058A9SRI/ref=pd_sim_hpc_2

• Pharmax, Butyrate Complex: Three reviews. Constipation, yeast, and a nothing.

http://www.amazon.com/Pharmax-Butyrate-Complex-90-vcaps/dp/B0037V3WTA/ref=pd_sbs_hpc_3

• Nutricology/ Allergy Research Group ButyrAid: 5 reviews. IBS, dysbiosis.

http://www.amazon.com/Nutricology-Butyraid-Tablets-100-Count/dp/B0014TDVXE/ref=pd_sbs_hpc_4

• Cal-Mag Butyrate: 1 review. Leaky gut.

http://www.amazon.com/Ecological-Formulas-Cal-Mag-Butyrate-Capsules/dp/B003TV99EA/ref=pd_sbs_hpc_5

• T.E.Neesby – Butyrex Cal/Mag, 600 mg, Micro encapsulated design: Two reviews. GI related and insomnia.

http://www.amazon.com/T-E-Neesby-Butyrex-Cal-Mag-capsules/dp/B00014G70C/ref=pd_sbs_hpc_9

http://www.jigsawhealth.com/supplements/butyrex

• Butyren, Allergy Research (Nutricology): “ButyrEn, from Allergy Research Group, is an enteric-coated tablet of the calcium and magnesium salts of butyric acid, providing 815 mg of butyrate and 100 mg of both calcium and magnesium…the enteric coating is designed to provide delayed release in the intestinal tract.” Two reviews which don’t offer much.

http://www.amazon.com/Allergy-Research-Nutricology-Butyren-tablets/dp/B00014FOCY/ref=pd_sbs_hpc_11

• BioCare Butyric acid complex (magnesium and calcium): No reviews.

http://www.biocare.co.uk/default.aspx?GroupGuid=29&ProductGuid=11890

• Digestix: Two fair reviews.

http://www.pinnaclebio.com/products/digestix-%E2%80%93-calcium/magnesium-butyrate/

Forms of butyrate not available over the counter, per se:

Tributyrin:

In many butyrate research studies, tributyrin is used. Isn’t it fascinating that it is tributyrin which naturally occurs in butter? (6) Tributyrin serves as a delayed-release source of butyrate, and hence achieves more sustained plasma levels. It is made of a glycerol backbone with three butyrate molecules attached.  However, even still, it is absorbed before the colon:

“Oral tributyrin (glycerol tributyrate) is absorbed in the small intestine and at high doses increases free butyrate concentration in peripheral plasma for up to 4 h. However, the hepatic uptake of intestinal butyrate is known to be almost complete, suggesting that systemic delivery of butyrate to the colon would be limited.” (7)

Tributyrin has been used in many studies including, but in no way limited to, cancer studies, metabolic studies, and neurological disease studies.  Oncologists were hopeful that it could achieve the cancer-slowing benefits in vivo as is seen with butyrate in vitro; about 20% of cancer patients achieved long-term disease stabilization when receiving 200 mg/kg 3 times daily in a pilot trial. In diabetes and obesity, reports suggest tributyrin has the ability to suppress the induction of obesity and insulin resistance in mice fed a high-fat diet. Researchers speculate there may be an impact of tributyrin on the cognitive function of patients with early Alzheimer’s disease, although they express concerns:

“From the standpoint of practicality, however, it would be necessary to incorporate tributyrin into a functional food, as it would not be feasible to require the ingestion of many dozens of capsules daily.”  (3)

Phenylbutyrate:

Phenylbutyrate is an “orphan” drug used in rare conditions. What in the heck is an orphan drug?  An orphan drug is one that has been pushed through the typical drug approval process usually because the disease it treats is so rare. Phenylbutyrate has activity similar to butyrate (induction of apoptosis and histone acetylation) and is used for urea cycle disorders. I have listed it here as its actions seem similar to butyrate, and if one is exploring butyrate, they can also pursue study of phenylbutyrate. (8)

Butyrylated Starch:

Some studies have started using high amylase corn starch with butyrate attached.  You’ve seen high amylase corn starch mentioned in this series before when I discussed resistant starch. (7, 9)  Potentially, they’d like to consider adding butyrylated starches to food products to promote health.  (Darn it, folks.  Why do we keep letting ourselves be manipulated this way?  Instead of a cheap study looking at the safety or toxicity of raw potato to deliver resistant starch to the colon to bolster butyrate production and butyrate promoting bacteria, they’re coming up with more ways to modify your food source.  Why can’t we get it together?  When is enough enough?  Stop eating processed foods.  Even gluten-free ones.)

Enemas:

These may be helpful in ulcerative colitis. Research results are mixed.  The one formulation I found pre-prepared had been discontinued.  I read some forums, but I couldn’t really find any strong leads here.  It seems that to get these, you have to take your prescription to a pharmacy which compounds (makes) them specially for you. The smell and delivery mechanism are undesirable I read–not to mention the exposure time of the colon epithelium to butyrate will be brief.  If you have anything to leave in the comments regarding these, some Googlers may find it helpful in the future.

Conclusion:

Thanks for reading.  I’m sorry this has taken so long to prepare.  I hate that I pretty much came to a halt on a series.  I’m in my first trimester of pregnancy.  I’m not a very pleasant pregnant person.  Give me a baby.  Give me a kid.  Don’t give me pregnancy or a toddler.  (Joke.)

The next Butryate Series post will revolve around using probiotics to increase butyrate in the gut.  But I may have to write some “bubble-gum” posts in the meantime, if I can even type up anything at all.  I’m about shot.  Please point out typos and mis-information, please.  I appreciate it.  ~~Terri

Sources:  There are some interesting sources today.  Read and scrutinize carefully.

1.  Acetate adaptation of clostridia tyrobutyricum for improved fermentation production of butyrate.  Adam M Jaros, Ulrika Rova and Kris A Berglund.  2013.  SpringerPlus 2013, 2:47.  http://www.springerplus.com/content/2/1/47

2. Minamiyama M, Katsuno M, Adachi H et al. Sodium butyrate ameliorates phenotypic expression in a transgenic mouse model of spinal and bulbar muscular atrophy.  Hum Mol Genet 2004 June 1;13(11):1183-92.  http://hmg.oxfordjournals.org/content/13/11/1183.long

3.  Tributyrin May Have Practical Potential for Improving Cognition in Early Alzheimer’s Disease Via Inhibition of HDAC2.  Mark F. McCarty.  March 2013.  Catalytic Longevity.

http://catalyticlongevity.org/

http://catalyticlongevity.org/prepub_archive/Tributyrin-AD.pdf

4.  Effects of Butyrate on Intestinal Barrier Function in a Caco-2 Cell Monolayer Model of Intestinal Barrier.  Peng, He, Chen, Holzman, and Lin.  Pediatric Research (2007) 61, 37–41.  http://www.nature.com/pr/journal/v61/n1/full/pr20079a.html

5.  SIDS Initial Assessment Report.  For 16th SIAM.  May, 2003.  http://www.epa.gov/hpvis/hazchar/Category_ButylSeriesMetabolic_HC_SIAR_0108_Interim.pdf

6.  http://en.wikipedia.org/wiki/Butyrin

7.  Butyrate delivered by butyrylated starch increases distal colonic epithelial apoptosis in carcinogen-treated rats.  Clark et al.  Carcinogenesis. 2012 January; 33(1): 197–202.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276328/

8.  A Phase I Clinical and Pharmacological Evaluation of Sodium Phenylbutyrate on an 120-h Infusion Schedule.  Carducci, Gilbert, et al.  Clin Cancer Res.  October 2001.  7;3047.   http://clincancerres.aacrjournals.org/content/7/10/3047.full

9.  Butyrylated starch increases colonic butyrate concentration but has limited effects on immunity in healthy physically active individuals.  West et al.  2013.  EIR.  102-119.

Related articles

Butyrate Series, Part 6

51 Replies

We’re working our way through butyrate and the foods that increase butyrate in the body.  We are on resistant starch today.  It’s a doozy.  [“Doozy” probably comes from the nickname (“Duesy”) for a kind of car called a Duesenberg.  It was a supreme, luxury car made in my home state of Indiana, in a tiny farming town called Auburn, north of Fort Wayne.  Each Labor Day weekend they host a huge car auction called the Auburn Cord Duesenberg Festival.]

Don’t be afraid to let your diet be unique.

Getting butyrate and short chain fatty acids in the gut seems pretty important, and there a few dietary Cute orange snackways to go about getting it.  No one way will work for every single person.  You must recognize absolutely how unique and special you are.  (Is this chick for real?)  Seriously, I do think you’re probably pretty special, but I am talking about nutrition here.  What makes one diet suitable for one person and detrimental to another?  (Why can’t I eat ice cream?  Whaaa-whaaa.)

  • Your genetics:  Yes.  Absolutely.  The genes we have will determine how well we can digest certain foods!  If your long ago ancestors are from an area who relied traditionally on more starches, you have more genes to make amylase (the starch break-down enzyme) and more amylase in your spit. (1)  Native Japanese people have genes to metabolize seaweed that people of European descent don’t.  (Ha!  For those who don’t like the flavor of seaweed, more power to ’em, eh?) (2)  But, ice cream.  Mmmm.  Does ice cream make you bloat?  Blame your genes’ inability to make lactase for you to break down the sugar in milk.  (3) And your mix of genes will be different than your sister’s or cousin’s.
  • Your gut bacteria.  With the trillions (edited post-writing) of bacteria in your body, you’re bound to be one-of-a-kind.  Some people will have more of one type of bacteria helping them eat than another kind.  I hope over the butyrate series you have come to see bacteria as an integral part of you, your diet, and your health.  Your bacteria will affect what you can comfortably eat or what happens when you eat it.  If the bugs you happen to have are strains that make lots of methane with cellulose, then cellulose may not be your friend.  Your bugs may do better with resistant starch. If you have significant overgrowths of putrefactive bacteria that make more toxic metabolites, maybe you’re at higher risk for disease from a high protein diet. (4) (5)  (Studies show, however, that diet can modify levels of bacteria.  So all is not lost!)
  • Your individual function:  We all have our own unique pathology.  FODMAPS, SIBO, slow transit, food intolerances, and glucose intolerance just to name a few.  If your small intestine is really bad at absorbing the sugars and sugar alcohols from foods (like in FODMAPS),  you’re going to have to watch and keep a food diary to figure out which vegetables and fruits you can tolerate.  If green bananas make you itch, you have to find another source for resistant starch.

Bottom line?  Short chain fatty acids and butyrate are pretty darn important for the gut and body.  Find a way to make your diet compatible with getting them.  You have several options.  For nearly any specialized diet, there is usually something you can tolerate to help boost needed nutrients.

Ok.  Rant over– resistant starch to boost short chain fatty acid and butyrate production.  This is going to be dry, dry, dry and long, long, long.  I thought about dividing it up, but I wanted all the resistant starch stuff on one page, not several.  And I figure those who actually read it are people really looking to learn about it– so they’ll like it on one page.  By the way, Merry Christmas-time.  I hope you are having a beautiful month.  May you be filled with joy and peace now and forever.

Is that a healthy diet?

What healthy diet removes beans, legumes, grains and potatoes?  When I began my food journey two years ago, I was SHOCKED to see grains and potatoes removed from many diets like Paleo, SCD, GAPS, Primal, and Whole30.  (Were you shocked when you started?) However, after much research, I decided there was no harm in removing them as I tried to treat my GI health problems.  I mean, my vegetable intake skyrocketed in compensation!  Now, though, my GI issues have plateaued, and I have been on the prowl again to see what else can be done.  I am tracking butyrate- producing foods.  In this series, I have covered dairy products, fermented foods, fiber, and now we are hitting resistant starch.

Resistant starch from foods makes it past the small intestine’s digestive process to enter the colon, where bacteria can ferment (“eat it”) it to make short chain fatty acids and butyrate as a result.  Great!  Resistant starch is a popular topic in health spheres now.  It has several possible health benefits.  Do you see anything which could help you?

  • Improved blood sugar control and insulin response to food.  Implications for diabetes, pre-diabetes, and metabolic syndrome.
  • Improved bowel health.  Implications for colon cancer, ulcerative colitis, Crohn’s Disease, diverticulitis, and constipation.
  • Improved cholesterol.  Implications for heart disease, high cholesterol, and metabolic syndrome.
  • Prebiotic to help stimulate the growth of “good” bacterial colonies in the colon.
  • Control of hunger and reduction of calories eaten.  Implications in obesity.
  • Increased micronutrient absorption.  Implications in overall mineral absorption for all and also in osteoporosis.
  • Thermogenesis.  Implications in diabetes and obesity.
  • Synergistic interactions with other dietary components, e.g. dietary fibres, proteins, lipids.  Implications for improvement of bowel health. (6)

Backtrack a second.  Working through the ways to Apples with almond butterpotentially increase butyrate:

The four ways to increase butyrate (as I see it) that I am working through:

  • Eat butyrate-containing foods.  (An aside:  I found something that said there was a form of butyric acid in butter AND honey!  The form is tributyrin, a form of butyric acid which is actually used in research studies to help the butyric acid not have such a short half-life.  No quantities listed in the abstract.  Isn’t that amazing?  Whole foods really can provide for us!) (7) 
  • Eat butyrate-producing foods like fiber and resistant starch.  (This is where we’re at in the series.)
  • Take butyrate supplements.
  • Take probiotics which contain bacteria known to make butyrate.

OK.  Back to resistant starch.  I know, some of you try not to eat starches.  So what is the difference between starch and resistant starch?  (Chemistry-wise, not much!  Actions in the body, HUGE!) 

What is starch?  Starch is plant carbohydrate.  A plant uses starch as a storage form for energy.  Starch is high in things like potatoes, corn, rice, other grains, and beans.  When we eat starch, it is usually completely broken down and absorbed in the small intestine by our amylase and other enzymes.  You know the rest– glucose, insulin, and calories.

Let’s talk a minute about the structure of starch because structure is going to help explain what makes starch resistant.  Starch is made up of two molecules, amylose and amylopectin.  Both molecules are simply made up of many glucose molecules hooked together—just hooked in different ways.  Amylose has many glucoses strung together in a tight, compact linear fashion.  Amylopectin has glucoses strung together in branching chains, forming a large structure.  Depending on the food/plant starch in question, these two players come together in different ratios and shapes.  They connect with each other through hydrogen bonding and form crystalline granules (an important point here in a bit) of varying sizes.  The crystalline granules are an effective way for the plant to store starch.  We have an enzyme called amylase, which works in the small intestine, and it is most often able to break apart the bonds of starch to make simple sugars which are easily absorbed.  (8, 9)

What is resistant starch?  Same stuff as starch!!!!  It’s just that for one reason or another (which we will talk about), it defies digestion by the small intestine and its amylase enzyme.  It moves into the colon and feeds bacteria, thus producing short chain fatty acids and butyrate.  Yeah!

How would the same stuff as plain, old starch do that?  We will look at that in minute.  First let’s mention the kinds of foods that have resistant starch.

What foods have resistant starch?

Obviously, starchy foods will have resistant starch, but how much resistant starch a food has– well, it willYellow pepper for Y keep your head moving like one of those darn, tiny bouncy balls your kids like to throw around.  Understanding resistant starch content is nearly insane.  So I’m going to list some examples of resistant starch values, but you have to keep reading to understand how truly variable and FICKLE resistant starch is.  For example, IT IS NOT ENOUGH TO SAY THAT A BANANA HAS LOTS OF RESISTANT STARCH—because sometimes it doesn’t!  I started to put together a nice table of resistant starch values.  I had research articles all over the schoolroom desk; I knew it was going to be a citation mess.  Every source had different values for resistant starch content and often even for the same food.  I decided making a chart was clearly was not a good time investment.  (Where do you want to invest your time?)  So here are some sources with lists of resistant starch contents for you to look over.  For your information, some sources suggest at least 20 grams of resistant starch daily; others suggest more.

Free the Animal.  Resistant Starch in Foods.  (Man.  What diligence.  Kudos.  This is what my table would have looked like.  He did a great job, and I’m grateful for his work!  This is a link to a PDF file which is featured on the blog.) (12)

An in vitro method, based on chewing, to predict resistant starch content in foods allows parallel determination of potentially available starch and dietary fiber  (10)

The Resistant Starch Report.  An Australian update on health benefits, measurement and dietary intakes.  (11)

Bananas (11)
8.5 grams/100 grams          Raw green, medium-size
2.4-5.4 grams/100 grams    Ripe, medium-size
Potatoes (10)
12.2 grams/100 grams        Boiled and stored at  5 degrees C –41 degrees F–fridge temperature
3.7 grams/100 grams          Boiled and not cooled
50 grams per pound           (Saw it on the internet gossip, but I need a legitimate source)  (About 97% of the starch in raw potato is resistant.)
1.3 grams/100 grams         Baked
Sweet potatoes (11)
1.1-2.1 grams                       Cooked
Raw  About 98% of the raw starch is resistant.  (Need source)
Plantains (12)
3.5 grams/100grams          Cooked
Raw much, much higher    (Need source)
Beans, white, boiled (10)
16.5 g/100 grams
Lentils, red, boiled (10)
13.83 g/100 grams
Chickpeas (11) 
6.6 g/100 grams
Nuts
Oats (12)
0.2 g/100grams                  Cooked
7.8 grams/100 grams        Raw
Pasta
1.4 grams/100 grams        Cooked whole wheat pasta (valemaisalimentos.com)
2.9 grams/100 grams        Boiled 9 minutes  (C)
Rice (11) (13)
3.1 grams/100grams         White, cooked
1.6 grams per 1/2 cup      Brown, cooked

The amount of resistant starch a food has will vary.  It will vary by the TYPE of resistant starch, the food source of the resistant starch, the food preparation, and many other factors I will try to point out.

There are four types of resistant starch RS:  Resistant starch type 1 (RS 1), resistant starch type 2 (RS 2), resistant starch type 3 (RS 3), and resistant starch type 4 (RS 4).

  • RS 1 is in seeds, legumes, and whole grains.  The starch is resistant because of the physical seed coat around the starch.  (Grinding and milling will decrease the amount of resistant starch.  Based on this, a wheat kernel has more resisant starch than ground flour.  Even chewing your food well decreases RS!)
  • RS 2 is in uncooked foods like potato, green banana, green plantains, sweet potato, cassava, yam, some legumes and high amylase corn.  The natural, raw shape of the starch granules in these particular plants does not allow our digestive enzymes to get in and break down the starch. (5)
  • RS 3 is in cooked and cooled starches, such as legumes, bread, cornflakes, potatoes, pasta salad or sushi rice. The starch when cooked becomes highly absorbable starch, but when it cools it forms a crystalline structure that won’t let enzymes in so it becomes resistant starch.  This is called retrogradation.  I will talk more about this below.
  • RS 4 is chemically modified starch and is not naturally found in nature.  It is often found in processed foods, but we don’t know if it acts the same as natural RS or not.  (So why are they putting it in our foods?  And why do people not care?  Ignorance is bliss.  But not really.) (6)

Both the plant species and the plant variety affects resistant starch content:  Bananas overall have more resistant starch than most rice.  Beans usually have more resistant starch than potatoes.  Within a species, long grain rice has more RS than short grain rice.  (14)  Jasmine rice has less RS than long grain rice varieties.  High amylose maize (corn) has been bred to have higher resistant starch than other corn.

Preparation method changes content of RS:  Long grain rice prepared in a pressure cooker has less RS than when prepared in a traditional rice cooker.  Baked potato has less resistant starch than potato salad.  Heated and cooled, heated and cooled, heated and cooled potato has more resistant starch than just potato that has been heated and cooled one time only.

Cooking at all changes RS:  Raw potato has immense amounts of RS.  Mashed potatoes have immensely less.

Foods can have more than one kind of resistant starch:  Potatoes have RS 2 when raw and RS 3 when cooked and cooled.

Ripeness decreases RS:  A green banana has great amounts of RS.  Ripe bananas have lots less.

Chewing decreases RS:  What are you going to do about this one?  LOL.  I think this is a great example of how you can find good in just about everything!  If you don’t chew well, you can get more resistant starch!

Remember how I mentioned amylose and amylopectin above?  In part, their association together will help determine how much RS there is:

  • Amylose and amylopectin come together in different ratios (maybe 20:80 or 40 :60 or 25:75) and will be different between species of plants and different varieties of the same plant, as I already mentioned.  The more amylose there is, the more resistant.  (5)  In fact, there’s this processed stuff called High Amylose Maize Starch that was bred to have high amylose.  It has great amounts of resistant starch.  1 tablespoon has 4.5 grams of resistant starch.  (13) Amylose takes higher heats to gelatinize so it is more resistant.  (When it gelatinizes, the body can digest it easier.)
  • Chain length of the amylose and amylopectin molecules will affect resistant starch content.
  • Size of the crystalline granules will affect resistant starch content. (15)

Non-starch components may affect the amount of resistant starch.  Amylase (our digestive enzyme) can bind with fats, and then change the breakdown of the starch.  If the amylase is all bound up, it’s not available to digest all of the starch.  Some plants come included with their own amylase inhibitors so we digest them less, allowing more RS to the colon.  Phosphorus can bind to the starch and make it more resistant.

Biological factors (such as transit time and menstrual cycles) can affect the digestion of starch. (6)

Yes.  Resistant starch values for any given food Water kefir with grape juicevaries dramatically. 

So when you look at different tables for resistant starch, you will see all kinds of different numbers.  The resistant starch values will be all over the place.  I know you don’t like it.  It’s just the way it is.  Nobody in life can give you an answer.  We just have to do the best we can.  God didn’t say, “Here.  Eat resistant starch.”  He gave you fresh vegetables, fruits, tubers, and yes, even grains.  And thankfully, He gave me a fridge to cool my tubers.

Why in the world does cooling change the amount of resistant starch?

When typical starch is heated, it becomes quite absorbable.  When it is cooled, it can form resistant starch and then not be absorbable.  This is termed retrograded starch or resistant starch type 3 or RS 3.  How does this happen?

Putting the starch in water and heating it allows the crystalline structure of the starch granules (made up of amylose and amylopectin) to swell.  Water can get into the starch granules, but it can’t break them apart because of hydrogen bonding between amylose and amylopectin.  The starch gelatinizes and swells.  With the swelling comes increased ease of getting amylase into the starch to break down the bonds holding it together.  So hot, cooked starch is easier to digest.

As the hot starch cools, its structure starts tightening back up and recrystallizing, becoming more like it was before water and heat was affected it.  Amylase can no longer get in to break the starch down into absorbable sugars.

The higher the amylose content, the more heat that is needed to gelatinize the starch.  Things with more amylose, such as high amylose corn starch, have more resistant starch.  In one study, high amylose corn starch showed an increase in butyrate formation, whereas low amylose corn starch did not. (15) (16) (5)

People often wonder why it matters if it’s cooled since when it is eaten it heats back up in our bodies.  I read that the answer to that is that it takes more heat than the temperature of your body to overcome the retrogradation.

Who might shy away from resistant starch?

SIBO people?  People with small intestinal bowel overgrowth (SIBO) may have problems with resistant starch.  (SIBO is a disorder which contributes to bloating, constipation, diarrhea, and stomach pain.  It occurs when bacteria inappropriately colonize the small intestine.)  I have seen the argument made that gastroesophageal reflux (GERD), SIBO, and some other GI disorders may be made worse by resistant starch.  Increasing the food supply for the bacteria that are inappropriately growing in the small intestine doesn’t seem like it would be helpful.  I can definitely understand this thought process.  However, on the other hand, production of SCFA has been found to increase the motility of the gut and make the environment more acidic.  These two mechanisms sound helpful!  Everything is an equilibrium.  Nobody right now knows the answer.  This is where you drag out a pen and a calendar, and you diligently journal what you eat and your symptoms and stop waiting to be told what to do.

FODMAP people?  One would think that FODMAP issues might actually do okay with resistant starch if there is no SIBO to go along and complicate the condition.  The gases usually made by the bacteria from FODMAP ingredients are not formed from resistant starch:  “However, RS [resistant starch] is believed to result in only a modest production of these gases [carbon dioxide, methane, hydrogen] compared with other non-digestible oligosaccharides, fructo-oligosaccharides and lactulose.” (6)  Potato, sweet potato, and rice are often well tolerated in those with FODMAP issues–although I read that sweet potato has mannitol which may cause some people problems.  (Sorry, no source.)

Diabetics:  They say that diabetics’ blood sugars will be fine on resistant starch and may even improve!  This seems like it would be quite variable and a diabetic should watch very closely.  (19)

Flatulence:  Excess gas.  Anecdotal evidence points out that there is excess gas as a person starts increasing their resistant starch.  The anecdotes say that it usually resolves in the first week at a stable dose.

Last tidbits with no good place to fit in above butFruit kabobs I want you to hear about:

Will resistant starch make me fat?  Resistant starch reportedly helps with the feeling of being full–so you’re not so hungry!  However, if it is metabolized by your bacteria, it does have calories (short chain fatty acids are made and absorbed).  Typical starch that is absorbed up in the small intestine supplies 4.2 calories per gram.  Apparently, resistant starch produces 2 calories per gram.  (6)  Want an anecdote?  I started potato starch as a resistant starch.  I stir one tablespoon in water twice a day.  I can honestly say that I’m not very hungry.  Of course, there could be a million and one other reasons for that.

Did you know we have a drug that makes starch resistant?  Acarbose is a diabetic drug.  It inhibits amylase and so increases the amount of resistant starch and also increases oligosaccharides.  It has been found to increase SCFA in the colon (but with side effects of bloating, diarrhea, stomach pain, etc).  (17)

Resistant starch versus non-starch polysaccharides (see last post for explanation) in butyrate production:  RS seems to do a better job than other carbohydrates at producing butyrate. Resistant starch acts as a prebiotic, raising the numbers of lactobacilli and bifidobacteria. (5)

Resistant starch diet helps increase the neurons that promote motility:  “After 14 days of RSD [resistant starch diet], the neurochemical phenotype of myenteric neurons of rats showed a significant increase of 35% in the proportion of ChAT-IR neurons complared with animals fed with the SD [standard diet]…As expected, RSD was associated with a significant increase in colonic concentration of butyrate compared with SD [standard diet].”   (18)  What is this saying?  On a resistant starch diet, the proportion of acetylcholine neurons increased!  Acetylcholine neurons play a large role in GI peristalsis and bowel movements.  Also, my friend butyrate, was found at increased concentrations.

Which form of resistant starch produces more butyrate?  This really seems to land you all over the place, trying to characterize all the different starch types and food types and how they each have a different effect.  Crazy.  Anyhow, RS 2 from raw potato starch is reported to increase the concentration of butyrate in humans and rats while RS 3 is reported to increase the concentration of acetate in pigs, but not in humans.  (5)

Great related reading:

I’m not saying I agree with all that is said.  I just like to see ALL that I can out there so I can think about how it applies to my body.  Does benefit outweigh risk in trying something?  Am I willing to accept that what somebody suggests could set me back significantly?  Does what they’re saying make sense in the context of what I know about physiology and biochemistry (which is NEVER enough!).

Free the Animal has about a million resistant starch posts, including posts on specific conditions (like SIBO, FODMAPS, high blood sugars, etc.)  This is really the place to go to read about resistant starch, although they have quite an enthusiastic stance.  I’m pretty excited, too, but I try to temper my excitement.  Nothing is a cure-all.  I haven’t had success coming off of butyrate with an increase in resistant starch using green bananas and Bob’s Red Mill Potato Starch (yet).

Animal Pharm:  HOW TO CURE SIBO, Small Intestinal Bowel Overgrowth:  Step #2 Eat Resistant-Starch-Rich Tubers, Grains, Legumes and Pulses (Guest Post: Tim/TATER)

Digestive Health Institute:  Resistant Starch–Friend or Foe

Done:

Please take good care.  Don’t be overwhelmed.  Track your symptoms.  Be patient with changes.  Don’t get frustrated.  Read.  Weigh benefits and risks.  Don’t flit from diet to diet to diet.  Pick a system, stick with it awhile, and then implement tweaks slowly and methodically.  Where you are at NOW does not reflect where you have to stay FOREVER!!!!!

As always, I need typos pointed out and faulty links.  I do the best I can, but this is a simply a hobby of putting together my findings for others to read.

Terri

Part 7

Sources:

  1. Diet and the evolution of human amylase gene copy number variation.  Perry, Dominy, Claw, et al.  Nature Genetics 39, 1256 – 1260 (2007) Published online: 9 September 2007.  (Link)

  2. Transfer of carbohydrate-active enzymes from marine bacteria to Japanese gut microbiota.  Hehemann, Correc, Barbeyron, et al.  Nature 464, 908-912 (8 April 2010). (Link)

  3. Archaeology:  The milk revolution.  Curry, Andrew.  Nature.  July 2013. (Link)

  4. Dominant and diet-responsive groups of bacteria within the human colonic microbiota.  Walker, Ince, Duncan, et al.  The ISME Journal (2011) 5, 220–230.  (Link)

  5. Starches, resistant starches, the gut microflora and human health.  Bird, Brown, and Topping.  Current Issues in Intestinal Microbiology.  2000.  1(1):  25-37.  (Link)

  6. Health properties of resistant starch.  Nugent, AP.  Nutrition Bulletin.  March 2005.  30 (1): 27-54.  (Link)

  7. (Abstract.)  Anticarcinogenic actions of tributyrin, a butyric acid prodrug.  Heidor, Ortega, de Conti, et al.  Curr Drug Targets.  December 2012.  13(14):1720-9. (Link to abstract.)
  8. http://www1.lsbu.ac.uk/water/hysta.html
  9. The synthesis of the starch molecule.  Smith, Denyer, et al.  Plant Carbohydrate Biochemistry.  1999.  Chapter 7.
  10. An in vitro method, based on chewing, to predict resistant starch content in foods allow parallel determination of potentially available starch and dietary fiber.  Akerberg, Liljeberg, et al.  The Journal of Nutrition.  1998.  128 (3): 651-660.  (Link)
  11. The Resistant Starch Report.  An Australian Update on health benefits, measurement, and daily intakes.  Landon, Colyer, and Salman.  Food Australia Supplement. 2012.    (Link)
  12. Link to a PDF file on Free the Animal blog listing resistant starch content:  http://freetheanimal.com/wp-content/uploads/2013/08/Resistant-Starch-in-Foods.pdf
  13. Natural Hi-Maize Starch website:  “Double Resistant Starch Intake.”  http://www.resistantstarch.com/NR/rdonlyres/DE2ADBB0-FF7D-40A7-B409-03493FEFFDFA/4601/Foodswithresistantstarch_LR.pdf

  14. Effect of variety and cooking method on resistant starch content of white rice and subsequent postprandial glucose response and appetite in humans.  Yu-Ting Chiu, Maria L Stewart. Asia Pac J Clin Nutr 2013;22 (3):372-379.  (Link)

  15. Understanding Starch Functionality.  Scott Hegenbart. Food Product Design.  January 1996. (Link)

  16. Butyrylated starch increases colonic butyrate concentration but has limited effects on immunity in healthy physically active individuals.  West, Shristophersen, et al. Exerc Immun Review.  2013.  19: 102-119.  (Link)

  17. Abstract for Effects of acarbose on fecal nutrients, colonic pH, and short-chain fatty acids and rectal proliferative indices.  Holt et al.  Metabolism.  1996.  Sep;45(9):1179-87.  (Link)

  18. Short-chain fatty acids regulate the enteric neurons adn control gastrointestinal motility in rats.  Gastroenterology.  May 2010.  138(5):1772-82. (Link)

  19. Consumption of both resistant starch and b-glucan improves postprandial plasma glucose and insulin in women.  Behall, Scholfield, et al.  Diabetes Care.  May 2006.  29(5): 976-981.  (Link)

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Butyrate Series, Part 5

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It’s only voodoo until you understand the sense (science) behind it…so what’s the sense for fiber?

Introduction:

Part 4 of the Butyrate Series summarized naturally occurring sources of butyrate in food.  Today’s post explains another source of butyrate in the diet: fiber. (More correctly, fiber is a source for our colon’s bacteria to make butyrate for us.) Today we will cover:

  • What fiber is
  • Different kinds of fiber
  • Fermentability of different kinds of fiber
  • Which fibers bring about butyrate

(And if you think this sounds boring, you are probably quite right.)

There is a book out there called Fiber Menace by Konstantin Monastyrsky which demotes fiber.  I’ve not read it, but I’d have to say in my former Caterpillarseating life, I tried adding in high amounts of fiber: peas, hummus, beans, lentils, Shredded Wheat Cereal, Grape Nuts Cereal, Metamucil, and Fiber Con. I always swore in my head that this fiber did nothing but make my GI symptoms worse; however, this seemed like an insane fragment of my overactive imagination until 2011. In 2011, I read a little blurb in my American Family Physician journal about fiber not helping slow transit constipation and then found sources stating fiber may actually worsen slow transit constipation.  From a World Journal of Gastroenterology article:  “Muller-Lissner emphasized that a diet poor in fiber should not be assumed to be the cause of chronic constipation. In contrast, they found that many patients with severe constipation deteriorated when dietary fiber intake was increased.” (1)  Hmmm. Is that right?

In the past, I’ve tried high fiber and I’ve tried low fiber; I didn’t know what to think. Guess I still really don’t. Today, studies say that fiber helps this or that. Tomorrow they will say that it doesn’t. Depends on the wind. But considering how important short chain fatty acids (including butyrate) are, I’m thinking fiber may be pretty helpful, but not in the way I was trained to think.  It has nothing to do with the bulk or the drawing of water into the gut.  It has to do with good bacteria, what they like to eat, and what they make for me when they eat.  So for myself, in order to increase my butyrate naturally, I will keep vegetables and some fruit a priority.  I will watch my symptoms closely and adjust as indicated.

What I want you to know (because the rest of this post is like broccoli with no dip—pretty dry):

  • “Fiber” is an oversimplified, generic word for a hodge-podge of substances from plants. The words soluble and insoluble do not even come close to explaining the types of fiber.
  • Fiber is basically carbohydrates that humans cannot digest. There are many kinds of fiber which get “eaten” by the bacteria in different amounts and at different rates in our colon.  (More below.)
  • Some fiber, like cellulose (think of the stems of broccoli and the peel of an apple), gets fermented very little and very slowly.  Other fiber, like inulin (think onions) gets fermented very completely and very rapidly.
  • Each vegetable or fruit will contain several types of fiber, not just one type. Broccoli is not ONLY cellulose! Each vegetable or fruit has its own complex fiber identity! Find some that you tolerate.
  • I think to optimize butyrate production throughout the entire colon, it is good to eat a mix of vegetables and fruits. The quickly fermented fiber will bathe the first part of the colon in short chain fatty acids, and the slowly fermented fiber will make it to the end to bathe the final part of the colon.
  • Please don’t buy fiber in a box or plastic container. Please? Eat the real deal. Why? Because remember that vegetables and fruits contain multiple kind of fibers in one package, and they ferment at different rates. This provides valuable short chain fatty acids throughout the whole colon. In addition, different fibers have been found to influence the fermentation of other fibers, promoting more butyrate production than the given fibers alone. Not to mention all the vitamin C, vitamin A, magnesium, calcium, and other nutrients.  Again I say, find a mix of vegetables (and fruits) that you tolerate.  (2) (3) (6)  (And I still say, vegetable, fruits, and meats.  Wheat is a treat. Don’t get your fiber from wheat. My personal opinion.)
  • Good bacteria can be cultivated. Drugs that cultivate good bacteria are called PREbiotics, but foods can do the same thing. Vegetables and fruits carry fibers that are prebiotic. By eating vegetables and fruits, you are not just allowing the bacteria you have to make butyrate, you’re actually promoting their growth.  (4)

Caterpillar making attachmentReminder: All the information in this blog is information I have gathered and assimilated for my own purposes. I enjoy sharing it, but I certainly expect you to use it as fodder for learning and questioning, not as diagnosis and treatment.  Every individual is unique and may react differently (and badly) to what others find beneficial and helpful.  For your safety, present the information to your favorite trusted healthcare provider before making any changes. 

You know it’s bad when there’s a glossary:

Carbohydrates:  Carbohydrates are made up of polysaccharides, oligosaccharides, and sugars.

Sugars:  Sugars are monosaccharides or disaccharides.  Examples:  glucose, fructose, lactose, sucrose. They are usually completely absorbed in the small intestine. (But if they are not, they can continue to the colon to be fermented.)

Polysaccharides:  Polysaccharides are complex carbohydrates made by linking many, many, many sugars together. They can be starch polysaccharides or non-starch polysaccharides. Starches are commonly used as energy storage; amylose and amylopectin are two very common starches.  Non-starches are usually used for structure, like cellulose.

Oligosaccharides:  These are smaller chains of sugars linked together. They’re bigger than sugars and smaller than polysaccharides. They can be found in onions, jicama, and wheat. They are things like inulin and fructooligosaccharides (FOS—often a part of prebiotics).

Starches (amylose and amylopectin):  Starches are polysaccharides, which means many sugars strung together. Common starches in plant matter include amylose and amylopectin. Amylose has its glucoses linked linearly in a very compact structure, making it digest more slowly. Amylopectin has its glucoses linked in a large, branched structure, allowing more easy penetration of digestive enzymes. We used to think that all starch was digested and absorbed in the small intestine. We now know this is false.  Starches are in things like flour, potatoes, and sweet potatoes.  (Aside for SCD followers:  Breaking the Vicious Cycle’s explanation of amylose and amylopectin is incorrectly reversed.)

Non-starch polysaccharides:  A very hodge-podge group. It’s what you think of as classic fiber. Cellulose, pectins, gums, and more fit in this category. They often provide structure to plant cells. The small intestine can’t digest them.

Fiber:  Usually defined as plant matter that escapes digestion by the small intestine and continues undigested to the colon. But a true definition is evasive because calling something “fiber” is like saying a shoe is a shoe is a shoe. Well, stiletto boots are a far cry from my New Balances. Non-starch polysaccharides make up a huge chunk of “fiber.” Also included, depending on who is writing the definition, are resistant starch and oligosaccharides.

Resistant starch:  There are several kinds of resistant starches, but basically they are all starches that manage to escape digestion in the small intestine, and therefore they act like fiber. (5)

Eating for butyrate production by bacteria

Ok.  So the goal is to produce butyrate by eating food.  (The bacteria will do the work for me.)  Let’s take a moment to remember why anyone should care.  Studies indicate butyrate may—

  • Heal leaky gut, and therefore improve food intolerances
  • Stabilize blood sugar responses, even to carbohydrates
  • Lessen hunger and help weight loss
  • Stimulate bowel motility
  • Help damaged nerve cells to function again
  • Cure and fight cancer
  • Other unknown functions (7)

(I take a butyrate supplement. I have noticed a huge improvement in my peristalsis and in my ability to eat nuts and eggs baked in pies. Although my supplement seems okay, a person can never tell what impurities are in their supplements or how much of the nutrient the body needs!  Too much of a good thing can potentially turn on you. So I want off of my supplement, and this is where this butyrate series came from.)

What foods do bacteria use to make butyrate?  Fiber and resistant starch are the best ingredients for bacteria to make butyrate in your colon.  (Bacteria can make butyrate from proteins, mucous, and sloughed cells, but these ingredients lead to the formation of chemicals detrimental to your colon, like ammonia.)  We will talk about fiber today and resistant starch next time.

Fiber: 

You’ve heard of fiber. But what is fiber? Do you want functional fiber? Physiologic fiber? Soluble fiber? Insoluble fiber? Resistant starch “fiber?”  Caterpillar made cocoonViscous fiber? Fermentable fiber? Microfiber???? (No.)

Fiber is a hodge-podge (word of the day) of chemical substances.  Like my shoe analogy up there in the glossary: work boots, snow boots, running shoes, basketball shoes, platform shoes, and stiletto heels. They all go on the feet. They all have a similar function. They are all shoes. But you can break them down into boots and shoes. Or active wear and formal wear. Or open-toed and closed-toe. Or open-toed formal and closed-toe formal.

Fiber may be fiber, but it can be classified many ways.  My little ditty of a definition for fiber in the glossary– “plant matter that escapes digestion by the small intestine and continues undigested to the colon”—keeps it about as simple as it can get. (Shoe. Fiber.)

Maybe you have heard of soluble and insoluble fiber, this is NOT the only way to classify fiber.  (In fact, experts are trying to phase out the terms soluble and insoluble. They have come to realize that the function of the fiber does NOT depend on its solubility.) (8)

Bottom line: Fiber is a complex issue. The Paleo Mom has a great fiber series that she published recently:  The Fiber Manifesto.

Let’s look at the types of fiber—the ways to categorize fiber.  I’ll warn you, categories overlap.  Just remember that fiber is plant matter (usually) that makes it to the colon undigested:

Fiber can be classified based on solubility, fermentability, viscosity, whether or not it is a starch, or whether it’s a synthetic fiber with physiologic function.

Different ways to classify fiber:

Soluble fiber:
Pectin, mucilage, gums,   psyllium, wheat dextrin		 Insoluble fiber:
Cellulose, lignins, some   hemicelluloses, some pectins
Fermentable:
Oligosaccharides like FOS and inulin, gums (guar), pectins, wheat dextrins		 Non-fermentable:
Cellulose, hemicellulose,   lignin
Viscous (gel-forming) fiber:
Pectins, gums (guar gum), psyllium		 Non-viscous (non gel-forming) fiber:
Inulin
Resistant Starch:
Polysaccharides made of starch		 Non-starch   polysaccharides:
Celluloses, hemicelluloses,   pectins, and gums
Functional fiber (designed or extracted fiber):
Inulin, psyllium, FOS, some   resistant starch		 Dietary fiber (fiber found naturally in food)

(9) (10)

Now, you can take just about all of those and mix and match them!!!  For example, you can have:

  • Soluble, fermentable (example:  pectins)
  • Insoluble, fermentable  (example:  resistant starch)
  • Soluble, non-fermentable (examples:  alginates, carrageenans)
  • Insoluble, non-fermentable (examples: cellulose and lignin—cellulose is actually a bit fermentable, see below)
  • Resistant starch, fermentable  (example:  resistant starch)
  • Non-starch polysaccharides, fermentable  (examples:  FOS and inulin)
  • Non-starch polysaccharides, non-fermentable  (example:  cellulose)

You can keep going with this, but I’m stopping. Just remember, foods are composed of several types of fiber in one package—so a banana is NOT completely made up of soluble fiber! It also has (at least) resistant starch (an insoluble fiber!), pectin, and hemicellulose.  And it gets even more complicated than this because a ripe banana will have a different fiber composition than a green banana. Ahhhh!)

To make butyrate, we are mostly concerned with the fiber that is fermentable.  Solubility has nothing to do with it.

The table below summarizes the fermentability of the different fibers mentioned above. Percent of fermentability is important. Butyrate isn’t made unless the bacteria in the colon have something to ferment. Less butyrate will be made from cellulose (20-80% fermentable) than inulin (100% fermentable). HOWEVER, all the inulin will be probably be used up early in the colon, as soon as there are bacteria to feast on it. Since less cellulose will be fermented early on, more will be available throughout the whole colon, not just the beginning—like a “slow release” formulation.

Please note that our bacterial microflora are exceptionally unique and therefore our tolerability to different fibers will be unique. In a study on the fermentation of cellulose in the cell wall of spinach, one group of people fermented the spinach with one group of bacteria–while the another group of people fermented it with another kind of bacteria. (11)  Since we have different bacteria with different capabilities and metabolite production (such as gas), perhaps this is why some of us do well with fiber and not others?

Colonic fermentability of dietary fibres in humans

Dietary   fibre

Fermentability   (%)

Cellulose

20-80

Hemicelluloses

60-90

Pectins

100

Guar gum

100

Ispaghula

55

Wheat bran

50

Resistant starch

100

 Inulin, oligosaccharides

  100 (if they are not in excess)

(12)

So now you know that fermentable fibers make butyrate best. You can see above which fibers are fermentable (remember it’s probably good to mix and match high and low fermentable foods). But which fibers make a higher percentage of butyrate? Cellulose, inulin, raffinose (in beans), and resistant starch made higher percentages than guar gum, lactose, pectin, and sugar beets sources.  Oat beta-glucans were pretty high and so was wheat bran. (6) I’ve not tried to tease out grains, mostly because I don’t eat them. They are problematic for me and for many other people as well  Studies using them for fiber sources give so many mixed messages too.

Fiber acts as a prebiotic for good bacteria and also inhibits the growth of bad bacteria:

By eating vegetables and fruits with fiber and resistant starch, you are also promoting the growth of “good bacteria.”  Many of the good bacteria make butyrate for your body. You have commonly seen the term PREbiotic (not to be confused with the closely related term PRObiotic). All prebiotics are considered fiber. For a fiber to be a prebiotic, it must have the following characteristics:

  • “Resists gastric acidity, hydrolysis by mammalian enzymes, and absorption in the upper gastrointestinal tract;
  • Is fermented by the intestinal microflora;
  • Selectively stimulates the growth and/or activity of intestinal bacteria potentially associated with health and well-being.”

You can buy prebiotic supplements, and some probiotics come with prebiotics mixed in. However, prebiotics occur naturally in foods such as leeks, asparagus, chicory, Jerusalem artichokes, garlic, onions, wheat, oats, and soybeans. (Eat real food.)

(By the way, have you ever wondered what makes a bacteria a “good” bacteria? I have:  “Generally, bacteria having an almost exclusive saccharolytic metabolism (i.e., no proteolytic activity) can be considered potentially beneficial. Such a metabolic profile is typical for lactobacilli and bifidobacteria.”  Quote is just basically saying that good bacteria can’t break down protiens.) (9)

Prebiotics (including types of fiber) also inhibit the growth of bad bacteria! As the good bacteria ferment fiber, they produce short chain fatty acids and make the inside of the colon more acidic. A more acidic environment in the colon reduces breakdown of peptides (proteins), resulting in less formation of toxic compounds such as ammonia, amines, and phenolic compounds. Also, the more acidic environment decreases the activity of undesirable bacterial enzymes. So again, looks like eating real food that is fermentable will act as a prebiotic to encourage the growth of good bacteria and discourage the growth of bad.  (9)

What I wish I understood more:

1. The Inuits lived on a primarily fat and meat diet. Yet they had low rates of disease. Where did their butyrate come from? Did they forage enough when possible to get some? Did they ferment some of the plant matter when it was available for use later when it wasn’t available? Did the fermented meats they made provide them with butyrate? (Here we go again; I just can’t find good information on quantification of fermented food content. Anyone?) Does subsisting only on high quality animal protein and fat change the environment of the colon and body such that lower butyrate production is needed? Did their unique diet cultivate a unique micro flora that maximized butyrate production?

2. If grains and isolated fiber are removed as fiber sources from studies, how would this affect results?

Closing:

Man. Thanks for reading. If you have FODMAP problems and you just can’t tolerate any vegetables, come back next post. Next post we will move on to resistant starch, a huge producer of butyrate.  Only about two butyrate posts left to go. As always, comments, constructive criticism, and pointing out of typos is always welcome.

Terri

Part 6

Sources:

1.  http://www.wjgnet.com/1007-9327/13/4161.pdf

2.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1374147/?page=6

3.  http://gut.bmj.com/content/34/3/386.full.pdf

4.  Starches, Resistant Starches, the Gut Microflora and Human Health.  Bird, Brown, and Topping.  Curr. Issues Intest. Microbiol.  2000.  1(1):  25-37.  http://www.horizonpress.com/backlist/ciim/v/v1/03.pdf

5.  Health properties of resistant starch.  Nugent.  Nutrition Bulletin.  2005.  30: 1(27-54)

6.  Short-chain fatty acid formation at fermentation of indigestible carbohydrates.  Henningsson, Bjorck, and Nyman.  Scandinavian Journal of Nutrition.  2001.  45:165-186.

7.  Review article:  the role of butyrate on colonic function.  Hamer, Jonkers, Venema, Vanhoutvin, Troost, and Brummer.  Alimentary Pharmacology and Therapeutics.  2008.  27: 104-119

8.  http://ajcn.nutrition.org/content/69/1/1.full

9.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705355/

10.  http://lpi.oregonstate.edu/infocenter/phytochemicals/fiber/

11.  http://www.ncbi.nlm.nih.gov/pubmed/20662929

12. http://www.fao.org/docrep/w8079E/w8079e0l.htm

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