Tag Archives: Chronic constipation

Do Slow Guts Need Loved?

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.

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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_kudabari I 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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Tenacity. 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.

Dairy Causes Some Kids to Have Constipation

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It’s the picture of Italian ice-cream in a shop of Rome, Italy (Photo credit: Wikipedia)

Tonight I found a site by Dr. John Briffa with a fairly recent post on cow’s milk and pediatric constipation: Could dairy products be the cause of some children’s constipation?

I nearly wanted to explode “YES!” because I just can’t get this information out there loud enough! Dairy causes constipation in (some) kids. We saw this one year ago in my (then 6-year-old) daughter when we completely removed dairy several times and added it back in several times. And what do you suppose happens to those constipated kids if dairy is never removed? Well, maybe they turn into adults like me with severe, severe constipation. I am not sure why (or if) dairy causes the initial constipation yet, but I do know that lifelong gut immotility has led me to have some issues with bloating, probably SIBO (small intestinal bowel overgrowth)–which makes sense because I was not getting the sweeping motion forward to keep the bacteria from creeping upwards. I also have lots of food sensitivities (non-IgE) that I can’t help but wonder if they didn’t form through the years with the continued insult on the GI (gastrointestinal) tract.

It may be encouraging to know that my 7-year-old daughter was exceptionally sensitive to ALL dairy one year ago. Even as a solely nursing infant, she would have longer than normal periods of no bowel movements, and I speculate it was due to my dairy intake. She can now tolerate an occasional ice cream cone with no stalls in peristalsis. We overhauled our diet in a big way, taking out “bads” and putting in “goods”, and maybe, just maybe, she can continue her dairy dalliances at times with exceptional nutrition otherwise.

The research article that Dr. Briffa was referring to was “The Role of Cow’s Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial.”

For those who are following along regarding my GI progress, I am currently “taking my diet down” to I guess what would be considered Autoimmune Paleo, although I still adhere to GAPS. I’ll let you know how it goes for my gut. I’ve done it for four days now, and the last two days I’ve skipped my magnesium with success. I believe any endeavor must have a goal. By “taking my diet down,” I’m hoping to see improved bowel movements with either less magnesium or preferably none at all, less bloating, no irritable bowel symptoms, and no headaches. I’m putting diet to the test. We’ll see how much that honey, almond flour, egg, and fruit actually affect things here.

Page Two

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I had the 2100 test done to help evaluate my chronic constipation. Neither myself nor my general surgeon really knew what in the heck we were looking at when we got the results. So I’ve been going through each section to try to figure out what the test has to offer to help me manage my chronic constipation and just brushing up on my general knowledge.

Currently, I have been reading up on the pathogenic bacteria Metametrix reports. Other than it’s perhaps too far-reaching of a test panel, nothing absurd jumps out at me here. Did I need to know my H. pylori status or C. diff status? No. I don’t have symptoms consistent with those. So, except for the idea that the test results offer information beyond what is necessary and which may be exceptionally confusing with regard to whether to treat or not in an asymptomatic patient, I don’t have much to say.

This is not meant to be a conclusive summary or viewpoint. It is not meant to be a means of medical advice. These are just some things I’ve looked up and found and thought about that I am sharing. Consider it fodder for discussion, that’s all.

Lingo

Helpful information to know:

GI Effects Profile= 2100
Microbial Ecology Profile= 2105= Only the second page of the GI Effects Profile
The “second page” reports pathogenic bacteria, yeast/fungi, parasites, adiposity index, and drug resistance genes.

Where to See More on the 2100/2105

Below are two Metametrix links to videos containing descriptions/case studies of the 2100 and/or the 2105 which will allow you to see more test results and how somebody on their staff interpreted them. Sound starts as soon as you open the link. There are outlines provided so you may speed through to specific slides and topics if you wish.

IBS and GI Effects: A video with a straightforward, simple case of irritable bowel syndrome and how the GI Effects Profile was used to address the patient’s irritable bowel syndrome.
GI Effects test description with two case studies: Gives an overall summary of what the test is, what it tests for, and two case studies. Case study one is regarding gluten removal. Case two is more of an overhaul approach; please note on the treatment slide that they forgot to put that she was also taking bifidobacter and lactobacillus probiotics, which also contributed greatly to her probiotic flora levels increasing.

SCD Lifestyles–these guys, their passion is infectious–gives an overview of the second page (also known as the Microbial Ecology) and some examples.

6 Gut Infection Case Studies: Why You Should Get Stool Testing Done ASAP.

Metametrix selected four pathogenic bacteria to report: Helicobacter pylori, E. coli 0157:H7, Clostridium difficile, and Campylobacter sp.

I think it is helpful to remember that even some of these pathogenic bacteria can exist normally in normal people. They are not always pathogenic, although at times they (or particular strains of them) can be horribly pathogenic. Escherichia coli 0127:H7 and Campylobacter jejuni you can pretty much count on being invaders intent on destruction, and they usually cause acute, more aggressive type symptoms, to let you know that. H. pylori and C. diff’s stories are not so clear.

Metametrix uses PCR to detect these bacteria, offering high sensitivity. No dispute about how the test is peformed, collected, validity of what they’re testing for, or if the results are misleading. Wandering thoughts include:

Since H. pylori and C. diff can be present in asymptomatic carriers, and the medical field doesn’t know what to do with that information at present, will positive tests on the 2100/2105 lead to over treatment? Over treatment can lead to encouragement of antibiotic resistance and also a huge shift in a person’s bacterial flora, perhaps predisposing the patient to other issues.
Should the 2100/2105 be broken apart into smaller pieces rather than offered as this huge, sweeping “shot-gun”, “let’s cover all of our bases” test? Metametrix does broach that topic here, Which GI Test is Best? The approach the writer advocates goes against my training as a medical doctor, which tells me to look at the patient, order tests based on my assessment, and then pursue further testing if needed based on those tests and how the patient is doing.
How often are Campylobacter sp. and E. coli 0157:H7 picked up on using this test? Unlike H. pylori and C. diff, Campylobacter and E. coli 0157:H7 don’t usually transpire into indolent, low symptom disease states. They’re usually, like, “BAM”–diarrhea, stomach cramps, and an apparent acute illness. Just because you can test for something, does it make sense to? I can’t see a physician ordering the GI Profile or Microbial Ecology for an acute illness, as the turn-around time isn’t rapid. And you don’t need to know about yeast, fungi, and H. pylori when someone shows up with fevers, diarrhea, and stomach cramps. It seems like these could have been omitted, maybe cutting costs and not changing the usefulness of the test. But since I don’t know if it would cut cost or change resource allotment, I can’t really say much. Sometimes adding on an element to a test does not actually require any more work, time, or money. This may be an instance.

Helicobacter pylori (H. pylori): H. pylori is a known gastric colonizer. You, and about 50% of the world’s adults, are not alone if you have H. pylori in your gut. So what’s the fuss? Some people will live with H. pylori and be asymptomatic all of their lives, but other unlucky people may get ulcers or cancers associated with H. pylori. A friend told me just yesterday that she’d been recently treated for H. pylori by a chiropractor. Treatment decision was based on a stool test result and used antibiotics and proton pump inhibitors. Her symptoms had not been GI (gastrointestinal) related, and she was questioning why he chose to treat based on what she was now reading. And therein lies a problem.

What do you do with a positive test in an asymptomatic patient?

Gnawing abdominal pain and nausea, it’s a no-brainer. No GI symptoms, and my friend wouldn’t even have been tested for H. pylori by most medical doctors. But what do you do now as a practitioner with a GI asymptomatic patient with a positive H. pylori on a “shotgun” test ordered for something like fibromyalgia or fatigue?

Why treat an asymptomatic, positive test? “Treatment of asymptomatic patients is somewhat controversial given the high prevalence of H. pylori–associated superficial gastritis and the relatively low incidence of clinical sequelae (ie, peptic ulcer disease). However, H. pylori is a class J carcinogen; eradication removes the cancer risk.” (1) H. pylori increases the risk of ulcers, gastric cancer and a certain lymphoid cancer. (2)
Why not treat any positive test? Aren’t ulcers and cancer bad? Of course they are! However, there are always two sides to every story. In Journal of Clinical Investigation’s article “Coadaption of Helicobacter pylori and humans: ancient history, modern implications” (scroll down to “Absence of H. pylori as a risk factor for disease”), the evidence that H. pylori belongs in our gut for particular reasons is discussed: “In historical terms, H. pylori is part of the normal microbiota of humans.” The authors assert that reflux esophagitis and esophageal cancer are likely outcomes of H. pylori absence and also speculate obesity and allergic disorders may go hand in hand, as well. In addition, the article cites many sources which are available for reading online which may interest anyone with a positive H. pylori test.

From Metametrix’s own blog comes “What’s the H. pylori Story?”:

“Most clinicians carefully weigh the patient’s clinical presentation to determine if H. pylori needs to be treated. Treatment is only warranted if lab data, symptoms, and clinical history are consistent with H. pylori infection. Adjunctive or repeat testing should be ordered to verify the presence of H. pylori.”

and

“Most people infected with H. pylori are asymptomatic and never develop a complication. Some experts have suggested that H. pylori may be a normal, commensal bacterium and should not be treated in asymptomatic individuals. In fact, non-ulcer dyspepsia and GERD have not been shown to improve with H. pylori eradication. Patients who were seropositive for H. pylori had markedly lower risk of developing Barrett’s esophagus, suggesting that H. pylori may even have a protective effect against certain illnesses.”

E. coli 0157:H7: E.coli 0157:H7 does not belong in your gastrointestinal tract. It is a type of Escherichia coli that makes a special toxin (called Shiga toxin or Vero toxin) that attaches to and damages the lining of the small intestine, allowing toxin access to the blood. This can be a terrible player. Severe bloody diarrhea, nausea, vomiting, abdominal cramps, hemolytic anemia, kidney failure, and death are potential outcomes. Not a good player, especially for young children and older adults. On the flip side, a person may develop only mild diarrhea and cramping.

The source of E. coli 0157:H7 is often cattle, who can be asymptomatic carriers of it in their guts (3). Thus, undercooked ground beef can be a source of outbreak if contamination occurs during slaughtering, but other sources include raw milk, unpasteurized juice, contact with infected animals, infected drinking water, or contaminated recreational water (lakes, swimming pools) (2, 3, 4).

Although knowing if you have this bacteria would be very important, in fact it’s a “reportable” illness to the CDC, I find it an interesting choice for inclusion on this panel. Usually the illness is acute (lasting 5-7 days from onset of symptoms), and this 2100/2105 panel seems more geared for longer lasting, more indolent type of issues. Doctors and hospitals wouldn’t be using the Metametrix test for E. coli 0157:H7 because they need more rapid turn-around time, and they don’t need all other information provided to evaluate bloody diarrhea (for example, yeast and H. pylori). So, for whatever reason, they chose to put this bug on there. Don’t know why. I’d love to hear why or if somebody had this come back positive. Seems like a waste. But maybe I’m missing something.

Clostridium dificile: C diff. has toxin producing strains and non-toxin producing strains. It’s the C. difficile that makes a toxin, toxigenic C. diff, that is the problematic strain here. “It has been known for >25 years that nontoxigenic C. difficile strains occur naturally and, when given to hamsters during or after antibiotic treatment, are able to harmlessly colonize the gut and prevent subsequent infection challenge with toxigenic strains of C. difficile. It has also been shown in patients that natural asymptomatic colonization with C. difficile (toxigenic or nontoxigenic strains) is associated with decreased risk of CDI [C. diff infection].” (5)

Up to Date has some C. diff information if you’re interested (symptoms, diagnosis, treatment, and special considerations such as in inflammatory bowel disease):

PCR detection of C. diff with the toxigenic gene seems as good, if not better, than most of the prior tests for C. diff diagnosis. (6) I left a question on Metametrix’s blog about their C. diff test, and it was promptly responded to. I questioned, “Does Metametrix’s PCR for C. diff test for the toxigenic genes or just C. diff in general?”

They responded, “Our C diff detection method looks for the Toxin A gene in C diff. If that is present in sufficient numbers for a positive it will be reported as positive. In the next version of the GIfx test (and the 2105) C diff findings will reflect the Toxin B gene as well, but not currently.” There was a bit of controversy in medicine about whether toxin A or toxin B was the problem, but the good news is Metametrix will soon test for both. And based on this article, it should: The role of toxin A and toxin B in Clostridium difficile infection.

Metametrix’s blog site has a post on C. diff testing, Clostridium difficile Infection and Gut Ecology.
Being symptomatic and positive is helpful knowledge, assuming there’s no other cause for your diarrhea. If you’re one of those asymptomatic patients, however, it’s just confusing territory. From “Smart Choice for C. diff detection–PCR” from the College of American Pathologists,

“Dr. Peterson [MD, director of microbiology and infectious diseases research, Department of Pathology and Laboratory Medicine, Evanston (Ill.) Hospital, and associate epidemiologist, NorthShore University HealthSystem] has been emphatic about testing only patients who meet the clinical criteria for C. difficile illness, Dr. Crist [PhD, technical director/ clinical microbiologist, Department of Laboratory Services, Division of Clinical Microbiology, York (Pa.) Hospital] points out. “At this point our data support that premise,” Dr. Crist says of the chart review for one-fourth of the patients in his study. “In that subset there were no positive PCR results in patients who did not fulfill clinical criteria. All PCR-positive patients were clinically ill, not just colonized, even if they were culture negative.” (6)

Even if you have diarrhea, it’s possible that you’re a carrier and your diarrhea is caused by something else. Dr. Timothy O’Leary in “Sensitivity, Specificity Higher With PCR Than Conventional EIA in C Difficile-Associated Diarrhea “ states, “It’s [PCR] not necessarily the perfect assay because, while it is extremely sensitive, it’s possible, for example, that an individual may harbor this organism and not have the disease. You will detect that they are a carrier, which is important knowledge, but it’s not actually diagnosing the cause of their diarrhea. So, as with all laboratory tests, this has to be put into context.” (7)

An aside–Interesting treatment for C. diff: http://ir.viropharma.com/releasedetail.cfm?ReleaseID=758059

Campylobacter sp. Some strains from Campylobacter sp. can be part of the normal flora; however, some species/strains of species are associated with disease. This seems pretty cut and dry. If you have had symptoms of new acute onset diarrhea for a while and you’re testing positive, you’ve likely found a contributing culprit. If you’re asymptomatic and positive, what do you do, since it has been found to be present in our flora? The links below talk about some species of campylobacter.

I’m a bit curious as to why, if campylobacter and E. coli 0157:H7 were included, why bacteria like Salmonella and Shigella were not also included.

That’s it. Will start reading about yeasts, which will be completely overwhelming. Yeasts? Sure, candida UTIs, candida pneumonia, thrush, etc, but not an overwhelming “candidiasis” in an immunocompetent patient.

1. http://www.merckmanuals.com/professional/gastrointestinal_disorders/gastritis_and_peptic_ulcer_disease/gastritis.html

2. http://en.wikipedia.org/wiki/Escherichia_coli_O157:H7

3. http://www.medicinenet.com/e_coli__0157h7/page3.htm

4. http://legacy.jyi.org/volumes/volume6/issue5/features/hu.html

5. http://cid.oxfordjournals.org/content/51/11/1306.full

6. http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2F0510%2F0510a_smart_choice.html&_pageLabel=cntvwr

7. http://www.medscape.com/viewarticle/713134

Slow and Steady Constipation Improvement

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You know all these GAPS, Paleo, Primal, SCD, Whole 30 diets? Well, they’re all the same bag with some different bows. And let me tell you. They suck. Can’t stand ’em.

I lived in Candyland in my former life. Now I’m walking through vegetable forest. Why me? My neighbors don’t eat this way. I’ve been doing GAPS since June 22, 2012, and all I want to do is eat a fresh-baked loaf of bread from the Wal-Mart bakery and slather some good Land-O-Lakes butter on it.

I tell my husband I want to quit. Too much cooking. Too much work. Not worth it to fix our non-life-threatening ailments. He used to encourage me and cheer me up. Now he just ignores me and lays the vegetables he wants for supper on the kitchen counter for me to chop into thousands of little pieces.

“Don’t cut your finger off. I’m on call today.” What a guy.

Has GAPS helped my chronic constipation?

Yes.

Has it been easy?

No.

Have I strictly adhered to GAPS?

I’ve done alright. Since last June, there have been about 10 days where I knowingly made a choice to eat “bad” food–Christmas Eve, Christmas, a couple of days on each vacation we took, and a couple of cake pieces for a couple of birthdays. There have been inadvertent failures where I didn’t catch an ingredient. Some occasional infringements with dark chocolate with known sugar. But mostly, I’ve worked hard to stay true.

How are your bowel movements?

Lately, for about the last 6 weeks, I’ve been pooping mostly every morning (pretty super for somebody who used to poop about every 14 days). The exciting kind of poops: strong urge, easy passage, formed yet soft, long and abundant poop. After the poop is evacuated, the urge is gone. No feeling like I need to pass more even though there’s nothing coming. When my bowels skip a day or two, I get panic-y that my severe constipation is coming back. You know, the kind that fails Miralax, probiotics, milk of magnesia, docusate, fiber, Activia, suppositories, and enemas. The kind where even Ex-Lax and magnesium citrate require double dosages and still don’t produce a bowel movement until 2-3 days later.

The road to this destination has been filled with all kinds of variances, changes, and tweaks.

I’ve identified problem foods. If I eat them or I eat too many of them, my bowels skip some days until I go back to strict veggie and meat GAPS. My problem foods are common GAPS/Paleo/Primal/Whole 30/SCD problem foods.

Dairy I can’t touch. After initial diarrhea, I won’t poop for weeks.
Eggs make me skip days.
Nuts make the poop hard and slows down the system.
Too much sweet stops things for a few days untill I get strict again.

There are these startlingly bizarre times when I actually have diarrhea all day, causing me to RUN to the bathroom. Let me tell you. I’ve NEVER had this EVER before in my life. I think this is caused by a food trigger, but it takes forever to sort out which foods cause which reactions. Since this phenomenon is unusual for me, I haven’t been able to pinpoint the culprit. And since I’ve always had constipation, diarrhea is a welcome problem to have. Crazy. It seems that GAPS has allowed my chronic constipation to move into the diagnosis of irritable bowel syndrome, which I prefer to my former problem.

Besides food changes, what do you do?

Before I discovered intensive nutritional rehabilitation for my gut, I used to just long for that one food or supplement that could make my bowels move. For Mom it was sauerkraut. For Dad it was pickles. For my husband it was fruit. Food never, ever worked for me. I tried aloe vera, milk thistle, and other expensive things from the store that smells like incense. No good.

So now I’m left with this exceptionally challenging nutritional intervention that is working quite well after ten months. I’ve been through GAPS/SCD legal recommended supplements: probiotics, digestive enzymes, betaine HCL, fermented cod liver oil, fish oil, magnesium, coffee enemas, and probably a few others I’m forgetting. Oh, yeah. I also tried early on doing the rifaximin/neomycin treatment for SIBO while simultaneously doing GAPS intro. Maybe all of it together got me where I am now. Maybe none of it did. God only knows.

However, for the last six weeks, I am only taking lactobacillus probiotic from GI Pro Health ( 20 billion CFU) and Magnesium Natural Calm (2 tablespoonsful), both right before bedtime. And it’s working. Please note, I have tried other magnesium preps with varying degrees of success. I finally settled on this one because my incense smelling store keeps it much more readily in stock than other formulations that also worked. Plus, I like the way it bubbles and brews. Goes along with my thoughts that I’m practicing “voodoo” medicine on myself, rather than my comfort zone of traditional Western medicine.

My goal is to get down to taking NO supplements. At times, I have been able to wean the magnesium down to 1 tablespoonful, but it won’t last. At other times, I’ve been able to skip magnesium for two days and still have the same morning bowel movement, although not as large. So that tells me it’s not solely the osmotic load of magnesium each night that produces my bowel movement each morning. But I just can’t buy that I’m that deficient in magnesium. Regardless, the goal is NO magnesium and to get probiotics from my food.

That’s It

That’s it in a nutshell. That’s what I’ve done and where I’m at. The biggest key to my success, I believe, was removing problem foods. The second key, I believe, was putting in nutrient dense foods. The third key has to be the magnesium and probiotics.

Unfortunately, the threads that tie it all together, without which nothing would have been achieved, have to be patience, persistence, diligence, and manipulation of all the variables. There are LOTS of variables ((hundreds of food items, supplements, stress, illness, travel–just to name a few) that must be played with . And that’s why modern medicine may never come to accept nutrition’s role in disease. Because there are just too many variables to contain in order to conduct a scientific study.

Wishing you only the best. Good luck.

Please make sure you get medical advice from a licensed, practicing healthcare professional. Constipation can be a sign of a significant, serious underlying problem, which you don’t want missed! Diets and treatments used to treat constipation can come with some serious “side effects.” Nothing here should be construed as medical advice. This is my story. If you want to try out any of the things I tried, please talk with your practitioner about it first.

Terri

Cow’s Milk and Refractory Constipation

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Dripped homemade yogurt

Here below, I’ve listed some medical articles that I have read in the last six months regarding chronic constipation and dairy’s potential role in its causation. No physician, in a professional relationship or friend relationship, ever mentioned to me or my husband that dairy could be causing my daughter’s chronic constipation that required daily Miralax for years. I just don’t think they knew that constipation could be a nearly sole symptom of milk-intolerance. I didn’t. I do now, and so do they (they’ve been texted, e-mailed, called, and “Christmas card updated”).

As dairy elimination did not take care of my issue with the same problem, I was relieved to find some journal articles on multiple food intolerances leading to chronic constipation. I am doing this thing called the GAPS diet for my gut, I don’t know if it is working as a “whole regimen” or if going through the diet has allowed me to identify problematic foods. Regardless, things are better for myself and my daughter, and I am glad I found these articles helping me to look beyond dairy as constipation triggers. Laxatives were not working for me so well, and I was getting worried.

As I will and must say, it is ever important to make sure that there’s no serious disorder that needs to be evaluated–like cancer, inflammatory bowel disease, or another bad illness. I’ve seen my doctors, and so must you make sure that nothing is being missed in your own body. Also, I would like to point out that, although many of these articles are regarding children, my constipation started in early childhood–so I translated the studies to myself and adult studies seem to support this.

Review article: chronic constipation and food hypersensitivity –an intriguing relationship. A. CARROCCIO* & G. IACONO. 2006. Alimentary Pharmacology and Therapeutics 2006; 24: 1295-1304.
Discusses the research available up until 2006 regarding dairy causing constipation in both children and adults.

Chronic constipation and food intolerance: a model of proctitis causing constipation.Carroccio A, Scalici C, Maresi E, Di Prima L, Cavataio F, Noto D, Porcasi R, Averna MR, Iacono G. Scand J Gastroenterol 2005 Jan; 40(1):33-42.
A pediatric study finding cow’s milk intolerance manifesting as constipation in 24/52 patients. Actual pathologic changes were found in the rectal mucosal biopsies of these affected patients, as well as decreased rectal mucus-gel layer.
(Proctitis is basically the inflammation of the anus and lower rectum, resulting in clinical symptoms of cramping, feeling like you still have to have a bowel movement even after you’ve had one, painful defecation, anal irritation/itching, and pus or blood in bowel movement. It can be caused by many things, but in this study, they found that dairy intolerant kids had it.)

Multiple food hypersensitivity as a cause of refractory chronic constipation in adults. ANTONIO CARROCCIO, LIDIA DI PRIMA, GIUSEPPE IACONO, ADA M. FLORENA, FRANCESCO D’ARPA, CARMELO SCIUME` , ANGELO B. CEFALU`, DAVIDE NOTO & MAURIZIO R. AVERNA. Scandinavian Journal of Gastroenterology, 2006; 41: 498/504. A very small sample of four women was found to have severe, refractory constipation alleviated by initiation of an oligo-antigenic diet (hypoallergenic diet–put simply, the women were put on a limited diet of foods that most people are not allergic to). Elimination diet eventually allowed each patient to pinpoint multiple food intolerances causing their constipation. Researchers also found pathologic changes in the rectum, duodenum, and esophagus of the patients as well.

Chronic Constipation and Food Hypersensitivity – An Intriguing Relationship. A. Carroccio, G. Iacono. Aliment Pharmacol Ther. 2006;24(9):1295-1304.
Great review article on the topic of food intolerance causing chronic constipation. Helpful.

Intolerance of Cow’s Milk and Chronic Constipation in Children Giuseppe Iacono, M.D., Francesca Cavataio, M.D., Giuseppe Montalto, M.D., Ada Florena, M.D., Mario Tumminello, M.D., Maurizio Soresi, M.D., Alberto Notarbartolo, M.D., and Antonio Carroccio, M.D. N Engl J Med 1998; 339:1100-1104October 15, 1998DOI: 10.1056/NEJM199810153391602. One of the first larger studies to support milk causing childhood chronic constipation. Also read the interesting editorials that both try to refute and support the findings. I believe the first criticism may be concerned about the implications of removing a nutrition-packed food source from children’s diets, especially very young children.

Functional constipation in children: does maternal personality matter? Alireza Farnam, Mandana Rafeey, Sara Farhang* and Saeedeh KhodjastejafariItalian. Journal of Pediatrics. 2009, 35:25 doi:10.1186/1824-7288-35 As my daughter quickly responded to dairy removal, I found this research article quite comical (but I’m secretly relieved that dairy elimination and low nut intake keeps her regular! Laugh!).

Constipation in children. Nadeem A Afzal¹^*, Mark P Tighe² and Mike A Thomson³ Italian Journal of Pediatrics 2011, 37:28 doi:10.1186/1824-7288-37-28.
A review article in general about childhood constipation. A brief blurb in there about cow-milk deserving a trial if there’s a family history of cow-milk intolerance, etc. However, in our family, prior to May, we were completely unaware of “milk-intolerance” presence in our family, as I just did not know that sinusitis, chronic cough, and constipation could be related to dairy intolerance.

Milk fats clue to inflammatory bowel disease: http://www.newscientist.com/article/dn21920-milk-fats-clue-to-inflammatory-bowel-disease.html
This is not about constipation, per se, but it does remind me that our intrinsic probacterial flora plays a huge role in manifestation of our disease–whichever it may be–and diet affects the probiotic flora. In this case, milk fat. Not protein. Interesting to follow along.

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines. Alessandro Fiocchi, (Chair), Jan Brozek, Holger Schu¨nemann, (Chair), Sami L. Bahna, Andrea von Berg, Kirsten Beyer, Martin Bozzola, Julia Bradsher, Enrico Compalati, Motohiro Ebisawa, Maria Antonieta Guzman, Haiqi Li, Ralf G. Heine, Paul Keith, Gideon Lack, Massimo Landi, Alberto Martelli, Fabienne Rancé, Hugh Sampson, Airton Stein, Luigi Terracciano, and Stefan Vieths. WAO Journal. 2010. 57-161. A huge review article. But buried in there are segments on constipation and dairy. Also other good information.

If you’re reading this to help yourself or your child, best wishes to you on your endeavors, and I hope you find clues to better GI health soon!

Update: I have come back through to edit this post a little. Our constipation has improved significantly with the removal of all dairy products. We even tried goat’s milk, but we failed the trial. My daughter occasionally gets ice cream or a cake with some dairy in it at a birthday party or on vacation, and we have noticed that although she may skip a couple of days, her GI tract gets moving again without any Miralax. Definitely an improvement!

A Doctor Visits the Doctor

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Not a homeschooling post:)

If you have chronic, severe constipation, I encourage you to have hope. When the probiotics, Miralax, Colace, Activia, extra psyllium, increased fruits and vegetables, whole grain cereals, and stimulant laxatives seem to be failing, keep looking. When the doctors offer you nothing but increasing your Miralax or using more stimulant laxatives, bear with them. Continue to be under their care, but keep looking.

In medical school, we are trained that nutritional intervention in most conditions is a non-player. Diabetes. Yes. Heart disease. Sure. Acne. Umm…no-oooo. Ulcerative colitis or Crohn’s. Umm…probably not. Fibromyalgia. Whatever. Chronic fatigue syndrome. Not likely. Headaches. Not unless they’re migraines triggered by red wine or MSG. Joint pain. Never heard of diet helping that, for crying out loud.

When patients come in touting this diet or that, we doctors graciously smile and nod as we would to a child. As we’d say to our children in a syrupy, soothing voice: “That’s nice. Yes, sweetie. I know. I’m so happy.” Internally, we’re wondering when we can move on to the next question required in our medical history taking to meet CPT coding bullet points for insurances, Medicaid, and Medicare coverage. So we don’t get accused of fraud. Because most medical doctors aren’t intentionally fraudulent. We do not have time to discuss diets that we were taught don’t work and can’t be broken down in such a way they can be actually scientifically studied. And they don’t work. Oh, maybe it worked for you. But, “…that’s nice, sweetie. I’m so glad it worked for you. If it’s not hurting you, it sure can’t hurt to try.” And off you both can go to the pertinent information necessary for this doctor’s visit.

For 37 years, I have dealt with symptoms such as hard stools, straining, lack of sensation to even have a bowel movement for weeks, digital disimpaction, and feeling of incomplete emptying after a bowel movement. Different laxatives and over the counter medicines would work for a while, and then they would stop helping. My doctors would ask, “So this has been chronic?” “Yes.” “Well, try eating more vegetables.” Or more Metamucil. Or Amitiza. I never fretted too much about this problem as I had no discomfort with it, except when I had a bowel movement. Which wasn’t too frequently anyway. And if I just took Miralax, it would keep the discomfort from peristalsis at bay. But, two bowel movements a month, and those only with stimulant laxatives, magnesium, and Miralax, cannot be healthy. The bloating started. Worries of colectomy for years of colonic inertia began setting in. And I started Googling information.

There is a TON of GI information on-line. Sifting through it is a tremendous challenge. Time consuming. Overwhelming. Some of it sounds like PURE hocus-pocus. Maybe it is. Maybe it isn’t. I don’t have time to read enough about all of it. But, for myself, I settled on the Specific Carbohydrate Diet. Much of the book made sense and seemed logical. Then, I took it a step further and started on Gut and Psychology Syndrome diet. Lots of it makes sense. Some of it doesn’t. There have been some great weeks and some terrible weeks. But overall, since June 22, 2012, my GI tract is definitely moving in the right direction. My husband, an orthopedic surgeon, cannot believe how GAPS has changed my GI tract. I’m no longer “the butt” of jokes about anal-retentive women. (I adore my husband. And the feeling is mutual.) Neither one of us “poo-poo” the role of diet in medical conditions anymore.

I cannot say what part of the GAPS diet is helping me. And pure success (near-daily bowel movements) has only been in the last 6 weeks. I would like to see 2-3 months of this kind of success before I get too excited. I was going to wait until 2-3 months of success before writing about “success.”

But today I had my gastroenterology appointment. In some ways, what a waste. In other ways, a success.

A success because I am now acquainted with a gastroenterologist here. So if my problem comes back despite this diet, I can go back to her. Sometimes it isn’t until you’ve been to a doctor a few times that you really get their attention. A success because she did a Chem 12, which will check out my liver, calcium, and renal function. Which I know are okay–but it never hurts to check! I love to get good grades on “tests.” LOL! And serological testing for celiac. Which would most likely be negative as I’ve been off of gluten for 7 months now. But she said that they can remain positive up to 2 years off of gluten. So if it comes back positive–question answered. If it comes back negative–keep on keepin’ on and who knows. And finally, a positive visit because she said if my symptoms come back, she could set me up over the phone for a Sitz marker study, rectal manography testing, and perhaps a colonoscopy. I wouldn’t have to drive the three hours again just for an office visit.

A waste because, although she knew I was a medical doctor, she continued to talk to me as if I were my mother. With no understanding. Explaining to me as if I didn’t already know about Sitz marker studies and rectal manography testing. Explaining perhaps the extra fiber and vegetable intake of my diet was making a difference. That I likely didn’t have FODMAP or SIBO because we should see diarrhea, not constipation. And the thing is, I’m thinking that IBS, Crohn’s, and ulcerative colitis patients who are out there reading and learning know more than she does regarding FODMAP, SIBO, and dietary interventions for their illnesses. I expect this from a primary care doctor or a non-gastroenterologist medical doctor. I expect much more out of a gastroenterologist. I asked her if she’d heard of the GAPS diet (in a VERY curious, polite, self-deprecating fashion). No, she had not. I explained it was similar to the Specific Carbohydrate Diet. “Oh. Those are all like the fructose intolerance, FODMAP, diets.” I didn’t bother to explain anymore. I chose to be a “silent genius” and not correct her. She thought she knew, and she didn’t ask me any more questions or show any interest. She was professional and kind enough. I wasn’t there to educate her, unless of course she asked me about it. And she didn’t. I got what I expected from the visit.

But, I’m being a responsible physician-patient. Not just treating myself.

I am hoping that dietary intervention will keep my GI tract healthy, and I’ll have no need of further testing. Time will tell. For now, I’ll encourage those with chronic constipation that the diet is helping me thus far after 6 months.

For further constipation related posts, please click on the GI Tracts Defying Gravity page.

What’s Working (A Constipation Post)

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NO! It wasn’t the…

…Yoga (although that’s real nice and my teacher gave me the best-student attendance award),

…Squatting in “the more natural poop position” ’til my legs and feet fell asleep and I fell over backwards,

…Relaxing magnesium baths with lavender essential oils while my three-year old stood by begging to take a bath with mommy,

…Raw fruits and vegetables or yummy prunes that made my midsection look like a nice, big, round balloon ready to float away or the illustration for the song, “The Old Gray Mare [She Ain’t What She Used To Be 20 Long Years Ago]”

…Daily Miralax that had me forcefully squeezing out about 20 soft, squishy 1 inch sized poops a day, leaving me unable to walk due to painful, itchy, bulging, billowing hemorrhoids

…Oatmeal and shredded wheat fasts

…Water ’til my pee ran clearer than water itself

…Exercise (How many miles of cardiovascular count? 4, 6, 12?)

Things are getting better and better! First thing in the morning and in the early evening, I am having unusual sensations that have never happened so frequently in my life! Bowel movements! Each morning that I wake up and have that urge, I want to come post it on this blog or go wake up my husband and tell him it’s all working! But the mornings that are urgeless, I get a little blue and grasping. What’d I do wrong? What’d I eat? What was it? Will it come back? Will I poop today? Has the magnesium stopped working? Is it like anything else I’ve tried in the past–and it will stop working for me completely?

I can’t say. But since starting GAPS diet in June and landing on the SCD with GAPS diet flourishes, and a few drops back to GAPS introduction here and there as needed–things are slowly improving. Not perfect. Not linearly. In spurts with progression and regression–but overall in slow progression. Things have been great for the last 2-3 weeks, although I got my kids’ gastroenteritis bug last week, which set me back. Whenever I get a gastroenteritis, it takes a lot of cranking to get things moving again. But this time, once I got them moving, things seem to be picking up speed. Twice in a day. That’s nearly a miracle for me. I am nervous to say that the diet is working. Because what if it stops? Then I have to eat my words. But, at that point, after being on this diet, anything will taste yummy! Ha!

So if you have severe, “worse-than-other-people-constipation”, don’t give up. I am just past month four on GAPS/SCD, and I can say that I am improved. Not quite cured yet. But moving in the right direction longer than I ever have been before. For the last 6 months, I repeatedly, repeatedly, repeatedly was on Google, GAPS Diet Yahoo Support Group, PecanBread, SCDLifestyle, and many alternative medicine sites. Now, I’ve chosen a plan, and I’m trying to stick to it awhile. And overall, the benefits are so positive, with some hang-ups in the road.

Current plan:

1. Continue SCD/GAPS Diet: I have really hammered out some of my sensitivities over the last four months. So valuable. (No dairy, low nuts, low egg whites–or baked a really long time). I’m still phasing in things to see how they affect me. I’m currently very heavy on meats and vegetables.

2. Magnesium: I am now using magnesium malate at 4 grams daily. When I run out of that, I have some Natural Calm to use up.

3. Betaine HCL: Doesn’t seem to matter which brand I use. I take 2-3 with each meal.

4. Digestive enzymes: Using GI Pro Health. Guess it’s working fine. Will be interested to phase out if my bowel movements continue. Along with the betaine HCL.

5. Fish Oil: Using GI Pro Health. One teaspoonful a day unless I just can’t stomach it. I think I take it about 5 times a week.

6. Fermented Cod Liver Oil: Nearly one teaspoonful a day unless I just can’t stomach it. Also taken about 4-5 times per week.

7. Continue high fat diet: I try to get a lot of animal fats, but I don’t fret about it too much. If I’m not eating animal fat that day, I dump on the olive oil on what I am eating.

8. I was tanking up on probiotics (lactobacillus). But after that gastroenteritis, I’ve had severe bloating. I don’t know if it’s SIBO, FODMAPs, or Candida. So I’ve switched to lactofermented vegetables instead of probiotics until I get that bloating down.

Well, so long for now! Got to go get my sleep!

For further constipation posts, please click on the GI Tracts Defying Gravity page.

How Many Medical Doctors Does It Take To Order A Metametrix Stool Test?

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In my pursuit for regular bowel movements, a couple of weeks ago Steve, as in Steve and Jordan from scdlifestyle.com, recommended a Metametrix 2105 stool test. That sounds very objective. I like objective, cut and dry tests, diagnoses, and treatments!

But this isn’t the stool test we typically order in medicine! If I wanted to check somebody for a parasite, I would order a “stool for ova and parasites X 3 ” and usually get an enteric culture, as well, to check for certain bacteria, too. Three stools would be collected and checked for actual eggs and parasites themselves. Yes, it is true. The test is not very sensitive. But it’s what we have. There may be too few parasites to detect. Even if you have them. That’s why we run three samples–to try to catch those “suckers.”

As doctors, it’s what we’re trained to order! I guess Metametrix (and other labs) offers different tests–ones maybe not so medically accepted. I checked them out a few months ago. It was mind-boggling. It was going to take more research time than I had to explore all the different tests. Which one to order? Were they really reliable? Just because they found “something” in my stool, was it really indicative of a pathological problem leading to my constipation? I couldn’t decide if these stool tests were really providing “sound” medicine or if they were a scam. Typical doctor attitude. Wary of anything different and not mainstream. So I passed at that time. Several months later and lots of things tried later–I was willing to give them a second look.

My dear husband curb-sided a good general surgeon here in town about my constipation while they were both between cases at the hospital. A “curb-side consult” is a medical doctor term for when we pick your brain about a patient when we see each other out and about. As we have no gastroenterologist in this small town, the general surgeons do the colonoscopies here. This surgeon said they see about five slow transit constipation patients a week. They can get most better. He proceeded to talk about the neurological deficits in slow transit constipation and how fiber is no help. He sounded like a good place to start here in town, and Brandon knew he was a good surgeon. So I got my appointment with him.

The night before my appointment, Brandon (my husband and an orthopedic surgeon) and I lay on the sofa talking about my impending appointment. If we thought I’d get anywhere. What I wanted to accomplish. I told him I wanted Dr. L to order a Metametrix stool test.

“A Meta-what?” he asked.

“A Metametrix stool test. It looks for bacterial overgrowths. Candida. Parasites,” I said.

“Oh. Do parasites cause constipation?”

“Sure. I guess they can. It’s atypical, though,” I answered.

“Huh,” he said.

Like any good patient, I had my list ready for Dr. L when I went. I wanted a colonoscopy, a TSH, and Metametrix 2100 stool study. He told me I absolutely needed a colonoscopy. It had been too long messing around with this. He thought I’d be surprised at the number of atypical cases of Crohn’s and ulcerative colitis he’d seen. And a TSH. Yes. And he added on his own choice of a calcium level to check my parathyroids since I’d had kidney stones. “And will you order me a Metametrix 2105 stool study?” I asked. “Sure……[long pause] what is it?” he asked.

Sure. What is it. I was medical doctor number one who had no clue about this. My husband was medical doctor number two. And here was medical doctor number three. Sure. What is it. Now, I know there absolutely have to be medical doctors who order this. But the ones I know don’t. So it’s certainly not common. I gave him the same answer I gave to Brandon. He wrote “Metametrix 2100” at the bottom of the laboratory order slip. I had a sneaking suspicion that I wasn’t going to get anywhere with that lab slip. And I didn’t . I took it to the lab, and I heard the lab assistant calling back to the surgeon’s office to see what it was. I jumped up and told her what I knew as the doctor’s office had not a clue. I was a little embarassed that I was even asking for this test. Voodoo, as I like to say. At this point, I had a suspicion that if I wanted this test, I’d either have to go see a naturopath or order it myself.

Luckily, my suspicion ended up being wrong.

I went home. Relooked at the Metametrix site. And I ordered the test myself, but nothing has to be paid until the specimen is sent back in.

I could have called back to the surgeon’s office and explained to them that they had to go the Metametrix website, scroll through to find the test I wanted, and fill out an application to become a clinical provider of the test. They would have done it for me. But, uh-uh. No way was I doing that. I have been a working medical doctor. An over-worked, busy-as-heck, cant’-see-through-all-the paperwork medical doctor. And I didn’t want to be the problem patient who puts a wrench in the whole day. Especially when I didn’t even really know what this test really was and if it was really even good at all. So the test is on its way to my house. I’ll send that one back, I guess, though. Because the next day, the office nurse called me and told me the lab had figured out what the test was and had ordered it.

Traditional medicine came through! Yee-haw! Go, team! Go, team! We’re not as backwards as they say we are!

So my Metametrix stool test is on its way to the hospital lab where I got my other tests done. It will be a fun experiment to submit the test and see the results. And analyze them. See if any results correlate with symptoms. Is it a parasite? Oooooh. Is it candida? Aaaaaah. Maybe, I don’t have any gut dysbiosis! Umm–no. Not possible.

Now, what is it? What is a Metametrix stool test? It is a stool test that uses DNA to detect bacteria, yeast, and parasites rather than actually looking for the organism itself or trying to culture it out. This may sound like a very good thing. And it indeed, it can be. But the question is, just because the organism is there, does that really make it pathological? No. It doesn’t. Most likely I have MRSA on my skin from working in the hospital for years. But it’s not pathological at this point. I’m not going to test for it. I’m not going to try to eradicate it. I may have candida in my gut, but how much is pathological? And the answer will be variable for each individual. I think that’s where a good clinician comes in, trying to tie together tests and the patient who is sitting in front of them.

I guess after my tests come back, I’ll have more to say and more areas to scrutinize.

Here is the Metametrix site:

http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/dna-stool-analysis-gi-effects

Here are some comments regarding Metametrix that I found, trying to figure out the validity of this test. I could not find much. I do not agree or disagree with the following posts. I don’t have a clue who the people are who wrote them, so don’t criticize me for putting the page here. I just read them and found it interesting to compare their views. I am putting them here so you may look at them if you want to. The slam on Metametrix doesn’t really seem to lie too much with their stool studies. It seems to come with some of their other, perhaps more questionable, tests.

http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/urine_toxic.html

http://forums.owndoc.com/candida/lufenuron-and-gut-parasites/

http://forums.phoenixrising.me/index.php?threads/are-metametrix-tests-valid-are-the-treatment-suggestions-useful.18575/

Would love to hear of any reader’s experience with Metametrix and how it played into their treatment program.

Terri

Further Metametrix posts:

More on My Metametrix GI Function Profile Test
Muddling Through Page One
Beginning Page Two

The HSD

What happens when a medical doctor becomes a stay-at-home, homeschooling mom

Tag Archives: Chronic constipation

Do Slow Guts Need Loved?

Maybe Slow Guts Need Poked

Smooth Move Tea and Laxatives

Herbs and Spices

Diverse Fiber

Triphala

Essential Oils

Acupuncture

Closing

Slow Guts Need Tenacity

Iodine

Probiotics and Probiotic Foods

Butyrate

Magnesium (Natural Calm)

Closing

Dairy Causes Some Kids to Have Constipation

Page Two

Slow and Steady Constipation Improvement

Cow’s Milk and Refractory Constipation

A Doctor Visits the Doctor

What’s Working (A Constipation Post)

How Many Medical Doctors Does It Take To Order A Metametrix Stool Test?

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Smooth Move Tea and Laxatives

Herbs and Spices

Diverse Fiber

Triphala

Essential Oils

Acupuncture

Closing

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Iodine

Probiotics and Probiotic Foods

Butyrate

Magnesium (Natural Calm)

Closing

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