Tag Archives: colonic inertia

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.

Butyrate and Constipation

37 Replies

I have been excited about butyrate because rat studies showed that it increased the motility of the colon (please let’s not dwell much too long on the fact I’m reduced to rat status and writing about constipation).  I am going to summarize and explain an abstract to a study, from which the following quote is taken:

“Little is known about the environmental and nutritional regulation of the enteric nervous system (ENS), which controls gastrointestinal motility. Short-chain fatty acids (SCFAs) such as butyrate regulate colonic mucosa homeostasis and can modulate neuronal excitability. We investigated their effects on the ENS and colonic motility.” 

~  from Gastroenterology,  2010, “Short-chain fatty acids regulate the enteric neurons and control gastrointestinal motility in rats.”  Emphasis was mine.

Aside:  Please note that I am probably a fool and excited about nothing, but it is a path worth exploring for my slow transit constipation.  Also note, I do my best to simplify studies and concepts, some of which are difficult for my basic molecular biology background.  My husband, being an exceptionally logical and fact oriented doctor, hates it when I do this.  Big time scowls.  He is right, sometimes the explanations become kind of inaccurate.  So I will do the best I can.  If you have any questions or note any errors, I would like to know.  Gaps in my understanding will be bridged this way.  And one last note, don’t use my blog stuff to cause any harm to yourself.  Please.  See your doctor.

What did these researchers do? 

  1. Fed rats a resistant starch diet.  (I will write a resistant starch post soon.  Soon is always relative.)
  2. Inserted short chain fatty acids (i.e. butyrate) into rats’ cecums (a part of their colons).  (I only have an abstract so we are left to our imaginations for this lovely process.)
  3. Applied butyrate to some “free-standing” cultures of enteric nervous system cells in a “test tube.”
  4. In the “test tube” cells, they examined how the cell “looked”–its “phenotype.”  What kind of receptors did the nervous system cells have on their outer membranes?  What kind of proteins are expressed?  Knowing this kind of information helps us to know what the cell is capable of responding to and what substances the cell makes.  Special antibodies that will seek out these known proteins and receptors on the cells are used.   Researchers also used polymerase chain reaction (PCR), a way to amplify and increase certain material.  Specifically, these researchers looked for antibodies to Hu, choline acetyltransferase (ChAT), and nitric oxide synthase (NOS).  If you refer back to “Changes in Severe, Chronic Constipation,”  you will see a couple of these discussed:  Less neurons immunoreactive for ChAT and more neurons immunoreactive for NOS.  They also proceeded to analyze signaling pathways using various tests.
  5. Observed the motility of the colon both in the rat and outside the rat.

What were the results?

  1. Resistant starch diet (which increases butyrate) and butyrate (but NOT acetate and propionate, other short chain fatty acids made from resistant starch by the colon’s bacteria) both:
      A.  Increased the ChAT neurons, these are the ones partly responsible for increasing peristalsis.  Neurons with ChAT should make more acetylcholine, the neurotransmitter that encourages the bowel to move forward and empty.
      B.  Did not alter the NOS neurons’ proportion and number.  NOS would bring about nitric oxide, which slows down the bowel’s movements.  It makes the bowel relax rather than move.
  2. Bowel neurons have a transporter called monocarboxylate transporter 2 (MCT2), which helps bring butyrate into the colon cell after the bacteria graciously make it.  Well, the researchers were able to “stop” these transporters so butyrate wouldn’t move into the cell so much.  By stopping the MCT2 transporters, the increase in ChAT neurons–and therefore neurons that would increase colon motility–was halted.
  3.  Butyrate increased histone H3 acetylation in enteric neurons.  When DNA is acetylated, it allows the DNA to be transcribed.  So butyrate alters the actual genetic expression of cells.
  4. Resistant starch diet increased colonic transit.
  5. Ex vivo it was noted that butyrate increased the circular muscles contraction when exposed to acetylcholine.

Their Conclusion

“Butyrate or histone deacetylase inhibitors might be used, along with nutritional approaches, to treat various gastrointestinal motility disorders associated with inhibition of colonic transit.”  And that’s as far as I’ve seen it up to this post.  I’ll keep looking.

My Conclusion

I’m not trying to live forever.  I don’t have cancer yet.  I’m eons away from a stroke.  But my gut has a mind of its own.  In addition to more information on butyrate (and resistant starch), I need to explore the outcomes of slow transit constipation in 80 year-old women.  Do they have a study on that?  Right now, things are tolerable with all the changes I’ve made the last 18 months or so of my life, but what happens later?  Or when the magnesium stops working again?  Anyhow, here are my closing thoughts:

  1. Butyrate is made in the gut and absorbed by the gut.  The gut has been my constant, lifelong problem.
  2. Butyrate may affect the immune system and decrease inflammation.  We have studies supporting food intolerances causing severe, chronic constipation and these studies document subtle inflammatory changes in the mucosa.
  3. Butyrate may affect the nervous system through modulation of gene expression.  We know the enteric nervous system is messed up in slow transit constipation.
  4. Butyrate may stimulate the contractile activity of the colon and accelerate GI transit.  We know slow transit constipation has a reduction in high amplitude propagating contractions and a disruption of the coordinated peristaltic activity.
  5. Butyrate is increased by eating resistant starch, a type of “fiber.”  (This is a bit confusing, but I will clarify later.  Resistant starch would be high in diets rich in lentils, beans, tubers, etc.  Please see Butyrate Series, Part 6 for a better, more thorough explanation)  Fiber has long been recommended for constipation.  Perhaps it’s not the fiber.  It could be the fiber.  Or it could be a rich bacterial population capable of making more butyrate for an individual.
  6. Butyrate has been shown to possibly decrease colon cancer.  Colon cancer is higher in patients with chronic constipation (Chronic Constipation Linked To Increased Risk of Colorectal Cancer–summary article from Science Daily).

And finally, I’ll leave you with this quote:

“If the promising results by Soret et al [the paper whose abstract I summarized and explained above] can be confirmed and expanded by controlled therapeutic trials, then butyrate-generating foods might become an effective and simple option to prevent or treat functional gut disorders via modulation of enteric neuroplasticity.” (2–a very good little commentary to read!)

Terri

Butyrate Series Page

Sources:

1.  Soret R, Chevalier J, De Coppet P, Poupeau G, Derkinderen P, Segain JP, Neunlist M.  Short-chain fatty acids regulate the enteric neurons and control gastrointestinal motility in rats.  Gastroenterology. 2010 May;138(5):1772-82.  Sadly, abstract only:  http://www.ncbi.nlm.nih.gov/pubmed/20152836

2.  de Giorio R, Blandizzi C.  Targeting Enteric Neuroplasticity:  Diet and Bugs as New Key Factors.  Gastroenterology.  2010 May; 138(5):1663-1666.

Also, if you will please see “Why Does My Gut Defy Gravity:  Changes in Severe, Chronic Constipation” and “But What Causes All of Those Changes Found in Chronic, Severe Constipation?” and “Cow’s Milk and Refractory Constipation”   then you can find further information plus sources for that information and information mentioned above.

Thanks,

Terri

Related articles

I also have run a whole series on butyrate.  I need to come back and link eventually; the WordPress blogging platform used to have a feature to do that but not now.  If you look under GI Tracts Defies Gravity page, there are links there to the series pieces.

But What Causes All of Those Changes Found in Chronic, Severe Constipation?

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Okay.  Great.  The slow movement of the colon in slow transit constipation occurs for a real reason.  There’s actually objective findings.  Super.

BUT WHAT CAUSED IT?  Here is where all of the great leads die.  All the fun and learning to get to this point–a hard, cold, concrete wall.  The etiology is unknown.  Don’t know.

Is there one of those changes discussed in the last post that could be a primary cause?  Or do these changes happen because of a discrete problem we haven’t connected and put together yet?  Or, more likely in my mind, are the changes a result of a multi-hit process in some of us?  I have had a problem with this since childhood, worsening, however, through the years.  Did it start as a dairy intolerance leading to inflammation?  The inflammation and food intolerance leading to constipation?  Constipation leading to chronic distention on the bowel wall?  Then worse constipation.  With the slowed transit did the bacterial flora get disturbed and changed?  Or did I have poor bacterial flora which in some way or other led to inflammation, constipation, distention, and worsening constipation?  I don’t know.  The hypotheses are endless for now.

  • Food sensitivities:  Would these be a source of chronic inflammation in the bowel which could bring about these insidious cellular changes?  Particularly if it was to something common like wheat, dairy or eggs?  I certainly don’t have an answer to this.  But studies do support food intolerances leading to severe, chronic constipation.  This next link is an excellent review article.  It starts out talking about cow’s milk and constipation, but near the end it starts talking about multiple food intolerances leading to constipation.  They go on to discuss inflammatory changes seen in chronic constipation patients, such as eosinophilia of the rectal mucosa.  (Full text, Review article: chronic constipation and food hypersensitivity –an intriguing relationship.)
  • Genetics:  Are you kidding me?  Of course!  Everything’s in your genes, slow transit constipation is no exception!  Researchers found an abnormal chromosome 1 in enteric neurons and glial cells.  (Abstract: Chromosomal study of enteric glial cells and neurons by fluorescence in situ hybridization in slow transit constipation.)  

These are the ones I found research supporting.  Fiber has been a mixed bag.  Bacterial flora is just starting to get sorted out.  So for now, this is it.  We are learning the structural, cellular, and hormonal changes that occur in slow transit constipation.  But we don’t know what initially causes all of it.

“Unfortunately, to date data are lacking on the possible factors causing neurenteric abnormalities in constipated patients. The current hypothesized mechanisms (often originating from experimental animal models) imply abnormalities in glial trophic factors leading to neural degeneration, and enteric localization of infective agents (bacteria, virus, prions) causing more or less selective degeneration of specific neurenteric cell populations (particularly EGC), whereas genetic factors or neurodegenerative changes due to aging seem to play a lesser role.”   (Full text,   Cellular and molecular basis of chronic constipation: Taking the functional/idiopathic label out.)

Citations are mostly links within the post.  Let me know if the links don’t work, please:

(1) http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2008.01109.x/full

Next up when time allows, what I think about as I approach this problem personally and the Metametrix report on short chain fatty acids/butyrate stuff.

Terri

Related articles

Why Does My GI Tract Defy Gravity: Changes in Severe, Chronic Constipation

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What is the problem?  There definitely is a problem, even if knowing what we know of the problem won’t help you move your bowels any more frequently yet.  And of all these “problems,” we don’t know which is the primary problem, if any of them!  I guess what I’m saying is, it’s good to know, but I’m sorry it won’t help you.  Advances in science occur in spurts, and then it takes time to shape these advances into hypotheses and then theories.  Even then, we may arrive at an incomplete understanding–as we may have in leading you to believe “fat is bad for you.”

I will describe in a later post how I use this and other information to try to gain any edge I can on my bowel function.

Please let me know if any of these links don’t work, please.  It is fascinating information, and if it may help you with your disease process, I’d like to make sure you can read it!

  • Less Interstitial Cells of Cajal (ICC).  Normal movement of the GI tract requires interstitial cells of Cajal.  These cells act as pacemakers and signallers between autonomic nerves and smooth muscle, causing the colon’s neurons to fire and bring about peristalsis, and alterations in their number and function are thought to bring about drastic functional changes.  Decreased ICC numbers and abnormal integrity are considered a hallmark in the gut disorders of diabetic gastropathy and slow transit constipation. (1, 2, 4)
  • Increased number of mast cells.  Mast cells are immune cells which are often found in connective tissue, particularly in sites where there is close interaction with the “outside world”—the external environment—like in the GI tract.  They are often associated with allergic responses, including food allergies.  In the GI tract, mast cells are preferentially located next to nerve terminals in the region known as the lamina propria and play an important role in the regulation of gastrointestinal visceral sensitivity, vascular permeability, and motor function.  Interestingly, they have also have been found to be elevated in many cases of irritable bowel syndrome.  (1,3)
  • Abnormal neurotransmitters and response to these neurotransmitters , including but not limited to– serotonin, vasoactive intestinal peptide, and substance P.  (1, 3, 4, 9)
  • Too many progesterone receptors.  Progesterone slows the GI tract down.   It does this, in part, by decreasing the effect of acetylcholine (the neurotransmitter that, in the bowel, leads to increased peristalsis) and serotonin.  This may explain why constipation may worsen during pregnancy and at certain times in female cycles.  Check. (1, 5)
  • Reduced Substance P Fibers.  Substance P brings about an increased GI motility effect. (1)
  • Less neurons immunoreactive for ChAT.  Basically saying there are less neurons sensitive to acetylcholine, which is necessary for peristalsis.  (6)
  • More neurons immunoreactive for NOS.  Basically saying that there are more neurons sensitive to nitric oxide (NO), a substance that allows the distal gut to relax as peristalsis occurs.  Having more NO sensitive neurons will make the gut more likely to be “relaxed” rather than peristalsing.  (6)
  • Less neuron density  (50% less), decreased neuron numbers, reduced number of ganglia, reduced number of cells per ganglion, and reduced enteric glial cells.  (6, 9)
  • Reduction in high amplitude propagating contractions and a disruption of the coordinated peristaltic activity.  Basically saying that there are less of the sweeping contractions that bring about defecation and that the whole system just is not coordinated at all like in normal person.  (6)
  • Weaker contraction to acetylcholine in the colon. (7)
  • Relaxation to adrenalin stronger than a normal colon. (7)
  • Possible antibodies to GnRH with decreased GnRH and its receptor in enteric neurons.  GnRH is gonadotropin releasing hormone.  (8)
  • Excitatory nerve fibers present in the circular muscle are deficient in tachykinins and encephalin.  (9)
  • Expression of c-kit mRNA and c-kit protein was also found to be significantly decreased, which may lead to reduced interstitial cells of Cajal. (9)

In summary, your gut (and mine) doesn’t move, and we aren’t sure exactly why.  However, there are MANY identifiable differences in a gut with slow transit constipation and a normal gut.  The unique nervous system of the gut is disordered, in both the neurons, hormone production, hormone processing, and the supporting cells for the neurons.

More posts to follow along this topic:  What could cause this problem?  What I personally do about it.  The role of butyrate and short chain fatty acids (SCFA) on the gut/my Metametrix result for SCFA.

Take care,

Terri

Citations:

(1)  This requires a log-in.  So you may not be able to pull this little review article up:   http://www.medscape.org/viewarticle/770638_3

(2)  http://cdn.intechopen.com/pdfs/31218/InTech-The_role_of_interstitial_cells_of_cajal_icc_in_gastrointestinal_motility_disorders_what_the_gastroenterologist_has_to_know.pdf

(3)  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033552/

(4) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710411/#!po=11.363

(5) http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2011.01705.x/full

(6)  http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2008.01165.x/full

(7)  http://www.ncbi.nlm.nih.gov/pubmed/12397730

(8) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885307/#!po=63.0435

(9) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710411/#!po=11.3636  (I really liked this article for pulling things together and giving me leads to follow.)

Slow Transit Constipation: A True Enteric Neuropathy

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Never apologize for a messy house.  (Reader, move on if this isn’t your deal.)

English: Pedestal squat toilet

English: Pedestal squat toilet (Photo credit: Wikipedia)

You’d think that being a not-so-old medical doctor, even now just eight years out of training, I would have known more about constipation than I did.  But I didn’t.  And the doctors I went to for help didn’t seem to know either.  I do remember one elderly OB/Gyn admitting that he didn’t know what to tell me to do, but to certainly do something; he had a friend who had severe constipation and had to have a colectomy (part of his colon cut out).  My OB/Gyn admitted, “I didn’t know constipation could get so bad.”  I appreciated his acknowledgement of the potential gravity of the situation.  However, nobody seemed to offer me anything helpful, and I just muddled through with various over the counter products with occasional, temporary success.  Luckily for most of my life, my slow transit was relatively asymptomatic (at least between bowel movements, which gave me quite a symptom-free interval—chuckle) and unaccompanied by too many other symptoms, until the last few years.

Since I got the awesome opportunity to homeschool my kids, I had just a couple of hours here or there to start reading for myself, so I could hopefully avoid that colectomy.  The first article that made me celebrate a couple of years ago was something about “fiber doesn’t help slow transit constipation (STC), in fact, it may make it worse.”  Validation of my own experience, counter to most suggestions from my own doctors and training!  However, mostly in my early searches, I came across depressing, belittling stuff like this (emphasis mine):

Now, I am beginning to read lines like this, helping me to see that, although research doesn’t know the answers, at least they’ve identified a REAL problem and there are researchers out there “fighting for me” (and my psychological profile):

Right.  So now I’ve got a nice review article to validate my personal knowledge that no matter what I try, nothing works great because I’ve got a real problem.  A problem that goes beyond trying  fiber, water, and yoga.  A problem beyond, “Well, you must have held your poop in too much when you were a kid so you wouldn’t have to poop in public places.”  Please.

So what is wrong down there?  A true problem with the nervous system and hormonal system of the gut, now in its early infancy of identification.  Science history in the making.

Thanks for reading.  I’m working up to my butyrate post.

Terri

Next up, Part Two:  Why Does My GI Tract Defy Physiology and Gravity?
(Alternate Titles To Amuse My Sense of Humor:  “Everybody Else Can Poop, Why Can’t I?”  or “Thank My ENS I Don’t Have To Touch The Toilet Bowl Brush!”)

Cow’s Milk and Refractory Constipation

1 Reply
Dripped homemade yogurt

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.

  • 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.

  • 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.

  • 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!
Other constipation posts: