Tag Archives: constipation

Are You Still Doing GAPS?

Chunky squash chicken soup I’ve fallen completely in love with nutrition. So I decided to do an interview with myself about the first, crazy, named diet I ever tried: GAPS. Read with a mild sense of humor at times. Please don’t use anything on my site as medical guidance. (I always say “please,” but I mean it…) Use what I write to scoff. Laugh. Plagiarize. But not as medical treatment or recommendations. Even thought I think I’m right, you should know that I’ve been known to lock myself out of my house, leave fully loaded grocery carts standing in the parking lot, and call my husband by my first real boyfriend’s name.

Are you still doing the GAPS diet? No.

Got a longer answer than that? Of course!

Why did you start the GAPS diet? It seems a bit loco sounding. I mean, bone broth and sauerkraut? Really? How did a legit, well-trained, seemingly-normal MD like you go off the nutritional deep-end like that? Well, honestly, it doesn’t sound too extreme anymore. Now, it all just sounds like good, old-fashioned, traditional food minus a few things. But to answer your question, I had a severe form of a very common problem. In fact, I was told never to talk about it with people, they don’t like to talk about it and they don’t want to hear about it. I suppose I can tell you. I trust you. I started the GAPS diet because my stupid gut wouldn’t move, even with medicines, more than twice a month. Anal retentive woman, I guess.

Did you try any other more normal diets before this?

Oh, like– vegetarian-in-a-box? I’m kidding. A traditional vegetarian diet I think is actually a powerful way of eating, especially if one throws in an occasional egg and/or some fish. But so many vegetarians think a vegetarian diet is about just not eating meat–and they sacrifice their own bodies to the industrialized food package.

Well, anyhow, the standard medical repertoire and more than 4-5 doctors had finally 100% failed me, and I scoured the internet hours and hours for alternative “cures.” I started reading tons on-line and trying this supplement and/or that food, falling into the idea that “one” thing would help. I tried a gluten-free and dairy-free diet for a couple of months while I researched. I tried an elimination diet with only sweet potato, lamb, and white rice too. Repeatedly, though, I kept hitting on people talking about special “healing diets.”

A healing diet? Pft. What in the heck is a healing diet? I know. I know this sounds so stupid to newbies and nutritional novices. When I first started reading about this stuff, I thought, “These people are crazy. CRAZY. WHAT do they eat? How can they think a person should cut THAT out of their diet? Oh, the gullible heap.” (I have a little judgmental problem. Life is working on it.)

And this leaky gut they keep talking about? I can’t remember which staff doctor in training told me that leaky gut wasn’t a real thing, but I know I was taught that!

To answer your question, a healing diet takes into account the fact that the condition of our gastrointestinal tracts helps determine our health—whatever part of the body we want healthy (skin, brain, intestines, joints, etc.). And food predominately determines the condition of your gut.

So, using food, a good healing diet will look to keep the immune cells of the GI tract happy. It will look to offer the nutrients the cells lining the intestines need. It will look to make sure the GI’s immune system is not barraged. It will look to make sure the mucous (Did you know mucus is the noun form and mucous the adjective? Cool, huh.) protective layer of the GI tract is regenerating. And it will nurture beneficial gut microorganisms and weed out not-so-beneficial microorganisms.

A healing diet will remove foods that commonly inflame the entire body and will provide abundance of foods which carry necessary nutrients and restorative properties. The best healing diets will also force you to address more than food, things like sleep, stress, skin care products, and so on.

Okay. I see what you mean about a healing diet now, I guess. But why GAPS?

SCD (Specific Carbohydrate Diet) then GAPS (Gut and Psychology Syndrome) were the first “nutritional intervention” diets I kept hitting on. They seemed maybe to be the rage, fad diets of the time. I don’t know. (I later learned of others. And I’m sure there will be plenty more.)

I read all the pertinent websites and bought the books to read. I decided to set out on the GAPS diet to give diet a full attempt to prove to myself that nutrition would not change anything in my health–because I was 100% convinced that diet would change nothing.

Why GAPS? It seemed the most radical and extreme! (Have I made it clear enough that I seriously thought all of this was INSANE. Detoxification? Gut dysbiosis? Leaky gut? Liver support? Adrenal fatigue?) But if there was something I could do to avoid a colectomy later in life, I was willing to try! And GAPS seemed, at the time to me, to be one of the most stringent diets, and I wanted to cut to the chase, do the hardest first, and cross diets off my list.

I knew nothing about nutrition, and that’s how I made my choice. Brilliant, eh.

How long did you stay on GAPS? I stayed on GAPS for about 18 months.

Eighteen months! New humans are turned out in less time than that. Did you cheat? Sometimes on accident. And sometimes I’d choose to “cheat” and see if I could expand my diet without having any problems from it. But the GAPS diet book says it can take up to two years, so I wanted to give it its due chance. If I clearly could see I had no issues with a food, I’d eat it on special occasions, like maple syrup or a baked potato. And dozens of times I struggled with eating too many dates, honey, almond flour, and peanut butter, all “allowed.”

Why did you stop GAPS? My constipation finally became manageable with lots of magnesium and the GAPS diet. I became enchanted with nutrition and kept reading. I stumbled across something called butyrate for gut health when I was interpreting a Metametrix stool test I had taken (I know. Weird. A stool test.) and decided to try it as a supplement for my GI tract. Its effect was magic on my gut–GAPS had gotten me part of the way and this seemed to finish it! But butyrate is still a supplement, and I don’t like supplements. We (well, our gut bacteria) can produce butyrate naturally from certain foods, so I next added in potato starch (Bob’s Red Mill) and began eating food sources of butyrate, like sweet potato (cold), rice (cold), green plantains, green bananas, potatoes (cold), and a few, diverse legumes. So after about 18 months, I think you have to technically say I came off of GAPS because I was routinely adding in foods not on the diet.

I still keep a lot of the ideas that GAPS taught me in my diet:

Homemade broths for gelatin, calcium, magnesium.
Fermented foods such as sauerkraut and kimchi.
Offal, such as liver, heart, tongue, and marrow.
Vegetables, vegetables, vegetables. (Some say GAPS doesn’t advocate carbohydrates and raw vegetables. I don’t think that is accurate. It is not written as a low carb plan per se. It allows a person to eat navy beans, lentils, parsnips, pumpkin, butternut squash, peanut butter certain fruit, and honey as tolerated by a person. And it only excludes raw vegetables until a person’s symptoms improve. Now, how each person will interpret and follow the diet will vary.)
Minimizing exposures to environmental things I can control and helping the body deal with them–such as avoiding plastics, excessive fluoride, unnecessary skin care products, etc. Taking Epsom salts baths.
Well-placed supplements.
A never give up attitude.

I will continue this long, verbose self-interview later. My kids need food and school…

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.

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

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

Digestive Link Sharing

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

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

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

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

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

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

The Digestion Sessions
http://digestionsessions.com/

Closing

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

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

Terri

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

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

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

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

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

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

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

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

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

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

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

Health to you and yours–

Terri

The Unglorious Call to Action

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That is a personal problem. Not a medical problem.

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

My History

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

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

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

Achieving Success

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

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

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

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

Closing

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

~~Terri
Photo credit:

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

For GI Readers

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My post and blog, they are not intended to treat or diagnose you. It is meant to stimulate your desire to read and learn. With your knowledge and research articles in hand, go visit your favorite healthcare practitioner. Ask them what’s right for you. The things I try may be detrimental to your health or have serious consequences that I may not even know about.

Dear Reader,

For about 20 months I have scoured the internet, looking to solve my lifelong, severe, medication-dependent constipation issue. Constipation persisted for years as my only symptom, albeit worsening each decade of my life, until in my thirties other symptoms started creeping in like bloating, headaches, and fatigue. In my stint as a practicing medical doctor, I saw at least two colectomies specifically for chronic constipation. This scared me a lot because I do not want to have colon surgery. However, nothing in my arsenal or in the arsenal of the doctors I chose could help me.

So about 20 months ago I started working with my diet (gluten-free, dairy-free). About 17 months ago I started what sounded like a crazy, voodoo diet called GAPS, in an attempt to prove to myself that no diet “so extreme” could possibly be effective. I wanted to check diet intervention off of my list as an alternative treatment choice. “I am a trained medical doctor; I know that won’t work. Diet won’t work.” Actually, I had some minor success using GAPS, figuring out food intolerances, and piling on the magnesium to effect (which I had tried very unsuccessfully to do in the past). I decided to stay on board with this strange, new way of eating (with a couple of boots by my husband when I cried around about it being too hard).

I have putzed along on GAPS, steady enough, but no real gains, trying this a bit and that a bit–all within the confines of GAPS. I recently followed a lead regarding short chain fatty acids, particularly butyrate, helping restore the enteric nervous system. In severe, lifelong constipation, researchers have found actual neurologic changes so I really thought this might be the tip I needed.

Resistant starch increases butyrate production in the colon. But I am on GAPS, and many of the starches aren’t legal. Plus, during my initial findings on butyrate, I was trying out very low carb to see if that would be my ticket. So what to do?

How about just go get some butyrate? I mulled it over. It’s supposed to be absorbed before it reaches the colon and therefore not have its desired effect, at least in the common preparations. But I went for it; I had nothing to lose except barrels of magnesium. I bought some magnesium-calcium butyrate from Amazon, and I started taking two capsules three times daily. It said to take it with food, but I thought I’d mix it up a bit. I took it sometimes with meals and sometimes right before bed on an empty stomach.

For twenty days I have been on magnesium-calcium butyrate (250 mg total per day of magnesium versus the plus two grams of magnesium I’ve been taking). For 19 days my GI tract peristalsis hasn’t missed a beat. Best ever, even while on medicines. I am trying to contain my excitement because perhaps it will stop working. But I don’t know. I mean, I’m completely off of my magnesium! I am on nothing but a GAPS diet tailored for my hard-earned knowledge of my food intolerances, fish oil/vit D about three times a week, and VSL #3 probiotic at night. None of that is new besides the butyrate. I have not changed my diet, if anything I’ve pushed nuts too much trying to get butyrate to prove itself. And it has.

I don’t like supplements. My next goal is to see if I can add resistant starch to my diet and get the same effect. I am very hopeful. However, I think my pure GAPS saga may be winding to a close. I believe my diet will now be GAPS but I will need to add in things like green bananas, cold potatoes, potato starch, and sweet potato. I am not entirely sure yet. I’m going to ride out a complete month on butyrate to complete a full monthly cycle. However, when my problem was always at its worst before, it was smooth sailing! I am very optimistic about this one.

I am currently composing a series encompassing all that I have learned going down this rabbit hole. It will cover short chain fatty acids, butyrate, sources of butyrate, resistant starch, things known to increase and decrease butyrate/SCFAs. My sisters are editing it for me now.

There is no perfect diet for anyone, but I think finding a good diet platform (such as Paleo, autoimmune Paleo, SCD, Whole30, Terry Wahls’, Perfect Health Diet, GAPS, etc) will allow you to slowly and surely figure your body out. And then with some nips and tucks, you can achieve your endpoint. I think. But it takes the patience of Job. Seriously. The patience of Job. And a good supporter; my husband has been super in helping me stay the course. It has been hard because I am a “sweetaholic.” I can’t tell you the diet and the supplements you need. But I will be more than happy to be your cheerleader and encourager if you drop a comment or an e-mail.

In closing, a good diet, I think, must not only incorporate foods that are full of their own natural nutrients, but a good diet must also TAKE OUT COMPLETELY foods that are either commonly known to be inflammatory or known to cause symptoms–whatever they may be, acne, depressed-like mood, sore throat, eczema, bloating, etc–in a particular individual. At this point, a broken body will need a little extra nutrition/supplementation in certain departments. Perhaps a little magnesium, perhaps a little resistant starch, perhaps a little coconut oil, perhaps a little glutamine, perhaps a little fish oil, perhaps a few B vitamins, perhaps low-carb, and so on.

I wish you only success.

Sincerely,

Terri

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 (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):

“Chronic idiopathic constipation: a psychological enquiry.” (click for abstract)
“Functional constipation in children: does maternal personality matter?” (click for abstract)

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):

“… labels such as “idiopathic” or “functional”, that basically conceal the fact that too little is known of a specific pathologic entity, should be hopefully replaced when more knowledge is available… As such, the recent recognition of neurenteric abnormalities in many patients complaining of constipation should point to reconsidering at least some of these forms (especially STC) as true enteric neuropathies, and to drop the “idiopathic”/“functional” label.” (full text available, from “Cellular and molecular basis of chronic constipation: Taking the functional/idiopathic label out”, World J Gastroenterol. 2013 July 14; 19(26): 4099–4105.)

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!”)

Is It Autoimmune?

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Zugspitze von der Alpspitze aus gesehen. Links der Jubiläumsgrat (Photo credit: Wikipedia)

A friend asked the other day, “What would you recommend diet-wise for an autoimmune disorder, such as lupus?”

Good question. However, allow me to change the question a little bit, yet not really. Because this blog is about my story. And I don’t have lupus.

“What would you recommend diet-wise for an autoimmune disorder, such as CONSTIPATION or IRRITABLE BOWEL SYNDROME?”

Now we’re talkin’. Could I have an autoimmune disorder?

Does Irritable Bowel Syndrome and Dysmotility Have an Autoimmune

Origin? (Neurogastroenterol Motil 2011;23:1000-1006, e459)

Jeong Eun Shin

Do you have an autoimmune disorder? I personally have been playing around with an autoimmune diet (while continuing on this thing called GAPS diet). I definitely notice a difference in how I feel, but I find the autoimmune protocol very challenging. I am no expert on any of this. I’m just a medical doctor who has the opportunity to explore nutrition as it applies to her own issues and the issues in her immediate family. I don’t know how this all fits together scientifically. I can’t wait to find out. Seriously. I have to forge my own path. Maybe you do, too. But still make sure and get real medical advice and guidance. But don’t sit around waiting. Move. For today, let’s say I had to pick two sources to send my sister to regarding addressing an autoimmune disorder, any autoimmune disorder, and nutrition. I’d send her here:

Terry Wahls’, MD “You Tube” video regarding her “curing” her multiple sclerosis: This video is A MUST WATCH. Just totally told me what I knew deep inside about food–it’s for the function of my body–not whatever else I or society tries to make it! Terry Wahl’s is a medical doctor who reversed her severe, debilitating MS. Basically, her nutrition was very similar to diets called GAPS/Paleo/SCD/Whole30, with a few tweaks here and there. Amazing story. She now has her own book, website, etc. I have heard the book is a bit outdated and she has made some changes. I am on the list for when the new edition rolls out. Can’t wait to read it and compare it to all I am learning.

and here:

Paleo Mom: She has a PhD in medical biophysics and has deeply explored an autoimmune diet for her health. She tries to base her posts on science as much as possible, yet she does so in a completely understandable manner for lay people. She had to take her diet down to autoimmune paleo to achieve results she needed. Her recipes all look awesome, but be careful signing up for her Facebook page. She rolls out all the sweet dessert recipes there. Kills me. Kills me.

Good luck in all you do! Eat right! You keep healthy so you can get down on the floor with your grandkids. Hike in a Costa Rican forest with them. Or just climb the bleachers to their ballgames. My grandma made one ballgame of mine that I can remember. One. She was an awesome smart woman, but diabetes, vascular disease, and obesity made it exceptionally difficult to navigate the likes of a high school sports event. I want to climb mountains with my grandkids. See you at the top!

Terri

The HSD

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

Tag Archives: constipation

Are You Still Doing GAPS?