Tag Archives: constipation

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

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

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!”)

Is It Autoimmune?

Zugspitze von der Alpspitze aus gesehen. Links...

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 Shincorresponding author

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

Part 2: A Success Story In Using the GAPS Diet to Stop Absence Seizures!

If you subscribe to my posts or check-in regularly, you know I am following this unusual (poorly scientifically supported) diet called GAPS.  For me, it started out solely to fix my beyond slow, almost-to-stop, GI tract that NO medicine, activity, or dietary change was helping.  Over the year, on what I call my “dietary rehabilitation” program, I’ve seen lots of improvement in my GI situation, and I have observed (incredulously) the effect that foods, even “healthy” foods, has had on my family and me in many ways I never dreamed of.  These foods include dairy, wheat, eggs, chicken, and fruit:  “healthy foods.” Although I follow GAPS in a self-experiment, my blog is to encourage awareness that food treats the body like any drug, with good and bad effects varying in different people; most doctors don’t know or adhere to this.  I wouldn’t either, was I not living it.  Food culprits ought to be considered in many more illnesses.  I want to raise awareness that diet needs to be scrutinized and a dramatic change may help where no medicine or surgery does.  I am talking dramatic food changes, and some [most] people just aren’t willing to go there. Starting with a  traditional medical doctor is the correct place to start; I go to get new symptoms checked out, even for myself.  Bad problems exist, and I don’t want to miss them because I was blinded by nutrition or alternative health treatments.  My blog is not written to be a source of medical information, medical diagnosis or medical treatment, and I am no expert in nutrition or different types of diets, including GAPS.

Today, I am continuing to publish the Kinder Family’s story about how they feel nutritional intervention cured their son’s seizure disorder.  The story is unedited, despite the fact that I would have have perhaps explained things differently or sought help in different ways.  To me, the important thing is they recognized that food matters and they were willing to change.  Thank you, Dan and Tammy, for sharing:

Part 1 of “A Success Story in Using the GAPS Diet to Stop Absence Seizures!”

Part 2:  A Success Story in Using the GAPS Diet to Stop Absence Seizures!

by Dan and Tammy Kinder

…The ENT immediately recommended surgery and stated that he does dozens of sinus surgeries every month. Not wanting to go through surgery unless absolutely necessary, we started researching and reading alternative ways to resolve the chronic sinusitis. We came across lots of information that may potentially help. We read about changing our eating habit and avoiding certain type of food like dairy which causes the body to produce excessive mucus. We read about washing your sinus cavities out with salt water called a saline nasal flush. We read about many other things like supplements and other treatments, but these two made the most sense to us. So my husband stopped eating and drinking dairy products, he continued drinking carrot juice and started doing saline nasal rinse 3-4 times a day. He found out very quickly that the nasal rinsing worked was very effective. These rinses could turn a sinus infection that would normally last three or four week in to one that would last only three or four days. A sixty-nine cent can of salt was all it took to resolve the sinus infection each time symptoms appeared. Changing what we ate eventually gave his body the ability to prevent the infections from even appearing. As time went on the sinus infections disappeared altogether. This long drawn out experience with 13 different doctors contributed greatly to our decision to steer away from conventional doctors that would only give us their best guess and the best known drug at that time to try to resolve our son’s epilepsy, which leads me to my son’s story.

At about four and a half years of age, one of my sons started having what looked like staring or day dreaming episodes. When I first notice the episodes, my husband was convinced they were only day dreams and nothing serious. In fact, the episodes were so infrequent that he did not see one for himself until several months after they started. But as the months went by, the episodes came more and more frequently. They also became more pronounced in their characteristics and duration. The length of the episodes seemed to be mostly random, but would last anywhere from a fraction of a second up to as long as about eight seconds. The characteristics of our son’s body during the episodes also seemed to change as time passed. These characteristics included half-way drooping eye lids, the dropping of his arms to his side, looking towards the ground, staring at or through the person talking to him as though he was in his own world and ignoring his immediate environment. Along with these symptoms he also experienced reoccurring stomachaches. Early in this process we did not relate these stomachs to the episodes, but looking back over the years we now realize that his body was screaming for help yet we did not recognize or listen to what his body was trying to tell us. Another symptom was that certain foods would make him feel “weird.” Sometimes he would tell us that his head felt like it was spinning or vibrating. As he got older, it was certain foods he ate that made his head have these weird feeling or his body feel strange. Sometimes these odd feeling would cause him to want to do strange things. I recall one time that he told us that his body was telling him to scratch his fingernails on the concrete. That thought leads me to another symptom that was very strange. At times, he would tell us that his body was telling him to do things. On occasion he said he would hear voices telling him to do certain things. The older he got, the better he was able to elaborate on how he felt and and how he thought certain foods made him feel weird…

Part 3 to follow soon…

Dairy Causes Some Kids to Have Constipation

It's the picture of Italian ice-cream in a sho...

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

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

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

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

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

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

Other constipation related posts:

Slow and Steady Constipation Improvement (April 17, 2013)

Cow’s Milk and Refractory Constipation ((January 2, 2013)

A Doctor Visits the Doctor (December 5, 2012)

Whats’ Working (A Constipation Post) (November 3, 2012)

Is it Eggs (October 21, 2012)

Jordan and Steve (A Constipation Post) (October 17, 2012)

Bowels of Steel (October 8, 2012)

Slow and Steady Constipation Improvement

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

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

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

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

Has GAPS helped my chronic constipation?

Yes.

Has it been easy?

No.

Have I strictly adhered to GAPS?

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

How are your bowel movements?

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

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

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

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

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

Besides food changes, what do you do?

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

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

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

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

That’s It

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

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

Wishing you only the best.  Good luck.

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

Terri

Other constipation posts:

Dairy Causes Constipation in (Some) Kids

Cow’s Milk and Refractory Constipation ((January 2, 2013)

A Doctor Visits the Doctor (December 5, 2012)

Whats’ Working (A Constipation Post) (November 3, 2012)

Is it Eggs (October 21, 2012)

Jordan and Steve (A Constipation Post) (October 17, 2012)

Bowels of Steel (October 8, 2012)

Cow’s Milk and Refractory Constipation

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 Pediatrics2009, 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 childrenNadeem 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: