Tag Archives: slow transit

Do Slow Guts Need Loved?

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

Alone Time First Thing in the Morning

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

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

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

Ileocecal Valve Massage, Gargling, and Gagging

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

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

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

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

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

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

Core Exercise

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

Changing Perception

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

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

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

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

Loving My Body’s Limitations

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

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

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

Diet

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

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

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

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

Closing

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

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

Terri

Maybe Slow Guts Need Poked

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

 

 

 

 

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

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

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!”)