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WBJ – A Functional Approach to Managing Constipation

November 7, 2022 By Alan Greenberg

Who likes to talk about poop besides little kids? Certainly, not many. It can be an embarrassing topic of conversation, even with your doctor. While CBD can relieve certain forms of constipation, we thought this article would be helpful to understand some of its causes. As always, we recommend getting a doctor’s help before using CBD if you don’t know the cause of your constipation.

The following article has been reprinted from the Vol 31, Spring 2022 of the Well Being Journal.

By Peter Kozlowski, MD

We all have a different schedule of when and how often we go to the bathroom. It can be considered normal to poop three times per day or three times per week—so there is variation in what is “normal.” I believe that healthy bowel habits include passing a log every day.

What is constipation?

Generally speaking, constipation is defined as irregular bowel movements lasting for an extended period of time, and marked by at least two of the following symptoms:

• Straining
• Lumpy or hard stools
• Sensation of incomplete evacuation
• Sensation of anorectal obstruction/blockade
• Manual maneuvers to facilitate defecations
• Fewer than three bowel movements per week
• Loose stools are not present and there are insufficient criteria for IBS

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Estimates suggest that about 16 out of 100 adults have constipation, and that number goes to 33 out of 100 in people over 60 years old. That is a lot of people!

Why is it so common? Our environment can be harsh on our guts, and when our gut is damaged it doesn’t work properly. When I say gut, I am referring to the tube that starts with your mouth and ends with the anus, and includes the esophagus, stomach, small intestine, large intestine, pancreas, liver, and gallbladder.

What Factors Contribute to Constipation?

The most important but least talked about reason is the gut-brain connection—the two-way communication between your gut and brain. Your gut tube has its own nervous system, called the enteric nervous system (ENS) and it is connected to your brain by your vagus nerve. Here is the magic key to unlocking your gut health: the vagus nerve.

The vagus nerve relays signals back and forth between your brain and gut. It runs on your autonomic nervous system. Of note, “auto-nomic” essentially means automat-ic; this system is always on and can go back and forth between your sympathetic nervous system and parasympathetic nervous systems.

Sympathetic response is known as “fight or flight” while para-sympathetic response is known as “rest and digest”—both responses are important for our survival but there should be a balance between the two. Let’s say you’re hiking in Montana and encounter a grizzly bear. In order to escape and survive, your sympathetic nervous system is activated, along with your brain and muscles. After you escape and are sitting comfortably by the campfire enjoying a meal, your parasympathetic system is activated. That is, your brain is relaxed, and the blood and energy are directed to your gut to digest your food so you can pass the byproducts. Using energy to digest food when you’re trying to survive from a bear attack is not a good survival mechanism.

These days, many of us are living stressed—as if we’re running from a grizzly bear 24/7. We wake up and check our phones first thing in the morning. For most of this activates fight or flight, as there are texts, emails, calls, social media, and breaking news. Our body is being told, “Today is a survival day, digestion will not be needed today.” To make matters worse, we watch the news while eating breakfast. Understandably, our gut gets so confused because there is food present, and it should be digested but the brain is telling the gut to shut down. If we are not properly digesting, we will not poop properly.

So, focusing on your vagus nerve is in my opinion the best way to make sure you are pooping regularly. When it is in the parasympathetic response it allows your gut to function properly. It can be very difficult to control since it works automatically, without you thinking about it. What are the best tools to help your vagus nerve? Stay in the present moment, breathe, meditate, slow down, try a Heart Rate Variability monitor, get a therapist, work on unresolved issues, and let go of control. Easy right? No, but it is worth it!

Another common reason people are constipated is our Standard American Diet (SAD). We don’t eat enough fiber in our diet, and we eat too many processed foods and sugar. According to the American Heart Association, the daily recommended value for fiber is 25 grams per day on a 2,000-calorie diet for adults. This number may also depend on age or sex: women under 50 should get 21 to 25 grams per day, men under 50 should get 30 to 38 grams per day. It is estimated that only five percent of Americans eat enough fiber per day. In fact, the average American eats only 15 grams of fiber per day.

Research indicates that in the hunter-gatherer diet, people ate 100 to 150 grams of fiber per day. There are two types of fiber, and both are important:
  • Soluble fiber allows more water to remain in your stool, making waste softer, larger, and thus, easier to pass through your intestines.
  • Insoluble fiber adds bulk to your fecal material, which hastens its passage through your gut and prevents that constipated feeling.

Many of us also don’t drink enough water. Constipation happens because your colon absorbs too much water into your body, which dries out the stool making it hard in consistency and difficult to push out of the body. If there is a limited amount of water available, your body will absorb too much, leaving an inadequate amount for your stool to pass through. Try drinking half your body weight (lbs) in ounces. If you weigh 180 pounds, make an effort to drink 90 ounces of water per day.

Besides drinking more water and increasing fiber intake, exercise can also help you achieve daily BM. Aerobic exercise increases blood flow to your gut, which results in stronger intestinal contractions and more digestive enzymes. The stronger the contractions and the more those juices flow, the more quickly and easily food waste will move through the colon and out of the body. Aerobic exercise can include walking, running, swimming, biking, basketball (my favorite), among others.

Additionally, hormonal imbalance can make you more constipated. A sluggish thyroid will cause your gut to slow down. Ask your doctor to check your thyroid levels if you are constipated. For females, constipation during your period may be common due to hormonal changes. This is a great time to drink more water, eat more fiber, and exercise.

The most common reason patients with constipation come to me—a functional medical doctor— rather than their regular doctor is to check their microbiome. Our gut is home to 3 to 5 pounds of bacteria that is called your microbiome. The bacteria live on the inside of the large intestine—they are alive and eat fiber. Healthy bacteria (probiotics) help keep our gut, immune system, and nervous system functioning well, but when an imbalance occurs (dysbiosis or Small Intestine Bacterial Overgrowth [SIBO]), they can cause or contribute to constipation or other inflammatory conditions like eczema and migraines.

Think of your microbiome like your own internal garden—the plants of your garden are the probiotics and fiber are the fertilizer of your garden. But what can happen in a garden when you don’t take care of it? Weeds can grow in your gut garden just like they can grow in your home garden, this is called dysbiosis—an overgrowth of imbalanced bacteria. Conditions like dysbiosis or SIBO are easily di- agnosed with stool and breath testing and should be ruled out if someone is suffering from chronic constipation.

IBS is thought to affect approximately 10 to 20 percent of adults and adolescents worldwide. It is the most common condition seen by gastroenterologists. IBS is defined as a group of functional bowel disorders in which abdominal discomfort or pain is associated with features of disordered defecation. It is also classified under Rome III Criteria as “abdominal symptoms persistent or recurrent for 6 months or more, with symptoms occurring on at least 3 days per month for at least 3 months.”

IBS symptoms include:

  • Abdominal pain, bloating or discomfort
  • Marked change in bowel habits
  • Change in stool frequency
  • Change in stool consistency (constipation or diarrhea)
  • Altered stool passage
  • Straining for normal consistency stool, urgency of defecation
  • Incomplete defecation

In my functional medicine experience, I have learned that IBS is usually undiagnosed food sensitivities, dysbiosis, or SIBO. When your microbiome is imbalanced these symptoms can occur, and the conditions should be tested for.

In conclusion, constipation is a common issue that factors such as stress, dehydration, poor diet, and lack of exercise can contribute to. When corrected, the condition improves. In the case those factors don’t lead to a more regular BM, talk to your doctor about testing your hormones and determining the health of your microbiome. ∆

Peter Kozlowski, MD, aka “Doc Koz,” did his residency in family practice but started training in Functional Medicine as an intern. He trained in clinics with leaders in his field, including, Mark Hyman, MD, Deepak Chopra, MD, and Susan Blum, MD. Overall, Doc Koz strives to empower patients to achieve true balance of body, mind, and spirit. His expertise is in gut health, but he also regularly works with food sensitivities, hormone imbalances, and detoxing from toxic chemicals.

Unfunc Your Gut: A Functional Medicine Guide, by Doc Koz, is a research-based fusion of the author’s medical insights and mind-body wisdom acquired through his own experience of addiction recovery and treating patients in his clinical practice. Complete with relatable, successful case studies and 50+ delicious recipes that will invigorate your life—simply put—it is an oasis of clear answers in the sea of contradictory online nutritional information. If you’ve been seeking grounded answers to your basic gut-health questions, Doc Koz guides you to boost your immune system, heal your gut, and unlock your mental, emotional, and spiritual health. Get ready to Unfunc Your Gut and feel amazing!

Filed Under: Blog, Well Being Journal, Uncategorized

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