14 May Constipation
Constipation is often treated more like an inconvenience rather than an overwhelming problem until it becomes just that, a serious problem. I view constipation as a life situation that is analogous to the boiling frog anecdote, in which the frog doesn’t notice the change in temperature until it’s too late. Some patients consider infrequent bowel movements normal, as that is all they have known their entire lives. So, what is the risk to the patient from chronic poor elimination?
Autotoxemia
“Bowel toxemia” explains the colon’s connection to a variety of conditions, whether acute or chronic. Dr. Kellogg wrote about this in his book, Autointoxication or Intestinal Toxemia in 1922. JH Tilden, MD used the term “autotoxemia” and stated, “toxemia is the cause of all disease.”
The patient who has infrequent or incomplete elimination is at increased risk of reabsorbing the toxins the body is trying to eliminate. Autotoxemia is increased in patients who have compromised liver function or are poor detoxifiers. Toxins produced in the colon include byproducts of amino acid metabolism, such as histamine, tryptamine, cadavarine, phenol, indole, skatole and hydrogen sulphide. Toxic metabolites, such as ammonia, are produced from every cell in the body. With normal elimination in a healthy individual, these toxic products are excreted efficiently. However, the longer the stool stays in the large intestine, the more water and toxic chemicals are reabsorbed into the blood stream. Certain tissues may have an affinity for specific toxins, such as the kidneys and nervous system for mercury. Other patients may have a genetic susceptibility in certain organs, their “weak link,” which becomes diseased under the burden of an increased toxic load.
The colon is like a river that needs to keep moving to be healthy. If the river gets stagnant, the fish die, the pH is altered and opportunistic plants such as algae flourish. Proper pH and a healthy balance of gut flora are vital to a healthy large intestine. A diet high in animal protein is associated with sluggish colon functioning, contributing to constipation. It promotes an alkaline pH in the colon (due to increased ammonia production), which discourages the growth of acid-loving bacteria such as Lactobacillus acidophilus and encourages overgrowth of pathogenic bacteria, resulting in dysbiosis – “a causative factor in numerous chronic degenerative diseases, such as arthritis, autoimmune diseases, colon and breast cancer, psoriasis, eczema, cystic acne and chronic fatigue.”
A diet rich in fiber and complex carbohydrates creates a slightly acidic pH, which encourages the growth of L. acidophilus. It has been shown that higher levels of acidophilus in the colon create a decreased risk for colon cancer by degrading cancer-causing enzymes. The presence of “good” bacteria in the gut, such as L. acidophilus and Bifidobacteria, reduces the numbers of pathogenic bacteria in several ways. Lactobacilli synthesize many antimicrobial substances, such as lactic acid, acetic acid, benzoic acid, hydrogen peroxide and, perhaps most important, natural antibiotics.
Treatment
The first thing I do is put patients on a regular daily routine to increase their bowel tone.
- Every morning, before getting out of bed, they should gently massage their abdomen in a clockwise motion. This encourages the normal flow of stool toward the rectum. Many people will find that this alone will result in a daily morning movement.
- After rising, patients should drink at least eight ounces of warm (not tepid) water to stimulate the gastrocolic reflex. This reflex, resulting from the distension of the stomach, signals the terminal ileum to empty its contents into the cecum, which then stimulates mass peristaltic movements.
- A gentle walk for 15-20 minutes after each meal will also stimulate a healthy bowel transit time.
Hydrotherapy
Utilizing the healing power of water, both internally and externally, can have a dramatic influence in treating constipation. First it is important to drink adequate amounts of high-quality water. How much water is enough? Eric Yarnell, ND, in his textbook Naturopathic Gastroenterology, recommends that patients “titrate to a dose that leads to urination every 1-1.5 hours.” For many, this averages around 64 ounces (or 2 liters) per day. Of course, the amount will vary depending on the person’s size, weight and activity level, and seasonal variations.
Patients can perform home hydrotherapy by ending their morning shower with a spray of cool (working up to cold) water over the abdomen to reflexively increase blood and lymph circulation to the intestines. Prolonged cold to the skin of the abdomen causes increased intestinal blood flow, intestinal motility and acid secretion to the stomach.
Fiber
Increasing fiber intake is important for a variety of reasons, and it is important to find the kind of fiber that works best for you. Substituting refined carbohydrates with whole grains and cereals as well as including brown rice, oat bran, fresh fruits and vegetables, dried figs and prunes, raw nuts and seeds (including ground flax seeds), lentils, peas and dried beans will increase your dietary sources of fiber. Certain types of fiber, such as pectin, also play a role in binding and eliminating heavy metals, toxins, cholesterol and bile acids from the system. Foods that are rich in pectin include apples, carrots, beets, bananas, cabbage, citrus fruits, dried peas and okra. In addition to dietary fiber, it may be necessary to add a fiber supplement to create a better effect. Many fiber products now contain a variety of fiber types to increase the overall benefit – including mucilages (such as psyllium), pectins, hemicellulose (like oat bran) and lignans (as found in flax seeds). Most people fare better with a fiber supplement that relies on a combination of fiber sources.
Resolving Difficult Cases
Some patients seem to have tried everything, without results. Keep in mind that there are two main types of constipation: atonic and spastic. Atonic often results from chronic lack of exercise, poor diet and low water intake. Resolving these cases may take time, but improvement should be visible once the patient makes the appropriate lifestyle changes. The spastic type of constipation can present a challenge to treat. Patients with spastic constipation are often of the type-A personality. They may have muscle spasms, twitching or cramping elsewhere in the body. They may also have issues of perfectionism and control.
The colon, rather than lacking tone, becomes spastic in areas, creating a temporary block in the flow of stool. No matter how many laxatives these patients take, the constipation doesn’t respond. Due to their irritant effects, the laxatives only make the situation worse. If you are in a situation where you are dependent on laxatives, it is important to wean off of the laxatives very slowly, adding a fiber supplement while decreasing the laxative dose so that eventually you replace the laxatives with a good, daily fiber supplement to encourage healthy elimination. Also of importance is to decrease stimulants (which can add to the colon spasticity).
I find it helpful to also supplement with EFAs and magnesium to aid normal GI motility. Food allergens can trigger spastic constipation. I have had patients completely relieved of life-long constipation simply by removing cow’s milk and dairy from their diets. In the Textbook of Natural Medicine, Drs. Murray and Pizzorno write, “Approximately two-
thirds of patients with [irritable bowel syndrome] IBS have at least one food allergy: Most common allergens are dairy products (40%-44%) and grains (40%-60%).” In my experience, the foods that make the most difference when avoided completely are dairy products and coffee.
Treating constipation can be a real clinical challenge. If the problem is long-standing, it may take months to find the underlying cause and remedy the situation. If I want to be a doctor that truly practices preventive medicine, I must acknowledge the long-term effects of chronic constipation on my patients. We all are being exposed to ever-increasing levels of chemicals and pollutants in the greater environment. The patient who suffers constipation simply stores and re-circulates a greater and greater load of these toxins. Eventually the scale tips and the tissues can succumb under the toxic load, leading to other conditions including heart disease, arthritis, diabetes, autoimmune disease and more. In practicing preventative medicine, I must recognize that efficient elimination is a cornerstone of good health and longevity, and treat the whole person accordingly.
If you or someone you know suffers with constipation, feel free to drop me a line on the “contact us” page on this site. I treat patients locally at my Naturopathic practice in Vancouver, B.C. and worldwide via phone or Skype.
To your best health!
Dr Tasnim Adatya
Naturopathic Physician, Menopause Clinician, Acupuncturist, and Health Educator
References
- Kellogg JH: Autointoxication or Intestinal Toxemia (ed 3). Battle Creek, 1922, The Modern Medicine Publishing Company.
- Tilden JH: Toxemia Explained. Yorktown, 1926, Life Science.
- Collins D: Colon therapy. In Pizzorno J, Murray M (eds): Textbook of Natural Medicine (ed 1), Seattle, 1985, John Bastyr College Publications.
- Donovan P: Bowel toxemia permeability and disease: new information to support an old concept. InPizzorno J, Murray M (eds): Textbook of Natural Medicine (ed 1), Seattle, 1985, John Bastyr College Publications.
- Davenport H: Movements of the colon. Physiology of the Digestive Tract (ed 5), Chicago, 1982, Year Book Medical Publishers Inc., p92.
- Pizzorno LU, Pizzorno Jr JE, Murray MT: Irritable bowel syndrome, Textbook of Natural Medicine (ed 3), 2006, Churchill Livingston.
- Yarnell E: Constipation. Naturopathic Gastroenterology, Arizona, 2000, Naturopathic Medical Press, p281.
- Balch J, Balch P: Natural food supplements. Prescription for Nutritional Healing (ed 2), New York, 1997, Avery Publishing Group, pp52-53.