Naturopathic Newsletter June 2010: Bowel Movements - Keeping it Regular

June 2010

As most of you know, the discussion and details of bowel movements is part and parcel to each initial assessment with my patients, as well as to many follow-ups. The reason for this is simple ... what comes out of our bodies is a very good indication of what is going on inside our bodies. So for those of you who flush before looking, start looking before flushing!

 

In my books, healthy bowel movements follow the following criteria:

1 -3 times daily (skipping days is considered constipation)

the approximate size, shape, and consistency of a banana (all the better if it is s-shaped; "rabbit pellets"are considered constipation)

medium to dark brown in color

absence of blood (bright red indicates bleeding from the lower part of the digestive tract, such as hemorrhoids, while black indicates bleeding from the upper digestive tract, such as an ulcer)

absence of mucus (white-yellow "snot" often seen in IBS, Crohn's, UC, dysbiosis; see definitions below)

absence of undigested food, aside from corn (this can indicate either an insufficiency of digestive enzymes, or a food intolerance, or an increased transit time, or insufficient chewing)

absence of abdominal or rectal pain (this can indicate a number of issues from diverticulitis to rectal fissures)

 

Unhealthy bowel movements can be defined accordingly:

Constipation: skipping days + straining to defecate + sensation of incomplete evacuation

Diarrhea: 3 or more loose or liquid BMs daily

Irritable Bowel Syndrome (IBS): characterized by alternating diarrhea and constipation (one of the 2 may predominate), abdominal pain, and bloating

Dysbiosis: microbial imbalance leading to altered bowel movements (see below for more information)

Crohn's Disease: Inflammation of the intestinal tract anywhere from mouth to anus causing abdominal pain, diarrhea (often bloody), vomiting, weight loss.

Ulcerative Colitis (UC): Inflammation of the intestines, mainly the colon, causing abdominal pain, diarrhea (often with blood and mucus), weight loss.

 

I would also like to add that chronic constipation is a VERY common symptoms of hypothyroidism (just as diarrhea is a common symptom of hyperthyroidism). Since diagnosed and subclinical hypothyroidism are epidemic in our society, thyroid function needs to be assessed as a possible causative factor of constipation (along with numerous other hypothyroid symptoms, including insomnia, depression, migraines and headaches, generalized aches and pains, weight gain, dry and itchy skin, etc ...).

 

Also, keep in mind that gas and bloating are symptoms that often accompany irregular bowel movements. It is normal to have a certain amount of gas, but if you find that your gas is above the norm and that it is accompanied by a foul odor, then this is important to discuss. Consistent bloating is also important to mention, taking note of whether it occurs on waking, progressively throughout the day, after a meal, or at certain times of the month (for women it can be related to the hormonal cycle). Please note that "normal" gas and bloating can occur when eating a diet high in legumes (beans) and cruciferous veggies (cabbage, cauliflower, brussel sprouts, etc ...).

 

Without need for much explanation, it should be obvious that our diet significantly impacts our bowel movements, hence the sayings ... you are what you eat; what goes in, must come out ...

 

Before we get into the discussion about food, let's discuss water. To have a well hydrated and well lubricated colon, you need to drink 1 to 1.5L of water daily. Water can NOT be exchanged for juice or soda or coffee or tea ... water is water. Very often, those with "rabbit pellet" stool or who have to strain to defecate will benefit from increasing their water intake.

 

Aside from water, another key ingredient to healthy BMs is adequate fiber, of which there are 2 types:

soluble fiber: dissolves in water and turns into a gel to help lubricate the colon and ease defecation. Examples include: nuts and seeds (including flax and chia), legumes, oats.

insoluble fiber: remains mainly undigested and in turn acts as ruffage, removing toxins, scraping the colon, and bulking stool. Examples include: leafy greens, whole grains. 

 

My general recommendations include eating:

half a dinner size plate of leafy greens daily (kale, collard greens, swiss chard, broccoli, cauliflower, rapini, etc ...)

1-2 tbsp ground flax or chia seeds daily

eliminating refined grains (including white and wheat) while focusing on alternative grains (quinoa, spelt, kamut, oats, millet, etc ...).

NOTE: some individuals are aggravated by the use of too much bulking fiber, such as psyllium or ground flax. It is important to drink adequate water to help expel the bulky stool.

 

A discussion on bowel movements can not go without a discussion on food intolerances. As i have discussed food intolerances with many of you, as well as in most of my newsletters, I will skip the introduction. For those of you unfamiliar with food intolerances (which are different from conventionally understood food allergies), feel free to google "food intolerances" for more information.

 

The most frequent food intolerances that interrupt healthy digestive function include:

dairy products: milk, cheese, yogurt, cream, ice cream, ...

wheat (potentially all gluten containing grains, such as barley, rye, spelt, kamut, ...)

eggs

If you suspect food intolerances, then you can eliminate all of the foods mentioned above or one at a time for a minimum of 3 weeks. This is sufficient time to see whether or not these foods affect you. There is always the alternate possibility of having a food intolerance test performed at our office, which includes testing for 96 different foods. For more information about the food intolerance test, feel free to call or email the office.

 

I would also like to share a clinical insight with you. For many, coffee acts a stimulant and a laxative. However, for some, it has the opposite effect. Coffee can be very drying to the mucous membranes, thus contributing to constipation for some. Just a little food for thought:)

Aside from water and fiber, the third fundamental pillar to health BMs is ... exercise! As many of you have heard it before, my saying goes ... exercise is not an option, it is a requirement. The human body is genetically designed to be active!! It is not designed to sit at a desk, in front of a computer, in a car and in front of a tv for most if not all of our waking hours. In terms of bowel function, you have to move to get things moving! As I recommend for all patients, you need to incorporate cardio exercise 3-4 times weekly for 45 mins. This can include a brisk walk, jogging, cycling, kick boxing, tae bo, swimming, dancing, etc ... When you don't exercise, you're entire body stagnates, inclduing your bowels.

 

As most of you already know, stress (both physical and emotional) significantly impacts how our bodies function. Our stress hormones, including corticol, have a direct impact on our digestive tract, influencing how we digest our food, absorb our nutrients, and expel our waste (through our BMs).  For some individuals, stress contributes to looser stool with greater frequency and urgency, while for others stress can have the opposite effect, resulting in constipation. The first step is becoming aware of how stress affects your body. Then you can start to see what stressors act as your triggers. From there, you can starting chosing to make changes in your life and in your perceptions, thereby minimizing the impact of stress on your body. Yes, it sounds easier said than done, but you have to start somewhere. You can include stress management tools, such as deep breathing, journaling, exercise, visualization, etc ...

 

For those with constipation aggravated by their go-go-go lifestyles, they often benefit from setting aside some quite time, especially in the morning, where they have some tea, breath deeply, read the paper, and communicate to their bodies that they have the time to go to the bathroom. It may seem silly, but if you think about it, it makes a lot of sense. How can your body know that it is allowed to sit down and have a pooh if you are constantly on the go occupied by every other thought except for those of your body's own needs.

 

As mentioned in the introduction, dysbiosis is a microbial imbalance which can result in altered bowel movements. So what does that mean ...Your digestive tract is inhabited by numerous healthy bacteria which act as foot soldiers protecting from foreign invasion by undesirable critters, such as unhealthy bacteria, parasites, and yeast (or candida). We are constantly exposed to these undesirable critters through our drinking water and our food supply. Many people make the erroneous assumption that we are at risk of acquiring these undesirable critters only when we travel to foreign countries. This is simply not true. These undesirable critters can be acquired anywhere and at any time, either due to their direct ingestion or due to the insufficient presence of healthy bacteria (often caused by antibiotic use, poor food quality, and or a weakened immune system). 

 

When this is suspected, I recommend a stool test which looks at the levels of healthy bacteria, and the possible presence of unhealthy bacteria, parasites, and or yeast. Unfortunately, the conventional stool test often yields false negatives due to its short list of detectable critters and its detection methods. Depending on the individual's case, I will recommend a non conventional stool test performed either through Doctor's Data or Metametrix laboratories. If the results show an imbalance, then i recommend a specified naturopathic protocol to a) kill off the undesirable critter, b) ensure adequate healthy bacteria, and c) maximize the evacuation of the undesirable critter, while re-establishing a healthy digestive environment.

 

For more information about these stool tests, feel free to call or email us at the clinic. 

As always, supplement protocols are individualized, based on the patient's specific needs. However, here is a list of save and effective supplements that one can consider to improve bowel health.

 

Probiotics: These are the good bacteria found in our digestive tract which are critical for healthy digestive function. To yield therapeutic effects, it is best to take probiotics, often along with prebiotics, in supplement form. Ensure that you visit a reputable health food store for such a supplement, and avoid using marketed probiotic rich dairy products. Such a supplement should be considered in cases of both constipation and diarrhea.

 

Magnesium: As a smooth muscle relaxant, magnesium can be helpful to alleviate constipation, especially when seen in a tense, stressed individual. Don't be afraid to gradually increase the dosing to a maximum of 400mg twice daily if needed.

 

Fish oils (omega 3): Acting as a lubricatant and as an anti-inflammatory, this supplement can be helpful to relief constipation. Again, be sure to visit a reputable health food store to ensure adequate quality of such a supplement. Don't be afraid to gradually increase the dosing to a maximum of 4 grams daily.

 

Bulking agents: To help with diarrhea, bulking the stool may be helpful. This can include using formulas with the following ingredients: l-glutamine, apple pectin, psyllium, rice bran, etc ...

 

These supplements are generally safe suggestions that can act as food for thought. For the best outcomes, a full assessment and protocol by your local ND is suggested.