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THE CONSTIPATION CORRECTION

Welcome

One out of every four people experiences constipation at some point in their lives. For some,
it has been a daily, lifelong struggle and for others, a transient though unpleasant experience.
Standard treatment of “eat more fiber or take a laxative” does little to alleviate suffering nor
does it strike at the root of the issue.

In this guide, we will cover the definition of constipation (I am sure you could write the
definition yourself!), the multiple reasons for why constipation manifests (hint: it’s not just
your diet), plus tools, testing and management strategies to cover each scenario plus a
comprehensive overview of therapies including nutrition, lifestyle and supplemental strategies
to correct your constipation and get you moving in flow.

What is constipation?
We often don’t spend much time thinking about various aspects of our bowel movements until
something goes awry - until they are not forthcoming, painful or make us feel horrible - sick,
full, bloated.

Constipation is a heavy burden to carry, both on individual and greater levels. Not only does
being constipated make you feel sluggish and run down, it can also predispose you for other,
additional health problems such as those created by an overload of estrogens, androgens,
other hormones and other compounds in the body.

This issue carries a hefty price tag, as well. In the United States alone, about $800 million is
spent on laxatives. Doctors write out over a million prescriptions for pharmaceutical laxatives,
and you can buy the super-sized version of Miralax at Costco. While laxatives can help stimulate
a bowel movement, they do nothing to tackle the underlying reasons for constipation and it is
quite easy to become dependent on them. Laxative dependence can be tricky to overcome, but
is rampant.

Clearly, something is awry.

Before we delve into the reasons for constipation, of which there are many, let’s run through
the technical definition of constipation, so we can all make sure that we are on the same page
together.

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Definition of constipation:

Three bowel movements or less per week

Hard stool 25% of the time

The sensation that you are not quite “done” 25% of the time or more

Feeling as if there is an obstruction 25% of the time or more

Needing to use an instrument - hands, tools, enema - 25% of the time or more

Stool is hard

If you and I were sitting across from each other in a visit, to technically diagnose you with
constipation, you would have to meet two of the above six criteria. That is great for checklists
and paperwork, but constipation is completely subjective as well. If someone who normally has
three bowel movements a day only has one and feels full and uncomfortable, that person is
constipated. If someone who moves their bowel daily begins to skip days and feels constipated
and full, well, that is constipation too. It’s not just about the lists of criteria, it is about that
body experience as well. Constipation is very much a feeling.

Digesting, fast and slow: transit time & transit time test

Transit time refers to the length of time that it takes for the food you are eating right now to be
pooped out. The average transit time for a person without digestive issues and in good health
is 12-24 hours. You can see right away, when we compare this little number to our above six
criteria, that if someone is not moving their bowels every single day, they have already met one
of the requisite two criteria for constipation. You’re halfway there if your transit time is slow.

It’s possible to test your transit time and check out how slowly or quickly your bowels are
moving with a very simple home test.

Grab a bottle of activated charcoal capsules OR chlorella tablets. If you are using charcoal, take
4-6 capsules and begin to monitor the color of your poop. Charcoal will make your stool turn
black. You could begin to see the black color entering the stool at 12 hours, but if the color is
not showing up within 24 hours, you are definitely a slow digester.

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Follow the same process with the chlorella tablets. Often, chlorella tabs are half the size of
charcoal capsules. Double up, taking 10 or so chlorella caps, and watch for the change of color
to your stool. Your stool will turn a bright, dark green. Again, as with the charcoal, you should
begin to notice the color change within 12-24 hours.

If you are severely constipated, it is not uncommon to see the color change 72-96 hours after
ingestion. You’re in the right place, reading this here and now, if you are in that boat.

Normal digestion 101


For optimal digestion to happen - start to finish - a variety of ducks need to be lined up in a
row. Indeed, digestion itself is a multilayered and multifaceted process, with plenty of room for
things to go wrong along the way.

First, eating foods that are appropriate for your body is key. Note that I said YOUR body. There
is no perfect nutrition plan out there, no single coach or doctor or guide that will be able to
give you some off-the-shelf program or plan that will work for you. The only diet out there
that works is the one that is best for YOUR body, and that takes some detective work, tweaking
and reworking to fully figure out and assess what works best for you. What works best for you
will be different than your spouse, your parents, your friends, and that guy down the road.
Every body is different. Are their guidelines we can follow in terms of nutrition, particularly
related to constipation? Of course there are, and we will cover those as well. Just know that
guidelines are just that - a guideline, a place to start, a scaffolding upon which to build. They
are merely pointing us in a direction, and it is up to us to fine tune according to our bodies,
our preferences and unique sensitivities.

Next, the ability to break down the food that you eat is key. Truth is, you could be eating the
most perfect-for-you meal, and if you lack the ability to break it down, not only are you not
absorbing all of that excellent nutrition, you are setting up your gut flora and the enteric
nervous system (ENS - the “second brain”, a huge conglomeration of nerves that lives in your
gut and controls all aspects of digestion and bowel movements) for problems. I use the term
“digestive fire” to describe the body’s ability to break down proteins, fats and carbohydrates
into their constituent building blocks of amino acids, fatty acids and sugars through the use of
digestive enzymes, stomach acid and bile. It is these teeny, tiny particles, these building blocks,
which are absorbed into your body and provide nutrition. I cannot tell you how many times
high-dose digestive enzymes for several weeks has been able to re-train someone’s bowel.

The microbiome - the 100-trillion cell strong population of beneficial bacteria that resides
in the large intestine - is instrumental in digestion of food, “humanizing” of plant nutrients,

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communication with the immune system and of course communication with the ENS to
promote optimal motility. Having a robust, balanced, uninfected microbiome will keep you
moving in the right direction.

The lining of the GI tract, top to bottom, also contributes to digestion, absorption and
movement. Constipation can negatively impact the integrity of the lining of the digestive
system, which can set us up for food sensitivities, immune provocation and other things that a
body is better off without.

Lastly (well, not really), the enteric nervous system (ENS) should be balanced. This depends
on several factors, including the balance of the autonomic nervous system (ANS). The ANS
is comprised of the “fight or flight” response and the “rest and digest” response. Good
autonomic tone begets good ENS tone which translate into optimal peristalsis (the rhythmical,
muscular contraction that propels food down and out) and neurotransmitter production. We
are learning now that the term “neurotransmitter” as the vast majority of neurotransmitters
are made and recycled in the gut, and the gut carries the greatest receptor density for most of
them, too. Particularly one called serotonin, which plays a major role in motility.

Reasons for Constipation


The reasons for constipation are multifold and varied, and are highly individual. In fact, I
would argue that there are as many causes and treatments for constipation as there are for
people who are constipated. Some will say, “it’s hereditary”. Actually, there is no constipation
gene. What often is passed down from parent to child is lifestyle behaviors, belief systems and
nutrition. Just because your mother is constipated doesn’t mean you are too, particularly if you
struggle with some aspect of your diet, movement/exercise, sleep or medication usage.

There are also variety of other health conditions that can create, contribute to or exacerbate
constipation, and we will cover all of those, including how to be evaluated for them if you
suspect that one of them may be true for you.
When looking at constipation through a broad lens, we can often find a reason for it that
dovetails into one of the major facets of digestion that we covered in the “Normal digestion
101” section. We look first at the areas of nutrition, ability to digest, the health of the gut flora,
the integrity of the gut lining, the health and balance of the ENS and our ability to compensate
from stress.

So, without further ado, let’s take a look. Are you getting enough of these in your daily
routine? These are the base of a non-constipated gut:

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Food/Nutrition/Water
When it comes to everyday nutrition, there are several major pillars of a non-constipated
day. Fat, fiber, minerals/electrolytes and water all need to be consumed appropriately for the
best bowel movements. I have sat with many whom were constipated because they ate an
exceedingly low-fat diet, and I have sat with those who were eating close to 35g of fiber daily
but couldn’t have a bowel movement because they were so dry and dehydrated.

These pillars should be in sync with each other and taken in appropriate amounts for your
body. So I am going to give you the guidelines for each category, and you are going to take it
home and tweak. Deal?

Water
It’s hard to pick one out of these big four that is the most commonly problematic, but if I were
going to take an average and do it, I would say that most people are dehydrated. Optimal
levels of hydration keep your bowel, well, hydrated so that things can move through. Your
large intestine resorbs almost 2 gallons of fluids every single day, so if you are not drinking
enough water or fluids, your stool is going to dry out rapidly. What happens with dry stool? It
sticks, it rubs, it is uncomfortable and difficult to pass.

Not only do many of us not drink enough water, we also over-consume things that are drying/
dehydrating. Caffeine, the temptress, can be stimulating to the ENS and help us to “go”, but it
is horribly dehydrating because it is a diuretic. So, loads of coffee, black tea, sweet tea (if you’re
in the South) and soda are not helping the cause. Likewise, sugary drinks like soda (again),
sweetened coffee beverages and so forth also can slow you down. Alcohol is also a diuretic and
dehydrating to the body.

I’m not telling you to give up your coffee or booze, by the way. What I would tell you is that if
you have a cup of coffee, have an extra glass of water, and ditto on the boozy drinks.

So how much water is enough water? Generally speaking, you want to drink enough to keep
your pee a pale yellow color (minus multivitamins, which will turn your urine fluorescent
yellow!). The typical rule of thumb is to take your weight, in pounds, and divide it by two. This
is the number of ounces of water you should be consuming daily, plus an extra four to eight
for a dehydrating drink, an exercise/sweat mesh or a cigarette. Thus, a person weighing 200lbs
should drink 100 ounces of water daily.

In my experience, not everyone likes or wants water. That is a whole other topic, but in these

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people I aim for at least 2 liters. Herbal tea, seltzer water (plain or naturally sweetened with
zero sugar or funky sweeteners), broth and soup can all contribute to this amount. Adding
lemon, lime, frozen berries, mint, sliced cucumber and so forth can help liven up the taste of
water, seltzer or low-or-no-caffeine teas.

Fat
Intake of healthy fats helps keep the bowel lubricated and thus things moving along
swimmingly. In figuring out of fat intake could be contributing to constipation, it’s best to take
stock of your current intake.

Choosing high-quality fats is of utmost importance, not just for digestion but for overall health
and wellness as well. Ina addition to being a lubricant, fats are key for building hormones,
cellular communication and nerve signaling/transduction, to name a few. They are also pivotal
in the production of inflammatory and anti-inflammatory compounds your body produces, and
you want a correct balance of both for not just would healing, to fight infection and to clean
up the mess left, but to be able to quench free radicals and other unsavory compounds as well.

A mix of fats, of animal and plant origin is ideal. When it comes to animal fats, buy the
absolute best that you can afford, focusing on fish that are wild-caught, meats that are grass
fed, and chicken/poultry that is pastured. If you can tolerate dairy (NOTE: Dairy and milk is
one of the constipating foods, so MAKE SURE it’s not a problem for you), buying organic dairy
products is critical. Dairy - butter, milk, cheese, sour cream, cream, etc - bioaccumulates and
biomagnifies all varieties of compounds, from hormones to pesticides to metals. Dairy taken
from overmedicated animals fed an inferior, non-biologically appropriate diet in cramped or
inhumane conditions is going to be woefully worse than dairy taken from grass fed animals
allowed to roam and graze.

In the plant kingdom, the easiest and safest options to stick with for cooking are olive oil (look
for labels that say 100% olive oil, otherwise you may be getting a blend cut with canola or soy
oil), coconut oil and avocado oil. Oils to stay away from are canola, soy and anything labeled
“vegetable oil”. Seed oils are best consumed raw, as in a salad or over veggies.

I recommend cooking veggies in oil. For those who feel like they need a little help on the fat
front, I recommend taking an additional teaspoon (to start) of coconut oil and/or 3-4 grams of
fish oil daily.

Avocado, nuts and seeds and their butters, coconut and coconut products, egg yolks, fatty fish

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(salmon, mackerel), fattier cuts of meat (ribeye, etc) are all good sources of fats.

Fiber
It is estimated that ancient man ate up to 100g of fiber daily! Whew, that is a lot of chewing!
Modern day man is lucky to consume a tenth of this amount, though classic recommendations
are for 25g of fiber daily.

When it comes to constipation, fiber can be a tricky issue. One, not all fibers are the same.
Two, in many cases, constipation is not the result of a fiber deficiency, and when we begin to
load up on Metamucil because our doctor said so, it can slow us down even worse, particularly
if we are dehydrated!

Fiber adds bulk and volume to the stool, which actually helps our second brain push it along
and out. This ONLY works, however, if we are well hydrated. So, if we are indeed fiber deficient,
the very first order of business is to begin to increase our water.

Now, my very favorite form of fiber is the type found in vegetables. If you are getting in non-
starchy veggies, you are also getting in a bit of water to go alongside your fiber and helping
the entire process move right along.

I recommend at least four cups of vegetables daily, at a bare minimum. Not only are the
veggies providing fiber and water, they are also providing minerals - also key for regularity -
they are also providing vitamins, antioxidants and a variety of healthy phytochemicals. Veggie
intake is hugely important.

For those of you who do not want to slog around with washing, chopping, prepping, cooking
and cleaning up afterwards with those fresh veggies, go for the convenience options. Frozen
veggies, preached and precut veggies — get them, there is no shame! My favorite recipe for
roasting or sautéing veggies is as follows:

For roasting: preheat oven to 350F & pull out a baking sheet. Dump a bag of frozen veggies of
your choice in a single layer. Drizzle with olive oil, sprinkle with salt, pepper and garlic powder.
Bake until golden, about ten minutes.

For sautéing: bring a medium frying pan up to medium high heat. Add in 1-2 TB olive oil and
if you have it, some chopped garlic. Stir until fragrant, 1-2 minutes. Add chopped veggies, a
pinch of salt, and cook until tender, stirring occasionally. Season at the end with more salt if
wanted, garlic powder and pepper.

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Easy and delicious.


Fiber can be broadly categorized into two types - soluble, which dissolves in water and thus
gets into the blood; and insoluble, which does not dissolve in water or the blood and thus
stays in the digestive system, acting as a broom and adding bulk to the stool. Insoluble fiber of
the supplemental form can be harsh, though, especially if you are dried out or already irritated
from some other condition.

In terms of supplementing fiber, there is pretty much one that is my go-to, and that is acacia
fiber because it is gentle on the body for the most part.

There is a golden rule with supplemental fiber, and it is this: start low and go slow.

Start out at a low dose, 1/2 tsp in 8 ounces of water, and every 3-4 days increase this amount
by 1/4-1/2 tsp until you are doing 2-3 tsp in 8-10 ounces of water twice daily.

If you have SIBO (small intestine bacterial overgrowth), dysbiosis or IBS, fiber is a unique
consideration for you, and you are more likely to experience problems not just with
supplemental fiber (acacia may be the exception to this) but with certain veggies and fruits as
well. Be sure to check out the “Special Considerations” section below!

Minerals/Electrolytes
Simply put, minerals and electrolytes help keep the bowl open and flexible and help maintain
hydration so that overall movements are easy and painless.

Magnesium (we will be talking a lot about this one), potassium, calcium, selenium, sodium and
zinc all work in harmony to achieve this state of fluid balance and open bowel.

Veggies and fruits, of course, are loaded with electrolytes and minerals, and thus can exert
their beneficial effects that way, and I often recommend either a complete mineral complex
to be taken daily OR a multivitamin that has a multimineral complex embedded in it (like
Metabolic Synergy by Designs for Health).

Certain medications readily deplete minerals and electrolytes, particularly meds that
regulate blood pressure, cardiovascular function, antibiotics and birth control. We will cover
constipating meds more in depth in a later section, but if you take one of those medications

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(or more!) you should also take a mineral complex or multivitamin too.

If you are increasing your water and/or your fiber, please increase this category as well.

Constipating Foods
True enough, some foods are inherently constipating. In addition, some foods may be
problematic for YOU specifically.

Have you ever heard of the BRAT diet? This was developed by mamas back in the day who were
trying to help their littles ones that were having diarrhea. They found a handful of foods could
help slow down the bowels of their kids. The foods are Bananas, Rice, Apples and Toast.

It’s ironic, then, that most mamas these days are told that baby’s first food should be rice
cereal, which is inherently constipating, and this sets the stage for so many gut problems later
on. That is another tale, perhaps. Toast here refers to wheat toast, and goodness knows that
wheat and the gluten contained therein have ground many a child and adult alike to a halt.

This BRAT diet does not just apply to kids, though. This little quad of foods can be problematic
for anyone. Take stock of your diet. Are you eating any or all of these foods every day? may be
time to cut them out for several weeks and see how you do.

Other foods that can be constipating in different bodies are: flour products, dairy products,
nuts, chia seeds and eggs. Within “flour products”, the most constipating item of course is
gluten, and then sugars and thickeners that may be added to the flour products likely aren’t
helping the cause, either.

If you have a sensitivity to any particular food, that can drive constipation as well and thus it
is important to avoid sensitivities if present and assess for sensitivities if you have not done so
already.

The best bang for your buck, more reliable than ANY test, method to determine sensitivity is
an elimination-challenge diet. An elimination-challenge diet will help you pinpoint sensitivities
and identify what does what to your unique body. It is a cornerstone for beating constipation
as well, to rule in or out any sensitivities.

Dietary Considerations for Special Conditions (gastrointestinal)

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There are a variety of conditions who by their very nature confer (often temporary, sometimes
not) dietary restrictions or considerations.

Most directly, conditions that feature dysbiosis, such as IBS (irritable bowel syndrome), SIBO
(small intestinal bacterial overgrowth), Candida and parasitic infection often require dietary
adjustments which in addition to ferreting out food sensitivities, often will be modeled after
a low-FODMAP or SCD protocol. This is because certain fiber and food compounds are more
fermentable to the unsavory characters in the gut flora, which can fuel the fire of constipation
and other symptoms like gas and bloating and spasm.

Inflammatory bowel conditions (Crohn’s Ulcerative colitis, microscopic colitis, etc) also require
special consideration terms of nutrition. In my experience, a detailed food elimination-
challenge diet is beneficial using high-FODMAP foods as a base to start elimination and
experiment from there.

Low Digestive Fire


A wide variety of things can dampen the digestive fire - the body’s ability to break down
proteins, fats and carbohydrates into their readily-absorbable forms through the use of
stomach acid, digestive enzymes and bile.

A lack of any of these things - acid, enzymes, bile - can interfere with gut motility and
regularity. Eating foods that you are sensitive to, infection, chronic stress, inflammatory
conditions, alcohol binge drinking, medications like acid-blocking drugs, malabsorption,
chronic stress, being under slept, over training without adequate recovery can all contribute.

Some signs of low stomach acid are having low appetite all of the time, feeling full for a long
time after you eat, early satiety, getting nauseous with supplements, frequent belching with
stinky burps, problems digesting meats or other protein-dense foods, reflux/burning, anemia
and peeling nails. Chronic yeast infections, whether they be in the skin or genitourinary system

Signs of low enzymes output are gas and bloating within a few hours of eating, undigested
food in the stool, inability to gain weight, cramping, feeling tired after eating, belching (like
low acid), shiny or light stool.

Signs of low bile output are related to fat ingestion. Difficulty digesting fat and pain with fat
consumption can point to issues with bile. Also, difficulty with passing bowel movements,
jaundice, history of gallstones or gb removal, water retention, light colored stool or stool that
floats can also indicate issues with bile production or storage.

Any issue with digestive fire (which are common, by the way) can interfere with gut motility.

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Microbiome Disruption
Housed within your gut is a vast colony of bacterial cells and microorganisms. They outnumber
your human cells ten-to-one. Their DNA is one hundred and fifty times your human DNA! This
mind-boggling number is represented by thousands and upon thousands of different strains
and species of bacteria.

As an entity, the gut flora have major implications for all aspects of digestion and gut motility.
Numerous strains have been studied specifically for constipation and have shown benefit.

Thus, disruptions in the microbiome, whether it is low numbers of beneficial flora, increased
numbers of less-than beneficial guys, frank infection with pathogenic bacteria, yeast or
parasites or overgrowth anywhere bacteria don’t belong in large numbers (the small intestine,
the stomach), it can spell trouble for your gut motility.

Lining of the Gut/Intestinal Barrier Dysfunction


No longer relegated to the waste basket of woo-woo, intestinal barrier dysfunction,
inflammation of the gut lining and increased permeability of the gastrointestinal lining (aka
leaky gut) are becoming more and more present in the conversation when dealing with a
huge variety of gastrointestinal complaints, from the functional to those with readily-made
diagnoses.

In terms of constipation, the most common way that issues with the intestinal barrier arise is
through dysbiosis of the gut flora creating inflammation in the gastrointestinal lining.

Chronic inflammation, left unchecked or untreated, will begin to loosen and uncouple the
tight junction between enterocytes. The enterocytes are the cells that line the GI tract. They
are supposed to stand tightly together. So tight, that there is a structure there that holds them
together. That is called a tight junction.

Once those tight junctions are loosened, the integrity of the lining has been breached. In a
chronic situation, this can become problematic. Tolerance that the immune system has to
the food particles we ingest and the bacteria that populate our guts can be lost. This results
in immune provocation, antibody formation against the foods we are eating which can
lead to food intolerance and of course more inflammatory molecules being made. It is this
inflammation that drives the whole intestinal barrier dysfunction/leaky gut ship forward. This

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inflammation, in turn, irritates the ENS, resulting in issues with motility.

Constipation itself can damage the lining of the gastrointestinal system. Diverticulosis is little
out pouchings in the wall of the colon from repetitive strain. If debris catches in these little
pockets, it can become infected, leaving to diverticulitis. Diverticulitis flares are often painful.

Hemorrhoids are another issue with the lining, or more specifically a structure found within the
lining. Hemorrhoids are engorged veins that can prolapse into the inner or outer rectum. They
can be painful, itchy and bleed.

All good reasons to keep the digestive lining in good working order with excellent integrity.

Balance of the Autonomic Nervous System (ANS) and the Second Brain (ENS)
I cannot highlight enough the importance of living a life where you feel like you are nourished,
both by food and by intangible, non-food items like good relationships, good self-talk, regular
sleep, and the ability to decompress from stress. The imbalance of the nervous system and
the second brain is a vast, under-represented reason for constipation, creating a “functional”
problem as opposed to a biochemical or nutritional one.

Let’s look at this with a finer lens.

From esophagus to rectum, there is an enormous plexus of nerves, with a volume and density
equal to the spinal cord. Only the brain has more nerve cells. Collectively, this plexus is known
as the enteric nervous system, the ENS, and is also called the Second Brain.

The ENS is responsible for monitoring, managing and adjusting the second-to-second pieces
of digestion, including secretion of enzymes, acids, bile, gut motility and more. The Second
Brain can operate independently of the Central Nervous System (CNS - comprised of the brain &
spinal cord), though it is continual contact with it, and takes input and influence from it.

A major way that the CNS influences the second brain is through yet another division called
the autonomic nervous system (ANS). The ANS is responsible for the things we have no control
over: heart rate, breathing, core temperature, desire, etc....the ANS is divided into 2 branches:

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The Sympathetic Branch, also known as the “Fight or Flight” branch, it’s responsible for the
release of stress hormones. That rush you feel when you get cut off and it’s a close call? That
is your sympathetic branch sharpening your reflexes, your senses, getting you ready to react
quickly, with the evolutionary goal of saving your life. This branch gets us ready to stand and
fight or to run away and escape. You ever hear of those practically unbelievable stories of a
mother lifting a car off of her baby or other acts of almost superhuman strength, speed and
courage by regular, every day people under mortal threat? That is the power of the fight or
flight branch, used for “good”. Nowadays, the rush of stress hormones we feel mostly comes
from non life-threatening situations. Arguments with our partners, time crunches, bizarre
family dynamics and grinding, mind-numbing work situations.

Planting an ancient nervous system in a modern lifestyle often means we are “under the
influence” of these stress hormones more than is healthy for our physiology.

The Parasympathetic Branch, also known as the “Rest and Digest” branch, it’s responsible for
healing, reparation, immune function, and resting and digesting. It only comes online when
we are resting, relaxed and in repose. It is where digestion happens optimally, influencing
the release of digestive factors and balancing motility. It is also when hormones are built,
recycled, cells repaired, immunoglobulin made, etc. It helps release the feel-good hormones
(think falling in love, hugs, the feelings you get from connection with people you love, orgasm,
nursing a baby, etc) and is largely responsible for not only the hedonistic pleasures we have
but also helps us connect into our frontal cortex and aspects of consciousness, gratitude,
connection and higher-level thinking and cognition. It helps, in part, keep us smart, sharp,
connected, flexible and creative (ever notice how these things suffer when you feel shut-down
from chronic, grinding stress?)

In a perfect world, with a balanced digestive system and ANS, the sympathetic and
parasympathetic branches of the ANS move together as if in a dance or see-saw. It’s give and
take, give and take. Back and forth, an ebb and flow. As a consequence of this balanced see-
saw action, the ENS/Second Brain is also balanced.

We know that in those with constipation and other motility disorders have issues with the
Second Brain that often stem from ANS dysfunction. This ANS dysfunction comes from an
imbalance of the see-saw. Instead of a back and forth, it’s as if an elephant (the fight or flight
branch) is sitting on one end of the see-saw and a chihuahua (the rest and digest branch) is on
the other end, languishing in space. This is called Sympathetic over-dominance and represents
an unraveling in that balance that ultimately impacts the functioning of your second Brain and
how you move (poop) and produce digestive factors (enzymes, acid, balance).

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Bottom line: when we can’t get into rest-and-digest mode because of fight-or-flight over
dominance, it negatively impacts our Second Brain and wreaks havoc on our digestion,
contributing to symptoms.

Conditions Associated with Constipation


There are a variety of conditions that you may have been previously diagnosed with or have
been as-yet-undiagnosed that have constipation going along for the ride. This list is not
exhaustive, but gives you an overview of what to look out for:

Hypothyroidism, including Hashimoto’s thyroiditis: almost 3/4 of all hypothyroidism is


autoimmune in nature, that is to say that Hashimoto’s is responsible for the lion’s share of low
thyroid function out there. The way to know if you have Hashimoto’s is to get your level of
antibodies checked (anti-TG and anti-TPO) but many docs don’t check for antibodies because
their treatment approach remains identical. A complete thyroid workup would include not only
thyroid antibodies, but also TSH, T3, T4, rT3 and vitamin D.

Multiple Sclerosis (MS): An autoimmune condition, diagnosed via blood testing and MRI of the
head/spinal cord.

Scleroderma: Another autoimmune condition. This one targets the skin and organs, creating
scar tissue.

Parkinson’s Disease: A disease affecting the signaling of neurotransmitters, so of course


motility could be impeded.

Diabetes: Diabetes is a classic example of a multi-system disease, and constipation goes


alongside of it.

Kidney Disease: Compromise to the kidneys can drastically alter fluid and electrolyte balance
and the balance of minerals, crucial for proper motility.

Colon Cancer: Obstruction from growths can create an inability to go to the bathroom
regularly.

Medications/Nutrients & Constipation

A variety of pharmaceuticals and nutraceuticals can create, contribute to or exacerbate


constipation, so it is a good idea to take stock of what you are taking to see if it could be

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playing a part in your symptoms.

First, a resource that I recommend to all of my clients is the website drugs.com so you can look
up all of the side effects that are associated with your prescription drugs. Unfortunately, the
gastrointestinal system is one of the most commonly impacted systems when it comes to side
effects. Virtually all medications will have some sort of digestive side effect and you want to
sort it out if your drugs could be contributing to constipation.

Commonly-prescribed classes of drugs that cause or worsen constipation are:

Opiates: these are used for pain relief & are also highly habit-forming. Examples are OxyContin,
Percocet and morphine derivatives.

Antidepressants: this includes SSRIs and SNRIs. Serotonin has a major role in gut motility,
and drugs that manipulate this chemical can have deleterious consequences for regular
movements.

A quick note on antidepressants: SSRIs and SNRIs do NOT replete Serotonin. They make your
body release all of the serotonin into the synapse. The synapse is the space between nerve cells
where communication happens. The body, based on feedback loops, thus thinks there is plenty
of serotonin. It then down-regulates its own natural production of serotonin and pulls in the
receptors for serotonin embedded on the cell surface. The result of this? Your body has less
endogenous (self-made) serotonin and with lowered receptor density, a lower ability to “hear”
serotonin’s message. They actually deplete your own production of this key chemical, which is
why it is so HARD to get off of these drugs. It has nothing to do with their efficacy. You could
put anyone on SSRIs and they would have a rough time getting off of them - they really can
alter your serotonin signaling that much. This mechanism also explains why doses for these
drugs invariably have to be increased over time.

Calcium channel blockers: Commonly prescribed for high blood pressure, these can interfere
with normal motility.

Aluminum-containing antacids: Often taken to reduce heartburn, these will also slow you
down if taken chronically.

Laxatives: ah, yes, seems counter-intuitive, right? Reliance on over the counter or prescription
laxatives is a surefire way to un-train your body to go on its own. Laxatives force the body to

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go, and their removal results in more constipation because essentially your body’s signals are
all crossed and dysfunctional at this point. I think laxatives can have their place in retraining the
bowel, carefully and infrequently used, but daily or multiple times per week usage will actually
worsen your problem over time.

On the supplement side, there are a couple to keep in mind as well:

Calcium in supplemental form, over 200mg per day can worsen constipation. I understand
that there is a lot of fear and discussion about the “calcium gap”, but if you eat green veggies,
take a multi and eat dairy products a couple times per week (and even if you don’t), excessive
calcium supplementation is not beneficial and actually can be harmful.

Iron supplements, particularly ferrous sulfate, are highly constipating. My favorite form of iron
is the ferrous bisglycinate form, which is more gentle, can improve anemia and energy and
does not have nearly the amount of constipating effects as other forms do.

Natural laxatives: As with over the counter or prescription laxatives, even strong herbal
laxatives can be habit-forming and ultimately worsen constipation for their dependency-
inducing effects. Not all herbs fall into this category, but the herbs Senna and Cascara Segrada
do. These are strongly cathartic herbs (cathartic = stimulate a bowel movement) only to be
used sporadically and infrequently. Daily use will un-train your body’s normal regularity.

The Constipation Correction Protocols


All of these protocols hit the myriad of reasons of WHY constipation occurs in the first place.
Many people do not get the relief from constipation they so desperately seek. You will notice
that each protocol covers nutrition, lifestyle and supplements.

There is no magic bullet. The secret is there IS NO SECRET. Digestive wellness is a process, and
I invite you to experiment with the process, getting the tools in place to achieve your means,
rather than focusing solely on the end game itself. I understand it is human nature to want
everything done and fixed as quickly as possible, but that is not often the world we live in. Take
the time to learn about your body.

Give any protocol you do 4 weeks of your time and dedication and diligence.

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Base protocol
Satisfy your requirements for water, fat, fiber and minerals as described above. IF you do not
eat 4 cups of vegetables daily, get some acacia fiber and take 1/2 teaspoon in 8 ounces of
water at dinner time to start.

First thing in the morning, have 10 ounces of room temperature water with a squeeze of lemon
and 1/4 teaspoon NOW brand Magnesium Ascorbate powder. This is a vitamin C powder,
buffered by magnesium. It is a very gentle laxative and bowel re-trainer, without the risk of
dependency like some of the herbal laxatives. The trick with the MA powder is to find the
right dose. I recommend, if this dose does not stimulate a bowel movement within an hour, to
slowly increase by 1/8 of a teaspoon every several days until you hit your right dose.

Minimize the use of constipating foods: wheat and flour products, dairy products, bananas,
brown rice and apples can all be constipating.

I strongly recommend an elimination-challenge diet to determine if any of the foods you are
eating could be contributing to your symptoms. I have written a very detailed blog about how
to do that here: http://bit.ly/1jqV7eM

Take 2 plant-based digestive enzymes before meals. Designs for Health, Klaire Labs, Digest
Gold and Enzymedica all put out great products.

Incorporate fermented foods into your weekly nutrition: Apple Cider Vinegar, kimchi,
kombucha, sauerkraut are all great choices. Taking a teaspoon shot of ACV before meals will
help stoke digestive fire.

Take 50-100 billion CFUs of a probiotic daily. Claire Labs, VSL3, Dr. O’Hira’s & Jarrow are all
good options. Take with food.

Establish a bathroom routine. Your bathroom should be soothing and pleasing to the senses.
Using aromatherapy, candles and fun wall coverings, art or paint can all help create a relaxing
atmosphere. Each morning, sit on the toilet and empty your mind. Focus on your breath. Sit for
5-10 minutes each morning, whether you have a BM or not. Even sitting with the intention to
go will help re-train your bowel.

Bring a small foot stool into the bathroom. It doesn’t have to be special or fancy, but as you
sit on the toilet, put your feet up on the foot stool. Ideally, your knees will be above the level of

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the hips. This puts your anatomy in all the right places for a smooth bowel movement. Use the
foot stool every single time you sit down for a bowel movement, whether you go or not.

Utilize perianal acupressure daily. Stay with me here. There are quite a few good studies that
say that daily perianal acupressure can reduce constipation by up to 80% over a 4 week period.
This is an enormous improvement. The acupressure point that is used is the space between
the anal opening and the penis or the vagina. This space is also known as the perineum. Apply
firm but comfortable pressure there for 60 seconds in the morning when you are sitting and
breathing. Do this activity every day.

Change up your eating experience: when you eat, always sit down. No eating on the run,
while standing, in front of the fridge, at the skink, etc. Sit somewhere. Turn your phone to “Do
Not Disturb” and do not look at your phone or computer while you eat. When you eat, chew
your food well, so that it is like a paste before you swallow. Put your fork/spoon/chopsticks/
food down in between bites, slow down. Notice the taste, texture and smell of your food. Do
not talk while you are chewing. Injecting mindfulness into mealtimes by using these small
strategies helps to re-train the bowel.

Go for a daily walk. Movement is the mark of life. Gentle movement, in the form of a leisurely
walk, greatly helps to re-train the second brain and the body and is one of my “secret
weapons” against chronic constipation. The walk, like meal times, should have an element of
mindfulness to it. Try to immerse yourself in the sensations - feel the sun and air on your skin,
notice the sounds around you. When your mind wanders, bring it back to those immediate
sensations. Aim for 30 minutes daily.
Keep regular sleep-wake times, optimally within 90 minutes every day. The best time to be
sleeping is before 11pm, after this your adrenal glands will kick in with some adrenaline to
keep you going. This of course heavily disrupts the ANS/ENS that we learned about earlier.
The bedroom should be dark and cool and quiet, perhaps with some white noise, and free of
clutter and definitely free of a television. Do not watch TV before bed. Turn off all electronics
20-45 minutes before bed.

Around bedtime, take 400-500mg of magnesium glycinate. This gently helps dilate and
re-trains the bowel and helps to set you up for a bowel movement in the morning. You can
increase by 200mg every several days until you achieve movement. Magnesium is very safe
to take in high doses, with the worst side effect being loose stool. Magnesium is good for
cardiovascular function, blood pressure, tight muscles and sleep. It covers a lot of bases.

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Chronic/ Tough Protocol


It’s true, sometimes we just need more help and that is all there is to it.

In addition to the Base Protocol outlined above

Triphala: This herbal formula (a mixture of three herbs) helps to stimulate digestive fire and
peristalsis both. I recommend taking 500mg daily. Find a product that has eval parts of the
three herbs contained in Triphala - Amlaki, Haritaki, Bibhitaki.

Glucomannan powder/fiber: This is a viscous fiber that stimulates the intestinal wall, helping
with motility. Add 1 tsp to your magnesium/lemon water in the morning.

When you are in a really tough spot, like more than 4 days without a bowel movement, have
some Smooth Move tea on hand. Brew one cup, pour half out and re-fill with water. Take a cup
of this diluted tea before bedtime. Do not use this more than twice weekly.

Extra Stress Protocol


If you are under slept, over committed, over exercising, over dieting, in an unhealthy
relationship or work environment or if you feel overwhelmed, wired but tired or on the verge
of tears or a breakdown most of the time, take these additional steps:

In addition to the Base Protocol:

Rhodiola rosea: 300mg daily, in divided doses if you’d like, but certainly first thing in the
morning. This helps support good adrenal function and smoothes out those rough edges.

Holy Basil (Tulsi): 500mg before bed. Holy Basil helps buffer the CNS and ANS from deleterious
effects of excess cortisol and will help you to sleep deeper.

Or, if Holy Basil is not your thing —

Phosphatidyl Serine: 500mg before bed. PS also buffers the brain against excessive cortisol
and has a soothing effect on the nervous system, and will sharpen you in the morning.

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Sleepy Time tea: One cup an hour or so before bed, to help get you ready and calm you down.

Floor routine: Go through 3-5 round of these poses, holding each one for 30-60 seconds. Start
with a forward bend at the waist, keeping back straight. Step back into Downward Dog. Step
forward again, and do the “Caveman” stretch, where the feet are wider than shoulder width
apart and you squat down as deeply as you can go. Finish the round with laying on your back
with your feet extended up a wall and resting there. Make sure your butt hits the wall. Breathe
through all of these exercises, repeat.

Meditation: Start a 5-35 minute a day meditation. I love the Byron Katie meditations on iTunes,
but go with whatever floats your boat. Meditation helps balance the ANS/ENS.

SIBO/Dysbiosis Protocol
The main thing to keep in mind with SIBO and dysbiosis - beyond killing infection and
restoring floral balance - is the fact that more gut-moving/motility enhancing herbs should be
incorporated. SIBO and dysbiosis greatly interrupt the ENS in a way that stress itself does not.
This protocol adds in a few more herbs to the mix.

In addition to the Base Protocol:

Gaia Herbs Gas and Bloating: This supplement, though marketed for gas and bloating, has
herbs that help with peristalsis. Also, it contains activated charcoal, which can help reduce not
just gas and bloating but also die-off symptoms as well. I recommend taking 1-2 tablets three
times daily, preferably after meals.

Ginger tea: brewed fresh or from a simple tea bag, ginger is definitely an herb that is a mover
and a shaker. Take 1 cup 2-3 times daily. Ginger is also a powerful anti-viral.

Peach Kernels: This is a Chinese Herbal Medicine formula that is inexpensive and greatly
enhances gut motility. Take 8 teapills (they are tiny!) three times daily, with food or on an
empty stomach.

When you are in a really tough spot, like more than 4 days without a bowel movement, have
some Smooth Move tea on hand. Brew one cup, pour half out and re-fill with water. Take a cup
of this diluted tea before bedtime. Do not use this more than 2 times weekly.

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These four protocols are an excellent place to start and are what work for the vast majority of
my clients. If things aren’t moving your way, I strongly recommend that you seek help from a
functional medicine doctor, a medically trained (ie - that has gone to one of the five accredited
schools) naturopathic doctor or someone else that can take a deeper look to figure out what
is going on and how to help you, whether that is by doing food allergy testing, stool or breath
testing or getting you help and support for stress or life situation you are going through.

I wish you the best. Thank you for including me on your health journey.

In Gratitude, Jillian

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