Wednesday, November 26, 2014

Wisdom Wednesday: Constipation

Constipation is the most common digestive complaint in the United States. It is a symptom, not a disease.

However, diagnostic workup generally does not occur until medical management of the symptoms fail. Even with a diagnosis, treatment is aimed at alleviating symptoms with a bulk laxative, a stool softener, and/or drug that increases peristaltic action of the bowel.

The medical definition is a having at least two of the following symptoms over the course of the past three months:
  • Fewer than 3 bowel movements per week
  • Straining
  • Lumpy or hard stools
  • Sensation of anorectal obstruction
  • Sensation of incomplete defecation
  • Manual maneuvering required to defecate

If you are not having a bowel movement every day, preferably twice per day, you are constipated.
The most common cause of constipation is a sluggish gallbladder. The gallbladder stores bile manufactured in the liver. When the food bolus moves from the stomach to the small intestine, the presence of HCl lowers the pH of the small intestine and stimulate the gallbladder to contract. The released bile travels down the common bile duct, stimulating the release of all the pancreatic digestive enzymes. The bile emulsifies the fat while the pancreatic enzymes breakdown our food for absorption.

If the fat is not broken down, the ileocecal valve will close, trying to prevent the fat from entering the large intestine resulting in constipation. Fat does not belong in the large intestine as it feeds the harmful bacteria in the bowel.

Enter the protein pump inhibitors (PPIs). Nexium is the third most commonly prescribed drug in the US, behind Synthroid and Creastor. Twenty million people in America take Nexium to prevent acid reflux, effectively stopping the normal digestive process. In addition to constipation, PPIs cause anemia, osteoporosis and a host of malabsoption syndromes.

Of course eating excessive fat will also cause a sluggish gallbladder. Americans eat too much fat. They just eat too much – too much protein and refined carbohydrates as well. The only thing well don’t eat too much of are fruits and vegetables.

Over time, as the gallbladder is abused, the bile thickens and doesn’t flow very well. In addition, the bile duct becomes constricted, further limiting bile flow. Many times stones will form in the gallbladder. The medical solution is to remove the gallbladder. While this will resolve the pain associated with gallstones, digestion is further impaired. The liver now has to continually drip bile into the bile duct rather than store it for use as needed in the gallbladder.

Beets are often effective in improving gallbladder function. Betaine, the phytochemical that makes the beet red, will dilate the bile duct and over time, thin the bile as well. Organic beet tablets will actually relieve a gallbladder attack in under a minute when chewed. The presence of the betaine on the tongue stimulates dilation of the bile duct through the sense of taste.

I frequently recommend Betafood (beet root powder) taken with meals as a digestive aid and chewed as necessary for relief of gallbladder pain. If the cause is a lack of HCl from the use of PPIs, then we have to wean the patient off the medication and stimulate HCL production again. This is a difficult process as most patients will suffer acid rebound if they stop taking Nexium resulting in more pain and reflux than they experienced prior to taking the medication. Zantac, an antacid, can work as a transition away from PPIs, until proper HCl production is reestablished.

If you suffer from constipation, review the amount of fat in your diet and reduce it if needed. Try eating a small slice of baked beet every day. I keep baked beets in the refrigerator at all times. Although I don’t really like the taste, I eat them daily. If you take a PPI, like Nexium, please consult and qualified nutritionist and try to get off the medication.

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