Constipation - What moves your bowels?

Regular bowels are an important sign of good health. Our bowels are a primary function of elimination and detox. When this is backed up, we start to use secondary organs of elimination such as your skin, or lungs...which is not ideal. ⠀

Do you suffer from constipation? Check out the bristol stool chart if you haven't seen it before. Constipation could mean daily hard to pass stool, or not going for several days. ⠀

Why are you constipated?

1. There could be an imbalance of bacteria in your gut, aka SIBO, or yeast overgrowth.

2. You could have stagnation of bile from the liver/gallbladder, which is very important to stimulate bowels. ⠀

3. You could have a low fibre diet (but this gets quite complicated for those who have experienced constipation for awhile - due to point #1 typically). ⠀

4. You are not stimulating movement of bowels by moving your whole body. Exercise and twists are key here. ⠀

5. You are STRESSED! If our body is stressed our muscles tighten, including our digestive tract.

What moves our bowels?

1. Get into a routine - We detox during the night for the most part, since our body is at rest, so the morning is when the cycle should be completed, aka a bowel movement. If you wake at the same time each morning, after a good night sleep, your body should start getting into a rhythm and you shouldn’t need extra support. Try it!

2. Try extra support - Try a mug of warm water with lemon. It helps to stimulate liver detox and the warm water gets your intestines warmed up (like a warm up before a big run). Your morning coffee may do the trick as well since it is bitter. Bitters stimulate stomach acid, enzymes and bile secretion, all essential for proper digestion and bowels.

3. Exercise and twist - The simple twist I’m doing above is one way to stimulate the bowels. It’s like wringing out a towel and moves things through. Exercise gets lymph moving, helpful for detox.

4. Hydration - The bowels absorb water to bulk up the stool. This then creates a signal to stimulate a bowel movement. Hydrate with lots of water throughout the day (ideally not ice water, and not just during meals!)

5. Get rid of bad bacteria - Methanobacteria are among those typically high with constipation. Bifido bacteria tend to be low with constipation. These are only 2 patterns I see in practice as it depends on the individual. We ultimately need to eliminate an overgrowth with antimicrobial herbs and a specific diet, then increase the beneficial bugs with supplements or food.

6. Stimulate bile flow - Bile is crucial for proper bowel stimulation. If it is trickling out too often and irritating bowels it can cause diarrhea, and if it is stagnant in the gallbladder (or liver if you don’t have a gallbladder) constipation tends to happen. Simple diet hacks, fibre, cholagogue herbs, and nutrients such as lecithin, and phosphatidylcholine all help to stimulate bile. Cholagogue herbs include milk thistle, burdock, dandelion or artichoke.

7. Relax - I know this is easier said that done but this is key! Deep belly breathing goes a long way to stimulate the vagus nerve ultimately stimulating your bowels.

Questions about constipation? Let me know!

In health & happiness,

Dr. Karen

Estrobolome - The Gut-Hormone Connection

Improving your digestion goes beyond keeping your gut happy. It is connected to a number of different “systems” in our body, one being your hormones, estrogen in particular. When this isn’t in balance it can affect mood, weight, cycle, libido, acne and even bone health. 

What is the Estrobolome?

The gut microbiome is the collection of bacteria, both good and bad, in the digestive system. Ideally there should be no imbalance in the bacteria, called a dysbiosis, but due to diet, antibiotics, stress, or environmental exposure it is common for an imbalance to occur. 

Among many roles, the gut microbiome plays a crucial role in regulating circulating estrogen levels. Specific microbes in the microbiome, called the estrobolome, specifically do this. The microbes in the estrobolome produce an enzyme called beta-glucuronidase, which deconjugates estrogens into their active forms. This increases estrogens that are reabsorbs and capable of binding to estrogen receptors in the body and influencing those hormonal physiological processes. This process is known as phase 3 estrogen detox and when there is the right amount of beta-glucuronidase, estrogen homeostasis is maintained. When dysbiosis occurs, the estrobolome up-regulates or down-regulates beta-glucuronidase leading to a deficiency or excess of estrogen in the body. I most commonly see an estrogen excess. 

Common signs of excess estrogen which can be influenced by estrobolome are:

• bloating, especially before your period

• irritability 

• acne

• breast tenderness

• heavy periods

• headaches or migraines 

• PCOS picture 

Issues with deficient estrogens post-menopausal influenced by the estrobolome are:

• increased risk of osteoporosis

• increased risk of cardiovascular disease 

• increase risk of obesity 

What affects the estrobolome?

Anything that disrupt the gut microbiome typically affects the estrobolome as well. 

• Poor diet and lifestyle are the most common triggers for dysbiosis. Certain bacteria feed on certain food we eat (sugar and gluten as common examples), grow and in tern tell the brain to eat more of that food, causing an overgrowth. Studies have shown that a shift in the diet can induce microbial shifts within 24 hours. Focus on organic food when you can, cruciferous vegetables such as broccoli and brussels sprouts and fibre. 

• Antibiotics and birth control pills both have been found to alter the microbiome and estrogen levels, leading us to believe it is affecting the estrobolome. 

• A broad spectrum probiotic can influence the microbiome to shift positively. Antimicrobial herbs may be effective at eliminate an overgrowth. Talk to an ND like me to discuss if these are advised for you. 

• Calcium-D-Glucurate is a supplement that is a beta-glucuronidase inhibitor. This allows estrogen to remain conjugated, in its inactive form, to be safely eliminated from the body. This is very handy for someone with known estrogen excess. 

This gut-hormone connection proves to me that gut health is again at the root of many health concerns. We don’t want to forget proper liver support or hormone support with certain herbs, but it is important to not skip the gut! 

In health & happiness,

Dr. Karen

SIBO - Test Don't Guess

Small intestinal bacteria overgrowth (SIBO) may be more prevalent than we think. Research shows that 50-84% of IBS patients test positive for SIBO. This is with old testing methods that would show many false positives, therefore my assumption is that it is even more prevalent than we think. All it may take for someone to develop SIBO is a bout of food poisoning! That’s it! For some it is more complicated than that.

I have discussed the main reasons someone may have SIBO in a previous post, but let’s jump right into how you accurately diagnose SIBO. In my practice I ask a lot of questions in the first visit. This is because we can gain a lot of clinical information about what may be going on by just getting all the information. A physical exam, specifically an abdominal exam in these cases, is my next step in gathering information. SIBO has a handful of specific symptoms I am looking for which guide my treatment plan. But SIBO also a handful of symptoms that are unique to the individual and can be systemic, for example joint pain, rosacea, hypothyroidism.

Test Don’t Guess

If your symptoms indicate to me that you may have SIBO, before jumping into treatment, it is very helpful to test for it. Not only will this confirm, or deny, a positive result, but it will also guide what type of antimicrobials I’ll use and for how long depending on what the results show. The higher the results, the more rounds of antimicrobials we typically have to do.

The SIBO breath test is the most accurate non-invasive way to diagnose SIBO right now. Research continues to be done to advance our testing methods. The best option is a breath test that is a 3-hour lactulose breath test looking at both Hydrogen (H2) and methane (CH4) levels. This is the type and amount of gas that is produced if you have SIBO. Hydrogen SIBO typically presents as diarrhea (among other symptoms), and methane SIBO typically presents as constipation. The 3 hour test ensures you are testing the entire length of the small intestine, where only a small amount of bacteria should be, not an overgrowth. Stool testing, which we may do for other GI complaints, is only relevant to the large intestine. There is no accurate test yet for a 3rd type of SIBO, hydrogen sulphide. However, there are patterns on the results and patterns in symptoms that may indicate this type. This is not testing for Candida, however it is common for these to present together.

Ultimately if you test positive for SIBO, I treat it. However, 2/3 of patients have shown to relapse post-treatment. There are number of reasons for this but this is why it is always important to treat the patients and not the condition. I aim to treat the root cause along with the SIBO - if we can. Sometimes this isn’t possible depending on the case, so we do are best. It can also take time, and even different circumstances, for example a less stressful job perhaps, to treat the root. 1/3 of cases are luckily non-recurring and the patients feels better quickly and for good. Phew!

All in all, testing is very helpful to me as a clinician if I suspect a bad case of SIBO. It takes the guesswork out of the treatment and ensures a more accurate and quicker treatment result. Treating SIBO is a team effort but the more information we have the better it can be!

Are you interested in getting tested for SIBO? Let me know!

In health & happiness,

Dr. Karen

Leaky Gut - Yes there could be "holes" in your gut!

As a Naturopathic Doctor who sees a lot of gut issues, I get questioned often by people who have heard the term leaky gut, wondering what it is and if it could be the cause of their health issues. This is something I do see often in practice and I find very important to fix in order to treat a number of different issues, such as IBS, eczema, depression and most autoimmune disorders.

What is leaky gut?

Your gut is actually quite fragile as the lining of your intestines is made up of only 1 layer of cells, called enterocytes, lying between your gut lumen and the blood vessels. A border of microvilli on top increases the surface area to aid in absorption of nutrients, water and electrolytes. The intestinal lining also regulates the trafficking of environmental antigens (1) . These enterocytes are held together by tight junctions, like water-way locks, preventing the cells to come apart when inappropriate. Remember the childhood game red-rover? This is the game your gut is always playing. However, damage to the gut lining from inflammation and stress, releases a protein called zonulin which weakens these tight junctions making the lining more permeable (2) and ultimately creating small gaps between the enterocytes that cannot close up. Food particles, or antigens get absorbed between the cells now instead of through the cells, activating an inflammatory and/or immune response in the gut and blood stream.

What health issues can this cause:

• Local inflammation - IBS symptoms such as bloating, cramping, diarrhea, constipation

• Autoimmune conditions (1) - Hashimotos thyroiditis, Rheumatoid arthritis, Lupus and IBD, MS

• Systemic conditions - eczema, psoriasis, acne, joint pain, headaches, seasonal allergies

• Mental/emotional issues - depression and anxiety, chronic fatigue

What causes leaky gut:

• Gluten - this was the first thing found to increase zonulin levels

• Bacteria and infections - or bacterial endotoxins also found to increase zonulin levels

• Stress - this decreases stomach acid and digestive enzymes leaving larger particles of food to descend into the intestines which irritate the gut lining

• Medications such as proton pump inhibitors, antibiotics and NSAIDs

• Simple sugars and food additives

How to fix leaky gut:

If you haven’t read my blog post about the 4Rs in gut health, I’d lead you there to shed a little more light on my whole gut healing protocol. Ultimately we need to reestablish the zonulin-dependent intestinal barrier function to close up those gaps between the cells. There are a few favourites of mine that been shown to be very effective at REPAIRING the gut, but don’t forget to REMOVE, REPLACE and REINOCULATE as well.

• L-glutamine - this is my go-to for any gut issues, from mild to major. Always given in powder form to ensure a high enough dose.

• Collagen - helps to support and strengthen the gut lining like glutamine. I love the brand Sproos that I carry in my practice.

• Zinc carnosine - studied to heal the gut, including the stomach lining after H.pylori or an ulcer or after NSAID use

• Mucilaginous herbs - marshmallow, aloe vera, DGL, slippery elm

If you struggle with any of the conditions listed above do not hesitate to reach out to discuss the best treatment options for you! Heal your gut to heal your body and start feeling yourself again.

In health & happiness,

Dr. Karen

References:

1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384703/

2 - https://www.ncbi.nlm.nih.gov/pubmed/21248165