Episode 65: How To Restore Gut Motility To Ease Constipation

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Thanks for joining us for episode 65 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show!

Today we are answering the following question from a listener:

“What are ways to restore gut motility? Constipation is always an issue for me. I exercise; drink plenty of water; eat a whole foods diet with a variety of vegetables, fermented foods, and healthy fats; and I supplement with magnesium. Herbal laxatives work to get things moving, but I’m scared of the long term side effects.”

If you’re doing everything you know of to ensure healthy gut motility but still experience constipation, you’re not alone. Constipation is a common complaint especially after transitioning to a different diet.

Often a closer analysis of our diet and even gut bacteria are key to getting things moving. Join us today as we delve deeper into possible causes of constipation and discuss solutions to restore healthy gut motility.

Here’s what Laura and Kelsey will be discussing in this episode:

  • Why constipation is a common symptom when transiting from a Standard American Diet to a Paleo/Ancestral type diet
  • The effectiveness of increasing carbohydrates to relieve constipation
  • The importance of analyzing your diet and lifestyle to ensure you are eating enough calories for your body
  • The importance of soluble fiber vs. insoluble fiber for constipation
  • Why too many vegetables in your diet can be problematic
  • The role of digestive enzymes in gut motility
  • Reasons why you may not be making enough digestive enzymes
  • Why you should consider testing for SIBO
  • The connection between the health of the microbiome and gut motility
  • The role of supplemental prebiotics in rebuilding the microbiome
  • How to introduce supplemental prebiotics
  • The importance of addressing stress when treating gastrointestinal issues
  • How supplementing with mucilaginous herbs can help with constipation

Links Discussed:

  • KettleAndFire.com – Use the code AncestralRDs for a 15% discount off your first order of Kettle and Fire bone broth!


Laura: Hi everyone. Welcome to episode 65 of The Ancestral RDs podcast. I’m Laura Schoenfeld and over there is Kelsey Marksteiner.

Kelsey: Hey guys.

Laura: So Kelsey, I guess it’s my turn to update people about all the ridiculousness that’s happening in my life, which some of it is personal life stuff that I’m not necessarily going to share on a podcast. But one of the things that is coming up in the next couple months is I’m actually going to be speaking at the Weston Price Conference in November in Alabama.

Kelsey: Exciting.

Laura: I’m not just speaking as in doing an hour long talk. I’m actually doing a full day seminar on the Monday of the conference.

Kelsey: Yikes!

Laura: It’s mildly terrifying. But I was kind of joking with Kelsey before I got on the call that go big or go home, right?

Kelsey: Mm hmm.

Laura: So if I’m going to do first major speaking engagement for people who actually know anything about nutrition and lifestyle recommendations, might as well be a full day seminar at the Weston Price Conference.

I’m a little nervous to say the least. It’s not until November so I have some time to prepare. But it’s definitely a big leap for me as far as I don’t do a lot of public speaking and public speaking is kind of my nightmare. So I feel like this is going to be a really interesting experience. It’s either going to be awesome and I’m going to love it and start doing this regularly, or I’m going to hate it and crawl into a hole and die afterwards. Those are the two potential outcomes.

Kelsey: Yeah.

Laura: I’m hoping I’ll enjoy it and that it’ll be something that can create new opportunities in the future.

Kelsey: Yeah.

Laura: It was just funny because Sally Fallon asked me if I wanted to do a seminar on…I guess she was saying adrenal fatigue. We’ve already talked about this a bazillion times, but the idea of adrenal fatigue, we’re trying to move away from that terminology as much as possible without totally throwing it out because most people still call it that and it’s hard to get people’s interest if you’re calling it hypothalamus pituitary adrenal axis disruption or dysregulation. They’re advertising it as…I guess they have it listed as “Treating Adrenal Fatigue on Monday November 14th.” It starts at 9:15 in the morning and goes until 4 with an hour long lunch break. That gives me I guess 6 hours.

Kelsey: Wow!

Laura: Oh my gosh. Just saying that makes me want to vomit.

Kelsey: That is a lot!

Laura: Yeah, that’s going to be really interesting. I guess it’s going to be kind of intense to create that presentation. Hopefully there’ll be a lot of interaction from the audience and it’s not just going to be me talking the whole time.

Kelsey: Yeah.

Laura: I went to go see the Balanced Bites seminar back a couple years ago. To be fair, it was two of them which I know makes it a lot easier to put on a full day seminar when you have two people. It’s the same things as us having a podcast with each other.

Kelsey: Right.

Laura: Do you want to come down with me and be my little co-presenter?

I remember that being a lot of information presented, and taking time for questions, and all that so it doesn’t have to be 6 solid hours of talking.

Kelsey: Yeah, and I imagine people would have a lot of questions about that topic which always makes it easier because they think of things that you wouldn’t even necessarily think to talk about but that are very important to them as well.

Laura: Right, so it’s just going to be a matter of me coming up with some major things to discuss and maybe getting some evidence to support it. My goal is to talk to about the five different lifestyle factors that affect stress. Actually, my session title that I had submitted…again, I don’t know if this is that they’re keeping on the schedule or if I need to tell them to change the “Treating Adrenal Fatigue” title…but my title was called “Stress Proof: Building A Diet And Lifestyle To Support Your Hypothalamic Pituitary Adrenal Axis.”

Kelsey: That’s nice. I like that.

Laura: Yeah. Well “Stress Proof” is kind of the catchy title, but maybe they thought that people wanted to have the adrenal fatigue terminology used or something. But my session description is this:

“Stress is one of the biggest contributors to chronic health issues and poor quality of life. Did you know that your diet and lifestyle can play a huge role in how your body responds to stress? After working one on one with hundreds of clients, Laura Schoenfeld, MPH, RD has found that under eating, overly restrictive dieting, inappropriate exercise, and inadequate attention to sleep and stress management is rampant in patients who are hoping to solve their health concerns through functional medicine and real food. In this seminar, Laura will teach you the five most important lifestyle factors that will influence the way your body responds to stress, maximize your energy and mental wellbeing, and improve your body’s ability to heal itself from chronic conditions.”

Kelsey: That sounds awesome!

Laura: Yeah, so it’s probably going to be structured a lot like our program as far as the five major topics. I don’t know if I’m going to talk about testing and supplementation at all.

Kelsey: Right.

Laura: I’m probably going to focus more on the lifestyle stuff, the dieting and how the ancestral diet can potentially become overly restrictive, people exercising inappropriately. So usually that means excessive exercise, it’s not often inadequate or not enough exercise is going to cause stress related issues, although it could. If somebody’s not doing any movement, that’s stressful, or not getting outside ever.

We were talking last podcast about our sleep concerns, which as I was describing in our last update, the lack thereof was definitely increasing my level of anxiety. I felt very strongly that my sleep deficit was impacting my stress response and me getting stressed about stupid things that normally I wouldn’t even be stressed about. That’s definitely a very clear example of that.

Kelsey: Right.

Laura: Also just incorporating stress management practices into regular life and talking about the different types that can helpful. I know in Chris’ Functional Medicine program, the Practitioner Training Program, we call it the exposome, so basically all of the things that are not genetically caused, I guess. I’m trying to think of how he describes the exposome. It’s basically the external or environmental factors that impact the way that our body responds to either disease or genetic issues, that kind of stuff.

Kelsey: Right.

Laura: I know that you and I have found, I mean this is basically our entire career is based on the fact that diet and lifestyle can improve or can worsen somebody’s ability to heal from either chronic conditions or infections. With the HPA axis, that in itself can be a condition even if it’s not associated with other conditions. People can just develop health problems simply because their HPA axis is not functioning well.

Kelsey: Right.

Laura: Or they can already have a chronic condition that causes them to have worse HPA axis functioning and then they’re not able to deal with that chronic condition because of the HPA axis.

Kelsey: Right.

Laura: That’s kind of where I’m at with what the topic is going to be. I haven’t started it yet, which don’t tell anybody because the presentation is due at the end of August and we’re close to the end of July now. I don’t have a ton of time to be creating the Power Point. But I have scheduled it in my calendar over the course of multiple days and just going to have to go to a coffee shop, and put my nose to the grindstone, and kind of focus because the summer’s been very distracted for me. I want to say I can’t remember when I agreed to do this, but I feel like maybe when I agreed to do it my schedule was a lot less busy. I was like, oh yeah, I can do that. That’ll be cool to have that challenge and kind of force me to do something a little outside my comfort zone.

Kelsey: Yeah.

Laura: Right now because my summer’s been so busy with all the traveling I’ve been doing, I’m like why did I agree to do this? But it’ll be fine.

Kelsey: What was I thinking?

Laura: I know. Well, we’ve already done so much work with the Paleo Rehab program that I’m sure I can pull a lot of content from that.

Kelsey: Yep.

Laura: Obviously expand on certain topics that we just briefly covered and not cover things like the DUTCH testing and that kind of stuff because I really don’t want to get into that level of clinical detail.

Kelsey: Yeah, and it probably doesn’t make sense in a forum like that.

Laura: Right, so probably just primarily focusing on diet and lifestyle. I’ll probably talk about carbohydrates a lot since we love to talk about carbohydrates and I know that’s one of the main things that Sally wanted me to cover. I’m not sure why she thought I could do a six hour presentation on carbs.

Kelsey: Wow. Yeah, that would be a lot. Maybe you could.

Laura: Yeah. Maybe I’ll have to go through all our podcasts on carbs and be like what did we talk about? What can I expand on? This is going to be a big project. But I guess what I’m hoping is that first of all it’ll be a good expansion of my business as far as the kind of things I can do.

Kelsey: Yeah.

Laura: They’re paying me, luckily, so it’s not like I’m just doing it for free.

Kelsey: Right.

Laura: But if I can pull this off, which fingers crossed that’ll happen, it could be something that I offer elsewhere so I can do that seminar other places and maybe charge for that as well. Then I do hope to create an online program that sort of talks about these kind of things. The population I would want to work with is a little more narrow, so there may be some things that I would talk to my group program about that I’m not going to include in this.

Kelsey: Mm hmm.

Laura: But it’s good to have that content created so I can repurpose for a group program at some point.

Kelsey: Yeah.

Laura: I don’t know. I’m definitely feeling a little overwhelmed and it’s ironic that the whole thing is about stress management and I’m like wow, I’m basically committing to a huge amount of stress over the next month or so.

Kelsey: I feel like that’s how we feel every time we do Paleo Rehab.

Laura: I know, it’s so funny. It’s like we’re trying to be practicing what we preach and I feel like I go in these ebb and flow periods. Right now I’m definitely in an ebb of doing very little work. I have my handful of clients that I’m working with, but I’ve been trying to minimize taking on new people and keeping my schedule as flexible as possible.

But eventually in the Fall I’m going to have to start picking it back up again and working a little harder. I guess the good news is even though I take high stress projects, I also balance that out with low stress periods, and vacations, and social events, and that kind of stuff. So I’m not a workaholic. I definitely know people who operate at that level of stress year round which to me sounds just horrifying.

Kelsey: Yeah, I could not do that.

Laura: Yeah. It shouldn’t be that big of a deal. I guess anytime you do something new that is a big commitment like that, it’s going to feel scary.

Kelsey: Yeah, I was freaked out about just doing two talks for my thing that I did. I mean granted, maybe public speaking is more of an issue that you’re freaked out about. But I at least found that I liked it more than I thought I would like it.

Laura: Yeah.

Kelsey: So I hope that that’s the case for you too.

Laura: Well considering I expect to literally have a panic attack, I feel like if I don’t have a panic attack, that’ll be a success.

Kelsey: You’re like, yes!

Laura: Yes! I kept it together and I didn’t vomit while I was talking.

Kelsey: Right.

Laura: Yeah, I think it’ll be good.  If I have to have the presentation done by August, I was considering doing a free version of it locally.

Kelsey: Oh yeah. That’s a good idea.

Laura: Just to practice. But I don’t know. We’ll see about that because that’s a big commitment and doing it for free, I don’t know. I guess if it’s free and you know that the people haven’t lost anything other than six hours of their lives, then it’s like I feel a little less nervous about it.

Kelsey: Yeah, right.

Laura: Worst case scenario, they just learn something and that’s great. I don’t know. That’s my thought and I’ll let you guys know if I’m going to do that so if you’re in the Raleigh area and you want to come, then you can.

Kelsey: Save six hours.

Laura: Or you can sign up for the conference in November. I think my presentation is an extra fee. It’s like $30 for the day, which I think is pretty reasonable for cost.

Kelsey: Yeah.

Laura: But that’s not included in the Thursday through…..I’m trying to remember if it’s Thursday through Sunday or Friday through Sunday. Anyway, it’s not included in the normal conference cost. Just keep that in mind if you do want to attend. Now you don’t have to attend the whole conference to attend my talk. It’s in Montgomery, Alabama. So if you’re in that area and you want to just come for the day, you can.

Apparently you need to register by September 14th for early bird discounts. Just think about that if you’re going to come. But if you are coming, then please feel free to introduce yourself to me. I’ll be there the whole weekend because my mom’s actually talking. She’s talking on Sunday so I’m actually going to be there for the whole conference. If you run into me if you want to give me a little encouragement pep talk kind of thing, I am more than happy to take positive words of affirmation. Have you heard of the love languages?

Kelsey: Yeah.

Laura: I’m definitely a words of affirmation type of person.

Kelsey: Gotcha.

Laura: Any positive words for me that people have, I’m quite happy to accept.

Kelsey: Well I think you’ll hopefully like it more than you think you’ll like it and I’m sure you’ll do an amazing job.

Laura: Yes, we’ll see.

Kelsey: I can’t imagine that you wouldn’t.

Laura: I can.

Kelsey: Of course you can.

Laura: I’m also quite hard on myself in a lot of ways.

Kelsey: Aren’t we all?

Laura: We’ll see what happens. Cool. That’s my update. I think tomorrow is my first scheduled time to work on it.

Kelsey: Nice.

Laura: I’ll probably just end up doing an outline and kind of see where that goes.

Kelsey: Well, good. I think it’ll be awesome. It sounds like a good topic. Obviously you know a lot about it, and you’ve talked about a bunch before, and we have a whole program on it. So I’m sure it will be fairly easy to put together even a six hour program. Yeah, that should be fun.

Laura: We certainly talked about this topic enough that I think I’ll have some insight about it.

Kelsey: Yeah, right. Definitely.

Laura: Anyway, well that is on the horizon for November. But for now, just going to be tackling the presentation creation. Honestly, if anyone has any thoughts about what they think would be good information to cover for that, please feel free to submit that through the contact tab on our website. Even if you’re not attending, because like I said, if it goes well it could be something that I continue doing elsewhere. And who knows, Kelsey, maybe you can I can do stuff together, some presentations.

Kelsey: Yeah, it’ll be fun.

Laura: But yeah, if anyone’s got some thoughts about information that would be helpful, I’m all ears. Definitely looking for as much input from people as possible.

Kelsey: Cool.

Laura: But anyway, we do have a good question for today. But before we answer that, let’s hear a word from our sponsor.

Alright. Today’s question is from Katelyn and she asks:

“What are ways to restore gut motility? Constipation is always an issue for me. I exercise; drink plenty of water; eat a whole foods diet with a variety of vegetables, fermented foods, and healthy fats; and I supplement with magnesium. Herbal laxatives work to get things moving, but I’m scared of the long term side effects.”

Kelsey: Alright. I love this question and I think it’s something that a lot of people deal with. First of all Katelyn, it sounds like you’re doing a lot of things correctly. You’re doing everything that you probably read about that helps with constipation. Exercise is absolutely crucial to get the bowel moving, drinking lots of water is important, getting tons of different variety of vegetables and fermented foods is also wonderful. You’re doing a lot of things right, which is why I totally get that it’s really frustrating that you feel like you’re doing all this right and things still aren’t moving.

Laura: Literally.

Kelsey: Yeah, right, exactly. Given that you’ve done so much good, what we’re going to do today is sort of run through what we think is missing from what you’ve described. Granted we don’t know your whole situation, so as usual this is just what we’re assuming from what you’ve written here. But feel free to write in again or comment on Facebook page if there are some other variables in here.

But the first thing that I would think of is I’m wondering about your carbohydrate intake because usually if you transition from sort of a Standard American Diet that is high in carbohydrates to a more Ancestral/Paleo type of diet, chances are you went at least somewhat lower carb than you were previously. For a lot of people it’s significantly lower carb. Eating carbohydrates brings water into the large intestine and it makes stool easier to pass; it’s softer stool. For most people that’s going to make it easier to pass.

I have seen, and I’m sure you have too, Laura, that when people transition from a Standard American Diet to more Ancestral or Paleo type diet, constipation is one of the most prevalent symptoms that I’ve heard of from my clients. What about you?

Laura: Yeah, definitely. Just GI changes in general.

Kelsey: Yeah.

Laura: But constipation is super common.

Kelsey: Yeah, so given that you haven’t mentioned here, Katelyn, how much carbohydrate you’re eating and you’re mentioning that you’re eating a whole food diet with a variety of vegetables, but you don’t mention fruits there, it does beg the question in my mind to know how much carbohydrate you’re actually getting. My guess would be that you’re probably not eating enough. Even if you are eating a decent amount, it might be worth experimenting with a higher carbohydrate intake to see if that improves the constipation.

Laura: Mm hmm.

Kelsey: Chances are it will. At least from both my and I assume, Laura, you too are experienced working with clients increasing your carbohydrate intake for the most part. I mean I would have to say that’s one of first things I try because it’s so effective with people.

Laura: Mm hmm.

Kelsey: Even if you’re eating a fair amount of carbohydrates already, I still find that increasing your carbohydrate intake really, really helps to reduce the amount of constipation that you’re experiencing. I would give that a try first. We’ve talked about increasing carbohydrates in other podcasts, so I would Google some of those or search some of those on our website and listen to those as well to get a better idea of how to start to increase your carbohydrate intake.

But you can just jump up a significant amount if you’d like to. It depends on what else is going on, but for constipation I usually would recommend that you just jump to a higher amount because it sort of kick starts things and get things moving a little bit more easily. That would be certainly one of the first things I would recommend you try because like I said before, it’s so effective for people that it’s just like the first thing that pops into my head when anybody says constipation.

Laura: Yeah, especially if they’ve switched over to a more Paleo type diet.

Kelsey: Exactly.

Laura: That’s not usually an issue for people who are eating typical America diet, but that’s not really our audience anyway.

Kelsey: Yeah, and I think the other thing that can feed into that along with that transition from a Standard American Diet to any kind of diet in general, but specifically a type of diet where you’re taking out a whole food group. So if you’re taking out carbohydrates as a whole, or even if you went vegetarian, you’re taking out meat as a whole, often what can happen with that is that you end up going too low calorie. You’re not eating enough calories to fuel your own metabolism and the kind of activity that you’re doing. I’ve definitely seen that able to cause constipation for people as well regardless of carbohydrate intake.

If that rings true for you, if there was a transition that happened from a Standard American Diet to some more specific diet and you feel like you’ve probably eaten less calories since doing that, so let’s say if you’ve lost a significant amount of weight, that would be an indication that you are lower calorie than you were before and it may be too low calorie. That’s hard to say without knowing your height, your weight, your calorie intake level before, and once you transitioned. There’s tons of variables there, but I would definitely do some analyzing to see if you think that you’re eating enough for your height, body weight, activity level, etc.

Laura: Mm hmm.

Kelsey: And again, we’ve had a couple podcasts on that as well so I’d go back to those, listen to those, and make sure that you are eating an appropriate amount for your body.

Laura: Definitely another issue we see a lot.

Kelsey: Yes. I think you hear about the carb intake one a little bit more than you do the calorie one maybe because it’s more common. But I also think that the two feed into each other a lot just because when you’re taking carbs out as a whole, again, you’re going to be cutting out a lot of calories and in a lot of cases you’re not necessarily replacing all of those calories with something else. The two problems definitely come hand and hand a lot of times.

Those would be the two things that I would assess first and just make sure you’re on the right page with those. Make sure you’re getting enough calories and then try increasing your carb intake to see if that helps.

Laura: Mm hmm.

Kelsey: Cool. Next thought on my mind would be your fiber intake. Again, this goes back a little bit to the carb intake because if you’re only eating non-starchy vegetables as your vegetable source, you’re not eating starchy vegetables, you’re not eating fruit, anything like that, chances are you’re going to be getting a lot more insoluble fiber than soluble fiber.

Laura: Mm hmm.

Kelsey: With constipation, you hear a lot of mixed things about the fibers you’re supposed to be eating. A lot of times, especially in more conventional medicine you’ll hear that you want to be having insoluble fiber if you have constipation because it gets things moving. But personally, I’ve actually found the opposite to be true. I like to get my constipation patients eating a lot of soluble fiber which comes from things like starchy vegetables like potatoes, sweet potatoes, yucca, that kind of thing, and fruit because again it’s bringing water into the large intestine, it softens the stool, it tends to be very soothing for the GI tract as well.

For my constipation patients, once they start eating more soluble fiber as a result of eating more carbohydrates, it’s hard to say which is the more important part of that. My opinion is that they’re both important. You want to get those carbs coming in, but you also want that soluble fiber. But the combination of the two really seems to help move things along for people with constipation. You could definitely, like we said, add in some more carbs. And if you’re already eating carbs, I would think about it as a way to just add more soluble fiber to your diet to get things moving a little bit more easily.

Laura: I think the main reason why insoluble fiber is recommended so much is because the average American is probably not eating much insoluble fiber.

Kelsey: Right.

Laura: Increasing that to a point can be helpful. But if you’re eating lots of plant foods in general, lots of vegetables, then you’re potentially like Kelsey said, getting too much insoluble. Not a big risk for the average person, but a lot of our health conscious, high veggie intake clients are actually eating way more insoluble fiber than they really need.

That’s why a lot of conventional recommendations are going to recommend an increase in that. If you see that or if you’re doctor suggests that, just try to keep that in mind because they’re just going on what the average person is going need.

Kelsey: Mm hmm.

Laura: Interestingly, it depends on the type of non-starchy veggies too because certain ones, like for example kale or something is going to be pretty low in soluble fiber whereas as something that’s a higher FODMAP vegetable like asparagus or something could be helpful. Now it’s not always helpful for constipation, but if you’re eating mostly leafy greens and low FODMAP veggies, then sometimes that can prevent you from having normal bowel movement.

Kelsey: Yeah and I would think about the overall, like Laura was mentioning, just the overall amount of vegetable matter that you’re eating. There is such thing as too much vegetable matter in your diet for some people especially when it comes to GI issues.

If that seems to be a problem, meaning the constipation started as you transitioned to a more Paleo/Ancestral diet and all of these things sort of happened at the same time. You stopped eating as many carbs, you probably were eating too low calorie, you were eating way more vegetable matter than your body was used to, all of those things really kind of feed into each other and make this problem worse for a lot of people.

When we’re working backwards to help reduce the constipation that you’re experiencing, we have to think about these things and sort of reverse them, but in a healthy way. You don’t want to take vegetables out to the point that you were eating them when you were on a Standard American Diet, but you may need to reduce your intake slightly and that might help.

Laura: Definitely.

Kelsey: Alright. The next thing I think about here is, and this starts to jump into a little bit more digestive focus stuff. One thing that can happen too with a transition or just if your gut balance is off, you can have trouble making digestive enzymes. That can be related to bacterial balance in your microbiome or if you have SIBO, something like that which we’ll talk about in a minute. But if you’re not creating enough digestive enzymes, that can definitely cause constipation issues as well. If you are not already taking them, that maybe something to experiment with and see if that helps. At least in my practice, that works a lot of the time both on constipation and diarrhea to help those conditions. What about you Laura?

Laura: Yeah, I mean I think sometimes with digestive function the type of clients that I’m seeing often comes with that calorie intake issue.

Kelsey: Which I think can affect digestive enzyme production, too.

Laura: Yeah, that’s my point is that that a lot of times if somebody is not getting enough enzyme production it’s for at least my clients a lot of times tied to the calorie question.

Kelsey: Right, fair.

Laura: Just because if you’re not eating enough or you’re avoiding certain foods like carbs, then your body is going to just start decreasing the production of certain enzymes. That’s why the carb increase can be helpful as well because you’re basically telling your body, okay I’m eating carbs again, start producing carb digestive enzymes.

Kelsey: Right.

Laura: I do have some clients that get worried about taking enzymes because they’re like if I take enzymes, it’s going to cause me to get hooked on them and then I’ll never get off.

Kelsey: Right.

Laura: Actually, I find that those with the easiest things to get off because as soon as you’re taking them and then you’re eating more, and then it’s kind of a nice little effect of telling your body, okay start producing more, and then you can get off them.

Kelsey: Yeah.

Laura: But like I said, my experience with the type of clients I work with is the enzyme production is usually impaired by low calorie intake.

Kelsey: Yeah, and that’s a good point just because taking digestive enzymes, you don’t want to think of a long term solution here. It’s more to help you get things moving so that you’re not stuck in a viscous cycle. That’s why I’m not overly concerned that this person is taking herbal laxative right now, especially if they’re working because as you work on other things hopefully you’ll find less of need for those herbal laxatives.

But you don’t want to be in a situation where you’re not going to the bathroom because then that backs things up, it causes bacterial imbalance which just starts the cycle all over again. You need to fix other parts of what is causing the constipation, but not be constipated at the same time, if that makes sense.

Laura: Yeah.

Kelsey: You need to be getting things out in order to fix other things.

Laura: Right.

Kelsey: I think the same thing goes for digestive enzymes. At a certain point it does make sense to start taking them if digestive enzyme production is impaired. Of course everything we’re going to work on is going to be in the pursuit of making more digestive enzymes so that eventually you don’t need those.

Laura: Right.

Kelsey: But in the beginning they help.

Laura: I would rather somebody be taking enzymes than taking herbal laxatives if the enzymes are helpful.

Kelsey: Yeah, for sure.

Laura: Those are a lot easier to get off of than the laxatives are.

Kelsey: Definitely, yeah. Just going back a second to reasons that you could not be making enough digestive enzymes. There’s two things that I would think of here which also feed into constipation on their own as well. One is SIBO, which stands for small intestine bacteria overgrowth. If you never heard of that, I think we’ve done a couple shows on that. I would definitely do a search and listen to those as well. But SIBO can definitely cause constipation and it’s one of the first things I think of once I kind of pick that low hanging fruit of calorie consumption and carb consumption making sure all of those things are within a normal level.

If we’re still having issues and let’s say the person has other symptoms like a lot of bloating, or they can’t eat carbs without feeling a lot of bloating, those short of things, I definitely start to think about SIBO. That’s because there’s a specific type of SIBO, which is methane positive SIBO, that is associated with constipation. If you have that type of SIBO, chances are that you are going to have constipation versus someone with hydrogen positive SIBO who is going to have diarrhea.

SIBO does not equal diarrhea. I think a lot of people have that misconception. They think oh I have constipation, I can’t have something like that. But it’s absolutely not true. It’s just a specific type of SIBO that is related to constipation.

SIBO also causes you to not create enough digestive enzymes and that’s just because you have this overgrowth of bacteria somewhere that is involved in digestion and it messes with a lot the processes that go on there. You want to definitely get yourself checked for SIBO if you have constipation, you have bloating, you have issues tolerating carbohydrates. Any of those kinds of symptoms, definitely get yourself checked for SIBO because if you have methane positive SIBO and that’s what’s causing the majority of your constipation, treating that makes a huge difference. For some people it can be pretty much all they have to do to help their constipation.

Laura: We’ve definitely talked about SIBO and how that’s necessary to go through the treatment and not just try to do dietary manipulations for that. I’ve seen a lot of clients with SIBO that they didn’t even realize that they had it, and with all their symptoms including something constipation, I recommended that they got tested for it. I’m trying to think if I’ve ever had a client that didn’t come up positive after being tested.

Kelsey: Right.

Laura: I don’t tell everyone to get tested obviously, but if I see symptoms like the one ones we’re talking about today, it’s usually a pretty good guess.

Kelsey: Yes. I’m trying to think if I’ve had anybody. I think I’ve had borderline people before that have had constipation. But SIBO testing also isn’t perfect too, so this is something that you would talk one with one with your practitioner about. But sometimes even if the SIBO test comes back maybe borderline or they just have so many symptoms of SIBO, it can be worth just trying the herbal antibiotics or if they’re doctor is willing, Rifaximin or something like that and seeing if they respond positively to that. But again, very personal choice dependent on your symptoms, etc. But for most people with constipation and the sort of symptoms we’re describing, I would say the SIBO test comes back positive.

The other thing to think about in terms of bacterial balance is not only what’s happening in the small intestine, but what’s happening in the large intestine. That’s what we call our microbiome, the bacteria that lives in our large intestine. What I‘ve seen to be really common for people with constipation is that they have low counts or even no growth of good bacteria in their microbiome. This we usually see on a stool test. They’ll do a functional medicine stool test, it’ll come back showing probably I’d say more often than not having no growth of things like bifidobacteria or lactobacillus. It’s really, really common for them have to have nothing.

When you think about it, stool is made up of dead bacteria. If you don’t have a lot of bacteria that’s supposed to be there, it makes sense that you might have problems passing stool or that you just don’t have this bulk of stool especially when it’s combined with a  lot of these other things we’ve already talked about.

You don’t have to do a stool test. I basically just assume that anybody with constipation issues has low counts of good bacteria and you don’t necessarily need a stool test to show you that because it’s not harmful in any way to feed good bacteria even if you already have enough of it.

Most of the time I would rule out SIBO, make sure they don’t have that, or if they do, it gets treated. Then from there, we basically want to rebuild the microbiome. Make sure that they have a lot of these good bacteria there so that their stool is more normal and they can more easily pass that.

Laura: Mm hmm.

Kelsey: The way that I do that is to incorporate prebiotics. For someone with prebiotics with constipation, I wouldn’t necessarily recommend only trying to get that from food. Though you can certainly get a lot, but the more therapeutic ranges of prebiotic levels would be difficult to get from food I think. I typically recommend a supplement for that and it works really well I have to say. It’s one of main things that I think can be very, very helpful for people with constipation.

Just remember that with prebiotics you want to start really, really slow and you have to start at a low dose as well. I typically recommend, there’s a product called Galactomune that I really like. I would recommend for most people to start off with 1/8 of a teaspoon, so that’s really not a lot.

Laura: Yeah.

Kelsey: Yeah, and just work your way up very slowly overtime. You can expect to get some bloating, some mild GI differences I guess I would say. It doesn’t even necessarily have to be discomfort, but things might feel a little bit different as you start to move up. But as your bacteria gets used to having that food coming in, that sort of feeling sort of dissipates and you should feel totally fine taking them. That really, really helps.

Do you use a lot of that in your practice with your constipation people, Laura?

Laura: Yeah, I mean sometimes I like to use the galacto-oligiosaccharides. For whatever reason I found that they can be a little bit more gentle.

Kelsey: That’s what Galactomune is.

Laura: Oh, right. Oh my gosh, I’m sorry. My listening skills dropped off for a second there. To be honest, a lot of my clients…I’m trying to think if I work with a lot of constipation because usually the things we’ve already talked about are so helpful that getting into the supplement level is not always even necessary, but I’ve seen some benefits of that sometimes. I think my problem is most of my clients, well I shouldn’t say problem. It’s not a problem. Most of my clients are the under eaters, under carb consumers, so those are usually where we’re seeing the major changes happen.

Kelsey: Yeah, that fixes everything, makes sense. Cool.

I’m sure you probably with your clients talk about stress a lot too in terms of constipation because that can definitely feed into that picture as well, especially with your type of client that tends to be an under eater or someone who is afraid of carbs, that kind of thing.

Laura: Yeah, well I actually had a client recently have a really…interesting is probably not even the right word, kind of crazy experience when she went out of town with her family. She was on a camping trip with her family for the weekend, which ironically usually if you’re going camping and there’s not good bathrooms available or something, that can cause people to have worse issues with bowel movements.

But the funny thing was that she contacted me when she got home…and she has SIBO for sure, and she has a lot issues with motility, and lots of bloating and indigestion, and that kind of stuff…and she said that during her family camping trip, her digestion was awesome and that she didn’t experience any digestion, and very little burping, and she had a bowel movement every single day. That was even as she was going a little looser on her diet than she would normally eat.

It was just funny because she was like, I kept thinking that this was because I’m relaxed and not stressed. So that’s definitely a big factor that I’ve seen in a lot of my clients, and that was just a very recent example of a massive adjustment in someone’s GI function just form a couple days of low stress.

Kelsey: Yeah, I mean I think a lot people equate stressful situations or being stressed out in terms of their digestion to things more like diarrhea, which makes sense honestly if you think about because your body…well, I guess it could go either way. But I think a lot of people think about it as, well my body just doesn’t want to digest anything so it’s just going to just like shoot it out, get rid of it. But I think it also definitely goes the other way as well where your body just doesn’t digest, it’s not producing digestive enzymes, it’s not inducing a lot of peristalsis, so things just kind of sit there.

Either way can cause a problem depending on which way your body tends to be leaning towards. It can cause either constipation or diarrhea issues. But I think for whatever reason people just have it in their heads that stress can equal diarrhea, but defianatly not always the case. So it’s certainly worth incorporating some stress relief or doing a camping trip to almost start that process and realize what it’s like when you’re not stressed out can be very, very helpful.

Laura: Yeah.

Kelsey: I definitely recommend incorporating some mind-body activities regularly, and one thing that I always recommend to pretty much most of my digestive issue clients is to do some deep breathing before meals to sort of kick start that rest and digest system because of course that’s what we want you to be doing at that time.

Laura: Yeah I think the stress relief piece is one that, as we just talked about in my update, is indicated in so many different things. Unfortunately its crazy, the more I work with people, the more I realize stress impacts their health and just even trying to get people to reduce the stress that they’re under, especially with work, I feel like work is always the biggest issue for people.

Kelsey: Yeah.

Laura: But just seeing the changes to GI function or any other symptoms that people are dealing when they’re either on vacation, or taking a couple days off, or just whatever the reason for the reduced stress, it drives me crazy because I feel like people just get into this kind of rat race type of function at their job.

Kelsey: Yeah.

Laura: They know it’s bad and they know that it’s causing problems, but they’re just so afraid to make any changes that they just continue to do it. I don’t know, I mean I guess we’re kind of spoiled because we make our schedules and we can really have a lot of control over how stressed we are. I’m just laughing because like this presentation, like I’m choosing to be under stress.

But basically just seeing how many people feel so helpful with the amount of stress that they’re under, I don’t know. It’s really frustrating because on one hand, I’m not telling people to quit their jobs or something. But on the other hand, sometimes that’s not an unreasonable thing to think about if you really have a huge amount of stress with your work.

Anyway, I feel like stress is one of those things that it just causes so many problems and in our culture it’s something that is almost expected as opposed to being seen as a problem. So it just frustrates me.

Kelsey: Yeah, no kidding. I would not be surprised if with the wave of a magic wand we could get rid of stress for people, I think we’d have half the amount the amount of people in our practices because it’s just so much a problem for so many people and I think it just makes a lot of conditions so much worse. In a lot of cases, honestly it probably kick starts the disease process for people as well.

Laura: Mm hmm.

Kelsey: So very important to make sure that you’re getting some restful time, you’re not constantly stressed out. There comes a point too where even things like mind-body activities, it’s not necessarily going to fix the problem. If you’re constantly stressed out, or the stress is so intense and you’re under it a lot, of course mind-body activities can help, but you at that point want to start to think about, okay, is there anything about this situation that I can change so that I’m not always under this kind of stress.

Laura: Yeah.

Kelsey: Sadly, which like you said, for a lot of people can mean figuring out a different type of job or career, which I know is stressful in and of itself. But for a lot of people I think in terms of the long term effect makes a lot more sense to think about.

Laura: For sure.

Kelsey: Yeah. Last couple of things to talk about here with constipation. Another thing that can help supplement wise is mucilaginous herbs. Those are things like marshmallow root, or slippery elm, deglycyrrhizinized …I actually never know how to say that. I always say deglycyrrhizinized, but that’s not right, licorice.

What those things do generally, is they absorb water in the colon, they create a bulking and softening effect for stool, so of course that tends to make things easier to pass. It shortens bowel transit time, so you’re going to not have food stay in your digestive tract for as long. It also reduces inflammation. Anytime you have any bacterial imbalance going on, or SIBO, you’re stressed, you’re going to have inflammation going on in the GI tract. Anything that we do to reduce that inflammation, of course we want to get the root cause. So it’s that’s SIBO, we want to treat that. But anything we can do on top of that to help reduce that inflammation or reduce that inflammation more quickly is going to be a good idea. So those can be really useful to add on if you don’t already have them incorporated.

Then from there, I like that Katelyn is supplementing with magnesium, so I wouldn’t change that. That really helps a lot of people. But ideally, I agree, I would like to get her off of the herbal laxatives that she’s on. I would try all of these things that we’ve talked about today. See if you can come off of the herbal laxatives even if it means going on something like a digestive enzyme. Like Laura and I just mentioned, we’d rather see you on the digestive enzyme than an herbal laxative because it tends to be much easier to wean off of.

Laura: Mm hmm.

Kelsey: Honestly, I don’t have a lot of people that end up needing herbal laxatives and think it’s because we go through this process where we’re figuring out, okay, what is the underlying cause of the constipation here? How can we fix that? So we look at the bacterial balance, we look at the carb intake, we look at the calorie intake, we look at the types of fiber that the person is eating. Then once we kind of figure all those things out and we get them to where they need to be, the constipation becomes much less frequent or disappears entirely.

Laura: Yeah, and just to clarify with that DGL product that you mentioned, I always pronounce this wrong too, but it’s deglycyrr…hold on, let me try this again. Deglycyrrhizinated.

Kelsey: Deglycyrrhizinated, okay.

Laura: Yeah, because I think that glycyrrhizin is the thing that’s in the licorice.

Kelsey: The active ingredient. Yeah, okay.

Laura: It’s when you take the glycyrrhizin out, it’s deglycyrrhizinated.

Kelsey: Got it, alright. I’ll have to remember that. I say it wrong every single time, and I always just say that I say it wrong, and I never figure it out. So thank you, Laura.

Laura: Yeah it’s just funny because I’m like maybe we should actually know how to pronounce this.

Kelsey: Yeah.

Laura: Because it’s just such a weird word and there’s so many consonants in it.

Kelsey: Yeah, exactly. So essentially its licorice without the glycyrrhizin, which is the active ingredient that affects cortisol. We wouldn’t want someone taking normal licorice with the glycyrrhizin intact because that’s going to mess with their cortisol levels in their body. So we take it out, we call it DGL, and then it’s perfectly fine to take larger amounts where it can be useful in the GI tract.

Laura: Definitely.

Kelsey: Cool. Hopefully this helps, Katelyn. I think we’ve gone over a lot here and I hope it gives you some things to think about and some things to try. This can be a fairly difficult problem to deal with. It can always be useful to work with someone on this to guide you through this process. Feel free to do that if it’s something you’re able to do.

But otherwise, start thinking about the big things here, so the bacterial issues, the calorie intake, and the carb intake. That would be where I would start and then maybe add on some of these other supplements we talked about after you kind of figure out those big things first.

Laura: Great. Well that’s I feel like a pretty comprehensive approach. Hopefully one of these or a combination of some things will be helpful.

But anyway, thanks for joining us again you guys. This is a little bit of a longer episode than usual, but we had a lot of good information. If you have any questions either related to constipation, GI issues, or anything diet and lifestyle related, feel free to go to TheAncestralRDs.com and click the Contact tab and you can submit a question and we might answer it on the next show.

Thanks again for being here. We’re always happy to have you and we’ll look forward to seeing you next week.

Kelsey: Great. Take care, Laura.

Laura: You too, Kelsey.

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