Constipation

Talks about basic treatment of constipation and the prevention of constipation related medical conditions. Preventative therapy with Psyllium husk not wheat-based fibre is critical.

 

Dr Xxxxx : Constipation is a much unrecognised problem. It is ubiquitous in Western society, even if people do not realise that it is occurring. Too many people think that because they are going to the toilet once a day, they are not constipated. In the absence of an illness – bowel motions should be – slightly wet and loose/slushy. To go to the toilet should take essentially - no effort. There should be no need to push, with the bowel motion falling out easily.

Low fibre in the diet is the root cause constipation. Low dietary fibre intake is essential ubiquitous in Western populations.

Kinkajou : A friend who likes his adult films told me that most young actresses have perianal skin tags.
Dr Xxxxx : That means they have suffered constipation related complications, for example perianal haematomas. Straining causes the blood vessels to “pop” or “explode” – causing the localised haematoma in the perianal region. These haematomas then progress to scar up – forming a flap or tag of skin adjacent to the anus. It means that this person’s diet is deficient in fibre – which is generally fairly par for the course - in Western society, (and in Brisbane Australia).

Interesting that so many young people should have symptoms and signs of health injury from low fibre intake so early in their lives.

Lack of fibre in the diet causes big problems over many years. Problems include
Haemorrhoids (which are varicose veins in the anal region),
Diverticular disease (causing lumpy poos – becoming more common as you age),
Increased bowel cancer risk.

Constipation and Diverticular Disease

 

Goo : It is tragic to have this degree of complications for a problem which has such a simple solution. Society in general pushes a “good” diet as the solution. But that means that you need to eat a lot of foods that are generally – less available – less common – less acceptable – less tasty – and less pleasant to consume.
Kinkajou : It is far easier to eat what you like and take some extra fibre twice a day. (Swallowing fibre once-a-day is not quite sufficient).

Dr Xxxxx : Not all fibres improve constipation or bowel function. And not all fibres are the same. The most commonly promoted fibre source to assist bowel function is wheat- or wheat cereals in particular. Wheat or gluten -containing products are unfortunately an anathema for a number of people. Approximately one in 100 people with two specific HLA (human leukocyte antigen) genes associated with wheat issues will develop coeliac disease. The condition (Coeliac) will only develop if you have two of these wheat sensitivity genes.

People with coeliac disease are known to have two HLA DQ genes that are associated with Coeliac disease, ( HLA DQ 2.5 (commonest), HLA DQ8 (less common) or HLA DQ2.2 (least common)).

Having these genetic factors makes it very probable that you will develop coeliac disease in your lifetime .

In people with coeliac disease, the HLA DQ genes code for structures (receptors) on the cells (inflammatory T cells) in the lining of the gut (mucosa) that recognise the protein gluten (from wheat, barley and rye in the diet) and cause inappropriate inflammation.
This does not occur in people  who don’t have these specific HLA DQ genes. 
When someone with coeliac disease goes on a gluten free diet, the T cells  are not  stimulated and inflammation does not occur.

It would be rare for someone medically diagnosed with coeliac disease not to have one of these HLA types. It’s thought to be less than 1%.

Up to 40% of the general population  carry ONE of these DQ types – they are very common. That is people have t one of the “at risk “HLA DQ genes. Only about I in 100, people have two of the HLA DQ genes associated with Coeliac disease: hence the population prevalence of Coeliac disease is 1 in 100.

Erasmus : If you have none of these HLA genes – you are of course normal.
Dr Xxxxx : The key question then becomes “If you have one of these HLA genes, are you normal?” About 1/3 of the general human population carries one of these genes.

Myself and other doctors believe that they do not have coeliac, but they are not however normal. Their health improves if they avoid wheat.

Wheat allergy causes a number of symptoms such as:
bloating, diarrhoea, wind, cramping
tiredness, weakness, low exercise tolerance and
behavioural and mood issues (very long-term).

Dr Xxxxx : The pattern is easy to test for. If you have any degree of wheat allergy, you develop malabsorption – specifically for Vitamin B12, Folic acid, Iron, Zinc and Protein. It is the same pattern all the time.

So that’s why I recommend people take their fibre from Psyllium husk. My recommendation is that people take the “flaky” form of Psyllium husk, NOT the powder. (Powder may be suitable for blending in with flour and for cooking with, but not for drinking. It does not mix well with water and tends to dry-  stick to the inside lining of the mouth causing a lot of discomfort.) Flaky Psyllium house by contrast mixes well with water and can be drunk quite easily.

Fibre in Raw Food

 

The Process of Imbibing Psyllium Husk
The dose is 2 teaspoons twice a day in a glass.
Add water or juice.
Mix.
Eat or drink. (If you take the Psyllium husk with juice, mix immediately – it can be drunk, if drunk immediately. But if you leave it for a few minutes, it will turn to jelly and you’ll have to eat this. Either method of ingesting the Psyllium house works quite well). Most people prefer to drink the mix immediately. But "eating" is OK too.
It needs to be taken with or after food. It does not work if taken in isolation.
It needs to be taken twice a day – once-a-day is simply not enough.

 

 

Goo : Are all foods high in fibre good for your bowels?
Dr Xxxxx : Some foods have a lot of fibre but may not help with bowel function. There are different sorts of fibre. Soluble fibre such as a present in oats or beans – will generally constipate you and cause you to have wind and flatulence problems.

So if you’re thinking of using supplements or medications to assist your bowel function,
this is the protocol I would follow:
Psyllium husk or Metamucil twice a day, (Metamucil is in fact processed Psyllium husk with added sugar and flavouring). The micro-milling (extra fine grinding) tends to make it much more able to be added into normal drinks such as tea or coffee in the day. It can be unflavoured and is essentially undetectable.

Take Coloxyl tablets, (one or two tablets, up to once or twice daily to a maximum of say Four a day – though it is quite safe to use even more).Coloxyl’s proper name is di-octyl sodium sulpho-succinate. It is a detergent. It is a good safe simple and cheap laxative – in my opinion best added into extra fibre as above.

A third line agent for people with real problems is Movicol or Osmolax.
Each sachet of Movicol Flavour Free powder contains macrogol 3350 13.125 g, sodium chloride 350.8 mg, sodium bicarbonate 178.6 mg, potassium chloride 50.2 mg. The content of electrolyte ions per sachet when made up to 125 mL is: sodium 65 mmol/L, potassium 5.4 mmol/L, chloride 53 mmol/L, bicarbonate 17 mmol/L. Macrogol is a complex molecule (polyethylene glycol).

Some brands have more salt others less. (Movicol has more salt than Osmolox). It is essentially a water retaining agent. The main argument against using this is simply expense as you need to take this several times a day – resulting in the packet running out fairly quickly and the need to buy a  new packet.

All these medications build themselves into the food as it progresses down intestinal tract. Hence the food / medications act slowly as they work their way through your intestines. They are not stimulants. They do not trigger bowel contractions. Some laxatives do. They are best suited to unblocking people with constipation, where there is substantial faeces within the large colon.

The final medication for people with constipation is a stimulant laxative such as: Senokot (Senna)  and Bisalax/ Durolax (Bisacodyl). These medications take about 6 to 8 hours to work after ingestion. They stimulate the bowel to contract. Hence they push out faeces which may be blocking your intestines. You can take one or two tablets up to every few hours: effectively up to 12 tablets a day.

But beware, these medications can give you diarrhoea or gut cramps . Long-term usage (years)- makes the intestinal muscles lazy. The intestinal muscles function less unless this agent is present. Very long-term usage of up to 20 years will cause a pigmentation of the large bowel (colon) : a sort of brown black staining. Not a problem in itself. but very distinctive. If you have a colonoscopy it tells the doctor that you have been a long-time user of these agents.

 

 

Dr Xxxxx : A few general exemptions:
If you have very large bubbling bowel sounds, noisy big bubbles in your intestines and a lot of smelly wind, you are quite likely to have caught an intestinal infection. Yes your bowel motions aren’t slushy - but is because you have a problem, not because that is normal for you.

Excessive fibre intake, especially soluble fibre can cause an extra wind, but this is generally well relieved by simply going to the toilet and emptying your bowels. Faeces that sits there too long starts to ferment especially if the soluble fibre content is high. The solution is just to get rid of it. Go to the toilet and poo it all out.