Lesson 2, Proper Elimination
Heal Your Gut with Lydia Shatney, NTP
If digestion works North to South like we learned last week, you may be wondering why I am talking about the southern most aspect of digestion in week 2. Well, there's a reason why it is important to start ironing it out sooner than later.
We all know that what goes in must come out , right? Therefore, it is really important to pay attention to your bowel movements. How do they come out (hard, straining or easy peasy) and what they look like. If you are keeping a food journal, I highly recommend that you do, it would be a really good idea to include when you move your bowels, along with what they look like. 12-24 hours is the length of proper optimal transit time. Today, I'm going to share with you a simple at home test you can do to determine your own bowel transit time. Before I do, let's talk more about transit time, optimal bowel/colon function and areas of dysfunction.
Maybe you've heard the phrase “Death begins in the colon”. It's critical to have healthy bowel movements daily to keep wastes from wreaking havoc on your overall health. It is really, really important not to go more than 24-36 hours without having a bowel movement. If this occurs, I want to teach you ways to get things moving to avoid further problems. As you begin to iron out the foundation of digestion your bowels should regulate. In the mean time, it's good to have ways to help clean out when needed.
Knowing the approximate times the digestive tract operates within can be very helpful in determining where a digestive problem might lie. There can be a wide variation in each individual including unique transit time, different foods ingested, and how they affect that person's bio-individuality.
Generally, food takes 24-72 hours to pass entirely through the body. Food from your meals can be in the stomach for about 2-4 hours before it passes into the small intestine for absorption. So, by the time you have your dinner at night your breakfast should be in the large intestine, your lunch in the small intestine and your dinner will obviously be in your stomach. So your stomach contents should be about 50% emptied in 2-3 hours with complete emptying in 4-5 hours. The small intestine contents should be 50% emptied in 2.5 -3 hours. Large intestine transit time can be 25-40 hours (feces are stored in the large intestine).
Frequency of bowel movements is a good health indicator. Successful bowel/large intestine health depends on what's going on in the northern parts of digestion. Proper diet, hydration, exercise/movement, removing food allergens, sensitivities, and resolving digestive dysfunction further up in the northern parts of digestion will greatly impact the success of colon health. Though there can be deeper issues that need to be worked on later, most people will restoring optimal bowel health goes a long way.
Bowel/Colon Function
If you can recall, we talked a little bit about the function of the large intestine in our last class. The large intestine is where any remaining water is reabsorbed back into the body. The large intestine also absorbs ions, including sodium and chloride and some dietary vitamins. By the time chyme has been in the large intestine for 3 to 10 hours it has become solid or semi solid also known as feces, which consists of water, inorganic salts, sloughed off epithelial cells, bacterial products from bacterial decomposition, unabsorbed digested materials, and indigestible parts of food. To provide lubrication for the passage of the feces, numerous cells line the walls of the large intestine and secrete mucus. The expulsion of feces requires optimal peristaltic function. With repeated peristaltic action the feces ispushed toward the rectum and anus and then eliminated. This movement is stimulated by the presence of food in the stomach. Peristalsis empties the cecum and makes it ready to receive new chyme from the small intestine. The time it takes for this chyme to turn into feces in the cecum and travel to the rectum depends on the amount of roughage and water in the food. Bulkier feces travel faster, as they provide substance with which the musculature of the bowel can work with. A soft, fiberless stool becomes very difficult for the bowel to move along. The longer it takes for the feces to move, the more water is absorbed, making the feces compact and hard, making elimination difficult.
Getting adequate good bacteria into the colon will help to encourage peristalsis, that rhythmic muscular activity that moves the contents of the intestines along. The pressure of the feces formed and pushed into the rectum initiates a reflex that will empty the rectum. This impulse and pressure along with parasympathetic stimulation opens the sphincter to expel the feces. The sphincter is voluntarily controlled, meaning you can choose to release the bowel movement or hold it. It is critical not to ignore your body's natural urge to defecate. Doing so can cause further problems with constipation. I know that some people have mental issues surrounding having bowel movements outside of their own home and comfort zone, but hey we all have to go, and when you gotta go, you really do gotta go! Infants don't have the voluntary aspect developed yet, but if you've noticed, babies/toddlers often run off and hide when they need to poop, it's definitely a mental/social thing.
Peristalsis is more efficient when the proper pH is kept in the colon, (perhaps you can remember that the stomach has a certain pH, very acidic. The small intestine becomes much more alkaline and the large intestine gets a bit more acidic, it's only slightly acidic though, but more acidic than the small intestine. Adequate beneficial gut bugs will help with this immensely. Since LABS produce lactic, acetic, and other acids which help to create an environment that enhances peristalsis. Also, the bacterial environment of the colon can synthesize certain nutrients including B1, B2, B12 and vitamin K. It is important to have fiber in the diet because the bacteria act on the fiber to produce butyric acid, which is one of the main sources of fuel for the cells that make up the colonic mucosa.
Bowel movements should be pain free. If there is pain with your bowel movements you may want to see a doctor to make sure you do not have any structural abnormalities - they can look for fissures, hemorrhoids or potentially more serious issues. When you have pain during a bowel movement it can actually cause a muscle spasm in the sphincter, potentially delaying the stool. Magnesium will help to relieve, as well as prevent muscle spasms. (We'll talk more about magnesium in a little bit).
Sluggish colon/constipation
Constipation is so prevalent that the average person who is constipated doesn't even know they are. Constipation can be a result of a need for healthier bile flow. Bile stimulates peristalsis in the colon. Dr. Natasha Campbell McBride (author of the Gut and Psychology Syndrome) says that constipation is always a sign of deficient gut flora. A lack of a good gut micro biome is an often overlooked cause of constipation. The beneficial bacteria that normally populate the bowel play a crucial role in proper stool formation and elimination.
A sluggish colon indicates that wastes are sitting inside your colon for too long. Poor transit time can increase the risk of colon disease. We need enough good bile flow from the gallbladder and the liver to emulsify our fats and help them give the bowel its natural incentive to produce bowel movements. The longer the wastes sit in the colon the more concentrated the bile acids become. Concentrated bile acids irritate the lining of the colon. Hormones that have been broken down by the body are also excreted via our feces. If the stool sits in the colon for too long, these hormones are reabsorbed into the blood stream, increasing the risk for estrogen-dependent cancers. Mucus can also build up during constipation. Irritated mucus membranes and bowel walls can get clogged so much so that the feces can hardly pass through. In addition, the thyroid regulates a number of functions and keeps them normal by releasing the hormone thyroxine into the body. When the thyroid is under active, all the bodily functions are slowed. Slowed digestion obviously can lead to constipation.
So it's clear that hormones can play a role in issues with constipation. Ladies have you noticed that your bowel habits change at various times in your cycle. Like right before you get your period you may notice some variances in your bowels. This has to do with hormones.
Constipation also increases the workload of the other excretory organs including the skin, the kidneys, the lymphatic system, and the lungs. These other organs and systems become hyperactive, overworked, and eventually worn out. Cellular metabolism thus becomes sluggish, repair and growth are delayed, the ability to eliminate wastes materials compromised, and the body becomes less energetic. The cells, instead of being alive and vibrant, become inactive and dull. The result is a decline in functional ability, beginning with the physiologically weakest organs, glands, tissues and systems of the body.
It is imperative to not go more than 24 hours, 36 at the most without moving your bowels. This can cause a lot of problems. Many doctors tell us it is normal if we don't go every day - it may be 'normal' meaning common but that does mean it's optimal or adequate. Let's talk about long term and short term resolutions for constipation. First, the long term would be to work on your diet. A nutrient dense diet with properly prepared foods would be a good place to start, along with consuming probiotic rich foods or supplemental probiotics (which we will talk about much more in depth later on in the course).
The use of laxatives only compounds the problem. The chronic use of laxatives or herbal laxatives will cause the bowel to become lazy and the muscles will become dependent on them to constrict and move. Some laxatives can cause damage to the nerve cells in the wall of the colon. The herbs in herbal laxatives such as senna and cascara sagrada (there are others too) work to force the bowel to go into spasm and cause a dumping effect. If you have used laxatives for any length of time it's going to be important to retrain your body to have normal bowel movements all on its own. I recommend the Squatty Potty so you can allow your body to sit in a way to support your colon. Please refer to the post I've included with the lesson materials on the Squatty Potty.
Chronic constipation can also indicate small intestinal bacterial overgrowth. If you are someone who has been chronically constipated you may want to ask your doctor to get a methane breath test to confirm if this is the case or not. The more severe your constipation the more likely SIBO is probably present in your body.
How to resolve chronic constipation
Proper hydration, exercise, a properly prepared nutrient dense diet, adequate fats and fiber (preferably from fresh vegetables -increase slowly- a GAPS/Paleo template is great), ruling out food sensitivities including lactose intolerance (dairy can be very constipating in people with lactose intolerance, we'll talk more about food sensitivities later in the course), and balancing gut bacteria are all important. Also, consider what medications you are on that could be adding to your constipation as well. Additionally, if you get the sense you need to go,do NOT hold it or ignore it. The more times you ignore the urge to go the more likely it will be for the rectum to stretch out and not be able to respond as it should.
A vitamin C flush OR magnesium to bowel tolerance could be a good support option to get things moving. Magnesium helps with peristalsis and magnesium deficiency is VERY common in the U.S. culture. It's a good idea for anyone to supplement with 400 mg of magnesium daily, a multi mineral supplement would be optimal. However, initially you may need a LOT more magnesium to keep things moving. This could be upwards of 2000 mg per day, this amount will lessen with time as your deficiency lessens. After about 3 months on a high dose you will want to make sure you are supplementing with a multi mineral to keep your minerals in balance. I recommend Multi Mins by Biotics - 2-4 per day. To find your dose of magnesium you want to get it to the point where you have a loose but formed stool - not diarrhea, if you find you get diarrhea back your dose down until you are at a loose but formed stool.
Another practice that is supportive would be an abdominal massage: Start at the lower right side of your belly, massage up to your ribs then across your upper stomach and down the left side making a big circle around your navel. Perform massage after every meal to stimulate the colon and train your bowels to move after each meal. Also, hot applications to the abdomen such as hot water bottles may help.
Rapid Bowel transit time (diarrhea)
Diarrhea is the bodies way of getting something out and fast. It occurs when your bowel transit time is TOO fast. The feces does not sit in the colon long enough for the water to be absorbed back into your body, so the stool comes out runny. We can absorb about two gallons of water a day just through the colon.
For situations of acute diarrhea
It's best just to let it flow, don't try to stop it with Immodium or other over the counter drugs. Be sure to stay hydrated, and include electrolytes. If you have severe abdominal or rectal pain, fever of at least 102, blood in your stool, signs of dehydration, dry mouth, anxiety, restlessness, excessive thirst, little or no urination, severe weakness, dizziness, light-headedness, or it lasts more than 3 days, call your doctor. Be even more cautious with small children, the elderly or those already with serious illness.
Milk kefir, if you tolerate dairy would be quite helpful, along with high quality yogurt with good strains of live active bacteria, obviously homemade would be best. Start with about a half cup or so to see how you tolerate it if it is a food that is new to you. Milk kefir, properly fermented, is a potent source of probiotics. Probiotics help normalize bowel function. They ferment fiber, which produces short chain fatty acids to fuel the colonic tissue. Homemade 24 hour yogurt can also stop diarrhea as it contains L. thermopiles and L. bulgaricus which help prevent and stop diarrhea. If you do not tolerate dairy you can make coconut yogurt using a yogurt starter culture, I use Custom Probiotics Yogurt Starter Formula 2 this has both of those strains, so it should work. This is an expensive starter but it lasts a LONG time and makes many batches of yogurt.
Kombucha, water kefir, and milk kefir all contain saccharomyces boulardii. This friendly yeast/bacteria strain can prevent and treat diarrhea. It can also help to boost secretory IgA, which is a protective part of the immune system. Water kefir and kombucha can also help replace lost electrolytes. Sipping on coconut water during the episode does this as well.
If you need something comforting to eat, and if you need to be out of the home you could try making a rice pudding with apples, rice, eggs and cinnamon to help bind your bowels. Try this if you don't have any of the probiotic type foods I mention above. OR you could try clay, charcoal or even just some probiotic capsules. Charcoal helps to bind toxins in the bowel and remove them, it can also have a bulking up effect. These techniques would be a far cry better than using say Immodium.
Chronic diarrhea is a sign of irritation; it could be a food sensitivity, celiac disease, low-grade underlying bacterial, fungal, or parasitic infection. Chronic diarrhea could also be a sign of constipation and impaction. When the bowel becomes impacted with feces, the body will often liquefy the colon contents in a last ditch effort to rid itself of the toxic-waste accumulation. Some people even have a reaction to fructose or lactose that can cause diarrhea. Consumption of sorbitol, mannitol or other types of insoluble sugars can cause loose stools as well. If you experience chronically loose bowels this is something that is critical to investigate,, do not ignore it. You may want to ask your physician to do some tests, such as a comprehensive digestive stool analysis with parasitology, a hydrogen breath test for SIBO, a lactose breath test, or food allergy and sensitivity testing including IgG and IgE.