The Constipation Protocol
Constipation is the quickest way to die
Constipation is the cousin of death.
This is the truth. If you fail to evacuate daily the amount of damage that is piling up is crazy. But why is that?
Enterohepatic Recirculation
The liver puts all the trash into your gut, just to be exported via the bile into your toilet. If that medium is failing, all the toxins your liver is metabolizing will be re-absorbed, leading to recirculation.
This is a disaster as your liver is the sentinel between your gut & system circulation. With increasing amounts of constipation, your liver looses control and your system circulation is exposed to all kinds of toxins stemming from your gut & body (hormones, endotoxins, heavy metals, medication, undigested food particles).
Sadly there is a massive pandemic of constipation which has to be addressed, otherwise healing will be impossible. So in this one I give you a quick plug & play guide to get the bowl moving. The following is designed to provide relief, but not a true root cause. They will be discussed in other newsletters.
Let’s jump in.
Root causes of constipation
Causes of constipation are manyfold, but the following are the most notable:
Circadian Rhythm Missmatch
Viral Infections (Herpes, EBV, Covid,…)
Mycotoxins & mold
Liver & Bile Issues
Hypothyroidism
Dietary Inputs
Exposure to toxicants & pollutions
Stress, Trauma & Dysautonomia
Adrenal Fatigue (low cortisol)
While we have to assess for each of those, one of the biggest causes of ongoing constipation is IMO, or intestinal methanogen overgrowth. It is the brother of SIBO, but is not caused by bacteria but by archaea, most notably M. smithii.
Important to understand is that these bacteria feed off of existing hydrogen within the gut (hydrogen is actually very important in the right amounts) and produce methane (CH4) as a consequence. High methane levels negatively impact gut motility by slowing it down, leading to the phenotype of IBS-C (C = constipation). Assess for this type of overgrowth if you suffer from really harsh constipation.
The Protocol
The protocol will evolve around quick fixes & ongoing support while getting down to the root cause. If the root cause is the IMO/ SIBO connection, it is always important to treat BOTH the SIBO & IMO.
IMO causing archaea are treated a bit differently from hydrogen producing bacteria, as the antimicrobial preferences will change. M. smithii does not like oregano, berberine or neem. Have this in mind or work with someone knowledgeable in creating a full fledged protocol to treat all of this combined.
Ginger + Orange Peel Tea: 2x daily
Ginger is the go to pro-motility herb. In numerous studies its benefits on gut motility have been shown. I like to add orange peel to the mix as it is a potent bile mover & liver adjunctive.
Prepare are decotation by adding in 2-3gr of each into 250-500ml of water, depending on the severity of your issues. Let it steep for 20-30 minutes on low heat. Drink throughout the day.
Adding in taurine, inositol & glycine will give added benefit due to the bile & oxidant support of these. Very potent stuff.
Magnesium Citrate: 400-1200mg
One of the most famous osmotic laxatives for a good reason. It can quickly aid to move fluids into the colon where it then helps to resolve constipation. There are two ways to go about it:
Divide the dosage into 3 and take throughout the day, or take on dosage before going to bed. It depends on the person.
Triphala: 800-3000mg
An ancient herbal combination of three ayurvedic plants:
amla
bibhitaki
haritaki
It has a very adaptive effect, as it can aid in diarrhea or constipation. These plants are loaded with phenols, tannins, Vitamin C, lignans and minerals, which can improve constipation. There are also studies on its anti-cancerous effects, which is very interesting.
Vitamin C: up to 5000mg
The classic functional doc Vitamin C can draw water into the large intestine and improve constipation. It also improves adrenal function, neutrophil function, oxidative stress (though it can be reductive in high dosages) and will benefit collagen formation within the gut.
You can go for ascorbic acid, though natural forms such as acerola, camu camu or rosehip are preferred on the long run, with lower dosages of up to 1200mg.
Electrolytes:
Potassium
Sodium
Magnesium
All of these are needed for proper fluid balance, nerve functioning & muscle contractions. In this world loaded with toxins, stressors, unregulated circadian rhythm & dehydration we all loose those essential electrolytes pretty quickly.
Starting my day with an “adrenal cocktail” improved my situation. Sea salt, cream of tartar and magnesium glycinate are all whats needed for that.
Aim to get over 4gr of potassium per day, while achieving magnesium saturation through multiple sources. Sodium is less of a problem, though you might need it in the morning to replenish the loss throughout the night.
Sodium Butyrate: 400-1200mg
This is superb gut fuel. Normally produced by commensal bacteria by the fermentation of fiber, it has many beneficial effects:
improves gut microbiota
rocket fuel for your colonocytes & mitochondrial
seals leaky gut barrier
improves blood-brain-barrier
improve neuroinflammation
has been shown to improve various diseases
And for this sake of discussion, butyrate also improves bowl evacuation. It is a staple in any gut protocol.
Iberogast: 60 drops (+ 3x20)
Iberogast is an herbal formula which is pretty famous in Germany but otherwise not so. It is very good at improving serotonin signaling within the gut (Peaters will like this one), thereby improving motility.
Start with 30-60 drops before going to bed. If that does not help, you might also add 20-30 drops around meal timings. This can move the needle pretty fast.
Senna: Optional
Senna tea is a last resort, as this type of herb acts directly on intestinal nerves. Use it very carefully and only after the other stuff, but otherwise it can be very powerful.
Drink it as a tea throughout the day.
The fiber paradox
Surrounding the topic of constipation, fiber has to be set into context. To give you an example:
Whenever I went on a low fiber diet, my bloating improved, but my constipation worsened. Fiber is a double edged sword where it might worsend constipation for some, but improves it for others.
There are two types of fiber:
Insoluble: not easily fermentable, draws in water & adds bulk to stool
Soluble: can be fermented, binds to bile & removes toxins
In SIBO, you often come around a low FODMAP diet. FODMAPs are often times fast fermentable soluble fibers, which are limited due to the fermentation happening within the small intestine, which leads to gas production & bloating.
High amounts of insoluble fiber, though adding bulk to the stool, can cause irritation, as the overall gut environment is already stressed & irritated, adding another burden on top.
So what to do about it?
You have to see for yourself: After trying on & off days of lower fiber diets I noticed that I need some fiber within my diet, to get frequent bowl movements, but too much will cause harm.
Partially hydrolyzed guar gum (PHGG) might be a good addition if you fit into this group. It is a special type of soluble fiber which is passing the small intestine to feed bifido- & lactobacteria preferentially in the colon. People suffering from gut issues often have diminished levels of these.
On top of that, it helps to produce SCFAs like butyrate, which has been mentioned beforehand. Likewise, it adds bulk & water, which gently promotes evacuation.
5-10gr have been studied in IBS-C & IBS-D (diarrhea) to improve each of these, so it can be worth a shot. Start with <5gr in the AM with plenty of water. Add your electrolytes. If you tolerate it and evacuate around breakfast it is a good sign that it can help you.
Lifestyle Changes:
Apart from supplements we have to get foundational practices right to allow digestion to happen effectively. Try to hit as many of these as possible:
grounding & sunlight (parasympathetic tone, lower inflammation, circadian signaling)
preying/ gratitude/ humming pre meal to activate the vagus nerve which primes us for digestion
post meal walks to improve blood flow, peristalsis & also vagus nerve
low stimulation while eating (no screen, full focus on eating)
chewing properly & often enough (it is the first step of digestion)
daily fascia release around abdomen, psoas, lower back
breathwork (anything that increases CO2 retention & biomechanics)
red light therapy (best: real sunlight) on abdomen, neck & lower back
2 kiwis a day have been shown to aid in constipation
carbonated water can improve blood flow in abdomen
ACV pre meal if you do not tolerate protein well
TUDCA if you do not tolerate fats well
And if its really pressing, let’s say you have been constipated for >5 days, coffee enemas are also a good way to get acute relief, though depending on it is NOT good.
Recap of the protocol:
Ginger/ Orange Peel Tea: 2x daily
Mg-Citrate: 400-1200mg
Triphala: up to 3000mg
Electrolytes: Sea Salt + Cream of tartar + Mg variation
Sodium Butyrate: 400-1200mg
Vitamin C: up to 5000mg
Iberogast: 30-60 drops/ evening
PHGG: up to 10gr, depending on situation
I hope you enjoyed this one!
If you need personalized 1:1 guidance to tackle your specific health related issues (gut, autoimmune, chronic conditions) feel free to book a call here.
See ya!