Constipation

How To Relieve Constipation in Children

I’m a gut health expert, who has done everything “right”... and my toddler daughter has been struggling with constipation!

Yes, it feels a little vulnerable to tell you this, but above all else I want to always be honest.

So here’s the honest truth: no matter how hard we try to care for ourselves and the ones we love, sometimes health issues still present themselves. When they do, we have two choices. We can either bury our head in the sand and wish it wasn’t so, or meet the challenge head on.

So today let’s dig into constipation in kids: what causes it, and how we can help. Plus, I’ll share my own story of helping my daughter through this health challenge.

 

My Daughter’s Constipation Story

From the time I found out I was pregnant, I did everything I could to set my daughter up for a lifetime of gut health. I used oral and vaginal probiotics leading up to her birth, and pushed for a vaginal delivery (even though I had a lot of pressure for a C-section). When she was born, I gave her probiotics on my nipple, and later in bottles of breastmilk. 

We waited to introduce solids until she was a little over 6 months, and then introduced them according to the book Super Nutrition for Babies, which is based on the work of Dr. Weston A. price and heavily influenced by the paleo diet. Her first foods were all high-fat, breast milk-mimicking foods like puréed liver and broth, egg yolk from a very softly boiled egg, puréed fish and lamb, and avocado. 

And it seemed to really work: by eight months old, she was downing a cup of broccoli at a time. She loved tasting new food - sauerkraut, pickles, curry, and all the veggies. 

But then, after a family vacation to Mexico and a bout of food poisoning, something seemed to change. Suddenly, her belly was protruding more than it had before, and she was skipping multiple days between bowel movements. When she did go, she sometimes cried and complained it hurt. Her diet hadn’t changed - so I couldn’t blame too many crackers and cookies, or low fiber intake. It was something deeper than just diet.

As a functional medicine practitioner, I had some hunches as to what was going on - and I’ll share exactly what I did to get her back to daily poops at the end of this post.

But first, let’s dive into constipation in children: why, what, and how we can help.

 

Signs of Constipation in Kids

Depending on the age of your child, they may not be able to communicate that they’re feeling backed up. That’s why it’s important for parents to keep an eye on things. (And even kids that are verbal may not connect that their tummy hurts because they haven’t been pooping!)

Here are signs of constipation, based on age:

Babies

Constipation is most common in babies during transitions - either from breastmilk to formula, or with the introduction of solids. If a baby is exclusively being fed breastmilk or formula and has constipation, that’s a red flag for a bigger issue, most commonly food sensitivities.

Signs of constipation include going 4+ days without a bowel movement, less frequent bowel movements than normal, crying while passing stools, dry or pebble-like stool, or struggling/straining while pooping. 

Toddlers

Normal is considered anywhere from daily to once every 3 days, but sudden changes are a red flag - like if your usual daily pooper has gone 3 days without going. Older toddlers might tell you their tummy hurts, or that it hurts to poop. You might also notice that their stomach pokes out more than usual, and that it’s hard to the touch. Bowel movements might be difficult to pass or unusually large. The stool may seem to move out and then back in before they can successfully pass it.  

Because pooping is painful when they’re constipated, toddlers might also start to hold their poop and avoid going. This only makes the problem worse, so it’s ideal to jump in right away with some of the solutions I'll outline here, before they start holding their bowel movements in.

 

Foods That Cause Constipation in Children

Not enough fiber is the most common food-related cause of constipation. Your child's age + 5 = the number of grams of fiber they should be consuming each day. The exception are babies under six months of age: they have no need for food besides breastmilk or formula. If you’ve introduced solids before six months and your baby is struggling with constipation, stop feeding them - especially if you started with rice cereal or something similar!

Hand-in-hand with not enough fiber goes too many high-starch foods like crackers, cookies, pasta, bread, etc.

Food intolerances, most commonly to cow dairy and wheat or gluten, are another common food-related cause of constipation. Many kids transition from breastmilk or formula straight to cow’s milk, which for many, is the primary cause of constipation. Wheat is also hard to digest and can be constipating for some children. Separately, they may also have gluten intolerance, where gluten exposure causes inflammation and various GI symptoms.

 

Foods to Help Constipation in Children

In general, kids should be on a Paleo-template diet that emphasizes lots of whole foods, in whole form, the majority of the time. (If your kids are eating this way, you likely don’t need to worry about fiber). There is always room for “excursions” from the diet for special occasions, but those excursions should remain excursions, and not become part of the everyday way of eating. 

If you need to overhaul the way your kids are eating, do it slowly and keep them involved. It’s great to have kids in the kitchen, helping you cook. And don’t forget you can blend veggies into all sorts of things! (I’ve included one of my favorite high-fiber, veggie packed recipes for kids at the bottom of this post!)

Adding in these foods to help constipation in children is especially beneficial:

Sugar free water kefir with chia seeds - provides hydration and beneficial wild probiotic strains, adding chia not only helps moisten the intestine, but makes it more fun for kids to eat

Fermented veggies - more beneficial bacteria and fiber. You might think your kid would never eat them, but you would be surprised how many toddlers and babies love them, especially fermented beets!

High fiber foods - strawberries, apples, pears, prunes, bananas, avocado, beets, blueberries, raspberries, broccoli, chickpeas, lentils, black beans, pumpkin, peas, spinach, and sweet potatoes are some of my favorites. 

What about oats? While oats get a ton of buzz for being high-fiber, I find that many children have a very hard time digesting grains. Grains contain lectins and phytates, two anti-nutrients that can cause leaky gut. I don’t recommend emphasizing grains, and instead focusing on other high-fiber foods. 

Finally, make sure your kids are well hydrated! Babies over 6 months can have 2-3 ounces of water, a few times daily (and will get the majority of their hydration from breastmilk or formula). Toddlers should be drinking 16-32 ounces of liquids daily, with the majority being water, not milk, milk substitutes, or juice. 

If your child refuses to drink enough water, soaking fruit in water in the fridge overnight can add some flavor, as can a splash of something flavorful such as the low-sugar Kefir Water drink mentioned above, or coconut water. 

 

What Else Causes Constipation?

If diet has already been addressed and constipation isn’t improving, it’s time to dig a little deeper. Some of the other causes of constipation I commonly see in children include parasites, H pylori, Candida overgrowth, and Small Intestine Bacterial Overgrowth (SIBO). 

Kids touch… everything! And they constantly put their hands in their mouths, making them prime candidates for parasites and pathogens. Plus, their immune systems aren’t yet fully mature, making them more susceptible to things like foodborne illness or parasites in water. (Water can be contaminated when traveling - but even city and well water can become constmainted. That’s why we use a Berkey water filter.)

Acute GI infections, such as food poisoning, can also lead to a condition called Post-Infectious Irritable Bowel Syndrome, better known as Small Intestine Bacterial Overgrowth (SIBO). Learn more about SIBO here.. 

All of these issues can be diagnosed via stool panels and treated naturally with child-specific herbal protocols. (As a mom, I know how hard it is to get kids to take anything yucky-tasting… so I worked hard to find a treatment plan kids would actually take!) 

If your child is old enough to blow into a tube, we can also run a SIBO breath test, but in kids I find treating dysbiosis more generally based on stool panels alone is typically adequate (and saves you money and time, too!)

 

Constipation Relief Supplements

In addition to diet, specific supplements can make a huge difference in kids’ constipation.

Herbs: I prefer gentle carminative herbs (gas-relieving) over laxatives, because laxatives can be habit-forming (even herbal ones!) That being said, I prefer herbal laxatives over Miralax any day!

Why I Don’t Recommend Miralax

Miralax is often a first line of defense against constipation in kids, but for several reasons, I don’t like it, including that it contains red dye, hasn’t been approved for use in kids or long-term use by the FDA, and is associated with ADHD and other mood/behavior disorders. It can often be habit-forming, and leave kids dependent on it to poop. There are lots of herbal alternatives that work just as well, without these concerns. 

Pre- and Probiotics: Probiotics are the good bacteria that live in the gut, and prebiotics are the food probiotics need to thrive. I recommend MegaSporeBiotic (which i use at ¼-½ the adult dosage of 2 caps per day, depending on the child’s weight) and MegaPre prebiotic (2 caps per day, which is ⅓ adult dosage). If you want to try a prebiotic option, I recommend Begin Health Growing up Prebiotics that use human milk oligosaccharides, which are identical to the most abundant prebiotic naturally found in breastmilk [plus get 20% off first purchase with my code: BRIE20].

Magnesium: This mineral can help bring water to the bowels. I use Mag-Go kids.

 

Try These Tricks to Help Ease Constipation

In addition to diet and supplements, there are a few other tricks to try:

Drink this: For quick relief, I like ¼-⅓ cup aloe vera juice and 1 teaspoon to 1 tablespoon of liquid chlorophyll, 3x daily.

Massage: I use Chinese medicine tuina techniques with oil, followed by raising the knees up to the right and then around clockwise in a circle. Repeat this several times a week for about 10 minutes.  Below is another massage location for constipation in children, on the hand. Start at the base of the thumb and work in a clockwise direction, pressing and releasing along the circle. 

Get into position: Giving kids a place to rest or elevate their feet while pooping puts them into an ideal posture for pooping. This makes a big difference. I like the Squatty Potty for Toddlers or Super Pooper Plus.

Make time to go every day: Kids are busy moving from activity to activity - and sometimes when the urge to go comes on, they’d rather ignore it than stop what they are doing. That’s why I recommend creating a habit of trying to poop at roughly the same time every day. (If you notice they have a time they most often poop, like after lunch, that’s a good time to try!) Just keep it light hearted: go sit on the toilet, read a book or sing a song, and don’t make a big deal out of it. If they don’t poop, NBD. It’s about building a habit. 

 

Putting The Plan Into Action

Let’s go back to my daughter’s story, and I’ll explain how and what I did to get her pooping regularly again.

Although she was already eating a diverse diet of lots of plant foods, I doubled down on getting her plenty of fiber, made sure she was well-hydrated, and added a magnesium supplement. Despite these changes, we still had an issue.

My next step was adding some simple herbs that are safe for kids, like Easy Going and Bioray Pooper

When that still wasn’t enough, I ordered a stool test for her. The test showed overall general dysbiosis and low secretory IgA, a sign of immune function. I created a custom protocol of herbs and probiotics to address the dysbiosis and clear the bacteria. We also added chiropractic and acupuncture - (both of which she loved! She asks me to give her acupuncture now, regularly!)

acupuncture

After a few weeks of treatment, we re-tested: the dysbiosis was improved, but her secretory IgA was still low, and now the stool panels had revealed candida and H pylori. (Note: it’s not completely uncommon to treat a finding, retest, and uncover another layer of pathogenic organisms. This often relates to disruption of biofilms). We started a new treatment and added massage and cat/cow stretching - and that did the trick! Now she’s back to regular pooping, her tummy isn’t hard or distended, and she doesn’t have pain when she goes.

As a mom and a health practitioner, there’s nothing like seeing a successful treatment! But as you may have noticed - it wasn’t a simple one-step process, or just a matter of adding in one supplement. The human body is complex, and often the treatments that are most effective are a little more complex, too. 

But don’t worry - you don't have to figure this out yourself! If you’ve already tried the suggestions in this blog post, and your little one is still struggling, book a free 15-minute consult with my team here

Brie

PS - Here’s one of my favorite recipes for muffins - kids love it, and it packs a great dose of fiber and veggies. 


What Causes Chronic Constipation in Adults and How to Relieve It

You’re all plugged up and can’t poop. You feel more backed up than a rush hour traffic jam.  

Maybe it feels like there’s something in there that refuses to budge.

Your stomach is so bloated it looks like you swallowed a bowling ball.

If you have chronic constipation, we’re sure you’ll agree when we say it’s a real pain in the butt.  

The good news? There are ways to get things moving again. But before we go into constipation relief, we’ll talk about what constipation actually is and what causes it. 

 

What Is Constipation?

From a conventional medicine perspective, constipation is defined as having less than three bowel movements per week. 

Functional medicine providers, on the other hand, usually want patients to have one to three bowel movements per day. That’s because they recognize the importance of bowel movements for removing toxins and other waste products.

Constipation can also refer to unhealthy stool. Doctors use what’s known as the Bristol Stool Chart to determine the health of a patient’s poop. This type of chart describes stool as being one of seven types. Type 1 (separate hard lumps) or type 2 (lumpy and sausage shaped) both indicate constipation.  

 

What Causes Constipation? 

Constipation can have a variety of causes, which is why it’s also a good idea to work with a functional medicine provider to find the root cause. 

In some cases, people can have structural and anatomical issues that cause constipation. Medications like opioid drugs can also lead to constipation. 

When those are not the issue, the most common causes of constipation are:

The Good Bugs vs. the Bad Bugs

The collection of microbes in your gut—both good and bad—are called the gut microbiome. When the microbes that make up the microbiome become imbalanced—either by the bad outnumbering the good or by too much of one type of microbe—it can lead to gastrointestinal problems, including constipation. 

Indeed, research shows that an imbalanced gut microbiome can affect how quickly food moves through your bowels and cause constipation. On the other hand, researchers have shown that a healthy gut microbiome prevents constipation. They accomplished this by performing what’s known as a fecal transplant, a procedure where fecal matter from patients who are healthy is transplanted into someone who has gastrointestinal problems. When scientists performed this procedure on patients with constipation, the patients’ gut microbiota and their constipation symptoms improved.   

Because constipation is linked to an imbalanced gut microbiota, it’s also linked to other health problems you would never think have anything to do with the gut. For example, people with constipation are at an increased risk of having hay fever

 

Candida or Yeast/Fungal Overgrowth

An infection with Candida or any other type of fungus can lead to an imbalance in the gut microbiome. This spells trouble for GI health and stool not moving as smoothly through the intestines. 

 

Sluggish Thyroid

The thyroid gland is important for many processes in our bodies. When it’s underactive—a condition known as hypothyroidism—it causes the body’s processes to slow down. Hypothyroidism slows down the speed at which food moves through the digestive tract. 

 

Dehydration

If you want to know how to relieve constipation in adults, drinking enough water is one of the best solutions. 

The large intestine isn’t supposed to be the Sahara desert. It needs fluids to function. When you haven’t had enough water, the colon will grab it from the food, turning stools hard, dry, and more painful to pass. Being well-hydrated also keeps food moving through the intestines. 

 

Parasite Infection 

Usually, a parasitic infection starts with acute diarrhea soon after the infection started, like right after returning from a trip. But in my clinical practice I regularly see parasite-caused diarrhea turn into either chronic constipation or constipation alternating with diarrhea. 

Patients who have parasite-caused constipation also have bowel movements that feel incomplete.

 

Pregnancy-Related Constipation

Constipation is a common complication of pregnancy. Nearly half of all pregnant women get constipated at some point during their pregnancy.

During pregnancy, constipation is caused by the dramatic increase in the hormone progesterone, which affects the intestinal muscle and causes food to move through the intestines more slowly.   

 

Small Intestinal Bacterial Overgrowth

Small intestinal bacterial overgrowth—SIBO for short—is another common cause of constipation. SIBO is an abnormal increase in the bacterial population of the small intestines, especially with species of bacteria not usually found in this area of the body.   

Diarrhea is a more common symptom of SIBO. When constipation occurs with this condition, it’s usually due to the methane-dominant form of SIBO. In this type of bacterial dysbiosis, there is an overgrowth of bacteria that make methane which can be detected on SIBO breath tests. 

 

 How To Relieve Constipation in Adults 

It’s no fun being all backed up. Your body can’t get rid of waste and digestion is hampered. You may lose your appetite and when the poop finally comes out, it hurts. While you have probably tried the popular recommendations of drinking water and taking fiber, it may not have been enough. Here are my tried-and-true chronic constipation treatments to get my patients regular again.

Stay hydrated – Drink at least eight glasses of filtered water every day. Coffee and juice don’t count. Neither does tea unless it’s herbal tea. Helpful hint: put a pinch of sea salt in the water. This will help you absorb the fluid better. 

Also, sip on warm water with lemon first thing in the morning. Drink this slowly and it will stimulate the gastrocolic reflex, which controls the movement of food through the GI tract after a meal.    

Get a good night’s rest – Our bodies have their own internal clocks which control our circadian rhythms. When we ignore our natural circadian rhythms, it can lead to many problems, including constipation. That’s why between 48% and 81.9% of people working either rotating or night shifts have some form of GI problem including constipation. 

Researchers also have found that morning IBS symptoms were worse after a night of poor sleep. The IBS symptoms improved after the study subjects slept better.

One reason why lack of sleep causes constipation is because it can affect the gut microbiota.  

Get Moving – Walking and yoga are both helpful for constipation relief. Exercise is linked to what scientists call better gut motility—in other words it helps move food faster through your digestive tract. 

Use a Squatty Potty – As the name implies, this allows you to squat when you poop. It’s a better, more natural angle and decreases straining. 

Biofeedback –  Biofeedback is a way to control some of your body’s functions. You can use it to help train your colon muscles to become more coordinated. 

 

Foods to Help Constipation in Adults

I have found that a paleo diet can really get things moving again. This diet mimics a hunter-gatherer diet of meat, fish, eggs, seeds, nuts, fruits, veggies, and healthy fats and oils. In the paleo diet, there is no sugar, refined flour, gluten or dairy. 

A low FODMAP diet or specific carbohydrate diet (SCD) has also worked in many of my patients with constipation. FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. These are nondigestible carbohydrates which can trigger gut symptoms in some people. The SCD eliminates most carbohydrates including grains, starches, dairy, and sugars with only specific carbohydrates that require minimal digestion allowed. Fresh fruit, most vegetables, grass fed meat, and wild-caught fish are allowed while starches, grains, and processed or canned foods are prohibited. Usually, these types of diets are used for chronic diarrhea, but I’ve seen them kickstart bowel movements, especially when a patient has a chronic infection or an imbalanced gut microbiome.  

If you find that your constipation gets worse with starches and sugars, stop eating sweets, which is really a good idea for your health anyway. Avoid using flours. Eat only whole food carbs like root veggies and whole grains if tolerated. Examples of root vegetables are daikon radish, beets, carrots, and parsnips. Beets are the best option especially if you notice that insoluble fiber makes your constipation worse.

Increasing healthy fats from olive oil, ghee, coconut, organic butter, and eggs is also helpful. Make sure you’re getting 2 tablespoons or more per meal—6 tablespoons per day. Fats can increase the rate at which foods move through your digestive tract.   

If you tolerate dairy, try making 24-hour yogurt from full-fat cream. Yogurt is a good source of probiotics, which nourish the gut microbiome.

Unless you know or suspect that FODMAP veggies make your constipation worse, get more fiber in your diet by eating seven to 11 servings of vegetables per day.

It’s also a good idea to boost potassium intake. A great way to do this is by making homemade juice with cucumber, tomato, spinach, chard, and melon. Ripe bananas, avocados, and kiwi are also rich sources of potassium.  

Fermented foods like chia soaked in kombucha are another ideal choice. These can promote a diverse and balanced microbiome.  

 

Supplements for Constipation 

The most common method of constipation relief are laxatives and stool softeners. Warning: these are gut irritants and are not a friend to the gut lining. What’s worse, you can become dependent (otherwise known as habituated) on laxatives so that your gut “forgets” how to poop regularly on its own. 

People also often use fiber supplements for constipation, but this can backfire. Fiber supplements can make some people worse. Acacia and partially hydrolyzed guar gum (PHGG) are often the fiber supplements that constipated people can handle the best.

Digestive enzymes and a hydrochloric acid (HCL) supplement are other good choices.  Bile support, especially in people who have trouble digesting fats, can help regulate gut motility and transit time (the amount of time food takes to get through your intestines). MegaGuard is a bile support supplement that works well for my constipated patients.

Magnesium oxide or citrate (500 – 2,000 mg at night) can get things moving. Work up to the higher dose slowly. Some people do better with magnesium hydroxide. Magnesium is osmotic, which is just a fancy way of saying it pulls water into the colon. Remember, the colon needs water and magnesium helps there. Natural Calm is a high-dose magnesium supplement you can try.

Another way to increase magnesium levels is to take an Epsom salt bath before bed. This will also soothe away stress.

Buffered vitamin C (2,000 mg) before breakfast and lunch will get your bowels moving. Colon Rx, which includes both Magnesium Oxide and the Ayurvedic herb triphala, has been used for millennia for bowel regulation. Both of these are non-habituating and very safe ways to reduce constipation.

If you have methane-dominant SIBO, Atrantil can treat constipation. It works for many people, but not everyone. It can take up to 21 days to see the full effect.

If you have a severe episode of constipation and nothing else is working, try glycerin suppositories or enemas using water, saline, or coffee. These can make a huge difference to get the gut moving in quick time.

Herbal formulas can work. But be cautious with ingredients like Senna, rhubarb, and aloe. You can become dependent (or habituated) on all of these stimulant laxatives if you use them too often and for too long. If you’ve been taking any of these ingredients, taper slowly while using other support. 

Some herbal formulas I like are:

Smooth Move tea is another herbal option to help with constipation relief. It also contains Senna, so only use it occasionally and work with your functional medicine provider to uncover and address the root causes of your constipation.

 

Probiotics for Constipation 

In choosing a probiotic supplement, avoid formulas that have too high a level of fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS), inulin, chicory, or arabinogalactan. These ingredients at too high a level can cause a flare in imbalanced gut microbiota. If you have a gut infection, wait until it is cleared to take any supplements with those ingredients.

Some probiotics for constipation that I like: 

Test one species first. Start with about 40 billion and then ramp up as far as 300 billion by doubling your dosage every three days. Stop if your symptoms worsen.

 

Critical Tests If You Have Chronic Constipation

As you read earlier in this article, there are a lot of causes of constipation. Some of them could be damaging more than just your GI tract. That’s why it’s important to test for parasitic and other gut infections, Candida and fungal overgrowth, and an imbalance in the gut microbiota. Depending on the specifics of your case, we might choose to use the GI-MAP, the Parawellness Stool Pathogen panel, or the BiomeFX panel. We might also include Lactulose and Fructose Breath Testing for gasses that can indicate SIBO.

You really don’t want to tackle these types of gut imbalances on your own. Instead, book a free 15-minute troubleshooting call with me to find out the best course of action. If after the call you come on board as a patient, I’ll order the right tests, recommend a plan customized for you, and put you on the path to feeling like your regular self again.   


Woman sitting on steps

What Working With A Functional Medicine Practitioner Is Really Like (Patient Case Study)

You’ve been to the doctor. He runs some tests and he says nothing’s wrong.

But you know you’re not you right now. Maybe you’re dealing with digestive problems that have taken the fun out of eating. Every dinner out is a potential threat.

Or maybe it’s your hormones that seem off. Your once predictable cycle is suddenly erratic. You feel like you’re in puberty all over again.

Or maybe you’ve never had a happy gut or healthy hormones. The doctors have thrown up their hands. They can give you The Pill or suggest you try a fiber supplement, but that’s all they’ve got for you.

You’ve always trusted your doctor - but right now it feels like there is nothing they can do to help you.

Where do you turn?

This story is how so many women end up looking for a Functional Medicine Practitioner. I know it well, because this is my story, too.

 

What Is Functional Medicine?

Functional medicine is an evidence-based approach to health that focuses on finding the root cause of health problems. Functional medicine looks at the body as one system - meaning that is something is “wrong” in one area of the body, it is likely having an impact on other parts of the body, as well.

Functional medicine incorporates both Western and Eastern approaches - the latest technology and ancient wisdom.

The #1 misconception about Functional Medicine is that it denounces modern medicine in favor of healing crystals and water fasts. Not true!

Listen, I won’t knock anything until I try it - including crystals and fasting - but the majority of work I do with clients in my clinic is much different than that. You might not know that though, because you’ve never seen a FMP before!

 

What Is It Really Like To Work With A Functional Medicine Practitioner?

Today, I want to walk you through the process of working with a Functional Medicine Practitioner. I’ll share one of our amazing patient’s own journey (yes - including test results!) so that you can understand what it’s really like to work with a FMP.

Before anything else, I always do a free 15-20 minute prospective patient interview. This is just a chance for us to connect (without any pressure) and be certain we’re a good fit for working together. From there we’ll go to official first step: the case review appointment.

The case review is like a deep-dive interview. I want to know as much about you as possible. I might even ask some questions about your childhood! Here I’m looking for clues as to the root causes of what is troubling you now.

Next, we’ll order some testing  - depending on your unique symptoms and history. I don’t want to waste your time or money, so we’ll only order the tests that are relevant for you.

Once test results are in, we’ll meet again to develop a treatment plan. You’ll implement the plan (usually diet & lifestyle changes, plus supplements) and we’ll have check-ins to see how you’re progressing and if we need to make tweaks to the plan.

Finally, we’ll re-test to check your progress. (This is the best way to know treatments are really working.)

I’m excited to share this story with you - let’s dig in!

 

Step 1: Marina’s Case Review

Marina met with Amelia, one of the clinicians who works in my practice, in January.  At her first meeting, we learned a lot about her!

She was 22 and was working as a paramedic with her local fire department. She wanted to become a helicopter medic (how badass is that?) but was struggling with health problems that were holding her back. Digestive problems and brain fog were zapping her of the energy she needed to go back to school.

First, Marina told us about what was going on right now: serious digestive problems. She was having oily stool, undigested food in her stool, and couldn’t tolerate eating meat at all unless she took her “meat pill” - a prescription anticholinergic medication. The digestive problems were wearing her out, and she was dealing with brain fog.

Then we went back in time: when did her health problems start?

Marina told Amelia that when she was younger, she had developed a cyst on her heart. Her doctors had treated it with back-to-back rounds of antibiotics.

As a side effect of the antibiotics, she developed neuralgias (a kind of nerve pain that causes severe pain) and vertigo. The vertigo led to 3 concussions in a row and she was ultimately diagnosed with a Traumatic Brain Injury (TBI).

It was at this time that the digestive problems started, too. Bloating, nausea, food intolerances, and fat malabsorption (which was causing the oily stool).

Her doctor told her the digestive symptoms were just Irritable Bowel Syndrome (IBS) and gave her the prescription for the “meat pill.” That was all he could offer.

6 years after the cyst on her heart, and Marina was still dealing with the repercussions of it. That’s how she came to see us.

Based on her history of antibiotic use and her current symptoms, we suspected Mishana was dealing with a gut infection. We suggested she start with a GI-MAP - a comprehensive stool analysis that can test for many gut infections at once.

 

Step 2: The Test Results Are In

Marina agreed to the test, and a few weeks later, results were in:

Pathogen test results

Pathogen test results

Pathogen test results

Pathogen test results

 

Marina tested positive for:

  • C. difficile
  • Enteroinvasive E. coli/Shigella
  • Enterotoxigenic E. coli LT/ST
  • Salmonella
  • Entamoeba histolytica
  • Enterococcus faecalis
  • Streptococcus spp.
  • Candida spp.
  • Chilomastix mesnelli
  • With relative elevations in other markers

You might be thinking these test results are crazy - but it actually isn’t that uncommon! Even in the United States, gut infections and parasites are fairly common. And if you have used antibiotics or have a compromised microbiome for some other reason (like you’ve been eating the Standard American Diet) you are more susceptible to picking up gut infections.

Why don’t doctors test for these infections?

Some Western-medicine doctors do - but many others don’t. They either wrongly believe that gut infections are unlikely or they think they are “non-symptomatic” infections - meaning they don’t cause problems, and don’t need to be treated.

In my experience, (both personally and with my patients) clearing gut infections makes a huge difference in how you feel.

For Marina, we started treatment with a prescription anti-parasitic, alongside a natural bacterial protocol. After she completed those treatments, we used a prescription anti-fungal. Finally, we completed a re-seeding protocol with both probiotics and prebiotics (the most important step after any type of clearing treatment!).

After treatment, I always recommend re-testing to be sure that all the infections have cleared. Feeling better is a great indicator that infections have cleared - but it can’t replace seeing the results on paper!

 

Step 3: The Second Test Results:

Pathogen test results

Pathogen test results

Pathogen test results

 

Pathogen test results

 

 

As you can see from the results - Marina was able to clear all her gut infections!

(Note: She did have some low beneficial flora that we worked on next.)

The results on paper back up what Marina experienced day to day: her digestion has improved. No more bloating or food intolerances.

Not just that, but after years of brain fog, Marina is finally thinking clearly again. She was even able to pass her paramedic cardiac program and enroll in medic school.

Now that the infections are cleared, Marina is working on improving her habits  - especially around eating foods that support gut health and getting enough sleep - so that the infections don’t have a chance to come back. I’ll keep working with her to make sure she keeps improving.

 

It’s Black, White, & Gray

I like to say that I look for “black, white & gray” results with my clients.

I want the black and white stuff - the test results that prove the treatments we’re using are working. And I know those results are important to you, too.

But I also want the “gray” - I want to hear that you’re going out to dinner with your boyfriend and you don't get sick, that you’re finally able to be back in school, that you don’t have to press snooze five times every morning before you drag yourself out of bed.

For Marina, we definitely got the black and white and the gray - and I am so thrilled to see her thriving again after years of struggle.

I hope this has helped you understand what it really is like to work with a Functional Medicine Practitioner. And if you’re ready to take the next step forward in your health, I’d be honored to work with you. You can book a free prospective patient interview anytime here.


Woman eating dinner

4 Crucial Steps for Mealtime that can make-or-break your digestion

When it comes to healing digestive issues, it’s certainly true that we need to test to identify and then treat any infections or dysbiosis that may be contributing.

But just as importantly, we need to optimize the environment of the gut.  In order to develop infections or overgrowths, the environment has to be right. Otherwise, our healthy gut terrain is inhospitable to the “bad guys”, and nurturing to the “good guys”.  

This mainly involves things like optimal digestive secretions (like stomach acid and pancreatic digestive enzymes) that set the pH and fully digest our food. This ensures that we both assimilate the nutrients contained in what we eat, but also prevents other organisms, like bacteria and yeast, from eating it instead.  

Other secretions, like bile from our liver/gall bladder, are also super essential.  Bile digests fat, but also is a powerful antimicrobial, and regulates the motility of our intestines.

Of all the digestive secretions, Stomach Acid might be the most important when it comes to resilience against infections.  Stomach acid (called Hydrochloric Acid, or HCL) is like your first line of defense.

You may know that stomach acid’s main role is to break down the proteins we eat, so that we can absorb the smaller amino acid building blocks to use as nutrition.

But stomach acid is also antibacterial to undesirable strains because of the low pH environment that it creates.

Keeping food in the stomach long enough is critical for the action of stomach acid to control the populations infused into lower regions with each pulsatile release of chyme. This is because food needs to be exposed to stomach acid (HCL) long enough to kill bad bacteria, preventing them from proceeding on into the small intestine.

So, if you have super-rapid motility (this is common in people who have chronic diarrhea), your food may pass too quickly through the stomach and into the intestines, and not have enough exposure to HCL. This equals increased risk of infections, in addition to not enough nutrient digestion.

Due to…

  • Stress
  • Nutrient deficiencies
  • Modern diet and lifestyle
  • And even just natural aging!

it’s unfortunately very common for people to produce less than optimal amounts of stomach acid to meet the demands of food intake.

And…..we need enough HCL present to keep the stomach pH below 4 for the entire time the food we are digesting in the stomach. If this doesn’t happen…pathogenic microbes pass unharmed into the intestines where they can take residence! (hello SIBO and parasites!)

Here’s the most important thing I want you to learn today:

HOW we eat our meals is one of the most important factors in optimizing gut environment.

Just becoming aware of HOW we eat, is one of the biggest things you can do to change what is happening with your digestive secretions, and therefore, with your microbiome.

Chewing: Why is chewing your food so important in regards to this?

Yes, chewing breaks your food down into smaller pieces, increasing the surface area, so that digestive secretions in the stomach and small intestines (like pancreatic enzymes, bile, and stomach acid) can further break them down.

But….there are other not so obvious reasons!

Chewing exposes foods to enzymes in the saliva that break down the cell walls of gram positive bacteria, causing them to die.

This means that chewing adequately is really our first weapon against pathogens that might be entering with our food!

Being relaxed while eating: Stress is a big factor that leaves us more prone to getting opportunistic gut infections, because stress shuts down our digestive secretions.   

When our brain thinks we need to run from the proverbial tiger, it focuses our body’s energy and attention on surviving NOW, and diverts it from activities that are about long term survival, like digesting our nutrients.   

Stress also spikes our cortisol, and this suppresses our gut’s immune system big-time--for much the same reason. And the hormone that our brain uses to signal the adrenal glands to make more cortisol, CRH,  can promote leaky gut.

Healthy Meal Hygiene for Healthy Gut Environment:

1) Focus on creating a state of overall calm before, during and after eating to encourage stomach acid and digestive enzyme secretion.

2) Chew adequately—more than you think….keep chewing!-- to reduce particle size and mix enzymes in the saliva.

3) Include balanced fats, carbohydrates and proteins in each meal to encourage food to stay in the stomach long enough.

4) Planning enough time for meals—not eating on the run—is critical, to help allow for parasympathetic (rest-and-digest) nervous system activity. This allows for proper secretion of digestive fluids. Otherwise, if our body thinks we are running from the hypothetical tiger, there’s no digestion being emphasized, and no secretions being made—“Ain’t nobody got time for that”!

Have any questions or comments on this?

Pop on over to my facebook page and ask me anything!  


Woman sitting on swing over valley

Why Your Gut Health and Microbiome Make-or-Break Your Hormone Balance

Acne worse than puberty, ten pounds that won’t budge, a period-induced mood swing that turns you into a totally different person-- these are sure signs your hormones are out of whack. The solution to hormone problems like these seems obvious: Fix your hormones.

But what if I told you that the first step to balanced, happy hormones (and clear skin, easy, regular periods, a healthy weight, and even-keeled moods) isn’t about estrogen, progesterone, or testosterone?

I’m going to let you in on a big secret about female hormones: They never break in isolation.

What does that mean? Simply that if something is not right with your hormones, it’s a sure sign that something ELSE is not working right in your body that is causing the hormone problems. If you’re having symptoms caused by imbalanced hormones, we have to do more than just treat the symptoms - and we even have to do more than just treat the hormone imbalance. (Prescribing artificial hormones is NOT the answer).

We have to go back even further and find out: What caused the hormone imbalance in the first place?

Finding and addressing the root cause of your hormone imbalance is the MOST important step to achieving hormone balance for life.

And 9 times out of 10, when we do the careful detective work to find the real root cause behind hormone imbalance, it’s actually related to gut health.

I know it sounds a little odd at first - but the health of our gut is actually closely tied to our hormone health. In this post, I’m going to explain the link between our gut and hormone health, and what you can do to optimize both.

The Gut-Hormone Dream Team

The gut and our hormones are meant to be in communication. They support each other and work together to make our body run smoothly. In fact, our intestinal cells have special receptors for hormones that allow them to detect hormonal shifts.

It’s intuitive that our hormone and gut interact, too - even women with symptom-free periods will report noticing slight changes in their bowel patterns before and during their menstrual cycle.

Both estrogen and progesterone impact gut motility & peristalsis - the rhythmic movement of the intestines that moves food from your stomach down through your intestines and eventually out of your body. Estrogen and progesterone play opposing roles in motility. Progesterone slows down motility in the gut by relaxing smooth muscle and slowing transit time (the time it takes for food to move out of your body). Even women without IBS or other digestive issues are more likely to feel mildly constipated, or just more “full” during the week prior to the period, when progesterone levels peak.

Estrogen, on the other hand, increases contractions of the smooth muscle in the intestines. When estrogen levels are just right, this helps keeps things moving. Estrogen also increases the diversity of your microbiome, which is a good thing for immune health. Estrogen levels drop off suddenly, twice, during a normal menstrual cycle: once right before ovulation, and again just prior to your period starting. This can cause spasm and fast motility in the digestive tract, which can cause diarrhea at these times (even in healthy women). For the same reason (sudden, dramatic drops in estrogen levels), this can also happen during perimenopause and menopause, too.

Pregnant women experience an increase in progesterone in early pregnancy and then again in the third trimester - this is responsible for the constipation so many women experience during pregnancy. The excess progesterone can also cause the sphincter in the upper GI tract to loosen, leading to heartburn and reflux.

When estrogen and progesterone are in balance, you’ll tend to have normal motility most of the time - neither constipation or diarrhea. (Unless you also have some gut infections like SIBO, Candida, or parasites….then you could still have constipation.)

The Estrobolome

Our gut and hormones do more than just “talk”-- your gut microbiome also regulates estrogen. The estrogen-regulating function of specific bacteria in the microbiome is called the “estrobolome.”

The estrobolome is really important to keeping healthy estrogen levels in the body -- but to understand why, you need to know how the estrogen cycle works. Here’s how it happens in a healthy system:

  1. Estrogen is produced in the ovaries (but also in the adrenal glands and adipose tissue to a lesser extent)
  2. Estrogens circulate in the blood, making their way to tissues in the breasts, brain, bones, uterus and elsewhere
  3. Eventually, the estrogens travel to the liver, where they are broken down and deactivated
  4. Detoxified estrogens are deposited in bile which is secreted into the intestines, and exits the body with the stool.  

 

Path of estrogen

So, where does the gut come in? The gut - or more specifically, the estrobolome - regulates the amount of estrogens circulating in the bloodstream through the creation of β-glucuronidase, an enzyme which breaks down estrogen into to its “free”, or biologically active form.  

But that isn’t all the gut does - it can also create its own estrogen, too!

Bacteria can manufacture estrogen-like compounds from foods that we eat. For example, lignans, found in plants like flax seeds, are converted into estrogen-like compounds when acted on by bacteria in the gut. On their own, they don’t have any hormonal properties, but once converted the can either promote uptake of our own more potent estrogens into receptor sites, or can compete for the same receptor sites,.   

Newer research also suggests that the microbiome (and also specific types of probiotics) can produce its own estrogen and also signal glands around the body to produce it. We don’t yet fully understand exactly which strains of bacteria are responsible for all of these hormone modulating roles, but we do know that we want good overall proliferation, and greater species diversity.

When Things Go Wrong

The gut and your hormones are closely linked. You can see that both the gut and the hormone systems depend of each other to work properly - and when something goes wrong with either one, it spells trouble for the other.

Problems in the gut-hormone relationship usually start with the gut - but once the delicate balance is thrown off, it’s hard to know where to pin the blame. Imbalanced hormones cause gut problems, and gut problems cause imbalanced hormones.

Here are just some of the ways gut problems can lead to hormone imbalance:

Leaky Gut Syndrome: Leaky Gut Syndrome (aka Increased Intestinal Permeability) occurs when the tight junctions between cells in the intestine become “leaky” and allow toxins called LPS (which are fragments of dead bacterial cell walls) to pass from the intestine, into the bloodstream, and circulate through the body. It sounds crazy, but it’s actually common and causes a wide range of symptoms.

If you have leaky gut syndrome (with or without symptoms), you are more vulnerable to developing hormonal imbalances. Why? Because leaky gut causes widespread inflammation throughout the body. LPS is known to cause inflammation in any tissue that it comes into contact with, and in the ovaries, the result is suppressed progesterone production. (Women with higher levels of LPS in the blood had elevated markers of inflammation in fluid inside the ovary (follicular IL-6), and correspondingly low progesterone production.)

Studies show that infections, allergic reactions, being born by cesarean section, and even chronic stress can all cause inflammation in the gut, as well. And inflammatory conditions like obesity and inflammatory bowel disease are associated with disrupted menstrual cycles and infertility.

If you’re not having digestive symptoms like bloating, diarrhea, or constipation, you may think you don’t have leaky gut syndrome - but leaky gut may not show up as digestive symptoms, depending on the person. Even without digestive symptoms, the “silent” inflammation caused by leaky gut affects nearly every other aspect of health - especially our hormones.

Gut Dysbiosis: Your intestines are filled with trillions of bacteria, fungi, and even some viruses, that are all collaborating to keep your system running smooth and healthy. These bacterial cells and their genes are called your microbiome, and they live not just inside the intestines, but on every surface of your body, from your skin, to your eyes, your lungs, vaginal walls, and bladder. When the microbiome gets disturbed and the type or number of bacteria is damaged, we call it gut dysbiosis.

Along with your brain, your microbiome regulates the expression of your hormones, and can restrict or promote hormone production elsewhere in the body. The bacteria in your microbiome are like air-traffic control for hormones. In addition to signalling other glands in the body to dial up or down the volume on hormone production, your gut flora regulate hormone metabolism post-production, by either helping (or hindering) detoxification of already-used hormones, when they are being cleared from your system to make way for new fresh hormones.

To work properly, your microbiome needs the right bacteria, in the right amount. When the type or number of bacteria gets messed up (from something like poor diet & stress, an infection or parasite, or even just a course of antibiotics) your gut can no longer perform it’s hormone-regulating functions properly.

Increasing reactions to food, bloating, skin outbreaks, constipation, stubborn weight that won’t budge despite your best efforts, and even heavy periods— can all be signs that your microbiome is compromised and you’re unable to properly metabolize hormones like estrogen in the gut. Ultimately, this causes a build up of hormones in your system, which shows up as worsening of your PMS, period symptoms, or menopausal symptoms, and leaves you bloated and moody.

Estrobolome Dysfunction: Remember, the estrobolome are the specific bacteria in the microbiome responsible for regulating estrogen in the body through the production of the enzyme β-glucuronidase. Disruption of the estrobolome are really a type of dysbiosis. The estrobolome can be damaged in the same way the rest of the microbiome gets hurt: common triggers are stress, poor diet, and especially antibiotic use.

If the estrobolome bacteria become overgrown, the result is too much beta-glucuronidase being made. This causes already-detoxified estrogen to be reabsorbed and recirculated, in really high levels. This leads to a state of estrogen dominance. And estrogen dominance creates all kinds of chaos - PMS, cramps, fibroids and cysts, endometriosis, PCOS, heavy bleeding, infertility, a zapped sex drive, and weight gain. And of course, it can increase the risk of certain types of breast and uterine cancers.

And while it’s clear that we don’t want gut bacteria producing too much  beta-glucuronidase enzyme, we actually don’t want them under-producing it either! When women have extremely low microbial diversity or even just extremely low levels of bacteria in the gut (think: excessive antibiotic use), the decrease in beta-glucuronidase causes a reduction in circulating free estrogens. Excess estrogen isn’t a good thing, but insufficient estrogen levels, especially in post-menopausal women, isn’t good for our health either! Estrogen is critical for maintaining healthy brain cognition, bone density, gut health, and cardiovascular health.

It isn’t just these gut problems that could be causing your hormone issues. The gut-hormone connection is a two-way street: here are some of the ways imbalanced hormones can wreak havoc on your gut health:

  • Gallstones - women get gallstones twice as often as men! Estradiol (one of the types of estrogen) increases cholesterol levels in bile produced in the liver. (Cholesterol is the building block of our reproductive hormones, so when they are detoxified and broken down, cholesterol is released.) This increased saturation slows bile flow, which can lead to more stone formation.
  • Leaky Gut - While inflammation caused by leaky gut can lead to hormone imbalances, low estrogen levels can also contribute to leaky gut. The epithelial layer of the intestinal wall needs estrogen to and keep it healthy and elastic. Leaky gut has been associated  development of food sensitivities, autoimmune diseases, weight gain, acne, depression and anxiety, as well as almost every chronic illness you can think of.
  • IBS - researchers know that estrogen and progesterone levels have an impact on the development of IBS (Irritable Bowel Syndrome). Symptoms of IBS include diarrhea, constipation, bloating, pain, and food intolerances.

Here’s the bottom line: if you want healthy hormones, you have to fix your gut!

Healthy Gut, Healthy Hormones

We know that we need a healthy gut to get healthy hormones - but what messed up your gut in the first place?

It’s a fair question, and not always easy to unravel. These are the most common causes for gut problems I see in my clinic - but there are many more (and most people have more than one contributing!)

Antibiotics: A single dose of the antibiotic Augmentin can kill off up to 90% of your gut flora - and most people are prescribed a 5-day course! Gut flora will regrow, (although it can take up to a year) but what types take hold and flourish impacts every aspect of our health. Generally we lose lactic-acid-producing species (like L. Acidophilus) first. This causes pH to go up in the intestines. Good colonic bacteria flourish in a more acidic environment, so in a less acidic environment, unfavorable strains can grow.  

Toxins: Pesticides, herbicides, glyphosate from GMO corn and other foods, environmental chemicals, infections, and even stress can negatively shift the microbiome.

Diet: Eating a diet low in fermentable fibers and resistant starches (found in veggies, fruits, nuts, seeds, legumes, and grains) will also decrease bacterial diversity. Dairy, sugar, and gluten are major culprits in promoting bacterial imbalances.

The Pill: Contraceptive pills damage your microbiome as much as antibiotics do! The pill is known to promote candida overgrowth and SIBO (small intestine bacterial overgrowth) as well. Recent research has linked oral contraceptive use to development of inflammatory bowel diseases such as Crohn's Disease and Ulcerative Colitis, too.  

The good news is there is a lot we can do to support better gut health - leading to better hormone health.

The best ways to support a healthy microbiome for healthy hormones, is through a diverse whole food diet, optimizing digestion, and taking steps to lower inflammation.

  • Eat fermented foods - Sauerkraut, yogurt, kefir, kombucha, etc.
  • Eat prebiotics/fiber - Found in root vegetables, flax seed, psyllium, beans, seeds, nuts, fruits and veggies. Women who eat more fibers from plants clear greater levels of estrogen in their stool.
  • Take probiotics - In particular, Lactobacillus Acidophilus helps lower beta-glucuronidase!
  • Optimize the environment of your digestive tract so good bacteria flourish there - This is similar to prepping the soil in your garden beds. Digestive secretions like pancreatic enzymes, stomach acid, and bile help optimize the conditions in the gut to promote the desirable bacteria. Taking these supplementally if you are deficient can help prime the gut for healthy colonization.

Get Your Gut & Hormones Humming

Every woman’s health is unique - but if a woman is having hormone symptoms, it almost always comes back to gut health! Heavy periods, adult acne, and PMS may not seem like they are related to your gut, but they so often are! That’s why I always test and treat the gut alongside hormone balance problems in my clinic.

Remember, our hormones don’t break in isolation! It’s almost always a sign of a problem somewhere else in the body. If you are struggling with your hormones, don’t forget to consider your gut health!

I hope this article and my suggestions for optimizing gut health help you. Need more help unraveling the root cause of your hormone issues? Want to run the right testing, so that you can really know for certain, what’s going on with your hormones and gut? I love to help women like you get back to radiant health so they can live big!  If you’re interested in learning more about how I do this, you can book a free 20-minute prospective patient call here.