I’ve updated the Wheat Belly conversation on constipation, as there have been some new developments.
Our ancestors who lived without grains, sugars, and soft drinks enjoyed predictable bowel behavior. They ate some turtle, fish, clams, mushrooms, coconut, or mongongo nuts for breakfast, and out it all came that afternoon or evening—large, steamy, filled with undigested remains and prolific quantities of bacteria, no straining, laxatives, or stack of magazines required. If instead you are living a modern life and have pancakes with maple syrup for breakfast, you’ll be lucky to pass that out by tomorrow or the next day. Or perhaps you will be constipated, not passing out your pancakes and syrup for days, passing it incompletely in hard, painful bits and pieces. In constipation’s most extreme forms, the remains of pancakes can stay in your colon for weeks.
Bran is not the answer.
We have been given advice to consume more fiber. So we eat bran cereal/muffins, whole grain breads or drink powdered fiber supplements. Most of these grain-based foods contain insoluble cellulose (wood) fibers. This does work for some, as indigestible cellulose fibers, undigested by our own digestive apparatus as well as undigested by bowel flora, yields “bulk” that people mistake for a healthy bowel movement. Never mind that all of the other disruptions of digestion, from your mouth on down, are not addressed by loading up your diet with wood fibers. What if sluggish bowel movements prove unresponsive to such fibers? That’s when health care comes to the rescue with laxatives.
Drugs are not the answer.
Laxatives are prescribed in a variety of forms, some irritative (phenolphthalein and senna), some lubricating (dioctyl sodium sulfosuccinate, Colace), some osmotic (polyethylene glycol, Miralax), some no different than spraying you down with a hose (enemas).
Opiate drugs such as Oxycontin and morphine are commonly constipating. There’s even a new drug being widely advertised to “treat” the constipation side-effect of opiates: Relistor, or methylnaltrexone, an opiate-blocker that requires injection and costs around $700 per month. Those of you who have read Undoctored or Wheat Belly Total Health recall that the gliadin protein of wheat and related proteins in other grains (e.g., secalin in rye) are partially digested to peptides that have opiate (“opioid”) properties, including binding to the opiate receptors in the human intestine. Wheat and grains therefore contain a disrupter of intestinal motility, slowing or halting the normal propulsive peristaltic waves that were supposed to expediently pass food through 30 or so feet of intestines. The opioid peptides of wheat and grains are therefore constipating, sometimes severely so.
Living grain-free is the start of the answer.
Simply remove wheat and grains and constipation, even obstipation (severe, unrelenting constipation with bowel movements occurring every several weeks), can be relieved within a couple of weeks, often within just a few days.
This works because you have just removed gliadin-dereived opioid peptides that slow the intestinal passage of food. You will have removed a source of cellulose fiber, as well as the modest content of prebiotic fibers from grains, namely amylose and arabinoxylan, but these are easily replaced.
The Wheat Belly/Undoctored approach to eliminating constipation is simple:
- Eliminate all wheat and grains–thereby eliminating gliadin-derived opiates.
- Cultivate the garden called bowel flora–by “seeding” with a high-potency probiotic, enthusiastic consumption of fermented foods, followed by “water and fertilizer” to nourish desired bacterial species with prebiotic fibers.
- Hydrate well.
- Supplement with magnesium. Ever notice that many laxatives are nothing more than forms of magnesium, such as milk of magnesia (magnesium hydroxide)? Virtually everyone begins with a magnesium deficiency that adds to disrupted intestinal motility. This is reversed by supplementing magnesium. However, the degree of stool loosening varies among the different preparations due to their variations in osmotic (water-imbibing) effects.
- The various forms of magnesium cause an osmotic effect, pulling water into the intestines, a benign process compared to irritative laxatives like phenolphthalein or senna that exert low-grade damage over time and are even associated with increased risk for colon cancer. Magnesium water and magnesium malate are among our preferred forms, as they are least likely to generate loose stools while softly helping out with regularity; you can intermittently up the dose (e.g., 8 ounces magnesium water) to increase the osmotic effect. Magnesium citrate can be used for its somewhat greater osmotic effect if you do indeed need a bit more stool softening and regularity (which can be due to delayed recovery of intestinal motility after removing wheat and grains). Taking 400 milligrams of magnesium citrate two or three times per day is a good place to start. If nothing happens after 24 hours, one or more doses of 800 to 1,200 milligrams will usually do the trick; then back down to the 400-milligram dose two or three times per day.
- Supplement with fiber. For most people, prebiotic fibers are the only form of fiber you need. Adding fibers beyond prebiotic fibers is not necessary for the majority of people living the Wheat Belly/Undoctored lifestyle. Only a rare person needs to add fiber beyond the prebiotic fibers that we supplement to cultivate bowel flora. Just by adhering to the simple strategies of consuming nuts; seeds such as pumpkin, sesame, chia, flaxseed, and sunflower; eating plenty of vegetable with limited servings of fruit and legumes like chickpeas and black beans, you obtain plentiful quantities of fibers. If you are among those who do better with supplemental fiber for “bulk,” ground golden flaxseed, chia seed, and psyllium seed (e.g., 1 tablespoon added to foods) are benign forms.
- Address Archaea overgrowth/methanogenic SIBO. Archaea are fascinating creatures, ones that have traditionally not felt to be pathogenic (disease-causing) in humans . . . but that attitude is now changing. For unclear reasons, these primitive and extremely adaptable creatures, present in limited numbers in most people, can proliferate in the human gastrointestinal tract and, when they do, produce methane gas that slows propulsive intestinal activity and thereby causes constipation. While the line distinguishing chronic constipation from irritable bowel syndrome with constipation and methanogenic SIBO is blurred, constipation is caused by methane-producing Archaea in all three conditions. Confirmation of this condition requires methane breath testing followed by antibiotic treatment. However, preliminary evidence suggests that our favorite bacteria, Lactobacillus reuteri, that we make yogurt out of, may be as effective as antibiotics in suppressing Archaea.
You can see that the Wheat Belly/Undoctored approach does not rely on artificial means of reversing constipation to restore normal gut motility, but works to restore normal gastrointestinal function by correcting/eradicating the factors that cause it.
This lifestyle does not load up on unnatural quantities of cellulose fiber, as you would by eating bran cereals and muffins, nor does it rely on intestinal irritants, softening agents, or opiate-blocking drugs. The Wheat Belly/Undoctored approach removes all disrupters of intestinal motility, restores bowel flora, and encourages the consumption of foods that naturally support bowel health. As with management of SIBO, management of Archaea and conditions such as methanogenic SIBO are a bit more complicated to manage, so I invite you to join our discussions in the Undoctored Inner Circle for advice and support should you embark on a management program on your own.