Hello, hello, and welcome to today's podcast. Today we are talking about constipation. Yep — very common problem. Very, very common problem. It happens with a lot of individuals, and it creates a lot of metabolic problems, disease, and chronic disease processes. So it's not just feeling full and bloated and having a hard stool; it's something that creates a lot of chronic disease, which can lead to problems for folks. We'll discuss all that today.
Really, it's just one of those things that makes people feel uncomfortable. You don't feel good when you're not having proper bowel movements — bloated and gassy, basically. The definition is someone who has fewer than three bowel movements in a week. There can be irregularities that occur, whether it be traveling or a change in diet, and we'll discuss all that. But in general, people who consistently have these kinds of problems — we have patients who will go days without bowel movements, and that's the norm for them, and that's just not normal. So: common, not normal.
16% of adults will suffer from constipation, and the older we get, the harder it is. By the time you get to be 60, greater than 33% of adults will have problems with constipation, so it's pretty significant.
What's Normal vs. What's Not
When you're constipated, you're dealing with hard, dry, lumpy stools. Conversely, an ideal bowel movement is soft, well-formed, and easy to pass, and you're eliminating completely — you feel like you've completely eliminated when you're done. Women also have more trouble with this than men, because of the hormone fluctuations they have, so that contributes to it a little more for women.
The Causes
Number one, I would say, is probably the standard American diet — lots of ultra-processed foods that are high in refined sugars and low in fiber. This awful diet that we're exposed to on a regular basis is a major contributing factor to a lot of problems, and constipation is one of those side effects. We have such poor nutrition, with a lack of proper nutrients and a lack of fiber. Fiber is essential for forming stool. In fact, fewer than 5% of people get the daily recommended amount of fiber, which is 35 grams a day. Because of our diet, we just don't get that.
Then there are hormone imbalances. For women, estrogen and progesterone — a lot of women will experience different bowel habits during a certain time of their cycle, due to how hormones are fluctuating. Cortisol can affect the bowel, and thyroid as well. Thyroid dysfunction — a lot of folks think constipation is a normal thing, but it's not. With the thyroid, that can be sneaky. Of the individuals who truly get diagnosed by their PCP or healthcare provider with hypothyroidism, that's only about 5% — a lot of people are just undiagnosed, walking around with measurably low thyroid hormone levels, not being treated, and that's the contributing cause for their constipation.
Another big one is exercise. We are a sedentary group of folks — we just don't get good enough movement — and sedentary people are 40% more likely to have chronic constipation problems than non-sedentary folks. That's a big deal.
The next cause is sleep disruption. When you're not getting good sleep, your gut doesn't have time to rest and digest — that's part of what sleep does for us. When we're not getting the sleep we need, our body doesn't have the time and ability to really digest and move things along. And sleep deprivation causes problems with stress hormones, which will also worsen the problem.
The Gut Connection
Let's look at this gut connection to chronic constipation — dysbiosis, which affects the balance of the natural bacteria in our gut. When you disrupt that, it takes a while to get it back in check, and there's a lot contributing to it: our diet, our medications, our sedentary lifestyles, our hormone imbalances. And malabsorption goes along with that. Two of the nutrients really affected by that malabsorption — just two of the many — are magnesium and B12. We're hearing a lot about magnesium and all the things it can do for us, and so many people are deficient. And B12 has a huge impact on our energy.
Those bacteria help us out a lot in the gut — they take that fiber and create a lot of things we can't digest and absorb on our own. So it's very helpful to create that good, natural balance and reduce dysbiosis.
Downstream and Systemic Effects
Constipation can create hemorrhoids and anal fissures — now you've created another problem from having to strain continuously. Diverticulosis affects a lot of adults — statistics say 35% of adults over 50 and 70% of adults over 80 — so it's a pretty significant contributing problem to a lot of GI symptoms.
Then there are systemic effects. When you're not properly eliminating, you've got toxic reabsorption, so your systemic inflammation and immune load are overtaxed. When you start having these chronic inflammatory states, that affects everything from heart disease to type 2 diabetes to autoimmune disorders — you name it. Chronic inflammation is contributable to a large number, a majority, of the deaths out there, so it's something to keep in mind.
And mental health — you wouldn't think being constipated would cause problems with mental health, but it does. There are a lot of numbers out there, but 70 to 90% of the serotonin in our system is created by our gut, and that's a mood regulator and stabilizer for us. So we'll have mental health disorders — depression and the like — that can be contributable to gut dysbiosis. If you are constipated, you are two to three times more likely to suffer from depression or anxiety. That's pretty big.
Other serious conditions that play into this are colorectal cancer — a prolonged exposure to constipation can be contributable to that. SIBO, small intestinal bacterial overgrowth, is another disorder — up to 60% of constipation-dominant IBS patients also have SIBO, which leads to lots of other things. And it affects our cardiopulmonary system too — cardiac strain, elevated blood pressures, and straining. One of the stats I saw was that 20% of the people who suffer a heart attack had a pre-existing history of straining with constipation prior to that heart attack. I don't know exactly who came up with that statistic, but it would be an interesting thing to look at and measure — and some of it makes sense.
The immune system is very well associated with our gut health and constipation, too. 70% of our immune system is located in our gut — the gut-associated lymphoid tissue. So when you start having issues with constipation or dysbiosis, that's going to affect the way your body fights infection, and it can lead to a lot of issues, even significant autoimmune diseases. And the toxic reabsorption also affects your immune system when you're not getting rid of that regularly. When you have gut imbalances, you're even up to 40% more likely to have chronic infections, from skin infections to sinus infections, believe it or not.
Treatment Options
So what are our treatment options? We'll start at the top of the list: nutrition. It's from absorption to dietary fibers, fruits, whole grains, and vegetables. We really want to stay hydrated and increase our fiber — that 35 grams of fiber a day is really where we want to shoot for. As far as water goes, you want to shoot for a number of ounces equal to half your ideal body weight — that's important. We all don't get enough fluids, that's for sure.
Balancing our hormones is also very important — estrogen, progesterone, testosterone, thyroid — those things have to be in balance, and when they're not, we're going to experience these constipation issues. And there are tools to regulate your stress hormones: meditation, yoga, movement, adaptogenic herbs like ashwagandha.
Exercise — we can't stress that enough. If you could have two things in the world you could fix to help improve your chronic health, it would be exercise and nutrition. Exercise is just so key to improving everything from your mood to your GI tract to type 2 diabetes. I always suggest people do 20 to 30 minutes a day. This isn't crazy exercise — just get out for a walk, and it doesn't have to be all at the same time. You can do these in little exercise snacks — 10 minutes here, 10 minutes there, or even three minutes. Go to a commercial break and do some exercises instead of sitting there; get up and do some squats, or go to the refrigerator and find something you want to drink — that's movement, that's exercise.
If you have a desk job, a standing desk and some movement throughout the day is fantastic. Little things are important too: don't park the closest you can to the door — park the farthest away, so you have to use another minute or two of time getting back and forth to the car. Set yourself up for success by thinking ahead. And if it's cold or raining, maybe you're going to run or walk a little faster, so it won't hurt that either.
Sleep is next. We need to be getting seven to nine hours consistently — whatever you need to do to get that consistent sleep will really improve your gut health. We have another podcast that talks about sleep hygiene.
Magnesium — magnesium citrate — is very important for that, and it helps with everything from our mood to our cellular health to our GI tract. One pearl: magnesium is a hot topic, but there are several different types, and each one has its main use, so if you're going to get a magnesium supplement, do a little research and know what type to look for, for what you're looking to help.
Probiotics are very important and helpful, because with our poor diets and sedentary lifestyles we create constipation and dysbiosis, and now we have a decrease in the good bacteria we actually need. Akkermansia is one that's out there, along with Lactobacillus and Bifidobacteria — those are very important, and there are probiotics that focus on them at different concentrations that will help reduce your leaky gut issues. Probiotics get a lot of talk, but prebiotics are really important too — part of that prebiotic is the fiber that the probiotics feed on. You've got to give the bacteria something to eat.
All our lifestyle tips — the hydration, the fiber, the exercise, getting up and moving after a meal — that keeps the GI tract going and reduces your glucose spikes. And relaxation techniques to reduce stress are also highly successful.
Wrapping Up
To wrap it up: there are little things people can do — things you don't do well enough, or could improve a little bit. If we take little parts and pieces of these and implement them in our daily habits and nutrition, that'll help a lot to reduce constipation. And reducing stress is highly important.
Just remember, the topic of constipation feels like you're just talking about poop, but it's really so much more than that. It really does affect your immunity, your mental health, systemic inflammation — all of those things. So it is a big deal. A lot of people think, "It's not a big deal," and maybe it's not the worst of your problems — but maybe it is. Anyway, we hope you've enjoyed a little conversation about constipation today. We're here for any questions or comments, or if you'd like us to talk about anything special on a podcast, reach out to us at Revelation Health and Wellbeing. We'll see you next time. Have a healthy day.