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Chronic Constipation – Not So Uncommon

In my practice this is not an uncommon symptom.  I call it a symptom as it is part of a bigger process in the body and not a disorder on its own.  And as with everything, there isn’t a one treatment for all.  Laxatives, whether it be chemical-based or natural herbs such as cascara, are temporary fixes but will lose its effectiveness after a while if the underlying problem isn’t addressed.  So let’s have a look what your body needs to do for proper bowel motions:


Digest Food

Yes, a very basic first step but so very important.  This includes chewing your food properly, eating in a relaxed environment for parasympathetic nervous system activity, and making sure you have enough stomach acid and pancreatic juices to digest food.  Certain medications such as antacids and proton pump inhibitors will suppress stomach acid and interfere with digestion in the long run.  Raw organic vegetables as found in salads provide live enzymes to help digest food.  Having apple cider vinegar or lemon juice in water before every meal can help increase stomach acid, but sometimes taking betaine hydrochloride, digestive bitters or pancreatic enzymes with meals are necessary, at least for a while.

How stomach acid is produced and why suppressing it is not a good idea.

Undigested food will put strain on the digestive organs, ferment and provide food for unwanted organisms that will crowd out the healthy bacteria needed for bowel motions.


Produce Bile

Bile is the body’s natural laxative.  It is produced by the liver, stored in the gallbladder and excreted into the small intestine in response to acidic food chyme from the stomach.  This means that you have to have good stomach acid production for the 1st stage of digestion in order to create an acidic food bolus.  If the stomach acid is too low and the food bolus too alkaline, it will not stimulate bile production from the gallbladder.  This is how longterm use of antacids such as nexium can result in constipation.

Bile also need certain nutrients such as taurine, choline, vitamin B12, folate and vitamin B6 for bile salt production and to keep the bile salts in emulsion.  Sometimes cholagogue herbs can be helpful to stimulate gallbladder contraction.


Have a Sterile Small Intestine

The role of gut bacteria is to ferment food and turn them into short chain fatty acids.  This process should occur in the large intestine and never in the small intestine.  The small intestine is for digestion, not fermentation.  Generally if you have good stomach acid and bile production it will keep the pH in the small intestine at a level where no organisms would want to grow.  They will only start to grow there once the pH changes to make the environment in the small intestine ‘comfortable’ for them.  Once bacteria grow here we have a condition called SIBO (Small Intestinal Bacterial Overgrowth).  This can be made worse with stress (as this decreases stomach acid production), poor methylation (inadequate bile production), constant grazing (through feeding organisms regularly) and eating highly fermentable foods such as sugars and starches (through feeding organisms).

SIBO (Small Intestinal Bacterial Overgrowth)


Functional Motility Reflex

This is the nervous system connection between the brain and the gut and is mostly regulated via the vagus nerve as part of the cholinergic pathway.  The vagus nerve (or cranial nerve X) regulates the autonomic nervous system which includes both sympathetic and parasympathetic.  Serotonin stimulates ganglion cells in the vagus nerve and acetylcholine is then released from the nerve terminals.  Acetylcholine stimulates muscle contractions (at the end of digestion) and stomach acid production (at the start of digestion).  Opioids (medications, casein in dairy, gluten in wheat) block this pathway and completely disrupts communication between the gut and the brain.  Studies show that up to 9x more serotonin is needed to stimulate peristalsis when opioids are involved.


Produce Serotonin

E. coli is a healthy aerobal organism that colonises the large intestine and produces up to 80-95% of all serotonin in the body.  It metabolizes dietary tryptophan to serotonin.  We all know serotonin as the ‘happy hormone’ involved with depression, but few people know of its role in gut motility.  Serotonin is one of the main neurotransmitters that keeps our bowels moving.  Individuals with Streptococcus overgrowth in their gut often have low E. coli levels.


Produce Short Chain Fatty Acids

In the large intestine healthy gut bacteria ferment fibers and starches from vegetables to produce SCFA’s or short chain fatty acids.  These SCFA’s provide food for healthy gut bacteria and this is how the gut keeps itself healthy.


Eat Enough Fiber

This ties in with SCFA’s as you need fiber to be fermented to produce SCFA’s to feed gut bacteria.


Drink Enough Water

This goes without saying.  Pebbly bowel motions are usually a sign of dehydration.  You need water to add moisture to stools to move easily through the digestive tract.  You will also produce more saliva when you are in a resting parasympathetic state with adequate histamine and gastrin for digestion.  When your mouth is constantly dry you may not be producing enough gastrin or histamine for proper digestion and your sympathetic nervous system may be overstimulated which is not the best time to eat.  You will not digest your food properly and this can cause or worsen constipation.


Gut Dysbiosis

There isn’t really such a thing as ‘bad’ gut bacteria.  Every strain has a function (mostly) but they have to be in optimal ratio’s for good gut function.  If you have an overgrowth of methane-producing gut organisms you will tend more towards constipation whereas hydrogen sulphate-producing organisms are more likely to cause diarrhea.  This needs to be balanced, but in constipation we may want to encourage more hydrogen sulphate production.  SAMe produced from methylation is needed to make hydrogen sulphate as well.  And as mentioned, healthy E.coli for serotonin production.

If you need guidance in the treatment of this or any other condition, please make an appointment with one of our practitioners.


This article is for information purposes only.  Please refer to our Medical Disclaimer policy for more information.  The opinions expressed here represents the author’s and not necessarily those of Realize Health.  In addition, thoughts and opinions change from time to time due to updates in research and as a necessary consequence of having an open mind.  Views expressed in out-of-date posts may not be the same to those we hold today.



Direct evidence of acetylcholine releasing effect of serotonin in the Auerbach plexus

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Elizma Lambert

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