constipation

[Sundancer]

oh well... there we go again.

It's an old issue and I've tried about all things that can be tried.
Having had IBS all my life I'm sort of used to it but now I'm baffled.

After many months of diarrhea normal poo came back in may last year, then for many months things went well, wow, that's nice. Just go once in the morning and that's it.
Then it became less easy and I added plums to my diet . Fixed.

In november last year I tightened up on my diet, less fruit, no potatoes, less grains, more fat, almost no goat-milk. At the same time I started with B12. and I have become more stopped up ever since. I now take lactulose to become unstopped.

In tandem with this the gallbladder is not working properly anymore, I know from experience that i have first to become unstopped, and then the bile will flow again.

I tried bifidobacterium infantis, some years ago this was the answer to the same sort of problem, but it just does not help.

By now all my belly hurts, the lactulose helps becoming unstopped, but also causes more pain

I cannot use fibers as are generally advised, they give me rolling bellyache. As the choice of foodstuff is very restricted I don't think there is an answer to be found in that either.

Some brisk walking, jumping up and down and walking stairs might help, but hey, I've got ME...

I do use a liberal amount of ascorbic acid
about 600 mg of magnesiumcitrtae
3 plums
3 figs
about two and a half liter of drink, mostly chamomile-tea ( with fresh ginger added)
two dessertspoons of linseedoil
A liberal amount of coconutoil in my dinner.

any ideas??

 

[Richard7]

Hi @Sundancer,

I think the issue might be to look at what is making your belly ache.

My history with this disease has been one of IBS-A so it my experience may be quite different to yours.

I have had two sorts of belly ache, or at least pain in the gut that I think I have been able to explain. One was related to SIBO the other (I think) was related to b. hominis.

I found that the SIBO ceased to be an issue when I started taking betaine HCL + pepsin + digestive enzymes and ox bile.

The betaine HCL acidifies the stomach, the breaks the proteins into peptide chains. The digestive enzymes I take are pancretin (CREON brand) and Klaire Labs "Sibb Zymes".

The pancretin is a pancreatic extract, so it emulates the human pancreas and contains lipases, amylases and proteases but the amylases and proteases are ones that break long carbohydrate and peptide chains (respectively) in the middle.

The Sibb Zymes are meant to replicate the action of intestinal brush border enzymes by nibling individual amino acids and sugars off the end of these chains so that you can absorb them.

The ox bile kills of a lot of microorganisms and emulsifies the fats so that the lipase can break them into the free fatty acids and monoglycerides that you can absorb. It is of course not needed if you are producing enough of your own. (I just judge this by stool colour.)

Once I had dealt with the SIBO I could of course eat fibre without lots of painful gas.

B. Hominis is a parasite. I had a lot of a sensation I called sunburn in the gut, because that is what it felt like. I imagine other parasites could case similar issues. when I was tested it was with a faecal PCR test that tested for about a dozen different common parasites. It was pretty straighforward - once I had convinced my doctor to order it.

One thing I noticed was that my bile started flowing again once I had dealt with the b. hominis. And that it declined and stopped again when I got reinfected.

(My doctor has since pointed out having diarrhoea or flushing the toilet with the lid up creates an aerosol that can spread microbes all over the bathroom reinfecting people who are not in the know.)

I hope this helps.

 

[Tuskentank]

You could try Mutaflor? Figs are a substrate for it too (the fucose in them).

 

[impossible]

Prescript assist probiotics (when i tolerated probiotics) were what finally did it for me, and helped other gut problems/pain as well. Nothing else, even other probiotics, really did much to help.

 

[Eastman]

In tandem with this the gallbladder is not working properly anymore, I know from experience that i have first to become unstopped, and then the bile will flow again.

I would have thought raising bile flow first would help with constipation.

Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation

Abstract
Objective. Bile acids are derived from cholesterol and are potent physiological laxatives. The aim of this study was to investigate whether bile acid synthesis is altered in constipation. Material and methods. Female patients with constipation (23 IBS-C, 4 functional constipation (FC)) were studied and compared with non-constipated subjects (16 IBS-D, 20 healthy women). Body mass index (BMI), blood lipids, lanosterol, sitosterol, colonic transit (oro-anal transit time (OATT), reference=4.3 days) and stool frequency were measured. C4 (7-α-hydroxy-4-cholesten-3-one) levels reflecting bile acid synthesis were measured at 0800 h and 1300 h. Results. When all the groups of constipated and non-constipated subjects were compared, it was found that only stool frequency and OATT differed between groups (p <0.001). When constipated patients were categorized according to OATT, absence of the usual C4 increase at lunchtime was noted in 82% of patients with delayed OATT compared with 17% in subjects with normal OATT (p <0.001). Symptom severity did not differ between groups. A subset of the patients with severely delayed OATT had markedly elevated C4 levels. Conclusions. Patients with IBS-C and FC have marked changes in bile acid synthesis in relation to colonic transit. The diurnal rhythm is altered in the slow transit colon when there is no C4 peak at lunchtime. Alterations in bile acid metabolism may be implicated in the pathophysiology of constipation.

 

[Sundancer]

thanks @Richard7 , @Tuskentank and @impossible, in the mean i've been reading some more too. It helps to get things in order. Like first find the good question.
Like: why are you stopped up

I do think it is SIBOrelated, that was the reason I tightened up on the diet. And helped, hardly any bloating, ( and due to that) better sleep.

There is also the issue with the digestion pancreas-wise, have to look into that. Digestion of fat and protein is OK. Normally bile flow is good, but severe constipation sort of blocks that off.

I do use betaine-HCL but am not aware of any effect, bicarb test showed I need it, one cap is enough, when I take two I get reflux ( urgh ).

I do have a parasite, forgotten its name, can lead to this kind of problems too. But as it became horrible after tightening up on the diet it must be gutflora related. And if not, I cannot yet fight this parasite...

so taking either mutaflor or prescript assist sounds like good advice.
I wonder about the prescript assist though. I do have an unused bottle of it. But never took it because I read some less good things about it. That it could make things worse...

I did not have much pain initially, but I know I have to act before I'm really stopped up. ( some experience through the years) Now I have pain, I think the lactulose is feeding the little sibomonsters... I'm bloated, windy and have cramps

in an other thread
http://forums.phoenixrising.me/index.php?threads/intractable-constipation.26478/

the old-fashioned epsomsalt came along. That may be a good option for the shortterm. It will not feed the SIBO monsters and it will help uncramp my gall-bladder-duct. Totally forgotten about that. I do have a bottle of it for exactly that reason memory-function pills would be nice too

further acaciafiber, is soluble, new to me and worth investigating. It might be of help. I need more soluble fibers but do not eat much. Have to research whether they might set of histamine though.

and a little tea of feverfew.. .never heard of that, but will investigate. It grows in my garden ( not now, it freezes outside) and may be useful to know about more.

Figs are nice, I tolerate and eat them.

I'll research the prescript assist and the acaciapowder, find out why prescript assist was thought to be no good...( I mean, maybe the solution is standing right in my cupboard

 

[Sundancer]

I would have thought raising bile flow first would help with constipation.

Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation

I agree totally with your post, but...experience has taught me that first I become constipated, with nice dark poo. And after some days/ a week sometimes longer, the gallbladder duct cramps up and then that strange putty-color when you look behind. It seems to be a problem with not the gallbladder/ bile production itself but with cramp of the gall-bladder-duct.

That one can also get cramped all by itself, hurts a lot and in that case is unrelated to the consistency of poo. I've been to doctors with that, they don't get it... they've looked with their scanners, asked about diet etc.

not surprisingly they ended up with telling me that it is psychosomatic and see a psych. Mind you, the pain was so severe that I could do nothing but lie flat on my back, not able to sit up without excruciating pains. Ah, but I should not take those little pains so serious.....
Those were the last intern doctors I've visited and I will not go back ever.

Old fashioned epsomsalt was then advised by my former ( old-fashioed) GP. It has done the trick before, so I'll try that first

 

[jpcv]

Strong Coffee +walking+everything above.

 

[Sundancer]

walking...oh my, i would that I could.
since last week I very carefully venture outside for some minutes, but not today as I had overdone it yesterday.

One mug of coffee is included though, now that sleep is better ( not tonight though, therefore I'm here, typing

 

[kangaSue]

Autonomic Neuropathy is often overlooked in being one of the known causes of constipation so given the high prevalence of autonomic dysfunction affecting members here, that'e where I would be looking when constipation is refractory to other treatment.

Be aware that with autonomic dysfunction in the GI tract, fat and fiber slow your motility even more and you should keep these low in your diet.

Look up TENS Therapy for slow transit constipation, some people have success using this electrical stimulation. Also, look into ileocecal valve release massage. You can also try placing a nicotine patch over the area of the ileocecal valve and if you get a bowel motion within about 3 hours, that's a handy guide to it being an autonomic issue.

And as a bowel stimulant, try adding cayenne capsules to the mag citrate combo

 

[Sundancer]

wow, @kangaSue , thanks! i like the ileocecal valve release massage.

Spoiler: ileocecal valve release massage

, I'll surely try that out, sounds like it is created for my gut .

As it is now I still think the problems more like change in diet and the change in gutflora and fibercontent that accompanies it. Also the adding of B12 is doing all kind of weird things with my body.

But appreciate your comments on autonomic dysfunction, as I did think of that ( when one starts to feel hopeless...) and it is now nicely put in this thread, completing it.

cayenne is out, the belly and the rest of me never have been able to use pepper of any sort, but is a good general advice.

 

[impossible]

I'd like to add a few things here. First, good job addressing all the normal stuff that works for 90% of people (normal people i guess).

Second, Myself, the several people that i've personally known to use it, and every doctor i've been to that recommends and personally uses it (probably 5 or 6), have never had or personally seen a problem using prescript assist.

And it helps huge with sibo, parasites, c-diff, candida, even gut virus's. I think somebody started an internet smear campaign against them or something.

That stuff literally saved my life when a wicked case of sibo and whatever other infections, caused by a week or 2 of oral hydrocortisone, set off my mcas so bad that i couldnt eat, at all, even elemental formulas, and couldnt even take any antibiotics or antifungals.

It was the only thing i tolerated and it only took 2 or 3 days to work enough that i could start to eat. I almost died. I was down to 112 pounds at 6' tall and nobody knew what to do. And for the record, I have no affiliation with the company.

If its autonomic/vagus nerve/acetylcholine related, Dr Driscoll has a supplement that will get the acetycholine recptors of the gut activated, much like the nicotine recomended above, but without the mast cell activating properties of nicotine. Which brings me to my last point...

ALOT of people, especially in this cohort, have mast cell activation syndrome in some form to some degree. Mast cells make and dump a lot of things into the body when they get set off. Some of those can slow intestinal motility to a crawl.

Constipation is a common symptom (as are some others you personally listed) in mcas and is often relieved with proper mcas treatment/meds.

Elevated prostaglandins, which go hand in hand with mcas, and cox-2 have been found to be present in studies of people with constipation. So possibly aspirin or white willow if you're not salicylate sensitive, or a cox-2 inhibitor (nsaids, boswellia, curcumin) might help some people too.

Dr Jill Carnahan is in a wonderful interview on youtube that touches greatly on bowel problems and offers a lot of insight and possible solutions to the problem. I'll let her do the talking.

And i think that about covers it all lol.

 

[Sundancer]

@impossible , thanks, this is very useful. I'll reply later, had a bad night

 

[Sundancer]

interesting vid explaining how low mito-function leads to low bile production and associated problems like sibo

Spoiler: low mito and bileproduction

https://www.youtube.com/watch?time_continue=9&v=aRl5XnDagZU

from this thread http://forums.phoenixrising.me/index.php?threads/pots.57806/

where @Richard7 says this

My approach to this has been to take betaine HCL with pepsin, ox bile and digestive enzymes.

The betaine HCL acidifies the stomach, in an acidic environment the pepsin will break the proteins into peptide chains. The digestive enzymes I take are pancreatin (CREON brand) and Klaire Labs "Sibb Zymes".

The pancreatin is a pancreatic extract, so it emulates the human pancreas and contains lipases, amylases and proteases but the amylases and proteases are ones that break long carbohydrate and peptide chains (respectively) in the middle.

The Sibb Zymes are meant to replicate the action of intestinal brush border enzymes by nibling individual amino acids and sugars off the end of these chains so that you can absorb them.

The ox bile kills of a lot of microorganisms and emulsifies the fats so that the lipase can break them into the free fatty acids and monoglycerides that you can absorb.

Based on Chris armstrong's presentation I would think that getting this right would help with the dysbiosis.

 

[impossible]

interesting vid explaining how low mito-function leads to low bile production and associated problems like sibo

Spoiler: low mito and bileproduction

https://www.youtube.com/watch?time_continue=9&v=aRl5XnDagZU

from this thread http://forums.phoenixrising.me/index.php?threads/pots.57806/

where @Richard7 says this

It really depends on the individual. I tried most of those supplements and they actually made my problems worse. Turns out they were setting off my mast cells which were part of the problem to begin with. For me, getting rid of the sibo with bacteria/yeast eating probiotics takes enough of a load off my mast cells which allows them to calm down and stop a lot of the inflammatory process, then things go back to normal. I could then quit taking them as long as long as i stayed away from any bad trigger foods enough.

My girlfriend really responds to supplementing with oils. Pretty much any will work, but I give her fish oil to get the added benefits, plus it seems like it takes less of it to work, likely due to its anti-inflammatory properties im assuming.

Most people I consult with respond just fine with magnesium, vitamin c, and enough fluid intake, sometimes oils. Sometimes an elimination diet is the key and is usually addressed to some degree. If there is reason to believe there is a problem, then betaine and enzymes.

Rarely ox bile and actual pancreatic enzymes because supplementing them can cause your body to lower production of its own. Only if stool testing shows the person is not making enough of their own should those be considered imo. Lack of peristalsis and sibo are usually considered and addressed, as mentioned above, before those are added.

 

[Sundancer]

Thanks @impossible , by reposting it here I now know that there is histamine risk involved.
I am looking into pancreas enzymes though, I really do need them. The rest seems not to be of interest to me.
Oils are important for me too, linseed-, hemp-, fish-, codliveroil, hm, and all tasty. Much ghee and coconutoil too, I'm a real fatlover.

But I'll start with a course of probiotics. I've been taking Bifido infantis, good against itchiness allover, now deciding what the next will be. I think I will try those strange black prescript assist things. I opened the bottle and sniffed at them( as a sort of first acquaintance )

But the vid was real interesting, good science i say!

 

[kangaSue]

interesting vid explaining how low mito-function leads to low bile production and associated problems like sibo

Autonomic dysfunction again can come into the picture here.

Mast cells are mostly produced in the GI tract and increase in response to even mild inflammation. DAO enzymes produced in the GI tract to break down histamine can become deficient at the same time when disturbed motility is involved.

Low bile production is generally concluded from having a low gallbladder ejection fraction, the most common cause of which is neurodegeneration changes, i.e. vagus nerve dysfunction, from Autonomic Neuropathy or some other cause of vagus nerve irritation.

The vagus nerve dysfunction can result in disturbed motility leading to GI inflammation leading to increased mast cell release rather than it being Mast Cell Activation Syndrome as such. Dr Driscoll come up with Parasym Plus in part to stimulate vagus nerve function, pretty much a herbal alternative to the prescription med Mestinon I believe.
https://www.healthrising.org/blog/2...nic-fatigue-vagus-nerve-stimulation-exercise/

 

[Sundancer]

The vagus nerve dysfunction can result in disturbed motility leading to GI inflammation leading to increased mast cell release rather than it being Mast Cell Activation Syndrome as such.

now that sounds like a good description of some of the things happening in the body.

But still wonder why taking methylcobalamine triggers this histamine thing...itchy it was ( but happily it has calmed down)

The last two mornings the poo was alright, this morning bile-flow clearly had resumed, so i wait and see how it goes further, I'm not yet there I think.

 

[ebethc]

@Sundancer

Good advice above (I second the Betaine plus Pepsin; pancreatic enzymes, e.g. wobenzym; mg; vitamin c) and I would add l plantarum for constipation, plus l rhamnosus (culturelle brand in u.s.) down-regulates histamine receptors, so good for inflammation and mast cells..

 

[Sundancer]

thanks @ebethc , I already had downed a bottle of rhamnosus, very good stuff and a good brand avalaibele here. I've looked up plantarum, was new to me and will definitely try it out. Also thinking of reuteri.

Constipation is gone btw.

Looking back it was indeed triggered by the B12 and has now stabilized to a healthy pattern of twice a day. I still need a liberal amount of ascorbic acid for that, but ascorbic acid is OK for other reasons too, problem is solved and I will be careful to up the dose of B12. It triggered histamineproblems too.

I have not yet started with pancreatic enzymes, but have bought them. I did start with old-fashioned herbal bitters , this is real great for bile production, makes me happy. I like old fashioned remedies and even though I know I need all those pills. When I'm putting all those sups into 6 different little boxes in the morning it is like...oh my....is this me.

and I can understand that people would think me crazy for taking so many supplements, but do not mind for I know why i take them and that it is good for me.

the latest is ubiquinol, It seems to do something for energy....yay, going forward.

thanks all, for the help given