Chronic Constipation - Gilbert's Syndrome, Bile Acids, Milk, Elobixibat

[SwanRonson]

I've been researching the newly approved Japanese drug for CIC called Elobixibat. It's an ileal bile acid transport (i.e. re-uptake) inhibitor. I dug into this a bit and found that people with Gilbert's syndrome, like myself, usually have reduced bile acid output because of the UGT1A1 polymorphism. This would mean that a re-uptake inhibitor would probably be a good therapy for Gilbert's co-morbid CIC. Bile Acids are one of the big factors in stool softness and colonic motility.

As a side-note, I've noticed many times over the years that milk causes constipation worsening in me very reliably. Nothing dries out my stool and stops things moving like milk does. It's the worst. And, I found a study showing that milk products precipitate secondary bile acids, which is bad when you already have low BA liver output. I'd love to drink more milk, but I guess that's out until Elobixibat comes to the U.S.

My mother also has had CIC her entire life, as did her mother. She also has GS.

Anyone else with Gilbert's Syndrome also have CIC?

 

[pamojja]

..one of the big factors in stool softness and colonic motility.

Only once my father for weeks had no bowel-movements despite prescriptions, did he become adventurous enough to try my recommendation: 1 teaspoon of ascorbic acid powder in a glass magnesium rich mineral water (Rogaska Donat Mg). Worked like a charm, some months later he even could drop the magnesium rich water.

Concerning elevated unconjugated bilirubin, from Labtestanalyzer.com:

If you have Gilbert's syndrome, make sure you stay hydrated, sleep well, and avoid fasting or extreme diets, stress, and strenuous exercise. Factors that stress out your body can cause spikes in bilirubin levels [R, R, R].

Supplements that can help:

• Zinc salts [R]
• Yin Zhi Huang, a chinese mixture of 4 herbs Artemisia capillaris, Gardenia jasminoides, Rheum officinale, and Scutellaria baicalensis. This remedy can help increase bilirubin clearance [R, R]
• Black cumin seeds (Nigella sativa) [R]
• Vanillic acid. It is abundant in Angelica sinensis, acai oil, argan oil, wine, and vinegar [R]
• Caffeine [R]
• Probiotics such as L. plantarum may prevent leaky gut caused by elevated bilirubin [R]

What is CIC?

 

[SwanRonson]

CIC = Chronic Idiopathic Constipation

I’ve done Ascorbic Acid in mineral water before. It worked great until it gave me gastritis, which led to shingles, which led to CFS. In a roundabout way my CFS started with Ascorbic Acid water for constipation. I’ve been scared of it ever since. It’s pretty hard on the stomach lining.

Thanks for the herbal recommendations. Much appreciated. I’ll give them a shot. I already dabble with caffeine.

 

[pamojja]

I’ve been scared of it ever since. It’s pretty hard on the stomach lining.

Sorry to hear about that terrible succession of events, admittedly a bit hard for me to believe being causal. Since I took 24 g ascorbic acid per day for the last 10 years (in my case it has been fundamental in experiencing remissions: PAD, COPD, T2D, finally ME/CFS too). Ascorbic acid is actually much less acidic then stomach acid itself (and one also could take pH neutral as sodium ascorbate). And one finds in the literature the clinical experience of Dr. Carthcart having given massive doses to 25.000 patients, for example in relation to the alleged side effect of kidney stones, without finding such severe side-effects:

http://www.doctoryourself.com/kidney.html
Robert F. Cathcart II, M.D. writes on “Why Don’t Massive Doses of Ascorbate Produce Kidney Stones?”

“Years ago when Linus Pauling wrote his book "Vitamin C and the Common Cold", the critics immediately labeled the taking of large doses of vitamin C dangerous because it would produce calcium oxalate kidney stones. This practice of telling people that vitamin C caused kidney stones continues today by the critics of vitamin C despite the lack of clinical evidence of kidney stones in people taking vitamin C.

“It was hypothesized that since a significant percentage of ascorbate was metabolized into and excreted as oxalic acid that this oxalic acid should combine with calcium in the urine and deposit as calcium oxalate kidney stones. It is true that those of us who take large doses of ascorbate have elevated oxalic acid in our urine but no kidney stones. With the millions of people in the world taking vitamin C, if vitamin C caused kidney stones there would have been a massive epidemic of kidney stones noticed by this time. There has been none.

“I started using vitamin C in massive doses in-patients in 1969. By the time I read that ascorbate should cause kidney stones, I had clinical evidence that it did not cause kidney stones, so I continued prescribing massive doses to patients. To this day (2006) I estimate that I have put 25,000 patients on massive doses of vitamin C and none have developed kidney stones. Two patients who had dropped their doses to 500 mg a day developed calcium oxalate kidney stones. I raised their doses back up to the more massive doses and added magnesium and B6 to their program and no more kidney stones. I think that the low doses had no effect and they, by coincidence, developed the kidney stones because they were not taking enough vitamin C.”

However, just came across a second report of it being detrimental to the stomach at the vitamin C forum, and worth to read for the speculations it's owner came up with: https://vitamincfoundation.com/forum/viewtopic.php?f=3&t=14308&sid=e2accb9848b1f023c2c0f4e7f479b819

In a roundabout way my CFS started with Ascorbic Acid water for constipation.

Think assigning the second link in the chain a causal role could be a big mistake. One would oversee why the constipation started in the first place. In the case of my father it was radiation therapy for a prostrate cancer. In your case it seems Gilbert's.

 

[PatJ]

Bile Acids are one of the big factors in stool softness and colonic motility.

Have you ever tried taurine for increasing bile output?

milk causes constipation worsening

It might be skewing your calcium/magnesium ratio. I think @pamojja may have implied this by mentioning the magnesium water.

 

[Archie]

It's somehow maybe catch 22 situation in some cases of low bile acid output. Liver & gallbladder gets impulses from what food ends up in our intestines, low fat diets might have negative effects to bile output, low cholestrol food might reduce bile...

I dont know does this implies to GS situations thought, but if you would take cholestrol lowering drugs and low fat diet it could seriously make things worse ?

https://www.atkins.com/how-it-works/library/articles/dealing-with-gallbladder-disorders

https://www.health.harvard.edu/heart-health/how-its-made-cholesterol-production-in-your-body


Probiotic mutaflor is know to reduce normal constipation, but i dont know does it help in cases like you have

So, if i understand this right , body needs bile acids to digest fats, and so if you cant have bile acids there, body gets less cholestrol/fats that are helping liver to produce bile acid.

 

[SwanRonson]

Think assigning the second link in the chain a causal role could be a big mistake.

To be clear, I'm not saying that VitC caused my CFS. I'm saying that the gastritis that resulted from the Effer-C I was taking started the chain of events (Gastritis->Stress->Shingles->CFS).

I do still take VitC. I just use the LivOn liposomal packets now.

Have you ever tried taurine for increasing bile output?

I used to take Taurine, but I never took it for bile acid support. Didn't know there was a connection there. Thanks for that.

 

[Patrick*]

I'me late to this thread, but adding my 2 cents now:

I have Gilbert's Syndrome and chronic constipation resulting in SIBO. I've known about Gilbert's well before my descent into chronic health issues in 2011, but I never developed a theory regarding how GS fit into the puzzle, so I never focused much on it.

Consistent with one of the posts above, I did notice a significant improvement starting about 2 years ago when I started taking caffeine mints, which also happen to contain taurine.

Any updates on Elobixibat? Did it continue to help?

 

[OK51MON]

Fructose malabsorption causes constipation

 

[Jwarrior77]

@SwanRonson Sorry for theses weird questions but how high was your bilirubin and are your stools pale? Also wouldn't taking ox bile supplements help these issues I'm slightly confused. Im having bile issues as well that's why I'm asking.