What Is Your Constipation Telling You About Your Overall Health And How To Fix It

You need to be able to evacuate your toxins, your metabolic waste. And the more that stool sits there, there are biochemical changes that happen in that stool that allow for the toxins and the compounds that your body didn't want anymore to leak back into your system.

Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's Pharmacy with an F-F-A-R-M-A-C-Y, a place for conversations that matter. And welcome to this special episode called House Call, where we dive deep into health conditions through the lens of functional medicine. And I'm here today with my friend and colleague, Dr. George Papanicolaou, and we are gonna get deep into the poop story. Or more importantly, why people don't poop, can't poop, have trouble pooping, and how to fix this terrible problem that affects millions and millions and millions and millions and millions and millions of people called constipation. Not a fun topic to talk about, but unfortunately, it's my favorite topic. because it's so easy to fix. And I just had this one patient who was so funny, I was going to quickly tell the story, then we'll jump right in, George. But she was like, so do you have regular bowel movements? She's like, yes, I have regular bowel movements. I said, how often do you go? She goes, I go every week. I said, that's not regular. She goes, it's regular for me, I go every week. And I'm like, whoa. So people have no idea what it's like to have normal bowel function. You should probably go two or three times a day, In modern industrial society, the average stool weight is four ounces. In hunter-gatherers who eat tons of plant foods and fiber, it's two pounds, which is eight times the weight of somebody who's not eating the right food. So I often hear from patients, Dr. Hyman, I didn't know that this was normal, that I could actually poop every day. So we're gonna get into it. So welcome, George. So let's talk about constipation. It's gonna be a fun conversation.

I just have to say, you're talking about the hunter-gatherer. I would have to say that the size of the toilet would have to have been the size of a dinosaur. All right.

That's right. Well, you see, like what is it? The elephants who ate like hundreds of pounds of roughage and fiber every day. I think they poop poop like 50 kilos a day or something ridiculous like that. So tell us about how common is this and what is going on?

It's a really it's a really common problem. About 80 million people per you know, the prevalence is very high. So 80 million people are going to suffer with constipation and It gets worse as you get older. And it's an $800 million business, and that's an underestimate because it doesn't include the over-the-counter meds. So it's only $800 million that's being spent to have a nice bowel movement.

Well, you mean from with doctors. You're not talking about like the stuff you get over the counter like X-Lax and Senokot.

That's what doctors, and I said it's an underestimate, because it doesn't include the OTC meds.

The over-the-counter meds you get in the grocery store, which is probably way more than that, right? So tell us what are the complications of constipation and why is it bad to not go regularly? Why is constipation bad?

Yeah, so first off, what is not regular and what do people consider constipation? Why is it something that people are, you know, we see people with gut issues, and constipation, almost one out of every three patients of mine, no matter what they're coming for, has a gut issue. So gut issues in general are just prevalent throughout the world, quite honestly, because we get people from all over the world in the center. So I'm always dealing with gut issues, particularly constipation. This constipation leads to bloating and distension, and then people identify foods that cause their constipation. Then there's food fear and anxiety. and it just begins to really take a toll on people's lives. And so it is a really big deal. What's a normal number of bowel movements? Now, I was taught anywhere from three bowel movements a day to one bowel movement every three to five days.

Ah, no.

Yeah, that's what I told a long time ago. But the most recent study using the most respected tool for determining, studying this called the ROM3, identified constipation is less than three bowel movements a week. So in conventional medicine, that's what is defined as less than three bowel movements a week for more than three months. I would know so.

Well, when you get constipated, it causes other health issues. So why is it bad to be constipated? Okay, so I go three times a week. I go pretty regularly. Why do I care?

Okay, I think there's two ways to look at that. One is that not like once I'm constipated with the problems, but what got me to being constipated in the first place. And that goes back to what we always talk about is how you live. It goes back to lifestyle, it goes back to nutrition, it goes back to stress, it goes back to exercise, Just to name three of the lifestyles that are most impactful. If you're not getting good exercise, you're not getting good sleep, you're not eating nutritious, you're going to be in a position to end up with gut issues, including constipation. How you got there is really important because if you've got constipation, that's just the beginning of the problems. And then once you have the constipation, the problem is that you need to be able to evacuate your toxins, your metabolic waste. And the more that stool sits there, there are biochemical changes that happen in that stool that allow for the toxins and the compounds that your body didn't want anymore to leak back into your system. And when that happens, then you begin to impact your immune system, you begin to increase inflammation. And as we always talk about, that inflammation begins to have an impact on every organ system in your body.

Okay, so bringing it down, there's really two main issues. One is just the direct harm from being constipated, which includes hemorrhoids, anal fissures, anal prolapse, pain, and also just feeling like crap because you're full of crap. You're full of crap. And you're literally reabsorbing a lot of the toxins that get excreted by your liver right into your intestinal tract. You're reabsorbing them. You're also affecting your hormonal metabolism and you're producing all these products in there that are getting absorbed. And what's true about your gut is it's a whole ecosystem of bugs in there that has to be healthy. It's like a garden. And if the garden isn't healthy, you're not healthy, your immune system's disrupted, you're toxic, it creates brain inflammation, it creates systemic disease, heart disease, cancer, diabetes, Parkinson's, I mean, Parkinson's disease, you're 400% more likely to have Parkinson's disease if you're constipated. And we know that Parkinson's disease is related to environmental toxins. So not only are you having this sort of anal and physical issues of being constipated, not only do you feel like crap, but it has long-term risk for many, many chronic diseases. So it's really important to go and go often and go every day or two or three times a day. And once you understand how to regulate your gut and fix the causes of constipation, then you won't be constipated. And most doctors just give you laxatives or tell you to have more Metamucil or fiber, and that can be helpful or drink a lot of water, but there's so much more to it. So tell us, what is the conventional medicine approach to constipation. And then let's talk about what the functional medicine approach is to constipation.

In conventional medicine, again, it is the name it, blame it, symptom, and treat it. And so, they treat the constipation. And so, over the counter, you can get all types of different products that will be either there'll be bulking agents, you can have, laxatives that bring more water into your stool. You can have lubricating agents. All these are available. All they do is get the poop out. That's it. And make you feel more comfortable, but it doesn't solve the underlying problem. Then for people with what's called chronic idiopathic constipation, which is the most common idiopathic means, by the way, I don't know. Right? So, I don't know why you have it, but I'm going to give you a really expensive drug to make your bowels move. And so, there are really expensive drugs on the market that stimulate the receptors in the bowel to get them to move so you can have a bowel movement. So, that's the conventional approach. Let's get it out and let's make the bowels move faster so that it will come out. But we're not going to look at the underlying root causes of why the person is constipated. Nor are we going to think about the downstream effects of that constipation, not only of the constipation itself, but to get to that constipation, again, it goes back to the fact that it's this long-term inadequacy of your diet, the long-term impact of stress that results in constipation, But what you can't see is the impact it's having on your brain, the impact it's having on the blood vessels of your heart, the impact it's having.

On.

Your immune system. So on the functional medicine side, that's what we do. We begin to focus on nutrition, stress, lifestyle, exercise. We begin to change people's lives so that they're living healthier, and therefore the constipation can resolve on its own. Yeah.

Well, before you jump into that, I want to talk a little bit about the problems with traditional treatments because, yes, it's fine to take extra fiber and so forth. All times that have weird artificial sweeteners in it and stuff is weird. You can take mineral oil, which is fine, but that's kind of gross. You can take various laxatives, and some positories. A lot of the treatments can be very dangerous, like Ex-Lax or Senokot or Cascara, things that are even considered natural because they create a lazy bowel. So, people who have been constipated a long time, they take these drugs which work for their body and even smooth move tea, which is fine for an occasional issue, but these things become habit forming and they cause a lazy bowel and people can get something called megacolon where they literally cannot eliminate without these these things that people get reliant on enemas or they get reliant on colonics. And the truth is, unless you dig down into the root causes of constipation with a functional medicine lens, all these things are just like Band-Aids and they often are harmful, not helpful.

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Let's look down into, you know, from a functional medicine perspective, how do you identify what's causing a person's constipation? What are the tests you do? How do you think about it? You know, what are the main causes of constipation in our patient population?

Yeah, so the main causes of constipation are going to be, one, I'd say there's food sensitivities, so not being aware of food sensitivities and that can create inflammation and alter the function of your gut. There's going to be nutritional issues, like you're just not getting enough fiber. I know you talked about using exogenous fiber to treat the constipation, but you don't get into that. into that situation if you're eating foods that aren't processed. All the processed foods that we eat don't have any of the indigestible fiber that's required for the stool to form correctly and also to maintain a healthy gut microbiome. So, again, it goes down to some nutritions involved. what else would be some causes?

I think there's a lot of causes. Let's just go through them. So you've got things that are often missed like thyroid, right? You've got low thyroid function as a big cause. Lack of magnesium, which is a huge issue for people. I think 40% of the population is low in magnesium and that can drive constipation. People often have yeast issues from taking lots of antibiotics. which can be a big factor in constipation, the cause of dysbiosis. Dairy is the number one cause of constipation in kids and not only constipation, but anemia because the dairy irritates the guts of these kids and causes blood loss in the stool. So constipation from dairy is a huge factor. So we've got a lot of things we think about. It can be also things like heavy metals, which are factors that can impair gut function or even weird things like tick infections.

Oh yeah.

Cause a neurologic problem in the gut that help damage the neurological pathways that cause peristalsis and that leads to constipation from tick infections. So from a functional medicine perspective, we really dive deep into figuring out what's going on. And the treatment is often so easy and so effective. And we really start with the foundational things, right? We start with diet and then we go on to the use of specific supplements and other things that can help fix it. So take us through this patient you had, and then let's dive deep into the story of what are the real treatments that we find so successful in rebuilding someone's gut so they have healthy bowel movements and have health as a consequence.

So the patient that I had, she was a 19-year-old nursing students who came to see me and she had had prolonged shed constipation after prolonged use of antibiotics for recurrent urinary tract infections. So interestingly enough, she was, you know, at the end of her first year of nursing school, lots of enormous stress. Tests she had to pass to be able to continue the nursing program, she was in a A new relationship, and her diet was really not very good. She was under a lot of stress. She was eating poorly. When she came to see me, she had significant constipation. We do some tests that really help us get down to the root problem. We do that complete diagnostic stool analysis that allows us to look at the microbiome, so we're able to see if you have a balance of your good and bad bacteria. we're able to see if you picked up any bad guys along the way like parasites and worms that can impact your gut function. And we look to see if you have all of the markers for healthy digestion, which is really key. So we're able to see if you're making enough of the pancreatic enzymes you need, is your gut detoxification working correctly, is your gut immune system working correctly, or markers of inflammation high. That gives us a complete picture of what's going on in your gut. We also look for something called leaky gut, that when you have enough inflammation, you have enough destruction of the mucosal membrane, you'll end up breaking down those gates that are responsible for keeping the bad guys out, letting good guys in, they're called tight junctions. And when those aren't operating, then bacteria and compounds and toxins can get into your system and trigger lots of inflammation. and disease. So we do those tests. We look for food sensitivities. The most common ones that we look for are going to be gluten, gluten cross-reactive foods that will include egg and dairy and soy and rice because they will act like gluten in your gut when you're sensitive to them. And those will be produced when you have leaky gut. So I did all those tests on her. and did I do any other tests with her? I just have to remind myself that was the, those are the tests that I did. And so what we did for, you.

Know, bacterial overgrowth, you look at stool, food sensitivity testing, right?

Yes. We did all that testing. And so what I found, what I found with her is that she did have significant leaky gut, and she had something that's called SIBO. She had the bacteria that lives in your large intestine, it's just should just live there, had migrated up into her small intestine, and now it's where we don't want it to be. All that digestion and fermentation should happen in the large intestine, that very thick walls, and now it can maintain all that fermentation without you experiencing discomfort. But when you're doing fermentation in a small intestine that has thin walls, that fermentation starts to happen, the gases build up, you get bloated and distended. And if the bacteria that's causing that overgrowth happens to be a methanobacter and produces methane, those organisms are more, they will slow down gut transit and that will lead to constipation. and oftentimes those people get labeled irritable bowel syndrome with constipation. And in conventional medicine, we put on medications like Lufesse, which will get the bowels to move but not solve the problem, which is bacteria in the small intestine. So in her case, we treated her small intestine bacterial overgrowth with herbal antibacterials, We treated her leaky gut by using something called L-glutamine, which supplies nutrients for the gut to heal. I use curcumin as well because curcumin can actually impact and regulate the tight junctions we talked about and begin to heal the leaky gut. So, you know, we took care of a leaky gut, we reestablished a good gut microbiome, and then we helped her understand the importance of her nutrition. Then I talked to her about getting more of the high fiber foods that she needs to get into her diet. Nuts, seeds, beans, chickpeas, chicory, dandelion root, onions, garlic, which she can't get right away. We had to increase her fiber after her SIBO was treated because some of those foods will actually exacerbate her symptoms. Once we treated her SIBO, once we took care of the dysbiosis, then we talked to her about the lifestyle changes that she could make, which included higher fiber with the foods I just mentioned, which included making sure you did drink enough water because water is important. You need that water in the stool to make it fluffy and move quickly and easily through the gut and finally out through the rectum. Because if you have hard stools, they're really uncomfortable. And lots of times people call constipation hard stools. I just have hard stools. I have them every day, but they're hard. And that is constipation to some degree, and it's uncomfortable and painful, but that is because they're just not drinking enough fluid, they're not getting enough fiber. Now, going back to Neanderthal man, His poops are really big because he was getting 150 grams of fiber a day. Today, less than 5% of the American public gets the amount of fiber they should, which is anywhere from 20 to 40 grams of fiber. Most people are getting about 8 to 10 grams of fiber per day. It has a lot to do with why we're having gut problems, dysbiosis, because that fiber also, when it's broken down, produces a lot of nutrients that are good for the colonocytes and good for the healthy bacteria so that they can maintain a good robust population. So, we fixed those things in her and her constipation was gone within six weeks.

Yeah, it's pretty amazing. I see this too in my practice, George, and we really take a comprehensive approach. It's the obvious things, right? Eat lots of fruits and vegetables, nuts and seeds, high fiber plant-rich foods, drink lots of water, get exercise, all those things really help. Medications are a huge factor sometimes. Iron supplements, blood pressure supplements, narcotics, diuretics, these are common medications. They will cause constipation, you have to work around them. Make sure you check your thyroid, make sure you check for diabetes because that can affect the neurological system. Heavy metals can be a factor. Even tick infections we talked about, and even things like the dysbiosis and yeast from eating all the antibiotics and processed foods. So all these things we want to think about. And then, you know, often it's, you know, in terms of supplements, there's some really simple things to do. Magnesium is a big factor. I had a patient who was, like, literally going every week. She had terry migraines. She had all these other magnesium deficiency symptoms, muscle cramps, insomnia, anxiety, palpitations. And I gave what was equivalent about 2, 000 milligrams of magnesium because that's what she needed in order to actually get her to poop. And, and in more time, she needed less and less. We gave her probiotics. We gave her extra vitamin C, which will help you poop. We can use things like fats. Fats are so great. They're a lubricant. MCT oil, which is basically derived from coconut. We, we say, we often joke and say that causes disaster pants, because if you take too much of it, it'll have empty poop. that's a good thing. So we really need to understand how to rebuild our whole gut using a comprehensive approach, looking for the causes and obviously getting rid of all the crap that makes you constipated. So that plus exercise, stress reduction, it's a comprehensive approach. I can tell you there isn't a single patient I've been able to help poop every day over 30 years.

Yeah, I will tell you it's one of the most fulfilling things that I treat because I can get it better, and do it frequently. I know when I'm helping somebody's gut get healthier, I am helping them prevent significant disease down the road because a healthy gut, as Hippocrates said, death begins in the gut. Because long-term negligence in your nutrition and your lifestyle is going to lead to an unhealthy gut, and the inability for you to get rid of toxins, to absorb the nutrients that you need that keep you healthy.

Yeah, that's right, George. And that's a very important point I want to emphasize in functional medicine. It's not just about treating your symptom of constipation, it's understanding how it connects to everything that can go wrong with your health. So being constipated is not just annoying or uncomfortable or pain, but it's actually something that's setting you up for really poor health outcomes across the spectrum of disease, whether it's heart disease, cancer. I mean, if you're constipated, you're more likely to get cancer. of the colon, for example. So it's really important to get your gut healthy. And we've done many podcasts on the gut. This is another one that focuses specifically on constipation. But I feel using a functional medicine perspective, using the kinds of thinking we use in functional medicine here at the Ultra Wellness Center, using the diagnostic tests that we do, which are quite different than traditional medicine. We look at bacterial overgrowth, we look at stool testing, we look at nutritional testing. We can really figure out what's going on with people and help them when no one else can. now doing stuff on Zoom. It's really awesome. And we can treat people from all over the world. And it's pretty, it's pretty really fulfilling because we can really help so many people who just don't get help anywhere else. And my, my goal is really to end needless suffering for millions of people through the power of functional medicine. And it works, and it really does work. And I, I think that, you know, the work we do here is just so gratifying for all of us who work there. And I think our patients are so happy, and I just I'm really glad to be able to share some of the knowledge of stuff we're doing with all of you because I just want people to know that there is an answer often for something that's causing you suffering that you might not be hearing about, that you might not be hearing about at your traditional doctor. So, I really am excited for you, George, that you've given us this deep dive into poop. And I'm excited for the next podcast with you. Right now, this is more important than ever to regulate your gut and immune system because they're connected. And in time of COVID we really want to double down on getting our.

Gut healthy and fixing our gut. Am I getting it? Am I getting a ticket to Hawaii.

For the next podcast? No, you're not getting a ticket to Hawaii. But, I'll show you the beach if you want. So, thank you, George, for joining us on the Dr. Schatz's Pharmacy once again. It's been great great having you. If you love this podcast, please share with your friends and family on social media. Leave a comment. Tell us how you've dealt with your constipation. Maybe we'll learn something from you. Subscribe wherever you get your podcasts, and we'll see you next time on the Doctor's Pharmacy.