Getting Unstuck: Constipation with Esther Blum, RD

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm bringing back an old favorite episode because today I landed in Paris for a well-deserved vacation. If you are a listener in Paris, je serai là jusque 2 juillet, alors n'hésitez pas à me contacter à mon adresse email dans les notes du programme si vous avez envie de se rencontrer. Pas pour un rendez-vous professionnel, mais juste pour se rencontrer ou boire un café ou un coup ensemble. On another note, I'm still looking for a summer intern to help with the podcast editing and promoting it on social media. If you are, or you have a college student in your house who needs something to do over summer break, please reach out. My email is Lindsey, L-I-N-D-S-E-Y, @highdeserthealthcoaching.com. So my guest today, Esther Blum, is an integrative dietitian and high-performance coach. She has helped thousands of women permanently lose weight, eliminate the need for medication, lose stubborn belly fat, and reverse chronic illness. Esther teaches her clients to cultivate a warrior mindset when it comes to healing their relationship with food and unconditionally loving their bodies. Esther is the bestselling author of Cavewomen Don't Get Fat, Eat, Drink, and Be Gorgeous, Secrets of Gorgeous, The Eat, Drink, and Be Gorgeous Project, and most recently, See Ya Later, Ovulator: Mastering Menopause with Nutrition, Hormones, and Self-Advocacy. Esther has appeared on Dr. Oz, The Today Show, and Fox News Live. And if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, hop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show.

Welcome, Esther. Thanks for coming on the show.

Thanks, Lindsey, for having me.

So today we're going to be talking all about constipation, and I remember you were really excited when I suggested the topic. Why is that?

Because constipation is a big problem when it comes to bloating, sleeping, balancing your hormones, detoxifying and eliminating excess waste products. So it's a really important part of daily necessary functions in your body.

Great. Well, I'm excited to talk about it. So let's start out by just— let me ask you how you defined constipation.

So constipation is not having one or more bowel movements every day. So even if you're going every other day, every third day, every fourth day, you are definitely constipated. And in spite of what your doctor tells you, it is not normal. Normal is often given as a term for people who experience the same thing. That doesn't mean it's normal or regular. And when your doctor says, oh, well, if that's your typical pattern, then that's normal for you. Nope. Still not okay. I liken this to taking out the trash. None of us would sit and leave big smelly piles of trash in the middle of our kitchen. When the garbage gets full, we take it out. Our bodies are no different. We need to actually take out the trash every day, sometimes 1 to 3 times a day. That is removing waste products. If you do not remove these waste products, they are sitting inside of you. So you've gotta get 'em out.

Okay. And does it matter what the consistency of your stool is to call it constipated?

Usually if they're hard to pass, if they're ball-shaped and very hard stools, that is the definition of constipation as well.

Okay. So what are some of the underlying causes of constipation?

First and foremost, stress. You know, if you're holding things in, if you're holding onto your stress, you can be very constipated. I remember when I worked in the hospitals, the nurse manager I worked with, she would only poop on the weekends when she sat and had time. Mm-hmm. And the— during the week, she would never poop at all. She just didn't even think about it. Her body didn't work that week. She was holding on to all of her stress. So the underlying causes. Okay. So poor liver function, poor gallbladder function. You need to release bile acids in order to be able to stimulate digestive juices and break down your fats and your nutrients. So you wanna make sure your gallbladder's functioning. Like if people have pale colored stools or ball-shaped stools, that's usually an indicator your gallbladder's not firing properly.

And the gallbladder holds the bile which digests fats.

Absolutely. Other causes of constipation are not getting enough fiber. So if you're eating a lot of bread, just white bread, white flour, you know, flour and water makes paste. So it really gums up your inside. I had a woman come to me, her testimonials on my website, her name's Denise. Denise came to me with a white flour diet and was so severely constipated that she had many surgeries and severe, severe diverticulitis and was in pain all the time and had not had normal bowel movements for over 10 years. And once we started working together and changed her diet and also cut back on her booze intake, within 1 month she had bowel movements every day after all the trouble she went through. You wanna make sure that you're getting a lot of fiber. You wanna make sure that you're getting at least 20 to 40 grams of fiber. I say 20 'cause start slow. If you're not eating any fiber and then you hit the gas pedal hard, you could have a lot of gas and bloating and discomfort. So you have to build up your fiber intake, but you really wanna make sure that you have digestive fires while you're making good amounts of hydrochloric acid in the stomach. And the ability to do this declines over the age of 30. Our hydrochloric acid production declines with age. So taking apple cider vinegar in water with meals Not diluting your digestive juices, like not drinking too much water with your meals, actually really helps digestion. You can take digestive enzymes with your meals. You can take hydrochloric acid, or if you've had your gallbladder removed, you could take Ox Bile to stimulate gallbladder, the release of bile through your gallbladder. You can also take what's called Swedish bitters in water about 10 to 15 minutes before a meal to stimulate digestive juices. And you can also chew your food really, really well. Most people don't realize that digestion begins in the mouth. And so you really, really have to chew your food until it's a slurry, it's the consistency of baby food before you swallow it. I read today actually that one of the most undigested foods was quinoa. And no surprise because quinoa is a seed. And most people are not really chewing nuts and seeds into a fine paste. So it's just a great example of the need to chew your food, especially if you notice you're passing particles of undigested food. Corn aside, corn is normal. It's pretty normal. Sorry to use the term normal after I disparaged it, but it's hard to digest corn really well for a lot of people. But the better you chew your food, the better you enhance your chances of digesting better, getting your hydrochloric acid acid production going.

If you're trying to find out how long it takes stool to get through your body, corn is a good, um, marker for that.

Yes. Corn and beets. You can track your transit time with either of those. Yes.

And, and what, what's an ideal transit time?

24 hours or less.

Okay. Were you gonna say something else about other underlying causes of constipation?

Yeah. I mean, stress is huge. Like a lot, how many times have you eaten a meal and had a really stressful conversation, right? When you were little, maybe your parents scolded you at the dinner table, or you, you know, as you're older, you get arguments with a spouse or a child at the dinner table and stress. When you're really stressed, your digestion shuts down because if you are in a fight or flight state, your blood is gonna rush to your extremities. It's gonna leave your stomach. It's gonna leave your digestive tract to go to your extremities because this is a function of evolution. In hunter-gatherer times, during Paleolithic times, we have the choice of often sleeping through the night or fighting off a saber-tooth tiger or trying to protect our family and ourselves from danger. So when you're in a fight or flight response, you know, you're— the last thing your body needs to be thinking about is digesting food. So if you are stressed out and you're trying to digest, it's not gonna happen. You're not gonna make your digestive enzymes that you need during a meal. So you really wanna make sure that if you're stressed, you don't eat, you don't try and eat and digest, just put the food down, walk away, and come back to it later, or you do some deep breathing, diffuse the stress situation, and then eat, and then you'll be much better off. So all of those can contribute to constipation. It's sometimes it's obvious things and sometimes it's more subtle things.

Okay. So you touched a bit on fiber and diet changes. So what kind of diet changes would you recommend to people who are constipated?

That you start shopping on the perimeters of the grocery store. The perimeters of the grocery store has all the fresh produce. It has meats and poultry and eggs, and it has vegetables and fish and fresh fruit. Fresh fruit can solve more constipation issues than anything else, but getting lots of veggies in as well and getting in starches from real whole foods like sweet potatoes and white potatoes and winter squashes. Just eating real food will solve your constipation issue. Eating fruit on an empty stomach will often solve your constipation issue as well. And then maintaining and bulking up your bowel movements to decrease their transit time, that's when fiber really shines. So getting in some chia pudding, you know, couple tablespoons of chia seeds has 8 grams of fiber, same with flaxseeds. And if you soak chia seeds, you mix chia seeds in a small mason jar with like 3/4 cup of almond or cashew milk, shake it or stir it vigorously and let it sit for 12 hours and then consume it. It forms this gel in your intestinal tract. So it's like liquid plumber for your intestinal tract.

Mm-hmm.

And it moves your— it bulks up your stool with fiber and moves it through, you know, within a reasonable amount of time.

Yeah. I actually had pancake this morning with 3 tablespoons of flaxseed. So I look forward to a nice solid stool this— this evening or tomorrow.

Yeah, exactly. Exactly.

And so do you recommend added fiber sources other than those sort of whole food types like psyllium husk or anything else like that?

If necessary, yes, but I recommend you really start with the basics first. Start with your diet. Start with some chia or flax pudding. Start with getting sweet potatoes. You know, one sweet potato has 6.5 grams of fiber in it, especially if you eat the skin. Eat apples with skins, grapes with skins. It's really, the funny thing is like people make it so complicated and they take all the fiber pills and laxatives and this and that. It's like, start with what you're eating first. If you can't digest raw vegetables, if they really bloat you, then cook them and puree them or roast them and puree them. Make them very easy to digest. And add in some digestive enzymes in the beginning if you can't, you really can't break down your food and you're really, really constipated. But most of the time I've never had anyone not respond to what I'm telling you now. Like it's really ridiculously simple.

Yeah. In terms of getting enough fiber though, I do find that if you're just eating fruits and vegetables without having any beans or legumes, it's pretty hard to hit like those, even the RDA, which I think for women is, is it like 28 and men maybe it's closer to 40 or—

Yeah. Again, I would tell you in that case to add in beans and legumes. For some people, if you're on a strict paleo diet or autoimmune protocol, you may not tolerate beans or legumes. But for the average Joe who comes in, you know, adding in beans and legumes really makes a huge difference. That has a ton of fiber too, for sure. And if you are on an autoimmune protocol and you can't get all the fiber from you know, legumes, or it's hard for you to get from your diet, then yes, you can add in some psyllium powder. But most of the time, honestly, I start looking at nutrient deficiencies as well. Magnesium deficiency is one of the most common nutrient deficiencies that we have, and magnesium is a vasodilator and a natural laxative without giving you a lazy colon. And so taking magnesium. I like magnesium citrate or magnesium glycinate as an extra added form of magnesium, and that also helps alleviate constipation, promotes a great night's sleep, helps with migraines.

Yeah, my general understanding is the magnesium citrate will help you move your bowels, but the magnesium glycinate will not do that.

Magnesium glycinate still works in constipation, and it actually does so without causing diarrhea. So if you're more prone to diarrhea from magnesium citrate, the glycinate is just better absorbed.

Right. Okay.

And I like glycinate 'cause it treats anxiety too.

Hmm. Nice.

Yeah.

So what kind of dosages do people typically need in order to get their bowels moving of magnesium?

So I start people at 400 milligrams. If they have really stubborn constipation, I'll go up to 800 milligrams and I couple that with vitamin C. To the tune of 1,000 to 3,000 milligrams. This is a great post-operative constipation protocol too, where the pain medicines often cause severe constipation, right? And cause the bowel to shut down. And if you're post-operative and you've been under anesthesia, you know, it takes a while for your intestinal tract oftentimes to wake back up. So I will dose people up to 10 grams of vitamin C. And 2,000 milligrams of magnesium under like really severe constipation cases. I would also be negligent if I didn't mention prunes. Prunes are another great laxative for a lot of people and get the bowels moving. So do dates, it's another great laxative.

Applesauce works really well too with little kids, I've noticed.

Yeah, applesauce is really good too, for sure.

So I have come across some clients who can't tolerate fiber at all. In any form from food or supplement because it just constipates them more. So how do you reintroduce fiber to someone who is constipated?

Making sure they're adequately hydrated. And so dehydration is another big piece of constipation because fiber draws water from the colon. So if you are adding in fiber and you're not increasing your fluids, it will just sit there like a rock in your gut. So you absolutely have to have adequate hydration.

And what does that look like?

So on average, the average person needs— you, you take your body weight and you divide it in half and convert it to ounces. So if you're 160 pounds, you need 80 ounces of water. That's 10, 8-ounce glasses. And for every 20 minutes of intense workouts, you need another 8 ounces. And for every cup of caffeine you drink, you need another 8 ounces.

Beyond the 8 ounces that came with your coffee.

Yeah, exactly. Exactly.

I like to drink water. I drink water all day long, but I really only can drink a lot of water when I'm eating. Like, I'm not the kind of person who could just sit there and down an 8-ounce glass of water by itself. So I always find it a bit challenging, the idea that I sh— I shouldn't be drinking water, a lot of water with my meals, because that's when I most want to drink water.

Mm-hmm. Again, I don't recommend chugging 8 ounces all at once for water. I kind of recommend having a full glass at your desk or in your car and sipping it throughout the day. You absorb it much more efficiently that way.

Yeah, no, that's pretty much what I do, but I also do drink a lot of it with meals, which probably is part of my digestive issues, but I just can't break the habit.

Yeah, you do have to train yourself for sure. I've trained myself over the years, but it takes time and practice.

Okay. So are there lifestyle changes that you recommend to people who are constipated?

Yeah. Waking up and walking first thing in the morning. Is wonderful because it's a gentle massage to your intestinal tract and your colon and the movement or certainly if you're a runner, you're definitely gonna get a good amount of movement in your intestinal tract there. Drinking warm water with lemon upon arising also gives your gallbladder and your liver a good flush. One of my favorite remedies for constipation is celery juice and there isn't a lot of clinical research to support it, but anecdotally in my practice, I've seen it work really well. Because it also gives you a good liver flush. So, on an empty stomach, you wake up, you cut off the base and the tips of an entire bunch of celery and you wash the stalks, you run them through a juicer and you drink the contents of that stalk of celery. It's usually around 12 ounces of juice, celery juice. You drink that, you wait 20 minutes, and then you carry on with your regular breakfast or your exercise or however that works. And that also in time alleviates constipation. And/or eating fruit on an empty stomach will also help alleviate constipation first thing in the morning.

Does exercise in general just help with constipation?

Yeah, totally, because you're moving your body. Like, you're not supposed to— the human body is not designed to sit all day. It's supposed to be moving and active, you know. If you're just lying in bed or just sitting all day, your intestines aren't moving around. They're not getting any stimulation.

Yeah. It also helps with back issues. My physical therapist tells me I need to get up every 20 minutes. I've got my alarm set 'cause I've got sciatica. I've got my alarm set for every 20 minutes where I have to stand up and stretch my back out and make sure I'm not getting compressed.

Yes. And as much as possible, you know, you can even get like a desk tray for your desk to, so you could stand while you do your work.

Yeah, that would be a bit challenging, but maybe for other people.

Yeah. Yeah.

Okay. So one of the reasons that I know some people develop constipation, including many people I know and/or am related to, is because they don't like to poop in public places and they're stuck at work or school all day. So how do you address those kinds of challenges?

Yeah. So you really have to start with toilet hygiene and you have to start practicing, you know, training your body to poop. First thing in the morning before you get to work. And so, you do that with taking 400 to 800 milligrams magnesium at night before bed so you wake up and have bowel movement and then you have some celery juice in the morning to clean you out. And, while you're waiting for those things to take place, you should absolutely just go and practice sitting on the toilet for 20 minutes and just reading. Women are not accustomed to reading on the toilet. Seems like men are better at this.

I think with cell phones that's changed.

Yeah, right. That's true. That's true. And oftentimes, like, the bathroom is the place you get away from your kids, and especially once they're not toddlers, they don't tend to bother you there so much anymore. Yeah, it's habit. It's building the habit. And I'm someone who before COVID was traveling a decent amount, or just— but always my toilet hygiene's so good, I just kind of— I wake up and just poop. That's it. Like I wake up, go to the bathroom and poop, and then carry on with my day. And then I'll poop again, like after breakfast. So it's just gotten me in the groove.

I just sit down and start checking my email and eventually it comes along.

Eventually it goes.

Yeah. And it's actually one of my favorite moments of the day.

Oh, well, good for you. That's awesome.

Yeah. You talked a bit about a client with diverticulitis, and I know that when constipation is left unchecked, that is one of the consequences, diverticulosis, diverticulitis. So can you just define those and tell a bit more? How you work with clients with those conditions?

Yeah. Diverticulitis— well, diverticulosis is sort of an outpouching along the walls of the colon. And so food can— small undigested particles like seeds, for example, or just undigested, poorly digested food can get caught and lodged in those outpouchings. And inflamed and infected and super painful. So how I treat that is, again, I change diet first and foremost, get people on a whole foods diet, get them off processed foods, get them off pizza, get them off dairy and gluten. Dairy in particular can be very binding, and so can flour products. So I get people off all of those things and introduce more real food protein broth-based soups, things that are really easy to digest, stews with vet— cooked vegetables, things are easy on the digestive tract. And then we'll start adding in digestive enzymes. I will add in magnesium. I will add in celery juice, things that make the stool soft and easy to pass, but still well-formed. And then fiber.

And that'll give them a chance to heal up the diverticulitis. And then you can transition them back to a more normal diet.

Yes, absolutely. And you don't even have to give up nuts and seeds if you have a history of diverticulitis. As long as you chew it well, there's no need to have to give them up.

I have come across clients who were told that by their doctors and I said, no, I think that advice has changed.

Yes, correct.

So are there any pathogenic bugs or organ-related issues that tend to go with constipation?

Yes, but typically with parasites and pathogens, I tend to see a lot more diarrhea than constipation. Constipation.

Okay. H. pylori though is one that often goes with constipation.

I see a lot more heartburn with H. pylori than constipation. I see a lot more gastritis and inflammation. It can happen, but it's not typical.

And then what organ-related issues often go with constipation?

Well, there's certainly a lot of intestinal bloating that happens with constipation. Pain, gas, it's usually in the intestinal area. But from an endocrine standpoint too, if you are not— let's say you are someone suffering with a lot of menopausal symptoms and you are constipated, and let's say you're on hormone replacement therapy, or even if you're just on the pill, you're gonna really suffer because you have to poop. Pooping, eliminating helps what's called phase 3 detoxification take place when you're able to excrete and eliminate external exogenous hormones. Left unchecked, they can really build up, and high amounts of circulating estrogen can make you more prone to breast cancer, for example. Too much circulating progesterone can make you very irritable and give you breast tenderness. So you really wanna make sure that you are eliminating every day so that you're not bloated, you're not having menopausal symptoms, you're able to metabolize and excrete excess hormones.

I was actually getting at with the organ-related more like how the gallbladder's involved, how the liver's involved, all those other organs that relate to digestion.

Yeah. Well, if your liver is not functioning properly, your liver is where your hormones are detoxified. So somebody with a fatty liver can often be constipated. A fatty liver is a poorly functioning liver. The job of the liver is to clean up and remove toxins from food, from the environment, from poor metabolic pathways of your hormones. So if those are not functioning properly and your gallbladder is not stimulating, getting stimulated when you're eating, then yes, you will definitely be constipated and super uncomfortable. So we do have to clean up a fatty liver with a lot of fruits and vegetables. And I do limit and decrease protein when I'm cleaning up a fatty liver for a couple months, 3 to 6 months, and then I'll gradually ramp up again.

What level of protein would someone wanna decrease to?

So I would have them have protein 0 to 1 times per day. That's it. If you have a really fatty liver, you're having a hard time losing weight, you're sluggish and exhausted. I see how people do without protein. I'll switch them to strict plant-based for at least 30 days. If they really can't take it after that, I'll add in protein 1 times a day, 2 times a day. But ideally, if someone tolerates it, I'll put them on plant-based for a good 3 to 6 months and they usually lose weight during that time. Their digestion improves, their skin clears up, and then I'll add back animal protein when they can handle it, when the liver can properly digest and handle what's put in its way.

Earlier you were mentioning stomach acid and betaine HCl. So can you talk a little bit about how you would have people supplement with that? Yeah.

I prescribe a few different types of digestive enzymes, but usually, so it depends. If someone has H. pylori, often the gut wall is very thin and, and betaine HCl can be more inflammatory. Towards that. So we have to heal that H. pylori, kill and heal it first, and then I can add it, betaine HCl. If someone does have H. pylori, then I will give a broad spectrum digestive enzyme just without HCl. And so it will have amylase, it will have protease, it will have all sorts of digestive enzymes, but just not from hydrochloric acid.

Do you do a challenge test for people who seem to have low stomach acid?

No, I do a stool test and I'll look for SIBO. I do a GI map test on my patients and I look for SIBO. I look for H. pylori. I look for, uh, what their calprotectin is, what their IgA is. I'll look at their status of their good bacteria. I look at any bacterial overgrowth that's headed in the wrong direction. And so that's how I will check.

Yeah, that's a good one. Okay. So I know that betaine HCl is not advised for some people, like if you have Barrett's esophagus, for example. What other conditions might preclude the use of HCl beyond that and H. pylori? And what are some alternatives to adding in stomach acid if it seems to be deficient?

None that I know of. I really don't, you know, most people tolerate HCl incredibly well and actually feel way better because they're actually absorbing their nutrients for the first time in a really long time. And we need hydrochloric acid in the stomach. Most people are terrified of it. They're terrified of stomach acid and they say, "Oh, I have heartburn. I can't— I have too much stomach acid." Heartburn, it's not caused by too much stomach acid. It's actually caused by a deficiency. You need adequate, if not optimal, levels of hydrochloric acid to keep the pyloric sphincter closed between the stomach and the esophagus. And you need adequate levels of zinc also to keep the flat closed. So most people do very, very well with hydrochloric acid. If you have Barrett's esophagus, then go with the whole foods approach, you know, do some celery juice and just do some plant-based digestive enzymes that, you know, pineapple and papaya are incredibly rich in digestive enzymes. So have a cup of those before each meal and you can have lemon and lime juice in your water. Fresh lemon and lime.

I was in Cuba over Christmas and every day they would put out a beautiful plate of fresh fruit, including papaya, often pineapple. And I just thought, this is how they eat, right? Like naturally they're eating in a way that promotes good digestion. And we just don't do that in the US.

No, we don't. And we combine a lot of different foods. You know, fruits really are digested and absorbed much more quickly than any other food group. So they can be eaten. There's an old school way to eat called food combining where you eat your fruit alone on an empty stomach, 20 minutes before meals, and then you either have protein and vegetables or you have starch and vegetables, but you don't have protein with starch. If you have sufficient digestive enzymes, that will never be a problem for you. But if you're really low in hydrochloric acid, then you wanna make sure that you, eat fruit away from meals, it, it really is optimal. If you're diabetic or have blood sugar issues, then switch it to half a cup of fruit, but have some bites of fruit. It really makes a difference in your digestive processes.

Because it has the enzymes in it.

Has the enzymes in it. Exactly. And if you can tolerate raw vegetables, those have digestive enzymes, live active enzymes in them too. I mean, one of the most healthy things you can do for your gut microbiome is pick food, pick your vegetables from the dirt and eat them then and there. Like leave the microbes on there, leave the dirt on there, and that will fuel your own healthy bacteria in your gut.

So you mentioned earlier about vitamin C and you were saying if you were restarting the gut after surgery that you might give up to 10 grams, but would you normally recommend that people take the vitamin C periodically throughout the day or in a big dose?

Yeah, no, definitely throughout the day it's gonna be much better absorbed 'cause vitamin C is water soluble, so it's better spread out throughout the day.

So how many different doses might, might you suggest to start with?

Well, so, I mean, the average person, you know, needs 1 to 2 grams per day. I, you don't typically need more than that, but if you really wanna do something fascinating, you can do a test where you check your bowel tolerance to vitamin C where you take a vitamin C powder, a buffered one if you— to protect any— protect you from any stomach upset and you take half a teaspoon to a teaspoon every 30 to 60 minutes and you see how high you can get. You know, there was a point in life where I was really sick with mercury toxicity and I was taking 8 to 9 grams a day of vitamin C. It's how much my bowels tolerated before I had diarrhea. So I knew my body needed a lot at the time. And then since then it's, it's gone way down.

And so when you hit diarrhea—

Then you know that's your bowel tolerance of—

And so you go how far short of that?

So I cut down a gram. The goal is not to give you diarrhea. And you spread it throughout the day. You don't need to take it all at once.

Right. So are you taking it 500, 500 milligrams at a time? 1,000?

You can take either is fine. 500 to 1,000 at a time is fine. And you could take that. 1 to 3 times a day.

So are there physical issues people might have related to using the bathroom in terms of like being too short to get in the right position or?

Yeah. I mean, the Squatty Potty is a very good seller for a reason. So we are meant to eliminate in a squatting position. The modern, the toilet and modern plumbing is also a big cause of hemorrhoids and constipation. So one of my colleagues, I'll never forget this, she was a nutritionist, she still is. And she used to go to the bathroom squatting on the toilet seat. That was long before the Squatty Potty came about. She told me she squatted.

Well, of course, that's how the toilets are in a lot of Asia, right? So they just are holes in the ground with foot areas to stand on either side of the hole.

That's right. And anatomically, when you're in a squatting position, it's the best. It's the most advantageous for elimination. So, you know, it's just the simple laws of physics. But so yes, if you are finding yourself constipated, give yourself— and you're doing the food things, you're doing the supplement things, but you still feel you could optimize, you can get a Squatty Potty or a stool. Just put a stool under your feet at the toilet, lift your knees up higher than your rectum.

We touched briefly on people who are having trouble with using the bathroom in public places. And I know that there are some things you can do because sometimes people are, feel awkward about the fact that somebody else might be hearing them outside the door.

Right.

Any simple recommendations there?

You just gotta get over it. I really, you know, it's like, it, it's carry a pack of matches with you if you're worried the smell's gonna be offensive. I mean, you just kind of have to relax and go with it.

You know, it's, I think a lot of people will flush the toilet just to make covering noises if they're in a public restroom. And yeah, and sometimes putting down a little bit of toilet paper can make it the quiet the sound.

Yeah, I mean, at the end of the day, if you're in a public restroom, if you're at work, I can see it being very tricky. One of my clients is very constipated because she owns a salon and there's no private bathroom for her. And so what she's doing now is she's building a private bathroom for herself. She put an addition under her spa She will have her very own bathroom and that will solve the problem.

It's a pretty extreme solution though.

It's a pretty extreme solution. Most of us don't have that luxury. And that is why I say train yourself to poop first thing in the morning before you've left the house. And then you'll never have that issue.

You briefly touched on hemorrhoids. So how often do you see hemorrhoids coming along with constipation or are there other reasons people might be getting them?

Yeah. I mean, it's hemorrhoids are cause— hemorrhoids are basically like varicose veins. Around the anal area. And so they're often caused, you know, you get them during childbirth from straining and pushing, and it's no different for bowel movements. You get them from straining, from very hard stools, or severe constipation. So again, getting enough water, getting enough hydration, getting exercise in to optimize your circulation. So you're getting good blood flow, you're getting lymphatic drainage. You could do dry brushing in the shower to improve your circulation for sure. But what's dry brushing? It looks like a, a back scrubber brush, you know, and you brush up, you help support your circulation by getting in the shower and before you've even turned the water on, you take this brush and brush your whole body up from, you start at the bottom of your feet and work your way up towards your heart. And it's to help aid circulation and bring the blood towards your heart. So again, if you're sitting or lying all day, you're gonna have very poor circulation. So you gotta move. And all of those— high fiber, water, adequate hydration— all of those will help relieve constipation. And, and definitely getting a Squatty Potty for that too. Really, really helpful.

I found that for me, when I cut out dairy, that got rid of not just my acid reflux, but also hemorrhoids.

Yeah.

So I, sometimes I think you don't realize the number of different ways in which you're, in which dairy can be bad for you. Cuz for me it was not just lactose intolerance, it was also casein intolerance.

Yes. And you know, dairy and gluten unfortunately are the two most sensitive foods that I see in people with constipation and hemorrhoids and heartburn and reflux, all of it.

Yeah.

No, it's a, it's tough because when you are out and about, you, when you don't eat gluten and dairy, which I don't, you're like, literally every single food available, say at this restaurant or at this cocktail party or whatever, has gluten or dairy. Like the entire diet, American diet is based on those two foods.

It is. It is.

Yeah.

Okay.

Anything else I should have asked, but didn't, about constipation?

I think we covered pretty in depth.

Yeah.

I think we covered it.

Great. Well, I appreciate you helping us take this deep dive on constipation. It's a topic we hadn't previously covered.

Yeah, this is awesome. Honestly, I'm psyched to share this with my audience too, because, you know, it's a very solvable problem. It really, really is. That's the good news.

Yeah. It's a shame that so many people seem stuck in that. And I mean, the fact that they're— somebody be getting diverticulitis surgery and not have a doctor tell them to change their diet is just unfathomable. Yeah.

Well, that's why nutritionists exist, right? So we can help solve the problem. And it's really, you know, the most exciting thing is when you have a chronic health issue that you can make disappear. I mean, that, like, having mastery over your body and having the knowledge and wisdom to know that your body is trying to be in balance every day, and when you give it the right tools, it will be. And I think that that is just the one of my favorite messages to empower people with.

That's a great message. So where can people find you?

So you can find me at estherblum.com. I'm on Instagram as Gorgeous Esther. I'm loading up a webpage on my site with all my podcasts, and I have a YouTube channel as well. I have a newsletter, and if you sign up, you're going to get my ebook, 3 Simple Tips to Lose 3 Pounds This Week. And you can reach out to me anytime, and you go to estherblum.com/call, C-A-L-L. Great.

Well, thanks for sharing that. I will go ahead and just put all those links in the show notes so people can find you and the various social media and such. Well, thank you so much for coming on. I appreciate it.

Thank you. My pleasure, Lindsey Parsons.

Well, there were heaps of helpful constipation tips in there, so I hope that was useful to you. But if you try them all and are still struggling, I wanted to remind you that helping people solve their gut health issues is my specialty. I work with clients not just here in Tucson, Arizona, where I live, but virtually on video chat. I offer individual consultations or a 5-session gut health or autoimmune reversal program for people with tougher or longer-standing issues. So if you think that a 5-session or longer course of health coaching might help you meet your health goals, you can set up a free 30-minute breakthrough session with me to talk about what you've been going through. I'll let you know if it sounds like something I can help you with, or you can just set up one appointment right off the bat. Also, a reminder, there are a few ways you can support the show. First, you can buy high-quality vetted supplements in my online Fullscript, Wellivate, or Designs for Health dispensaries. So there's a link in the show notes if you wanna sign up for an account there. Do compare prices if you find the same supplements elsewhere. I also have affiliate accounts at eVitamins, iHerb, and Amazon. So if you go through my links, I'll get a percentage. And you can also support me with a monthly $2 or $5 donation on Patreon. And if you want to connect with me online, you can join my Gut Healing Facebook group to ask a question about gut health or suggest a topic or a guest for the show. And you can also follow my High Desert Health Facebook page or find me on Instagram, Twitter, or Pinterest. And those links are all in the show notes. Thanks for listening, and here's wishing Shiyo, the perfect stool.