Let’s Talk About…Elimination Habits….Baby!

Fermented Foods

Let’s talk about something that’s often on everyone’s minds, but no one wants to talk about: bowel movements.

The process of eliminating bodily waste is an arduous digestive woe for many people.

The prevalence of chronic constipation is 20% of the general population, increasing up to 50% in the elderly (>65 years) and  can occur concurrently with pelvic floor dysfunction (1, 2).

Considering the slew of available over-the-counter (OTC) products from fiber to stimulant laxatives, it’s possible to try to tackle symptoms with supplements and prescription medications, but it’s important to distinguish the physiology and underlying mechanisms contributing to and exacerbating the issue. Moreover, the OTCs are laden with tons of artificial additives, colorants, and preservatives – which are not only unnecessary but further burden digestion and detoxification.

Interestingly, many of the products marketed for constipation have been inspired by natural products and plants. For example, bulk-forming fiber powders, which are considered first-line treatment, come from psyllium husk (Plantago spp.) – and can be taken in its natural whole or ground plant form, sans harmful additives. Other seeds that can be used as soluble fiber are chia and flax, which also have the added benefit of being rich in the plant precursors to omega-3 fatty acids (from alpha-linolenic acid) (3, 4).

Fiber-Rich Foods

One of the most ubiquitously sought stimulant laxatives, senna (available with or without a prescription), was found to be superior to or equally efficacious to other laxative agents of multiple pharmacological classes (5). The commercially available sennoside products are still derived from the crude Senna plant, and many other plants contain stimulant laxative anthraquinones, in varying concentrations. Some milder ones that act as amphoterics and can be helpful in regulating the elimination of both constipation and diarrhea are yellow dock root (Rumex crispus) (6).

The microbiome and nervous system also play a huge role in our elimination patterns. Gut bacteria are responsible for producing up to 90% of the body’s serotonin, which can explain the connection between them (7). The gut-brain connection, as well as healthy bowel movements, can be supported with probiotic and magnesium supplementation. There is a ton of evidence supporting this therapeutic approach, with different strains of probiotics and various salts of magnesium studied (8, 9).

On the other side of the spectrum to constipation, there is a very limited amount of pharmaceutical solutions for diarrhea. A speedy elimination pattern typically indicates either an immune or a nervous system response. In the former, a foreign microbe or allergen can trigger inflammation and diarrhea, in an attempt to promptly rid of the noxious agent via the GI tract. The latter etiology is attributed to nervous system excitability, such as anxiety, which can trigger the same inflammatory response, ie: IBS which can present as constipation, diarrhea, or a mixed type (10).

Our OTC options here are Imodium (loperamide), which is effective at curbing elimination – but doing so would impede the outflow of the microbe or parasite that may be triggering this response in the first place. Next, we have Pepto Bismol (bismuth subsalicylate), which is based on the mineral bismuth and the anti-inflammatory component of salicylic acid and has antimicrobial and bactericidal activity – a step up from loperamide and useful for a lot of digestive discomfort (but is contraindicated in children under 16 due to the risk of Reye’s syndrome) (11).

The holistic approach would be to first determine the cause of the diarrhea and then address the underlying physiology. Whether the trigger is microbial or nervous system-mediated, there are a number of drugless approaches. Digestive bitters, tannin-rich herbs, carminatives, antimicrobial and antiparasitic herbs, and fermented foods, and probiotics can all mediate a healthy elimination pattern and address diarrhea. The benefit of this approach is that it’s multifactorial, and has little to no contraindications, side effects, or tolerance issues.

Digestive Bitters and Herbs

Check out my Fullscript dispensary for my favorite digestive support to transform your “cringe” time into the most mundane and peaceful experience! I also recommend this detox tea to help not only open up the elimination pathways, and liver but also support your immune and adrenal function to mediate inflammatory processes. And of course, don’t forget the basics: please hydrate your body with good quality water (and trace minerals or electrolytes). I’m team Berkey for clean, plastic-less, and sustainable water.

PS If you’re a practitioner, sign up for Fullscript to create your own virtual dispensary here.

PPS I’ve included some recommended products and platforms that I consciously partner with, and if you purchase from them I may be eligible for a small affiliate commission. I only recommend what I truly have researched, tried, and tested, and this commission allows me to continue sharing lots of free high-value content with you! Thanks in advance for your support in my work and please share with someone who may benefit from my content. Let’s keep our ecosystem and planet healthy!

Works Cited

  1. Epidemiology and management of chronic constipation in elderly patients – PMC
  2. Efficacy and safety of laxatives for chronic constipation in long‐term care settings: A systematic review
  3. Protein content, oil content and fatty acid profiles as potential criteria to determine the origin of commercially grown chia (Salvia hispanica L.) – ScienceDirect
  4. Lipid components of flax, perilla, and chia seeds – Ciftci – 2012 – European Journal of Lipid Science and Technology – Wiley Online Library
  5. Efficacy and safety of laxatives for chronic constipation in long‐term care settings: A systematic review
  6. Anthraquinone Glycosides – an overview | ScienceDirect Topics
  7. Serotonergic Mechanisms Regulating the GI Tract: Experimental Evidence and Therapeutic Relevance – PMC
  8. Efficacy of Probiotic Compounds in Relieving Constipation and Their Colonization in Gut Microbiota – PMC
  9. Magnesium Oxide in Constipation – PMC
  10.  Brain and Gut Interactions in Irritable Bowel Syndrome: New Paradigms and New Understandings – PMC
  11. Bismuth subsalicylate: Uses, Interactions, Mechanism of Action | DrugBank Online

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