multiple sclerosis

Plugged up?

It’s not something that is discussed much in circles of friends and colleagues – for obvious reasons – but constipation is common. In the UK, approx.12% of the general population suffer from chronic constipation. Twice as many women than men struggle with it, and the over 65s are most affected: 25% of free living older people experience constipation, but a shocking 80% of the elderly living in nursing homes. Because bowel habits are not a popular topic of conversation, it is hard to know what is normal and what isn’t. If you can answer ‘yes’ to two or more of the following, you are probably constipated:

  • Do you ‘go’ less than three times per week?
  • Do you often strain (at least 25% of the time)?
  • Are your stools often hard or lumpy (at least 25% of the time)?
  • Do you often feel that you haven’t been able to excrete everything (at least 25% of the time)

A comparison with the Bristol Stool Chart may also help you see where you are.

Man sitting on toilet bowl
Man sitting on toilet bowl

Why does it matter?

Not being able to ‘go’ can be extremely uncomfortable, but not everybody feels that way. Some people have infrequent bowel movements and feel fine. In fact, according to the (official) diagnostic criteria just emptying the bowel three times a week is ok. However, the ideal transit time for food is 12 to 24 hours. Defecating three times a week constitutes an average transit time of 56 hours, which really is too slow. A bowel movement at least once a day is what we should all strive for.

If you are not sure, you can test your transit time: Eat three or four whole beetroots and make a note of when you ate them. Wait and see when the beetroot comes out the other end. It should dye your faeces crimson. If you don’t like beetroot, try it with a generous amount of corn on the cob.

Having faecal matter sit in the colon for too long is undesirable for several reasons. Bile acids contained in it can irritate the gut wall, if faeces aren’t excreted swiftly, causing damage. The colon’s main function is to recycle nutrients and water back into the system and to eliminate waste products. In order to do this job properly it needs a healthy gut microflora. Chronic constipation can upset the balance of good and bad bacteria, and an imbalanced gut flora can lead to constipation – a vicious circle. If waste remains in the colon for too long, putrefying bacteria start working on it, releasing toxins, which then cause damage to the intestinal lining with potentially serious long-term consequences.

Old oestrogen, which was meant to be excreted, gets attached to a protein called sex-hormone binding globulin (SHBG) in the liver. SHGB is the vehicle to see the oestrogen out. However, some strains of bad bacteria have the ability to uncouple hormones from SHBG, thus enabling those hormones to get reabsorbed. This can contribute to oestrogen dominance and related disturbances and diseases (e. g. PMS, fibroids, breast cancer). The slower your transit time, the more time bacteria have to send old hormones back into circulation.

Straining to excrete hard stools is the most common underlying cause for haemorrhoids (piles): enlarged, swollen blood vessels around the anus. Once formed, they can make defecation even harder and very painful, and they often cause rectal bleeding.

Other health issues linked to constipation are bad breath, body odour, depression, fatigue, flatulence, food sensitivities, headaches, indigestion, joint pain and dark circles under the eyes.

What causes constipation?

The most common causes by far are a sedentary lifestyle, dehydration and a low-fibre diet. The vast majority of sufferers get rid of the problem by increasing exercise, increase fluid intake and change to a diet high in fibre, eg from vegetables, beans and pulses, as well as wholegrains.

You can add extra soluble fibre by taking linseeds (flaxseeds) or chia seeds. These seeds soak up water and form a gel, which makes stools soft and easy to pass, but make sure to always have them with lots of water otherwise they can make the problem worse. Prunes, too, are excellent helpers. Not only does the fibre they contain help bulk up the stool and move things along, but they are also food for the good bacteria. Bacteria convert the fibre from prunes into short-chain fatty acids, which become fuel for the cells of the gut wall.

Another common contributor to constipation is magnesium deficiency. (Remember last week’s post on vegetables?) Magnesium is involved in the proper function of muscles. The entire digestive system is surrounded by smooth muscle, which contracts in stages (like a Mexican Wave) to move intestinal contents along, a process called peristalsis. For peristalsis to work, magnesium is required. Food processing causes the loss of 75% of the magnesium contained in food, and deficiency is very common. Yet another good reason to move away from junk food – which is also low in fibre! - and start cooking your own.

Putting off going to the toilet can also lead to constipation. If you continuously postpone a bowel movement, the nerves of the rectum become less sensitive to the rectum being stretched and stop sending the message to the brain. If you think that you may already have lost that sensitivity, you can retrain your nerves: Sit on the toilet for 20 minutes every morning and relax. Your colon will soon learn to relax again, too. And stop putting off your trip to the loo: You may not like to go and empty your bowels when you’re not at home, but at work or travelling, but you need to get used to that. It’s what people do.

Other reasons

There are many more reasons why someone would develop chronic constipation. It is, for example, a very common side effect of medication. If you suspect your prescription drugs, take out the leaflet and have a look. If constipation is listed, speak to your doctor. Maybe there is a similar drug that you can tolerate better.

Constipation is also part of a number of diseases, such as stroke, diabetes, kidney disease, illnesses that affect the nervous or muscular systems (eg multiple sclerosis, spinal injuries), over- or underactive thyroid. Stress or depression, pregnancy, high calcium levels, iron supplements and the long-term use of laxatives can be behind the problem. Constipation is very common in irritable bowel syndrome (IBS), diverticulosis and colon cancer. If your bowel habits change for no apparent reason, you must tell your doctor.

For more on constipation and bowel habits and more tips on what to do, read tomorrow’s Nutrilicious News. It is not too late to sign up.

If you are experiencing digestive issues, why not come and see me in clinic at The Body Matters in Leigh-on-Sea, Essex? Contact me and we'll have a chat on the phone first to decide whether you would benefit from a personalised Health & Nutrition Programme with me. 

Snooze yourself to health

According to a report published by The Sleep Council in March 2013 the number of Britons getting just five to six hours sleep per night has risen dramatically: 40% of us are not getting the six to nine hours recommended by the NHS. Why is that? In the majority of cases health conditions, such as depression and anxiety or chronic pain are keeping us awake at night. Many are unable to sleep due to worry, but a great many of us are just not going to bed on time to get the rest we need. Some see sleep as a waste of time, which would be better spent working. Others don’t like going to bed early, because the only me-time they can get is in the evenings, when at last they get home after a long and stressful day at work or when the kids are finally tucked up and asleep. Understandable. But is it wise?

The fact that sleep is something our body just demands is a strong clue that we need it and that it is in fact good for something. If we are prevented from sleeping – and remember: sleep deprivation is a form of torture! – we will die. But even without this drastic outcome, sleep deprivation seriously affects our health.

Photo: Ambro, FreeDigitalPhotos.net

While we sleep, the body is very busy repairing and maintaining muscles, bones and organs. The brain needs sleep-time for clean-up, not just of “mind clutter”, but also of the chemical waste of brain cell metabolism that accumulated in the course of the day.

In the short term, sleep deprivation affects our memory and creativity, slows reaction time, and leads to micro-sleeps and drowsiness during the day, impatience and moodiness. Tiredness also shows on your face, and you won’t be looking your best. Apart from the fact that most of us really want to look good, research has found that people can easily spot a tired person and we instinctively know not to expect much from them, a fact that can affect your career and business.

Prolonged sleep deprivation, however, has much more serious consequences as it can lead to hormonal and neurological changes and even depression. With 40% of us not getting enough sleep, it is no wonder that symptoms are so common that they are easily mistaken as normal.

Sleep deprivation impairs insulin sensitivity, which promotes weight gain and contributes to diabetes II over time. It also affects weight by messing with the hormones ghrelin and leptin: Ghrelin is the "hunger hormone", which makes you feel peckish and slows down your metabolism, i.e. you'll burn energy more slowly. Leptin is the "satiety hormone", which makes you feel full, tells you when to stop eating and speeds up metabolism. If you are not getting enough sleep, leptin production is suppressed, while ghrelin production goes up. You'll want to eat more and the calories thus consumed will stick.

As if that wasn't bad enough, sleep deprivation is also pro-inflammatory. Continuous low-grade inflammation is known to promote degenerative diseases such as heart disease, diabetes II, Alzheimer's disease and multiple sclerosis.

If you need an alarm, use the snooze button, tend to fall asleep when you’re not in bed – for example on the train, a plane or in a meeting, the theatre or cinema – and feel the need to catch up on sleep on weekends or on holiday, you are not getting enough sleep. When we do, we wake up naturally, without needing an alarm. We should be able to get through the day without copious amounts of caffeine, and remain alert until it is time to go to bed at night. Yet for many of us that is not the case.

If you suffer from insomnia, whether you have trouble falling asleep (sleep-onset insomnia) or staying asleep (sleep-maintenance insomnia), you should go and see your doctor, especially if you suspect that you might suffer from depression and/or anxiety. Insomnia can be a side effect of medication, most commonly thyroid drugs or oral contraceptives. Ask your GP whether there is an alternative drug that you might tolerate better.

If there is no obvious medical reason, you could look at your diet:

Are you eating late and/or having heavy dinners?

If you need to digest during the night, your sleep will almost certainly be disturbed. Eat no later than 3 hours before bedtime if at all possible. Ideally, you should have your main meal at lunchtime and a lighter meal in the evening. If you have a business dinner, ask if it can be arranged a little earlier – perhaps at 18:30. This will get you all home earlier, too (more sleep time – bonus!). Choose light meals for dinner and avoid refined carbohydrates and sugar to balance blood sugar.

Balance Blood Sugar

Keeping blood sugar levels balanced throughout the day is the best way to ensure a steady supply of energy without mid-afternoon slumps and to get a good night’s sleep. If your evening meal is rich in refined carbohydrates, e. g. from white rice, white pasta, or sugar, this can cause a blood sugar spike which is soon followed by a steep drop. If this drop occurs during the night, stress hormones are released to increase blood sugar, and they are likely to wake you up (cortisol is in fact what gets you out of bed in the morning). A blood sugar drop can also happen if you have eaten a very low-carb meal too early in the evening. If that is the case, a small (!) snack of complex carbohydrate paired with protein just before bed can help stabilise blood sugar to get you through the night. Think one oatcake with hummus, cottage cheese or a piece of smoked salmon; a piece of banana with peanut butter, a small tub of plain yoghurt with berries.

Are you having too much caffeine?

Different people detoxify caffeine at different rates. While some can drop off easily after a post-dinner espresso, others are kept awake by caffeine even if they had their last cup at lunchtime. To find out whether you are sensitive to caffeine, cut it out completely for 7 to 10 days and see what happens. Make sure to eliminate all caffeine during that time: tea, coffee (including decaff), green tea, chocolate, caffeine drugs and energy drinks all contain varying amounts of caffeine. If it turns out that you sleep better without it, you may want to stay off it or at least not drink coffee any later than lunchtime.

Are you using alcohol to help you sleep?

Using alcohol to help induce sleep is very common, and it does in fact do that. The problem is, however, that it can disturb sleep further into the night. Alcohol is known to suppress the rapid eye movement (REM) phase of sleep, when we would normally dream and when the brain tidies up our memory, discarding what we don’t need and consolidating what we do. Also, carbohydrates in alcohol can lead to blood sugar spikes followed by drops, which then encourage the release of stress hormones (see above). Moreover, alcoholic drinks – especially beer – act as diuretics and may encourage you to get up and use the toilet during the night.

Eat your greens!

The minerals calcium and magnesium are required for relaxation of both the mind and the muscles. You are more likely to be low in magnesium than in calcium: Magnesium-rich foods are nuts and seeds, green vegetables, wholegrains and seafood. Green vegetables, nuts and seeds, seafood, tofu and molasses are also great sources of calcium. Adequate B vitamins, too, are important for good sleep, but if you are taking a multi-vitamin or B-complex supplement make sure to take them earlier in the day as B vitamins are involved in energy production.

Eat lettuce at night: Apart from magnesium lettuce contains the natural sedative lactucarium, which encourages deeper sleep. Lettuce can also be eaten cooked in soups or stir-fries. Try it, you may be surprised. Foods that are high in the amino acid tryptophan, such as chicken, cheese, tuna, tofu, eggs, nuts, bananas, dates, seeds and milk can help improve sleep. For more on tryptophan, have a look at my blog on Seasonal Affective Disorder (SAD). Other foods associated with inducing sleep are celery, oats and kiwi fruit.

To learn more:

The Sleep Council’s website is a great resource for everything sleepy. From mattresses to jet lag, there’s great advice here.

Tomorrow’s Nutrilicious News will have more tips on how to get a good night’s sleep, a sleepy recipe and some links. There is still time to subscribe!