pregnancy

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. 

Coffee - It's not black and white

Do you love your coffee? And if you do, do you feel guilty about it? After all, coffee seems to be bad for you and many health experts discourage its consumption. But as with most things concerning health and nutrition: It’s not black and white. We all know people who can guzzle a “venti” (20 fl oz = 600 ml) and still have a nap afterwards, when others only so much as sniff an espresso and are wired all day long. That’s because how you respond to caffeine - coffee’s most predominant active compound - is governed by your genes, some of which affect the way your liver processes caffeine, others influence how the brain reacts.

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Coffee and Blood Sugar Levels If you are stressed - and who isn’t these days - or are struggling with your weight, you should learn how to control blood sugar levels. You need to avoid sudden spikes, because high blood sugar levels stimulate the release of insulin, which in turn contributes to weight gain. Caffeine, a stimulant, does raise blood sugar levels. However, a Finnish study found that coffee increases insulin sensitivity (that’s a good thing) and lowers the risk for diabetes II. This is effect is attributed not to caffeine, but chlorogenic acid, an antioxidant in coffee. Chlorogenic acid is also responsible for many of the other beneficial properties of coffee.

So, coffee does raise blood sugar levels to some extent. We all love a biscuit or even a slice of cake alongside a cup of coffee, but combining coffee with sugar triples it's effect on blood sugar. Bad news, I know. So on to the good news …

Coffee and cardio-vascular disease Coffee is often thought to adversely affect the heart. However, according to an article published in Current Vascular Pharmacology in 2014, it is actually beneficial when consumed in moderation. Coffee lowers the risk for stroke and it does not even affect blood pressure to any great degree, but patients suffering from arrhythmia should avoid it. A word of warning though: Some people’s genetic make-up causes them to metabolise caffeine more slowly, and for them, there is indeed an increased risk of non-fatal heart attacks. (Fast caffeine metabolisers, on the other hand, actually lowered their risk of heart attack through coffee consumption.) Also, even if blood pressure is not greatly affected in healthy people, you should exercise caution and steer clear of coffee if you know that you suffer from hypertension.

But coffee does hurt the stomach. Doesn't it? It appears that even the most stubborn rumours about the ill effects of coffee are being overturned. A 2013 cross-sectional study in Japan found no correlation between coffee consumption and stomach ulcers, upper intestinal ulcers, or heartburn.

More good news Coffee has been found to protect from Alzheimer’s and Parkinson’s disease, depression, liver cirrhosis and liver cancer. Moreover, higher coffee consumption was found to significantly reduce the risk of recurrence of colon cancer, and reduces the overall risk of mortality meaning: Coffee makes you live longer - at least as long as you do not overdo it.

Who should avoid coffee? If your genes have not equipped you to tolerate coffee well, you very likely already noticed. If it makes you feel jittery, wired, causes tremors and gives you palpitations - avoid. You won’t need me to tell you that. Also, coffee is undoubtedly an addictive substance, as anyone who has ever gone through withdrawal will know, and that in itself will put a lot of people off who would rather not go there.

Pregnant and breastfeeding women and those trying for a baby should avoid coffee as it has been linked to miscarriage, stillbirth, premature delivery and lower birth weight. If you can’t live without the stuff, do not have ore than one cup a day.

If you are not sure whether or not you are a slow metaboliser - whose risk for heart disease, if you remember, is increased when they drink coffee - and would like to find out, you could do a gene test, which have recently become available at very affordable prices. (Note: The tests look at a number of health genes, not just the way you metabolise coffee.)

How to make your coffee The way you make coffee can change its properties: Boiled and unfiltered coffee may raise cholesterol and triglycerides, and paper-filtered coffee appears to contribute to inflammation. A possible reason for this is that with this method, the beneficial polyphenols in coffee are filtered out.

Consider what you’re adding Much of what gives coffee a bad reputation is not so much the coffee itself, but ingredients we like to add to it: Coffee as such has 0 calories. It may contribute to weight gain by raising blood sugar levels, but all by itself, it won’t do much damage. Consider, however, what you add to it: sugar, including syrups, lead to much greater blood sugar spikes and thus greater insulin excretion. Sugar also has powerful pro-inflammatory properties, and avoiding it is generally a good idea. Milk and cream (and sugar) all increase the calorie content of your coffee. And need I even mention marshmallows?

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On the other hand, you can improve on the properties of coffee by adding either cinnamon or ginger to it. Both substances have been tested in combination with coffee - albeit only in vitro - and were found to have enhanced anti-radical and anti-inflammatory properties. Other spices that go well with coffee are cardamom, cloves, or saffron.

Is decaf a good alternative? No, is the short answer.

First of all, be aware that “decaffeinated” does not mean that the caffeine content is zero. Processing usually removes 97% of the caffeine. Most commercial brands use chemical solvents to remove caffeine from the green coffee beans, and although the industry ensures us that there will be no residues when we drink it, I personally just don’t like the thought, and it will still impact on the environment.

How much coffee is ok? It appears that coffee consumption “in moderation” is not only harmless, but even healthy for most people. But how much is “moderate”? I’ve seen recommendations that say up to 600 mg of caffeine daily is ok, but most are lower, 400 - 500 mg. Translated into cups of coffee this is approx. 4 - 5 cups. That amount of coffee is also associated with the lowest risk of death (meaning: people drinking less than that are at a higher risk of death!).

So, that’s the lowdown on coffee. If you would like to read more on coffee, click here. Or - better still - sign up to my newsletter. Tomorrow morning's edition has more on antioxidants and a recipe for cinnamon almond latte.