Support for Constipation & Motility

Supporting gastrointestinal motility and bowel regularity are core features of a comprehensive treatment protocol for SIBO and IBS-C.

I've been hard at work behind the scenes at my day job (Product Development Manager at Moss Nutrition) developing two new products to address these needs and I am thrilled to announce that both are now officially launched!

MMC Select™ is a prokinetic formula designed to help promote gut motility by supporting healthy function of the migrating motor complex (MMC)—the "cleansing wave" that sweeps food, bacteria and debris out of the stomach and small intestine towards the colon. As we've discussed before on Sexy Sibo, the MMC is active between meals when the digestive system is at rest, which is why practicing "meal spacing" is so important for SIBO! MMC Select™ contains a careful selection of evidence-based ingredients for motility support: organic prokinetic ginger root, a premium concentrated DGL deglycyrrhizinated licorice extract researched for motility support, 5-HTP + P-5-P to help increase gut serotonin levels, absorption-optimized anti-inflammatory curcumin phytosome and alkalinizing potassium, a traditional prokinetic nutrient.

Colon Select™ is designed to help provide safe, gentle relief from occasional constipation with meaningful levels of researched and traditional ingredients. This formula features:

• Magnesium in two forms: ascorbate (vitamin C) and hydroxide
• Triphala, the revered Ayurvedic triple herb combination for enhancing bowel tone & function
• Aloe ferox extract (Cape Aloe) in the clinically relevant potency for helping to promote elimination: minimum 18% aloin content
• A blend of 5 time-honored botanicals to help stimulate complete and comfortable bowel movements: Marshmallow, Ginger, Sweet Fennel, Barberry Bark & Turkey Rhubarb Root.

Click on the product names above to visit the Moss Nutrition website and read more about these fabulous SIBO-specific products. I am so happy to be able to offer them to the world, and to my patients and clients in particular! (If you are a new patient or client, contact me for details about ordering.)

Yours in joyful service,
Diana🌀

Article Review: SIBO Treatment Strategies by Aglaée Jacob

Aglaée Jacob, MS, RD is a French Canadian holistic dietitian specializing in the Paleo approach to digestive health. I've been following her work since 2013 when I first found out about SIBO, and have always appreciated her professionalism and attention to detail.

Today I'd like to share some highlights from an informative article by Aglaée on the Treatment and Management of SIBO, published in Today's Dietitian in December, 2012. I've underlined the parts that stand out to me for emphasis:

"SIBO and IBS symptoms are the same: abdominal distension, flatulence, cramping, diarrhea, and constipation. These digestive symptoms result from both the high osmotic activity and fermentation potential of incompletely digested and unabsorbed carbohydrates present in the small intestines."

In other words, bloating and distention are caused by accumulations of gas (the byproduct of bacterial fermentation) and water (drawn into the gut via osmotic activity) that build up in the small intestine. The presence of gas and water make your belly expand like a balloon. The reason this fermentation and osmotic activity happens is related to the presence of undigested carbohydrates in your gut.

"Both the gas produced by intestinal fermentation and the water drawn through osmosis can contribute to bloating in SIBO patients. The type of gas produced by the bacteria also seems to impact the motility of the intestines. Hydrogen-producing patients are more likely to suffer from diarrhea, while methane producers are more prone to constipation."

I'm super fascinated by the impact of bacterial gas type on motility. A C-type myself, I have long been a proud producer of odorless methane farts. Methane-producing bacteria get overgrown when slow transit time causes an overgrowth of hydrogen producing bacteria. But isn't it ironic (if not ingenious, from the microbe's point of view) that methane itself is a CAUSE of constipation. Why might this be?

"Research conducted by Mark Pimentel, MD, director of the gastrointestinal motility program at Cedars-Sinai Medical Center and author of A New IBS Solution, indicates that increased intestinal transit time associated with methane isn’t due to decreased motility but rather to hyperactive reverse peristalsis.[1]"

What the hell: hyperactive reverse peristalsis? Doesn't that sound a lot like "poop going in the wrong direction—with a quickness"? I need to learn more about this. According to the dictionary, "reverse peristalsis" also means "vomiting." Con-fu-sing! Note to self: further investigation warranted.

Anyway, the article continues with some basic dietary recommendations for IBS, specifically the strict avoidance of fermentable carbohydrates. This means a) following a low-FODMAP diet and b) further avoidance of all polysaccharides (grains and starchy veggies), even those which are considered lower in FODMAPs, until symptoms resolve:

"Digestive symptoms tend to significantly improve after SIBO treatment, but it’s important for patients, especially in the beginning, to avoid foods that can contribute to intestinal fermentation. Damage to the lining of the small intestines can impair secretion of brush border enzymes, such as lactase, sucrase, and maltase, according to SIBO expert Allison Siebecker, ND.[2] Undigested lactose, sucrose, and maltose (starch fragments) aren’t absorbed and can become substrates for intestinal fermentation. Restricting lactose, sugars, and starches can attenuate bloating and normalize bowel movements until the brush border is sufficiently healed to normally produce digestive enzymes again.[2]

"Foods containing FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) also can ferment in the small intestines and therefore should be limited if they induce symptoms in SIBO patients.[2] FODMAPs include fructose (eg, high-fructose corn syrup, agave syrup, honey, apples, pears); lactose (eg, milk and yogurt); fructans (eg, wheat, barley, rye, onions, garlic); galactans (eg, legumes); and polyols (eg, sugar alcohols, mushrooms, cauliflower, avocados, stone fruits)."

Beyond eating the right foods (for as long as necessary until healing has occurred) another recommendation for treating SIBO is to NOT eat between meals, also known as meal spacing. Meal spacing allows for proper functioning of the MMC (Migrating Motor Complex), a mechanical wave-like process that cleans out the small intestine between meals:

"One of the most common underlying causes of SIBO is the impairment of the migrating motor complex (MMC). The MMC corresponds to cleansing waves activated approximately every 90 minutes in the small intestines when fasting to prevent the accumulation of debris and excessive amounts of bacteria. Pimentel found that the MMC is decreased by 70% in SIBO patients.[1] Apart from snacking, stress also negatively impacts the MMC. Encourage patients to space their meals every three to five hours and better manage their stress to promote regular MMC activation and prevent SIBO from returning."

Eating too often throughout the day (the popular Graze Method) and high stress levels both impair the MMC. Meal spacing boils down to waiting at least 3 and preferably 4-5 hours after a meal before you consume any kind of caloric food or drink. This means only water (or another non-caloric beverage, such as unsweetened herbal tea) would be allowed. Such mini-fasts permit the cleansing wave of the MMC to push excess bacteria out of the small intestine.

Meal spacing is a strategy I try to apply consistently. Bonus: Meal spacing rests the digestive organs, increases energy and helps stimulate healthy appetite, adding to the pleasure and enjoyment of eating. As for stress management, consider deep breathing, meditation, yoga and exercise. A strong, metabolically active body and a calm, quiet mind are well worth cultivating, don't you agree?

Click here to read the Today's Dietitian (Vol. 14, No. 12, p.16) article, excerpted above, in its entirety.

Click here to visit the website of Aglaée Jacob, The Paleo Dietitian. (You really should. She's got sound advice, tasty recipes and great diet handouts available for free download, too!)

REFERENCES
1. Pimentel M. A New IBS Solution. Sherman Oaks, California: Health Point Press; 2005.
2. Siebecker A. Small intestine bacterial overgrowth: clinical strategies (webinar). September 17, 2011. http://ce.ncnm.edu/course/search.php?search=SIBO. Accessed September 25, 2012.

Hydration practice: For motility and emotional well-being.

After years of chronically dehydrating myself, I recently started drinking a quart of water first thing in the morning. I fill a 1QT mason jar at bedtime and chug-a-lug in the AM. 

It was hard at first but I'm starting to crave it. Sometimes I add fresh lemon juice for taste, or a slice of lime or lemon to make it pretty. Pretty counts.

Water is so important to just about every aspect of health, including motility. After all: Water flows. It’s silly to expect your bowels to operate in a regular flow pattern if they are lacking water. 

Plus, the whole job of the large intestine is to pull water (and the nutrients it contains) out of the stool prior to elimination. 

Imagine if the stool is low in water to begin with? The colon just might want to hold on to that stool for as long as possible, straining to extract every last drop.

“Hold on” is the operative phrase in the previous sentence. And it’s not just about poop. Holding on—to people, objects, feelings, the past—is common in people with C. There is a huge emotional component to constipation that needs to be addressed if motility is to improve. One way to do this, interestingly, is by drinking more water.

This was explained to me by a wise young woman named Chaya Leia Aronson. Chaya is a registered nurse, Reiki practitioner and certified practitioner/teacher of the Arvigo Techniques of Maya Abdominal Therapy^™. I went to see her for an abdominal massage two weeks ago (my first time ever) and again, yesterday. (Maya Abdominal Massage, by the way, is amazing. If you’ve got belly issues, I highly recommend it.)

At our initial meeting, Chaya noted from my health questionnaire that I don’t take in a lot of H2O. That’s for damn sure. For decades, it’s been no secret that “I need to drink more water.” Many of my clients are in the same boat (water, water everywhere…) and I’ve successfully counseled them on improving their hydration status. But when it came to following my own advice, not so much. 

Here’s a list of my main excuses:

•I don’t like the taste of plain water.

•I’m never thirsty.

•I don’t drink with meals because it dilutes the digestive juices.

•I’d rather drink tea.

•Herbal tea counts.

That kind of thinking kept me stuck in a chronic state of dehydration for most of my life...until something Chaya said struck a deep and resonant chord in me. She said that in her experience, she has observed that women who don’t drink enough water often are anxious, and often have a hard time allowing themselves to experience their emotions.

Epiphany.

She also said that the choice to drink water—the very act of drinking it—is a way of nourishing yourself and, in particular, your emotional self. As a symbol (in dreams, for example) water represents feelings. The idea that drinking water equals giving yourself permission to feel your feelings, well, that’s a million dollar idea, baby. That’s a key.

How many adults with IBS-C suffered trauma of some kind in childhood, and have been stuffing or suppressing those emotions ever since? Possibly most, according to the research. (To read more about it, try: Early life risk factors that contribute to irritable bowel syndrome in adults: a systematic review.)

Anyway, sitting there in Chaya’s warmly lit office as we spoke about water and feelings, I realized that what she was saying made total sense. And I knew I was ready.

I listened carefully as she introduced the concept of Hydration Practice. Similar to yoga practice or meditation practice, hydration practice means consciously committing to nourishing yourself with water. Beautiful idea!

The goal is to drink 2 – 3 quarts of water per day. Chaya said I could start with just two (phew!) and suggested I get the first quart into me first thing in the morning, via a process she calls “front-loading”. Before tea, before food: 1QT of water. Just glug it down. And then after lunch, in the afternoon: Quart number two.

So I started. I bought a nice glass 1-liter pitcher; I bought a lemon. I bought a pretty green glass to drink out of at work. 

By now, I’ve been doing hydration practice for two weeks and the weird thing is, I really like it! At first my tummy felt uncomfortably full from the morning quart, but now, it doesn’t. My famous craving for tea is less. My dry skin looks plumper and pinker. And my motility…

Well, the motility is a work in progress. Adding two quarts of water a day has not produced an overnight miracle. But I expected a cumulative effect. 

It’s going to take some time for my formerly perma-shriveled, water-starved cells to get used to the fact that they don’t have to conserve every microscopic particle of H2O that comes their way. There’ll be more where that came from.

The drought is over. It’s a miracle.