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Digestive health
Hello!I have been working to improve my gut health and wanted to see what you recommend for chronic constipation, leading to possible hemorrhoids?
Also, any input you have on how to get rid of candida would be helpful!
Thank you!
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6 Replies
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Hi – I know you mentioned that you’re making your way through the Gut Health Masterclass, so if you haven’t yet made it to the section on “Understanding Your Stool”, here’s the video on the possible root causes for constipation.
Let’s go through some of the basics together so we can start ruling out some of the basic possibilities before getting into more esoteric reasons:
1. Dehydration. Do you drink enough water? How much do you drink?
2. Insufficient magnesium from green leafy veggies, nuts, etc. Do you supplement with magnesium by any chance? If so, what form? Magnesium citrate supplementation is a good rapid relief remedy to ensure a daily bowel movement, while working on the root cause. I have my constipated clients who have no kidney disease start with 400mg with dinner or before bed, and then increase daily by 100mg if needed to bowel tolerance (or up to 1200mg). If stool becomes too loose the next day, they took too much, and they should decrease their dosage accordingly. I like this magnesium citrate by Pure Encapsulations.
3. Insufficient intake of dietary fats. Do you consume avocados, olives, extra virgin olive oil, coconut oil, nuts & seeds, nut butters, grass-fed butter, etc.?
4. Hypothyroidism. Have you ever measured your thyroid levels? Here’s a video with the suggested markers. If thyroid function is the root cause, then we can guide you to help you figure out what’s affecting thyroid function as this opens up a whole new set of possibilities like insulin resistance, stress, nutrient deficiencies (iodine, protein, zinc, vitamin A, iron, selenium). But step 1, test thyroid function if you haven’t already.
5. SIBO or SIFO (Microbial overgrowth) / not enough serotonin. You mentioned candida, so I’m assuming you’ve done a stool test before which confirmed you have high candida? Having high levels of microbial overgrowths can affect the production of serotonin, which not only helps regulate mood and sleep, but also motility. Low serotonin can therefore lead to constipation and yes, hemorrhoids from straining. The supplement 5-hydroxytryptophan (5-HTP) with P5P (vitamin B6) taken during the day and before bed would help in this regard, if slow motility is due to low serotonin production. Pure Encapsulations has a supplement called MotilPro which can also be used as a rapid relief remedy while addressing the root cause.To answer your question about getting rid of candida – I can recommend watching this video on antifungals, but again, the bigger question to be asking is “what allowed the overgrowth to happen in the first place?”. As to not overwhelm you, I will leave this one for now and focus on getting to the root cause of constipation/hemorrhoids because this will help in the process of eliminating candida as well.
And finally, I did not mention it in the video, but since you mention hemorrhoids being an issue, I wanted to bring up a 6th possibility.
6. Low cortisol (hypoadrenal function). Low adrenal output of cortisol (usually due to sustained stress – either mental/emotional and/or physiological stress) may impair circulation, especially in veins that must work against gravity to return blood upward. This is the same dynamic that contributes to orthostatic hypotension when one stands up quickly, and low cortisol impairs optimal vein function in returning blood to the brain against gravity. Do you get dizzy when you stand up quickly? Do you suspect stress might be a factor in your case? Low cortisol affects thyroid function, and when thyroid function is affected, everything in the body slows down, including digestion and motility. Does this resonate with you?
I know I’ve thrown a lot of possibilities at you, but if you reply back with what you feel are possible root causes in your case, we can start narrowing it down and getting more specific so you can start to take action.
Let me know if you have any questions in the meantime.
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Hi!
Thanks so much for your detailed response!
1. I know this is something I struggle to do, drink enough each day, but I am conscious off it! I generally get at least 50oz of water per day (which would be about 1/2 my body weight in oz)
2. I don’t have a dedicated magnesium supplement but magnesium citrate is included in some supplements I am currently taking, adding up to about 285mg. I also try to eat leafy green veggies regularly. I will look into the kind of magnesium you recommended.
3. I do consume healthy fats, however probably not enough! I have had difficulty in the past with digesting them so it can be a bit of a balancing act for me to eat healthy fats.
4. I have not had anything come up flagged on blood work for my thyroid, however, I realize that just because it was not flagged by my conventional doctor does not mean it may not be struggling.
5. While I have not had a stool test for candida, I have done the less official spit test and found it to be consistently giving results for it. What are your thoughts on the accuracy of the spit test?
6. As far as I have noticed, I don’t get dizzy when I stand up quickly. Stress, however could very well be a huge factor. I have had adrenal issues for several years and have been working to manage stress and feed my adrenals well, but as you can see I am still working on it!Also, to give you a bit of background info, I am 35, a professional ballet dancer and my job places high demand on my body physically and mentally. In addition, the past year has been traumatic, with the passing of my mom due to cancer. The past 6 years I have been on a health journey to holistically take care of my body and eat well – gluten, refined sugar and mostly dairy free (not 100% of the time, but fairly close).
Thank you for the resources you shared and taking time to answer questions as well as look into things more. I appreciate your feedback!
Alyssa
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Thank you for sharing the additional information. Functional medicine is literally like a big puzzle and the more pieces we have, the clearer the picture becomes, so the more information you can share with us, the more we can help guide you with more targeted solutions.
I will reply to your responses 1 by 1 again, to keep things organized.
1. If you haven’t yet watched my Hydration pillar in the Beginner’s Health Roadmap, I share some practical tips that can help increase hydration like an app for reminders and elastics on bottles, and flavoring your water, etc. Here’s the video.
2. If you’re take magnesium citrate in different supplements that amount to 285mg and still constipated, it’s likely that it’s not enough for your needs. As I mentioned before, I usually have my clients START at 400mg, and work there way up or down based on their stool type. It should lead to a type 3-4 on the Bristol stool chart. Here’s a handout for you to see.
3. Ok, big clue here! Not being able to digest fats can indicate an issue with liver/gallbladder function, pancreatic enzyme production and/or low stomach acid. Do you experience bloating, gas, nausea, greasy stools, floating stools? Have you ever measured your liver markers ALT, AST, GGT, Direct bilirubin? If so, please remove any identifying info and upload them so I can take a look.
If you haven’t yet watched the Duodenum video, I explain its role in releasing bile needed to emulsify fats so we can digest it. We also need good strong stomach acid to trigger the release of enzymes like lipase, needed to break down our fats. So this is where I’d encourage you to watch the symptoms of hypochlorhydria to see if you feel that’s at play. If so, I can guide you on the next steps.
4. Correct – “normal” is far from optimal. If you have thyroid results you can share with us, please do so.
5. Do you know the name of the spit test you did? It’s possible that there’s candida overgrowth in the oral cavity and not necessarily in the gut. A stool test would confirm that, but if you have GI symptoms like gas, bloating, abdominal pain, nausea, etc we can safely assume there’s dysbiosis. If you can share more of your symptoms, it would help paint the picture better.
6. With everything you’ve shared about the stress in your life, I think we’ve hit the nail on the head with the possibility of either high cortisol or low cortisol being possibly one of the main root causes, affecting circulation, thyroid function, and therefore motility. Sluggish thyroid = sluggish everything! I share a few different testing options in the adrenal balance course (which you should make time to watch as well) to test adrenal function at home, in blood, and through functional tests (urine/saliva). My preference is the DUTCH Adrenal test. If you have problems with energy when you wake up, I’d go for the DUTCH Plus which includes the Cortisol Awakening Response test which isn’t included in the DUTCH Adrenal. Let me know if you’re interested in pursuing functional testing and I can get you access to it.
And I’m sorry to hear about your mom. I wish words could heal, but I’m glad you’re taking care of yourself. It is a journey indeed. If you feel like you need help with releasing emotions and addressing trauma, I share some healing modalities towards the end of the Adrenal Balance course including a resource for finding Neo Emotional Release practitioners worldwide who offer virtual and in-person sessions. I think working on the emotional component will be a game changer for you. ❤️
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Thanks for your informative reply!
1. Will check it out!
2. I agree, not enough magnesium. I typically have Bristol stool chart type 1 or 2, and usually at least once a day. Sometimes more than once a day. Then I can swing to 5 or 6. The link to the handout was helpful.
3. I do experience bloating regularly and gas, though not as regular. I have gone through time periods with floating stool, but currently have not had that issue. I will upload my latest blood work, so you can see, but I don’t know if I have ever had those specific liver markers. I will try the baking soda test and let you know the results
4. I am including my latest blood work, but I don’t think they include the best thyroid markers.
5. The only name I can see is “Candida spit test” Interesting, I did not realize that candida could be just in the oral cavity. I do feel that my digestion is ‘off’ with bloating, gas, although I don’t usually have abdominal pain / nausea. With the bloating, it does not seem to matter too much what I eat, just that my intestine area will blow up like a balloon, I can ‘pull in my stomach’ for the most part, but my overall sense is that something is not right with digesting. I try to chew my food well, but realize that could be a factor of eating too fast for some meals? Also, I feel that if I eat a lot of gluten I tend to then have looser stool.
6. I had not previously heard about the at home adrenal testing you shared and I am excited to get into the full adrenal course! I was curious what the DUTCH test involves and an approximate cost? I have been experiencing fatigue and struggle to wake up in the morning even after getting 8-9 hrs of sleep consistently. So, not sure if it’s my adrenals or thyroid, or both!Thank you for your kind words and encouragement to keep going on this journey!
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thank you for sharing your labs.
1. So your blood test does show patterns of dehydration (higher RBC, hemoglobin and hematocrit). All 3 being on the higher end of the reference range can indicate dehydration. So definitely work on this and watch the video for more tips on how to increase hydration.
2. Keep me posted if increasing magnesium citrate helps you achieve a type 3-4 stool daily.
3. Unfortunately, only total bilirubin was measured. Liver markers look good. If you’re going to get more tests done, it would be good to ask them to get a breakdown of bilirubin: total, direct and indirect bilirubin, as it can give us clues about biliary tract health. Alkaline phosphatase is suboptimally low, and since it is a zinc dependent enzyme, this could point to a need for more zinc, B6 and B12.
Also, your MCV of 95.5 is suboptimally high, which means the size of your red blood cells are large. This can happen when there’s a need for more folate/B9 and B12. Are you taking any supplements with methylated forms of B vitamins?
4. Unfortunately, TSH and free T4 only do not give us enough information about thyroid health. Here is a video in the Thyroid Balance course that explains what a full thyroid panel entails, so you can ask for it (and insist) the next time you test. If the doctor isn’t willing – there are plenty of others who are. And if you don’t want to bother with a doctor, you can always pay out of pocket. If you’re in the US, we partnered with True Health Labs. Here’s their full thyroid panel.
5. Have you tried an elimination challenge before? Removing gluten 100% for at least a month and then re-introducing it once symptoms disappear to see if it’s a food sensitivity or not? Here’s a handout on how to do an elimination challenge. And here are handouts on how to eliminate gluten and dairy – the 2 most common food sensitivities.
6. The DUTCH Plus would be a good idea if you’re experiencing fatigue in the morning as it would also show the cortisol awakening response (plus all sex hormones, and some organic acid markers for B6, B12, glutathione, etc). It’s not cheap though and turnaround time is about 4 weeks +/-. With True Health Labs, it’s $569. With Nordic Labs, they charge $499 plus shipping. We can help with the requisition with Nordic Labs. No need with True Health Labs.
And to answer your question, I suspect the main driver to be adrenal function, given that your labs show a pattern of parasympathetic dominance (lower sodium and chloride, and higher potassium). Here’s the video where I explain the electrolyte markers. The pattern you are showing is common when stress has been prolonged, and the body starts to slow down on purpose as a protective mechanism. It is appropriately responding and skewing the HPATG axis to protect you from a prolonged threat. So I would recommend focusing on adrenal health first and foremost, but also thyroid health as it can be impacting digestion by slowing everything down.
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Amazing, thank you for reading the labs, much more informative than I realized!
1. Working on hydration!
2. Will update you on how my body handles the magnesium
3. I am taking notes for my next doctors appointment and the tests that I will ask for. I am not taking any supplement with methylated forms of B in it.
4. Taking notes and watching the videos you suggested!
5. I have done an elimination challenge before, although I would like to try it again and see what happens. I think that with address the hydration part, and I purchased MotilPro & Magnesium, that might have an impact on how well things get reintroduced.
6. The DUTCH test sounds intriguing and I would like to get it done at some point, although I am not prepared to do that at the moment.Another factor that I wanted to mention is that since my mom’s cancer, there is now a family history of my maternal grandmother and my mom both having pancreatic cancer. My mom had hodgkin’s lymphoma twice, candida overgrowth as well as the pancreatic cancer. I am wanting to be wise to do what I can to take care of my body well and be proactive to not let this come any further in my family line.
Appreciate your help and I will keep you updated!
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