The Dr. Hyman Show - What Is Your Constipation Telling You About Your Overall Health And How To FIx It with Dr. George Papanicolaou

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. You need to be able to evacuate your toxins, your metabolic waste. And the more that stool sits there, there are biochemical changes that happen in that stool that allow for the toxins and the compounds that your body didn't want anymore to leak back into your system. Hey everyone, it's Dr. Mark. Now I don't think there's anything better than waking up feeling super rested, relaxed, and energized. When we get high quality sleep, that's normal.

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Starting point is 00:04:25 meat that you eat. Now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman and that's pharmacy with an F-F-A-R-M-A-C-Y, a place for conversations that matter. And welcome to this special episode called House Call, where we dive deep into health conditions through the lens of functional medicine and I'm here today with my friend and colleague Dr. George Papanikolaou and we're going to get deep into the poop story or more importantly why people don't poop, can't poop, have trouble pooping and how to fix this terrible problem that affects millions and millions

Starting point is 00:05:05 and millions and millions and millions and millions of people called constipation not a fun topic to talk about but unfortunately it's my favorite topic because it's so easy to fix yeah uh and i just had this one patient who was uh was so funny i'm just gonna quickly tell the story then we'll jump right in george but i i she she was like so i was like so so do you have regular bowel movements she's like yes i have regular bowel movements she's i said how often do you go she goes i go every week i said that's not regular she goes it's regular for me i go every week and i'm like whoa so people have no idea what it's like to have normal bowel function. You should probably go two or three times a day. In modern industrial society, the average stool weight is four ounces.

Starting point is 00:05:51 In hunter-gatherers who eat tons of plant foods and fiber, it's two pounds, right? Which is eight times the weight of somebody who's not eating the right food. So I often hear from patients dr hyman i didn't know that this was normal that i could actually poop every day so we're going to get into it so welcome george so let's talk about constipation it's going to be a fun conversation i just have to say you're talking about the hunter-gatherer i would have to say that the size of the toilet would have to have been the size of a dinosaur all right that's right well you see like one of the elephants who eat like

Starting point is 00:06:25 hundreds of pounds of roughage and fiber every day i think they poop like 50 kilos a day or something ridiculous so tell us about how common is this and what is going on it's a really it's a really common problem uh about 80 million people per you know the prevalence is very high so 80 million people um are going to suffer with constipation. And it gets worse as you get older. And it's an $800 million business. And that's an underestimate because it doesn't include the over the counter meds. So it's only $800 million that's being spent to have a nice bowel movement.

Starting point is 00:07:04 What do you mean mean you mean from with doctors you're not talking about like the stuff you get over the counter like x-locks that's that's what that's with doctors and i said it's an underestimate because it doesn't include the otc the otc meds the over-the-counter meds you get in the grocery store which is probably way more than way more than that right so tell us tell us what are the complications of constipation and why is it bad to not go regularly? Why is constipation bad? Yeah, so first off, what is not regular and what do people consider constipation?

Starting point is 00:07:39 Why is it something that people are we see people with gut issues and constipation. Almost one out of every three patients of mine, no matter what they're coming for, has a gut issue. So gut issues in general are just prevalent throughout the world, quite honestly, because we get people from all over the world in the center. So I'm always dealing with gut issues particularly constipation this constipation leads to bloating and suspension and then people identify foods that cause their constipation then there's food fear and anxiety and it just begins to really take a toll on people's lives. And so it is a really big deal. What's a normal number of bowel movements?

Starting point is 00:08:34 You know, I was taught, you know, anywhere from three bowel movements a day to one bowel movement every three to five days. Ah, no. Yeah, that's what I was told a long time ago. But the most recent study using the most respected tool for determining, studying this called the Rome 3, identified constipation is less than three bowel movements a week. So in conventional medicine, that's what it's defined as, less than three bowel movements a week for more than three months. Wow. I would, you know, so. Well, why? So when you get constipated, it causes other health issues. So why is it bad to be constipated?

Starting point is 00:09:14 Okay, so I go three times a week. I go, it's pretty regularly. Why do I care? Okay, I think there's two ways to look at that. One is that not like once I'm constipated with the problems, but what got me to being constipated in the first place? And that goes back to what we always talk about is how you live. It goes back to lifestyle. It goes back to nutrition.

Starting point is 00:09:39 It goes back to stress. It goes back to exercise. And just to name three of the lifestyles that are most impactful. So if you're not getting good exercise, you're not getting good sleep, you're not eating nutritious, you're going to be in a position to end up with gut issues, including constipation. So how you got there is really important because if you've got constipation, that's just the beginning of the problems. And then once you have the constipation, the problem is that you need to be able to evacuate your toxins, your metabolic waste.

Starting point is 00:10:20 And the more that stool sits there, there are biochemical changes that happen in that stool that allow for the toxins and the compounds that your body didn't want anymore to leak back into your system. And when that happens, then you begin to impact your immune system, you begin to increase inflammation. And as we always talk about you know that that inflammation begins to have an impact on every organ system in your body okay so so bringing it down there's really like two main issues one is just the the direct harm from being constipated which includes hemorrhoids anal fissures anal prolapse pain and also just feeling like crap because you're full of crap. You're full of crap.

Starting point is 00:11:09 And you're literally reabsorbing a lot of the toxins that get excreted by your liver right into your intestinal tract. You're reabsorbing them. You're also affecting your hormonal metabolism. And you're producing all these products in there that are getting absorbed. And what's true about your gut is it's a whole ecosystem of bugs in there that has to be healthy. It's like a garden. And if the garden isn't healthy, you're not healthy. Your immune system is disrupted.

Starting point is 00:11:37 You're toxic. It creates brain inflammation. It creates systemic disease, heart disease, cancer, diabetes, Parkinson's. I mean, Parkinson's disease. You're 400% more likely to have Parkinson's disease if you're constipated. And we know that Parkinson's disease is related to environmental toxins. So not only are you having this sort of anal and physical issues of being constipated, not only do you feel like crap, but it has long-term risks for many, many chronic diseases.

Starting point is 00:12:04 So it's really important to go and go often and go every day or two or three times a day. And once you understand how to regulate your gut and fix the causes of constipation, then you won't be constipated. And most doctors just give you laxatives or tell you to have more Metamucil or fiber, and that can be helpful but or drink a lot of water but there's so much more to it so so tell us what is the conventional medicine approach to constipation and then let's talk about what the functional medicine approach is to constipation you know conventional medicine again it is the name it, blame it symptom and treat it. And so, you know, so they treat the constipation.

Starting point is 00:12:49 And so over the counter, you can get all types of different products that will be either there'll be bulking agents. You can have laxatives that bring more water into your stool. You can have lubricating agents. All these are available. So all they do is get the poop out. That's it. And make you feel more comfortable, but it doesn't solve the underlying problem.

Starting point is 00:13:15 And then for people with what's called chronic idiopathic constipation, which is the most common. Idiopathic means, by the way, I don't know, right? So I don't know why you have it, but I'm going to give you a really expensive drug to make your bowels move. And so there are really expensive drugs on the market that stimulate the receptors in the bowel to get them to move so you can have a bowel movement. So that's the conventional approach. Let's get it out and let's make the bowels move faster so that it will come out.

Starting point is 00:13:50 But we're not going to look at the underlying root causes of why the person's constipated. And nor are we going to think about the downstream effects of that constipation, not only of the constipation itself, but to get to that constipation, again, it goes back to the fact that it's this long-term inadequacy of your diet, the long-term impact of stress that results in constipation. But what you can't see is the impact it's having on your brain, the impact it's having on the blood vessels of your heart, the impact it's having on your immune system. So on the functional medicine side, that's what we do. We begin to focus on nutrition, stress, lifestyle, exercise, begin to change people's lives so that they're living healthier.

Starting point is 00:14:48 And therefore the constipation can resolve on its own. Yeah. Yeah. Well, before you jump into that, I want to talk a little bit about the problems with traditional treatments because, you know, yes, it's fine to take extra fiber and so forth. All times I have weird, you know, artificial sweeteners in it fiber and so forth all times i have weird you know artificial sweeteners in it and stuff that's weird right you can take you can take like mineral oil which is

Starting point is 00:15:10 fine but that's kind of gross you can take various laxatives uh and suppositories a lot of the treatments uh can be very dangerous like x-lax or senna cod or cascara things are even considered natural because they create a lazy bowel. So people who have been constipated a long time, they take these drugs which work for their body, like even smooth-move tea, which is fine for an occasional issue, but these things become habit-forming and they cause a lazy bowel. And people can get something called megacolon,

Starting point is 00:15:39 where they literally cannot eliminate without these things. Or people get reliant on enemas or they get reliant on colonics. And the truth is, unless you dig down into the root causes of constipation with a functional medicine lens, all these things are just like Band-Aids. And they often are harmful, not helpful. So, you know, let's look down into, you know, from a functional medicine perspective, how do you identify what's causing a person's constipation? are the tests you do how do you think about it you know what are the what are the main causes of constipation in our patient population yeah so so the main causes of

Starting point is 00:16:18 constipation are going to be one i'd say there's food sensitivities. So not being aware of food sensitivities that can create inflammation and alter the function of your gut. There's going to be nutritional issues like you're just not getting enough fiber. I know you talk about using exogenous fiber to treat the constipation, but you don't get into that situation if you're eating foods that aren't processed. All the processed foods that we eat don't have any of the indigestible fiber that's required for the stool to form correctly and also to maintain a healthy gut microbiome. So, again, it goes down to some nutrition is involved. And what else would be some cause? I think I think there's a lot of causes. Let's just go through them.

Starting point is 00:17:12 So you've got you've got things that are often missed, like thyroid. Right. You've got low thyroid function is a big cause and lack of magnesium, which is a huge issue for people. I think 40 percent of the population is low in magnesium and that can drive constipation. People often have yeast issues from taking lots of antibiotics, which can be a big factor in constipation that causes dysbiosis. Dairy is the number one cause of constipation in kids and not only constipation, but anemia because the dairy irritates the guts of these kids and causes blood loss in the stool. So constipation from dairy is a huge factor. So we've got a lot of things we think about. It can be also things like heavy metals, which are factors that can impair gut function,

Starting point is 00:17:57 or even weird things like tick infections that cause a neurologic problem in the gut that help damage the neurological pathways that cause peristalsis. And that leads to constipation from tick infections. So from a functional medicine perspective, we really dive deep into figure out what's going on. And the treatment is often so easy and so effective. And we really start with the foundational things, right? We start with diet and then so we go on to the use of specific supplements and other things that can help fix it so take us through the this patient you had and then let's let's dive deep into the story of what are the what

Starting point is 00:18:36 are the real uh treatments that we find so successful in rebuilding someone's gut so they have healthy bowel movements and have health as a consequence. So the patient that I had, she was a 19-year-old nursing student who came to see me and she had had prolonged constipation after prolonged use of antibiotics for recurrent urinary tract infections. So interestingly enough, she was, you know, at the end of her first year of nursing school, lots of enormous stress tests she had to pass to be able to continue the nursing program. She was in a new relationship and her diet was really not very good. She's under a lot of stress. She was eating poorly. So when she came to see me, she had significant constipation. And we do some tests

Starting point is 00:19:35 that really help us get down to the root problem. And we do that complete diagnostic stool analysis that allows us to look at the microbiome. So we're able to see if you have a balance of your good and bad bacteria. We're able to see if you picked up any bad guys along the way like parasites and worms that can impact your gut function. And we look to see if you have all of the markers for healthy digestion, which is really key. So we're able to see if you're making enough of the pancreatic enzymes you need. Is your gut detoxification working correctly? Is your gut immune system working correctly?

Starting point is 00:20:12 Are markers of inflammation high? That gives us a complete picture of what's going on in your gut. We also look for something called leaky gut, that when you have enough inflammation, you have enough destruction of the mucosal membrane you'll end up breaking down those gates that are responsible for keeping the bad guys out letting good guys in they're called tight junctions and when those aren't operating then bacteria and compounds and toxins can get into your system and trigger lots of inflammation and disease. So we do those tests. We look for food sensitivities.

Starting point is 00:20:53 The most common ones that we look for are going to be gluten, gluten cross-reactive foods that will include egg and dairy and soy and rice because they will act like gluten in your gut when you're sensitive to them. And those will be produced when you have leaky gut. So I did all those tests on her. And did I do any other tests on her? I just have to remind myself. Those were the tests that I did. And so what we found.

Starting point is 00:21:20 You look for spectral overgrowth. You look at stool, food sensitivity testing, overgrowth. You look at stool sensitivity testing. Yeah. Yeah. We did all that testing. And so what I found, what I found with her is that she did have significant leaky gut and she had something that's called SIBO. She had the bacteria that lives in your large intestine. It's just she just lived there and migrated up into her small intestine and now

Starting point is 00:21:47 it's where we don't want it to be all that digestion and fermentation should happen in the in the large intestine has very thick walls and now it can it can maintain all that fermentation without you experiencing discomfort but when you're doing fermentation in a small intestine that has thin walls, that fermentation starts to happen, the gases build up, you get bloated and extended. And if the bacteria that's causing that overgrowth happens to be a methanobacter and produces methane, those organisms, they will slow down gut transit. And that will lead to constipation. And oftentimes those people get labeled irritable bowel syndrome with constipation.

Starting point is 00:22:33 And in conventional medicine, we put on medications like Lunseth, which will get the bowels to move but not solve the problem, which is bacteria in the small intestine. So in her case, we treated her small intestinal bacterial overgrowth with herbal antibacterials. We treated her leaky gut by using something called L-glutamine, which applies nutrients for the gut to heal. I used quercetin as well because quercetin can actually impact and regulate the tight junctions we talked about and begin to heal the leaky gut. So, you know, we took care of a leaky

Starting point is 00:23:13 gut. We reestablished a good microbiome and then we helped her understand the importance of her nutrition. So then I talked to her about getting more of the high-fiber food that she needs to get into her diet. You know, nuts, seeds, beans, chickpeas, chicory, dandelion root, onions, garlic, which she can't get right away. We had to increase her fiber after her SIBO was treated because some of those foods will actually exacerbate her symptoms but once we treated her SIBO once we took care of dysbiosis and then we talked to her about the lifestyle changes that she could make which included higher fiber with the food I just mentioned, which included making sure you did drink enough water because water is important.

Starting point is 00:24:09 You need that water in the stool to make it fluffy and move quickly and easily through the gut and finally out through the rectum. Because if you have hard stools, they're really uncomfortable. And lots of times people call constipation hard stools. I just have hard stools. I have them every day, but they're hard. And that is constipation to some degree. And it's uncomfortable and painful. But that is because they're just not drinking enough fluid. They're not getting enough fiber. Now, going back to, you know, Northampton, Neanderthal man, his poops are really big because he's getting 150 grams of fiber a day.

Starting point is 00:24:46 Today, less than 5% of the American public gets the amount of fiber they should, which is anywhere from 20 to 40 grams of fiber. Most people are getting about 8 to 10 grams of fiber per day. And that has a lot to do with why we're having, you know, gut problems, dysbiosis, because that fiber also, when it's broken down, produces a lot of nutrients that are good for the colonocytes and good for the healthy bacteria so that they can maintain a good, robust population. So we fixed those things in her, and her constipation was gone within six weeks. Yeah, it's pretty amazing. And I see this, too too in my practice, George. And we really take a comprehensive approach.

Starting point is 00:25:29 It's the obvious things, right? Eat lots of fruits and vegetables, nuts and seeds, high-fiber plant-rich foods. Drink lots of water. Get exercise. All those things really help. Medications are a huge factor sometimes. Iron supplements, blood pressure supplements, narcotics, diuretics, these are common medications. They will cause constipation. So, you have to work

Starting point is 00:25:50 around them. Make sure you check your thyroid. Make sure you check for diabetes because that can affect the neurological system. Heavy metals can be a factor. Even tick infections we talked about. And even things like the dysbiosis and yeast from eating all the antibiotics and processed foods. So, all these things we want to think about and then you know often is you know in terms of supplements there's some really simple things to do magnesium is a big factor I had a patient who is like literally going every week she had terrible migraines she had all these other magnesium deficiency symptoms muscle cramps insomnia anxiety palpitations and

Starting point is 00:26:22 I gave what was equivalent about 2,000 milligrams of magnesium because that's what she needed in order to actually get her to poop. And the more time she needed, the less and less. We gave her probiotics. We gave her extra vitamin C, which will help you poop. We can use things like fats. Fats are so great. They're a lubricant.

Starting point is 00:26:41 MCT oil, which is basically derived from coconut. We say, we often joke and say that causes disaster pants because if you take too much of it, it'll make you poop. That's a good thing. So we really need to understand how to rebuild our whole gut using a comprehensive approach, looking for the causes. And obviously getting rid of all the crap that makes you constipated. So that plus exercise, stress reduction, it's a comprehensive approach. I can tell you there isn't a single patient I haven't been able to help poop every day

Starting point is 00:27:09 over 30 years. Yeah, I will tell you, it's one of the most fulfilling things that I treat because I can get it better, you know, and I do it frequently. And really, when I know when I'm helping somebody's gut get healthier, I am helping them prevent significant disease down the road. Because a healthy gut, as Hippocrates said, death begins in the gut.

Starting point is 00:27:36 And because long-term negligence in your nutrition and your lifestyle is going to lead to an unhealthy gut and the inability for you to get rid of toxins, to absorb the nutrients that you need to keep you healthy. Yeah, that's right, George. And that's a very important point I want to emphasize in functional medicine. It's not just about treating your symptom of constipation. It's understanding how it connects to everything that can go wrong with your health. So being constipated is not just annoying or uncomfortable or pain, but it's actually something that's setting you up for really poor health outcomes across a spectrum of disease, whether it's heart disease, cancer. I mean, if you're constipated, you're more likely to get cancer of the colon, for example. So it's really important to get your gut healthy.

Starting point is 00:28:17 And we've done many podcasts on the gut. This is another one that focuses specifically on constipation. But I feel using a functional medicine perspective, using the kinds of thinking we use in functional medicine here at the Ultra Wellness Center, using the diagnostic tests that we do, which are quite different than traditional medicine. We look at bacterial overgrowth. We look at stool testing. We look at nutritional testing.

Starting point is 00:28:37 We can really figure out what's going on with people and help them when no one else can. And we're now doing stuff on Zoom. It's really awesome. And we can be from all over the world. And it's pretty, it's pretty really fulfilling because we can really help so many people who just don't get help anywhere else. And my, my goal is really to end needless suffering for millions of people through the power of functional medicine. And it works and it really does work. And I, I think that, you know, the work we do here is just so

Starting point is 00:29:03 gratifying for all of us who work there. And I think our patients are so happy. And I just I'm really glad to be able to share some of the knowledge of stuff we're doing with all of you, because I just want people to know that there is there is an answer often for something that's causing you suffering that you might not be hearing about that you might not be hearing about at your traditional doctor. So I really am excited for you, George, that you've given us this deep dive into poop. And I'm excited for the next podcast with you. Right now, this is more important than ever to regulate your gut and immune system because they're connected. And in time of COVID, we really want to double down on getting our gut healthy

Starting point is 00:29:41 and fixing our gut. Am I getting a ticket to Hawaii for the next podcast? No, you're not getting a ticket to Hawaii. But I'll show you the beach if you want. So thank you, George, for joining us on The Doctor's Pharmacy once again. It's been great having you. If you love this podcast, please share it with your friends and family on social media. Leave a comment.

Starting point is 00:30:03 Tell us how you've dealt with your constipation. Maybe we'll learn something from you. Subscribe wherever you get your podcasts and we'll see you next time on The Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health.

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The Dr. Hyman Show - What Is Your Constipation Telling You About Your Overall Health And How To FIx It with Dr. George Papanicolaou

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