Constipation, normal transit

Chapter 21

Constipation, normal transit Summary Essence: Painful defecation ≥ 3 times per week due to insufficient moisture of the stool often with biliary stasis. Terrain: Unfavorable stool composition due to one or more: (a) Diet: Insufficient fiber and/or water intake, (b) Dysbiosis, (c) Biliary stasis (sphincter of Oddi spasmophilia): Para insufficiency, excess alpha, beta blocked or delayed.

Treatment goals Symptomatic: Soluble fiber, lubricant, osmotic/stimulant laxatives Terrain: ●

● ●

ANS: ⇓ Alpha, support Para, ⇑ Beta--resolve spasmophilia on gallbladder DRAIN: 1°Hepato-biliary-Exocrine Pancreatic unit GI: Correct dysbiosis as indicated

Sample treatment 1. Diet: Hydration, soluble fiber, fruit, fermented foods, probiotics, oils 2. ANS-Emunctory-dysbiosis: Carduus marianus MT 160 mL, Cynara scolymus MT 160 mL, Raphanus niger MT 160 mL, Artemisia dracunculus EO 6 mL, Satureja montana EO 4 mL: 3 mL three times per day before meals × 3–4 months 3. Lifestyle: Exercise, sleep optimization (before midnight, 6.5–8 h total, excluding night waking and time in bed)

Terrain in detail

iii. Beta: blocked or insufficient for excretion of bile b. Gonadotropic: i. Estrogen excess: diminishes biliary secretion ii. Progesterone excess: favors biliary stasis 2. Intestinal: Dysbiosis (cf. Theory of Endobiogeny, Volume 2, Chapter 6: Disorders of dysbiosis) 3. Emunctory: Hepatobiliary-Exocrine pancreas dysregulation delaying biliary excretion due to exocrine pancreatic insufficiency

Agent The quality of food or iatrogenic causes challenges the competency of the gallbladder: ● ●

●

●

Insufficient intake of sufficient soluble fiber Insufficient water intake for Endobiogenic equilibrium (neuroendocrine fluid management) Overconsumption of fatty, fried food diet (oversolicits congested gallbladder) Contraceptive medication (estro-progestive impairs biliary function)

Critical terrain Parasympathetic tone is solicited to compensate for the dietary or iatrogenic aggression on the gallbladder. The reactive nature of alpha exceeds that of para, and expressed specifically at the level of the gallbladder. 1. ANS hyperfunctioning: Spasmophilia of sphincter of Oddi ● Hyper-Alpha > Para, Beta blocked, or delayed on gallbladder

Precritical terrain

Mechanisms

Bile increases intestinal motricity and has antimicrobial effects. In the precritical terrain, there is an underlying dysfunction of biliary dynamics:

Insufficient movement of stool from insufficient bile + insufficient roughage to stimulate optimal moisture content of stool

1. Gallbladder: insufficient excretion: a. ANS: dysfunctional relationships impair choleresis i. Para insufficiency: diminished rate of bile production ii. Alpha excess: tonic closure of sphincter of Oddi

The Theory of Endobiogeny. https://doi.org/10.1016/B978-0-12-816965-0.00021-4 © 2020 Elsevier Inc. All rights reserved.

Result Normal transit constipation: pain defecation, stool dry or hardened, normal defecation frequency per week

153

154 SECTION | C  Assessment and treatment of common disorders

History and BoF findings

●

The precritical terrain can be evaluated in order to apply a prophylactic treatment, especially with intermittent normal transit constipation. Some possible correlations between precritical and/or critical symptoms and Biology of Functions are presented in Table 21.1.

●

●

●

Stool not palpable in distal colon Evaluate ANS loco-regional (digestive) and global dysfunction Evaluate gallbladder points: palpable on abdomen, right leg and feet Evaluate hepato-pancreatic blockage

Treatment

Physical exam and BoF findings During presentation with constipation, the following may be observed on physical exam with some possible Biology of Functions correlations (Table 21.2).

In the treatment of normal transit constipation, there are numerous symptomatic treatments, focused primarily on evacuating the stool already formed and difficult to pass. They can be stratification based on severity of symptoms (Table 21.3).

TABLE 21.1  Precritical and critical terrain symptoms and biology of functions correlations. Area

Finding

Terrain

BoF

Stool frequency

3 or more per week

cf. above

Defecation quality

Difficult to pass, painful to pass, straining

Insufficient bile production, excretion, and timing ANS imbalance, ⇑ Alpha > Para, blocked Beta

Intestines

Post-prandial bloating, headache, joint pain, etc.; flatulence

Dysbiosis

ANS

Post-prandial fatigue

Hyperparasympathetic digestive

Spasmophilia

Spasmophilia

↑/↓ LMI + ↓ PMI

Gonadotropic

PMS: Estro-progestive excess: breast swelling, breast tenderness, Menstruation: multiple days with clotting

Estro-progestive excess

↑ Estrogen indexes ↓ Progesterone

Medications

Oral estro-progestin-type contraceptive pills

Iatrogenic estro-progestive excess

↑ Estrogen indexes ↓ Progesterone

Key: LMI: Leukocyte mobilization index; PMI: Platelet mobilization index.

TABLE 21.2  Critical terrain signs and Biology of Functions correlations. Area

Finding

Terrain

BoF

Colon

Stool is nonpalpable in distal colon

Neuro

Chvostek

Spasmophilia

⇑ LMI, ⇓ PMI

Brisk DTR, Clonus, Eyelid flutter on Glabella tap

⇑ TRH

⇑: Thyroid relaunching, Thyroid relaunching corrected, Hypothalamo-Metabolic, TRH/TSH

Gallbladder

Tender on deep palpation: gallbladder sphincter of Oddi

Sphincter dysfunction

N/A

Liver

Tender, superior-medial

Vascular hepatic congestion

⇑/⇓ LMI

Tender, inferior-lateral

Metabolic hepatic congestion

⇑/⇓ LMI

Tender, above umbilicus

Congestion: general

N/A

Tender, right of umbilicus

Over-solicitation: exocrine

⇑/⇓ Somatostatin

Tender, left of umbilicus

Over-solicitation: exocrine

N/A

Tender: Ascending, Transverse colon

FSH, LH over-solicitation

⇓: FSH, LH

Pancreas

Colon

Key: DTR: Deep tendon reflex; LMI: Leukocyte mobilization index; PMI: Platelet mobilization index.

Constipation, normal transit Chapter | 21  155

TABLE 21.3  Overview of symptomatic treatment based on severity of symptoms. Priority

Symptoms

Treatment

Rational

Urgent

Feeling of toxicity, aggravation of other conditions

Laxative

Stimulate contraction of colon

Hyperosmotic

Hydrate stool

Complications, e.g., anal fissure

Cicatrizant

Heals wound

Timely

Chronic, discomforting but tolerable

Monodiet, Hydration

Acutely increase fiber and fluid intake

Chronic

Intermittent or frequent

Diet Lifestyle Medicinal plants

Regulate the Endobiogenic terrain

Based on an Endobiogenic reflection, an elaboration of this approach to treatment is as follows: 1) Urgent a. Stimulant laxatives i. Short-term relief from constipation, can cause bloating, gas, spasmophilia. b. Glycerin suppository i. Hyperosmotic lubricant, for occasional use in all ages, up to 3 times per week c. Treatment of anal fissures: i. Ingredients: 1 tsp peanut oil, diatomaceous earth to make paste 1. Burning pain: add 1 pinch Sodium bicarbonate 2. Infection: add 1 drop Lavandula angustifolia EO ii. Instructions: Anus: clean, pat dry, apply 2–3 times per day after defecation 2) Timely a. Hydration and hyperosmotics: i. Water: Alkaline, Artesian well water: 1–2 L per day ii. Fruit juices, 4–12 oz (120–350 mL) per day in divided doses: 1. Spring: white grape, celery 2. Summer: watermelon 3. Autumn: prune, pear, apple (unfiltered) 4. Winter: grapefruit iii. Honey: hyperosmotic, demulcent: 1 tbsp AM and before bed followed by glass of water with lemon b. Lubricants: Oils i. Options: Olive: Lubricating, choleretic; Sesame: Lubricating, use in anxious or hyperactive patients; Borage: Lubricating: use in obese or anxious patients

ii. Dosing: 0–11 months: ¼ tsp, 12–23 months: ½ tsp, 2–4 years: 1 tsp, 5–7 years: ½ tbsp, 8 years and older: 1 tbsp iii. Frequency: AM before breakfast and before bed, followed by 250 mL of spring water if it does not interfere with sleep and urinary habits. c. Monodiets (cf. Chapter 44: Endobiogenic diets and nutrition) i. Grape cure ii. Apple-sardine iii. Fruit-Vegetable-Brown rice diet 3) Chronic a. Diet i. High-fiber foods (Table 21.4) ii. Fermented foods (for dysbiosis) b. Lifestyle: regulates autonomic tone and colon motricity i. Movement: exercise, yoga, meditative movement ii. Sleep: Restorative, before midnight, 6.5–8 h per night c. Long-term regulation of stool quality (Table 21.5) d. Drainage (Table 21.6) e. Regulation of dysbiosis (Table 21.7)

Exemplary prescriptions Based on an Endobiogenic approach to normal transit constipation, a number of prescriptions can be derived. 1. Neuro-drainage-dysbiosis, Adults: 4 mL three times per day before meals Agrimonia eupatoria MT 120 mL, Plantago major MT 120 mL, Mentha piperita EO 2 mL, Artemisia dracunculus EO 2 mL, Origanum vulgare EO 1 mL 2. Neuro-drainage-dysbiosis, Children: 1–3  mL three times per day before meals Rosmarinus officinalis GM 60 mL, Juglans regia GM 60 mL, Mentha piperita EO 0.5 mL (Optional) In patients with chronic issues of constipation with poor eating habits and a sedentary lifestyle, the following transformational approach to wellness can be offered: Week 1: Symptomatic relief and starting a new lifestyle 1) Fruit-Vegetable-Brown rice diet×6 days 2) Olive oil and 6 glasses of water per day 3) AM: 1 tbsp olive oil+1 glass water 15 min before meal 4) 2 glasses water between breakfast and dinner Week 2: High-fiber foods: 10 g per day Week 3: Increasing fiber: 20–30 g per day ● ● ● ●

1 cup Puréed sweet potatoes 2–3 per week (6g fiber) 1 cup hummus 2–3 times per week (6g fiber) Buckwheat, 1 cup once 2–3 times week (4g fiber) High-fiber flax bread (10 g fiber per square)

TABLE 21.4  High-fiber foods by category. Category

Food

Serving

Fiber (g)

Grains

Bran Cereal

1 cup

20

Barley

1 cup

14

Bulgur

1 cup

8

Freekeh

1 cup

7

Flax seeds*

3 tsp

7

Quinoa*

1 cup

6.5

Whole wheat spaghetti

1 cup

6

Buckwheat*

1 cup

4.5

Groats (Kasha)*

1 cup

4.5

Ezekiel bread

2 slices

4

Oats, raw*

1 cup

4

Corn*

1 cup

4

Brown rice*

1 cup

3.5

Lentils*

1 cup

15

Black beans*

1 cup

15

Pinto beans*

1 cup

15

Kidney beans*

1 cup

13

Lima beans*

1 cup

13

Navy beans*

1 cup

11

Chick peas*

1 cup

6

Split peas*

1 cup

16

Green peas*

1 cup

9

Kale*

1 cup

7

Yam*

1 cup

6

Broccoli*

1 cup

4

Spinach, cooked*

1 cup

4

Pistachios*

4 oz

12

Hazelnuts*

4 oz

9

Pumpkin*

4 oz

4

Almonds*

4 oz

2.5

Grapefruit*

1

14

Avocado*

1, med

12

Raspberries*

1 cup

8

Pear*

1

5

Apple*

1

5

Banana*

1

4

Blueberry*

1

4

Orange*

1

4

Figs, dry*

2

4

Dates*

4

3

Legumes

Vegetables

Nuts

Fruits

Key: *=gluten-free, Bold=high in protein.

Constipation, normal transit Chapter | 21  157

TABLE 21.5  Medicinal plants with polyvalent symptomatic actions. Plant

Demulcents

Althea officinalis

•

Laxatives

Bulking

Balance microbiota

Artemisia dracunculus

•

Glycyrrhiza glabra

•

Eugenia caryophyllata

•

Trigonella foenum

•

•

Mentha piperita

•

Plantago ovata (Psyillium)

•

•

•

Satureja montana

•

Taraxacum officinale

•

TABLE 21.6  Medicinal plants for ANS regulation and drainage. Plant

HBExP

Agrimonia eupatoria

•

Plantago major

•

Arctium lappa

•

HB

ExP

ANS

Other properties a

Vagolytic

Immunomodulation

Mentha piperita

•

•

Sympatholytic

Antiflatulent, regulates dysbiosis

Fumaria officinalis

•

•

Digestive spasmolytic

Acts on sphincter of Oddi,

Juglans regia

•

•

Rosmarinus officinalis

•

Raphanus niger

•

Regulates dysbiosis, digestive astringent, cicatrizing Digestive spasmolytic

Eupeptic, hepatoprotector, intestinal antispasmodic Regulates dysbiosis, cicatrizing

Key: ANS: Autonomic nervous system, ExP: Exocrine pancreas; HB: Hepatobiliary; HBExP: Hepatobioliary-Exocrine Pancreatic unit. a

Indirect by improving digestive function.

TABLE 21.7  Polyvalent medicinal plants for dysbiosis. Plant

GI

ANS

Mentha piperita

Antiflatulent, digestive, eupeptic, cholagogue, choleretic, exocrine pancreatic stimulant (lipase, amylase), antinausea,

Mild: sympatholytic, parasympathomimetic

Origanum vulgare

Digestive antispasmodic

Sympatholytic, parasympathomimetic

Artemisia dracunculus

Digestive antispasmodic, aperitif, carminative, antinausea, drainage: splanchnic bed, pancreas, pelvis

Vagolytic

Syzygium aromaticum

Eupeptic, digestive, carminative, choleretic

158 SECTION | C  Assessment and treatment of common disorders

●

Smoothie for breakfast (17 g fiber): a. Protein powder, 1 scoop b. ½ Avocado (6 g fiber) c. ½ cup frozen raspberries (4 g fiber) d. 1 cup kale (7 g fiber) e. Dilute with unsweetened vanilla almond milk to taste

Week 4: Expanding diet 1) 1 serving of fermented food four times per week Week 5: Movement 1) Standing up every 55 min and walking around for 5 min 2) 20 min of brisk walking 4 times per week with a friend