Constipation and the Brain-Gut Axis
Constipation can be a major problem. It affects daily life. It can make or break someone’s day. Yet, statistics show that 1 in 6 Americans live with chronic constipation. It is estimated that $725 million dollars are spent yearly on laxatives. These can get things moving (no pun intended)… but do not correct the underlying problem.
Some key diagnoses to rule-out for acute constipation are colonic obstruction, appendicitis, diverticulitis, peritonitis, and possible stone obstruction from the gall bladder or kidneys. For chronic constipation, some key rule-outs include celiac disease, hypothyroidism, and irritable bowel syndrome (IBS), as well as inflammatory bowel disease and colon cancer.
Gastroenterologists have classified chronic constipation into 4 subtypes:
- Slow-transit constipation
- Pelvic floor dyssynergia
- IBS with constipation
- Functional constipation
- (Functional constipation is defined as chronic idiopathic constipation that does not have a physiological cause. Research suggests that those using this subtype as the diagnosis have not looked deeply enough into possible etiologies.)
CAUSES OF CONSTIPATION
The following are the most common causes of and contributors to constipation:
- the nature of the diet
- Food sensitivities and allergies
- Dysbiosis and Leaky Gut
- deficiency or a faulty composition of the intestinal secretions
- gastrointestinal inflammation
- due to infection, parasite or LPS interference
- Small Intestinal Bacterial Overgrowth (SIBO)
- Celiac Disease
- Inflammatory Bowel Syndrome (IBS)
- Impairment of muscular power, which leads to a deficiency in the propelling power, which may result from brain related issues (concussion, vertigo, depression, anxiety and other brain related issues)
- congestion of the portal circulation
- Genetic SNP mutations
- Poor Brain-gut Axis function
First, evaluation of the gut-brain axis may reveal reasons for altered secretions of the organs and glands of the whole digestive system, including secretions from stomach and intestines, biliary secretions from the liver and gall bladder, and pancreatic enzyme secretions. The major player in this arena is cranial nerve X (10), ie, the vagus nerve, also named the “wandering nerve” because of its far-reaching impact in the body.
Secondly, you must evaluate the diet for potential food intolerances and sensitivities, and for low-quality foods or poor choices of food or food combining that may be contributing to the constipation. I have observed adverse reactions to foods lead to leaky gut and congestion in the whole digestive tract. The elimination of dairy – a mucus-promoting and potentially binding food – is a dietary change that I’ve seen help correct constipation in some patients. Eliminating gluten and has also produced noticeable improvement. Individual testing is optimal for best outcomes.
The gut-brain axis is a bidirectional communication system. If the GI tract is not working properly, brain issues can result. The intestinal microbiome impacts brain development and imbalanced gut flora, as well as leaky gut as a result of inflammation, can also affect brain neurochemistry.
Conversely, if the brain is not working properly, you can have GI issues. The brain controls the movement of food through the intestines – called “motility”, the release of gastric and pancreatic enzymes, and liver/gallbladder bile release. The vagus nerve carries information to and from the brain. The brain activates the brain stem, and the brain stem activates the vagus nerve. The vagus nerve activates the enteric nervous system (which controls the entire GI system). The enteric nervous system then stimulates secretions, motility, and function of the gut. Loss of digestive function can thus be linked back to loss of brain function and/or loss of vagus nerve function. An underactive vagus nerve may express with gastroparesis, overactive heart rate, stomach pain, nausea, heartburn, stomach spasm, weight loss, and/or maldigestion.
Three observations in the office can help evaluate whether vagus nerve function is diminished:
- bowel sounds are diminished
- the uvula does not rise when the patient says, “ahhh”
- the gag reflex is not very responsive
STIMULATING THE VAGUS NERVE
The vagus nerve’s plasticity and function can be improved with neurological exercises that stimulate the muscles in the back of the throat (which in turn stimulates the vagus nerve). These can be repeated daily for 2-4 weeks.
Gargling: Gargle long enough and deep enough to make it an exercise. Drink several 8-oz glasses of water daily by gargling each mouthful.
Singing loudly: Sing in your car, sing while gardening, or cooking, or cleaning; sing while driving, or while working out; chant following meditation; and go to a kirtan or a sing-along whenever you can.
Gagging: Stimulate the gag reflex several times a day; use a tongue depressor, a toothbrush, or your finger, though only to the point of gagging, not vomiting.
In addition, coffee enemas’ ability to reestablish motility works in 2 ways, both through the vagus nerve. The distention activates the stretch receptors, which activates the vagus nerve. The caffeine acts on cholinergic receptors, thereby restoring plasticity to the vagus nerve.6
Addressing the depressed regions of activity of the brain and vestibular system are by far the most consistently effective option we have found in our clinic. When you combine functional neurology and functional medicine approaches to altering constipation, it is really second to none from a natural approach.
Rao SS. Health-Care Burden and Costs of Constipation and Fecal Incontinence: The Silent Afflictions. May 6, 2015. American Gastroenterological Association Web site. http://tinyurl.com/zrzmv5c. Accessed November 23, 2015.
Constipation: NIDDK. From NIH Publication No. 95-2754; July 1995. Right Diagnosis for Health Grades Web site. http://www.rightdiagnosis.com/artic/constipation_niddk.htm. Accessed November 23, 2015.
Prather CM, Subtypes of constipation: sorting out the confusion. Rev Gastroenterol Disord. 2004;4 Suppl 2:S11-S16.
Ellingwood F, Lloyd JU. American Materia Medica, Therapeutics, and Pharmacognosy. Sandy, OR: Eclectic Medical Publications. Portland, OR; 1983. First published Cincinnati, OH; 1919.
Boston District Eclectic Medical Society Meeting. September 15, 1903. The Eclectic Review. 1903;5-6:287.
Kharrazian D. Why Isn’t My Brain Working? Carlsbad, CA: Elephant Press; 2013.
Boston District Eclectic Medical Society Meeting. September 15, 1903. The Eclectic Review. 1903;5-6:289.
Boston District Eclectic Medical Society Meeting. September 15, 1903. The Eclectic Review. 1903;5-6:288.
Moore L. Classical Formulas in the Western Herbal Tradition. Self-published by Les Moore; 2002.