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Welcome to AIM for health: Root Cause Conversations with Dr. James Biddle. All content from the conversations in this podcast are created and published for informational purposes only. This is not intended to be a substitute for professional medical advice and should not be relied on for personal medical decisions. Always seek the guidance of your doctor with any questions you have regarding a medical condition.
Hey, I’m Dr. Biddle and today is the 3rd of June, 2020. And then I have our new patient coordinator, Joy Lambert to help us out today. Hi joy.
>> Hello! It’s good to be back.
Yes! So we have people sending in questions. What do we have today?
>> So a question that came across my desk today is people are wanting to know, is there a connection between sluggish bowel habits and hypothyroid?
Are we done? Should we go home?
>> Well, no! What’s the connection?
What’s the connection…..!? Well, if you’ve got sluggish thyroid, you’ve got sluggish bowels and why is that word, metabolism.
>> Well, what is metabolism?
It’s basically how well you turn food into usable energy in your body at the cellular level. And what drives the metabolism!? The thyroid. So your thyroid gland of course makes thyroid hormone. And that travels through your bloodstream and tells all your cells to be active. You know, and it’s almost easier to say what happens when you lack thyroid hormone, because that shows you then what thyroid hormone does. So if you have somebody whose thyroid just shuts down completely, and they’re not diagnosed after a few months, they’ll have all kinds of interesting things.
They’ll of course have mental dullness, they’ll have a weight gain, they’ll have fluid retention and this very weird stuff called non-pitting edema, meaning that when you press on it, it does not make it a little bump. It just doesn’t really give at all. It’s called myxedema, and it’s not so much fluid it’s more like a fatty fluid under there….very interesting…from the lack of the metabolism going on…and they get the dry hair and hair loss and dry skin and dry nails and coarse facial features. And of course, constipated. Everything just kind of stops moving because every cell in your body now doesn’t have the cellular energy production, energy production of ATP, which is kind of our little dollar bill currency of energy that we turned food into to actually do things in our cells.
And so every cell in your body is not doing what it’s supposed to do. A couple of fascinating things about that…..I had one patient go to another practitioner who’s not really licensed. And you know what…they did muscle testing and said, Oh, this thyroid hormone is not good for you, you should stop it. And so six months later she was in the intensive cardiac intensive care unit with a pericardial tamponade.
There’s a sack around your heart called the pericardium. And there’s a little thin layer of fluid to lubricate it so that your heart can beat and have a smooth surface to meet on inside there. But that can fill up with fluid and then push on your heart so tight that your heart can’t then relax to fill up with fluid anymore. And she almost died from not taking her thyroid hormone. So that’s kind of the extreme case when I was in residency. In my actual medical school inpatient psychiatric rotation, I met a young man in his twenties with myxedema madness. He had temporary psychosis from a complete lack of thyroid hormone. He had hypothyroidism and had not been diagnosed. And that made him crazy. I mean, literally by the definition of crazy, he could not understand conscious reality and what was going on. He was seeing and hearing things.
So that’s all the wild stuff that profound hypothyroidism can cause, but usually what’s happening is people are going to their doctor and they have hypothyroidism and they’re given a certain medication, but it doesn’t work quite right. Or they’re given a lack there of. They’re not diagnosed with hypothyroidism and they’re given a lab test and told, Oh, your lab tests are normal, go home and stop whining at me. And, but in fact, they do have a functional hypothyroidism going on.
>> So is the hypothyroidism defined by T4…or T3? Or you mentioned ATP?
Well, no, the energy action is actually TSH. If you’re going to define hypothyroidism, it’s that your pituitary hormone or TSH goes high, trying to drive your thyroid gland. So normally it’s like 0.4 to 5.0, and if it goes higher than that, then you get an official diagnosis of hypothyroidism and then sometimes your T3 and T4 are low. And sometimes they’re not so low, and we’ve talked about this before, it’s that conversion of T4, your thyroid gland makes T4, and it has to be converted into T3 at the cellular level in order to really turn on your metabolism. And if people have anything wrong with them medically, they won’t do that perfect perfectly and “anything wrong” could mean you’re post-menopausal and you’re not on female hormones. It could mean you’re stressed. You know, there’s a lot that can go wrong with people. And of course in my medical practice, people are coming here because they’ve seen other doctors and not gotten the answers they want.
So the majority of my patient population has something going on that could mess up their metabolism or thyroid. So just giving them the usual medication of Synthroid or T4 and making their lab tests normal does not necessarily fix it. And then we check that up by checking their temperatures. And then sometimes you can check their T3, the reverse T3, but the problem is it doesn’t really happen in the bloodstream. It happens at the cellular level. So we like to have temperatures really tell the answer. And then what we do differently is rather than giving the Synthroid or T4, which is Levothyroxin, we’ll give natural thyroid like Armour or Nature Thyroid. And that is 25% of the T3 is still 75% T4, but at least it’s 25% better. If that’s still not good enough, then we’ll just give T3. And that’s through contacting pharmacies as a sustained release T3, or it’s from big pharma as Cytomel or Liothyronine.
Either way, now you’re half T3 and you can’t go down that weird pathway to reverse T3 and plug everything up. But I also want to point out that hypothyroidism is not the only thing that clogs-up or creates sluggish bowels.
>> What else causes sluggish bowels?
Well, there’s a whole lot of possibilities. So one of the things, a simple straightforward thing, is you’re not eating enough fiber. The average American gets about 15 grams of fiber a day and they should be getting 50. So what constitutes what you would consider to be the right kind of fiber? Well, any dietary fiber is the right kind of fiber and you want a variety, but it’s fruits and vegetables and beans and nuts and seeds. And as a supplement, I like ground flax seeds for extra fiber because they have great nutritional value and they change how you get rid of toxins and they change how you metabolize your gender hormones.
So they decrease the risk of breast cancer, colon cancer, prostate cancer, diabetes, and heart disease, all those things for pennies a day for grinding up some flax seeds and throwing it into your smoothie or oatmeal or something like that. It’s easy to get those in and just basically your prebiotic or your probiotic. It’s what your probiotic eats and ferments in order to make great things that give you a good gut health, which brings us to the next common cause of constipation. And that’s not good bowel flora, your microbiome is off and what’s been shown to actually control your microbiome is your diet. Are you eating enough fiber? Are you exercising?
So how does exercise regulate your gut for? A lack of activity is another being cause of constipation. Not only does it help your microbiome through some mechanism or another, but it just gets everything moving. I mean, you just get up and move and that’s going to help your gut regulate and move.
>> And when it comes to your gut flora, I’ve heard you say this before, but just so that everyone gets this benefit, when it comes to your actual stool, it’s not all just the food we’ve eaten, right?
There is a relationship with the gut flora. My understanding is about half of what comes out as your poop is the dead bodies of the good bacteria in your gut. It’s your gut bacteria multiplying and then dying. And that makes up a large percentage of our bowel movements. So you have to have those good bacteria. And we’ve been trying out a new type of probiotic called a spore biotic, (I’ve tried many types of probiotics…I personally never saw a difference, but I tried this and I actually saw a change in my bowel movements. They even got even better.) Other people that aren’t starting to report at the same thing, and the difference is the regular probiotics are alive. And so they can be killed by your stomach acid by sitting on the shelf by many things, the Spore Biotics are not alive. They’re the “seed”…. They are the heat resistant, drought resistant spore of the probiotic. And they go in past your stomach acid and seed into your small intestine and your large intestine. They have been shown to establish there better and to reverse leaky gut syndrome and food allergies. So we really like the Spore Biotics. It may not pan out, but it seems good from where I sit right now.
Dehydration, people not drinking enough water through the day, can also cause constipation.
>> And since we’re getting into hot weather now, when it comes to drinking enough, what’s enough water?
I suspect that the science around this is not as good people say with such confidence, like you should drink six glasses of six ounces of water a day. Well, you know what, if you’re a hundred pounds or 250 pounds…..there’s a difference.
>> I’ve heard a general rule of half your body weight. And then that in ounces would be a reasonable target.
>> Yeah. I like to use looking at your urine. Your urine should be diluted and not concentrated. You know, when you’re getting dehydrated, your urine is getting really dark. Now, when you take the multivitamins and stuff, you have B2 which makes it fluorescent yellow. But otherwise, your urine should be fairly pale. And if it’s getting to where it’s getting really dark yellow or brown, you are dehydrated, then that’s a sign you need to start drinking more.
If you’ve noticed you haven’t peed for three hours and you just squeeze out a couple tablespoons, you got a problem. You know, you’ve got to keep those kidneys flushing well.
>> If you’re dehydrated, then doesn’t your body absorb more moisture out of your stool as you’re digesting, which would make your stools harder and more compact and therefore make you more likely to be constipated?
That’s right. And that kind of brings us back to the root thing of why do we poop in the first place? And, what are they supposed to be like? So we proved to get rid of this stuff, the dead bodies of the bacteria we put to get rid of toxins, and poop to get rid of the stuff that we’re not using by our cells. The part of food that we are saying, okay, thank you very much…you become part of me and YOU don’t become part of me. And then we poop out the part that’s not become part of us. It is liquid when it moves from your small intestine to your large intestine. At that point, your stool is still liquid really. And the largest role of your large of your bowel of your colon is to reabsorb water.
And as it reabsorbs water, it also happens to reabsorb toxins. And that’s another reason why fiber is so important… the fiber binds onto toxins and helps you poop out toxins rather than continuously reabsorbing them up through the liver. This is called entro-hepatic-circulation, where your liver works all day long to conjugate and excrete things like the bad estrogen that causes breast cancer. But then in your bowel, if you don’t have enough fiber to hang on to, now you have bacteria that unconjugated them and you reabsorb them right back up to your liver again. And you’ve got to do all that work all over again. Now you are toxifying yourself just by not pooping enough.
>> And so how often should you poop?
Well, how often do you eat? You know, most people eat two, three, four times a day, and I think they should poop two, three, four times a day. You want to keep it moving and it should be formed or loosely formed, it should no float and it shouldn’t be difficult to get rid of. You shouldn’t have time to read in the bathroom. You should be able to sit down, take care of your business, clean up, and move along. If you’re not doing that yet then there’s things you can do to get there.
I’m amazed at how many people think that pooping three times a week is fine. And it may be average for Americans, but it’s not fine.
>> No, that just sounds terribly uncomfortable.
They are full of it and they’re getting toxic. So other things that can cause constipation that I’ve found is food allergies can cause constipation. Food allergies in our experience cause gut paralysis and in women that tends to show up more as constipation, in men it tends to show up more as acid reflux. It certainly crosses both ways, but what happens is if your things aren’t moving down, then they kind of back up and you get the acid reflux or you get the constipation. One of the biggest food allergens, I think, especially for women, is being allergic to their own candida or yeast growing in their gut.
>> So you’re saying I could be allergic to myself?
Well, you can be allergic to what’s growing in your gut, which also relates to how good is your microbiome. Because if you have a stronger probiotics in your gut, you’re going to have less yeast. And how good is your diet? Because if you have less sugar and more fiber, you have less yeast. And how well balanced are your hormones? We all hear about women who go through their menstrual cycles and in part of the month, usually the PMs phase, they get constipated when their hormones change.
And part of what happens when the hormones change is it makes the terrain more hospitable for yeast growing.
>> Candida is yeast, just to make sure everyone understands that.
Yes, it’s a type of yeast that grows in our gut and everybody has it. You can’t eradicate it, but it supposed to be in balance, like staph on your skin. We all have staph on our skin. You can’t get rid of it. It’s always there, but you should not be having staph infections on your skin. The same is true for yeast. You know, in our mouth, the overgrows is thrush, obviously vaginally, you can get vaginal yeast infections, but in our gut it’s candida. And it’s one of those things that conventional doctors have not been very open-minded to, but it’s been known in the alternative world for over 40 years that this yeast overgrowth is a very common problem.
Part of what’s making that worse and food allergies worse is the amount of toxins we’re exposed to like, like glyphosphate or Roundup in our diet, right? And even heavy metals like mercury really disrupt the gut lining and cause leaky gut syndrome. And then we get more food allergies from the immune system, seeing undigested particles of food going across the gut wall. And then that snowballs and you get yeast overgrowth, you become allergic to that and all of a sudden your constipated. There’s so many things that go into this, it can be a lot! So it’s not just that you have, if you’re constipated, you have a sluggish thyroid, that’s just one thing that can make you constipated.
So when we’re looking down the constipation protocol we want to look at all those different things. And then once we make sure we’ve cleaned those things up, or even before, we can certainly give people things to help the constipation. And my favorite is magnesium.
>> Tell me about that. How does that work?
Well, magnesium relaxes your muscles. And if you take more magnesium than you can absorb in your small intestine, the rest hits your colon and moves on through, and if you overdose the magnesium, you can get a roaring diarrhea. And that’s what magnesium oxide does. There’s basically three different categories of magnesium: that which absorbs very poorly, so it’s used to cleanse the bowel like magnesium oxide, and that which absorbs really well, so it’s used to raise the blood levels like magnesium chelates that are hooked on to an amino acid to help them absorb better, so they get better blood levels and less effect on your bowels. And then middle of the road is magnesium citrate. It both raises blood levels well and can help move your bowels if you’re constipated.
We mentioned the ground flax seeds and more water and probiotics and eating more fruits and vegetables. And then there is an Ayurvedic preparation called Triphala. It’s kind of the concept of prunes, but it’s three fruits and it’s not addictive. You can use it the rest of your life. It helps actually helps tone the bowel and it’s put into capsules. And we find it’s one of the gentle ways to keep people regular who have had long-term chronic constipation problems. And then of course fixing the thyroid.
>> Now, when you’re talking about magnesium, that if you take enough of it more than your body can absorb, it can have a laxative effect. Doesn’t vitamin C do the same thing?
It does. The dosages for magnesium is about 200mg for most people….around 200 to 250 milligrams per dose that will do that. If you get up to 300 or 400 per dose, you know, then you can spread it out and you can have a dose in the morning and dose in the evening. And so you can get more into your body without the laxative effect. And then for vitamin C, it’s around 2000 milligrams per dose for most people, but there’s a wide degree of individual sensitivity. But again, if you spread it out, you can get a thousand milligrams, three to four times a day, and most people will be fine. But most people, when they get above about 6,000 to 8,000 milligrams a day, they’ll start to get gassy bloating diarrhea…whereas the magnesium stool is more slick, surprising diarrhea. That’s a tough decision where it catches you off guard. And if you do both together then it can really get shocked by what’s going on, but you won’t be constipated anymore.
The best idea to titrate is to find your bowel tolerance and to get just a little bit too much action. And then you back off and find your sustainable dose, where you’re helping your body out by getting blood levels of magnesium and vitamin C so you’re pooping regularly, but you’re not having accidents.
>> Anything else we should cover about constipation? Now that we know that there’s all these different reasons why it could be happening, what’s a good place to start in terms of what do I do next?
Well, you drink more, you move more, you eat more of the right foods. You add ground flax seeds. You make sure you get your thyroid tested. And if your lab tests are normal, but you’re still suspicious, you take your temperatures, not first thing in the morning, cause everybody’s cold. You want to take your temperatures in the middle of the day, like between 11:00 AM and 3:00 PM. And we actually prefer the old glass thermometers under the tongue for 7 to 10 minutes for accuracy. The other ones are okay, but they have too much variability. If you do them three times in a row, you notice you get three different numbers, and it should be about 98.0 or better on the average. And if you’re constantly less than 98.0, then you’ve probably got a thyroid conversion issue.
Even if you don’t have a thyroid production problem, the lab test tells you if you are making enough thyroid hormone. And then your temperature should tell you if you are using it the right way. And you know, I gotta say, if it’s a newer problem you should make sure you don’t have a serious medical condition. Cause a large colon polyp, colon cancer, these very serious things. We are fans of screening to make sure you’re not missing a bad thing.
>> A thought along those lines is about hemorrhoids. Would hemorrhoids cause constipation or just constipation lead to hemorrhoids or is it something different altogether?
Constipation leads to hemorrhoids for sure. And as people who live long-term with constipation, and haven’t really learned how to poop properly by relaxing, this can be common. We often teach people about the Squatty potty. If you put your body in a position of squatting by raising your feet and knees then that relaxes the anal sphincter muscle and it lets everything out better and people really should not have to push regularly to poop. And if every day you’re pushing to poop it causes hemorrhoids. The other thing that contributes to hemorrhoids is things like weightlifting or working-out in pregnancy and such.
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