Gastrointestinal

Chronic Constipation:

Types, Causes and Evidence-Based Solutions

Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

Constipation, either acute or chronic, can be described as difficult, infrequent, or incomplete bowel movements. The stool tends to be small and/or hard. Bowel movements should, under normal circumstances, occur at least daily.

How do you know if you have constipation?

This chart, called the Bristol Stool Chart, is a way of identifying constipation. Constipation generally refers to poo that is type 1 or type 2 on the chart. The poo is often hard and difficult to pass.

Chronic Constipation: Types, Causes and Evidence Based Solutions

Why Does Constipation Occur?

There are three main mechanisms that may cause constipation:

Normal transit constipation

Normal transit constipation (NTC) is a type of constipation where stool moves through the colon at a normal rate, but patients still feel constipated. Patients may experience difficulty evacuating their bowels, hard stools, bloating, and abdominal pain or discomfort. NTC is the most common type of constipation

Slow-transit constipation

Slow transit constipation (STC) is a condition that occurs when stool moves too slowly through the large intestine, causing a delay in passing stools. There are infrequent bowel movements, limited urgency, or straining to defecate. The colonic movements are slow.

Dyssynergic Constipation (Pelvic Floor Dysfunction)

Dyssynergic defecation, also known as anismus, is a functional pooping disorder that can cause constipation. It occurs when the muscles and nerves in the pelvic floor don't coordinate properly to have a bowel movement. These muscles, which support the bladder, rectum, and other pelvic organs, need to relax in a coordinated way to eliminate stool. When they don't, it can make it difficult to know when you're ready to have a bowel movement, pass stool, or complete a bowel movement. These patients have a poor ability to co-ordinate these muscles during defecation.

I recommend finding a practioner skilled pelvic muscle rehabilitation (PMR)

Pelvic rehabilitation, also known as pelvic floor rehabilitation or pelvic muscle rehabilitation (PMR), is a noninvasive treatment that aims to strengthen the pelvic floor muscles and improve coordination.

Pelvic floor therapy can help with constipation because the pelvic floor muscles control the passage of stool. Pelvic floor therapy can help identify and address any imbalances, tension, or weakness in the pelvic floor muscles that may be contributing to constipation.

A small-scale 2022 study involving 34 people found that behavioral therapies, including pelvic floor muscle training, helped improve inflammatory bowel disease (IBD) symptoms, including constipation.

Here is a directory to locate a practioner skilled in PMR

https://pelvicrehab.com/

What Are the Causes of Constipation?

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Credit: Dr. Michael Ruscio -https://drruscio.com

According to Dr. Michael Ruscio he provides a detailed overview on the four common causes of constipation

1: Insufficiency (Inadequate water consumption, lack of optimal amount of fiber and poor exercise habits)

Adequate Water Consumption: Drinking enough water is important for preventing constipation because it helps fiber work better and keeps your intestines smooth and flexible. When you're dehydrated, your large intestine draws more water from your stool, making it harder to pass.

It is recommended to drink 8-10 glasses of filtered water a day or half your bodyweight in ounces of water per day. For example if you weigh 160 pounds I recommend drinking 80 ounces of filtered water a day

Fiber: Soluble fiber, found in foods like psyllium husk or ground flaxseeds, can help add bulk to stool and promote regularity.

It is recommend to consume between 25-30 grams of fiber per day. I recommend Psyllium Husk and Modified Citrus Pectin

Modified Citrus Pectin, is a soluble fiber which turns into gel in your digestive tract in the presence of water. As such, they soften the stool and speed the transit time of material through the digestive tract, reducing constipation.

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Credit: Dr. Michael Ruscio -https://drruscio.com

Exercise and Movement has been found to be effective in improving bowel function and relieving constipation.

The Centers for Disease Control and Prevention (CDC) recommends that adults get 150 minutes of moderate-intensity aerobic exercise per week to help relieve constipation. This could be 30 minutes of exercise a day, at least five times a week. If you're short on time, you can break up your activity throughout the day, such as taking three 10-minute walks instead of one 30-minute walk 2 hours per week.

2: Bacterial Overgrowth

A common cause of bacterial overgrowth is Small Intestinal Bacterial Overgrowth (SIBO)

Small Intestinal Bacterial Overgrowth (SIBO) can cause constipation. SIBO happens when there are large amounts of bacteria in the small intestine, where food mixes with digestive juices and nutrients are absorbed into the bloodstream. Normally, the small intestine has relatively few bacteria because of the rapid flow of contents and the presence of bile. However, in SIBO, stagnant food in the small intestine can become a breeding ground for bacteria.

SIBO can disrupt normal intestinal motility, leading to slowed transit times and difficulty passing stool.

** I strongly recommend that you have your healthcare provider to obtain objective evidence to determine if you have SIBO.

I commonly use the services of Genova Diagnositics

https://www.gdx.net/products/sibo

Genova's SIBO Profiles are non-invasive breath tests which capture exhaled hydrogen (H2) and methane (CH4) gases following patient ingestion of a Lactulose solution to evaluate small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO).

The SIBO-Constipation Connection

The relationship between SIBO and constipation lies in the disruption of normal gut motility caused by excessive bacteria in the small intestine. When bacteria overpopulate the small intestine, they can produce gas and other byproducts that interfere with the coordinated muscle contractions required for efficient bowel movements. As a result, stool transit slows down, leading to constipation. Additionally, excessive bacteria can compete with the host for available nutrients, further contributing to constipation.

Nutritional Strategies for SIBO-Related Constipation

Addressing chronic constipation associated with SIBO often requires a multifaceted approach that combines dietary modifications with targeted nutritional interventions. Here are some nutritional strategies that can help alleviate constipation in individuals with SIBO:

Low-FODMAP Diet: A low-FODMAP diet restricts certain fermentable carbohydrates that can exacerbate SIBO symptoms. This diet can help reduce gas production and bloating, which may alleviate constipation.

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Credit: Dr. Michael Ruscio -https://drruscio.com

Monash University FODMAP Diet
Download the Monash University FODMAP App
https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/

Probiotics: While probiotics aren't suitable for all individuals with SIBO, specific strains may be beneficial for some.

The following chart represents the most evidence based probiotics for SIBO and improving bowel function

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Credit: Dr. Michael Ruscio -https://drruscio.com

Bacterial deconjugation of bile acids is another important feature in SIBO.

Bacterial deconjugation is a process that occurs when intestinal bacteria break down bile acids through an enzymatic reaction
Deconjugation can play an important role in Small Intestinal Bacterial Overgrowth (SIBO). When deconjugation occurs, it can create free bile acids that damage the intestinal lumen and reduce micelle formation. This can cause the bile acids to be absorbed in the jejunum instead of the ileum

Bile ox supplements can help with constipation and act as a natural laxative in the human body. Bile acids, which are produced in the liver and released into the digestive system, help break down fats, absorb them into the body, and promote bowel movements. They do this by softening stool and speeding up how quickly it moves tact as a natural laxative in the human bodyhrough the colon.

Bile acids can help with constipation by stimulating the intestinal walls, which can speed up gut transit time. They do this by causing the colon to secrete fluids and electrolytes, and by stimulating contractions in the colon.

Digestive Enzymes: Digestive enzyme supplements can assist in the breakdown of food, potentially reducing the substrate available for bacterial fermentation.

Herbal Therapies: Herbal antimicrobials like berberine, oregano oil, and neem may help reduce bacterial overgrowth in the small intestine.

Nutraceuticals: Nutritional supplements like magnesium citrate or oxide can act as natural laxatives to promote regular bowel movements.

** Word of Caution: I strongly advise all readers to seek medical advice from a healthcare provider knowledgeable in the prescriptive and botanical approach to SIBO.

The Elemental Diet

An elemental diet can help with small intestinal bacterial overgrowth (SIBO).

An elemental diet is a liquid diet that provides the body with easily digestible nutrients. It reduces the amount of food in the small intestine, which starves the bacteria that cause SIBO symptoms. It also eliminates complex carbohydrates that feed bacteria, which can reset the microbiome and alleviate symptoms.

Clinical studies have shown that an elemental diet can be highly effective in reducing gastrointestinal symptoms and normalizing lactulose hydrogen breath tests, which are often used to diagnose SIBO. One study found that 80% of subjects had a normal breath test on day 15 of the diet, and 85% had a normal breath test by day 21. Those who successfully normalized their breath test also saw a 66.4% improvement in bowel symptoms, compared to 11.9% for those who didn't.

There are a variety of elemental diet formula. I have found good success with Physicians' Elemental Diet from Integrative Therapeutics
https://integrativepro.com/products/physicians-elemental-diet?variant=47686039667002

Some healthcare providers recommend 2-3 weeks on an elemental diet however I have unfortunately seen low compliance and recommend 1-4 days and check to see if there is an improvement in bowel function.

Prokinetic agents

Prokinetic agents promote intestinal motility and are used for severe constipation-predominant symptoms associated with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC)

They work by increasing the frequency or strength of contractions in the gastrointestinal tract, which improves motility and can help with constipation symptoms.

** Word of Caution: I strongly advise all readers to seek medical advice from a healthcare provider knowledgeable in the Prokinetic agents

Dr. Michael Ruscio has written a wonderful detailed article on both prescriptive and natural prokinetic agents

https://drruscio.com/prokinetic-agents.

3: Abnormal/Altered Structural Abnormalities of the Colon (Tortuosity in the colon)

Tortuosity in the colon, also known as a redundant colon, can cause constipation. A redundant colon is a congenital condition that causes the colon to twist and loop to fit inside the body, often making it longer than 5 feet. This can lead to constipation, as well as other symptoms like: bloating, abdominal pain, impacted stool, gassiness, and cramping.

A redundant or tortuous colon is an abnormally long colon that cannot fit inside the body without looping or twisting. There is no obvious cause, but it can lead to complications and gastrointestinal problems, including constipation.

The following photo shows a worsening of tortuosity in the colon going from left to right.

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Credit: Dr. Michael Ruscio -https://drruscio.com

Treatment to consider:

Abdominal Massage

Some people with a tortuous colon may benefit from abdominal massage, which can help with constipation and promote bowel movements.

Here are some abdominal massage techniques you can try:

Clockwise circles
While lying down, place your palm on your abdomen and make small, clockwise circles around your belly button. You can gradually widen the circles to cover your entire abdomen.

Smooth strokes
Place your hand below your breastbone and glide it down the length of your abdomen. Repeat the movement with your other hand, and continue for several minutes.

Firm circles
Press firmly into your belly and slide your hand in a circular motion up toward your ribs, across your belly, down to your left hip bone, and back across the bottom of your belly. Repeat 10 times.

L-shape
Apply moderate pressure from the right side of your ribcage, underneath the ribcage to the left, and down to the front of your left hipbone, forming the letter "L".

U-shape
Stroke 10 times from the front of your right hipbone up to your right ribcage, across to your left ribcage, and down to your left hip bone, forming the letter "U".

Clockwise circular finish
Finish with 1-2 minutes of a clockwise circular massage 2-3 inches away from your belly button to stimulate your small intestine.

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Credit: Dr. Michael Ruscio -https://drruscio.com

The following short three minute video from the work of Dogan, Gursen, Akbayrak, Balaban, Vahabov, Uzelpasac? and Ozgul explained in their paper titled Abdominal Massage in Functional Chronic Constipation: A Randomized Placebo-Controlled Trial reveals 28% to 70% reductions in constipation severity.

https://www.youtube.com/watch?v=Hcjo9gLxJsw

I also want us to consider the potential of developing adhesions in the intestines from a variety of GI and neurological issues contributing to chronic constipation.

I suggest reviewing the following for more information in the effective treatment for breaking up adhesions

https://clearpassage.com/

Consider Biofeedback Therapy

Biofeedback therapy can help with constipation by training the muscles in the rectum and pelvic floor to achieve regular bowel movements. Biofeedback therapy can also help with other bowel problems, such as fecal incontinence, rectal hyposensation, and difficulty emptying the bowel

4: Gut-Brain and Constipation

The brain and gut are connected, and this connection can play a role in constipation. Research shows that the brain and the gut are intimately connected, sharing bi-directional communication which makes up the “brain-gut axis”

Constipation can cause the enteric nervous system (ENS) to send signals to the brain, which can trigger feelings. The ENS is sometimes called the "second brain" because it contains millions of neurons that directly affect gut activity

The stress response triggers the release of corticotropin-releasing factor (CRF), which has been shown to alter gut motility and sensitivity. During periods of stress, the body's “fight or flight” response can suppress digestion and slow down the movement of food through the GI tract, leading to constipation

Action Steps to Reduce the Fight or Flight” Response and Improve Bowel Function

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Credit: Dr. Michael Ruscio -https://drruscio.com

1: Spend Time in Nature

Spending time in nature may improve gut health, which can in turn improve bowel function.

2: Meditation

Studies have shown that meditation can improve gut health, which may also improve bowel function.

Meditation can influence the gut-brain axis at both the brain and gut levels. Stress hormones can affect gut bacteria, and meditation can help balance these hormones and decrease inflammatory markers.

3: Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) can be used to treat constipation in a number of ways, including:

CBT can help improve bowel symptoms, quality of life, and psychological distress in people with IBS, regardless of subtype. CBT is a short-term, collaborative therapy that focuses on modifying behaviors and changing thought patterns to affect mood and physiological symptoms. Stress and anxiety can aggravate bowel symptoms, and CBT can help with these negative emotions.

The Link Between Vagus Nerve and Constipation

Chronic Constipation: Types, Causes and Evidence Based Solutions

The human brain is composed of approximately 86 billion neurons. The human gut is comprised of an extensive network of 200-600 million neurons (nerve cells) known as the enteric nervous system (ENS). One method of communication is the vagus nerve which carries electrical signals information from the gut to the brain.

If you are stuck in a sympathetic-dominant state, or fight, flight, or freeze, for an ongoing period the vagus nerve can become weak and lose its “tone”. The vagus nerve tells the intestines to contract alowing for normal peristalsis, which is the movement of food through the gut. If the vagus nerve isn't working properly, gut motility can slow down, which can lead to constipation.

So both in a chronic state of chronic stress and/or constipation, vagal tone becomes weak.

Activating Your Vagus Nerve

Recent research by neuroscientists has identified the following strategies to help stimulate our vagus nerve and get our neurons firing again.

Gargling and gagging
Singing and humming
Alternate nostril breathing and deep breathing
Cold exposure
Exposure to sunlight
Meditation
Laughing
Music therapySupplements (probiotics and omega 3 fatty acids)
Body work such as massage, acupuncture, cranial sacral therapy
Essential oils-Vagus Nerve Kit (https://shop.vibrantblueoils.com/product/vagus-nerve-kit/)

The following two tools have been effective in improving Vagus function:

1: Rezzimax Tuners (https://rezzimax.com/)

2: Hoolest (https://hoolest.com)

Dr. Grisanti's Comments:

Here is a summary of the key take aways to effectively address constipation from an evidence based perspective:

1: Adequate Water- drink half your bodyweight in ounces of water per day
2: 25-30 grams of Fiber (High fiber food and/or Psyllium Husk and Modified Citrus Pectin)
3: Exercise and Movement-150 minutes of moderate-intensity aerobic exercise per week
4: SIBO- get evaluated and properly treated (FODMAP Diet, Probiotics, Enzymes, Prescriptive and Herbal Therapies, Elemental Diet, Prokinetic agents
5: Abnormal/Altered Structural Abnormalities of the Colon (Abdominal Massage and Biofeedback Therapy)
6: Identify and treat the Brain-Gut Connection (Time in Nature, Meditation, CBT and Vagal Nerve Rehab)

Additional Secondary Causes of Constipation to Consider:

Other types of constipation include secondary constipation, which can be caused by medication, chronic disease such as hypothyroidism, diabetes, neurological conditions such as Parkinson's disease and multiple sclerosis.

It is important be aware that chronic constipation may in fact be an early warning sign of a patient developing Parkinson's disease.

By implementing the information thoroughly outlined in this article you have the opportunity to significantly improve bowel function and reduce the incidence of constipation.

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References:

** Always consult with a physician or healthcare practitioner with significant integrative or functional medicine training before starting any of the above recommendations.

You can find a qualified and certified functional medicine practitioner by going to: www.FunctionalMedicineDoctors.com

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his functional medicine community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com for more information on our training in functional medicine. Look for practitioners who have successfully completed the Functional Medicine University's Certification Program (CFMP) www.functionalmedicinedoctors.com. This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Grisanti is required.

Chronic Constipation & Cognitive Decline

Chronic Constipation and Cognitive Decline (Early Dementia)--What Is The Connection?

Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

I have always had a strong foundational belief that when your gut is well your overall health is well.

New studies are beginning to see a distinct correlation between poor gut health especially chronic constipation and early dementia.

Chronic constipation may not only be an indicator of gut health, but a potential warning sign of cognitive decline.

Researchers found that among more than 110,000 middle-aged and older U.S. adults, those who were chronically constipated who had fewer than three bowel movements a week showed early signs of poor brain health.

The findings presented at a meeting of the Alzheimer's Association in Amsterdam showed that people with chronic constipation typically performed worse on tests of memory and thinking,

In addition, 73% of these same people stated that were more likely to say their cognitive skills were waning.

Although the study is strictly preliminary and did not absolutely prove that constipation caused the aging brain to deteriorate faster, the researchers of this study do believe there is evidence connecting gut health to brain health.

The researchers theorize that constipation and cognition are linked via the gut microbiome.

The science is exploding with research linking abnormal gut microbiome and various diseases, including degenerative brain diseases like Alzheimer's.

Claire Sexton, senior director of scientific programs and outreach for the Alzheimer's Association stated the it is unclear at this point whether constipation itself or the underlying cause of constipation,that being disruptions in the gut microbiome, is driving this association.

Dr. Dong Wang of Brigham and Women's Hospital and Harvard Medical School and the senior researcher on the study stressed the importance of clinicians discussing gut health, especially constipation, with their older patients.

Of special interest the researched found that people with constipation and worse cognition tended to have relatively few gut bacteria that produced butyrate -- an important fatty acid that helps control inflammation.

I strongly would encourage any and all people suffering with chronic constipation to have a functional medicine or integrative practitioner to do deep dive into their gut health via a comprehensive stool test.

I say why wait for science to catch up with may indeed be a potential connection between compromised gut health poor cognition.

I recommend finding a healthcare practitioner who can order one of the following excellent stool tests:

GI Effects--https://www.gdx.net/products/gi-effects

Gut Zoomer-https://www.vibrant-wellness.com/test/GutZoomer

GI 360-https://www.doctorsdata.com/GI360-stool

With the results obtained from any of the above stool tests you will have deep window into your gut health and understand what steps you can take to address any potential issues found on the test.

The question remains: Can improved gut health have a positive impact in improved cognitive health?

To be quite honest, I tend to lean toward an affirmative yes and would not risk having a disease as serious as dementia take hold of any patient without at least testing the waters and see if one's cognitive health improves with improved gut health.

You can find a qualified and certified functional medicine practitioner by going to: www.FunctionalMedicineDoctors.com

Reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730313/
https://www.cnn.com/2023/07/19/health/constipation-cognitive-decline-gut-health-wellness/index.html
https://www.frontiersin.org/articles/10.3389/fnins.2021.821654/full
https://www.wavy.com/news/health/chronic-constipation-may-lead-to-dementia/
https://www.nature.com/articles/s41531-021-00191-w
https://www.newscientist.com/article/2383117-chronic-constipation-is-associated-with-cognitive-decline/
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01644-2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286902/

Compliments of Functional Medicine University www.FunctionalMedicineUniversity.com

Inflammatory Bowel Disease and Red Dye

Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

Inflammatory bowel diseases (IBDs)—like Crohn's disease and ulcerative colitis—affect millions of people around the world.

They cause lasting structural damage—such as inflammation, ulcers, and sores—to your gastrointestinal (GI) tract.

Until now no one could really pinpoint exact causes behind IBDs.

However a new study made an eye-opening discovery: Some very commonplace and “colorful” foods may actually TRIGGER these debilitating diseases.

For this study, researchers fed lab mice a normal diet—or a diet that included something called Allura Red AC (FD&C Red 40 or E129) for 12 weeks.

To the researcher surprise the Red Dye caused new inflammation in their GI tracts.

It also disrupted the gut barrier.

It even increased serotonin production in the gut, which, in turn, increases susceptibility to IBDs. In fact, the researchers said there's enough evidence to suggest Allura Red AC may “trigger” IBD in otherwise healthy subjects!

These results offer a serious warning about the potential dangers of food dyes in our diet.

Perhaps worst of all is the fact that we've known about the problems with Allura Red FC for almost 50 years! And one of the most long-standing concerns involves its effect on behavior in children—which is why many countries in Europe (including France, Germany, and Switzerland)
banned it years ago.

Avoiding these “colorful” foods could be instrumental in aiding patients suffering with IBD.

How to Know If Red Dye 40 Is in Food

It would be hard to determine if restaurant food contains the red dye. But on packaged food, the FDA requires food manufacturers to list ingredients, including color additives. Look for the following on packaging labels:

Red 40
Red 40 Lake
FD&C Red No. 40
Food Red 17
Allura Red AC

As you might have guessed, Allura Red AC is one of the most widely used food dyes in the world.

You commonly find it in breakfast cereals, soft drinks, dairy products, candies, and even vitamins!

Now, since you'll find Allura Red FC in countless products in the United States, it's up to YOU to keep it out of your diet.

Reference

https://www.webmd.com/ibd-crohns-disease/news/20221221/study-says-food-dye-red-40-can-trigger-bowel-problems
https://www.medicalnewstoday.com/articles/ibd-common-red-food-coloring-may-cause-intestinal-inflammation-colitis
https://www.sciencedaily.com/releases/2022/12/221220112440.htm
https://www.diabetes.co.uk/news/2023/jan/inflammatory-bowel-diseases-could-be-initiated-by-a-common-food-dye.html
https://www.nature.com/articles/s41467-022-35309-y
https://www.sciencetimes.com/articles/31181/20210514/chronic-gut-inflammation-triggered-two-common-food-coloring.htm

Compliments of Functional Medicine University www.FunctionalMedicineUniversity.com

Parkinson's & Gut Dysfunction

Parkinson's Disease & Associated Gut Dysfunction

Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

A recent study in Nature Communications suggests that Parkinson's disease may actually start in the gut.

The microbiota-gut-brain axis has been suggested to play an important role in Parkinson's disease (PD)

Parkinson's is a brain disorder that can cause uncontrollable movements such as shaking, limb stiffness, and difficulty with balance and coordination.

The study published in Nature Communications involved recruiting 490 people with Parkinson's and 234 individuals who were neurologically healthy.

Each provided a stool sample and information about themselves.

When samples were analyzed, researchers found that bacteria, genes, and biological pathways differed by more than 30% in those with Parkinson's compared to those who were neurologically healthy.

Of special interest was the fact that a specific bacterial species called Bifidobacterium dentium commonly known to cause infections such as brain abscesses, was seven times higher in folks with Parkinson's

On the other hand another bacteria called Roseburia intestinalis commonly found in healthy colons, was 7.5 times lower.

I recommend ordering the Gut Zoomer Stool Test from Vibrant Wellness. https://www.vibrant-wellness.com/test/GutZoomer

Here is a sample report which includes both the Bifidobacterium dentium and Roseburia intestinalis

//www.functionalmedicineuniversity.com/GutZoomerSampleReport.pdf

It is important to note that constipation is a common complication of Parkinson's disease. Many people who have Parkinson's disease notice difficulties with constipation before they notice motor symptoms such as tremor or stiffness

In addition to the above mentioned bacteria, elevated levels of Escherichia coli, Klebsiella pneumonia, and quasipneumoniae have also been found in those with Parkinson's.

Although the research is in the early stages of the relationship between Parkinson's disease and gut dysfunction, it is my suggestion to consider ordering a stool test to determine if in fact the above profile is apparent and take the appropriate action steps to improve the gut microbial environment.

You simply don't know the possible positive impact this can make in moving one more step closer to improving Parkinson's disease outcomes.

References:

https://www.nature.com/articles/s41467-022-34667-x
https://www.nature.com/articles/s41467-023-38248-4

Compliments from Functional Medicine University www.FunctionalMedicineUniversity.com

Restless Leg Syndrome & IBS

Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

There appears to be a direct correlation between restless leg syndrome (RLS) and irritable bowel syndrome (IBS).

What is restless leg syndrome?

RLS is a disorder in which a person experiences uncomfortable urges to move their legs. Symptoms typically occur during times of rest or inactivity, particularly in the evening and into the night and may contribute to insomnia. These bothersome urges are often relieved with movement. It is estimated that RLS affects approximately 7-10% of the population

What Causes RLS?

Researchers have identified the following as possible contributors to the problem:

Genetic predisposition
Problems with the neurotransmitter dopamine
Problems with the metabolism of iron
Problems with nervous system motor pathways

Clinical studies are showing that some people who have certain gastrointestinal disorders have a higher rate of RLS, including celiac disease, Crohn's disease, and IBS.

Studies estimate that approximately one-fourth to one-third of IBS patients may also have RLS.

The specific gut issue associated with RLS is a condition called Small Intestine Bacterial Overgrowth (SIBO).

SIBO is a condition in which rare gut-residing bacteria are over-represented in the gut.

Why does SIBO cause restless legs?

Chronic inflammation caused by SIBO or gut dysbiosis [when there's an unhealthy balance of types of gut bacteria] in the colon may release additional hepcidin — a hormone that can decrease iron availability in the brain and contribute to RLS.

A Stanford findings suggest that, potentially, treating a person's SIBO may help resolve the brain iron deficiency that contributes to RLS.

Promising Treatment

In one study, 13 IBS patients who tested positive for SIBO using breath testing were treated with the antibiotic rifaximin for a period of 10 days. Following treatment, according to the study, 10 of these patients experienced "at least 80% improvement" in their RLS symptoms. At a later follow-up date, half of these patients reported complete relief from their RLS.

For a more comprehensive natural treatment for SIBO, I recommend seeking the skills of a well trained functional medicine practitioner. (https://functionalmedicinedoctors.com)

They will review dietary recommendations specific for SIBO and natural botanicals (herbs) that are effective in treating SIBO.

Conclusion:

Although the studies are small I believe there is hope that in patients suffering with IBS (SIBO) and RLS, treatment to eradicate SIBO could in fact be helpful.

References

https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2012.01011.x
https://www.verywellhealth.com/ibs-and-restless-leg-syndrome-1944740
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479257/
https://www.sciencedaily.com/releases/2019/06/190607122406.htm
https://www.sciencedirect.com/science/article/pii/S1389945720305426

Chronic Constipation:

Types, Causes and Evidence-Based Solutions

Chronic Constipation & Cognitive Decline

Chronic Constipation and Cognitive Decline (Early Dementia)--What Is The Connection?

Inflammatory Bowel Disease and Red Dye

Inflammatory Bowel Disease and Red Dye

Parkinson's & Gut Dysfunction

Parkinson's Disease & Associated Gut Dysfunction

Restless Leg Syndrome & IBS

Restless Leg Syndrome & IBS

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