Podcast Episode #91: All Things Digestion

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Podcast Episode #91: All things digestion

Topics:

1. A link between menstrual periods and constipation? [17:28] 2. Chronic Constipation [31:49] 3. Stomach pains and bathroom use even though I haven't eaten all day! [39:22] 4. No regular BM’s ever! [49:26]

The Hormone Cure

Previous episodes about digestion:

#8: Guest Chris Kresser – all about digestion
#83: All about digestion – bloating, constipation, IBS, and more. 

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Liz Wolfe: Hello, friends. Welcome to Episode 91 of the Balanced Bites Podcast! This is Liz, and Diane is here, too. She's taking yet another walk on her treadmill desk, and I'm yet again making fun of her mercilessly off the air. I bet you look really cool.

Diane Sanfilippo: Especially because I've not showered yet today and I'm in sweats/pajamas.

Liz Wolfe: I get a little depressed about that, just as someone who's based out of her home office.

Diane Sanfilippo: Her basement.

Liz Wolfe: Her basement. I work remotely now, so I'll wake up, roll out of bed, and it's kind of like: Well, I'll just get started. And then it's 3 o'clock and I look up and I'm still in my retainer. Ugh, it's not a good feeling. I have to wake up and get ready for the day, tie my dreadlocks up on top of my head. I'm just kidding. I don't have dreadlocks.

Diane Sanfilippo: Not that there's anything wrong with that.

Liz Wolfe: No! No, not at all, but I always thought that they would be more work than just putting my hair in a ponytail. Maybe not, though.

Diane Sanfilippo: Probably.

Liz Wolfe: Are they more of a statement? Or are they something…

Diane Sanfilippo: Are you asking me based on experience?

Liz Wolfe: I'm just asking you because last time I saw you your hair looked a little matted.

Diane Sanfilippo: It looks a little nappy right now, I'm not going to lie. It was braided two days ago, and then I slept on the braids and then went to the gym yesterday, and I did not wash it since then, so it's a little bit like… wavy, weird, unkempt.

Liz Wolfe: Unkempt. That's a good word. Are you still doing the no ‘poo method, the no shampoo method that I advocate?

Diane Sanfilippo: I was on it. I am off of it currently because I was away from home. Actually I feel like it wasn't working with the water here. I don't know, I just kind of got thrown off after being away for a week and then weekends, and it's just been kind of weird, but I'll get back to it.

Liz Wolfe: It's all or nothing, Diane. All or nothing.

Diane Sanfilippo: It is!

Liz Wolfe: Always all or nothing.

Diane Sanfilippo: Confession time, as far as all or nothing is concerned. Are we ready for a confession?

Liz Wolfe: Uh… yeah?

Diane Sanfilippo: You didn't know I'd have anything else exciting to say because we just spoke a little while ago!

Liz Wolfe: I had no idea.

Diane Sanfilippo: Some people who might follow me on Facebook, Twitter, Instagram… stalkers.

Liz Wolfe: Oh, my goodness. You're on Instagram?

Diane Sanfilippo: Instagram is awesome!

Liz Wolfe: No. Stop. I'm not doing it.

Diane Sanfilippo: Oh, you're going to do it.

Liz Wolfe: I can't. No.

Diane Sanfilippo: Yeah, it's really fun. The cool thing about Instagram is you can just tick off for it to post to Facebook or Twitter or not. Maybe half of what I post on Instagram ends up also on Facebook for people to see, but not everything, mostly not the cat pictures. Those stay on Instagram for my fellow cat lovers.

Liz Wolfe: I love that angry cat, that really sour-looking cat that people are circulating.

Diane Sanfilippo: He's awesome.

Liz Wolfe: Yeah.

Diane Sanfilippo: So we have talked ad nauseam on this podcast about caffeine and coffee and all that. We also talked, I would say, last year when I was writing Practical Paleo about how I felt like I was going to die writing that book.

Liz Wolfe: Yeah.

Diane Sanfilippo: I've been a lot better writing this book. I say “writing” very loosely because I'm just so bad at writing and it takes me so long to finally get my head straight and then sit down and write a section because I just don't work in a linear fashion. I'm not like: OK, here's the beginning of the book, the middle, and the end. It's just all over the place, whatever I can focus on that day and I'm excited to write about that day. Anyway, I am drinking coffee right now.

Liz Wolfe: Hmm.

Diane Sanfilippo: Primarily iced coffee because it's summer.

Liz Wolfe: Love it.

Diane Sanfilippo: But I will say that the way I've approached it is pretty much the way I've advocated the whole time, so I'm not perfect but I'm trying to get this stuff done, trying to write the books, and I'm actually feeling way, way better this summer than I was last year. I think I'm just a little bit better equipped for what I'll be handling writing a book again, and this book, luckily, is not as much of a monster as Practical Paleo was, and I just know a lot more about what to expect and how much I really need to be getting done every day. So yeah, I've been drinking one cup of coffee in the morning. Every now and then, a day here or there, I might have some in the afternoon, pretty much only if I'm going to work out or if I have something I'm going to be working on as well and not just because. But yeah, I'm feeling pretty good, and my sleep's been pretty solid, and I'm just trying to make sure I can get through all of these days for working and writing. That's my kind of my plan. I'll probably be drinking it for the next couple of months, maybe even through the fall because I'll be working on another book, too, the cookbook for Sugar Detox, but I'm feeling really good with it. I'm not cracking out and doing the 9 p.m. coffee run, and that's really what I'm definitely looking to avoid, but it may come into play the last week or so before this thing goes off to print. I'm just throwing it out there because I know people are always interested in kind of what we're doing and how we're modifying what we said before and what we're doing and all of that. I'm still in line with what I've always said about it, just to be honest with yourself about the way it affects you and whether you feel like you need it or not and how long it's happening for. So yeah, that's kind of where I'm at.

Liz Wolfe: Very interesting. I was actually going to bring up coffee.

Diane Sanfilippo: You were?

Liz Wolfe: Yeah.

Diane Sanfilippo: And the kind I've been drinking as much as I can because it's… I'm kind of blaming this re-upped love affair with coffee… I almost fell off the treadmill right there!

Liz Wolfe: [Laughs]

Diane Sanfilippo: I'm kind of blaming it on PaleoFX. That was around Easter weekend. They had this amazing cold brew in the greenroom for speakers and presenters. It's called Chameleon Cold-Brew. They're not paying me to say that.

Liz Wolfe: [Gasp] That is my favorite! That cracks you out!

Diane Sanfilippo: Yeah! You know?! Now I remember you talked about it.

Liz Wolfe: Yes, I did. When you drink it, you literally start acting like a chameleon. Like, dit-dit-dit-dit. What's over there? What's over there? Which way are my eyes pointing? I don't know.

Diane Sanfilippo: I'm not a black coffee drinker. I still will do coconut milk or something like that, but I drank it black iced at PaleoFX, and I was like: Wow. This really smooth, it's not bitter, I don't feel like I need sweetener in it, and it was just fantastic. It's organic, fair trade. It's a cold process. I don't know how it would compare to something like Bulletproof Coffee. People ask about that stuff all the time. I don't know what kind of aflatoxin or toxins there might be in the Chameleon Cold-Brew, but I know I feel pretty good drinking it, and it tastes really great. It doesn't have any weird bitterness to it or any of that. I'm pretty much a slave to ordering it from their website right now because my Whole Foods doesn't carry it. My Whole Foods doesn't carry Hail Merrys or Jeni's Ice Cream, which is a grass-fed ice cream. They don't carry anything good. That's not really true, but they don't carry the Chameleon Cold-Brew, so anyway, I've been ordering it from their website, and for those of you who go to their website and you want to tell them you heard about it from Balanced Bites, that's fantastic. I don't know. Maybe they'll give me some love and send me some free coffee one day or something. I'm currently not being paid to promote this product, but I do enjoy it.

Liz Wolfe: So is it coffee grounds that are just excellent for cold brew, or are you actually having to order the jugs of pre-made cold brew?

Diane Sanfilippo: It's pre-made and the thing that I'm enjoying about that is that so much of what I'm dealing with stress-wise is just the fact that I still need to feed and water myself while I'm trying to write this book, whereas last year it was: Mom? Can you get me some Chipotle?

Liz Wolfe: Oh, my goodness.

Diane Sanfilippo: Oh, totally. I was living at home. I was in a chair the entire month of June last year, literally 24/7. PaleoStix dipped in guacamole and iced coffee and Chipotle or whatever my mom was cooking that day. Bless her heart because she's amazing, but now I'm in my own place and still trying to make sure I eat. Yeah. Anyway, that was kind of my tangent about coffee. What else did you want to say about coffee?

Liz Wolfe: Well, I've been thinking about how we had Dr. Gottfried, author of… shoot, now the book name escapes me, but I loved it.

Diane Sanfilippo: The Hormone Cure?

Liz Wolfe: Yeah, The Hormone Cure. I was thinking of The Mood Cure by Julia Ross. But we had her on a while back twice, and she was awesome, and one of the things that she said to both of us was as long as you're moderating how you're using coffee, and we were talking about writing a book and all this stuff, and she was saying just exactly what you're saying right now. And at the time I was kind of giving myself a free pass because I've been working so hard on this book and just stressing about it and freaking out about it for the longest time. And like you say, you have to be honest with yourself. I've definitely been abusing coffee, and I've been allowing that to happen just trying to get through the last six weeks of finishing up a book and with the knowledge that people are going to actually be reading it and reviewing it and that I'm on the cover of it and all of these insecurities all bubbling to the surface, and I've just been like: I need coffee to get through this! So, the point is I've definitely been abusing it. I've always had a really balanced relationship with coffee. You know that. I mean, I would drink coffee every morning at the workshops, but I'd drink three sips of it and that'd be it.

Diane Sanfilippo: Yeah.

Liz Wolfe: It was just kind of something to hold onto and aroma to enjoy and whatnot. But I can definitely recognize that I've been treating it very differently over the last weeks and allowing myself to do so just while I'm getting this book done. So I do have plans to do a pretty conscientious systemic support type of protocol. I don't want to call it “detox,” although that is a little bit what it is.

Diane Sanfilippo: That's what it is.

Liz Wolfe: That's what it is. And as much as that can be a buzzword kind of outside of the way you and I use it, I think we both know that it's a very real thing. It's a mechanism that the body uses and a mechanism that does need to be supported sometimes. Some people have been asking about that, so I am going to design myself a recovery protocol, a detox-type protocol with some digestive support and some systemic support just to get me back to fighting shape now that this book is wrapping up. So I'll definitely share more about that as time goes on and hope to document it. But just with everything that's been going on with the move and trying to start this dang homestead, which is super hard, apparently. Nobody remembered to tell me that it's really hard to become a farmer when you don't know how to be a farmer. So anyway, just trying to get things back in line and support my system as much as possible, and part of that is going to be giving up coffee for a little while until I can come back to it in a more balanced state of mind. So I thought you'd be interested in that.

Diane Sanfilippo: Hear, hear! Yeah, I think that's great. I'm pretty sure I kind of gave you the green light, permission sort of… you know, we all look for that sometimes, kind of the other person with the balanced voice to let us know whether or not what we're doing is kind of OK right now, and I remember saying to you: Don't try and quit coffee right now while you're writing a book! And I think for some people if it's so much stress on your system that… I think that I should probably have figured out how to quit before I wrote the last book and then stayed with that, but I don't know that drinking the coffee made any of the stress any better. Do you know what I mean? I feel like it almost just made it worse. But I know that everything else and the way that I'm handling the whole process this time around is just different, so I don't feel the same way where I'm burning the candle at three ends this time!

Liz Wolfe: Yeah.

Diane Sanfilippo: So yeah, I think that's a good idea. I'm curious to hear how it goes with the detox. I remember last year it was the CrossFit Games, I think, so that was July, and I think the book went off to print probably at the end of June last year, really tight timeline. We were definitely kind of cutting it really close, but I remember that was probably the last time I had coffee until sometime a couple months ago now. At least on a regular basis, I should say. I probably had a cup here or there. Anyway. Any other fun updates to share?

Liz Wolfe: Oh, the only other thing is I wanted to do a little shout-out to a program that I'm enrolled in. I'm obsessed with online learning these days. There are some amazing programs out there that people have put together that you can just enroll in and do at your own pace. I just completed a really cool business training, and now I'm on to doing a program called Lazy-Lady Living.

Diane Sanfilippo: [Laughs]

Liz Wolfe: I know, the title is a little funky, but it's basically for amateur homesteaders. So it's kind of a program where we learn about all these different facets of owning and working your own land, and I'm very excited about that, so I wanted to give a little shout-out to Lazy-Lady Living. I don't think enrollment is open anymore, but I'll definitely be talking about that as my experience goes on. I honestly thought I was going to lose all my blog followers when I turned into this crazy goat-lady homesteader, but it seems like people are really engaged with the whole process.

Diane Sanfilippo: You lost me. I stopped reading.

Liz Wolfe: Right? I know. But I'm excited to share with interested parties how this all goes.

Diane Sanfilippo: I'm kidding. I actually really like reading or at least skimming your blog.

Liz Wolfe: [Laughs]

Diane Sanfilippo: But if people don't know, you've got a really cool thing, Email Mondays. If they subscribe, they get this fun email every Monday. I very much enjoy my email from Cave Girl every Monday.

Liz Wolfe: Why, thank you, my friend! Yes, I do a special blog post only for newsletter subscribers because I know newsletters can be a little annoying because a lot of time they're just soliciting or like: Hey, here's this deal, X, Y, and Z.

Diane Sanfilippo: Yeah.

Liz Wolfe: And I don't want to do that. I want to provide value for people that are subscribed to my newsletter. They know if I'm telling them about something it's because it's actually something fabulous. But in the meantime, I try and create content every week just for them. So come subscribe! It's fun!

Diane Sanfilippo: That's so nice of you, Liz. I have a million projects that I'm working on, so at some point soon there will be a special little nugget for my subscribers as well, but that'll be sometime. Unfortunately writing books that have deadlines seems to just get in the way of other things. I don't know why that has to be, but yeah.

Liz Wolfe: I don't know why I started implementing Email Monday and Skincare Saturday at the Skintervention Guide blog in the middle of finishing a book.

Diane Sanfilippo: I don't either. I think you're absolutely crazy. It was coffee.

Liz Wolfe: It was!

Diane Sanfilippo: OK, what are we talking about today? Are we talking about digestion?

Liz Wolfe: Yes, we are talking about digestion. We haven't talked about digestion in a while, or at least I feel like that. Maybe it's just because I haven't been around.

Diane Sanfilippo: I talk about it every day. I actually just… ugh, I won't even get into it.

Liz Wolfe: [Laughs] Don't go any farther with that!

Diane Sanfilippo: Nope. It's gross. All right, well, let's get into questions!

Liz Wolfe: Cool. I feel like it's been awhile since we've actually done Q&A, so this will be exciting.

Diane Sanfilippo: Let's do it.

1. A link between period and constipation [17:28]

Liz Wolfe: All right, question #1, a link between period and constipation. “Hi, Diane and Liz! Please forgive the fake last name.” Didn't even read your name at all, so don't worry about it. “But since it's a poop question, well, you know. I really enjoy listening to your podcast, and I'm hoping you can help me out with a lady issue I've been having. Every month in the week before my period I tend to get very constipated. I usually go two to three, or in bad months maybe even four, days without a BM, and then once my period starts, the floodgates open and I have the opposite issue with everything going through me much faster than normal for a day or two. This has always been the case, even when I ate a standard American diet, and I've heard from friends that they experience similar things, but I was kind of hoping it would go away with a better diet and it hasn't, so I'm wondering if you can suggest anything from food to supplements or anything specific to help me deal. The constipation is my main target because it makes me feel really tired and gross and I feel like it contributes to skin breakouts and other general skin rashiness. I would be grateful if you could help me make my lady time a little easier. Thanks in advance.”

“P.S. Diane, I bought your book for my mother who's living with young-onset Parkinson's, and switching to paleo with your help has been an amazing and wonderful change in her life and symptoms. She brought your book to show my grandmother when she last visited, and my grandma loved it so much she wouldn't let my mom take it home, so now my mom has to order a new copy.”

Diane Sanfilippo: Aww.

Liz Wolfe: That's really sweet.

Diane Sanfilippo: That is sweet.

Liz Wolfe: So here's what her food looks like: “30 to 60 minutes prior to breakfast one huge glass of water with half lime juice and salt and trace mineral drops.” Sounds like you're missing some tequila there, my friend. “Breakfast is two to three eggs, two chicken sausage links, one cup of leafy greens, one quarter cup blueberries, two tablespoons coconut cream, and one cup of coffee with stevia. Lunch is greens, protein such as grass-fed beef or bison, salmon, sardines, roast duck or chicken, or braised lamb or beef shanks, or leftover steak from the night before, half an avocado, side of vegetable that changes with the season, some kind of broccoli, cauliflower, or zucchini. More rarely I'll add some purple sweet potato, Asian yam, or kabocha squash. Snack is usually a piece of fruit, like grapefruit, plum, or peach or a very small piece of dark chocolate. Dinner is similar to lunch: protein served with veggies, though I'm less hungry at dinner, so portions will be smaller. I also regularly eat sauerkraut or kimchi and drink my homemade kombucha and coconut water kefir. I try to keep my carbs under 60 a day since when I go over I really crave fruit and I have a hard time staying between 60 and 100.”

“I'm a healthy weight: 5'10”, 135. I drink lots and lots of water, maybe too much, I love it, and I exercise five to seven times a week by doing Ashtanga yoga, focus on strength rather than flexibility, walking two to three miles, or swimming in the ocean. I sleep super well. I'm very protective of my sleep, and I get 7-1/2 to 8 hours of sleep a night. It used to be more, but since paleo, that's all I seem to need. Supplements: I take cod liver oil two to three times a week, and I just recently added D3 drops and magnesium daily. I'm not very good about taking supplements, so I try to get everything from food if possible. One macaroon cookie one time a week, gluten-free but lots of sugar. Occasional butter or cheese. I'm going to count that and the chocolate as not ‘paleo’ because I know it has bad effects on me, so it's on my cheat list.”

OK, so I wanted to read through all of her food stuff because as we know, food can affect hormonal function. It can also affect digestive function, and this question is really about the intersection between both. Really simply, what we see if we're just talking about menstruation and constipation, and we're talking about the female cycle, which is a whole fascinating topic of hormonal fluctuations when one hormone drops, when another rises in the female body, and what we're actually talking about here is probably the drop in progesterone before she begins menstruating. What progesterone does is it actually causes a slowing down or I guess you could call it a down-regulation of the contractile functions of the smooth muscle in the digestive tract. That's just kind of the pretty basic cause/effect type of thing, so it's not unusual, it's not surprising that this type of thing would slow down, but just because it's common, like you say, Diane, doesn't mean it's normal. Lots of stuff does end up straightening out over time. I'm not sure how long she has been on this new way of eating this nutrient-dense diet. Sometimes it really just takes time. I honestly can't say at what point things changed for me, but they did change. I used to have basically the same problem. This pendulum would swing from one extreme to the other just within about a week or so during my cycle. And I think what can be really, really helpful is to actually chart your waking temperature and your hormones. Get the book Taking Charge of Your Fertility so you actually get an idea of where your hormones are at different points in your cycle, and you can track that along with your digestive function. And yeah, that's a process and it takes some commitment, but like I said, this whole process of rebalancing hormones does take time, so you might as well fill that time with something that's going to tell you a little something about your body and how it's working.

We also want to talk about, and another thing that hails back to our podcast with Dr. Gottfried where she talked about the utility of fiber in detoxing estrogen from the body. Depending on how your digestive function is, and Diane, you and I talk a lot about how this fiber myth of how insoluble fiber is necessary for good digestive function and how it can actually be mechanically irritating on your digestive tract, but there is potentially a use for fiber when we're talking about something besides just healing a potentially damaged digestive tract. Fiber can be useful for women when it comes to detoxing hormones, and that might be helpful. It might not. That's just something I wanted to throw out there to consider, but that really depends on the rest of digestion, how it's working, how comfortable you are with leafy greens. It seems like she's OK and she seems to eat quite a bit. She's talking about broccoli, cauliflower, that type of thing, so that can be helpful. Actually crucifers do have a compound that helps to detoxify, I guess you could call it, “bad” estrogen. So that could be helpful. That may not be what's going on here. Again, it may just be that she needs a little bit more time. She needs to evaluate her hormonal fluctuations.

I'd also say that magnesium can be really helpful. I wouldn't say a magnesium supplement, but maybe trying some topical magnesium oil, especially in that week before progesterone is going to dip. Progesterone is high and that's when those contractile properties kind of slow down, and then in the three or four days before you actually start menstruating, progesterone drops. So kind of timing that magnesium with the rise in progesterone, and again, you'd have to track your hormones a little bit just to make sure when that is because it does vary from woman to woman, surprisingly enough. Our gynecologists like to tell us that we're all pretty much the same, and that is just not the case at all. What else did I want to say on this? I think that's pretty much it. Diane, did you have any thoughts on this one?

Diane Sanfilippo: You were talking about fiber, and she has some different types of veggie intake that she has for fiber, but it might be worth just doing a little bit of charting, that week before, maybe going in and eating a little bit extra of some of those veggies, or maybe shifting whether it's more starchy stuff versus more leafy stuff, and just kind of see if that affects things. Do it one month one way and then adjust it a different way the next month. I definitely notice that kind of on day one of my cycle, when I get my period, there's an absolute change in what's happening in the toilet. And for me, it just kind of signifies, OK, this is really day one. It feels like a hormonal detox. It feels like my body is just saying: OK, there's a change in hormones, and I'm moving some things out a little more quickly than I normally would. So just from personal experience, too, that change is definitely something I can identify, and I don't actually see it as abnormal for me because it has been that way for so long, and I would say it has been that way when I feel like I'm in a place where things are good and very healthy for me and then at other times, too. It's just that is my norm. For a lot of women there are things that we consider normal just because they're common or because they're regular for us, but I do think that that is kind of a normal sign of change in hormones.

Liz Wolfe: You know what I did want to say is… and I want to tread delicately here because she did say she tries to keep her carbs under 60 a day because when she goes over she really craves fruit, etc., etc., and I think that's great to be in tune with your trigger foods and things like that, but this may be a little skinny on the carbohydrates for what she needs. So if she can feel comfortable with upping that good healthy soluble fiber, especially followed by some of these probiotic foods to give that bacteria something to eat, that could be helpful.

Diane Sanfilippo: Agreed.

Liz Wolfe: Yeah. Maybe it's just a matter of getting over that feeling, that tension where you're like: Oh gosh! If I do this, then my X, Y, and Z's going to go crazy.

Diane Sanfilippo: Right.

Liz Wolfe: And honestly, I think the magnesium could probably help with some of those sugar-type cravings.

Diane Sanfilippo: Yeah, for sure. And I think there are a couple things here, too. Like, so what if you have some fruit? She says she goes over and craves fruit. Well, maybe have some fruit. I don't know why she might be craving that

Liz Wolfe: A little vitamin C.

Diane Sanfilippo: Yeah, I mean, fruit isn't bad. Just people who are overdoing it and have goals that kind of go against what that might do. I've been eating kind of a lot of fruit lately, mango and things like that fresh because I know that I'm kind of stressed and I want that vitamin C. Also what I think you were alluding to here was just the mental stress of too many dietary restrictions. Mental stress can definitely make you constipated, if she's putting too much pressure on herself for that, but I think also maybe timing the carbohydrates to after dinner or with dinner and after dinner so that you basically get them and then are going to sleep within a couple of hours. Not right on top of eating you're going to sleep, but to where you then don't have hours and hours to potentially have cravings. So it's maybe your sweet potato with dinner or even an hour after dinner as a treat with some cinnamon and butter or coconut butter, and then that's it and an hour or two later you're off to bed and there's not a chance for you to have those cravings where you're going to need to deal with them because you just basically are asleep. That might be something to consider.

Liz Wolfe: I think there's a pretty good chance she's craving carbs because she needs carbs.

Diane Sanfilippo: For a reason, yeah.

Liz Wolfe: She's extremely active.

Diane Sanfilippo: And I think, too, it's good to recognize that we are getting magnesium from some plant foods. I know we have some certain nuts and seeds that are rich in minerals, but we do also have our leafy greens and even starchy foods that'll have magnesium. So who knows if it's that type of deficiency and she's craving it? If you're craving a piece of fruit or some berries, have 'em.

Liz Wolfe: Have 'em, yo.

Diane Sanfilippo: Yeah, just have a serving and move on with your life.

Liz Wolfe: In the summer I tend to eat more fruit anyway. You know what I learned from my friend, Ashley, who is the coolest? She's Huntress Prep on Twitter. She does hunting and field dressing, and she goes and she hunts and stabs wild boar, and she just takes complete responsibility for her own food and is just my total role model. I want her to teach me how to be awesome like her, but anyway, Huntress Prep on Twitter. Yeah, she's awesome. She told me the other day that mango skin actually has some of the same compounds as poison ivy, so never bite into the skin. Not that you would, but FYI. If you bite into mango skin and you get all over your face, that's why.

Diane Sanfilippo: That's interesting.

Liz Wolfe: Isn't it?

Diane Sanfilippo: Yeah, I have eaten mango skin in the past and I had a really, really, really ripe mango, because it just felt more like an apple skin where you could eat it versus a lot of times when it's not super ripe it's a little thick. That's interesting.

Liz Wolfe: I've never seen a mango like that before.

Diane Sanfilippo: I don't know if I bit into it, but I just kind of couldn't get all the skin off because it was so thin and the mango was so ripe that I just of ate it because it was there. Interesting.

Liz Wolfe: Very.

Diane Sanfilippo: Wow. How much time have we been going right now?

Liz Wolfe: I honestly don't know because I think we talked a little bit before we started recording.

Diane Sanfilippo: Wow. Question 2.

Liz Wolfe: I'm definitely seeing 45 minutes on this current call, which is crazy.

2. Chronic constipation [31:45]

All right, next question: Chronic constipation. This is what Donna has to say: “Hi, ladies! Love your podcast and follow you both on Facebook. I'm really enjoying your book as well, Diane. Thanks for all you do. My problem is chronic constipation. I'm 53 and in menopause. I was a vegetarian for four years and was the most regular I had ever been in my life. I started eating meat about four months ago and noticed my digestion slowing down to my pre-vegetarian sluggishness. Since just before going paleo three weeks ago, it has all but halted to a stop. I've been listening to podcasts, reading books, etc., and trying to do everything right, taking probiotics in the morning before breakfast, enzymes with my meals, no water while eating, trying to relax and chew slowly and adequately, but nothing seems to be working. It's gotten so bad that about once a week I break down and drink some Yogi brand herbal laxative tea. Could this be related to being a vegetarian for four years and eating lots of beans, oats, and grains? Am I not giving myself enough time? I'm beginning to worry and don't feel like going to my general practitioner will give me any answers. If you could give me some advice, I would greatly appreciate it.”

She strength trains two to three times a week, cycles three times a week for about an hour at a moderate pace, lost 25 pounds on a low-fat diet about two years ago, and has maintained the loss but would like to lose about 10 more pounds, “particularly in my belly. Sleep can be good, but I often wake up and can't go back to sleep. Eating 100% paleo except for a few times I was with friends and didn't know how to say no without being rude, ate small portions of treats with wheat and sugar. One cup of coffee in the morning. I have always liked vegetables, so I eat them for lunch and dinner every day. I don't have any stomachaches or discomfort, just can't seem to get things moving on my own anymore.”

I think this is a great question. Do you have any immediate thoughts, Diane?

Diane Sanfilippo: A couple of things. Kind of on the heels of what we were just talking about, we know that hormonal changes, she said she is in menopause, and sometimes those are bits and pieces that people kind of leave out, and sometimes they add them in, and sometimes it's swaying our opinion just because these extra details are included, but more details always really help us to uncover the whole picture of what's going on. I think that the hormonal changes that we might go through in menopause or during different times of our cycle can have a lot more impact on our digestion than we really know. I don't think it's that bad that she might drink an herbal laxative tea. I don't really think that that's something to feel badly about. If you are constipated, it's something to definitely address. It's not like I would say do whatever you need to do to go to the bathroom because I don't want people really taking Ex-Lax type of things, but I think an herbal laxative tea, if that helps you and you need to drink a little bit of it more regularly to get your digestion going and get these eliminations going, I think that might be OK to just make sure that you're getting your eliminations out. You really need to be going to the bathroom at least once a day because that's going to support detoxing hormones. That's kind of just one little piece there.

I don't think that being vegetarian for four years and eating lots of beans, oats, grains, I don't really think that that's what's causing this. I think it's been about four months that she's been eating meat, and it can be longer than that to really get your digestion into kind of a different place with a new way of eating. I remember when I first went paleo it probably took at least six months to have my eliminations kind of become more regular in terms of just how solid they were. I remember at first they were actually really soft, and I think that was just from a lot more fiber maybe from the veggies, and it was maybe from more fat that I wasn’t used to. She said, “Since before going paleo three weeks ago,” and she started eating meat about four months ago, so yeah, I think if it's just been three weeks since going paleo, it could be a really big issue that she could be taking in a lot less fiber than she was before. And I know that you and I are not the “eat a million grams of fiber a day” people, but in the beginning I think it is important to recognize that what you were doing before was probably giving you more fiber and also more irritation to the gut. I think that can be a little bit confused with normal bowel movements. Some people who are eating a plant-based, heavy grain diet are going to the bathroom three or four times a day very regularly. I don't know that I think that's normal. I think twice a day is probably fine. Anyway, I think she might need to just get in some more veggies. Maybe she needs to, again, pay attention to the mix of insoluble and soluble fiber, so that’s the green leafies versus the squash or sweet potato kind of thing.

I don't know. That's kind of what I'm getting just at first glance here. And it has been not that long, so I like that she's like: “Am I not giving myself enough time?” Yeah, it is going to take time. And she said she's taking probiotics, but what about eating some probiotic foods and getting some other types of different bacteria in that might be available in that supplement?

Liz Wolfe: We also don't know… She's always eaten vegetables, but like you said, we don't know what kind of vegetables. We like to have people eat a good source of healthy soluble fiber, like a sweet potato or butternut squash or acorn squash or whatever, something like that, which is what our gut bacteria actually feed on, and I think really healthy digestion is really fueled by good bacteria that feeds on soluble fiber versus insoluble fiber from grains that's going to mechanically irritate and cause that everybody-out reaction. We don't actually know how much of that she's getting. She may just be eating some leafy veggies or something like that and, like you said, just gone from a ton of insoluble fiber from grains or beans or whatever she was eating before and transitioned straight to getting a hell of a lot less insoluble fiber, taking away that mechanical irritation, which in the long run is probably a good thing but hasn't actually fed and helped make more robust that good bacteria that's in her gut that's going to help her digest her food better going forward. Those are my thoughts.

And there's the hormonal stuff, too, of course, that she's in menopause right now. This is definitely going to be a process of working out what works for her, and I imagine that she transitioned away from vegetarianism for a reason. She's talking about how her digestion has slowed down to her “pre-vegetarian sluggishness,” which is interesting to me. I think a lot of times folks give up meat because they don't feel like they can digest it, not realizing that digestion is really a “use it or lose it” type mechanism, where if you're not asking your body to do something for long periods of time, then you actually do lose the ability to make that happen on its own. So it does take time. It definitely takes time. Cool.

3. Stomach pains and bathroom use even though I haven't eaten all day [39:22]

Question #3: Stomach pains and bathroom use even though I haven't eaten all day. “Hi, Diane and Liz! First of all, can I just say I love your podcast, and as a new listener, I'm loving all the great info you guys are putting out there. I've spent countless hours listening to previous podcasts.” Thank you for listening. “So to my question, or should I say my frustration: This is a problem that I've had for years, and I'm at a loss of what to do about it. I've had digestion problems for ages. I think it probably started back in 2000 or 2001, and back then I had a lot of issues with bloating and feeling full after eating a small amount of food. My friends would joke that I would get full after eating one grape, and they weren't far off. Fast-forward to about two years ago, and I'm still having issues with bloating, but add to that diarrhea, pain, and discomfort, and that's me pretty much every day. I've just finished my first Whole30 and still nothing has changed. I eat paleo 95% of the time, but even that hasn't stopped the problem.”

“I've had so many tests done, including blood tests, a colonoscopy, an endoscopy, and have been put on different medications, but again, the tests have not shown anything and the medication hasn't done anything. The problem is that I can't pinpoint what foods cause this reaction because sometimes it feels as if everything does. My bowel movements are all over the place. I will have slept for 9 to 10 hours and wake up needing to go and I haven't even eaten anything. It happens during the day as well. I'll have breakfast and will be so full I literally can't eat the whole day. Then all of a sudden I'll get stomach pains and again have to use the bathroom even though I haven't eaten all day. I also often have gas, which comes out in the form of burping. Sorry, TMI.” It's never TMI. Don't you worry, sweetheart. “It also gets worse when I'm stressed, angry, upset, and because of this, a lot of doctors I've seen keep saying I have IBS, but I feel like that's such a “one size fits all” approach. I've also started taking digestive enzymes, which haven't helped, and I've been eating even more fermented foods, but still nothing. Anyway, sorry for going on, but I was wondering if you could shed any light on my situation.”

“Breakfast is eggs, some veggies, some greens. If not eggs, then meat of some sort, usually grass-fed beef or lamb, chicken breast, sometimes bacon. Lunch as above, more salad, sardines or tuna in oil. Dinner is meat and veggies. I do eat some dairy, mainly just full-fat plain yogurt, recently cut back a lot, would eat it every day before. Grain-wise, no bread or pasta. Occasionally I'll have some rice, and that's as far as I go with grains. Supplement-wise, I take digestive enzymes before each meal. It doesn't seem to be helping, though. Fish oil from Nordic Naturals and sometimes I take herbal peppermint tablets before eating to help my discomfort.”

If she's been listening to our podcasts, Diane, she may know that we're about to say this, but I appreciate her incisiveness in saying that the IBS diagnosis is kind of “one size fits all,” but I don't think that doctors are incorrect in connecting emotional states with digestive function issues. I think maybe this is a little bit of a false correlation, but they're definitely on to something, and it's something that we talk about a lot, and it also comes through a lot in the way people phrase questions and the way they come through via their entries on the Internet when they're a little bit high-strung or really concerned or just actively stressing about something. We can feel it, and it comes through.

Diane Sanfilippo: Yeah.

Liz Wolfe: So I don't want to say this is a problem of personality because it's not, but it's definitely something to be vigilant about, how to modulate the emotional state and tackle that part because it has an incredibly profound effect on the function of our digestion. And that's just a damn fact.

Diane Sanfilippo: Yeah, and it's not that IBS is a “one size fits all.” It's just that it's not really a diagnosis because telling you that you have irritable bowel syndrome is just telling you what you said to them with a “diagnosis,” so it's really not much of a diagnosis at all. And it almost doesn't really matter what the diagnosis is unless the treatment protocol is going to vary based on that.

Anyway, what I'm really getting are a couple of things from here, and I'm absolutely with you on the whole stress thing. I know many, many people who have extreme states of discomfort and distress with digestion, and I can probably attribute about 80% of the problem to the way that they manage stress in their lives. These are the kinds of people who'll tell you a story about waiting in line somewhere, and the way that the story is told is like it was the most outrageous experience. And I love a good storyteller, don't get me wrong, but you know what I'm talking about where there's this person who you're like: Why do you sound so stressed about the fact that somebody cut in front of you in line? Or whatever it is, something ridiculous that all of a sudden the way that this person perceives the situation is totally different from what somebody would have perceived. Anyway, I think that's huge, and the way that our mental stress, the way that our neurotransmitters affect our digestive system is huge. We heard about in a previous question about someone who's kind of chilling out and chewing and being mindful when they're eating. Getting your digestion on track really, really has to start with de-stressing your life, and part of that may be – as crazy as it sounds – trying not to stress about the fact that your digestion is messed up right now. Just be like: You know what? I'm dealing with it. You just have to have a different approach. It happens to all of us. Like Liz was just saying on a previous episode having some kind of bug and being away in Mexico, you don't just sit there freaking out about it. You recognize it's happening, and you say: OK, well, I'm working on it. I'll figure it out, and next week it'll be different, or next month or next year. At some point it'll change and you just have to kind of chip away at possibilities.

That being said, there are a couple of possibilities I have here. One, she said she's taking digestive enzymes. She didn't say whether or not there's hydrochloric acid in those digestive enzymes, and she could really be having an issue with very low stomach acid. At the same time, she said she couldn't figure out which foods it was, but it could be also really low bile output from the gallbladder. Again, I don't know what's in the digestive enzymes. I would look at adding a hydrochloric acid, HCl, betaine HCl supplement. You don't really take it before the meal. You take it a few bites into the meal so it's not hitting an empty stomach because it is an acid supplement. Or taking some ox bile, getting that gallbladder support. I would test one for maybe a week or two and then test the other one and then test them together. You really have to just do these things and see what's working for you.

That being said, one reason for having low stomach acid besides just mental/emotional stress, which can absolutely lower stomach acid, is there could be something going on with a gut pathogen. If this started a long time ago, we don't know what happened in that year, 2000 or 2001. Were you traveling abroad? Did you maybe pick something up? Again, if you're a person who has high stress in your system, you will be more susceptible to picking up different types of pathogens that maybe somebody else doesn't. Something like H. pylori is a really big culprit for low stomach acid, so getting a stool test done, maybe getting tested for small intestinal bacterial overgrowth, which will essentially put too much bacteria in your small intestine. It's not supposed to be in your small intestine. Most of the bacteria we talk about being in our gut is going to be in our large intestine. If it gets into the small intestine, it causes a problem, and that could absolutely cause some issues with bloating. But it sounds a little more like it's higher up in the process. It sounds like it's a stomach issue, so it's something dealing with low stomach acid. But again, that could be caused by a type of infection, so I would definitely get tested for different gut pathogens and specifically also for H. pylori, and that may result in needing antibiotics of some sort. Maybe it's a prescription or maybe it's just a very strong botanical, oregano or other herb base. It really depends on the practitioner that you go to, but I definitely recommend getting some testing done for it because I don't think this is something that you'll just be able to resolve on your own. That's my hunch. More thoughts? Are you muted?

Liz Wolfe: Yep, I was muted for a second. The only thing that I was going to say while you were talking about the digestive support was just a note for anybody and everybody: If enzymes are helpful to you, then I think that's great, but I think a lot of times people skip the stomach acid support in favor of enzymes, and I don't think that's the way to go. If you have good, robust stomach acid, you will actually stimulate your pancreas to produce enzymes. And a lot of times, the reason you are not producing enough enzymes is because your stomach acid is not where it should be. So I think it's really important to look one step above that enzymatic situation.

Diane Sanfilippo: Yeah. She can probably re-read the digestion section in my book to kind of get more of what I just said on paper and read it again and just kind of make some sense of it. Do we have time for maybe one more?

Liz Wolfe: Yeah, I think we can do one more question.

Diane Sanfilippo: OK.

4. No regular BM’s ever![49:25]

Liz Wolfe: Question #4: This one is from *****Loll. OK, *****Loll says: “Hi, Diane and Liz! First off, thanks for the fantastic podcast. They make every Friday a little more sparkly. I'm in Australia, so we get the update overnight. I've listened to all the episodes, and although there's useful information in each, none truly fit my issue, so please help. I've had stomach issues for as long as I can remember. I was suffering from bouts of constipation and diarrhea, constipation dominance definitely for five years until I was diagnosed with an overgrowth of candida. I went on a detox and successfully overcame the issue; however, I still can't say that I've had a fortnight with regular bowel movements ever.” Major points for using the word “fortnight,” I'm just saying. “On a weekly basis I have a maximum of two regular BMs if I'm lucky and then go for three or four days with no movement at all. By this stage, I feel emotional and nauseous, so I take a dose of magnesium oxide to get things moving along. I don't like doing this, as I've been told it's not something I should use regularly, but I get desperate. My husband and I are hoping to conceive in the next few months, and I'm concerned that the situation will get worse or that I'll pass any issues on to the future generation. I'm currently taking chaste tree for a very minor estrogen imbalance, but my cycle runs like clockwork, and my monthlies are a breeze, so I suspect everything is back to normal. I initially thought the constipation was linked to this, but now I'm not so sure.”

“So this is a snapshot of me now. I hope I cover everything. Diet is paleo 99.9% of the time. I eat raw dairy in small quantities and completely avoid caffeine and alcohol, including chocolate. I eat as paleo as I can when I'm out but very infrequently have a tiny amount of sugar or grains if the family has made something especially for me or it's awkward not to. I strictly avoid wheat. Exercise: I do two cardio sessions, two Pilates sessions, and one weight session a week at the gym, each lasting 45 minutes. Supplements: I take a high-quality prenatal multi, certified clean fish oil, and high-strength vitamin C. I've been taking probiotics in the hope they will help but have had no luck so far. I have beetroot lacto-fermenting in the kitchen and will be making my own raw milk yogurt as of next week. I can't locate any scobies or kefir starters in my area, and I worry about the caffeine content in kombucha, so I've avoided those thus far. Personality: …” She knows us so well. “I'm a naturally highly strung person, but I've taken great steps in changing my thinking and being a calmer person all around, as I know stress affects my gut. My job is fairly stress-free apart from some annoying moments, and my home life is happy. Small amounts of sugar and grains once a month max.”

I have a few thoughts on this one.

Diane Sanfilippo: Go for it.

Liz Wolfe: OK, so we've covered a ton of different variations of the same issue during this podcast, but I'm wondering if this may not have something to do with serotonin and the gut. I don't know a whole lot about this, but I do know that serotonin production or serotonin… something can affect bowel motility, it can cause constipation, and I'm wondering if some of Julia Ross' work could be helpful with regards to these neurotransmitters and how they can affect digestion. That's really an incomplete thought but where I went first because she has the moderate exercise, she seems to be eating well, she's not afraid of some of these good nutrient-rich, fertility, probiotic foods that we like, so I think she has a lot of those bases covered, so I was kind of trying to think outside the box a little bit.

Diane Sanfilippo: Yeah. She hasn't really said a lot about what she's eating. She's saying what she's not eating but hasn't said a lot about what she is eating, so definitely I would say to listen back to what we're recommending for some of these other folks, it seems like they've all been women, about how to kind of address maybe getting in the right types of fiber and different balances for that because that might be really helpful for her. Checking out what I have as far as recommendations for constipation in Practical Paleo, which are all things that we've covered her, but just to get a review in one place of everything.

She's taking probiotics. Again, I'm going to stress that sometimes taking the supplement is not the same as eating the foods, and also if that supplement's not working for you, don't take it anymore. If you're taking it specifically to try and get your motility moving and it's not working, try something different. I know the brands that are available in different countries are all going to vary, and maybe look at how many parts are supposed to be in that supplement that you have, and maybe see if you can get one that's a little more potent, perhaps. There are a couple of brands I know that are available on Amazon. Dr. Ohhira's is one that you might want to check out. Just see if that maybe makes a difference.

I think outside of that, what was I going to say? To your point about the serotonin, 95% of serotonin is actually made in your gut, so if you're not really experiencing normal digestive function, maybe you're not making the serotonin and it could be kind of a cycle there where it's not enough serotonin, not getting the right motility, and then it just feeds into itself. She could try and take maybe some 5-HTP. That's kind of along the lines of the Julia Ross stuff. Take some 5-HTP and see if that maybe helps things a little bit. That's kind of it, you know, along with all of the other recommendations that we've made throughout this whole podcast.

Liz Wolfe: Yeah, a lot of times with the candida overgrowth stuff, people will make some changes that can be really, really drastic, and while they can help clear candida, these detoxes can sometimes cause the pendulum to kind of swing in the opposite direction very quickly. And while she's having these same symptoms, they could potentially be from something entirely different. There are a lot of moving pieces here, but it sounds like she has a practitioner. If she's taking chaste tree for an estrogen imbalance, I imagine somebody told her she had an estrogen imbalance, so this might be something to talk to that practitioner about, whether it be the 5-HTP or just talking about the potential aftereffects of… not a candida cleanse gone too far, but the potential consequences to clearing one thing and what potential issues could possibly arise after having done that. It's not always a process where once you've cleared candida you're done and everything's all better. Sometimes you take drastic measures to take care of one thing and then you have to do a little bit of recovery to tackle other things that popped up in the meantime. Anywho, keep in touch on that. Let us know if you figure it out.

Diane Sanfilippo: That's it.

Liz Wolfe: Yep, so that's it for this episode, everybody. We'll be back next week with more questions. And until then, you can find Diane at BalancedBites.com, and you can find me, Liz, at CaveGirlEats.com. Thanks for listening!

Cheers!
Diane & Liz