Constipation and Fat Loss Resistance
By: Dr. Jillian Teta
Your digestive system is the Grand Central Station of your body. Not only is it the avenue through which you take in, break down and absorb your nutrition, it plays pivotal roles in your immune, neurological, psychological and endocrine systems. In fact, there isn’t a single cell or system that your gut does not interact with every single day.
How silly of us, then, to address the question of fat loss without picking up the topic of the digestive system. One could argue persuasively that major stumbling blocks to fat loss remain overlooked within the reaches of the gastrointestinal tract.
Specifically, when it comes to female fat loss, there is one parameter that must always be addressed: bowel regularity and motility. Ladies who are constipated, whatever their age, will have a harder time shaving inches off their waists and burning fat.
Constipation can induce and maintain fat loss resistance via many different avenues.
Your body uses your large intestine to remove spent estrogen from your body
The gut contains two out of the five organs of detoxification – the liver and the large intestine. Your liver acts as a smart filter of your blood, removing spent androgens, drugs, toxicants, products of metabolism and a plethora of other things. It subjects these to a detoxification process so they can be neutralized and removed from your body.
When it comes to estrogen, the liver uses a two-step process for detoxification. Phase I and Phase II of estrogen detoxification are well known. In Phase I, through a process known as hydroxylation, a hydroxyl group is added to estrogen (-OH). In Phase II, it undergoes methylation and glucuronidation in order for it to be transportable via the bile.
Once in the bile, the spent estrogen ends up in the large intestine, as all bile ends there eventually. It gets added to the stool, and your job is to poop it out. This will complete the process of estrogen removal from your body.
Except, of course, if you are not pooping. The large intestine has a blood supply, and if your stool is simply sitting there and not moving on through, these spent estrogens get resorbed back into general circulation. They end up back at the liver. The liver has already dealt with them, and now has to deal with them again.
We can say that when the bowel is constipated, the liver is constipated too, at least from the perspective of removing estrogen and other androgens from the body (most androgens are removed via the liver/bile/large intestine pathway).
As you well know, an imbalance of hormones, particularly androgen imbalance and estrogen excess, can result in fat loss resistance.
Thus, in women with constipation, one of the very first orders of business is to determine cause of constipation and get the bowels moving regularly again.
Constipation favors a microbiome better suited for fat gain than fat burning
Your large intestine houses quite a wonder – a colony of beneficial bacteria numbering anywhere from one trillion to one hundred trillion cells. For context, you have about one trillion human cells, making you at least as much bacterial as you are human.
Collectively, these cells are known as the microbiome. They represent thousands upon thousands of different strains and species, and provide innumerable services for your body. Not only do they help with digestion and absorption of nutrition, they play roles in hormonal activation and metabolism, gut motility, immune function, inflammatory response and demonstrate impact on your state of mind, your blood lipids – and your waistline.
There have been numerous studies into the microbiome landscapes of overweight and obese persons compared to non-overweight and obese persons. Certain strains of bacteria help your body burn fat better or could help you extract more caloric density from food.
To thicken the plot, studies also show that constipated folks will drift towards a microbiome that is not ideal for fat burning. Decreased amounts of strains of Prevotella plus increased amounts of Firmicutes were shown in constipated patients in a 2014 study. It appears that Firmicutes favor a slow digestive tract, and large numbers of these guys will crowd out more fat-burning friendly bacteria like Bacteroidetes.
Constipation, over time, can lead to endotoxemia and metabolic damage
Chronic constipation is a vicious feed-forward cycle, often with many factors contributing to the end result. While many will dismiss constipation as a mere inconvenience or a part of normal life, the truth is that is can have serious consequences for not just how well you fit in your clothes, but how your body feels and functions.
There is a term floating about that is gaining traction in both the conventional and integrative medical communities. Endotoxemia, auto intoxication and metabolic toxemia all describe a phenomenon that is being shown to underpin a vast majority of chronic disease states, from obesity to depression to neurodegenerative conditions and more.
The process occurs when inflammation in the gut remains at higher than normal levels for a certain amount of time, typically months to years. Increased inflammation (from a variety of factors, but in our example, an imbalanced or dysbiotic gut flora secondary to chronic constipation) leads to increased permeability of the tight junctions of the lining of the intestine.
Increased permeability means that inflammatory compounds, immune complexes formed from interaction of the immune system with food and bacterial antigens, and metabolic products can cross out of the gut and into general circulation. Many of these compounds are capable of crossing the blood brain barrier as well.
Once the gates of the intestine have been opened, and these inflammatory and antigenic compounds are floating around, we then begin to see other consequences in the physiology. Hormonal manufacture, signaling and breakdown can be disrupted. Neurological function can be impacted, along with immune function. The immune system is in a primed, pro-inflammatory state, making it reactive. Muscle and joint pain, malaise, brain fog and low mood are all common consequences (interestingly, endotoxemia is also thought to play a role in complex pain syndromes like fibromyalgia and chronic fatigue syndrome).
Here at Metabolic Effect, we call this “metabolic dominoes” and it leads to metabolic damage as the coordination of the hypothalamus, pituitary, ovaries and adrenals become compromised and essentially uncoupled. Fat loss is very difficult in these circumstances.
Backing out of constipation
If you are constipated, one of the very best things you can do to improve your fat-loss game is to poop. Try these three techniques to get started:
Don’t just blindly take fiber.
We can’t talk constipation without talking fiber. In many, many cases of chronic constipation, unless you are eating a diet of white flour and cheese, taking fiber doesn’t help very much and can even make the issue worse and introduce new symptoms like gas and bloating.
While adequate fiber (25-40 grams/day) is crucial to bowel regularity, many reaching this goal still struggle. In long standing constipation, especially if there is a history or past diagnosis of IBS (irritable bowel syndrome), SIBO (small intestine bacterial overgrowth) or any type of dysbiosis (an imbalance in the microbiome), the type of fiber consumed is important.
In these folks, emphasizing low-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) can help increase comfort levels and begin to get things on the right track.
Swapping from Metamucil to something like Metabolic Effect’s Fiber Complex, Paleo Fiber or Acacia fiber can also be quite helpful. The golden rule with fiber supplementation is always start at a low dose and increase slowly over days to weeks.
Make sure that you are consuming fat and protein with your fiber as well, two macronutrients integral for appropriate bowel function. Micro nutrition – electrolytes and minerals – are also important to maintain the water balance and thus motility of the gut.
Dehydration is an oft-overlooked contributor to constipation. Not only do many of us not get all of the water we need, we also over-consume coffee, alcohol and cigarettes, all of which are dehydrating.
The general yardstick for water consumption is to take your weight in pounds and divide by two. This number is the amount of ounces you should be consuming daily, plus an additional 4 ounces for each vice, and up to 12 ounces for a good workout.
Like fat, water helps lubricate your digestive tract and will also help the stool not get too dry. If you are taking supplemental fiber and not increasing your water intake along with that, you are more likely to experience gas and bloating from fiber, so take note!
Take magnesium glycinate.
For effectiveness, gentleness, multiple additional benefits and cost considerations, magnesium glycerinate takes the cake to help reinstate regularity. The body uses Magnesium in over 400 biochemical reactions, and in addition to alleviating constipation, it can reduce muscle soreness, headache frequency and help with sleep.
Try a starting dose of 300-350mg around bedtime. The rationale for bedtime dosing is that in the morning you can wake up, have a big glass of water, go into the bathroom, grab your squatty potty or footstool, and have a nice bowel movement. Doses can be increased by 100mg every several days. The major side effect to magnesium is loose stools.