Unable to drop the kids off at the pool, daddy freaks out

 

Ever the helpful sort, I thought I would share the secret to the absolute best way to become constipated. Apparently so many enjoy it because they continue to eat the very foods that cause it. And good for them I say! Why let constipation and its related acid reflux, heartburn, gas, bloating, cramping, hard stools, diverticulitis, anal fissures and hemorrhoids get in the way of eating pleasure! We’re Americans after all and we’re entitled to have our cake and eat it too goddamnit!

However, before I get around to dispensing this particular dietary pearl of wisdom, let me first cover an interesting, albeit relatively unknown cause of constipation: opioid-induced bowel dysfunction or OBD. As the name implies, this is constipation brought about by using opiates—both legal and illegal—and it’s a major source of distress for those taking these drugs.

In 2005, an estimated 365 million prescriptions were written for opioids globally mainly to treat chronic pain including pain caused by cancer. According to the 2012 report from the United Nations Office on Drugs and Crime, an estimated 26 to 36 million people use illegal opiates like opium and heroin worldwide.

Prescription and illegal drug use isn’t the only place humans get their opioids. Our GI tract also produces them like met-enkephalin, leu-enkephalin and B-endorphin. These opioids help co-ordinate the movement of our digestive tract. In times of stress, inflammation or trauma endogenous opioids are released to slow or stop intestinal movement so energy is redirected elsewhere. Kinda like an emergency breaker switch at the hot dog factory.

Three major opioid receptors exist in the digestive tract: delta, kappa and mu. Of these, mu receptors seem to be the most prone to responding to external opioids. In response to their presence, these receptors paralyze the GI tract and interrupt secretion of substances necessary for proper digestion. As a result, gut hormones that signal the gallbladder to contract or the pancreas to release digestive enzymes are not produced. As many of these gut hormones also increase the feeling of fullness or satiety after a meal, the brain doesn’t get that message either.

Opioids slow or stop everything in the digestive tract. Propulsive waves that would normally move things right along stop and constipation results. Feces stays in the colon longer than it should and is sucked dry of water turning it hard and difficult to pass. Straining becomes common which in turn leads to injury of the colonic gut wall predisposing to diverticulitis, anal fissures and hemorrhoids.

Other symptoms of opioid induced constipation include gastroesophageal reflux disease or GERD. The pyloric sphincter that releases stomach contents into the duodenum doesn’t open as regularly. So food sits in the stomach churning and churning with nowhere to go but up into the esophagus and throat, especially if this food has expanded due to the presence of insoluble fiber which acts like a sponge.

Abdominal cramping, heartburn, spasms, bloating, sensations of incomplete evacuation and bowel obstruction are common in OBD. Opiates also decrease testosterone and estrogen production so there goes the sex drive. They depress immunity and have been linked to the initiation and acceleration of cancer which is sadly ironic given how many are given pain-relieving medications during hospice care.

In one survey of cancer patients, constipation and its related symptoms ranked higher than the pain they experienced from their tumors. Some even stated they would rather experience pain than suffer through the constipation brought about by their pain-relieving meds.

Having suffered with constipation I know how miserable it can be so I certainly can empathize. God knows I tried everything including extra fiber in my diet, psyllium husks, loads of water, exercise, situps, magnesium, prunes, olive and coconut oil, apple cider vinegar, cascara sagrada and the occasional enema. Fun times let me tell you!

Now I’m sure some of you are thinking, “Oh, here it comes. He’s going to talk about his damn probiotics and prebiotics again” and you’d be partly right. The best way to relieve constipation apart from diet change is increase the amount of colonic bacteria. 60% to 70% of your feces is actually composed of bacteria and I can’t think of a better way to increase their number than by probiotic and prebiotic supplementation. As gut dysbiosis will always cause defecation issues, curing it will help resolve the issue.

However, let’s get real here. Do you think your caveman or cavewoman ancestors were popping probiotics to get things moving under their leopard skins? Of course not. Nature didn’t design us to suffer constipation so there must be something in the diet causing it in those not taking legal or illegal opiates. And that something was introduced to the diet around 10,000 years ago when humans made the transition from hunter-gatherers to agriculture.

Gluten grains and their gut paralyzing substances are that “something”. As I covered here and here, five different opioid peptides are released when you eat this clogging crap, er…I mean “wholesome food blessed by God and the Academy of Nutrition and Dietetics”. Another substance called adenosine, an inhibitory neurotransmitter, is also produced when gluten is digested which adds to the effect. I don’t know about you, but when I was a kid and I had a bout of diarrhea, my mom would give me toast or crackers and guess what? It worked. Now you know why. Ain’t science fun?

So the absolute best way to plug yourself up without using a sex toy is to eat lots of rye or barley or America’s favorite grain, wheat. Stuff yourselves silly and you too can enjoy the symptoms suffered by those on pain meds. And since compromised peristalsis is the number one way to acquire a raging case of small intestinal bacterial overgrowth, you can kiss healthy gut flora populations and all the good things they do goodbye!

This brings to mind a humorous little story, or at least humorous to me. Never one to shy away from Schadenfreude, I have a female friend who enjoys mocking my warnings about gluten grains. She’s always fond of telling her husband and kids that Ray wouldn’t approve of this or that because it has gluten in it.

I usually ignore these remarks because life is just too damn short to reason with those in denial. I say denial because when she stayed with us once, she lamented that it had been three days since she had had a bowel movement and last I checked, she wasn’t sporting track marks on her arms. That, of course, didn’t prevent her from eating her submarine sandwich for lunch or her pizza for dinner. I must admit that I was smiling inwardly as I pictured her straining away on our guest-room toilet as by then I was well done with telling her that gluten and gut dysbiosis was the problem. You can lead a horse to gluten-free, probiotic-rich water but….

So my dear reader, the next time someone you know complains about constipation, diverticulitis, GERD, heartburn, bloating, anal fissures and hemorrhoids in the absence of opiate use you can rest assured that it was self-induced by a gluten-rich diet and resulting gut dysbiosis. Pity I’m not a gastroenterologist. Just think of the job security!

 

References:

Bishop, H., Frazier A. C., Robinson G. B., Schneider R. (1963). The Nature of the Antiperistaltic Factor From Wheat Gluten. British Journal of Pharmacology, 21: 238-243.

Fukudome S., Jinsman Y., Matsukawa T., Sasaki R., Yoshikawa M. (1997). Release of opioid peptides, gluten exorphins by the action of pancreatic elactase, Federation of European Biochemical Societies Letters, 412: 475-479.

Fukudome S. and Yoshikawa M. (1991). Opioid peptides derived from wheat gluten: their isolation and characterization. Federation of European Biochemical Societies, 296: 107-111.

Fukudome S. and Yoshikawa M. (1992). A novel opioid peptide derived from wheat gluten. Federation of European Biochemical Societies, 316 (1): 17-19.

Huebner F. R., Lieberman K. W., Rubino R. P., Wall J. S., (1984). Demonstration of High Opioid-Like Activity in Isolated Peptides From Wheat Gluten Hydrolysates. Peptides, 5: 1139-1147.

Panchal S.J., Muller-Schwefe P., Wurzelmann J. I. (2007) Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. International Journal of Clinical Practice, 61 (7): 1181-1187.

Robinson G. B., Schneider R., Frazer A. C. (1964) A Substance From Wheat Gluten, Which Inhibits the Intestinal Peristaltic Reflex. Biochimica Et Biophysica Acta, 93: 143-149.

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