Epilepsy Sparks

Clearing Out The Poop Chute!


Clearing Out The Poop Chute!

Meet Georgina Goss: Dietician and Founder of "Meals. Muscle. Mind"!


 

Favourite film/TV Series:    Game of Thrones


Favourite band:                     Malavita!


Favourite book(s):                 The Horse Whisperer (by Nicholas Evans)



There are a lot of misunderstandings around the root causes of, and the remedies for, constipation. As a qualified dietician working in the NHS, I hear all kinds of misinformation thrown about on the topic. That’s partly because many of those who suffer from it, are unlikely to report it1 and will instead attempt to self-treat rather than consult a healthcare professional. That can mean that of the 14% of people who suffer from constipation globally2, a good chunk of them may end up wasting money on well-marketed supplements which don’t actually fix the problem (and could interfere with your medication).

 

Epilepsy Research UK states that constipation can lead to a build-up of toxins in the system and this may lead to an increase in seizures3. Coupled with the fact that some anti-epileptic drugs can cause constipation, getting to the bottom of how to make dropping "the kids off at the pool" that bit smoother (all puns intended) is pretty important. 

So, I thought for my first blog for Epilepsy Sparks I’d lay out the core facts:


Fibre

Medication aside, one of the main factors that affect our poop is the amount of fibre in our diet. In the UK the average fibre intake in adults is 19g per day, well below the recommended 30g per day for the population4. That’s likely due to the increased availability of low-fibre refined, processed foods which dominate our lives, coupled with a lack of knowledge on what fibre actually is. So, let’s help clear this up…

In a nutshell, fibre is a form of carbohydrate that we’re unable to digest, so they pass through our entire digestive system from entry to exit. There are three main types: Insoluble, Soluble and Resistant starches, all which play a different but equally important role in our gut health and motility. What is less known is that having a healthy gut also improves both our physical and mental health!





 

 

-          Insoluble

This type of fibre travels through the digestive tract intact, as it can’t be broken down by our body. It acts like a school janitor and sweeps through our bowels. This fibre is also known more commonly as ‘roughage’ and mildly irritates the gut (in a good way) to get the digestive tract moving things along.

 

Surprise, surprise, fruit and veg are a great source of insoluble fibre, especially the skins. So, stop juicing your fruit and veg! As that’s a whole lot of insoluble fibre you end up tossing out at the end. Only 31% of adults and 8% of teenagers meet the 5 A Day recommendation for fruit and vegetables4, so get creative and make sure you hit that target. Other good sources include wholegrains such as brown rice, wholegrain bread, rye and spelt.

As a general rule, the more processed and refined foods have been stripped of insoluble fibre, and whole foods have the insoluble fibre intact.

 

-         Soluble

This type of fibre acts like a sponge and draws water into your bowels. This helps to soften your poop and makes it much easier to pass. Soluble fibre is also good at binding to cholesterol in your gut and dragging it out the other end, rather than letting it be absorbed – great news for your heart!

 

Good sources of soluble fibre include oats, psyllium, nuts, beans (tinned or dried), apples, berries and linseeds (The same seed but often cheaper than ‘flaxseeds’ and can be bought for as little as £1 from a supermarket range).

 

-         Resistant starch

This type of fibre cannot be digested in the small intestine and therefore passes through and gets fermented in the large intestine. Because of this, it is also known as "prebiotic" fibre (as it feeds the bacteria in our gut). These bacteria are so important for overall health as they create vitimins, produce by-products which are important for our immune system, and produce neurotransmitters such as serotonin - aka the happy hormone!


 

Good sources of resistant starch include green banana, which also comes in a flour to use for baking, legumes and pulses, seeds, cooked and cooled grains or potatoes.

 

Interestingly, I found a recent study with people who have drug-resistant epilepsy, looking at manipulating the gut bacteria. They provided 4 different strains of probiotics (different types of bacteria) as a treatment with some promising initial results, 28% of the 45 people who took part in the study had a 50% reduction in seizures.5 However, it is important to remember this was a small study and although there were good results, more research needs to be carried out. But do not fear, it looks as though this is in hand according to an article on some potential new research6…so watch this space!



Ketogenic diet

 

Most of you will have heard of the ketogenic diet as a treatment option for epilepsy, it could be that a change in the gut bacteria whilst on the ketogenic diet is the key to its success6. We are not going into detail on this diet, but it is a method of treatment mostly with children and is undertaken with the supervision of health care professionals. For those of you who are interested in the ketogenic diet, here is a link from Epilepsy Action for more details7.



 

So, back to the fibrous foods that those gut bugs love! How easy is it to achieve this 30g of fibre/day? Well, it’s not as hard as you may think!  Additionally, you do not need to go to some fancy-pants health food shop and spend a small fortune on foods.



Example meal plan that meets fibre requirements


 

 

I hope the above meal plan shows you that eating healthily and hitting that fibre target can be achieved on a budget. Bulking out your meat dishes with beans and lentils is a great fibre and purse win! Using frozen fruit or vegetables is cheaper than fresh, and all of the foods mentioned in this article can easily be bought online or at a supermarket.

 

It is also important to remember that when increasing your fibre, to do so gradually; in order to avoid discomfort and bloating as your bowel needs time to adapt and it will take several weeks to see the benefits.

 


Fluid intake

It’s often overlooked, but fluid actually softens your poop, taking it from a hard to a softer consistency. When we are dehydrated, our poop will remain hard and therefore difficult for our intestine to push through to the other end. Best way to check your hydration is by looking at the colour of your wee - the lighter it is, the more hydrated you are. Most achieve this with 1.5-2L fluid/day, but this will vary from person to person and will depend on factors such as your activity/exercise levels.

 


AEDs & dry mouth

As a side note, one of the side-effects of some AEDs (Anti-Epileptic Drugs) that many people experience is a dryness of the mouth. This can lead to you feeling that you need to drink more fluid than your body actually needs. To try and combat this (and the tooth decay, gum disease and smelly breath that can come with a dry mouth!), you can try:

1.       Chewing sugar-free gum made with xylitol (xylitol is a much better sweetener than that used by most brands of gum, as it doesn’t contribute to tooth decay and gum disease) 8;

2.       Oral saliva replacement gels such as Biotène8;

3.       Artificial saliva sprays which stimulate your salivary glands8;

4.       Salivix pastilles (these can be prescribed in the UK) 8

 

Also:

1.       Limit your caffeine intake9;

2.       Stop all tobacco use9, and;

3.       Sip small amounts of water regularly9

See here for more tips.9





Supplements

Always, always – try to get the vitamins and minerals that you need from your diet first! Often there is no evidence behind these products and they could be harmful. Before taking any supplement speak with your doctor, epilepsy nurse or neurologist first to ensure it will not interact with any of your medications.

 

So, by now, I hope it has been made clear how important dietary fibre intake is for your bowel health and comfort. Whilst making sure your diet is on point, it’s also important not to forget these other non-dietary steps you can take to help keep the poop chute moving….

 


Toilet habits

Don’t ignore the urge to go to the toilet! This in itself can lead to constipation. Additionally, try and give yourself enough privacy and time to poop comfortably, where possible. Toilet position also matters – some find a footstool helps them to get into a better position with knees raised higher than ankles. If you haven’t read this already, for some light entertainment and a short interlude, check out this entertaining customer review on a poop stool from Amazon10!






 


Exercise

As always, exercise has so many benefits and can really help to keep things moving. Aim to do at least 150 minutes of physical activity a week. Exercise will also help improve you mood, energy levels and general fitness. You may well be experiencing lethargy due to your medication or seizures, therefore it is a good idea to gradually increase exercise into your schedule. As little as 10mins has been shown to have health benefits and you do not need an expensive gym membership in order to achieve this. For example, you can do things in the house, dance to some music whilst cleaning, or look on YouTube for some exercise videos (I mean; what can't you find on the internet these days?!). Also, getting out into the fresh air can also help, e.g. a walk around the park at lunchtime. Additionally, the NHS provides a Couch to 5K: week by week11regime which can be great for motivation and/or if you aren'et sure where to start.. . 


  

Stress

Our mind can affect our bowels in many ways, for example, we have all experienced butterflies in our stomach when nervous and may have experienced a ‘panic poop’ before stressful situations such as interviews or exams! Therefore, stress levels should not be forgotten when considering any issues we may have with our bowels (although most people experience looser motions rather than constipation). Try and manage your stress levels through yoga, meditation, or exercise to help with this.

In fact, we are also now discovering how much our gut affects how we feel rather than our brain dictating our emotions. Therefore, eating more fibre as already discussed should help to keep your mind healthy too.

 

So, start to make these changes to your diet and lifestyle and you should see an improvement. However, it is important to remember that if you ever experience any changes in your bowels (more mucus, change in stool consistency etc.) best to check in with your GP first.






Conclusion

With some simple, long-term observations and changes in diet and lifestyle, we can help to unclog the poop chute - epilepsy or no epilepsy!


Georgina Goss


Dietician & Founder of: "Meals. Muscle. Mind."

  

     

 

References

1.        Tack, J. Muller-Lissner, S. & Stanghellini, V. et al. (2011). Diagnosis and treatment of chronic constipation - a European perspective. Neurogastroenterology and Motility. 23(8), 697-710.

2.        Suares, N.C. & Ford, A.C. (2011). Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. American Journal of Gastroenterology. 106(9), 1582-1591.

3.        Epilepsy Research UK. (2014). FAQs about Anti-Epileptic Drugs. [Leaflet]

4.        Public Health England (2018). NDNS results from years 7 and 8 combined: appendices and tables. London: Public Health England.

5.        Gómez-Eguílaz M, Ramón-Trapero JL, Pérez-Martínez L, & Blanco JR. (2018). The beneficial effect of probiotics as a supplementary treatment in drug-resistant epilepsy: a pilot study. Benef Microbes. 10:1-8.

6.        Olson, C., Vuong, H., Yano, J., Liang, Q., Nusbaum, D., & Hsiao, E. (2018).  The Gut Microbiota Mediates the Anti-Seizure Effects of the Ketogenic Diet. Cell. 173(7): 1728-1741.

7.        Epilepsy Action: https://www.epilepsy.org.uk/info/treatment/ketogenic-diet

8.        Nehal Patel, Pharmacist, Perfucare (info provided verbally, 19.11.2018), https://www.perfucarepharmacy.co.uk/

9.        Thomas J. Salinas, D.D.S, Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dry-mouth/expert-answers/dry-mouth/faq-20058424

10.      Amazon UK, https://www.amazon.com/review/R3SNTSII1C8R1X

11.      NHS, Couch to 5K: week by week

 

 

Comment



I have had epilepsy for 48 years had many different medications. A few months back my meds have been increased and new ones. The problem is they are working but also making me put weight on which I hate. Been dieting for over 3 weeks not an ounce have I lost. Can you as a dietician help. Thank you

didnt know most of this until now. Thank you for the info.