Kim (00:01.378)
Hello, Rachel. Thank you so much for joining me today. I am excited to chat about constipation. You reached out to me via Instagram and said I really wanna come and join you and talk about constipation. And of course, that is a huge topic for my audience. So anybody who wants to talk about constipation, they are welcome to join me. So I'm really happy to have you.
Rachel Fobert (00:21.689)
I'm happy to be here and I hope I can do the topic of pooping justice.
Kim (00:27.84)
I'm sure you can. So maybe if we can start out by how you got to the point where you talk about poop and you're a naturopathic physician, what led you down the path of becoming a naturopath and what then brought you into the topic of really wanting to educate people about poop?
Rachel Fobert (00:44.297)
That's a good question. It's funny because when I started online talking about poop everyone would Everyone personally in my life would be like, I don't know if you want to be known for the person who talks about poop And now I'm like This is just what I do. Yeah, I think I do actually want that so naturopathic medicine the way I kind of ended up in that route is I Just love the fact that nothing works in isolation
Kim (00:56.67)
Yes, I do.
Rachel Fobert (01:13.891)
and our body doesn't work in isolation very well. So everything's always interconnected and intermingling with each other. And I wanted to be able to provide a medicine that took all of that into consideration. And that's how I ended up actually in the field of naturopathic medicine. But talking about pooping itself really came from a bit more of a personal side of things. I'm pretty open with the fact that I went through my own journey. I had IBSC, which is irritable bowel syndrome,
patient type. So I really had a hard time getting improvement in anything that I did and I ended up feeling really lost and I thought that I was some weird unique case. I happen to be a weird person that doesn't respond to laxatives or like I was a weird case that the fiber doesn't work for me, I'm a medical mystery. And when I ended up actually graduating and going out in practice and
they were having the same response I was. And it kind of dinged a flag for me to say, hey, maybe we're approaching this wrong. Maybe we're approaching constipation in an incorrect way. Let me kind of dig into what's going on. And once I started doing that, I realized a lot of the things that get recommended to constipated people are done really haphazardly, so people don't get a lot of details on how to use tools and techniques like fiber or laxatives correctly. So they have bad expectations.
going in and they're always disappointed. And then also a lot of the recommendations that were being given weren't specific to constipated people. So a lot of the testing and a lot of the generalized fiber recommendations were coming from data in generally healthy people and we saw them poop more. It wasn't coming from a constipated group of people as a therapeutic approach. So that's when I kind of ended up diving into that because I wanted to be a part of the solution and no longer a part of the problem.
Kim (03:13.686)
love that. Okay, so you mentioned IBSC and there's IBSD which is the diarrhea form. I think there's, I'm not an expert, but I think there's maybe just regular good old IBS. But what are some of the other gastrointestinal type challenges that people may have that could potentially lead to or contribute to constipation?
Rachel Fobert (03:14.838)
Yeah.
Rachel Fobert (03:21.986)
Yep.
Rachel Fobert (03:39.661)
Hmm, that's a good question. Everybody that I work with has a really different variety of symptoms. And we can definitely have diagnostic concerns that lead us towards getting constipated. There can be thyroid issues, diabetes. There's a cluster of things that kind of lead us to being constipated itself. Um, but everybody has a different cluster of symptoms based on their diagnosis. So there's the IBSC side of things in which you would be
abdominal pain associated with having more or less bowel movements or changes in your bowel habits in general. If you don't have pain, then you more likely fall into that category of just good old chronic constipation. And that's where I think it's nice for people to differentiate, where am I? Because oftentimes people don't get a diagnosis and they come to me and they really don't know what's going on. They're just like, I'm not pooping or my poops are hard. SOS. So that's a good difference.
differentiator to know and then of course with IBS comes the pain aspect of things but both sides will get things like gas, bloating, especially if we're really full of poop. We get a lot of upper gut stuff just simply because of pressure so some people will start getting kind of irritation at the base of their breast bone and tenderness there and people will be getting heartburn, reflux in digestion so we see kind of things going symptoms-wise from the throat all the way
Rachel Fobert (05:10.525)
Thank you for watching.
Kim (05:11.43)
Okay, so what would you, how do you define, obviously we know that constipation is not pooping well, but what's the actual diagnosis of what is constipation?
Rachel Fobert (05:23.297)
Hmm.
That's a good clarity point here. You do not have to miss days of a bowel movement to be considered constipated. So in chronic constipation, you need to have a certain number of eight diagnostic criteria. You only need two. And some of those diagnostic criteria include straining when you're having a bowel movement or having hard, pellety bowel movements.
you're considered constipated. So by no means do you need to be missing days and I think that's a really important piece of the puzzle because when people go into their doctor's offices and they say, hey I think I'm constipated, the doctor will often respond and say having three bowel movements a week is normal and then they kind of get dismissed off and a lot of questions don't come of what do those bowel movements look like? What do they feel like when you're passing them?
and we kind of just walk off thinking it's normal to have three bowel movements a day. So when we're talking about what constipation is, it can be a whole slew of things that change the actual hydration of your bowel movements and how fast they're moving through your bowels. That's the simplest way to put it.
Kim (06:42.582)
Okay, I just want to clarify. I think it was just a mispronunciation. But you said that you can get dismissed from doctors that you'd be pooping three times a day, but you meant, I think, three times a week. Yeah, okay. Okay, got it.
Rachel Fobert (06:49.457)
Mm.
Rachel Fobert (06:56.745)
Yes, sorry, three times a week. The range of normalcy is three times a week to three times a day. Just to tell you. Yeah.
Kim (07:04.386)
Got it. Okay, perfect. Thank you for clarifying that. Yeah. So then what should a good poop look like and feel like? You talked about those being two important points that we should be evaluating. So you just said up to three times a day would be considered normal. And now we wanna say what should those up to three times a day poops look like and feel like when we have them?
Rachel Fobert (07:15.936)
Yeah.
Rachel Fobert (07:24.823)
Right.
Um, this is a really easy thing that everyone can do at home, something that they can start tracking and kind of have a ton of information when they go in for help, if they choose to do so. So there's a couple of things that I'm always looking for and asking people. Um, one is how hydrated is your bowel movement? The way that we actually reference this is with the Bristol stool chart. So this is a really easy Google to pull up the Bristol stool chart. It tells us how hydrated your bowel movements are. If they're dehydrated.
you're going to fall into a constipation side of things so it's going to be hard and lumpy. You'll be able to visually see that in the toilet bowl. This is a really easy thing to be able to take a look at. So we want to know how hydrated the bowel movements are. That matters how they look. The other piece of the puzzle is we don't want to just be passing little tiny pellets. That volume isn't necessarily enough. So the way that I usually gauge this for people is we want
bowl and sigmoid colon like varies person to person but we're looking for about a foot's length of a bowel movement is what I would like in what I call unicorn poop for people. It's just like our picture perfect bowel movement. We also want it to be really nice deep and brown that tells us we've actually released enough bile to be digesting our food and moving poop through. That's a really important piece as well. So we've got those three main criteria and then the last one is
when you're actually passing the bowel movement, there should be no straining and it should be able to pass within 30 seconds of you sit, or sorry, 60 seconds within you sitting down on the toilet. So a trick I like to tell people is to know if you're straining or not when you sit on the toilet, talk out loud. Oftentimes if you're straining, there'll be a jump in your voice. That's a really easy way for you to know if you are not straining and then you can time yourself on the toilet to see, am I passing it in a short enough time period.
Kim (09:25.686)
Okay. And yeah, I had been told this is several years ago. There was a presentation I was in at a fitness conference and the person teaching was talking about bowel movements of a distance or measurement between the wrist crease and the elbow crease, which is now that you've set a foot, it's like that's roughly about what a foot would be. So ideally that should come out at one time or could that be over the three during the day or should each of like if we poop three times a day, should they each be a foot long?
Rachel Fobert (09:42.01)
Mm. Yeah.
Rachel Fobert (09:53.152)
Hmm.
Right, so the goal is just to move that amount of mass within the day. So if it comes out in multiple times, that's okay. If it comes out all at once, that's also great. Yeah.
Kim (10:07.126)
Good. And you talked about color there as well. So you mentioned a deep brown. That would be an indication of good bile. So what if we didn't have good bile? What would our poop like? What color would our poop look like?
Rachel Fobert (10:22.433)
So it becomes a little bit more pale. So it's...
How do I explain this well? It's like a yellow, more type of tone because it's pulled out those deep brown hues. Bile is literally just a deep brown color. So when it's placed into our poop, that's how it gets that color formation. So we're looking for a more yellow pale one. This happens when people often have digestive issues that are quite severe. I don't see this typically in a casual constipation case. So this is more like people with ulcerative colitis or celiac.
Kim (10:54.51)
Got it. And like, how would you then, so if somebody is constantly having this kind of yellow, light brown poop, and we could say potentially, like how would you test for low bile and then how would you increase somebody's bile production so that they would have better poops?
Rachel Fobert (11:09.965)
Hmm.
So this really depends on the case. And if something like this is happening, I'm always sending people for testing first, because we want to know what we're treating here. The goal is not to just blindly increase bile. I know we kind of have a tendency sometimes to just go directly to the source, but the way that naturopathic medicine works is can we find the root and treat that? So that's usually when I'm assessing people's symptoms and going, hey, are we having a gallbladder issue? Do we need to be sent for some testing and assessment?
Do we have symptoms of celiac? Do we need to be sent for some lab work to be tested for that? And we're going through that piece far before we're trying to fix anything. Otherwise we don't get any long-term results. We're just kind of stuck on a supplement forever.
Kim (11:55.19)
Got it. And how do you, is it a blood test or is it saliva, is it a poop test? How do you test for that?
Rachel Fobert (12:01.717)
So actually just visually looking at the bowel movement is enough to tell us that the hue is off and we don't have enough. You can certainly run stool tests for just the basic functionality of the gut and it will show you if you're not actually digesting some of your nutrients and that can be a roundabout way to see it. But oftentimes we're just looking for why are you not releasing enough of it and fixing that problem as the solution and then monitoring the bowel movements
change in color.
Kim (12:33.046)
Got it. So bile is helping us digest better fats and that's going to help. So then what other like a lot of people talk about stomach acid as it pertains to poop and constipation. So low stomach acid is another thing that.
Rachel Fobert (12:36.557)
Fats. Yep.
Rachel Fobert (12:45.664)
Mm.
Kim (12:49.106)
You know, you say people are like, oh, I have low, I must have low stomach acid. So I'm going to go and take digestive enzymes and hydrochloric acid to boost that up. So how would you test for low stomach acid? Is that really an, is it an indicator that you look for and could it be helpful if somebody was to optimize their stomach acid, like production or levels to help with poop?
Rachel Fobert (12:55.178)
Yeah.
Rachel Fobert (13:08.383)
Right?
Yeah, so if somebody has low stomach acid production, it is helpful just because the bowels kind of function in compartments. And if certain compartments are slow moving, like the stomach, it can still contribute to the overall slow movement throughout the bowels. So if somebody does have low stomach acid, it can help.
This is kind of a tricky area because at the end of the day, we just want the stomach to be moving properly. And the amount of acid within it can affect how your stomach is moving. When I am assessing this for people, I always make sure they're testing before we assume that there's a problem there. I would say in about 25% of my cases, people need some stomach acid support and the rest often do not.
Stomach acid levels are heavily regulated by your stomach and by the nervous system within your stomach So it just points to a deeper problem that can be fixed without actually pumping yourself with a ton of HCl or digestive enzymes. So again, the answer is kind of it depends on your case and The way we want to approach your care and that's kind of the brilliance of personalized medicine is not everybody gets treated the same
Kim (14:28.406)
Yeah, yeah, exactly. And how do you test for low stomach acid? So I've seen the one where you put the baking soda into water and see if you burp basically in a certain period of time. Is that helpful? Is that useless? Like how would you test for low stomach acid?
Rachel Fobert (14:43.357)
Yeah. So that's a really crude way to do it, but I do have people do that at home if we're doing that method just because it's a little bit less reliable. Reliable. I make them do it every single morning for many mornings in a row and then take an overall average.
just because things change day by day so much that we don't want if you're having one off day for you to be like, I have low stomach acid, ah. We want it to be really clear and show a pattern over time. So I've definitely done baking soda tests. The other option that's really toed in the functional medicine world is using a Betaine HCL capsule and see if when you take one of those capsules it generates heartburn or burning sensation. You would take it before your highest protein meal of the day and see if that causes
and then the theory is if it does cause burning then you have adequate stomach acid if it doesn't you do not have adequate stomach acid is how they're doing the test
Kim (15:40.514)
it. Okay and that makes sense. So we kind of have a picture now about what a great bowel movement would be and what it you know it should feel how much should be coming out it should feel complete and empty and kind of I always use the term like pooforia we should have at least a little relief and if somebody's like I maybe I have a little stomach acid maybe I have a bile production but I know that I don't poop well so they could work with somebody like you and
Rachel Fobert (15:56.127)
Yeah.
Kim (16:08.706)
But in this day and age especially, there's all sorts of health influencers and professionals. We're all on Instagram, we're all sharing our tips and people, you know, it's not really totally personalized but people are looking for other sources of information. And of course, there's lots of people talking about fiber. So fiber is always usually, if you're constipated, eat more fiber. So let's talk a little bit about fiber and is that always the best approach? Just take some fiber supplement, take some Miralax or...
Rachel Fobert (16:16.397)
Yeah.
Rachel Fobert (16:30.742)
Yeah.
Kim (16:38.518)
go restore lax or whatever all the laxes are. What's the best approach in terms of somebody wanting to address constipation maybe before they start working with somebody?
Rachel Fobert (16:48.421)
Right, so we're kind of trying to cover some of the basics before they go into an appointment. So absolutely the first thing that I always want people to do and when people message me too and they're like, what can I do while I'm waiting to start? I always want them on a laxative routine. I think there's so much fear around this topic and it irks me because there shouldn't be, but I always want people on a regular laxative routine.
that when we are full of poop, it creates a massive pressure system in our abdomen. Like I kind of mentioned before, we can start getting upward pressure and getting some of that belching and heartburn just simply because there's so much pressure and then the pelvic region can also get a lot of downward pressure from that. So we don't wanna create more problems from the problem that we already have. And that's why we wanna make sure we're really, really using a laxative to make sure you're going every single day. So that's step one, and there's a proper regimented way
that doesn't give you raging diarrhea every day. So there's that side of things. And then secondary wise, when we're using fiber, there's a big difference between using fiber to fix constipation if you are fiber deficient in your diet versus using fiber therapeutically because you're constipated. And I think that's where things get really messed up and why it's often said, hey, just have more fiber.
people and we know this from massive cohort data's that most people are not eating enough fiber in a day. So many people who are having kind of some off bowel movements once they increase their fiber to hit that like 25 to 30 grams a day.
are now pooping normally and that's awesome. It means your constipation was simply just because you were deficient in a macronutrient of fiber. But if you're chronically constipated, when you increase fiber there's a chance it's going to make you very bloated because you are already full of poop and fiber is actually a bulking laxative what we would call it.
Rachel Fobert (18:57.521)
So it helps with moving poop through because it bulks up your poop and makes it a lot larger. And obviously this can compound and worsen the problem if you are already full, which is why we want to be really, really gentle with an approach. We still want you to be having adequate amounts of fiber. We know it's so important for the health of your bowels. And we also know if you're eating adequate fiber, your bowels tend to respond better to therapies down the line. Like if we end up working on the microbiome, like response to laxatives.
want the fiber in, but we want it to be done in a way that's not going to irritate your system, make you feel bloated and horrible and confused at why you're doing this and why nothing's working. So it's a very, very different approach based on what the cause of your constipation is.
Kim (19:43.946)
And with laxatives, I have a two-part question. So when you say that there is a bit of a regimen so that we aren't gonna just all of a sudden have, you know, disaster pants everywhere, how, what is that regimen? And then my next question is, what are the laxatives that you think are the most beneficial for people to use?
Rachel Fobert (19:54.658)
Yeah.
Rachel Fobert (20:03.361)
Hmm.
So there's great guidelines on using laxatives, and I don't particularly know why, but this happened in my own education. I'm assuming it happens on all ends. We don't actually learn the guidelines, and I think this is why people, including myself, will try a laxative and think either it didn't work on me or it just makes my life more miserable because now I can't control my bowel movements and I'm running to the bathroom. So the guidelines say that we should be taking
laxative every single day if we are constipated. Most people are doing this first step incorrectly. They're only taking a laxative when they think they need it, which is if they haven't gone for many days. And just to clarify, an osmotic laxative is the type that's going to be pulling water into your bowels. So these are your magnesiums, your Miralax or Restorlax, and your Lactulose. It's often used in the hospital and elderly. These are all your
done every single day. A big reason why this matters is because there's a delay in response. So for osmotic laxatives, it takes a minimum of 18 hours for them to start working, which means just because you take it that day does not mean it's going to actually help that day, and it's why we want to start taking them every day to compound the effects.
So we do osmotic laxatives every day. That's step one. Step two is actually to add in a bulking laxative. So that's where we're slowly increasing fiber. And we can decide which fiber. I usually do this with patients depending on what they're typically tolerating at the moment. We'll usually start with low FODMAP fibers just so we're not aggravating any sort of symptoms.
Rachel Fobert (21:47.781)
but these are also things like your psyllium, so your metamucil, that people often take. That's a bulking laxative. That's a fiber. We're going to add that onto your osmotic laxative. This will help reduce the risk of diarrhea and it also just helps improve how that osmotic laxative works. So you will likely need a lower dose and therefore less water flushed into your bowels. And then the very last piece that the guidelines say is to actually use a stimulating
Rachel Fobert (22:18.196)
have not gone for two or three days, you should be using a rescue laxative to go because once things slow down it's really hard to get them back sped up.
Kim (22:29.202)
it. So I'd never actually, I know that magnesium is often used for poop, but I'd never thought of it as an osmotic laxative. And so now that you've positioned it that way and talked about the time frame of 18 hours, a lot of people are advised to take magnesium before bed. And usually magnesium citrate is the one that's advised because that's the one that's most likely to
contribute to looser stools? Is that, so that would be the osmotic laxative, would be the site rate. Is that, first of all, is that, am I accurate in that? But also then, should we be taking it earlier in the day so that the 18 hour is associated more when we're waking up in the morning?
Rachel Fobert (23:08.969)
Yeah, so that's a good question. There's two types of magnesiums that are laxatives. So there's a magnesium oxide, that's gonna be your most potent osmotic laxative that comes from magnesium, and there's a magnesium citrate. It's a more mild version. And then the way that they work also changes if you're going to use a capsule versus a liquid. So there's like a lot that goes into that piece. But yes, ideally, we would want to kind of try
taking your laxative to when you are most likely from 18 if 18 hours from then it's going to be the most likely time that you are going to have a bowel movement which should be in the morning and then again not everybody responds in that first day which is why I usually tell people you've got to do it for quite a few days like three or four days before we can really confirm that it's working for you or not and then same thing goes with other laxatives they
Rachel Fobert (24:08.803)
some are faster than others.
Kim (24:10.958)
Interesting. OK, cool. So then we're kind of leading into the next question, which is motility. So we could potentially have lots of poop in us. And there's a certain sort of transit time that would be ideal in terms of how long it takes for things to get out of our system. So what is the ideal transit time? And what role does motility play in?
And then third part of that is how can we increase our motility?
Rachel Fobert (24:41.91)
Right.
So just for reference, motility is simply just the movement of the gut. It's not much more complicated than that. And the gut moves simply so that things can push through it. When we swallow food, our throat moves so that we can move food down. So motility is just simply the movement of the bowels. And when the motility slows down, we can get constipated. When it speeds up, we get diarrhea.
The simple reason for that is because when things, when motility slows down, our stool sits in our colon for so long, it starts getting dehydrated. And when it speeds up, it's not sitting in our colon enough and there's too much water in it. And that's how we kind of ebb and flow back and forth. So motility is simply just that movement. And we can test if that movement through your entire bowels is fast or slow through a transit time test.
I particularly love you doing the blue poo test. I've talked about this a little bit recently. So transit time is simply how long it takes for things to go in your mouth and out the other end into the toilet, which is why it's kind of this crude way of us to say if motility is fast or slow. So we would like your total transit time from your mouth out to the other end to be around 24 hours.
What this doesn't tell us is if your bowels happen to be dehydrating poop extra fast. And this is why I especially love the blue poo test because we can actually dye our poop blue and we can eat these blue muffins. It's the way that we get the blue in us is via muffins. So we eat a couple of blue muffins and then we wait to see how long it takes for us to start passing blue and stop passing blue. And then we can also use our Bristol stool chart,
Rachel Fobert (26:38.995)
see, hey, are these blue poops that we are passing in a normal time extra hard? It helps us determine what's really going on and what we're trying to target here because what some people may notice is that they have really hard poops even though they have a very normal transit time.
Kim (26:56.338)
So what makes, like what's in the blue muffins that makes them blue?
Rachel Fobert (26:59.921)
And blue dye, it specifically needs to be a royal blue. Otherwise for some reason, our body just metabolizes it in a weird way and it doesn't show up in our poop. Yeah.
Kim (27:11.95)
Okay, so other things that I've heard about from a transit time are sesame seeds, corn, and beets, because sometimes beets can make your poop red, but something I learned recently is that not everybody's poop and pee would be red, but if it is red, then it would be an indication of low ferritin. Is that accurate or iron?
Rachel Fobert (27:26.327)
Right.
Rachel Fobert (27:33.397)
I don't think that would be accurate based on the way that I understand iron works. The way that dye works though in the body is that after 24 hours it starts going away. So the reason why don't use beets is because if your transit time is more than 24 hours, the red is gone. So we can't actually determine an accurate number for you and then track if that's improving because you've already metabolized and removed the dye.
Kim (27:45.93)
Hmm.
Kim (28:02.934)
Got it. So could it be like blue food coloring? Would that be adequate or is there a specific dye that we should be getting?
Rachel Fobert (28:06.794)
So.
Right, so that's why we use the royal blue gel dye because that's the specific one that we know doesn't get metabolized over that time and can show up in your poo. But the actual red dye in beets because it's just natural and I don't know what it is in particular about it, but it just gets metabolized and taken away by 24 hours. So it's not a really accurate way for us to test at home.
Kim (28:30.898)
Okay, so that blue dye, is that something that we have to get through a provider or is that something that we can just get at a store?
Rachel Fobert (28:36.717)
just out of store. It's the same dye that people would use making cupcakes. Yeah.
Kim (28:41.41)
Got it. OK, and now that leads to another question, which is you say the ideal transit time being 24 hours. So if it is less, is that also an indication of not such a good thing and we need to make changes? Or could it be good if somebody had, say, a 12 to 18 hour transit time?
Rachel Fobert (29:00.545)
Right, so if the transit time is a little bit short, then that can represent the fact that your body just actually didn't have enough time to absorb all the nutrients from your food and all the nutrients before it turned into a bowel movement and left your body. So we don't want it to be too short, just as much as we don't want it to be too long. So the ideal for me, I like to give people some wiggle room here, and it is dependent on how you feel, but 24 to 36 hours is kind of my happy zone.
good at 36 hours, then we want to bring it down closer to 24. But I like to kind of stay in that zone because either end ends up changing how your bowel movement actually looks in the toilet, the hydration amount, but also changes how much time your body has with whatever is in your stool.
Kim (29:51.03)
Okay, okay, now hydration. You're like, you're perfectly funneling me into all the questions that I have. So with hydration, I know myself that water plays a huge role in whether I have a great poop or not. And sometimes even the timing of my water. So if I have water in the morning before I eat something.
Rachel Fobert (29:55.797)
haha
Kim (30:13.286)
Usually that's good, but if I haven't had enough water before I eat and then I don't drink enough in the morning, then it's maybe not so good. How precise do we need to be with water? How much water should we be drinking? And is it that important from a good poop perspective?
Rachel Fobert (30:32.646)
That's a
Rachel Fobert (31:00.339)
for safety for us to say, hey, we've hit our baseline needs here. But there's hardly any data in constipated people on water itself playing a part. It definitely helps in people who do not have chronic constipation or IBSC. It does help with bowel regularity in that cluster of people. If timing of your intake matters, I would actually relay you back to, it's actually
the amount of water or the fact that you're drinking water is helping and more likely that the stretch on your stomach and the intake of something in the morning is triggering your gastrocolic reflex which is like the reflex to help motility and that's why it's helping with the bowel movement in the morning per se versus not later in the other parts of the day where you're less likely to have that strong pushing motion.
Kim (31:54.634)
Yeah, interesting. Okay. Thyroid you mentioned earlier on is another thing that can, hypothyroidism we often hear low and slow. So there's the hypothyroid and Hashimoto's, which is a large, very large group of women in particular, especially in the perimenopause phase.
Rachel Fobert (31:56.557)
Yeah.
Kim (32:22.167)
Do any does anything that you've said here shift or change or are there any additional tricks or tips that you have for the hypothyroidism and Hashimoto's community?
Rachel Fobert (32:36.429)
Good question. So if your Hashimoto's and hypothyroidism is well controlled and well treated, the constipation should resolve and improve itself. If that's not happening, then there are likely issues locally within the bowels that is problematic. So there was a really cool research study that came out this year that showed the overlap in thyroid and gut symptoms and how they can almost mimic each other.
thyroid patients come in being like, my TSH looks fine, I feel better but I still have symptoms and oftentimes we're finding it's actually just their gut and not particularly the thyroid case itself. So I would say tip wise, make sure you get an adequate assessment. Don't always assume a symptom is thyroid or gut because they do overlap so very much but for sure constipation is a symptom of
We know this, but if it's well controlled it should improve.
Kim (33:42.006)
What's your opinion on the poop test, like the stool test, the GI map test, those types of things? Are they, do they provide us enough valuable information and can they be helpful from a diagnostic perspective for certain constipation issues or other gut health issues?
Rachel Fobert (33:59.161)
That's a good question. That one's a bit of a tricky space. So there is parts of the GI map that, or like the stool testing, that is accurate. And those are typically the parts that tell us the functionality of our gut. What is your digestion like? What is your immune system doing down there? Those kind of pieces of the puzzle, is there inflammation? Those pieces of the test are quite accurate. And then the other piece of the test that's accurate
down there. We know that this comes out really well in stool. What we don't have a lot of accuracy in is the microbiome piece, which is what I think a lot of people want to get their hands on. They want to be like, what's wrong with my microbiome? And unfortunately, things die and change in numbers as they move through the gastrointestinal tract. And when you're doing a stool test, all your testing is the output, not what's happened as it's moved through. So it's really hard for us to
tests are wildly accurate or not. And we don't have any data to say, if we treated something specific within that test, does constipation go away? So I actually don't use it diagnostically. I don't find that it's needed because if we actually treat the cause of what's going on with constipation, if we kind of help with that motility and we make sure that the sensory function in the bowel is improved, we don't need to know the nitty gritty tiny details of what's happening in the microbiome.
Kim (35:29.218)
Got it. What about, you mentioned parasites are the bad pathogens, and there are certain people that will talk about parasites potentially being a contributor to constipation. Is that something that you see clinically? And is it, you know, I had one person had to be convinced that I must have parasites in order for me to truly be healthy, I needed to get rid of them. And then there was another.
person who said, you know what, sometimes it's good to have a little bit of parasites in there. So and I kind of agreed with that one actually, with the more I thought about it, I was like, yeah, you know, we all need a little bit of dirt and bad things, and it helps balance things out. So where do you sit in that in that thinking about parasites? Should we eliminate them all? Should we do a regular parasite cleanse? Or should we just let a few of them hang out?
Rachel Fobert (36:00.009)
Yeah?
Rachel Fobert (36:17.685)
Right. I think it's good to remember that the microbiome isn't just made out of bacteria. There's also yeast down there and parasites. So there are commensal parasites in our bowels that we want there because they give us protection. They actually give us benefit. So like trying to clean sweep everything is not the solution here. In regards to pathogenic parasites,
always diarrhea. So like if you've got a tapeworm or a pinworm or something like that, you're going to have the very stereotypical parasite symptoms. And I think when people talk on social media and stuff about parasites, I think they're trying to allude more to a commensal parasite.
They can overgrow and that is seen in the data. But again, it works just the same as any other microbiome type treatment that we would do. We don't need a massive parasite cleanse to wipe everything out if that happens to be your case. But again, it's very, very rare.
Kim (37:21.514)
Yeah, yeah. And the way that you describe it there too, it's sort of, when we think about antibiotic use, antibiotics coming in and wiping out the microbiome and destroying a lot of what's good there. And so the way that you just described it, maybe like especially regular parasite cleanse could potentially do the same thing and be disruptive of all the goodness that we have living in our gut.
Rachel Fobert (37:43.531)
Yep.
Yeah, and I mean, the microbiome, again, just like how humans don't do well in isolation, neither does the microbiome. They want to be able to create communities and live together, and that creates resiliency. So antibiotics are one of the biggest triggers for chronic constipation, and they tend to disrupt, especially with repetitive long-term use, those communities. And we don't want to kill them off and leave open space for something else to
and eyes in that area, right? So it's not good to just constantly be wiping things out. That's not the goal. And a lot of people I see have come to me and been like, I've done so many SIBO kills and I've done so many antimicrobials and nothing's working. And I really try and remind people like the goal is not to just murder everything within your gut. That doesn't help us at the end of the day. And you have a really long process to rebuild all of those
back up now if you've been doing that chronically.
Kim (38:47.746)
Yeah. Just because you mentioned it, you said SIBO. Can you tell us what SIBO is and why that would be an issue?
Rachel Fobert (38:54.677)
Yeah, so SIBO stands for small intestinal bacterial overgrowth. And the idea is, is that the commensal, so the microbes that are meant to be within our bowels that give us benefit and we give them benefit have for some reason, being able to overgrow to larger numbers than our body likes. And what is now happening is there's irritation happening within the system and it's changing motility. Um, so that can cause either diarrhea or constipation.
a real condition but again I will kind of wrap it back. Unfortunately the testing for it stinks. It's not very good when we actually take a look at what's going on in the small intestine in a lab versus what comes back as a result from your SIBO test. They're not aligned so just because your SIBO test comes back positive doesn't always mean you have an overgrowth in your small intestine and vice versa.
So it makes it a little bit tricky and I think at this point people are kind of leaning towards moving with symptoms and the symptoms that people have over some of the testing because it's just not wildly helpful for us yet.
Kim (40:06.906)
Okay, you said another word that's prompted me and I have another question. You said stinks. What does it mean? Like why does poop smell differently? Sometimes it's absolutely putrid and sometimes there's really no scent at all. What are the reasons why we would have a stinkier poop one day compared to another? And is that a bad thing if we have a stinky poop?
Rachel Fobert (40:19.347)
Mm-hmm.
Rachel Fobert (40:26.357)
Yeah, that's a good question. And this just makes me think of all my ulcerative colitis patients. If you've ever known somebody with ulcerative colitis, they'll tell you their farts can clear the room and their poop is just horrendous. So the reason being, there's a couple reasons, but the main one will actually be the change in short chain fatty acid production by the microbiome. So oftentimes, if we have a change in butyrate production, it will change the scent of our bowel movements.
And we can kind of extrapolate this data from the ulcerative colitis people that when they don't make a lot of butyrate and therefore their gut lining is not getting that like anti-inflammatory great input. What happens is they have extremely horrendous smelling farts. And that's kind of the pathway that I take with people is if something smells different, it's often because of something your microbiome is or isn't making.
That's what we want to end up targeting and fixing.
Kim (41:30.018)
Okay, interesting. One more question before I let you go. If people are listening and they're thinking, you know, I've done, I ate the blue muffins and I did all, I've drank my water and I've been on a laxative routine and I've done all the things that you've said and I still am struggling, what are some of the other contributing factors or reasons why somebody may not be pooping well?
Rachel Fobert (41:53.068)
Mm.
I think that's a, this is a nice wrap up cause I can kind of explain the two pieces of constipation here. So we talked about motility and how it's a reflex. I like to explain to people, think about like that reflex hammer that when you go into your doctor and they bang your knee, your knee pops up and you didn't do it. It just happened without your conscious control. That's what motility is like. And that reflex hammer, a lot of those things are within your control. So there's a lot of adaptability.
things we can do to use as a reflex hammer to push that motility. But the other half of the puzzle is that doesn't necessarily mean that your colon is going to respond, right? Just because your doctor banged the hammer in the right spot, the reflex needs to be in place for your knee to kick up. So just because we have everything in place and you're doing the fiber and you're doing the laxative and you've got all the things in place for motility doesn't mean your bowels are
respond and that really comes back to the fact that your gut is designed to constantly be sensing what's going on in its environment. It needs to know if it's being stretched out. It needs to know if there's microbes and pathogens that aren't supposed to be there and if for some reason that sensing capacity has been changed then it will not respond appropriately anymore and that's a lot of the deep diving and the deep healing that I'm doing with people is how do we
away that's disrupting that sensory function because you could have everything beautiful in place and it doesn't actually mean your colon is going to respond and then you can kind of add on your piece that you talk about a lot which is doesn't even mean that your pelvic floor is going to let it release out even if we do all of this great work. So there's multiple pieces and if you take this journey on alone and you decide to be your command center for it, it can be exhausting and overwhelming and it's significant.
Rachel Fobert (43:53.787)
easier if you work with somebody who knows what they're talking about and can manage each piece of this or refer you out to somebody who might be able to.
Kim (44:03.31)
Yeah, and so obviously, you know, you talk a lot about this is something that you do in your practice. Is there, would there be a team approach that people be working with a gastroenterologist as well? Or is that, is that like, do you recommend sort of naturopathic as a first line of defense and then proceed if needed later? Or how would you direct people to work with a practitioner?
Rachel Fobert (44:23.917)
That's a good question. I do see a lot of people land on my doorstep first, but a typical route would be taken where I'm doing the intake and pulling in all of the information. And because I really understand how other professions work, I then know who we need to pull in as a team. So I almost always have everybody get a assessment done by a pelvic floor physio. I want to know what's going on and I want to know how much that is contributing to your case. So I always add that in.
And then if I do happen to see red flags or I am picking up a condition like a thyroid or other things that might be contributing to the constipation We didn't talk about some of them, but they're like vitamin D deficiency diabetes. There are other things that can contribute Sometimes then I'm referring out to say hey, we need somebody to come in here who can maybe Give you a colonoscopy, which I know nobody wants but sometimes we need
Rachel Fobert (45:24.111)
as well. So sometimes I am the command center for people. Sometimes they've kind of hit somebody else, a different practitioner first, and they're their command center and I'm one of the referrals.
Kim (45:37.73)
one more question with the colonoscopy. I haven't had one done before. What is it, a lot of people say it's the bowel prep that they hate so much. So what is it that people hate so much about a colonoscopy?
Rachel Fobert (45:38.554)
Mm, yeah.
Rachel Fobert (45:47.178)
Yeah.
Yeah.
Good question. So funny enough, when I was experiencing my constipation, I got sent to a gastroenterologist and her solution to me, she actually didn't want to do the colonoscopy, but wanted me to do the colonoscopy prep for once every three months. So I've done many, many preps, never actually had the colonoscopy. Um, but two parts to that one. So when you do a colonoscopy prep, it completely empties your bowels out the entirety of the tract, not just the end area that we're talking about,
want to empty every day, which means it needs to liquefy absolutely everything within your bowels and evacuate it within like a 24-hour span. So people are running to the toilet like crazy, things get raw, it's not a great experience. So that's one half. But then the other piece of the puzzle is you are actually getting a scope that's going up rectally, and that can be quite
Rachel Fobert (46:50.739)
to take before their colonoscopy to help just kind of calm down that tension rectally, but I would say those are kind of the two pieces of the colonoscopy that nobody likes.
Kim (47:03.874)
Yeah, fair enough. Are there, do you know of anybody who shouldn't have a colonoscopy? Like I get asked this question and I don't know the answer and I need to do a little bit more research and speak to some pelvic physios about it as well is people who've had like myself a rectocele repair or any sort of rectal surgery, is there any contraindication do you know of with colonoscopies?
Rachel Fobert (47:27.625)
I don't know if there's any contraindication. I definitely know that if it's not indicated, they're not going to do it because there is risk and benefit to everything that we do, including a colonoscopy. So if you do not need to take on the inherent risk, oftentimes a gastroenterologist will say, no, we don't need to do it. And they're pretty good with that. But I don't know specifically in regards to rectocele or anything locally to the pelvis, if that would be a contraindication.
Kim (47:55.658)
Right. Okay, cool. Okay, I think I've used up all my questions. Thank you so much for sharing your time. Where can people learn more about your work and potentially work with you?
Rachel Fobert (47:57.875)
Yeah.
Rachel Fobert (48:02.238)
Awesome.
Rachel Fobert (48:07.389)
I think the easiest way probably to get in contact with me is through my Instagram at this point and then I kind of direct people to where they need to go and get them all booked into my schedule if you do want to work with me. Yep.
Kim (48:19.73)
Okay, and we'll have the links for that below. I'm going to put a link to the Bristol stool chart. Is there like a blue muffin recipe? Or is that like an ancient secret that you have? Or is that just something you find on the internet?
Rachel Fobert (48:24.309)
Yes. No, it's actually something that you can just find on the internet. So tips that I give people, don't use a really high fiber muffin. We want this to be the plainest muffin that you have ever had, because we don't want the dye to get attached to fiber sources and then.
not come out nicely in your poop. When you do this test you should literally see a line between brown blue and it should be very clear and the easiest way to do it is the most plain muffin you can find and royal blue gel dye. The research studies use about two tablespoons of dye per six to eight muffins. Yeah no problem it's lots of fun it's fun for the whole family.
Kim (49:08.61)
surely going to do the blue poo test. Thank you.
Kim (49:15.697)
Yeah, I'll get my husband and my son to do it too. Cool. That's awesome. Well, thank you. That was so informative and I definitely learned a lot and I know my listeners will too. So I appreciate all the work you do and thank you for sharing your wisdom with us today.
Rachel Fobert (49:15.737)
Kids love it. Yeah.
Rachel Fobert (49:24.588)
Awesome.
Rachel Fobert (49:27.937)
You're very welcome. I'm very grateful for being able to pop on here and share. No problem.
Kim (49:33.154)
Thanks so much.
