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Episode 199:
Show Notes 


The 199th episode of the Real Health and Weight Loss podcast features Dr Mary and Dr Lucy delving into a topic that might be considered delicate but is crucial for understanding overall health: poo. As doctors specialising in weight management and metabolic health, they tackle the common issue of changes in bowel habits that often accompany dietary transitions, particularly when adopting a low-carb or real food lifestyle. Throughout the episode, they provide insightful tips and practical advice for managing constipation and diarrhoea effectively, empowering listeners to take charge of their digestive health.

Constipation Management: When experiencing constipation, there are several strategies you can employ to promote regular bowel movements and alleviate discomfort. Dr Mary and Dr Lucy offer the following recommendations:

  1. Hydration: Dr Mary emphasises the importance of maintaining adequate hydration during dietary transitions, as changes in kidney function due to reduced sugar and starch intake can lead to dehydration, exacerbating constipation.
  2. Salt Intake: Dr Lucy highlights the need for increased salt intake on low-carb or real food diets to replenish electrolytes lost due to reduced insulin levels, preventing dehydration, which can contribute to constipation.
  3. Fibre: Dr Mary suggests incorporating fibre from whole foods like low-carb vegetables, chia seeds, or psyllium husk to regulate bowel movements, starting with small amounts and gradually increasing intake to prevent discomfort.
  4. Magnesium Supplements: Dr Lucy recommends magnesium citrate supplements to aid bowel movements, particularly for individuals experiencing constipation during dietary transitions, as magnesium citrate is easily absorbed and can help stimulate bowel movements.
  5. Fermented Foods: Dr Mary encourages consuming fermented foods to promote gut microbiome health, potentially alleviating constipation, but advises introducing them gradually to avoid adverse reactions.
  6. Dairy Audit: Dr Lucy suggests conducting a dairy audit to identify whether dairy products are contributing to bowel irregularities for individuals experiencing constipation.
  7. Coconut Oil or MCT Oil: Dr Mary suggests experimenting with small doses of coconut oil or medium-chain triglyceride (MCT) oil to aid in lubricating the digestive tract and potentially easing bowel movements while monitoring fat intake accordingly.
  8. Medications: Dr Lucy advises using osmotic laxatives like Macrogol or Movicol for short-term constipation relief while cautioning against stimulant laxatives containing bisacodyl or senna due to potential side effects.
  9. Allow Time for Bowel Movements: Both Dr Mary and Dr Lucy emphasise the importance of allowing sufficient time for bowel movements and prioritising bodily signals to maintain natural bowel function.
  10. Avoid Certain Remedies: Dr Mary and Dr Lucy advise against using remedies like prune juice and sugarless candies containing sugar alcohols, as they can worsen constipation.

Diarrhoea Management: When dealing with diarrhoea, it's essential to take measures to alleviate symptoms and restore digestive health. Dr Mary and Dr Lucy provide the following recommendations:

  1. Minimise Sugar Substitutes: Dr Lucy recommends reducing the consumption of sugar substitutes, especially sorbitol, mannitol, and maltitol, to avoid triggering diarrhoea in some individuals.
  2. Moderate Nut Intake: Dr Mary suggests limiting nut intake due to their high fat and fibre content, which may exacerbate diarrhoea for some people.
  3. Watch for Fake Fibres: Dr Lucy advises being cautious of processed foods containing fake fibres like inulin, which may disrupt digestion and contribute to diarrhoea.
  4. Evaluate Fat Intake: Dr Mary recommends monitoring fat intake, as excessive consumption of seed oils can lead to diarrhoea for some individuals.
  5. Don't Follow Facebook Advice: Avoid relying on advice from unverified sources, particularly on social media platforms like Facebook, as it may not be scientifically accurate or suitable for your individual health needs.

Recommendations to Avoid: It's important to be aware of certain remedies or foods that may exacerbate constipation or diarrhoea. Dr Mary and Dr Lucy advise against the following:

  1. Prune Juice: Dr Lucy advises against consuming prune juice due to its high sugar content and unnecessary use for addressing constipation.
  2. Sugarless Lollies: Dr Mary warns against consuming sugarless lollies containing sugar alcohols like sorbitol, mannitol, maltitol, lactitol, and isomalt, which can cause gastrointestinal issues. 
  3. Excessive Nut Consumption: Both Dr Mary and Dr Lucy caution against excessive nut consumption, as it may lead to diarrhoea due to their fibre and fat content.
  4. Avoiding Fake Fibre and Processed Oils: Dr Lucy advises avoiding processed foods containing chemically constructed fibre or seed oils, which can disrupt digestion.

Dr Mary and Dr Lucy wrap up by encouraging listeners to share their podcasts with friends and leave a five-star rating to support the spread of information on real food for health and metabolic management. They remind listeners to consult a doctor for personalised medical advice. Additionally, they reiterate Dr Mary's disclaimer at the beginning of the episode regarding changes in bowel habits, emphasising the importance of seeking medical attention if there are persistent issues or concerning symptoms.

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Episode 199: 


Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.

Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.

Both (0:16) And this is the Real Health and Weight Loss podcast!

Dr Lucy Burns (0:23)  Good morning, gorgeous friend. How are you today? I am, of course joined by the effervescent and glorious, Dr Mary. Hello, gorgeous one. How are you today?

Dr Mary Barson (0:31)  Oh good. I feel well, a bit tired. My baby kept me up with a cold. But I feel, I feel well and ready to take on the day with a bit of mindful pacing. So don't get too tired. How are you gorgeous one?

Dr Lucy Burns (0:45)   Yeah, I'm awesome, I’m yeah feeling great. I do love a bit of autumnal weather, although I will tell you, I really love warm, warm mornings and live a bit a bit chilly, especially when I dip my toe into the pool. So as you know, humans are resilient we can do hard things so we can do hard things. In the scheme of the hardest things humans have ever done dipping my toe into a pool when the morning temperature is 14 degrees is not that hard.

Dr Mary Barson (1:19)   Today we're talking about it's a bit of an in delicate topic, I would say one that well, it's important, important, but in delicate. We are talking about poop.

Dr Lucy Burns (1:32)   Indeed, in fact, I was going to do a little segue there, which I only thought of from you know, we can do hard things to talking about hard poop. Yeah.

Dr Mary Barson (1:40)   Hopefully we're not doing hard poos. 

Dr Lucy Burns (1:45)   Yes. But it is a question that we get asked all the time on people who are changing what they eat and perhaps embarking on their low carb lifestyle. Changing bowel habits is common and we thought we'd chat about that today. The first thing we wanted to do, though, was have a disclaimer. So Miss, can you just explain why we've got this disclaimer?

Dr Mary Barson (2:09)   It's really important to know that sometimes, rarely changes in your bowels either constipation or diarrhoea, particularly if it's persistent, could be a sign of something more serious going on and you need to say your medical health professional. So if you've got a persistent change in your bowel habit, if you've got blood in your stool or mucus in your stool, go and see a doctor and get checked out. Usually, it's nothing, sometimes it really is something. So that is our first most important point whenever we talk about poo, we start with that.

Dr Lucy Burns (2:48)   Absolutely. Now, assuming that there is no sinister pathology going on, we do know that there is commonly a change in poop because what goes in must come out. But what we want to do is actually describe what is constipation, because quite often people have different understandings and it's not something that you yak on about at a party, is it? So Miss, can you just explain what constipation is and perhaps what it isn't?

Dr Mary Barson (3:22)   Constipation is an uncomfortable decrease in stool frequency with the emphasis on the uncomfortable, so if you change what you eat, you might make less poo, especially if you're eating less grains and bran, you may simply make less poo and that's not necessarily a bad thing, provided you feel comfortable and you feel well. But if you're uncomfy, bloating, pain, straining when you open your bowels, that is constipation, and it's not very nice, and it can happen with when you transition to low carb, real food. It's often one of the sort of temporary symptoms, but it doesn't have to be and we're going to chat about the simple things you can do to both prevent and treat constipation if you get it when you change your diet to a lovely real food diet naturally lower in sugar and starch.

Dr Lucy Burns (4:20)   Absolutely. So number one thing that you can do to prevent or improve constipation, you start Miss. 

Dr Mary Barson (4:32)   I'd say number one is hydration, water fluids. Get more fluids into you, especially during that transition phase. When you change what you eat beautiful changes happen in your gut, in your cells in your metabolism, and it can take your body a while to fully adjust. One of the things that happen when you reduce your sugar and your starch taking is your insulin levels go down, so important for metabolic health, and having a good metabolic balance. But as you do that some changes happen in your kidneys, and you start to weigh out more salt and wherever salt goes, water follows, so you weigh out more water as well and you can get dehydrated during that transition phase, and if you get dehydrated, that can contribute to constipation, so you need to be mindful of drinking and having enough water.

Dr Lucy Burns (5:34)   Absolutely. which leads me on to number two solution, which is the salt. So as you mentioned, when we lower insulin, we will we add our salt, which is wonderful, but can make us feel a little bit average while that happens. So again, particularly during the transition phase, you do need to have extra salt. And a lot of us when we move into the low carb lifestyle or moving into a real food, lifestyle as well. So there's very little salt in real food, compared to say processed or preserved food, which is often high in salt. So not only do you have to replace the salt that you've lost, but you actually have to have adequate dietary salt. So for some people, and again, assuming there's no medical contraindications for this, people will need somewhere between one and two teaspoons of salt a day, which can feel like a lot when you're not used to that. So if constipation is your problem, then adding salt to your food may be helpful and for some people, they may even take electrolytes or add salt to their water. Okay, number three solution.

Dr Mary Barson (6:51)   Fibre bit controversial. So the role of fibre is controversial there is scientific debate as to how much fibre we humans need and if we really need fibre at all. But I would say that we are all individuals and for some people, fibre is extremely helpful and extremely beneficial and potentially increasing your fibre intake may help with constipation. There are a few ways you could do this. We love fibre from whole food sources. So have some delicious low carb veggies those beautiful above-ground veggies. If that works for you have posts in your diet, that's great. Another way to experiment with increasing fibre if you wanted to, would be to have some chia seeds, they're really high and insoluble and soluble fibre and psyllium husk is another thing that you could get you can buy it in the chemist in the supermarket, it's often used in low carb baking and psyllium husk it's like a bulking agent really high in both soluble and insoluble fibre and you can have one to two teaspoons of that mixed with water and see if that helps you. The next thing is we're moving on from the salts but a particular type of salts lovely Lucy, what's the other thing that can be really helpful in constipation?

Dr Lucy Burns (8:16)   Yeah, so magnesium. So magnesium is again, a mineral an element that is important in our metabolism. And a lot of people find that particularly when they move into that lower carb lifestyle their body really misses its magnesium, and they can feel a bit terrible. So it can give you headaches and things like that. So replacing that can be really helpful with that thing that is sometimes referred to as keto flu, we just like to call it transition symptoms. It's all it is but same with your bowel. So with your bowel, you can take magnesium and it can be super helpful and if constipation is the problem, then you can take it as magnesium citrate. Magnesium citrate is helpful because the magnesium in that form is easily absorbed. So that's good for your body and the citrate component is the thing that helps stimulate the bowel. So if diarrhoea is the problem, then don't use magnesium citrate. But if constipation is then it's your friend and it's easily available. It's pretty cheap form of magnesium, you can just buy at the chemist. So yeah, I would be looking at that.

Dr Mary Barson (9:29)   And the other thing that can be really helpful if you've got some constipation is to look at fermented foods. So one reason why we might be getting constipated when we transition to a low carb real food diet is because of the changes in your gut microbiome. And with real food, you get beautiful healthy changes, you get an increased diversity of the microbiome, you get more of the healthy helpful microbiome that makes all of these beautiful metabolites that are so helpful and healthy for your gut, your body, your brain, every single part of you. But again, the transition, you know, can be a little bit rocky and you can help your gut microbiome by eating healthy bacteria in the form of fermented foods. That could be you know, your kimchi or sauerkraut, it might be some kefir, some fermented drinks. It is important with fermented food, though to start low and go slow. So just introduce them a little bit at a time. Otherwise, it can be a bit of a sharp shock to your system, and you can get symptoms that aren't too helpful. But fermented foods are so good for you all the time. They're good for you, but especially if you've got problems with constipation. 

Dr Lucy Burns (10:42)   Yeah absolutely and I think just being mindful of the commercialisation of fermented foods, we don't want to be eating or drinking foods that are fermented, but then they have added sugar because fermented foods in general are quite tart. Like that's part of the fermentation process and then, you know, companies go, oh, well, we'll just add a whole pile of sugar on it to make it palatable. So Yakult was one of the very first sort of, you know, little probiotic drinks that's still incredibly popular, but not that helpful. So yeah, plain yogurt plain. Again, looking if you're going to use kombucha, looking at either making your own or using one that's a low sugar one. So definitely fermented foods. The second, not second, whatever we're up to now. 

Dr Mary Barson (11:36)   Number six, I think, yeah, yeah.

Dr Lucy Burns (11:38)   Again a little review of your dairy intake. So there's two things that seem to happen with dairy and again, this just highlights the individual nature of people, for some people, dairy will give them diarrhoea and for some people, it will give them constipation. You know, if you're in camp constipation, and you eat a lot of dairy, then just do a little experimenting, reducing it. It's really interesting and this will lead to the next one. But I do know that people who put cream in their coffee, for example, will often find that they get diarrhoea, they have to run to the toilet, it can be a combination of a couple of elements. But yeah, so I've just a little dairy audit, which is, again, something we love doing. This is not about cutting something out, it's doing an audit, it's doing a little investigation, you're doing your own experiment, you're your own compassionate scientist, and then you get to see what works for you and what doesn't, rather than just blindly following somebody's protocol. 

Dr Mary Barson (12:45)   It's empowering, being your own scientist and another thing you could experiment with is coconut oil and or MCT oil, not and probably or. So, coconut oil is interesting in that it contains certain oils, including medium-chain triglyceride oils that we're not particularly good at absorbing. So we can but not all that well, and not all that efficiently and so they're sort of just go through our gut and that can help lubricate things and can help ease sort of the store passage. Again, you want to go slow, start low and go slow and experiment with this. If you add too much too quickly, it might not go in your favour, just sort of be mindful as well that you know, it is adding in extra dietary fat, which means that's what your body will burn before it burns your own stored fat. So you want to experiment with it and see how it goes. But having a teaspoon or two of coconut oil can be extremely helpful same with MCT oil. 

Dr Lucy Burns (13:54)   Yeah and I mean, it's interesting, you again, coming back to the olden days, you know, castor oil used to, you know, that's what people go for constipation, a dose of castor oil, or cod liver oil. And then we just completely stopped doing that because we moved into the fibre the bulking agents, and everybody was using, you know, either stimulant laxatives or bulking agents, which we can talk a bit about later. But yeah, again, it's this is this is not new. These are old remedies and that makes sense. Excellent. So we're, we're now up to number eight, which is caffeine, which is the one I talked about before. So it's really interesting again, you know, how the gut works it's complex and simple, yet complex at its heart, it's just a tube that goes from you know, your mouth to your bottom, and that's all it is just a tube. However that tube performs so many functions, and it has one hormone and nerves and all the things attached to it. So hormone receptors, neurotransmitters, nerve cells, like it's complex. But there is this thing called the gastrocolic reflex, which actually, you know, lots of mammals have, which is why often when people have fed their dog, they'll put the dog outside because it'll then go into a poop and humans have it. Although for lots of us, it's not very strong and for lots of us, we've stopped listening to it but the concept is that when you stimulate the gut, a couple of neurological and hormonal processes occur that then get the bowel to move so you eat food and you poop, that's it and at some. So caffeine is a powerful driver of this, which is quite often why people after having a coffee, will then want to go to the toilet, 

Dr Mary Barson (15:57)   That gastrocolic reflex, yes, indeed. The next thing that you could explore if these other things have not been helpful, and I would keep this one, you know, further down the list for a good reason, is medications, there are a plethora of medications out there that can help you poop and they, you know, they can be helpful, particularly in the short term, and they've got Lakia, there are a few different kinds that you could use, there are medications that are osmotic that is that just increase like the drug water into your bowels and that can be quite helpful, and that can be things like Macrogol or Movicol as one of its brand names, usually pretty safe. It can cause diarrhoea if you take too much, but that's that could be a pretty good option. Another one is the bulk-forming agents, which we've already talked about. Things like psyllium husk are generally one of these there are a few medications out there that include psyllium husk. What would be a little bit cautious of is the stimulant medications, the ones that include bisacodyl or senna, they stimulate the muscles along your gut, helping them to move and they can help, you know, sort of move capacity along. Look, they can be fine for a lot of people, but they can cause problems in some people especially if there's something already going on in the gut that might not be good and they can tend to cause perhaps a little bit more crampy pain and things. But it's an option for some people and you can get medications that have got the stimulant and another class is stool softener, like docusate mixed together with cloxacillin senna, etc. But if you're going down this path, I reckon generally a good one to start with is those osmotic laxatives because they're just generally safer. 

Dr Lucy Burns (17:53)   Yeah absolutely and what we do know is that prolonged use of these medications becomes unhelpful, especially the stimulants that do cause long-term problems with, again, just the neurobiological biology of the gut. So these are all short-term options. The thing I would add in with something like the psyllium is you can just buy psyllium from the supermarket, you don't have to buy it in a medication form and be mindful of brands, you know, such as say Metamucil because they have colourants. They have often sometimes sugar, chemical sweeteners, and things like that in them. They're not just plain old real food. So I'd be just mindful of those. I guess the last thing is, and again, this is just a summary, I guess, of our busy life, a symptom of our busy life isn't most a lot of people, we don't even give our body time. We don't even allow it to poop. We're so busy, you might get that so a little urgent guy, I've gotten a lot of time I'll do it later and by that stage again, our body listens, if it gives you a signal and you ignore it, and you ignore it enough, it will stop giving you the signal. So this is particularly that gastrocolic reflex if you've eaten something in the morning, you know, and I know it's boring to talk about this but it is worthwhile just going to have a sit on the toilet and you know there are people that use particulars little there's sort of toilet stools that you can buy now to just look at your positioning and all that sort of stuff. Again, it's just part of our modern society. is unhelpful with our still primitive biology. Yep. Okay, couple of things that we would recommend you don't try and again these you'll be getting all sorts of advice from you know, Joan down the road or Tom up the shops that just don't fit into your low carb lifestyle. So, Miss, you want to start the ball rolling with a couple of those. 

Dr Mary Barson (20:08)   Yeah, so be mindful of things like, like prune juice. Yep, prunes have got a large amount of particularly soluble fibre in them, but they're also really high in sugar and prune juice is high in sugar so that's not necessary. There are so many things you can do without dumping all that sugar into your system. 

Dr Lucy Burns (20:27)  Yeah, absolutely. The other one that comes up a lot on Facebook groups is the sugarless lollies so if you've ever read any of the reviews on gummy bears, they have particular sweeteners in them. So these are like the Double D lollies as well they have a sweetener in them usually maltitol, which is I mean, it's its own. It's got its own problems, but one of its problems is actually still acts on your insulin level. So if you're wanting to reduce insulin, which is what we recommend, everybody should be aiming for, then they don't actually help you do that. It's false advertising. But the second thing is that the sweeteners in them are really toxic to our gut. Our gut doesn't like them, which is why sorbitol in particular is another sugar alcohol which is on all the chewing gums, which says things like excessive consumption may cause laxative effects. It's because it is harmful to the gut. The gut does not like it. So those lowly saying so. Yeah, don't follow Facebook's advice. In general, don't follow Facebook's advice.

Dr Mary Barson (21:40)    Just be aware of those sugar alcohols in general particularly well if you've got diarrhoea. We haven't talked about that but if you're experiencing diarrhoea really look to see how much Sorbitol, Mannitol, Maltitol Lactitol, and Isomalt you're eating because yes, they can really cause those loose stools and they can be quite problematic and not a great way to treat your constipation. There are better ways. 

Dr Lucy Burns (22:05)   No absolutely and you know and as you said it's interesting because we've got this you know, people with constipation, people with diarrhoea people all ends of the spectrum again, just emphasising how different humans are. But one of the things again with so we get a lot of people who go– I've got diarrhoea, so we've got a couple of tips for that as well and people who go– but what about I don't have a gallbladder and I get diarrhoea when I eat too much fat and that can be a problem. So I thought we'll just finish up today with you know, a couple of things that you can do here getting diarrhoea, you want to go first Miss? 

Dr Mary Barson (22:45)   Look, I've just said it. But number one, just check out make sure you're not having too many of those sugar substitutes, particularly the ones we just mentioned, the Sorbitol, Mannitol, Maltitol Lactitol, and Isomalt, they're not your friend, not your friend. 

Dr Lucy Burns (23:02)   No my number two tip is actually nuts. Like, I know, when people move on to a low carb lifestyle you know, they will often eat a lot of nuts and boy am I nuts and they've never eaten before and that can be, you know, not so good for you. But like everything, too much of a good thing and it's really interesting because what happens is our body can actually absorb all the nuts, you know, there's a lot of insoluble fibre in them, there's moderately, in fact, some nuts have very high in fat, and that that can actually cause diarrhoea for a lot of people. So again, diarrhoea is what's going on, do a little audit and see two things. One, what is my nut content? And what is my dairy content? In fact, it's a big audit, and what is my sugar alcohol or my fake sugar content? And even amongst all of that are some of the newer processed foods that have what we like to call fake fibre in them. So it is it's chemically constructed fibre, or fibre that's pulled out of the original source. So particularly something like Inulin, which is used because it's slightly sweet, and it's a fibre seek and whack fibre five-star fibre rating on the front of your packet. But again, from a lot of people that they've got doesn't like it, it's not how it's supposed to be eaten. So again, just doing a little audit there, I think can be super helpful.

Dr Mary Barson (24:28)  Yeah and finally, just think about your fat intake with diarrhoea if you're that something that you are experiencing, you know, if you're having extra coconut oil or MCT oil, really think about that. If you haven't excess seed oils in your diet seed oils and vegetable oils. Our bodies actually haven't really evolved to cope with vast amounts of these processed oils and surprisingly, that can cause diarrhoea for some people. So you know, focus on real foods or on whole foods and your natural healthy fats, and things should definitely settle down.

Dr Lucy Burns (25:04)   Absolutely. All right, lovelies, well, I have our top 10 tips for constipation with five extra tips for diarrhoea that have been helpful. Again, if you love our podcast, we would love a rating. If you ever feel like just whacking out a five-star rating that would be super, super helpful for us and of course, share it with your friends because that's the only way that we get to spread the word around the whole eating real food for health, around improving metabolism and managing mindset. So gorgeous ones out we will see you back next week have a wonderful week. 

Dr Lucy Burns (25:09)  The information shared on the Real Health and Weight Loss podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.

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