Using Fiber to Deal with Constipation Predominant MC

by wayne persky

Founder and President of the Microscopic Colitis Foundation

I've had constipation problems most of my life. I can remember events from my childhood, when typically, several days would pass before I would have a bowel movement, and of course, even then, the event usually wasn't accomplished easily. As I was growing up, I didn't realize that this was an abnormal pattern of bowel movements. But when I was in my early 50s, my bowel movements suddenly became marked by a little fresh blood with each event.

But the Flipside of This Issue Suggests That a Fiber Deficient Diet Inhibits Diarrhea Predominant Colitis
​

After two or three of these episodes, I went to see a gastroenterologist, who used a sigmoidoscope to determine that I had an inflamed blood vessel (hemorrhoid) causing the bleeding. Although he didn't mention this, I was pretty sure that it was because of my difficult bowel movements. He prescribed two weeks worth of suppositories (to suppress the inflammation), after which the problem was resolved.

My gastroenterologist recommended surgery.​

During that follow-up visit, he pointed out to me that the issue would need to be resolved by surgery, if I hoped to have any long-term relief. Being well aware of how painful recovering from that surgery typically was, thanks to a graphic description from a friend who had experienced the surgery a few weeks earlier, I respectfully declined with, "Thanks, but I think I'll see how things go, first." To which he replied, "Okay, but you'll be begging me to schedule the surgery before long." That was almost 35 years ago, and I'm happy to report that I never went back to beg him to schedule the surgery.

I decided to try to resolve the problem with fiber.

I was well aware that treating a hemorrhoid wouldn't completely resolve the problem, so I decided to change my diet routine. I began to eat a bag of microwave popcorn every night, as I watched TV. It was something that was easy to do, because I loved popcorn. And after a couple of weeks, I became progressively less concerned about the problem as I realized that the daily dose of popcorn was resolving it by making a "first-thing-every-morning" bowel movement much easier to accomplish. And I made sure that I followed the routine every morning, so that I didn't fall back into the constipation rut, again.

When my MC symptoms first began, I was in my late 50s,

and I first thought the problem was food poisoning, because my work schedule caused me to eat lunch at various fast food restaurants in different cities, on many days. But eventually, I noticed that the reactions occurred about every 4 to 6 weeks on a somewhat regular schedule, and they followed a regular pattern. And as time passed, the 4 to 6 week cycle gradually contracted to about a 10 day to two week cycle.

​Reactions would begin with urgent diarrhea, for three or four days or so, followed by a couple of days of no bowel movements, after which normal bowel movements would resume. Then the cycle would repeat. Looking back now, I recognize this as a pattern of constipation-predominant microscopic colitis (MC) reactions (although cycle time and details can vary), but of course, I didn't realize that at the time it was occurring.

This pattern of reactions continued for a few months,

and then one morning the diarrhea changed to persistent watery diarrhea, day after day. I tried a couple of Pepto-Bismol tablets each morning for a few days, but all that did was to turn the liquid black. Like many men typically choose to do, I continued to try to tough it out for a couple of weeks, but I finally decided that I must have colon cancer or some other serious problem, so I caved in and decided to go to see my doctor. Back in those days, it was possible to get a doctor appointment quickly, and during the visit, he palpated my abdomen, and confirmed my fears — "You have a tumor in your colon as big as a man's fist", he told me, shaking his fist in my face for emphasis.

He sent me to a gastroenterologist, whom I was able to see that same afternoon, and the G.I. Doc confirmed my GPs diagnosis — colon cancer. He immediately sent me for a series of CAT scans, later the same afternoon. After swallowing a large container of prep solution before the scan, I had a huge bowel movement, and the lump that those doctors had felt, apparently disappeared into the toilet. After the scan, I asked the medical technician if he had found anything. "Only that your colon is larger than normal, the walls are thicker than normal, and your colon is flat shaped. No signs of any tumor.", he told me.

Evidently that lump that my doctors assumed was a tumor, was nothing more than a lump of compacted feces (a side effect of constipation) that was dissolved by the prep solution.

​That was back in January of the year 2000.

Between then, and June of that year, I had a long series of various tests, ending with a colonoscopy, before the follow-up appointment. At the follow-up appointment, my gastroenterologist told me that there was nothing more that he could do for me, as there was nothing wrong with my digestive system. When I asked him what I should do when the symptoms return, his reply was, "See a good psychiatrist." And back in those days, I didn't realize that he had failed to take biopsy samples during the colonoscopy, nor was I even aware that he should have. Back then, most gastroenterologists just assumed that microscopic colitis (MC) was a disease of "older women", and it never even occurred to most of them that men, or younger women, might have the disease.

Fast forwarding to today.

Researchers are finally making progress regarding constipation problems.

A recent Medscape article describes research published in the Journal Cell Host & Microbe detailing how researchers have identified certain genes in probiotic bacteria that are capable of increasing gut motility (Cell Press, 2023, November 21).1 The researchers discovered how a cluster of genes, known as the abfA cluster, found in the species Bifidobacteria longum is able to use an indigestible fiber known as arabinan to resolve constipation. Arabinan is found in plant cell walls, particularly in fruits, vegetables, grains, various seeds, and roots. Its name comes from the arabinose sugars of which it's composed, and it's considered to be a prebiotic fiber.

According to the article, the worldwide prevalence of constipation ranges from 10 to 15%. Previous research has implicated gut microbial dysbiosis as a possible cause of impaired gastrointestinal motility. The condition typically involves a reduction in population levels of what are known as "beneficial gut bacteria", some of which are often referred to as “probiotic” bacteria. And various gut bacteria strains have been commercially produced and sold as probiotics over the years. But to date, published research trials based on the use of various probiotic products, in an attempt to resolve IBD symptoms, have shown mixed results. And research trials designed to demonstrate that probiotic products can resolve constipation issues have shown mixed results, and inconclusive findings, because of inconsistent performances of various probiotic strains, in various individuals.

These trials all tend to follow a common pattern.

Interestingly, over the years, many studies have been done. And not surprisingly, published studies financed by probiotic manufacturers always show beneficial results. By contrast, research trials financed by independent organizations are unable to show any significant benefits that can be attributed to the use of the products being trialed. And, of course, this pattern can be found in many other products that are marketed today. The reliability of research conclusions can often be gauged by considering the source of funding for the research project.

Theoretically, a properly designed probiotic product should be capable of resolving constipation, and even constipation predominant MC.

The original research article shows that the researchers used a double-blind, randomized, placebo-controlled (the gold standard) clinical trial, to demonstrate that certain genes in the probiotic bacterium B. longum (the abfA cluster of genes), enhanced the utilization of arabinan, and reduced constipation symptoms.(Zhang, et al., 2023).2 The researchers showed that in humans, the concentration (or scarcity) of abfA gene clusters can be used to predict constipation. Furthermore, they showed that transplanting human microbiota enriched with abfA gene clusters into constipated mice, improved their gut motility. And together, these discoveries should pave the way so that reliable probiotic products designed to reduce constipation can be produced and marketed.

Are we having more digestive issues than our ancient ancestors?

Researchers have noted that residents of industrialized nations are more likely to have lost certain gut bacteria strains than residents of less-developed nations (Ben-Gurion University of the Negev, 2024, March 18).3 Specifically, we appear to be losing certain bacteria strains that our evolutionary ancestors apparently possessed, namely bacteria capable of digesting cellulose. These bacteria gave our ancestors some of the digestive capabilities of animals known as ruminants.

Ruminants produce their own probiotics and prebiotics.

Ruminants are grazing animals possessing specially developed digestive systems that are fully capable of digesting plants, so that they can not only extract the common nutrients, but they are also capable of digesting the abundant cellulose available in plants, to convert it into simple sugars that allow their microbiomes to thrive.

Ruminants are named in reference to these unique gut bacteria.

Cellulose degrading bacteria (Ruminococci) are any bacterium of the genus Ruminococcus, and they are capable of producing unique protein complexes known as cellulosomes that are able to digest cellulose, to convert it into simple sugars. These simple sugars benefit ruminants directly, and by nourishing their microbiomes.

Interestingly, it appears that the strains of cellulosome-producing bacteria found in humans are more closely related to those found in livestock, than those found in our primate ancestors. Researchers speculate that strains of these bacteria may have become incorporated into our microbiome from livestock domestication that occurred during our evolution.

But there may be a more likely explanation.

Although this wasn't mentioned in the article, it certainly appears possible that these bacteria may have been introduced into our microbiome as far back as Paleolithic times. It's worth noting that, although many authorities fail to mention this behavior, many early Hunter gatherers almost surely took advantage of the nutrition available in partially digested vegetable matter (known as digesta) that was available in the stomachs and intestines of the ruminants they hunted, killed, and ate (Sherburne, 2023, April 26; Garvey, 2023, April; Kuhnlein, and Humphries, n.d.).4, 5, 6

North American Plains Indians routinely consumed Buffalo guts.

Even in relatively recent times, up until they were driven onto reservations by the European migrants who settled North America from East to West during the 18th and 19th centuries, certain tribes of North American Plains Indians considered Buffalo intestines to be a delicacy, and some tribes ate them raw. It doesn't take much of a stretch of the imagination to realize that Paleolithic hunter gatherers almost surely did the same, providing plenty of opportunity for gut bacteria of ruminants to become established in our own microbiome as we evolved.

​And as our diets continue to shift farther and farther away from our ancestors' evolutionary diets, we are slowly losing the diversity of gut bacteria that our ancestors possessed. Because our diets typically contain much less fiber, we're no longer able to support bacteria such as the cellulosome producing strains, for example.

And, as mentioned at the beginning of this article,

On the flipside, researchers have confirmed that a fiber restricted diet is beneficial for treating diarrhea predominant colitis.

Out in the real world, as MC patients, we've known this for a long time, but at least now the medical community may be officially embracing it. An article recently published in Cell Host & Microbe points out that using an enteral feeding technique that utilizes a fiber free diet, can be effectively used to bring clinical remission in pediatric patients who have Crohn's disease, without the use of any steroids (Kruffa, et al., 2023).7

As the researchers noted, "Using a model of microbiota-dependent colitis with the hallmarks of CD," they demonstrated that a fiber free diet eliminates, or at least minimizes the presence of a pathobiont (as they refer to an organism that can cause harm under certain circumstances) known as Mucispirillum schaedleri, that normally dwells in the intestinal mucosa, and is capable of triggering inflammatory bowel disease. They demonstrated that a fiber free diet eliminated M. schaedleri from the intestinal mucosal layer, and brought remission from the disease.

References

1. Cell Press. (2023, November 21). How gut microbes help alleviate constipation. Medical Xpress, Retrieved from https://medicalxpress.com/news/2023-11-gut-microbes-alleviate-constipation.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

2. Zhang, C., Yu, L., Ma, C., Jiang, S., Zhang, Y., Wang, S., . . . Zhai, Q. (2023). A key genetic factor governing arabinan utilization in the gut microbiome alleviates constipation. Cell Host & Microbe, Retrieved from https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(23)00415-8#%20

3. Ben-Gurion University of the Negev, (2024, March 18). Industrial societies losing healthy gut microbes. Science Daily, Retrieved from https://www.sciencedaily.com/releases/2024/03/240318142440.htm

4. Sherburne, M. (2023, April 26). Did early foragers eat partially digested food from large animals? Futurity, Retrieved from https://www.futurity.org/ice-age-hunter-gatherers-diet-food-2911282/

5. Garvey, R. (2023, April). Human consumption of large herbivore digesta and its implications for foraging theory. Evolutionary Anthropology, 32(3), pp135–143. Retrieved from https://onlinelibrary.wiley.com/doi/10.1002/evan.21979

6. Kuhnlein, H. V., and Humphries, M. M. (n.d.). Traditional Animal Foods of Indigenous Peoples of Northern North America. McGill, Retrieved from http://traditionalanimalfoods.org/mammals/hoofed/page.aspx?id=6136

7. Kruffa, P., Pickard, J. M., Campbell,A., Yamashita, M., Schaus, S. R., Martens, E. C., . . . Caruso, R. (2023). Fiber-deficient diet inhibits colitis through the regulation of the niche and metabolism of a gut pathobiont. Cell Host & Microbe, ISSN 1931-3128, Retrieved from https://www.sciencedirect.com/science/article/pii/S1931312823004201?via%3Dihub