Poop or Get Off the Pot! (AKA. Constipation Clarification)

Forgive the expression, but it's tough to think of a catchy title to talk about CONSTIPATION. That being said, constipation is a really common complaint- from toddlers to toddering elders. When I talk to patients about constipation, the first thing I do is to establish what is NORMAL for the patient. Often folks are surprised to hear that "normal" does not equal "daily" bowel movements. If you go once every few days and have no abdominal bloating or discomfort, then you are NOT constipated, that is simply YOUR "normal". Others have several bowel movements each day, and again, that is "normal" for them if there are no associated uncomfortable symptoms.

So what IS constipation? Constipation is "unsatisfactory defecation" with relatively infrequent and/or painful passage of stool. Typically this means less than three BM's per week, too much time straining (or hanging out reading) on the potty, or a sense that there is either bloating in your belly or that after you go, you feel like you still should poop more. Women suffer from constipation twice as much as men (likely in part from our hormonal swings that may affect the gut.)

Please don't ignore constipation, because there are many medical conditions that can slow the gut and cause constipation, such as diabetes, low thyroid hormones, pregnancy, metabolic disturbances (like low potassium levels), to name a few. Additionally, medications such as blood pressure pills (calcium channel blockers especially), antacids, antihistamines, antidepressants and pain pills also can slow the bowels.

The vast majority of the time, however, constipation is simply the result of a poor diet. Three things are needed to move your bowels: FIBER (goal 25g/day), MOVEMENT (walk, run, skip, bike- whatever works, just get up and move!) and HYDRATION (more water.) Caffeine is a gut stimulant, which is why people often poop right after their morning java, but too much caffeine dehydrates you and actually slows down the process. What's the goal? Whatever frequency is "normal" for YOU, and no abdominal discomfort. That being said, I rarely see a patient who truly averages 20g of fiber per day in their diet (not from supplements) who does not have "comfortable" daily BM's.

BOTTOM LINE: If you've had no change in your diet, medications or activity level, and you notice your bowel movements have become painful or less frequent, go and get checked out at your family doctor.

Another Reason to Enjoy Coffee!

Okay, before my patients have a HEART ATTACK, please note that I did not say a fully leaded cup of joe! Caffeine STILL causes headaches, fatigue, insomnia, heart burn, bladder irritation and breast tenderness, BUT...

A new study shows that men with high coffee use (6 or more cups per day) have a decreased chance of getting prostate cancer- specifically in this study of 48,000 health professionals, a 20% lower risk overall of developing prostate cancer, plus a 60% lower risk of developing advanced (lethal) prostate cancer. Happily, even those who averaged a more reasonable 1-3 cups of coffee per day had a 30% lower risk of the severe prostate cancer. For the record, it made NO DIFFERENCE whether or not the coffee was DECAF or regular.

Right now, 1 in 6 men will develop prostate cancer during their lives, with the average age at diagnosis being 71. Prostate cancer is the most common cancer in men, and the second leading cause of cancer death. As such, we are always looking for something that might prevent it! We know that diets high in lycopene (from TOMATOES) may help and that overly high calcium intake may increase risk. Other supplements or dietary modification may have an effect, but the jury is still out.

BOTTOM LINE: Men, if you are already a coffee drinker, enjoy a cup or two of decaf coffee each day with the knowledge that you may be reducing your risk of serious prostate cancer!

And yes, Eddie, apparently there is a Santa Claus...

Still Can't Sleep?

Insomnia. We've all had the occasional night or two when no matter what we try, we simply cannot fall sleep. Usually those sporadic nights have an identifiable stressor- a test, a job interview, or a change in time zones. For theses occasional situations, I have no problem with my patients taking a sleep aid (prescription or over-the-counter.)
Chronic insomnia, however, is a whole different ball game. Every night becomes a challenge and by 2:00am you're beginning to panic about how you'll be able to function in the morning. Patterns emerge of heavy caffeine intake in the morning to "get going", then an afternoon "pick me up" coffee or soda, followed by a glass or two of alcohol to "relax and wind down" from the day. Most people know caffeine is a stimulant, but did you know even morning coffee can impair your quality of evening sleep? Alcohol, though a sedative, may help people relax and fall asleep, but realize that it,too, disturbs the quality of sleep. So how can you break this pattern? Here are a few ideas that might help.
1. Start your day with exercise. Even a quick fifteen minutes of brisk walking will release adrenaline and help decrease your need for caffeine. Did you know exercising 30 minutes daily yields the same amount of mood enhancement as a low dose of an antidepressant? (Don't exercise just before bed, though, because as noted above, that adrenaline release will keep you up!)
2. Create a bedtime routine. If you have children, you know how important this is, and it works for adults as well. Take a warm bath or shower, appeal to your senses with relaxing aromatic bath soaps or gels, and then GO TO BED. Do not pass GO and collect $200. This means no stopping to unload the dishwasher, fold clothes, check email or watch television. If you want to read or watch t.v., do it before your shower. Get in bed, close your eyes, and consider some form of relaxing breathing or meditation.
3. Cover your alarm clock. Check it three times before you cover it if you need to, but if it's covered, you'll break that habit of waking up at exactly 2:17am each night. Yes, you might still wake up, but if you're not seeing the clock, it's easier for your brain to go back to sleep because you're not gearing up all the emotions that come with seeing that dreaded early morning time.
4. Consider an underlying medical issue.Medical causes of chronic insomnia include an underlying issues such as sleep apnea, restless leg syndrome, thyroid disease, anemia or depression. Make an appointment with your doctor to discuss it!

BOTTOM LINE: For the occasional sleepless night, go ahead and use a sleep medicine if you'd like, but if you're taking a sedative every night and stimulants every morning, recognize the habits that are aggravating the problem and make some healthy changes!

Time to decaffeinate?

How much caffeine is too much? Most of my patients would laugh and tell you I think any caffeine is too much, because I have asked so many of them to give it up (and, for the record, had very positive feedback from those who have!) In reality, though, here is my standard answer. Do you have headaches, insomnia, heartburn or fatigue? If you have any of those, I would advise you to completely decaffeinate, because caffeine aggravates all these problems. Yes, I understand that you drink your coffee because you are tired and need the "pick-me-up", but all that you are doing is perpetuating the cycle. The more caffeine, the worse quality of sleep, and the more tired you get.
So how do you wean? Many people get intense headaches if they abruptly quit caffeine. (Here's a hint- if you do get caffeine withdrawal headaches, this should be a clue you're consuming "too much" for you!) Start mixing your coffee with roughly a third decaf, then several days later go to half decaf/half regular, and then several days after that drop down to 1/3 caffeinated. By day 10, you should be fully decaffeinated without getting a headache. I have found that after a couple weeks of NO caffeine, most people begin to have more energy.
BOTTOM LINE: If you have no trouble falling asleep, wake up rested and energetic, and never have heartburn- enjoy your Starbucks guilt-free! BUT...if you have any of those issues, it's time to DE-caffeinate!