Every patient's story is unique and so is their DNA. At Hope for Healing, we used advanced SNP panels created in partnership with Fagron to uncover the genetic clues that guide us toward more personalized care.

This week, we're taking a closer look at the GSTP1 gene, which tells the body how much glutathione is made in the gut. Without enough glutathione, you may become constipated.

we're grateful to Fagron for sponsoring this podcast and for helping us bring hope for healing from the inside out. Thank you so much for meeting with us, Dr.

K. I remember the first time, I think it was like day one of me working at Hope for Healing and there's so much about the Bristol stool chart that I learned and so much about constipation.

So I'm really excited to unpack this with you because I think it's something that can so easily be overlooked as a cause of so many other problems. But let's just start off with the obvious.

Why is constipation so common with kids today? And why is it so oftenly brushed off as super normal? I think a lot of our foods have things in it that make our poop like glue.

It's so gluten causes gluey stools. So there's a lot of uh toxic things in our food. Really, we've talked about non-food items. So just a lot of junk that binds you up and just not a lot of movement and things like that, you know?

Yeah, it's… oh get a lot more into that so parents frequently though like if they're gonna go the allopathic way they're told that this is like it's just a phase or you know it just takes some mere lacks um why is this not the greatest approach to this idea Yeah, well, one of the things that I was told and I even told people when I before I knew any better was, uh Miralax, which is polyethylene glycol.

Yeah, is inert, meaning it just stays in the gut and just draws water into the bowel. But. By definition, if you've got constipation, your bowel is not moving like it should, you have what's called increased intestinal permeability.

So by golly, you are absorbing that garbage and who wants to eat something or drink something that's kind of related to the antifreeze family? So we don't wanna put Miralax in our body because it's not inert.

Mm-hmm. There are parts of it that get absorbed and that's not a good thing. well, that's so good to know. And yeah, I guess if I can't pronounce it or spell it, I probably don't want it in my body.

uh So let's start with there. So what exactly then is constipation? Like what would be the definition of constipation? Okay, well, there's a little bit of variability that's considered normal, but why don't we start from birth on?

So um let's say a breastfed or a formula fed baby. Breastfed babies typically poop every time they eat. Okay, so that's normal. And the consistency of the stool is seedy and mustardy.

But around four to six months of age, the frequency that a child poops that is breastfed drops way down. Why is that? That's because if you're solely breastfed, the nutrients within the breast milk, the body just absorbs all that goodness so you don't make as much stool.

So a baby, we have moms and dads say, my child's constipated. Well, tell me what you mean. they haven't pooped for four or five days. And then we ask, well, are they comfortable?

They're not like wiggly and act like they hurt their bellies, not distended. No, and then when they finally do poop, it's creamy and soft and it's this mega blowout that goes up the front and the back of the diaper all over the place and It's normal for a breastfed baby to go as long as I know this sounds crazy 10 to 14 days without pooping and when they go it's soft and it's this ginormous volcano of soft seedy mustardy poop now as you age and then you start to eat solid food, you should have a soft serve banana sausage looking poopy.

But if the child's in a diaper, it needs to look like kind of like a soft cow patty. oh And yeah, so this is reality because if you have a baby that's pooping every time you feed them, then all of a sudden they don't poop for seven days.

So if they act uncomfortable, we stimulate the booty tooty, you know, and just kind of see how they do and then big blowout. There's also little exercises that, you know, little tummy massage to get them to go anyway.

But then once, you know, a child is eating solid foods, um pretty much with every meal, it's normal to poop one to three times a day. And um when they're able to go into the toilet, it should sink and it should look like little snakes and it should have the caliber of like, you know, half to an inch diameter and it shouldn't clog the toilet.

So that's what's normal. Now, you should usually stool every day, but if people have and we can provide the hope for healing poopy doopy chart. our little modified poop chart as a freebie for you to look at.

If a child or an adult poops every other day, but it's soft, it's type three or type four, and it doesn't hurt their bottom coming out, and they're not uncomfortable otherwise, then that may be their norm.

But it's okay to poop one to three times a day that's soft and sinks. Okay, so what I love that you said, even though like we giggle because it is one of those like we're describing what it looks like, I love the calm and peace that you can add to anybody listening or watching to this episode that didn't know some of these things were normal.

But what are the things that we would start to see that we would want to have more, maybe some questions that this may be starting to lead towards constipation?

And you know, it's interesting, little kids. They may not know what normal is because they've had dysfunctional stools all their life. So I think really good questions are, is, you know, asking how often they poop, but also showing them a chart and what's it look like if you look at it.

And, you know, they giggle and they might look away, but I'm like, well, hey, everybody sleeps and everybody poops. We got to know this is important. So it can be fun.

But I always ask kids, does it ever hurt your bottom when it comes out? And so. So if they kind of lean into that, if they're contemplative about it, well yeah, it does sometimes.

And I said, when that happens, what's typically going on in your life? And so you just ask a few more questions. I love that. Well, because you're inviting, first and foremost, you're inviting the child into the space to be observant of their body because just because they're children doesn't mean that they don't know and that they can't.

We just have to learn how to ask the right questions. And I've always loved that in sitting in on your appointments. Are there, if I guess maybe first starters, if it's a little uncomfortable, are there positions that they could try that could kind of help the body move a little bit easier?

Mm-hmm. Yeah. So, you know, before we had toilets, we would squat out in the woods. Okay. So um if you if you have the knees. slightly above the hip level.

So we like the squatty putty um at Hope for Healing and we have them in all of our bathrooms. um You know, and em you know, can have one for a grownup and then get the next level.

But with the knees slightly above the level of the hips because, and then also if you gently put the knees together, it opens up the rectal vault so that stuff comes out easier.

Because it shouldn't hurt and you just sit and boom and you're done. And you should not be on the toilet very long. You need to like get on. Yes, you get on and you get off.

You don't want to sit there very long because if you strain, you could get uh built up of blood in the veins and that can lead to hemorrhoids even in children.

They can be internal and external. It's painful and yucky. Yeah. Well, and okay, so you should be on and off for people who I know this is so funny, because it's a comedy skit of almost of people about how long they're on the toilet.

What is, what is too long? Honestly, you know, if you talk to pelvic floor therapists, you know, you should basically be able to get on and go within three minutes.

many times less than that, be a lightning pooper. Okay. You know, just get on, get off, and it's like you're done, you know. So then, then. uh you know, and listening to the body to go when you feel like you have to go.

We've all watched little kids that are becoming aware of their body and they have a diaper on and they're toddling around and they look at you funny and they go behind a chair and they squat and they poop in their diaper and it's like they're getting the feeling of it.

So it's just like staying in tune. You know the whole thing having a childlike attitude. It's like listen to your body. Don't suppress it. Don't don't squeeze it in.

Don't do the potty dance. em That's another thing parents if you're watching your kids kind of you know they're playing a game or they're doing something and they're kind of rocking and moving around they may be stool holding so it's like hey let's go to the bathroom don't say do you have to go to the bathroom just say it's time to go let's go and make it a positive experience let's get in there and get that out Mm-hmm.

Well, and that's exactly what I was going to say. So if we are noticing these behaviors, we first and foremost want to create a safe environment in the bathroom and that they can go as easily and that this is just this open environment.

If I think I need to go, that's where we're going to go and we're going to practice. And so I love that environment. But if we are starting to have different tendencies or we're noticing their answer is uncomfortable or maybe they're making a face, that experiencing discomfort, what are some of the first things that we should try if we think our child is experiencing constipation?

You know, typically parents and the kids have the answers, but you know, if they're school age, they may not want to poop at school. That's a big one.

And then the two biggies are hydration, are you dehydrated, and fiber. So if they're in a different environment, they're not drinking as much water, em and if they're not getting fiber, so you want to drink water.

um And then if your child or you doesn't like water, think about fruit or vegetable infusions that taste good. And you know, a lot of people go, well, I give my kid a sippy cup with juice in it.

Well, why don't you do this? Take a sippy cup and put a slice of fruit in it. And you still get that natural fructose from the fruit. but you're not separating the juice from the fiber.

And then when we think about fiber, you know, I love summertime, but I also love the fact that with some of our big uh warehouse places like Costco and Sam's, you can buy organic berries year round that are in the frozen fruit department.

So red raspberries have more fiber per cup than any other fruit. So. I, you know, and if the kiddo doesn't like that, go back to good old apples, organic apples.

So eating a few apple slices with some nut butter. um Also a really good source of fiber and naturally occurring sugar is majeure dates. So eating a majeure date, um you know, that's a great way to get fiber in too.

So water. So they're not dehydrated. And parents will tell me all the time, you I start asking these kids about their poop in their well child visit and the parent will say, well, they don't tend to drink as much water at school.

They come home and their water bottle is like halfway full. em So hydration, fiber, and the position, and that's a good place to start. And where are you or where are you not pooping?

It could be as simple as I don't like to use the potty at school. Mm-hmm. I love that. Okay, so you talked about hydration There is so many different ways that you can Google on what hydration looks like Is there a formula that you would recommend for someone to say like this is what hydration is a good starting place?

You know, after a child has weaned uh off a formula or breast milk, um the main thing that they should be drinking is water. And so if you take your weight in pounds and you divide it in half, that's about how many ounces of water you should be consuming in a day.

And when you think about children and you're wanting them to be dry at night, you want almost all of that fluid to go in before dinner if you're working on nighttime potty training.

Oh, that, yeah, no, that makes perfect sense. And also, does that kind of play into the way that we eat? Because I know that's kind of, they do cut off times.

And what people are calling intermittent fasting is really just sometimes the starting goes of, I shouldn't eat after seven, eight o'clock, and I shouldn't eat again until, and so does that affect anything with constipation?

ah It can, but not usually. But one thing I would remember as far as the whole constipation and how our GI tract functions is that if you don't drink while you eat and you fluid load before you eat, and if you're eating any fruit with a meal, So you don't have a water glass, you know, like they serve you at restaurants.

It's like, no, thank you. I don't drink while I eat. um But or I fluid load before my food arrives. And then if I have fruit, I eat the fruit first because there's enzymes in the fruit.

So if you're if you're giving a child a little lunch to go to school. or you're eating dinner and you've got fresh fruit, you're like, well, here, let's eat our pineapple first, or let's eat our blueberries, let's eat the few little red raspberries, and now let's eat this.

You know, let's eat our chicken, let's eat our lentils, let's eat our quinoa or whatever. So em that will give the gut enzymes, and you're not diluting all those enzymes by drinking the entire time.

And that will help you not get constipated. No, that's really cool. So it's not the timing, but almost the order of how you eat, like the order. So you're drinking fluids, which can feel silly because you're like, oh, fruit is like the fruity, it's the sweet part, but it's actually helping the body prepare for ultimately getting everything that it needs to get.

And so that actually leads us to the enzymes and everything. um There's this big word that everybody talks about all the time. I think moms or dads who are listening will know about it from their personal selves where it's like detoxification.

Oh, we're going to go on detoxes. But where does detoxification come into play with constipation? Well, detoxification means removing garbage. Okay. So how does our body detoxify?

We pee, we poop, we sweat, and we breathe things out. So I always use the illustration with children, what would happen if nobody dumped the trash in your kitchen?

And these kids get it. They're like, oh man, it would fill up, the dog would get in it, and then it would start to stink. And I'm like, What if nobody dumped the trash at all?

What would happen in the kitchen? would go everywhere, wouldn't it? And what would happen? It would stink. So that's what happens to our body when we are not taking the trash out on a regular basis.

So that's why we make such a big deal about finding out when do you poop? What does it look like? Does it hurt you? em And so detoxification is the elimination of waste.

And so our major detoxification organs, as we said, are our GI tract, our bladder, our skin, and our respiratory tract. Are there people who are prone to not being capable of detoxing the way, like genetically not being capable of detoxing the way that our bodies would typically be designed or the way that in a perfect world it would work this way?

Yeah. So typically people that struggle with constipation, if they have impaired genetic detoxification, they lack an enzyme. um The, the gene name is GSTP1.

ah It concentrates itself in the gut wall. And so a lot of times just by taking oral glutathione, the detoxification end product, That helps people poop.

wow, that's really cool. And so how does someone like find out if they, is that something that, is that a test or how do they find out if that isn't working properly in their body?

like a single little swab, or you can do what's called a detoxification panel. then if you have that, like maybe with both copies from both parents, like if someone has that, they tend to have kind of like a lot of things, but constipation is a biggie.

They may have lots of sinus infections and ear infections and asthma. They may have eczema. They may have urinary tract infections or skin infections like bad diaper rashes and little babies that struggle with constipation too.

em You you don't want those rabbit pellets and those hard things. And it's like by taking or applying glutathione, it's a game changer. It just is so helpful because in essence, What is a leaky gut?

What is increased intestinal permeability? It's a lack of glutathione in the entire GI tract. It's lowering inflammation. It's helping the gut work. Now there's all kinds of other things too that play into that, but that's the genetic piece.

So testing for that specific gene or doing the detoxification panel that we offer. or Fagran, genetics offers is just a great way to support your body, especially if you've struggled with chronic constipation, which is terrible.

Yes, absolutely. Well, I love that you started off with really creating any type of, um, maybe fear that someone may have around what it could look like.

And so is there any last minute before we dive into a lot more of, what the bigger picture and what some bigger chronic things could be? Is there any closing comments that you have for just the basics where people are starting.

So basics, keep yourself hydrated, eat enough healthy fiber, move your body, and when you do poop, get your hips, your knees slightly above hip level, get on and off, and you don't have to have a squatty potty.

We used to have telephone books, but we don't anymore. listen to your body when you feel like you've gotta go. So with your kids, if they're doing that potty dance, Hey honey, let's go to the potty.

Let's see what we can do. And for your kids, don't let their legs dangle off the toilet. Get them supported on that little squatty potty. That's it. I love that Dr.

K, thank you.

Constipation, Part 1: What’s Normal, What’s Not, and Why It Matters

Paula Kruppstadt, MD, DABP, FAAP, IFMCP

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