Does Constipation Cause Dementia?
Recent research has shown that there is a significant correlation between constipation and dementia. Many people who have dementia have had chronic constipation in their lifetime. But does constipation cause dementia? We were lucky enough to get some insight from Dr. Ken Brown, gastroenterologist, on this topic.
Does Constipation Cause Dementia
How can constipation impair cognitive function and contribute to dementia risk?
Constipation in itself does not cause cognitive impairment. This is backed by the fact that there is a whole section of dementia patients who do not experience constipation. However, there is a strong correlation between constipation and the severity of dementia.
A study found that there is a significantly faster progression of dementia symptoms in those who experience constipation.
So although constipation does not cause dementia, constipation is a symptom of an underlying cause.
There are many potential causes of constipation and some of them can be linked to cognitive decline, such as medication side effects, dehydration, and underlying diseases like hypothyroidism.
The recent studies on the link of constipation and cognitive decline, more likely is a result of an unhealthy microbiome, known as dysbiosis.
When the gut microbiome is unhealthy, the whole body will feel the effects including the brain. With a healthy microbiome, there are anti-inflammatory bioactive metabolites that keep inflammation down and can cross the blood-brain barrier.
The exact opposite happens where an inflamed gut can produce inflammatory cytokines, and these can have a direct effect by crossing the blood-brain barrier. This leads to localized inflammation in the brain.
Short-term inflammation results in decreased production of neurologic transmitters, and an increase in oxidative stress. When neurotransmitters like GABA, serotonin, and dopamine are not at sufficient levels cognition is affected. Over time this can result in deposits of amyloid proteins and neurofibrillary tangles causing dementia.
How can constipation negatively affect brain health and mood?
Mood swings are a common experience in both dementia and constipation.
When an individual experiences constipation, characterized by infrequent bowel movements, hard stools, or difficulty in passing stools, it can trigger not only the above-mentioned direct effect on the brain but a series of effects on overall well-being, and indirectly affect the brain.
The discomfort and bloating associated with constipation can lead to mood disturbances due to physical discomfort arising from constipation which can amplify stress and anxiety levels. This heightened stress combined with physical discomfort can also affect sleep patterns resulting in fatigue and worsening mood and cognition.
What are your top tips for those who struggle with chronic constipation to encourage a daily bowel movement?
If you are constipated and bloated, look for the underlying cause first. This may be the canary in the coal mine–a sign of gut dysbiosis and possibly intestinal inflammation.
People with Alzheimer’s disease often start having gastrointestinal problems–specifically bloating and constipation–many years before they develop dementia.
After ruling out the typical underlying causes of constipation, such as medication side effects and thyroid issues, here are some tips on how to beat constipation.
Fiber intake: type of fiber matters
If you have constipation, the first suggestion you will likely hear is to increase your fiber intake. This isn’t always the answer.
If you do not have a healthy gut microbiome–the population of bacteria living in your intestines–then fiber may cause bloating and discomfort. A good way to start is with soluble fiber like psyllium husk because insoluble fiber can cause worsening symptoms in some people with small intestinal bacterial overgrowth (SIBO).
Start with small doses and gradually increase. Too much fiber can also cause problems if taken in large amounts without sufficient water.
Drink plenty of water
Studies have shown that dementia patients who have constipation decline two times faster than those without constipation. But they also show that water intake can drastically change both constipation and cognitive decline in addition to overall dementia symptoms. So ensuring proper hydration is important in those with dementia or those who are at a higher risk of having it.
It has been shown that people with dementia lose their ability to know if they are thirsty or not which makes this difficult to keep up with. And sometimes suggesting them to drink more can feel like you are infantizing them and cause more irritation. So do what you can to get them to drink more water, but it may require some creativity to do so if irritation does occur.
Try getting them a new water bottle, setting alarms, or adding fresh lemon or herbs to get them to drink more water.
Plan your food/drink intake and bathroom schedule for when you’ll be near a bathroom
The next thing is to take advantage of something called the gastrocolic reflex. This is when the first thing, fluid or solid, hits your stomach, it sends a signal to your colon that you need to make room for the day’s food. The key here is to not ignore that urge to go; try to plan around this physiological process.
For instance, if you have a long commute and are having your coffee on the drive to work and this urge kicks in, it can train your colon to not go, and this can lead to chronic constipation.
Try holding off drinking your coffee until you get to work where you can use the restroom.
Position yourself for success
Another really important thing to think about is that constipation can not only be a lack of an urge to go but also the inability to fully evacuate.
One way to help this is to change the angle of defecation. This can be done by putting your feet on a stool so that your knees are above your hips and you lean slightly forward.
A popular commercial brand that accomplishes this is the Squatty Potty. This position helps the rectum to straighten out and this helps to have larger more effective bowel movements so you can fully evacuate.
Dietary improvements: Fiber and Polyphenols
One of the best ways to support your gut health long term is to feed your microbiome what it wants, which is large complex polyphenols and fiber.
These large polyphenols are metabolized by our microbiome into many bioactive metabolites that include anti-inflammatory, anti-aging, and promotility molecules.
One clinical study looked at how one of the largest and most complex polyphenols called Quebracho Colorado along with Chestnut was able to produce more beneficial metabolites than inulin, the gold standard fiber.
Both Quebracho Colorado and chestnut are main ingredients in Atrantil. So you can easily get your daily dose of these beneficial metabolites by grabbing a bottle for yourself.
While constipation is not a cause of dementia, it is an easy way to determine disease progression. There is no current cure for dementia, but if you or a loved one are suffering from dementia and are experiencing constipation, this may be a sign to get constipation under control.
Take care of your gut microbiome and it will take care of you in return.
Resources:
https://onlinelibrary.wiley.com/doi/full/10.1111/cns.13940
https://www.frontiersin.org/articles/10.3389/fnins.2021.821654/full