Stool Softeners

To start to address this topic we must ask why are stools not soft in the first place? Here are some thoughts

1. The transit in the colon is very long leaving much time for adsorption of water and electrolytes. This of course is often defined as constipation.
2. Something is causing the bacteria and/or undigested food to form a brick like substance

The goal is to make sure the stools are moving at least 1-2 times per day so that less time for toxins in the stool to cause inflammation in the intestines and to be sure that toxins have best chance of leaving in the stool rather than being reabsorbed.

A Miralax.

Yes, take Miralax separate from the clay (preferably 1 hour away). I searched for a while and did not find more convincing evidence that antibodies against PEG are an emerging clinical problem

B. MgO, more reasons to push aside than just biofilms

Stephen Fry has started a campaign about health effects of biofilms isolated from the blood. [1] The evidence seems to be sort of scant that these films are alive and part of the parthenogenesis. [1] Dr Fry’s website [2] and discussion forums [3] promote the idea biofilms are making us sick. Song and coauthors had an interesting publication suggesting that Mg²⁺ can bind Pseudomonas to extracellualar polysaccharides. [4] Another reason to discount MgO is a Japanese study that found that this agent can not only increase colonic pH but also decrease short chain fatty acid production and the overall makeup of the colonic microbiome. [5]

C. Coconut oil

FussyBody promotes coconut oil as a stool softener. The claim is that coconut oil triglycerides are composed of medium chain fatty acids. No peer reviewed references were cited in this post. [6] A review on over the counter remedies for constipation failed to mention coconut oil. The FussyBody claim that coconut is the only common source of medium chain fatty acids is so far holding up. Could medium chain fatty acids in coconut oil triglycerides speed up GI transit to two Bowell movements a day with soft, but not too soft feces? On a whim a search for the receptor of medium chain fatty acids was performed yielding GPR84. [8] GPR84 is expressed in immune cells and microlia. It has C8 to C12. GPR84 is expressed in the enteroendocrine cells of the colon [9] making it a logical explanation of any perceived benefit on the property of human feces. [6] These GPR84 expressing EEC seem to be part of the mucosal innervation. [10]

References

1. Ellis JE, Heuser R, Missan DS, Martinez D, Heningburg A, Shabilla M, Schwartz R, Fry S. Evidence for polymicrobial communities in explanted vascular filters and atheroma debris. Mol Cell Probes. 2017 Jun;33:65-77. PubMed
2. https://stephenefrymd.com/
3. https://www.healthrising.org/forums/threads/dr-stephen-fry-and-protozoa-my-life-is-greatly-improving.2122/ biofilm forum comment
4. Song B, Leff LG. Influence of magnesium ions on biofilm formation by Pseudomonas fluorescens. Microbiol Res. 2006;161(4):355-61. PMC free article
5. Omori K, Miyakawa H, Watanabe A, Nakayama Y, Lyu Y, Ichikawa N, Sasaki H, Shibata S. (2021) The Combined Effects of Magnesium Oxide and Inulin on Intestinal Microbiota and Cecal Short-Chain Fatty Acids. Nutrients. 2021 Jan 5;13(1):152. PMC free article
6. https://fussybody.com/coconut-oil-for-constipation/
7. Rao SSC, Brenner DM. Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review. Am J Gastroenterol. 2021 Jun 1;116(6):1156-1181. PMC free article
8. Marsango S, Barki N, Jenkins L, Tobin AB, Milligan G. Therapeutic validation of an orphan G protein-coupled receptor: The case of GPR84. Br J Pharmacol. 2022 Jul;179(14):3529-3541 PMC free article
9. Peiris M, Aktar R, Reed D, Cibert-Goton V, Zdanaviciene A, Halder W, Robinow A, Corke S, Dogra H, Knowles CH, Blackshaw A. Decoy bypass for appetite suppression in obese adults: role of synergistic nutrient sensing receptors GPR84 and FFAR4 on colonic endocrine cells. Gut. 2022 May;71(5):928-937. PMC free article
10. Peiris M, Aktar R, Raynel S, Hao Z, Mumphrey MB, Berthoud HR, Blackshaw LA. Effects of Obesity and Gastric Bypass Surgery on Nutrient Sensors, Endocrine Cells, and Mucosal Innervation of the Mouse Colon. Nutrients. 2018 Oct 17;10(10):1529. PMC free article