Digestive Difficulties

Constipation, Diarrhea, Nausea & Vomiting and Mucositis

Breast cancer treatments disrupt your digestion. 

Digestion is a complicated process, involving multiple steps and several different organ systems.

In addition, pain medication routinely given after surgery causes constipation.

Chemotherapy drugs can have you running to the bathroom with diarrhea, induce nausea and vomiting, and give you uncomfortable sores in your mouth.

At this point, you might feel like treatment will never be over and you won’t be able to get through it.

These side effects of treatment are difficult to endure, but there are ways to lessen their impact and make life a little more comfortable for you.

An Overview Of Digestion

It’s helpful to understand a bit about digestion and know ways to keep it on track.

The process of digestion starts as soon as food enters your mouth, so chewing slowly and thoroughly is helpful. Chewing releases saliva, which begins the process of breaking down the food.

The food then travels through your esophagus and enters the stomach, where hydrochloric acid and digestive enzymes break the food into smaller particles that are then sent on to the small intestine.

With the assistance of bile from the liver and digestive enzymes from the pancreas, food continues to be broken down. It is moved through the intestines by peristalsis (involuntary intestinal muscle contractions). About 90 percent of the nutrients are absorbed into the bloodstream in the small intestine.

When the remaining food enters the large intestine, bacteria continue to extract nutrients, break down waste, and absorb water. Fecal material is what’s left over when your body has extracted all it can use. Finally, the feces from the large intestine exit the body through the anal canal.

In order to be healthy, you need to eliminate waste from the previous day on a daily basis. Ideally, this should happen soon after awakening and then maybe once or twice throughout the day.

Your body’s treatment of food through consumption-absorption-elimination relies on making choices that support that process. One of the foundational ways to take care of yourself is to provide your body with what it needs to do its work and carry you through your journey of breast cancer to renewed health and wellness.

Constipation

Most of us would probably prefer not to think about the latter part of the digestive process, but when it goes wrong, it’s generally all we can think about!

When you don’t consume enough fiber and/or water, the muscles in the colon aren’t able to contract properly, causing the stool to move too slowly and lose more water. The stool then becomes dry and difficult to eliminate.

When fecal matter remains in the intestines longer than it should, some of the byproduct material is reabsorbed into your body.

These materials are inflammatory antibodies, toxins, and can result in even more fatigue, sleep disturbances, depression and anxiety, memory and concentration issues, and hormone imbalances, besides bloating and discomfort.

There are a number of reasons your body may not be able to eliminate waste regularly:

• You are eating too many processed foods, which are lacking sufficient fiber to produce a good bowel movement.

• You aren’t drinking enough of the right liquids – water and herbal teas. Coffee, sodas, and alcohol don’t count.

• You are on pain medication after surgery. Opiates cause constipation.

It’s especially important to have more than one evacuation every day to remove accumulated toxins.

What You Can Do About Constipation

Fiber: Regularity depends on having plenty of fiber in your diet. I’ve had many people resolve their constipation simply by adding more fiber to their diet.

Your body can’t actually digest fiber, but insoluble fiber (which doesn’t dissolve in water) increases the bulk of your stools, making it easier for your body to pass solids.

Chia seeds, flax seeds, and psyllium husk are good examples of bulking agents.

Similar to the insoluble fiber in fruit, beans, and potato skins are also bulking agents and increase the volume of stools, making them easier to pass.

However, “adding fiber” does not mean using some of the over-the-counter products, such as Metamucil.

Those products actually do the opposite of what they claim; when you put them into your intestines, they suck up all the water in your gut, increasing transit time and making your stool dry. It becomes difficult to expel the fecal material and can result in hemorrhoids.

The best fiber comes from your diet, and it’s actually quite easy to add. All you need to do is eat at least four servings of organic, fresh vegetables and up to two pieces of fruit daily.

Prunes: One particularly helpful food for achieving regularity is Prunes. Their well-deserved reputation comes from their effectiveness.

They are high in insoluble fiber, but also contain quite a bit of sorbitol, a natural laxative. You might want to start with just a few prunes and gradually add more.

Prune Compote

Place in a medium-size saucepan:

• 2 cups dried organic prunes

• 1 cup of dried organic figs

• 1 cinnamon stick

• 3 whole cloves

• 3 cardamom pods

• 1 organic lemon, cut in half, juice squeezed into the pan and the lemon added

  
  

Remove stems from dried fruit and cut into quarters.

Cover completely with water, cover with lid, and simmer slowly until dried fruit is very tender approximately 15 minutes.

Let cool and store in glass jar. This may be added to gluten-free hot cereal. If you are eating whole milk organic yogurt, it’s delicious added to your yogurt.

Liquid: Liquid is also necessary for healthy elimination. Stools that are too dry can be painful to eliminate.

A good way to start your day is by drinking a large glass of warm water with the juice of a fresh organic lemon.

(By the way, lemons should be left on the counter at room temperature and not refrigerated.) Fresh lemon juice in the morning stimulates your gut, provides nutrients and Vitamin C for your immune system and helps keep your body in an alkaline state, which lowers inflammation and promotes healing.

Throughout the day, if you can drink an additional five glasses of water or herbal tea, you will have provided your body with at least the minimum amount of liquid it requires. If you are exercising and sweating, or are outside in hot weather, this number should double.

Note: I know this may sound obvious, but I’ve seen how often people are so busy that they ignore their body’s signal that “it’s time to go to the bathroom.”

By the time it’s convenient for them to use the restroom, the fecal material has moved back up the intestine and has become more difficult to eliminate. Give yourself the time and space your body needs to go to the bathroom.

Diarrhea

Diarrhea is a common side effect of chemotherapy drugs. Additionally, your immune system is in a weakened state and you might pick up an infection that can cause diarrhea. Often treated with antibiotics that can also cause diarrhea!

Sometimes diarrhea can be a sign of something serious, or, if left untreated, can cause severe dehydration.

Call your doctor if you have

• 6 or more loose bowel movements in a day for more than two days

• blood in your stool

• fever of 100.5F or higher

• inability to control the bowel movements

• severe abdominal pain or cramping that lasts more than a day

• symptoms of dehydration: dizziness, dry mouth, and decreased urine output.

  
  

Please notify your doctor if you are taking chemotherapy in pill form and get diarrhea.

What You Can Do About Diarrhea

While there is medication (Imodium) you can take for diarrhea, dietary options provide a supportive and more natural form of relief.

• Drink plenty of clear liquids, such as coconut water and bone broth. You have to replace the liquid you are losing so you don’t get dehydrated, so drink 8-12 cups a day.

• Eat low-fiber foods, such as the BRAT diet (bananas, rice, applesauce, and gluten-free toast). Other mild foods include eggs, potatoes, chicken, and gluten-free noodles.

• Eat 5-6 small meals a day.

• Avoid irritating foods—dairy products, spicy foods, beans, alcohol, foods with high-fat content, and caffeinated beverages or orange juice.

  
  

Peppermint tea has long been shown to calm the stomach and aid digestion. Peppermint contains antispasmodic properties, calming the gastrointestinal tract and allowing for more regular elimination.

Take five organic peppermint tea bags, a knob of ginger (skin removed), and steep with several cups of boiling water. This will make a very strong decoction of tea. Drink as much of this as you can.

Clay: Bentonite clay is a safe remedy for diarrhea. You can add ¼ - ½ to peppermint tea. Taken internally, Bentonite clay, also referred to as “healing clay,” absorbs toxins from the body and helps to relieve gas, bloating, and constipation.

Nausea And Vomiting

Some of the more unpleasant side effects of chemotherapy are nausea and vomiting. Whether or not you have that reaction depends on the types of chemo drugs that are used, the dosage of the drugs, when and how often the drug is given, and how the drugs are given. IV drugs may cause nausea and vomiting faster than an oral drug because they are absorbed faster. And interactions with other drugs, such as pain medication, will make a difference.

Of course, not everyone will respond to a drug in the same way. Certain women are more likely to be at risk for nausea and vomiting.

Risk factors include:

• Being younger than 50

• Being very anxious or nervous (anxiety causes very real physical symptoms and nausea is a common symptom of anxiety)

• Having had morning sickness during pregnancy

• Having had motion sickness

• Having had chemo in the past

• Being prone to vomiting when sick

• Having been a non-drinker or light drinker of alcohol

Different Types Of Nausea And Vomiting

• Acute: happens a few minutes to hours after chemo is given but goes away within the first 24 hours. The worst usually happens 5-6 hours after chemo.

• Delayed: starts more than 24 hours after chemo, up to 5-7 days later! This usually happens only with certain types of chemo.

• Anticipatory: if you’ve had chemo before, you may start feeling nauseated and/or vomit even before the chemo is actually given. About 1 in 3 women will get anticipatory nausea, but only 1 in 10 will vomit before chemo.

• Breakthrough: nausea and vomiting happen even though you’ve been given medications to prevent it.

• Refractory vomiting: When you no longer respond to medication to prevent or control nausea and vomiting. You need more or different medicines.

What You Can Do About Nausea And Vomiting

You can guard against nausea and vomiting by:

• Drinking fluids such as room temperature water, coconut water, and herbal tea throughout the day. This is especially important to replace the fluid lost to vomiting so you don’t get dehydrated.

• Eat small amounts of food throughout the day and eat before you get too hungry.

• As with morning sickness, start the day with rice crackers or gluten-free toast without any liquid.

• If you are not able to utilize intermittent fasting, avoid high fat, heavy, and greasy meals before chemotherapy.

• Avoid strong odors.

• Don’t lay down flat for at least two hours after you have eaten, and don’t exercise after eating.

When you go for chemotherapy treatment, try to keep yourself relaxed and distract your mind with soothing music, guided meditations, relaxation tapes, or a funny movie to watch on your pad or tablet. You can suck on ice chips, and bring the Anti-Nausea Tea to drink throughout treatment.

If you do start vomiting, stop eating. When you start back on food, begin with small amounts of bone broth or water.

Call your doctor if

• You continue to have nausea and vomiting despite taking anti-nausea medication.

• Nausea is interfering with your ability to eat.

• You have vomited 4-5 times in a 24-hour period.

• You feel bloated or have a painful or swollen stomach.

Natural remedies

• Drink mint and ginger tea throughout the day.

• Aromatherapy—place a drop or two of essential oil on a tissue and inhale the scent when you feel nauseated while having your chemotherapy treatment. At home, you can use an essential oil diffuser to scent the air. A blend of ginger, spearmint, peppermint, and cardamom essential oils works well, as does diffusing lemon or grapefruit essential oil. Adding fresh mint to a smoothie or infused in water also brings relief.

• You can freeze lemon slices or wedges and eat them slowly when nausea hits.

• Acupuncture and Acupressure—researchers have found that acupuncture is at least as effective as medications in controlling nausea. ¹Acupuncture stimulates certain nerves in the body, which then send signals to the brain to release hormones that reduce the feelings of pain and nausea.

• Coconut milk, flaxseed, and sesame milk soothe the stomach while bringing in nutrients that feed the immune and metabolic systems.

• Here’s a strange one: cayenne peppers can control nausea. How? Well, there’s an area in the brain called the emetic (vomiting) region that is stimulated by neurotransmitters or hormones. The capsaicin in chili peppers causes certain neurotransmitters to be released, sending a message to the brain to block nausea and restore appetite.

• Take slow, deep breaths when you start to feel nauseated. Breathe in through the nose and exhale through the mouth three times, especially when using aromatherapy scents. Studies have shown the combination of aromatherapy and breath control relieve nausea in over half the cases.

While these natural remedies may not totally alleviate your symptoms, they often decrease the severity and uplift your mood, knowing you are taking an active role in your health.

Homeopathic Remedies

Homeopathy is a unique system of health care that is based on the principle of like cures like. The term homeopathy was first used by Dr. Samuel Hahnemann in 1807 in Germany.

The word homeopathy comes from the Greek, meaning “like the disease.”

Unlike the standard approach to medical treatment, homeopathy is based on the belief that disease has an energetic aspect, impacting a person on both physical and energetic levels. The person responds to the impact of their system with certain symptoms; these symptoms are the vital force’s attempt to re-establish health.

Homeopathic remedies are made in specialized licensed pharmacy laboratories, through a process known as potentization. Because homeopathic remedies are potentized, there are no live molecular or biological products remaining when a remedy has been made, they are safe to use throughout all aspects of your cancer treatment.

Remedies used frequently for nausea and vomiting are:

Ipecac: This remedy is made from the Ipecac plant. Symptoms include constant and continual nausea. There is lots of saliva with nausea. The main symptom is nausea, feeling like you’re going to vomit with lots of coughing and gagging.

Phosphorous: This remedy is made from the mineral phosphorous. Symptoms include vomiting or nausea.

As soon as water touches the stomach and becomes warm, it is thrown up.

Because symptoms of nausea, vomiting are very individual, if these acute remedies are not helping you, please use support@thepathofbreastcancer.com if you would like a referral to a qualified homeopath.

Mucositis

As far as your body is concerned, your mouth is an extension of your intestines—the first stop in the digestive process along the gastrointestinal tract. What is going on in your digestive tract is reflected in your mouth. Our approach is to support your intestines as well as to attend to the actual mouth sores.

The oral mucosa is a very sensitive part of the body, and very vulnerable to cancer treatments. Chemotherapy treatments damage the mucosal tissue inside the mouth and throat, causing painful inflammation and ulcerated sores in these areas, a condition called mucositis.

Prior to receiving chemotherapy, you probably never even heard of the word mucositis, or thought it would happen to you! But here you are, somewhere between five and fourteen days after chemotherapy treatment and you suddenly have these painful sores in your mouth! Not only are they painful, but they are making it very difficult to swallow and eat.

Before you begin radiation or chemo treatments, it is a good idea to see a dentist, preferably one who deals with cancer patients and complete any major dental work a month before starting treatment. Make sure any dentures fit properly.

If you don’t have a good oral care regimen with proper brushing techniques, please start. A good mouth rinse (see below) is also vitally important to help prevent or decrease the extent of mucositis, or infection through open mouth sores.

Symptoms of Mucositis

• shiny, red, or swollen mouth and gums

• sores in the mouth or on the tongue or gums

• pain in the mouth or throat, which can make it harder to eat

• blood in the mouth

• difficulty talking or swallowing

• when eating, a feeling of dryness, mild burning, or pain

• whitish soft patches in the mouth or on the tongue

• thicker saliva or more mucus than usual in mouth

Healing Tea Recipes

• Marshmallow Root

• Comfrey or Slippery Elm

• Peppermint

• Ginger

Directions: Put equal amounts of herbs into an 8-cup glass Pyrex bowl, pour boiling water over. Steep for 15 minutes, strain and enjoy. 

Next Steps

Everyone responds to treatment differently. The key is to reach out to an integrative practitioner as part of your care team to individualize your holistic support during treatment.