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Musical inspiration:  Led Zeppelin  “In through the Out door”

Today we are going to talk a bit about your “out door” as part of the brain gut series continues.  Today I am going to show you how spinal biomechanics and defecation are intimately related to good or poor physiologic function and may result in illness.  The human spine has 5 lumbar verterae and one block of bone distal to it called the sacrum.  The sacrum forms the back bony wall of the pelvis.  The pelvic skeleton is the anchor points for the pelvic muscles that support our pelvic and abdominal organs.  One of these organs is our colon.  Colon cancer is now the second most common cancer.  In 1900 it was number 37th on the list of cancer deaths.  What caused such a dramatic rise in 112 years?  Could this some how be related to spinal degeneration and or the modern diet?  How might some modern behaviors be additive to this puzzle?

The pelvis floor has many muscles in it but we are going to focus on the muscle group that connects the colon to the pelvis today to illustrate a point about how altered bio mechanics can lead to disease.   The levator ani is a broad, thin muscle group, situated on the side of the pelvis.  The levator ani is divided into three parts:

Iliococcygeus muscle

Pubococcygeus muscle

Puborectalis muscle

ANATOMY GEEK FEST:  It is attached to the inner surface of the side of the lesser pelvis, and unites with its fellow of the opposite side to form the greater part of the floor of the pelvic cavity.

It supports the viscera in pelvic cavity, and surrounds the various structures which pass through it.  The pelvic floor is different in men and women because their pelvic anatomy is quite different.

In combination with the coccygeus muscle, it forms the pelvic diaphragm.

The fibers which form a sling for the rectum are named the puborectalis or sphincter recti.

They arise from the lower part of the pubic symphysis, and from the superior fascia of the urogenital diaphragm.

NON GEEKS:  These muscles act in unison normally to meet with the corresponding fibers of the opposite side around the lower part of the rectum, and form for it a strong sling. Relaxation of this sling increases the angle between rectum and anus, allowing defecation in conjunction with relaxation of the internal and external sphincters of the rectum.  In essence, the muscles are designed by evolution to work best with the help of gravity.   When we use gravity and the muscles together well we avoid disease of the colon.  The combined action and coordination of these muscles allows us to avoid frequent bouts of colitis, hemorrhoids, constipation, inflammation of the proximal colon causing appendicitis, and possibly even colon cancer due to sustained chronic inflammation that can develop over time.  This can also lead to many dysfunctions of pelvic floor if it is left untreated for decades.

COLON CANCER ALERT:  55% of colon cancers show up in the sigmoid colon and 25 % more show up in the cecum (proximal colon) where the appendix sits right behind the ileocecal valve.  Remember that inflammation is usually present before cancer shows up.  This may help you understand why appendicitis is so common today. 

In my opinion, dysfunction of this valve due to inflammation is the most common cause of appendicitis in North America.  The source of the inflammation can vary greatly.  Heretofore, many people have looked predominately at the dietary causes of inflammation in the gut,  but few people have thought how modern biomechanics of the spine might affect physiologic function of the colon.  Today we are going to examine how your spinal biomechanics might be one of the major co variables in your colon issues.

GEEK FEST:  The levator ani group relies heavily on the lumbo-sacral angle of the spine.  This angle is formed by where the lumbar spine ends at L5 and the big bone of the sacrum (our vestige of a tail) is located in the pelvis.  The greater the slip angle present in our spine, the more stress is placed upon the puborectalis muscle.  This sling is altered when the spine loses it normal mobility or when we sit with our hips and knees at a 90 degree angle.   This slip angle is increased by degenerative disc disease (DDD) of the L4-5 and L5-S1 discs or by a process called a spondylolisthesis.  This problem can be inherited or can be acquired by a fracture in the pars interarticularis of the spinal vertebrae.  It is not important that you know about these conditions unless you have been diagnosed with it already.  When this process is chronic in the spine, it walks hand and hand with modic changes of the disc and vertebrae.  This means the disc is dehydrated.  Many people with modic changes also have dehydrated stools and this results in constipation.  In my years as a spine surgeon I have noticed a correlation of severe colonic disease in my patients with DDD or in degenerative or lytic spinal slips.  It became so clinically prominent in 2007, that I began to look for a link  between the spinal angle and to colon disease.  I found a relationship between the lumbo-sacral bony angle and anorectal angle.


NON GEEKS AND GEEKS UNITE:  I found that patients with altered bony anatomy also had alter muscular anatomy and this lead to higher incidences of colon disease.  Back then it did not seem like a great insight.  Most spine surgeons know that bone position often dictates muscular action.  What I failed to realize for ten years is how this alteration in biomechanics was tied to colon health.  The link in the altered musculature of the proximal and distal colon due to this altered spinal and pelvic biomechanics.   It appears as if the slip angle increases and the discs degeneration by losing water content while simultaneously these people lost the ability to hydrate their stools well because of the longer transit times in the colon.  Many times these patients would require enemas and dis-impaction post op by our nursing staff after surgery on their spine.   After I made this link I decided I needed to figure out a way to help offset this in these patients to help them.  It was here I began toying with the idea of improving mitochondrial efficiency of their smooth muscles in theor colon’s to help inflammation and transit time.  I came up with the Mitochondrial Rx and the EPCOTx plans.  My members have already heard the webinar on the the EPCOTx protocol.  Soon I will release the Mitochondrial Rx on  the blog.  I have found it has many more clinical uses than just helping the colon.

span style=”text-decoration: underline;”>MORE GEEKINESS?

What did I also find in almost all these patients clinically?  The common tie in these patients was some degree of DDD,  low iodine levels, disc dehydration, higher HS CRP’s, low DHEA and Vitamin D levels on their labs.  Many also had altered testosterone and progesterone levels too.  These things all made sense when I learned about the ties of sex steroid levels and gut flora.  We covered that in Brain Gut 9, so maybe you hit the link and review it now.  After three years of observation,  I was convinced these findings had to be correlated with things also present in the colon directly.  So on some of my patients I began to ask them to consider get formal GI testing with their doctors and using Metametrix GI testing.  Some also had PCR analysis done of their gut flora when I explained the situation to them.  Many told me of years complaining of constipation to their PCP and GI doctors and just got told to eat more fiber.  That made their problems worse by report.  Pro and prebiotics will help but they wont solve an altered gut flora and altered hormone panels.

The common ties I found were that most people with these spine problems had higher levels of inflammation systemically in their serum labs but it also correlated with alterations in their SCFA profiles and low butyrate levels in their colon.  This connection had profound meaning to their clinical symptoms.  Most also had altered gut flora’s as well by history and lab testing.  I felt I might have stumbled into something important.  When I tested them further, I often found very altered sex steroid levels and pretty significant hypothyroidism.  Often times they were being treated for hypothyroidism with T4 only meds and they needed more support to help their colons and spines work better.  Hypothyroidism is a sure sign of leptin resistance and the major underlying cause of mitochondrial dysfunction as you will see later this year on the blog. The patients who tended to be more obese with less mobility of their spines had more significant DDD and colon diseases. 

This appeared to be another way the brain gut axis acted together in illness to cause disease in both organ systems.  The larger the patient was (especially the belly) the higher the incidence and prevalence of constipation and hemorrhoids seemed to be.  I also noted that the mobility of their spinal biomechanics was very abnormal in most cases.  This did not surprise me as a spine surgeon but the link to colon disease was pretty remarkable consistent observation.  Most of these patients insidiously lost the intrinsic ability to flex, extend and rotate their lumbar and sacral spines normally.

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Please Note: The author of this site is not engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained within this work are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision. I shall not be liable or responsible for any loss or damage allegedly arising from any information or suggestions within this blog. You, as a reader of this website, are totally and completely responsible for your own health and healthcare.