Have you ever wondered if your chronic constipation or the little bits of food that are in your stool could be related to a tongue tie?
Or maybe you have wondered why you have “done everything” and still get constipated?
If you're a “why” and “how” person that loves knowledge, get your Nerd goggles on and get ready to take a deep dive in because info dumping is my love language. If you prefer quick info without details, I got your back. Just head to the bolded TLDR sections below.
We're first going to break down the basics on eating from start to finish and where tongue ties play a role in digestion and constipation.
Step 1: Chewing and Tongue Ties
Digestion begins in our mouths. When we first put food in our mouth, our body's job is to start the digestive process with both digestive juices and breaking down food. We chew on one side of our mouth in a rotary fashion, pushing the food from side to the other with our tongue. In an ideal world, we chew each bite 32-40 times before swallowing.
The chewing process helps take larger food and turns it into much smaller and softer food. It basically turns food into mush. This mush is called a bolus. Chewing also helps your body produce more saliva so you don't have to depend on water to help you swallow. If you are used to chugging water while eating, it may be because you aren't chewing enough or your body isn't creating enough saliva to help turn your food into that bolus.
Oftentimes, with a tongue tie we aren't able to lateralize the tongue allowing for the rotary chewing mentioned above. That means we can't easily move the tongue from side-to-side and we become dependent on chomping our food rather than using that rotary movement to grind. This requires a lot more energy and for many with a tongue tie, they naturally gravitate towards soft foods or end up not chewing food well enough.
One way to visualize this is using a mortar and pestle with something as soft as basil. Normally we take the pestle and we grind the basil within the mortar. This helps break down the basil by crushing and grinding. In the case of a tie, we're basically stabbing it up and not able to fully break it down or grind it. If we do end up pulverizing the basil, it takes a lot more time and energy! When this happens, chewing also becomes a lot more cumbersome and takes a lot more energy. Oftentimes, people are only chewing six to eight times before gulping the partially chewed food down because if they chew the full 32x they feel exhausted afterward.
Finally, chewing releases digestive enzymes to further break down our food. The two main enzymes are amylase and lipase. Amylase helps break down complex carbohydrates into sugars so they're more easily digestible. Lipase helps break down fats and fatty acids. Additionally, there's lysozyme, which breaks down the cell walls of bacteria. These enzymes help break down food, so the nutrients are more easily absorbed and can help with preventing bacteria from entering the GI tract (especially helpful in GERD, bowel disorders, constipation and diarrhea). Since digestion starts with the physical breakdown of food, when we aren't properly chewing, this increases our risk for constipation as the other parts of the digestive system were not designed to break down large chunks of food.
TLDR: How do tongue ties affect chewing? Tongue ties limit how much people chew, causing large bits of undigested food in stool and decreasing digestive enzymes needed to break down food for absorption.
Step 2: Swallowing and Tongue Ties
When we're ready to swallow that bolus of food, the anterior parts of the tongue naturally move to gather the bolus onto the tongue so it's securely against the hard palate (roof of the mouth). This movement is what keeps us from having food shoot out the sides of our mouths when we swallow.
Next, there's an elevation and retraction of the soft palate. This movement helps block air from the nose from going down while also blocking liquids from going up and out the nose.
At the same time, there's relaxation of the upper esophageal sphincter. You can think of sphincters as automatic control valves that open and close to either create movement or prevent the movement of something from one area to another. In this case, the upper esophageal sphincter stops air from entering the esophagus (where food should go) during eating and also prevents food from going into the larynx and trachea (aka “windpipe” or where air should go) while breathing. For the swallowing of liquid and food, our bodies naturally close off the larynx and contract the pharynx to block food from entering the respiratory system.
This closure and contraction is deeply intertwined with the tongue! You see, our tongue muscles are attached to the front aspect of the hyoid. On the back side of that hyoid is our epiglottis... the epiglottis is in charge of closing off the larynx to prevent food from entering the respiratory system and also preventing air from entering the digestive system. This is often why people with tongue ties complain they always choke on food or water and often experience reflux. Their tongue isn't able to freely move which limits the strength and timing of the epiglottis. When the tongue isn't able to move freely, it can prevent the closure of the larynx and let air and/or food go where it shouldn't…which causes chronic choking or aerophagia/swallowing air which can lead to reflux.
TLDR: How do tongue ties affect swallowing? Tongue ties limit or delay the movement of the tongue which makes it easier for air to be swallowed or shoot out the nose and also easier to choke on food and water.
Step 3 & 5: Peristaltic Movement and Tongue Ties
Peristalsis is the involuntary contraction and relaxation of the esophagus and intestinal tract in a wave-like movement that pushes food through the system. I'm including this as steps 3 and 5 because it occurs in the esophagus and intestines with the stomach in between.
This peristaltic movement starts with the tongue. When we swallow a bolus of food the front of the tongue acts like a wave or piston and pushes the food down towards the pharynx and this wave-like motion continues through the esophagus.
Fun fact: Both the posterior aspect of the tongue and the esophagus are innervated by the Vagus nerve. The Vagus nerve is largely recognized as being part of the Autonomic Nervous System and responds to stress. When we are in a relaxed and flowing state, we are said to be in a parasympathetic state allowing for both rest and digestion. When we are in a stress response, we are in a sympathetic state where the body is prepared to fight, flight or freeze. Vagus nerve stimulation is frequently activated in the back of the throat and tongue. When there's a tongue tie, it makes it harder for the first wave-like motion of the tongue to be started and this can delay the parasympathetic response for rest and digestion and decreases peristalsis. This decrease in peristalsis is a fancy way of saying that food stays in the intestinal tract for too long. Ideally food takes 1-3 days to fully pass through the system. If you are seeing food you ate 3+ days ago coming out in your poop, this is a sign that you are not chewing well enough and you have slow transit constipation because your food is in your system longer than it should be.
Once food has reached the intestines, the main focus is on nutrient absorption. The food should have been broken down by the digestive enzymes in the mouth and stomach. The small intestine is where 90% of nutrients and minerals should be absorbed. The goal of the large intestines are to absorb electrolytes and water, absorb vitamins and minerals as well as use that peristaltic movement to propel feces towards the rectum for it to be removed.
More than half the dry weight of poop is bacteria. If we think back to peristalsis, if our body is in a sympathetic state (fight or flight), one of two opposites typically happens. First, we can have diarrhea. This is when the body has acknowledged a stressor and basically said, "we don't have time for this" and it pushes the food through quickly so it doesn't have to use energy to break down and digest the food. The other extreme is constipation. In the case of chronic stress, the body never fully relaxes or rests so peristalsis decreases causing constipation. That means your body is absorbing more bacteria than we would like which can cause more digestive problems.
TLDR: How do tongue ties affect digestion/peristalsis? Tongue ties cause increased nervous system dysregulation and decreased peristalsis making the digestive process go from “rest and digest” to “fight or flight” and can slow down digestion causing constipation.
Step 4: The stomach
The stomach is an interesting organ because it's basically a balloon with two openings instead of one. Just like a balloon, our stomach can only handle a certain quantity inside it. If you are taking in too much air (see step 1) or your peristalsis is slowed (see steps 3&5) your risk of reflux is increased. There's an equally nerdy, information-packed blog dedicated to reflux so it's attached here.
TLDR: How do tongue ties affect the stomach? If you are taking in too much air (see swallowing above and reflux article attached above), your stomach is unable to support the increase in pressure and you are more likely to have reflux.
Step 6: The pelvic floor and bowel movements and tongue ties
Have you ever heard of the TMJ/jaw and pelvic floor connection? There's another action-packed blog on that connection here. But to summarize:
TLDR: How do tongue ties affect the pelvic floor? People with tongue ties often have upregulated nervous systems and tension. When we clench the jaw we also instinctively clench the pelvic floor muscles which can cause constipation.
The foundation to all steps: nervous system regulation and tongue ties
I mentioned this earlier with the Vagus nerve and peristalsis but it is important enough to have its own section. More and more research is highlighting that tongue ties cause open mouth breathing and can lead to sleep apnea or sleep disordered breathing. Open mouth breathing means that people aren't breathing through their noses. Nasal breathing is important because it filters air thereby decreasing risk of infection, it warms the air before it reaches your lungs, decreases dry mouth and activates the parasympathetic nervous system, causing a rest and digest or calming sensation through the body. Oftentimes people with tongue ties struggle to get a full breath or feel like they can't fully exhale because of their tongue ties. Once released, they feel like they can fully and freely breathe for the first time ever.
Sleep disordered breathing is a beast of its own because it can cause ADHD-like symptoms where kids often act wired and adults are chronically fatigued despite labs “being normal”. One way to look at this is to imagine you are attacked by a bear, your body doesn't care if you need to poop…it only cares if you escape from the bear. So it turns to the sympathetic state or “fight and flight” to help you escape rather than allowing you to “rest and digest” in the parasympathetic state. If your body is under stress from sleep apnea or chronic sleep deprivation, it will slow the bowels to account for the stress. When this happens, we often see bedwetting or “waking to pee” along with chronic constipation because the body doesn't know when to release the appropriate hormones.
TLDR: How does a tongue tie afgext the nervous system? Tongue ties increase your risk for sleep apnea and open mouth breathing which both increase the sympathetic nervous system or “fight and flight” and decrease the parasympathetic or “rest and digest system” which causes constipation
Now, because you know I hate leaving you without actionable steps, watch out for the follow up on how to support and improve constipation while you still have a tongue tie.
