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What we do early (and why it works): Hydration plan (not just drink more, but a measurable daily target) Fiber strategy tailored to tolerance (some patients worsen with aggressive fiber early) Movementeven short daily walks help gut motility Clinician-guided use of magnesium or other supports when appropriate Sherman Oaksspecific insight: In the San Fernando Valley, we see constipation worsen quickly in patients who are busy, underhydrated, and spending time outdoors year-roundespecially when appetite drops and fluid intake drops with it

However, when the vagus nerve is impaired, the bodys ability to interpret gut signals is disrupted, leading to increased food noise

186 Throughout the host lifespan, the gut microbiome provides essential signals to microglia during health and disease

Wang MD, Huang Y, Zhang GP, Mao L, Xia YP, Mei YW, et al

Karen called me yesterday to tell me she finally figured out her food situation