- What Is Known About Constipation
- Healthy Steps: Constipation—First Steps
- Healthy Steps: Constipation—Full Program
- Preventing Constipation
- From Dr. Deborah's Desk
Tallying up the sale of laxatives in the US—over $750 million a year—constipation appears to be quite a problem for a lot of people. From infants to the elderly, irregular bowel movements interfere with health and vitality.
The symptoms of constipation are obvious and include infrequent bowel movements, hard stools, and difficulty passing stools. The side effects of constipation commonly include abdominal discomfort, bloating, gas, bad breath, headaches, nausea, and fatigue. It’s no wonder laxative sales are big business.
Conventional stimulant laxatives force your digestive tract into overdrive—which deprives your body of nutrients as food is rushed along. Massive quantities of gelatinous fiber drinks, swallowed in an attempt to prevent constipation, can cause problems of their own with spasms, bloating and irritation of the gut lining. Consider the gentler, easier methods offered at DrDeborahMD to help your digestive tract perform both naturally and optimally.
It makes perfect sense that the primary causes and cures for constipation are related to diet. A diet that relies heavily on processed foods lacks fiber, and a certain amount of fiber is considered essential for regular, effortless elimination. A diet based on whole, unprocessed foods provides the necessary bulk to keep waste material moving smoothly through the intestinal tract which helps to decrease the body’s load of toxins. The more sluggish your bowels, the longer your body is exposed to toxins you are trying to shed.
2017 update! I've spoken with and read the work of an assortment of zero-carb'ers: physicians and self-taught experts, their diet consists only of meat and eggs and perhaps a little cream in their sole-plant-food: coffee. Their bowels work great. I should say, when their bowels don't work, they don't stay on the diet. More than one blogger with IBS claims a cure with the total elimination of plants: fruits, vegetables, grains are gone and so are their cramps, gas and constipation. I have a growing respect for the knowledge and experience of these zero-carb'ers and they deserve an entire post of their own. Watch for it!
Fiber is the indigestible part of plants, and vegetables and fruits are the best fiber sources, rather than grains. Although grains are often recommended, they can actually cause problems because of their anti-nutrient coatings and greater potential for allergies. Fruits and vegetables are also rich in carotenoids and other phytonutrients, which help keep the mucosal lining of the large intestine healthy.
A fiber-rich diet supports the growth of beneficial bacteria, which make their home in the intestinal tract. These bacteria encourage regular bowel movements. Some studies show that improving the population of friendly intestinal flora is enough to cure stubborn cases of constipation. Supplementing your diet with naturally lacto-fermented foods such as pickles, sauerkraut, kefir, and yogurt helps replenish the supply of these beneficial microorganisms. It may also be necessary to supplement your diet with concentrated sources of probiotics, particularly if constipation is chronic or internal flora has been disrupted by the use of antibiotics.
In addition to dietary considerations, lifestyle may play a significant role in constipation, especially in stubborn cases of chronic irregularity. Regular exercise is one of the best ways to get your bowels moving. Walking and other rhythmic exercise massages the intestinal tract and stimulates peristalsis. Regular exercise also helps alleviate the stress that can contribute to constipation.
A little recognized but increasingly frequent cause of chronic constipation is a disorder elsewhere in the bowel, specifically small intestinal bacterial overgrowth, or SIBO. Please, if you have unusual constipation (by that I mean a sudden change in your bowel habits OR long-standing and seeming uncontrollable symptoms), ask your health care practitioner to check you for SIBO! Testing through a gastroenterologist is very spendy ($2500 one patient quoted me), while self-administered home kits through Genova Diagnostics and others cost less than $200. SIBO is a stubborn problem even once it's recognized; it's unlikely to go away on its own; and it can lead to serious nutritional deficiencies, especially for iron and calcium.
Ignoring your body's signals is an often-overlooked cause of constipation. Instead of postponing the urge to “go,” always heed these signals as quickly as possible. Establishing a regular toilet routine also helps. For example, begin your morning with a cup of hot herbal tea or a brisk walk, both of which help stimulate peristalsis.
Most cases of constipation can be resolved with simple dietary measures. If constipation persists, however, you should always consider other underlying causes. Prescription drugs are a common culprit, particularly opiate-derived pain medications, blood pressure medications, diuretics, antidepressants, and some antacids. Constipation is also one of the symptoms of hypothyroidism, and thyroid function should be evaluated. Food allergies can be at the root of chronic constipation as well; the most common problematic food is pasteurized dairy products, but soy, beef, peas, legumes, beans, tomatoes, oranges, and black tea can also be problematic.
Even emotions have been found to play a role in constipation (giving new meaning to the adjective “uptight”). Whether you suffer from occasional irregularity or are plagued by daily bouts of constipation, taking a natural, drug-free approach is best.
For the greatest improvement with the fewest steps, do the following:
- Probiotics are an important first step in treating constipation. Take Bio-Immersion Original Synbiotic Formula, starting at 1/4 tsp daily, increase to 1/2 Tbsp daily. Lacto-fermented foods such as yogurt, kefir, sauerkraut, and pickles also provide probiotics.
- Prunes: Soak prunes in water overnight, and eat 2-4 in the morning with soaking liquid.
- Flax Seeds, organic: Consume 2 teaspoons of freshly ground organic flaxseeds once or twice daily, followed by a full glass of water. Flax seeds keep well in a jar or in the freezer.
- Thorne Research Magnesium Citramate: Take 150-450 mg, decrease dosage when stools soften and follow nutritional guidelines in the Full Program.
- Salt your food more generously! Our bowels need salt for two reasons: it helps to hold water in the colon and it directly feeds the cells lining the GI tract. Enjoy your salt!
A comprehensive constipation treatment program involves many areas in which action steps can be taken, gradually or all at once. Start by following the basic nutrition and healthy lifestyle guidelines, with the following modifications:
Savor Helpful Foods:
- Enough salt! Ignore the conventional wisdom to limit salt. Avoid processed foods and salt to taste. Especially for those on low-carb diets, depleting your body of salt can lead to constipation, light-headedness or dizziness, and dangerous drops in blood pressure.
- Vegetables: Eat 3-4 cups of lightly steamed vegetables every day. Adding butter not only makes them delicious but also helps your body absorb vital nutrients. In addition, eat a large salad of raw vegetables daily with apple cider vinegar dressing.
- Probiotics: Lacto-fermented foods such as yogurt, kefir, sauerkraut, and pickles are a natural source of probiotics, whose beneficial microbes colonize the intestinal tract.
- Healthful fats: Consume liberal amounts of healthful fats such as organic butter, extra virgin olive oil, coconut oil and omega-3 fats from cold-water fish.
- Prunes: Soak prunes overnight in filtered water and eat 2-4 in the morning, along with soaking liquid. This old-fashioned remedy effectively stimulates bowel movements because prunes are rich in fiber and contain natural laxative compounds.
- Carbonated water: Sip a glass of naturally carbonated water (e.g., Gerolsteiner) several times a day. Research indicates that carbonated water helps alleviate constipation. Although not as curative of constipation as once claimed, drinking plenty of fluids is important if you suffer from dry stools.
- Licorice: Look for organic licorice free of high fructose corn syrup, and be guided by results, not taste!
Avoid Problematic Foods:
- Sugars and processed foods: This includes all types of processed sugars, high-fructose corn syrup, and foods made with hydrogenated and trans fats such as fast foods and French fries.
- Cheese: Cheese is low in fiber and contains little water, factors that contribute to constipation in susceptible individuals.
- Gluten: Avoid wheat, barley, rye, oats, kamut, spelt, and all foods made from these grains.
- Laxatives: Avoid stimulant laxatives, including those considered natural such as senna or cascara sagrada. Stimulant laxatives speed food through the digestive tract, preventing complete digestion. They can also be habit-forming.
- High-fiber supplements: Metamucil and other bulking laxatives work temporarily, but food-based fiber such as freshly ground flax seed is more nutritious.
- Iron supplements.
- Unsoaked, unsprouted grains.
- Allergenic foods: Pasteurized milk, soy, beef, peas, legumes, beans, tomatoes, and oranges have been shown to cause constipation in those sensitive to them.
- Black tea: Contains tannins, which can be constipating, if over 4 cups daily.
Supplements Can Help:
- Flaxseeds: Consume 1-2 teaspoons freshly ground flax seeds one to two times daily. Use whole, organic flaxseeds. Store in a closed jar or in the freezer to prevent rancidity and grind fresh daily. Add to yogurt or water at breakfast; repeat in the evening if necessary. Follow with 8 ounces of water. Flaxseeds are preferable to flaxseed oil, but if necessary, use 1-2 tablespoons of high-quality flaxseed oil daily mixed with olive oil as a salad dressing. Flaxseed oil must be refrigerated to keep fresh; rancid oils will do more harm than good.
- Probiotics: Bio-Immersion Original Synbiotic Formula. Start with 1/4 tsp daily and increase to 1/2 Tbsp daily as tolerated. For greater simplicity, another excellent choice is Integrative Therapeutics Probiotic Pearls, take 1-6 daily between meals.
- Thorne Research Magnesium Citramate: Take 150-450 mg, decrease dosage when stools soften
- Gaia Herbs Sweetish Bitters: Add 60 drops to a small amount of water and take 15-20 minutes before meals or sip during meals 3 times daily.
- Iberogast promotes upper intestinal motility, so it is especially useful in cases of SIBO-related constipation. If it works for you, please get tested for SIBO! Take 10-20 drops before meals, and 20-40 drops before bed, diluted in water.
Daily Life Activities
- Exercise: Daily physical activity is vitally important for relieving constipation, especially for the elderly.
- Establish a regular toilet time: Try to get into the habit of moving your bowels first thing in the morning; drinking a cup of warm herbal tea can stimulate peristalsis. Pay attention to your body's signals and if possible, do not delay bowel movements.
- Identify allergies: If all else fails, try an elimination diet to determine if a specific food is at the root of the problem. See special diets for more information. Note that RAST testing (blood testing for allergies) is unreliable.
- Evaluate medications: Many medications cause constipation, especially pain-relieving narcotics such as codeine and oxycodone, antacids that contain aluminum and or calcium, blood pressure medications, antidepressants, anticonvulsants, diuretics, drugs for Parkinson's disease, and antispasmodics. Ask your doctor if any of these can be eliminated or reduced to relieve constipation.
- Check thyroid health: Always consider that an untreated thyroid condition can lead to constipation. This may be a hidden source of your problem. See our upcoming article on Hypothyroidism.
- Consider emotional causes: Research shows that psychological therapy improves both emotional health and bowel function in patients with chronic constipation. Biofeedback (a behavioral therapy) can also improve activity in nerve pathways to the gut.
To prevent chronic constipation, avoid the use of stimulant laxatives. Instead, use natural remedies such as soaked prunes and flaxseeds and make the dietary and lifestyle changes outlined above. Frequent use of stimulant laxatives causes the colon to become “lazy,” making it difficult to have a bowel movement without the excessive stimulation provided by drugs. This is true for herbal laxatives (e.g., cascara sagrada and senna) as well as pharmaceutical laxatives.
Making the effort to eat a healthful diet rich in natural fiber and probiotics is the best way to ensure a healthy internal environment and promote regularity. In addition, taking the time to exercise regularly, manage stress appropriately, and schedule appropriate toilet time allows the body to perform the task of elimination with ease.
What I love about probiotics is that they are often a perfect solution for either constipation or diarrhea! I never travel without Magnesium Citramate and Probiotic Pearls. I take the probiotics regularly and pull out the magnesium if I'm stuck sitting for too long without time to exercise. The probiotics are essential when the opposite problem arises.
A family with two young siblings came to the office recently: the girl was constipated after diarrhea the week before and now her brother was getting the diarrhea. One package of Probiotic Pearls (kids seem to love their size and shape), fixed up the two of them within 24 hours.
This information is provided for educational purposes only, and any individual diagnosis or treatment should be determined by you and your doctor. See Additional Information.