Everything you need to help Constipation
Strategies to Fix Constipation
In this article I will walk you through foundations in nutrition, supplements, and really important other factors to consider outside of diet and supplements when it comes to correcting constipation. Many people only look at diet, pills, and powders to fix this problem. However, some individuals have underlying factors that need to be addressed that diet and pills will not fix!
Just how constipated are you?
There is an experiment you can do to get the answer to this question. Try eating corn or beets, document the day and time you ate it. Then wait and see how long it takes to see the red in your stool and/or the corn. Ideal time is 12-23 hours. However, it is very common for people to take much longer. Just because it is common though doesn’t mean it is healthy.
"Eat food, not too much, mostly plants"
– Michael Pollen
Plant foods should be the foundation of our diet to support a healthy gut and healthy bowel movements. Unfortunately, when you are chronically backed up, many of these foods, especially in higher quantities, can cause more discomfort. When this is the case, it is suggested to increase plant foods slowly as needed while supporting yourself with laxatives at the beginning. Start with cooked veggies and smoothies.
Eventually your goal is to be getting in leafy greens, whole grains, beans, nuts, seeds, and other fruits and veggies. While increasing these foods in the diet, you will automatically be eating less white flour, white sugar, and animal products. All of these have been shown to negatively impact our microbiome in excess. Once you are a little further along it is good to add in fermented foods like raw kraut, kefir, yogurts, and other fermented foods.
Fiber Intake: Emphasis on whole grains, fruits, vegetables, nuts, seeds, and legumes. Minimum of 20-25 grams of fiber a day, and working up toward larger quantities 30-40 g/day depending on your caloric needs/size.
Functional foods: There are a number of foods which, due to either their fiber profile and/or other properties contained in them, are great foods to support constipation. These include prunes, flax, chia, celery, oats, apples, pears, lentils, olive oil, hot tea, and barley.
Morning Routine: Try and eat at the same time every day. When you first wake up take 1-2 Tbsp. of a good cold pressed extra virgin olive oil on empty stomach. Then have at least 16 oz. of water. If you skip breakfast, consider drinking a bit more than that first thing in the morning. Consider making it warm lemon water (drink with a straw so not to damage your teeth), or an herbal tea which supports gut health, liver, and or motility.
Nutrient dense supplemental foods: Nutrient deficiencies can contribute/cause constipation. Particularly, a number of vitamins, minerals, healthy fats, and proteins, are needed to support various parts of the digestive system needed for healthy bowel function. There are numerous foods which are nutrient dense which can help fill in these gaps. Consider 1 tsp of bee pollen a day (contraindicated for heart conditions/high blood pressure), 2-3 tsp. black strap molasses diluted in warm water, sipped slowly for 2-3 months. Kelp granules- kelp is one of the richest natural sources of iodine. Sprinkle onto food (great with Japanese food).
Foods/Beverages to avoid: Artificial sweeteners (some are not good for microbiome and/or cause gas), carbonated beverages, might need to decrease raw veggies and replace with more cooked or blended (i.e. smoothies).
Caffeine-free teas that support gut/motility: Celebration Herbals Angelica Tea , Celebration Herbals Meadowsweet tea , Traditional Medicinals Lemon Balm , Traditional Medicinals Ginger Aid , Chaga Organic Herbs Buddah Tea , Celebration Herbals Artichoke Leaf Tea , Alvita Organic Milk Thistle tea
Fluid Intake: Increasing fiber without also increasing fluid intake will cause constipation. Caffeine requires more water. For every 8 oz. of coffee you should have double that in EXTRA water. Every tablespoon of fiber supplement requires at least 1 cup of water. This is in addition to the minimum 8-10 cups of water a day recommendation. Having a large glass of water when you wake up in the morning, can also be very helpful.
Chewing/Blending: Slowing down when you eat and making sure you are chewing food enough is very important to support all areas of gut health. Some (not all) individuals may get added benefit by doing only cooked or blended. Essentially avoiding raw whole fruits, salads, nuts, seeds, but including these foods cooked/blended/ground, depending on level of constipation and potential other factors impacting gut health.
When eating more fiber and drinking more fluids isn’t enough to get you regular, natural laxatives and fiber supplements are the first line of defense. There is not a one size fits all approach with dosing supplements. It is always suggested to work with a knowledgable healthcare provider in this area. Belly is a telehealth app that takes insurance and has a team of dietician's trained to help you throughout this process! Download GI Trak app to get started today!
Osmotic laxatives pull water into the colon to help with constipation. Be consistent with your laxative. Once you find what dose works for you (which takes trial and error), be consistent and take it every day while you are doing all the other tips provided to strengthen and rebuild the gut! Be consistent on the front end. The biggest mistake people make with laxatives is not being consistent daily with taking it. The goal is that, once you have built a foundation (through other tools provided), you can slowly wean off your laxative. It takes time to tone the muscles, build up the microbiome, and retrain the gut. You may need to be on a laxative for up to 6 months.
My favorite osmotic laxatives: These are particularly important when you have hard stools because it fulls in water to help soften the stool.
Avoid stimulant laxatives like Senna, Dulcolax and Cassia. These can be more habit forming.
Other Pro-kinetic Support:
These are products designed to support gut motility/peristalsis.
Prokine (#1 pick)
Ginger - Juiced (2-4 Tbsp.)
Doctor prescribed Motegrity
Perilla Extract as another herbal to support constipation, motility, and inflammation
There is not one fiber supplement that is best for everyone. Some fiber supplements do a better job than others. Some fiber supplements are better tolerated than others. Psyllium has great research showing that it can be very effective for constipation. However, because it does contain insoluble fiber, some people cannot tolerate it. Many people do not like the taste of the natural psyllium powder. Depending on the dose of psyllium needed, capsules might not be practical.
My favorite fiber supplements:
Psyllium powder (better tasting option then plain: natural flavored/sweetened with sugar alcohol and stevia)
Hydrolyzed guar gum (psyllium-free, no texture/flavor issue)
Prebiotic fiber (psyllium-free)
Freshly ground whole flax seeds (2 Tbsp. freshly ground) - It is suggested to keep flax seeds whole and refrigerated and grind in blender, food processor, or spice/coffee grinder before use. Flax is high in delicate healthy fats which go rancid easily. This is why it is best to grind fresh and keep refrigerated after opening package. Add to smoothies, hot cereal, yogurt, or apple sauce.
Chia Seeds (2-3 Tbsp.) - It is also suggested to keep these refrigerated (all nuts and seeds ideally should be refrigerated to prevent rancidity). Soak overnight in any liquid. You can use a lot of liquid to make it more of beverage or use a ratio of 2 Tbsp. chia per 1/2 cup of liquid to make a chia pudding.
Another way to sneak in fiber is this psyllium flax muffin recipe (3.5 Tbsp. ground flax, 1/2 Tbsp. psyllium in 3 small muffins)
Other good fiber supplements:
Unfortunately, the companies that make these add a bunch of unneeded ingredients (i.e., artificial colors, artificial sweeteners). However, when you can’t tolerate psyllium, and don’t like the taste of the more natural options, Citrucel is recommended.
For those that tolerate psyllium, but don’t tolerate sugar alcohols or the taste of plain psyllium power, Metamucil is an option.
Beyond Diet and Supplements
Dyssynergic Defication (DD) - poor neuromuscular coordination impacting one's ability to have proper bowel movements. Sounds complicated, but guess what...Biofeedback has been shown to be clinically effective at treating this type of constipation. In fact, a meta-analysis actually showed that biofeedback was over 3 times more effective for DD than fiber, laxatives, and prescription drugs. This is often done with a physical therapist trained in this area. One study showed that 35% of patients with constipation had DD with other research claiming up to 50% of constipation cases being due to DD. Potential causes include: psychological trauma, chronically "holding it", muscle/pelvic floor issues after childbirth, poor neuromuscular skills (from childhood), and pain avoidance. Chronic constipation in and of itself can lead to DD as well. Unfortunately, it is not so easy to self diagnose. There are no symptoms that are exclusive for DD. However, this study revealed that those that have DD are more likely to have an urge "to go" and need to strain for longer than 2 minutes to have a bowel movement, and feel like they do not empty completely after they do go. If you think you might have DD, you can ask your doctor to test to see if you have this (anorectal physiology test and balloon expulsion test). Here is a video to learn more about biofeedback for DD.
Stay Calm: As you probably already noticed, stress can significantly impact digestion. It is important to try and address stress that occurs throughout the day to support healthy digestion. Pay extra attention to try and stay relaxed and calm while eating and while in the restroom. Try some slow deep breathing if needed. Consider 8 rounds of deep 4 second nose inhale, 2-4 second hold, and 8 second slow exhale through the mouth. Do this 3 times a day. Your nervous system will thank you!
Hot water bottle: An old remedy that targets constipation through activating a sluggish liver! Try using a heating pad or hot water bottle over the area of your liver for 15-30 minutes a day.
Support Muscles: There are exercises to help strengthen muscles that can help support bowel movements. Try these YouTube videos Meridian Exercises for CONSTIPATION | 10 Minute Daily Routines, Exercises for Relieving Constipation, IBS Bloating and Abdominal Pain (also includes massage technique), Nadya Andreeva: A healthy lifestyle you can stomach.
Squatty Potty: Research shows that using devices such as squatty potty significantly decreases straining, shortens time in bathroom, and improves complete elimination. There are multiple options for squatty potty on amazon. Here is a fancy bamboo squatty potty and this one is one of the least expensive options. The standard height is 7”, but they do make some that are higher.
Medications: Some medications can increase constipation. These include: Antipsychotics/neuroleptics that have anticholinergic effect, Sleeping pills, Antidepressants, Anticonvulsant anxiolytics, Opioid analgesics, Antiparkinsonian drugs, Antispasmodics, Anticholinergic bronchodilators, Anticholinergic antihistamines, Antidiarrheal drugs. When these medications are needed, proper diet, and possibly additional supplement support to counteract these constipating effects might be necessary.
Conditions that can cause constipation: low caloric diet, hypothryoidism, hypercalcemia, Parkinson's, diabetes, spinal cord injury, traumatic brain injury, or other condition impacting the vagus nerve. It is important to properly address the primary condition in these cases.
Elevated serotonin can increase constipation. This is why SSRI's can cause constipation. However, Chris Masterjohn PhD proposes it is possible to have higher levels of serotonin even if you are not on medication or supplements which increase serotonin. He suggests, comprehensive nutrition panels (if needed) to look at potential deficiencies in nutrients needed to power pathways needed to clear serotonin (i.e., sodium, riboflavin, Vitamin B5, and methylation).
Vagus Nerve: The vagus nerve is the part of our brain that controls the movement of food through the digestive system (AKA peristalsis) as well as stimulating gastric secretions important for digestion. The vagus nerve can dysfunction secondary to head trauma, infection, and chronic inflammation. There are many modalities to try and stimulate the vagus nerve in order to help support gut motility/peristalsis:
Slow Rhythmic Diaphragmatic Breathing (YouTube: How to do belly (diaphragmatic) breathing)
Humming/Singing/Chanting- (YouTube: Hum to activate the Vagus Nerve)
Splash cold water on the face or put a big bowl in the freezer with some water in it. Then just add extra water before putting your face in the water.
Hot/Cold Shower: Start with hot water (2 min.) then change to very cold (30 seconds) shower (2-3 times back and forth)
Meditation (Try headspace or Calm app)
Balancing Microbiome - start with nutrition suggestions in article, consider adding probiotic
Accupuncture (certain points can be effective in stimulating vagus nerve)
Corotid Sinus Massage – (YouTube: Activate your vagus nerve with this simple massage technique)
Specific head, neck, eye movements (YouTube: Vagus nerve stimulation - head tilt and eye gaze, Three easy eye exercises to access your vagus nerve)
Reflexology – (YouTube: Classical Reflexology Vagus Nerve)
Lying or Sleeping on Right Side
Technology/Treatments: Sine Wave, Frequency Specific Microcurrent, Neural Therapy, Biomag (PEMF) - May need to work with a knowledgable healthcare provider.
References to Studies for Supporting Vagus Nerve
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