Updated: Jun 2
At some point in everyone's life, we've all experienced bouts of constipation. But what if it's a chronic problem? How do you get things moving for good? Western medicine tends to quickly treat chronic constipation with laxative drugs like Mira-lax. Did you know that American's spend almost $725 million annually on laxatives?!? Because doctors have very little training in nutrition, and insurance does not cover key tests that address true status of gut health, the patient is left dependent on medication that is potentially harmful to the body (Mira-lax is a petroleum derivative now being compared to antifreeze in its neurological impacts on the body). Laxatives make the bowels lazy and cause muscles of the gastrointestinal tract to become dependent on them in order to constrict.
The problem with this approach is multi-fold, neglecting to address the main causes of constipation. With some changes in diet and lifestyle, your constipation woes should become be a thing of the past. You want to aim for at least one bowel movement per day, two is also OK. It should be formed but not hard, and brown in color. Red flags would include very small hard to pass stools, mucus, green or pale coloring, blood, or stools with large amounts of undigested food.
Here's some basic tips that have proven successful in my practice:
1. The biggest contributor to constipation is the Standard American Diet of low fiber, highly processed foods. Avoid refined grains and added sugars and instead stick with whole, nutrient dense alternatives. If it has ingredients on the label that you don't know or can't pronounce, skip it. Even better, consume foods that have no labels!
2. Reduce or eliminate dairy. Dairy is extremely constipating and inflammatory to the intestinal tract. There are many milk alternatives out there. We have tried many different varieties in our house, and my kids unanimously said that Flax milk tastes most similar to cow's milk. If you just can't give up dairy, opt for raw cow's milk and drastically reduce your intake.
3. Remove foods from the diet that damage the integrity of the gut lining, leading to inflammation and ultimately constipation or bowel dysfunction. These include artificial sweeteners, excess sugar and fructose, chemical additives, antibiotics in meats and dairy, gluten and pesticides.
4. Increase fiber. Most Americans consume an average of 15 grams of fiber per day. To get bowels moving, you should aim to get at least 35 grams per day. Be weary of product marketing and stay clear of "processed food fiber" like FiberOne bars or cereal which are full of unwanted ingredients and won't truly address the problem. Vegetables that contain high amounts of fiber include Brussel sprouts, asparagus, cabbage, cauliflower, peas, kale and potatoes. Pear and apples, beans and oatmeal are great sources. Add hemp, flax or chia seeds to your smoothies. Consider a fiber supplement, or psillium seed husks and gradually work up the dose to avoid gas and bloating. Many of my favorite fiber supplements are listed in my dispensary and are available at below retail prices.
5. With increased fiber intake, you will also need to increase your water intake in order for the fiber to work and get things moving. You should be drinking at least half your body weight in ounces of water per day. Remember caffeine and alcohol are dehydrating, and many sports drinks are full of additives and extra sugar. Fruit juices are still a source of sugar that feeds bad bacteria in the gut and should be avoided.
6. Populate your gut with good bacteria. Increase your intake of fermented foods such as coconut or water kefir, sauerkraut and pickles, kombucha, and miso. My kids love kombucha! While many people think yogurt is a good source of probiotics, pasteurization kills most strains of live bacteria. Instead consider high dose probiotic supplements from reputable brands. Many of my favorite probiotic supplements for adults and kids are listed in my dispensary and are available at below retail prices.
7. Supplement with magnesium, which increases contractions along the GI tract. Most people are deficient in magnesium, and supplementing with this really helps to restore and maintain regularity. Dosing is different for each person. For an adult, start with 100 mg per day, gradually increasing the dose up to 600-800 mg (better if taken in several doses throughout the day). When looser stools appear, you know you have reached your dose. For children, you can expect about half the dose. Magnesium citrate is a great choice as is magnesium glycinate for sensitive stomachs.
8. Vitamin C in the form of ascorbic acid is a great stool softener. Slowly increase the dose as you would magnesium.
9. Lastly, get moving. Exercise helps the bowels to move!
After a month of making changes and you still see no improvement, it may be time for some professional intervention to assess if there are deeper issues going on like food intolerances, gluten sensitivity, bacterial overgrowth or dysbiosis, or leaky gut. Comprehensive stool analysis tests can paint a clearer picture into the status of gut health, along with identifying if there are any enzyme deficiencies, inflammation, or parasitic infections that need to be addressed. Under-active thyroid and some medications can also be a cause of chronic constipation and should be considered. Test, don't guess!