You’re trudging into your doctor’s office to discuss your infrequent hard painful poops after having scoured the supplement store. You’ve tried every supplement you could find. And after a short visit your doctor prescribes a new medication. But you want to find out what’s causing the constipation and treat the root cause rather than just treating the symptom.
First, what causes constipation. For most people it’s related to diet. But there are some more serious causes, so it is advisable to consult your doctor especially with persistent constipation.
We don’t hear much about ancient hunter-gather groups having problems with constipation. I’m not aware of any hieroglyphs depicting problems with it. So we can assume that modern lifestyles are largely to blame. We know that antibiotic use and chronic stress can wreak havoc in your gut. A diet high in processed foods and sugar can cause constipation. A lot of this is probably related to how foods influence the organisms that live in your gut. This environment which includes the organisms living there is called your microbiome. Your microbiome has a tremendous impact not only on what your poop looks like, but also on other things like energy and mood.
The first step in fixing constipation then is to eat an ancestral diet. A proper human diet. A real whole food diet. There are lots of other descriptions for eating in a way that helps us be healthy. But the most important is to avoid processed foods that come in cans, boxes, or tins.
And eating out is usually not a healthy alternative to this.
Avoid specific foods that are known to cause constipation. Dairy and gluten are common culprits.
Fiber is controversial. Traditionally we have been taught that fiber is necesary in creating healthy poop. But that is not always the case in constipation. In a study called “Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms” published in 2012, researchers asked people with constipation to stop eating fiber and see what happens. They were told to completely stop their intake of dietary fiber. This meant not eating vegetables, cereals, fruits, whole grain bread and brown rice. Almost magically, the people who ate no fiber had complete resolution of their constipation. This would support the theory that if there’s a traffic jam in your intestines you don’t fix it by adding more traffic which in this case would be adding more fiber. This study was small, but the results completely change my perception of fiber’s role in managing constipation. So if eating a diet of unprocessed whole foods doesn’t fix your constipation you may want to ask your doctor if a fiber free diet is right for you. Fiber free diets are essentially diets based on animal foods. Meat, organs, eggs, fish, and bone broth are typically included in these types of diets.
A very significant root cause in constipation is magnesium deficiency. When using magnesium to treat constipation you want a form that is absorbed fairly well but also causes loose stools. Magnesium citrate is that form of magnesium. You can use between 200 and 1000 mg per day for adults as long as you don’t have kidney disease. If you get loose stools, decrease the dose a bit.
Recognize that magnesium is needed in a variety of other processes in the body. Research on different forms of magnesium for different problems is inconclusive. Based on experience, magnesium glycinate tends to be an excellent all-around form of magnesium that is well absorbed. Magnesium malate tends to give you a little more energy. Magnesium threonate has been shown to cross the blood brain barrier so it may be better for sleep. And these forms of magnesium all help to get absorbable magnesium which is helpful to address magnesium deficiency.
MCT oil (often made from coconut oil) is an excellent laxative. Some suggestions on how to use it are to add it to your coffee(which also is a laxative) or use it in place of other oils in your homemade salad dressing.
Vitamin C can also be used as a laxative in higher doses. You can take up to 4000 mg or even more per day. When you get loose stools just back off a bit. Note that higher doses of vitamin C tend to cause an upset stomach and may cause heartburn.
You likely will benefit from adding fermented foods such as sauerkraut, kombucha, or kimchi. Fermented foods have been shown to improve the microbiome in a way that we thing is beneficial. Probiotics may also be helpful.
Exercise helps with having normal bowel movements.
Staying hydrated is also critical in having normal bowel movements. And to stay hydrated you need more than just water. You also need salt. More on that in a later article.
Note that low thyroid function can also cause constipation. So if you’re tired, your hair is falling out, and you just can’t lose weight, ask your doctor about having your thyroid levels checked.
Traditional medical therapy typically includes one or more of the following that I didn’t include above:
· Polyethylene Glycol (Miralax)
· Fiber supplements such as psyllium
· Magnesium oxide (I’d say magnesium citrate is better since it’s absorbed better)
· Bisacodyl (Dulcolax)
· Fruit based laxatives such as kiwi, mango, or prunes
There are also other supplements that can be quite helpful in promoting soft bowel movements. They generally include some combination of senna, aloe, cascara sagrada, ginger, rhubarb, grape root, and a variety of other products. These are generally safe short term, but there's evidence they can cause dependence when used long term. There are few if any long term (4 weeks or more) studies. Talk with your doctor about using these since they are not entirely risk free.
Some less studied causes of constipation include organophosphate herbicides such as Roundup™. Multiple other toxins also likely have a role. We know that toxins influence what organisms live in our gut. In my opinion (note this is my opinion, not something based on well done studies) it is likely that eating foods containing toxins leads to changes in our microbiome which then cause mood changes, anxiety, pain, low energy, heart disease, diabetes, and multiple other chronic conditions. And then a plausible mechanism for the carnivore diet resolving many chronic diseases is that you avoid a lot of toxins if you alter your diet to eat only meat, organs, eggs, fish, and possibly dairy.
If you’re interested in helping provide interesting studies to your doctor, print a copy of “Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms” to take to your doctor the next time you go. Especially if you are wondering about the risks and benefits of a fiber free diet. The citation is: Ho KS, Tan CY, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012 Sep 7;18(33):4593-6. doi: 10.3748/wjg.v18.i33.4593. PMID: 22969234; PMCID: PMC3435786. You can access it directly at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435786/pdf/WJG-18-4593.pdf.
This was written by Wesley Eichorn, DO who practices at Citadel Health Center in Caledonia, MI.
This article does not constitute a personal relationship with a physician and is not medical advice.