Diet for Constipation

by Sue Kira, Naturopath & Clinical Nutritionist

About Constipation
What is constipation?
Potential causes of constipation:

Constipation and Diet
Introduction to diet for constipation
Fibre and other foods that make or break constipation

About Constipation

In the notes below you will be presented with an array of possible causes of constipation so that you, with the support of your health practitioner, can ‘get to the bottom’ of why you have constipation (pardon the pun). ?

What is constipation?

The word constipation comes from the Latin constipare meaning ‘to press, crowd together’. (So if you’re packed together like sardines at a football match, would everyone be constipated? Just wondering).

To understand constipation is to understand the large intestine, also known as the colon, which is a tube about 1.8 m (6 feet) long that transfers waste from the body in the final stage of digestion. Apart from processing waste products before elimination, the colon’s function is to absorb liquid from the waste in the bowel and send that liquid to the kidneys which filter out nutrients essential for the body and good health. That’s why you lose electrolytes (minerals) when you have diarrhea because the liquid goes straight through the intestine.

Some consider that constipation is when stool frequency is less than daily. But movement of faecal waste depends on many factors such as the type of foods eaten and/or frequency of eating. For example, someone who eats a lot of meat will have more stool than someone who eats a predominantly plant based diet, because vegetables and fruits have a high percentage of water and less residue.

Having said that, about a third to a half of stool matter is made up of waste from the body such as discarded blood cells or sleuthed off internal skin, rather than just waste and fibre from the foods we eat.

Whatever way you look at it, constipation is a condition of the digestive system which occurs in most cases because the colon has absorbed too much water from the digested food that is in the colon, or, the muscles in the colon contract poorly and then the stool moves too slowly and loses more water.

The slower that food moves through your digestive tract, the more water the colon will absorb.

Some people have a very long intestine and food waste takes longer to be eliminated. As a result, the stool can become dry and hard and emptying the bowel can be very painful, and in serious cases there may even be bowel or rectal tearing or bowel obstruction.

Potential causes of constipation

Please ensure that you consider all possible causes with the help of your doctor or health care provider. Let’s have a look at some of these….

Bacterial imbalance or parasites
Bacterial imbalance or parasites can cause constipation, which can relate to parasitic infections, bacterial overgrowth such as SIBO (small intestine bacterial overgrowth) or insufficient good bacteria in the gut. These need to be checked properly, because taking a probiotic may not be the answer as you could be low in only one strain of good bacteria but high in others.

Out of balance hormones
Sometimes hormones can be out of balance. For example, a sign of imbalance could be when a woman goes to the toilet without any problems during her period, but at other times, has problems. Other hormones such as thyroxin or endocrine hormones may not be optimal which can affect the bowel.

Even if a doctor says thyroid levels are fine, that does not necessarily mean they are optimal. I suggest to also check with your naturopath.

Pregnancy
Pregnancy brings about hormonal changes which can make some women more susceptible to constipation. The uterus may also compress the intestine, slowing down the passage of the food. However, for others, pregnancy is a time when they ‘go to the toilet’ better than ever because their hormones are more stable.

If pregnant, it is very important to do what you can regarding diet, fluid and appropriate exercise (movement) to ensure that you are passing faecal waste effectively, as it is certainly not a good time to use drugs or laxatives to move the waste through your system.

It’s best to talk to your doctor or health practitioner for advice on what is best for you.

Neurotransmitters
Serotonin is a neurotransmitter that not only helps with mood and sleep patterns but also with bowel function. Around 80% of serotonin receptors are found in your gut. With insufficient serotonin, the movement of the bowel doesn’t function properly.

Physical inactivity or excessive exercise
Exercise is very helpful for good bowel function (provided you drink plenty of water to prevent your body and colon from dehydrating).

Some say that physical activity keeps our metabolism high, making our bodies more efficient. Elderly people tend to have more sedentary lifestyles compared to younger people and are therefore at higher risk of constipation. Having said that, many young people have a less active life because of many hours spent on electronic devices and computers.

Physically active people are much less likely to be constipated than inactive people.

Dehydration
If you already have constipation, drinking more water might not get rid of it, but if you regularly drink plenty of water you are less likely to become constipated in the first place.

If you suffer regularly from constipation, consider increasing your consumption of water and reduce dehydrating drinks containing caffeine or alcohol as these have a diuretic effect, meaning they drain fluid from your body.

You may have noticed that tea, coffee, soft-drink/sodas with caffeine and drinks such as beer make you want to go to the toilet to pee more often. This fluid is then not available to lubricate the bowel and keep things moving.

Aging
As we get older our metabolism slows down, resulting in less intestinal activity. The muscles in the digestive tract do not work as well as before, so it is super important to do your best with diet, fluid and movement to keep things ‘flowing in the right direction’.

A change in routine
Irregular routines, travel and shift work can affect our digestive system, which sometimes results in constipation. Meals might be eaten at different times or we might go to bed and get up and go to the toilet at different times. These changes can increase the risk of constipation, so try to stick to regular meal times and routines if possible.

Overuse of laxatives
Overuse of laxatives can lead to dependency and constipation. Many people self-medicate with laxatives which can be effective for constipation but can be habit-forming. The bowel can get used to the dose, which means more (and more) laxatives need to be taken to make them work. By becoming dependent on them, there is an increased risk of constipation when we stop taking them, or they simply stop working.

Postponing going to the toilet
There can be many reasons to delay going to the toilet, but if you ignore the urge to have a bowel movement, that urge can gradually go away until you no longer feel the need to go. The longer you delay, the drier and harder the stool will become.

Stress & mineral imbalances
Stress robs the body of minerals and nutrients, particularly magnesium, B vitamins and vitamin C. Mineral imbalances can cause constipation, therefore, stress can be a driver of constipation. Apart from stress management, a diet rich in these nutrients can help.

Slow migrating motor complex (MMC)
The MMC is a wave like activity of the smooth muscles in the stomach and small intestine which is triggered by fasting states. Generally if you haven’t eaten for 3-4hrs the MMC will be activated to move food along from the stomach and through the small intestine. But if during this 3-4hr timeframe you have something else to eat then the migrating motor complex stops and gets ready for incoming food.

How does MMC affect constipation? If you snack regularly or have small meals often then food isn’t going to be pushed along as it should be and digestive stagnation occurs. This creates a slower transit time overall in the digestive process.

You see, each process of digestion stimulates the next, so if one phase of digestion is slowed down, then the rest is. This creates digestive imbalances, bacterial overgrowth, changes in the gastric pH, and gas build-up in the intestines.

If the MMC is not working properly due to eating too frequently or by poor Vagus nerve function, then prokinetics (things that make the bowel move) can be used to facilitate this process. Chewing well during eating, having a 3-4hr break between feeds, eating bitter tasting herbs, or eating vegetables such as leafy greens, can all help to increase MMC and prevent constipation.

Medications
(Note: Do not stop any medication, even if you feel it is causing your constipation, until you seek medical advice)

Medications that may cause constipation include:

Narcotic (opioid) pain drugs, such as codeine (Tylenol#3), oxycodone (Percocet), and hydromorphone (Dilaudid)
Antidepressants, such as amitriptyline (Elavil) and imipramine (Tofranil)
Anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol)
Iron supplements
Calcium channel blocking drugs such as diltiazem (Cardizem) and nifedipine (Procardia)
Aluminium-containing antacids (e.g. Amphojel, Basaljel)
Diuretics like chlorothiazide (Diuril)

Diseases and disorders can cause constipation

The following diseases and disorders can cause constipation:

IBS: people with IBS get constipation more frequently
Tumours: can compress or restrict the flow of faecal matter through the colon, causing constipation
Scar tissue/adhesions, such as from appendix surgery or endometriosis
Diverticulosis and diverticulitis (inflamed pockets in the bowel)
Narrowing of the colon or rectum from colorectal stricture
Hirschsprung disease: a birth defect where nerve cells are absent in the large intestine, not stimulating bowel contraction to move waste out, which subsequently gets blocked.

Diseases that slow down faecal movement

Diseases that can slow down faecal movement through the bowel include:

Neurological disorders such as MS (Multiple Sclerosis), Parkinson’s Disease, Stroke and Spinal Cord Injuries
Endocrine and metabolic conditions such as Uraemia, Diabetes, Poor Glycaemia Control, Hypothyroidism, Hypocalcaemia (low blood calcium)
Systemic diseases, which are diseases that affect various organs and tissues, or the whole body. These include SLE (systemic lupus erythematosus), scleroderma and Amyloidosis – a condition where an abnormal protein called amyloid builds up in the tissues and organs, affecting shape and function
Cancer, mainly due to the medications for pain and chemotherapy, but can also occur if a tumour blocks or squeezes and narrows the digestive system.

Constipation and Diet

Introduction to diet for constipation

For many, constipation is more about what you need to leave out of your diet rather than what you should add to it.

It is common for people to think that adding more fibre by way of psyllium husks etc will help. For some this works a charm, but for others it’s more about what specific foods not to eat.

This is when we need to consider food intolerances. Allergic reactions to various foods are usually severe and dramatic, whereas food intolerances are often subtler, yet can still be very disturbing.

Intolerance to gluten foods and dairy products are very common. Even if you think you are not intolerant to these foods, they can commonly create inflammation in the bowel which then initiates an immune reaction.

This can leave you feeling tired, subsequently making you crave sweet foods that then feed the bad bacteria in your gut. This overload of bad bacteria in the gut pushes out the good guys which are needed for proper absorption of nutrients. This scenario creates further depletion of your energy making you choose carbs and sugars for an energy boost.

The inflammation from the dysbiosis (imbalance in bacteria) and inflammation from the foods irritating your gut creates extra heat (inflammation) in the bowel which dries out the stool so it can’t pass out effectively, even if you drink plenty of water and eat lots of fibre rich foods.

This is why I suggest that it’s more about ‘eliminating the crap’ from your diet rather than what you add to your diet, which can make the difference between constipation and good moving stools.

Fibre and other foods that make or break constipation

It is well known that those whose diets include a good quantity of fibre are significantly less likely to suffer from constipation. Foods that are low in fibre and high in fats, such as eggs, meats and cheese are generally considered types of foods that promote constipation.

If you like to eat these foods then ensure you also eat enough fibre rich fruits, vegetables, whole grains, nuts and seeds to help clear the fibreless foods.

There are two main types of fibre, soluble and insoluble. Soluble dissolves in water, while insoluble doesn’t. Fibre is generally not digested, but instead acts like a broom to sweep out debris. This helps to feed the good bacteria in our gut and produce long chain and short chain fatty acids that help our digestive system to absorb nutrients and stay healthy.

Most foods contain both insoluble and soluble fibre but are usually richer in one type than the other. Soluble fibre is found in nuts, seeds, beans, lentils, peas, some fruits like apples and some vegetables as well as in seeds like chia, flax and psyllium.

Insoluble fibre is found in foods such as whole grains and certain vegetables, such as celery and sweet potatoes. These fibres can help the lower bowel more than the small intestine.

Fibre in our diet promotes bowel movements and helps to prevent constipation. However, fibre is better to prevent constipation rather than clear it. If you are already blocked up, then a bulking load may not push it out, so it will first need softening with herbal laxatives, magnesium or vitamin C – and then eat fibre rich foods to maintain good bowel function.

Fibre can also create constipation if it does not contain enough liquid to maintain a jelly like consistency, so also ensure that you drink plenty of water.

Some insoluble fibres such as those found in grains like wheat are considered to promote constipation and are scratchy for sensitive colons. These insoluble fibres also contain phylates (anti-nutrients that can deplete some of your vital nutrients) while moving through your digestive system.

There are many reasons why someone might be constipated, therefore it is difficult to have a ‘one-size-fits-all-best-diet’ for constipation. However, a diet for constipation could be great for you, particularly if you have excluded other potential issues to ensure you are doing everything you can to have efficient bowels.

Go for foods based on being soluble fibre rich, highly nutritious (especially B vitamins, C vitamins and magnesium), and high in good oils such as seafood, fish, avocados, nuts and seeds to help get you moving. Gluten, dairy, and additives free foods are highly recommended, along with minimal sugar.

Timing of meals (meal spacing)
It is important to only eat up to three times a day (without snacking) to allow plenty of space between meals so your body can fully digest one meal before more food is added to your digestive system. There are specific gut hormones (Migrating Motor Complex) that are released after your stomach has been empty for a few hours; these hormones trigger peristalsis, which is very important to prevent constipation.

Important: Before you commence a new diet, see your medical or health care professional for qualified guidance about what foods and supplements are best for your body. While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional.

Note: During the early stages of a new diet, you may experience symptoms such as fatigue, headaches or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.

Case study: simple constipation

Client name and identifying information changed

When I say ‘simple constipation’ I refer to the fact that this case of constipation was not hindered by issues such as hormones, parasites or allergies. It was purely a case of my client not eating the right foods to suit her body.

Suzy came to me saying that she had suffered from constipation for most of her life. We conducted lots of stool tests, mineral and hormonal tests and while there were some minor issues which we addressed, at the end of it all she was still constipated.

Suzy previously had a colonoscopy that showed everything looked fine on the inside, or else I may have thought there was an obstruction from a tumour. Fortunately that wasn’t the case but her bowel length was longer than average, which meant the transit time from mouth to anus was longer than normal.

Suzy’s diet was quite good with plenty of fibre rich foods. There were days when she would eliminate normally and at other times would have no bowel movements for days or even a week at a time. She drank lots of water and exercised most days, so she seemed to be ticking all the boxes.

With Suzy’s food sensitivity tests, all that showed was a very slight reaction to gluten and to eggs (mainly the whites). She had already eliminated gluten from her diet some time before due to previous strong reactions. Suzy then recalled how she had reacted to an all egg-white omelette with severe headache that lasted for days. She went off eggs for a while but her bowels were still the same.

We decided to try something different and that was to create a routine. The body, especially the bowel loves a routine. We discussed regular times for waking, sleeping and meals.

We also made her diet more regimented with breakfasts of a blended seed porridge with home-made almond mylk with berries (to increase soluble fibres) and a lunch of salad with either seafood or chicken. Dinners to have loads of vegetables, stir-fried or steamed, with a sprinkle of chopped nuts and seeds, or fish/seafood or chicken livers (rich in B12, choline, zinc and B6 but easy to digest).

I asked Suzy to lay off the eggs (nice pun) for the time being. We didn’t use red meat in Suzy’s diet as she already knew this made her even more constipated and we kept the heavy proteins to a minimum but enough for her needs.

After 3 days Suzy was going to the toilet and pooing every single day, sometimes twice per day. This was an amazing transformation for her.

We then decided that she could try eggs once a week, but she was constipated the following days, so eggs were dropped from her diet.

No eggs plus soluble fibre for breakfasts (consistently) made all the difference. I added the word ‘consistently’ because if she had anything different for breakfast, there were no visits to the loo the next day and sometimes the day after.

Routine, no reactive foods (even mild), plenty of good soluble fibre, low GI fruits, water and exercise were the keys to her consistent visits to the loo and a happy, less bloated and slimmer Suzy.

This case study highlights the importance of looking at more than one reason for constipation. In other clients, constipation has been the result of a combination of things such as hormones e.g. thyroid or serotonin levels (happy hormones), parasites and diet. Often these factors can create a vicious cycle as one affects the other and so on.

If you can work with a health practitioner experienced with constipation, then you will have a better chance of ‘working it out’. While there are some great laxatives out there and the use of vitamin C and magnesium can help to clear the bowel and keep you regular, it is still best if you can work out the causes and cure your constipation naturally.

Constipation Diet by Sue Kira