Constipation can be challenging to resolve because of its complexity. If you don’t fully understand the root cause of your constipation, you may feel like it is a never-ending battle.
This guide is intended to help you take impactful action for lasting relief.
There are five main parts to this guide:
- What is constipation?
- Vitamin C and Magnesium for Constipation
- Foods to eat for constipation relief
- Probiotics for constipation
- Anatomical and physiological considerations
- The most common causes of chronic constipation
- How to identify the root cause of your constipation
What is constipation?
Before we can talk about how to resolve constipation, we first need to define constipation.
Constipation is defined as having two or more of the following symptoms with at least 25% of bowel movements:
- Straining
- Lumpy or hard stools
- Sensation of incomplete evacuation
- Sensation of obstruction or blockage
- Manual maneuvers to facilitate
- Fewer than 3 defecations per week
Another way of identifying constipation is via the Bristol Stool Chart. A visual aid that classifies poop into seven categories based on appearance. It tells us about transit time – how fast or slow the food you’ve eaten moves from mouth to anus.
Passing a bowel movement that matches Type 1 or 2 on the chart below indicates constipation. It’s normal for there to be occasional episodes of constipation. However, if it is a common experience for you, it should not be ignored and warrants further investigation to resolve.
Vitamin C and Magnesium for Constipation
Before we jump into this topic, I want to clarify that diet isn’t the only factor to consider in resolving constipation. However, it is a critical piece of the puzzle, and it’s the first place to start.
Does vitamin C cause constipation?
The short answer is no! Unabsorbed vitamin C relieves constipation because it is osmotic, drawing water into your intestines and softening your stool. The adult body’s requirement for vitamin C is about 65-90 mg. Reaching the saturation point at which vitamin C can have an osmotic effect isn’t difficult if you eat vitamin C-rich fruits and vegetables. Vitamin C has the added benefit of boosting your immune system.
Vitamin C-rich fruits and vegetables:
- Guava: a single fruit contains 126 mg of vitamin C
- Sweet yellow bell peppers: 1 cup contains 150 mg of vitamin C
- Kiwi: 1 fruit contains 70 mg of vitamin C
- Kale: 1 cup chopped contains 80 mg of vitamin C
- Lemon: 1 fruit contains 83 mg of vitamin C
- Strawberries: 1 cup contains 89 mg vitamin C
- Broccoli: 1 cup cooked contains 100 mg vitamin C
- Kakadu plums: this Australian superfood contains 481 mg of vitamin C per little plum – this is the highest known concentration of vitamin C in an edible plant
- Acerola cherries: 820 mg per half cup
Some individuals with chronic constipation may need to take 1,000 mg of supplemental vitamin C twice daily to get things moving. I recommend using food as your primary vitamin C source and temporarily adding supplemental vitamin C if that’s not quite cutting it.
Magnesium-rich foods
Magnesium is a mineral that also acts as an osmotic agent and can signal peristalsis—the contraction of muscles that move stool through the digestive tract.
It’s one of the most common nutrient deficiencies in adults due to modern industrial agriculture practices that deplete our soil of magnesium. Your daily requirement is 400 mg.
The best food sources of magnesium include:
- Black Beans: 120 mg per 1 cup, cooked
- Spinach: 150 mg per cup
- Beet greens: 100 mg per cup
- Peas: 70 mg per cup
- Tofu: 53 mg per 3.5 oz
- Pumpkin seeds: 150 mg per oz
- Dark chocolate: 64 mg per oz
Magnesium is the active ingredient in the laxative milk of magnesia. You can skip all the harmful additives in Milk of Magnesia and just take magnesium citrate. I like Pure Encapsulations magnesium citrate. Start with 300 mg, wait several hours, and if that doesn’t get things moving, repeat.
*Always check with your doctor before incorporating supplements if you have any chronic health conditions.
Whole food sources of fiber
I specify food sources of fiber rather than supplemental fiber found in fiber powders, bars, cereals, and shakes because these processed forms can frequently worsen constipation. Whole food sources of fiber come with just the right balance of water-soluble and insoluble fibers essential for easing constipation.
You’ll notice many of the foods listed above also contain a fair amount of fiber—this is Mother Nature’s brilliance. All whole foods naturally contain a combination of nutrients that promote health in various ways.
Aim for 25-30 grams of fiber from whole foods daily. If you are eating very little fiber, you will want to slowly work up to that goal to avoid unpleasant symptoms like gas and bloating. Be sure to drink plenty of water as you increase your fiber intake.
Best sources of fiber from whole foods:
- Beans, legumes, peas: 8-12 grams per cup
- Fruits: about 5 grams per tennis ball sized serving
- Vegetables: 4-6 grams per cup
- Potatoes (with skin) & other root vegetables: about 4 grams per 1 cup serving
- Whole grains: about 3 to 6 grams per half-cup
- Chia seeds: 5 grams per 1 tablespoon
Healthy fats
Healthy fats like olive oil, olives, avocado, oily fish (wild-caught salmon, mackerel, herring), nuts, and seeds stimulate the gallbladder to release bile, which stimulates intestinal motility, leading to a bowel movement.
The critical thing here is avoiding unhealthy fats, such as vegetable oils – corn, soy, canola, cottonseed, trans fats, and other highly processed oils that increase inflammation.
Probiotics For Constipation
Probiotic-rich foods contain billions of living microorganisms that benefit our health. These benefits range from improved digestive symptoms to a stronger immune system!
Most studies have focused on the beneficial impact of Bifidobacterium and Lactobacillus species in improving the frequency of bowel movements and softening stools to make them easier to pass (1). Still, there are likely many more species present in the fermented foods we eat that provide benefits.
To take full advantage of these microbes’ power, consider adding a daily source of living, unpasteurized, probiotic-rich foods to your diet. Here are a few ideas to get you started:
- Kimchi
- Refrigerator pickles (live ferment, not vinegar)
- Sauerkraut (refrigerated, not canned)
- Kefir (raw is preferable)
- Kombucha
- Yogurt—Nancy’s Organic Yogurt contains BB12, a strain clinically shown to speed small intestinal transit time, stimulate more regular occurrence of phase III MMC cycles, and produce higher amplitude intestinal contractions. This is really effective for constipation.
A note of caution for those individuals dealing with histamine intolerance: Fermented foods like kombucha and kimchi may worsen symptoms of histamine intolerance. It’s best to avoid them until you’ve resolved the source of your histamine intolerance.
Best supplemental probiotics for constipation (ideal for those with histamine intolerance):
- Daily Bowel Regularity by Life Extension contains Bifidobacterium lactis HN019, a specific probiotic strain shown to significantly speed up motility, reducing bowel transit time from 49 to 21 hours.
Anatomical & Physiological Considerations
Let’s move on from diet to anatomical reasons for constipation. Beginning with the longest cranial nerve in your body, the vagus nerve.
The gut-brain connection via the vagus nerve
The vagus nerve activates the parasympathetic nervous system, responsible for rest and digestion. When the vagus nerve is not firing correctly, the brain cannot send the appropriate signals for digestion, a condition known as poor vagal tone. Poor vagal tone is a significant cause of slowed motility, leading to constipation.
To improve vagal tone, add one or two of the following to your daily routine:
- Sing loudly: this will activate the muscles at the back of your throat, stimulating the vagus nerve.
- Gargle: do this hard enough that your eyes start to tear, activating the vagus nerve.
- Yoga: in addition to stimulating the vagus nerve, yoga decreases stress and builds muscle. Bonus if your instructor leads the class through chanting Om, as chanting can also stimulate the vagus nerve.
- 4-7-8 breathing: inhale fully for 4 seconds, hold for 7 seconds, and exhale slowly for 8 seconds. This breathing technique is also a powerful tool you can use to fall back asleep.
Pelvic floor dysfunction & Constipation
Pelvic floor dysfunction (PFD) refers to the impaired relaxation and coordination of the pelvic floor and abdominal muscles during pooping. Ruling out pelvic floor dysfunction requires a visit to a medical professional trained in its assessment and treatment.
Sleep Disorders & Constipation
Based on data from 14,590 adults (2), people who sleep more or less than the recommended 7-9 hours per night report significantly more constipation than normal sleepers. This highlights one of many important reasons to get enough sleep.
The most common causes of chronic constipation
If addressing nutrition, sleep, and vagal tone doesn’t improve your constipation, it is time to dig deeper to identify your root cause.
Constipating Medications
Medications are one of the most common and obvious reasons for chronic constipation. The frequency of use plays the most significant role in how constipating they are likely to be.
- Ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs
- Benadryl, Zyrtec, Allegra and other antihistamines
- Iron supplements
- Blood pressure medications
- Opioid pain relievers
- Tricyclic antidepessants
- Urinary incontinence medications
The Most Common Causes of Chronic Constipation
Intestinal Methanogen Overgrowth (IMO)
Intestinal methanogen overgrowth is an overgrowth of methane-producing archaea in the small or large intestine. The methane they produce slows transit time, resulting in constipation. It is common for people with IMO to experience unexplained weight gain, abdominal bloating, excessive burping, and even increased food sensitivities.
Overgrowths of methane-producing archaea, bacteria, or fungi slow motility (movement of stool through the digestive tract), causing chronic constipation. The most common organisms that lead to constipation are:
- Archaea: Methanobrevibacter smithii
- Fungi: Candida albicans, aspergillus, yeast
We can assess the small and large bowel for these overgrowths utilizing a combination of triple sugar breath testing to assess for elevations of methane outside the normal range and identify down to the genus level bacterial overgrowths using 16S rRNA sequencing, a DNA-based molecular technique.
Benefits: It is very inexpensive and gives us a more accurate, complete picture of the microbial ecosystem. Temperature changes don’t impact it during transport in the mail. It allows us to accurately see the impact of medications and changes in diet that can’t be assessed via culturing techniques.
Its limitations are that it does not detect fungi, protozoa, helminths, or viruses. For those, we need to utilize other testing methods. During my initial consultation with clients, we decide which testing methods to use based on their unique medical histories, symptom profiles, and budgets.
Bacterial overgrowths and gut infections are commonly acquired from:
- travel abroad
- food poisoning
- exposure to contaminated water
- or in the case of Candida and fungal overgrowth, after a course of antibiotics
Antibiotics and dysbiosis
Antibiotics wipe out native species of beneficial bacteria that would otherwise hold organisms like Candida in check. After antibiotics, opportunistic yeast, bacteria, and pathogens can proliferate, altering the gut microbiome’s commensal balance. These microbiota shifts can cause yeast infections, strong sugar and alcohol cravings, bloating, abdominal pain, constipation, and diarrhea (3).
Although people associate a gut infection more commonly with diarrhea, constipation is also quite common and tends to be more challenging to reverse. Pathogenic bacteria release neurotoxins that damage the nerves that signal peristalsis (4). Peristalsis is the contraction of the muscles that move food through the gastrointestinal tract.
Food Sensitivities Are A Root Cause of Constipation
Food sensitivities often result from intestinal permeability (a.k.a. leaky gut) caused by bacterial overgrowth in the small intestine, which can worsen constipation.
Regardless of whether food sensitivities are the root cause of your constipation, they will need to be addressed to resolve symptoms because they can cause inflammation that leads to incomplete bowel movements, straining, and abdominal discomfort.
- Identifying food sensitivities using a quality food sensitivity test, such as Mediator Release Testing. Avoid IgG panels, as they tend to show whatever you’ve most recently eaten rather than what you are actually reacting to.
- Remove reactive foods while utilizing a gut healing protocol so that you can eventually eat them again without symptoms.
Take note: For some, removing dairy products can quickly relieve constipation.
How to identify the root cause of your constipation
Testing provides a clear roadmap to healing by identifying the root cause of your constipation. Guessing doesn’t work and usually results in a lot of wasted time and effort.
I use the following tests to help clients get clear on what’s causing their symptoms:
- Stool tests that identify gut infections and provide detailed microbiome analysis
- Breath testing for SIBO and IMO
- Mediator Release Testing for food sensitivities
If you are struggling with constipation, this guide can help you make adjustments to your nutrition and lifestyle that are within your control. If those changes do not resolve your constipation, seek support and testing to get to the root cause. The first step is to schedule a FREE strategy session to discuss your case and how I can help.