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Curing Constipation

Update:  Please DO enjoy the article below, but I have an even Bigger opportunity for you!  This particular aspect of patient Rapid Relief has been so popular that I created and entire mini Deep Dive Clinical Course about it.  When you join our weekly Clinical Tips email distribution, you’ll receive this entire course free-of-charge as a small gesture of our gratitude.  Please don’t miss out on this deeper dive into a frequently dismissed, but notably concerning symptom:  Access the Conquering Constipation free clinical course.

Let’s dive into a topic that almost no one talks about, but everyone thinks about and looks at: our poop. This is a critical topic to discuss with every one of your clients. After our fourth birthday, very few of us keep sharing details of our toilet trips with friends and family. But as it turns out, the status of your bowel movements is a powerful reflection of your overall health.

As a practitioner, I ask everyone about their bowel movements. Over the years, this means I have collected a rather amusing bunch of stories. Most typical is the exchange I have with first-time clients about BM frequency…

“So, John, let’s talk about your bowel movements. Are you regular?”
Silence. Throat clearing. Arms cross over his chest.
“Uhhhmmm. Yeah. I’m regular.”
“So what does that mean exactly, John?”
Silence – more fidgety this time.
“Well, you know – I go when I need to.”
“It’s okay, John; I’ve heard it all before.  Can we dive into a little detail?  To start, how many days a week do you have a regular, formed, complete bowel movement?”
Finally giving up on avoiding this conversation.
“Look, I think my BMs are just fine. I very regularly go at least once a week – and sometimes even twice.  As long as I have something to read, I just hang out in the bathroom until things start moving.  It doesn’t take long…maybe 10 or 15 minutes at most.”

Because we don’t talk about it, most of your clients don’t understand what makes up “regular” or “healthy” bowel movements. Sure, things like occasional sleep loss or airplane travel will be exceptions. But generally, we should all be having at least one, fully formed, complete bowel movement every day. We may even have 2 or even 3, essentially one for each meal (as is seen in studies of most indigenous cultures). Our stool should be easy to pass (no reading material required). You shouldn’t have to strain to pass a stool; that pressure can build up inside your colon and cause inflammation in the colon (diverticulosis). Healthy BMs should be light brown in color with no discernible food bits, indicating good strong stomach acid and efficient digestion. You want most of your BMs to be long, log-like pieces (or even the fully-formed letter S that Dr. Oz has made famous), not hard little marbles and ping pong balls. If these details don’t describe your client’s typical experience, they are not “regular”. If they have to take some kind of over-the-counter medication or fiber-in-a-canister every day to get these results, they are certainly better off but are still not “regular”. Normal, perhaps. But not regular. And they need your help.

The average American is constipated. Chronically constipated. Early man ate a tremendous amount of fiber each day, drank plenty of water, slept well, exercised all the time, lived in a low-toxin environment, had healthy intestinal flora, and enjoyed a relatively low-stress lifestyle. Compared to the average American today, that sounds a bit like a spa experience. But here’s the truth: if your clients don’t have regular bowel movements, it is only a matter of time until they get sick. Plus, it’s really uncomfortable. Alleviating your client’s constipation will give you immediate credibility and probably earn you some sincere gratitude.

Here’s a great way to explain constipation to your clients: Not having daily BMs is like not taking out the trash from your kitchen when the can is full. Things start to spill over and get messy and smelly. Harmful bacteria flourish as your stool continues to ferment. Waste products continue to irritate and perhaps poison your gut lining. Worst of all, your body will eventually begin to reabsorb the trash. Yes, it’s like eating the kitchen trash all over again. This is an image your client will understand! Your stool is the primary exit pathway for waste in your body. I am not just talking about leftover fiber from your salad. A significant part of your body’s waste is toxins, things like pesticides, drugs, chemicals, plastic, heavy metals, damaged cholesterol, and excess estrogen.

Here is a list of key lifestyle changes that can get your clients’ bowels moving:

  • Take magnesium. This is really important for your clients! Most Americans are deficient in magnesium. And my experience is that this is actually more important and more powerful than the typical solutions we might recommend for constipation (e.g. water and fiber – which are indeed included below).

Your typical client probably eats few foods high in magnesium (e.g. halibut, almonds, spinach, cashews, seaweed). Even if they do, the magnesium content in many plant foods has plummeted rapidly since the mid-1900s due to over-farming of the same soil. If your clients are constipated and the fiber/water/fat/probiotics combination isn’t working, have them try 400-800 mg magnesium citrate each evening after dinner. Unlike medications which force your body to shove out a stool artificially, magnesium works for bowel movements because it’s what your body naturally uses to move them along in the first place (in a natural wave-like muscle movement all along the GI tract called peristalsis). Many times chronic constipation is just chronic magnesium deficiency. Magnesium is a particularly good idea if your client has other symptoms of being “bound up” or “tight” (e.g. high blood pressure, acid reflux, muscle spasms/soreness, frequent headaches, impatience).

For your clients who are adverse to taking supplement pills, I recommend magnesium powder that fully dissolves in hot water (my favorite brand is called Natural Calm). This allows them to enjoy a relaxing warm drink before bed that will work its peristalsis magic overnight. Note: I have never encountered a case of constipation that I cannot resolve for a client with sufficient magnesium. But warn them ahead of time that taking too much might just give a short-term case of loose stools or diarrhea; you’ll just need to cut back on the dose.

  • Take a daily probiotic supplement. Our guts are teaming with microbes – what I call good bugs and bad bugs. Sometimes your client’s gut gets sluggish due to poor digestion (medically called decreased motility) or inflammation in our intestines. Beneficial bacteria help to calm inflammation and move things along. A good multi-strain probiotic is normalizing for the body. However, when your clients are already constipated, make sure the probiotic has a significant percentage (at least 1/3 – ideally ½ or more) of Bifidobacterium units (usually called CFUs on the label). If the variety they choose is mostly Lactobacillus, this will likely make constipation even worse. Lactobacillus is one of the dominant bacterial species in the small intestines (which is helpful for many other concerns), but our large intestines (where stool formation happens) are overwhelmingly colonized by Bifidobacteria.
  • Eat plenty of healthy fats. This is an overall concept that many of your clients will need to learn – and be repeatedly convinced of – due to intense health media emphasis otherwise. Despite common myths otherwise, fat is not bad for you. In fact, a diet relatively high in healthy fat has been shown to be cardio-protective and helpful for body fat loss. Encourage your clients to enjoy foods such as olive oil, coconut oil, avocados, wild salmon, walnuts, almond, pumpkin seeds, and eggs daily. Explain it to your clients this way: the best lubrication for pipes is grease, not water; the same is true for your GI pipes. Fat helps to move your stool along. If your clients have trouble digesting fats (makes them very gassy or stools that float), there are other GI issues at play. Drop me an email, and I’ll give you some more guidance (these issues are extensively addressed in the GI class series).
  • Eat plant foods. Here’s one you already probably know! There is no substitute for real, food-based fiber in our diets, especially fruits, vegetables, nuts, and seeds. But realize that this is only one of several potential issues at play. Increase fiber in a constipated client gently, or you will likely make the issue worse. I recommend getting them “moving” with magnesium and healthy fats first. Then, you can work on slowly increasing fiber for better long-term GI flora health and motility. Note there are two kinds of fiber in our food:

a. Soluble fiber helps to form a stool (adds bulking). So it’s key for fully-formed BMs and helpful for intermittent loose stools or diarrhea (think of rice, oatmeal, apples in particular) but not useful for constipation. Psyllium husks are a great natural soluble fiber supplements Mix them up in a smoothie, stir into yogurt, or blend with a protein shake. I also recommend you work with your clients to give up any “PseudoFiber” powders they might use as most of them contain artificial colors, flavors, and sweeteners (e.g. Metamucil). Be sure to read labels carefully.

b. Insoluble fiber helps to move a stool along for easy exit (think of all vegetables, especially leafy greens). This kind of fiber is particularly helpful for constipation. Flaxseed (especially whole) is an excellent insoluble fiber source as well.

  • Drink plenty of water. This is one you probably already know but needs repeating as most of your clients are probably a bit dehydrated. Fiber helps form a stool, but water is what allows soluble fiber to work its magic. Think of trying to use a dried out sponge without water: not very effective. Here are some general tips for your clients:
  1. Ideally, sip water throughout the day. Help them to choose a water bottle with a nipple on it, as they will drink more (vs. using a glass or a water bottle that must be unscrewed or have a wide opening).
  2. Most important, drink a large glass right after rising in the morning. It’s the time of day when we are most dehydrated and most toxic.
  3. Hydrate well in between meals – but not during meals. Have a small glass with only a few sips of water as needed to cleanse the palate (or to take supplements). We need strong, undiluted stomach acid in order to have efficient digestion, and a big glass of water will significantly slow upper-GI motility (food leaving the stomach). In addition to poor nutrient absorption, this may also cause belching, bloating, distension, or acid reflux. Small changes like this can bring your clients major relief – and greater trust in you and compliance in your future recommendations!


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24 Questions for “Curing Constipation”

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  1. 11
    Jodie Campbell says:

    Why would someone feel exhausted or fatigued after emptying their bowels?

  2. 10
    Jodie Campbell says:

    How long can someone continue to take Magnesium Citrate at 800mg? Can over use cause firm/hard stool?

    • 10.1
      SAFM Team says:

      An overuse of magnesium citrate typically leads to loose stools. And there’s no hard rule around how long one should be taking it, but no supplement should be taken forever. It is absolutely key to work on the root causes and figure out WHY the magnesium may be lacking in the first place and if there are other drivers that are causing constipation. The Conquering Constipation free clinical course goes in-depth into all the possible drivers of this dynamic.

  3. 9
    Kimberly Zoubek says:

    What about chronic constipation in children?

    • 9.1
      SAFM Team says:

      This is na interesting question, Kimberly. While the root causes of constipation are often similar in children as they are in adults, the younger patients/clients may require a bit different focus. First, exploring all the same possible contributing factors discussed in detail in the Curing Constipation course mentioned at the top of the page may be a helpful expansion on the constipation root causes.
      In the case of chronic constipation in children, there may be a few specific challenges such as:
      -‘picky eater’ habits that may be preventing them from getting enough healthy fiber to facilitate healthy BMs
      – too much dairy products in the diet, as those are known to promote constipation
      – irregular meal times
      – also sometimes not enough emotional support during transitions, facing new-for-the-child events, aka children’s stress.
      Another challenge may come from gut microbial imbalance, as the gut microbiome starts being shaped right at birth (possibly even earlier) and continues to develop over the course of the first 4-5 years:
      On top of that many children suffer from ear and sinus infections and end up being treated with antibiotics, which can create undesirable gut microbial imbalance and contribute to chronic constipation. As you can see, to fully asses what is at play for each particular child one needs to ask many questions and cast a wide net to help the parents support their child. Hope this perspective is helpful to you.

  4. 8
    Gail Altschuler, MD says:

    Can you please review some of the steps in looking for the cause, especially if it has not improved after trying many of the suggests for relief. Thanks.

    • 8.1
      SAFM Team says:

      This is a great question, Gail and we believe that this is where the coaching approach can really shine. Once you review with the client/patient all of the possible root causes of constipation – we highly recommend reviewing the free course mentioned at the top of this page as it expands on the list described in this article and goes deeper into this topic – and have them truly try all that is necessary to resolve it, it usually boils down to regularly practicing what has worked as there is no one time solution. The daily practice is where many fall short as it is so easy to revert back to old habits once the issue seems to be ‘gone’. What helps with this daily practice of what truly helps is education, support & empowerment, and accountability – really good coaching.

  5. 7
    Joanna Dubinsky says:

    What about taking supplemental enzymes? Some research and experience suggests this can help with constipation.

    • 7.1
      SAFM Team says:

      Yes, insufficient digestive enzymes output in the pancreas or the brush border can also contribute to constipation. Keep in mind that the upstream root cause of this insufficiency can be low stomach acid and thus supplemental digestive enzymes could be helpful for a period of time while working on the root causes of the low stomach acid. You may appreciate this post as well:

  6. 6
    Bucky says:

    Can you recommend a probiotic which has 1/2 Bifidobacterium as suggested? Thank you!

  7. 5
    Samantha Press says:

    If a client had trouble digesting fats and gets gassy what are so other options to help with bowel movements. Mine had been chronically constipated her while life and she was just diagnosed with PD.

    • 5.1
      SAFM Team says:

      Typically issues with fat digestion lead to loose stools, so I would question where this assumption comes from and what supports that notion. Constipation can be the cause of gassiness and bloating, of course, and this course addresses many if not all possible solutions to help with that. Interestingly, there is a connection between PD and digestive issues, which was addressed here:

  8. 4
    rohit panwar says:

    What if the stool is not s shape, long,but it has small pieces of undige
    sted food and it passes on as a lump ,

    • 4.1
      SAFM Team says:

      Undigested food is usually an indication of rapid transit time and/or insufficient digestive enzymes (which can be promoted by insufficient stomach acid in some cases too). I would think about ensuring good eating hygiene, using soluble fiber to help bind/form stool, and supporting a trial with digestive enzymes at each meal.

  9. 3
    Ruchika Behal says:

    Would Senna be a good option for regular BM?

    • 3.1
      SAFM Team says:

      Senna can be an effective agent (thought it’s very potent), but it’s basically just a stimulant. It is not addressing any root cause. Thus it might be helpful as a short-term triage, but we don’t recommend ongoing use of it.

  10. 2
    Heather Conley says:

    Pysllium husks not good for constipation correct?

    • 2.1
      SAFM says:

      Actually, my experience is that psyllium can indeed be helpful for constipation. It is a mix of soluble (2/3) and insoluble fiber (1/3). For constipation, I would be more likely to choose something like ground flaxseed for it’s overall nutritional (in addition to fiber) value; flax has an inverted ratio of soluble and insoluble fiber. BUT it is super critical that one consume a large glass of water with each dose of psyllium husks. Otherwise, psyllium is likely to be *more binding* by over-absorbing water in the intestines. Soluble fiber is a HUGE water magnet. A good example of the ‘devil in the detail’ of how recommendations are implemented. I have paired psyllium husks along with magnesium with good success when using magnesium alone results in small, “pencil thin” stool.

      • Heather Conley says:

        I think I meant to type diarrhea. Ugh

        • Ruchika Behal says:

          As Tracy mentions, Pysllium husks when taken with a large glass of warm water, give relief from Constipation. While when taken mixed with very small amount of water, it is more likely to be binding.

  11. 1

    Will mag malate help with constipation as well as the mag citrate does?

    • 1.1
      SAFM says:

      No, it won’t. In fact, mag malate is usually chosen because it *doesn’t* have a strong effect on the bowels (when systemic magnesium help is needed for someone who already has normal or even loose bowels). Some of my clients needs to use two forms for optimal results: mag citrate for bowels and mag malate or glycinate for systemic needs (esp. cardiovascular or skeletal muscle cramps/tightness).

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