Calling out constipation

Calling out constipation

It’s not exactly the most glamorous subject matter. Most of us prefer not to dwell on what happens (or, perhaps doesn’t happen, as it were) in the bathroom. – That is, until things aren’t working properly. What is constipation?   Although the definition varies, depending upon who you talk to, anything less than at least one good, properly formed and reasonably voluminous bowel movement per day is probably less than optimal for most. Constipation is defined by western medicine as having fewer than two or three bowel movements per week. I would say by then, it’s a real problem. For many it means a problem with having to constantly strain to eliminate, while passing sometimes painful, hard, dry or “ball-like” stools, together with a lack of daily regularity .

It’s not exactly the most glamorous subject matter. Most of us prefer not to dwell on what happens (or, perhaps doesn’t happen, as it were) in the bathroom. – That is, […]

“I wish that being famous helped prevent me from being constipated.” ― Marvin Gaye

More than simply an uncomfortable inconvenience, chronic constipation is something to be taken quite seriously and can lead to an increased risk of colon cancer, appendicitis and diverticulosis.

The Paleo Way is a program that endeavors to optimize quality nutrition, digestive and overall health based upon, in part, those foods to which humans are the most genetically adapted. I have long maintained that this evolutionary basis is absolutely an essential starting place when it comes to understanding what is and is not optimal for our best possible health. In my book, Primal Body, Primal Mind I also take into account both human longevity research (as a way of helping to distill the most important health principles from all the noise and better align those ancient dietary principles with modern science), as well as looking closely at the uniquely challenging world that we live in now and making appropriate adjustments for that. The Paleo Way has adopted much of this approach and actually goes a step beyond popular “Paleo” concepts toward that, which is truly in strongest alignment with what it takes to genuinely build optimal health.

In spite of the superb engineering of this undeniably natural dietary approach, it does constitute a change to many—and even positive change can be uncomfortable or discombobulated at times. Sudden changes in diet can lead to sudden changes in bowel habits for some. One common source of constipation with respect to this program has to do with the fact that a lower utilizable carbohydrate diet can lead to significant initial water loss and increased sodium loss. The loss of excessive, stagnant extracellular water is not a bad thing, but it does mean that improved hydration is important. The combination of water and sodium loss can lead to a temporary slowing of the bowels for some, though. In truth, this is very easily remedied. The value of proper hydration should never be underestimated, and sometimes just stepping up quality water intake throughout the day can be sufficient to resolve this issue. But one more thing that I commonly recommend is an increase in the use of full-spectrum salt (NOT regular table salt, mind you), which includes things like Himalayan or Celtic Sea salt—containing a variety of more balanced trace elements, of which sodium is merely a part.   The combination of increased hydration and improved quality sodium intake is frequently all that is needed to “get that train rolling again.”   But for others, the issue may be more complicated.

Yet another “sticking point” (no pun intended) for some involves giving up coffee, and other sources of caffeine.   For all too many, what seems like “regularity” is in fact a chronic regular irritation of the colon by the use of stimulants.   Far too many people become dependent on that morning cup of coffee to irritate their bowel into elimination.   Such evacuation is typically less than healthy, though—and typically less than sufficiently complete. When certain individuals adopt this healthier dietary approach and surrender their morning coffee, the result can seem “constipating”, when what is really happening is the removal of the artificial panacea and revealing what is fundamentally a chronic underlying issue that needs to be addressed.   Also, the colon can develop somewhat of a dependence on artificial stimulation over time, and can come to rely on things like caffeine and laxatives (even seemingly natural ones like herbal senna or cascara sagrada). So the bowel may also require reconditioning and a restoration of more natural tone and signaling.

Another source of irritation for the bowel can be some of the antigenic and antinutrient effects of dietary grains. Contrary to popular belief, the fiber content of grains is anything but colon-healthy and has a tendency to contain numerous damaging lectins that are more likely to irritate your bowel than support its optimal health.   Eliminating grains has never led to any form of nutritional deficiency in any one, nor can it possibly lead to poor health in any way. But if you have become dependent upon the irritation grains provide, then removing them might seem constipating at first.   In some people, in fact, grains can be alternately constipating and getting rid of them actually improves regularity, depending on who you are. Regardless, I will submit that getting rid of grains is always a good thing. If removing grains has left you feeling constipated, then your constipation problem has nothing whatever to do with the absence or “deficiency” of grains. The removal of this unnatural dietary inclusion has merely revealed an underlying problem that needs to be addressed.

There ARE healthy alternatives to using laxatives and a number of things a person can do to restore healthy bowel function, but first it makes sense to look at what the underlying problems might be in order to better understand the best solutions for you.

Constipation (although the “butt” of a lot of jokes) is really no laughing matter for those that suffer from it. It has been popularly said that “Death begins in the colon.”   The discomfort and the consequences of constipation can be very real over time. It has a number of potential causes, and a number of ways in which it may be approached.

What are some of the potential causes?

  • Excess sodium and water loss due to heat exposure, physical exercise or change to a healthy, lower carbohydrate diet
  • Chronic dehydration
  • Stress
  • Chronic anxiety issues
  • Sudden changes in routine/diet (such as giving up caffeine)
  • Traveling (which can be dehydrating, among other things)
  • A tendency to hold bowel movements too long leading to excess resorption of water in the colon and potentially impaired signaling over time
  • Dysbiosis (unhealthy composition of bacteria in the bowel)
  • History of antibiotic use (leading to dysbiosis)
  • Dairy foods (milk, cheese, etc.—having a glue-like “binding effect”)
  • Iron supplements (especially inorganic iron, such as ferrous sulfate or iron oxide forms)
  • Calcium supplements (especially calcium carbonate)
  • Low thyroid function
  • SIBO (small intestinal bacterial overgrowth – especially methane producing bacteria-type)
  • Laxative abuse
  • Medications (blood pressure meds, antidepressants, antacids)
  • Head injury and/or Neurological impairment leading to impaired vagal tone

For some, constipation is the byproduct of years of poor dietary habits and gradual accumulation and impaction of waste material in the large intestine, leading to the gradual narrowing and slowing of movement there. For others, a lack of proper motility in the gut is to blame, and this can be the result of dysbiosis, neurological issues (leading to poor vagal tone) or thyroid problems. Constipation can be problematic on multiple levels and many people may have several of the aforementioned issues at play.

The fact that your colon is a major eliminative organ means that it is critical for it to be functioning normally and healthfully in order for proper detoxification to occur. It is also important for proper endocrine health, as the bile helps conjugate spent hormones (such as estrogen, for instance) so that they may be properly eliminated from the body. But when things are not moving properly, spent hormones that should have been naturally eliminated through the bowel, along with a plethora of numerous toxins, can reabsorb back into your circulation, leading to endocrine imbalance, as well as feelings of fatigue, malaise and general irritability while adding unhealthy burden to the liver.

Colon health 101

The typical healthy colon transit time is roughly 12 to 18 hours.   For many in the Western world it has grown to more than twice that, to considerable detriment. One way to determine your own transit time is to sit down and eat a plate of beets, paying attention to the day and time. Then see how long it takes for that reddish bowel movement to appear. If it takes more than a day, then you likely have issues needing to be addressed.

A slowing of transit time means that as more food goes into the system, more and more “backup” and unhealthy accumulation begins to take place.   If this goes on for too long, then fecal impaction can occur, and even eventually a development of diverticula (little stretched out pockets in the colon that can become severely inflamed and/or harbor infective pathogens). The longer unexpelled fecal matter remains, the more unhealthy bacteria and other pathogens may start to grow and take over, and the harder it becomes for healthy bacteria to thrive. With respect to bacterial health in the gut, the typical rule-of-thumb is that at least 85% of your gut bacteria need to be the good kind, and no more than 15% bad bacteria.

One visible telltale sign of longtime trouble with constipation for some is the protruding gut (often even propped up on skinny legs), where sometimes years of abnormal accumulation lead to a swelling and distention of the impacted transverse colon, which often just sort of seems to hang over a person’s belt. For all too many people, what seems like regularity amounts to little more than “crap pushing crap.” Truly healthy elimination is far more elusive than most people realize.

The Myth of Fiber

Contrary to common belief, fiber is actually not necessarily an essential component of the human diet, much less any sort of preventative for colon cancer. –The Harvard Nurse’s study of over 80,000 people over 16 years (published in 1999 in The New England Journal of Medicine) proved fairly conclusively that a high-fiber diet makes no real difference with respect to colon cancer.[1] And in fact, too much fiber can bring problems of its own—whether through excessively binding important minerals and leading to potential deficiencies of nutrients, or potentially feeding unhealthy bacteria in a person already suffering from pronounced dysbiosis or SIBO (small intestinal bacterial overgrowth).

But fiber has its useful side, for sure, and it certainly does add bulk that can help move things along in the colon, as it were.   Where the colon is colonized by mostly healthy bacteria, fiber can serve is a food for them that in turn helps them produce butyric acid—a short chain fatty acid that the cells of the colon recognize as a favorite food.   The Paleo Way diet plan incorporates a large amount of fibrous vegetables and greens, as well as promoting the use of cultured and fermented vegetables and other foods and beverages as a rich source of healthy probiotics.   For most people, this offsets any issues with sodium or water loss and leads to seamless regularity. For a few, however, the healthy, relatively high fiber and probiotic content of The Paleo Way diet plan can mysteriously lead to issues of gas and bloating.   The problem isn’t with the diet in this case, but rather with the type of problematic bacteria colonizing the large and even small intestine in certain people.   Feeding bad bacteria won’t make them good.   There has to be a plan to cleanse the colon and gut of these unwelcome residents that have entrenched themselves, while restoring a beneficial environment in which healthy bacteria can thrive where they belong.

To fully address all of the potentially helpful subject matter surrounding this issue would literally result in a book, and cannot be thoroughly addressed in a way that takes everyone’s potential issues into account through a mere blog post (yes, even one of mine).   But by understanding a few basic things and by using a few basic strategies, significant relief can be achieved by most.

Cleansing and Detox

The first step for many embarking upon the Paleo Way and/or experiencing constipation issues might be undergoing some form of initial cleansing and/or detox program.   This sort of thing can be accomplished in a number of ways.

It’s important to point out that cleansing and detox can mean different things, and there are varying approaches depending on whether a person is seeking to cleanse their liver, their urinary tract or their colon, etc. If you are just getting started, the cleansing your colon needs to come first.   It is a mistake to do any form of so-called “comprehensive detox program” until your primary avenues of elimination are open and functioning properly.   It does you no good at all to “cleanse your liver” if the toxins are just going to wind up stagnating in your colon, even potentially re-absorbing back into your body again.

If you happen to be somebody that suffers from significant and or chronic health issues, cleansing/detox programs are typically best accomplished under the guidance and supervision of a qualified natural healthcare provider. A more detailed evaluation may also be in order, and might additionally include stool laboratory analysis through an expanded G.I. panel as a means of determining the overall health and composition of your colon. This sort of thing can never hurt, and it can often make what needs to be done to restore the health of the colon much more apparent and simplified.   It also pays to find a practitioner that has been schooled in the identification and treatment of a specific form of potential dysbiosis known as SIBO (small intestinal bacterial overgrowth). Only relatively identified and researched, SIBO is now recognized as a distinctly unique form of dysbiosis that requires highly specific approaches to remediation.   Too often, the protocols that are popularly used to improve the health of the colon can actually make SIBO much worse.

Still others seeking an approach to cleansing/detox gravitate toward prepackaged over-the-counter “cleansing programs” sold in health food stores, which vary a great deal in their ingredients, quality and effectiveness. I tend to shy away from these, to be honest.   Most contain herbal laxatives and diuretics and have questionable quality. Products such as psyllium might work for some but can have the opposite effect in others. Also, psyllium is a heavily sprayed crop, which means many sources are contaminated with pesticides, herbicides, and fertilizers (so organic sourcing would be essential). Over-the-counter laxatives are never a good idea, except under the most dire of circumstances where immediate relief is critical.   They easily become habit-forming, however, and should not be used unless there is no other choice… and even then, only on rare occasion and never habitually.

For any detox program to work, regardless, proper hydration is absolutely essential. The value of consuming sufficient, simple, pure clean and unadulterated water is perhaps the most underrated of all health habits.   Water is the universal cleansing solvent and ALL life on earth requires water in order to survive and be optimally healthy.   Obviously, water is also the best single cleanser for water-soluble toxins. That said, not all toxins are water-soluble.

Healthy biliary function is also critical to this equation, and biliary support can be a critical part of any detox program.   Fat-soluble toxins require bile in order to be properly conjugated (i.e., made water-soluble by the body) and eliminated effectively. If you have had your gallbladder removed, this may mean you will need to use bile salts with fat-containing meals and/or bile-thinning agents in order to help facilitate healthy and ongoing nutrient absorption and effective detoxification.

Other approaches

When it comes to cleansing the colon, a traditional natural medicine approach sometimes includes what is in natural health circles traditionally called “colon hydrotherapy”.   Popularized by the late, great Dr. Bernard Jensen, this therapeutic modality goes well beyond being a mere “enema”—which only really empties the last few inches of your very long large intestine.   Enemas can be fine for short-term relief (and are decidedly healthier than laxatives), but they are merely a superficial palliative, at best. That said, what are called “coffee enemas” (using only organic coffee) actually do have a unique detox value and can help promote healthier bile flow. But true Colon Hydrotherapy is a much more involved procedure performed using sophisticated equipment by a certified practitioner. It most typically involves a series of treatments. In it, purified water is gravity-fed through a small tube into the rectum—gently flushing out the contents. This can be a very useful treatment for removing sometimes decades-old accumulations of dry and impacted material and unwelcome pathogenic denizens in a more accelerated and relatively painless manner. I have seen this procedure give people a whole new lease on life and I personally know several people who make this an annual practice.   Although I think this has real value in those with severe long-term intestinal issues—there is another potential side to the coin.   The human large intestine is host to more than 1000 species of bacteria, comprising close to 99% of all DNA in the human body—vastly outnumbering the human kind!   Little has been known about the human GI microbiome until extremely recently—and although it is just about the hottest topic in health circles right now, relatively little about these massively important denizens of our GI tract are as yet understood.   Research has been done on only a handful of species, and little to nothing is known about the rest, much less their full potential impact on varying aspects of our physical and mental health. The growing body of research in this area is decidedly exciting, but far from comprehensive.

As such, the idea of flushing everything/everybody out may or may not be the best approach for everyone.   But if your elimination problems have been chronic, long-term or severe— this might constitute a very worthwhile approach for you.   It will also mean that re-colonization with healthy bacteria is going to have to be a critical and dedicated focus.

Other aids and solutions

Exercise can also be important for the restoration and maintenance of bowel health. Your large intestine actually has muscle, and it’s designed to work together with the muscles of your abdomen in moving the contents along.   Overly relying on fiber, stimulants and irritants to move things along can leave these muscles in your large intestine weak.   Core exercises can help stimulate circulation in these areas and help improve intestinal function.

Another often-overlooked issue has to do with the basic mechanics of defecation.   In the wild, humans typically assumed a deep squatting position in order to naturally and properly align the lower colon and rectum for full evacuation.   Our unnatural, throne-like modern-day toilets frequently compromise proper positioning, leading to less than effective or complete bowel evacuation.   A number of compensatory products have entered the marketplace in recent years, the best known and researched of which is the “Squatty Potty”— a platform that molds to the base of your toilet, allowing you to rest your feet and align your posture in a more natural squatting position.   It may sound silly, but these devices really do work.   For anyone that hasn’t tried one, you owe it to yourself to pick one up. Once you’ve experienced the difference you will never want to make a trip to the bathroom without it ever again. Seriously…they are awesome. I have one in every bathroom at home and at work.

Another natural and logical approach to improving colon health includes the liberal use of probiotics, both through supplementation with high potency, viable sources, and also cultured and/or fermented vegetables, and other foods/beverages.   All this is fine and good, HOWEVER, if gas and bloating accompany this type of supplementation/approach, you need to consider that small intestinal bacterial overgrowth (also known as SIBO) could very well be an issue for you.   I wrote an extensive article on this particular subject for The Paleo Way blog and encourage you to read it carefully if postprandial gas and bloating are an issue for you—even on a low sugar and starch diet.   In these instances, extra fiber, probiotics and prebiotic’s (like added FOS and inulin) actually have the potential to make this condition worse—much worse—so it’s important to know what you’re dealing with.

Magnesium deficiency is a rampant problem in today’s world—and is vastly more common than any sort of calcium deficiency.   In fact, calcium is probably the single most over consumed supplement anywhere, and literally one I never recommend. I wrote an article on this topic of the problems with calcium supplementation on my own personal blog, at www.primalbody-primalmind.com (see: http://www.primalbody-primalmind.com/get-enough-calcium-dont-eat-dairy/). Long-term, high carbohydrate diets tend to be extremely depleting of magnesium, and a deficiency of magnesium can reveal itself at times through issues with constipation (among other things).   Healthy intracellular magnesium is essential for a calm, normally functioning digestive system.   First and foremost, digestion and elimination are parasympathetic processes (i.e., require a calm, relaxed state in order to function).   Magnesium oral supplementation can be extremely helpful toward restoring regularity.   Although inorganic sources of magnesium and common sources like magnesium citrate tend to do a rather poor job of restoring healthy intracellular magnesium levels, they can have a useful and non-irritating laxative effect.   The protocol I recommend for this involves taking a capsule of magnesium before going to bed at night and then seeing what ensues in the morning. If no result, then the following night add an extra capsule to the regimen… and so on until success is ultimately achieved (and sooner or later it WILL be!). This said, if you feel compelled to rely upon high-dose magnesium long-term, this isn’t necessarily a good or optimal thing. In order to avoid long-term mineral imbalances, it always pays to find out what the source of your constipation is in the first place.

Although I have generally learned to shy away from specific product endorsements, there is one available online called “Oxy-Powder” that can also be a non-habit-forming colon cleanser with little downside (unless, of course, you happen to take too much of it). I find it far more preferable than herbal irritants such as senna or cascara sagrada. Caveat: I believe the recommended dosage is 4 capsules on the label, which many find to be too much.   Better to start with a single capsule and work your way up to what works for you. Go gradually and cautiously with either magnesium or Oxy-Powder, unless you don’t mind emergency and/or unpleasantly prolonged trips to the bathroom. NOTE: this is really just a short-term solution. No one is deficient in “Oxy-Powder” or its ingredients, so it needs to be looked upon as a temporary palliative, while you work on identifying the real underlying problems and solutions to your elimination issues.

In Summary

In the end, restoring the health of your colon is essential to your overall health.   A quality diet that is in alignment with human genetic make up and one that includes sufficient nutrient density to supply ample nutrition is the long-term answer. The Paleo Way does just that.   But in the short term, depending on who you are and what issues you might have, restoring the health of your G.I. tract may require some additional steps and/or qualified intervention/supervision to be effectively accomplished.

Hopefully the information in this blog post has been able to supply you with and important (albeit cursory) understanding of some of the potential causes of constipation.   I have supplied a number of potential solutions here that can be useful under this circumstance— However, this article is not meant to replace careful evaluation and/or treatment by a qualified natural healthcare provider.

Once you have successfully restored the health of this key eliminative organ, The Paleo Way can help keep everything running smoothly long-term!


[1] Stolberg, S. G. January 21, 1999. “Fiber Does Not Help Prevent Colon Cancer, Study Finds.” The New York Times

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