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Health Protocols

Constipation

Integrative Interventions

Magnesium and Vitamin C

Magnesium supplements can have a laxative effect by drawing water into the intestines (Izzo 1996). Several forms of magnesium (eg, carbonate, oxide, citrate) can be used to treat constipation (Yamasaki 2014; Siegel 2005; Liu 2011; Ranade 2001).

In one study, 3835 women’s diets were assessed for magnesium intake. Compared with women with the lowest magnesium intake, those with higher intake had up to 30% lower risk of constipation. The investigators considered the possibility that some dietary magnesium remains in the digestive tract and attracts water by an osmotic effect (Murakami 2007). Also, high doses of vitamin C can facilitate bowel evacuation (LPI 2014).

Obtaining Immediate Constipation Relief

Instead of relying on chemical laxatives, the proper nutrients taken at the right time can support soft fecal consistency and induce colonic peristaltic action without serious adverse effects (Tatsuki 2011; Jones 2010; Farlex 2015).

There are convenient powdered formulas available that contain magnesium mixed with ascorbic acid that can induce a bowel movement relatively quickly (typically 30‒90 minutes). A teaspoon or more of vitamin C and magnesium crystals will evacuate the bowel within 30‒90 minutes if taken on an empty stomach with several glasses of water. One of these powdered formulas provides 4500 mg of vitamin C and 250 mg of magnesium in each teaspoon. The dose needs to be individually adjusted so it will not cause day-long diarrhea.

Buffered vitamin C powders combined with primarily potassium salts can work as well as magnesium/vitamin C powders and may be used on alternate days for those needing ongoing relief.

The suggested number of times these nutritional colon cleanses be used is about three times per week. Excess use may create tolerance and require higher dosing.

Fiber

Soluble fiber supplements absorb water and hold it in the intestines, keeping the stool soft and easy to move, and tend to create a lubricating film when exposed to water; insoluble fiber supplements add bulking particles to the stool and shorten transit time by stimulating peristalsis (Yang 2012; Suares 2011b; Eswaran 2013). Soluble fibers are generally fermentable, which means they can be digested by microbes in the intestines. This quality is referred to as “prebiotic.” Prebiotic fermentable fibers are important for establishing and maintaining healthy colonies of beneficial bacteria in the gut (Quigley 2010). Soluble fiber is present in psyllium husk, legumes, nuts, seeds, and some fruits and vegetables. Sources of insoluble fiber include wheat bran, whole grains, and vegetables (NLM 2014b).

Psyllium. The husk of the psyllium seed, a product of the Plantago ovata plant, is rich in soluble fiber and contains some insoluble fiber (Moreno 2003); many well-designed trials have demonstrated that psyllium fiber supplementation relieves constipation and irritable bowel syndrome (McRorie 1998). Psyllium has also been associated with increased stool frequency in constipated Parkinson’s disease patients (Ashraf 1997). In patients with chronic primary constipation, taking 5 g of psyllium twice daily improved stool consistency and frequency (Ashraf 1995).

In one clinical trial, 5 g of psyllium per day was shown to be superior to docusate sodium as both a stool softener and a laxative (McRorie 1998). In fact, psyllium fiber supplements are FDA-approved as laxatives. Psyllium should be taken with a full 8 oz glass of water and be accompanied by adequate fluid consumption throughout the day. It is considered best to introduce psyllium gradually (UMMC 2013b; Eswaran 2013).

Psyllium has several ancillary benefits as well, including improving the lipid profile (Komissarenko 2012; Sartore 2009), glucose metabolism (Ziai 2005; Karhunen 2010), and blood pressure control (Cicero 2007).

Other fibers. Although psyllium is one of the most common and most thoroughly studied types of supplemental fiber, several other fibers can be used to supplement dietary intake as well:

  • Inulin. Inulin is a prebiotic soluble starch that functions as fiber in the digestive tract. Inulin is found in many plant foods, most notably in Jerusalem artichoke and chicory root, but also in more commonly eaten vegetables like onions, garlic, and asparagus (Nishimura 2015). It is considered a prebiotic fiber because of its positive effects on colonies of beneficial bowel bacteria (Kolida 2002). A rigorous analysis of many randomized controlled trials concluded that supplemental inulin can decrease transit time, increase stool frequency, and improve stool softness in people with chronic constipation (Collado Yurrita 2014).
  • Partially hydrolyzed guar gum. Guar gum is a product from the guar bean (Cyamopsis tetragonoloba). Partially hydrolyzed guar gum is a soluble, fermentable fiber that is more palatable and less likely to cause adverse effects than whole guar gum (Lewis 1992; Slavin 2003). Preliminary research shows that supplemental guar gum helps relieve constipation symptoms in patients with constipation-predominant irritable bowel syndrome (IBS-C) (Polymeros 2014; Russo 2015; Quartarone 2013; Slavin 2003).
  • Glucomannan. Glucomannan is a soluble, fermentable fiber found in many plants, especially the root of the konjac plant (Amorphophallus konjac). It has prebiotic effects, supporting the beneficial bacteria in the large intestine (Tester 2013). Several clinical trials showed that glucomannan improved multiple measures of constipation better than placebo (Marzio 1989; Passaretti 1991; Chen 2008).
  • Pea fiber. In a preliminary study that included 114 elderly subjects who lived in nursing homes and had constipation, the addition of 1–3 g of pea fiber powder to other foods three to four times per day for six weeks significantly increased stool frequency and decreased laxative use (Dahl 2003).
  • Flaxseed. Flaxseed is a source of both soluble and insoluble fibers. The soluble fiber in the outer coating of the flaxseed is a mucilage that becomes slippery when wet. Mucilages, like all soluble fibers, increase moisture in stool (Kajla 2015) and are thought to have lubricating effects (Hanif Palla 2015).

Probiotics

The gut microbiota is increasingly recognized as a key factor in the functioning, or malfunctioning, of the entire digestive tract. Probiotics are supplements containing live microorganisms that are taken to improve digestive and overall health (Narula 2010). Their effectiveness in treating a wide array of disorders, including chronic constipation and IBS-C as well as myriad gastrointestinal and other disorders, is the subject of intensive research (Quigley 2011; Varankovich 2015; Quigley 2012a).

A thorough analysis of research into probiotic supplements concluded that those made with Bifidobacterium lactis (also called B. animalis ) can effectively shorten intestinal transit time in both constipated and non-constipated people, with the greater effect seen in those with constipation (Merenstein 2015; Miller 2013). Another review of the research found that probiotic supplements with B. lactis and Lactobacillus casei ( L. casei) may have positive effects in adults with chronic constipation (Chmielewska 2010). A number of probiotic supplements, such as those made with L. GG, L. plantarum, L. acidophilus, L. casei, and B. animalis, have been found to alleviate individual IBS-C symptoms, such as bloating, flatulence, and constipation (Quigley 2012a). Trials using B. lactis and B. infantis have demonstrated benefit in patients with IBS-C (Quigley 2011).

Cascara Sagrada

The bark of the buckthorn tree, known as cascara sagrada (Rhamnus purshiana) (UU 2015a), has traditionally been used to treat constipation. Like senna, which is a commonly used stimulant laxative in the conventional management of constipation (Rogers 2013; Rao 2014), cascara sagrada contains anthraquinones, which stimulate peristalsis by irritating or stimulating the intestinal neuromuscular apparatus (Sigma-Aldrich 2010; NLM 2015; UU 2015a). Stimulant laxatives like cascara may cause diarrhea and electrolyte loss, and so are generally recommended for short-term use only (UMMC 2013a).


Disclaimer and Safety Information

This information (and any accompanying material) is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the treatments discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.

The protocols raise many issues that are subject to change as new data emerge. None of our suggested protocol regimens can guarantee health benefits. The publisher has not performed independent verification of the data contained herein, and expressly disclaim responsibility for any error in literature.