Constipation Relief: Back to Basics
If you’re reading this blog post, I’ll make the assumption that chronic constipation, bloating, and discomfort after eating (especially as the day goes on) is something that you’re hoping to resolve. I’ll also make the assumption that you’ve worked with a handful of gut specialists, coaches, consumed piles of supplements, tested out elimination diets, liquid diets, SIBO protocols, and even tried pharmaceutical options yet still struggle with digestion and motility.
I see you! Gastroparesis, severe bloating, and flu-like histamine reactions after eating were major hindrances in my life for 13+ years. With time, experimentation, and research, I’ve found some tricks and tools that I’m hoping will get you where you want to be without falling for fads or quick fixes.
As many of you know, chronic and debilitating constipation was one of the symptoms that intensified and compounded my journey with ME/CFS, Lyme + co-infections, anxiety, muscle loss, and severe food sensitivities. Perhaps similar to the advice you’ve received from gastroenterologists, nutritionists, health coaches, functional doctors, acupuncturists, increasing water and fiber or following a low FODMAP diet did not in fact “cure” my chronic constipation and in reality, made things much worse. Similarly, sticking to minimal ingredient, meat-based diets, the GAPS diet, AIP, etc. may have increased the quality and nutrient density of my diet (in some ways), but did nothing to improve digestion, absorption, or elimination. It also created debilitating food fears and phobias regarding reactions to food. With time I started to realize that the excessive amounts of “health foods”(salads, cruciferous veggies, almond milk, nuts, seeds, and gluten free products) I was encouraged to eat by nutritionists and naturopaths may have been continuing to suppress my metabolism, compounding the issue year after year.
Thyroid Function
Which brings me to my first point: without adequate thyroid function, stomach acid, digestive enzymes, bile production and flow, and intestinal contractions remain suppressed. This digestive slow down creates the conditions that even the most nutrient dense diets will sit, ferment, creating gas, excess endotoxin, gut irritation, and constipation. Similarly, chronic stress impairs thyroid function, leading to the same conundrum of symptoms downstream.
So first things first: supporting thyroid function.
In the simplest of ways, thyroid hormone production can be blocked by an excess of estrogen and cortisol, a lack of protein and carbohydrate, chronic stress (emotional, nutrient depletion, illness, over-exercising), or even over-doing grains, nuts, seeds, and cruciferous vegetables and unintentionally suppressing the thyroid gland’s function with lectins, phytic acid, and goitrogens. It's in our best interest to start upstream and nail the dietary basics before hopping on the supplement train or pharmaceutical train. Why overcomplicate the landscape of metabolism before stabilizing the foundation? Why spend money on supplements, prescriptions, or glandulars when we could focus on food first and get the results we’re looking for? How might we reduce estrogen levels (which rise from constipation and reabsorption and hinder thyroid function) and cortisol (which also rise when we are chronically backed up and filled with fermented food, similarly suppressing thyroid function) using diet and gentle lifestyle shifts?
Managing Estrogen
First: Be mindful of avoiding foods, chemicals, and prescriptions that increase estrogen levels: flax seeds, excessive amounts of polyunsaturated fats and seed oils, perfumes, fragrances, alcohol (especially hoppy beers), cleaning products, non-stick pans, polyester clothing, and birth control pills. Even lavender in lotions, soaps, and salves can be problematic for estrogen dominance.
Thiamine, Riboflavin, + Fiber
Supporting the body to detoxify, bind, and excrete estrogen relies on robust liver function (the primary organ responsible for preparing estrogen for clearance). Liver supportive nutrients include thiamine (vitamin B1), riboflavin (B2), pyridoxine (B6), folate (B9), cobalamin (B12), flavanoids (naringen, quercetin, silibinin, apigenin) and fiber (raw carrots, cooked mushrooms, well-cooked oat bran–as tolerated–ripe fruit, cooked fruit, and properly prepared beans and psyllium husks as tolerated). I will circle back to these “functional fibers” towards the end of this post.
Everyone will have a fiber sweet spot: too much too soon can cause distension and bloating, especially when bacterial and fungal overgrowths are present). Not enough can also cause distension when circulating estrogen has nothing to bind to in order to be excreted in the next bowel movement and is thus reabsorbed. Too much soluble without enough hydration can sometimes lead to impactions and blockages in the colon (something I’ve experienced!). Too much insoluble fiber can irritate the gut lining as it “scrapes” the sensitive tissue, especially in those who are inflamed and leaky in their GI tract.
If SIBO is an issue, favoring low fermentable fibers and non-fermentable insoluble and soluble fibers until the overgrowth is managed. It’s a catch-22: the more constipated one becomes, the more estrogen is re-absorbed, blocking thyroid function, impairing digestion, motility and tilting the balance towards constipation, allowing bacteria to translocate into the small intestine and flourish.
That being said, if someone is not having at least 2 bowel movements a day (ideally 3) while getting their thyroid function in better shape, it can be helpful (in the short term) to use properly aged cascara to encourage evacuations while the more fundamental issues of metabolism are being addressed. Adequate amounts of B1, B2, and non-irritating fibers to detoxify and bind to estrogen for excretion will synergize with the bowel moving and anti-estrogenic effects of cascara sagrada.
Protein, Carbs, Minerals, + Light
In addition to making sure thyroid function isn’t blocked by high estrogen or high cortisol, it’s important to consume adequate protein (.6-1.0 grams/lb), carbohydrates based on appetite (often a minimum of 200 grams per day and likely much more based on weight and activity level), as well as thyroid supporting co-factors like selenium and iodine, infrared light (PMID: 28698222). Some studies suggest that specific wavelengths of red and NIR (near infrared) wavelengths can support thyroid function.
I’ve heard of people stopping their thyroid medication completely when they started using red light on their neck 3x a week for 10-15 minutes. This is something I’m still currently testing on myself before I can speak more on the matter.
If you’re looking to buy a red light device, be mindful of the specific wavelengths that are thyroid supportive.
Both red and near-infrared (NIR) light wavelengths are used in photobiomodulation (PBM) therapy for their potential to support thyroid function. The optimal wavelengths used in research and products fall within the 600–1000 nm range, with specific wavelengths like 660 nm and 850 nm often targeted for their different penetration depths.
Red light wavelengths
660 nm: This red light wavelength is commonly used because it effectively influences cytochrome c oxidase, an enzyme vital for cellular energy production. It helps promote healthy thyroid function and supports circulation in the gland. (PMID: 23316383)
Near-infrared (NIR) wavelengths
830-850 nm: This NIR wavelength penetrates deeper into tissues and is associated with supporting metabolism, hormone balance, and cellular resilience in the thyroid, helping with inflammation, reducing thyroid antibodies, and repairing tissue damage (PMID: 32186976).
Managing Cortisol
If low thyroid function (and the resulting constipation) is triggered by high cortisol levels, it’s important to manage the chronic stress, acute stress, thoughts, behaviors, beliefs, habits, relationships, light exposure, meal times, and lifestyle that are keeping the body in a state of alarm (keeping cortisol chronically elevated). With time, the goal is to create the conditions where the body-mind-spirit feels safe enough to be curious, notice abundance, be creative, feel inspired, which has downstream effects on chronic stress
EFT tapping (the main tool I use in 1:1 sessions and the basis of the brain rewiring app and communty I host called Tapping with T), breathwork, guided meditations (NSDR/yoga nidra, visualizations), parts works have been monumental in helping clients shift out of a wired-tired-panic state and into a place where they can so down, enjoy themselves, and feel their stress hormones normalizing.
In terms of more physical support (assuming a client is eating protein (especially gelatinous cuts of meat or supplemental gelatin and collagen), carbs, and mostly saturated fats every 3-4 hours to stabilize blood sugar and prevent spikes in adrenaline and cortisol), vitamin C, magnesium, l-theanine, and zinc can all be helpful to dramatically reduce cortisol levels, allowing the thyroid hormone to work as intended.
In some cases of severe constipation, trauma, high estrogen levels, even a solid diet plan paired with red light, targeted supplements, emotional stress management is not enough to restore thyroid function. In these cases, taking a compounded T3 and T4 (ideally in a 1:4 ratio or less), in small doses (3-4mcg of T3 with T4 every several hours, monitoring temperature, pulse, appetite, and mood) can be used in the short term to help someone step out of the hypothyroid-constipation conundrum. I’ve also had clients take dessicated thyroid (in small divided doses reporting better energy, brain function, and digestive health.). I’ve also seen clients reduce their dose with time and eventually just rely on a solid diet (protein, carbs, saturated fats, minerals, hydration) and intentional lifestyle practices (light exposure and circadian hygiene, appropriate movement and rest) and stress management without the need of thyroid medication.
After addressing potential barriers to thyroid function as “root-cause” approach, there are other tools that can support motility, estrogen clearance, lowering endotoxin and cortisol levels while your body takes the time it needs to restore balance. Here are my go-tos. I’ve experimented with all of these “tools” at different times (while restoring good thyroid function) and noticed massive improvements in motility, energy, optimism, focus, and creativity. I hope the same for you as you continue to experiment and find greater health and ease in your
B1 + Magnesium
B1 (also known as thiamine) it my favorite vitamin. It plays a critical role in restoring bowel motility and mitochondrial function, reversing or “curing” the associated fatigue when someone is in a low energy, constipated state, which almost always come hand in hand.
Even when someone’s blood tests come back “normal,” mega-doses of thiamine in the 600-1,500mg/day range have been shown to restore bowel function and completely reverse the associated chronic fatigue states so common in those with IBS/IBD (PMID: 33210299).
What’s so fascinating about thiamine is how a deficiency in thiamine can result in a deficiency in every other vitamin, likely due to the critical role thiamine plays in digestive enzymes, absorption, and motility, and energy metabolism at large. I am beyond grateful for finding Elliot Overton’s work on high dose thiamine therapy for those with treatment resistant SIBO and constipation: this one supplement was a game changer in restoring energy and bowel movements for me personally while still in a very hypothyroid state (and responding poorly to thyroid hormone).
In hypothyroidism there is little stomach acid, and other digestive juices (and even intestinal movement) are inadequate, so gas and constipation are common." -Ray Peat
Thanks to Elliot’s research, I was able to understand why chronic SIBO, slow motility, gastroparesis, and feeling unable to turn off a feeling of chronic stress (vagus nerve impairment) can all be tell-tale symptoms created by a lack of thiamine and how it disrupts autonomic nervous system function and all aspects of digestion. When we understand the nutrients and inputs needed to ensure proper ATP production via the electron transfer chain, B1 is a rate-limiting vitamin at complex 1, meaning a lack of bioavailable B1 will necessarily impair ATP production.
Fatigue Support
Like so many of you are aware, the full-body debilitating fatigue you’ve likely experienced is in direct correlation to lower ATP production and dysfunctional mitochondrial function. In addition to supporting thyroid, replenishing thiamine (often with megadoses temporarily) can resolve chronic fatigue entirely by directly supporting ATP production at complex I.
Malnutrition
The term “malnutrition induced malnutrition” refer to how a thiamine deficiency can lead to a deficiency in all other vitamins and minerals. More specifically, a common side effect of chronic thiamine deficiency is the inability to digest and absorb foods, and therefore produce a deficiency in most of the other vitamins and minerals that also play critical roles in motility and ATP production, creating a sneaky catch-22 of low energy and poor bowel function. Poor nutritional status (despite the best diet!) can also be from a reduction in brush border enzymes located on the intestinal wall, which are responsible for further breaking down food pre-absorption. These enzymes include sucrase, lactase, maltase, leucine aminopeptidase and alkaline phosphatase. Thiamine deficiency was shown to reduce the activity of each of these enzymes by 42-66% (PMID: 6465054).
There are different forms of thiamine. TTFD has shown in studies to “remarkably” increase the amplitude of intestinal contractions and restore motility in cases of severe constipation. Of all the forms of thiamine tested, TTFD was the ONLY one which could increase gut motility (PMID: 40271433). That being said, I’ve noticed clients taking thiamine HCL at higher doses (400-600mg/day) started regaining energy and in tandem, started to rely less on cascara and more on natural bowel movements. It’s important to note that B1 and magnesium are co-factors. Some individuals will notice that if they slowly increase their thiamine intake, they will avoid the pitfalls (insomnia, feeling keyed up) by simultaneously increasing their magnesium and potassium intake.
Restoring bowel motility requires creativity, patience, and addressing the core pillars of metabolic function: thyroid status, liver function, estrogen clearance, cortisol regulation, hydration, and appropriate fiber intakes (depending on someone’s unique fiber reactions + tolerance. Initially, less is more).
Once the basics have been addressed, I’ve seen massive improvements in digestion in clients (and in my own journey with):
Kefir:
The unique bacterial strains in kefir (A2 or goat kefir if you struggle with conventional A1 proteins), are known to increase gastrointestinal motility while shifting the microbial balance towards anti-inflammatory butyrate producing strains. (PMID: 36360671)
Psyllium husks:
an (almost) non-fermentable soluble fiber that can help support bowel movements by shifting the microbial terrain and increasing the water content of stools. (Some people find psyllium to be life-changing for their regularity, while others find it increases bloating. Experimentation and honoring individuality is key!) (PMID: 30669509)
Cooked Mushrooms:
Very well-cooked mushrooms exert anti-bacterial, anti-inflammatory, anti-estrogen, biofilm-busting and bowel-promoting effects in individuals with constipation. I boil mine for about an hour until they are soft and plump. Unlike traditional antibiotics, they can be taken safely every day. For those with SIBO, white button mushrooms and oyster mushrooms tend to be well-tolerated (PMID: 24250542).
Raw Carrots:
Raw carrots have amazing anti-bacterial, anti-fungal, and yes, prokinetic effects. Popularized by Dr. Ray Peat, a grated carrot salad with vinegar and olive oil (or coconut oil) to help bind to endotoxin, estrogen, heavy metals. I’ve written about it here.
Bitters + bile flow:
Tasting bitter foods activates taste-receptors in the tongue that trigger the vagus nerve and signalling to the gallbladder to release bile. When bile flows in response to bitter foods or fats, it exerts a gentle anti-microbial action on the small intestine, clearing out excessive bacterial growths and stimulating peristalsis (PMID: 30120064). Having bitter compounds with meals (dandelion, green tea, coffee, cacao, arugula, etc), and tolerable amounts of medium to long chain fatty acids (avocados, coconut oil, butter, ghee, tallow, cream, and olive oil) can stimulate bile flow and enhance motility (PMID: 31878000).
Thyroid Function:
Normalizing and supporting the thyroid gland directly with red and infrared light, selenium, iodine, lowering cortisol with vitamin C, tyrosine-rich foods, and when needed, glandular support or targetted T3+T4 in the appropriate ratios (closer to 1:2 or 1:3 for women who already have difficulty converting T4 to T3).
Breathing
Many individuals with chronic belly discomfort tend to clench or suck in their belly, often without awareness of the fact that they are doing so. It’s natural to brace or clench areas of the body that are continuously uncomfortable, yet it seems to compound digestive irregularities. As counterintuitive as it sounds, letting the belly fully relax and learning to properly breathe helps move congested lymph out of the abdomen while simultaneously massaging the digestive organs, improving circulation, waste clearance, water retention and thus improving the structure and function of the digestive organs to move food along. If you take several deep, full breaths and intentionally extended exhales, you might even notice gurgling sensations as the fluid “pumps.” Learning to inhale fully, expanding the ribs three dimensionally by engaging the diaphragm is essential for nervous system function, which will have downstream, supportive effects on digestion, as well.
Sunlight on the Belly:
While exposing your belly to the sunlight isn’t likely to cause an immediate need to empty the bowels, full-spectrum light can support mitochondrial function (vitally important for parastalsis and normalizing inflammation), while helping to restore vitamin D levels. Those with low 25-hydroxy vitamin D [25(OH)D] serum concentrations tend to have comorbid constipation and magnesium depletion (as Vitamin D can help regulate electrolytes). In addition to exposing the belly to UVB to increase vitamin D production, narrow band ultraviolet light has been shown to alter the intestinal microbiome in a favorable, health promoting direction (PMID: 31708890). If someone has long-standing gut issues, midday light exposure on the abdomen might be worth experimenting with.
Lymph + Fascia Massage
Similar to diaphragmatic breathing, directly massaging the lymph and releasing any constrictions in the facia helps to restore blood flow, nutrient delivery, and therefore improves function of the organs within the GI tract. Here’s a technique I use to help release trigger points and move some of the deeper congested lymph.
Minerals, Glucose, Water, Movement, + Light for Cellular Hydration
Plain water, while helpful for restoring total body fluids, isn’t the most hydrating liquid. Studies show that tea, soda, orange juice, skim milk, whole milk, and oral rehydration solution are far more effective for rehydrating our tissues and refueling liver glycogen than just plain water. Of course, if you are craving a glass of plain water, honor that. If you are looking to rehydrate cellularly, try 8 oz. of your favorite mineral rich juice (orange, pomegranate, blueberry, aloe, pineapple, coconut, etc), 24 oz. of water, and a 1/4 tsp of salt. Pay attention to how the blend of minerals, glucose, and water quench your thirst in a way that water alone does not. In addition, movement and infrared light seem to help with cellular hydration, lending to structured water within the cell. Rebounding, walking, shaking, jogging, while under natural light can help to restore hydration in ways that are unlikely sitting at a desk under blue lights.
While it might seem like a never-ending struggle filled with defeat and frustration, regular, easy bowel movements are within reach, especially when we restore the energetics of the gut with thyroid support, B-vitamins, minerals, hydration, supportive touch, and intentional breathing techniques.
I’m so curious if you find any of these tips and tricks helpful. Leave a comment below if you have any questions: I’m here to help!
