Spend an hour watching television and you’ll realize we’ve become a country comfortable with chatting about our bowels. Bikini-clad young women, gal pals bouncing out of yoga classes, colleagues in the elevator…everyone in commercial-land seems positively chirpy as they grin and wink and discuss their gassiness or regularity and the products that can help get things moving.
But jovial ad talk aside, bowel irregularity is no laughing matter: Constipation affects one in six adults—primarily women and older people—with symptoms that range from uncomfortable to downright disruptive. Chronic constipation means waste (and toxins) sit longer in your body and can cause cramps, embarrassing gas, and painful bowel movements, leaving you feeling sluggish, full, and constantly uncomfortable.
Lucky for irregularity sufferers, we’re finally coming out of the constipation closet. Chalk it up to the relentless marketing of mass-market products like Activia, Dannon’s probiotic-infused yogurt, and the dozens of similar products created in the last five years touting the benefits of probiotics and live cultures. In fact, the yogurt sector is growing, with Activia and similar probiotic-enhanced products accounting for 10 percent of total yogurt sales.
“This issue is just more on the radar right now,” says nutritionist Suzanne Farell, RD. “In my practice I’ve noticed a definite increase in inquiries about bloating, constipation, and bowel issues.” But how did we get so backed up to being with?
Constipation itself is not a disease, but a symptom of other imbalances in the body. The official definition of constipation is three or fewer bowel movements per week (the gold standard is one to two per day) and hard, painful stools. The complaint is common in older people who are less active and may not get enough water and fiber in their diets, but even young and otherwise healthy people suffer from it, too. A recent Mayo Clinic study showed that “slow transit constipation,” the result of a sluggish colon, predominantly affects young women.
The causes of constipation can run the gamut—from physiological (like that sluggish colon), to stress, poor eating habits, lack of exercise, food allergies, an imbalance of bacteria in the gut, and digestive enzyme deficiencies. “Constipation is often related to a combination of factors,” says Nicole Egenberger, ND, director of Remède Naturopathics, an alternative medicine clinic in New York City. “Most commonly, I find it is related to diet—not enough fiber or water,” which makes bowel movements dry, hard, and slow to pass.
There are other, less-obvious causes, too. The next most-common culprits are magnesium deficiency—magnesium plays a critical role in the function of the body’s enzyme system, which helps with digestion—and medications such as antidepressants and codeine painkillers that cause constipation as a side effect. Conditions like pregnancy, depression, and hypothyroidism can also lead to backlog due to complex hormonal changes in the body. Even switching to vitamins high in iron and calcium might slow things down.
On the more serious end, constipation can also be a result of intestinal polyps or bowel cancer, so persistent constipation isn’t something to ignore. Fortunately, a few key, integrative strategies for regularity tend to work across the board, whatever the cause of constipation.
Poor or irritating diets do a number on hard-working digestive system, and here is where much of the constipation trouble starts. “It sounds simple, but sometimes the problem really is that basic,” says Farrell, who has a private nutrition practice in Denver, Colorado. “I have clients come in who are highly educated when it comes to nutrition information, but we still end up going back to the basics and assessing the number of servings of fruits and vegetables they’re getting and the amount of water they drink,” she says. The surprise? Most get far less than the daily four to six servings of whole grains, two to three fruits, and two to three cups of vegetables she recommends. American Dietetic Association data shows that the average American gets only half of the 20 to 35 grams of dietary fiber recommended daily.
The fix is pumping up intake of high-fiber foods like vegetables, beans, nuts, and fruit—they not only provide the right fuel for the “friendly” gut bacteria that aid digestion, but also act as brooms that help cleanse the colon. Add fiber superstars such as blueberries, strawberries, apples, pears, and carrots to your shopping list. Opt for whole grains whenever possible; refined carbohydrates can cause unhelpful intestinal bacteria to proliferate. When looking at packaged foods, choose breads, cereals, or energy bars with added fiber.
Sometimes food choices aren’t the answer, but rather the culprit if allergies are involved. “I am seeing more and more patients who feel better when they stop eating gluten, despite their blood work indicating that they do not have celiac disease,” says Egenberger. “Eliminating gluten and other allergens like dairy is not the answer for everyone,” she admits, “but I would encourage anyone who suffers from constipation to try eliminating common allergens like gluten, corn, eggs, and dairy for several weeks and watch for improvement.”
Another easy strategy is to drink plenty of fluids. Drinking eight, eight-ounce glasses of water per day keeps you hydrated and helps prevent stools from becoming dry and hard (and harder to pass). And limit daily caffeine intake to 200 to 300 mg—that’s about two cups of coffee—and alcohol to one drink per day, to avoid further dehydration.
Lastly, commit to an exercise routine. Exercise increases blood flow to the digestive system, speeding absorption and decreasing the amount of time it takes to move food through the digestive tract—which means less backup.
Enzymes are tiny plant proteins that act to catalyze chemical reactions in our body. When it comes to the issue of constipation, plant enzymes are critical. “They’re like little Pac-Men,” says Lita Lee, PhD, a chemist and co-author of The Enzyme Cure (Future Medicine Publishing, 1998). “They break down fats, carbohydrates, and protein for easier digestion.” If you have a hearty army of enzymes aiding digestion, your body is not only better able to deliver nutrients to cells and tissues, but also able to get rid of toxins and the waste products of metabolism.
There are three main types of enzymes: metabolic, pancreatic, and plant. Our bodies create the first two, but plant enzymes we get only though raw foods and supplements. “Our bodies don’t make plant enzymes,” explains Lee. “Fresh, organic, raw foods contain enzymes. And, the catch is, these enzymes are destroyed by cooking.”
So then, how do we replenish enzymes? Up your intake of raw, organic foods, and consider plant enzyme supplements geared specifically to digestion. For her clients suffering constipation, Lee recommends plant enzymes that help support peristalsis (the urge to go), as well as stool formation and body pH balance. (See “Help for Regularity” below for our enzyme picks.)
Flora, Flora Everywhere
Products with probiotics cram the dairy cases and supplement shelves these days, and it’s hard to know how—or if—you should integrate these helpful microorganisms into your diet. The short answer is yes. According to Gary Huffnagle, PhD, professor of microbiology and immunology at the University of Michigan, research in the last five years has dramatically changed our understanding of how mighty these microbes really are. “Microflora such as yeast and bacteria play a very, very important role in our health, especially gastrointestinal health,” he says. “And we’re recognizing there are more and more diseases linked to changes in that flora.”
We’re still learning exactly how probiotics operate, but we do know that stress, illness, and poor diet can wipe out the good ones, leaving others to proliferate and resulting in poor digestion, constipation, and gas. To keep the helpful bacteria flourishing, eat a high-fiber diet, which will provide the fuel they need to thrive. And “adding supplemental troops to the war is important,” too, says Huffnagle. “Probiotics are constantly being crowded out or excreted, so adding live cultures back into your system is essential, especially after illness or taking a round of antibiotics.
You can easily consume probiotics from food sources—they’re a part of the fermentation process used to make yogurt (and other fermented foods, like kombucha and kimchee). Regular yogurt normally contains the lactobacillus bulgaricus and streptococcus thermophilus strains of probiotics, while Greek yogurt contains up to six different strains, with kefir topping the charts at up to 10 strains. Supplements are also a good source, but Huffnagle stresses that quality—and thus effectiveness—of the cultures found in supplements can vary wildly, so be sure to do some research and spend a little extra to purchase live cultures from a reputable manufacturer.
As for the hyped-up brands with added probiotics? Well, the bubbly babes in TV land are on the right track. Those products do contain beneficial flora that replenish and support your body’s own. But manufacturers have been challenged on some of the claims they made, such as improving digestion within two weeks. Keep an eye on ingredients, too, as manufacturers can also hide high levels of sugar or high-fructose corn syrup in their products.
As much as we would all love a silver-bullet solution, no one product is the right answer for any one person’s regularity issues. But by experimenting with enzymes, probiotics, and diet modification, you can safely sample the options out there and see what strikes the right chord with your own system.
When You’re on the Go and Can’t Go
Travel can be especially constipating—after all, you’re probably skipping workouts, eating out, maybe tipping back more alcohol and coffee, not to mention you might not be near a toilet when you need one. Here are a few doable tricks dietician Suzanne Farell uses to help clients stay regular.
- Add some kind of activity. Even if it’s not a formal workout, it’s important to get your blood flowing and move.
- When you go out to eat, eat what you like, but add a salad to your meal.
- Make an extra effort to eat two fruits per day.
- Carry water with you everywhere, and when you’re at a party or out for drinks, drink a glass of water between cocktails.
Help for Regularity
Sometimes you need a little support to get things moving—here are some good products to keep handy.
>> Enzymes Enzymedica Digest Basic Essential Digestive Enzymes (enzymedica.com) contain the enzymes necessary to digest all four basic food groups. // Therazyme LgI provides nutritional support of the large intestine to help with hard, painful stools, or lack of bowel movements (litalee.com).
>> Kefir Lifeway Lowfat Kefir Cultured Smoothies contain 10 active live cultures and taste like drinkable yogurt—try the strawberry (lifeway.net). // Redwood Hill Farm Naturally Cultured Goat Milk Kefir is made with more-easily digestible goat milk and comes in delicious flavors like blueberry pomegranate (redwoodhill.com).
>> Yogurt Stoneyfield Farms yogurts—which include regular, Greek, soy, and probiotic blends— are organic, packed with live cultures, and produced according to strict green-business practices (stonyfield.com). // Wallaby yogurts are also organic, free of high-fructose corn syrup, and contain live and active cultures (wallabyyogurt.com). // Green Valley Organics are made with real dairy and lactose free (greenvalleylactosefree.com).
>> Probiotics Dr. Ohhira’s Probiotics 12 Plus Original Formula supplements stay stable without refrigeration (essentialformulas.com). // Enzymatic Therapy Acidophilus Pearls are made with a patented capsule that ensures cultures are undamaged by stomach acids (enzymatictherapy.com). // Health Plus Probiotic Fiber capsules are part of a colon cleanse line designed to repair the entire digestive system (healthplusinc.com).
>> Tea Laci Le Beau Super Dieter’s Tea is a laxative tea that’s made with senna leaf, which helps stimulate movement of sluggish bowels (lacilebeau.com). // Smooth Move Senna is organic and also made with senna leaf (traditionalmedicinals.com).
By Cara McDonald