Published October 13 2014
Chronic constipation is common in people with thyroid and autoimmune thyroid conditions. And while chronic constipation is more commonly associated with hypothyroid conditions, it’s not uncommon for those with hyperthyroid conditions to experience constipation. Prior to being diagnosed with Graves’ Disease I personally suffered from chronic constipation for many years, as throughout my teenage years and into early adulthood I would have one or two bowel movements per week, and I relied on taking laxatives and eating high fiber cereals to move my bowels. In this article I’ll discuss some common causes of chronic constipation, and I’ll also discuss some things you can do to help improve this problem.
Although the topic of chronic constipation usually doesn’t directly relate to thyroid health, there are a couple of reasons why I decided to write about it. One of the main reasons is because many of the patients I work with experience chronic constipation. And while it might not be directly related to their thyroid or autoimmune thyroid condition, this doesn’t mean it’s something that doesn’t need to be addressed. Having chronic constipation means that you have a compromised gastrointestinal tract, which obviously isn’t a good thing. Although chronic constipation might not trigger an autoimmune response like a leaky gut can, it can potentially set the stage for other health problems, which I’ll discuss later in this article. The second reason why I’m writing this article is due to my personal experience with chronic constipation. Even though I now have daily bowel movements, it took a long time to reach this point.
What Are Some of the Causes of Chronic Constipation?
While the overall goal of this article is to discuss how natural treatment methods can help with chronic constipation, I would first like to discuss some of the common causes of chronic constipation.
1. Hypothyroidism. Although hypothyroidism isn’t the most common cause of chronic constipation, since this article is aimed at those people with thyroid and autoimmune thyroid conditions I figured I’d start out with this. Constipation is common in people with hypothyroidism and Hashimoto’s Thyroiditis. However, not everyone with a hypothyroid condition will suffer from constipation. Similarly, while many people with hyperthyroidism and Graves’ Disease have an increased frequency of bowel movements, there are some people with hyperthyroid conditions who have constipation. But even though hypothyroidism can cause constipation, most cases of chronic constipation are actually caused by some of the other factors I’m about to discuss.
2. Poor diet. Eating a diet high in refined foods and sugars, and low in fiber is a common cause of chronic constipation. This no doubt this played a big role in my chronic constipation, as growing up I at plenty of refined foods and sugars, and although I did eat fruit, I never ate vegetables…unless if you count French fries! When I was constipated, my greatest source of fiber was All-bran cereal. This did help, but if you suffer from chronic constipation then you really do need to eat a minimum of four or five servings of vegetables daily. And eating more than this would be even better. Truth to be told, if someone is suffering from chronic constipation I would try to consume at least two or three servings of vegetables with each meal, which would mean consuming between six and nine servings daily.
It’s not uncommon for someone I consult with to have chronic constipation, yet to be eating mostly whole foods while avoiding the refined foods and sugars. So why would a person eating a healthy diet have chronic constipation? First of all, they need to consider some of the other factors I will discuss in this article. Second, a lot of people eat healthy overall yet still don’t consume enough vegetables. I look at food diaries all of the time, and it’s very common for someone to be eating whole foods with minimal refined foods, but only eating two or three servings of vegetables per day. For some people, eating a couple of servings of vegetables per day is enough to have daily bowel movements. But many people need to double or triple their daily vegetable intake.
3. Dehydration. Not drinking enough fluids is another common reason for chronic constipation. Most people reading this know they should be drinking plenty of purified water daily. Drinking some other fluids such as green tea and/or herbal teas also can help. On the other hand, you want to try to avoid drinking beverages such as coffee and soda. Ideally you want to drink at least 40 to 50% of your body weight in ounces of water per day. And if you suffer from constipation I would start out the day by drinking one or two cups of water first thing in the morning when you wake up. However, keep in mind that drinking water usually will only help with chronic constipation if someone is in a dehydrated state. In other words, if dehydration is not a factor, then increasing one’s water intake usually won’t help to increase the frequency of bowel movements (1).
4. Lack of physical activity. Regular exercise can help to improve chronic constipation. So if you have an occupation which involves sitting for long periods of time, this can potentially cause or exacerbate constipation. As a result, you not only want to engage in regular exercise three to five days per week, but if you sit for prolonged periods of time every day then you will want to take frequent breaks where you get up and walk around. In addition, taking a walk during your lunch break would be a good idea, rather than sitting at your desk during lunch and then surfing on the internet after you have eaten. If you work from home then you might want to consider investing in a treadmill desk.
5. Problems with the peristaltic reflex. While I’m sure a poor diet played a big role in the development of my chronic constipation, another big factor involved resisting the urge to defecate. This might sound strange to some people reading this, although it’s a common occurrence. For example, I’ve always hated using public restrooms, and I think it’s safe to say that most people would prefer sitting on the toilet in their own home. Sure, you can and probably should line the toilet seat with toilet paper or use toilet liners, but in any case, if I needed to move my bowels growing up I would do everything I could to avoid using the restroom. I still have some wonderful memories in high school of having to defecate while in class, yet holding it in until I got home.
So what’s wrong with resisting the urge to defecate? Well, if you do this on a frequent basis then this most likely will cause problems with the peristaltic reflex. Peristalsis involves the contraction and relaxation of smooth muscles, and this happens in both the esophagus and small intestine after eating food. And it also happens in the large intestine, which is the urge you have to move your bowels. If you resist the urge to defecate on a frequent basis then this is likely to cause problems with the peristaltic reflex, and you will no longer have the natural urge to move your bowels on a daily basis.
Having healthy levels of serotonin is also important for normal functioning of the peristaltic reflex (2) (3). As a result, if someone has low serotonin levels then this can cause decreased peristalsis, which in turn can cause constipation. This is why the drug Prucalopride can frequently help with constipation, as it affects the serotonin 5-HT4 receptor, which is a potent stimulator of gut motility (4) (5). It’s also possible to have a polymorphism of the serotonin transporter gene, which can be a factor in chronic constipation (6) (7). Although I’m not a big fan of testing for neurotransmitters in the urine since they don’t test for the levels in the CNS, chronic constipation is one of those situations when such testing might be valuable.
6. Certain medications. Taking certain medications can cause constipation. This includes narcotic pain medications (Tylenol #3, Percocet) antidepressants (Elavil, Endep), anticonvulsants (Dilantin, Tegretol), calcium channel blocking drugs (Cardizem, Procardia), aluminum-containing antacids (Amphojel), and iron supplements (8).
7. Other hormone imbalances. Obviously low thyroid hormone levels can cause constipation. However, there is evidence that high estrogen levels can also lead to constipation (9). Hyperparathyroidism results in constipation because of reduction in neuromuscular excitability by high calcium levels (10).
8. Problems with bile metabolism. There is evidence that alterations in bile acid metabolism may be implicated in the pathophysiology of constipation (11) (12). And so doing things to help with bile metabolism might be beneficial, or even just giving the person bile salts might help. I recently released a post entitled “The Importance of Bile in Thyroid Health“.
What Are Some of the Complications of Chronic Constipation?
When I experienced chronic constipation I really didn’t think of this condition as causing any long term health consequences. It did eventually cause hemorrhoids, which was bad enough. However, besides the risks of hemorrhoids and anal fissures, there are other risks of chronic constipation. For example, fecal impaction may occur in some cases. This is when the hardened stool gets stuck in the rectum, and it may lead to complications such as bowel obstruction leading to aspiration, stercoral ulcers, perforation, and peritonitis (13). There is also the risk of a rectal prolapse, as the constant straining to have a bowel movement can cause the rectum to protrude from the anus.
Plus, let’s remember what the purpose of a bowel movement is. The purpose of a bowel movement is to remove the waste products from your body. Stool consists of numerous toxins, and so obviously it can’t be a good thing to not be able to excrete these toxins on a frequent basis. There is also a potential risk of developing colorectal cancer and benign colorectal neoplasms in those with chronic constipation (14).
Chronic Constipation and Conventional Treatment Methods
There are numerous medications which can potentially help with chronic constipation. Many people resort to using laxatives, and in addition to eating plenty of All-Bran in the past, I also took laxatives. Medical doctors may recommend osmotic agents (e.g. lactulose, polyethylene glycol) or a chloride channel activator such as lubiprostone (15). Newer drugs to treat constipation include Prucalopride, which belongs to a novel class of 5-hydroxytryptamine-4 receptor agonists (16), Linaclotide (17), Plecanitide, and Velusetrag (18). Although these might be effective in helping with chronic constipation, they of course do nothing to address the cause of the problem.
Although many medical doctors will recommend medication for chronic constipation, many medical doctors will wisely tell patients to increase their fiber intake and to increase their water intake. However, many times this is the extent of the dietary recommendations. For example, many will tell you to eat cereals with added fiber, but they won’t tell you to increase your intake of whole foods which are high in fiber, such as vegetables, fruits, nuts, and seeds.
How Can Chronic Constipation Be Treated Naturally?
I can tell you from self experience that chronic constipation can be reversed, although it’s not easy, and in many cases it can take a long time to correct. With that being said, here are some of the things I would recommend for those suffering from chronic constipation.
1. Eat at least six cups of fresh vegetables every single day. Yes, you read this right. I know earlier I recommended eating 2 to 3 servings (I consider 1/2 cup to be one serving) of vegetables with each meal, and for many people with chronic constipation this would be greatly beneficial. But try to eat at least six cups of fresh vegetables on a daily basis for at least one month and see how you do. Although this might seem like an excessive amount of vegetables to eat, doing this will ensure that you are getting enough fiber. In fact, if you can eat nine cups per day this would be even better. I would eat a combination of raw and steamed vegetables, eat a wide variety of different vegetables (kale, carrots, arugula, avocados, etc.), and adding a few cups of vegetables to smoothies each day is perfectly fine.
2. Eat other foods rich in fiber. Eating other foods rich in fiber can also help, such as nuts and seeds. If someone is following an autoimmune paleo diet then they will be avoiding nuts and seeds, and will need to rely on eating plenty of vegetables. Fruit can be a good source of fiber, especially apples and prunes, although if someone has blood sugar imbalances they want to be cautious about eating too much fruit. Grains can be a good source of fiber, but just as is the case with nuts and seeds, if you’re following an autoimmune paleo diet, or even a standard paleo diet, then you won’t be consuming any grains. Flaxseeds are also a good source of fiber.
3. Drink 2 cups of purified water when you first wake up. Within 30 minutes of waking up I would drink at least 2 cups of purified water. And no, coffee doesn’t count. If you start your day with a smoothie and add a couple of cups of water to this that would be fine. Overall I would make sure to drink at least half your body weight in ounces of water per day. In other words, if you weigh 160 pounds, then you will want to drink 80 ounces of water per day.
4. Correct intestinal dysbiosis. Intestinal dysbiosis is an imbalance of the gut flora, and this can be a source of constipation. Some people will notice an improvement in their bowel movements simply by taking a probiotic supplement, and/or eating fermented foods on a regular basis such as sauerkraut. However, many times taking probiotics alone isn’t enough to correct constipation. I’ve written a separate article entitled “Intestinal Dysbiosis and Thyroid Health“, where I discuss some of the common causes of intestinal dysbiosis, and what you can do to correct this.
5. Exercise regularly. I realize that some people with thyroid and autoimmune thyroid conditions don’t have the energy to exercise. And some people with hyperthyroid conditions need to be cautious about exercising due to the increased heart rate. Just keep in mind that not being active for most of the day can affect the frequency of your bowels. This is especially true for many people who work behind a desk all day, as if this is the case you want to take frequent breaks, or as I mentioned earlier, if you work from home then you might want to consider investing in a treadmill desk.
6. Sit on the toilet every day after eating breakfast. Even if you don’t have the urge to defecate I want you to sit on the toilet every single day for at least five to ten minutes, preferably in the morning after breakfast. Doing this, along with everything else I recommended, can help to restore the peristaltic reflex. However, you want to make sure not to strain hard during this time.
7. Correct any hormone imbalances. One can make a good argument that this should be listed first, as if someone has depressed thyroid hormone levels which is causing constipation, then correcting this very well might correct the constipation. However, as I mentioned earlier, most cases of chronic constipation aren’t caused by hypothyroidism. With that being said, if someone has low or depressed thyroid hormone levels this can be a contributing factor, and should be addressed. Similarly, if someone has estrogen dominance which is causing or contributing to constipation, then this needs to be addressed as well.
8. Be aware of any medications you’re taking. Remember that taking certain medications can cause constipation. And so if you noticed that your constipation started after taking a certain medication, then you might want to do some research to see if this is a potential cause, and if so, run this by your medical doctor. Even taking certain supplements might lead to constipation. A common example is iron supplements, and some people experience constipation when taking calcium supplements.
9. Improve bile metabolism. I would read my article on bile and thyroid health that I mentioned earlier for information on how to improve your bile metabolism. In some cases, simply taking some bile salts might help to improve constipation.
10. Increase serotonin levels. Because low serotonin levels can slow down peristalsis and lead to constipation, doing things to help increase serotonin levels might be beneficial. Tryptophan converts into 5-hydroxytryptophan (5-HTP), which in turn converts into serotonin. And so taking either tryptophan or 5-HTP can help to increase serotonin levels. However, as I discussed in my article entitled “Neurotransmitters and Thyroid Health“, certain nutrients are also important for this conversion process. Iron is necessary for the conversion of tryptophan to 5-HTP, and certain nutrients (i.e. vitamin B6, B12, folic acid, magnesium) are necessary to convert 5-HTP into serotonin.
11. Supplement with at least 400 mg of magnesium per day. Although you want to be getting most of the magnesium through the food you eat, if you are dealing with chronic constipation I would also supplement with magnesium until you are moving your bowels regularly. I listed 400 mg per day, although some people will need to take higher doses. And if you prefer starting with a smaller dose (i.e. 200 mg) then of course this would be fine. Taking higher of doses magnesium usually has little risk, and if you begin to experience loose stools or diarrhea then this is an obvious sign that you need to reduce the dosage.
12. Vitamin C supplementation. Taking high doses of vitamin C per day (up to 5 grams) can help with some cases of constipation. It would be wise to start with smaller doses and gradually increase it.
13. Take herbs to help with constipation. Certain herbs might help with constipation, such as aloe vera, slippery elm, senna, and fenugreek. However, the herbs usually aren’t addressing the cause of the condition, and frequently won’t help much when the constipation is chronic.
14. Fiber supplements. Although some healthcare professionals are opposed to people taking fiber supplements, I’d rather someone take a fiber supplement which is helping someone to move their bowels daily than to have the person not take any and to continue to deal with constipation. Obviously I prefer for people to move their bowels regularly without having to take a fiber supplement, which is why I listed this option last. Psyllium is commonly used to improve constipation, and while this is an option for some people, some other options include, rice bran fiber, apple pectin, and prune powder.
In summary, many people with thyroid and autoimmune thyroid conditions experience chronic constipation. There are numerous causes of chronic constipation, including poor diet, dehydration, lack of physical activity, problems with the peristaltic reflex, certain medications, hormone imbalances, and problems with bile metabolism. Although conventional treatment methods usually involve the use of laxatives, osmotic agents, or newer drugs, these of course don’t do anything to address the cause of the problem. Some factors which can help address the cause include increasing your consumption of vegetables, along with other foods rich in fiber. Drink plenty of water, correct intestinal dysbiosis, exercise regularly, sit on the toilet daily even if you don’t have the urge to defecate, correct any hormone imbalances, improve bile metabolism, increase serotonin levels, and if necessary supplement with higher doses of magnesium and/or vitamin C, and in some cases a fiber supplement can help as well.
