Causes and Cures for Constipation

Constipation seems to be very common; we’re frequently asked about it. Constipation can afflict low-carb dieters: It was widely reported among Atkins dieters, and is the most common side effect reported on clinical ketogenic diets for epilepsy. [1]

Fortunately constipation is usually easily cured. There are a few common causes, and most of them have simple fixes.

Antioxidant Deficiency

Among the most common causes of constipation among low-carbers is deficient antioxidant capacity.

The gut is a challenging environment, full of oxidizing compounds. If glutathione and other antioxidants become deficient in intestinal cells, then the gut becomes leaky [2], leading to inflammation and the potential for constipation. Oxidative stress can also lead to loss of neurons or neuronal axons from the colon and consequently a loss of motility. Constipation is a common symptom of irritable bowel syndrome.

The cure is simple: supplement. Specifically:

  • Selenium, 200 mcg/day (perhaps 400 mcg during a starting period). Selenium is needed for glutathione peroxidase, a glutathione recycling enzyme.
  • Vitamin C, 1 g/day (perhaps 4 g/day during a starting period). Vitamin C and glutathione recycle one another.
  • Zinc and copper. Total zinc intake should be 30-50 mg/day including food and multivitamin; copper intake should be 2-5 mg/day. Food typically provides 15 mg zinc and 1 mg copper.
  • Cysteine and glycine. These are the component amino acids for glutathione. For constipation I would suggest eating some beef gelatin for glycine, and taking one 500 mg capsule of N-acetylcysteine per day.

Egg yolks also increase glutathione production [3], and eating a dozen per week is highly recommended. Lipoic acid may also help. [4]

Glutamine, a supplement frequently recommended for gut ailments, can also enhance glutathione production [5]. However, I would generally avoid this, because it can promote proliferation of pathogenic bacteria.

Hypothyroidism

Hypothyroidism may be the most common cause of constipation.

A vicious circle often develops: Gut problems lead to autoimmune hypothyroidism, and constipation is only one symptom of the damage hypothyroidism does to the gut. The vicious circle can be broken by treating the hypothyroidism.

The cure:

  1. Eliminate wheat, soy, and other autoimmune-promoting or goitrogenic toxins from the diet.
  2. Supplement with thyroid supporting nutrients like:
    • Selenium (as above).
    • Magnesium (citrate or chelate) 200 mg/day.
    • Zinc and copper (as above).
    • Iodine.
  3. Improve circadian rhythm. Circadian rhythm therapies for hypothyroidism were discussed in two posts, Intermittent Fasting as a Therapy for Hypothyroidism (Dec 1, 2010) and Seth Roberts and Circadian Therapy (Mar 22, 2011).
  4. See your doctor to consider replacing thyroid hormone and investigating related problems. Your doctor can prescribe thyroid hormone and can explore related problems that may contribute to hypothyroidism, such as adrenal fatigue or iron deficiency.

As always, a few cautions about iodine supplementation. Before starting iodine, eliminate wheat from the diet and supplement with selenium, copper, and magnesium. If you have thyroid-related effects from copper supplementation, before proceeding further supplement copper until your thyroid no longer reacts. Start iodine at a low dose, say 500 mcg (0.5 mg) per day. Increase the iodine dose no faster than one doubling per month. When you increase the dose, if you have a reaction to the higher dose, phase it in: say, alternate between 0.5 mg and 1 mg for a week before trying 1 mg/day every day. Go slowly, plan on spending 4 months to reach 3 mg/day, which is a quarter Iodoral tablet. Tablets can be cut into pieces with razor blades and liquid solutions can be diluted; don’t hesitate to reduce doses.

Insufficient Dietary Fat and/or Bile

Not long ago Jamie Scott (That Paleo Guy), a very smart nutritional advisor, discussed his solution for constipation. There were several gems in there, for instance, that foods that stimulate opioid receptors can cause constipation [5b]:

For example, both gluten grains (and I suspect grains in general) plus dairy contain opiate-like compounds that serve to reduce the motility (movement) of your gut.  This effect is commonly seen in those who have to take the likes of codeine (also an opiate) for any length of time.

Chocolate also has opioid peptides. But don’t worry, chocolate isn’t usually the cause of constipation!

But Jamie’s main advice was:

[M]any of the people I work with just are not eating enough fat….

People are a bit skeptical when I suggest increasing fat intake to overcome constipation.  Thankfully I can now point to a clinical study in which a high fat diet, in very short time, increased gastrointestinal transit time, reducing the likelihood of constipation occurring;

Gastrointestinal transit, post-prandial lipaemia and satiety following 3 days high-fat diet in men

High-fat diets promote stool passage for several reasons.

  1. Just a tiny bit of undigested fat can help grease the passage of stool through the colon. Even modest amounts of fat in the stool make it difficult to retain feces and cause fecal incontinence. This is why indigestible oils, like jojoba oil or Olestra, cause diarrhea.
  2. A second factor is that bile is released into the intestine when fats are eaten, and bile acids have a laxative effect. Both the primary bile acid chenodeoxycholic acid (CDCA) and the secondary bile acid deoxycholic acid (DCA) act as laxatives by inducing water secretion in the colon. An excess of bile therefore causes diarrhea and an insufficiency can cause constipation. [6] This is why people who have had their gallbladders removed typically develop diarrhea: bile is constantly leaking into the digestive tract.

Just be sure that the high fat you eat comes from healthy natural sources, not high-omega-6 industrially processed seed oils.

Also, bile acid metabolism has a diurnal rhythm. [7] Improved bile acid metabolism may be another pathway by which circadian rhythm therapies could help constipation.

Insufficient Gut Flora

Fiber is often recommended for constipation, and though I believe insufficient fiber is rarely the primary factor in constipation, it can help by several mechanisms.

First, bacteria, dead and alive, form a large fraction of the stool, and the more fiber you eat, the more bacteria you will have. Bacteria are surrounded by fatty cell membranes which are a little bit slippery.

Second, and probably more important, gut bacteria tend to increase the laxative effect of bile.

This is because the body controls water secretion in the colon in part by sulfation of bile acids; sulfation eliminates the induction of water secretion.

Gut bacteria usually want more water in the colon than the body does, so they’ve evolved sulfatase enzymes that desulfate human bile acids. [8, 9] The desulfated bile causes water release and the stool becomes soft and loose.

Some bacterial species do this more than others – especially virulent strains that spread by inducing diarrhea – and I’m sure everyone’s experienced at some time in their lives what happens when one of these species overpopulates the gut. We often call this “food poisoning” and it can be treated by large doses of probiotics, to displace the bad species with bacteria that release fewer sulfatase enzymes.

At the opposite extreme, if gut bacteria are lacking then bile acids will be excessively sulfated and won’t induce water secretion. Constipation may develop.

Thus, antibiotics can induce constipation. Presumably a zero-carb, zero-fiber diet would also make constipation more likely.

Adding some fiber to your high-fat diet, therefore, can relieve constipation.

Choline

Even though choline deficiency is not a proven cause of constipation, I’ll put this in because choline is so important for health. Choline is needed to produce the neurotransmitter acetylcholine. A deficiency of acetylcholine is associated with loss of colonic motility and constipation. [10]

Egg yolks and liver are good sources of choline. There’s nothing wrong with choline supplementation either.

Hypercalcemia

Some people over-do vitamin D supplementation and/or calcium supplementation. Elevated blood calcium levels, which can be brought about by too much vitamin D, will cause constipation. If you supplement either vitamin D or calcium and have constipation, ask your doctor to check serum 25OHD, 1,25D, and calcium levels.

Gut Infections

Some pathogenic bacteria are able to paralyze the gut and induce constipation. Some bacterial species that induce diarrhea can also induce constipation when they choose – for instance, C. difficile. This is one reason why patients with bowel disorders such as Irritable Bowel Syndrome or ulcerative colitis often experience both constipation and diarrhea.

Antibiotics like vancomycin that work well against Clostridium have successfully reversed cases of constipation. [11]

Infection-induced constipation may also cause bloating, gas, acid reflux, and gastroparesis, so if your constipation is accompanied by these symptoms you should see a doctor.

Don’t over-use laxatives

It can be risky to over-use laxatives. The riskiest is probably senna, which promotes bowel movements by (a) inhibiting water absorption by the colon and (b) promoting muscle spasms in the colon wall. Unfortunately, senna is a toxin that can cause lasting damage, notably to nerves.

If you must use laxatives, magnesium citrate liquids are the best. This will restore your body’s magnesium status as well as promote clearing of the bowels.

Conclusion

With good diet and nutrition, and normalization of thyroid function, constipation is usually easily cured. The exceptional cases are those of chronic gut infections; these may require some detective work on the part of a doctor.

I’m sure this reads like a laundry list, but it should give those with constipation some ideas!

References

[1] Neal EG et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 Jun;7(6):500-6. http://pmid.us/18456557.

[2] Rao R. Oxidative stress-induced disruption of epithelial and endothelial tight junctions. Front Biosci. 2008 May 1;13:7210-26. http://pmid.us/18508729.

[3] Young D et al. Egg yolk peptides up-regulate glutathione synthesis and antioxidant enzyme activities in a porcine model of intestinal oxidative stress. J Agric Food Chem. 2010 Jul 14;58(13):7624-33. http://pmid.us/20540508.

[4] Chandrasekharan B et al. Colonic motor dysfunction in human diabetes is associated with enteric neuronal loss and increased oxidative stress. Neurogastroenterol Motil. 2011 Feb;23(2):131-8, e26. http://pmid.us/20939847.

[5] Cao Y et al. Glutamine enhances gut glutathione production. JPEN J Parenter Enteral Nutr. 1998 Jul-Aug;22(4):224-7. http://pmid.us/9661123.

[5b] Tuteja AK et al. Opioid-induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil. 2010 Apr;22(4):424-30, e96. http://pmid.us/20100280.

[6] Hofmann AF et al. Altered bile acid metabolism in childhood functional constipation: inactivation of secretory bile acids by sulfation in a subset of patients. J Pediatr Gastroenterol Nutr. 2008 Nov;47(5):598-606. http://pmid.us/18955863.

[7] Abrahamsson H et al. Altered bile acid metabolism in patients with constipation-predominant irritable bowel syndrome and functional constipation. Scand J Gastroenterol. 2008;43(12):1483-8. http://pmid.us/18788050.

[8] Huijghebaert SM, Eyssen HJ. Specificity of bile salt sulfatase activity from Clostridium sp. strains S1. Appl Environ Microbiol. 1982 Nov;44(5):1030-4. http://pmid.us/7181500.

[9] Ridlon JM et al. Bile salt biotransformations by human intestinal bacteria. J Lipid Res. 2006 Feb;47(2):241-59. http://pmid.us/16299351.

[10] Burleigh DE. Evidence for a functional cholinergic deficit in human colonic tissue resected for constipation. J Pharm Pharmacol. 1988 Jan;40(1):55-7. http://pmid.us/2896776.

[11] Celik AF et al. The effect of oral vancomycin on chronic idiopathic constipation. Aliment Pharmacol Ther. 1995 Feb;9(1):63-8. http://pmid.us/7766746.

Leave a comment ?

277 Comments.

  1. Do fermented foods trigger gout attacks? I have had a severe gout exacerbation while on a ketogenic zero carb diet. I understand why after reading your site and others and am currently adding some safe carbs back into my diet.

    Also what is the best way to analyze quantitatively what supplements I am lacking and what what chronic infections may be lurking in my body?

    I don’t mind spending a few hundred dollars and I have health insurance to acquire perfect health.

  2. Hi John,

    I’m not aware of fermented foods triggering gout attacks, I would have to look into that.

    Have you read our book? It has a discussion of optimal supplement amounts and some on chronic infections.

  3. I was wondering if cultures of foods would have increased purines from the organisms in the culture. I am avoiding items like kefir for that reason.

    Is there an electronic version of the book available for sale anymore?

    Your blog is so informative that I have been reading all the posts starting at the beginning.

  4. Hi John,

    There are slightly more purines in fermented food, but I don’t think that’s a sufficient reason to avoid it.

    I will work on the electronic versions after my CrossFit NYC talk Nov 19.

  5. Thanks, Ellen. I’m now using Ciclopirox Olamine Cream for my fungal rash and this improved the rash considerably. However, I’ve applied some to my fungal toenails and they got worse! So perhaps the nails do require another product, such as what you’re recommending. I’ll try yours and post results!

  6. Vincent, another question, if you don’t mind. Are you still taking ThreeLac? How long have you been taking it?

    You said you solved the problem after trying ThreeLac. Well, I think the same thing happened to me too, although it may be too early to tell. I’ve been taking 2 packets of ThreeLac daily (as recommended), olive leaft extract, Kolorex, Now Foods candida clear, and 2 tbsp beetroot juice everyday. So it seems to have been candida that caused my 3-year constipation (before, I was led astray by signs of hypothyroidism, FODMAP, fructose intolerance, etc.)

    Prior to this, I was also taking Paul’s gut antioxidants (NAC, copper, zinc, Vit C, selenium). I had normal bowel movements for the past 5 days, the first time where the entire stool was intact for 2 or more consecutive days in like 3 years. Wow! Plus, I’m taking 1 tsp of Epsom Salt as Paul recommended — actually I stopped that 2 days ago since it seemed to make me “too regular!” — 2 or more BMs per day! Anyway, it’s very exciting and I need to thank you and Paul.

    Just to be specific, I think there are 3 components to constipation. I attained colon wall moisture with Paul’s 150g safe starch recommendation. And the intact stool (candida is my guess on the cause) with ThreeLac and various candida supplements (Paul/Vincent). And regularity with Epsom Salt (Paul).

    Paul, Shou-Ching, and the guys: you’re geniuses! No conventional medical doctor would have come up with the solutions you have! We should rename this site, “Being Geniuses Together.”

  7. Hi Randle,

    That’s great! Congratulations!

    Re the epsom salt, I wouldn’t do more than 1/4 tsp per day orally for any extended period.

    Best, Paul

  8. Paul,

    Why would you not advocate more than a 1/4 tsp of epsom salt for an extended period(defined as ?) A tsp is less than 500 mg of magnesium which is close to the RDA? Could you elaborate as I have been taking close to double that dose for a couple years but not as epsom salts.

  9. Hi Rich,

    The concern is too much sulfur feeding sulfur-metabolizing bacteria in the gut. If you want high doses of magnesium I would go with magnesium citrate or amino acid chelates for the extra magnesium.

  10. Randle: Very glad to hear about your progress! I wish you continued success.

    I have taken ThreeLac on and off for a bit over three months, sometimes using two packets (especially in the first couple of weeks), sometimes one. I just finished a box of ThreeLac and am planning to stop for a while to see how I do without it.

    Sincerely,
    Vincent

    PS: Taking ThreeLac to assist in treating a Candida infection was Paul’s suggestion (possibly mentioned in another thread), so he gets the credit. I’m just a willing guinea pig. 🙂

  11. The concern is too much sulfur feeding sulfur-metabolizing bacteria in the gut. [Paul]

    Paul, didn’t you recently say that you started to support higher sulfur supplementation ?

    How does this relates to MSM supplementation (16% epsom salt vs 10% MSM in sulfur mass fraction) which is touted as great for infection.

  12. Hi maj,

    Yes, I do. 1/4 tsp epsom salt a day is higher than I was advocating before, which was none.

    I think the sulfate form is likely to be more useful than the MSM form, but would like to see that tested.

  13. It looks like MSM is not used by microbiota unlike its precursors:

    http://mic.sgmjournals.org/content/105/2/335.full.pdf

  14. majkinetor,
    “It looks like MSM is not used by microbiota unlike its precursors”.
    Is that a good thing or bad thing? (the pdf is bit over my head).

    I ask because i currently take a small amount of MSM every day (1/2 tsp, approx 2 grams).

    (i do not currently take epsom salts).

  15. Paul,

    A very good friend of mine suffers from ulcerative colitis. I’ve searched your website and other like-minded sites looking for information that might help her. The doctors tell her that it is a genetic disorder that largely effects Jewish people–she’s jewish–and that, save for steriods, there is very little that one can do. As expected, her GI said that diet would do little if anything. I know one person’s colitis seemed to have responded well to the PHD, but I was wondering, is there some part of PHD, or the supplements that you recommend, that you think we should look into?

    thanks so much,

    james

  16. Hi James,

    The assumptions that UC and Crohn’s are entirely “autoimmune” and that the autoimmunity is genetic rather than infectious (ie molecular mimickry) in origin are both unfounded. Steroids are best avoided because they provide temporary symptomatic relief but aggravate the underlying condition, which is usually infectious in origin.

    Gut dysbioses are difficult to cure because it is hard to reshape the gut flora. The best thing, actually, is a fecal transplant, purging the gut of bacteria and then receiving donor feces from a healthy person. But there are many things that can be done short of that. I would suggest reading our bowel disease category, http://perfecthealthdiet.com/?cat=47, starting from the back (the oldest posts). Also reading our book.

    I would also suggest getting a test I frequently recommend, to look for pathogens in the colon: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology.

    In general, our book is a program for general bodily health, and implementing the whole thing will help. But usually an experimental process is also needed, since every disease has its own individual features.

    Best, Paul

  17. @James – My husband’s UC responded very well to a combination of things, including:

    – PHD without the starches. We are hoping to successfully add back starches in time, but right now they’re not well tolerated. White rice is the only one that seems to be ok, but only infrequently and in small doses. Sweet potato and other sugary foods (e.g., fruits) cause the most symptoms. I’m guessing this points to bacterial infection.

    – GAPS diet principles like really emphasizing bone broth (as in, 3 cups a day of the gelatinous stuff). GAPS Intro can be a worthwhile short-term experiment for stubborn bowel disease.

    – Commercial probiotics in large CFU numbers and a variety of species. Some swear by VSL#3, for example.

    – Acupuncture. This had an immediate positive effect. You might also try Chinese herbs if you’ve got a good prescriber.

    – Stress management techniques like meditation.

    Some have reported success using low dose naltrexone with UC. We don’t have personal experience with LDN. Fecal transplant, as Paul said, is also very promising. And of course making sure all systems are working with and not against you is important, so have thyroid, vit D, iron panel and similar tests done. All this is covered in Paul’s bowel disease posts.

    Even though he is asymptomatic right now, we’ve got a Metametrix test on order to see if it turns up anything.

    I hope this helps and that your friend finds relief.

  18. @James, continued.

    I forgot to mention that my husband believes taking Paul’s recommended supplements, especially glutathione, has helped. He also uses Great Lakes gelatin to beef up, no pun intended, less than stellar broths.

  19. I have had constipation my entire life. I have hard stools (Bristol Type 1-3) that are difficult to pass 2-3x per week. Oddly, if I eat gluten, my stools become near perfect (Type 4) and pass with little effort, but usually follow with some kind of diarrhea shortly thereafter, so I avoid gluten completely.

    I’ve tried elimination of dairy, megadoses of Vitamin C (1g-4g), drinking excessive water, and a combination of these things, but nothing changes my infrequent and hard stools.

    Outside of experimentation mentioned above, my normal diet consists of only whole foods. Nothing processed. No legumes, gluten, tree nuts, milk, or caffeine. I eat only some cheese and yogurt. My diet consists of mostly pastured eggs/butter/beef/lamb wild salmon/shellfish/mollusks, berries/bananas/apples, carrots, spinach/kale/greens, rice and tubers. I track my food consumption in Cron-O-Meter, and my vitamins and minerals seem okay. This is all from food, no supplementation other than 2000 IU Vitamin D a few times a week.

    Male, 30, 6′ 155lbs, low body fat, rigorous exercise twice per week, regular sleep, good mood/well-being. I generally feel very good with no other symptoms to note.

    Per-day, averaged over 11 months:

    2500 cal
    150g protein
    120g carb (20/40 fiber/sugar)
    150g fat

    900mg Calcium
    1.5mg Copper
    18mg Iron
    325mg Magnesium
    3650mg Potassium
    175ug Selenium
    20mg Zinc

    160mg Vitamin C
    1000 IU Vitamin D
    320ug Vitamin K
    13ug Vitamin E
    600ug Folate
    730ug Retinol
    750mg Choline
    All B’s around 150-200% RDA

    65g/55g Saturated/Monounsaturated
    4g:11g Omega-3:Omega-6

    What can I try to attack my constipation? I see many of your suggestions above are to replace something that might not be present in the food, but my micronutrient levels seem okay.

  20. Hi BaleoNub,

    My first recommendation would be to cut the iron. See http://www.ehow.com/how-does_4926479_does-excess-iron-cause-constipation.html. Men should not be supplementing iron. Be sure your multivitamin has no iron, and donate blood to help get rid of it. You might want to test ferritin levels.

    My next recommendation would be to cut the calcium. See http://www.buzzle.com/articles/calcium-supplements-and-constipation.html. We generally favor avoiding calcium supplements or minimal calcium supplementation, ie no more than 200 mg or so.

    My third suggestion would be to eat a bit less protein and more carbs.

  21. Thanks for the quick reply. I will try to make these changes, however two things:

    1) The levels of vitamins and minerals I described above are from whole foods. I do not take a multivitamin and take no other supplements besides 2000 IU Vitamin D a few times per week.
    2) I’ve had the same constipation problems before I ate Paleo-ish. I was eating a lot of carbs and less animal product. In fact, I didn’t eat beef for about 10 years before going Paleo and still suffered the same issues.

  22. Hi BaleoNub,

    Odds are it’s some sort of gut dysbiosis, so fermented foods esp fermented vegetables are the most likely to help. But you might try supplementing extra magnesium, selenium, iodine, and vitamin C, maybe zinc and copper also. Also, have your TSH and thyroid hormone levels been tested?

  23. I’ve seen dairy (including cheese & yogurt), rice and bananas and even cooked carrots on lists of constipating foods. Also, people with a redundant (long) colon are more prone to constipation.

  24. @Paul Jaminet

    I will attempt to add more fermented foods into my diet and control the iron and calcium. The supplementation is probably the only thing I haven’t tried yet, so I’ll work that in as well. Regarding fermented foods, I typically eat lacto-fermented pickles and sauerkraut (Bubbies brand, bought refrigerated). Does this count, or do I need to make it myself? Also, what kind of quantities are we talking about?

    @Connie

    These things may be a factor, but they are not the root cause. I’ve experimented with no dairy for up to a year, VLC for months at a time (minimal fruit, no rice, no starchy plants), etc. The diet I described above is where I’ve settled, but I’ve tried many different diets along the way. Nothing improves my BM or stool quality.

  25. Hi Baleo,

    If you’re eating the Bubbies that ought to be enough. I would try our supplement regimen, maybe a little extra for glutathione, taurine for bile conjugation (maybe an ox bile supplement to test if it’s a bile issue?). And get thyroid hormone levels tested next time you’re at the doctor, especially if you have any other hypothyroid symptoms.

  26. Hi Paul,
    I’ve been following the PHD and taking the recommended supplements and many of the therapeutic supplements for several months. Last week, I just started supplementing with Zinc and NAC. This week – no more constipation for the first time in many, many years – amazing! Thank you so much!

  27. Here’s the correct link for Jamie Scott – That Paleo Guy:

    http://thatpaleoguy.com/

    And here’s the correct link for his constipation discussion:

    http://thatpaleoguy.com/2011/03/08/everybody-lies/

  28. Hi Paul,

    I have chronic constipation since the past 3 to 4 years. Have started supplementing as follows:
    NAC 600mg, Vit. C 1gram, Selenium 200mcg, Copper 3mg, Zinc 30mg.

    I have been on these since the past 3 days, but still face difficulty in passing stools (bristol type 3). I have eliminated wheat and use olive oil, butter and diet as per your PHD book. I have minor rheumatic pain on the index finger of my right hand, and used to supplement 150 to 250 grams of protein(regular weight training) but stopped 10 days back after I read the downside of protein and increased carb intake. While on protein I used to pass stools every other day. Do you have any suggestions that I can follow please? Your guidance is highly appreciated…and thanks to You and Shou Ching for the hard work and information….Regards Manoj Nand

    • Sorry typo, please read as 24 to 48 grams protein (150 to 250 calories) per day.. thanks

    • Are you not taking any Iodine? I think what ur taking is useful as gut antioxidants. However, the first order is to determine whether you have any moisture in your GI tract. Type 3 can be passable with sufficient moisture – in fact all BC types can. And I found Pau’s suggestion about taking in enough carbs to restore moisture to the tongue, eyes, and GI tract to be invaluable. After that, I think you can move onto the other aspects of constipation. Of course , that’s all assuming you may be lacking moisture.

      • Hi Mambo,
        No I am not taking any iodine so far. I do consume carbs (white rice, sweet potato, potato) and lots of greens, but stopped protein intake after reading Paul’s comments…I am vegetarian but consume eggs daily. I have tried many remedies (ayurvedic, fiber, etc) but unable to get a permanent solution. Thanks mambo…

    • Hi Manoj,

      Possibly a magnesium deficiency? Magnesium glycinate 400-600 mg per day; divide dose some before bedtime and morning could be something to try. Magnesium draws water into the colon.

      Thanks,
      Mark

    • Hi Manoj,

      First, I would cut the zinc and copper in half (15 mg zinc / 1 or 2 mg copper is sufficient) and start supplementing magnesium. They sell magnesium citrate as a laxative in pharmacies here, I would look for that, and take a bit of it every day; or get pills. You want 200 to 400 mg/day.

      You do need adequate protein. I’m having a hard time telling how much protein you are eating. Vegetarians such as yourself are often protein deficient. Too little protein might be your problem.

      If egg whites are your source of protein, then you should stop the selenium supplements. Egg whites have a lot of selenium.

      You might supplement taurine along with extra vitamin C, to support bile production. Be sure to eat plenty of egg yolks.

      Best, Paul

      • Hi Paul,

        Should I read this to mean 100 mcg selenium total from all sources (food+supplements)?

        Selenium
        •Supplement up to 100 mcg per day including multivitamin (eg 200 mcg every other day; note reduction from book rec)
        •Or, eat food sources: Brazil nuts, kidney, shellfish.

        Just wanted to save this info on selenium in eggs. ~20 mcg in 3 large egg whites, ~48 mcg in 3 large whole eggs.

        The majority of the selenium in eggs is located in the yolk. An egg white from a large egg provides 6.7 micrograms, whereas the entire egg provides 15.9 micrograms, according to the USDA National Nutrient Database for Standard Reference.

        http://www.livestrong.com/article/440701-selenium-and-eggs

        Thanks,
        Mark

        • Hi Mark,

          No, you still want 200 mcg – 400 mcg from food and supplements combined, but our diet is very selenium rich, so I no longer think it’s desirable for PHD’ers to routinely supplement. Our intake worked out to 350 mcg/day for instance. Shellfish, seafood, beef, organ meats, bone broth soups, eggs, all selenium rich.

          I think no PHD’ers will get less than 100 mcg/day, so no one should need to supplement more than 100 mcg/day.

          • Hi Paul,

            Makes sense, do you have example breakdown of selenium amount per food for your intake of 350 mcg/day of selenium? I only seem to get around 130 mcg/day eating 3 eggs, 4 oz ground beef, 4 oz seafood per day, plus 4 oz beef liver once/week.

            Thanks!
            Mark

  29. Hey Paul. What do you mean by goitrogenic toxins? Do you mean foods like broccoli, carrots, sweet potatoes?

  30. Hi Paul,
    I am 50 yrs old and have been sffering from chronic constipation for 3 yrs. I have been on prilosec 20mg/day for 13 years. I am a bad eater. Too much sugar/salt/grains, not much vegetables(hate them). My GI doc has been throwing powders and pills at me to no avail. Colonoscopy ok, some divoticulosis but not bad yet. I am going to try the paleo and above listed suppliments. Does the long term prilosec use seem like a factor here?

  31. Hi Paul,
    Our friends in India have a 3 year old boy who is constipated very often. When they were here visiting some people suggested fiber so they gave him prunes and made sure he was hydrated. I don’t know if that helped him or not. But, they’re still facing the same problem with him. I know he has been on antibiotics before so I know about that possible cause, but this has been going on long-term so I’m guessing it’s something else. I told them to try adding a little fat to his food like butter and maybe eggs for the egg yolk. I’m not sure about their daily diet, but my guess would be that a main staple is rice and lentils, also some yogurt. I don’t know apart from that. Does adding the fat sound like a reasonable thing to try?
    They do take him to a doctor but there doesn’t seem to be any great help there.

    I also sent them this post. Is there anything else you can think of to suggest or make a guess on about his case? I know I’ve given you very limited info, but any guess will be great for them to try.

    Thanks so much!
    KH

    • Hi KH,

      Yes, that was good advice. All the advice in this post should be tried. He might be magnesium deficient, he might be glutathione deficient, he might be fat or bile acid deficient (vitamin C and taurine for bile, ox bile could be used temporarily to test). It could be that the lentils cause a problem with his particular gut flora. Making sure his fiber comes from healthy sources, like berries and potatoes, not lentils, would be a step forward

      The best thing the doctor could do is test for thyroid status.

      Best, Paul

  32. Ok, thanks Paul. I’ll pass on these ideas to them and see if they think they can get thyroid tested. I’m not sure about their medical situation over there, but I’ll suggest it.
    Thanks!

  33. If you’re restricting carbs in any amount, you might be passing more water and salt (Volek and Phinny). Try intaking more salt.

  34. Paul,

    Have you every heard of person having a body odor issue from digesting food. I noticed that when I eat near zero carbs people seem to think that I stink. It seems the body odor occurs maybe 1/2 to 2 hours after eating food.

    I noticed that if I fast I rarely every notice anyone turning on fans or using breath mints.

    I am lactose intolerant, so I avoid any dairy products. If I eat pizza I get a extremely bad body odor next day while my body is processing the food.

    Also I have noticed that if I try eating certain things like ox tail or bone marrow women steer clear of me or start popping breath mints.

    Is it possible that my liver or intestines are damaged allowing the bad smell?

    I think that some of my problems are with protein digestion. For instance eating a steak or bacon for dinner and the next day hearing comments that I stink or smell like bacon. This is frustrating.

    Is there some sort of test for body odor related to food digestion?

    Any tips on how to reduce food related body odor. I know there are certain things like eliminating soda, coffee, sugar, gluten, dairy, spicy foods.

    I just took a comprehensive blood test and should have the results soon if that would help you.

    By the way I shower every day, brush my teeth, and was my clothes once a week. So it is not a personal hygiene issue.

    I would appreciate any suggestions.

    Thank you,
    Steve

    • Hi Steve,

      Odds are the body odor comes from eating too much protein. When gut bacteria metabolize protein they generate smelly (and toxic) compounds. This makes the stool smell unpleasant, and probably body odor too.

      Wheat can also cause digestive tract distress. Do you get the body odor if you eat rice?

      I would try to increase carbs and reduce protein, but if the carbs cause the problem too, then I’d get a stool test and try to remodel the gut flora.

      Another possible source of body odor is that many toxins are excreted in the sweat, especially metals and selenium. So if you have an excess of these it could cause odor.

      • Paul,

        Appreciate the response back. I don’t think I have had body odor with white rice.

        I do like sushi and sashimi and have noticed at times that I had body odor eating sashimi.

        You might be on to something that I can’t digest too much protein and that might be the cause of most of the body odor.

        I did notice that I had a sulfur like odor after eating some chinese food with lots of fried rice a few times. Another time eating Mcdonald’s chicken nuggets with large fries and lots of ketchup.

        I read your book but can’t recall all the tips for repopulating the gut bacteria. If I recall correctly fermented vegetables like Kim Chee, sauer kraut.

        I have also started drinking Kombucha not sure if this will help out.

        This Saturday I will pickup my general blood test results and can note anything that looks abnormal.

        A few years ago my liver enzymes were out of tolerance but have lost about 10% body fat and 40 lbs of weight and it began normal.

        I will try reducing my protein and increasing my carbs using white rice and see what occurs.

        Thank you,
        Steve

        • Hi steve,

          For protein digestion you can try taking betaine hydrochloride with meals and/or eating more salt to support stomach acid production.

          It takes time to remodel gut flora. The first step is a healthy diet.

          • Paul,

            Appreciate the tips. Finally got back the blood test results few things out of tolerance. glucose 107 mg/dL little high, H1Ac 5.4, creatine serum 0.73 mg/dL little low.

            NMR liprofile LDL-P 1246 nmol/L, 138 LDL-C mg/dL, HDL-C 63 mg/dL, Triglycerides 26 mg/dL, HDL-P total 35.2 umol/L, small LDL-P 283 nmol/L, LDL 21.4 nm large pattern A, LP-IR score 15 Lipoprotein insulin resistance score, 45 more insulin resistant.

            I did check my body odor by eating a lot of bbq beef brisket and I was definitely stinky the next day. It appears that you are correct that I have some sort of problem digesting large amounts of protein.

            Is there anything else that you notice about the above cholesterol values and few out of tolerance metabolic tests?

            Again appreciate your great website, book, and support.

            I will definitely recommend your book to my immediate family and
            friends.

            Thank you,
            Steve Kaleta

          • Hi Steve,

            The only oddities in your numbers are the low triglyceride and high fasting blood glucose. I’m not sure what’s causing those. I’d be curious what happens to the numbers if you eat more carbs.

          • Hi Steve,

            That fasting glucose is definitely a little high. I’m not sure but you A1c might indicate that for the rest of the day you’re in normal range.

            Consider getting a glucose meter? Definitely not expensive and you’ll be able to track your glucose levels during the day.

            High morning glucose could be the “dawn phenomenon” in which the liver makes excessive glucose in the morning. I’m not sure what causes that, could be insulin resistance in the liver or hormonal imbalances esp stress related from what I understand.

            My mom had much higher readings than that but by avoiding alcohol or carbs in the evening it’s gotten better (still not good).

  35. What test do you believe is MOST beneficial for assessing gut health overall (parasites, yeast, bacteria SIBO etc) that you can do at home? thank you!

  36. Constipation on paleo diet – my problems only started after being on a paleo diet for 16 months. Constipation coincided with steady increase in weight – in last 7 months have gained 8 kgs from a starting weight of 50kg. I keep thinking things will just sort themselves out, but to no avail. I exercise, I eat plenty of fresh meat and veg, I tried supplementing with selenium, magnesium, and started eating seaweed and kimchi. I have not been to my GP because I know she will just tell me to eat grains. I intend to purchase your new book when the kindle edition becomes available in Australia. As I have been on an even more nutrient rich diet than previously (my previous diet was very good apart from grains) I don’t understand why constipation and weight gain should develop for the first time in my life – I am 51 yrs old.

    • Hi Katy,

      Try taking an oxbile supplement with meals, see if that helps. Ask your doctor to test your thyroid status, see if that has changed; if so see if thyroid hormone cures the constipation. If neither of those works, then a stool test to diagnose the gut flora might be helpful.

  37. Would these recommendations also work for constipation caused by pregnancy hormones? I was regular before pregnancy, although according to the Bristol Stool chart still constipated. Consistency of bm hasn’t changed just frequency. We’ve been PHD for almost a year, and take most of the supplements. I haven’t added the cysteine or glycine, so maybe that’s the step I need to take next. Thanks for your help!

    • Hi Ashley,

      I haven’t really looked into the mechanisms by which high progesterone in pregnancy leads to constipation, so I’m not sure what’s best to do about it. From summaries like http://www.babycenter.com/0_constipation-during-pregnancy_836.bc, it looks to me like more exercise is probably an excellent thing to do, and also having iron levels tested to make sure you don’t have iron overload. I do think increasing glutathione levels is safe and has a chance to be beneficial. Also, the choline idea (extra egg yolks) is good in pregnancy.

  38. Paul and Wout,

    Appreciate the follow up replies. The one thing I didn’t mention is that I have been intermittent fasting (IF) everyday. I have read that doing IF can increase your insulin sensitivity because pancreas is starting to function correctly to carbs again. I started eating bad carbs again a couple of weeks before my follow up blood test. Most websites said that if you have a low carb diet that you should eat a moderate amount of healthy carbs 3-4 days before a blood test or glucose level will be high, not sure if this is true.

    Also A1c scores can be affected by life of red blood cells, not certain if mine are dying quicker or slower than normal skewing the A1c results.

    Also I have getting bad on my sleeping habit, getting an average of 4-5 hrs a night.

    I think that Wout has a good idea of getting a glucose meter to see if any food or drinks are sending my glucose levels high and removing them from my diet.

    I will let you know how things turn out. Plan on eliminating some veggies that are on the Fodmaps bad list to see if that helps lower gas and body odor and follow the Perfect Health Diet.

    So definitely a few things I know that I need to fix.

    Paul keep up the great work on your website. I just bought a copy of the PHD book for my brother.

    Regards,
    Steve

  39. So that article about the guy with no small intestine got me thinking. If a high carb diet is dehydrating, I should try to really make sure I’m under at least 35% carb calories, and I’ll be more regular (I don’t fast well either). I think it’s working.

  40. Hi Paul,
    I’ve been eating Paleo for about 2 years ( invluing 3 eggs a day, meat, veggies, bone broth and also dairt, and liver pate ) and have been pretty regular ( taking Oxbile supplement 2x a day) but since I’ve started to eat rice and potatoes ( not even as much as the recommended amount on PHD) I’ve been having constipation every day, it’s getting pretty painful. I’ve been also taking 400mg magnesium citrate for about a year, fish oil ( trying more fish but not liking it yet) iodine and vitamin D3-2000-4000 IU , depending on the season. I ordered vitamin c and vitamin k, but not the other weekly vitamins yet. So it seems that rice and potato might be the culprit?? I really dont want to eliminate them, they’re helping with my sugar cravings. Any advice would be appreciated.

    • Hi Gabriella,

      Especially on VLC diets it’s easy for the gut flora to be disrupted and a few species to become overabundant. So the trick is to repopulate the gut with a diverse range of species.

      In extreme cases this might need antibiotic treatment plus probiotics or even a fecal transplant, but I would just try fermented vegetables, fermented dairy, and reduce but don’t eliminate the starches that give you trouble.

      • Hi Paul,

        I’ve been reading about gut dysbiosis and probiotics. But I am unclear about a few things:

        Is this correct: Fermented foods and probiotic supplements are only a source for Lactobacillus and/or Bifidobacter?

        So someone trying to correct for low Bacteroides sp. will not benefit from probiotic foods/supplements – correct?

        Are there probiotics for other strains (e.g. Bacteroides sp., Clostridia sp., E. Coli)?

        Thank you for your time!

      • Thank you Paul, I will try the fermented veggies, and dairy. Fortunately sweet potato, white potato is not a problem at all, it’s only rice. I will just experiment with the amount of rice.

  41. Infection-induced constipation may also cause bloating, gas, acid reflux, and gastroparesis, so if your constipation is accompanied by these symptoms you should see a doctor.

    I sought out three different gastro’s. I had all these symptoms (and rapid loss of 35lbs), but none suggested an infectious cause. Two PPI scripts and an offer of gallbladder surgery later, I took to looking for alternative explanations.

    My GI DNA profile shows fungus and protozoa, both of unknown taxonomy.

    I intend to implement strategies discussed here and report results.

  42. Is there a safe/natural way to increase pancreatic and/or biliary secretions for fat absorption? My wife suffers from constipation (pretty much since birth) and after conducting the Metametrix 2100 GI profile the only thing that came back out of range was Elastase 1 which was 143 (moderately out of range), and her Long Chain Fatty Acid and Total Fat scores were high, which the test report says means she has fat malabsorption. Any help would be greatly appreciated. She has been gluten free for five years.

    • Hi Paul,

      She can try supplementing vitamin C, taurine, and maybe glycine to support bile production. Taking ox bile with fatty meals would also have diagnostic value, if it helps then she is deficient in bile. I would suggest those changes first.

  43. I wonder if Paul or anyone can expand on this comment in the Hypothyroid section of this post:

    “If you have thyroid-related effects from copper supplementation, before proceeding further supplement copper until your thyroid no longer reacts.”

    I do seem to have side-effects correlated with copper supplementation — constipation mainly. Also when I supplemented copper for 2 days recently it seemed to correlate with a worsening of the H pylori infection I’m dealing with.

    I do not know if I’m hypothyroid. TSH was 1.43 at last lab test, body temp approx 97F in morning. I do have a # of possible symptoms on a hypo checklist.

    Should I try increasing copper gradually through food sources? Do I not supplement iodine during this time?
    Thx…

  44. Hi! I a 23 month old who had chronic constipation before putting him on the Paleo diet. But I have found that most of the “safe” carbs of Paleo constipate him as well. All types of squash, pumpkin, banana, and root veggies like beets. He can eat potatoes and sweet potatoes though which he loves. I wanted to add rice since finding your website and to give him more variety but am worried that will stop him up as well. I really believe that wheat was a big problem for him because he used to not go for up to 5 days until we gave him a suppository but with the squash and the root veggies it is about a day or two and after a bit of prune juice he is fine. Do you think this is a fat problem? He does not consume dairy except for ghee. Thanks for any advice!

  45. Hi Paul,

    I’ve been reading articles about constipation because my mother, in her fifties, has been dealing with constipation for 5 years now. Her average bowel movement is only once a week up to now. I’m greatly worried because it is not really healthy anymore.

    Her intestines start to swell that doctors gave her an advice to stop eating because her intestines might burst if she don’t get waste our of her body.

    We don’t know what to do because we can’t feed her as much as she or we want to. I’m not sure if drinking dulcolax tablets are safe for this certain situation.

    Thanks for any advice.

    Kate

    • Hi Kate,

      It’s definitely unhealthy and needs to be addressed. And obviously not eating is not feasible. She can minimize fiber, however.

      Has she tried the steps outlined in this post? Magnesium supplements to begin with, ox bile supplements at meals, NAC and other antioxidant nutrients. Also she should get a stool test like the Metametrix Microbial ecology profile. A fecal transplant is likely the most helpful therapy. Search our blog for those words for a few blog posts on it.

      Best, Paul

      • I searched your blog Paul and I found useful information but my mother was fed through IV for 4 days and amazingly her intestines went back to normal. The doctor said that it’s the human body’s nature that removed the swelling. Her body healed itself. I’m still in awe and amazed by what had happened to her. I thought we’ll loss her.

        Thanks for your concern Paul!

        Kate

    • I heard somewhere that magnesium is what makes plants green. When I eat more greens I seem more regular.

  46. Sarenda Davison

    How do I send this article to my daughter?

  47. Oh, wow, my doctor prescribed L-Glutamine for me, and I take a powdered tablespoon every night before I go to bed. By mistake I just ran out, and lo and behold got constipated.

    But now you say to avoid it! Since your book is due to arrive any day now, I’ll slowly taper off the L-Glutamine and start trying some of your other remedies.

    (And I’ll pass this news along to my doc!)

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