Are Your Supplements Making You Constipated?

Constipation is a common gastrointestinal (GI) concern, affecting over four million Americans. The rate of constipation tends to increase with age, from 16 in every 100 adults to 33 in every 100 adults over 60. In addition to older adults, constipation is more frequently reported in women after childbirth and non-Caucasians. While numerous factors may contribute to constipation, including dehydration, medications, and medical conditions, certain supplements may also play a role. This article will discuss constipation, its symptoms, and the supplements that may be associated with constipation. We'll then explore functional medicine testing for constipation and how to approach it with an integrative perspective. 

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What is Constipation?

Constipation can be a temporary or ongoing condition and usually involves hard or dry stools, making them uncomfortable to pass or making it difficult to eliminate the stool completely. Additionally, having fewer than three bowel movements per week is also common with constipation. 

Constipation Symptoms

Constipation symptoms can include:

• Lumpy, hard stools
• Painful, difficult-to-pass stools 
• Needing to take something to have a bowel movement
• Feeling as though there is a blockage preventing the stool from coming out

Supplements That May Be Associated with Constipation 

Multivitamins and Constipation

Multivitamins, including prenatal vitamins, typically contain various vitamins and minerals. These supplements usually contain the recommended daily allowance (RDA) of vitamins and minerals; however, some may have higher amounts. Iron is a mineral found in most multivitamins. Although necessary for oxygen circulation, iron can also draw water from the intestines, potentially leading to hard, dry stools. Calcium is another mineral found in multivitamins. Calcium is necessary for muscular contractions and bone formation. It may also contribute to constipation by slowing movement throughout the GI tract. 

Berberine and Constipation

Berberine is a phytonutrient that has been used for thousands of years in Chinese medicine. Commonly used to support blood sugar regulation, berberine may also have anti-inflammatory and antimicrobial properties. Because of this, it is often used in metabolic, gastrointestinal, and immune contexts. While low doses have minimal side effects, higher doses may be associated with constipation, although the mechanism is unclear. The standard dose of berberine is 500mg three times per day. 

Fiber and Constipation

Fiber is a non-digestible carbohydrate found in many plant foods. While fiber can be beneficial for constipation, it may also contribute to or exacerbate constipation in some people. There are two types of fiber, soluble and insoluble; insoluble fiber is known to bulk or increase fecal matter. For those who already have difficulty passing stool, adding insoluble fiber and thus increasing the size of fecal matter may make constipation worse. Additionally, fiber can slow the movement in the gastrointestinal tract, further contributing to constipation. 

Cinnamon and Constipation

Cinnamon is a common culinary spice and also has historical use as a medicinal herb. Cinnamon has anti-inflammatory, antioxidant, and anti-bacterial properties and may be helpful for cardiovascular and metabolic contexts. However, constipation with the use of cinnamon may occur. 

Functional Medicine Labs to Explore Causes of Constipation

Functional Medicine Practitioners often use functional lab testing to explore potential causes of constipation. Below are some of the most common labs run:

Micronutrient Panel

Micronutrient panels, such as the Spectracell Micronutrient test, assess the level of numerous vitamins and minerals in the blood. As discussed above, certain micronutrients like iron and calcium may be associated with constipation; thus, checking levels could be helpful. Additionally, low levels of certain micronutrients, such as magnesium and thiamine, may also be linked to constipation. 

Comprehensive Stool Analysis

Constipation is a condition of the GI tract. So, assessing GI health and function is essential to the approach. Also, certain supplements containing specific vitamins could directly impact the health of the gut microbiome, a collective group of bacteria, viruses, and fungi within the gut. If the microbiome is imbalanced, constipation may occur. Therefore, a comprehensive stool analysis, such as the GI360 test by Doctor's Data, could be beneficial for evaluating whether the supplements you are on are affecting your gut health. This test provides insight into each step of the digestive process. Markers of digestion and absorption are analyzed, as well as inflammatory and permeability markers and an in-depth assessment of the microbiome. 

Nutrition For Constipation

As discussed above, fiber may be beneficial for constipation, or it may make it worse. A meta-analysis of randomized control trials evaluating over 1,200 people showed the fiber supplement Psyllium could support improvements in constipation. However, conditions that inhibit movement throughout the GI tract may feel worse with high-fiber diets and may even benefit from low-fiber diets. Gastroparesis is a condition causing slow movement of food from the stomach to the small intestine and often causes constipation. Thus, those who have gastroparesis may benefit from a low-fiber diet. Pelvic floor dysfunction, another condition that can cause constipation, occurs when muscles that make up the pelvic floor aren't properly working. Healthy pelvic floor muscles are required to push stool out; thus, large stools from the increasing fiber may worsen the condition. Therefore, when evaluating options for the best diet for constipation, it's important to consider the underlying causes of constipation. 

Probiotics For Constipation

Probiotics are supplements that contain strains of beneficial microbes that are found in the microbiome. A randomized control trial (RCT) used two formulas of probiotics that included various strains of the beneficial bacteria Lactobacillus and Bifidobacterium, and there was also a placebo group for comparison. Both groups given the probiotic formulas showed improvements in stool frequency and quality compared to the placebo group.  

Prebiotics For Constipation

Prebiotics are fibers that serve as fuel sources for the microbes in the microbiome. A review in the journal Current Clinical Pharmacology assessed 21 RCTs that evaluated the role of prebiotics in chronic idiopathic constipation, a form of constipation with no underlying cause. The results suggested that prebiotics may effectively increase stool frequency and consistency while reducing bloating. The authors concluded that the addition of prebiotics was effective in supporting the management of chronic idiopathic constipation. 

Botanical Medicine For Constipation

A study was performed using a supplement with a combination of botanical medicines, including peppermint oil, fennel oil, rhubarb extract, activated charcoal, calcium sennosides, and purified sulfur, to evaluate its potential in supporting constipation relief. The supplement was given to 1,000 people between the ages of 18 and 75 for two weeks. Results showed that participants reported a reduction in constipation severity. Over 72% of participants also reported decreased straining during bowel movements, and the feeling of not having a complete bowel movement was reduced by over 71%. 

Abdominal Massage For Constipation

Abdominal massages may also be helpful for constipation. Abdominal massages may help support muscular contraction and movement in the GI tract, increase stool motility through the GI tract, and thus lower discomfort associated with constipation. Massages should be done when a normal bowel movement would be expected, usually 30 minutes to one hour after a meal. Making circular motions while tracing the large intestine, from the hip bone up to the ribs, across the abdomen, and down to the left hip bone, can be one component of the massage. 

Summary

Constipation is a common concern that affects many people. While all causes, including underlying medical conditions, should be evaluated as potential contributors to constipation, care should be taken to also consider supplements as a factor. Additionally, functional medicine testing can aid in exploring the root cause of constipation and help formulate a plan to support symptom management.