Treating Constipation without Destroying Your Gut

May 29, 2012 in Categories: , by

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Perhaps you are wondering how on earth I am going to address this topic delicately.  The answer is:  I can’t.  It’s an impossible task and I’m just plain old going to be frank, cross over into TMI territory, and talk about poop.  Although, I will spare you the drawing of a constipated stick figure. Perhaps you are wondering exactly why this is even a worthy topic for my blog.  Well, constipation is a relatively common complaint during the adjustment period when people first transition to a paleo diet (as is diarrhea, but that’s a topic for another day).  And even the best of us can suffer constipation on occasion as a result of stress, eating foods we shouldn’t, and traveling.  But perhaps more relevant, you may be interested in how to treat constipation if you have some type of gut pathology than lends itself to constipation or if you suffered nerve damage caused by years of chronic constipation like I have.

Before discovering paleo, I had chronic constipation for about as long as I can remember.  I was officially diagnosed with Irritable Bowel Syndrome in my early twenties and prescribed daily doses of stool softeners and laxatives.  As a result of 12 years of irregular bowel movements, constipation and laxative use, I have nerve damage that may never fully heal.  Transitioning to a paleo diet allowed me to stop taking these medications; however, I do need to be constantly vigilant.  And, because I have a (thankfully, fairly minor) case of Small Intestinal Bacterial Overgrowth, the two chief symptoms that I get when I consume sugary or starchy foods is bloating and constipation.  The first time after transitioning to a paleo diet that I was faced with the need to take something to help me poop, I did a little research into what was safe to take.  I was shocked to find out that most of the commonly used laxatives and stool softeners available are gut irritants and can directly damage the lining of the gut (in fact, for many of them that is actually how they work!).  Since my diet and lifestyle choices now prioritize gut health, I needed to know what is safe to take for constipation!

I will spare you the long exhaustive list of what not to take (except perhaps to make sure to tell you that I include natural, senna-based laxatives, including teas, in the gut irritant list as well as fiber supplements of any kind).  Here are the ONLY treatments that I recommend:

  1. Use a squatty potty every day.  The better angle for pooping decreases straining, and makes pooping easier and more comfortable.
  2. Milk of Magnesia (or another high dose magnesium supplement like Natural Calm), taken at bedtime in conjunction with LOTS of water.
  3. Glycerin Suppositories
  4.  In extreme cases, you may wish to try a Saline Enema in addition to milk of magnesia.

But there are a few other tricks that are helpful as a preventative and also for minor constipation.  This may seem obvious, but make sure that your diet includes plenty of plant matter and make sure that you are drinking sufficient water (this is the most common cause of constipation in individuals following a paleo diet who do not have a history of digestive problems).  It’s also very important to make sure that you have a source of probiotics in your diet, whether it’s from fermented foods or a supplement.  Taking 1-2 Tbsp of Lemon Juice or Raw Apple Cider Vinegar 10-15 minutes before each meal can help with the secretion of digestive enzymes and decrease transit time.  Avoiding starches and sugary foods that feed bacteria and contribute to hunger hormone disregulation can be very helpful for some people (especially those who suspect they have Small Intestinal Bacterial Overgrowth).  Sauerkraut can be very helpful in regulating stomach acidity as well as providing probiotics.  Ginger is a miracle.  It helps regulate stomach acidity, stimulates peristalsis, and decreases transit time.  I drink several cups of ginger tea daily (my favorite brand is Yogi), and when I need a little extra, I like to eat alot of homemade honey-candied ginger (especially because the honey doesn’t aggravate my SIBO due to its monosaccharide content).  Exercise can be very helpful, especially something like going for a nice long walk.  Doing alot of spinal twist yoga poses can help too.  For a simple one, lie on your back with your legs bent and your arms out in a T position.  Drop your legs to the left, leaving your shoulders on the floor, and look to the right.  Hold for a good five minutes and then do the other side.

These paleo-friendly strategies work well if you are proactive and take some action after skipping just a couple of days of bowel movements (my rule of thumb is if I skip two days, but I have to be very careful, so depending on who you are, you may consider anywhere from 2 to 4 days as your metric).  Here is the important caveat though:  whether you are dealing with constipation as part of a greater pathology or the occasional reaction to traveling, food, or stress, you need to know when the gentle paleo-friendly strategies are not working.  There comes a point where problems caused by severe constipation are far worse than the gut irritation caused by taking a laxative.  Constipation can even be life threatening.  Please, do not hesitate to see a doctor if your attempts to get your bowels moving again are not working.  And don’t do what I did in grad school and wait two full weeks and then have to spend a night in the ER (where the very helpful resident diagnosed me as “full of shit”, his exact words).  I am still paying for the nerve damage that caused now.


Thanks for this post… I’ve had some of the same things going on for as long as I can remember (without diagnosis of anything or any reason why this might be happening.) I appreciate this.

Would you recommend colonic irrigation as part of efforts to take an unhealthy bowel towards a healthy one? A colonic irrigation is certainly gentle, and as a side effect is amazing for re hydrating the body.

I am not convinced that colonic irrigation is particularly helpful, but I also don’t see the harm provided it’s done carefully without applying too much pressure to the colon.

Thanks for your post, how do you make your homemade candied ginger. Before I started eating Paleo I was taking Metamucial 3x a day so I am very carefull with how things move along. I have also made ginger tea by grating ginger and placing that in hot water.

Metamucil nearly destroyed me about 10 years ago. It made my constipation even worse. sigh. I wish I knew then what I know now!

I will post my recipe for honey-candied ginger tomorrow.

I also recommend magnesium with the probiotics, at bedtime. And omega 3 fish oil in the mornings. This combo makes all the difference in the world to me. Pre-paleo, I had a horrible problem with this too, my laxitive use always bordered more on abuse because it was such a problem.

I appreciate your post. I’m not paleo, but I’ve been on GAPS Intro Diet for 2 months (very similar to paleo) to recover from ulcerative colitis and SIBO. Do you have a recipe for honey-sweetened ginger that you can share? I tried a google search but couldn’t come up with anything. Pre-GAPS I ate crystallized ginger for tummy upset. I’d love to be able to do that again, only without the sugar.

i can attest to this….having lived with a bunch of medical students! Thank you so much for the information here. I think cashews might be making me constipated. This is such a blow as I love them….and ice cream….woe woe and thrice times woe!!!

Thank you for addressing this topic. My 16 month old daughter suffers from chronic constipation and my search for answers is what led me to find paleo. She takes magnesium and probiotics every day. That along with eliminating dairy and grains has helped, but she still isn’t healed yet. I suspect we (I am breastfeeding so I have to do what she does) need to follow the autoimmune protocol too and I have been easing my way into it, but it is really hard to stay on top of it because I work full time and am the only cook in the house.

Thank you for sharing all the work you are doing. I am finding it very helpful!

My 5-year old had chronic constipation as well (she’s still not regular, but we managed to wean her off the miralax that she had been taking for 3 years). She’s not a big fan of vegetables, so I let her eat quite a bit more fruit than I would prefer (I keep telling myself that it’s just for now, sigh). Oddly enough, I have found that bananas actually help her (even though conventional wisdom is that they are constipating). It sounds like you are on the right track.

I know the Autoimmune Protocol is tough. Last night as I was cooking instead of going to bed because I knew that we needed a picnic lunch today and I wasn’t gong to have much time for preparing supper, I was feeling a little disgruntled that we can’t eat anything prepackaged. Other than saying I understand, I’m not sure I have any great solutions (maybe someday I’ll make frozen dinners for the Autoimmnune Protocol! LOL!).

Thanks for sharing this lovely post. It is helpful in getting relief from constipation without being in problem. Ginger helps regulate stomach acidity, stimulates peristalsis, and decreases transit time.

So glad I found your blog. I’m looking into paleo after being vegan for 20+ years all for bowel reasons (constipation).
Does eating fattier cuts if meat help the bowels work better?
I think the vegan diet (I’ve been grain free for 10 yrs) made my colon worse :-(
So I’m hoping to hear meats and fats actually help bowel function?

I take the product “Calm” magnesium suppliment every night as my stool softner yet I’m still a mess.
I was lo diagnosed full of poop!!!! Along with redundant colon and melanosis coli due to cascara sengrada damaging my villi.

Fats and protein will help your body heal. It will take some time and if you have nerve damage from chronic constipation, it may take even longer. If its been a while since you’ve eaten meat, go slow. You might want to look into some digestive enzymes to help at least at first. Continuing with natural calm is a good idea (I take it too). Also a good probiotic is a good idea (look for one with many strains, and you might want to look at both acidophilus and solid based probiotics).

what does it mean if you get constipated everytime you eat meat. I don’t eat much grains and eat mostly fruits and vegetables and try to incorporate oils (mainly flax seed and olive oil because coconut oil gives me really bad pains in my heart after I eat it for awhile. Is it better to stay away from lean meats? Thanks!

I was wondering if you could tell me how you get a confirmed diagnosis of nerve damage due to chronic constipation,as well as a diagnosis for intestinal bacterial overgrowth.

I had the test for it, it’s a motility test I had done through my gastroenterologist at a nuclear medicine clinic. You have to drink some stuff then go and get scanned every morning for a week and they track where the markers are, showed up I had colonic inertia which means nerve damage to the colon.

My experience with fat says it will move things along nicely. If it moves things along *too* nicely, that’s where veggies can save you; the ones higher in soluble fiber (rather than insoluble) slow things down a bit for me. You’ll want to experiment, of course, as we’re all different.

Yeah, fat really helps me, too. If I get constipated, I know I’ve been neglecting fats. My body seems to need a LOT of good fats (not oils, except coconut oil), for this and other reasons, so I haven’t had the issue of things going through too quickly.

My grain-free 11-month-old is very constipated. She is pooping about 1-2 times/week. Sigh. Our acupuncturist suggested more veggies, more veggies, more veggies to get things flowing regularly. Any other thoughts? At least she doesn’t seem to be an unhappy constipated baby.

I would suggest going with food sources of soluble fiber instead of insoluble fiber, so fruits and starchy veggies rather than roughage type veggies. Too much insoluble fiber can make constipation worse. Is your baby eating any probiotic foods? some kind of probiotic supplement is definitely a good idea here. Also, is your baby getting any dairy? One way that dairy intolerance manifests is as constipation. I hope this helps!

No, no dairy in our house at all, though I was considering adding butter or goat yogurt (which no one else in our house consumes). She is allergic to eggs (both of my kids are, sigh!), She likes sauerkraut, but I am thinking maybe it’s too salty? Salt would bind things up a bit, I expect. Our ND recommended HMF Natogen as the baby probiotic, but the tiny bit of dairy seems to irritate her skin, so I am thinking of going with Klaire Labs instead. I’ve read veggies should go with fat and that’s why I was thinking to add butter; would coconut oil, or unheated olive oil do the trick? Thanks for replying so quickly on an older post :-)

My DD is allergic to eggs also, and has a gut problem which I suspect is due to antibiotics she had when she suffered pneumonia. She alternates between diarrhoea and constipation. Diarrhoea I think may be caused by any consumption of dairy. I’m thinking of starting coconut kefir to try heal her gut. I’ve used watermelon (had her eat a big bowl of it) to relieve her constipation when it became bad and was pleasantly surprised when it worked.

I’m fairly new to Paleo and have struggled with digestion issues for the past 10 years. Could you recommend a good Probiotic supplement to purchase next time I go to the Health Food Store? I tried the Atkins diet in the past for weight loss and although it worked, I was painfully stopped up time and time again and decided it wasn’t worth it. I found the Paleo diet after a friend suggested it for the IBS benefits. I am hoping I will do better if I take the supplements along with it!

The two that I take (and really like) are Prescript Assist (a soil-based probiotic) and Kirkman Biogold (a lactobacillus-based probiotic)

I suggest taking the soil-based probiotic 1-2 times per week and the lactobacillus-based probiotic every day that you aren’t taking the soil-based probiotic (you can take it less often if you are eating a lot of raw fermented foods).

It’s also worth looking into digestive support supplements (these would include digestive enzymes, ox bile, and maybe stomach acid supplements like HCl or just taking 1-2 Tbsp of apple cider vinegar 10 minutes before a meal). The best resource for more information on this is and Diane Sanfilippo’s book Practical Paleo.

I’ve delt with occassional constipation both before and since becoming paleo. However, in the past six weeks, it seems to have gotten worse. I’ve recently been diagnosed with chronic myofasial pain syndrome and have been tested for auto-immune conditions, but all the tests were negative. Even so, I’ve been doing the AI diet for the past two and half weeks (was doing whole30 for three weeks before that) to see if there is an improvement in my symptoms. Since the diet change, my stool has been very hard and rocky with lots of undigested food particles (tmi, i know). I’m consuming kombucha or sauerkraut on a daily basis and taking acv before breakfast and dinner. My fruit intake is usually between 2-3 servings a day. I eat a ton of ginger and drink a lot of water. What else should I be doing? Why would a diet that should improve my gut seems to be making it worse?

Are you following my version of the AIP? Are you eating starchy vegetables? If so, I would cut those out of your diet completely. And any other sources of inulin fiber like coconut or fiber supplements. Are you eating leafy greens? Are you taking a magnesium supplement? Are you drinking enough water? Another possibility is adding in some digestive enzymes….

I was following the diet outlined in Practical Paleo for fibromyalgia. I was still eating coconut and coconut butter so i will stop that. And I am eating some Butternut squash. Should that go as well? What about fruit? I eat leafy greens, but not daily. Lots of cruciferous vegetables. I do take magnesium glycinate. Do you have an enzyme you recommend? Btw loved hearing you on the balanced bites pod cast

I take magnesium glycinate because I read that it is the best absorbed, but that it is not so good as a laxative, which I can attest to. The mag glycinate does not help me poop! The only thing that has worked well and consistently for me, is powdered magnesium citrate. I’m not thrilled that citrate is often from corn, as I don’t eat any grains, but pooping regularly is more important to me. I’ve been constipated since at least 7 years if not earlier, and having a regular soft poop daily just gets those dang toxins OUT of my body. I use the NOW brand of Powdered Magnesium Citrate, about an hour before bedtime – 1 tsp in a glass of water.

Hi Diana, I’ve been using the NOW brand Mag citrate capsules and have not noticed an improvement in bowel movements. Do you know if there is much of a different between the capsule and powdered forms? I am feeling so discouraged…

Hi Anne, The capsules don’t work for me. I must use the powdered form, and I use a full teaspoon nightly which is 630mg. If you are really constipated, you may need to use twice a day for a day or two until things start moving. Try eating only broth with maybe some cooked carrot and kale until regular.

Thanks, I ordered some Natural Calm…. I really hope the powdered form makes a difference.

I feel that my constipation got a little bit worse since beginning to take magnesium citrate regularly, but I know that doesn’t make sense. I just found that since taking it, I had to strain a lot to get things moving, and experienced what is possibly partial prolapse… I don’t know if its a maybe just a coincidence that I was taking mag citrate at the time? What a nightmare.

I’m no expert, but I wouldn’t think Magnesium Citrate would have that effect. Mag Citrate is what they use in the hospital. Straining is no good. Gotta keep up on the magnesium and take extra when eating offending foods, so you don’t get that way in the future. I’ve had my share of blockages, and I know it’s no fun. Hope things are running smoothly soon!

Honestly I would recommend OXY-POWDER its an american brand which I buy in the UK ..Its on Amazon, it really is an effective colon clenser but is toally safe and gentle the oxygenated magnesium breaks up any impacted matter.

Since going on Paleo, this is an issue I’ve struggled with. I eat at least 5 servings of vegetables a day and 2 to 3 of fruit, though I must confess, sweet potatoes are my absolute favorite. Maybe I should cut those out? I only drink water, and I take digestive enzymes before every meal. Right now I’m taking 1 tbsp of acacia fiber daily to help, and while it worked good at first, now it doesn’t seem to. I’m guessing I’ll have to increase the amount, though I really don’t want to. Any advice? Thanks!

What do u do if u have histamine/glutamate reactions (and thus lemon juice, ACV, and other fermented foods are out), and are dealing with mold/fungus issues (thus no enzymes due to the aspergillus and fermented foods )? I have neurogenic bowel (nerve damaged gut from bad UC and constipation)…and low HCl and enzymes

Supporting the neural health side with high omega-3 fatty acid intake and high tryptophan foods (organ meat and seafood) as well as stress management and lots of sleep should be helpful. Can you take an HCl supplement?

I’ve been vegan for 5 year and I’m as regular as a swiss commuter train. Big bowl of oats every morning for breakfast! But u can try hemp seeds. If u need to take all these supplements then I’m sorry to say your diet is lacking. FIBER FIBER FIBER!!!

Okay, I’m going to feed the troll and ask, have you ever considered that people on liquid diets poop, and the implications of that for your “bigger broom” theory of gut health?

Hi! Really enjoyed reading this. I have recently started the Paleo diet for me and my family. My 1 year old daughter has seemed to be suffering some constipation as of late. She will have a bowel movement every day, but they tend to be hard little balls. I have cut out the whole milk from her diet and started doing homemade coconut milk made from coconut cream and coconut oil for her 2 times a day. I blend in a date to help with a little sweetness. I am not sure if this is working or not, but I have noticed her bowels have gotten a little better. It wasn’t until I read in your first paragraph that coconut will sometimes cause you constipation that I now have concerns about replacing her cow’s milk with coconut milk. Any help is appreciated! Thank you.

My oldest had chronic constipation until we cut grains out of her diet (biggest difference was gluten, but other grains helped too). You could try some probiotic foods (raw sauerkraut, fermented pickles, coconut milk yogurt, kombucha, water kefir). I don’t think coconut oil is a problem so much as the coconut cream (the fiber is soluble and highly fermentable, so it slows down gastric motility and feeds bacteria like crazy). Hydration is important.

Oddly, for me, I get constipated without high fiber.. Vegetables don’t help, but fruits, like dates and watermelon, help the constipation. However, these aren’t good to eat with yeast issues. What do u recommend for someone like me who gets worseC with veggies and a low/no fruit candida type diet (grain free of course and no dairy)

These are all the things that I think are worth trying: a low FODMAP diet (I have a post about it), digestive enzymes with meals (see the autoimmune protocol page), a probiotic supplement (i recommend Prescript Assist), more organ meat in your diet, a magnesium supplement, and concerted efforts to manage stress and get more sleep (because gastric motility is regulated by neurotransmitters, organ meat is high tryptophan which your bodies needs to produce those neurotransmitters and cortisol interferes with neurotransmitter production, magnesium can act as a still softener, but it is also important for cortisol regulation). A vitamin C supplement might also be helpful.

Ok, looking back on my comment, I think I meant to say the coconut milk is made from water, coconut oil and coconut butter. Is that different than coconut cream? I am not using the canned sweetened stuff. Not sure if I miscommunicated. Sorry. Does that make a difference? Anyhow, I have not cut out grains altogether, but she eats them very rarely. So it wouldn’t be a problem getting rid of those altogether. I will try the sauerkraut and fermented pickles…I don’t know if they will win her over, though. Thank you so much! I know that if I take her to the doctor, they will just tell me to giver her some type of laxative. That is the last thing I want, but I am very concerned about her poop! I stress about it every day.

Do you think it would be better for me to give her canned coconut milk instead of making it from coconut butter? Just asking because you suggested coconut milk yogurt. Thank you again.

You are my favorite Paleo blogger. So smart. Thank you! My son has a long, complicated health story that I won’t go into…you’re welcome. But, this constipation thing has been front and center for him (us). His ND prescribed Orthomolecular Fiber, which combined with digestive enzymes has been working for quite some time. Our ND is eats and recommends a Paleo diet/lifestyle. Would you be able to explain why this product is an irritant? Thanks so much!

The sources of fiber contain a large amount of antinutrients and protease inhibitors. But, I do agree that digestive enzymes is an excellent strategy. I think combining digestive enzymes with vegetables and fruits makes more sense, but at the same time, if it’s working for him, you should stick with it.

I have had lifelong chronic constipation since childhood. Doing GAPS plus your version of autoimmune Paleo. In your experience, any hope I’ll get off of this too high of a dose of magnesium (Natural Calm)? Regardless, at least magnesium works now! It never did before. Your work is greatly appreciated! Good luck with your book!

I take a much lower dose of magnesium than I used to and also switched to a more absorbable form. Don’t know if I’ll ever get off it completely (since magnesium is both depleted in the modern food supply and is required in greater quantities if you’re stressed).

My 1-month-old baby is very gassy and seems to be in pain from his digestive troubles. My pediatrician recommends going dairy free myself (I was eating mostly paleo + dairy) and introducing a dairy-free baby probiotic. Do you have any recommendations for a good dairy-free infant probiotic?

I’m afraid that supplements for kids is not my area of expertise. For my youngest, we used an adult dairy-free probiotic that I broke open the capsule and then put a little bit of the powder in her mouth before she nursed, but this is really something you should check with the pediatrician.

This is what my ND prescribed my eldest, but she was well beyond an infant. Note that one explanation for colic is a delay in mylenation causing irregular perisolsis – the only cure is time. That said, lots of healthy fats and fish in your diet can’t hurt. And don’t let anyone tell you that there’s a product out there that’s going to be better for him than your milk in this situation! Good luck, mama, it’s hard to see our babies in pain.

I have chronic constipation and eat similar to The Perfect Health Diet. Anyway I’m still struggling and use Micralax enemas to assist but don’t really wanna do that long term. Should I cut
out all grains ? I’ve read conflicting ideas and just

It’s good to see an article about a subject which is rarely spoken about because of it’s delicate nature. I’ve no doubt there are many constipation sufferers who need help and are too embarrassed to ask.

I am having a flexible sigmoidoscopy soon and they want my bowels clear for it – My bowels are usually good (once or even twice a day, perfect texture!) they have given me 2 senna tablets for the night before and a sodium dihydrogenphosphate and disodium phosphate dodecahydrate enema for the morning! Do you think either of these will be a problem as a one off? Would you have any protective / healing suggestions? (I plan to spend the next day drinking copious bone broth!)

I’ve heard Chris Kresser talk about colonoscopy preps magically fixing issues for people and doing the reverse, or creating issues. That being said, you really need to be cleaned out for them to be able to see anything. I would focus not just on broths, but on fermented foods, lots of veggies (starchy and non-starchy), and seafood afterward to help your bacteria recover.

I read through all the comments looking for the candied ginger recipe but perhaps I missed it. Just wanted to check if you had posted it. Terrific article, thank you so much x

My 2 kids (6 and 4) and I all struggle with constipation. My 6 yr old was on the miralax for about 2 years. He was doing well for a while bit now is having problems again. I give him 1/2 teas natural calm. Would like to increase it so what is the max that I can give him without causing a problem ?

I’ve had chronic constipation since childhood and can totally relate to your 2-week story (in times of stress). Paleo solved the problem entirely for the first year and then it started being problematic again. Beets and maybe plantains make it worse unfortunately. Magnesium citrate works for a few days and then not. Ditto prune juice (pint). Miralax and metamucil make it worse. Water always helps. I have Sjogrens so dry foods (e.g., flours) make it worse. There is one thing that often works, but regrettably takes some discipline. If I lie in bed and do some biofeedback and try to relax the upper left part of my colon (transverse into descending) and try to twist it open (like an empty paper towel roll) mentally, I often can feel things start to move again right away. It’s like stress makes me clamp down at that spot. I know I’m weird, but I think we have more control over our innards than we think.

Nancy, that’s an awesome tip! I’m going to try that as a mindful antidote to weekends at my MIL’s, which leave me struggling for easily two weeks afterwards, between the travelling there and back, the food, and the tension.

Abdominal massage can also help constipation – you can either do it your self or find a massage therapist and get it done as part of a regular massage.
If doing it yourself, you want to always move in a clockwise direction from your right to your left. Start with gentle big circles on your abdomen, then progress to smaller circles, working from the bottom right hand side of your abdomen, up to the top right hand side, across to the top left and then down to the bottom left. and then repeat. Only work as deeply as is comfortable to you, and only for as long as you are comfortable doing it… little and often is best!
Nearly all of my massage clients who have an abdominal massage need to go to the bathroom afterwards!

I do massage to help and this works. At least in the short term. I find my deep abdomen is often very tender feeling, does that mean anything? Also eating an apple each day is helpful.

Hey Sarah,

Sorry if you mentioned it in the comments above – just wondering how you can tell its nerve damage? I’ve had constipation for the last 10 years and it’s gotten to a point I can’t poop without an enema or harsh laxatives (overdosing on magnesium no longer works :-( ) I’m currently treating SIBO and a parasite called Blastocystis… But I feel there’s more… These days I’m also at a loss as to what to eat as too much vegetables cause me pain so I’m low FODMAPS and a low carb ‘starve the bacteria’ diet has made things much worse. I’d truly love your insight as this year no naturopath or MD has been able to offer any guidance or relief.

To add: I eat AIP, low fodmaps, avoid a few extra things like coconut (except oil) and all fruit… I also drink lots of water and get lots of good fat. I’m currently not taking digestive enzymes but have some in the mail and have played around with probiotic foods and actually reduced my intake of probiotic supplements due to SIBO. So confused!

Also, any thoughts on diatomaceous earth for regularity and pathogen killing claims?

There’s no good science on diatomaceous earth, so I wouldn’t recommend that. I definitely recommend the digestive enzymes to help up the vegetable intake (that whole starve the bacteria thing can be really hard on the thyroid and can lead to undergrowth long term, so I usually only recommend doing that for a couple weeks if at all). Are you getting enough carbs? I would also try reintroducing some fruit. And fish? (long chain omega-3s actually help correct gut bacteria levels and diversity). I was once told by a doctor that I probably had nerve damage, but I’ve never been tested. I also recommend getting a squatty potty or something similar.

You truly are amazing – such a quick reply :-) I have a wee kids seat thing that I use instead of a squatty potty to put my feet on, try to eat fish twice a week but certainly don’t get enough carbs! So fruit is ok but starchy vege not? Is that along the lines on the SCD thinking of fruits being easier to break down then some other carbohydrates? I just got the all clear on the candida I had so think it’s safe to add back in some fruit. Otherwise the last 6 weeks my carbs have been winter squash, carrots and coconut water… I was doing an elimination diet and crashed hard (I already have adrenal fatigue). I added in some white rice the last few days after reading ‘Fast Track Digestion’ as apparently it’s fermentation potential is incredibly low (I don’t have an AID)… I’ll start playing with fruit and see what I can tolerate. Thanks for being an incredible and generous wealth of knowledge! X

Starchy veggies are fine… better for blood sugar regulation than fruit, and can help support normal gut bacteria growth, just don’t overdo it (lots of non starchy veggies too). Fruit is okay as long as you aren’t going crazy on fructose (try to stay under 20 g per day, which is 2-4 servings of fruit depending on the fruit).

I have nerve damage. U can get tested by an emg (rectally) and external electrodes to measure nerve conduction. Like u, I cant go without enemas. It’s hell and not a way to live, so i feel ur pain

Thanks Sarah – I just didn’t think starches were any good for SIBO, which I have (took some antibiotics recently as a biopsy showed heavy overgrowth of staphylococcus aureus so my MD gave me some Keflex plus herbals. But I feel in starving my good flora too which is having an adverse reaction!

Bee, I haven’t really implemented fast track digestion as I eat low FODMAPS, fruit free, AIP already… I did find the findings on jasmine rice and red skin potatoes interesting though… But a lot of the foods he suggests are still pretty processed so didn’t gel with me so much. I much prefer Anne Angelone’s ‘FODMAP Free Paleo Breakthrough’ as a dietary outline for people with compromised gut function.

Kris, it also depends on the type of gut flora Imbalance u have. I have klebsiella pneumoniae, which thrives off starch, so starches make me feel horrendous. Some strains thrive off simple sugars, so avoiding those will help. Some thrive off ammonia, so avoiding high protein diets helps. I think that’s why this is all so difficult…. Everyiones dysbiosis is so different and stool tests aren’t very good at figuring out the exact strains, since they only test for a few, compared to how many are actually in the gut.

How do u feel on ur current low fodmaps, fruit free, aip diet? Would u be able to share what u typically eat for bf lunch dinner and snacks?

All the evidence for avoiding starches is annecdotal and this approach has never been validated in the scientific literature (although low FODMAP has). Anne is one smart cookie, and that’s a great e-book.

U mention increasing soluble fiber bc insoluble fiber can make constipation worse. How do u do this if one needs to avoid fruits and starches (food allergies and bacterial infections)?

Also, how did u heal the gut nerve damage? How did u get your officially diagnosed?

That’s interesting about the different kinda of dysbosis Bee, I didn’t know that. I actually feel better with a few more carbs which could make sense as to way my fatigue went through the roof when I went super low carb thinking I was doing myself some good. High protein, high fat actually makes me pretty nauseous too… What I’ve been doing is over here: maybe shoot me an email if you wanna chat so we don’t take over Sarah’s blog ;-)

I’ve been dealing with constipation for quite some time now. I”ve taken laxatives, pills, even cut out all drinks but water and diet green tea with ginseng. My diet has improved a little from before too. But it gets to the point where I am so sore I don’t even want to walk. Which is a huge problem because I want to continue to work out, but the pain can get unbearable. I have never ever had this problem before. It was sudden when it occured, if anything when I started I was healthier and in sports. I still don’t understand why my body is deciding to react now I am only 15, not overweight and am in sports. I am almost convinced I have hormonal imbalance though because I have stubborn acne and stubborn leg fat that doesn’t go away ever. I also take a birth control shot for periods, but I didn’t think constipation was a side effect. Its to the point where I’m considering going to a doctor. At one time, I avoided eating all together because it hurt so bad (I’m not one for internal pains). My question is why would it start so sudden and why didn’t I have it before? It is never ever fully gone either. Despite drinking water with laxatives. I am probably going to go Paleo. But that would mean I would have to get off the shot I get because without milk they said you can get osteoporosis. I know when I do go to the doctors however, that they will give me a prescription, tell me to eat fiber(I do eat quite alot of fiber), and tell me to change my diet. Which isn’t much help.

I had chronic constipation most of my childhood, but it wasn’t a real problem until I started depo provera (I had an ER trip once it was so bad while I was on depo). Progesterone naturally slows down peristalsis (the coordinated muscle contractions of your intestines to push food through your digestive tract). Even when I went off the shots, it was better but still not gone until I went both grain-free and dairy-free. I suggest reading my posts on dairy and calcium and also investigating other alternatives to the shot.

What we eat has a lot to do with constipation. If we paid more attention to the types of food we eat, then perhaps we wouldn’t have so many issues with our guts.

A new technique I’m trying is grass-fed gelatin powder. thespunkycoconut discusses this and many of the comments also relate success with drinking 1T of gelatin in a warm liquid each day.

Thanks for the post, I also have nerve damage(colonic inertia, and gastroparesis) so constipation is something I have to control daily.
I use magnesium, suppositories, squatty potty, probiotics and enzymes already(like you suggest) and they help heaps. But since going paleo I get very loose stools(not diareer as I still find it hard to go), but when I do it’s always watery and loose. When I include grains the stool becomes formed again. Do you have any advice for this? Or is it bad for this to happen? Because of gastroparesis it’s hard for me to follow completely paleo with lots of fat and more protien, raw foods, nuts etc- because these things give me pain. Thanks would love any thoughts you have

Katie, would u be willing to post a sample of ur daily diet? I’d give anything to have looser stools lol. I am currently undergoing gi testing to assess the extent of the colonic inertia and ibd. Sitz marker is the gold standard for colonic inertia. Anal manometry tests the muscle and nerve conduction. Defecogram can show pfd and inappropriate muscle response. Upper gi tests can also be used to test for upper gi inertia. Colonoscopy would also be employed to rule outccancer, ibd, and other issues.

TX is often physical therapy, diet, med, supps and surgery, sometimes going so far as a colectomy with ileosotomy as a last resort.

Paleo mom, what is ur opinion on colon Preps for Colonoscopies? Most are made from Polyethylene glycol, peg, which is basically a plastic. This worries me and I’ve read some disturbing things on it. They are also notorious for making people nauseous, at the very least. What other prep methods have u seen work?

Hi bee, more then happy to do that. My email is if you want to pm me, a am more then happy giving you an example of what I eat and do. started writing it here but was just would take up too much space so thought it would be easier to contact you directly : )

I am on day 28 of strict aip and still not regular. Before the diet, I was eating pretty healthy in general, and no digestive problems or constipation…to put it bluntly….healthy and regular bm’s. I am trying “calm” magnesium, drinking plenty of water (I think) and all those veggies but still constipated. I am ready to go back to adding flax but I know that’s a no no. I also get plenty of exercise. hELP!

For severe constipation, you should always consult your doctor. Sarah discusses strategies to help with constipation (chewing slowly, etc) issues on the AIP in The Paleo Approach. You may want to jon The Paleo Approach Community on Facebook: I do believe this topic was recently discussed in the group. — Tamar, Sarah’s assistant

Thanks for posting this. We are dealing with chronic mild constipation in our 20 month old, and you gave me some new ideas.

Thats one thing that scares me about starting AIP. I take multiple supplements for constipation and still have trouble. I am off all of acid reducing meds and take enzymes. Eat lots of homemade sauerkraut and take mag citrate pills. I drink almost a gallon of water every day and take 30 ml of ACV daily. Not sure what else I could do?

It could be several things. You may still be eating something you react poorly to, you may have an additional complication like SIBO or hormone imbalance(s), or you may not be getting enough exercise, stress management, sleep, or sunlight. – Christina, Sarah’s assistant

So in smaller doses they’re stool looseners? I currently take a fibre supplement and lactalose daily. Not sure if it’s good to take lactalose for ever so keen to learn if other alternatives for stool looseners

Yes, magnesium or vitamin C at the right dosage (you will have to experiment to see what dose works for you) can loosen without creating the immediate urge to go. – Christina, Sarah’s assistant

More and more to think about. I have a 9 year old with chronic constipation, my bm history has never been good either and my father was diagnosed with a bacterial overgrowth after years of breaking out in hives for no apparent reason. He used to always joke about his BMs as well so I’m seeing family history. Thanks so much and I’m hoping to incorporate some of these in. I would love to see a book specifically focused on kids and Paleo. I found this info great but I also found for the kids, it;s kind of all over the place (for eg, for specific topics like this). The info is generally in the comments and I have trouble keeping it straight (pretty sure I’m ADHD like my son :} ) I’ve been trying to move toward paleo more and more myself for the past 3 months but it’s not always easy with a big family (and picky!) and a limited income. Also, I’ve also historically been a big fan of part time veggie eating and so the elimination of legumes and beans has been truly difficult. I so appreciate this site as guidance

I suffered chronic constipation for 15 years. I attempted a vegetarian diet 7 years ago and sibo set in, then I became IBS-D. Xifaxin didn’t work. I have been on antibiotic therapy for over a year. Now, if there is not a daily BM, I blow up b/c of the sibo. I started to rely on bisacodyl to help move things along. It works, however, I am so afraid of the damage it causes. I don’t love ginger, and MOM makes me gag. Doing research, I came across The IBS Solution by Dr. Pimenton. He says Citrucel is a good supplement. This type of fiber is not fermentable by bacteria. So far a BM everyday without bloating. My mood is so much better!

I also find buffered vitamin C helps in the morning on an empty stomach- and occasionally Mg oxide. Personally, I also find iron rich foods make it worse.

What brand of Digestive Enzymes do you recommend for AIP? I really need them, but want the best for my body. Free of yeast, dairy, corn, soy, wheat etc…

I just read the following suggestion and was wondering if you think it is safe:

“Having had scary bouts of constipation in the past I was given some great (and effective) advice from a colorectal surgeon friend. Drink a large glass of warm water. Wait five minutes and drink another. Repeat this for up to five glasses — no more than that, total (since it is possible to over-hydrate and that is not good). Apparently the bloodstream can’t absorb that much water at once and so it flushes it out through the intestines. I’d say this works best on an empty stomach.”

(I found this comment on a blog at – I have no affiliation with that blog )

I have had problems with constipation since I was a kid. I’ve been to the doctor several times about it. He recommended stool softners that didn’t work. My sister recommended drinking coffee (I wasn’t a coffee drinker the ) and it works like magic! I gave up coffee because of cortisol issues but haven’t been able to find a good replacement. Magnesium sort of works, but not regularly. Any recommendations on how I can drink coffee without having sleep/stress issues? Decaf doesn’t work.

You may need a different type or higher dose of magnesium. Vitamin C can also help. Eating more fermented foods and taking probiotics is also a good idea. – Christina, Sarah’s assistant

Thanks for your article. I’m glad it mentioned my favorite, which is sauerkraut. I don’t find ginger to be all that helpful. But it might help others. Sauerkraut has several reasons why it’s good. It has probiotics and fiber all in one, it contains acetylcholine which stimulates peristalsis (and my problem is motility all along my digestive tract, things just don’t move along), and it is decaying vegetable matter, which is exactly what my body needs. Yogurt or kefir by comparison is decaying milk matter. So the probiotics for that are simply different. I’d like to add that if you then go on and eat kale or go all paleo and eat the turnip greens from some nice turnips you get at the farm market (or any crucifer), you get hydrogen sulfide gassy flatulence. That’s not a bad thing for your health, but it can be socially embarrassing. So keep in mind you don’t want crucifers before important business meetings if you’re a fan of sauerkraut. like me.

On the healthy front, the smelly gas just means there are good bacterias actually reducing the quantity of gas in your gut from the large volume of hydrogen gas to the smaller volume of hydrogen sulfide. The rotten egg smell is the price you pay for not having painful bloating or in my case, bowel obstruction. For me, it’s a matter of survival to eat sauerkraut for breakfast every day. The kraut itself doesn’t give me smelly gas, it’s only after I eat crucifers, so I eat them at lunch, then have the gas after work, then sleep well after it’s over. I’ve got it all worked out! :P

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