We need to talk about what constipation really is and what it isn’t.
What is constipation?
Most people come to me thinking that having a bowel movement less often than they’re used to is constipation – but that’s not constipation. Some people come to me worried that they’re not having a bowel movement every day – that’s also not constipation. Constipation is hard stools or hard-to-pass stools. Some people will come to me having one or two bowel movements a day for most of their life. When they change to this way of eating or a new way of eating and they’re only having a bowel movement once a day or once every other day, they’ll complain to me that they have constipation. That’s not constipation. It doesn’t matter how often you go for a bowel movement. I know that might sound strange, but it’s true. As long as the bowels are moving freely, there’s no straining, and you don’t feel uncomfortable, then that’s not a problem. You may think it’s a problem but it’s not a medical problem.
Bowel movements will change with a new diet
You don’t have to have a bowel movement every day. This is a widespread myth that is perpetuated by lots of different companies that want you to buy their products, that sort of thing. And people do have certain behaviors. It’s typical for some people to go every day, a couple of times a day, or maybe every other day. The main point is that when you change your way of eating, the number of times you have to go to the bathroom for a bowel movement may change. In fact, it typically does change. Most people who change to a low-carb keto type of diet will have fewer bowel movements, meaning they’ll go less often. You won’t have a bowel movement every day and that’s okay, as long as the stools aren’t hard or hard to pass.
Why might your bowel movements change with a new diet?
Your body is more efficient when you’re eating more nutritious foods. This is because your body has less waste to eliminate. In the medical world, we think of bowel movements as being the elimination of waste. In fact, your body will excrete or put some bad things into the bowel movements so they can get out of your body. Toxins excreted by the liver, for example, can be put out through waste (i.e., via the bowel movements).
Bowel movements are not a cleansing
I don’t think of the bowel movement as a “cleansing” or a “detoxification.” I know a lot of people think of it that way and they get concerned if they’re not having a bowel movement as often, thinking that they’re going to have a buildup of toxins. I don’t think that way about it. I see having a bowel movement in the same way as taking the trash out at your home or apartment. You don’t want to do that every day if you don’t have to. It’s common to go less often for bowel movements on a low-carb or keto diet. If you used to go three times a day and now you’re going once a day or you used to go once a day and now you’re going every other day, it’s fine, as long as the stools are not hard or hard to pass. Constipation is a medical problem that is defined by hard stools or hard-to-pass stools, being uncomfortably bloated, feeling like you have to have a bowel movement.
Reasons you may be constipated and how to relieve the symptoms
In my experience, when people change to a well-formulated, real food-based diet, if someone does have hard stools or hard-to-pass stools, there are several things that I think through. (I don’t ask people to add oils, medium chain triglycerides and those kinds of things that can actually tend toward diarrhea for some people.)
First of all, there is the essential need for water and salt. If you don’t have high blood pressure being treated with medication, then you want to be sure you’re getting plenty of salt. Salt and water are what will hold onto the water in your bowels, which is why the stools come out hard if you’re not getting enough salt and water. If you think about it, your colon or your large intestine, it is the last chance for your body to suck back water that you’ve consumed. If your body thinks it’s low on fluid it’s going to extract all of the water out of the stool and the stool will be left hard and dry. If the stools are hard or hard to pass, the first thing to think about is water and salt. If you think you’re drinking enough, it might be summertime where you’re losing more water than you’re aware of in the form of water vapor (water evaporating through your skin). Be sure to increase your fluid and salt intake. If you feel like you need a supplement or something to help and you’re not sure how to do the water and salt thing, electrolytes can be very helpful. The main electrolyte to think about is magnesium. A little trick that I’ve learned is that there’s a liquid form of magnesium called milk of magnesia. It’s very common and is available at any pharmacy or drugstore without a prescription. Adding just a teaspoon of milk of magnesia at bedtime for about a week or maybe two weeks until your feeling of hard stools is gone can be very helpful. You might even use the milk of magnesia (a teaspoon at bedtime) as a preventative. Don’t use a capful, which is two to four tablespoons. That will really get you going if you’re desperate for something. At the dose I recommend, it’s just a gentle laxative.
You can go the extra mile and learn about proper stool hygiene. I refer people to a very nice video done by a physical therapist in Australia. It’s called ‘MOO to POO’. There are some elements to proper stool hygiene, like sitting up straight, taking some deep diaphragmatic breaths to push down the diaphragm, and vocalizing. Another component is raising the feet. It turns out humans were designed to squat when they take a bowel movement and many people around the world still do. A modern toilet, where you’re raising the bottom off the floor, can introduce a kink into your intestines, which makes it harder to have a bowel movement. There’s actually a company that sells a little stool that raises the feet for proper stool hygiene. The final thing that I think is important is to minimize external irritations. You can make use of devices like a bidet that would be found in other countries to minimize the external irritation as part of proper stool hygiene.
The majority of people will not experience constipation on a keto diet
Most people don’t have a problem with constipation when they change to a low-carb keto diet. This happens probably in 25 percent of people in my clinical world of teaching a proper real food diet without the use of special keto products, so most people don’t get this problem.
Pharmaceutical treatment can be useful and I treat a lot of people on medications who are also already on laxatives. I’ll just ask people to stay on whatever they were taking from their other doctors as they get started to see how things change. Some laxatives can be habit-forming, so I prefer the electrolyte supplementation, like magnesium. If you’ve had trouble with this before, you can use over-the-counter suppositories and enemas, but these are not needed frequently.
Watch the full video here.