The Big C
Inspired by reading an article from the Natural Medicine Journal we're talking about the Big C this week. No, not covid, not even cancer... we're talking about constipation! I know, I know, some of you find talking about bowel movements difficult but it's sooooo important. I'll always remember one of my nutrition lecturers at university who just loved talking about the digestive tract, bowel motions and fibre (thanks Professor Mann!)
Being aware of our bowel movements is essential to knowing our baseline health status. So first of all, what is normal in regards to digestion? Having 1-3 formed and easy to pass, bowel movements per day. Yes you read that right, per day.It still amazes me how many people think it's normal to skip a day. Defining medical constipation basically depends on two criteria - the consistency of the bowel movements i.e. hard/dry or difficult to pass, and the frequency of bowel movements - fewer than three bowel movements per week.
Click here for the full list of diagnostic criteria.
The first step to addressing constipation is ensuring enough fibre and water in the diet and adequate exercise. Fibre is basically the parts of plants which are not digested and absorbed in the small intestine, therefore they continue to the large intestine where they are partially or fully fermented. There are different types of fibre - insoluble fibre which provides bulk to the stool, soluble fibre which pulls water into the stool to make it soft and easy to pass and resistant starch which acts as a prebiotic to feed the microbiome (helpful bacteria in the large intestine).
Eating plenty of unrefined plant foods is the easiest way to get fibre:
vegetables - unpeeled if they're organic as the skins are a great source of insoluble fibre
fruits - same as above
whole grains e.g. oats, brown rice, quinoa, amaranth, barley, wholemeal bread, wholemeal pasta
legumes - lentils, beans, chickpeas, green peas
nuts & seeds
If these foods make up the majority of your meal, you'll be doing well for fibre. Meat and dairy products do not contain fibre so these are best eaten in small amounts and balanced out with plenty of plant foods.
We also need water and exercise to have good bowel movements but we won't go into details about those here except to say 25-35ml water per kg per day and 30-90mins of exercise per day depending on the intensity.
If you are eating plenty of fibre (25-30g/day), have checked your water intake and are still feeling symptoms of constipation, this article may be of interest.It's a summary of a study that compared using kiwifruit, prunes and psyllium husk (in the form of metamucil) to add 6g dietary fibre/day for people with chronic constipation. All three interventions improved bowel movements and the kiwifruit was the most well tolerated and complied with...probably because it involved eating 2 kiwifruit per day compared to 6g metamucil twice a day or 6 prunes twice a day! If you are considering using psyllium husk, metamucil or prunes I would recommend starting with a much lower dose and gradually building it up.
If trying all of the above doesn't help improve constipation please see your GP to discuss other causes including medications. Here are some medications that can cause constipation. This list is designed to be a talking point with your GP, please do not stop any medications suddenly or without a discussion with the doctor that prescribed them.
Analgesics - Opioids, Non-steroidal anti-inflammatory drugs
Anticholinergics - Antihistamines, Antispasmodics, Antidepressants, Antipsychotics
Neurally active drugs - Antihypertensives, Ganglion blockers, Vinca alkaloids, Thalidomide, Calcium channel blockers, 5HT3 antagonists
Iron supplements Antacids containing aluminium
Happy bowel moving!