Let’s Talk about Regularity (and how Natural Medicine can Help)

Plenty of people are medically, diagnosably constipated. However, many more are somewhere in the range of “normal,” but still a little backed up sometimes. These suggestions are for everyone who could use a little help “going.”  None of these are the strongest, most “dramatic” remedies. But all of them are reasonably safe in the short term, and non-habit-forming in the long.

Water: make sure you’re drinking enough. How do you know what’s enough? Especially when the experts can never agree with each other? Here’s a simple rule of thumb: the darker your urine (pee), the more likely you are to be dehydrated. If your urine is pretty dark, try drinking more water over the course of the day. Of course bearing in mind some medications, plus vitamin B2, make urine unnaturally dark. 

Fiber: Fiber is a generic term for indigestible starch. Since it’s not digested, it pretty much goes in one end, and comes out the other. On the way through, it acts like a brush (insoluble fiber) or a sponge (soluble fiber). And since it absorbs water, it takes up space, and creates bulk in the stool.

So, how does fiber work?   Bearing in mind fiber takes up space in the gut, here’s an analogy: it’s easier to squeeze toothpaste out of the tube when the tube is full. Beyond that, soluble fiber feeds healthy probiotic gut bacteria, which also help.

I could go on and on about research studies, but I won’t. After all, I don’t think anyone needs me to prove to them fiber works.

Instead of adding fiber-rich foods to the diet, try replacing foods you already eat with higher-fiber versions. Instead of pasta, try half pasta/half broccoli. Or sub out regular pasta for a higher-fiber bean pasta. Try carrots dipped in hummus vs. tortilla chips dipped in sour cream.  Bean chips instead of tortilla chips.  Roasted parsnips instead of baked potatoes[1].

If you’re looking to supplements, you can keep it simple with psyllium husks, which provides soluble and insoluble fiber, to form bulk, absorb toxins, and scrub the gut clean. Or ground flax seed, which contains omega-3 fats, plus detoxifying lignans to help balance hormones.  Or acacia fiber, which is gentle, and especially good at feeding your healthy gut bacteria.    

A standard dose is… enough for it to work. Although generally speaking, a total daily intake of 45 g fiber is a reasonably target. Make sure to ramp up slowly, and to match your fiber with plenty of water. Without enough water, fiber can actually be counterproductive.

Magnesium: most of us do not get enough magnesium. Magnesium-rich foods – whole grains, beans, nuts, seeds, sea vegetables, and mineral water – are some of the first we left behind as we adopt modernized diets.  Magnesium is needed to maintain healthy bones and hearts, healthy blood pressure and kidney function. It can reduce muscle tension, especially night-time leg cramps.  It may also help with emotional tension: anxiety, and PMS mood swings.

And then there’s magnesium in the bowels. When we take magnesium orally, not all of it absorbs (because not all of anything absorbs). The magnesium that doesn’t absorb stays in the gut, where it draws more water into the stools. This leads to the #1 “side effect” of magnesium: loose stools. Well, one person’s side effect is another person’s side benefit… 

If you’re trying to avoid loose stools, stick to a well-absorbing form of magnesium. If, on the other hand, you want it to help loosen things up, take larger doses all at once, and/or a poorer-absorbing form like magnesium oxide.

When it comes to constipation, magnesium can help anyone.  But I especially like it when there are signs of magnesium deficiency, like night-time leg cramps.  Or with stools that seem especially dry and compacted. A standard dose is 400-500 mg in one dose at night. You can double or triple that if you need to, and you can also add more in the morning.

Triphala is a popular herbal formula from India. The name translates literally as “three fruits.” We have records of Triphala going back over 2,000 years.  Many scholars believe Triphala is the most-used herbal formula on the planet today.   

Triphala is a reliable, uncomplicated aid to intestinal peristalsis. In other words, it helps you “go” without any of the cramping or habituation we risk with stronger herbals.

In India, Triphala is considered a rasyana – one of the rare class of herbal medicines that promote health and vitality in almost anyone, at almost any life stage. It is not uncommon for people to use Triphala daily for decades. 

A standard dose is 1-3 grams nightly. It may work overnight, or take 3-4 days for others.

Probiotics: “probiotic” (noun or adjective) is a general term for the “friendly” bacteria that live on, and in us. Probiotics help our immune systems, help our livers, help our… everything.

And intestinal probiotics help us stay regular.  They don’t work quickly.  Generally, you take them for a few weeks, sometimes as long as three months, before they establish themselves. But once they do, you don’t suddenly get backed up again if you skip a day or two. After all, probiotics are living organisms: they can grow and multiply on their own.

I like to recommend probiotics to people who have spent a long time eating less-than-ideal diets. Or who developed constipation around antibiotic use.  I especially like them when there are poorly formed stools, or when people suffer from IBD or IBS (inflammatory bowel disease or irritable bowel syndrome).  And in children, even infants, especially with a history of colic. 

You can increase your probiotics consumption through the diet, by adding traditional fermented foods.. There’s yogurt, of course, and all the other kinds of fermented dairy. And fermented vegetables, like the kind of sauerkraut and kimchi you find in the fridge. 

And of course there are probiotic supplements. For daily use, I’d look for something that has a strength of at least 10 billion CFUs, and at least a few different species. For a corrective or therapeutic potency, or to kick-start your probiotic regimen, look for something with 25-70 billion. Or more: you don’t have to worry about overdosing on probiotics. You don’t absorb them. You don’t metabolize them. They don’t get into the bloodstream.

Probiotics are more of a nudge than a push. You take them for a month or two and – nothing dramatic – just things get… easier.

Finally, for those looking for a more emphatic solution… there are stronger, stimulant laxative herbs, too. So by all means, come in and pick up some senna, cascara, aloe latex, etc.  Just remember that they’re better suited as short-term fixes, vs. long-term solutions. They’re more likely to give you cramps, more likely to be habit-forming. Try the gentle stuff first, okay?

• [1] Because potato is not a vegetable! Okay, technically it is… But nutritionally, we really ought to think of it as a starch.