Low-FODMAP Diet Not Helping Constipation? Now What?

We often think that Irritable Bowel Syndrome (IBS) causes the same symptoms in everyone but this isn’t true.  IBS is categorized into 4 types:

  • IBS-D (diarrhea predominant)
  • IBS-C (constipation predominant)
  • IBS-M (mixed diarrhea and constipation)
  • IBS-U (unclassified; the symptoms cannot be categorized into one of the above three subtypes)

Today we are going to focus on IBS-C and many of these tips are also helpful for IBS-M.

Although a low-FODMAP diet helps about 75% of people with IBS, those suffering with constipation may not get full relief or it may take longer to receive positive results.  Here are 8 tips to try before deciding a low-FODMAP diet isn’t helping.

  1. First and foremost have you ever been tested for Small Intestinal Bacterial Overgrowth (SIBO)?  SIBO is an over colonization of bacteria in the small intestine, these bacteria ferment food causing gas, bloating, diarrhea and constipation, similar to IBS.  In fact many people with IBS also have SIBO.  Constipation predominant SIBO is caused by an overabundance of methanogenic archaea which produces methane gas.  Treatment with antibiotics or antimicrobials is important because diet alone is not enough.
    • Take away: Talk with your doctor about getting testing for SIBO if you haven’t already.
  2. Are you hydrating your body and bowels.  We often think we are consuming enough water but are not.  Start each morning with 2-4 cups of room temperature water before eating or drinking anything else, including coffee.  Buy a water bottle and commit to drinking from it every hour through out the day.
  3. Add 1-2 Tbs. of ground flaxseeds or chia seeds.  These are low-FODMAP sources of soluble fiber that help pull water into the stools.  Start with 1 Tbs. a day and increase to 2 Tbs.  You can add it to smoothies, yogurt or grains.  You can also soak 1-2 Tbs. in 1/4 cup of water and drink/eat it, it will get thick and may not be palatable to everyone.  It is very important to do this in conjunction with drinking more water or else it may cause worsening constipation.
  4. Drop the dairy, especially cheese.  If you find you are consuming a lot of dairy this means your fiber intake may be low.  Replace dairy with extra servings of low-FODMAP fruits, vegetables, ground flax and gluten free whole grains like quinoa or brown rice.  I know it’s hard to give up cheese but try it for 2 weeks and if it doesn’t help you can resume eating it.
  5. Drop the flour products, such as gluten free bread, crackers, pancakes and muffins.  Replace all flour products with whole gluten-free grains.  Try buckwheat (a starchy seed with a nutty flavor), millet, brown and black rice, teff (a tiny high protein grain that is used to make injera bread) and oatmeal.  This will help to increase stool bulk because overall whole grains have more fiber and water than whole grain flours.  For example, one slice of whole grain bread may have 1-2 grams of fiber but 1 cup of cooked buckwheat has about 5 grams.
  6. Use a squatty potty.  Squatting relaxes and unkinks your colon which helps with complete elimination.  A squatty potty has become popular and you can find one at Home Depot but it isn’t necessary to buy a special contraption.  using a small step stool in front of your toilet will help elevate your knees and is all you need.
  7. For occasional relief try magnesium citrate.  It is gentle and acts as an osmotic laxative, meaning it pulls water into the bowels.  Magnesium is generally safe for most people, in fact many of us are magnesium deficient.  My favorite kind is Natural Calm powder, a usual dose is 2 tsp. mixed into room temperature water before bed.   Don’t use if you have kidney disease, vomiting, under the age of 3 or if you are on a sodium or magnesium restricted diet.
  8. Move your body with walking, light jogging, yoga, even lifting weight-whatever you prefer.  Exercise has been shown to stimulate the bowels.  This is especially helpful if you find you are more constipated while traveling.  When you reach your destination move your body at the hotel gym, in your room or better yet, get out and explore the city on foot.

As you can see there are many small tweaks you can try to relieve constipation.  If the above doesn’t work you may want to consider working closely with a dietitian or another health professional to fine tune your diet and lifestyle.  For example, you may need a probiotic or further adjustment with the kinds and amounts of foods you are consuming.

Wishing you a happy and healthy gut!

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