Constipation and autoimmune: 4 tips to help toilet time

Constipation literally makes us feel like crap. It’s a drain on energy, creates additional inflammation in the body and can prevent us from eating … when we should be eating more of key nutrients to help bring our bodies back into balance.

About 14-24% of adults experience constipation and it’s a common complaint with those with hypothyroidism, hashimoto's, rheumatic conditions  (RA, JIA, AS, PsA, Lupus, Fibro) and those with an IBD like Crohn’s/Colitis and Celiac.

Many autoimmune clients (young and old alike) come to me complaining of constipation as one of their top digestive symptoms, even if they don’t have an IBD, so I figured I would share the scoop on backed-up poop and some strategies to help unplug the drain.

WARNING. Graphic Description Ahead

What is constipation?

Constipation is the opposite of diarrhea - it's when stool tends to stick around longer than necessary. This is called “slow transit time.” Often it's drier, lumpier, and harder than normal, and may be difficult to pass. It’s defined by having less than 3 movements a week and it becomes chronic when this happens for three months.

On the Bristol stool chart, tell-tale visuals are separate, small little “rabbit pellets” (Type 1 = severe constipation) or a lumpy looking sausage (Type 2 = mild constipation), and it typically comes along with abdominal pain and bloating.

Constipation should be taken seriously. If you are struggling with constipation, please consult with your medical doctor to rule out medical or structural problems with the gut.

With autoimmune, it’s also important to think holistically because the various systems in the body are connected. That’s why we’re going to explore potential root causes, why digestive function is essential for optimum health and how it’s connected with your nervous system, hormones and immune regulation.

What causes constipation?

There are various influences for constipation. It's my experience that people generally have a combination of influences:

• Structural or medical issues with the gut (please see a doctor to rule out)
• Anti-inflammatory medications like NSAIDS like ibuprofen (Motrin/Advil), naproxen (Aleve)
• Anti-histamines (Benadryl, Allegra, Claritin)
• Antidepressants
• Medications for urinary continence
• Opioid painkillers
• Blood pressure medications
• Anti-nausea Rx
• Antacids or acid blockers (Tums, Pepto Bismol, PPIs)
• Iron supplements 
• Dehydration
• IBS (irritable bowel syndrome)
• Lack of essential fatty acids in diet
• Not enough fibre in diet
• Too much fibre in diet (depending on the person)
• Food sensitivities
• A diet high in sugar or refined flours (even gluten free flours)
• Stress hormones (cortisol)
• Lack of movement (sitting all day)
• Hypothyroidism
• Anxiety
• Bacterial imbalances
• Common culprits I see in my practice are yeast overgrowth and SIBO (small intestinal bacteria overgrowth).

Why is fixing constipation important for autoimmune and immune health?

The digestive tract is the gateway to every single cell in the body.

• It is responsible for breaking down the food we eat into molecules so that the body has the resources it needs to optimally function.
• It is home to trillions of bacteria, and each strain has a very specific role to play. When they are in balance, the body benefits.
• The bulk of our immune system is found in/around the digestive tract (in the surrounding lymphoid tissue).
• Our digestive tract produces the bulk of serotonin (neurotransmitter responsible for mood).
• The digestive tract is also responsible for removing waste, toxins, excess hormones and other compounds which can cause additional inflammation.

For these reasons, addressing digestive imbalances is critical to restoring balance and helping you reach your health goals, whether that be reducing pain, improving your energy or losing weight. And it's for these reasons that digestive function is also a key part of the Autoimmune Nutrition Triad, a professional framework I use with my private clients and members inside The Integrative Autoimmune Network.

The Autoimmune Nutrition Triad includes core ingredients for better energy metabolism, immune regulation and digestive functions. These three factors are inter-connected.

Here’s why.

First of all, when a body is hyperactive and fighting an autoimmune condition, it takes an incredible amount of cellular energy and resources because the body is literally trying to put out fires and rebuild at the cellular level. That is the nature of a cytokine storm and inflammatory response. When we have a dsyregulated nervous system (or high amounts of stress), we also require additional ingredients because we use up antioxidants at a much higher speed.

Despite the fact that 70% of the immune system is found in/around the digestive tract in surrounding lymphoid tissues, the digestive system is considered a “lesser” system in comparison to the heart, lungs, brain, or an inflammatory crisis … like a flare. Resources are diverted to the crisis at hand and that can negatively impact the digestive cascade and transit time, potentially showing up as … constipation.

Yet, energy metabolism and immune regulation depend on the body’s ability to break down food so molecules are absorbed and delivered to cells. When we consider that those with autoimmune have higher nutritional needs to fuel energy, our stress response and a balanced immune response, getting the right types of nutrients and improving absorption is a key step in bringing the body back into balance.

Additionally, constipation can alter the microflora (bacteria) in the intestinal tract (mostly the large intestine or bowel), which can contribute additional, low grade inflammation. This places an additional and unnecessary load on the body, which can actually lead to more problems (and constipation) down the line.

No one needs this when fighting to bring an autoimmune back into balance.

For these reasons, digestive function and gut health are an essential part of the healing process with autoimmune, no matter the diagnosis. It’s also why I make it a top priority when working with clients.

What to eat for constipation with an autoimmune disease?

Getting onto the right nutrition plan - one that also considers your energy metabolism and immune system requirements - will go a long way to helping ease digestive burden. The nutritional protocol must consider common or unique food sensitivities, how you eat and nutrient dense foods.

An elimination diet can help open up pathways very quickly. In my professional practice, I use five distinct plans - Anti-Inflammatory / Itis, A Modified Paleo, The AIP (Autoimmune Protocol), Low Histamine and Low FODMAP. The right nutrition depends on the person and their symptoms and can help improve: 

• The absorption of proteins, fats, carbohydrates and all the micronutrients/antioxidants found in these foods which feel cellular health and energy
• The quality of bowel movements (blood, frequency, colour, effort to pass)
• Gas, bloating and acid reflux
• Constipation and diarrhea
• Mucosal lining of the intestinal tract (a protective layer against leaky gut and the development of yeast/bacteria biofilms)

I go into much greater detail with my clients. For instance, solutions on how to address side effects of necessary medications, enzymatic support, superfoods for digestive wellness, and how to minimize food and other factors that are notorious for contributing to poor digestion). If you're interested in learning more, you can book a call below to discover what that may look like for you.

In the meantime, what do you do with all this information?

Well, there are some starting strategies we can use to help when we get blocked up.

Eat these 2 foods for constipation as a first step

Dietary fibre is a type of plant-based carbohydrate that we can’t digest and absorb. Unlike cows, humans don’t have the digestive enzymes to break it down. Even though we can’t digest it ourselves, fibre is very important for our digestive health and autoimmune wellness for two reasons.

First, fibre helps to absorb  and push waste, toxins and excess hormones (like cholesterol, sex hormones)  through our system (and out the other end). Second, fibre is an important food for feeding the friendly microbes in our gut.

There are two kinds of fibre: soluble and insoluble.

Soluble fibre dissolves in water to make a gel-like consistency.  This is important for those with autoimmune because our digestive systems are often more sensitive. We want smooooooth moves.

Soluble fibre can soften and bulk up the stool, helping to ease the burden on the poop chute, and it is found in fruit (apples, bananas, berries, citrus, pears, etc.), vegetables (broccoli, carrots, spinach, etc.) and for those who can tolerate them, legumes (beans, peas, lentils) and oats.

Insoluble fibre, on the other hand, holds onto water and can help to push things through the gut and get things moving. This is an important consideration for autoimmune when transit time is impacted because of medications or other underlying factors like I’ve already explained. Insoluble fibre is found in the skins and seeds of fruits and vegetables like asparagus, broccoli, celery, zucchini, as well as the skins of apples and pears.

NOTE: There is conflicting evidence on how fibre affects constipation. In some cases, less insoluble fibre may be better, especially with certain digestive issues or in an IBD flare. It’s important to monitor how diet affects bowel movements and adjust accordingly. And don’t be afraid to seek out a healthcare provider when necessary.

It’s recommended that adults consume between 20-35 grams of fibre per day. I typically recommend upwards of 40 grams daily which sounds like a lot, but easy to achieve when following a BWH Autoimmune Plate, which is naturally high in plant foods.

Remember to increase fibre intake slowly! Radically changing diet overnight can make things worse, which is why I use a very specific process when helping clients.

And, it’s also very important to combine increased fibre intake with my next point … drink more fluids.

Dehydration and constipation

Since constipated stools are hard and dry, drinking more fluids can help keep everything hydrated and moist. This is especially true when trying to maintain a healthy gut every day, rather than when trying to deal with the problem of constipation after it has started.

Dehydration can also amplify joint/muscle pain, brain fog, fatigue and sugar cravings. This is something SO simple and effective that many don't consider.

And it doesn't only have to be water - watery foods like soups, and some fruits and vegetables can also contribute to your fluid intake.

Adequate hydration and drinking according to thirst is recommended for gut health as well as overall health. Thirst is an indication of dehydration.

This is particularly true when you exercise or have a physically active job like healthcare workers, teachers, on-floor staff at retailers.

Why do fluids matter for autoimmune? Water is involved with thousands of metabolic reactions in the body. If we are dehydrated, the body will prioritize and allocate water to other systems for survival, and you’ll remain in the constipation cycle of eat > wait > wait some more > discomfort > potentially pain > and finally relief.

Increase your probiotics for constipation and gut health

Probiotics are beneficial microbes that come in fermented foods and supplements. They have a number of effects on gut health and constipation. They affect gut transit time (how fast food goes through us), increase the number of bowel movements per week, and help to soften stools to make them easier to pass.

Probiotic foods (and drinks) include fermented vegetables (like sauerkraut and kimchi), miso, kefir, and kombucha.

Not all probiotics are created equal and more research is needed when it comes to recommending a specific probiotic supplement or strain. When considering supplements, make sure to read the label to ensure that it’s safe, and take it as directed.

For those with autoimmune, it’s important to discuss the use of probiotics with the doctor first to make sure they are not contraindicated with medication or treatment. I also advise avoiding probiotics with FOS as an added ingredient because it can trigger adverse reactions.

It is always a good idea to get a your supplement recommendations from someone trained in supplementation for autoimmune versus the local health food store clerk who may be promoting a certain product based on availability or an in-store promotion. Certain products and ingredients can be contraindicated with medications and diagnosis, and can sometimes make symptoms worse.

Providing clients with safe and strategic supplement recommendations is one part of how I support clients in my group program, The BWH Autoimmune Action Plan and private client work. I am trained in orthomolecular nutrition (supplementation) and I tailor all my recommendations to the person based on their health history, symptoms, goals, diagnosis and medications. I’m a firm believer in “less is more” and as a result, will often rotate supplements - or swap out for other brands - every 8 - 12 weeks.

Stress and digestion (lifestyle is important too!)

Some studies show a gut benefit from regular exercise or movement regime, and ideally aim to “move” for at least 30 minutes, five times a week. That may seem like a lot and there are various ways to get there … it doesn’t need to be high impact or intensive. In fact, low impact is better with autoimmune as it doesn’t overly stress an already hyperactive immune system. Walking and yoga are options that are proven to benefit the immune system.

In terms of stress, when we’re stressed, it often affects our digestive system. The connection between our gut and our brain is so strong, researchers have coined the term “gut-brain axis.” In fact, there is an entire system called the autonomic nervous system residing in the gut and it contains more neurotransmitters than the spine!

By better managing stress, we can help to reduce emotional and physical issues (like gut issues) that may result from stress. Try things like meditation, deep breathing, and exercise. These are so effective that I've included them in our monthly membership, The Integrative Autoimmune Network where we create customized meditations, breath sequence and yoga flows to use throughout the day, to better manage stress, support digestion and your immune health. 

For more information on The Integrative Autoimmune Network, you can click here >>> The Network

Conclusion

Constipation is a common problem with autoimmune that shouldn’t be ignored.

Constipation has many root causes, including many commonly used medications. It’s important to speak with a medical doctor to rule out any medical conditions and a professional to help mitigate the side effects of essential medications. Rx and natural support can co-exist ... it needs to be done with purpose and safely.

Ensuring you're on the right nutrition plan for your condition and body is important. It will help you increase fibre and water intake, and support friendly gut microbes, which are  key to help things move along.

And don't forget how lifestyle habits can affect bathroom habits! Movement and stress management can also help maintain great gut health.

These are small basic strategies you can do today, which are all a small part of The Integrative Autoimmune Network, when you’re ready to move beyond the basics and live a thriving life despite an autoimmune condition.