Monthly Archives: February 2016


Constipation  and You – a healthier approach

[ The following post is for informational purposes only. This is not meant as medical advice. Please consult your physician or your child’s Pediatrician before treating any constipation symptoms. ]

I had a Gastroenterology attending who once told me from the day we are born until the day we die we all are fixated on our bowel movements. When , how , how much, how hard, how often?

Of course constipation can be a medical problem which requires immediate attention by a physician. [Any changes in your bowel habits please contact a medical professional]

The vast number of people in western cultures who suffer from constipation or are actively treating it belies the fact that this is really for the most part a man made problem. A large percentage of bowel and intestinal problems are self inflicted. Most constipation is behavioral including diet, lifestyle, and poor potty skills. To a much less extent,  especially in the elderly or patients  with chronic illness it is medical or genetic. Even colon cancer is now considered to be caused in part by your diet. Meaning the more fiber, more plant based, the faster your bm comes through the less you are constipated,  the less associated disease you may develop.

[Please consult your physician before treating any type of constipation on your own].

Is it part of our society, culture, diet , or is it a normal genetic variant as part of the human condition?

I believe that starting at birth with breastfeeding and following through with a primarily healthy plant based diet, humans would not be nearly as constipated. Ask your local neighborhood “healthy vegan” if they have problems passing stools . They will very gladly offer advice. But more than likely they will mention the virtues of fiber from plants and how they do not have to think twice about constipation quite the opposite.

What is constipation?

Reduction in normal frequency of stool to what is normal for age and individual, often accompanied by pain on defecation, hard stools,  difficulty in evacuating a stool, blood around it. No matter where you start if it becomes difficult to have a bowel movement or accompanied with pain or bleeding this is constipation or could have a medical source and need to seek advice from your physician..

Constipation by age:

Babies when breastfed can go 10 times a day or once a week . It’s the consistency that counts . Pushing for a long period of time and either not going , straining to go, or a hard stool can be constipation.

The “Potty training” age is it’s own category. Children in this stage commonly hold in their stool and have problems with self induced behavioral constipation.

Children should generally go once a day. Certainly a child with hard stools, any blood or pain, or difficulty evacuating a stool could have constipation and should be checked by their Pediatrician.

Adults- any change in bowel pattern, pain, prolonged time to go, hemorrhoids, blood, difficulty passing stool. [please consult your physician}

Foods to avoid that are responsible for a large percentage of constipation consist of low fiber, highly processed,with added chemicals. Mostly unnatural foods changed significantly from their natural state.

How much fiber do we need?

Women 21-24 gm day, men 31-38 gm a day. A child’s  general guideline is the age plus 5 gm for the total recommended grams of fiber for a day, but I believe more is probably healthier.  Once an individual is used to a whole healthy food diet they will be able to manage with more then the recommended amount of fiber.  For example a 7 year old should have a total of 12 grams of fiber a day based on this formula. Look below for some sample fiber amounts. In most cultures that are based on healthy plant based foods particularly bean based they consume much more fiber and have been shown to have better health statistics.

Dietary Culprits in constipation – foods to eliminate when you or your children are constipated

Any animal products, especially red meat and diary.

Sugary foods, fried food.

Carbs particularly processed  white carbs like pasta and white rice.

Processed low fiber breads, crackers, bagels, cakes, cupcakes, etc.

Applesauce, bananas, chopped carrots also are binding due to the breakdown in the pectin.


Best foods to treat and prevent constipation.

Whole foods are the best food source of natural fiber.

My super constipation busting smoothie

Smoothie for bowel health and treating constipation- start with a good healthy fruit base- either apple, orange, pineapple, etc. avocado for an excellent source of fat and to thicken it like a milk shake .Add vegetables to your liking the leafier the better. Spinach hides well. If the green color is not tolerable for your child go with purple, like prunes, acai, grapes, or for orange color- add oranges, sweet potatoes, squash ( but NOT pumpkin). Include figs for fiber and substance, and dates to sweeten it if needed.  Add ground flax seed or chia seed, nuts or nut butters which add  good protein, oil, and fiber . 

Juicing takes out a lot of the fiber and often defeats the purpose. So even though juice is often the go to treatment for constipation there is actually less fiber in juice than the whole fruit or smoothies.

Slowly make the change to a high fiber lifestyle. Increase the amount of healthy high fiber food gradually so you do not get cramping or bloating or pain.

Natural healthy treatment of constipation:

1.Natural fiber additives – senna. psyllium, ground flax seeds, hemp seeds or hearts. Can buy “greens” in a natural food store to add fiber

2. Vegetables all have fiber  especially the leafy green ones. Iceberg lettuce does not have enough fiber to make it worthwhile. It only has 0.5 gm fiber compared to romain which has 1.8 gm, and arugula 1.6 gm.Kale 2.6 gm fiber per chopped cup, broccoli, 3.8 gm fiber, spinach 4.3 gm cup cooked. Sweet potato has 4 gm of fiber.

3. Nuts and seeds particularly adding ground flaxseed 1.9 gm fiber per tablespoon or Chia seed 10 gm fiber per ounce can offer a good source of healthy fiber.

Almonds 1 oz -3.5gm fiber , walnuts 1 oz 1.9 gm fiber, sunflower seeds, 1 oz is 2.5 gm fiber.

4. Fruits are filled with fiber not just prunes which has 12 gm per cup of fiber.

Figs 1.5 gm for each fig, 15 gm per cup, dates 12 gm per cup, apples 4.5 gm per apple (not applesauce), blueberries 3.6 gm per cup , raisins 6 gm fiber per cup,  apricots 3.3 gm cup

5. Beans are excellent source of fiber, partially digested in your intestinal tract with both soluble and insoluble fiber. But start your bean introduction slowly. You know what they say? …One half cup of beans have 15 grams of fiber.

Red beans- kidney beans cooked has 19 gm fiber per cup, black beans 19 gms cup cooked, pinto beans 18 gm fiber cup cooked

6.Increase fluid – just water is good enough. Adults should have 8 glasses of water a day. Healthy smoothies are an excellent way to get fruits, vegetables, protein , and fiber. See above.

7.Teas – senna, peppermint , and basic green tea. The caffeine itself helps much like with your morning coffee

8. Probiotics help in those whose bowel flora has been altered by poor diet.

9. Exercise actually helps – so get moving . Like all parts of your body your intestinal system will move better if you move. There will be more blood flow to the gastrointestinal system in general, and the activity itself will cause your bowel to function better.

With any exercise make sure you hydrate well, before , during , and after.

General causes of constipation by age groups.


Breast fed babies are rarely if ever constipated .It is said that Breast milk is a laxative for babies stools but this reaction is for all intents and purposes normal or regular. Breast milk keeps the baby bowel functioning and flowing with the proper peristalsis and creating the proper bacteria flora so,a breastfed baby should not need probiotics , should not have constipation,  have better immunity , and less colic.

Formula fed babies ( particularly milk based) Are much more likely to have constipation and colic. The ingredients in formula change the bowel flora and function. It is common for breastfed babies to become constipated with transition stools when making the switch to formula or milk.

Toddler 1 – 3 year old

Not getting enough fluids, the typical western toddler diet of pasta, carbs, junk foods, low fiber ,and the age of potty training is almost guaranteed to  cause constipation. Much of the toddler diet contributes to having poor bowel habits.

Older child- poor bowel habits, not taking enough time to go to the bathroom, being too busy to go, holding it in, being painful, and the typical western diet. Biggest culprits are the most commonly eaten foods- all that cheese, pizza , milk, ice cream, macaroni and cheese, pasta, big plates of white carbs, cookies, breads, fried foods with breading .

Adult – stress, not eating enough, not getting enough fluids, not exercising, poor diet , and travel.

[Before self medicating with laxatives and pills please contact your physician or pediatrician.]

Warren Krantz MD, FAAP