From having a “gut” instinct to “feeling” something in your gut, our GI tract plays a critical role in the health and well-being of our entire body.
Our gut – more specifically, the gut microbiome –is literally a second brain that plays a role in our moods, our immune system, our weight, and metabolism, and even influences the metabolism of hormones, such as estrogen.
This lesson will focus on some gentle nutritional and lifestyle strategies we can use to treat and prevent constipation, a problem many women and people going through menopause experience at midlife. Having a healthy microbiome (also referred to as the estrobolome) can improve just about everything in our life! Note: If you are currently in treatment for an eating disorder and/or you are having gastrointestinal issues, please reach out to your medical team for more specific and individualized care.
How do we define constipation?
Ask yourself the following questions:
- Do you regularly have less than three bowel movements a week?
- Is passing stool difficult on a usual basis?
- Are your stools often hard and lumpy?
- Does your body feel blocked or like your bowels are not completely empty?
If you answer “yes” to any of these questions, you have constipation, defined as infrequent or difficult evacuation of bowel movements. As food passes through the digestive tract, water and nutrients are absorbed into the body. What is left over is solid bodily waste. Muscle contractions then push the stool through the intestines to the colon before exiting the body. Sluggish colon contractions make the stool pass through too slowly, becoming dry, hard, and difficult to pass. The resulting abdominal pains and bloat are the result of this.
Why is constipation a problem?
Many people going through menopausal changes at midlife experience constipation, which can have a negative effect on our body image. Constipation can also influence the metabolism of estrogens throughout our bodies and increase the risk of hormonally driven cancers. Finally, constipation can weaken pelvic floor muscles increasing the risk of prolapse, a condition that many people dare ever talk about!
By giving your body a good intake of fiber, which contain both prebiotics and probiotics, you can improve the gut microbiome to help alleviate constipation. Add in some extra fluid, movement, and stress reduction and these changes can keep your bowels working regularly. Of note, if the constipation does not resolve after making some dietary changes, you might benefit from pelvic floor therapy or other treatment recommendations. Always consult your physician if these problems persist.
Foods and Lifestyle Shifts that Can Improve Constipation
Probiotics are live microorganisms within the gut, or more simply put, the “beneficial bacteria. Foods that are cultured or fermented are good sources of probiotics. Examples of probiotic-rich foods include cultured yogurt, miso, tempeh, kefir, buttermilk, sauerkraut, pickles, fermented cabbage, kombucha and kimchi. While some of these foods have bacteria which grow naturally, some include bacteria that are adding during the preparation process.
Prebiotics are non-digestible carbohydrates fermented by the gut microbiota, or simply: “food” for the probiotics. Prebiotics are typically available in high fiber foods and these resistant starches are not easily digested by the body. Here are some examples of high fiber prebiotic foods:
- Fruits: blueberries, raspberries, strawberries, pears, apples with skin on, prunes (dried or stewed) and raisins.
- Nuts and seeds: almonds, peanuts, pecans, and walnuts, as well as pumpkin, sunflower, flax, and chia seeds.
- Vegetables: broccoli, sweet potato, winter squash, pumpkin, kale, onion, leek, garlic, artichokes, asparagus.
- Whole grain foods: oatmeal, barley, quinoa, brown rice, whole grain bread and rolls, whole grain pastas, wheat bran and bran cereals.
- Legumes: beans and peas.
If you have not been eating foods high in fiber, slowly increase your fiber intake to avoid abdominal discomfort. Perhaps you might try adding one new food every 2-3 days.
Try and consume an adequate fluid intake, as fluids are essential when adding in extra fiber. How much water you need depends on a lot of things and varies from person to person. The general recommendation from The U.S. National Academies of Sciences, Engineering, and Medicine is about 11.5 cups (2.7 liters) a day for women and people with a uterus. This includes fluids from water, beverages like teas and juice, and from food. You get an average of 20 percent of your water from the foods you eat. Fluid needs will vary depending on your levels of physical activity, climate, etc., but recognize that if you have been constipated, increasing your fluid intake might be helpful.
According to the Academy of Nutrition and Dietetics, a quick and easy way to check if you are getting enough water overall is to take a peek at the color of your urine. If you are consuming enough, the urine color will be a pale yellow color. If it is a dark yellow or amber color, you may need to increase the amount you consume.
Movement can also help to keep your bowel movements regular. Perhaps a short walk after meals can be helpful. If you haven’t exercised regularly, be gentle with yourself and move within your capacity.
Our bodies are sensitive to stressors. Anxiety and heightened emotions can cause or make constipation worse. If stress is contributing to chronic constipation, can you work on stress management? Here is more information on breathwork and meditation. Yoga has also been shown to be an effective strategy for stress relief, as can speaking with your partner, friend, or counselor. And if stress is constant and considerable, medication needs to be normalized. Midlife in and of itself is stressful!
Supplements and Alternative Health Suggestions
While we recommend a food-first approach, there are times where a supplement might be indicated.
- Fiber Supplement: A fiber supplement can be helpful if consuming more fruits and vegetables is challenging. Fiber supplements include Benefiber®, Metamucil® , Regular Girl, among many others. Start slowly and monitor how you feel.
- Magnesium: Some of my clients have reported good success taking Magnesium Citrate, an over-the-counter supplement. Be cautious if you have kidney disease or are on a special diet prescribed by your doctor.
- Probiotics: There are so many probiotics on the market it can be downright confusing! Research suggests that a probiotic containing B. Lactis, seems to be the most beneficial for helping with constipation. I personally take a combination prebiotic AND probiotic mix called Regular Girl, but there are many others on the market.
- Massage: Massage is using pressure to manipulation muscles. It’s been practiced for thousands of years in different cultures. An abdominal massage stimulates peristalsis waves in the colon. A three-to-five-minute massage can help get things moving.
- Acupressure: Acupressure is a touch therapy using the principles of acupuncture. Instead of sticking points with needles, is used. Tapping on acupressure points on the arm, trunk and legs relieves constipation.
- Aromatherapy: Aromatherapy uses essential oils from plants to enhance well-being. Essential oils of basil, lavender, myrrh, and rose might help strengthen the digestive system.
Seek Help if Constipation Persists
Constipation can cause uncomfortable bloating and can influence your appetite. If constipation persists, contact your healthcare provider. Ask if an over-the-counter medicine, such as a stool softener or laxative, may be helpful for you. Be very cautious about laxatives as they can be habit-forming, especially for those with a history of an eating disorder.
Here is a recipe that has both prebiotic, as well as probiotic fibers.
Creamy Mediterranean Tempeh
Prep time: 15 minutes
Cook time: 30 min
- 1 lb tempeh, cubed
- 1/2 cup non-dairy yogurt, plain 1/4 cup nutritional yeast
- 2 tsp olive oil
- 1/2 cup sweet onion, chopped 3 cloves garlic, minced
- 1/4 cup sun-dried tomatoes, drained
- 1 tsp oregano, dried
- 1 tsp basil, dried
- 1/4 tsp thyme, dried
- 1 cup vegetable broth
- 3 cup spinach
- 1/4 cup parsley, fresh, chopped
- Chop spinach/mince garlic.
- In a large skillet, sauté tempeh in 1 teaspoon olive oil until browned on all sides.
- Remove from pan and set aside.
- Add another teaspoon to the skillet and, over medium heat, sauté onion until soft. Stir in garlic, sun-dried tomatoes, oregano, basil, and thyme and sauté for another few minutes until fragrant.
- Stir in yogurt and vegetable broth, then nestle tempeh pieces in pan. Simmer for about 20 minutes.
- Stir in spinach and cover pan until wilted. Top with parsley just before serving.
Ready to Ditch Diets and Embrace Intuitive Eating?
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Erica Leon is a Registered Dietitian and practices from a Health at Every Size (HAES®) lens. She is certified as an eating disorder specialist and is passionate about helping women at midlife, menopause and beyond to make peace with food and body image.
Erica is a highly sensitive nutrition therapist who takes the time to learn where you or your family are in the pursuit of health. Respectful of your individual needs and lifestyle, she will provide an honest assessment of whether or not you are a good fit to work together. Click here to schedule a 15-minute Discovery Call with Erica to let us know about your needs, and to see which of our Dietitians is the best fit for you!
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