Constipation is the most common complaint of the gastrointestinal (GI) tract, with over four million Americans suffering from constipation. A poor diet consisting of certain micronutrient imbalances, including both high and low levels, has been associated with constipation. This article will discuss micronutrients, constipation, and how micronutrient imbalances cause constipation. Functional medicine testing can help uncover micronutrient imbalances in relation to constipation and treatment options based on results.

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What are Micronutrients?

Micronutrients are vitamins and minerals that are ideally obtained from the diet. Micronutrients are essentially what our bodies run off of; every biochemical process in the body uses micronutrients, impacting cellular growth and repair, energy production and metabolism, immune function, and more. Because of this, micronutrient imbalances can lead to chronic fatigue, chronic pain, infertility, cardiovascular disease, metabolic diseases, digestive disorders, and more. Micronutrients can be divided into fat-soluble vitamins, water-soluble vitamins, macrominerals, and trace minerals.

What is Constipation?

Constipation is the most common gastrointestinal (GI) complaint, with 16 out of every 100 Americans having constipation. Painful stools, stools that are difficult to pass or don't completely expel, and a frequency of less than three bowel movements per week can all indicate a diagnosis of constipation. With constipation comes bloating, gas, abdominal cramping, and more.

How Do Micronutrient Imbalances Cause Constipation?

Micronutrients seem to impact the flow of water into and out of the GI tract, which can affect the consistency of stool. Micronutrients may also affect the rate of movement, or motility, throughout the GI tract. Each specific micronutrient plays an important role in healthy digestion, so imbalances in any of them will affect the GI tract in a particular way, potentially leading to constipation.

Which Micronutrient Imbalances Are Associated With Constipation?

Micronutrients can be found in both low and high levels, and we see both excess and deficiencies of certain micronutrients leading to constipation.

Micronutrient Excess That Can Cause Constipation.

Micronutrient excess can cause constipation through various mechanisms such as reducing gut motility, altering the water balance in the intestine, and interfering with the absorption of other essential nutrients. Here are some examples of how specific micronutrients in excess can cause constipation:

Iron Excess

Iron is a mineral required for proper development and growth. Iron is essential for the creation of hemoglobin, the part of the red blood cell that carries oxygen around the body. Iron deficiencies can be common, especially in pregnant women, and supplementation of iron is often required. One of the most common side effects of iron supplementation is constipation, as it is thought that iron pulls water away from the GI tract, causing hard stools. Iron can come in many forms, with ferrous/ferric sulfate, ferrous/ferric gluconate, and ferrous/ferric fumarate being the most commonly found in supplements. However, other types of iron are available, including ferrous glycine sulfate (ferrous glycinate or ferrous bisglycinate), iron protein succinylate, and ferric citrate, and might be a better option as they are gentler on the GI tract and are not as constipating as the former types of iron mentioned.

Calcium Excess

Calcium is the most common mineral found in the body. It is essential for strong bones, muscular contractions, nerve signaling, hormone release, and blood flow. However, calcium's ability to contract muscles can act on the muscles of the GI tract and slow the transit of stool, leading to constipation. Like iron, different types of calcium may affect the GI differently. Calcium in the form of calcium carbonate has been labeled as the most constipating type of calcium.

Vitamin D Excess

It is estimated that 40% of Americans are deficient in vitamin D. Vitamin D deficiency can lead to bone pain, impaired immune function, mood swings, low energy levels, and more. Because vitamin D is primarily made from the sun, vitamin D supplementation in northern regions is quite common. In cases of over-supplementation, excessive vitamin D can lead to hypercalcemia or too much calcium in the blood. As discussed above, elevated calcium can cause constipation, and thus elevated vitamin D can also lead to constipation.

Zinc Excess

Excess zinc intake can cause constipation by interfering with the absorption of other essential nutrients, such as copper and iron, which are important for maintaining bowel regularity. Sources of zinc include oysters, red meat, poultry, beans, nuts, and fortified cereals.

Micronutrient Deficiencies That Can Cause Constipation

Micronutrient deficiencies can cause constipation by affecting the proper functioning of the digestive system. Here are some examples of how specific micronutrient deficiencies can cause constipation:

Vitamin D Deficiency

While excess vitamin D can cause constipation, so can low vitamin D. Vitamin D may aid in gastric motility or movement of the muscles in the GI tract. Deficiencies, thus, may lead to the slowing of the movement in the GI, causing constipation.

Thiamine/B1 Deficiency

Thiamine, or vitamin B1, is essential for cellular growth and development. This vitamin is found in whole grains, nuts, seeds, pork, and legumes. Thiamine deficiencies are considered rare in the U.S. but occasionally do occur. In the presence of a B1 deficiency, cells in the pancreas will greatly reduce the amount of digestive enzymes they release, which can slow down the digestive tract and lead to constipation.

Potassium Deficiency

Potassium is a mineral used by every cell in the body, as it plays an important role in cellular fluidity and chemical signaling. A potassium deficiency can cause motility in the GI tract to slow, and in severe cases, it can cause it to stop completely.

Magnesium Deficiency

Magnesium is utilized in over 300 reactions in the body, making it an abundant mineral. Magnesium is widely used in the treatment of constipation, but a study on over 3,000 Japanese women showed an association between low magnesium status and a higher prevalence of constipation. Magnesium helps to pull water into the stool, softening it while also stimulating contractions in the GI tract, causing movement of the stool.

Vitamin C Deficiency

Vitamin C deficiency can cause constipation by reducing the production of collagen, which is necessary for the proper functioning of the intestinal lining. Vitamin C also acts as a natural laxative by increasing the water content in the stool. Sources of vitamin C include citrus fruits, berries, kiwi, peppers, and broccoli.

Functional Medicine Labs to Test for Root Cause of Constipation

Micronutrient deficiencies leading to constipation can be the result of improper nutrition, high levels of other micronutrients, or gastrointestinal issues. Thus, a micronutrient panel and a comprehensive stool analysis may be necessary to get to the root cause of constipation.

Micronutrient Panel

In order to ensure optimal levels of micronutrients, especially those discussed above, a micronutrient test can be helpful. Micronutrient testing will show levels of numerous vitamins and minerals, allowing for the assessment of both deficiencies and surpluses. It is also beneficial to see micronutrient levels alongside each other, as certain nutrients interact with one another and may lead to deficiencies.

Comprehensive Stool Test

Comprehensive stool tests analyze gastrointestinal functioning, including markers of digestion and absorption, intestinal permeability, and inflammatory markers, and give insight into the composition of the microbiome. Markers of digestion and absorption can be helpful when evaluating micronutrient causes of constipation, as improper digestion and absorption can lead to micronutrient deficiencies, some of which may cause constipation. Increased intestinal permeability will allow nutrients to pass into the blood prior to being properly broken down. If food is not fully degraded, the nutrients will not be absorbed and thus can lead to deficiencies. Inflammatory markers can indicate inflammation in the GI tract. Inflammation can damage the lining of the GI, leading to further permeability but may also cause improper absorption of nutrients throughout the small intestine. Lastly, the microbiome is responsible for further digestion and absorption of food. If dysbiosis, or an imbalance in the gut bacteria, is present, that will also hinder micronutrient absorption.

Nutrition for Constipation

The Mediterranean Diet can be a great way to eat to avoid micronutrient deficiencies and relieve constipation. The Mediterranean Diet consists of whole foods, unprocessed grains, and healthy fats. It typically includes foods that contain an array of micronutrients, including fresh fruits and vegetables, legumes, herbs, nuts, seeds, olive oil, and fatty fish. Followers of the diet are encouraged to eat locally and seasonally, as foods consumed in this fashion tend to be more nutrient dense. The Mediterranean Diet is also high in fibrous foods, which can help to bulk stool and relieve constipation.

Hydration for Constipation

Water intake is essential to avoid constipation. Dehydration causes water to be pulled from the intestines and into the circulation, leaving hard, dry stools. Additionally, water is needed to properly absorb micronutrients, which can, in turn, affect constipation.

Microbiome Support for Constipation

Comprehensive stool testing can result in the creation of a targeted treatment plan focused on the area, or areas, of the GI tract that are functioning suboptimally, causing micronutrient deficiencies.

Supplements for Constipation

Digestive enzymes are naturally produced by the stomach, liver, and pancreas and function to break down foods. If markers of digestion are low, digestive enzyme supplementation may be necessary to aid in the breakdown and absorption of food.

Intestinal permeability

L-glutamine is an amino acid and the primary fuel source for small intestine cells. Glutamine has been shown to strengthen the tight junctions that hold the intestinal cells together, lowering intestinal permeability.

Inflammation

Boswellia serrata is a medicinal plant containing multiple phytonutrients that may inhibit inflammatory production. In a randomized, double-blind study of 102 people with Crohn's disease (CD), which is an inflammatory GI Disease, half were given Boswellia, and half were given a standard CD treatment, the antiinflammatory drug mesalazine. The Crohn's Disease Activity Index, the gold standard assessment for CD, improved more in the Boswellia group as compared to the mesalazine group.

Dysbiosis

Dysbiosis occurs when there is an imbalance between beneficial and harmful microbes. Probiotics are supplements containing beneficial microbes that can help to replenish the good microbes while limiting or reducing the harmful microbes.

Summary

As the most common GI complaint, many people are searching for a solution for constipation. Investigating micronutrient levels, as both high and low levels of certain micronutrients can cause constipation, can aid in the resolution of constipation. Micronutrient and comprehensive gastrointestinal testing can assess which micronutrients are out of balance and if impaired digestive functioning is the root cause of the imbalances.