When Will I Use You Again?


In the last, I told you how the consumption of gluten-grains is the number one dietary reason of constipation. However, it isn’t the only reason you may have trouble going to the bathroom. A number of people who are gluten-free have contacted me expressing frustration with their constipation. So what could be causing their problems?


There is another common opioid present in the diet, and it comes from consumption of dairy, specifically from A1 beta casein dairy. As I wrote in part five of my small intestinal bacterial overgrowth series:

“I would be remiss if I didn’t mention that certain types of dairy also release an opioid fragment called A1 beta-casomorphin-7. It is prevalent in the milk of certain breeds like Holsteins and Friesians, but low or absent in the milk of Jersey and Guernsey cows, goats and Asian and African cattle. These latter animals have A2 casein in their milk and this type of casein does not form an opioid fragment when digested by humans. Casein is found in the protein part of milk, but not the fat so butter and cream are largely casein free while cheese is casein rich. So you may need to rethink your dairy consumption or switch to A2 milk sources.”

As some of you know, I recently traveled to help celebrate my dad’s 85th birthday. When in California, the milk I pour on my Rice Chex cereal in the morning is raw, full-fat 100% Jersey Milk. I’m not advocating raw milk consumption here so please hold the comments and email. I just find that raw milk agrees with my digestion and tastes oh so good. I have no lactose intolerance or constipation issues when I drink this particular brand of milk.

We have another commercial raw-milk dairy available to us here in California but I can’t drink their milk without it constipating me. I suspect it’s due to the difference in casein.

When I was back East, I tried the highest quality organic pasteurized milk I could find and regretted that decision long after drinking it. Apart from lots of gas (even after consuming two Lactaid® tablets), I was stopped up.

So, if you are gluten-free and still find yourself constipated, suspect dairy from A1-casein milk sources.

Very Low-Carb Diets

It is not uncommon to experience constipation on these diets. Some claim it’s due to low fiber intake. However, most low-carbers I know eat lots of vegetables and veggies contain lots of fiber, so I don’t think this is the main issue.

I’ve expressed my concerns about extremely low-carb or ketogenic-type diets in earlier posts. These diets have several unfortunate consequences. They are known to depress thyroid function and depressed thyroid function will impair peristalsis in the digestive tract, including peristalsis in the colon. This impaired thyroid function is called euthyroid sickness syndrome and is covered in this blog post by Anthony Colpo. I suspect the cause of this is due to gut-induced inflammation generated by a glucose deficiency coupled with gut dysbiosis.

Glucose deficiency will lead to low or patchy mucus production in the intestine. This will directly compromise gut-wall barrier function and increase the risk of bacteria, especially gram-negative bacteria, translocating to systemic circulation and provoking an immune response. Immune signaling proteins or cytokines have been implicated in thyroid disorders. I believe the higher cytokine levels are due to endotoxemia.

Apart from its protective role as part of the gut-wall barrier, the mucosa also serves two other important purposes. First, it helps lubricate the colon so that feces slides along nicely on their way to the rectum. Secondly, it’s where many of your friendly gut flora call home. Disrupt this layer for any reason and you also risk disrupting gut flora populations.

Anything below 50 carb grams a day is cause for concern, and for many, this threshold is still much too low, especially if you do any amount of exercise. I’ll refer you to this blog post at Paul Jaminet’s Perfect Health Diet blog for more on glucose deficiency.


In the research studies I’ve read, constipation is very common in populations suffering gut dysbiosis. When these populations are supplemented with bifidobacteria from probiotics or given prebiotics to encourage their growth, constipation usually resolves. As I wrote in this post:

“In one study done in Germany, 35 elderly and hospitalized female patients suffering from constipation had their hospital food supplemented for 19 days either with the milk sugar lactose or the prebiotic inulin to see if there would be any change in bowel movement frequency. Before the study began all patients had only one or two bowel movements per week so we’re talking serious constipation here.

Those treated with lactose had results that varied widely. Some reported more frequent bowel movements while others experienced even worse constipation along with increased gas. In the inulin group, however, 7 out of 10 experienced improvements between weeks eight and nine. Stools were softer and easier to pass. Not only was stool frequency improved but an increase in friendly Bifidobacterium was noted from collected stool samples as well as decreases in potentially pathogenic Enterococci bacteria.

In a randomized, placebo-controlled study conducted in France on elderly volunteers, supplementing with 15 grams of inulin daily for 28 days led to a significant increase in friendly bifidobacteria as well as increased frequency in bowel movements.

In yet another study conducted in an elderly population suffering from constipation, supplementing with both a probiotic and prebiotic resulted in an increase in stool frequency and increased measures of well-being and quality of life.

Another randomized, placebo-controlled study was performed in five French hospitals to study the effects of prebiotics on patients reporting minor bowel disorders. 105 patients were randomized into two groups. One group received 5 grams of prebiotic daily while the other group received a placebo. The study lasted six weeks. On day 43 of the trial, those receiving prebiotics experienced a 43.6% reduction in their symptoms as opposed to an increase of 13.8% in reported symptoms in the placebo group. 75% of the subjects in the treatment group reported improvements in their symptoms as opposed to 53.8% of the placebo group that saw no change. A quality of life questionnaire showed an increase in satisfaction in the prebiotic group and either no change or worsening quality of life scores in the placebo group.”

As far as I’m concerned, constipation is a sign of dysbiosis. Diet isn’t the only cause of constipation as I pointed out in the last post. Apart from opiates, there is evidence that previous antibiotic use can also cause problems by disturbing bacterial populations. As I wrote here:

“In adults, a course of ciprofloxacin (Cipro) had marked effects on host gut flora within three days of ciprofloxacin initiation, but the good news is that commensal gut flora communities were pretty resilient after the antibiotic course ended. However, after two five-day courses of oral ciprofloxacin over a ten-month period an altered gut flora population was established that was different from what existed prior to treatment.

A study that tracked the effects of a short course of metronidazole (Flagyl) and clarithromycin (Biaxin) found disturbed effects in both commensal oral and gut communities for up to four years after treatment.”

Dysbiosis has many causes: diet, drugs and chronic stress being major ones. Apart from determining how these factors can be changed to avoid the pitfalls of constipation, correcting gut flora via prebiotics and probiotics is a necessary step. How you choose to do this, through food or supplements or both, is up to you. But do it you must or you’ll continue suffering the consequences.


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