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Constipation and the AIP Diet

Many people suffer from chronic constipation.  And while I have written articles and blog posts on this topic, in this blog post I’m going to focus on those people who had regular bowel movements prior to starting the autoimmune Paleo (AIP) diet, but then became constipated shortly after starting it.  After all, while there are many factors that can cause constipation, certain dietary changes can be a culprit.

Why do some people experience constipation when following an AIP diet?  Well, a big reason is because an AIP diet excludes many foods that are high in fiber.  This includes the following three categories of foods:

The good news is that most people don’t need to eat these three categories of foods to have regular bowel movements.  The bad news is that many people don’t eat enough AIP-friendly foods that are high in fiber.  One of the main reasons for this is because most people with Graves’ disease and Hashimoto’s don’t know which foods they should eat.  For example, someone might eat a lot of green leafy vegetables in the form of salads and smoothies.  And while I definitely encourage my patients to eat green leafy vegetables, these are low in fiber when compared to other vegetables, which I’ll discuss shortly.

Is Low Fiber Really The Main Problem?

Some healthcare practitioners disagree that the decrease in dietary fiber is the main reason why many people experience constipation when following an AIP diet.  And while I’ll list some other common reasons for constipation below, if someone had regular bowel movements and then began to experience constipation soon after starting an AIP diet, there is a very good chance that the decrease in fiber was the culprit.  While it’s true that some people who experience constipation while following an AIP-diet don’t experience an increase in bowel movements when eating more fiber, it’s still something to consider.

I look at many food diaries of my patients, and the truth is that it’s common for people to not eat enough vegetables overall, let alone vegetables that are high in fiber.  Another common scenario involves someone who eats a few daily servings of AIP-friendly foods high in fiber (i.e. broccoli, sweet potatoes), but not enough.  Sure, everyone is different, and I’m not suggesting that everyone needs to eat a large amount of high fiber foods on a daily basis to avoid constipation, but as I’ve mentioned numerous times already, if constipation wasn’t a factor prior to starting the AIP diet then increasing your fiber needs to be strongly considered.

What AIP-Friendly Foods Are High In Fiber?

I listed some of the AIP-friendly foods high in fiber in a blog post I wrote entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and SCFA [1]“, but I’ll list the foods again below:

The Role of Fiber In Bacterial Diversity

One of the ways in which fiber can help with constipation is by increasing the bulk of the stools.  However, fiber can also help with bacterial diversity, which in turn can help someone to have regular bowel movements.  In other words, the greater the variety of bacteria you have in your gut the better.  What’s important to understand is that different strains of bacteria prefer different types of fiber.  This is why it’s a good idea to eat a wide variety of fiber-rich foods, mostly in the form of vegetables.

So one problem with an AIP diet is that by decreasing fiber, it decreases bacterial diversity.  And there is evidence that this decrease in bacterial diversity can happen very quickly.  As a result, if you started to experience constipation a few days after starting the AIP diet then this very well could be a factor.

Other Causes of Constipation

While not eating enough fiber is a big factor for those who experience constipation upon following an AIP diet, here are a few other common causes of constipation you need to consider:

What About Other Causes of Constipation?

There definitely can be other causes of constipation, although keep in mind that we’re focusing on constipation that was caused by following an AIP diet.  For example, many people with small intestinal bacterial overgrowth (SIBO) experience constipation, but following an AIP diet isn’t going to cause SIBO, which is why I didn’t bring it up here.  Similarly, there are other causes of constipation that I won’t bring up in this post because it’s not related to following an AIP diet.

How To Overcome Constipation When Following An AIP Diet

1. Eat AIP-friendly foods high in fiber.  How much fiber should you consume each day to have regular bowel movements?  This depends on the person, although I would aim for at least 25 to 30 grams per day.  Just keep in mind that some people need less than this to have regular bowel movements, while others might need to consume more fiber, and so you need to listen to your body.

2. Do other things to increase your gut diversity.  Eating fiber-rich foods isn’t the only way to increase your gut diversity.  Eating fermented foods (i.e. sauerkraut, kimchi, pickles) and/or taking probiotic supplements can help.  And while plant-based foods act as probiotics, some people can benefit from taking a prebiotic supplement.  Every now and then someone will ask me about green food powders, and while I wouldn’t consider this to be an adequate substitute for eating vegetables, it’s fine to use certain green food powders as one source of prebiotics.  Of course you want to make sure to choose a good quality green food powder, and ideally one that uses organic vegetables.

3. Drink plenty of fluids.  As I mentioned earlier, being well-hydrated is important in order to avoid constipation.

4. Choose green tea over coffee.  I do recommend for some of my patients to avoid caffeinated green tea, especially those with adrenal imbalances.  However, if someone absolutely feels the need to drink a caffeinated beverage to help move their bowels then I would encourage you to drink a cup or two of green tea each morning.  While both coffee and green tea have numerous health benefits, green tea arguably has more health benefits than coffee, and without question has less caffeine.

5. Take a 15-minute walk after each meal.  I spoke about the importance of being active, and even if inactivity isn’t the main cause of your constipation, many people find that taking a 15 minute walk after meals can help them have a bowel movement.

Can You Eventually Reintroduce Nuts, Grains, and Legumes?

If you’re following a strict AIP diet, you might wonder if you will eventually be able to reintroduce some of the excluded foods.  While many foods are excluded on an AIP diet, I want to focus on nuts, grains, and legumes, as these are good sources of dietary fiber.  First of all, when a patient of mine is following an AIP diet, one of my goals is to have them transition to a “standard” Paleo diet.  Keep in mind that nuts are part of a “standard” Paleo diet, while grains and legumes aren’t.

That being said, some people are able to reintroduce grains and legumes without a problem.  In fact, while I’m not big into legumes, I can’t say that I’ve been grain free since being in remission from Graves’ disease.  Although I did avoid grains while getting into remission, I reintroduced grains after restoring my health and I do fine eating them occasionally.  As for whether or not you will be fine reintroducing these foods, there really is no way to know for certain.  This is part of the reintroduction phase, as while some people successfully reintroduce nuts, grains, and legumes after restoring your health, others aren’t able to reintroduce all of these.

Some healthcare practitioners advise anyone with an autoimmune condition to permanently give up grains.  The truth is that we don’t need to eat grains, and without question there are some people who do better when completely avoiding grains after getting into remission.  In fact, some people experience severe symptoms when eating grains.  So you need to listen to your body, and I’ll admit that you can’t always go by symptoms.  For example, some people will reintroduce grains and legumes before getting into remission, and while they might not experience any symptoms upon doing this, if their health isn’t improving then I would suggest to take a break from these foods and see if this is what’s affecting your progress.

In summary, some people develop constipation shortly after starting an AIP diet.  One of the main reasons for this is due to the decreased consumption of fiber-rich foods.  When this is the case then eating AIP-friendly foods that are high in fiber can help many people have regular bowel movements.  Fiber not only increases the bulk of the stools, but it also increases bacterial diversity, which can help with defecation.  Some other common causes of constipation include not staying hydrated, decreased caffeine consumption, and inactivity.  Addressing these areas while increasing your fiber intake can help many people overcome constipation.

Have you experienced constipation while following the AIP diet?  If so then please feel free to share your experience in the comments section below.