Pooping was something I didn't think much about... until I stopped doing it.
Late last year I shared that I was diagnosed with an H Pylori infection, a serious bacterial infection in the stomach that causes ulcers and can lead to cancer if untreated.
Eradicating my H pylori infection eliminated several of my symptoms (persistent stomach aches, severe abdominal pain (especially with an empty stomach), black/tarry stools, feeling like I have the flu, skin itchiness, among others).
However, I was still having a GIGANTIC HUGE BALLOON BELLY (severe bloating and distension), persistent constipation, a general inability to empty my bowels, plus nausea, low back pain, and swelling (particularly in my hips, low back, and thighs) if I was constipated for multiple days after treatment.
I'm not exaggerating, see for yourself:
Having been vegan since 2007 and plant-based vegan since 2008, I couldn't understand why I was constipated.
According to Johns Hopkins, the causes of constipation are medications, lack of exercise, not enough liquids, not enough fiber in the diet, IBS, ignoring the urge to have a bowel movement, lifestyle changes (e.g. travel, pregnancy, old age), problems with intestinal function, and use of laxatives.
I tracked my fiber and found I was eating well over 30g of fiber PER DAY.
I was also drinking a minimum of 8 glasses of water (I set an alarm to drink an 8-oz cup every hour) walking at least one hour a day (3-4 miles) plus regularly taking yoga and dance classes on zoom.
I also wasn't traveling or pregnant, I definitely wasn't "holding it", and I wasn't on any medications.
I had also tried the "IBS Diet" (low FODMAP) several times and saw ZERO improvement. (I had also completed several elimination diets before my H pylori diagnosis).
This left me with what? Problems with intestinal function?
Except I had a colonoscopy, which was normal. I had also been seeing a colon hydrotherapist every couple of weeks to remove my impacted waste, and she assured me each time my bowel function was terrific.
I read 14 different books on "gut health" including The Good Gut by Erica & Justin Sonnenburg which I think is #1 the best book on this topic and Fiber Fueled by Will Bulsiewicz which I feel is second best (and also more plant-based/vegan specific).
Point is, EVERY BOOK said to eat MORE fiber and eat/drink fermented foods like kefir, yogurt, miso, kombucha, sauerkraut, kimchi, and so on for gut health and constipation relief.
Let me tell you, I was pounding kombucha and kefir water like a champ. I was also eating loads of plant-based yogurt and fermented foods. My diet was primarily raw vegetables with a few raw fruits, small amounts of beans and lentils, plus boiled/cooked potatoes and GF oat bran hot cereal (to maximize my fiber).
I felt like a gorilla reaching upwards of 100g of fiber per day...
and yet I was getting sicker and sicker.
I also tried taking the prebiotic fiber "supplements" recommended by Dr. B in Fiber Fueled such as acacia, inulin, and psyllium husk. I took care to take a pure form of the supplement, e.g. psyllium husk from the store and not "Metamucil" that has a number of strange additives.
They made everything so. much. worse. The pain was excruciating.
HOWEVER, psyllium husk was a revelation to my husband who suffers from an IBD.
Back to me: eventually my abdomen became so large my friends and family stressed concern.
After an exhaustive amount of research and "thinking outside the box" I finally found my cause.
Here are a few key facts you need to know:
- The extreme bloating and distension happened as a result of constipation.
- A high fiber diet exacerbates the issue.
My GI explained it to me like this: Because I (or anyone on a mostly whole foods plant-based diet) consume so much fiber, that causes even more fermentation and bloating. "A high fiber diet is great IF you're not already constipated," he said, "adding fiber on top of constipation, however, is asking for extreme bloating pain."
My GI also said eating and drinking all those fermented foods made it even worse. I already had a lot of fermentation going on (that's what the bloating and distension is) I didn't need to add MORE of that.
He also noted I should absolutely not take any kind of fiber supplement when I'm already constipated.
He also suggested when I was constipated, to still eat my whole foods, plant-based diet, but to cut back on "ruffage" and foods that ferment (FODMAPs).
My GI didn't recommend a low fiber diet to me; he noted that too would make things worse. He encouraged me to maintain my "dietary lifestyle" but said that I needed to help my body out by eating plant foods that were easier to digest.
Initially, I couldn't believe a doctor was suggesting that I eat less kale... but then I realized the recommendations in the books I read, or the guidelines on the internet, those aren't for ME or a plant-based vegan. They're for people who aren't already eating a lot of fiber.
Bottom line: My high fiber "good gut" diet was a part of the problem.
HOWEVER, my GI didn't recommend a low fiber diet to me; he noted that too would make things worse.
Interestingly, my colon hydrotherapist had made similar statements to me previously. She pointed to all the yeast (foam) coming out in the waste tube. In fact, over HALF of the tube was foam like you see on top of a beer. You shouldn't have ANY foam!
She said to me, "Wow you have a lot of yeast and fermentation! No wonder your belly was so big. You should stop eating fermented foods and foods that easily ferment for a while."
To my total and complete surprise, they both also asked me to stop taking my pricey probiotic.
Like the fermented foods, they believed the probiotic was making the situation worse.
My GI also scheduled me for a colonoscopy, out of an abundance of caution since my H pylori infection was rather severe and I'd been having these issues for over two years. He also thought it was the only way to stop my constipation cycle.
Here's how you know I was truly constipated:The medicine for the colonoscopy prep did not work.
All day long I was looking forward to my "pooping safari" (finally emptying my bowels) except nothing happened. I waited two hours and called the emergency number. The doctor on call had me take the second dose. That still didn't work.
The on-call doctor then made me do two rounds of enemas in the middle of the night (a new and not pleasant experience for me).
THAT seemed to shake some things loose, but I showed up for my colonoscopy not sure I'd actually be able to get one.
Fortunately (?) they were able to clean me out while I was asleep.
For the next week or so I felt great. Being less aggressive about my fiber intake, forgoing the fermented foods, and ditching my probiotic seemed to help.
Then my stomach ballooned up again.
At this point, I became deeply depressed and started to wonder if I could continue to live like this...
Talking things out with a close girlfriend, we realized the only thing that had changed was I had resumed taking my vitamins after the colonoscopy.
(For three days prior to the colonoscopy I was told not to take anything, and then I'd forgotten to start again a few days after).
Background:About 3 years ago I experienced massive "burnout" from years of workaholism. My 80-90 hour work weeks without breaks caught up with me.
My NP diagnosed me with "adrenal fatigue" (HPA Axis dysfunction) and my "regular" doctor said my thyroid hormones were slightly out of whack. I wasn't willing to take medication, so both doctors suggested supplements (plus quitting my job and otherwise moving at a slower pace) to help repair my body without medication.
Initially I resisted taking supplements, too. I had a long standing personal belief that "food is thy medicine" and absent emergency nutritional deficiencies or some other serious limitation, it is best to get the goods directly from nature.
Yet I was also I was scared I might cause long-term consequences if my hormones didn't re-regulate and I was desperate to feel better, so I caved and took a handful of supplements most people are prescribed (e.g. Vitamin D, Omega 3s).
THE SUPPLEMENTS CAUSED MY CHRONIC CONSTIPATION.
Within days of stopping the supplements, I was spontaneously healed.
I've been feeling good with ZERO issues ever since.
I've subsequently spent a great deal of time researching and have learned there is a good size body of evidence that several supplements lead to constipation or decreased bowel motility or slower bowel transit.
SUPPLEMENTS THAT CAUSE CONSTIPATION
- iron (includes daily vitamins or prenatal vitamins)
- calcium (includes things "fortified" with calcium like some packaged foods)
- protein powders (includes protein drinks and foods with added protein like "protein cookies" or "high protein cereal") *this includes vegan protein powders!
- NAC (N-acetyl cysteine)
- vitamin D
- ubiquinol (co-enzyme 10)
- NSAIDs (e.g. Advil)
THE ABOVE LIST IS NOT COMPREHENSIVE.
It's only what I found during my own research and reading about supplements and constipation generally.
If you are taking any kind of vitamin, supplement, or medicine, and you have my symptoms or some other mystery GI issue you can't seem to pinpoint, consider doing an online search for "vitamin name + constipation" and see if any studies or articles from trusted sources (e.g. Healthline) come up.
For example, if you search "NAC constipation", you'll find this study on "Adverse reactions associated with acetylcysteine" which lists constipation.
It's also important to see the dose amount used in the study.A study may say "only high amounts of this supplement cause constipation" but what do they consider "high"???? Your dose, even if it is less than what your doctor or the bottle recommends, may still be considered "high" by the standards in the study.
You might also need to complete a "constipation search" for each of the components (e.g. inactive and active ingredients).
OR you could just ditch the supplements for a few weeks and see if you heal ;)
I also want to add that I spent an incredible amount of time researching the supplements I took. I made sure they were vegan, free of common allergens, made in the USA or EU, from a reputable company, organic and fair-trade where possible, etc. etc.
Basically the supplements I took were the cream of the crop and some of the most expensive supplements on the market. I was paying around $120/mo for my supplements.
Yet NONE OF THAT MATTERED. If "Vitamin X" causes constipation, then it really doesn't matter what the capsule is made from or the source it is derived from, does it?
BIRTH CONTROL ALSO CAUSES CONSTIPATION.
One thing I found digging deep in the research on my hormonal issues was how constipation (and hormone therapy) is a common cause of constipation, but that is not regularly disclosed to women.
It is also worth noting that having hormone issues can also cause constipation so it is worth getting a full thyroid panel and other bloodwork to rule that out as a cause, especially if you are a woman.
A few last PSA's:
CONSTIPATION CAN BE LIFE-THREATENING
If you watch ALONE (on the History Channel), you might recall a contestant from a recent season had to leave because of their constipation and the toxins caused by it. She (the constipated woman) became very ill.
Chronic constipation has also been suggested as the true cause of Elvis Presley's death...
CONSTIPATION CAN CAUSE DEPRESSION
There are loads of studies on this. Pooping makes everyone happier.
If you are vegan, plant-based and have the bloating and constipated like I did:
- Avoid fermented foods until the issue resolves
- Avoid dry and dehydrated foods like crackers. You want foods with moisture.
- Avoid flour products (GF included)
- ABSOLUTELY NO DAIRY
- Stop eating isolated anything. Respect the food matrix.
- Do an internet search to see if your supplement or medication is linked to constipation.
- Consider trying a popsicle/broth (clear liquid) fast for 24-48 hours to "reset" your system.
- Walk after meals and daily (movement stimulates movement).
- Take a break from probiotics to see if it helps.
- Drink more water. High fiber diets require more water than you think.
- Have your MICRONUTRIENT levels checked (vitamin B12, D, E, Magnesium, Copper, Selenium & Zinc).
- If your levels are low; consider eating foods rich in what you need instead of taking "vitamins" and "supplements."
- Try a magnesium supplement if you're constipated.
- Take a stool softener or enema if you're suffering.
- Talk positively to your body. Anytime I poop I tell my body "good job! great work!"
When I was really backed up, I would do a saline enema, or preferably, see my colon hydrotherapist to get flushed out. I simply could not go any longer being so impacted (2-4 pounds of waste was removed each time).
After the colonoscopy and "clear liquid fast" my GI prescribed taking Miralax twice a day (AM and PM) for two weeks to get my system running again.
When I continued to have movements on my own without assistance, I was told to take Metamucil. I do't want to take Metamucil because the ingredients are concerning to me, so I'm using ColonBroom.
It's been a little over a week and I'm still regular without bloating so I'll keep at it a little while longer. It does make your stool have mucous, which might be... surprising to you, but remind yourself that it's basically lube so things slide out and don't get stuck ;)
NOTE: EXTREME DISTENSION IS DIFFERENT THAN MILD BLOATING AND GAS.
What I've described here is not 'typical' bloating, gas, or GI upset. (See pictures above). It is EXTREME.
If you are relatively new to a plant-centered diet, you may experience some gas and bloating andthat is normal.
TIPS FOR HELPING REDUCE GAS AND BLOATING ON A VEGAN DIET
- Take digestive enzymes such as Rainbow Light (covers everything) or Beano, which is specific to beans.
- Utilize over-the-counter medications such as GasX that can help provide relief. For a more 'natural' approach, you can use Gaia's gas and bloating tea or their gas and bloating herbal pills. Papaya enzyme (dietary supplement) can also be taken.
- GO SLOW with fiber. For example, if you're having stir-fry veggies for dinner, it might be best (for now) to serve that with white rice rather than brown rice. Likewise, it might be good to avoid raw vegetables (e.g. salads, baby carrots as a snack) for now and focus on eating your vegetables cooked really well. If your diet wasn't high in fiber before, it is crucial to take it slow if you want to avoid gas. I went from eating a vegan diet that was high in refined and processed foods (e.g. white pasta, white bread, white rice, frozen meals like Boca Burgers) to a "whole food" plant-based diet that was all vegetables, brown rice, beans, and fruits, and my body was not having it! I had to back off and eat more 50/50 (e.g. veggies with white rice). I also had to initially limit beans to 1/4-cup per meal.
- You can be a healthy vegan and never eat beans, legumes, or cruciferous vegetables. So if they bother you, omit them and don't worry about it. As long as you get enough calories and aren't eating mainly processed foods you'll be okay absent special medical conditions.
- Cook your food really well (and chew it to mush). Boiling is the best. Pureeing food (e.g. pureed veg soup or hummus) is also easier to digest. I also find soaking my rice before cooking it makes it easier to digest. For cooking beans and lentils, I bring the pot to a boil, then dump that water and start over. Seems to make a difference. Some people find a small piece of seaweed added to the beans/lentils when cooking improves digestion but that never made much difference for my belly.
- Eat smaller portions. Overeating (especially on plant foods) will cause backup and massive bloating.
- Drinking lots of water (8-oz hourly) and walking daily helps move things along and constipation can cause gas and bloat
- 'Contrary' to what you read on the internet, if you're having a lot of gas and distention, fermented foods are not always helpful and can make things worse. Avoid kombucha and other fermented things until your bloat/gas is gone.
- If you're using my simple, easy, plant-based vegan meal plans, avoid the slimming options for now. Wait until your stomach has adjusted. (The 'slimming' options have much more fiber and are designed to provide a workout for your guts to take advantage of the thermic effect -- you need to get your belly in shape for that first!)
Thanks to the hundreds of people who have messaged me since my original posts to share your stories with me. I am so glad my story can give you answers and hope and hugs to all the people who shared their own recovery stories with me.
TRUST YOUR BODY. TRUST YOUR INTUITION. BE YOUR OWN ADVOCATE.