When most people think about celiac disease, “diarrhea” is one of the first symptoms that comes to mind. Constipation rarely comes to mind. Even doctors frequently do celiac blood testing for patients whose primary symptom is diarrhea, yet anecdotally it seems that constipation rarely raises red flags for them.
However, research has shown that about 15% of celiac patients with gastrointestinal complaints experience constipation. A 2012 study suggests that any person experiencing constipation that doesn’t respond to laxatives should be tested for celiac disease.
Constipation is no mere inconvenience. It can reduce the body’s ability to eliminate toxins and can contribute to gastroesphageal reflux. It can cause symptoms such as pain, fatigue and anal fissures. It is important to address this symptom and to understand its potential connection to celiac disease and the gluten-free diet.
What Causes Constipation for Celiacs?
When a person has celiac disease, the intestinal villi (tiny fingerlike projections on the internal walls of the intestines that absorb nutrients) become damaged due to the celiac antibodies created by the ingestion of gluten by a person with the disease. This decreases absorption of nutrients from food as it travels through the gastrointestinal tract. The food is now travelling through the gut in a less thoroughly digested form. As it enters the lower end of the small intestine, the body cannot fully process this under-digested, unabsorbed food (now in stool form) and can often only absorb the moisture from the stool – sometimes more moisture than it should. The over-absorption of moisture from the stool by the small intestine causes hardened stools that can be difficult and painful to pass.
To make matters worse, gluten-free processed foods tend to be made with low-fiber starches and flours like white rice flour, potato starch and tapioca starch. The fiber that people on standard diets get through consuming whole wheat products is not available, and whole wheat bread or pasta is often replaced with gluten-free substitutes that contain little to no fiber. Many gluten-containing products these days are fiber-fortified, but few gluten-free products are. Even brown rice, a popular gluten-free whole grain, is not a very high fiber grain.
What Can Celiacs Do to Prevent Constipation?
To use food as a remedy for constipation, someone with celiac disease should choose high fiber grains like quinoa, millet and amaranth. They must increase their fluid intake significantly, especially if they are consuming fiber supplements such as psyllium husk or inulin (common ingredients in fiber powders, drinks or capsules). In fact, dramatically increasing your fiber intake without increasing your water intake can make the situation even worse. You must also increase your intake of high-fiber vegetables and fruits, including those with edible skins (such as bell peppers, corn, and apples). Dried fruit, such as prunes, are also highly recommended. Binding foods such as bananas and low-fiber breads and crackers should be minimized.
What If Fiber Isn’t Helping?
Functioning villi are not the only requirement for proper gastrointestinal health. The proper balance of flora in the gut is extremely important as well. Probiotic-containing foods or supplements can help restore the proper balance of intestinal flora which can lower inflammation, therefore lowering damage to the gut and improving absorption. Probiotics often help regulate bowel movements, reducing the incidence of both diarrhea and constipation symptoms.
By using a healthy, high-fiber, high-liquid gluten-free diet in conjunction with exercise and probiotic supplementation, many people can wave goodbye to constipation and learn to enjoy healthier and more regulated gastrointestinal health.