Dr. Amy Nett: For constipation, things that you would think about using: Magnesium would be a good option, magnesium glycinate and magnesium citrate. I sometimes use those in combination. Magnesium glycinate you might use about 400 milligrams to 600 milligrams, and then you can also use Natural Calm, which is magnesium citrate. Natural Calm is a powder, and it’s basically magnesium citrate. Magnesium citrate tends to bring water into the bowel, so I just give patients a heads-up to be cautious with that one because it’s very easy for them to get loose stools very quickly. Magnesium glycinate is great in terms of just more general magnesium supplementation, and then the citrate I’ll add on top of that, specifically when I want to help increase motility. When you have patients who have longstanding chronic constipation, what you often want to do is try to get them to a looser, watery stool, and that’s so that their colon can start having more normal motility. When someone comes to our practice and they’re having really difficult longstanding constipation, we do actually suggest that they might go towards a looser stool, and magnesium citrate is often an easy one to do that with because, again, it’s an osmotic. It brings fluid into the colon and just gives you watery stool, unfortunately, but that’s good to help get the colon contracting normally again. Vitamin C, like ascorbic acid, and Ageless Hydro-C, another good one, act similarly.
I only use the magnesium citrate to help the constipation. Magnesium glycinate I like as kind of a maintenance supplement. I think I mentioned long term my favorite supplements are cod liver oil and magnesium glycinate just because those are the two things difficult to get from food sources. So magnesium glycinate ongoing, and then magnesium citrate is much more of an as-needed medication for constipation. That’s only really as needed.
Ageless Hydro-C is another supplement we might use to help with constipation. Aloe vera is another one. You can have patients take aloe vera orally. Triphala is another one that you could try. It’s a gentle laxative, not a stimulant laxative, but I still advise patients not to stay on it for too long because I don’t want them to develop tolerance. I sometimes suggest that people do a rotation of different treatments for constipation to try to keep things moving but without developing a tolerance. Those are some of the things I would start with for working with constipation.
Then coming back to difficult-to-treat constipation, one other thing we sometimes use when we’re really stuck is occasionally we’ll use MiraLax and try to see if that gets things moving. I have some patients who will use coffee enemas. We don’t generally like using coffee enemas. Patients who have absolutely no other options to get things moving—and most often who already come to the practice doing that—we are very cautious, and we advise them only to do low-volume and low enemas, meaning don’t send the coffee up to the higher reaches of the colon. We’re always worried about dependence, so you want to keep the bowel moving as best you can naturally, so MiraLax is another one of our sort of go-to last-resort options.