When good bacteria go bad – Why probiotics can leave you constipated

How to manage probiotic-induced constipation

If you are taking probiotics, you are probably doing so in an effort to improve your gut health. The last thing you would expect is for your probiotics to leave you constipated.

But, it can happen. Read on to discover why probiotics can sometimes cause constipation and what you can do about it.

Probiotics explained

Our bodies are full of bacteria, both good and bad. Our health depends on having a balance between the ‘good’ and ‘bad’ bacteria. 

Probiotics are live bacteria and yeasts that are good for you, and especially for your digestive system. Doctors often suggest probiotics to help with digestive problems.

Probiotics also come in handy to replace ‘good’ bacteria in your body if you lost some after taking antibiotics.

When you take probiotics, they compete against potentially harmful microbes in the gastrointestinal tract to try and inhibit their effects. 

They do this by producing anti-microbial substances that can kill off pathogens by binding onto the viruses themselves.

It’s well known that probiotics can benefit the digestive system, but quite a few benefits have been researched. They have been shown to also improve the immune system and cognitive function.

Plenty of research has gone into using probiotics to manage irritable bowel syndrome (IBS), a common condition that causes stomach cramps, bloating, diarrhoea and constipation.

Changes in the gut microbiome have been linked to IBS symptoms. But what if you take probiotics, and it gives you constipation?

Foods that are rich in probiotics

Not that keen on taking supplements? Add some of these to your plate to ensure you get your probiotics the natural way: Yoghurt, especially those with “live and active cultures”.Unpasteurised sauerkraut and kimchi. Both of these are also great for your immune system. Miso soup. Miso is a fermented soybean paste that is commonly used as a seasoning in Asian cuisine. Soft cheeses.Sour pickles. They need to have been naturally fermented, not using vinegar. Source: www.webmd.com/digestive-disorders/ss/slideshow-probiotics

Side effects of probiotics

Taking probiotics is mostly safe, and only a small percentage of the population might suffer some side effects.

People with serious illnesses or compromised immune systems should be aware of possible side effects, which can include the following:

• Headaches. Some foods that are high in probiotics contain biogenic amines. This is a substance that forms when protein-containing foods age or are fermented by bacteria, for example sauerkraut.
  Amines may trigger headaches in people sensitive to the substance.

• Allergy symptoms. Some bacterial strains used in probiotic supplements can produce histamine inside your digestive tract. Histamine is usually only produced by the immune system if it detects a threat.
  As your histamine levels rise, blood vessels dilate to bring more blood to the affected area.
  This process creates redness and swelling, and can also trigger symptoms such as itching, watery eyes, a runny nose or difficulty breathing.

• Ingredient-specific allergies. If you have allergies or intolerances, carefully read the labels of probiotic supplements, as some might contain allergens like dairy, egg or soy.
  Lactose is also a common ingredient of probiotic supplements.

• Increased risk of infection. In rare cases, the bacteria and yeasts in probiotics can enter the bloodstream and cause infections in susceptible individuals.
  However, the risk of this happening is very low. Those with suppressed immune systems, venous catheters or who have undergone surgery or were in hospital a long time are most at risk.
• And then, sometimes, probiotics can cause the exact symptoms that you are trying to soothe: gas, bloating and constipation.

The best times to take probiotics

Get the most out of your probiotic supplement and reduce possible side effects by taking them at the right time.  Probiotics are killed off by your stomach acid, and they need to make it past stomach acid into the gut to be effective. Some probiotics come with a coating that protects them from stomach acid. They are usually marked as being “stomach acid resistant, delayed release” or having an “enteric coating”. This type of probiotic can be taken at any time, and they can be taken with or without food. It is recommended that you take them before bed on an empty stomach if you want to reduce the chances of suffering from bloating or gas.  If your probiotics don’t come with a protective layer, it’s best to take them 30 minutes before a meal, to maximise probiotic survival. You can also take your probiotics with milk instead of water. Milk will increase the number of probiotics delivered to the gut. This is because many probiotics contain species that thrive in milk.

Probiotics and constipation

Constipation refers to difficulty passing stool. This happens when your colon absorbs too much water from its contents. This dries it up, making it hard in consistency and difficult to push out of your body.

There are many causes for constipation, including lifestyle factors, certain medications and medical conditions. And yes, ironically you can end up with constipation after taking probiotics.

There are two reasons why this could happen.

1. You just started taking probiotics.

It is possible to experience intestinal side effects, including constipation, in the few days after starting on probiotics, and that these will disappear in time.

Reduce the likelihood of side effects by starting with a low dose of probiotics so your body can get used to it. Slowly increase to the full dosage over a few weeks.

2. Certain species of bacteria

Lactobacilli is a species of probiotic bacteria that can cause constipation. The different strains that make up the Lactobacillus family are among the most common and most effective probiotic bacteria.

Lactobacillus are characterised by the fact that they convert sugar to lactic acid, which helps your body to control glucose levels.

Should you experience constipation, the benefits still make it worthwhile to take the probiotics – that’s your decision of course. You can however up your fibre intake to help ease the symptoms of constipation.

3. There is an underlying issue

Probiotics generally promote healthy, regular bowel movements. Because constipation is not typical when taking probiotics, when it does happen it might be a sign that you don’t have enough water or fibre in your diet.

Therefore, you would once again have to look at including more sources of fibre in your diet, as well as drinking enough water. Another option is taking a prebiotic fibre supplement.

How to increase your fibre intake

According to the American Heart Association, women under 50 need on average 25g of fibre per day. But what does 25g of fibre look like? Here are a few examples:

• 100g uncooked wholegrains
• 1 cup of cooked beans
• 2-3 servings of fruit
• 200g broccoli
• ½ cup of leafy greens
• 1 tablespoon of flaxseeds

How to drink more water

For some people drinking enough water is easy and you always see them carrying a water bottle, while others just simply don’t like it. 

Our bodies need water for a myriad of functions, including the prevention of constipation. Here’s a few tips to help if you struggle to drink enough water:

• Set a SMART goal – specific, measurable, attainable, realistic and time-bound. It would sound something like this: “By 10am I will have had three glasses of water.”
  This technique helps you to manage and track your progress, and keeps you motivated.

• Become one of those people who always carry a water bottle. It helps to remind you to drink water, and makes it very easy to do just that.

• Set reminders on your phone to help you remember to drink water.

• If you don’t like the taste of water, you can infuse your water with fruit. Alternatively, you can also purchase water enhancers in powder or liquid form – these are available in many different flavours.

In summary

Waking up with an intestinal ailment of some sort can leave you in severe discomfort as you navigate your day. 

A healthy gut is important. Not only because you want to wake up feeling good, but because it affects everything from weight management to mental health to skin health.

Based on this, there will always be a place in the world for probiotics. Fortunately side-effects are rare, and usually manageable when they occur.