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KEY POINTS:

  • Accidental or intentional gluten exposure is one of the main causes of constipation in people with celiac disease.

Quinoa_Broccoli

  • If you are constipated, take a close look at your diet. Have you added a new food? Re-read labels? Have you checked your medications and supplements? Did you examine your kitchen for potential cross-contamination? Consider where you dine out and how safely your meals are being prepared.
  • If you have any questions about whether or not a product or a restaurant meal is gluten-free, talk to the manufacturer or the restaurant manager.
  • Do not hesitate to talk to your doctor or dietitian about your concerns.

The typical gluten-free diet is low in fiber. Gradually introducing fiber, along with adequate fluid, is recommended as the first treatment for constipation. Dietary fiber is found in foods that come from plants and is the indigestible carbohydrates and lignin that give a plant its structure.

Nuts_Raisins

Dietary fiber comes in two forms: soluble and insoluble fiber. 

  • Soluble fiber dissolves in water in the gut to become a smooth, slimy gel that passes slowly through the gastrointestinal tract.
  • Insoluble fiber absorbs water but retains its rough texture, which scrapes old cells off the intestinal lining as it moves through.
  • Water helps ensure that the stool, while bulky from fiber, is soft enough to easily pass out. 1
  • It is best to get your fiber from food. People with celiac disease can meet the recommended daily intake for fiber with fruits, vegetables, dried beans and legumes, gluten-free whole grains, nuts and seeds.

Visit Healthy Eating on the Gluten-Free Diet sections for more information on fiber. 

Berries

IDEAS TO ADD GLUTEN-FREE FIBER TO LUNCH OR DINNER:
  • Brown rice and beans with chunky salsa, guacamole and your favorite mixed greens salad
  • Cook 1/2 portion of your regular rice with 1/2 portion of labeled gluten-free quinoa, amaranth, or millet. Add enough water for all the grains.
  • Add cooked dried beans to your own soups, salads, or casseroles, or cut the meat portion in your chili by half and replace it with beans
  • Quinoa salad: cooked quinoa (labeled gluten-free) with plain pumpkin or sunflower seeds, almonds or walnuts, and a light dressing
  • Be sure to drink liquid at each meal and snack and eat plenty of fresh or frozen fruit

Reference: Adapted from Higgins, L. Whole Grains = Nutritional Gold. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press. Bethesda, MD, 2010.

  • If you cannot get all of the fiber you need from your diet, you can talk to your doctor or dietitian about adding a gluten-free fiber supplement.
    FIBER SUPPLEMENTS*
    Product Gluten Free? Manufacturer/Contact Information

    Metamucil
    Capsules
    Powders and singles
    Wafers

    Yes
    Yes
    No

    Proctor & Gamble
    www.metamucil.com
    800-983-4237

    Fibersure
    Powders

    Soft chews

    Capsules

    Yes
    Yes
    Yes

    Proctor & Gamble
    www.fibersure.com
    800-525-2855

    Citrucel
    Powders

    Caplets

    Yes
    Yes

    GlaxoSmithKline
    www.citrucel.com
    800-897-6081

    FiberChoice
    All products

    Yes

    GlaxoSmithKline
    www.fiberchoice.com
    877-553-4237

    Konsyl
    Powders

    Caplets

    Yes
    Yes

    Konsly Pharmaceutical, Inc.
    www.konsyl.com
    800-356-6795

    Fibercon
    No gluten in ingredients but will not guarantee raw ingredients have not been in contact with gluten.

    N/A

    Wyeth Consumer Healthcare
    www.fibercon.com
    800-282-8805

    Resource Benefiber

    Yes

    Nestle Nutrition
    www.nestlenutritionstore.com
    888-240-2713

    Benefiber
    All products contain wheat dextrin but test to 10 parts per million of gluten, which is considered gluten free.

    Yes

    Novaris
    www.benefiber.com
    800-452-0051

    Reference: Adapted with permission from Gluten-free status of commercial fiber supplements. Pract Gastroenterol 2009;XXXIII(1):54. 

    Updated October 2011

  • Modest physical activity, such as daily walks, may help you overcome mild constipation, although it is not likely to help you improve severe constipation. 2

Woman_Walking

  • Other causes of constipation can be*:
    • Certain medications including pain medications, diuretics and those used to treat Parkinson's disease, high blood pressure and depression, 3 "pain medications (especially narcotics), antacids that contain aluminum and calcium, blood pressure medications (calcium channel blockers), antiparkinson drugs, antispasmodics, antidepressants, iron supplements, diuretics, and anticonvulsants" 4
    • Certain supplements including calcium and iron
    • A sign of another medical disorder such as thyroid disease, endocrine disorders, neurological disorders, structural abnormalities, or intestinal motility disorders, 1 such as constipation predominant irritable bowel syndrome
    • Hormonal changes, such as underactive thyroid
    • Changes in lifestyle or routine, such as pregnancy, travel and aging 3
    • Food intolerances - such as lactose intolerance 5

TAKE HOME MESSAGES:

pitcher

  • To help with constipation, increase your dietary fiber gradually, as tolerated, until you see an improvement in your stool. Drink 6-8 glasses of fluids throughout each day and participate in regular physical exercise.
  • Add gluten-free whole grain side dishes, higher fiber gluten-free flours, plain nuts and seeds, legumes such as beans and peas, and more fruits and vegetables to your diet.
  • If your constipation does not resolve with simple dietary changes, speak to your doctor about starting a fiber supplement or medication to treat the constipation, 1 or possible other causes.
  • Not everyone's body can tolerate moderate or high-fiber diets. Speak to your doctor if you feel this is you!

*This list is not comprehensive.

References:

  1. Simpson, S. Constipation. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffer D, eds. AGA Press. Bethesda, MD, 2010.
  2. Meshkinpour H. et al. Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci 1998;43:2379-83.
  3. Mayo Clinic. Constipation: Causes http://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/dxc-20252715 . Accessed April 20, 2011.
  4. National Digestive Diseases Information Clearinghouse: Constipation.http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/#what . Accessed April 20, 2011.
  5. Campbell AK, Matthews SB, Vassel N, Cox CD, Naseem R, Chaichi J, Holland IB, Green J, Wann KT.Bacterial metabolic 'toxins': a new mechanism for lactose and food intolerance, and irritable bowel syndrome . Toxicology. 2010 Dec 30;278(3):268-76.

Revision Date: 8-23-12 
Author: Melinda Dennis, MS, RD, LDN 
Editors: Suzanne Simpson, RD and Rupa Mukherjee, MD

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