Level 2

KEY POINTS:

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Constipation is common in people with celiac disease, both before diagnosis and after starting the gluten-free diet. For some people, starting the gluten-free diet resolves the constipation. However, for others, constipation is a new problem that happens after starting the gluten-free diet. 1

  • Symptoms can include infrequent bowel movements (often fewer than three bowel movements per week), straining, and hard stools. 2
  • Accidental or intentional gluten exposure is one of the main causes of constipation in people with celiac disease.
  • The typical gluten-free diet is low in fiber. 3 Fiber, along with adequate fluid, is recommended as a very common way to treat constipation.4
  • However, too much fiber can lead to gas and bloating. Therefore, it is important that you add fiber slowly to your diet as well as drink enough fluid to prevent these undesirable side effects. Your intestines needs to adjust to the higher fiber load and this takes time.
  • To help treat constipation, be sure you are also drinking adequate water throughout the day.
IDEAS FOR ADDING FIBER TO BREAKFAST:
  • Hot cereals made from labeled gluten-free buckwheat, amaranth, quinoa, and specially produced labeled gluten-free whole rolled oats with sliced almonds, ground flax seed, and dried or fresh fruit
  • Yogurt (preferably Greek yogurt) with dried, fresh or frozen berries or other cut fruit, ground flax seed or chia seed, homemade gluten-free granola or plain nuts
  • Whole egg or egg white frittata made with roasted peppers, spinach, asparagus, tomatoes, and shavings of your favorite cheese with gluten-free high fiber crackers or toast
  • Be sure to have something to drink at each meal and in between.
ADEQUATE WATER INTAKE

LIFE STAGE

WATER (LITERS PER DAY)

Children
1-3 years
4-8 years

1.3
1.7

Male
9-13 years
14-18 years
>19 years

2.4
3.3
3.7

Female
9-13 years
14-18 years
>19 years

2.1
2.3
2.7

Pregnant

3.0

Lactating

3.8

Note: 1 liter = about 4 cups

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Reference: Reprinted with permission from “Dietary Reference Intakes: Recommended Dietary Allowances and Adequate Intakes, Total Water and Macronutrients,” 2011, by the National Academy of Sciences, Courtesy of the National Academies Press, Wash, DC. http://www.nap.edu/catalog.php?record_id=13050.

Look at this chart on Fiber Recommendations to see if you are getting enough fiber in your diet. If not, visit Constipation Level 3 and the sections on Healthy Eating on the Gluten-Free Diet and to see how to gradually add more fiber into your diet. Don't forget to also drink more water.

FIBER RECOMMENDATIONS

AGE (YEARS)

GENDER

FIBER (GRAMS PER DAY)

<>

Both

Not determined

1-3

Both

19

4-8

Both

25

9-13

Male

31

9-18

Female

26

14-50

Male

38

19-50

Female

25

>50

Male

30

>50

Female

21

All Ages

Pregnancy

28

All Ages

Lactation

29

Reference: Reprinted with permission from “Dietary Reference Intakes: Recommended Dietary Allowances and Adequate Intakes, Total Water and Macronutrients,” 2011, by the National Academy of Sciences, Courtesy of the National Academies Press, Wash, DC. http://www.nap.edu/catalog.php?record_id=13050. 

Other causes of constipation can be*:

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  • Certain medications such as pain medications and supplements
  • A sign of another medical condition, such as problems with your thyroid
  • Not going to the bathroom when you feel the urge to do so
  • Lack of physical exercise 5
  • Inadequate fluid intake
  • Generalized illness
  • Irritable Bowel Syndrome
  • Frequent use or misuse of laxatives 6

TAKE HOME MESSAGES:

  • The amount of fiber that is needed to correct constipation varies person by person. It Ais best to gradually increase the amount of fiber in your diet so that your intestines can adjust. 1
  • Drink enough water as you increase your fiber intake.
  • Inform your doctor or dietitian if you are struggling with constipation.

*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. AGA Press. Bethesda, MD, 2010.
  2. Eoff JC, Lembo AJ. Optimal treatment of chronic constipation in managed care: review and roundtable discussion. J Manag Care Pharm 2008; 14(9, Suppl. S-a):S1-S17.
  3. Midhagen G, Hallert C. High rate of gastrointestinal symptoms in celiac patients living on a gluten-free diet: controlled study. Am J Gastroenterol 2003;98:2023-26.
  4. Locke GR, Pemberton JH, Philips SH. American Gastroenterological Association technical review on constipation. Gastroenterology 2000;119(6):1766-78.
  5. National Digestive Diseases Information Clearinghouse. Constipation.
  6. Mayo Clinic. Constipation: Causes http://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/dxc-20252715 . Accessed April 20, 2011.

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

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