Most people think constipation is simple: eat more fiber, drink more water, problem solved. And sometimes it is that simple. But when it's not — when a client is doing all the "right things" and still struggling — that's when you need a framework that goes deeper than the standard advice.
One of our practitioners, Kaha, recently presented a constipation deep-dive during grand rounds that I thought was worth sharing more broadly. What she built was a systematic root-cause framework that pairs the conventional approach with the holistic one at every level — and the contrast is striking. What kept coming up, over and over, was how quickly conventional medicine reaches for laxatives and supplements while skipping the basics entirely.
That pattern — jumping from zero to a hundred while ignoring what's in between — is exactly what we're trained to catch.
This article is adapted from the video above. Watch for the full conversation, or read on for the structured version.
Start With the Foundation
Before you get into root causes and targeted interventions, you need to establish the floor. This is the part that sounds obvious but gets skipped constantly — even in clinical settings.
One of our cohort members shared a story about a family member in the hospital for rehab. The hospital was feeding them jello. Jello. For someone who needs to recover and rebuild. As Kaha put it:
We need to go back to basics. Let's start with eating more fruits and veggies.
The foundation is three things:
- Fiber: Gradually increase both soluble and insoluble fiber to 25-38 grams per day. They work together — insoluble fiber creates bulk and speeds transit, soluble fiber feeds beneficial bacteria. Most whole foods give you both. Chia seeds, flax seeds, and prunes are workhorses here.
- Hydration: Add 1.5 to 2 liters of water per day. If your client drinks anything diuretic — coffee, certain teas — add an extra 8 to 16 ounces on top of that to compensate. Start each morning with warm water and lemon. It stimulates the bowels and gives a hit of vitamin C.
- Movement: Thirty minutes per day. It can be as simple as 1,000 to 5,000 steps — that's a 20-minute walk. Movement stimulates peristalsis. Sedentary people get constipated. It's that direct.
One thing Kaha flagged that I see all the time: increasing fiber without increasing water is a recipe for making things worse, not better. I had a client once who was eating a fantastic, fiber-rich diet and couldn't figure out why she was so backed up. She wasn't drinking anything. Great diet, no water. That was the whole problem.
The Intervention Ladder
Here's the framework I teach for working through constipation with clients. You start broad and get more specific only as needed:
- Foundation first — fiber, movement, hydration. These are macronutrient-level basics. Give them time to work.
- Add micronutrients — if the basics aren't enough, layer in vitamin C (through food — kiwis, oranges, grapefruits) and magnesium (also through food first, not high-dose supplements).
- Targeted products — probiotics, prebiotics. More specific to the individual's gut health picture.
- Herbs — the most targeted tier. Turmeric for H. pylori-related constipation, senna leaf for acute relief, licorice root for antibacterial support.
The point is you don't jump to tier four when tier one hasn't been tried. Most clients haven't genuinely committed to the basics — they've tried them for a few days, didn't see results, and moved on to supplements. Your job is to hold the line on the foundation long enough for it to actually work.
The Root Causes Nobody Talks About
Once the foundation is solid and a client is still struggling, you start investigating root causes. This is where it gets interesting — and where holistic practitioners have a real advantage over the conventional approach.
Magnesium Deficiency
Magnesium relaxes smooth muscle, including the muscles of the colon. When someone is chronically low in magnesium — and a lot of people are — the colon can't do its job effectively. The conventional approach is high-dose oral magnesium citrate. It works fast, but it can cause electrolyte imbalances, disrupt potassium and sodium levels, and in extreme cases, even cardiac arrest. As Kaha pointed out, we don't talk about the risks of high-dose mineral supplementation enough.
The holistic approach: increase magnesium slowly through food. Leafy greens, nuts, seeds, dark chocolate, avocados. Add abdominal massage — every night, or before and after meals — to help stimulate movement mechanically. This takes longer but doesn't carry the downstream risks.
Food Sensitivities
Unidentified food sensitivities are a sneaky driver of chronic constipation. The inflammation they cause disrupts gut motility. The approach here is an elimination diet to identify triggers, combined with anti-inflammatory foods and nervous system regulation. This is where stress management becomes part of the constipation conversation — because inflammation and stress are deeply intertwined.
H. Pylori
When H. pylori is involved, the gut environment is compromised at a deeper level. The conventional response is proton pump inhibitors and antibiotics — which work, but also wipe out healthy gut bacteria and can cause a cascade of other issues.
The holistic toolkit for H. pylori includes turmeric, kanuka honey, licorice root, and green tea — all with antibacterial properties. The key is also adjusting fiber intake: cook meals down so fiber is less abrasive on the already-irritated stomach lining, while still maintaining adequate intake.
Stress and the Gut-Brain Axis
This one doesn't get enough attention. Stress will bind people up. I've seen it over and over in practice. The gut and the brain are connected and interrelated in everything — when cortisol is chronically elevated, gut motility slows, inflammation increases, and constipation follows.
Stress will just bind people up. I've seen that too.
Managing cortisol isn't a nice-to-have for constipation — it's often the missing piece. Especially for clients who are doing everything else right and still not seeing results. The answer might not be in their diet at all. It might be in their nervous system.
Why Women Are Hit Harder
Here's a statistic that should change how you approach this: women are two to three times more likely to experience constipation than men. The reason is hormonal — fluctuations in progesterone and estrogen during menstruation, pregnancy, perimenopause, and menopause all directly affect gut motility.
This means your approach needs to be different for women in these life stages. Cortisol management becomes even more important. Caffeine — already a diuretic that can worsen constipation — should be limited to less than 100 milligrams per day for women dealing with hormonal shifts. That's roughly one small cup of coffee.
The payoff of the holistic approach for hormonal constipation goes beyond regularity: improved metabolism, reduced estrogen dominance, decreased bloating, enhanced nutrient absorption, and better thyroid function. You're not just fixing constipation — you're supporting the entire hormonal ecosystem.
What Conventional Medicine Gets Wrong
This was the most striking pattern in Kaha's research. Every time she looked at how Western medicine approaches a root cause of constipation, the answer was the same: laxatives, stool softeners, proton pump inhibitors, or high-dose supplementation. Every time.
Every time I would research how they would approach it in the Western medicine, it was always just laxatives and proton pump inhibitors. They never talk about just eating fibrous foods. They always go to that last.
The side effects of these interventions are real: bloating, diarrhea, electrolyte imbalances, vitamin deficiencies, wiped-out gut bacteria, and — with long-term laxative use — dependency. Laxative dependency is a growing problem in this country that doesn't get the attention it deserves.
The holistic approach isn't about rejecting these tools entirely. Sometimes a client needs acute relief and senna tea or magnesium citrate is the right call in the moment. But it should be the exception, not the default. The default should be food, water, movement, and time.
A Note on Senna
Smooth Move tea — which contains senna leaf — is available everywhere and works. But a word of caution: some people are far more sensitive to senna than others. When you recommend it to a client, tell them to start with a few sips and wait. Don't drink a full cup the first time. Some people get cramps. Some can't tolerate it at all. It's a powerful herb and should be treated with respect, not grabbed off the shelf casually.
Putting It Together
If a client comes to you with constipation, here's the path:
- Assess the basics. Are they actually eating 25-38 grams of fiber? Are they drinking enough water? Are they moving their body? Don't assume — ask specifically.
- Fix the foundation first. Give it real time. Two weeks minimum, often more. Add warm lemon water in the morning. Add abdominal massage at night.
- Investigate root causes. If the foundation isn't enough, look at magnesium status, food sensitivities, H. pylori, hormonal fluctuations, and stress levels.
- Layer interventions thoughtfully. Micronutrients through food before supplements. Probiotics before herbs. Each tier gets more targeted and more specific to the individual.
- Don't ignore stress. The gut-brain axis is real. A client who is eating perfectly and chronically stressed will still be constipated.
That's the ethos. Not anti-supplement, not anti-intervention — but foundational first. Always.