How to overcome constipation associated with calcium and iron supplements?

From the Guidelines

To overcome constipation associated with calcium and iron supplements, it is essential to increase daily water intake to at least 8-10 glasses and add more fiber to your diet through fruits, vegetables, and whole grains, as recommended by the American Gastroenterological Association 1.

Key Recommendations

• Increase fluid intake, focusing on those with low levels of fluid intake, as it can help prevent constipation 1.
• Consider taking supplements with food rather than on an empty stomach and split larger doses throughout the day to minimize gastrointestinal side effects.
• For calcium, calcium citrate may cause less constipation than calcium carbonate.
• With iron supplements, try a slow-release formulation or switch to liquid iron, which may be gentler on your digestive system.
• Regular physical activity, even just a 20-30 minute daily walk, can stimulate bowel movements.
• If constipation persists, consider adding a stool softener like docusate sodium (100-300 mg daily) or a gentle osmotic laxative such as Miralax (polyethylene glycol 3350, 17g daily).
• It is also crucial to take calcium and iron supplements 2 hours apart, as one may inhibit the absorption of the other, according to the British Obesity and Metabolic Surgery Society guidelines 1.

Additional Considerations

• Fiber supplements, particularly psyllium, can be used as first-line therapy for chronic idiopathic constipation, especially for individuals with low dietary fiber intake 1.
• Adequate hydration should be encouraged with the use of fiber supplements to minimize side effects like flatulence.
• Consult your healthcare provider about alternative supplement formulations or adjusting your dosage if symptoms remain severe despite these measures, to ensure you still meet your nutritional needs.

From the FDA Drug Label

Uses for relief of occasional constipation (irregularity). This product generally produces bowel movement in 12 to 72 hours. To overcome constipation associated with calcium and iron supplements, consider taking psyllium (2) as it is used for relief of occasional constipation.

• Take the supplement as directed to help produce a bowel movement in 12 to 72 hours.
• Note that iron supplements (3) may cause constipation, so managing the dosage and timing of iron intake may also help alleviate constipation.

From the Research

Overcoming Constipation Associated with Calcium and Iron Supplements

To overcome constipation associated with calcium and iron supplements, consider the following strategies:

• Increase fluid intake: A study published in Hepato-gastroenterology 4 found that drinking 2 liters of mineral water per day enhanced the effect of a high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation.
• High-fiber diet: The same study 4 found that a daily fiber intake of 25 g can increase stool frequency in patients with chronic functional constipation.
• Osmotic laxatives: A review of laxative therapies for treatment of chronic constipation in older adults 5 found that osmotic laxatives, such as polyethylene glycol or lactulose, can be effective in increasing stool frequency.
• Bulk laxatives: Psyllium, a bulk laxative, was found to be effective in the treatment of constipation in a study published in the Journal of the American Medical Directors Association 6.
• Lubiprostone: A new drug, lubiprostone, was found to be effective, safe, and well tolerated in older adults treated for chronic constipation in studies up to a year 6.

Calcium Supplementation and Constipation

• A study published in the Canadian journal of dietetic practice and research 7 found that calcium supplementation does not contribute to constipation in healthy women.
• However, another study published in the American journal of clinical nutrition 8 found that calcium supplements can inhibit nonheme-iron absorption, which may be a concern for individuals taking iron supplements.

Iron Supplementation and Constipation

• Iron supplements can cause constipation in some individuals, but the evidence is limited.
• A study published in the American journal of clinical nutrition 8 found that long-term supplementation with calcium did not reduce plasma ferritin concentrations in iron-replete adults consuming a Western-style diet containing moderate to high amounts of calcium in most meals.