How to Identify and Treat Your Child’s Constipation Naturally

Episode Transcript

Dr. Nicole Beurkens:
Hi everyone, welcome to the show, I am Dr. Nicole, and on today’s episode, we’re going to talk about all things constipation in children. Not only the physical parts of that, but how it’s connected to mental health and behavior and all of those kinds of things in our kids. You know constipation is one of the most common physical health complaints in kids, can cause a lot of discomfort physically, but also emotionally for children and for their parents. There are many safe and effective ways to address constipation in kids, and it’s really important not just to focus on it for the physical health piece, but also for the learning, the mood, the anxiety and the behavior components as well. So here to talk with us all about this important issue is my friend and colleague, Dr. Asia Muhammad, let me tell you a bit about her.
She really values the power of lifestyle modifications to achieve optimal health. She uses evidence-based medicine to provide individualized care to each patient. As a naturopathic doctor, she is able to provide care in the realm of nutrition, exercise recommendations, supplementation, botanical medicine, and mind-body therapies such as hypnosis. She has a special interest in gastroenterology, mind-body medicine, and stress management, as increasing research demonstrates the role of stress in many diseases. She has received additional training in mind-body therapies, including hypnosis, guided imagery, biofeedback, lots more. Dr. Asia Muhammad, welcome to the show!

Dr. Asia Muhammad::
Thanks so much for having me, I love your show, by the way!

Dr. Nicole Beurkens:
Thank you so much! I’ve been wanting to have you on. I’m so glad that we got our schedules to sync up to be able to do this and to talk about a really important topic related to kids and health. I know it’s like oh, we’re going to spend a whole show talking about poop, but yes we are, because it’s that important for kids, right?

Dr. Asia Muhammad:
It really is.

Dr. Nicole Beurkens:
Yeah. And I think so many parents have kids who struggle with anywhere from maybe mild constipation issues to really, really severe ongoing issues. It’s the kind of thing that doesn’t just impact the kid. It impacts parents too having to manage it. So I want to dive into lots of specifics around this, but I think let’s start by having you talk a bit about what we mean when we say constipation. What does it mean when a child is constipated? How do we use that term? Let’s start there.

Dr. Asia Muhammad:
Constipation refers to a change in our bowel habits, bowel frequency. Honestly, it doesn’t even have to be the bowel frequency because a kid can go to the bathroom everyday, but if it’s small volume stool, that’s still constipation. So typically, a healthy bowel movement should be that you go once a day, a nice sausage-shaped stool, it’s formed and it comes out, meaning you’re not having to sit on the toilet and strain, there is no blood in the stool from hemorrhoids or something, there is not a lot of abdominal pain with the bowels moving. So that’s what constipation refers to, a change in your bowel habits whereby the bowels are either really small, kind of like pebble-like stools, or you’re going days without a bowel movement.

Dr. Nicole Beurkens:
I think that’s such an important starting point, because I already know several of our listeners have gone “Okay, wait a minute. You’re supposed to have a bowel movement everyday?” Because some people really — I’ll ask parents, like any time a new family comes in for an intake, I ask about bowel movements for the child. And if you just ask a parent, “Does your child struggle with constipation, most of the time, they’ll say no. But when you delve into “How often is your child having a bowel movement, what is the quality of the bowel movement?” Suddenly you discover, oh, wait a second. This child is not having normal, healthy bowel movements. And parents go “Oh my gosh, I never knew.” Parents will say, “I have always had a bowel movement every three days. I thought that that was normal.” So I think it’s important to start from that foundation of what a healthy stool is, right?

Dr. Asia Muhammad:
Yeah. A lot of kids, that’s their normal. Their normal for them is going to the bathroom every few days, right? Some kids also may have anal fissures or little tears in their bottom end from these rock-hard stool, so they don’t want to go to the bathroom so they’re holding it in, right? I think it’s really important to ask your kid: Look in the toilet after you poop. What does it look like? How do you feel when you’re going to the bathroom, so you can kind of develop those qualities around their stool.

Dr. Nicole Beurkens:
I’m really glad that you mentioned that it’s not just about the frequency, because I think that’s true. Kids can be having a daily bowel movement, but it is. It’s sort of those little pebbles, those little rabbit turds, or it’s not a good volume or they’re going everyday but they’re having a lot of pain or straining or discomfort. So what you’re saying is really what we’re aiming for, it’s for kids to be having at least one bowel movement a day where it’s sort of sausage or snake-like, soft, not too soft, it’s formed, it’s easy to pass. Pooping shouldn’t be a big ordeal, right? If it is, then it probably means there is an issue.

Dr. Asia Muhammad:
There is an issue and a lot of times what you find is like nowadays, kids will take their phones or their little iPads with them, and they’re in the bathroom for such a long time, and that’s constipation, right? I guess they need something to keep them busy while they’re waiting for the stool to pass.

Dr. Nicole Beurkens:
That’s a great point. If you or your child are having to bring things into the bathroom to pass the time while you’re waiting to poop, that probably is an indication that there are some issues there too. But again, I think it’s so important to start from that understanding so that parents can wrap their head around, you may not have recognized that your child is struggling with constipation, but that may very well be an issue. So let’s talk about — because I think the next thing that comes up is parents go “Okay, well, I get it, alright. My child should be pooping more”, physically that’s healthy, but let’s talk about why having good healthy, daily bowel movements is so important overall for a child? I mean yes, it’s important for physical health, but it’s important for them overall, right?

Dr. Asia Muhammad:
Oh, it’s super important. When you look at — and we hear this all the time, but three or four pounds of our body weight is bacteria. We have more bacteria in our gut than we have body cells. If you have stool just sitting around in the colon, bacteria eat on poop, it’s like dessert for them. So they just eat the poop, and you create all this gas. What can happen is the bacteria can create their own metabolites or their own toxins that can wreak havoc in the gut, and then lead downstream more inflammation in the system, more inflammation in the gut. So outside of just having healthy bowel movements for the sake of getting stool out, it’s paramount to our entire being as humans in terms of general health status.

Dr. Nicole Beurkens:
Absolutely, and I think as we’ve had more and more research over the last two decades on the connection between gut health, gut microbiome, digestive issues and kids who have things like autism, ADHD, a whole host of learning and behavioral kinds of disorders, those connections between what’s going on in the gut and what’s going on in the brain are huge.

Dr. Asia Muhammad:
They’re very huge, and when you look at some of the literature around bacteria, specific bacteria can produce their own types of chemicals, right? They can produce GABA, which is neuro inhibitory, it gives a calming effect. If you have dysbiosis, you have less of those types of bacteria. They can reduce certain gases, slow the transit time in the colon. Now you may be having a normal bowel function, but if you have more constipation, you can have more of these methane-producing gas bacteria, now your transit time is slower. So the colon is less spastic, right? So you’re not getting things going down, so there is more constipation or slower bowels.

Dr. Nicole Beurkens:
I think it’s so important for parents and professionals to understand how interrelated these things are. I would say, even on a more surface level, from an emotional and behavioral standpoint, kids who are not pooping regular or are not having comfortable poops, that just builds up stress and anxiety and distress, and you can get into lots of patterns too because of the pain or the aggravation of it or the stress of it. That becomes a cycle that’s really problematic from a mental health perspective as well.

Dr. Asia Muhammad:
100%. Completely. Our bowels, pretty much — I’ve seen adult patients who — I had this case once of this person, they went 12 weeks without a bowel movement. Their history was significant in terms of why that happened, and just the level of discomfort and pain they were in. I had patients who were used to going everyday. They are constipated for three days, their mental health, you could actually see a change there. So I could imagine a kid — and bowel function is something that when we look at society, it doesn’t really talk about it. It’s embarrassing to talk about our bowel. So as a kid growing up, it can also put a hamper on that as well.

Dr. Nicole Beurkens:
It’s so true. I’m thinking of several kids that I treated over the course of my years in practice where it can get very severe. So some of you listening may have a child who you are realizing now, as we are talking, yeah, okay, there is some constipation there, they’re having bowel movements every few days, it’s not super comfortable. Some of you may be listening to this going “Yeah, I know, my kid has been severely constipated for years”, and particularly in some of the more severely impaired children that we see in the clinic setting who may be are struggling to have a bowel movement every two weeks, who are experiencing a lot of tension and pain, who need to be hospitalized on a regular basis to clean them out. And the impact that that has, not only from a physical pain and discomfort perspective, but also, as you mentioned, imagine not detoxing in that way and having all of those toxins building up. How can we expect a child to be able to have a brain that is functioning appropriately or to be able to regulate their emotions and their behavior when they’re dealing with that kind of pain and lack of detoxing?

Dr. Asia Muhammad:
When you think of leaky gut, you think of what causes that, and one of the things is dysbiosis, and what these bacteria can create and how they make the intestines more permeable, which means more toxins are recirculating into the system.

Dr. Nicole Beurkens:
Yeah, absolutely. I want to get into that because I think the next thing that’s helpful to talk about is how it is that kids become constipated in the first place. What are some of the issues that are involved there that may lead to constipation for children?

Dr. Asia Muhammad:
So when I think about constipation, I think about a few different key factors. One is hydration. When our body is dehydrated, it’s going to pull water from our colon, which means your stools are going to be smaller, drier, harder to pass. Think about motility. So the movement in the colon, the spastic contractions of the colon to squeeze things down. If you have dysbiosis, you’re producing certain types of gases that slow that entire process down. There is also the nervous input, stress in the kids’ life that may be causing their bowel transit time to be slowed down. One of the biggest ones is fiber or lack of fiber in the diet. So soluble fibers are ones that hold water within the colons. So stools are not as rough or bulky. Then your insoluble fibers, which helps to give some volume and bulk to the stools so it’s not diarrhea. So I think a lot of times kids don’t really like eating vegetables taste-wise, then you have kids who are more sensitive, taste is a bigger factor there. So I think fiber, hydration and also motility dysbiosis are some key things that I always look at with anybody that comes in with constipation.

Dr. Nicole Beurkens:
Great. With the dysbiosis piece, just for those of you who maybe haven’t caught some of our previous episodes about the gut microbiome and gut health and all of that, that dysbiosis referring to that imbalance of helpful versus unhelpful bacteria and other microorganisms in the gut. Kids can have dysbiosis in their gut for lots of reasons, right?

Dr. Asia Muhammad:
Tons of reasons. When you think about the history of antibiotic use, you look at the literature there, how many kids have taken antibiotics? The parents are just like “Oh, the doctor said I need to give this to my kid for an ear infection” or for whatever, and that’s one of the questions I always ask, it’s like what is your antibiotic history of use? Are you somebody who has used antibiotics once a year? A couple of times a year? Or never? That kind of gives me some information in regards to what could be possibly going on in their gut. You look at some of the literature, it can take up to a year or longer for your microbiome to return back to what its normal make up was after a single use of an antibiotic. So think about double use or triple use or an antibiotic. What was your question?

Dr. Nicole Beurkens:
Just the cause of dysbiosis, ways that kids can end up with dysbiosis. And I agree, antibiotics are one of the number one things. We see kids in our clinic who have been on multiple rounds of antibiotics every year since they were born, and while the antibiotics can be necessary and important for killing really infectious kinds of things, what we also have to realize is they kill all of the bacteria, so the good guys too, and that really — especially in young, developing kids can create this chronic dysbiosis in the gut, then.

Dr. Asia Muhammad:
For sure, and I’m not sure if it’s standard practice now in pediatric clinics to give probiotics with antibiotics, I’m not sure if that’s…

Dr. Nicole Beurkens:
I find it depends on the pediatrician and the person prescribing. Some of them really do recommend that now, and a lot of parents that I still see, no one has talked with them about how to rebuild the gut. So yeah.

Dr. Asia Muhammad:
When you look at a lot of foods that kids enjoy, there are a lot of processed foods. So things that are sweet, crunchy, salty and a lot of those things have added components that are man made chemicals that also wreak havoc in the gut and can contribute to dysbiosis and leaky gut. So diet dysbiosis, antibiotic dysbiosis, environmental factors, right? The stress. There is some literature detailing stress and how that affects our intestinal epithelial cells, the lining within the gut. I think there are so many factors that contribute to dysbiosis, I think the biggest ones are going to be what you’re putting into the system. So the environment. That can include your diet and medications you might be taking.
Dr. Nicole Beurkens:
So many pieces. Again, I think what we see in kids who tend to have a wider variety of challenges, thinking about kids with maybe neurodevelopmental issues, more significant emotional and behavioral kinds of issues, very, very, very often, we also seem to have these co-occurring gut kinds of issues. The research just shows more and more that those things are so interconnected, that things going on in the brain have a direct relation to what’s going on in the GI system, and what’s going on in the GI system and the bowels has a big impact on what’s going on in the brain. So it’s just so common that we see those things happening together. So let’s talk a bit about parents who say, “Okay, I have this concern about my kid”, they go in and talk to the primary healthcare provider, the pediatrician, whoever it might be. Let’s talk about what some of the common recommendations that parents are often given are, then I want to transition to us talking about some of the things that you have found are important and helpful.

Dr. Asia Muhammad:
Common recommendations for constipation: The biggest one is MiraLAX, they even still recommend it for adults, and it’s just kind of a powder you dissolve in some liquid and they say it’s tasteless, just put it in some juice and have the kid drink it down, and it’s supposed to give you one stool everyday. It works like 8 hours after you take it, but you should be going to the bathroom once a day on MiraLAX. I’ve also seen, depending on how old the kid is, LINZESS, which is a prescription for constipation. I don’t really see a lot of stool softeners used in kids, I’ve seen Mag Citrate, they’ll say “Do a bottle of Mag Citrate”, but MiraLAX is the biggest one, it’s one of the oldest ones we see used for constipation in kids.

Dr. Nicole Beurkens:
Often what I hear from parents is they bring their kids in and they say they’re having some discomfort around this or only having a bowel movement a couple of times a week, and sometimes, practitioners will just go, “Oh, don’t worry about it, that’s normal for them.” Which you and I are both being clear, that is not normal, that is not appropriate, but I think you’re exactly right: When they do recommend something, they just say, “Oh yeah, just give ‘em MiraLAX”, which used to be a prescription. Now, for the last many years, it’s been over the counter, but I will often see kids who have been on MiraLAX for years in order to combat constipation, and what parents find is the minute they stop giving the MiraLAX, now their kid goes back to being constipated. So it’s not really getting resolved. Also, there are some concerns about MiraLAX as far as kids’ overall physical health, as well as mental health, right?

Dr. Asia Muhammad:
Yeah. Like we discussed, there is not any long term literature to say this is the safety profile of MiraLAX 5-10 years down the line.

Dr. Nicole Beurkens:
Absolutely, for kids or adults, and especially in children. What I will just mention to all of you listening is there have not been any studies looking at, as Asia said, the long term safety and efficacy in a child population. It’s all based on adult data. If you look at the packaging itself, it tells you not to use it long term, and yet, many people are being told “Leave your kids on this, long term.” Now on the one hand, you could say, “Well, if it’s working for a child to have comfortable daily bowel movements, okay.” But to me, I always look at it as: If we’re not really addressing the root issue, if the minute you stop giving the MiraLAX, the kid is totally constipated again, you’re really just putting a bandaid on the problem and you’re not really addressing what it is internally that needs to be addressed for their brain and their body to function well. we

Dr. Asia Muhammad:
Exactly, and there are so many issues — when I was in residency, I was with two GI docs, and we often recommend MiraLAX. They say “It’s fine, it’s not absorbed systemically, it just stays in the gut, so you’re fine, it’s not going to cause any issues, you can take it for the rest of your life.” I heard that. But when you think about leaky gut, you think about intestinal permeability, who is it fine for?

Dr. Nicole Beurkens:
That’s exactly right. And maybe some of you listening have had this experience: We’ve got good anecdotal information. In fact, there was a study that was started, The Children’s Hospital, Pennsylvania, it never finished, to any of our knowledge, but to look at the vast number of complaints related to neuropsychiatric symptoms in children who have been prescribed MiraLAX. Everything from increased irritability, hyperactivity, those kinds of things to even full-blown psychosis symptoms have been reported, and formal complaints have been made. We’re still waiting for someone to do the studies really looking at that. It should raise our level of concern, I think, when we have some of those things going on and when we don’t have good data showing us that these things are safe and effective, long-term. I think that applies to any medication we give kids, MiraLAX included. So commonly then, parents are either told “Don’t worry about it/give some MiraLAX or a stool softener”, or something like that.
So let’s talk about the things that you feel like are important if a child is experiencing ongoing constipation. What are the things that parents should be looking at and addressing to really support getting their microbiome more balanced and really working at it from a root level.

Dr. Asia Muhammad:
I always recommend it, and it’s really easy to squeeze things into a smoothie. So that’s one thing that I will always recommend for parents. I typically stick with the 4 P’s: Peaches, pairs, prunes, plums. In residency, we would learn about foods that are constipating. So when people have diarrhea, we put them on the BRAT diet: Bananas, rice, apple, toast. So I tell patients to make sure that the kids are not eating five apples a day. I had a case where this kid just loved apples. So we reduced the number of apples. We think it’s natural, it’s safe. And apples are safe, but in terms of their frequency, you might actually be slowing the bowels down. So I’m moving away from those fruits in concentration and kind of trying the P ones out. So I’ll have them do smoothies with prune juice or kind of add more flax seeds or psyllium seed powder to it just to help with the bowels, but the goal of moving in the intestinal tract should be using fibers to help with the motility piece, and then fibers also interact with your microbiome to produce something called butyric acid, which is really important in terms of energizing the colon cells, there’s also some really cool literature around butyric acid helping to normalize behavioral changes in these populations where you have these kinds of concerns.

Dr. Nicole Beurkens:
Absolutely. It’s a really fascinating and important byproduct of that, and so many more studies coming out around that that really are helping us understand more about the connection between the gut microbiome and conditions like autism, ADHD, even things like seizure disorders, all of those kinds of things. Really important there. I like focusing on the 4 P’s. So we want to be getting more of those types of foods into our kids’ diets. What about the processed foodstuff, what do you see some of the culprits are there in far as diet changes that can be helpful?

Dr. Asia Muhammad:
For processed foods, a lot of them are devoid of fiber, right? They’re bleached flours and stuff, there’s not really a lot of wholegrain there. So I would say just trying to push more towards the whole grain products. The issue is if you add in too much fiber at once, you can actually constipate somebody. So the recommendation is no more than 5 grams per week, and you titrate up to a goal. So I think the recommendation in America is like 25 grams of fiber a day, and most of us don’t get that. When you look at some African populations where they have no constipation, they have the lowest rates of colon cancer, which is associated with constipation, they eat around 50 grams of fiber a day. You shouldn’t be jumping to 50 grams, just try to do incrementally 5 grams per week, until you get to the goal, or until the stool looks normal.

Dr. Nicole Beurkens:
I’m glad you raised that, because it reminds me of sometimes, what can happen. Sometimes a practitioner recommendation is for parents to put Metamucil or a fiber powder in there, but you’re so right: If you start ramping that up too quickly, you may worsen the constipation, or your kids just feel awful. Maybe some of you as adults have had that experience, right? It’s like if you suddenly start doing a whole lot more fiber, you may really feel uncomfortable: Gassy, bloated, constipated — So I think your point there is an important one that we want to carefully increase the amount, let the system adjust to it.

Dr. Asia Muhammad:
Exactly. The simplest way for me, is like I said, the smoothies. But in terms of snacks, just being mindful of the types of foods, what the additives are, choosing the foods that have the least amount of additives and more fibrous components. There are snacks these days, that they add that kind of fiber into the snack, so you might consider some of those options. But obviously things like potato chips will slow down motility in the gut. Kids love cookies, right? You have the white flowers in there and you have sugars in there that the gut, the bacteria, it’s like a party when you give them sugar. They just grow and reproduce and whatever they want.

Dr. Nicole Beurkens:
Yeah, and that becomes really problematic in terms of continuing that gut dysbiosis when we put all those sugars in there. Then we can end up with yeast overgrowth and all kinds of other things that create issues. So focusing some of those specific fruits and fibers, trying to reduce the processed stuff, moving more towards whole foods. How about in terms of hydration? What do you think there?

Dr. Asia Muhammad:
Hydration, there is one thing I do to help kids, get kids to drink more water, there are these little stir sticks that I love, they have lemon and, I think, stevia in them. I had this girl once that came in to see me, and her mom — she told me I can tell this story. The daughter would have these really large bowel movements and they would clog the toilet up, and they were so painful. Poor thing did not even want to go to the bathroom. Her mom said she hates drinking water, she hates healthy food. So I found these little stir sticks, and I just had put those in a couple of water bottles a day. Her bowels literally changed just from hydration. We didn’t do anything else but just increased water. She was going to the bathroom.

Dr. Nicole Beurkens:
Hydration is so important, making sure that kids are getting water throughout the day and not focusing on hydration through milk or sugary juices and sports drinks and all that, but they need to be getting water. Sometimes, we need to jazz it up a little, right? So adding some natural flavors or stevia sweeteners. Fruits are great! I tell kids “Make your own fruit ice cubes, throw the fruits that you like into little ice cubes.” Kids love doing that, and then throw it in the water. But really pushing that hydration, because I’ve seen the same thing as you. Sometimes it’s just as simple as they can’t have good smooth, regular bowel movements because they’re so dehydrated.

Dr. Asia Muhammad:
Exactly. I see that often. So many people, kids and adults, just changing the hydration picture is a big thing. Then when you think about motility, helping the colon move, some people just have slower-moving colons, right? So there are things you can focus on there in terms of prokinetic agents that help move things throughout the colon. There are medications that are prokinetic agents, but you would never give them to a kid or a person for constipation. When you think about ginger, ginger has pro kinetic activity, so that’s one that I’ll always sneak into a smoothie, and kids can not taste ginger in a smoothie. There are some other botanicals as well that can help to move things.

Dr. Nicole Beurkens:
And it’s interesting because there is a good amount of research literature on motility issues in kids with a wide variety of neurodevelopmental issues. We look at kids with Down Syndrome, look at some kids on the autism spectrum, some kids with epilepsy, more of those neurologically-based things, the motility is driven by the brain in large part. So we can get disconnects there. So sometimes, we need to address it from the gut, and sometimes we need to address it from the brain, but I think that gets me thinking about that brain-body connection and the stress connection. You said that stress is a big issue that can lead to abnormal bowel movements as well, and some kids are sitting on the toilet with their XBox games or whatever. What are your recommendations for parents around things like stress reduction or things like kids sitting there with their Game Boys and that kind of stuff?

Dr. Asia Muhammad:
This sounds really weird, but I love to have kids visualize themselves going to the bathroom and pick a particular time of the day where they visualize. “I get out of bed in the morning and I go sit on the toilet and I have a really longer stool, it comes out, there’s no straining, I just go for it.” So I will have them do visualization exercises, I also have them do some Bio Breathing technique. I have emWave, a biofeedback program that I will use just to show them how their breathing actually modulates their physiology or changes their body. So I’ll have them do some deep breathing exercises, those are two of the things that I find useful for kids. So visualization and then working on their breathing techniques.

Dr. Nicole Beurkens:
The stress reduction or just getting the brain around that. I find and recommend to families that being in the bathroom, sitting down to have a bowel movement, our focus needs to be on that. I think that we can create lots of cycles that are problematic when kids get into these patterns of sitting there when their brain is focused on this video game and having a bowel movement, especially if kids have struggled with constipation or other kinds of gut issues, if they’re distracted with other things, it’s not helpful. They need to be sitting there, focused on what they’re doing and getting into this habit of “When I go into the bathroom, it’s to have a bowel movement” or even for that matter, urinating completely. It’s like I need to have my focus on what my body is doing. My brain and my body need to be connected right now and not have my brain distracted over here with scrolling on my cell phone or playing my video games or watching a movie. We need to have it be, I think, a brain-body attentive experience.

Dr. Asia Muhammad:
It does, and I think for parents one thing to be mindful of is when the kid has that urgency to go, go to the bathroom. Don’t hold it in. When you’ve got to go, go. So the body knows, when I have the urge, the stool is able to exit. Or don’t sit on the toilet looking at your phone because now your body has been normalized to think “When I go to the bathroom, it’s time to look at YouTube, not time to have a bowel movement”, like you said.

Dr. Nicole Beurkens:
And that reminds me of another thing that I have seen, why kids can sometimes get caught in these cycles of being more constipated, this can happen sometimes in kids who are really hyperactive or distractible. They get so busy, and they’re not attuned to their inner body signals. And then, by the time it’s finally so — the body is sending them such huge signals, now they’re constipated and it’s painful. So really needing to work with those kids from a young age of periodically, throughout the day, stopping what they’re doing to go in, to use the bathroom, to tune in to what their body is telling them because I think some of those kids, especially if they tend towards more of that real impulsive hyperactivity, they’re not attuned to the body signals, or they don’t want to take the time to stop what they’re doing, to go in and sit on the toilet, but then that can get in some really problematic cycles.

Dr. Asia Muhammad:
You’re right.

Dr. Nicole Beurkens:
I’m curious — to talk about the fiber piece, the hydration piece, stress piece — I have found that magnesium can be a really nice tool, a very supportive tool for kids in many areas, particularly around constipation, I’m wondering what you find with that, what your recommendations are with magnesium.

Dr. Asia Muhammad:
I love magnesium. I will recommend supplements when I feel patients have gotten the basic foundations down because once I say “Here, let’s try magnesium”, if it works, it’s like “Oh great, I don’t have to worry about the fiber, the hydration or anything else.” It’s like no! So I love magnesium and I always start out with lower doses and kind of titrate them up to bowel tolerance, but I love recommending magnesium. It’s one of the safer things in terms of supplements and cheap, cost effective ways to help improve bowel function. So many of us are magnesium deficient and we don’t know it.

Dr. Nicole Beurkens:
I love magnesium, there are forms of magnesium, but magnesium citrate in particular is so good. I love it for so many kids with constipation because it not only helps with them moving their bowels more consistently, but you also get some of those calming and just regulating and even sleep-supportive effects, so it’s like one of those nutritional tools that hits a lot of marks for a lot of these kids. I like one of the products that I often recommend for kids and teens, it’s Natural Calm.

Dr. Asia Muhammad:
I love Natural Calm!

Dr. Nicole Beurkens:
It’s so great because it’s the right form of magnesium, you can get it in different flavors, they don’t have nasty artificial sweeteners or dyes, but they do have a variety of flavors so kids can choose what they like. They also have it unflavored. I just find that can really be a nice tool even while we’re working on improving the diet because sometimes getting processed foods out or getting more fiber in can be a process, I find that something like magnesium can help in the meantime too just to get things moving a bit.

Dr. Asia Muhammad:
Totally. I think it’s a really great way to bridge patients off of what they’re doing onto something else while they’re working on everything else. I totally agree with that.

Dr. Nicole Beurkens:
The Natural Calm is nice because it’s just a powder. I think they have it in gummies and things too, although I’m not a fan of gummies and things for lots of reasons, but the Natural Calm is a nice powder and it really does mix up nicely in things and so it’s an easy way to get started with that for kids and adults. Man, the world of difference that kids feel. If they’ve been constipated for a long time, you don’t know what it feels like to not…

Dr. Asia Muhammad:
Exactly.

Dr. Nicole Beurkens:
So I’ll have kids come in and they’ll be like “I didn’t know that I was supposed to feel this way!” They’re like “My belly doesn’t hurt” and they wouldn’t have said that their belly hurt before because they didn’t know any different, but now when you start getting them cleared out and having those regular bowel movements, suddenly they realize, like “Oh! This is how my belly is supposed to feel!”

Dr. Asia Muhammad:
Oh yeah. Bloating is a huge issue, I find in kids. You think about the number one reason for gas and bloating, so that’s something they’re not even aware of. Like you said, they come and they’re like, ”Oh I feel different. I feel lighter!” You hear people say that.

Dr. Nicole Beurkens:
Absolutely. And kids notice it too. The last thing I wanted to ask about before we wrap up is probiotic supplementation and your thoughts around that because there are different schools of thought on that, but I’m curious as we’re thinking about kids and teens with constipation issues in particular, do you find that probiotics can be helpful? Do you tend to not recommend them? What do you find most effective?

Dr. Asia Muhammad:
For me, it depends on their history. So if it’s a kid that has a history of chronic antibiotic use, I’m going to recommend a probiotic, regardless. If it’s somebody who comes in and they are going to the bathroom everyday, but they’re just not getting enough of the stool out, then I might think it’s a fiber bulking issue or a hydration component. But I love recommending probiotics. One of the things that I will recommend for people with constipation, starting out in terms of adding in supplements for them, I love recommending different brands of probiotics, so ones that have a different variety. There are some really interesting probiotics like lactobacillus reuteri that have been shown to reduce the amount of methane gas in the intestinal tract, so that’s that slower transit time. So it helps with actually moving the stool out of the colon. So I’m a huge fan of probiotics. I’ve never had an issue with patients taking probiotics.

Dr. Nicole Beurkens:
Yup, and I think that’s an important point about different types because sometimes parents will say, “Well, we’ve done the probiotic.” But it’s important to understand there are a lot of differences among probiotics. Even within the same company, there are different formulas, they have different strains of them, different amounts, and so sometimes you do need to try some different things in order to figure out what’s going to work best with your child’s system. I think that that’s just an important point that it’s not like, “Oh, we tried one probiotic, that’s it.” There’s a large variety and different ways of approaching it.

Dr. Asia Muhammad:
It’s like there are so many bacteria.

Dr. Nicole Beurkens:
Even some of the interesting things now we are finding with things like spore biotics, different ways of addressing that. Lots of research coming out about new innovative formulas and even studies that we have seen in kids with different diagnoses and types of issues, what strains of bacteria may be more beneficial for them, so I think that’s just such a valid thing that you bring up about it possibly being important to try a number of different types. Some kids do really well rotating them too, instead of just being on one long term, rotating them on different ones, right?

Dr. Asia Muhammad:
Oh yeah. Something I will also have patients do if their kids can not swallow capsules or such, I’ll have them open them up and put them in a little applesauce or put them in the smoothie because sometimes when you look at the literature around probiotics with certain fruits or certain prebiotics, it actually helps grow more bacteria, so you’re getting more bang for your buck.

Dr. Nicole Beurkens:
That’s a great point because we tend to think about the probiotic itself is what’s needed, but if you’re putting the good bacteria in there and they don’t have the food they need to feed on and take hold in those prebiotic fibers, you’re not really getting everything you could, so that’s a great point about the importance of prebiotic foods, the different fibers and things that work together.
Awesome. Such great information and practical tips for people. I want to make sure that our listeners know where they can find out more about you, your work, the resources you have available.

Dr. Asia Muhammad:
Totally. So my website is just my name, it’s www.asiamuhammad.com and my Instagram is @dr.asiamuhammad. So I post a lot of content on instagram, and my website is just about who I am and what I do, but Instagram is probably where you want to go to learn more information.

Dr. Nicole Beurkens:
I love your Instagram, you provide such great content, really like blog posts on there, but just in a more visually engaging form. I highly encourage all of you listening, if you are interested in learning more about all things gut health and digestion and brain-gut connection and all of that, related to those things, definitely go to Asia’s Instagram account because she has lots of really, really great stuff there. I know that takes a lot of time to put together and I really admire you for doing it.

Dr. Asia Muhammad:
Thank you so much!

Dr. Nicole Beurkens:
And thank you for spending the time with us today and talking about this. Really, really helpful tips for people, so thank you.

Dr. Asia Muhammad:
Thank you, it’s been fun talking crap with you!

Dr. Nicole Beurkens:
I love it! And thank you as always, to all of you for tuning in and listening, we will catch you back here next week for our next episode of The Better Behavior Show.