Constipation-IBS

2 Capsules

three times per day

Take with food

Ongoing

Additional notes

"Why it is here: For bloating, distension, and gas pressure alongside constipation, especially when methane-associated patterns are suspected. Begin one product from this protocol at a time, not several. How to take: Begin at 2 capsules three times a day, each dose at the beginning of a meal. Once relief is achieved, step down to 2 twice a day, then 2 a day for maintenance. Published evidence: A small double-blind, placebo-controlled trial of the Atrantil blend in constipation-predominant IBS reported reduced bloating and constipation. Supporting open-label work is from the same group. Clinical experience (observation): I use the original Atrantil for constipation-predominant IBS, and across many patients over many years, the results have been exceptional. For many, symptoms reduce within days, as bowel regularity improves. Caution: Contains tree nut (horse chestnut extract). Not to be taken by pregnant or nursing mothers. This is the original Atrantil, not Atrantil PRO. Not a laxative. Review: Track bowel frequency, Bristol type, straining, bloating, pain, and any side effects. Add the next product only after this one's effect is clear."

1 Capsule

evening

Take with food

Ongoing

Additional notes

"Why it is here: For hard, dry stool (Bristol type 1 or 2) and delayed transit patterns, where magnesium is medically appropriate. Begin one product from this protocol at a time, not several. How to take: In the evening, with a meal. Begin with 1 daily for 3 days, then increase to 2 daily for 3 days. Do not exceed a dose of 350 mg daily without your clinician's approval. Published evidence: Magnesium citrate draws water into the colon by osmosis. The literature contains no placebo-controlled trial of it at supplement dose for IBS-C. Clinical experience (observation): I use magnesium citrate when hard, dry stool is the dominant problem. Caution: Each capsule supplies 150 mg of elemental magnesium; two is 300 mg. The label allows up to 4 capsules a day; this protocol does not. Use clinician oversight in kidney disease: magnesium can accumulate. Separate by 2 to 4 hours from levothyroxine, tetracycline and quinolone antibiotics, oral bisphosphonates, and iron supplements. Loose stools are the expected sign of too much. Review: Track bowel frequency, Bristol type, straining, bloating, pain, and any side effects. Add the next product only after this one's effect is clear."

2 Capsules

twice per day

Take with water

Ongoing

Additional notes

"Why it is here: Gentle herbal support for regularity. Begin one product from this protocol at a time, not several. How to take: 2 capsules twice a day with water, morning and evening, before or after meals. Published evidence: The thinnest evidence in the guide. Human studies in functional constipation are small and largely open-label, and there is no well-powered placebo-controlled trial of a standardized capsule in IBS-C. Clinical experience (observation): Triphala comes after magnesium and fiber have been tried and do not resolve symptoms or provide consistent bowel regularity. I use it rarely. It is the weakest product in this group, and I include it as an option for people who do not tolerate or do not respond to the others. Caution: May cause loose stools, cramping, or discomfort, especially in mixed diarrhea and constipation patterns. Do not use it if pregnant or nursing without consulting a physician. The product's labeling carries a California Proposition 65 warning that it can expose you to lead. Review: Track bowel frequency, Bristol type, straining, bloating, pain, and any side effects. Add the next product only after this one's effect is clear."

1.00 Tablespoon (tbsp)

evening

Take with water

Additional notes

"Why it is here: A soluble fiber option; the IBS-C guide names psyllium as a primary fiber strategy. Choose one fiber, psyllium or Sunfiber®, not both. Begin one product from this protocol at a time, not several. How to take: Vigorously mix 1 level tablespoon into at least 12 ounces of water or juice and drink it immediately. Drink plenty of additional fluids through the day. Start low, go slow, and hydrate well. The guide gives no amount for psyllium; the label directs 1 to 2 level tablespoons daily, and this protocol uses 1. Clinical experience (observation): Effective, natural, soluble fiber option, safe for daily use. Caution: Take it with at least a full glass of liquid; without enough liquid it may cause choking. Do not take it if you have difficulty swallowing. For adults only. The label says to consult a physician if pregnant or nursing, taking medication, or managing a medical condition. Review: Track bowel frequency, Bristol type, straining, bloating, pain, and any side effects. Add the next product only after this one's effect is clear."

1 Scoop

once per day

Take with water

Ongoing

Additional notes

"Why it is here: Daily maintenance fiber, for inconsistent stool form and gentle long-term support when other fibers are not well tolerated. Choose one fiber, psyllium or Sunfiber®, not both. Begin one product from this protocol at a time, not several. How to take: Mix about one scoop (7 g, supplying 6 g of soluble fiber) into 6 to 8 ounces of water or any non-carbonated beverage. Published evidence: A randomized, double-blind, placebo-controlled trial in 121 IBS patients used 6 g a day. A review counted 14 clinical studies in 631 participants showing improvement in constipation. Several of these trials were run by the manufacturer. Clinical experience (observation): This is my fiber of choice for people who failed psyllium or developed excessive gas from psyllium. I advise a 30-day trial. Caution: Fiber is not usually a same-day rescue tool. Start low, increase gradually, and pair with adequate hydration. The label says to consult your healthcare practitioner if pregnant, nursing, or taking prescription drugs. Review: Track bowel frequency, Bristol type, straining, bloating, pain, and any side effects. Add the next product only after this one's effect is clear."

1.00 Softgel

once per day

Take with water

Additional notes

"Why it is here: For cramping, abdominal pain, and spasm in IBS-C. This is a comfort tool, not a constipation mover. Begin one product from this protocol at a time, not several. How to take: 30 minutes before a meal. The label directs 1 to 2 softgels, 1 to 3 times daily; this protocol uses 1 once a day. Published evidence: A meta-analysis of 10 randomized trials found peppermint oil superior to placebo for global IBS symptoms and abdominal pain; the largest trial did not meet its primary endpoint. The trials studied peppermint oil alone; this product also contains ginger and fennel oil. Clinical experience (observation): The first thing I reach for when pain and cramping predominate the picture. Best avoided in patients with reflux or heartburn, or a mint allergy. I do not use it as a daily maintenance product. Caution: The label advises against use in pregnancy or lactation, with gallbladder problems, or with prescription medication, except as advised by your clinician. Contains bovine gelatin and soybean oil. Review: Track bowel frequency, Bristol type, straining, bloating, pain, and any side effects. Add the next product only after this one's effect is clear."