Dr.SurgeonPGH said:The mechanism is slowed transit plus reduced intake, and that combination determines which interventions work.
Worth saying plainly that not all of this is benign. Severe constipation on delayed gastric emptying has produced obstruction and ileus cases, rarely but genuinely. Pain with vomiting and no bowel movement is not a fiber conversation.
amsterdam_pete said:I added fiber, made it noticeably worse, and only later worked out that I had added the bulk without adding the water.
Drug interaction alert relevant to constipation: if you take oral levothyroxine (Synthroid), GLP-1 agonists can reduce absorption due to delayed gastric emptying. My TSH drifted up after starting semaglutide.
Solution: take levothyroxine on an empty stomach, 60 minutes before any food, and have your TSH rechecked 6-8 weeks after starting or changing GLP-1 dose. My endo had to increase my Synthroid by 12.5mcg.
RetaRick_CA said:Worth saying plainly that not all of this is benign.
Gastroparesis symptoms with constipation: the delayed gastric emptying from GLP-1 agonists can cause early satiety, bloating, and feeling "full" for hours after a small meal.
Tips: eat your protein FIRST (most important macro), then vegetables, then carbs last. Chew thoroughly — 20-30 chews per bite isn't excessive. Avoid carbonated beverages with meals. If symptoms are severe, your doctor may recommend a gastric emptying study.
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Browse GL BiochemFollowing on from mike_mod — and this may be the naive question:
What the mechanism is, because if it is transit rather than water then fiber is the wrong lever?
Closing the loop on my own question.
Water and magnesium first, soluble fiber second, and dropping the bran entirely. Resolved in about a week after two months of getting it backwards.