Constipation is one of the most common digestive issues, affecting over 15% of adults worldwide and one out of three people over age 60. But those who struggle with regularity on a daily basis know that it impacts far more than just digestion. It’s also a quality-of-life issue that affects everything from mood to sleep to our social lives. And progress can be elusive.
 
In recent years, Americans have become so reliant on over-the-counter laxatives that it has led to a shortage on drugstore shelves. But this common approach brings a risk of long-term side effects and does nothing to address one of the most significant and under-recognized contributors to constipation: stress.
 
An alternative approach showing promise in research utilizes herbal ingredients to address stress, while simultaneously soothing the digestive tract. And the benefits could extend far beyond the bathroom. 

Improved Regularity, Sleep, and Mood

In a recent randomized, double-blind, placebo-controlled study, 48 adult men and women suffering from constipation received either 300 mg or 500 mg of the botanical ingredient Digexin for 14 days, or a placebo. Created by NXT USA, Digexin is a proprietary blend of extracts from the root of the adaptogen ashwagandha (Withania somnifera) and the mucilaginous fruit of the vegetable okra (Abelmoschus esculentus).
 
Even in such a short timeframe, the subjects experienced some substantial benefits. “Participants receiving both doses of the supplement experienced a significant reduction in reported constipation symptoms,” said Douglas Kalman, PhD, RD, who reviewed but was not involved with the study. “But beyond that, they also reported improvements in overall quality of life, specifically improvements in GI discomfort (as per the gold standard) Gastrointestinal Symptom Rating Scale (GSRS), and also achieved improvements in sleep quality resulting in reduced stress.”
 
A subsequent study that Kalman is involved with—currently in the manuscript write-up phase of publishing—expanded the population to 135 men and women, and the duration of supplementation to 60 days. The participants consuming both doses experienced a similar and significant reduction in constipation and related symptoms. But once again, they also experienced improved quality of life, anxiety, depression, and sleep quality.
 
Both of these studies point to the complex and personal nature of constipation, according to Kalman.
 
“Constipation isn’t just physiological,” he said. “It significantly affects our quality of life in many dimensions of health, and in turn, it is affected by what’s going on in our lives. Managing this problem clearly requires a multidimensional approach.”

A New Perspective on the Gut-Brain Axis

The unique benefits experienced by the subjects receiving Digexin raise a complex question: Did improved regularity lead to the participants’boosts in mood or were they able to go to the bathroom more effectively because they were feeling less stressed out?
 
The answer is likely both, according to Eric Withee, director of ingredient innovation at Freemen Nutra Group, which distributes Digexin. 
 
“What is known popularly as ‘gut-brain axis’is actually a two-way street,” Withee said. “There are thousands of ingredients out there that say, ‘We can affect the microbiome and have downstream effects on stress.’But we’re the first to target both sides of the gut-brain axis and say, ‘We’re also going to help with stress, and that will help your digestion.”
 
Ashwagandha has been shown in a number of studies to raise levels of the neurotransmitter serotonin, which in turn can help alleviate symptoms of anxiety and depression, in addition to lowering perceived stress levels. But serotonin is also fundamentally linked to gut health. More than 95% of the body’s supply of serotonin resides in the digestive tract, and increasing serotonin levels is known to boost peristalsis, or the body’s ability to move food through the gut.
 
Digexin’s other ingredient, okra, has a more gut-specific effect. As a food, it has traditionally been used to improve digestion and to soothe irritated stomachs. It was chosen because, as Withee explained, “In the early stages of product development they discovered that okra and ashwagandha synergistically stimulated peristalsis. This came as a great surprise as there was no microbiome in the testing model used, indicating the synergistic effects act directly on the nervous system.”

The Link Between Stress and Constipation

The unique results of the Digexin study also point to the chicken-and-egg relationship of mental and digestive distress.
 
An October 2020 article in The Lancet analyzed epidemiological studies and concluded that 50% of cases of functional gastrointestinal disorders (FGID) were preceded by psychological distress. But in the other 50% of cases, the GI distress came first, and psychological distress followed. FGIDs are a group of conditions that include not only constipation, but also chronic diarrhea, bloating, irritable bowel syndrome, and others.
 
“If you’re constantly stressed out, we know that’s horrible for digestion,” Withee said. “You stop salivating and secreting digestive enzymes and juices. Peristalsis slows down. And it’s the same whether you’re being chased by a predator, or you have a deadline for work. Your body doesn’t know the difference.”
 
Further complicating the situation, common problems like sleep deficiency are associated with both a worsening of constipation symptoms and a higher susceptibility to life stress. Such a complex web of factors demands a new way of thinking about, and supplementing for, digestive health.  
 
“Digexin’s unique formula represents a ‘whole person’ approach to health by supporting multiple dimensions of health and wellbeing via the gut-brain axis,” Kalman said.
 

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About the Author: Nick Collias is a writer and editor with over a decade of experience working in the health and fitness industry. From 2016 to 2021, he was the host of over 100 episodes of the Bodybuilding.com Podcast, interviewing elite athletes and health thought-leaders on a wide range of exercise, nutrition, and lifestyle topics. Additionally, he has worked for the last 20 years as a longform print and online journalist, as well as a book author, ghostwriter, and editor.