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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

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Can You Use LDN for Constipation Relief?

Written by Dr. Michael Ruscio, DC on December 13, 2024

Written by Dr. Michael Ruscio, DC on December 13, 2024 — Reviewed by Kellie Blake

• LDN Uses|
• LDN and Constipation|
• Constipation Treatments|
• Using LDN|
• Other Treatments First|

Using low-dose naltrexone (LDN) for chronic pain, depression, and inflammatory conditions is very popular right now.

But what about constipation—can LDN help with this, too? The quick answer is no, as LDN isn’t a laxative, nor does it have any properties that help people poop. 

That said, if your constipation is a symptom of an underlying gastrointestinal issue, especially an inflammatory disorder, LDN might be a helpful therapy.

Let’s dig into this nuance to see if LDN might be worth a try for constipation. If not, I’ll give you better ways to increase bowel movements.

What is LDN Used For?

Low-dose naltrexone therapy has been around since the 1980s, when an AIDS doctor began using 1.5 to 3 milligrams of naltrexone as an off-label drug to improve AIDS treatment.

Since then, LDN has become a popular go-to for many in alternative medicine, but the drug lacks the rigorous study of large-scale clinical trials, so a lot of its use is not evidence-based 1.

That said, LDN falls under the category of safe and affordable ($20–30/month 3) for many who may want to try it for pain or inflammatory conditions. For example, the LDN Research Trust says popular uses of LDN include treating cancers, autoimmune diseases, chronic pain, and mental health issues 4.

LDN and Pain

While there aren’t large or high-quality LDN studies for any disease or health condition, pain relief is the potential LDN benefit with the most scientific backing. Studies have found:

• LDN use is linked with reductions in chronic pain and uncontrollable muscle contractions in people with complex regional pain syndrome 5.
  • This type of chronic pain usually develops after an injury, surgery, stroke, or heart attack, and is excessively painful.
• LDN may safely improve some symptoms for people with fibromyalgia (widespread muscle pain) 6.
• LDN and amitriptyline (an antidepressant that can reduce nerve pain) may be equally good at helping patients with painful diabetic neuropathy, but LDN is far more tolerable than amitriptyline 7.

The standard of evidence is still quite weak in all these cases, and higher-quality research is necessary to confirm the findings.

Skin Conditions

Evidence also suggests that LDN may be helpful for some rare skin conditions, including severe itching, lichen planopilaris (which causes scarring of the scalp), and the rare genetic condition, Hailey-Hailey disease 8. 

Depression

One tiny but encouraging study found that LDN may help enhance the benefits of antidepressants in people with major depression 9. 

Inflammatory Bowel Disease (IBD)

LDN and Constipation

If LDN can benefit general constipation, there’s no solid evidence for it. 

Methylnaltrexone reduces constipation specifically related to opiate (opioid) use 12 13 14 15. Unlike LDN, methylnaltrexone can’t cross the blood-brain barrier, so it only acts on opioid receptors in places like the gut, and it has very different effects 16. Plus, methylnaltrexone is given at high doses (like 150 mg) compared to LDN (less than 5 mg), and it’s most effective when delivered under the skin. 

All this means is that LDN and methylnaltrexone should be considered very different medications. Unfortunately, the ample research showing that methylnaltrexone is a good treatment for opioid-induced constipation doesn’t extend to low-dose naltrexone.

LDN and Gut Conditions

To say that LDN doesn’t help constipation isn’t the whole picture. We can’t discount that some people swear by LDN for easing gut conditions that may include constipation as a symptom. 

Gut conditions that people use LDN for include:

• Irritable bowel syndrome (IBS)
• Small intestinal bacterial overgrowth (SIBO)
• Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis (remember, we have some data suggesting that LDN may help with Crohn’s).

Patient Experiences

It’s not in-depth or strong research, but one survey asking patients about the good and bad effects of the LDN they took for gastrointestinal conditions had some interesting findings on constipation 17.

The patients in the survey were from a single gastroenterologist’s practice and had been prescribed LDN for IBS (with or without SIBO), chronic constipation of unknown origin, or IBD.

Only 12 patients with chronic constipation completed the survey, but of these respondents:

• 7 (~58%) reported a considerable improvement 
• 1 (~8%) reported a moderate improvement
• 3 (25%) reported a mild improvement
• 1 (~8%) reported no change

For the other conditions, the results were mixed:

Of 12 patients with IBS but not SIBO, seven (58%) reported moderate or considerable improvements, two (17%) had no changes, and three (25%) reported feeling a lot worse. 

As for the 85 people with IBS and SIBO, about 47 (55%) reported moderate or considerable improvements, 11 (13%) said they had mild improvements, 23 (27%) had no changes, and four (5%) reported feeling moderately or considerably worse.

Finally, of the eight IBD patients, three (37%) reported moderate or considerable improvements, one (13%) said they had mild improvements, and four (50%) were unchanged. 

It’s worth noting that 74 (63%) of the 117 GI patients who took the survey had side effects while taking LDN—their complaints were mostly related to the nervous system and gut. However, plenty of other research has demonstrated a much lower rate of side effects. 

The side effect rate in this study may have been high because of its observational design. In other words, people need motivation to send back a mailed survey, so those with unusually good or bad experiences are more likely to respond. In contrast, people who had an average experience of LDN might not have been motivated to fill out and return the survey.

Circling back, the bottom line is that LDN therapy is not a proven treatment for constipation, but some people report that it works for them.

That said, it doesn’t make sense to try LDN without first trying diet and lifestyle steps that are proven to relieve constipation.

Proven Constipation Treatments

Before you reach for LDN, take a look at the following natural, science-based approaches I’ve found to relieve and prevent constipation.

Quick Relief

• Psyllium is a gluey, bulk-forming fiber that helps to regulate the bowels without producing excessive gas, making it particularly useful for people with IBS 18.
• Magnesium—specifically magnesium citrate or hydroxide (Milk of Magnesia)—is an effective osmotic laxative, which means it draws water into the bowel and softens the poop, making it easier to pass 19. 
• Senna is a tropical herb shown in a randomized clinical trial to reduce constipation in 69% of patients 19. Aloe can be an effective alternative to senna.

See the following table for science-based dosing information.

Prevention

Diet Changes

Getting relief from constipation involves making changes both to foods in the diet as well as when and how they’re eaten.

• For healthier, more frequent bowel movements, a healthy, balanced diet is key. I advise my constipated clients to eat 20:
  • Mainly whole foods 
  • Plenty of dietary fiber (fruits, vegetables, and whole grains, taking into account any fiber sources you may not tolerate well)
  • Watery foods (like soups and vegetables)
  • Fewer sweets, dressings, and spicy, greasy, or processed foods
  • Fewer of any foods they associate with constipation (for example, some people may notice cheese or eggs can be problematic)
• We also work on improving their eating habits to ease their constipation, I recommend that my clients 20:
  • Eat only when hungry, start with smaller portions, eat slowly, and stop when they feel full.
  • Don’t lie down after eating or eat close to bedtime.
  • Don’t use a straw for beverages (introduces air into the digestive tract, which can contribute to constipation).
  • Eat without distractions.
  • Don’t do intense exercise right after eating.
  • Keep a food diary to try to identify what foods make constipation worse. 

Probiotics

Probiotics can play a crucial role in preventing constipation long term. Extensive research indicates that probiotics can improve stool frequency, consistency, and motility (the movement of food through the digestive system) 21 22 23. Additionally, probiotics can help alleviate bloating that comes with constipation 23 24.

Research suggests that when it comes to relieving constipation and other gut conditions, multistrain probiotics may be more effective than single-strain probiotics. For example, one meta-analysis found that multistrain probiotics were especially good at softening stools and increasing the number of times people moved their bowels. They were also good for reducing bloating 23.

This reflects our experience at the clinic, where we routinely find that a three-pronged approach to probiotic therapy has the best results. The three probiotics we use are:

• A Lactobacillus/Bifidobacterium blend
• Saccharomyces boulardii (a beneficial yeast)
• Soil-based probiotics

Exercise and Hydration

It makes sense that getting regular moderate exercise can help prevent constipation. Moving around on two feet helps the normal contractions of the digestive tract and helps gravity pull gut contents downward. Consistently doing aerobic exercises, like jogging or a pump class (fast-paced, repetitive strength training), seems to work best to diminish constipation 25.

When exercising, it’s important to stay hydrated, especially in hot weather. Drinking plenty of fluids helps prevent constipation because it ensures the fiber in the digestive tract is soft and easy to pass 20.

Make Time for Yourself

These supports for the gut-brain connection may also help prevent constipation:

• Spending time outdoors 26 27 28 
• Practicing mindfulness 29 and yoga 30
• Gut-focused cognitive behavioral therapy 31

If constipation continues despite trying all the above self-help measures, it’s time to see your health care professional or a gastroenterology specialist 20.

Still Want to Try LDN?

When starting LDN, the usual protocol is to gradually increase the dose from 1 mg (or less, if you’re very sensitive) to up to 4.5 mg over 10–14 days.

In general, all doses of naltrexone appear to be safe and unlikely to cause serious negative side effects for up to 1 year 6 10 32. Longer-term data are lacking, though. 

The most common adverse effects appear to be mild abdominal pain, diarrhea, constipation, nausea, and vivid dreams 6. 

LDN and Constipation: Other Treatments First

There’s no evidence that LDN is useful for general constipation. Most people can successfully prevent constipation by eating a healthy high-fiber diet, taking probiotics, exercising, relieving stress, and drinking plenty of fluids. And for quick relief, excellent choices are psyllium, magnesium, and senna.

Nevertheless, if constipation is a consequence of inflammatory bowel disease, a prescribing clinician can help decide whether LDN could relieve it. But if constipation is related to opioid usage, a different naltrexone derivative called methylnaltrexone—not LDN—may be helpful (with a doctor’s assistance).

Chronic constipation is often just part of a bigger gut health picture. If you need help with anything on your journey toward better digestive health, we are here to help. I invite you to read my book, Healthy Gut, Healthy You, or reach out to our clinic for a consultation.

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