Speaking of the best foods for chronic constipation… have you already included kiwis on your shopping list?
New guidelines from the British Dietetic Association, published this Monday, state that this fruit, along with rye bread and certain supplements, can help improve symptoms of constipation.
According to their authors, they are the first evidence-based recommendations for treatment with diet instead of drugs.
Chronic constipation affects about 16% of adults worldwide and causes 2.5 million doctor visits a year in the U.S., according to the American College of Gastroenterology.
Eirini Dimidi, lead author of the guidelines, notes that existing recommendations largely focus on drugs. The few dietary recommendations available—eat more fiber, drink more water—are ambiguous and often lack supporting research.
“I remember looking at the guidelines and realizing that they were very limited in the number of dietary recommendations they offered,” says Dimidi, a dietitian and professor in the Department of Nutritional Sciences at King’s College London.
To prepare the recommendations, published in magazines Journal of Human Nutrition & Dietetics and Neurogastroenterology & Motility, The authors analyzed clinical trials and evaluated the effectiveness of each method in treating constipation.
Constipation, defined as fewer than three bowel movements a week, is considered chronic if it lasts more than three months. Symptoms can vary, but the most common are hard or lumpy stools, stomach pain, and nausea. Other more serious ones are blood in the stool, fever and vomiting.
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Constipation can be caused by diet, lifestyle, certain illnesses and injuries, and some medications.
It is extremely common and affects people of all ages, sexes and races. “I see chronic constipation across the spectrum,” says Sue-Ellen Anderson-Haynes, a dietician and spokesperson for the Academy of Nutrition and Dietetics. “In young children, in school-age children and adults. So it’s common,” he says.
Chronic constipation can seriously affect people’s lives and limit their physical capabilities, worsening their quality of life and productivity at work.
“If you have chronic constipation, you may not even be able to do physical activity because you feel bloated, sore, and sore, which can affect your mood,” explains Anderson-Haynes, who is also the owner of 360 Girls and Women, a Boston-based health and nutrition practice.
How is chronic constipation treated?
William Chey, professor of gastroenterology at the University of Michigan and incoming president of the American College of Gastroenterology, said most studies have focused on fiber supplements, such as psyllium, and medications such as bisacodyl, senna and amitiza.
He added that the US guidelines “focus heavily on medical therapies for chronic constipation.”
Traditional treatments include increasing fiber intake through foods such as prunes and other fruits and vegetables, drinking more water, and using different types of laxatives.
Although the new guidelines include certain high-fiber foods and fiber supplements, there is no guidance on a “high-fiber diet” in general.
“When we developed these guidelines and reviewed the literature, we expected to find a lot more evidence for a high-fiber diet, but there simply isn’t enough when it comes to constipation,” Dimidi said.
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“There is a lot of evidence that a diet rich in fiber is very beneficial for our overall health and also for intestinal health, since it reduces the risk of colorectal cancer,” he added.
“But when it comes to constipation, we don’t have enough evidence to say that it relieves it,” he adds.
What are the new recommendations?
Chey, who was not involved in developing the new guidelines, said they “provide a valuable roadmap of measures (people) can try while waiting to see their primary care doctor.”
He added that people with more severe cases of constipation may need to see a gastroenterologist.
Among the recommendations are:
- Fiber supplements: More than 10 grams of fiber supplements, such as psyllium, per day can improve the frequency and consistency of stool movements and help reduce straining. Fiber supplements should be used slowly and the dosage increased gradually.
- Probiotics: certain strains of probiotics, such as B. lactis and Bacillus coagulans Unique IS2, may help some people with symptoms. Patients should take the supplement of their choice and follow the manufacturer’s instructions for at least four weeks.
- Magnesium oxide supplements– Between 0.5 and 1.5 grams per day can help improve the frequency and consistency of stool passage, reduce symptoms such as bloating and abdominal pain, and improve overall quality of life. The dosage should start with 0.5 grams per day and be gradually increased each week.
- Kiwis: three a day, with or without skin, can help improve the frequency of bowel movements, but not their consistency.
- Rye bread: Six to eight slices of rye bread a day may also help the frequency of bowel movements, but not their consistency. The authors noted that this amount may not be realistic for some people.
- Water with high mineral content: In combination with other treatments, 0.5-1.5 liters per day of water with high mineral content can also help. One of the minerals, magnesium, is a known laxative.
Still, overall, he said, “I think these kinds of recommendations are going to be very helpful.”
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Dimidi said he hopes the publication of the guidelines can “empower” people with chronic constipation.
“We hope that they will allow doctors to be very well informed and able to offer their patients personalized advice that is very effective,” he says, “but also that people with constipation themselves can now access evidence-based information, feel empowered to manage symptoms and alleviate a condition that has a tremendous impact on quality of life.”
