When it comes to the best foods for easing chronic constipation, are kiwis on your grocery list?
New dietary guidelines from the British Dietetic Association, published Monday, say that kiwis — along with rye bread and certain supplements — can help improve constipation symptoms.
The guidelines, the authors say, are the first evidence-based recommendations for treating constipation with diet, not medications.
Chronic constipation affects around 16% of adults worldwide, and constipation is the reason for almost 2.5 million doctors visits in the U.S. per year, according to the American College of Gastroenterology.
Eirini Dimidi, a lead author of the guidelines, said the existing guidance for managing chronic constipation is largely focused on pharmaceuticals.
The few dietary recommendations out there — eat more fiber, drink more water — are ambiguous and often lack research to back them up.
“I remember looking at the guidelines and realizing that they are just really limited in the number of dietary recommendations they make,” said Dimidi, a registered dietician and associate professor in the department of nutritional sciences at King’s College in London.
To come up with the new guidelines, the authors analyzed clinical trials and evaluated each method’s effectiveness for managing constipation. The recommendations were jointly published in the Journal of Human Nutrition & Dietetics and Neurogastroenterology & Motility.
What is chronic constipation?
Constipation — defined by fewer than three bowel movements a week — is considered chronic if it lasts for more than three months.
Symptoms can vary from person to person, but common ones are hard or lumpy stool, stomachache and nausea. More serious symptoms of constipation include blood in stool, fever and vomiting.
Constipation can be caused by diet, lifestyle, certain illnesses and injuries, and some medications. It’s extremely common, affecting people of all ages, gender and race.
“I see chronic constipation across the spectrum,” said Sue-Ellen Anderson-Haynes, a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. “I see it in toddlers, I see it in school-age children, I see it in adults. So it’s a common thing,” she said.
Chronic constipation can severely impact people’s lives and limit their physical abilities, worsening their quality of life and work productivity.
“If you’re chronically constipated, you may not be able to even participate in physical activity, because you feel bloated, you’re in pain, you’re achy, it may affect your mood,” said Anderson-Haynes, who also owns 360 Girls and Women, a nutrition and health practice based in Boston.
How is chronic constipation treated?
Dr. William Chey, professor of gastroenterology at the University of Michigan and incoming president of the American College of Gastroenterology, said most studies on treating chronic constipation have focused on fiber supplements, like psyllium, and medications, like bisacodyl, senna and amitiza.
He added American guidelines “focus pretty heavily on medical therapies for chronic constipation.”
Traditional constipation treatments include increasing fiber intake through foods like prunes and other fruits and vegetables, drinking more water, and using different kinds of laxatives.
While the new guidelines include certain fiber-rich foods and fiber supplements, there’s no guidance on a “high-fiber diet” overall.
“When we were building these guidelines, and looking at the literature, we were expecting a lot more evidence on a high-fiber diet, and there simply isn’t enough in constipation,” Dimidi said.
“There’s plenty of evidence that a high-fiber diet is very beneficial for our overall health and also for elements of gut health, such as reducing the risk of colorectal cancer,” she added. “But when it comes to constipation, specifically, we just don’t have enough evidence to say that it improves constipation.”
What are the new recommendations?
Chey, who wasn’t involved with the new guidelines, said the recommendations “provide a valuable road map to things that [people] can try as they’re waiting to see their primary care physician.”
He added that people with more severe cases of constipation may need to see a gastroenterologist.
The recommendations include:
- Fiber supplements: More than 10 grams of fiber supplements, such as psyllium, per day can improve stool frequency and consistency and aid in reducing straining. Fiber supplements should be slowly introduced and dosage gradually increased.
- Probiotics: Certain strains of probiotics, including, B. lactis and Bacillus coagulans Unique IS2, may help some people with symptoms. If taking one, patients should take a supplement of their choice and follow the manufacturer’s instructions for at least four weeks.
- Magnesium oxide supplements: 0.5-1.5 grams daily can help with stool frequency and consistency, reduce symptoms such as bloating and abdominal pain and improve overall quality of life. Dosage should start at 0.5 grams per day and be gradually increased weekly.
- Kiwis: Three daily, with or without the skin, can help improve stool frequency but not consistency.
- Rye bread: Six to eight slices of rye bread per day can also aid stool frequency, but not consistency. The authors noted that this amount may not be realistic for some people.
- High mineral-content water: In combination with other treatments, 0.5-1.5 liters per day of high mineral-content water may also help. One of the key minerals in high mineral-content water, magnesium, is a known laxative.
The one recommendation that gives Chey pause is for probiotics. “People’s microbiomes … vary a lot from location to location based on diet, based on genetics, based on the environment, and so it’s very hard to make any generalizable statements about the use of specific probiotics,” he said.
Still, overall, he said, “I think these kinds of recommendations are going to be very helpful.”
Dimidi said she hopes the release of the guidelines can “empower” those with chronic constipation.
“We’re hoping [the guidance] means that clinicians are very well-informed and can provide personalized advice to their patients that is very effective,” she said. “But also that people themselves with constipation can access now evidence-based information, feel empowered to take control of the symptoms and improve a condition that has a tremendous impact on quality of life.”
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