A recent large study to assess the associations of dietary fiber and liquid intake to constipation concluded: “The findings support clinical recommendations to treat constipation with increased liquid, but not fiber or exercise.” To read the study, click here.

This conclusion is no surprise based on the The Dark Side of Fiber blog series on this site and these two excerpts from the new Fast Tract Digestion IBS book:

“Constipation can be caused by a variety of factors including insufficient fluid intake, excessive use of laxatives, antacids, or pain medicine such as Tylenol 1, 2, 3 and 4, which contain codeine.  Health conditions including Parkinson’s disease, multiple sclerosis, or colon cancer can also cause constipation. Chronic constipation can lead to the diagnosis of IBS-C. While no specific cause has been identified for IBS-C, researchers have discovered that IBS-C is often accompanied by the presence of methane-producing Archaea microbes in the gut. This is an important clue, which we’ll follow up later on in the book.

The first thing you should try for constipation is increasing your water intake. Also evaluate the medicines you are taking to see if constipation is listed as a potential side effect. People who find that these basic steps don’t help their constipation often reach for a laxative. Laxatives can include both foods (like prunes) and drugs that loosen stools allowing for easier passage through the intestine. Laxatives include both oral medications and suppositories.”

Note: The book lists side effects of a variety of laxatives and evaluates the efficacy claims. Also, prunes should not be used due to their very high fermentation potential that can drive new symptoms.

Fiber Laxatives

Bulk-forming laxatives, including high-fiber foods and fiber supplements such as psyllium, methylcellulose, and polycarbophil, are often recommended for people suffering from chronic constipation. The goal is to accelerate the movement of food through your digestive tract. There is considerable doubt as to the effectiveness of this approach. One clinical study looked at the use of bran fiber to reduce constipation. Twenty grams of bran per day did not improve constipation symptoms when compared to a placebo.[i] A systemic review of the effectiveness of different fiber types in treating constipation in IBS patients found only marginal benefits. In some cases, fiber actually worsened IBS symptoms.[ii] Another study found that treating 275 IBS patients with psyllium or bran fiber for three months did not improve their quality of life, though psyllium, the soluble fiber, did offer some improvement.[iii] The group that added bran to their diet experienced a high dropout rate because the participants’ IBS symptoms kept getting worse.”

And, from Fast Tract Digestion IBS Chapter 8

“If you suffer from mild constipation, you should follow the Fast Tract Diet, drink plenty of water (at least 6 glasses per day), and eat extra green vegetables (also make sure you have adequate fat in your diet). For more severe constipation, stool softeners, laxatives, or enemas may also help. These medicines should only be used occasionally, as overuse causes its own problems. Fiber supplements have also been used for constipation, but I would urge significant caution with these as they sometimes make the problem worse. If severe constipation persists for several days, schedule a doctor’s visit. (Refer to Chapter 1 for a review of medications that can help constipation.)”

One more idea is taking supplemental magnesium citrate as a large study has linked low magnesium levels to constipation. One other supplement to try is Iberogast, an herbal extract that improves motility.

[i] Badiali D, Corazziari E, Habib FI, Tomei E, Bausano G, Magrini P, Anzini F, Torsoli A. Effect of wheat bran in treatment of chronic nonorganic constipation. A double-blind controlled trial. Dig Dis Sci. 1995 Feb;40(2):349-56.

[ii] Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004 Feb 1;19(3):245-51.

[iii] Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009 Aug 27;339:b3154.

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