Fiber is a popular way to promote digestive health, because it helps move food out of the gut and down the digestive tract. And, when it comes to treating constipation, there are two methods commonly recommended: the fiber-busting laxative, such as bisacodyl; or the fiber-enhancing fiber, such as psyllium or guar gum. But, new research suggests that there may not be a big difference between them, regardless of whether you’re using them for constipation or to treat constipation.
The constipation problem, for many people, is their most common health concern. Most people have some kind of bowel movement that does not feel like a “normal” one, and that feeling can make it hard to get up in the morning. While there are a variety of reasons why people experience constipation, we can identify a few common symptoms. These include: feeling bloated and uncomfortable, feelings of having too much gas, pain and cramping in the abdomen, painful bowel movements, feeling the need to go every few hours, long lasting issues, and feeling too empty.
Fiber is the indigestible part of the food that you eat. It is primarily found in fruits, vegetables, whole grains, nuts, seeds, beans, etc. In this blog, I am going to review one of the recent studies that has been done to help with the problem of constipation. This study will look at a commonly consumed food (fiber) and looks at its effect on constesting.
If you have constipation, you’ve probably been advised to eat more fiber. However, according to a recent study, removing fiber may be a better method to alleviate the symptoms of chronic constipation. Is this the best option?
In this week’s Research Review, we’ll look at several data that contradict popular wisdom about constipation treatment and leave you with… ehem, the bottom line.
It’s a given that whatever goes in has to come out.
Caca, turd, doo-doo, or poop are all terms for the same thing. Regardless of how much we make fun of the product of elimination, most individuals probably don’t give it any thought.
However, bowel function is a complicated process that requires the synchronization of a number of nerves and muscles. The following is how it works:
The bowel is a component of the digestive or gastrointestinal (GI) system, which is responsible for absorbing nutrients from the foods and beverages we consume. The small intestine absorbs nutrients such as proteins, lipids, carbs, and vitamins.
Anything the body can’t use makes its way to the colon, or large intestine. Water and some minerals are reabsorbed here, while the leftover foodstuff is converted into feces.
If you have a sensitive stomach, be prepared for the following section.
In a “normal” stool, there is some variance. However, it should have a sour odor (because to bacterial fermentation), a dark color (due to bile), and a soft consistency, similar to toothpaste. To put it another way, you shouldn’t have to strain your eyes to pass it (1).
How often should you go to the bathroom?
The frequency of occurrence varies. There is no such thing as a “normal” amount of times a person should go, only averages.
Some folks poop at the same time every day, like clockwork. Others go several times per day. Others visit once or twice a week, or every other day. (Factoid! Only once a week do sloths poop, and they have to crouch at the base of a tree to do so.)
The term “constipation” is difficult to define because of this variety. Our bowel speed varies according on our genetic makeup, age and sex, what we’ve eaten, our lifestyle, stress, and other factors.
If, on the other hand:
- you only pass three stools per week;
- They’re brittle and arid (2, 3); and
- It can be difficult to find time to go to the bathroom…
…then you’re most likely constipated.
Treatments for constipation that are commonly used
The majority of constipation is only transitory. Perhaps you’ve lately changed your diet or experienced some stress. Your bowels will usually return to normal shortly after your life has returned to normal.
But what if constipation becomes a persistent problem?
The most typical advice is to eat more fiber, drink more water, and exercise more (1, 2, 3).
What if these gimmicks aren’t enough to get things moving? Most patients then turn to stool softeners, make an appointment with their doctor, or even try colonic irrigation. That is, without a doubt, one technique to keep your colon clean!
When it comes to colonics, the film The Road to Wellville, starring Anthony Hopkins and Matthew Broderick, focused on them. Who’d have known that John Harvey Kellogg, the inventor of corn flakes and a holistic medical practitioner, was also a vegetarian and a proponent of colonics?
Constipation is not the same for everyone.
The truth is that most traditional constipation remedies lack scientific backing. And they’re frequently selected without much thinking.
We need to know what form of constipation we’re dealing with before we decide on treatment.
Constipation caused by a long transit time may respond favorably to pharmacological drugs such as stool softeners, or it may improve if the patient drinks more water, exercises more, or eats more fiber – providing he or she is deficient in one or all of these.
Psyllium and bran, two common bulk-forming substances, can help in these conditions. Traditional Chinese Medicine and probiotics have also been shown to be beneficial. (For more information, see Research Review: Gut Health and Exercise.)
However, in circumstances where constipation is idiopathic (arising spontaneously from an unknown or ambiguous etiology), there are few evidence-based therapy alternatives (3, 4).
Question for investigation
This week’s analysis looked into whether increasing the quantity of fiber in people’s diets could help them with idiopathic constipation. The researchers sought to see if giving the subjects less dietary fiber (rather than more) would help them feel better and defecate easier.
You Mei, Daud, Muhd Ashik Mohd, Seow-Choen, Francis Ho, Kok-Sun Tan, Charmaine You Mei, Daud, Muhd Ashik Mohd, Seow-Choen, Francis (September 2012). Constipation and related symptoms are reduced when dietary fiber intake is stopped or reduced. 18(33):4593-4596 in World J Gastroenterol. wjg.v18.i33.4593, doi: 10.3748/wjg.v18.i33.4593
The participants in this study served as their own controls in a prospective longitudinal case study. When researchers wish to focus on how individuals respond to an intervention over a long period of time rather than how groups respond, they utilize this sort of design.
We can draw correlations from research like this, but we can’t prove cause and effect.
Constipation, stomach distention, pain or bloating, and trouble passing stools with or without indications of rectal bleeding were all symptoms that the participants sought medical care for.
Constipation was defined as passing stool less than once every three days for at least three months, or experiencing problems with bowel motions, according to the researchers.
They didn’t do much more to define the types of issues these folks were having, but they did perform colonoscopies to ensure that colonic lesions weren’t causing their problems.
For six months, 63 participants with constipation were followed up on – 16 men (25.6%) and 47 women (74.4%), with a median age of 47 years (range 20-80 years).
Researchers highlighted at the start of the study that all of the participants were eating high-fiber meals or taking fiber supplements.
Protocol for the experiment
The researchers described the bulking impact of dietary fiber and explained how the gastrointestinal tract works to the volunteers.
- Participants gave up all fiber vegetables, fruits, whole grain bread, cereals, and brown rice for the first two weeks. They could eat clear vegetable soup and sieved fruit juices, but not much else in the way of carbohydrates, leaving them with a somewhat limited food menu.
I’m thinking of a high-protein, low-carbohydrate diet. All of the vegetarian participants’ whole grains had to be exchanged for processed white grains, and their beans had to be exchanged for processed bean products! That had to be dry, powdered beans, similar to the hummus mixtures you can buy.
Overall, it seemed to me to be somewhat unhealthy, but hey, the technique backed up the research question.
- Participants were asked not to use laxatives during the first two weeks of the no-fiber diet.
- Participants followed a low-fiber diet for a total of six months after the two-week no-fiber diet period. They returned for follow-up at the end of month one and at the end of month six, and the six-month results were analyzed.
The researchers gathered data that was both objective and subjective.
Age, sex, and constipation symptoms were among the objective data (recorded as the interval in days between bowel movements).
Subjective data included the subjects’ perceptions of how difficult it was to poop (which the researchers dubbed “evacuation”).
On a scale of “no straining” to “moderate straining” to “straining most of the time,” participants rated the difficulty.
The researchers gathered data on dietary fiber intake in general, but the paper did not explain how they did so (through a diet log, for example) or how they categorised “no fiber,” “low fiber,” and “high fiber” diets.
I sent an e-mail to the lead researcher but received no answer. I’d like to know this information so that I can put the findings in context, but I’ll get to that when I talk about the study’s strengths and limitations.
The researchers wanted to see if popular assumptions regarding fiber’s role in constipation relief were true. They were particularly interested in seeing if lowering fiber consumption could assist patients with idiopathic constipation.
They discovered that patients who followed a low fiber diet for 6 months had more frequent bowel motions in this research population.
- In the first six months, 63 people signed up for the study, and 61 of them finished it. Of those, 41 went on a no-fiber diet, 16 went on a low-fiber diet, and 6 went back to a high-fiber diet.
|Symptom||Symptoms at the start of the trial (n=63)||Diet high in fiber (n=6)||Diet with Low Fiber (n=16)||There is no dietary fiber (n=41).|
|Pain in the abdomen||13||3||2||0|
After 6 months, the 41 people who stopped eating fiber had one bowel movement per day, down from one every 3-4 days on average.
Twelve of the 16 people who ate a low-fiber diet had bowel movements every day, three had one every 2-3 days, and one had one every 4-6 days.
The 6 participants who continued to eat a high-fiber diet had no change in bowel movement frequency, with one every 6-7 days.
The effects of reducing fiber consumption were statistically significant, not just in terms of increasing bowel movement frequency, but also in terms of reducing other constipation symptoms including bloating and straining.
Are you surprised by the outcomes? I was surprised, because these findings contradict what we often hear about managing constipation.
The findings demonstrate a robust link between lowering dietary fiber consumption and alleviating constipation symptoms.
For starters, the researchers believe there is a gap between what the average person considers constipation to be and how it should be handled, and what it truly is.
Constipation is most commonly defined as the inability to pass feces. And we’re told that if we generate more poop (by eating more fiber and bulking up our diets), it’ll be simpler to “go.”
However, the researchers hypothesize that fiber’s impact in constipation is similar to merging cars in congested traffic.
Adding more cars to a traffic gridlock does not solve the problem. So what makes you think that adding more fiber and increasing the amount and bulk of your excrement will make it easier to go?
This parallel appears to be valid. At the same time, I don’t believe any broad conclusions can be drawn from a single study.
More information about the amount and type of fiber in the individuals’ diets, as well as their other behaviors like activity levels, would have been beneficial in this study. Furthermore, the sample size was insufficient for us to confidently generalize.
Also, keep in mind that constipation can have a variety of causes, and different causes may necessitate different treatments. Indeed, a recent evaluation of the current research came to the same conclusion (3).
Patients who complain of constipation should have a comprehensive medical examination to ascertain the cause of the condition, according to the reviewers. The typical triage of treatments should help if the reason of constipation is a lack of fiber, fluids, or activity.
Pharmacological and bulking agents like psyllium are generally a better bet if the culprit is delayed transit time.
There is some evidence to support biofeedback as a treatment for constipation induced by a pelvic floor dysfunction. Traditional Chinese Medicine, on the other hand, may be beneficial in some circumstances.
The etiology of constipation in the study we’ve been looking at was idiopathic, and the individuals were already eating a high-fiber diet. That’s presumably why adding more fiber wasn’t a good idea in this circumstance.
However, extrapolating from this specific example would be a mistake.
In actuality, few research have looked into conventional constipation therapies such lifestyle changes, biofeedback, and pharmaceutical medicines. It would be beneficial to conduct more research in this area (3).
Because not every constipation is the same, it’s critical to figure out what’s causing it before deciding on a remedy.
First, determine if your bowel movements are less frequent than they should be. You are the best judge of yourself.
After that, evaluate your current fiber consumption, exercise level, and fluid intake.
Adults should consume roughly 20-35 grams of fiber per day, or about 11 grams per 1000 calories, according to current fiber recommendations.
For exercise, you should try to be active for at least 30 minutes (for chronic disease prevention) and at least 60 minutes (for illness prevention) (for weight management).
Meanwhile, if you’re a guy, drink 3-4 liters per day, and if you’re a woman, drink 2-3 liters each day (5, 6).
If you answered yes to all of these questions, you should see your doctor to discover the main cause of your condition and the best treatment option.
However, I would not recommend sticking to a low-fiber diet without medical supervision because the long-term implications are unknown at this time.
To see the information sources mentioned in this article, go here.
- WebMD is a website that provides medical information (2013). The truth about poop.
- Mayo Clinic is a medical center in Rochester, Minnesota (2013). Constipation.
- L. Leung, T. Riutta, J. Kotecha, and W. Rosser (2011, July-Aug). An evidence-based review of chronic constipation. J Am Board Fam Med, vol. 24, no. 4, pp. 436-451, doi:10.3122/jabfm.2011.04.100272.
- Merriam-Webster Online Dictionary (http://www.merriam-webster.com/ (2013). Idiopathic.
- Department of Health and Human Services of the United States of America (2010). The American Dietary Guidelines are a set of dietary recommendations for people in the United States.
- USDA (United States Department of Agriculture) (2010). Dietary Reference Intakes (DRIs) are a set of dietary guidelines that
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Fiber is one of the foods that we hear about most often in discussions about diet and health, but we don’t often talk about it in the context of constipation, which is a very common problem.. Read more about i eat a lot of fiber but still can’t poop and let us know what you think.
Frequently Asked Questions
Can a low fiber diet help constipation?
Fiber is a type of carbohydrate that your body cannot digest. It passes through the digestive tract without being broken down, which can help with constipation.
How does fiber intake help with constipation?
Fiber intake helps with constipation by increasing the bulk of your stool, which makes it easier to pass.
Does fiber help or worsen constipation?
Fiber is a type of carbohydrate that helps to move waste through your digestive system. It can help with constipation, but it can also worsen it if you are not used to eating fiber.
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