New Dietary Guidelines for Managing Chronic Constipation

Are kiwis on your grocery list when you think about foods that may ease chronic constipation? According to new dietary guidelines released by the British Dietetic Association, they should be. Along with rye bread and some specific supplements, kiwis can help alleviate symptoms of constipation.

These guidelines are notable because they’re the first set of evidence-based recommendations focused specifically on dietary approaches rather than medications. Chronic constipation is a widespread issue, affecting about 16% of adults globally, and it leads to nearly 2.5 million doctor visits annually in the U.S., according to the American College of Gastroenterology.

Eirini Dimidi, who led the development of these guidelines, points out that past recommendations on managing chronic constipation have been heavily weighted towards pharmaceutical solutions. Existing advice—like eating more fiber or drinking additional water—often came off as vague and lacked sufficient research support.

“It struck me how limited the dietary recommendations were,” said Dimidi, a registered dietitian and associate professor at King’s College London. To create the new recommendations, the authors meticulously reviewed clinical trials to assess various methods for constipation management. This research was published in the Journal of Human Nutrition & Dietetics and Neurogastroenterology & Motility.

Understanding Chronic Constipation

Constipation, characterized by having fewer than three bowel movements weekly, is considered chronic if it persists for over three months. Symptoms differ from person to person but often include hard or lumpy stools, stomachaches, and nausea. More serious issues may encompass blood in stool, fever, and vomiting.

Factors contributing to constipation can range from diet and lifestyle to certain illnesses, injuries, and medication. It’s a common occurrence that can impact people of any age, gender, or background.

“I see chronic constipation in everyone,” mentioned Sue-Ellen Anderson-Haynes, a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. “It’s prevalent among toddlers, school-age kids, and adults alike.”

This condition can greatly affect one’s daily life and physical capabilities, causing limitations that hinder overall quality of life and productivity.

“If someone is consistently constipated, they may find it difficult to engage in physical activities due to bloating, pain, or mood changes,” noted Anderson-Haynes, who runs a nutrition practice in Boston.

Methods of Treating Chronic Constipation

Dr. William Chey, a gastroenterology professor at the University of Michigan and the incoming president of the American College of Gastroenterology, commented that much of the research around treating chronic constipation has focused on fiber supplements and medications designed for this issue.

He noted that American guidelines mainly prioritize medical therapies for chronic constipation. Traditional treatments generally suggest increasing fiber intake via foods like prunes, staying well-hydrated, and employing various laxatives.

While the new guidelines do include certain fiber-rich foods and supplements, they don’t promote a blanket “high-fiber diet.”

“When we were compiling these recommendations, we expected stronger evidence supporting a high-fiber diet for constipation, but it simply isn’t there,” Dimidi explained. “There is solid evidence that a high-fiber diet is good for overall health and may help with gut health, including reducing colorectal cancer risk. Yet for constipation specifically, the evidence is insufficient.”

Key Recommendations

Though Chey was not involved in creating the guidelines, he regards them as a useful resource for individuals dealing with constipation while awaiting appointments with their primary care physicians. For severe cases, he advises consultation with a gastroenterologist.

The new recommendations are as follows:

• Fiber supplements: Consuming over 10 grams of fiber supplements daily, such as psyllium, can enhance stool frequency and consistency while reducing straining. Start slowly and gradually increase dosage.
• Probiotics: Specific probiotic strains like B. lactis and Bacillus coagulans Unique IS2 may benefit some individuals. If you choose to take one, follow the manufacturer’s guidelines for at least four weeks.
• Magnesium oxide supplements: A daily dosage of 0.5-1.5 grams can help increase stool frequency and consistency, alleviate symptoms like bloating, and improve overall quality of life. Begin with 0.5 grams per day, increasing weekly.
• Kiwis: Eating three kiwis per day, with or without the skin, may boost stool frequency but not necessarily improve consistency.
• Rye bread: Consuming six to eight slices daily can also promote stool frequency, though not consistency. Some may find this amount impractical.
• High mineral-content water: In conjunction with other treatments, drinking 0.5-1.5 liters of high mineral-content water daily may help, as magnesium—a key mineral in it—acts as a laxative.

A noteworthy aspect for Chey is the guidance around probiotics. “People’s microbiomes vary significantly due to factors like diet, genetics, and environment, making it tricky to provide universal recommendations,” he stated.

Nevertheless, he believes these recommendations could prove quite beneficial overall. Dimidi expressed hopes that these guidelines would “empower” those suffering from chronic constipation.

“Our goal is for clinicians to have well-informed strategies to give personalized advice to their patients. We also want individuals with constipation to access evidence-based information and feel empowered to better manage their symptoms,” she concluded.