If you’re one in four Canadians who suffer from constipation, you probably know all too well that the condition can make you miserable – bloated, gassy, lethargic and irritable.
For some people, constipation only lasts for a short time, but for others it can last for weeks and months.
Recommendations for treating constipation focus on increasing fiber intake, including using a fiber supplement. But guidelines on the type, dose, and duration of fiber supplementation are unclear.
Now, an updated review of studies — the largest review to date — provides evidence for optimal fiber supplementation guidelines for improving chronic constipation.
What is chronic constipation?
Not having a bowel movement daily does not mean you are constipated. Medically speaking, constipation is defined as having less than three bowel movements per week.
Chronic constipation occurs when you have infrequent bowel movements — whether hard, formed, or small stools — or difficulty passing stools for several weeks or longer. The condition interferes with quality of life, affecting work and social relationships and mental well-being.
Research suggests that for half of people with chronic constipation, recommendations to increase fiber intake or use laxatives are either ineffective or associated with uncomfortable side effects such as bloating and gas.
The latest research
The goal of the current research was to identify the optimal type of fiber supplement, dose, and duration of treatment for the management of chronic constipation. The analysis, published in the October issue of the American Journal of Clinical Nutrition, included 16 randomized controlled trials involving 1,251 adult participants.
Researchers assessed the effect of fiber supplements on stool frequency, intestinal transit time (i.e. the time it takes for food to travel through the intestine), as well as symptoms such as bloating, gas, abdominal pain and exercise intensity.
The studies used various types of fiber supplements, including psyllium powder, polydextrose powder, inulin, guar gum, pectin powder, and wheat bran. Doses ranged from four to 40 g per day and treatment durations ranged from two to eight weeks.
Overall, fiber supplementation was effective in relieving constipation. The results showed that psyllium was the most effective, increasing stool frequency by three times a week, improving stool consistency and decreasing the severity of straining.
In terms of supplement dose and duration, fiber doses greater than 10g per day and a course of at least four weeks have been shown to be optimal for managing constipation.
The study also found that fiber supplements made flatulence worse, especially supplements containing inulin. Inulin, a prebiotic fiber derived from chicory root, is fermented by gut bacteria; consuming large doses can cause gas and bloating.
Fiber Supplement Considerations
Before starting a fiber supplement, review your medications with your pharmacist. Fiber supplements may decrease the absorption of certain medications, including those used to treat thyroid disorders, depression, and type 2 diabetes.
Start slowly to avoid digestive discomfort. Start with the lowest recommended dose and gradually increase the amount of fiber.
Take a fiber supplement with at least 250ml of water to improve effectiveness and prevent side effects. To be coherent; take your fiber supplement daily.
Don’t neglect dietary fiber
Aim to get most of your daily fiber from whole foods, which contain various types of fiber (many fiber supplements only provide one) as well as nutrients and protective phytochemicals.
In addition to supporting digestive health, a high-fiber diet is linked to a lower risk of type 2 diabetes, cardiovascular disease and certain cancers.
Daily fiber recommendations for adults 19-50 are 38g (men) and 25g (women). Men and women over 50 need 30 and 21 g per day respectively.
Whole grains, fruits, vegetables, legumes, nuts, and seeds contain two types of fiber in varying amounts: soluble and insoluble fiber.
Soluble fiber dissolves in water and forms a gel-like material during digestion. It helps to lower blood sugar and blood cholesterol levels. Good sources include oats, oat bran, psyllium husks, barley, beans and lentils, citrus fruits, pears, apples, and chia seeds.
Insoluble fiber remains largely intact as it passes through the digestive tract. This type of fiber adds bulk to stools, promoting regularity. Wheat bran, whole wheat pasta, whole grain rye bread, pinto beans, nuts, sweet potatoes, kale, green peas and raspberries are examples of foods high in insoluble fiber. .
Leslie Beck, a dietitian in private practice in Toronto, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD
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