“Previous medical guidelines offered only limited dietary recommendations and were often outdated,” says the lead author. Eirini Dimidi, PhDregistered dietitian and nutritionist and professor of nutritional sciences at King’s College London.
Through what Dr. Dimidi and her team describe as “a comprehensive evaluation of existing research,” the new guidelines provide dietary recommendations “that have been shown to be effective for constipation, providing practical, clear and effective options to people with chronic constipation.”
One surprising finding was the lack of strong evidence in favor of generic high-fiber diets, which doctors often recommend to relieve constipation, Dimidi says.
These recommendations are certainly vague, agree Lisa Malter, MDdirector of the inflammatory bowel disease program at Bellevue Hospital Center in New York City.
Guidelines Identified 59 Evidence-Based Remedies
The new guidelines, published jointly in the Journal of human nutrition and dietetics and Neurogastroenterology and Motilityare based on four systematic reviews and meta-analyses focusing on randomized controlled trials of dietary interventions for chronic constipation.
Randomized controlled trials are considered the gold standard in scientific research because they provide the strongest evidence that a given intervention causes an observed outcome.
The multidisciplinary research team, which included dieticians, a nutritionist, a gastroenterologist, an intestinal physiologist and a general practitioner, identified a total of 59 interventions to relieve constipation, including:
kiwis
Rye bread
Water with high mineral content
Guidelines suggest that 0.5 to 1.5 liters (about 2 to 6 cups) per day may help improve constipation symptoms when used with other treatments. Mineral water usually contains magnesium, which has known laxative properties.
Magnesium oxide supplements
The review found that magnesium oxide supplements reduced bloating and abdominal discomfort in people with constipation. The authors recommend 0.5 to 1.5 grams (g) per day to reduce symptoms and improve stool frequency and consistency, starting with 0.5 g per day and gradually increasing the dose weekly.
Magnesium oxide works by drawing water into the intestines, “allowing for a smooth exit,” he says. Sue-Ellen Anderson-Haynes, RDNspokesperson for the Boston Academy of Nutrition and Dietetics who was not involved in the study.
Fiber supplements
Fiber supplements can help with constipation by adding bulk to stool, according to Anderson-Haynes. To relieve constipation, the review recommended taking at least 10g per day of a fiber supplement such as psyllium.
Probiotics
Some probiotic strains, including Bifidobacteria lactis and coagulant bacillus UIS2 may help some people relieve constipation, but the study notes that “compelling evidence is lacking to recommend specific strains of probiotics for constipation.” If you try one, researchers recommend following the product’s instructions for four weeks.
What is chronic constipation and how is it treated?
“If these symptoms occur for more than three months, you meet the criteria for chronic constipation,” it says. Latour Rage, MDgastroenterologist and director of endoscopy at NYC Health and Hospitals/Bellevue. Dr. de Latour did not contribute to the new guidelines.
“Patients with chronic constipation should be aware that if their symptoms are mild, they can manage them independently with dietary changes and not have to suffer through the symptoms or rely solely on medications for relief,” Malter says.
How to Safely Use Supplements to Relieve Constipation
Always talk to your healthcare team about any new supplements you are interested in using to make sure they are safe for you and will not interact with any medications you are taking.
Malter says anyone consuming high-fiber foods or supplements for constipation should drink plenty of water to avoid cramps, bloating, and excessive gas.
If you are new to using fiber supplements, start with a small dose and increase the amount gradually, and be sure to increase your fluid intake as well.
Magnesium-based supplements can raise mineral levels in the blood, which could be dangerous for people with kidney disease or interact with certain medications, Malter says.
Anderson-Haynes suggests working with a gastroenterologist to identify the cause of constipation and a registered dietitian to get relief through food. Following these steps can help you prevent constipation in the future.
