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January 25, 2005

BehindTheMedspeak: If constipation's the question, fiber's not the answer


Oh, no, you say: not another cherished belief down the drain. [I simply could not resist]

It's even worse than you thought: not only is fiber not helpful in opening up your pipe: it makes things even harder. [Oops, I did it again]


And that's not all: drinking more liquid is useless, and exercise won't help, contrary to what you've been told (and which I too believed, I must admit).

But wait - there's more. [This is getting to be a - dare I use the word? - habit]

Laxative are perfectly safe: they do not, as some experts state, increase your risk of bowel cancer.

Nor are they psychologically habit-forming; they don't cause physical dependence either.

Laxative do not lead to "rebound" constipation, nor do they damage the nerves and muscles that control the bowel.

As to what's normal in terms of how often you poop, Dr. Stefan Müller-Lissner, professor of medicine at Humboldt University in Berlin, said it's up to you.

Müller-Lissner is the lead author of a review article in the January issue of the American Journal of Gastroenterlogy which debunks these and a number of other apparent urban medical myths.

Said Müller-Lissner, "The statistical range of normality is from three stools a day to three stools a week. But in clinical terms, this is irrelevant. A low stool frequency by itself does no harm."

Now, don't you feel better?

I know I do.

Here's Nicholas Bakalar's reassuring article, from the January 18 New York Times Science section.

    Is Fiber the Answer? Researchers Doubt It

    Despite the barrage of television commercials that insist otherwise, a diet low in fiber is usually not the cause of constipation, and taking fiber supplements is probably not the cure, according to a new study.

    In fact, a fiber supplement can actually make symptoms worse in some patients, particularly the most severely afflicted.

    A review study published in the January issue of The American Journal of Gastroenterology suggests that many other common beliefs about constipation are also little more than durable myths.

    According to the American College of Gastroenterology, constipation is the reason for at least 2.5 million doctor visits annually in the United States, and ACNielsen, the marketing information company, reports that Americans spent more than $700 million last year on over-the-counter laxative medicines.

    Yet much of the advice they got - including many suggestions from doctors - was probably not helpful.

    Fiber is far from a panacea.

    In one study, fewer than half of the patients with self-described constipation had any response to added fiber, and studies comparing people with chronic constipation to comparison groups without the condition show no difference in their dietary fiber intake.

    At best, a diet low in fiber may be a contributory factor in a minority of patients, and fiber supplements may help them, the reviewers, led by Dr. Stefan Müller-Lissner, a professor of medicine at Humboldt University in Berlin, found.

    Drinking more liquid is often recommended, but studies show it does not work.

    Although it may seem that adding water to hard stools will soften them, adding liquid does not accomplish this, nor does it relieve constipation.

    If fiber and liquids do not help much, will increasing exercise?

    The studies say no.

    Despite its other benefits, exercise is largely ineffective in preventing constipation.

    It seems to help in the elderly if it is part of a broader program, but it does not work in young, severely constipated patients.

    While workouts like marathons can increase gut activity, moderately increased exercise in healthy people has no discernible effect on bowel function.

    What really works for constipation? "I do start with a trial of dietary fiber," Dr. Müller-Lissner said. "Prunes and other fruits may be effective, although bloating can occur as a side effect."

    If those measures do not work, Dr. Müller-Lissner recommends laxatives.

    In addition to the fiber additives, there are three other types: stool softeners (Colace, for example); saline laxatives like milk of magnesia; and stimulant laxatives, including Dulcolax, Correctol, and others.

    "I prescribe macrogol," the active ingredient in Colace and many other brands, he said.

    He added, "If this is ineffective or not tolerated, I switch to bisacodyl" in Correctol and other stimulants, "or a related compound."

    These drugs are not harmful in normal dosages, Dr. Müller-Lissner said.

    Some experts believe that stimulant laxatives that amplify bowel motility can increase the risk for colorectal cancer, but the evidence is weak.

    Chronic constipation is itself associated with an increased risk of the cancer, but no evidence supports a belief that laxatives used in recommended doses increase the risk.

    Other doctors suspect that the drugs have a host of adverse side effects - that they can be psychologically habit-forming, that they cause physical physical dependence, that they lead to "rebound" constipation, or that they damage the nerves and muscles that control the bowel.

    But studies have found no evidence.

    Dr. Müller-Lissner says he believes that what constitutes a normal frequency of bowel movements is up to the patient.

    "The statistical range of normality is from three stools a day to three stools a week," he said.

    "But in clinical terms, this is irrelevant. If there is no organic disease underlying the constipation, a low stool frequency by itself does no harm. The only motivation for treatment is the patient's complaint."

January 25, 2005 at 04:01 AM | Permalink


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Fiber.....Nature's Broom....

Posted by: Robin | Jan 26, 2005 10:47:06 AM

In a world filled with anal retentives is it any wonder that constipation is a problem?

Posted by: ScienceChic | Jan 25, 2005 10:07:21 PM

thanks for getting to the bottom this, etc etc

Posted by: Russ | Jan 25, 2005 2:00:53 PM

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