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Wang DC, Peng XF, Chen WX, Yu M. The Association of moisture intake and constipation among us adults: evidence from NHANES 2005-2010. BMC Public Health 2025; 25:399. [PMID: 39891106 PMCID: PMC11783823 DOI: 10.1186/s12889-025-21346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 01/06/2025] [Indexed: 02/03/2025] Open
Abstract
BACKGROUND Constipation is a common gastrointestinal disorder that affects the quality of life of millions of adults worldwide. Dietary moisture intake is considered to have a significant impact on intestinal health, yet its specific role in constipation has not been thoroughly investigated in large-scale population studies. This study aims to explore the correlation between adult dietary moisture intake and constipation by analyzing the NHANES database, filling a knowledge gap in the literature. METHODS Data from NHANES participants aged 20 years and older from 2005 to 2010 were analyzed. Moisture intake was assessed using dietary recall data, which included moisture from all food and beverages consumed. A weighted logistic regression model was used to assess the relationship between moisture intake and the risk of constipation, calculating the odds ratios (ORs) and their 95% confidence intervals (CIs), while controlling for potential confounders. Additionally, restricted cubic splines (RCS) were applied to further explore potential non-linear patterns in the relationship between moisture intake and constipation, along with subgroup analysis. RESULTS The study included 14,492 participants, of whom 1,514 reported constipation issues. After adequately adjusting for confounders, a significant negative correlation was observed between moisture intake and constipation risk (OR 0.81; 95% CI: 0.74-0.89). Quartile analysis of moisture intake demonstrated that, compared to the first quartile Q1 (0.06 to 1.90 kg), the constipation risk for the second quartile Q2 (1.91 to 2.53 kg), third quartile Q3 (2.54 to 3.36 kg), and fourth quartile Q4 (3.37 to 16.97 kg) were OR 0.80 (95% CI: 0.64-0.72), OR 0.57 (95% CI: 0.45-0.72), and OR 0.54 (95% CI: 0.44-0.67) respectively, with a trend test P-value ofless than 0.001. RCS regression revealed a significant non-linear negative relationship between moisture intake and constipation prevalence (P < 0.001). Depression may modulate the relationship between moisture and constipation (interaction effect P = 0.014). CONCLUSION The findings of this study indicate that appropriate dietary moisture intake is significantly associated with a lower risk of constipation, demonstrating a dose-response relationship. This emphasizes the importance of considering adequate moisture intake in the prevention and management of constipation. Future studies should adopt a prospective design to further verify the causal relationship between dietary moisture intake and constipation progression.
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Affiliation(s)
- Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China.
| | - Xue-Feng Peng
- Department of General Surgery, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
| | - Wen-Xing Chen
- Department of General Surgery, Zigong Fourth People's Hospital, 19 Tanmulin Road, Zigong, 643000, Sichuan, China
| | - Miao Yu
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, Sichuan, China
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2
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Gray M, de Janon A, Seeler M, Heller WT, Panoskaltsis N, Mantalaris A, Champion JA. Intracellular Biomacromolecule Delivery by Stimuli-Responsive Protein Vesicles Loaded by Hydrophobic Ion Pairing. ACS OMEGA 2025; 10:2628-2639. [PMID: 39895718 PMCID: PMC11780410 DOI: 10.1021/acsomega.4c07666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 12/05/2024] [Accepted: 12/20/2024] [Indexed: 02/04/2025]
Abstract
Proteins can perform ideal therapeutic functions. However, their large size and significant surface hydrophilicity and charge prohibit them from reaching intracellular targets. These chemical features also render them poorly encapsulated by nanoparticles used for intracellular delivery. In this work, a novel combination of protein vesicles and hydrophobic ion pairing (HIP) was used to load protein cargo and achieve cytosolic delivery to overcome the limitations of previous protein vesicle properties. Protein vesicles are thermally self-assembling nanoparticles made from elastin-like polypeptide (ELP) fused to an arginine-rich leucine zipper and a globular protein fused to a glutamate-rich leucine zipper. To impart stimuli-responsive disassembly, physiological stability, and small size, the ELP sequence was modified to include histidine and tyrosine residues. HIP was used to load and release protein cargo requiring endosomal escape for cytosolic function. HIP vesicles enabled delivery of cytochrome c, a cytosolically active protein, and a significant reduction in viability in both a traditional two-dimensional (2D) human cancer cell line culture and a biomimetic three-dimensional (3D) organoid model of acute myeloid leukemia. By examining the uptake of positively and negatively charged fluorescent protein cargos loaded by HIP, this work revealed the necessity of HIP for cytosolic cargo delivery and how HIP loading influences protein vesicle self-assembly and disassembly using microscopy, small-angle X-ray scattering, and nanoparticle tracking analysis. HIP protein vesicles have the potential to broaden the use of intracellular proteins as therapeutics for various diseases and extend protein vesicles to deliver other biomacromolecules, as the strategy developed here resulted in the first cytosolic protein cargo delivery using protein vesicles.
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Affiliation(s)
- Mikaela
A. Gray
- Chemical
and Biomolecular Engineering, Georgia Institute
of Technology Atlanta, Georgia 30332-0002, United States
| | - Alejandro de Janon
- Biomedical
Systems Engineering Laboratory, Georgia
Institute of Technology, Atlanta, Georgia 30332-0002, United States
| | - Michelle Seeler
- School
of Biological Sciences, Georgia Institute
of Technology, Atlanta, Georgia 30332-0002, United States
| | - William T. Heller
- Neutron
Scattering Division, Oak Ridge National
Laboratory, Oak Ridge, Tennessee 37831-6473, United States
| | - Nicki Panoskaltsis
- Biomedical
Systems Engineering Laboratory, Georgia
Institute of Technology, Atlanta, Georgia 30332-0002, United States
- School
of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
- Department
of Haematology, St. James’s Hospital, Dublin 8, Ireland
| | - Athanasios Mantalaris
- Biomedical
Systems Engineering Laboratory, Georgia
Institute of Technology, Atlanta, Georgia 30332-0002, United States
- School
of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
- National
Institute for Bioprocessing Research and Training, Dublin A94 X099, Ireland
| | - Julie A. Champion
- Chemical
and Biomolecular Engineering, Georgia Institute
of Technology Atlanta, Georgia 30332-0002, United States
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3
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Cheever CR, Shams RB, Willingham KR, Sim H, Cook LM, Ahmidouch MY, Scholand KE, Wilson LA. Understanding constipation as a geriatric syndrome. Geriatr Nurs 2025; 61:440-448. [PMID: 39731934 DOI: 10.1016/j.gerinurse.2024.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 11/07/2024] [Accepted: 12/18/2024] [Indexed: 12/30/2024]
Abstract
Constipation is common among older adults and significantly impacts their quality of life (QoL). Prior studies have extensively detailed constipation, but conceptualization of constipation as a geriatric syndrome is lacking. In this review, we provide an overview of constipation in the geriatric population and conceptualize constipation as a geriatric syndrome given its high prevalence, under-recognized status, and association with poor QoL and adverse outcomes among older adults. The conceptualization of constipation as a geriatric syndrome, as with frailty and delirium, highlights its importance and need for a multi-faceted approach. Future research is needed to 1) better define constipation, 2) explore the multifactorial nature of constipation in older adults and relationship with other geriatric syndromes, 3) include more older adults in pharmacological and non-pharmacological interventions for constipation, and 4) curate multidisciplinary care models. Appreciating constipation as a geriatric syndrome will yield tailored management strategies, ensure timely intervention, and avoid adverse outcomes.
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Affiliation(s)
- C Ray Cheever
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Rayad B Shams
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - K Reese Willingham
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Hyoungjun Sim
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Lauren M Cook
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | | | - Katherine E Scholand
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; University of North Carolina, Department of Internal Medicine, Division of Gastroenterology, Chapel Hill, NC 27599, USA
| | - Lindsay A Wilson
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; University of North Carolina, Department of Internal Medicine, Division of Geriatric Medicine, Chapel Hill, NC 27599, USA.
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4
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JanssenDuijghuijsen L, van den Belt M, Rijnaarts I, Vos P, Guillemet D, Witteman B, de Wit N. Acacia fiber or probiotic supplements to relieve gastrointestinal complaints in patients with constipation-predominant IBS: a 4-week randomized double-blinded placebo-controlled intervention trial. Eur J Nutr 2024; 63:1983-1994. [PMID: 38653808 PMCID: PMC11329592 DOI: 10.1007/s00394-024-03398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To date, no adequate treatment for irritable bowel syndrome with predominant constipation complaints (IBS-C) is available. Fibers with prebiotic properties and probiotic compounds have shown promise in relieving IBS-C-related complaints. We aimed to determine the effects of a 4-week intervention with either an Acacia fiber (AF) with prebiotic properties or a probiotic Bifidobacterium Lactis (BLa80) supplement, compared to a control supplement, on stool pattern, IBS symptoms and Quality of Life (QoL), in IBS-C individuals. METHODS A parallel, double-blind, randomized controlled trial involving 180 subjects meeting the ROME IV criteria for IBS-C was conducted. Following a 4-week observation period, subjects received either AF (10 g), Probiotic BLa80 (4 g; 2 × 1011 CFU/g) or a maltodextrin placebo (10 g) daily for 4 weeks. Subjects reported daily information on stool pattern and gastrointestinal complaints. Before and after each 4-week period, questionnaires on symptom severity, constipation symptoms, anxiety and depression and QoL were completed. Stool mass was measured for 5-days before and after the intervention. RESULTS Stool frequency significantly improved in the AF and Probiotic BLa80 groups compared to placebo (P < 0.001, P = 0.02, respectively). Probiotic BLa80 showed a significant reduction in IBS symptom severity (P = 0.03), for AF a trend towards decreased constipation symptoms (PAC-SYM, P = 0.10) was observed. No significant changes in stool consistency, stool mass or QoL measures were observed between the AF and Probiotic BLa80 compared to placebo. CONCLUSION Daily dietary supplementation with Acacia fiber and probiotic supplements might help IBS-C patients by relieving IBS-related complaints compared to a placebo supplement. REGISTRATION NUMBER OF CLINICAL TRIAL The trial is registered at ClinicalTrials.gov: NCT04798417: Study Details | Nutrition to Relieve IBS Constipation | ClinicalTrials.gov.
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Affiliation(s)
| | - Maartje van den Belt
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, the Netherlands.
| | - Iris Rijnaarts
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Paul Vos
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Ben Witteman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
- Gastroenterology and Hepatology department, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Nicole de Wit
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, the Netherlands
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5
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Coss-Adame E, García-Cedillo MF, Bustillo-Armendáriz G, Huerta-de la Torre MF, Delgado-Bautista MK, Arenas-Martinez J, Cassis-Nosthas L. Agave tequilana Fructans Versus Psyllium plantago for Functional Constipation : Randomized Double-blind Clinical Trial. J Clin Gastroenterol 2024; 58:475-482. [PMID: 37389917 DOI: 10.1097/mcg.0000000000001888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
GOAL The aim of this study was to evaluate the efficacy of supplementation with Agave tequilana Weber blue variety fructans (Predilife) in the improvement of symptoms in functional constipation. BACKGROUND Fiber supplementation is the first-line treatment for constipation. Fibers-like fructans have a known prebiotic effect. MATERIALS AND METHODS A randomized, double-blind, study comparing agave fructans (AF) against psyllium plantago (PP). Four groups were randomized. Group 1: AF 5 g (Predilife), group 2: AF 10 g (Predilife), group 3: AF 5 g (Predilife)+10 g maltodextrin (MTDx), and group 4: PP 5 g+10 g MTDx. The fiber was administered once daily for 8 weeks. All fibers were similarly flavored and packaged. Patients kept their usual diet and fiber sources were quantified. Responders were defined as ≥1 complete spontaneous bowel movement from baseline to 8 weeks. Adverse events were reported. The study was registered in Clinicaltrials.gov with registration number NCT04716868. RESULTS Seventy-nine patients were included (group 1: 21, group 2: 18, group 3: 20, and group 4: 20), of which 62 (78.4%) were women. The responders were similar across groups (73.3%, 71.4%, 70.6%, and 69%, P >0.050). After 8 weeks, all groups significantly increased complete spontaneous bowel movements, showing the greatest increase in spontaneous bowel movements in group 3 ( P =0.008). All groups improved in symptoms, stool consistency, and quality of life. Diet and fiber intake were similar between groups. Adverse events were mild and similar between groups. CONCLUSIONS AF (Predilife) are as effective at different doses and combined with MTDx as PP and are a feasible option for the treatment of functional constipation.
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Affiliation(s)
| | | | | | | | | | | | - Lorena Cassis-Nosthas
- Food Science and Technology, Salvador Zubirán National Institute of Health Sciences and Nutrition, Mexico City
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6
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Lucy AT, Massey GB, Cobbs P, Miltner RS, Cox MG, Russ K, Dasinger E, Parmar A. Successful de-implementation of an ineffective practice: The fall of docusate. Am J Surg 2024; 228:126-132. [PMID: 37652833 DOI: 10.1016/j.amjsurg.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Reducing wasteful practices optimizes value in medicine. Docusate lacks treatment efficacy yet is widely prescribed. This quality improvement project aimed to de-implement docusate in place of a new evidence-based order set. METHODS This is an ambidirectional study of inpatient laxative orders from 2018 to 2022 at one institution. We stratified docusate data by service/unit to target prospective deimplementation initiatives. A new evidence-based constipation order set was embedded in Cerner. RESULTS There were 701,732 docusate orders across 75 services on 68 units. Top docusate ordering services were Trauma, Obstetrics and Hospitalist. Docusate administration rates were higher than for other laxatives. Our efforts reduced docusate orders by 44% over 4 months. PEG and senna orders increased by 58% and 35%. CONCLUSION Docusate has no efficacy yet is widely prescribed. A structured de-implementation strategy can drive systematic change by leveraging technology and applying multidisciplinary improvement efforts. Our work removed docusate from the inpatient formulary.
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Affiliation(s)
- Adam Timothy Lucy
- UAB Department of Surgery, 1808 7th Ave S, BDB 505, Birmingham, AL, 35233, USA.
| | | | - Parker Cobbs
- UAB Department of Surgery, 1808 7th Ave S, BDB 505, Birmingham, AL, 35233, USA
| | | | - Mary Grace Cox
- UAB Quality Improvement and Data Analytics, 619 19th St S, JT 1407, Birmingham, AL, 35249, USA
| | - Kirk Russ
- UAB Department of Medicine, Division of Gastroenterology, 1808 7th Ave S, BDB 349, Birmingham, AL, 35233, USA
| | - Elise Dasinger
- UAB Hospital Pharmacy, 619 19th St S, JT 1728, Birmingham, AL, 35249, USA
| | - Abhishek Parmar
- UAB Department of Surgery, 1808 7th Ave S, BDB 505, Birmingham, AL, 35233, USA
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7
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Brenner DM, Corsetti M, Drossman D, Tack J, Wald A. Perceptions, Definitions, and Therapeutic Interventions for Occasional Constipation: A Rome Working Group Consensus Document. Clin Gastroenterol Hepatol 2024; 22:397-412. [PMID: 37797905 DOI: 10.1016/j.cgh.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND & AIMS Functional constipation is the most common of the disorders of gut-brain interaction, affecting approximately 12% of the world population. Although classically considered a chronic condition, many individuals experience shorter yet repetitive bouts of constipation representing a different clinical entity. There has been increased interest in this latter disorder, which has recently been classified as occasional constipation. This Rome Foundation working group document reflects the consensus of an international team of specialists who summarized currently available research to provide a working definition of and treatment algorithm for occasional constipation. The recommendations herein are based on current evidence, accounting for gaps in the literature as well as international variance in definitions and health seeking behaviors for constipation. METHODS The committee members reviewed the scientific literature, focusing specifically on occasional constipation, with the understanding that as a new entity, a paucity of data would be available. We used Rome IV research and clinical definitions to establish the framework for our definition of occasional constipation. Where possible, treatment recommendations were determined on the basis of the earliest extractable data from functional constipation studies, focusing on positive results within the first 2 weeks of treatment. We used the Delphi method to create consensus with 100% agreement between the authors. RESULTS An evidence-based review of the literature resulted in the definition of occasional constipation as follows: "individuals who experience the presence of at least 1 functional constipation symptom, in the absence of alarm signs or symptoms, occurring at irregular and infrequent intervals, which is bothersome enough to induce a patient to seek medical management." Medical management whether seeking medical care or self-treatment was left to the individual's discretion, and we did not include time anchors because these thresholds require further investigation. Polyethylene glycol and stimulant laxatives are recommended as first-line interventions, whereas magnesium-containing compounds are suggested in individuals failing to respond to these therapies. There are insufficient data to make recommendations for using fiber or stool softeners. Prescription laxatives should be reserved for individuals with chronic constipation. CONCLUSIONS Occasional constipation is a unique clinical entity characterized by infrequent but recurrent symptoms. Data are limited because consensus definitions have been lacking. Establishing a standardized definition and therapeutic recommendations provides a framework for future studies focusing on epidemiologic and symptoms-based outcomes. Further studies are needed to confirm and refine these recommendations.
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Affiliation(s)
- Darren M Brenner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Maura Corsetti
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Douglas Drossman
- Center for Education and Practice of Biopsychosocial Care, UNC Center for Functional GI and Motility Disorders and Drossman Gastroenterology, Chapel Hill, North Carolina
| | - Jan Tack
- Department of Gastroenterology, University Hospitals, Leuven, Belgium
| | - Arnold Wald
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Wei DJ, Li HJ, Lyu ZP, Lyu AP, Bian ZX, Ld Zhong L. A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong, China. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:550-560. [PMID: 37989695 DOI: 10.1016/j.joim.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 08/03/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Functional constipation (FC) is a common intestinal disease worldwide. Despite the presence of criteria such as Roman IV, there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches. This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients. METHODS A systematic search of the PubMed, Cochrane Library, and China National Knowledge Infrastructure databases was performed from their inception to June 30th, 2022, collecting the current evidence about the efficacious integrative management for FC. We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process. RESULTS We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts. This pathway includes a hierarchy of recommendations for every step of the clinical process, including clinical intake, diagnostic examination, recommended labs, diagnostic flowchart, and guidance for selection of therapeutic drugs. CONCLUSION This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine; it will help to provide high-quality medical services in Hong Kong for patients with FC. Please cite this article as: Wei DJ, Li HJ, Lyu ZP, Lyu AP, Bian ZX, Zhong LL. A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong, China. J Integr Med. 2023; 21(6): 550-560.
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Affiliation(s)
- Dong-Jue Wei
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Hui-Juan Li
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Zi-Pan Lyu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China; School of Biological Sciences, Nanyang Technological University, 637551, Singapore
| | - Ai-Ping Lyu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Zhao-Xiang Bian
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
| | - Linda Ld Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China; School of Biological Sciences, Nanyang Technological University, 637551, Singapore.
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9
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Abstract
PURPOSE OF REVIEW Epidemiologic studies and clinical trials have demonstrated the benefits of dietary fiber. This occurs through a combination of the physiochemical properties of fiber and through microbial fermentation that occurs in the colon which result in the production of short-chain fatty acids (SCFA). The purpose of this review is to highlight the physiochemical properties of fiber that result in the range of physiologic effects and to review the literature on the health benefits of acetate, propionate, and butyrate. RECENT FINDINGS Of the variety of properties and functions exerted by dietary fibers, the fermentability and production of SCFA's are emphasized in this review. Studies done in both animal and humans reveal the anti-obesity, anti-inflammatory, and possible anti-neoplastic roles SCFAs exert at the mucosal level. Many clinical questions remain regarding the optimal dose, type, and method of delivery of fiber to exert the desired beneficial effects. It has the potential to be used in the management of clinical symptoms, prevention of disease, and improvement in human health. Further studies to address this novel use of fiber has the potential to make a large impact in clinical practice.
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10
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Lyu Z, Fan Y, Bai Y, Liu T, Zhong LLD, Liang HF. Outcome of the efficacy of Chinese herbal medicine for functional constipation: A systematic review and meta-analysis. World J Clin Cases 2022; 10:4856-4877. [PMID: 35801027 PMCID: PMC9198889 DOI: 10.12998/wjcc.v10.i15.4856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/14/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Functional constipation (FC) is a common and chronic gastrointestinal disease and its treatment remains challenging.
AIM To evaluate the efficacy and safety of Chinese herbal medicine (CHM) on efficacy rate, global symptoms, bowel movements and the Bristol Stool Scale score in patients with FC by summarizing current available randomized controlled trials (RCTs).
METHODS RCTs with CHM to treat FC were identified by a systematic search of six databases from inception to October 20, 2020. Two independent reviewers assessed the quality of the included articles and extracted data. Meta-analyses were performed to odds ratio (OR), mean differences (MD) and 95% confidence interval (CI) using random-effects models. Subgroup analyses and sensitivity analyses were used to explore and interpret the sources of heterogeneity. The funnel plot, Begg’s test and Egger’s test were used to detect publication bias.
RESULTS Ninety-seven studies involving 8693 patients were included in this work. CHM was significantly associated with a higher efficacy rate (OR: 3.62, 95%CI: 3.19-4.11, P < 0.00001) less severe global symptoms (OR: 4.03, 95%CI: 3.49-4.65, P < 0.00001) compared with control treatment, with the low heterogeneity between studies (I2 = 0%, P = 0.76). CHM was also associated with more frequent bowel movements (MD 0.83, 95%CI: 0.67-0.98, P < 0.00001), a lower score on the Bristol Stool Scale (OR: 1.63, 95%CI: 1.15-2.32, P < 0.006), and a not significant recurrence rate (OR: 0.47, 95%CI: 0.22-0.99, P = 0.05). No serious adverse effects of CHM were reported.
CONCLUSION In this meta-analysis, we found that CHM may have potential benefits in increasing the number of bowel movements, improving stool characteristics and alleviating global symptoms in FC patients. However, a firm conclusion could not be reached because of the poor quality of the included trials. Further trials with higher quality are required.
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Affiliation(s)
- Zipan Lyu
- Teaching and Research Division, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR 99977, China
| | - Yibo Fan
- Teaching and Research Division, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR 99977, China
| | - Yang Bai
- Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Tao Liu
- Department of Digestive Endoscope Center, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Linda LD Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China
| | - Hui-Feng Liang
- The Institute for Science, Technology and Humanities, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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11
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A high-fibre personalised dietary advice given via a web tool reduces constipation complaints in adults. J Nutr Sci 2022; 11:e31. [PMID: 35573462 PMCID: PMC9066321 DOI: 10.1017/jns.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022] Open
Abstract
Constipation can greatly impact the quality of life (QoL), which can be relieved by dietary fibres; however, preserving a higher fibre intake remains a challenge. We investigated the effects of a personalised dietary advice (PDA) on fibre intake and mild constipation complaints. A total number of twenty-five adults with mild constipation complaints were included in a 4-week observation period followed by a 4-week personalised intervention. The PDA provided high-fibre alternatives via a web tool. In weeks 1, 4 and 8, dietary intake, constipation complaints and QoL were assessed. Furthermore, participants collected a faecal sample at weeks 1, 4 and 8 to determine microbiota diversity and composition, and short-chain fatty acids (SCFA). Participants completed questions daily for 8 weeks regarding abdominal complaints, stool frequency and stool consistency. Fibre intake in week 8 was significantly higher compared to week 1 (Δ = 5·7 ± 6·7 g, P < 0·001) and week 4 (Δ = 5·2 ± 6·4 g, P < 0·001). Constipation severity and QoL significantly improved at week 8 compared to the observation period (P < 0·001). A higher fibre intake significantly reduced constipation severity (β = -0·031 (-0·05; -0·01), P = 0·001) and the QoL (β = -0·022 (-0·04; -0·01), P = 0·009). Stool consistency (P = 0·040) and abdominal pain (P = 0·030) improved significantly during the intervention period (P = 0·040), but stool frequency did not. Average microbial alpha diversity and composition and SCFA concentrations did not change over time, but indicated individual-specific dynamics. Several SCFAs were associated with constipation complaints. To conclude, a PDA effectively increased fibre intake and subsequently reduced constipation complaints, indicating that guided dietary adjustments are important and feasible in the treatment of mild constipation complaints.
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Key Words
- BMI, body mass index
- Constipation
- Dietary fibre
- EMA, ecological momentary assessment
- FFQ, food frequency questionnaire
- Functional bowel disorders
- IBS-C, Irritable Bowel Syndrome constipation predominant
- MET, metabolic equivalent task
- PAC-QoL, Patient Assessment of Constipation Quality of Life
- PAC-SYM, Patient Assessment of Constipation Symptoms
- PDA, personalised dietary advice
- Personalised nutrition
- QoL, quality of life
- Quality of life
- SQUASH, short questionnaire to assess health-enhancing physical activity
- VAS, visual analogue scale
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12
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Mechanisms of Action of Current Pharmacologic Options for the Treatment of Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation. Am J Gastroenterol 2022; 117:S6-S13. [PMID: 35354770 DOI: 10.14309/ajg.0000000000001687] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
Multiple therapeutic agents are currently available for the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation. A better understanding of the mechanism of action of each treatment provides important insights into expected responses and is key to optimizing treatment outcomes. Some constipation treatments, such as stimulant laxatives, may increase bowel movement frequency but are ineffective at relieving, and may even exacerbate, abdominal symptoms. On the contrary, prescription treatments, such as the guanylyl cyclase-C agonists, for example, may improve bowel symptoms and reduce visceral hypersensitivity. This review summarizes the mechanisms of action of commonly used over-the-counter and prescription therapies for chronic idiopathic constipation and irritable bowel syndrome with constipation, outlining how these mechanisms contribute to the efficacy and safety of each treatment option.
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13
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Brigstocke S, Yu V, Nee J. Review of the Safety Profiles of Laxatives in Pregnant Women. J Clin Gastroenterol 2022; 56:197-203. [PMID: 35050942 DOI: 10.1097/mcg.0000000000001660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Chronic constipation is one of the most common complaints seen in the gastroenterology clinic and is particularly prevalent in women. Women who become pregnant may suffer from existing constipation or develop constipation de novo. A thorough understanding of the safety of laxative therapies during pregnancy and the postpartum period is essential to successfully treating these women. Current understanding of the safety of both over the counter and prescription laxatives has not been adequately evaluated. In this article we provide an updated and comprehensive review of the safety profiles of laxatives that are currently used for the treatment of chronic constipation to aid the clinician in risk-benefit discussions with women who are currently or planning to become pregnant.
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Affiliation(s)
- Sophie Brigstocke
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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14
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Guan ZW, Yu EZ, Feng Q. Soluble Dietary Fiber, One of the Most Important Nutrients for the Gut Microbiota. Molecules 2021; 26:molecules26226802. [PMID: 34833893 PMCID: PMC8624670 DOI: 10.3390/molecules26226802] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022] Open
Abstract
Dietary fiber is a widely recognized nutrient for human health. Previous studies proved that dietary fiber has significant implications for gastrointestinal health by regulating the gut microbiota. Moreover, mechanistic research showed that the physiological functions of different dietary fibers depend to a great extent on their physicochemical characteristics, one of which is solubility. Compared with insoluble dietary fiber, soluble dietary fiber can be easily accessed and metabolized by fiber-degrading microorganisms in the intestine and produce a series of beneficial and functional metabolites. In this review, we outlined the structures, characteristics, and physiological functions of soluble dietary fibers as important nutrients. We particularly focused on the effects of soluble dietary fiber on human health via regulating the gut microbiota and reviewed their effects on dietary and clinical interventions.
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Affiliation(s)
- Zhi-Wei Guan
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Department of Human Microbiome, School of Stomatology, Shandong University, Jinan 250012, China; (Z.-W.G.); (E.-Z.Y.)
- School of Life Science, Qi Lu Normal University, Jinan 250200, China
| | - En-Ze Yu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Department of Human Microbiome, School of Stomatology, Shandong University, Jinan 250012, China; (Z.-W.G.); (E.-Z.Y.)
| | - Qiang Feng
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Department of Human Microbiome, School of Stomatology, Shandong University, Jinan 250012, China; (Z.-W.G.); (E.-Z.Y.)
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
- Correspondence:
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15
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Nguyen T. The Role of Docusate for Constipation in Older People. Sr Care Pharm 2021; 36:501-507. [PMID: 34593092 DOI: 10.4140/tcp.n.2021.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To provide brief information on the effectiveness of docusate use for constipation in older people. Data Sources: PubMed search using the following terms ("docusate and chronic constipation," "docusate, chronic constipation and geriatric," "docusate, chronic constipation and older adult," "docusate and randomized controlled trial" and included relevant information related to docusate and chronic constipation in the population described. Study Selection: Studies that fit the criteria for "chronic/general constipation," "geriatric/older adults," and/or "randomized controlled trials" were included. Four studies described docusate for chronic/general constipation and older people. Not included were other studies not related to chronic/general constipation and older people (eg, surgery-related). Data Extraction: Data extraction from each study included primary outcomes related to chronic constipation and efficacy of docusate. Data also included relevant reports from other relevant trials and discussions. Data Synthesis: Docusate when compared with placebo or psyllium or sennosides in these trials did not show any benefits for constipation. Psyllium and sennosides showed to be more effective compared with docusate. No differences found between docusate versus placebo. In summary, there is a lack of data to support the use of docusate for constipation and the data presented that docusate is not effective for use in constipation. Conclusion: Docusate is commonly used for constipation despite little evidence supporting its efficacy. There is not enough randomized controlled trial and data to support the use of docusate for constipation. Pharmacists along with health care providers should reassess and reconsider whether to use it and add extra layers to an already complex medication regimen in the older adult population.
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16
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Naseer M, Poola S, Uraz S, Tahan V. Therapeutic Effects of Prebiotics on Constipation: A Schematic Review. ACTA ACUST UNITED AC 2021; 15:207-215. [PMID: 32048977 DOI: 10.2174/1574884715666200212125035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
Constipation is a highly prevalent functional gastrointestinal disorder that may significantly affect the quality of life and health care costs. Treatment for constipation has been broadly reviewed by cognitive therapies, medications, and surgical interventions. Gut microbiota such as Bifidobacterium, Clostridium, Bacteroidetes, and Lactobacilli have been demonstrated in functional gastrointestinal disorders and prebiotics to play a role in augmenting their presence. Prebiotics are ingredients in foods that remain undigested, stimulating the bacteria. There are a variety of prebiotics; however, there exists only a handful of studies that describe their efficacy for chronic constipation. The purpose of this study is to review the available literature on the utility of different commercially available prebiotics in patients with functional and chronic idiopathic constipation. To fulfil the objectives of the study, published articles in the English language on databases such as Pubmed, Ovid Medline, and EMBASE were searched. The terms prebiotics, constipation, chronic constipation, functional constipation were used. We reviewed and included 21 randomized controlled trials exploring the role of prebiotics in constipated adults. Prebiotics are effective treatments for chronic idiopathic constipation and showed improvement in the stool consistency, number of bowel moments and bloating. Although which prebiotic formulary would promote improved symptoms of constipation is still not clear.
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Affiliation(s)
- Maliha Naseer
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, East Carolina University, Greenville, NC 27834, United States
| | - Shiva Poola
- Department of Internal and Pediatric Medicine, East Carolina University, Greenville, NC 27834, United States
| | - Suleyman Uraz
- Department of Internal Medicine, University of Missouri, Division of Gastroenterology and Hepatology, Columbia, MO 65211, United States
| | - Veysel Tahan
- Department of Internal Medicine, University of Missouri, Division of Gastroenterology and Hepatology, Columbia, MO 65211, United States
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17
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Akram M, Thiruvengadam M, Zainab R, Daniyal M, Bankole MM, Rebezov M, Shariati MA, Okuskhanova E. Herbal Medicine for the Management of Laxative Activity. Curr Pharm Biotechnol 2021; 23:1269-1283. [PMID: 34387161 DOI: 10.2174/1389201022666210812121328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 11/22/2022]
Abstract
Constipation is one of the most common and prevalent chronic gastrointestinal conditions across the globe that is treated or managed through various methods. Laxatives are used for the treatment or management of chronic/acute constipation. But due to the adverse effects associated with these laxatives, herbal foods should be considered as alternative therapies for constipation. In this review, the laxative potential of plant-based medicines used for constipation were discussed. Constipation may be caused by various factors such as lifestyle, particular food habits, pregnancy and even due to some medication. Chronic constipation is responsible for different health issues. Pharmacological and non-pharmacological paradigms are applied for the treatment or management of constipation. In the pharmacological way of treatment, medicinal plants have a key role, because of their fibrous nature. Numerous plants such as Prunus persica (Rosaceae), Cyamopsis tetragonolobus (Leguminosae), Citrus sinensis (Rutaceae), Planta goovata (Plantaginaceae), Rheum emodi (Polygonaceae), Cassia auriculata (Caesalpinacea), Ricinus communis (Euphorbiaceae), Croton tiglium (Euphorbiaceae), Aloe barbadensis (Liliaceae), Mareya micrantha (Euphorbiaceae), Euphorbia thymifolia (Euphorbiaceae), Cascara sagrada (Rhamnaceae), Cassia angustifolia (Fabaceae) have laxative activity. Medicinal plants possess a significant laxative potential and support their folklore therefore, further, well-designed clinical-based studies are required to prove and improve the efficacy of herbal medicine for constipation. The present review showed that herbs laxative effect in various in-vivo/ in-vitro models.
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Affiliation(s)
- Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | - Muthu Thiruvengadam
- Department of Crop Science, College of Sanghuh Life Science, Konkuk University, Seoul 05029. South Korea
| | - Rida Zainab
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | - Muhammad Daniyal
- Faculty of Eastern Medicine, Hamdard University, Karachi. Pakistan
| | - Marc Moboladji Bankole
- African Centre of Excellence (World Bank) Public Health and Toxicological Research (ACE-PUTOR) University of Port Harcourt, Rivers State. Nigeria
| | - Maksim Rebezov
- V. M. Gorbatov Federal Research Center for Food Systems of Russian Academy of Sciences, Moscow. Russian Federation
| | - Mohammad Ali Shariati
- K.G. Razumovsky Moscow State University of Technologies and Management (the First Cossack University), 109004, Moscow. Russian Federation
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18
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Rijnaarts I, de Roos N, Zoetendal EG, de Wit N, Witteman BJM. Development and validation of the FiberScreen: A short questionnaire to screen fibre intake in adults. J Hum Nutr Diet 2021; 34:969-980. [PMID: 34378249 PMCID: PMC9290675 DOI: 10.1111/jhn.12941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/28/2021] [Indexed: 01/10/2023]
Abstract
Background Health effects of dietary fibres are the topic of many studies. Eligibility criteria often include a certain fibre intake, which requires dietary screening during recruitment. However, dietary assessment methods are extensive and burdensome for both the researcher and participant. Therefore, we developed and validated a short questionnaire (FiberScreen) to screen fibre intake. Methods The initial five‐item questionnaire assessed fruit, vegetable, whole grain, pasta/rice/potato and legume intake. The optimised FiberScreen included 18 items, which further specified intake of the above‐mentioned categories, and included nuts and seeds. The FiberScreen was completed during two fibre promoting interventions. In Study A, participants without constipation completed the five‐item FiberScreen and a food frequency questionnaire (FFQ) during screening (n = 131), and the 18‐item FiberScreen and a FFQ at 3‐month follow‐up (n = 87). In Study B, 29 constipated participants completed the 18‐item FiberScreen at screening and a FFQ during the first study visit. Results The fibre estimate from the five‐item FiberScreen and the FFQ was moderately correlated (r = 0.356, p < 0.001). Importantly, the 18‐item FiberScreen and FFQ, when data of both studies were combined, had a strong correlation (r = 0.563, p < 0.001). The 18‐item FiberScreen had a lower fibre estimate compared to the FFQ (Δ = 1.2 ± 5.9 g, p = 0.030) but the difference was relatively small. Bland–Altman plots showed a good agreement between the questionnaires. Completion time of the 18‐item FiberScreen was 4.2 ± 2 min. Conclusions The 18‐item FiberScreen is a suitable short screening questionnaire for ranking the fibre intake of adults. The 18‐item FiberScreen can help to reduce screening burden for both the participant and researcher.
Dietary screening during recruitment is more elaborate than is often needed, and burdensome for both the researcher and participant. An 18‐item FiberScreen questionnaire to screen fibre intake was developed and validated in Dutch adults with and without gastrointestinal complaints. The 18‐item FiberScreen had a good agreement with a food frequency questionnaire.
Completion time of the 18‐item FiberScreen was around 4 min, compared to 45–60 min for the food frequency questionnaire.
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Affiliation(s)
- Iris Rijnaarts
- Division of Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands.,Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands.,Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, The Netherlands
| | - Nicole de Roos
- Division of Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Erwin G Zoetendal
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Nicole de Wit
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, The Netherlands
| | - Ben J M Witteman
- Division of Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands.,Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
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19
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The composition of Australian Plantago seeds highlights their potential as nutritionally-rich functional food ingredients. Sci Rep 2021; 11:12692. [PMID: 34135417 PMCID: PMC8209032 DOI: 10.1038/s41598-021-92114-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/26/2021] [Indexed: 02/05/2023] Open
Abstract
When wetted, Plantago seeds become covered with a polysaccharide-rich gel called mucilage that has value as a food additive and bulking dietary fibre. Industrially, the dry husk layer that becomes mucilage, called psyllium, is milled off Plantago ovata seeds, the only commercial-relevant Plantago species, while the residual inner seed tissues are either used for low value animal feed or discarded. We suggest that this practice is potentially wasting a highly nutritious resource and here describe the use of histological, physicochemical, and chromatographic analyses to compare whole seed composition/characteristics of P. ovata with 11 relatives already adapted to harsh Australian conditions that may represent novel commercial crop options. We show that substantial interspecific differences in mucilage yield and macromolecular properties are mainly a consequence of differences in heteroxylan and pectin composition and probably represent wide differences in hydrocolloid functionality that can be exploited in industry. We also show that non-mucilage producing inner seed tissues contain a substantial mannan-rich endosperm, high in fermentable sugars, protein, and fats. Whole seed Plantago flour, particularly from some species obtained from harsh Australian environments, may provide improved economic and health benefits compared to purified P. ovata psyllium husk, by retaining the functionality of the seed mucilage and providing additional essential nutrients.
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20
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The effects of psyllium husk on gut microbiota composition and function in chronically constipated women of reproductive age using 16S rRNA gene sequencing analysis. Aging (Albany NY) 2021; 13:15366-15383. [PMID: 34081625 PMCID: PMC8221300 DOI: 10.18632/aging.203095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/04/2021] [Indexed: 12/16/2022]
Abstract
Chronic constipation is a common gastrointestinal disorder that occurs in the elderly and in women. Psyllium husk is widely used to treat this condition. Recent studies have shown that psyllium husk can improve the clinical symptoms of constipation by regulating gut microbiota, but its clinical effects and potential mechanisms in constipated women of reproductive age have not been previously investigated. We compared fecal microbiota after treatment with placebo (n = 29) and psyllium husk (n = 25) using 16S ribosomal ribonucleic acid (rRNA) gene sequencing analysis. Psyllium husk relieved the symptoms of constipated women of reproductive age. Sequencing results showed that the psyllium husk group exhibited a different gut microbiota composition compared to that of the placebo group. Moreover, network analysis indicated more significant correlations and clustering of operational taxonomic units (OTUs) in the psyllium husk group. Kyoto Encyclopedia of Genes and Genomes (KEGG) annotation analysis showed that the relative abundances of metabolism-related KEGG pathways were enriched in the psyllium husk group. In conclusion, these findings suggest that the composition of gut microbiota was altered and that symptoms of constipation were alleviated via psyllium husk intervention. The changes in metabolic function might be related to constipation. Furthermore, these studies are warranted to elucidate the potential metabolic mechanisms contributing to chronic constipation.
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21
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Abstract
Chronic constipation is one of the five most common symptoms seen by gastroenterologist. In the absence of alarm symptoms, a confident symptom-based diagnosis can often be made using the Rome criteria. Three different subtypes have been identified to date: normal transit constipation, defaecatory disorders and slow transit constipation. Differentiation between these subtypes can be made through functional testing using tests such as anorectal manometry with balloon expulsion and a radio-opaque marker test. In general, patients are initially advised to increase their fluid and fibre intake. When these general lifestyle recommendations do not improve patients' symptoms, a step-wise and add-on treatment approach should be applied. This review summarises the diagnostic criteria to differentiate functional constipation from other causes of chronic constipation. In addition, current drug treatment options, including discussion of new therapeutic targets are discussed. Further, practical treatment approaches (choice and dosing), include discussion of combination/augmentation, treatment failure (adherence/expectations), and relapse prevention are mentioned. Finally, treatment and management of pain and bloating aspects are included.
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Affiliation(s)
- Jasper Pannemans
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Herestraat 49, Box 701, 3000, Leuven, Belgium
| | - Imke Masuy
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Herestraat 49, Box 701, 3000, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Herestraat 49, Box 701, 3000, Leuven, Belgium.
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22
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Abstract
Primary care physicians frequently evaluate patients with constipation. The history is crucial in uncovering warning symptoms and signs that warrant colonoscopy. Particular elements in the history and rectal examination also can provide clues regarding the underlying etiology. Regardless of etiology, lifestyle modifications, fiber, and laxatives are first-line therapies. Patients who fail first-line therapies can be offered second-line treatments and/or referred for testing of defecatory function. In those with severely refractory symptoms, referrals to a gastroenterologist and a surgeon should be considered.
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Affiliation(s)
- David B Snell
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University, 550 First Avenue, New York, NY 10016, USA.
| | - Saamia Faruqui
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University, 550 First Avenue, New York, NY 10016, USA
| | - Brian P Bosworth
- Department of Medicine, New York University, 550 First Avenue, HCC 3-15, New York, NY 10016, USA
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23
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Mishra D, Jain A. A minimalistic approach to benign anorectal pathologies: Retrospective analysis of 100 patients in armed forces. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Gyamfi ET. Assessment of essential and non-essential elements in selected traditional medicines from India, Ghana and China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:1812-1822. [PMID: 32857308 DOI: 10.1007/s11356-020-10607-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
Traditional medicine (TM) also known as folk medicine consists of medical knowledge systems that were developed over generations in various countries before the era of modern medicine. Over the last few years, there has been a shift in universal trend from modern medicine to TM because it is believed that these medicines are non-toxic to humans, have little to no side-effects, are readily available and affordable. The purpose of this study was to investigate the essential and non-essential elemental concentrations of ayurvedic medicines (AM), Ghanaian traditional medicines (GTM) and Chinese traditional medicines (CTM). The results indicate that the mean elemental concentrations in TM varied greatly. The mean concentrations of copper and mercury in AM, GTM and CTM ranged from 4 to 45 mg/kg and 0.01 to 2 mg/kg, respectively. Multivariate statistical analyses applied to recognise inter-element associations indicated that at 0.05 significant level, there was a positive correlation between elements suggesting they may have originated from the same source. The study concludes by highlighting the need for monitoring of the elemental concentrations in commonly consumed traditional medicines regularly to detect contamination in these medicines since the occurrence of metals in these medicines above or below legally permissible limits can be harmful to consumers.
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Affiliation(s)
- Eva T Gyamfi
- Department of Earth and Environmental Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
- Nuclear Chemistry and Environmental Research Centre, Ghana Atomic Energy Commission, National Nuclear Research Institute, P. O. BOX LG 80, Legon, Accra, Ghana.
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25
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White N. A Guide to Recommending Fiber Supplements for Self-Care. Am J Lifestyle Med 2020; 14:589-591. [PMID: 33117099 DOI: 10.1177/1559827620947375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The health benefits of dietary fiber are extensive and wide-ranging, yet most Americans do not consume the recommended amount of fiber from their diet. Fiber supplements may be used as a means to augment a low-fiber diet. But which, if any, of the benefits of dietary fiber are achieved through supplementation? And are all fiber supplements equally effective? An evidence-based approach to recommending fiber supplements for self-care will be discussed.
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Affiliation(s)
- Nicole White
- School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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26
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Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation. J Am Assoc Nurse Pract 2020; 32:15-23. [PMID: 31764399 DOI: 10.1097/jxx.0000000000000346] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Treatment guidelines for chronic idiopathic constipation (CIC) recommend an "increase in fiber intake" as a first-line therapy, but most epidemiologic studies fail to support an association between a high-fiber diet and a reduced risk of constipation. Furthermore, randomized controlled clinical studies show that most isolated fibers (e.g., supplements) are not different from placebo for a laxative effect, and several may be constipating. OBJECTIVES The objective of this review was to compare the effects of two isolated fibers, coarse wheat bran and psyllium, on stool output and stool water content in patients with CIC. This review will also address misconceptions about fiber that are perpetuated by treatment guidelines. DATA SOURCES A comprehensive literature review was conducted with the use of the Scopus, SciFinder, and PubMed scientific databases, limited to the previous 50 years (1968-2018; latest date included, December 31, 2018). CONCLUSIONS In patients with CIC, nonfermented gel-forming psyllium was 3.4 times more effective than insoluble wheat bran for increasing stool output. Both psyllium and coarse wheat bran increased stool water content, a stool-softening effect, but finely ground wheat bran decreased stool water content, a stool-hardening effect. IMPLICATIONS FOR PRACTICE It is a misconception that dietary fiber and all isolated fibers provide a laxative effect in patients with CIC. Our analysis suggests that treatment guidelines for CIC should make specific evidence-based recommendations as it pertains to fiber. To do otherwise takes the risk of perpetuating myth and misunderstanding and depriving patients of an effective therapy for CIC. A generic recommendation to "increase fiber intake" is akin to a recommendation to "increase pill intake" without regard to therapeutic or adverse effects.
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27
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Phan JL, Cowley JM, Neumann KA, Herliana L, O'Donovan LA, Burton RA. The novel features of Plantago ovata seed mucilage accumulation, storage and release. Sci Rep 2020; 10:11766. [PMID: 32678191 PMCID: PMC7366641 DOI: 10.1038/s41598-020-68685-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
Seed mucilage polysaccharide production, storage and release in Plantagoovata is strikingly different to that of the model plant Arabidopsis. We have used microscopy techniques to track the development of mucilage secretory cells and demonstrate that mature P.ovata seeds do not have an outer intact cell layer within which the polysaccharides surround internal columellae. Instead, dehydrated mucilage is spread in a thin homogenous layer over the entire seed surface and upon wetting expands directly outwards, away from the seed. Observing mucilage expansion in real time combined with compositional analysis allowed mucilage layer definition and the roles they play in mucilage release and architecture upon hydration to be explored. The first emergent layer of hydrated mucilage is rich in pectin, extremely hydrophilic, and forms an expansion front that functions to ‘jumpstart’ hydration and swelling of the second layer. This next layer, comprising the bulk of the expanded seed mucilage, is predominantly composed of heteroxylan and appears to provide much of the structural integrity. Our results indicate that the synthesis, deposition, desiccation, and final storage position of mucilage polysaccharides must be carefully orchestrated, although many of these processes are not yet fully defined and vary widely between myxospermous plant species.
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Affiliation(s)
- Jana L Phan
- Australian Research Council Centre of Excellence in Plant Cell Walls, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia.,Australian Academy of Science, Ian Potter House, 9 Gordon St, Canberra, ACT, 2601, Australia
| | - James M Cowley
- Australian Research Council Centre of Excellence in Plant Cell Walls, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia.,Australian Research Council Centre of Excellence in Plant Energy Biology, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia
| | - Kylie A Neumann
- Australian Research Council Centre of Excellence in Plant Cell Walls, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia.,Australian Research Council Centre of Excellence in Plant Energy Biology, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia.,IP Australia, PO Box 200, Woden, ACT, 2606, Australia
| | - Lina Herliana
- Australian Research Council Centre of Excellence in Plant Energy Biology, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia
| | - Lisa A O'Donovan
- Australian Research Council Centre of Excellence in Plant Energy Biology, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia
| | - Rachel A Burton
- Australian Research Council Centre of Excellence in Plant Cell Walls, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia. .,Australian Research Council Centre of Excellence in Plant Energy Biology, School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Urrbrae, SA, 5064, Australia.
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Du D, Wu H. Synthesis and crystal structure of 7-bromo-3,3-dibutyl-8-methoxy-5-phenyl-2,3-dihydrobenzo[ b][1,4]thiazepin-4(5 H)-one. JOURNAL OF CHEMICAL RESEARCH 2020. [DOI: 10.1177/1747519820907877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
7-Bromo-3,3-dibutyl-8-methoxy-5-phenyl-2,3-dihydrobenzo[ b][1,4]thiazepin-4(5 H)-one is prepared from 6-methoxybenzo[ d]thiazol-2-amine and 2-(bromomethyl)-2-butylhexanoic acid as the key starting materials via five simple steps including hydrolysis, substitution, condensation, bromination, and aromatic amidation under microwave conditions. This new route has reduced the reaction time and increased the overall yield to 43%. Moreover, the structure of the target product is also confirmed by X-ray crystal analysis, and further studies indicate that the existence of an intramolecular C–H···C g1 non-classical hydrogen bond is effective in stabilization of the crystal structure.
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Affiliation(s)
- Damin Du
- Department of Physics, Taizhou University, Taizhou, P.R. of China
| | - Haijian Wu
- Advanced Research Institute and Department of Chemistry, Taizhou University, Taizhou, P.R. of China
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Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology 2020; 158:1232-1249.e3. [PMID: 31945360 PMCID: PMC7573977 DOI: 10.1053/j.gastro.2019.12.034] [Citation(s) in RCA: 293] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022]
Abstract
With a worldwide prevalence of 15%, chronic constipation is one of the most frequent gastrointestinal diagnoses made in ambulatory medicine clinics, and is a common source cause for referrals to gastroenterologists and colorectal surgeons in the United States. Symptoms vary among patients; straining, incomplete evacuation, and a sense of anorectal blockage are just as important as decreased stool frequency. Chronic constipation is either a primary disorder (such as normal transit, slow transit, or defecatory disorders) or a secondary one (due to medications or, in rare cases, anatomic alterations). Colonic sensorimotor disturbances and pelvic floor dysfunction (such as defecatory disorders) are the most widely recognized pathogenic mechanisms. Guided by efficacy and cost, management of constipation should begin with dietary fiber supplementation and stimulant and/or osmotic laxatives, as appropriate, followed, if necessary, by intestinal secretagogues and/or prokinetic agents. Peripherally acting μ-opiate antagonists are another option for opioid-induced constipation. Anorectal tests to evaluate for defecatory disorders should be performed in patients who do not respond to over-the-counter agents. Colonic transit, followed if necessary with assessment of colonic motility with manometry and/or a barostat, can identify colonic dysmotility. Defecatory disorders often respond to biofeedback therapy. For specific patients, slow-transit constipation may necessitate a colectomy. No studies have compared inexpensive laxatives with newer drugs with different mechanisms. We review the mechanisms, evaluation, and management of chronic constipation. We discuss the importance of meticulous analyses of patient history and physical examination, advantages and disadvantages of diagnostic testing, guidance for individualized treatment, and management of medically refractory patients.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Influence of Lactitol and Psyllium on Bowel Function in Constipated Indian Volunteers: A Randomized, Controlled Trial. Nutrients 2019; 11:nu11051130. [PMID: 31117218 PMCID: PMC6566185 DOI: 10.3390/nu11051130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 12/11/2022] Open
Abstract
Psyllium and lactitol have been reported to increase fecal volume, moisture content and bowel movement frequency (BMF). However, the benefits of their combined use on constipation has not been examined. The aim of this study was to evaluate the effects of a 4-week intervention with lactitol and/or psyllium on bowel function in constipated volunteers. Adults (N = 172) who were diagnosed with functional constipation per Rome III criteria were randomized to four treatment groups: 10 g lactitol, 3.5 g psyllium, a combination of 10 g lactitol and 3.5 g psyllium, or placebo. The primary endpoint was change in BMF from Day 0 to 28 as compared to placebo. Secondary endpoints were assessed by inventories, including stool consistency, patient assessment of constipation symptoms and quality of life, relief of constipation, 24-h food recall, physical activity, product satisfaction and adverse events (AE). BMF increased by 3.0 BMs with lactitol, by 2.9 with psyllium, and by 3.1 with the combination, but was not different from placebo (3.7 BMs). Other clinical endpoints were similar between treatments. No serious AEs were reported. In conclusion, this study showed a similar effect on relief of constipation in all treatment groups. The treatments that were administered to the volunteers were well tolerated.
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Eady SL, Wallace AJ, Butts CA, Hedderley D, Drummond L, Ansell J, Gearry RB. The effect of 'Zesy002' kiwifruit ( Actinidia chinensis var. chinensis) on gut health function: a randomised cross-over clinical trial. J Nutr Sci 2019; 8:e18. [PMID: 31080591 PMCID: PMC6498757 DOI: 10.1017/jns.2019.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Functional gastrointestinal disorders including constipation affect up to 14 % of the world's population. Treatment is difficult and challenging resulting in a need for alternative safe and effective therapies. The present study investigated whether daily consumption of three gold-fleshed kiwifruit could alleviate constipation and improve gastrointestinal discomfort in mildly constipated individuals with and without pain. A total of thirty-two participants were enrolled in a 16-week randomised, single-blind, crossover study. Participants received either three 'Zesy002' kiwifruit or 14·75 g Metamucil® (5 g dietary fibre/d (a positive control)) for 4 weeks each with a 4-week washout between treatments. A 2-week washout period was included at the beginning and end of the study. Daily bowel habit diaries were kept throughout the study. The primary outcome measure was differences in the number of complete spontaneous bowel movements (CSBM). Secondary outcome measures were bowel movement frequency and stool form as well as digestive symptoms and comfort. The number of CSBM per week was significantly greater during daily consumption of three kiwifruit compared with the baseline (6·3 v. 3·3; P < 0·05) and the Metamucil® treatment (6·3 v. 4·5; P < 0·05). Stool consistency was also improved, with kiwifruit producing softer stools and less straining (P < 0·05). Gastrointestinal discomfort was also improved compared with baseline for abdominal pain, constipation and indigestion (P < 0·05) during the kiwifruit intervention and constipation during the Metamucil® intervention (P < 0·05). This randomised controlled trial demonstrates that daily consumption of three gold-fleshed kiwifruit is associated with a significant increase of two CSBM per week and reduction in gastrointestinal discomfort in mildly constipated adults.
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Affiliation(s)
- Sarah L. Eady
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, New Zealand
| | - Alison J. Wallace
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, New Zealand
| | - Christine A. Butts
- The New Zealand Institute for Plant & Food Research Limited, Palmerston North, New Zealand
| | - Duncan Hedderley
- The New Zealand Institute for Plant & Food Research Limited, Palmerston North, New Zealand
| | - Lynley Drummond
- Drummond Food Science Advisory Limited, Christchurch, New Zealand
| | - Juliet Ansell
- Zespri International Ltd, Mount Maunganui, New Zealand
| | - Richard B. Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Clayton ZS, Fusco E, Schreiber L, Carpenter JN, Hooshmand S, Hong MY, Kern M. Snack selection influences glucose metabolism, antioxidant capacity and cholesterol in healthy overweight adults: A randomized parallel arm trial. Nutr Res 2019; 65:89-98. [PMID: 30952505 DOI: 10.1016/j.nutres.2019.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022]
Abstract
Including carbohydrate/fructose-rich foods (predominantly fruit) in the diets of overweight individuals can improve chronic disease risk factors. We hypothesized dried plums (DP) would improve nutrient consumption, total antioxidant capacity (TAC), lipid and adipokine profiles, and would decrease adiposity and inflammation. To test this, we studied the effects of 8-weeks of twice-daily snacking of macronutrient-matched 100kcal servings of DP or refined carbohydrate-rich snack (low-fat muffins: LFM) on daily energy and nutrient consumption, and chronic disease risk factors in overweight adults. Body weight/composition, waist circumference, blood pressure, plasma glucose, insulin, c-peptide, lipids, TAC, adipokines and inflammation were measured at baseline and throughout the study. Postprandial glucose and insulin were assessed following assigned test foods at baseline and 8-weeks. Repeated measures ANOVAs were undertaken to examine group and time differences. Post-hoc independent and paired samples t-tests were conducted where necessary. DP increased (P<.05) overall intake of dietary fiber and potassium, and TAC, from baseline to 8-weeks. Baseline postprandial glycemia tended (P=.09) to be lower with DP versus LFM, while both groups had a decreased response after 8-weeks. Postprandial insulinemia was lower (P<.05) for DP at both time-points. No differences in body weight/composition, blood pressure, or fasting glucose, insulin, triglycerides, total cholesterol, HDL-C, inflammation or adipokines were detected. Low-density lipoprotein cholesterol (LDL-C) increased (P<.05) throughout the trial following LFM. Overall, DP lessened postprandial insulinemia, improved nutrient consumption and plasma TAC, and maintained plasma LDL-C compared to a macronutrient-matched refined carbohydrate snack, which could decrease chronic disease risk.
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Affiliation(s)
- Zachary S Clayton
- San Diego State University, Department of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182.
| | - Elizabeth Fusco
- San Diego State University, Department of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182.
| | - Lisa Schreiber
- San Diego State University, Department of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182.
| | - Jennifer N Carpenter
- San Diego State University, Department of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182.
| | - Shirin Hooshmand
- San Diego State University, Department of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182.
| | - Mee Young Hong
- San Diego State University, Department of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182.
| | - Mark Kern
- San Diego State University, Department of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego, CA 92182.
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Fu X, Li R, Zhang T, Li M, Mou H. Study on the ability of partially hydrolyzed guar gum to modulate the gut microbiota and relieve constipation. J Food Biochem 2018; 43:e12715. [PMID: 31353659 DOI: 10.1111/jfbc.12715] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/29/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Abstract
The aim of this study was to evaluate the effects of high- (HHGG, Mw 10,000-30,000 Da) and medium-molecular-weight (MHGG, Mw 2,000-10,000 Da) partially hydrolyzed guar gum (PHGG) on modulation of gut microbiota and relief of constipation in mice. Mice were treated with galacto-oligosaccharide (GOS) and xylo-oligosaccharide (XOS) at a dose of 1 g/kg bw as positive controls. Low- and high-dose HHGG and MHGG groups received 250 mg or 1 g/kg bw, respectively. Treatment was administered intragastrically for 15 days, and constipation model was induced by loperamide lavage at d 16. PHGG could increase fecal moisture and small intestinal transit and shortened the time to first black stool defecation after constipation. The highest short-chain fatty acid production was observed in the high-dose MHGG group. Additionally, PHGG, GOS, and XOS predominantly promoted the accumulation of Bacteroidetes and inhibited the growth of Desulfovibrio. This study suggested that MHGG treatment could elicit constipation relief in mice. PRACTICAL APPLICATIONS: In this study, partially hydrolyzed guar gum (PHGG) produced by mannanase hydrolysis was applied for the relieving constipation in mice. The medium-molecular-weight product (Mw 2,000-10,000 Da) could elicit constipation relief and modulate the gut microbiota in mice, which shows the potential to act as dietary fiber for constipation treatment.
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Affiliation(s)
- Xiaodan Fu
- College of Food Science and Engineering, Ocean University of China, Qingdao, China
| | - Rong Li
- Qingdao Women and Children Hospital, Qingdao, China
| | - Tan Zhang
- College of Food Science and Engineering, Ocean University of China, Qingdao, China
| | - Meng Li
- College of Food Science and Engineering, Ocean University of China, Qingdao, China
| | - Haijin Mou
- College of Food Science and Engineering, Ocean University of China, Qingdao, China
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Affiliation(s)
- John O'Grady
- Department of Medicine and APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland.
| | - Fergus Shanahan
- Department of Medicine and APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland
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Abstract
PURPOSE OF REVIEW To evaluate and report current evidence regarding the management of bowel dysfunction in spinal cord injury. There is a paucity of high-quality large studies on which to base management advice. RECENT FINDINGS Recent research has focused on defining the nature of symptomatology of bowel dysfunction in SCI and describing the effects on quality of life and social interactions. Technical aspects of colonoscopy have received attention, and aspects of understanding the pathophysiology in relation to both neural and non-neural dysfunction have been studied. There has been refinement and expansion of the pharmacological and non-pharmacological treatment options for bowel dysfunction in SCI. Management of bowel dysfunction in SCI requires a comprehensive and individualized approach, encompassing lifestyle, toileting routine, stimulation, diet, medications, and surgery. Further high-quality research is required to inform best practice.
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Affiliation(s)
- Zhengyan Qi
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- The University of Sydney, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Kolling Institute of Medical Research, Level 12, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Allison Malcolm
- Neurogastroenterology Unit and Department of Gastroenterology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- The University of Sydney, Sydney, Australia.
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Islam BN, Sharman SK, Browning DD. Clinical utility of plecanatide in the treatment of chronic idiopathic constipation. Int J Gen Med 2018; 11:323-330. [PMID: 30127634 PMCID: PMC6089121 DOI: 10.2147/ijgm.s125051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Constipation is an important health burden that reduces the quality of life for countless millions of people. Symptom-centric therapeutics are often used to treat constipation due to unknown etiology, but in many cases, these drugs are either inadequate or have significant side effects. More recently, synthetic peptide agonists for epithelial guanylyl cyclase C (GC-C) have been developed which are effective at treating constipation in a sub-population of adult constipation patients. The first to market was linaclotide that is structurally related to the diarrheagenic enterotoxin, but this was followed by plecanatide, which more closely resembles endogenous uroguanylin. Both the drugs exhibit almost identical clinical efficacy in about 20% of patients, with diarrhea being a common side effect. Despite the potential for reduced side effects with plecanatide, detailed analysis suggests that clinically, they are very similar. Ongoing clinical and preclinical studies with these drugs suggest that treating constipation might be the tip of the iceberg in terms of clinical utility. The expression of cGMP signaling components could be diagnostic for functional bowel disorders, and increasing cGMP using GC-C agonists or phosphodiesterase inhibitors has huge potential for treating enteric pain, ulcerative colitis, and for the chemoprevention of colorectal cancer.
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Affiliation(s)
- Bianca N Islam
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA, USA,
| | - Sarah K Sharman
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA, USA,
| | - Darren D Browning
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA, USA,
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Noureddin S, Mohsen J, Payman A. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med 2018; 40:1-7. [PMID: 30219432 DOI: 10.1016/j.ctim.2018.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/09/2018] [Accepted: 07/03/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To compare the effects of baked psyllium supplementation versus those who received a placebo on constipation symptoms, body weight, glycemic and lipids control in patients with type 2 diabetes (T2D) and chronic constipation. METHODS In a single-blinded, randomized controlled trial, 51 patients with T2D and chronic constipation with body mass index (BMI) 20-47 kg/m2 received either 10 g of psyllium pre-mixed in cookies twice per day or placebo cookies for 12 weeks. Constipation symptoms, body mass index (BMI), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and lipid profile were determined at the beginning and end of 4, 8, and 12-week period. Constipation was evaluated with a stool diary (ROME III). RESULTS The psyllium group showed improvement in constipation symptoms, body weight, glucose and lipid values compared with the baseline and the placebo group. Body weight and FPG decreased from baseline in the psyllium group (P < 0.001 and P = 0.056, respectively). The differences (95% CI) of absolute change of body weight (-2.0 (-3.0, -1.0) kg; P < 0.001), FPG (-13.6 (-24.3, -2.9) mg/dl; P = .040), and HbA1c (-1.7 (-2.9, -0.5)); P = 0.002) between the groups were statistically significant. Cholesterol (-21.5 (-25.6, -14.4); P < 0.001), triglycerides (-20.0 (-32.3, -7.7); P = 0.021) and constipation symptoms (1.5 (0.4, 2.3); P < 0.001) decreased in the psyllium group. The compliance was good and no adverse effects were observed. CONCLUSION In patients with T2D and chronic constipation, psyllium supplementation decreased constipation symptoms, body weight, glycemic, cholesterol, and increased HDLC levels.
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Affiliation(s)
- Soltanian Noureddin
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Janghorbani Mohsen
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Adibi Payman
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Sethi T. Constipation. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pang PKM, Lim B, Lee KP, Lok CL, Chung CS, Ngan HK. How Evidence-Based is our Practice in a Hong Kong Emergency Department? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate how evidence-based our daily practice was. Design Retrospective study. Setting Emergency department of a public district hospital. Patients and Methods Between 1st August 2000 to 7th August 2000, 91 patients' records were chosen at random. A chief diagnosis was assigned for each patient. Corresponding treatments were reviewed by searching relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses. Each patient had only one chief diagnosis but could have multiple interventions for that diagnosis. Results Out of 91 records, 14 were discarded. All of them had not been given any intervention and 11 required admission. For the remaining 77 records, there were 38 subjects in medical, paediatric, or gynaecological specialties and 39 in surgical or orthopaedic specialties. Intervention(s) given for each subject were then searched electronically through our hospital Knowledge Gateway and the results were expressed as either EBM-positive or EBM-negative. “EBM-positive” interventions denoted a support by RCTs. “EBM-negative” interventions denoted an absence of any supportive RCTs. Each patient might have EBM-positive and/or EBM-negative interventions together if that patient received more than one treatment. There were 52 patients (52/77 = 68%) who had one of their interventions being RCT-supported. The majority were patients with (1) antipyretic use of paracetamol in upper respiratory tract infection, or (2) control of pain by nonsteroidal anti-inflammatory drug, dologesic and paracetamol. There were 25 patients (25/77 = 32%) who did not receive any RCT-supported interventions. Concurrently 53 patients out of 77 (69%) received EBM-negative interventions. The majority were patients with (1) the use of antibiotics, antitussives and antihistamines in upper respiratory tract infection, (2) antispasmodics in gastroenteritis or patients with nonspecific abdominal pain, and (3) the use of analgesic balm in minor orthopaedic complaints. Conclusion Sixty-eight percent of patients had EBM-positive interventions. Thirty-two percent of patients did not receive any EBM-positive intervention. It was quite encouraging as compared to studies in other specialties with similar design. Concurrently 69% of patients had also been given EBM-negative interventions. There were areas for improvement if we were to implement EBM practice in the emergency department.
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Affiliation(s)
- PKM Pang
- Yan Chai Hospital, Accident and Emergency Department, Tsuen Wan, N.T., Hong Kong
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Shamloufard P, Kern M, Hooshmand S. Bowel function of postmenopausal women: Effects of daily consumption of dried plum. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2017. [DOI: 10.1080/10942912.2016.1266498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pouneh Shamloufard
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Mark Kern
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Shirin Hooshmand
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
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El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med 2017; 40:607-613. [PMID: 28731144 PMCID: PMC5548066 DOI: 10.3892/ijmm.2017.3072] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/09/2017] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly fermentable dietary fiber, such as oligosaccharides results in rapid gas production that can cause abdominal pain/discomfort, abdominal bloating/distension and flatulence in patients with IBS. By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS. Dietary fiber acts on the gastrointestinal tract through several mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation byproducts, particularly short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management.
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Affiliation(s)
- Magdy El-Salhy
- Division of Gastroenterology, Department of Medicine, Stord Hospital, 5416 Stord, Norway
| | - Synne Otterasen Ystad
- National Centre for Functional Gastrointestinal Disorders, Department of Medicine, Haukeland University Hospital, 5020 Bergen, Norway
| | - Tarek Mazzawi
- Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Doris Gundersen
- Department of Research and Innovation, Helse-Fonna, 5528 Haugesund, Norway
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Luo D, Qu C, Lin G, Zhang Z, Xie J, Chen H, Liang J, Li C, Wang H, Su Z. Character and laxative activity of polysaccharides isolated from Dendrobium officinale. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Laxative Effects of Dietary Supplementation with Sujiaonori Algal Biomaterial in Japanese Adult Women with Functional Constipation: A Case Study. J Funct Biomater 2017; 8:jfb8020015. [PMID: 28505119 PMCID: PMC5491996 DOI: 10.3390/jfb8020015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/07/2017] [Accepted: 05/11/2017] [Indexed: 12/17/2022] Open
Abstract
Constipation is a gastrointestinal motility disorder that represents a major health problem in Japan. Approximately 26% of young Japanese adult women are reported to have this complaint. We report on the health effects of daily intake of Sujiaonori algal biomaterial (SBM) on constipation on 12 Japanese adult women. Data are from a four-week dietary intervention study on the health effects of daily Sujiaonori supplementation on cardiovascular, skin, and gastrointestinal health in which 32 adult Japanese volunteers (age range: 20-54 years) participated. They underwent clinical and laboratory investigations, and completed two study questionnaires (the brief diet history questionnaire (BDHQ) and the current health questionnaire) before and after dietary intervention. Of the 12 women volunteers with functional constipation, there were six SBM-supplemented subjects who received 3 g of Sujiaonori powder twice daily during meal, whereas the six others (controls) were from the group of those who took 3 g of a power made of 70% corn starch and 30% Japanese spinach mixture. The analysis of data on daily nutrient intake showed no significant dietary changes for nutrients (minerals, proteins, fiber, fat) and calorie intake (except alcohol intake that was reduced) in both groups. In SBM group, a significant reduction of the proportion of women with constipation was observed (p < 0.001), whereas no significant change was noted within the control group (p > 0.05). When both groups were compared, SBM was more effective than the control product; 66.7% (4/6) of SBM-supplemented women had their constipation relieved, whereas only one control (16.7%) controls benefited from dietary intervention (p < 0.001). In addition, no adverse effect was reported in the SBM group, whereas two controls reported nausea at post-survey. These results suggest that Sujiaonori contains compounds that can improve gastrointestinal function and relieve constipation.
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Singh B, Bala R. Radiation formation of psyllium cross-linked poly(hydroxyethylmethacrylate)-co-poly(acrylamide) based sterile hydrogels for drug delivery applications. POLYMER SCIENCE SERIES A 2017. [DOI: 10.1134/s0965545x17030166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Garg P. Psyllium Husk Should Be Taken at Higher Dose with Sufficient Water to Maximize Its Efficacy. J Acad Nutr Diet 2017; 117:681. [PMID: 28449791 DOI: 10.1016/j.jand.2017.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Indexed: 12/31/2022]
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Treatment Algorithm for Chronic Idiopathic Constipation and Constipation-Predominant Irritable Bowel Syndrome Derived from a Canadian National Survey and Needs Assessment on Choices of Therapeutic Agents. Can J Gastroenterol Hepatol 2017; 2017:8612189. [PMID: 28271055 PMCID: PMC5320366 DOI: 10.1155/2017/8612189] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/23/2016] [Accepted: 12/18/2016] [Indexed: 12/15/2022] Open
Abstract
Background. Chronic idiopathic constipation (CIC) and constipation-predominant irritable bowel syndrome (IBS-C) are common functional lower gastrointestinal disorders that impair patients' quality of life. In a national survey, we aimed to evaluate (1) Canadian physician practice patterns in the utilization of therapeutic agents listed in the new ACG and AGA guidelines; (2) physicians satisfaction with these agents for their CIC and IBS-C patients; and (3) the usefulness of these new guidelines in their clinical practice. Methods. A 9-item questionnaire was sent to 350 Canadian specialists to evaluate their clinical practice for the management of CIC and IBS-C. Results. The response rate to the survey was 16% (n = 55). Almost all (96%) respondents followed a standard, stepwise approach for management while they believed that only 24% of referring physicians followed the same approach. Respondents found guanylyl cyclase C (GCC) agonist most satisfying when treating their patients. Among the 69% of respondents who were aware of published guidelines, only 50% found them helpful in prioritizing treatment choices and 69% of respondents indicated that a treatment algorithm, applicable to Canadian practice, would be valuable. Conclusion. Based on this needs assessment, a treatment algorithm was developed to provide clinical guidance in the management of IBS-C and CIC in Canada.
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Prasad VGM, Abraham P. Management of chronic constipation in patients with diabetes mellitus. Indian J Gastroenterol 2017; 36:11-22. [PMID: 27987136 DOI: 10.1007/s12664-016-0724-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/27/2016] [Indexed: 02/04/2023]
Abstract
AIM The aim of this review is to provide an overview of the clinical assessment and evidence-based treatment options for managing diabetes-associated chronic constipation. METHODS A literature search of published medical reports in English language was performed using the OVID Portal, from PUBMED and the Cochrane Database of Systematic Reviews, from inception to October 2015. A total of 145 abstracts were identified; duplicate publications were removed and 95 relevant full-text articles were retrieved for potential inclusion. RESULTS Chronic constipation is one of the most common gastrointestinal symptoms in patients with diabetes, and occurs more frequently than in healthy individuals. Treatment goals include improving symptoms and restoring bowel function by accelerating colonic transit and facilitating defecation. Based on guidelines and data from published literature, food and dietary change with exercise and lifestyle change should be the first step in management. For patients recalcitrant to these changes, laxatives should be the next step of treatment. Treatment should begin with bulking agents such as psyllium, bran or methylcellulose followed by osmotic laxatives if response is poor. Lactulose, polyethylene glycol and lactitol are the most frequently prescribed osmotic agents. Lactulose has a prebiotic effect and a carry-over effect (continued laxative effect for at least 6 to 7 days, post cessation of treatment). Stimulants such as bisacodyl, sodium picosulphate and senna are indicated if osmotic laxatives are not effective. Newer agents such as chloride-channel activators and 5-HT4 agonist can be considered for severe or resistant cases. CONCLUSION The primary aim of intervention in diabetic patients with chronic constipation is to better manage the diabetes along with management of constipation. The physician should explain the rationale for prescribing laxatives and educate patients about the potential drawbacks of long-term use of laxatives. They should contact their physician if short-term use of prescribed laxative fails to provide relief.
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Affiliation(s)
- V G M Prasad
- VGM Hospital, 2100, Trichy Road, Coimbatore, 641 005, India.
| | - Philip Abraham
- P D Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India
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McRorie JW, McKeown NM. Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber. J Acad Nutr Diet 2016; 117:251-264. [PMID: 27863994 DOI: 10.1016/j.jand.2016.09.021] [Citation(s) in RCA: 296] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/20/2016] [Indexed: 12/18/2022]
Abstract
Enduring misconceptions about the physical effects of fiber in the gut have led to misunderstandings about the health benefits attributable to insoluble and soluble fiber. This review will focus on isolated functional fibers (eg, fiber supplements) whose effects on clinical outcomes have been readily assessed in well-controlled clinical studies. This review will also focus on three health benefits (cholesterol lowering, improved glycemic control, and normalizing stool form [constipation and diarrhea]) for which reproducible evidence of clinical efficacy has been published. In the small bowel, clinically meaningful health benefits (eg, cholesterol lowering and improved glycemic control) are highly correlated with the viscosity of soluble fibers: high viscosity fibers (eg, gel-forming fibers such as b-glucan, psyllium, and raw guar gum) exhibit a significant effect on cholesterol lowering and improved glycemic control, whereas nonviscous soluble fibers (eg, inulin, fructooligosaccharides, and wheat dextrin) and insoluble fibers (eg, wheat bran) do not provide these viscosity-dependent health benefits. In the large bowel, there are only two mechanisms that drive a laxative effect: large/coarse insoluble fiber particles (eg, wheat bran) mechanically irritate the gut mucosa stimulating water and mucous secretion, and the high water-holding capacity of gel-forming soluble fiber (eg, psyllium) resists dehydration. Both mechanisms require that the fiber resist fermentation and remain relatively intact throughout the large bowel (ie, the fiber must be present in stool), and both mechanisms lead to increased stool water content, resulting in bulky/soft/easy-to-pass stools. Soluble fermentable fibers (eg, inulin, fructooligosaccharide, and wheat dextrin) do not provide a laxative effect, and some fibers can be constipating (eg, wheat dextrin and fine/smooth insoluble wheat bran particles). When making recommendations for a fiber supplement, it is essential to recognize which fibers possess the physical characteristics required to provide a beneficial health effect, and which fiber supplements are supported by reproducible, rigorous evidence of one or more clinically meaningful health benefits.
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McRorie JW, Chey WD. Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect. Dig Dis Sci 2016; 61:3140-3146. [PMID: 27680987 DOI: 10.1007/s10620-016-4304-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/07/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Misconceptions about the effects of dietary fiber and 'functional' fiber on stool parameters and constipation persist in the literature. METHODS A comprehensive literature review was conducted with the use of the Scopus and PubMed scientific databases to identify and objectively assess well-controlled clinical studies that evaluated the effects of fiber on stool parameters and constipation. RESULTS The totality of well-controlled randomized clinical studies show that, to exert a laxative effect, fiber must: (1) resist fermentation to remain intact throughout the large bowel and present in stool, and (2) significantly increase stool water content and stool output, resulting in soft/bulky/easy-to-pass stools. Poorly fermented insoluble fiber (e.g., wheat bran) remains as discreet particles which can mechanically irritate the gut mucosa, stimulating water & mucous secretion if the particles are sufficiently large/coarse. For soluble fibers, some have no effect on viscosity (e.g., inulin, wheat dextrin) while others form high viscosity gels (e.g., β-glucan, psyllium). If the soluble fiber is readily fermented, whether non-viscous or gel-forming, it has no effect on stool output or stool water content, and has no laxative effect. In contrast, a non-fermented, gel-forming soluble fiber (e.g., psyllium) retains its gelled nature and high water-holding capacity throughout the large bowel, resulting in soft/bulky/easy-to-pass stools. CONCLUSION When considering a recommendation for a fiber supplement regimen to treat and/or prevent constipation, it is important to consider which fibers have the physical characteristics to exert a laxative effect, and which fiber supplements have rigorous clinical evidence of a significant benefit in patients with constipation.
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Affiliation(s)
- Johnson W McRorie
- Global Clinical Sciences, Procter & Gamble, Mason Business Center, 8700 Mason-Montgomery Road, Mason, OH, 45040, USA.
| | - William D Chey
- University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
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