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Best Treatment for Constipation

Constipation is a common problem that affects up to 20 percent of the world’s population. Nearly 60 million Americans suffer from chronic constipation, which is particularly a problem in women and the elderly. It is a pathological condition that is often severe enough to disrupt daily activities and derange quality of life. It responds poorly to available medical remedies and may prompt sophisticated and potentially harmful surgical procedures. Despite all this, it is still frequently considered a trivial issue and affected individuals tend to self-medicate either using over-the-counter laxatives or ‘natural’ remedies, none of which had been adequately investigated. Until now. Fiber supplements can be inconvenient, taste nasty, and cause bloating—even choking. Prunes could present a natural, convenient, tasty alternative, but do they work?

A randomized clinical trial of prunes vs. Metamucil was recently published. I present the results in my 4-min video Prunes vs. Metamucil vs. Vegan Diet. Each dot on the graph represents a complete spontaneous bowel movement. You’ll notice when you watch the video how many had zero a week. Study participants went from an average of 1.7 a week up to 3.5 on prunes (at least one every other day), then back to baseline when prunes were removed. On Metamucil they got up to 2.8  a week. Not as good as the prunes, and a significantly better stool consistency was also noted when using the prunes, as measured by the famous Bristol Stool Scale.

The researchers concluded that treatment with dried plums resulted in a greater improvement in constipation symptoms than the commonly used fiber supplement. Given their palatability, tolerability, and availability, dried plums should be “considered as a first line therapy for chronic constipation.”

If that’s what adding one plant can do, though, what if all you ate was plants? Vegans are off the charts, averaging 10.9!

For more on optimizing bowel function, see:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


17 responses to “Best Treatment for Constipation

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  1. Ahh, you’ve been holding this one in for a while. Thanks for letting it go.

    Please consider doing a post or video on the harmful aspects of senna. It seems a lot of people use this stuff (according to the herbalists and health food store supplement employees.) I’ve been told by herbalists that
    people should not take sennna (then why is it on your retail shelf?) and GI doctors have said to avoid this herb. Apparently there is some bad data on it out there.

    Ripe kiwis.

    1. Having seen many patients over the years who have become reliant on stimulant cathartics like Senna it is nice to see that some research that shows a more natural approach to avoiding this common problem. Our understanding of the science of the GI tract is also getting better so you need to stay tuned as the science just keeps coming. With the exception of certain rare conditions patients should be able to avoid needing to take medications or over the counter supplements.

      1. Dates help too. The problem is that the sorbitol in prunes and apricots can be really painful for sensitive individuals…. The cramps and bloat are beyond painful. What would a person do whom is fodmaps sensitive, yet very constipated, as well as dealing with severe dysbiosis of yeast/fungus/mold/bacteria?

        Lastly, thoughts on coffee enemas?

        1. The trouble with these complex systems is that there is usually not a single correct answer and identifying the “upstream” cause is often difficult. I favor a starch centered approach as advocated by Dr. McDougall. This eliminates alot of the issues with FODMAPS such as sorbitol, galatose and fructose. Starches are just long chain glucose molecules. For complex issues not responsive to fairly straightforward changing of diet to whole plant based starch centered I recommend the “Diet for the Desperate” see McDougall newsletter in Dec 2002. In my experience what works varies from individual to individual and you need to adopt a plan that works for you. In my experience alot of the issues associated with “dysbiosis” resolve as well. Additionally, more recently I have been persuaded by Jeff Smith and his references to recommend non GMO foods… see website, Institute for Responsible Technology. I have no experience with coffee enema’s I would tend to avoid. It is important to work with your physician or other health care professional.

  2. I think prunes are great for constipation, but the gas can be annoying. What about acrylamide in prunes? Because I wasn’t sure about the safety of that, I’ve been using dried apricots. They are more expensive but seem to work ok and with less gas.

  3. Constipation is also business. First the industry removes the fiber so you get a piece of white bread. The lack of fiber makes you constipated, and then the industry will sell you the fiber, that was in the grains to begin with. I would suggest to skip the constipation, and eat the whole grain from the beginning.

  4. Has anyone ever looked into the position we take while evacuating our bowels? Most of the world squats while people using toilets sit; how natural is that? Obviously diet and water intake are the big factors, but I suspect this might also play a role.

  5. I have found as a vegan who had the ol’ gas problem that Dr. Weil’s suggestion of Triphala to work quite well – both for the gas and regularity! I get the 2,000 mg tabs from vitacost.com at a very reasonable price. If
    you go there and order ’em, I would appreciate a reference, as I get some sort of recognition. Thanks Ted “Teddy” Rodosovich teddyrodo@hotmail.com

  6. I am surprised no one is recommending good old fashion greens. Drop a handful of kale, one whole lime, and ice water in the Vitamix first thing in the morning. Hey it works for me.

  7. Best remedy for constipation is a plant based diet of healthy dark leafy greens and beans, or other plants from the garden rather than processed foods from a box.

    Also drinking a good supply of cleaner, purified water using a carbon filter and if necessary reverse osmosis. My minerals come from plants rather than from the water supply.

  8. I’m a vegan but find starches constipating. I can’t eat potatoes or gains of any kind. I take prescription and over the counter laxatives. Any suggestions?

    1. Hey, Paula,

      what about eating more laxative foods? Such as watermelon, lueberries/strawberries, dark leafy greens, aloe vera, raising, chia/flax seeds, etc. :) Sleeping and drinking more water could also help.

      Take care,

      Adam P.

      1. Thanks Adam. I know that helps. I also know that eating too much food, even good food, is bad for me. Why do we keep doing the things we know we shouldn’t?

  9. I’ve been doing a wholefoods vegan diet for a while now, following the advice I get from your videos and articles.

    I am having a problem, though… All this fiber is starting to clog me up. My stomach is so hard, and I am unable to go to the bathroom… I do get some of it out, each day, but just a tiny bit, and it’s extremely hard and compact.

    I drink over 2,5 liters of water every day, and some days even 3,5 liters, so I know I’m getting enough liquids.

    I also train every day, for about 1,5 hours of strength training, with cardio on the weekends.

    What’s going on here? Is my Viking, fish eating heritage betraying me? Am I simply getting way too much fiber? If so, what can I eat to reduce this amount to more manageable levels?

    1. One way of sorting this out is to do a careful food diary for three days and use an online calculator to figure out exactly how much fiber you are getting. If you take in particularly dense fiber foods (eg, loads of lentils or very high fiber cereals), replacing those with more greens might be useful. It does seem you’re getting plenty of water. Best luck!

      Dr Anderson, Health Support Volunteer

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