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Diets for Constipation


Abstract and Figures

Chronic constipation is a very common disease in children. Successful treatment of constipation can be achieved not only with medication but also with lifestyle changes, including a proper diet. Diets including fruits, fluids, and probiotics are good for constipation. Some dietary components are helpful for constipation, and some are harmful. In this study, we present diets related to constipation from the literature, and propose some perspectives regarding diets related to constipation. © 2014 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition.
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pISSN: 2234-8646 eISSN: 2234-8840
Pediatr Gastroenterol Hepatol Nutr 2014 December 17(4):203-208
Review Article
Diets for Constipation
Sun Hwan Bae
Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
Chronic constipation is a very common disease in children. Successful treatment of constipation can be achieved
not only with medication but also with lifestyle changes, including a proper diet. Diets including fruits, fluids, and
probiotics are good for constipation. Some dietary components are helpful for constipation, and some are harmful.
In this study, we present diets related to constipation from the literature, and propose some perspectives regarding
diets related to constipation.
Key Words: Constipation, Diet, Fluid, Child
Received:December 13, 2014, Accepted:December 18, 2014
Corresponding author: Sun Hwan Bae, Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine,
120-1, Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. Tel: +82-2-2030-7554, Fax: +82-2-2030-7748, E-mail:
Copyright 2014 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
his is an openaccess article distributed under the terms of the Creative Commons Attribution NonCommercial License ( which permits
unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The outcome of a disease treatment generally de-
pends on patient or guardian cooperation, partic-
ularly in pediatric patients. In children with func-
tional constipation, the better the patients eat, the
better their bowel movements. This phenomenon is
observed more frequently in young patients with a
defecation diary. This study focuses on diets asso-
ciated with constipation, such as the 3Fs: fluid
(water, juice, and veberage, etc.), fiber, fruits, pro-
biotics, and milk products. Fruits include bananas,
persimmons, kiwifruit, plum, (prune), etc.
The amount of total fiber ingested per day includes
that from dietary and functional fiber sources.
Dietary fiber is nondigestible carbohydrate and lig-
nin that are intrinsic and intact in plants. Functional
fiber includes isolated, nondigestible carbohydrate
that has beneficial physiological effects in humans.
The recommended daily total fiber consumption for
children >1 year is expressed as “age plus 5-(10) g”
or “0.5 g/kg” [1-3]. Common fiber-rich foods include
cereals (rice, corn), bread, vegetables, fruits, pota-
toes (with peel), and whole grains. The mechanism
of action of fiber on constipation includes: 1) Fiber
increases stool bulk and accelerates colon transit; 2)
fermenting fiber produces short-chain fatty acids
(butyrate, propionate, acetate, etc.), which increase
osmotic load and accelerate colon transit; 3)
short-chain fatty acids change the intraluminal mi-
crobiome (mass) directly or indirectly by decreasing
luminal pH, which accelerates colon transit; and 4)
fiber contains water. All these improve stool con-
204    Vol. 17, No. 4, December 2014
Pediatr Gastroenterol Hepatol Nutr
sistency and amount [4-6].
Classically, fiber is classified into water-soluble
and water-insoluble fiber. Water-insoluble fiber in-
cludes cellulose, hemicellulose, methylcelluose, lig-
nin, and synthetic fibers (calcium polycarbophil).
Water-soluble fiber includes gums (fenugreek gum,
guar gum, tara gum, locust bean gum, or carob gum),
pectin, mucilage, psyllium, and glucomannan.
However, this classification is too theoretical to apply
to actual treatment because every component of fi-
ber exists in nature. A more complex classification
for naturally occurring fiber has been proposed.
According to this classification, 1) short-chain carbo-
hydrates or fiber are oligosaccharides. 2) Long-chain
carbohydrates: Soluble, highly fermentable non-
starch polysaccharide fiber includes resistant starch,
pectin, inulin, and guar gum. Intermediate solu-
ble and fermentable fiber includes psyllium, ispa-
ghula and oats. Insoluble, slowly fermentable fi-
ber includes wheat bran, lignin (flax), and fruits and
vegetables. Insoluble, non-fermentable fiberin-
cludes cellulose, sterculia, and methylcellulose [7].
Generally, it is well-known that water-insoluble fi-
ber is helpful for constipation. However, some au-
thors insist that intermediate soluble and ferment-
able fiber is helpful for constipation [7]. The Food
and Drug Administration approved methylcelluose,
psyllium, and polycarbophill for constipation as of
2014. Higher dietary fiber intake (fruits, legumes,
and vegetables) is associated with a lower incidence
of constipation in some studies [8,9]. In terms of
treatment, water-insoluble fiber with wheat bran and
rye bread improves bowel movement frequency and
defecation difficulty significantly [10,11]. However,
the water-soluble fiber (psyllium and glucomannan)
results are conflicting [12-14]. As of 2014, North
American Society for Pediatric Gastroenterology,
Hepatology, and Nutrition (NASPGHAN) and Euro-
pean Society for Paediatric Gastroenterology, Hepa-
tology and Nutrition (ESPGHAN) do not support the
use of fiber supplements in the treatment of func-
tional constipation [15].
For perspective, it is warranted to verify that for
which children and at what point should fiber treat-
ment for constipation begin? How should the fiber
source be selected? Which constipation subtypes
should be considered?
About 10 L of fluid per day, including about 2 L
from the diet, are loaded into the adult gastro-
intestinal tract, and 8.5 L are absorbed by the small
intestine. Another 1.3-1.4 L is absorbed in the colon,
and 0.1-0.2 L is excreted in stool. About 5 L are load-
ed into the gastrointestinal tract of a small child per
day. The absorptive capacity of the small bowel and
colon can increase within a wide range to meet needs
[16]. However, considering toddler’s diarrhea [17],
the absorptive capacity of the small bowel and colon
may not reach maturity at least until 5-6 years of age.
Against common sense that drinking water is help-
ful for constipation, many well-known studies, in-
cluding the 2014 ESPGHAN and ESPGHAN paper,
insist that no evidence supports the use of extra fluid
intake to treat functional constipation [15]. However,
additional fluid during treatment for chronic func-
tional constipation led to better outcomes in terms of
bowel movement frequency and stool consistency in
children who were administered polyethylene glycol
(PEG 4000, Forlax; Beaufour Ipsen Pharma., Paris,
France) (Fig. 1 and 2) [18]. Considering the mecha-
nism of action of osmotic and fiber agents, sufficient
fluid intake is helpful for treating constipation.
Fruit juices contain sorbitol, fructose, and phy-
tochemicals as well as water. Some juices have a fiber
component. Fruits juices are generally helpful for
constipation, particularly in young children, whose
intestinal function has not fully matured. Apple,
prune, and pear juices are usually recommended for
Lubiprostone (type-2 chloride channels) and lina-
clotide (cystic fibrosis transmembrane conductance
regulator) are recently introduced drugs for treat-
ment of adult constipation that act on intestinal epi-
thelial ion channels and increase intestinal luminal
water content [19,20]. We believe that lifestyle
changes are important to treat constipation and pre-
Sun Hwan Bae:Diets for Constipation
Fig. 1. Bowel movement scores for patients on polyethylene
glycol 4000 (PEG 4000, Forlax;
Beaufour Ipsen Pharma., Paris,
France). Scores for the better fluid intake periods were signi-
ficantly better than those for the worse fluid intake periods
(median, 27.78; range, 21.43-30.00 vs. median, 25.13; range,
19.00-30.00; p=0.009).
Fig. 2. Stool consistency scores for patients on polyethylene
glycol 4000 (PEG 4000, Forlax;
Beaufour Ipsen Pharma., Paris,
France). Scores for the better fluid intake periods were signifi-
cantly better than those for the worse fluid intake period
(median, 20.00; range, 11.79-20.00; vs. median, 15.91; range,
11.00-25.00; p=0.002).
vent a relapse. Thus, increasing fluid intake is recom-
mended rather than using luminal fluid-increasing
agents in terms of safety and long-term efficacy.
Probiotics are live microorganisms that confer a
health benefit on the host when administered in ad-
equate amounts. Dysbiosis of intestinal flora, high
frequencies of Clostridium and Enterobacteriaceae spe-
cies, which are rarely isolated in healthy children,
have been reported in children with constipation
[21]. The proposed probiotic mechanism for con-
stipation involves 1) Bifidobacteria and lactobacilli
produce lactic acid, acetic acid, and other acids,
which lower pH in the colon and enhance peristalsis.
2) Probiotics may exert anti-inflammatory effect and
immunomodulation effect, which may improve cer-
tain mechanism of dysmotility. 3) Metabolic func-
tions of the altered microbiota may affect intestinal
luminal content. For example, methane gas can slow
gut transit, and probiotics may improve this effect. 4)
Particular probiotic strains stimulate motility and
peristalsis, which is particularly helpful to treat slow
transit constipation [22].
Lactobacillus reuteri has a positive effect on bowel
frequency in infants with functional chronic con-
stipation but no improvements in stool consistency
are observed [23]. Bifidobacteria (B. bifidum, B. in-
fantis, and B. longum) and Lactobacillus (L. casei, L.
plantarum, and L. rhamnosus) increase bowel move-
ment frequency, decrease fecal incontinence, and re-
duce abdominal pain in children 4-16 years of age;
however, they have no effect on stool consistency
[24]. In one study, Lactobacillus GG was ineffective as
an adjunct to lactulose for treating constipation in
children [25]. As of 2014, NASPGHAN and ESPGHAN
do not support the use of pre- or probiotics in the
treatment of childhood constipation [15]. Some pro-
biotics are helpful for diarrhea, and some are useful
for constipation. Further studies are warranted for
probiotic specificity for diarrhea or constipation. Is
there strain specificity for constipation or diarrhea
within the same Lactobacillus species?
Breast-milk-fed infants are less frequently con-
stipated than those who are formula fed. Several
mechanisms were proposed for this. 1) Large amounts
206    Vol. 17, No. 4, December 2014
Pediatr Gastroenterol Hepatol Nutr
of prebiotic oligosaccharides in human milk provide
substrates for gut bacteria and this improves osmotic
balance and stool consistency. 2) The fat composi-
tion of human milk may help create softer stools. 3)
Breast milk contains non-digestible oligosaccharides,
which act like dietary fiber, stimulate the growth of
beneficial bacteria, and promote maturation of the
gastrointestinal tract. 4) Breast milk also has the op-
timal whey protein composition and a low phos-
phorous content. 5) Increased levels of gastric in-
hibitory peptide, neurotensin, and vasoactive in-
testinal peptide are observed in formula-fed infants
compared with those in breast-fed infants [26]. A
food allergy to cow milk protein can also cause
constipation. A crossover dietary trial demonstrated
an association between chronic functional con-
stipation and cow milk consumption [27]. In one
study, type IV allergies developed frequently and
lymphocyte stimulation test values were related to
constipation. Symptoms improved in the majority of
infants after eliminating the cow milk antigen [28].
Colon peristalsis in infants with constipation is abol-
ished after ingesting cow’s milk but recovers after
stopping cow’s milk. Colonic stenosis due to a cow
milk protein allergy mimicking Hirschsprung’s dis-
ease is well known [29]. As of 2014, NASPGHAN and
ESPGHAN state that evidence is conflicting for al-
lergy testing to diagnose a cow milk allergy in chil-
dren with functional constipation [15]. Investigations
into the immunological or biochemical mechanisms
occurring during chronic functional constipation are
required, including investigations of intolerance
Fruits contain water, sorbitol, fructose, fiber, and
phytochemicals. Fruits thought to be useful for
treating constipation are pear, grape, plump, and ap-
ple with peel, which are rich in fiber. Here, some
fruits available in Korea will be considered, includ-
ing green kiwifruit, prune (plum), banana, and
Green kiwifruit
Green kiwifruit significantly increases defecation
frequency, stool volume, softness of bowel motion,
and ease of defecation in adult clinical studies. The
proposed mechanisms for this are as follow: 1) Green
kiwifruit contains 2-3 g of dietary fiber per 100 gm.
Fiber plays a physicochemical role during consti-
pation. 2) Actinidine, a protease enzyme in green ki-
wifruit, stimulates upper gastrointestinal tract mo-
tility. Possible induction of activity in the colon re-
mains to be clarified. 3) Kissper, a peptide in green
kiwifruit, has been characterized by anion selectivity
and ion channeling. 4) Phytochemicals occurring
naturally in the fruit may have biological sig-
nificance [30].
A prune is a dried plum, and these fruits are bene-
ficial for constipation. They contain high levels of fi-
ber (6.1 g/100 g), fructose (fructan), and sorbitol
(14.7 g/100 g). Large amounts of phenolic com-
pounds (184 mg/100 g), mainly as neochlorogenic
and chlorogenic acids, may aid in the laxative effect
[12]. Prune juice contains less sorbitol and fiber than
that of prunes. Japanese apricot (Prunus mume;
Mae-sil) increases defecation frequency and con-
traction of the rat colon [31].
Persimmons are not usually eaten in western
countries; however, they are one of the most popular
fruits in eastern Asia. Several types of persimmon are
available. However, we will classify them into non-
astringent varieties (sweet persimmon), which have
a lower tannin acid concentration, and astringent va-
rieties (mellowed persimmon and dried persimmon),
which have a higher tannin acid concentration.
Astringency of persimmons depends on the quantity
of soluble tannins in the fruit flesh. As persimmons
mature, soluble tannins become insoluble, which
makes the fruit much less bitter. The total quantity of
tannins decreases as the persimmon increases in size
[32]. However, healthy individuals experience pain-
ful defecation when even ripe persimmons are eaten.
Sun Hwan Bae:Diets for Constipation
Tannin acid reduced small intestinal secretions and
inhibits peristalsis. Thus, any forms of persimmons
should be avoided in children with constipation.
Several types of banana are available worldwide.
However, we will consider only the species of banana
that is normally available in markets. Unripe ba-
nanas contain 100-250 mg tannins/100 g and have
high amylase-resistant starch content. Thus, they
can cause or aggravate pre-existing constipation.
This property has been used in the BRAT (banana,
rice, apple sauce, and toast) diet for diarrhea. As ba-
nanas ripen, the quantities of tannins and amy-
lase-resistant starch decrease, while soluble sugars
accumulate. Ripe bananas contain 3 g fiber/120 g,
mostly in the form of soluble fiber. They also contain
amylase-resistant starch and tannins [33]. We rec-
ommend not feeding banana to a constipated child,
as many other good sources of fiber are available.
Constipation cannot be managed using medi-
cation alone. Better short- and long-term outcomes
are achieved with lifestyle changes, including a prop-
er diet. Pediatricians treating a child with consti-
pation should pay more attention to these changes.
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... Diets including fruits, fluids, and probiotics are good for constipation. Fruits contain water, melatonin, sorbitol, fructose, fiber, and phytochemicals (69,(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83).Fruits thought to be useful for treating constipation are pear, oranges, berries, grape, plump, and apple with peel, which are rich in fiber (71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). Fruits juices are generally helpful for constipation, particularly in young children, whose intestinal function has not fully matured. ...
... Fruits juices are generally helpful for constipation, particularly in young children, whose intestinal function has not fully matured. Apple, prune, and pear juices are usually recommended for constipation (69). Berries are rich in fiber and melatonin. ...
... Common fiber and melatonin rich foods include cereals (rice, corn), bread, vegetables, fruits, potatoes (with peel), and whole grains (69,84). The mechanism of action of fiber on constipation includes: 1) Fiber increases stool bulk and accelerates colon transit; 2) fermenting fiber produces short-chain fatty acids (butyrate, propionate, acetate, etc.), which increase osmotic load and accelerate colon transit; 3) short-chain fatty acids change the intraluminal microbiome (mass) directly or indirectly by decreasing luminal pH, which accelerates colon transit; and 4) fiber contains water. ...
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... Similar to fruits, and rather surprisingly, vegetable intake did not significantly correlate with constipation in either the bivariate analyses or the multivariable linear regression model. Vegetable intake has been usually linked with decreased constipation, explained mainly by their being rich in dietary fiber [68]. We did not investigate the cooking method employed for any food or nutrients, and it is known that cooking methods may directly influence food digestion [69]. ...
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... Nutritional and lifestyle changes, along with probiotics and supplements, represent a first-line approach to improve chronic constipation, especially if characterised by mild severity and benign/functional aetiology [13]. Along with apples and prunes, kiwifruit (Actinidia spp.) consumption is often traditionally recommended to provide relief from intestinal constipation and to promote laxation [10,14]. ...
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Conference Paper
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Tibb Unani a holistic traditional approach to the way of living incorporating Tibb Nabawi Ghiza. An upsurge of the medicinal system among other alternative systems of medicine in India. This research paper provides an insight into four physical humours which lead to an imbalance of equilibrium in health. The quality of temperament and behavioral aspects of senses of humour can be rectified through Tibb Nabawi Ghiza which is widely used in USM. A methodology of mixed mode with semi-structured interviews with Unani physicians and SDC (Secondary Data collection) determined the list of Ghiza and Dawa which can be utilized. Hence, paving way for advancements in labelling Unani as Muslim Friendly medical service across the globe.
... The mucilage in fenugreek seeds helps to soften sore throat, treat asthma, shortness of breath, appetizer and helps digestion (Alaghem et al. 2017;Bukhari et al., 2008;Haouala et al., 2008;Kaviarasan et al., 2007;Zuppa et al., 2010). Relieve constipation helps in the digestion, protection of colon infections because fenugreek plant has anti-inflammatory properties (Ke et al., 2012;Bae, 2014), reduces blood cholesterol, triglyceride (Bordia et al., 1997) increases sexual ability in men (Sindhu et al., 2012). Foliar fertilization is one of the most suitable methods used in adding microelements to the plant, where the plant extends its needs of nutrients through the vegetable total and not by the roots, where research has shown that all the nutrients absorbed by the roots can be absorbed by leaves, stems and fruits. ...
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This investigation was carried out to study the effect of spraying with microelements and compost extract on the productivity, seeds, oil yield per plant and feddan and active substances of fenugreek plants under North Sinai conditions. The experiments Field were carried out at Baloza Research Station, Desert Research Center, during two successive seasons 2017-2018. The experiment was of split plot design including 8 treatments with three replicates, the main plot was sprayed with compost extract, while the sub-plot was sprayed with chelated microelements forms. The treatments that were sprayed with compost extract include a control treatment and a compost-extract sprayed treatment, whereas the treatments of the different chelated microelements forms comprised a control, mineral form, EDTA form and humic form. The results showed that, all treatments showed a highly significant increase in all parameters under study in both seasons compared with the control treatment. The highest values of all parameters under study from combining compost extract plus M. E. Humic form. The percentage of increase in the seed yield was from 30 to 29% and in fixed oil, the increase reached 131 to 116% in the first and second season, respectively. Also, there was a significant increase in the active substance inside the plant, and we found a significant increase when treating the plant with spraying compost extract plus M. E. Humic form, where the percentage of increase in mucilage, protein and trigonelline was 128, 68 and 70 % in the first season in a row, while the increase rate was 99, 64, 64% in the second season.
... Surgical management is usually needed for patients with perforation, when a long bowel segment is involved, or when conservative management fails [ 7 ,20 ]. Patients with chronic constipation or those who have a history of previous fecal impaction or SC should be educated regarding a proper dietary regimen (increasing fiber, vegetables, fruit, and adequate fluid intake) and if needed, pharmacologic therapy such as osmotic and stimulant laxatives should also be given to prevent constipation in the future [21] . In our case, the patient was managed conservatively with a combination of manual fecal disimpaction and an appropriate oral and bowel regimen, therefore a histopathologic diagnosis of SC was not obtained in this case, as a consequence of successful conservative treatment. ...
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Stercoral colitis is a rare inflammatory condition involving the large bowel wall secondary to fecal impaction. Stercoral colitis has a clinical course ranging from non-complicated fecaloid impaction to colonic perforation. This case report aims to give a brief review of this condition and discuss its imaging findings. Case Presentation We herein report a case 74-year-old female who presented with abdominal pain, abdominal distension, and the absence of gas-feces discharge for a few days. The patient had a one-year history of chronic constipation and recent femoral neck fracture surgery. Physical examination shows abdominal distension with slight tenderness. Abdominal radiographs demonstrated bowel distention and fecal material in the colorectal regions. Computed tomography (CT) images demonstrated abundant fecal material with massive dilatation in the rectosigmoid colon, focal mural thickening, subtle pericolic fat stranding, and minimal free fluid in the abdominal and pelvic cavities. Based on these findings, the diagnosis of stercoral colitis was made. The patient was treated conservatively and eventually discharged with a good health condition. Conclusion Stercoral colitis seems to be more common in elderly patients with comorbid diseases. Chronic constipation causing fecal impaction is a major risk factor. CT scan is the most helpful imaging modality for the diagnosis of stercoral colitis. CT findings that should prompt the radiologist to consider this diagnosis include colonic dilatation containing impacted feces, mural thickening, and pericolic fat stranding. If the fecal impaction is not promptly relieved, life-threatening complications such as colonic perforation can occur.
Insects as food have been consumed all over the world, mostly by ethnic communities, since time immemorial. With the ever-increasing human population causing an imbalance between food production and nutrition, edible insects are gaining importance as an alternative food source. The aim of this paper is to record the region-specific current practices of entomophagy and their implications in food security. The study involved field investigation to find out the pattern of entomophagy among the scheduled tribes of the Bodoland Territorial Region (BTR), Assam. Following this, we made an effort to estimate the diversity of edible insects at different sampling sites in the studied area. Nutritional profiling of some of the edible insects was carried out to know their potential as a measure of food security. A total of 25 edible insects belonging to 9 orders and 18 families were recorded during the study period. Species diversity was recorded highest in forest/backyard forest habitat followed by agricultural field habitat, open field habitat and swampy area habitat in all the four districts in BTR, Assam. During the consumer survey, a total of 4,051 people belonging to four different scheduled tribes, Bodo, Rabha, Garo and Sarania were interviewed and out of them, 3,840 (94.79%) people were found to consume insects as food. The insects are mostly consumed in fried form, followed by smoked, raw, paste, roasted and curry form. The biochemical analysis of nutrient contents of 11 commonly consumed edible insects showed that they are a rich source of protein, vitamins and micronutrients with a reasonable amount of carbohydrates and lipids with higher radical scavenging activity. To manage insects in the context of food security, increased attention should be given to sustainable collection and successful farming of edible insects for the creation of export potential, giving emphasis on the nutritional advantages.
Ethnopharmacological relevance The genus Amaranthus is phytonutrients-rich plant distributed worldwide and has been recognized as having medicinal value in traditional use against several diseases and conditions. There are a large amount of research data on the polyphenol profiles of Amaranthus plants and their links with potential benefits against gastrointestinal disorders. Aim of the review This review article aims to provide a comprehensive review of Amaranthus phenolic compounds and their microbial metabolites, as well as the biological and/or pharmacological effects of those compounds/metabolites. Methodology The relevant information about the genus Amaranthus was collected from various sources and databases, including Google Scholar, Google Books, PubMed, Web of Science, Scopus, Science Direct, and other internet sources. The World Flora Online (2021) database was used to verify the scientific names of the plants. Results Comprehensive review of identified compounds in Amaranthus plants revealed the presence of phenolic acids, flavonoids, and coumarins in each part of the plants. The biotransformation by gut microbiota enzymes prominently produces diverse bioactive metabolites that are potentially active than their precursors. Lines of the evidence support the beneficial roles of Amaranthus extracts in several gastrointestinal diseases, particularly with the polar extracts of several plant parts. Dietary fibers in Amaranthus plants also coordinate the alteration of gut microbiota-related metabolisms and may be beneficial to certain gastrointestinal disorders in particular, such as constipation. Conclusions Amaranthus plants are rich in polyphenols and dietary fibers. Several microbial metabolites are biologically active, so alteration of gut microbiota is largely linked to the metabolic feature of the plants. Based on the evidence available to date, several Amaranthus plants containing a combination of phytonutrients, particularly polyphenols, and dietary fibers may be a promising candidate that is of interest to be further developed for use in the treatment of certain gastrointestinal conditions/disorders.
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Dietary fiber intake is one of the most influential and efficacious strategies for modulating the gut microbiota. Said fiber can be digested by the microbiota itself, producing numerous metabolites, which include the short-chain fatty acids (SCFAs). SCFAs have local and systemic functions that impact the composition and function of the gut microbiota, and consequently, human health. The aim of the present narrative review was to provide a document that serves as a frame of reference for a clear understanding of dietary fiber and its direct and indirect effects on health. The direct benefits of dietary fiber intake can be dependent on or independent of the gut microbiota. The use of dietary fiber by the gut microbiota involves several factors, including the fiber’s physiochemical characteristics. Dietary fiber type influences the gut microbiota because not all bacterial species have the same capacity to produce the enzymes needed for its degradation. A low-fiber diet can affect the balance of the SCFAs produced. Dietary fiber indirectly benefits cardiometabolic health, digestive health, certain functional gastrointestinal disorders, and different diseases.
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Resumen Una de las estrategias que más impacto y mayor eficacia tiene para la modulación de la microbiota intestinal es el consumo de fibra dietaria, que puede ser digerida por la propia microbiota generando numerosos metabolitos. Entre estos, se encuentran los ácidos grasos de cadena corta (AGCC) con funciones tanto locales como sistémicas, que impactan en la composición y función de la microbiota intestinal y por lo tanto en la salud humana. El objetivo de esta revisión narrativa fue generar un documento que sirva como marco de referencia para conocer acerca de la fibra dietaria y sus efectos directos e indirectos. Los beneficios directos de la ingestión de fibra dietaria pueden ser dependientes o independientes de la microbiota intestinal. La utilización de la fibra dietaria por esta última depende de varios factores y de sus características fisicoquímicas. La clase de fibra dietaria influye sobre la composición de la microbiota intestinal debido a que no todas las especies tienen la misma capacidad de producir enzimas necesarias para su degradación. El consumo de dietas con bajo contenido de fibra dietaria puede afectar el balance de los AGCC producidos. Los beneficios indirectos de la fibra dietaria impactan sobre la salud cardiometabólica, la salud digestiva, ciertos trastornos funcionales gastrointestinales y enfermedades diversas.
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Despite years of advising patients to alter their dietary and supplementary fiber intake, the evidence surrounding the use of fiber for functional bowel disease is limited. This paper outlines the organization of fiber types and highlights the importance of assessing the fermentation characteristics of each fiber type when choosing a suitable strategy for patients. Fiber undergoes partial or total fermentation in the distal small bowel and colon leading to the production of short-chain fatty acids and gas, thereby affecting gastrointestinal function and sensation. When fiber is recommended for functional bowel disease, use of a soluble supplement such as ispaghula/psyllium is best supported by the available evidence. Even when used judiciously, fiber can exacerbate abdominal distension, flatulence, constipation, and diarrhea.Am J Gastroenterol advance online publication, 2 April 2013; doi:10.1038/ajg.2013.63.
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The aims of this study were to: (1) determine whether replacement of cow's milk protein with soy resolves Chronic Functional Constipation (CFC); and (2) investigate the effects of cow's milk β casein A1 and cow's milk β casein A2 on CFC. Children diagnosed with CFC were recruited to one of two crossover trials: Trial 1 compared the effects of cow's milk and soy milk; Trial 2 compared the effects of cow's milk β casein A1 and cow's milk β casein A2. Resolution of constipation was defined as greater than eight bowel motions during a two week intervention. Thirteen children (18 to 144 months) participated in Trial 1 (6 boys, 7 girls). Nine participants who completed the soy epoch all experienced resolution (p < 0.05). Thirty-nine children (21 to 144 months) participated in Trial 2 (25 boys, 14 girls). Resolution of constipation was highest during the washout epoch, 81%; followed by cow's milk β casein A2, 79%; and cow's milk β casein A1, 57%; however, the proportions did not differ statistically. The results of Trial 1 demonstrate an association between CFC and cow's milk consumption but Trial 2 failed to show an effect from type of casein. Some other component in cow's milk common to both A1 and A2 milk may be causing a problem in these susceptible children.
Part of the authoritative series on reference values for nutrient intakes , this new release establishes a set of reference values for dietary energy and the macronutrients: carbohydrate (sugars and starches), fiber, fat, fatty acids, cholesterol, protein, and amino ...
Preclinical experiments in rodent models have recently provided new information on the mechanisms underlying pain sensation in chronic visceral hypersensitivity, as well as insights into the mechanism of action of new drugs targeting abdominal pain in irritable bowel syndrome (IBS). This article describes the evidence base supporting the role of guanylate cyclase C (GC-C) activation in the modulation of gastrointestinal transit and, in particular, in visceral hypersensitivity. We propose that GC-C activation represents an important emerging target for pharmacotherapy in IBS with constipation (IBS-C), particularly given the recent regulatory approval of the GC-C agonist linaclotide as a treatment for IBS-C. More specifically, we address the following questions: “How is pain transmitted from the colon?”; “How is abdominal pain increased in IBS-C?”; “How can we reduce IBS-related abdominal pain – what drugs have been developed?”; “Does linaclotide reduce abdominal pain in animals and humans?”; and “How does linaclotide reduce abdominal pain?”
Constipation is a pediatric problem commonly encountered by many healthcare workers in primary, secondary and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) were charged with the task of developing a uniform document of evidence-based guidelines. Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, Medline, The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials and PsychInfo databases. The approach of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the GRADE system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During three consensus meetings all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no Randomized Controlled Trials (RCTs) were available to support the recommendation. This evidence-based guideline provides recommendations for evaluation and treatment of children with functional constipation in order to standardize and improve their quality of care. In addition, two algorithms were developed, one for infants less than six months of age and a second for older infants and children. This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regards to diagnostic evaluation and treatment.
Changes in tannins, ascorbic acid and sugars in astringent persimmons ‘Rojo Brillante’ and ‘Kaki Tipo’ were investigated during fruit maturation and after postharvest treatments. Soluble tannins exhibited a significant initial increment, followed by a marked constant decrease that led to values between 0.2 and 0.3g/100g fresh weight (FW) in the last stage of maturity studied. During the entire period monitored, insoluble tannins represented the minor component of the total tannic fraction, accounting for 9–27% (Rojo Brillante) and 17–32% (Kaki Tipo) of total tannins; levels of insoluble tannins were comparable to or higher than the soluble tannins in softer fruits. Total vitamin C decreased from 0.18–0.20 to about 0.08g/100gFW during fruit development owing to fruit growth rather than to degradation processes. Total sugars increased from about 4g/100gFW at the early stage of fruit development to 17g/100gFW after reaching the commercial stage of maturity. Glucose and fructose increased during the entire period monitored, while sucrose reached a maximum and then gradually decreased, probably owing to a strong invertase activity. Antiradical activities were significantly related to the corresponding tannic fraction. In both ‘Rojo Brillante’ and ‘Kaki Tipo’, postharvest treatment with CO2 was more effective than with ethylene in reducing soluble tannin concentration (0.031–0.067 and 0.220–0.262g/100gFW, respectively).
Disorders of gastrointestinal motility are common, resulting in a decreased quality of life of individuals, and an economic burden. Gastrointestinal motility is categorized according to location within the gastrointestinal tract: stomach, small intestine, and colon, with the colon being the dominant compartment in determining overall gastrointestinal transit. Constipation results from gastrointestinal dysmotility and is a significant chronic health issue globally. Clinical studies in a range of adult populations consistently indicate that kiwifruit are a highly effective dietary option to promote laxation. This, together with emerging evidence for the putative effects of kiwifruit in beneficially promoting gastric emptying and digesta mixing, suggests that kiwifruit are physiologically active throughout the gastrointestinal tract. Although the mechanisms of this action remain unknown, the unique behavior of kiwifruit fiber during digestion and the potential action of bioactive components in kiwifruit may contribute to the effectiveness of kiwifruit in modulating gastrointestinal motility.
Maesil (the fruit of Prunus mume Siebold & Zucc.) has long been used as an alternative medicine and functional food in Korea and Japan for preventive and therapeutic purposes. We examined the laxative effect of unripe Maesil (UM) and ripe Maesil (RM) in a rat model on constipation induced by a low-fibre diet and the possible mechanisms of Maesil in the rat colon. In vivo studies were conducted on the low-fibre diet-induced constipation rat model, and isolated rat colon was used in in vitro experiments to measure the changes in spontaneous colon contraction generated by Maesil and organic acids as standard and effectual ingredients, respectively. The aqueous extract of both UM and RM applied orally (100 and 300 mg/kg) produced significant increase of faeces frequency (p < 0.05) and moisture (p < 0.001). Moreover, the number faecal pellets number was reduced (p < 0.05) in the distal colons of the Maesil-treated rats. Gastrointestinal (GI) motility, measured by charcoal meal, was activated more fully by UM than in the low-fibre diet group. Both UM and RM and its organic acids produced a dose-dependent stimulation of the spontaneous contractile amplitude (p < 0.001) and frequency (p < 0.01) of the isolated rat colon. Although both UM and RM were an effective laxative, the RM was significantly more effective than the UM in the in vivo and in vitro constipation experiments because of the changes in the composition of organic acids during the ripening of the fruit. Our results demonstrated that Maesil was effective in promoting the frequency of defaecation and contraction of the rat colon, which provided scientific basis to support the use of Maesil as potential therapeutics in treating constipation.
Irritable bowel syndrome (IBS) and chronic constipation (CC) are common problems worldwide and are associated with significant impact on activities of daily living and quality of life. Recent interest, in IBS in particular, has focused on the potential roles of the microbiota and its interaction with the host's immune system. Recently, high-quality clinical trials have been performed on prebiotics and probiotics in IBS or CC. Although strategies that seek to modify the microbiota, such as the use of probiotics, offer much promise in IBS and CC, more high-quality trials and, studies of longer duration are required.