Article

The perceived effect of various foods and bevereges on stool consistency

Authors:
  • Israelitisches Krankenhaus in Hamburg, Germany
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Some people believe that chocolate and other foods or beverages may cause constipation. This study was undertaken to quantify the effect of potentially constipating foods and beverages on apparently healthy and constipated populations of German individuals. A questionnaire asking for the effect of certain foods and beverages on stool form (perceived consistency) was answered by 200 healthy controls, 122 patients with chronic constipation, and 766 patients with irritable bowel syndrome with constipation (IBS-C). Patients with constipation or IBS-C reported altered stool form after food and beverage consumption more often than controls (controls 42.5% vs constipation 52.0% vs IBS-C 57.0%, P < 0.001). Controls experienced hardening of stools less often and experienced softening more often than either constipation or IBS-C patients. When patients were asked which foods or beverages caused constipation (open ended question), chocolate was most frequently mentioned, followed by white bread and bananas. The results of systematic questioning yielded chocolate (48-64% of respondents), bananas (29-48%), and black tea (14-24%) as constipating, while prunes (41-52%), coffee (14-24%), wine (8-30%), beer (14-24%), and smoking (42-70% in those who smoked) were considered stool softeners. Several foodstuffs may exert an effect on stool consistency. Chocolate, bananas and black tea are perceived to cause constipation, while prunes are perceived to soften stools in many people. Coffee, wine and beer were perceived to soften stools in a minority of people. Cigarettes are perceived to soften stools by about half of the smokers.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Our understanding of how diet and other factors influence stool consistency in healthy adults is also limited. Studies of constipated adults have shown associations with certain food groups and intakes of liquid (19), caffeine (20)(21)(22)(23), and dietary fiber (19,(21)(22)(23)(24). Interventions with constipated participants showed a beneficial effect of dietary fiber (11,(25)(26)(27), probiotics (28,29), and prebiotic-probiotic "synbiotics" (30,31). Likewise, some dietary interventions for irritable bowel syndrome (IBS) demonstrated symptom improvement (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). ...
... Our understanding of how diet and other factors influence stool consistency in healthy adults is also limited. Studies of constipated adults have shown associations with certain food groups and intakes of liquid (19), caffeine (20)(21)(22)(23), and dietary fiber (19,(21)(22)(23)(24). Interventions with constipated participants showed a beneficial effect of dietary fiber (11,(25)(26)(27), probiotics (28,29), and prebiotic-probiotic "synbiotics" (30,31). ...
... Both studies reported that fruit and vegetable intake correlated with a lower constipation prevalence, suggesting that higher intake of these food groups may improve stool consistency. Similarly, other studies (23,25,68,69) showed that increased fiber intake, whether in the form of fruits and vegetables or fiber supplements, correlated with an improvement toward normal stool among diarrhea-or constipation-predominant subjects. However, these dietary interventions aimed to alleviate gastrointestinal symptoms in subjects with a chronic gastrointestinal disorder. ...
Article
Background Prior studies of adults with constipation or diarrhea suggest that dietary intake, physical activity, and stress may affect stool consistency. However, the influence of these factors is unresolved and has not been investigated in healthy adults. Objectives We assessed the relations of technician-scored stool consistency in healthy adults with self-reported diet, objectively monitored physical activity, and quantifiable markers of stress. Methods Stool consistency was scored by an independent technician using the Bristol Stool Form Scale (BSFS) to analyze samples provided by healthy adults, aged 18–65 y, BMI 18–44 kg/m2, in the USDA Nutritional Phenotyping Study (n = 364). A subset of participants (n = 109) were also asked to rate their sample using the BSFS. Dietary intake was assessed with two to three 24-h recalls completed at home and energy expenditure from physical activity was monitored using an accelerometer in the 7-d period preceding the stool collection. Stress was measured using the Wheaton Chronic Stress Inventory and allostatic load (AL). Statistical and machine learning analyses were conducted to determine which dietary, physiological, lifestyle, and stress factors differed by stool form. Results Technician-scored BSFS scores were significantly further (P = 0.003) from the central score (mean ± SEM distance: 1.41 ± 0.089) than the self-reported score (1.06 ± 0.086). Hard stool was associated with higher (P = 0.005) intake of saturated fat (13.8 ± 0.40 g/1000 kcal) than was normal stool (12.5 ± 0.30 g/1000 kcal). AL scores were lower for normal stool (2.49 ± 0.15) than for hard (3.07 ± 0.18) (P = 0.009) or soft stool (2.89 ± 0.18) (P = 0.049). Machine learning analyses revealed that various dietary components, physiological characteristics, and stress hormones predicted stool consistency. Conclusions Technician-scored stool consistency differed by dietary intake and stress hormones, but not by physical activity, in healthy adults. This trial was registered at clincialtrials.gov as NCT02367287.
... The intake of water and tea was significantly higher in A-IBS compared to subjects without IBS and the intake of water and carbonated beverages was particularly high in subjects with D-IBS. Plain water is recommended as a beverage for subjects with IBS [34], while tea may be constipating [35], and coffee, which was not associated with IBS in our study, may be related to diarrhoea [31]. Tea contains salicylates, which may cause gut symptoms [30]. ...
... Supportive of our results, alcohol consumption was associated with gastrointestinal symptoms in other studies [4,38]. Two studies showed support for stool softening properties of alcohol [35,39]. Hey et al. suggested that alcohol may produce osmotic diarrhoea through its high sugar content [40]. ...
Article
Full-text available
Patients with irritable bowel syndrome (IBS) often relate symptoms to the intake of certain foods. This study assesses differences in diet in subjects with and without IBS. The cross-sectional, population-based study was conducted in Norway in 2001. Out of 11078 invited subjects, 4621 completed a survey about abdominal complaints and intake of common food items. IBS and IBS subgroups were classified according to Rome II criteria. IBS was diagnosed in 388 subjects (8.4%) and, of these, 26.5% had constipation-predominant IBS (C-IBS), 44.8% alternating IBS (A-IBS), and 28.6% diarrhoea-predominant IBS (D-IBS). Low intake of dairy products (portions/day) (Odds Ratio 0.85 [CI 0.78 to 0.93], p = 0.001) and high intake of water (100 ml/day) (1.08 [1.02 to 1.15], p = 0.002), tea (1.05 [1.01 to 1.10], p = 0.019) and carbonated beverages (1.07 [1.01 to 1.14], p = 0.023) were associated with IBS. A lower intake of dairy products and a higher intake of alcohol and carbonated beverages were associated with D-IBS and a higher intake of water and tea was associated with A-IBS. In subjects with IBS the severity of symptoms was associated with a higher intake of vegetables and potatoes in subjects with C-IBS, with a higher intake of vegetables in subjects with A-IBS, and with a higher intake of fruits and berries, carbonated beverages and alcohol in subjects with D-IBS. In this study, the diet differed in subjects with and without IBS and between IBS subgroups and was associated with the severity of symptoms.
... Increasing dietary fiber intake is known to have positive effects on stool weight and GI transit times (29). Prunes are considered to have a laxative effect and are traditionally used to relieve constipation (30). This is mostly due to the high fiber content, but other components found in the European plum including the sugar alcohol sorbitol and phenolic compounds may contribute to the laxative quality (29). ...
... European plum cultivars are used mostly as a processed plum, found in compotes, mousse, dried, canned, jams and most commonly, prunes (16,30,57). Japanese plums are typically consumed as whole, fresh fruit. ...
Article
Prunus salicina, Japanese plums, and Prunus domestica, European plums, are naturally rich in fiber, minerals, vitamins and phytonutrients. Consuming plums can increase overall fruit intake and can be incorporated into part of a healthy diet. Through local plum production, harvesting can be completed without the need for cross-country shipping, which can increase overall acceptability and nutritional quality of the fruit. Furthermore, the increase in local production can help to boost Maine’s economy and creates a market for new plum product production. The first objective of this study was to determine consumer acceptance of locally grown plum cultivars at a tree-ripened stage. Sensory testing was conducted in the Sensory Evaluation Center at the University of Maine on plum cultivars harvested at Highmoor Farm in Monmouth, ME. The highest rated cultivar for ‘overall’ acceptability was the Japanese plum, Oblinya, with an average rating of 7.27±1.42. Toka, Kahinta and Superior also had high ‘overall’ acceptability scores with average ratings of, 6.98±1.4, 6.97±1.55 and 6.9±1.37, respectively. European varieties Early Italian and Caselton also had high ‘overall’ acceptability ratings at 6.98±1.46 and 6.76±1.35, respectively. In a similar consumer study, fruit was believed to be accepted among consumers with likeness ratings of >5.0. All cultivars tested in this study outperformed this value. The second objective of this study was to evaluate phytonutrient content of the plum cultivars. Phytochemical constituents were extracted using 80% acidified methanol for twelve locally grown plum cultivars at a tree-ripened stage. Total monomeric anthocyanin, total phenolics, and free radical scavenging ability was measured on the cultivars. The European plum Caselton had the highest anthocyanin content (1242.83±14.05mg /100 g.) Toka had the greatest antioxidant capacity, demonstrating 50% inhibition of the free radical 2,2-diphenyl-1-picrylhydrazyl (DPPH) (1.28±0.14 mg/mL.) Toka also had the highest total phenolic content (1006.04±21.88 mg/ 100g.) Statistically significant differences were found between Japanese and European varieties for total phenolic content and free radical scavenging ability, with Japanese cultivars having higher values in both categories. Cold-hardy plum cultivars that can be produced in Maine were successfully cultivated and were widely accepted among consumers. Producing plums that are well liked by consumers provides a new agricultural sector for Maine’s farmers, in turn boosting local economies and creating a new market for processed plum products. The evaluation of consumer acceptance and bioanalysis of plum cultivars establishes a deeper understanding of novel, tasty, and healthy plums for producers to incorporate into their production programs. This study fills the gap in knowledge of cold-hardy cultivars, and demonstrates that tree-ripened cultivars Oblinya, Toka, Kahinta, Superior and Early Italian all have favorable marketing potential for tree-fruit farmers in Maine.
... Neither of these reactions in IBS-patients is clear, but many factors may be involved. Eating stimulate different colonic and motor activity that might explain postprandial gastrointestinal symptoms [30,31,32,33,34,35]. ...
... The general understanding of biological active substances in food items and their potential role in GI symptoms are improving, because food items are a complex mix of different proteins, fats, and vitamins minerals, carbohydrates that may vary in different region and seasons etc [22]. For example, one study reported that chocolate had a constipating effect [34]. In this study chocolate was included in the sweets and cake group, but some responders mentioned solely chocolate as a provoking item, while others used the general word sweets. ...
Article
Nutritional changes are often considered first-line treatment in public health diseases that apply to many gastrointestinal (GI) disorders, as different food and beverages may modulate GI motor and sensory functions, and may provoke GI symptoms. The aim of this study was to examine dietary coping and possible changes in food and beverage intake in relation to GI symptoms reported by identified irritable bowel syndrome (IBS) patients compared with healthy controls, and whether any sex differences were observed in these respects. A population-based case-control design was used. Three primary healthcare centres were selected in the city of Linköping in Sweden. The IBS patients were recruited from the studied primary healthcare centers on the basis of diagnoses from computerized medical records. The controls were randomly selected from the general population in the same region. A questionnaire was used with specific questions about self-reported food and beverage increase or decrease of GI symptoms and self-reported changes in dietary habits. Female IBS patients seem to be more willing to change dietary habits because of their GI problems than men. Effects of these nutritional behaviour changes were reported for almost all participants that had made dietary adjustments. Fatty food, certain vegetables, dairy products and eggs were significantly more reported to cause GI complaints among IBS patients compared with their controls. Female IBS patients reported more changes in their dietary habits because of GI problems than men with the disease. The majority of both women and men who changed their dietary habits because of GI problems experienced improvement in their symptoms.
... Given that the etiology of IBS is still not fully understood, it is difficult to assess why smoking led to a decreased incidence of IBS in our study population. Studies have been conducted to investigate the effects of smoking on gut mucosa (20), gut motility (21), and stool consistency (22), one of which may serve to explain the possible mechanism behind our findings. A study conducted on mice gut demonstrated that the components found in cigarette smoke led to an alteration in the composition of gut microflora, and reduced mucosal inflammation, associated with an increased expression of tight junction proteins (20). ...
... Furthermore, smoking was also found to decrease gut motility by prolonging the mouth-cecum transit time (21). In addition, a study investigating the role of various foods and beverages on stool consistency reported that cigarettes acted as a stool softener in half of the smokers who had constipation-predominant IBS (22). While these studies may not fully explain our findings, they suggest that certain components of cigarette smoke may be responsible for affecting the gut and /or gut mucosa and preventing the development of IBS. ...
... Given that the etiology of IBS is still not fully understood, it is difficult to assess why smoking led to a decreased incidence of IBS in our study population. Studies have been conducted to investigate the effects of smoking on gut mucosa (20), gut motility (21), and stool consistency (22), one of which may serve to explain the possible mechanism behind our findings. A study conducted on mice gut demonstrated that the components found in cigarette smoke led to an alteration in the composition of gut microflora, and reduced mucosal inflammation, associated with an increased expression of tight junction proteins (20). ...
... Furthermore, smoking was also found to decrease gut motility by prolonging the mouth-cecum transit time (21). In addition, a study investigating the role of various foods and beverages on stool consistency reported that cigarettes acted as a stool softener in half of the smokers who had constipation-predominant IBS (22). While these studies may not fully explain our findings, they suggest that certain components of cigarette smoke may be responsible for affecting the gut and /or gut mucosa and preventing the development of IBS. ...
Article
Full-text available
Background: Irritable Bowel Syndrome (IBS) is one of the most commonly diagnosed gastrointestinal disorders, and its etiology is believed to be multifactorial. The role of smoking in the pathophysiology of IBS still remains inconclusive. Hence, we aim to investigate whether or not an association exists between smoking and IBS. Methods: A cross-sectional study was conducted in a tertiary care hospital of Karachi. A sample size of 200 smokers and 200 non-smokers was selected. A two-part self-reported questionnaire was administered to the participants and the diagnosis of IBS was based on the Rome III diagnostic criteria. All data were analyzed using the Statistical Package for the Social Sciences version 17. Statistical tests employed were Independent samples t-test, chi-square test, and binary logistic regression analysis to obtain Odds Ratio (OR) for various variables. A P-value <0.05 was considered statistically significant. Results: Overall prevalence of IBS based on Rome III criteria was 9.5% (95% CI 9.45-9.60). Smoking was significantly found to be associated with IBS (P=0.002). Binary logistic regression analysis indicated that non-smokers were more likely to have IBS (Crude OR: 3.00, 95% CI 1.23-7.30) than smokers, and females were more likely to have IBS (Crude OR: 3.73, 95% CI 1.56-7.69) than males. Age, BMI, and food groups were not found to be significantly associated with IBS. Conclusion: Our study concludes that IBS was more prevalent among non-smokers and amongst females. Further studies are required to firmly establish the role of smoking in IBS.
... Prunes (dried plums, Prunus domestica) are perceived by the public to have a laxative effect 21 and are traditionally used as a remedy for constipation. The putative action of prunes has been attributed to the high dietary fibre content. ...
... This systematic review is the first to summarise the evidence for the effect of prunes on GI function in constipated and non-constipated subjects. Despite the common perception that prunes have a laxative effect, 21 we found few trials investigating this, including only one conducted in constipated subjects. ...
Article
Background: Prunes (dried plums) are high in fibre and are perceived to promote healthy gastrointestinal (GI) function. Aim: To assess the effect of prunes on GI function through a systematic review of randomised controlled trials (RCTs). Methods: Sixteen electronic databases were searched, a hand search was performed and key opinion leaders were contacted. RCTs investigating the effect of prunes on GI function were included. Two reviewers independently screened relevant articles, extracted data and assessed risk of bias. Results: Four trials met the inclusion criteria, one in constipation and three in non-constipated subjects. In constipation, 3 weeks of prune consumption (100 g/day) improved stool frequency (3.5 vs. 2.8 CSBM per week, P = 0.006) and stool consistency (3.2 vs. 2.8 on Bristol stool form scale, P = 0.02) compared with psyllium (22 g/day). In non-constipated subjects, prunes softened stool consistency in one trial and increased stool weight (628 g vs. 514 g/72 h wet weight, P = 0.001) in another trial, compared with control. No trials found differences in GI symptoms between prunes and comparator. Meta-analysis was not appropriate due to heterogeneity in populations and methods. Two of the trials were limited by unclear risk of bias. Conclusions: In constipation, prunes appear superior to psyllium for improving stool frequency and consistency, however, the evidence for other outcomes and the effects in non-constipated subjects is weak. Although prunes may be a promising intervention for the management of constipation and increasing stool weight, this needs to be confirmed by further rigorous research.
... Dark chocolate is also thought to have effects on gastrointestinal function and is traditionally used as a home remedy for diarrhoea (10) ; however, objective evidence for the impact of cocoa on the gastrointestinal time or symptoms is lacking. Similarly, although chocolate has hedonic appeal and a positive influence on mood (11,12) , the central mechanisms behind these effects remain uncertain. ...
... At the same time, there was a clear trend to slower colonic transit documented by radioopaque markers swallowed every day with the dark chocolate bars compared with the control. These findings are consistent with the widely held view that dark chocolate can be constipating (10) . ...
Article
Dark chocolate is claimed to have effects on gastrointestinal function and to improve well-being. This randomised controlled study tested the hypothesis that cocoa slows gastric emptying and intestinal transit. Functional brain imaging identified central effects of cocoa on cortical activity. Healthy volunteers (HV) ingested 100 g dark (72 % cocoa) or white (0 % cocoa) chocolate for 5 d, in randomised order. Participants recorded abdominal symptoms and stool consistency by the Bristol Stool Score (BSS). Gastric emptying (GE) and intestinal and colonic transit time were assessed by scintigraphy and marker studies, respectively. Combined positron emission tomography–computed tomography (PET–CT) imaging assessed regional brain activity. A total of sixteen HV (seven females and nine males) completed the studies (mean age 34 (21–58) years, BMI 22·8 (18·5–26·0) kg/m ² ). Dark chocolate had no effect on upper gastrointestinal function (GE half-time 82 (75–120) v. 83 (60–120) min; P =0·937); however, stool consistency was increased (BSS 3 (3–5) v. 4 (4–6); P =0·011) and there was a trend to slower colonic transit (17 (13–26) v. 21 (15–47) h; P =0·075). PET–CT imaging showed increased [ ¹⁸ F]fluorodeoxyglucose (FDG) in the visual cortex, with increased FDG uptake also in somatosensory, motor and pre-frontal cortices ( P <0·001). In conclusion, dark chocolate with a high cocoa content has effects on colonic and cerebral function in HV. Future research will assess its effects in patients with functional gastrointestinal diseases with disturbed bowel function and psychological complaints.
... With respect to caff eine and cigarettes, both have been demonstrated to aff ect motility in normal individuals ( 1,25 ). However, their roles in IBS patients are less clear ( 1,26 ). Prior studies have reported that coff ee drinking is not more common among IBS patients, but a role of caff eine in IBS symptoms is supported by studies demonstrating that reintroduction of coff ee led to the return of IBS symptoms in up to a third of IBS patients ( 1 ). ...
... Prior studies have reported that coff ee drinking is not more common among IBS patients, but a role of caff eine in IBS symptoms is supported by studies demonstrating that reintroduction of coff ee led to the return of IBS symptoms in up to a third of IBS patients ( 1 ). For cigarette smoking, results from one study indicated that half of IBS patients with predominant constipation who smoked cigarettes reported that cigarette smoking led to soft er stools ( 26 ). However, any other evidence linking smoking to GI symptoms in IBS patients is lacking. ...
Article
Full-text available
Objectives: Heavy alcohol intake may exacerbate gastrointestinal (GI) symptoms in adults with irritable bowel syndrome (IBS); however, the role of alcohol in IBS is unclear. We investigated prospective associations between daily patterns of alcohol intake and next day's GI symptoms using daily diaries. Methods: In an observational study of women aged 18-48 years with IBS and healthy controls, participants recorded daily GI symptoms, alcohol intake, caffeine intake, and cigarette smoking for ≈ 1 month. GI symptoms included abdominal pain, abdominal bloating, intestinal gas, diarrhea, constipation, nausea, stomach pain, heartburn, and indigestion. Binge drinking was defined as 4+ alcohol-containing drinks/day. Results: Patterns of alcohol intake did not differ between IBS patients and controls. Although patterns of drinking were associated with GI symptoms among women with IBS, this was not the case with the healthy controls. The strongest associations for IBS patients were between binge drinking and the next day's GI symptoms (e.g., diarrhea, P=0.006; nausea, P=0.01; stomach pain, P=0.009; and indigestion, P=0.004), whereas moderate and light drinking either were not associated or weakly associated with GI symptoms. Associations between alcohol intake and GI symptoms were stronger for women with IBS-diarrhea than for IBS-constipation or IBS-mixed. Effects of binge drinking on GI symptoms were strongest when comparing between individuals (rather than within individuals). Conclusions: Our findings indicate that IBS symptoms differ according to the pattern of alcohol intake among IBS patients, suggesting that the pattern of drinking may in part explain the inconsistent findings between alcohol and IBS symptoms.
... However, up to 47% of patients are not completely satisfied with such treatments, with the main reasons being treatment efficacy, inconsistent symptom response, and concerns with regard to safety, adverse effects, taste, inconvenience, and cost (10). Accordingly, patients with functional constipation commonly adopt self-management approaches, with 80% having tried over-the-counter products (10) such as foods believed to exert a laxative effect, "functional foods," and nutraceuticals (11). ...
... However, up to 47% of patients are not completely satisfied with such treatments, with the main reasons being treatment efficacy, inconsistent symptom response, and concerns with regard to safety, adverse effects, taste, inconvenience, and cost (10). Accordingly, patients with functional constipation commonly adopt self-management approaches, with 80% having tried over-the-counter products (10) such as foods believed to exert a laxative effect, "functional foods," and nutraceuticals (11). ...
Article
Background: Functional constipation is a prevalent, burdensome gastrointestinal disorder whose treatment remains challenging. Probiotics have been increasingly investigated in its management. Objective: The aim was to investigate the effect of probiotics on gut transit time, stool output, and constipation symptoms in adults with functional constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Design: Studies were identified by searching 4 electronic databases, back-searching reference lists, contacting authors, and hand-searching abstracts. RCTs that reported administration of probiotics in adults with functional constipation were included. Two reviewers independently performed the screening, data extraction, and bias assessment. Outcome data were synthesized by using weighted mean differences (WMDs) or standardized mean differences (SMDs) with the use of a random-effects model. Results: A total of 660 records were identified of which 14 were eligible (1182 patients). Overall, probiotics significantly reduced whole gut transit time by 12.4 h (95% CI: -22.3, -2.5 h) and increased stool frequency by 1.3 bowel movements/wk (95% CI: 0.7, 1.9 bowel movements/wk), and this was significant for Bifidobacterium lactis (WMD: 1.5 bowel movements/wk; 95% CI: 0.7, 2.3 bowel movements/wk) but not for Lactobacillus casei Shirota (WMD: -0.2 bowel movements/wk; 95% CI: -0.8, 0.9 bowel movements/wk). Probiotics improved stool consistency (SMD: +0.55; 95% CI: 0.27, 0.82), and this was significant for B. lactis (SMD: +0.46; 95% CI: 0.08, 0.85) but not for L. casei Shirota (SMD: +0.26; 95% CI: -0.30, 0.82). No serious adverse events were reported. Attrition and reporting bias were high, whereas selection bias was unclear due to inadequate reporting. Conclusions: Probiotics may improve whole gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B. lactis in particular. However, caution is needed with the interpretation of these data due to their high heterogeneity and risk of bias. Adequately powered RCTs are required to better determine the species or strains, doses, and duration of use of probiotics that are most efficacious.
... Lifestyle modifications such as increased dietary fibre intake are recommended as first line therapy but the evidence base for this is poor (2) . Prunes (dried plums) are commonly believed to have a laxative effect (3) and used as a traditional remedy to improve bowel function, however there has been no systematic review of the quality or number of clinical trials investigating the efficacy of prunes on gastrointestinal health in constipated or healthy subjects. The aim of this study was to assess the effect of prunes on markers of gastrointestinal health in constipated and healthy subjects through a systematic review of randomised controlled trials (RCTs). ...
... Given the negative consequences of delayed return to bowel function, there would be a benefit to adding a non-pharmacological option to medication regimen for postoperative constipation in benign gynecologic surgery. Prunes (dried plums, Prunus domestica) are commonly believed to have stool softening properties [5]. Some recent studies support the role of prunes in chronic constipation [6,7]. ...
Article
Full-text available
Objective To investigate the effect of postoperative prune consumption on time to first bowel movement after benign gynecologic surgery. Materials and methods In this randomized, open label, controlled trial, 77 adult women who had benign gynecologic surgery that required at least one night in the hospital were enrolled from July 2018 to April 2019. Participants were randomized in a 1:1 ratio to one of two groups using a randomization assignment: 4 oz prunes daily plus docusate sodium 100 g twice daily versus docusate alone. The study’s primary objective was time to first bowel movement (BM). Secondary outcomes were pain associated with first BM, stool consistency using Bristol stool scale, and patient satisfaction with bowel regimen and surgery experience. Results Postoperative survey data was available for 68.4% of participants (n = 52). There was no difference in time to first BM between the two groups (p = 0.29); however, consumption of > 12 prunes was associated with an increased likelihood of having a BM in the study period. Among women who consumed at least 12 prunes, hospital discharge was earlier, and there was a not statistically significant greater satisfaction with postoperative bowel regimen. Conclusions The addition of prunes to postoperative bowel regimen of docusate sodium may be a beneficial adjunct to postoperative bowel regimen. Clinical trial The Institutional Review Board at the University of Southern California approved the study, and the study was registered at clinicaltrials.gov (ID: NCT03523715).
... The above-quoted studies used multiple agents to relieve constipation, so it is difficult to judge the effect of dried plums alone. However, in a systematic German population study, dried plums were perceived as the best food to soften stool by people suffering from constipation, irritable bowel syndrome with constipation, or healthy controls (Müller-Lissner et al., 2005). They were asked which foods or beverages altered stool consistency (open-ended question), and then were specifically questioned about prunes, bananas, coffee, tea, chocolate, beer, wine, and cigarettes. ...
Article
Full-text available
This paper describes composition of dried plums and their products (prune juice and dried plum powder) with special attention to possibly bioactive compounds. Dried plums contain significant amounts of sorbitol, quinic acid, chlorogenic acids, vitamin K1, boron, copper, and potassium. Synergistic action of these and other compounds, which are also present in dried plums in less conspicuous amounts, may have beneficial health effects when dried plums are regularly consumed. Snacking on dried plums may increase satiety and reduce the subsequent intake of food, helping to control obesity, diabetes, and related cardiovascular diseases. Despite their sweet taste, dried plums do not cause large postprandial rise in blood glucose and insulin. Direct effects in the gastrointestinal tract include prevention of constipation and possibly colon cancer. The characteristic phenolic compounds and their metabolites may also act as antibacterial agents in both gastrointestinal and urinary tracts. The indirect salutary effects on bone turnover are supported by numerous laboratory studies with animals and cell cultures. Further investigation of phenolic compounds in dried plums, particularly of high molecular weight polymers, their metabolism and biological actions, alone and in synergy with other dried plum constituents, is necessary to elucidate the observed health effects and to indicate other benefits.
... It can be eaten fresh, dried to obtain prunes, or used to produce jam, juice, wine, and, after distillation, a brandy called Slivovitz. Plums are known for their laxative effect (Muller-Lissner, Kaatz, Brandt, Keller, & Layer, 2005;Piirainen, Peuhkuri, Bäckström, Korpela, & Salminen, 2007), which depends on the prune/plum variety, and can be explained by their relatively high content of both soluble and insoluble fibers, and also sugar alcohols such as xylitol and sorbitol, which increase gastric emptying and encourage the growth of acid-producing intestinal microflora (Dikeman, Bauer, & Fahey, 2004;Salminen et al., 1989;Stacewicz-Sapuntzakis, Bowen, Hussain, Damayanti-Wood, & Farnsworth, 2001). ...
Article
The aim of the present work was to characterize the pectins present in plum fruit, juice, and pomace for three plum varieties, “Promis,” “Najbolja,” and “Dąbrowicka” (all belonging to the species Prunus domestica L.). The content of dietary fiber in the pomace was 5 to 9 times higher than that in the fruit. In turn, the content of soluble fibers and readily soluble pectins (water and chelator soluble pectins) was markedly lower as compared to the fruit, and their hydrodynamic volume was decreased, especially in the case of water soluble pectins. As a result, the hydration capacity of AIS from the pomace was half of that of AIS from the fruit, but its levels were still high enough for it to be used as an ingredient in food products (WBC > 5.5 g/g). Thus, plum pomace could be an efficient source of functional fibers.
... Positive, but to a less extend, gastrointestinal effects were also observed in banana drink group. Our results contradict the reported perceived effect of bananas on stool consistency, which relates banana consumption with induction of constipation in apparently healthy people [17]. Furthermore, our data confirm that most healthy people would probably experience no detected increase in intestinal gas when bananas are eaten in customary amounts [18]. ...
Article
Banana is a widely consumed fruit, which contains considerable amounts of potential prebiotic indigestible carbohydrates. In our randomised, controlled trial we aimed to evaluate the in vivo prebiotic effect of banana consumption on faecal microbiota. Thirty-four healthy women participated in the study, having Body Mass Index (BMI) 24-30 kg/m(2), age 19-45 years, without history of gastrointestinal disease and no antibiotic and other medication use two months prior the initiation and during the study. All women were asked to maintain their usual dietary habits for 60 days and they were randomly assigned to consume twice a day a pre-meal snack, either one medium banana, or one cup of banana-flavoured drink or one cup of water (control group). Stool samples were collected at baseline, on days 30 and 60 of intervention for enumeration of total anaerobes, bifidobacteria and lactobacilli by plate count techniques, as well as for pH and short chain fatty acids (SCFAs) measurement. Gastrointestinal symptoms were also recorded. Mean bifidobacterial levels were increased only in the banana group both at 30 and 60 days of intervention, but this change did not reach a statistical significance. No significant overall differences in the total concentrations and molar ratios of SCFAs were detected according to dietary intervention. Analysis of the gastrointestinal symptoms records revealed significantly lower bloating levels in the banana group, compared to controls, at 26-35 days (p = 0.009) and 51-60 days (p = 0.010). Banana consumption had also no adverse effects on evacuation patterns. We concluded that daily consumption of bananas is a well-tolerated eating behaviour, which may induce bifidogenesis in healthy women experiencing body weight problems.
... There is currently not sufficient evidence to suggest that dietary modifications of any kind can improve GERD symptoms or pathological measures (123). Interestingly, one study found that chocolate was the most often cited constipation-causing food among patients with constipationpredominant irritable bowel syndrome (177), but no other studies have investigated this reported effect. ...
Article
Full-text available
Cocoa contains more phenolic antioxidants than most foods. Flavonoids, including catechin, epicatechin, and procyanidins predominate in antioxidant activity. The tricyclic structure of the flavonoids determines antioxidant effects that scavenge reactive oxygen species, chelate Fe2+ and Cu+, inhibit enzymes, and upregulate antioxidant defenses. The epicatechin content of cocoa is primarily responsible for its favorable impact on vascular endothelium via its effect on both acute and chronic upregulation of nitric oxide production. Other cardiovascular effects are mediated through anti-inflammatory effects of cocoa polyphenols, and modulated through the activity of NF-κB. Antioxidant effects of cocoa may directly influence insulin resistance and, in turn, reduce risk for diabetes. Further, cocoa consumption may stimulate changes in redox-sensitive signaling pathways involved in gene expression and the immune response. Cocoa can protect nerves from injury and inflammation, protect the skin from oxidative damage from UV radiation in topical preparations, and have beneficial effects on satiety, cognitive function, and mood. As cocoa is predominantly consumed as energy-dense chocolate, potential detrimental effects of overconsumption exist, including increased risk of weight gain. Overall, research to date suggests that the benefits of moderate cocoa or dark chocolate consumption likely outweigh the risks.
... These findings substantiate previous reports of smaller samples of women with FI that patients not only believe that their diet influences FI but act on this perspective. 2,4,5 We found no studies evaluating the effectiveness of dietary modifications on FI severity; these findings may help to guide the development of such an intervention. ...
Article
The study aimed to describe modifications in diet and eating patterns made by community-living people to manage fecal incontinence (FI), and to compare these differences according to sex, age, and FI severity. Subjects were 188 community-living adults (77% female, 92% white, 34% aged 65 years or older) in the upper Midwest who participated in a study about managing FI with dietary fiber. Subjects were interviewed about diet and eating pattern changes that they made to manage FI, and self-reported demographic data. FI severity was recorded daily. Fifty-five percent of participants perceived that some foods worsen their FI (eg, fatty or spicy foods and dairy products). More women than men (40% vs 18%, P = .008) reported avoiding foods to manage FI. A greater percentage of younger than older people believed that fatty/greasy foods (15% vs 4%) and alcohol (14% vs 3%) worsened their FI. Subjects with a higher FI severity score appeared to wait until FI was more severe before restricting caffeine than those with lower severity scores (22.2 ± 9.8 vs 11.69 ± 8.3, P = .034). One-third of subjects consumed foods rich in dietary fiber to prevent FI. Subjects also reported altered eating or cooking patterns, skipping meals, or eating at consistent times to manage FI. Diet modification for managing FI incorporates restriction of some foods, along with adding others foods to the diet. Nursing assessments of self-care practices for FI should include diet and eating pattern changes when developing a plan of care.
... The first literature references, according to Ferrer and Boyd [10], date back to 1345, when French observers reported that prunes were a natural intestinal stimulant. Since then, plums and prunes have been recommended for the treatment of constipation, and are even today believed to soften stools and to relieve constipation [11]. Prunes have been shown to increase fecal output in non-constipated men [12]. ...
... Prunes are known to soften stools and to relieve constipation (Muller-Lissner et al., 2005a) and have been shown to increase faecal output in non-constipated men (Tinker et al., 1991). Their efficacy in elderly subjects has been reported in a few early studies in which prunes in yoghurt (Ferrer and Boyd, 1955) or prunes with cascarin (Stern, 1966) or fibre (Hull et al., 1980) have been ingested. ...
Article
Full-text available
Constipation is a common problem in the elderly. Dietary fibre is recommended for its treatment. The aim was to examine whether yoghurt containing galacto-oligosaccharides (GOS), prunes and linseed relieve constipation in elderly subjects. A randomized, double-blinded, cross-over study. Free-living subjects. A group of 43 elderly subjects with self-reported constipation (mean age 76 years, range 61-92 years, 32 females, 11 males). The study consisted of a 2-week baseline period and 2, 3-week dietary interventions, with a 2-week wash-out period between the interventions. During the interventions, the subjects ingested, in random order, 260 g/day of either control yoghurt or test yoghurt containing GOS (12 g/day), prunes (12 g/day) and linseed (6 g/day). The use of laxatives was controlled and only allowed after 2 days without defecation. Defecation frequency was 5.7 times/week during the baseline period. During the test yoghurt period, defecation frequency was higher (8.0 vs 7.1 times/week, P=0.011), defecation was easier (on the scale 0-3, 1.3 vs 1.5, P=0.010), and there was a tendency towards softer stools (on the scale 0-3, 2.1 vs 2.2, P=0.059) compared with the control yoghurt period. The subjects felt that the test yoghurt relieved constipation more effectively than the control yoghurt (P=0.005). The sum of gastrointestinal symptoms did not differ between the interventions. The use of laxatives remained constant throughout the study. Daily intake of yoghurt containing GOS, prunes and linseed reduced the severity of constipation in elderly subjects with mild constipation. Valio Ltd, R&D.
... Prunes (dried plums) are generally perceived to have a laxative effect [11]. They are high in fibre (~6 g/100 g), including hemicellulose (3.0 g/100 g), pectin (2.1 g/100 g) and cellulose (0.9 g/100 g) [12]. ...
Article
Full-text available
Background & aim: Prunes (dried plums) are perceived to maintain healthy bowel function, however their effects on gastrointestinal (GI) function are poorly researched and potential mechanisms of action are not clear. We aimed to investigate the effect of prunes on stool output, whole gut transit time (WGTT), gut microbiota and short-chain fatty acids (SCFA) in healthy adults METHODS: We conducted a parallel group, randomised controlled trial with three treatment arms in 120 healthy adults with low fibre intakes and stool frequency of 3-6 stools/wk. Subjects were randomised to 80 g/d prunes (plus 300 ml/d water); 120 g/d prunes (plus 300 ml/d water) or control (300 ml/d water) for 4 weeks. Stool weight was the primary outcome and determined by 7-day stool collection. Secondary outcomes included stool frequency and consistency (stool diary), WGTT (radio-opaque markers), GI symptoms (diary), microbiota (quantitative PCR) and SCFA (gas liquid chromatography). Group assignment was concealed from the outcome assessors. Results: There were significantly greater increases in stool weight in both the 80 g/d (mean + 22.2 g/d, 95% CI -1-45.3) and 120 g/d (+32.8 g/d, 95% CI 13.9-51.7) prune groups compared with control (-0.8 g/d, 95% CI -17.2 to 15.6, P = 0.026). Stool frequency was significantly greater following 80 g/d (mean 6.8 bowel movements/wk, SD 3.8) and 120 g/d (5.6, SD 1.9) prune consumption compared with control (5.4, SD 2.1) (P = 0.023), but WGTT was unchanged. The incidence of flatulence was significantly higher after prune consumption. There were no significant differences in any of the bacteria measured, except for a greater increase in Bifidobacteria across the groups (P = 0.046). Prunes had no effect on SCFA or stool pH. Conclusions: In healthy individuals with infrequent stool habits and low fibre intake, prunes significantly increased stool weight and frequency and were well tolerated. Prunes may have health benefits in populations with low stool weight. Clinical trial registry number and website: ISRCTN42793297 http://www.isrctn.com/ISRCTN42793297.
... [12] The authors speculated that fibre, phenolic compounds (184 mg/100 g), mainly as neochlorogenic and chlorogenic acids, and sugar alcohol content may have contributed in the laxative effect of dried plum. [12] Although the laxative effect of dried plum and the other health benefits of this fruit have been perceived by the public, [15] there is still relatively little evidence to provide a cause and effect relationship between the consumption of dried plum and maintenance of normal bowel function. [8] Therefore, this study was conducted to compare the effect of different doses of daily dried plum consumption on the bowel habits of older postmenopausal women. ...
Article
Calcium and vitamin D were provided to forty-eight postmenopausal women for six months and randomly assigned into control, 50 g/d dried plum or 100 g/d dried plum groups to examine dried plum influences on bowel habits. No adverse effects of dried plum were detected; whereas, pain and constipation ratings increased (P<0.05) in control group. Pain was higher (P=0.049) at six months for control versus 50 g/d dried plum and lower (P=0.042) at three months for 100 g/d dried plum versus 50 g/d. Constipation ratings were higher for control than 100 g/d dried plum at six months. Dried plum in the dose of 50 or 100 g per day did not produce adverse effect and may decrease discomfort of bowel movements.
... 27,28 Some fruits are perceived to have stool softening abilities, with a survey of 1088 participants, including healthy individuals and patients with constipation or IBS-C, reporting prunes to be the most stool softening. 29 However, there is limited evidence regarding the mechanisms of action of fruits towards gut motility and constipation, and few studies have addressed their effectiveness in impacting gut transit time and reducing constipation symptoms in clinical trials. The aim of this review is to discuss the existing evidence on the effects of fruits on gut microbiota, gut motility and constipation, with a focus on the mechanisms of action and effectiveness. ...
Article
Fruits are the seed-bearing product of plants and have considerable nutritional importance in the human diet. The consumption of fruits is among the dietary strategies recommended for constipation due to its potential effects on the gut microbiota and gut motility. Dietary fiber from fruits has been the subject of research on the impact on gut microbiota, gut motility and constipation, however, fruits also contain other components that impact the intestinal luminal environment that may impact these outcomes including sorbitol and (poly)phenols. This review aims to explore the mechanisms of action and effectiveness of fruits and fruit products on the gut microbiota, gut motility and constipation, with a focus on fiber, sorbitol and (poly)phenols. In vitro, animal and human studies investigating the effects of fruits on gut motility and gut microbiota were sought through electronic database searches, hand searching and consulting with experts. Various fruits have been shown to modify the microbiota in human studies including blueberry powder (lactobacilli, bifidobacteria), prunes (bifidobacteria), kiwi fruit (Bacteroides, Faecalibacterium prausnitzii) and raisins (Ruminococcus, F. prausnitzii). Prunes, raisins and apple fiber isolate have been shown to increase fecal weight in humans, whilst kiwifruit to increase small bowel and fecal water content. Apple fiber isolate, kiwifruit, fig paste, and orange extract have been shown to reduce gut transit time, while prunes have not. There is limited evidence on which fruit components play a predominant role in regulating gut motility and constipation, or whether a synergy of multiple components is responsible for such effects.
... Применение Дюспаталина, наряду с уменьшением интенсивности боли в животе, приводит к значимому росту качества жизни пациентов с различными вариантами СРК [36]. Мебеверин также обладает высоким профилем безопасности, его хорошо переносят больные при длительном применении [37]. ...
Article
Objective of the Review: To describe and compare some pharmacodynamic and pharmacokinetic parameters of antispasmodic drugs used in complex management of irritable bowel syndrome (IBS) in the Russian Federation. Key Points. IBS is a chronic recurrent disease associated with abdominal pain and bowel disorders. The key factors of IBS pathogenesis include intestinal motility disorders and visceral hypersensitivity. Both processes are controlled by endocrine and neural systems. In a target cell, voltage-operated calcium channels mediate neuronal signals for unstriped muscles to contract and for glands to start secreting. Antispasmodic drugs are a group of products that have been used for IBS management for decades. The review describes contemporary idea of molecular mechanisms to control contraction of GIT muscle cells and a comparison of antispasmodic drugs used in complex therapy of IBS in the Russian Federation. Their key pharmacodynamic and pharmacokinetic characteristics are discussed. Conclusion. The fundamental difference of mebeverine (Duspatalin) is its ability to normalise bowel motility in patients with IBS without the need in complete motility suppression. Also, its inability to block muscarinic receptors and stimulate opioid receptors is another advantage in improving the quality of life of patients. Keywords: pharmacodynamics, pharmacokinetics, antispasmodic drugs, therapy of irritable bowel syndrome, mebeverine.
... Tea/coffee consumption has been shown to be a risk factor for IBS and dyspepsia [11]. In another study, tea and coffee were associated with constipation and diarrhea [34]. Plausible explanation for coffee leading to diarrhea is that it softens the stool consistency, and for tea is that it contains salicylates leading to activation of mast cells [35]. ...
Article
Background/PurposeThere is scarcity of data on prevalence, overlap, and risk factors for functional gastrointestinal disorders (FGID) by Rome IV criteria. We evaluated these factors among medical, nursing, and humanities students.Methods Rome IV Diagnostic Questionnaire (for all FGIDs), Rome III questionnaire (for irritable bowel syndrome [IBS], functional diarrhea [FDr], and functional constipation [FC]), and questionnaires assessing demography, physical activity, anxiety, and depression were used.ResultsA total of 1309 college students were included (medical 425, nursing 390, humanities 494; mean age 20.5 ± 2.1 years; 36.5% males). Prevalence of Rome IV FGIDs was 26.9% (n = 352), significantly higher among females compared with males (32.3% vs. 17.6%; p < 0.001) and significantly higher among medical (34.4%) and nursing students (29.2%) compared with humanities students (18.6%) (p < 0.05). Most common FGIDs were functional dyspepsia (FD) (15.2%), IBS (6.2%), reflux hypersensitivity (3.5%), FDr (2.9%), FC (2.1%), and unspecified functional bowel disorder (2.1%). FGID overlap was present in 9.3%, most common being FD-IBS overlap (4.4%). With Rome III criteria, prevalence of IBS was higher (9.5%), while that of FDr (0.92%) and of FC (1.3%) were lower. On multivariate analysis, independent predictors for FGIDs were female gender, medical student, non-vegetarian diet, junk food, tea/coffee, poor physical activity, anxiety, and insomnia.Conclusion Rome IV FGIDs were present among one-fourth of college students with preponderance among females and medical students. FD, IBS, and reflux hypersensitivity were the most common FGIDs. Rome IV criteria led to a reduction in IBS prevalence and increase in FDr and FC prevalence. Dietary factors, physical activity, anxiety, and insomnia affected FGID prevalence.
... Nevertheless, behind the chemotherapy there are also biologically ac- tive substances that may cause the constipation [16,17]. Müller-Lissner et al. [18] pointed out that these patients with constipation report altered stool form after food and beverage consumption more often than healthy subjects. Additionally, among these chocolate was the most frequently mentioned and perceived as caused constipation. ...
Article
Full-text available
Aim of the study: To evaluate an association between food products consumption, dietary intake and the incidence of selected gastrointestinal symptoms (nausea, vomiting, diarrhea and constipation) in cancer patients undergoing chemotherapy. Material and methods: Fifty six women receiving chemotherapy for ovarian cancer were eligible for the study. Anthropometrical measurements were assessed. The dietary intake was evaluated by 24-hours food records. The association between the consumption of selected food products and gastrointestinal symptoms incidences was assessed by modified semi-quantitative food frequency questionnaire including 77-different food items that was developed and applied in cancer patients undergoing chemotherapy. Results: BMI values indicated 9%, 45%, 30% and 16% of patients as underweight, normal weight, overweight and obese respectively. Only 23% and 32% of patients never experienced nausea and constipation when 43% and 45% never experienced vomiting and diarrhea. Nausea was promoted by oils, constipation by chocolate and chocolate products and diarrhea by dairy products, stone fruit and apple. Significant inverse correlations were found between vomiting and the intake of energy, fat, protein, carbohydrates, B groups vitamins, vitamin D, phosphorus and zinc. The difference in energy intake between marginal values of vomiting incidence exceeded 400 kcal. Conclusions: Dietary intake as well as specific food products influence on gastrointestinal side effect of chemotherapy in cancer patients. The dietary approach based on either exclusion or limited intake of selected food products and improvement of diet could reduce and prevent chemotherapy induced gastrointestinal symptoms therefore should be taken under consideration in clinical practice.
... Dark chocolate has been proposed as an ergogenic aid via increased nitric oxide [38]; however, caution should be advised given our results of high avoidance pre-race, although we did not distinguish between the different types of chocolate. Chocolate has been described as a food item that provokes GI disturbance, particularly constipation [39], although research in athletes is lacking. Chocolate contains several biologically active compounds including cocoa, caffeine, and fat; thus, the mechanisms are unclear. ...
Article
Full-text available
Background: Endurance runners frequently experience exercise-induced gastrointestinal (GI) symptoms, negatively impacting their performance. Food choices pre-exercise have a significant impact on the gut's tolerance to running, yet little information is available as to which foods runners restrict prior to exercise. Methods: A questionnaire designed to assess dietary restrictions pre-racing and gastrointestinal symptoms was administered to 388 runners. Fisher's exact tests determined differences in gender, age, performance level, and distance with follow-up multivariable logistic regression modeling. Results: Runners regularly avoided meat (32%), milk products (31%), fish/seafood (28%), poultry (24%), and high-fiber foods (23%). Caffeinated beverages were commonly avoided in events 10 km or less (p < .001); whereas in females, increased running distance was a predictor of avoiding high-fiber foods (OR = 6.7; 95% CI = 1.6-28.5). Rates of food avoidance were elevated in younger and more competitive runners. Common GI symptoms included stomach pain/cramps (42%), intestinal pain/discomfort (23%), side ache/stitch (22%), urge to defecate (22%), and bloating (20%). The prevalence of GI symptoms was higher in younger athletes, especially females, which may explain their propensity to avoid foods. Lower recreational athletes were the least likely to report GI symptoms. Diarrhea incidence increased with running distance. Conclusions: Identification of voluntary food restrictions in the pre-running meal highlights trends that can direct further research.
... Nevertheless, behind the chemotherapy there are also biologically active substances that may cause the constipation [16,17]. Müller-Lissner et al. [18] pointed out that these patients with constipation report altered stool form after food and beverage consumption more often than healthy subjects. Additionally, among these chocolate was the most frequently mentioned and perceived as caused constipation. ...
Article
Full-text available
Aim of the study To evaluate an association between food products consumption, dietary intake and the incidence of selected gastrointestinal symptoms (nausea, vomiting, diarrhea and constipation) in cancer patients undergoing chemotherapy. Material and methods Fifty six women receiving chemotherapy for ovarian cancer were eligible for the study. Anthropometrical measurements were assessed. The dietary intake was evaluated by 24-hours food records. The association between the consumption of selected food products and gastrointestinal symptoms incidences was assessed by modified semi-quantitative food frequency questionnaire including 77-different food items that was developed and applied in cancer patients undergoing chemotherapy. Results BMI values indicated 9%, 45%, 30% and 16% of patients as underweight, normal weight, overweight and obese respectively. Only 23% and 32% of patients never experienced nausea and constipation when 43% and 45% never experienced vomiting and diarrhea. Nausea was promoted by oils, constipation by chocolate and chocolate products and diarrhea by dairy products, stone fruit and apple. Significant inverse correlations were found between vomiting and the intake of energy, fat, protein, carbohydrates, B groups vitamins, vitamin D, phosphorus and zinc. The difference in energy intake between marginal values of vomiting incidence exceeded 400 kcal. Conclusions Dietary intake as well as specific food products influence on gastrointestinal side effect of chemotherapy in cancer patients. The dietary approach based on either exclusion or limited intake of selected food products and improvement of diet could reduce and prevent chemotherapy induced gastrointestinal symptoms therefore should be taken under consideration in clinical practice.
Article
BACKGROUND This study investigated the in vivo prophylactic effect of probiotic chocolate on constipation. Rats were administered with chocolate containing 2.5 × 10¹⁰ CFU g‐1 of probiotics daily for four weeks and treated with loperamide (5 mg kg‐1) daily at the fourth week of treatment. RESULTS Probiotic chocolate treatments significantly (P < 0.05) increased the intestinal motility, colon length, fecal moisture content, and the number of excreted fecal pellets in the constipated rats. Moreover, qRT‐PCR data and histological images also revealed that both probiotic chocolate LYC and BB12 treatments were capable of up‐regulating the mRNA expression levels of colonic ZO‐1, occludin, and AQP8, leading to the maintenance of the defensive barrier function in the constipated rats compared to the negative controls. Interestingly, these treatments also modulated gut bacterial populations by increasing the abundance levels of Lactobacillus and Bifidobacterium, as well as reducing the abundance level of Enterobacteriaceae. CONCLUSION The present study demonstrated that probiotic chocolate LYC and BB12 could potentially be used as alternative agents for prophylactic constipation. This article is protected by copyright. All rights reserved.
Article
Constipation is a common complaint in childhood, and the etiology of many healthcare referrals. Despite literature documenting the high frequency of this problem, there is little research directly relating the food consumed and the eventual stool consistency. There is literature suggesting the importance of adequate fiber intake in children to maintain soft stools. Other dietary modifications actually have not been shown to be helpful or are not based on actual clinical studies. The presence of dietary allergies may also contribute to etiology of constipation. More studies to provide further linkages between diet and constipation are clearly needed.
Article
Symptoms of fecal incontinence and constipation are common in the general population. These can, however, be unreliably reported and are poorly discriminatory for underlying pathophysiology. Furthermore, both symptoms may coexist. In the elderly, fecal impaction always must be excluded. For patients with constipation, colon transit studies, anorectal manometry and defecography may help to identify patients with slow-transit constipation and/or pelvic floor dysfunction. The best documented medical treatments for constipation are the macrogols, lactulose and isphagula. Evolving drugs include lubiprostone, which enhances colonic secretion by activating chloride channels. Surgery is restricted for a highly selected group of patients with severe slow-transit constipation and for those with large rectoceles that demonstrably cause rectal evacuatory impairment. For patients with fecal incontinence that does not resolve on antidiarrheal treatment, functional and structural evaluation with anorectal manometry and endoanal ultrasound or magnetic resonance (MR) of the anal canal may help to guide management. Sacral nerve stimulation is a rapidly evolving alternative when other treatments such as biofeedback and direct sphincter repair have failed. Advances in understanding the pathophysiology as a guide to treatment of patients with constipation and fecal incontinence is a continuing important goal for translational research. The content of this article is a summary of presentations given by the authors at the Fourth Meeting of the Swedish Motility Group, held in Gothenburg in April 2007.
Article
Irritable bowel syndrome (IBS) is a complex clinical process with multiple pathophysiologic mechanisms. There has recently been a shift in the treatment of patients with severe IBS symptoms to disease-modifying therapies as opposed to symptomatic treatment. Because pathophysiologic differences exist between men and women, so does the efficacy of treatment options. These differences could further explain gender-related differences in disease prevalence and treatment response. A brief discussion of the definition, epidemiology, and diagnostic criteria of IBS is followed by a comprehensive review of the current treatment choices and potential future therapeutic options of IBS in women.
Article
Constipation is a very common condition that is frequently managed suboptimally. A recent single-blind, randomized, crossover study has reported the superior effects of dried plums (prunes) over the stool-bulking fiber supplement psyllium in the treatment of mild to moderate symptoms of constipation.
Article
Full-text available
Background and Purpose: Physical therapists need to be informed that low back pain in an athlete may originate from a gastrointestinal dysfunction such as constipation. A 21-year-old Caucasian American male basketball player was referred to physical therapy with intermittent back and hip pain. The athlete had recurrent bouts of lower back and hip pain since he was in high school. However, the athlete reported no specific incident where he injured his lower back or hips, but included periodic constipation on his medical history. The purpose of this case report was to describe how an athlete with nonspecific low back pain was evaluated for a gastrointestinal dysfunction as a potential source of pain. Methods and Findings: A review of the literature was conducted to find the latest treatment strategies for an athlete with low back pain originating from constipation. Clinical Relevance: The key step in managing constipation should be to rule out secondary causes of constipation, such as anatomical lesions, endocrine disorders, neurologic diseases, or medication side effects. Conclusion: A young athlete with a history of lower back and hip pain without a specific mechanical cause or injury should be carefully evaluated to rule out a gastrointestinal dysfunction.
Article
Prunes are believed to have a laxative effect. Our aim was to study whether prune juice affects gastrointestinal function in adults with certain gastrointestinal symptoms. The study comprised 54 volunteers (13 men, 41 women) whose mean age was 44 years (range, 24-82 years). The study began with a 1-week baseline period, followed by a 2-week prune juice period, and finally a 1-week follow-up period. During the prune juice period, the subjects drank, twice a day, 125 mL of the test prune juice, which consisted of plum juice concentrate, prune puree, water, and fructose. During the 4 study weeks the subjects kept a daily record of fecal frequency, difficulty of defecation, stool consistency, and gastrointestinal symptoms. The subjects reported fewer days with difficulty in defecation during the prune juice period (combined first and second weeks) than during the baseline week (1.3 vs 1.7 days, P = .02). This effect appeared to continue into the follow-up week. The mean frequency of days with flatulence was higher during the prune juice period than during the baseline week (2.1 vs 1.4 days, P = .02). Regularly ingested prune juice had a mild laxative effect in adults with certain gastrointestinal symptoms. However, it also increased flatulence. Prune juice may offer an alternative to laxatives, at least, in cases of mild constipation.
Article
This review describes the history of banana in human nutrition and the latest progress in research concerning treatment with the banana diet in diarrhea and undernutrition. Abundant literature supports banana's advantages in prevention of cancer, cardiovascular diseases and hypokalimia.
Article
Background and Purpose: Physical therapists need to be informed that low back pain in an athlete may originate from a gastrointestinal dysfunction such as constipation. A 21-year-old Caucasian Ameri-can male basketball player was referred to physical therapy with intermittent back and hip pain. The athlete had recurrent bouts of lower back and hip pain since he was in high school. However, the athlete reported no specific incident where he injured his lower back or hips, but included periodic constipation on his medical history. The purpose of this case report was to describe how an athlete with nonspecific low back pain was evaluated for a gastrointestinal dysfunction as a potential source of pain. Methods and Findings: A review of the literature was conducted to find the latest treatment strategies for an athlete with low back pain originating from constipation. Clinical Relevance: The key step in managing constipation should be to rule out secondary causes of constipation, such as anatomical lesions, endocrine disorders , neurologic diseases, or medication side effects. Conclusion: A young athlete with a history of lower back and hip pain without a specific mechanical cause or injury should be carefully evaluated to rule out a gastrointesti-nal dysfunction.
Article
Objectives: The pathophysiology behind functional gastrointestinal disease (FGID) has not been defined, but an intestinal accumulation of fermentable short-chain carbohydrates (FODMAPs) is thought to be involved. A restricted coffee intake is recommended. The aim was to investigate if symptoms of FGID were associated with intake of certain foods (including FODMAPs), as well as beverages (including coffee and tea). Method and materials: Data were used from participants, age range 45-75 years, who had answered the EpiHealth questionnaire about their background factors, health status and intake of food and beverages. After exclusion of organic bowel diseases, 16,840 participants remained. The impact of food and beverages on functional abdominal pain, functional bloating, functional constipation and functional diarrhea were examined by adjusted binary logistic regression. Results: Wholemeal bread (Swedish cracker) (OR: 1.361; 95% CI: 1.001-1.851) and white bread (low fiber content) (OR: 1.527; 95% CI: 1.075-2.169) were associated with constipation, whereas soft wholemeal bread (high fiber content) was associated with diarrhea (OR: 1.601; 95% CI: 1.040-2.463). Cheese was associated with bloating (OR: 1.460; 95% CI: 1.004-2.123). A high tea intake was associated with abdominal pain (p for trend =.003), bloating (p for trend = .039) and diarrhea (p for trend <.001), whereas coffee intake was associated with a decreased risk of abdominal pain (p for trend = .002) and bloating (p for trend = .007). High soda intake associated with abdominal pain and bloating and juice with diarrhea. Conclusion: There are weak associations between intake of grain and dairy products and FGID symptoms. Tea is associated with increased risks, whereas coffee is associated with lower risks, of FGID symptoms.
Article
Objective: The aim of this review was to examine (1) the prevalence of smoking in subjects with irritable bowel syndrome (IBS), (2) whether smoking prevalence significantly differs between subjects with and without IBS, and (3) whether smoking significantly predicts the presence or the development of IBS. Methods: Articles were retrieved by systematically searching the Scopus, Web of Science, and PubMed electronic databases from inception to July 2016, using the keywords "smoking" and "tobacco" combined with "irritable bowel syndrome." Reference lists of included articles were also searched. Articles were included if they (1) reported data on smoking prevalence in subjects with IBS and/or on the association (assessed by means of multivariate analyses) between smoking and IBS, (2) identified IBS according to Manning criteria or Rome I-III criteria, (3) were English-language articles, and (4) involved only adult subjects. Results: The electronic searches yielded a total of 1,637 records, and 42 articles met inclusion criteria. Another 13 articles were retrieved through manual search, leading to a total of 55 included articles. Smoking prevalence in subjects with IBS was assessed by 48 articles and ranged from 0% in university students to 47.1% in patients with microscopic colitis. Thirty-three articles compared smoking prevalence between subjects with and without IBS. In 25 articles no significant difference was found. In seven articles smoking was significantly more frequent in subjects with IBS compared to those without IBS, while one study found a significantly higher smoking prevalence in controls. Eighteen multivariate analyses assessing the association between smoking and IBS were presented in 16 articles. Only one study employed a prospective design. In 11 analyses, smoking was not significantly associated with IBS after adjusting for covariates. In seven studies smoking independently predicted the presence of IBS. Conclusions: According to the selected articles, a significant association between smoking and IBS cannot be confirmed. However, different shortcomings may hinder generalizability and comparability of many studies. A dimensional assessment of smoking, a prospective design, the differentiation between IBS subgroups, and the recruitment of patients in clinical settings, especially in primary care, are necessary to clarify the role of smoking in IBS.
Article
Full-text available
Case-control studies are vital for understanding the pathophysiology of gastrointestinal disease. While the definition of disease is clear, the definition of healthy control is not. This is particularly relevant for functional bowel diseases such as irritable bowel syndrome (IBS). In this study, a systematic review formed the basis for a prospective study evaluating the effectiveness of commonly used techniques for defining healthy controls in IBS. A systematic review of the literature was conducted to identify case-control studies involving functional gastrointestinal disorders. "Lack of Rome criteria", self-description as "healthy" and the bowel disease questionnaire (BDQ) were common methods for identifying healthy controls. These 3 methods were then applied to a cohort of 53 non-patient subjects to determine their validity compared to objective outcome measures (7-day stool diary). "Lack of Rome criteria" and "healthy" self-description were the most common methods for identifying healthy control subjects, but many studies failed to describe the methods used. In the prospective study, more subjects were identified as non-healthy using the BDQ than using either lack of Rome criteria (P=0.01) or "healthy" self-description (P=0.026). Furthermore, stool diaries identified several subjects with abnormal stool form and/or frequency which were not identified using lack of Rome criteria or the "healthy" question. Comparisons revealed no agreement (κ) between the different methods for defining healthy controls. The definitions of healthy controls in studies of functional bowel diseases such as IBS are inconsistent. Since functional symptoms are common, a strict definition of "normal" is needed in this area of research.
Chapter
Pregnancy in the twenty-first century is challenging as the woman who becomes pregnant today may have a significant medical history that poses increased risks to a healthy pregnancy. This chapter will explore how to achieve the healthiest pregnancy possible with regard to nutrition, beginning with preconception nutrition, addressing nutrition needs during pregnancy and including the multiple nutrition-related challenges that occur along the way during the 9 months.
Article
Background Symptoms of irritable bowel syndrome (IBS) have been associated to altered colonic motility and sensation. Smoking affects pain perception and is a risk factor in the development of post-infectious IBS, but its effect on abdominal pain and colonic transit remains to be elucidated in IBS. Methods Forty patients with IBS-C and 28 with IBS-M were selected based on Rome IV criteria. Colonic transit time was studied and smoking habit was recorded. Presence of mild or severe abdominal pain and the prevalent pain characteristics (diffuse or localized, chronic or acute, with cramps or gradually distending) were recorded. Data were analyzed by univariate and stepwise multiple logistic regression analysis to verify the risk association between pain and all other variables. Results IBS-C patients had a longer transit time in the right colon and scored more chronic pain than IBS-M patients. When severity of abdominal pain was used as discriminating factor, a significant number of subjects reporting severe pain were males and smokers (16/30 vs. 4/38 and 20/30 vs. 4/38, both ƿ<0.001). Multivariate analysis confirmed that smoking was an independent factor associated with severe abdominal pain (OR 14.3, CI 2–99, p=0.007). Smoking was not associated with colonic transit times and colonic transit was not associated with IBS symptoms’ severity (both ƿ=N.S.) Conclusions Smoking was the only factor independently associated with severe abdominal pain. As smoking does not seem to affect colonic transit time, we suggest that smoking may influence visceral perception and symptoms severity in IBS patients.
Article
Full-text available
A recent major theory was that a meal high in carbohydrate increased the rate that tryptophan enters the brain, leading to an increase in the level of the neurotransmitter serotonin that modulates mood. Although such a mechanism may be important under laboratory conditions it is unlikely to be of significance following the eating of any typical meal. As little as 2-4% of the calories of a meal as protein will prevent an increased availability of tryptophan. Arguably the food with the greatest impact on mood is chocolate. Those who crave chocolate tend to do so when they feel emotionally low. There have been a series of suggestions that chocolate's mood elevating properties reflect 'drug-like' constituents including anandamines, caffeine, phenylethylamine and magnesium. However, the levels of these substances are so low as to preclude such influences. As all palatable foods stimulate endorphin release in the brain this is the most likely mechanism to account for the elevation of mood. A deficiency of many vitamins is associated with psychological symptoms. In some elderly patients folate deficiency is associated with depression. In four double-blind studies an improvement in thiamine status was associated with improved mood. Iron deficiency anaemia is common, particularly in women, and is associated with apathy, depression and rapid fatigue when exercising.
Article
Full-text available
Ninety nine healthy young volunteers (58 men, 34 women, aged 17-27 years) answered a questionnaire concerning their bowel habit with particular reference to the effects of beverages. Twenty nine per cent (63% women) claimed that coffee induced a desire to defecate. The rectosigmoid motor responses to black, unsweetened coffee were then investigated by multiport manometry in 14 healthy-subjects (12 men, two women, eight of whom claimed coffee caused a desire to defecate (responders). Results revealed an increase in motility index within four minutes after ingestion of both regular and decaffeinated coffee (p less than 0.05) in the eight responders, but not in the six non-responders. The increase in rectosigmoid motility induced by coffee lasted at least 30 minutes. There was no increase in the motility index in any subject after a drink of hot water. These results suggest that drinking coffee can stimulate a motor response of the distal colon in some normal people.
Article
Full-text available
Regardless of where they live or under what circumstances, mothers throughout the world seem to have a compelling desire to provide the best possible health care for their children (Huston, 1979). Haitian mothers living in the Dominican Republic were no exception. The health beliefs and practices of these mothers related primarily to diarrhea among their children which demonstrated a concern and resourcefulness that is commendable. The results of this study clearly indicate the importance of transcultural nurses conducting culturally relevant research as a basis to develop sound health programs in developing countries. Diarrhea was identified as the single most important threat to a child's health in these communities. That mothers did not know about the correct ingredients and/or proportions for oral rehydration solutions (Western views) was of interest. Although the Dominican government makes some commercial packets of ORS, most of the women interviewed did not have ready access to this product. This finding reflected the need for transcultural nurses to offer to teach mothers how to make ORS using the sugar, salt, and water they had available. Since the mothers' perception that diarrhea was a dangerous threat to their children's health, was verified by childhood mortality statistics in the bateys, it would seem that ORS could make a significant impact on the health status of the children. Breastfeeding also was a major health belief factor associated with the treatment of diarrhea. Even though the majority of mothers believed breast feeding should be continued if a child had diarrhea, a number believed it should be discontinued. Nurses working with CHWs will need to emphasize the importance of breastfeeding and help them to develop creative ways of communicating this information to the mothers. The second most dangerous threat to the child identified by the mothers was respiratory ailments. This suggests a new area of concentration for future research and training of CHWs. A host of new questions related to respiratory problems such as health beliefs, causative factors, course of disease, traditional treatments, mortality rate, etc. need to be investigated. When transcultural nurses plan health care programs for women and children in other cultures, it is important to recognize the concerns mothers have for their children, and their intense desire to nature and care for them. In this study, mothers willingly participated and demonstrated active interest in learning to use methods to improve the health and well being of their children. It is well documented (Lieban, 1977) that established health beliefs are not automatically discarded when new knowledge is made available, but that exploration and incorporation of new information when presented in a culturally relevant framework does occur. An understanding of local beliefs surrounding health is fundamental to the development of appropriate transcultural nursing interventions. PIP Interviews conducted by community health workers with 83 Haitian women working in sugar cane fields in the Dominican Republic underscored the importance of understanding local health beliefs so that culturally appropriate interventions are implemented. The respondents all had at least 1 child under 5 years of age; their average age was 29 years and they had a mean parity of 4.9. The mothers identified gastrointestinal problems, chiefly diarrhea, as the greatest threat to their child's health. 82% of the mothers had at one time had a diarrheal episode among her children and 31% reported that a child currently had diarrhea; 16% said at least 1 child had died of diarrhea. Water, food, and microbes were identified as the major cause of diarrhea. Although not routinely cited as a cause of diarrhea, the evil eye (transmitted by male of female witches) was viewed by all but 1 mother as a powerful factor in child mortality. The foods mothers claimed they would give a child with diarrhea included lemonade, soups, bananas, and other fruit juices. Both cooking oil and milk were considered harmful. Of concern was the finding that 38% of mothers would discontinue breastfeeding during a diarrhea episode. None of the mothers had heard of oral rehydration; however, most were treating diarrhea with a solution prepared by pouring boiling water over herbs and leaves. This practice suggests that these mothers can be instructed to prepare oral rehydration solutions in which all ingredients are precisely measured. Since diarrhea is a major cause of child mortality in these Haitian communities in the Dominican Republic, promotion of oral rehydration could make a significant contribution to child survival. It is essential, however, that all such interventions incorporate existing beliefs and present new information in a culturally relevant framework.
Article
Full-text available
Two hundred patients (156 women) with the irritable bowel syndrome were treated with dietary exclusion for three weeks. Of the 189 who completed this study, 91 (48.2%) showed symptomatic improvement. Subsequent challenge with individual foods showed that 73 of these 91 responders were able to identify one or more food intolerances and 72 remained well on a modified diet during the follow up period (mean (SD), 14.7 (7.98) months). Of the 98 patients who showed no symptomatic improvement after three weeks of strict exclusion only three were symptomatically well at follow up (mean (SD), 12.48 (8.09 months). There was no close correlation between response and symptom complex. There was a wide range of food intolerance. The majority (50%) identified two to five foods which upset them (range 1-14). The foods most commonly incriminated were dairy products (40.7%) and grains (39.4%).
Article
Full-text available
Hormonal fluctuations associated with the menstrual cycle influence appetite control and eating behaviour. Energy intake varies during the reproductive cycle in humans and animals, with a periovulatory nadir and a luteal phase peak. Patterns of macronutrient selection show less consistency but a number of studies report carbohydrate cravings in the premenstrual phase, particularly in women with premenstrual syndrome. The cyclical nature of food cravings are frequently, but not invariably, associated with depression. Fluctuations in appetite, cravings and energy intake during the menstrual cycle may occur in parallel with cyclical rhythms in serotonin, which can be accompanied by affective symptoms. The premenstrual phase can be considered as a time when women are especially vulnerable to overconsumption, food craving and depression; this is often associated with low serotonin activity.
Article
Full-text available
Prunes are dried plums, fruits of Prunus domestica L., cultivated and propagated since ancient times. Most dried prunes are produced from cultivar d'Agen, especially in California and France, where the cultivar originated. After harvest, prune-making plums are dehydrated in hot air at 85 to 90 degrees C for 18 h, then further processed into prune juice, puree, or other prune products. This extensive literature review summarizes the current knowledge of chemical composition of prunes and their biological effects on human health. Because of their sweet flavor and well-known mild laxative effect, prunes are considered to be an epitome of functional foods, but the understanding of their mode of action is still unclear. Dried prunes contain approximately 6.1 g of dietary fiber per 100 g, while prune juice is devoid of fiber due to filtration before bottling. The laxative action of both prune and prune juice could be explained by their high sorbitol content (14.7 and 6.1 g/100 g, respectively). Prunes are good source of energy in the form of simple sugars, but do not mediate a rapid rise in blood sugar concentration, possibly because of high fiber, fructose, and sorbitol content. Prunes contain large amounts of phenolic compounds (184 mg/100 g), mainly as neochlorogenic and chlorogenic acids, which may aid in the laxative action and delay glucose absorption. Phenolic compounds in prunes had been found to inhibit human LDL oxidation in vitro, and thus might serve as preventive agents against chronic diseases, such as heart disease and cancer. Additionally, high potassium content of prunes (745 mg/100 g) might be beneficial for cardiovascular health. Dried prunes are an important source of boron, which is postulated to play a role in prevention of osteoporosis. A serving of prunes (100 g) fulfills the daily requirement for boron (2 to 3 mg). More research is needed to assess the levels of carotenoids and other phytochemicals present in prunes to ensure correct labeling and accuracy of food composition tables in order to support dietary recommendations or health claims.
Article
Full-text available
Because of the beneficial intestinal effects of dietary fibers, we have evaluated the therapeutic effects of green banana or pectin in children with persistent diarrhea. In a double-blind trial, 62 boys, age 5-12 months, were randomly given a rice-based diet containing either 250 g/L of cooked green banana (n = 22) or 4 g/kg pectin (n = 19) or the rice-diet alone (control, n = 21), providing 54 kcal/dL daily for 7 days. Stool weight and consistency, frequency of vomiting and purging, and duration of illness were measured. Most children (60%) had no pathogens isolated from stools, 17% had rotavirus, 5% Vibrio cholerae, 4% Salmonella group B, and 11% had enterotoxigenic Escherichia coli infections. By day 3 posttreatment, significantly (P < 0.001) more children recovered from diarrhea receiving pectin or banana than controls (59%, 55%, and 15%, respectively). By day 4, these proportions correspondingly increased to 82%, 78%, and 23%, respectively, the study diet groups being significantly (P < 0.001) different than controls. Green banana and pectin significantly (P < 0.05) reduced amounts of stool, oral rehydration solution, intravenous fluid, and numbers of vomiting, and diarrheal duration. Green banana and pectin are useful in the dietary management of persistent diarrhea in hospitalized children and may also be useful to treat children at home.
Article
Full-text available
Because the risk factors for constipation in the general population are poorly defined, we examined the association between age, body mass index, and selected lifestyle and dietary factors with the prevalence of constipation in the Nurses’ Health Study.MethodsA total of 62,036 women, aged 36–61 yr and free of cancer, responded to mailed questionnaires in 1980 and 1982, which assessed bowel movement frequency, dietary, and lifestyle factors. Constipation was defined as two or fewer bowel movements weekly.ResultsA total of 3327 women (5.4%) were classified as having constipation. Age and body mass index were inversely associated with constipation (p for trend < 0.0001). In multivariate analysis, women who reported daily physical activity had a lower prevalence of constipation (prevalence ratio [PR] = 0.56, 95% CI = 0.44–0.70). Women in the highest quintile of dietary fiber intake (median intake 20 g/day) were less likely to experience constipation (PR = 0.64, 95% CI = 0.57–0.73) than women in the lowest quintile (median intake 7 g/day). The PR for constipation for women who both reported daily physical activity and were in the highest quintile of fiber intake was 0.32 (95% CI = 0.20–0.54) compared with those with physical activity less than once weekly and those who were in the lowest quintile of fiber intake. Higher frequency of aspirin intake was associated with an increasing prevalence of constipation (PR = 1.38, 95% CI = 1.17–1.62). Current smoking and alcohol use were inversely associated with constipation.Conclusions Our data suggest that moderate physical activity and increasing fiber intake are associated with substantial reduction in the prevalence of constipation in women.
Article
Tetrahydro-beta -carbolines (TH beta Cs), potential neuroactive alkaloids, were found in chocolate and. cocoa. 6-Hydroxy-1-methyl-1,2,3,4-tetrahydro-beta -carboline (60HMTH betaC), 1,2,3,4-tetrahydro-beta -carboline-3-carboxylic acid (THCA), 1-methyl-1,2,3,4-tetrahydro-beta -carboline-3-carboxylic acid (MTCA) in both diastereoisomers (1S,3S and 1R,3S), and 1-methyl-1,2,3,4-tetrahydro-beta -carboline (MTH betaC), besides serotonin and tryptamine biogenic amines, were identified and quantified in dark chocolate, milk chocolate, cocoa, and chocolate-containing cereals by RP-HPLC-fluorescence and HPLC-MS. For each TH betaC, the concentration ranges were determined: 60HMTH betaC (0.16-3.92 mug/g), THCA (0.01-0.85 mug/g), 1S,3S-MTCA (0.35-2 mug/g), 1R,3S-MTCA (0.14-0.88 mug/g), and MTH betaC (nd-0.21 mug/g). The highest content was generally found in chocolates and cocoas, but cereals containing chocolate also showed an appreciable amount of TH beta Cs. The possible biological implications of this novel group of alkaloids in chocolate are discussed.
Article
We studied 5 healthy volunteers and 9 patients with irritable bowel syndrome (IBS) during infusion of the colon with saline solution, bile acids, fatty acids and balloon distension. Our results show that the pain threshold was significantly (p less than 0.001) higher in controls than in IBS patients. Bile acids and fatty acids brought on the habitual pain in 5/7 and 7/8 patients respectively, while they did not have any effect in the control group. On the basis of our data we can conclude that the IBS patients are more sensitive to colonic distension and perfusions, thus suggesting a non-specific irritability of the colon which could be a characteristic of these patients.
Article
A study on the effects of a laxative jam was done on a group of veterans hospitalized at Le Centre hospitalier de l'Université Laval, Sainte-Foy (Québec). The jam, made up of a mixture of dates and prunes, was tried as a form of treatment to see whether it would increase the frequency of bowel movements and decrease laxative use in long-term care elderly patients. Analysis of the treatment group revealed a significant increase in the frequency of bowel movements and a similar decrease in laxative use. No change was observed in the other patients. Although the addition of this jam amounted to a monthly expense of 167$, it has remained part of the diet on a PRN basis.
Article
Inadequate fluid intake is though to be one frequent cause of chronic constipation, although this has never been shown. In order to test whether fluid deprivation has an influence on colonic function, we studied eight healthy male volunteers (median age 23 y, range 21-28 y) with respect to stool frequency, stool weight and mean oroanal transit of radiopaque markers in a control week with a fluid intake of more than 2500 ml beverages per day and in a week with a fluid intake of less than 500 ml beverages per day. The two weeks followed each other in randomised order (with a wash out week in-between) and were standardised as to nutrition and physical activity. Stool frequency diminished from 6.9 +/- 0.9 to 4.9 +/- 0.3 (mean +/- SEM) defaecations per week (p = 0.041) and stool weight from 1.29 +/- 0.20 to 0.94 +/- 0.17 kg per week (p = 0.048) during fluid restriction. Mean oroanal transit times were similar in the two weeks. In conclusion, our study shows that a relatively short period of fluid deprivation decreases stool frequency and stool weight in healthy volunteers. Therefore, a low fluid intake may well be an aetiologic factor for chronic constipation in some patients and too low a fluid intake should be corrected. There is no evidence, however, that an increase of fluid intake within feasible limits has a beneficial effect on chronic constipation.
Article
We investigated the association between self-reported constipation and several demographic and dietary variables in 15,014 men and women 12-74 years of age examined between 1971-75 during the first Health and Nutrition Examination Survey. Overall, 12.8 percent reported constipation. Self-reported constipation correlated poorly with stool frequency. Nine percent of those with daily stools and 30.6 percent of those with four to six stools/week, reported constipation. Constipation was more frequent in Blacks (17.3 percent), women (18.2 percent), and those over age 60 (23.3 percent); after adjusting for age, sex, and race it was more prevalent in those with daily inactivity, little leisure exercise, low income, and poor education. Constipated subjects reported lower consumption of cheese, dry beans and peas, milk, meat and poultry, beverages (sweetened, carbonated and noncarbonated), and fruits and vegetables. They reported higher consumption of coffee or tea. They consumed fewer total calories even after controlling for body mass and exercise.
Article
Two hypotheses were tested: (a) lowered tolerance for balloon distention of the rectosigmoid in patients with irritable bowel syndrome is caused by a psychological tendency to exaggerate the painfulness of any aversive stimulus, and (b) contractions elicited by balloon distention are responsible for pain reports. Tolerance for stepwise distention of a balloon in the rectosigmoid was compared with tolerance for holding one hand in ice water in 16 irritable bowel patients, 10 patients with functional bowel disorder who did not satisfy restrictive criteria for irritable bowel, 25 lactose malabsorbers, and 18 asymptomatic controls. Contractile activity was measured 5 cm above and 5 cm below the distending balloon. Psychometric tests were used to assess neuroticism, anxiety, and depression, and a standardized psychiatric interview was administered. Patients with irritable bowel syndrome had significantly lower tolerance for balloon distention but not ice water, and balloon tolerance was not correlated with neuroticism or other psychological traits measured. Rectosigmoid and rectal motility were also not related to tolerance for balloon distention. Both hypotheses were rejected. A peripheral mechanism such as altered receptor sensitivity may be the cause of distention pain in irritable bowel syndrome.
Article
Many women report that bowel symptoms are associated with menstruation, but neither the prevalence of these complaints nor their physiological basis is known. This study aimed to estimate prevalence, to determine whether patients with irritable bowel syndrome are more likely to make such complaints, and to determine whether bowel complaints during menstruation are attributable to psychological traits such as increased somatization. To estimate prevalence, 369 clients of Planned Parenthood of Maryland were asked whether gas, diarrhea, or constipation occurred during menstruation. These subjects were compared with women referred to a gastroenterology clinic and found to have irritable bowel syndrome or functional bowel disorder (abdominal pain plus altered bowel habits but not satisfying restrictive criteria for irritable bowel syndrome). Thirty-four percent of 233 Planned Parenthood clients who denied symptoms of irritable bowel syndrome or functional bowel disorder reported that menstruation was associated with one or more bowel symptoms. Gastroenterology clinic patients with irritable bowel syndrome were significantly more likely to experience exacerbations of each of these bowel symptoms, but especially increased bowel gas. Self-reports of bowel symptoms during menstruation were not associated with psychological traits or with menses-related changes in affect.
Article
Twenty original papers that reported on the effect of wheat bran on large bowel function were analysed. Bran increased the stool weight and decreased the transit time in each study in healthy controls and in patients with the irritable bowel syndrome, with diverticula, and with chronic constipation. Statistical evaluation of the data showed, however, that constipated patients had lower stool output and slower transit whether or not they had taken bran, and they responded less well to bran treatment than controls. From these data it is concluded that bran can be expected to be only partially effective in restoring normal stool weight and transit time in patients who are constipated.
Article
Uncontrolled clinical observations in our outpatient clinic suggested that severe constipation in young adults was related to tea consumption of one to two litres daily. The authors carried out a study on healthy volunteers. Twelve healthy volunteers aged 23-30 years participated in the study, which comprised two test periods of seven days. Diet was unrestricted except for beverages, which in one test period were limited to two litres of tap water daily and in the other to two litres of tea (four bags of 2 g Assam/Ceylon Brook Bond tea per litre, steeped for five minutes). On day 5 of each test period the subjects ingested 20 radio-opaque plastic markers, and daily excretions of urine and faeces were collected on days 5, 6, and 7. On day 7 body weight was recorded and blood samples taken. Faeces were analysed for mass, total bile acid concentration, and number of plastic markers excreted (to measure intestinal transit time). Urine analysis included volume, specific gravity, and oxalate concentration. Each subject served as his own control, and the sequence of the test periods was randomised. The rank sum test was used for paired observations. Significantly fewer plastic markers were excreted over 72 hours in the tea period than in the water period (p<0.05), indicating significantly increased intestinal transit time. The mean faecal bile acid output decreased from 436 to 310 μmol/24 h (p<0.05) during the tea period, whereas faecal mass showed only a slight and non-significant reduction. The effect of tea was probably due to theophylline, which (presumably via the kidneys) causes extracellular dehydration, a secondary increase in intestinal fluid absorption, and hence constipation.
Article
This study aimed to provide a detailed analysis of the experience of food craving in a healthy, non-clinical group of women. Twenty-five women who reported food cravings prospectively recorded their experiences over a period of 5 weeks using a Food Craving Record. The average number of cravings recorded was just under 2 per week. Craving for chocolate amounted to 49% of all the food cravings. Subtle differences in the change in arousal and hunger were noted between chocolate cravings and those for other sweet foods. Additional differences were found between these cravings and those for savoury foods, in their situational circumstances and speed of disappearance. There was a premenstrual increase in food cravings but no selective change in the types of food craved. Overall, the food cravings reported by these women were hunger-reducing, mood-improving experiences, directed at wanting to consume highly pleasant tasting food. This analysis should serve as a template against which other subject groups and other forms of craving may be explored.
Article
This is the first experimental study directed at differentiating between physiological or sensory accounts of the satiation of nondrug cravings, using chocolate craving, the most common craving in North America. At the onset of craving, chocolate cravers consumed a chocolate bar, the caloric equivalent in "white chocolate" (containing none of the pharmacological components of chocolate), the pharmacological equivalent in cocoa capsules, placebo, and no treatment conditions had virtually no effect. White chocolate produced partial abatement, unchanged by the addition of all the pharmacological factors in cocoa. This result indicates no role for pharmacological effects in the satisfaction of chocolate craving. It also suggests a role for aroma independent of sweetness, texture, and calories.
Article
Fifty young-adult and 48 elderly Ss participated in a structured interview study on food cravings (defined as an intense desire or longing to eat a particular food). Elderly Ss were less likely than young Ss to report cravings and reported craving a smaller number of different foods. In contrast to a number of other researchers, we found a relationship between dietary restrictions and cravings. Types of food craved differed by gender and age. Women reported significantly more cravings for chocolate and for sweets than did men. However, craving for sweets declined with age among women. Cravings were not evenly distributed throughout the day, but tended to occur in the late afternoon and early evening.
Article
The radio-opaque marker technique (ROMT) is a safe and noninvasive method to determine total colonic (TCTT) and segmental colonic transit times (SCTT). Previous results have shown that smoking volunteers had significantly longer TCTT than nonsmokers, but the underlying mechanism was not clear. We investigated the effect of transdermal nicotine application in two different doses in a non-blind randomized experiment involving three distinct phases. In phase 1 baseline transit times were determined with an abdominal X-ray after a 6-day period of marker ingestion and again after the following bowel movement to study the influence of a bowel movement just before the X-ray. TCTT was nearly twice as high before than after defaecation (42.6 h vs. 25.1 h, P < 0.05). The main acceleration was found in the rectosigmoid (RS) (18.6 h vs 7.1 h, P < 0.05) with no significant changes in right (RC) and left colon (LC). In phase 2 and 3 nicotine was applied in two doses of 17.5 mg day-1 and 35 mg day-1 in random order. Both doses resulted in a significant decrease of TCTT compared to the predefaecation baseline (42.6 h vs 32.2 h/28.2 h, respectively, P < 0.05). Again the main effect was located in the RS (18.6 h vs 9.9 h/7.6 h, P < 0.05). Short-term application nicotine results in a decrease of TCTT which is due to an accelerated transit in the RS.
Article
Female patients with bowel disease commonly report worsening symptoms in relation to the menstrual cycle. Our aim was to determine the nature of gastrointestinal symptoms correlating with the menstrual cycle in women with inflammatory and irritable bowel disease. This was a retrospective study involving 49 women with ulcerative colitis (UC), 49 women with Crohn's disease (CD), 46 women with irritable bowel syndrome (IBS), and 90 healthy community controls. Participants were interviewed using a questionnaire including information regarding general health, medication history, pregnancy, as well as premenstrual and menstrual symptoms. Chi2 testing and logistic regression modeling were used to test for differences in frequencies between groups and for risk analysis. Premenstrual symptoms were reported by 93% of all women but statistically more often by patients with CD (p < 0.01). CD patients were also more likely to report increased gastrointestinal symptoms during menstruation ( < 0.01), diarrhea being the symptom reported most often. All disease groups had a cyclical pattern to their bowel habits significantly more than controls (p=0.01). Cyclical symptoms included diarrhea, abdominal pain, and constipation. Logistic regression revealed an odds ratio (OR) of 1.1 (95% CI 0.9-1.2) for experiencing bowel symptoms during the premenstrual and menstrual phases and an OR of 2.0 (95% CI 1.2-3.2) for experiencing a cyclical pattern in bowel habit changes in women with bowel disease. The prevalence of menstrually related symptoms is high, and appears to affect bowel patterns. The physiological and clinical effects of the menstrual cycle should be taken into consideration when assessing for disease activity.
Article
We surveyed elderly individuals in an Asian community to determine the prevalence of constipation and its association with sociodemographic and lifestyle factors. This information will be used to plan a health promotion program for the elderly. A random sample of 2807 residents aged > or = 60 yr in Singapore were interviewed in their homes, using a standardized questionnaire. The response rate was 87.4% (n = 2454). The overall age- and gender-adjusted prevalence rate of functional constipation was 11.6 per 100 persons (95% confidence interval [CI], 11.4-11.7). There were no gender or ethnic differences in constipation rates. Increased rates of constipation were significantly associated with advancing age. We found a significant dose-response relationship of increased constipation rates with decreased intake of rice, increased intake of Chinese tea, and number of chronic illnesses and medications, after controlling for potential confounders. Constipation was also significantly associated with lower intake of fruits and vegetables, but no dose-response gradient was seen. Patients taking many medications should be monitored for constipation and given advice to avoid constipating factors. Further studies are needed to establish the causal-effect relationship of rice and Chinese tea with constipation.
Article
Although addictive behavior is generally associated with drug and alcohol abuse or compulsive sexual activity, chocolate may evoke similar psychopharmacologic and behavioral reactions in susceptible persons. A review of the literature on chocolate cravings indicates that the hedonic appeal of chocolate (fat, sugar, texture, and aroma) is likely to be a predominant factor in such cravings. Other characteristics of chocolate, however, may be equally as important contributors to the phenomena of chocolate cravings. Chocolate may be used by some as a form of self-medication for dietary deficiencies (eg, magnesium) or to balance low levels of neurotransmitters involved in the regulation of mood, food intake, and compulsive behaviors (eg, serotonin and dopamine). Chocolate cravings are often episodic and fluctuate with hormonal changes just before and during the menses, which suggests a hormonal link and confirms the assumed gender-specific nature of chocolate cravings. Chocolate contains several biologically active constituents (methylxanthines, biogenic amines, and cannabinoid-like fatty acids), all of which potentially cause abnormal behaviors and psychological sensations that parallel those of other addictive substances. Most likely, a combination of chocolate's sensory characteristics, nutrient composition, and psychoactive ingredients, compounded with monthly hormonal fluctuations and mood swings among women, will ultimately form the model of chocolate cravings. Dietetics professionals must be aware that chocolate cravings are real. The psychopharmacologic and chemosensory effects of chocolate must be considered when formulating recommendations for overall healthful eating and for treatment of nutritionally related health issues.
Article
The urinary excretion products of serotonin (5-hydroxytryptamine, 5HT) are 5-hydroxyindole-3-acetic acid (5HIAA) and 5-hydroxytryptophol (5HTOL), and the ratio of 5HTOL to 5HIAA is normally very low (< 0.01 ) in man. Intake of foods rich in 5HT (high amounts in banana, pineapple, and walnuts) induces a general increase in the output of 5HT metabolites, without affecting the 5HTOL/5HIAA ratio. In contrast, during metabolism of ethanol there is a shift in the catabolic pattern of 5HT, and the formation of 5HTOL increases appreciably at the expense of 5HIAA. Accordingly, the urinary 5HTOL/ 5HIAA ratio increases and does not recover to baseline levels until several hours after ethanol has been cleared from the body. When 10 healthy subjects ingested a moderate dose of ethanol (0.5 g/kg), the urinary 5HTOL/SHIAA ratio was increased approximately 70-fold on average at 4 h after intake. When the same amount of ethanol was ingested together with 3 bananas (approximately 10 mg 5HT), this ratio was increased approximately 100-fold at 4 h and still significantly higher than baseline levels at 24 h. Starting at 3-4 h after the combined intake of ethanol and banana, 7 subjects experienced one or more unpleasant symptoms (diarrhea, headache, and fatigue) which are associated with the 5HT system. The events were transient but typically lasted for several hours, and the duration correlated with the time period during which 5HTOL levels were raised. Intake of ethanol and banana separately produced much lower increases in 5HTOL output and caused no corresponding effects. This observation indicate that dietary 5HT intake together with even a moderate dose of ethanol can provoke unpleasant physiological symptoms. The symptoms may be attributed to the high concentration of 5HTOL.
Article
Tetrahydro-beta-carbolines (THbetaCs), potential neuroactive alkaloids, were found in chocolate and cocoa. 6-Hydroxy-1-methyl-1,2, 3,4-tetrahydro-beta-carboline (6OHMTHbetaC), 1,2,3, 4-tetrahydro-beta-carboline-3-carboxylic acid (THCA), 1-methyl-1,2,3, 4-tetrahydro-beta-carboline-3-carboxylic acid (MTCA) in both diastereoisomers (1S,3S and 1R,3S), and 1-methyl-1,2,3, 4-tetrahydro-beta-carboline (MTHbetaC), besides serotonin and tryptamine biogenic amines, were identified and quantified in dark chocolate, milk chocolate, cocoa, and chocolate-containing cereals by RP-HPLC-fluorescence and HPLC-MS. For each THbetaC, the concentration ranges were determined: 6OHMTHbetaC (0.16-3.92 microg/g), THCA (0.01-0.85 microg/g), 1S,3S-MTCA (0.35-2 microg/g), 1R,3S-MTCA (0.14-0.88 microg/g), and MTHbetaC (nd-0.21 microg/g). The highest content was generally found in chocolates and cocoas, but cereals containing chocolate also showed an appreciable amount of THbetaCs. The possible biological implications of this novel group of alkaloids in chocolate are discussed.
Article
Regardless of the type and dose of beverage involved, alcohol facilitates the development of gastroesophageal reflux disease by reducing the pressure of the lower esophageal sphincter and esophageal motility. Fermented and nondistilled alcoholic beverages increase gastrin levels and acid secretion. Succinic and maleic acid contained in certain alcoholic drinks also stimulate acid secretion. Low alcohol doses accelerate gastric emptying, whereas high doses delay emptying and slow bowel motility. Alcohol facilitates the development of superficial gastritis and chronic atrophic gastritis--though it has not been shown to cause peptic ulcer. Alcoholic beverages, fundamentally wine, have important bactericidal effects upon Helicobacter pylori and enteropathogenic bacteria. The main alcohol-related intestinal alterations are diarrhea and malabsorption, with recovery after restoring a normal diet. Alcohol facilitates the development of oropharyngeal, esophageal, gastric, and colon cancer. Initial research suggests that wine may be comparatively less carcinogenic.
Article
Nicotine decreases diarrhoea and pain in ulcerative colitis without reducing inflammation. (i) To evaluate the effect of ulcerative proctosigmoiditis on motor functions of an uninflamed segment of descending colon; and (ii) to assess nicotine's effects on colonic motor functions in patients and healthy subjects. In healthy subjects (n=30) and patients with ulcerative colitis (13; 11 active, two quiescent colitis), we studied the effects of intravenous nicotine on colonic transit of solid residue by scintigraphy (healthy subjects) and on colonic motility in healthy subjects and 11 patients. In ulcerative colitis, fasting colonic motility was increased, whereas motor response to a meal was significantly reduced; compliance was unchanged. In healthy subjects, high-dose nicotine induced transient high amplitude propagated contractions and relaxation of the descending colon followed by decreased phasic contractions. This dose also accelerated colonic transit. Low-dose nicotine (mimicking a transdermal nicotine patch) reduced colonic compliance in healthy subjects, but did not affect motor function in ulcerative colitis. Ulcerative proctosigmoiditis increases fasting colonic motility and reduces tone response to a meal in the descending colon without affecting colonic compliance, suggesting changes in physiological responses but not intrinsic wall properties. Nicotine has dose-dependent effects on colonic motor activity in healthy subjects.
Article
Constipation is mentioned occasionally as a possible tobacco withdrawal symptom, but no systematic data have been published on this issue. Smokers' clinic patients provided ratings of their level of constipation on three occasions prior to their quit date, and then weekly after they stopped smoking. The total of 1067 participants maintained at least 1 week of continuous abstinence and provided usable data. The three precessation ratings of constipation were stable. After cessation of smoking, the ratings increased significantly (P < 0.01). In 514 patients who maintained continuous abstinence for 4 weeks and provided complete data, constipation peaked at 2 weeks but remained elevated over the whole period. The net proportion of patients affected was 17%, including 9% who were symptom-free at baseline and became very or extremely constipated. In patients on nicotine replacement the increase in constipation, although significant, was less than in patients on bupropion. Clinicians treating smokers need to be aware of a possibility that one in six quitters develop constipation, and that for about one in 11 the problem can be severe. Descriptions of tobacco withdrawal syndrome should include constipation.
  • Muller-Lissner