Which are the best foods to treat – and prevent – constipation? Is bran better than fruits and vegetables? What about fibre supplements?
Not having a bowel movement everyday doesn't mean you're constipated. For some people, it's usual to go three times a week; for others, "normal" means going three, even four, times a day.
Constipation can make you feel bloated, distended, anxious and downright miserable. And, for some people, its uncomfortable symptoms can interfere with normal life. The good news: making simple lifestyle changes – especially dietary ones – is often all it takes to get your system back on track.
Medically speaking, constipation is defined as having less than three bowel movements a week. While it's common to experience constipation from time to time, chronic constipation occurs when you have infrequent bowel movements or difficulty passing stools for several weeks to several months.
Not all fibre is the same
Not eating enough fibre often causes constipation and, not surprisingly, adding more of it to your diet can ease, and prevent, the condition. Not all fibre is created equal, though.
Grains, fruits, vegetables, pulses and nuts contain two types of fibre: soluble and insoluble, in varying amounts. Soluble fibre slows digestion and helps regulate blood sugar and cholesterol levels. It's plentiful in oats, oat bran, barley and psyllium (e.g. Metamucil, psyllium-enriched bran cereals).
On the other hand, foods such as wheat bran, whole grains, nuts and many fruits and vegetables contain mainly insoluble fibre. It's this type that retains water and adds bulk to stool, helping it pass more quickly through the intestines.
By keeping your bowel habits regular, a high fibre diet can help reduce the risk of hemorrhoids, diverticulosis, and possibly colon cancer.
How much fibre do you need?
Women aged 19 to 50 are advised to consume 25 grams of fibre each day; men require 38 grams. As we get older and our calorie requirements decrease, so do our fibre needs. After 50, women need 21 grams daily and men, 30 grams.
That's certainly more than the 11 to 17 grams of fibre the average Canadian consumes each day. To ensure your daily diet provides enough, you need to make strategic food choices.
Bran vs. fruits and vegetables
Many people are successful at treating constipation by adding a concentrated source of insoluble fibre, such as wheat bran, to their diet. Two tablespoons of raw wheat bran has 4.5 g of fibre, one cup of bran flakes contains about 5 g and one-half cup of 100 per cent bran cereal delivers 12 grams.
Bran will do a better job than fruits and vegetables at treating constipation because it is a concentrated source of bulk-forming wheat bran.
But don't stop there. I also encourage my clients to increase their intake of fruits and vegetables to boost overall fibre intake.
Fruits high in insoluble fibre include apples, berries, figs, kiwifruit, mango, oranges and plums. When it comes to vegetables, bell peppers, carrots, green beans, parsnips, peas and spinach are good sources.
Other decent sources of insoluble fibre include whole-wheat pasta (4 to 6 g fibre per cup, cooked), freekeh (10 g fibre per cup, cooked) quinoa (5 g fibre per cup, cooked), brown rice (3.3 g per fibre cup, cooked), 100 per cent whole grain breads (look for 2 to 3 g fibre per slice) and nuts and seeds.
Increase your fibre intake gradually, over a period of weeks, to prevent bloating, cramps or gas. And don't forget to drink more water as you add fibre to your diet; fibre needs to absorb water in order to work effectively. Women need 9 cups of water each day and men require 12 cups.
Food vs. supplements
When consumed with water or added to foods, powders made from pysllium husks, inulin or natural fruit and vegetable fibres do increase your fibre intake. And, for some people, they are an effective constipation remedy. For others, though, they can worsen bloating. (Pysllium and inulin are soluble fibres; soluble fibres absorb water in the intestinal tract to form a gel, which can cause a bloating sensation.)
Popping a few capsules of a fibre supplement each day, however, won't do much to shore up your fibre intake. One Metamucil Fibre capsule, for instance, has half of a gram (525 mg) of fibre. To be fair, the recommended dose is five capsules taken three times daily (total: 7.9 g fibre).
Personally, I'd rather eat real food than swallow 15 pills a day because, along with fibre, it also delivers vitamins, minerals and countless phytochemicals.
Other constipation culprits
Lifestyle factors may contribute to constipation, including very low calorie diets (less food means less bulk in your intestinal tract), a lack of exercise and repeatedly ignoring the urge to go. Changes in your daily schedule and travel can also wreak havoc with bowel habits.
Other causes can include low thyroid, problems with the nerves and muscle of the digestive tract, side effects of certain medications (such as from pain killers, antidepressants and antihistamines) and bowel blockages.
Check in with your doctor if you experience unexplained changes in your bowel movements that have lasted more than two weeks or if increasing your fibre intake makes your symptoms worse.
Leslie Beck, a registered dietitian, is based at the Medisys clinic in Toronto.