Tag Archives: constipation

Dried plums beat psyllium for constipation

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A paper just published in the the journal Alimentary Pharmacology and Therapeutics pitted dried plums against psyllium in a randomised clinical trial to determine if either is more effective in treating chronic constipation. The authors first observe:

“Treatment of chronic constipation remains challenging with 50% of patients dissatisfied with current therapy. There is an unmet need for natural and safe alternatives. Dried plums (prunes) have been used traditionally for constipation but their efficacy is not known.”

Over the course of an 8-week, single-blind, randomised cross-over study, subjects received either dried plums (50 g 2x/day; 50 g = 1.76 oz) or psyllium for 3 weeks each. They then swapped after a 1-week washout period. Outcome considerations included the number of complete spontaneous bowel movements per week, overall relief of constipation, stool consistency, straining and tolerability. What did they find?

“Forty constipated subjects (m/f = 3/37, mean age = 38 years) participated. The number of complete spontaneous bowel movements per week (primary outcome measure) and stool consistency scores improved significantly with dried plums when compared to psyllium.“

Whether dried plums also contribute beneficial flavonoids is a possibility worth looking into. Clinicians should, of course, educate patients that the underlying causes of chronic constipation must be determined and properly treated. Meanwhile we can keep in mind the authors’ conclusion for palliative care:

“Dried plums are safe, palatable and more effective than psyllium for the treatment of mild to moderate constipation, and should be considered as a first line therapy.“

Children with constipation: cow’s milk intolerance in more than one third

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A study recently published in the Journal of Pediatric Gastroenterology and Nutrition reminds us that bovine (cow’s) milk allergy or intolerance can cause childhood constipation even though the laboratory tests are negative. The authors first note:

“It has been reported that a number of children with constipation respond to a diet free of cow’s-milk (CM) proteins, although evidence is lacking to support an immunoglobulin E-mediated mechanism.”

They found that thirty-five of 69 children (51%) improved during an initial CM-free diet phase with a significant increase in bowel movements per week; 39% developed constipation during the CM challenge and improved during the second CM-free phase. Interestingly…

“Seventy-eight percent of the children with developmental delay responded to the CM-free diet.”

The authors conclude:

“A clear association between CM consumption and constipation has been found in more than one third of children. However, analytical parameters do not demonstrate an immunoglobulin E-mediated immunologic mechanism.”

I want to draw your attention to the final comment about the absence of IgE antibodies. I have found any kind of antibody test (IgE, IgG, IgA) to be unreliable for the diagnosis of food allergy or intolerance due to numerous factors that can prevent their expression, resulting in false negatives (the allergy is present but undetected by the test). The immunological ‘gold standard’ is the elimination-provocation protocol (as conducted in this study).