Fruits for Constipation Relief and Bowel Health

The magic of fruit- can it relieve constipation?

Almost every day, one of my patients tells me they struggle with constipation. Many times, they are taking stool softeners and laxatives to help relieve their discomfort and promote bowel evacuation. Some people do not like taking medications long-term, as there can be negative health consequences and undesirable effects. Recent numbers suggest that over 3 million outpatient visits and 800,000 emergency room visits were associated with chronic constipation. Furthermore, the cost burden reached between $2000 and $7500 per patient in the United States.

Constipation can be defined in 2 subgroups:

-          IBS- constipation

-          Functional constipation

Current nutrition recommendations for people diagnosed with IBS are to follow a Low FODMAP diet, which focuses on lowering fermentable fibers in the diet which results in reduced IBS symptoms. Functional constipation is different and recommended intake of certain high-fiber fruits like Prunes (which contain sorbitol and fructans) can alleviate symptoms.

How does fruit promote good bowel health and reduce constipation?

1. Fruit is a good source of fiber. There are 2 types of fibers: soluble and insoluble. Soluble fiber is the type of fiber that is viscous meaning that it can absorb and bind to water which is important for softening the stool (think of the inside of an apple- that is where you will find this type of fiber).

Insoluble fibers are also important for bowel health because they add bulk to the stool (think of the outside of an apple, or the peel- that is where you will find this type of fiber). Insoluble fibers also promote the fermentation of healthy gut microbes in the colon leading to a diverse gut ecosystem and an increase in short-chain fatty acids which are anti-inflammatory.

2. Fruit contains sorbitol which is a sugar alcohol found in fruits like prunes. Sorbitol is not absorbed or digested by the small intestine and is highly fermentable in the colon. It holds water which is good for the promotion of water to the gut- this helps to soften stools and ease defecation.

A recent meta-analysis identified that the intake of fruits is linked to the alleviation of functional constipation. They identified 11 randomized controlled trials to support this claim.

Happily, kiwifruit has been extensively researched for its bowel health properties, including constipation relief through the increase of fecal and small bowel water content in humans. Other fruits such as prunes, apples, and raisins can increase fecal weight in humans. Overwhelmingly there is positive evidence to support the intake of fruits to ease constipation in humans. Below is a list of fruits that have been identified to possibly ease constipation:

In general, if you suffer from constipation, talk with your doctor to find out if your constipation is related to IBS or if it is functional constipation. If the latter, try adding a variety of these fruits to your diet to see if your symptoms resolve. Talk with a dietitian if you have more questions regarding this.

1. _{Gao, H., Huo, J., Cao, H., & Gao, Q. (2022). Effect of fruits intake on functional constipation: A systematic review and meta-analysis of randomized and crossover studies. https://doi.org/10.21203/rs.3.rs-1702671/v1}
2. _{Katsirma, Z., Dimidi, E., Rodriguez-Mateos, A., & Whelan, K. (2021). Fruits and their impact on the gut microbiota, gut motility and constipation. Food & Function, 12(19), 8850–8866. https://doi.org/10.1039/d1fo01125a}
3. _{Koyama, T., Nagata, N., Nishiura, K., Miura, N., Kawai, T., & Yamamoto, H. (2022). Prune juice containing sorbitol, pectin, and polyphenol ameliorates subjective complaints and hard feces while normalizing stool in chronic constipation: A randomized placebo-controlled trial. American Journal of Gastroenterology, 117(10), 1714–1717. https://doi.org/10.14309/ajg.0000000000001931} 

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