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Is Fiber the Answer? Researchers Doubt It
NY Times ^ | January 18, 2005 | NICHOLAS BAKALAR

Posted on 01/21/2005 8:36:54 PM PST by neverdem

Despite the barrage of television commercials that insist otherwise, a diet low in fiber is usually not the cause of constipation, and taking fiber supplements is probably not the cure, according to a new study.

In fact, a fiber supplement can actually make symptoms worse in some patients, particularly the most severely afflicted. A review study published in the January issue of The American Journal of Gastroenterology suggests that many other common beliefs about constipation are also little more than durable myths.

According to the American College of Gastroenterology, constipation is the reason for at least 2.5 million doctor visits annually in the United States, and ACNielsen, the marketing information company, reports that Americans spent more than $700 million last year on over-the-counter laxative medicines. Yet much of the advice they got - including many suggestions from doctors - was probably not helpful.

Fiber is far from a panacea. In one study, fewer than half of the patients with self-described constipation had any response to added fiber, and studies comparing people with chronic constipation to comparison groups without the condition show no difference in their dietary fiber intake.

At best, a diet low in fiber may be a contributory factor in a minority of patients, and fiber supplements may help them, the reviewers, led by Dr. Stefan Müller-Lissner, a professor of medicine at Humboldt University in Berlin, found.

Drinking more liquid is often recommended, but studies show it does not work. Although it may seem that adding water to hard stools will soften them, adding liquid does not accomplish this, nor does it relieve constipation.

If fiber and liquids do not help much, will increasing exercise? The studies say no.

Despite its other benefits, exercise is largely ineffective in preventing constipation. It seems to help in the elderly if it is part of a broader program, but it does not work in young, severely constipated patients. While workouts like marathons can increase gut activity, moderately increased exercise in healthy people has no discernible effect on bowel function.

What really works for constipation? "I do start with a trial of dietary fiber," Dr. Müller-Lissner said. "Prunes and other fruits may be effective, although bloating can occur as a side effect."

If those measures do not work, Dr. Müller-Lissner recommends laxatives. In addition to the fiber additives, there are three other types: stool softeners (Colace, for example); saline laxatives like milk of magnesia; and stimulant laxatives, including Dulcolax, Correctol, and others. "I prescribe macrogol," the active ingredient in Colace and many other brands, he said.

He added, "If this is ineffective or not tolerated, I switch to bisacodyl" in Correctol and other stimulants, "or a related compound."

These drugs are not harmful in normal dosages, Dr. Müller-Lissner said. Some experts believe that stimulant laxatives that amplify bowel motility can increase the risk for colorectal cancer, but the evidence is weak. Chronic constipation is itself associated with an increased risk of the cancer, but no evidence supports a belief that laxatives used in recommended doses increase the risk.

Other doctors suspect that the drugs have a host of adverse side effects - that they can be psychologically habit-forming, that they cause physical physical dependence, that they lead to "rebound" constipation, or that they damage the nerves and muscles that control the bowel. But studies have found no evidence.

Dr. Müller-Lissner says he believes that what constitutes a normal frequency of bowel movements is up to the patient. "The statistical range of normality is from three stools a day to three stools a week," he said. "But in clinical terms, this is irrelevant. If there is no organic disease underlying the constipation, a low stool frequency by itself does no harm. The only motivation for treatment is the patient's complaint."


TOPICS: Business/Economy; Culture/Society; Extended News; Germany; News/Current Events
KEYWORDS: constipation; fiber; health; medicine
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To: neverdem

Wow and I actually gave credit for my daily BM to the evening dose of Metamucil. For some reason, after you hit 60 things just seem to slow down. Guess I had better stop taking it since it does not work.


21 posted on 01/21/2005 9:10:22 PM PST by Dustbunny (The only good terrorist is a dead terrorist)
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To: neverdem

22 posted on 01/21/2005 9:13:51 PM PST by Mad Dawgg (French: old Europe word meaning surrender)
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To: neverdem
In my youth, (millennia ago) I had to take belladonna for a "hyperactive colon"..
That could be the problem in some of these cases..

Also, avoiding coffee, or any caffeine-based drinks is helpful..

23 posted on 01/21/2005 9:15:58 PM PST by Drammach (Freedom; not just a job, it's an adventure..)
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To: Drammach

IIRC, belladonna is a preparation made from opium. Any opiate taken chronically for pain will cause constipation.


24 posted on 01/21/2005 9:37:00 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: Nuzcruizer

Prune juice works. So does citracel.

Metamucil probably does too, but it's too ghastly to take.


25 posted on 01/21/2005 9:40:58 PM PST by altura
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To: Nuzcruizer
Prune Juice works and is used in hospitals and nursing homes all over the place. It DOES work! It's also high in iron.

Never had much luck with prune juice. The nurses were always surprised that it didn't work for me. Also, I thought iron could cause constipation.

26 posted on 01/21/2005 9:48:45 PM PST by Netizen (jmo)
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To: goodnesswins
psyllium

Makes me cringe, just thinking about it. Gets caught in the little pockets and makes irritable bowel symptoms go wild!

27 posted on 01/21/2005 9:51:17 PM PST by Netizen (jmo)
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To: neverdem

I have to laugh at this. Enough spicy food and your bowels will go into hyperdrive. Think projectile vomiting except a different orifice.


28 posted on 01/21/2005 9:56:47 PM PST by meatloaf
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To: Netizen
Also, I thought iron could cause constipation.

Iron supplements such as ferrous sulfate can cause constipation. No one ever accused prunes of causing constipation.

29 posted on 01/21/2005 9:58:03 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem
I thought this was on fiberoptics tech! LOL!
30 posted on 01/21/2005 10:07:52 PM PST by endthematrix (Declare 2005 as the year the battle for freedom from tax slavery!)
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To: Constitution Day

EPSON SALT!


31 posted on 01/21/2005 10:10:19 PM PST by endthematrix (Declare 2005 as the year the battle for freedom from tax slavery!)
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To: neverdem

What a poopy article.


32 posted on 01/21/2005 10:11:40 PM PST by spodefly (Yo, homey ... Is that my briefcase?)
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To: SolidRedState
How long does it take to eat that many apples?

LOL

The whole piece sounds like a mega push for more prescription drugs and doctor visits ($$$) to me.

Old timey remedies still work: bran cereal/muffins, prunes, yogurt (with the live bacillus) ...these are all mild and non-cramping. I pretty much just use acidolphilus capsules, as these are much less expensive than yogurt but have the live bacillus which reestablishes the 'friendly' bacteria in the gut and keeps things moving. And walking, exercising does help too. It helps gravity move things along.

My rule of thumb: stay away from any and all prescription drugs possible. (I have CHF and take my heart med faithfully - but have refused to take 3 other drugs over the past 5 years that have, all 3!, now been banned for causing heart attacks and strokes!)

33 posted on 01/21/2005 10:20:09 PM PST by maine-iac7 (...but you can't fool all of the people all of the time." Lincoln)
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To: Nuzcruizer
Prune Juice works and is used in hospitals and nursing homes all over the place. It DOES work! It's also high in iron.

Klingons, of course, LOVE prune juice! And you can't imagine any of those big dudes being irregular, can you?

CA....

34 posted on 01/21/2005 10:29:27 PM PST by Chances Are (Whew! It seems I've once again found that silly grin!)
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To: elmer fudd

"Refried beans and kim chee."

It doesn't get better.


35 posted on 01/21/2005 10:37:49 PM PST by aroostook war
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To: maine-iac7
I have CHF and take my heart med faithfully - but have refused to take 3 other drugs over the past 5 years that have, all 3!, now been banned for causing heart attacks and strokes!

What three are you referring to?

36 posted on 01/21/2005 11:06:52 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: maine-iac7
"The whole piece sounds like a mega push for more prescription drugs and doctor visits ($$$) to me."

The reason I posted the article was because I thought it provided some reassurance in the last paragraph.

Dr. Müller-Lissner says he believes that what constitutes a normal frequency of bowel movements is up to the patient. "The statistical range of normality is from three stools a day to three stools a week," he said. "But in clinical terms, this is irrelevant. If there is no organic disease underlying the constipation, a low stool frequency by itself does no harm. The only motivation for treatment is the patient's complaint."

37 posted on 01/21/2005 11:18:08 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem
What three are you referring to?

Baycol and Vioxx - and one I can't remember the name of - When I was prescribed Baycol, I researched it and didn't like all the "possible" side effects, so never took it. The stats on Vioxx were not so alarming, so I took it. It worked very well, but , fortunately, I took it sparingly. I also refused to take - for decades - HRT, hormone replacement therapy, because even 30 years ago, there were too many references to possible links to cancer. Glad I stuck to my guns on that one!

38 posted on 01/21/2005 11:20:48 PM PST by maine-iac7 (...but you can't fool all of the people all of the time." Lincoln)
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To: neverdem; Eaker; TheMom; humblegunner; TexasCowboy; Tijeras_Slim; cyborg; ChefKeith
Eeeeeek yer professional opinion is needed over here !

Ya'll are aware that eaker eats so much fiber he can make ya a really nice wicker basket with just a little extra strain errrr ahhh effort !

Course ya wouldn't want to handle it er anythang......:o)

It's supposed to be a Robert Maplethrope spin off of artistic expresion according to my buddy Eeeeek.

39 posted on 01/21/2005 11:25:57 PM PST by Squantos (Be polite. Be professional. But, have a plan to kill everyone you meet. ©)
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To: maine-iac7
Vioxx wasn't banned. Merck withdrew it. HRT is still prescribed for women who can't tolerate the symptoms of menopause. But thank you for your reply. For some reason, I didn't recall WHI-HRT study was a placebo controlled trial.

Estrogen Plus Progestin Trial Stopped Due to Increased Risk, Lack of Overall Benefit

40 posted on 01/21/2005 11:58:28 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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