Which sources of dietary fiber and fiber supplements are available in the treatment of constipation?

Updated: Jul 05, 2019
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Answer

Dietary fiber is available in diverse natural sources, such as fruits, vegetables, and cereals. Ingestion of natural fiber sources is nutritionally superior to supplementation with purified fiber. However, advising patients to eat more fruits and vegetables is frequently unsuccessful, at least in American patients. American patients do respond reasonably well to prescriptions and often seek them; accordingly, prescribing a fiber supplement, such as wheat, psyllium, or methylcellulose, is often useful.

Many of the available products vary substantially in their potency. For instance, sugar-free Metamucil (psyllium) has twice the potency of standard Metamucil on a volume basis because the latter is half sugar. Pharmaceutical companies may argue that one type of fiber is better tolerated or more effective than another. This may not make much difference in treatment or in fiber tolerance in most patients as long as the fiber supplementation doses start low and are slowly titrated upward.

Theoretical considerations suggest that the use of a fermentable fiber, which increases short-chain fatty acid concentrations in the colonic lumen, may have other health benefits (as opposed to methylcellulose). However, this suggestion remains controversial and awaits further exploration.


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