How Do Three Natural Remedies for Chronic Constipation Measure Up?

By Megan Brooks

June 11, 2021

NEW YORK (Reuters Health) - When it comes to natural remedies for chronic constipation, kiwifruit, psyllium fiber and prunes all significantly improve constipation symptoms, but kiwifruit has the fewest side effects and is most liked by patients, according to results of a comparative effectiveness study.

This study "confirms the benefits of psyllium and prunes for the treatment of chronic constipation (and) shows that two green kiwifruit can also be effective for the treatment of constipation," Dr. Shanti Eswaran of the University of Michigan and Michigan Medicine, in Ann Arbor, told Reuters Health by email.

"While the improvement seen in the kiwifruit was not as robust as that seen for psyllium fiber or prunes, the difference was not statistically significant. The most interesting finding was how well tolerated kiwi was throughout the study - patients in the kiwifruit group reported fewer adverse effects like bloating, and higher treatment satisfaction overall," she said.

Psyllium and prunes are proven treatments for chronic constipation (CC). Kiwifruit is a popular digestive aid in Asia, but there remains a "relative paucity of comparative literature describing its impact on bowel habits and effectiveness as a treatment in patients with CC," Dr. Eswaran and her colleagues note in the American Journal of Gastroenterology.

To investigate, they randomly assigned 79 adults with CC to consume 100 grams of pitted prunes, 12 grams of psyllium or two peeled green kiwifruits daily for four weeks. Eligible patients had three or fewer complete spontaneous bowel movements (CSBM) per week.

Complete data were available for 75 patients - 29 in the kiwifruit group, 24 in the prunes group and 22 in the psyllium group.

There was no statistically significant difference between groups in the primary outcome - the proportion of patients in each group reporting an increase of at least one CSBM per week compared with baseline for at least two of four treatment weeks - with rates of 67%, 64% and 45% in the prune, psyllium and kiwifruit groups, respectively.

Prune eaters had the greatest increase over baseline in average bowel movements per week (+2.7), followed by psyllium eaters (+1.7) and kiwifruit eaters (+1).

Stool consistency significantly improved with kiwifruit and prunes but not psyllium; straining significantly improved with all three remediess.

There were significant and statistically similar decreases in the average proportion of reported bowel movements with a sensation of incomplete evacuation for kiwifruit, prunes and psyllium.

The kiwifruit group reported significant improvement in bloating scores and the psyllium group reported significant improvement in abdominal discomfort.

Side effects were most common with psyllium and least common with kiwifruit.

For kiwifruit eaters, 68% expressed satisfaction with the intervention, compared with 48% of prune eaters and 48% for psyllium eaters.

Conversely, 17% of prune eaters and 38% of psyllium eaters were dissatisfied with their assigned treatment, compared with 7% of kiwifruit eaters. This difference in dissatisfaction between kiwifruit and the other groups was statistically significant.

"Patients are increasingly seeking evidence-based natural treatments for many medical conditions, including CC," the authors note in their article. "Many patients believe that natural products are safer and less costly than prescription medications. Along these lines, so called 'functional foods' are growing in popularity. This study confirms the benefits of prunes and psyllium and offer the first U.S. data for green kiwifruit as a safe, effective, and well-tolerated treatment for a subset of patients with CC."

In Dr. Eswaran's view, "treatment selection can be based on patient preference and a patient's prior experience with these natural strategies. Whether such issues might influence the choice of and/or adherence to kiwifruit, prunes or psyllium among patients with constipation requires further study," she told Reuters Health.

This study was funded in part by kiwifruit producer Zespri. The authors have no relevant disclosures.

SOURCE: https://bit.ly/3cqMhOY The American Journal of Gastroenterology, June 2021.

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