"Prunes: A Natural Remedy for Constipation"
The act of defecation involves a very private sphere
and is the object of cultural taboos, so much so that
it’s rarely thought of, even by physicians—but it should be.
Constipation accounts for three million annual visits to doctors
in the United States and 800,000 emergency room visits.
Depending on how you define it, up to 80 percent
of the population may be suffering.
Even people who don’t think they’re constipated
may very well be clinically constipated.
A quarter of their so- called healthy subjects
reported experiencing incomplete emptying,
and approximately half indicated increased straining.
In fact, more than half had found blood
on their toilet paper within the past year.
In severe cases, the blood pressure spike associated with
straining at stool can even trigger a heart attack or a stroke.
There are drugs for it. There are always drugs,
resulting in side effects like headache, nausea, diarrhea,
and abdominal pain, leaving most patients unsatisfied.
So why not instead just try to treat the cause?
Common causes of chronic constipation include lack of
adequate whole plant foods or insufficient water intake,
and so making changes in the patient’s diet and lifestyle
is the preferred method for relieving constipation.
Such nonpharmacological clinical effective interventions
including engaging in physical
activity for about 30 minutes a day.
A systematic review and meta- analysis found aerobic exercise
interventions help, starting at about 140 minutes a week.
And then, of course, a diet centered around whole plant foods,
which are the only naturally concentrated sources of fiber.
Any plants in particular?
If you give elderly women with severe constipation about
a dozen prunes a day they experience significant
improvement within the first week.
The control group in the study wasn’t told to do anything though.
And any time you have one group doing something and
the other doing nothing, you can’t discount the placebo effect.
And the placebo response for constipation trials can range
up to 44 percent, meaning up to nearly half of the people given
a sugar pill claimed to experience an improvement.
So, that’s why we need studies like this.
Subjects were randomized to about 8 prunes a day
plus a large glass of water; 12 prunes and water;
or just the water alone; so, even the control group got
an intervention they were told might help with constipation.
Previous studies mostly assigned 10 prunes or so a day,
so the researchers wanted to see if more was better or less
was sufficient and...they found a significant improvement
in stool bulk on the prunes and a significant increase
in bowel movement frequency, though no real difference
between 8 and 12; so, 8 a day seems sufficient.
Prunes even appear superior to psyllium, sold as Metamucil,
beating it out in terms of improved stool frequency and consistency.
We used to think it was just all the fiber in prunes
that was helping, but prune juice evidently works too,
which, like most juices, has had the fiber removed.
Other potential active components include a natural sugar alcohol
known as sorbitol that’s used in some sugar-free gum.
Once you eat more than a dozen or so large prunes a day, however,
the dose of sorbitol could start reaching laxative levels
in susceptible individuals. So, be careful.
If you don’t have constipation, should you avoid prunes?
That’s been put to the test, and... most people should
be able to eat a dozen or so a day without any issues.
In fact, it’s interesting to note that prunes have been
traditionally used as both a laxative and an antidiarrheal remedy.
What about dried figs? One of the few medicinal plants
mentioned explicitly in the Bible.
Researchers took patients with the type of irritable bowel syndrome
characterized by constipation and randomized them to one fig
with breakfast and one fig with lunch, each with a glass of water,
and there was a significant improvement in frequency of defecation
and a significant drop in the frequency of hard stools,
compared to control. Ah, but what was the control?
The control group was just asked to continue their normal diet.
In other words, to do nothing special.
The placebo response for irritable bowel is infamous.
Give people with IBS a fake sugar pill, and sometimes 72 percent
say they magically feel better.
That’s why we need this kind of study:
a randomized, double-blind, placebo-controlled trial.
Researchers made a gross- sounding fig paste placebo
that supposedly had the same taste, smell,
and appearance as the real deal.
Those who got the real figs, about six a day,
seemed to improve colon transit time, stool consistency,
and abdominal discomfort compared to the placebo.
Researchers measured transit time by having people swallow
little beads that would show up on x-rays so they could track
the progress thorough their digestive system.
They found that those eating the real figs sped up their
gut movement by a full 24 hours
Defecation frequency per week didn’t beat out placebo though,
and in fact, they tested so many different outcomes
even the stool consistency and tummy discomfort results
may have been statistical flukes.
So, it looks like prunes would be the better treatment choice.