Monday, April 8, 2013

"Gritty" Topic (Glad Someone Else Is Studying This)

The BLUF:  Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms


AIM: To investigate the effect of reducing dietary fiber on patients with idiopathic constipation.
METHODS: Sixty-three cases of idiopathic constipation presenting between May 2008 and May 2010 were enrolled into the study after colonoscopy excluded an organic cause of the constipation. Patients with previous colon surgery or a medical cause of their constipation were excluded. All patients were given an explanation on the role of fiber in the gastrointestinal tract. They were then asked to go on a no fiber diet for 2 wk. Thereafter, they were asked to reduce the amount of dietary fiber intake to a level that they found acceptable. Dietary fiber intake, symptoms of constipation, difficulty in evacuation of stools, anal bleeding, abdominal bloating or abdominal pain were recorded at 1 and 6 mo.
RESULTS: The median age of the patients (16 male, 47 female) was 47 years (range, 20-80 years). At 6 mo, 41 patients remained on a no fiber diet, 16 on a reduced fiber diet, and 6 resumed their high fiber diet for religious or personal reasons. Patients who stopped or reduced dietary fiber had significant improvement in their symptoms while those who continued on a high fiber diet had no change. Of those who stopped fiber completely, the bowel frequency increased from one motion in 3.75 d (± 1.59 d) to one motion in 1.0 d (± 0.0 d) (P 0.001); those with reduced fiber intake had increased bowel frequency from a mean of one motion per 4.19 d (± 2.09 d) to one motion per 1.9 d (± 1.21 d) on a reduced fiber diet (P 0.001); those who remained on a high fiber diet continued to have a mean of one motion per 6.83 d (± 1.03 d) before and after consultation. For no fiber, reduced fiber and high fiber groups, respectively, symptoms of bloating were present in 0%, 31.3% and 100% (P 0.001) and straining to pass stools occurred in 0%, 43.8% and 100% (P 0.001).
CONCLUSION: Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber.

The interesting thing to me is how we came to believe we need fiber at all.  The Inuit do fine with almost zero fiber, and Brit Sailors (as recounted in Taubes' classic "Good Calories Bad Calories") who stayed with the Inuit reported their constipation from shipboard fare went away when they ate with the Inuit.

What seems to drive constipation is gut bacteria - so a simple model that might make sense of folks' observed trend of getting relief from constipation by taking fiber gut bombs (Metamucil, "Shitrucil") is:
1.  First you eat so much neolithic crap that the gut flora and fauna no longer resemble anything a living human prior to 200 years ago; especially by eating sugar and high fiber foods which digest slowly and are still digesting when they reach the colon
2.  Then you drink beverages which are either sugary or contain other non-hydrating elements

Against that back drop, 18 boxes of Colon Blow might indeed be beneficial, but apparently, just eating "high fiber" foods is part of the problem.
PS - click the Colon Blow link if you like classic SNL

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