Psyllium most effective fiber type for constipation relief

Psyllium was the most successful type of fiber to treat chronic constipation, according to a recent systematic review and meta-analysis published in the American Journal of Clinical Nutrition.

In addition, researchers found that the optimal regime for fiber supplementation was a daily dose greater than 10 g for a duration of at least four weeks.

The findings provide potential avenues for many patients with chronic constipation who are “dissatisfied with current treatment options,” Alice van der Schoot, MSc, a PhD student at King’s College, and colleagues wrote.

Chronic constipation, which affects about 12% of adults, is difficult to treat and accounts for more than 2.5 million visits to medical centers every year, according to the researchers. Previous research has suggested that increasing fiber intake might help patients find relief, but “recommendations on type, dose and duration are unclear,” they wrote.

Van der Schoot and colleagues conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of fiber supplementation on gut transit time, stool output, symptoms and quality of life among adults with chronic constipation.

The researchers identified studies through electronic databases, hand-searching abstracts and backward citation. The final analyses included 16 RCTs of 1,251 participants.

The results revealed fiber increased stool frequency (standardized mean difference [SMD] = 0.72; 95% CI, 0.36-1.08) and improved stool consistency (SMD = 0.32; 95% CI, 0.18-0.46). Overall, 66% of people responded to fiber treatment, according to the researchers.

Specifically, fiber doses of more than 10 g/d (RR = 1.72; 95% CI, 1.35-2.18) and psyllium supplements “were most effective in improving response to treatment, stool output and straining,” van der Schoot and colleagues wrote. Treatment that lasted for at least a month was also identified as “optimal for improving” whole gut transit time and stool frequency, they added.

“Psyllium led to an increase of three bowel movements/week, indicating that psyllium is as or even more effective than osmotic and stimulant laxatives, which increase stool frequency by 2.5 bowel movements/week,” the researchers wrote.

Van der Schoot and colleagues noted that there was substantial heterogeneity between the included studies, so “caution is needed when interpreting the results.” However, they concluded that their review “provides important evidence on the optimal fiber supplementation that can support clinicians to provide standardized and effective recommendations to patients with chronic constipation.”

“This meta-analysis provides evidence that psyllium is the most efficacious fiber investigated at providing constipation relief with improvements in stool frequency and straining, which highlights its potential to be used as a first-line strategy for the management of constipation,” they wrote. “These findings provide evidence for the optimal type and regime of fiber supplementation that could impact clinical care and recommendations to patients, ultimately improving their care and treatment response.”