Tags

Type your tag names separated by a space and hit enter

Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation.
J Am Assoc Nurse Pract. 2020 Jan; 32(1):15-23.JA

Abstract

BACKGROUND

Treatment guidelines for chronic idiopathic constipation (CIC) recommend an "increase in fiber intake" as a first-line therapy, but most epidemiologic studies fail to support an association between a high-fiber diet and a reduced risk of constipation. Furthermore, randomized controlled clinical studies show that most isolated fibers (e.g., supplements) are not different from placebo for a laxative effect, and several may be constipating.

OBJECTIVES

The objective of this review was to compare the effects of two isolated fibers, coarse wheat bran and psyllium, on stool output and stool water content in patients with CIC. This review will also address misconceptions about fiber that are perpetuated by treatment guidelines.

DATA SOURCES

A comprehensive literature review was conducted with the use of the Scopus, SciFinder, and PubMed scientific databases, limited to the previous 50 years (1968-2018; latest date included, December 31, 2018).

CONCLUSIONS

In patients with CIC, nonfermented gel-forming psyllium was 3.4 times more effective than insoluble wheat bran for increasing stool output. Both psyllium and coarse wheat bran increased stool water content, a stool-softening effect, but finely ground wheat bran decreased stool water content, a stool-hardening effect.

IMPLICATIONS FOR PRACTICE

It is a misconception that dietary fiber and all isolated fibers provide a laxative effect in patients with CIC. Our analysis suggests that treatment guidelines for CIC should make specific evidence-based recommendations as it pertains to fiber. To do otherwise takes the risk of perpetuating myth and misunderstanding and depriving patients of an effective therapy for CIC. A generic recommendation to "increase fiber intake" is akin to a recommendation to "increase pill intake" without regard to therapeutic or adverse effects.

Authors+Show Affiliations

Healthcare Research and Development, Procter & Gamble, Mason, Ohio.Department of Animal Sciences, University of Illinois, Urbana, Illinois.Healthcare Research and Development, Procter & Gamble, Mason, Ohio.University of Michigan Health System, Ann Arbor, Michigan.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31764399

Citation

McRorie, Johnson W., et al. "Laxative Effects of Wheat Bran and Psyllium: Resolving Enduring Misconceptions About Fiber in Treatment Guidelines for Chronic Idiopathic Constipation." Journal of the American Association of Nurse Practitioners, vol. 32, no. 1, 2020, pp. 15-23.
McRorie JW, Fahey GC, Gibb RD, et al. Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation. J Am Assoc Nurse Pract. 2020;32(1):15-23.
McRorie, J. W., Fahey, G. C., Gibb, R. D., & Chey, W. D. (2020). Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation. Journal of the American Association of Nurse Practitioners, 32(1), 15-23. https://doi.org/10.1097/JXX.0000000000000346
McRorie JW, et al. Laxative Effects of Wheat Bran and Psyllium: Resolving Enduring Misconceptions About Fiber in Treatment Guidelines for Chronic Idiopathic Constipation. J Am Assoc Nurse Pract. 2020;32(1):15-23. PubMed PMID: 31764399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation. AU - McRorie,Johnson W,Jr AU - Fahey,George C,Jr AU - Gibb,Roger D, AU - Chey,William D, PY - 2019/11/26/pubmed PY - 2020/9/18/medline PY - 2019/11/26/entrez SP - 15 EP - 23 JF - Journal of the American Association of Nurse Practitioners JO - J Am Assoc Nurse Pract VL - 32 IS - 1 N2 - BACKGROUND: Treatment guidelines for chronic idiopathic constipation (CIC) recommend an "increase in fiber intake" as a first-line therapy, but most epidemiologic studies fail to support an association between a high-fiber diet and a reduced risk of constipation. Furthermore, randomized controlled clinical studies show that most isolated fibers (e.g., supplements) are not different from placebo for a laxative effect, and several may be constipating. OBJECTIVES: The objective of this review was to compare the effects of two isolated fibers, coarse wheat bran and psyllium, on stool output and stool water content in patients with CIC. This review will also address misconceptions about fiber that are perpetuated by treatment guidelines. DATA SOURCES: A comprehensive literature review was conducted with the use of the Scopus, SciFinder, and PubMed scientific databases, limited to the previous 50 years (1968-2018; latest date included, December 31, 2018). CONCLUSIONS: In patients with CIC, nonfermented gel-forming psyllium was 3.4 times more effective than insoluble wheat bran for increasing stool output. Both psyllium and coarse wheat bran increased stool water content, a stool-softening effect, but finely ground wheat bran decreased stool water content, a stool-hardening effect. IMPLICATIONS FOR PRACTICE: It is a misconception that dietary fiber and all isolated fibers provide a laxative effect in patients with CIC. Our analysis suggests that treatment guidelines for CIC should make specific evidence-based recommendations as it pertains to fiber. To do otherwise takes the risk of perpetuating myth and misunderstanding and depriving patients of an effective therapy for CIC. A generic recommendation to "increase fiber intake" is akin to a recommendation to "increase pill intake" without regard to therapeutic or adverse effects. SN - 2327-6924 UR - https://www.unboundmedicine.com/medline/citation/31764399/Laxative_effects_of_wheat_bran_and_psyllium:_Resolving_enduring_misconceptions_about_fiber_in_treatment_guidelines_for_chronic_idiopathic_constipation_ DB - PRIME DP - Unbound Medicine ER -