July 18, 2023
3| Constipation Solutions: Discover Foods that Really Work
Do your patients suffer from constipation? Join host Colleen Sloan and Registered Dietitian Patricia Skolnik as they unpack the best foods for constipation relief. Don't miss this informative conversation filled with practical tips to help your patients achieve smooth and comfortable bowel movements.
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Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.
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Kiwi has been shown to relieve constipation, effectively and without some of the sort of unpleasant side effects that a stimulant laxative can have, or even prunes in Some people, but two kiwis a day over the course of one to two weeks.
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Can promote regular bowel movements that are softer, easy to pass, a little bit more spontaneous, and help to clean you out and get you going regularly and more easily
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Are you ready to transform the way you communicate about nutrition with your patients?
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Welcome to Exam Room Nutrition, the podcast where the worlds of nutrition, medicine and communication collide.
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Whether you're a seasoned physician or a healthcare student, this podcast is for you, so stick around and let's make our patients healthier.
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One exam room at a time.
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Welcome back to the Exam Room Nutrition podcast.
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I'm your host, Colleen Sloan.
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I'm a registered dietician and pediatric pa.
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We're gonna be discussing a topic that I know affects a lot of people, but it can be very uncomfortable and embarrassing to discuss sometimes, which can make it difficult to diagnose and sometimes not even brought up altogether, so therefore, it's missed completely.
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Our topic for today is constipation.
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It's a common GI issue that affects a significant amount of adults worldwide.
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We're gonna be addressing this for our adult population since children have other nuances to cover and think about, Our expert today is going to help us answer a question that our patients might ask us.
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They might say, I'm constipated and so uncomfortable.
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Are there any foods that can help relieve my pain?
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And I couldn't think of anyone better to have on our podcast episode today than Patricia Skolnik.
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Patricia is a registered dietician of 20 years recently making a pivot from inpatient acute care to GI private practice.
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You can find her on Instagram at Patricia Skolnik Nutrition and on the web at www.patriciaskolniknutrition.com.
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I'm gonna go ahead and link those down below so you can absolutely follow her.
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I love following her page and find her content so useful.
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Outside of being a dietician, you can expect to find her tinkering with food products and spending time with her family and friends.
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Patricia, thank you so much for being here.
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I'm so excited for this conversation and I'm grateful for the gift of your time.
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Welcome to the show.
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Thank you very much for having me.
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I'm very excited to be here.
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All right, so everyone knows I'm in the pediatric world and constipation is an extremely common complaint among kids.
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So I'm really excited to kind of shift gears here and discuss our adult population because a lot of my listeners are in the adult world, and whether you're in GI practice or family medicine, I know you're gonna come across this.
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So this conversation's gonna be extremely helpful for you in educating your patients on.
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The signs and symptoms of constipation, and then the foods that they can eat to relieve those symptoms, and then maybe some of those foods that they really shouldn't be eating.
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So we've got a lot to cover today.
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Patricia, why don't we start by actually defining what constipation is, because sometimes the patients might think they're constipated and it might be something altogether different.
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So give us a working definition of constipation and how we can accurately diagnose these patients.
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Yes, thank you.
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So constipation would be when the stool that you are passing becomes hard and dry and more importantly like dip.
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Difficult to pass.
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and so like maybe you're sitting for a long time on the toilet, maybe you're having to push or strain to pass that bowel movement.
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And oftentimes constipation comes with sort of like how frequently or not frequently you're passing the bowel movement.
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And so, typically speaking, we look at that three times per week or less.
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In passing a bowel movement that helps to define constipation.
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but I think it is more important to focus on what our stool is looking like in the toilet and how easy or difficult it is to pass because you could 100% be passing a bowel movement every single day and still be constipated.
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That's so interesting.
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So actually dig a little bit deeper into that.
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why can you still be constipated even if you're pooping every day?
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I.
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Right.
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So we are looking at those situations where, y you're taking a long time to pass the bowel movement.
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Maybe you're having to push and strain to really just like get that stool out of your body.
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But when you feel like you're done or when your stool stops exiting your body, you don't.
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Feel empty.
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and maybe what has come out is small hard pebbles and low in volume.
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So like maybe two or three small hard pebbles that were really difficult to get outta your body.
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and then maybe later in the day or the next day, you have this same situation where like you sit on the toilet and maybe only just small pieces of hard, dry, difficult to pass stool end up, coming out of your body.
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And you said something important because you described what a normal bowel movement looks like or should feel like, and I think as clinicians, it's so important to know what normal is so that you can know when there's something abnormal or when there is constipation.
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So, Educating our patients on, okay, hey, this is what normal stooling behaviors look like, is, does this sound like something that you're doing?
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Or something different than that?
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so I think establishing.
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Do we have an issue of constipation Is first and foremost the most important thing that clinicians can do.
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The next thing, now we've established that the patient's constipated, they're clearly uncomfortable.
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we maybe confirmed this on physical exam.
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Let's talk about food, right?
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You are the expert, you're the registered dietician, so we can't wait to glean some information from you.
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And there's a lot of different foods and things that we can recommend, but as clinicians, we really don't wanna just give blanket bland.
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Not helpful information, like eat more fruits and vegetables.
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So obviously we all know that fruits and vegetables are helpful, but let's get into the details.
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What fruits help relieve constipation?
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I'm so glad that you asked because I'm so excited to tell you because this is a little bit random, but specifically Kiwi has been studied.
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Kiwi has been shown to relieve constipation, effectively and without some of the sort of unpleasant side effects that like say, a stimulant laxative can have, or even prunes in Some people, can sort of have the bloaty gassy uncomfortableness, but two kiwis a day over the course of one to two weeks.
00:06:36.206 --> 00:06:50.555
If it even takes that long, can promote regular bowel movements that are softer, easy to pass, a little bit more spontaneous, and sort of help to clean you out and get you going regularly and more easily.
00:06:50.555 --> 00:07:01.776
And so I actually just double checked this information the other day because when I first looked at the study, it was, they studied green kiwi and they're like, ah, golden Kiwi isn't exactly the same.
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But then they did a follow-up study with Golden Kiwi and so, It is a little bit more the same now they've found that the green kiwi has more of a sort of proteolytic enzyme that helps to break down and helps you digest your food and such.
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the Golden Kiwi doesn't have as much of that, but long story short, like in the end, both gold and green Kiwi can help relieve your constipation.
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That is so cool and honestly, My opinion is kiwi tastes way better than p prunes, but that's just a side note.
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So I think it might be easier to get two kiwis in a day than two prunes.
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Now, let's stick on fruit.
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Are there any fruits that maybe worsen constipation or aren't helpful, or would all fruits be a good thing?
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honestly, I think, most, if not all fruits would be beneficial in some way because, so for example, the Kiwi, they have a viscous fiber.
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It helps to absorb water and it forms a gel in your gi, which is part of what helps.
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Soften the stool and helps you go to the bathroom.
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there are a lot of high water content, fruits that would help to just introduce more moisture, into your gi and into your stool.
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So things like grapes and watermelon even.
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things like apples and pears and figs, That high fructose content in that fruit draws water into your GI and just helps, to soften your stool in that way.
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and so, there are a lot of different really sciencey, really nerdy reasons why fruits.
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And different fruits might help, but, I can't think of any fruits particularly that might worsen constipation, because most fruits are, good water content, good fiber content, differing types of fibers that will help to soften or bulk or, just help you go to the bathroom a little bit easier.
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That's great, and I know at least most people can find at least two or three fruits that they like.
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It's kind of an easy way to incorporate into their diet.
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So let's shift gears a little bit and talk about the other helpful thing, which is vegetables.
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So give us some information and some tips on high fiber sources of vegetables and things that we can suggest for our patients to start eating.
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Right.
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So when it comes to trying to relieve constipation, we're looking at the types of fibers that will, draw and hold water into the GI to help soften the stool in addition to bulking the stool.
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Right?
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So on the vegetable side, that would be things like, your cruciferous vegetables, your broccoli and Brussels sprouts.
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your cabbage and cauliflower, but also sweet potatoes are really good sources of that soluble fiber that is going to hold onto water and help soften your stool.
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Now talking about potatoes, maybe there's this debate of skin's on, skin's off.
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Do you have any expert opinion or advice if we get thrown that random question?
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Right.
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So generally speaking, I think skin's on, um, however, there are some people who are so constipated that just adding more and more fiber to their situation to try and get them to go is going to make the problem worse.
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like they're at a point where they need something a little bit more aggressive, something that's going to be more successful than just trying to eat more fiber.
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And so I suppose there are going to be some times When having the skin on your potatoes or any other fruit or vegetable for that matter, might not be the right choice.
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But generally I would say skin's on.
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Now we've covered some fruits, we've covered some veggies that these patients can start to eat.
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Let's talk about grains.
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So you know, that's gonna cover our pasta, our rice, our bread.
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Talk to me about brown rice and the whole grain things.
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Can we be eating the white stuff?
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Which ones better Educate us on which grains would be best for our patients.
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Right.
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So generally speaking, and this goes back to like the general guidelines, when we are choosing our grain foods, we want at least half of the time when we're choosing our grain foods to be a whole grain.
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And so these more refined versions of grains, whether it be like an instant noodle or instant rice that you can just throw into the microwave for two minutes and it's ready to eat, you know those types of what you might call ultra processed foods, they have less fiber.
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That's on purpose.
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And so if that is the only type of grain that you're consuming most of the time, that could contribute to constipation type situation for you, especially if your fruit and vegetable intake is also low.
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So, Spreads, pastas, crackers.
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These are fine to choose, but we still wanna make sure that we are choosing higher fiber containing grains like quinoa or Pharaoh or, or lentils, man, give me some lentils, any day of the week.
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they have more fiber, they have that soluble fiber that we're looking for, to help, soften the stool.
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and so.
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Yeah, those would be the types of things that you would want to incorporate, some of the time to make sure you're getting a variety of whole grains and other types of foods that you just like to eat because they're delicious and that's fine too.
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So is there a set number of fruits and a number of vegetables that you.
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Try as a goal for your patients to get to eat, or can we just say, one or two a day, how many would be the most beneficial?
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Right.
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So generally speaking, I like to have a goal for my patients and my clients, for them to have at least one serving of a vegetable.
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Two times a day and at least one serving of a fruit of some sort two times a day.
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we're at about at minimum four servings of that fruit and vegetable category, to start with.
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And then as.
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As tolerated.
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as I say, as you like, it is best to try and, have about, five to nine servings of fruits and vegetables in a day.
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And that is a lot for some people, right?
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And so I think meeting people where they are and saying, okay, let's have like some green beans at lunch and a small apple at lunch and get started with that.
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And then, at dinner time, Something similar, but different, to try and incorporate some fruits, some vegetables, throughout the day.
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And then you can, add on from there.
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I think that's really helpful because yeah, it feels very overwhelming, especially if I'm educating a patient on.
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We gotta get nine fruits and vegetables every day.
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And they're not even eating one right now, so their eyes bug out at me and it's like panic mode.
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So I think two fruits, two vegetables, throughout the day is a really good place to start.
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So let's shift gears and talk a little bit about dairy products, because I know there's some mixed opinions on this and milk is constipating or cheese is constipating.
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So clear up some of these myths.
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Give us the facts on dairy products for our patients.
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Gary does have a reputation for being constipating.
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Right?
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And there are a couple of reasons for that.
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It is a.
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Low fiber, high fat, high calcium food, and, calcium.
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Well, a lot of calcium can be binding, as they say, as well as, high fat foods can be binding and then it's a low fiber food.
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You don't have that fiber to, help bulk your stool and help move things through the gi.
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so it's not that dairy.
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Causes constipation.
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it's more about the balance or rather the imbalance of the amount of the cheese or ice cream that is going to be that low fiber, high fat food.
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I think this is important to have a little bit of nuance here.
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It's not that dairy is bad.
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It's not that if you eat dairy, it is going to cause constipation.
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but looking at the bigger picture of like your pattern of eating, do you eat a lot of cheese and ice cream?
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Also not a lot of whole grains and fruits and veggies.
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That's really kind of what we would be wanting to suss out, so to speak, when considering if dairy intake or cheese intake is the cause of the constipation.
00:15:07.530 --> 00:15:12.270
and here's a fun fact for you, for some people with lactose intolerance.
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That actually presents as constipation rather than the typical like bloaty, gassy diarrhea that most people have with lactose intolerance.
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And so, it's about 30% of people, with lactose intolerance present with slower motility and constipation, rather than the other.
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And when I learned that, that kind of blew my mind a little bit.
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And so I wanted to make sure to share that, with you today.
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That is really interesting cuz I don't think I knew that either.
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so thank you so much.
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That's gonna help a lot of people with accurately dying, dosing some lactose intolerance.
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so.
00:15:47.160 --> 00:15:51.551
And that's also really helpful too, talking about dairy, because I know a lot of people who love milk?
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Who love milk and cereal, who love cheese on sandwiches.
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So I think it'll be such a shame to just automatically tell them, no more dairy, because again, we're trying to foster a healthy relationship with food while at the same time helping them relieve their constipation.
00:16:05.581 --> 00:16:10.561
So just cutting out a dairy product because you think it's causing constipation as a blanket statement.
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Not helpful.
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So thank you so much for clarifying that.
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Looking at their diet.
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As a whole is more important than just cutting dairy out completely.
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Now since we're on the topic of liquids being, dairy or milk products, let's move over to water cuz I know this is so important.
00:16:26.850 --> 00:16:33.510
Hydration is so vital because we could talk about soluble and insoluble fiber all day long, right?
00:16:33.510 --> 00:16:38.331
But if there's not any water to help soften that, Stool up then We're not really relieving any issues.
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So give us the water talk.
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How much water should we be drinking?
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Why is it important so we can help educate our patients on the importance of hydration.
00:16:48.234 --> 00:16:50.244
So you're absolutely correct.
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Hydration is one of the, key components to a healthy digestive tract, especially if you're dealing with, trying to resolve constipation.
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So generally speaking, a, a general water goal for most people if you were to take your weight in pounds and divide that in half and use that number as the number of.
00:17:08.318 --> 00:17:11.778
Ounces, that you should be drinking in a day.
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So, if you had a 200 pound person, their water goal would be 100 ounces of fluid.
00:17:18.503 --> 00:17:28.523
and so while water is very important, I think, I think it's important also to recognize that most, if not all fluids contribute to hydration and.
00:17:29.473 --> 00:17:30.433
I hear it a lot.
00:17:30.433 --> 00:17:34.663
I don't know about you, but a lot of people don't like plain water, right?
00:17:34.663 --> 00:17:39.134
So I feel like it's okay to drink the flavored water.
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It's okay to use the flavoring drops, and it's the middle of summer right now anyway.
00:17:45.449 --> 00:17:55.239
And so, drinking something with electrolytes or even just an outright sports drink, that is an important part of your hydration for the day.
00:17:55.288 --> 00:17:56.959
So, yes, water is crucial.
00:17:57.269 --> 00:18:03.598
we need it for so many metabolic processes in our body in addition to the whole digestion thing.
00:18:03.679 --> 00:18:08.808
but, juice counts, soda counts, caffeinated beverages.
00:18:10.999 --> 00:18:14.179
I mean, here's what I'm gonna say about caffeinated beverages.
00:18:14.209 --> 00:18:19.759
They do trigger you to urinate more than if you were to not drink them.
00:18:19.759 --> 00:18:24.949
But they don't totally negate what you've drank in the day, right?
00:18:24.949 --> 00:18:29.598
So tea and coffee and soda can have their place, right?
00:18:29.604 --> 00:18:34.878
But I think they're again, looking at the bigger picture of like, What do you drink the most of?
00:18:34.878 --> 00:18:39.558
Like if you are drinking soda all day long, let's reevaluate that.
00:18:39.808 --> 00:18:42.148
That's really helpful because I think that's easy to remember.
00:18:42.179 --> 00:18:50.153
there's always all kinds of crazy equations and of course, Your fluid intake is gonna depend on your day-to-day activities.
00:18:50.153 --> 00:19:08.753
If you're really an avid exerciser or you're sweating a lot, obviously, but we're just talking about some general guidelines that you can provide to your patient, your average patient with a goal, because if they can meet that goal with liquids that they're drinking, hopefully they're also increasing their fruit and vegetable intake, which also have a lot of.
00:19:08.959 --> 00:19:12.519
Fluids in it so you know you can meet it, with both things.
00:19:12.848 --> 00:19:14.709
So that was a really, really helpful guideline.
00:19:14.709 --> 00:19:20.048
So half of your body weight in pounds, that would be how many ounces you should drink throughout the day.
00:19:20.169 --> 00:19:20.679
Excellent.
00:19:21.419 --> 00:19:29.898
So since we've been talking a little bit about juice, Prune juice is a big one that comes up all the time, as a, a natural way to relieve constipation.
00:19:30.169 --> 00:19:32.868
And should we be recommending this to our patients?
00:19:32.874 --> 00:19:36.138
And if so, how much should they drink?
00:19:36.259 --> 00:19:38.298
And what if they think it's disgusting?
00:19:38.298 --> 00:19:40.249
So help us tackle those couple of things.
00:19:41.493 --> 00:19:45.193
Right, so prune juice and prunes they worked.
00:19:45.193 --> 00:19:50.743
They help to relieve constipation, and it's not just the fiber content of the prune or the prune juice.
00:19:50.844 --> 00:19:54.023
prunes are actually naturally high in sorbitol, which is a.
00:19:54.203 --> 00:20:00.493
Sugar alcohol, it draws water into the gi and that's the thing that helps with the constipation more than anything else.
00:20:00.493 --> 00:20:02.233
And so, yes, it works.
00:20:02.294 --> 00:20:07.644
and in my opinion, I would start with a short glass of prune juice.
00:20:07.743 --> 00:20:08.973
Once or twice a day.
00:20:09.023 --> 00:20:17.334
because since it is the sorbitol, it is that sugar alcohol that helps to move things along in your gi.
00:20:17.604 --> 00:20:20.334
Some people don't react so well to sugar alcohols.
00:20:20.388 --> 00:20:23.439
it makes them, a little bit crampy or gassy.
00:20:23.898 --> 00:20:28.989
and then of course you don't want to overshoot your goal and end up with.
00:20:29.709 --> 00:20:34.298
Urgency and loose liquid unformed stools as well.
00:20:34.638 --> 00:20:39.769
it really is kind of a goldilock situation when trying to resolve constipation, right?
00:20:39.769 --> 00:20:43.788
Like, you wanna move things along, but you don't wanna swing too far to the other end, right?
00:20:43.788 --> 00:20:50.019
So, for most of the time I feel like people can start off with, a short, I say a short glass.
00:20:50.019 --> 00:21:03.128
And what I mean by that is four to five ounces of prune juice, maybe once or twice a day, along with adequate hydration and if you would rather not have the prune juice, like I, I, myself, I'm not sure if I could drink prune juice.
00:21:03.128 --> 00:21:05.409
I usually reach for the prunes themselves.
00:21:06.034 --> 00:21:07.743
rather than the prune juice.
00:21:07.773 --> 00:21:19.574
and there again, you might try one or two at a time, one to two times a day, along with adequate hydration and moving your body to help stimulate your GI and move things along.
00:21:20.018 --> 00:21:21.458
Excellent, and I'm with you.
00:21:21.698 --> 00:21:27.637
Prune juice to me is not, Not the most palatable juice out there.
00:21:27.637 --> 00:21:30.337
So I would rather do some more fruits and vegetables than that.
00:21:30.337 --> 00:21:32.107
But I know a lot of people who say it's helpful.
00:21:32.617 --> 00:21:33.038
All right.
00:21:33.038 --> 00:21:41.218
So I would love for you to share with us anything that we missed or anything else that might help our patients help relieve their constipation.
00:21:41.307 --> 00:21:42.657
Anything else that you'd like to add?
00:21:43.464 --> 00:21:43.765
Sure.
00:21:43.765 --> 00:21:45.444
So a couple of things come to mind.
00:21:45.444 --> 00:21:48.384
Number one, fiber supplements have their place.
00:21:48.904 --> 00:22:12.085
and I feel like if we are in a situation where you just can't get the fiber that you want or need, to resolve your constipation or keep your bowels moving, on a daily basis and have that sort of perfect poop that you're looking for, that that soft but formed easy to pass, perfect poop, fiber supplements have their place.
00:22:12.140 --> 00:22:18.349
And for most people, the good old sodium fiber supplements are going to like work just fine.
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