Constipation is an uncomfortable, but common condition that occurs when stools become infrequent (twice a week or less) or are difficult to pass.1,2 Other symptoms, such as abdominal discomfort, cramping, and bloating may accompany constipation.1,2 Constipation can have several causes, such as certain medications or supplements, changes in routine, gastrointestinal disorders, health conditions, and lifestyle habits, such as a lack of physical activity or diet.1-3 For most people, constipation will be a minor, temporary inconvenience.1,3 However, prolonged or recurring episodes of constipation should be discussed with a healthcare practitioner.
In practice
- Constipation is a common condition that can be caused by a multitude of factors, such as certain medications or supplements, changes in routine, gastrointestinal disorders, and lifestyle habits, such as a lack of physical activity or diet.
- It is widely agreed upon that no specific food will singlehandedly cause constipation.
- An overall lack of fibre and water in the diet are common contributors to the development of constipation.
- There is no evidence to support that milk products, specifically cheese, have any negative impacts on digestive function and bowel habits.
- Increasing evidence is supporting the benefits of fermented dairy on constipation. However, more research is needed.
Diet and constipation
It is widely agreed upon that no specific food will singlehandedly cause constipation.1,4 Rather, it is an overall lack of fibre and water in the diet that are common contributors to the development of constipation.1,2,4 Consequently, general dietary advice for constipation includes consuming enough liquids and favouring foods that are rich in fibre, such as fresh vegetables and fruits, whole-grains, nuts, and legumes.1,5 It is recommended to increase fibre gradually to allow the digestive system to adapt and increase water consumption accordingly.1
Dairy and constipation
Debunking certain myths. A prevalent myth is that dairy products, specifically cheese, cause constipation. However, there is no evidence to support that cheese has any negative impacts on bowel habits, including intestinal transit time.6,7 While it is true that cheese does not naturally contain fibre, its role as a part of a balanced diet is mainly to supply energy, protein, and many important micronutrients. Balancing the consumption of cheese and other milk products with more whole plant foods may promote regularity without compromising the intake of other important nutrients. Boosting fibre intake can be accomplished by increasing the amount of high-fibre foods or by making strategic substitutions (i.e., swapping refined grain products for whole-grain versions).8
Fermented dairy. Emerging evidence is now suggesting that certain fermented dairy products, such as probiotic yogurt, may help alleviate constipation.9-11 A meta-analysis of 14 studies found that probiotics, many of which in the form of yogurt or fermented milk, reduced gut transit time and improved stool consistency.10 A systematic review of 108 studies found fermented dairy products had benefits on digestive regularity in several settings.9 These findings are supported by an earlier systematic review of five randomized clinical trials, including 377 subjects, which associated probiotics, several of which were in the form of probiotic yogurt, with improved outcomes related to constipation.12 However, while these results may be promising, more research to elucidate the benefits of specific probiotics strains is needed.9,11,13
References
- National Institute of Diabetes and Digestive and Kidney Diseases. 2018. Constipation. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation. Accessed August 4, 2021.
- Andrews CN and Storr M. The pathophysiology of chronic constipation. Canadian Journal of Gastroenterology 2011;25:16B-21B.
- Tack J et al. Diagnosis and treatment of chronic constipation–a European perspective. Neurogastroenterology & Motility. 2011;23:697-710.
- Canadian Digestive Health Foundation. 2021. Constipation. https://cdhf.ca/digestive-disorders/constipation/what-is-constipation/. Accessed August 2, 2021.
- Lindberg G et al. World Gastroenterology Organisation global guideline: constipation—a global perspective. Journal of clinical gastroenterology 2011;45:483-7.
- Aslam H et al. Associations between dairy consumption and constipation in adults: A cross-sectional study. Nutrition and health 2021. doi: 10.1177/02601060211004784.
- Mykkänen HM et al. Effect of cheese on intestinal transit time and other indicators of bowel function in residents of a retirement home. Scandinavian journal of gastroenterology 1994;29:29-32.
- Heart and Stroke Foundation. 2021. Fibre and Whole grains. https://www.heartandstroke.ca/healthy-living/healthy-eating/fibre-and-whole-grains. Accessed August 4, 2021.
- Savaiano DA and Hutkins RW. Yogurt, cultured fermented milk, and health: A systematic review. Nutrition reviews 2021;79:599-614.
- Dimidi E et al. The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. The American journal of clinical nutrition 2014;100:1075-1084.
- Zhang C et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clinical Nutrition 2020;39:2960-2969.
- Chmielewska A and Szajewska H. Systematic review of randomised controlled trials: probiotics for functional constipation. World journal of gastroenterology: WJG 2010;16:69-75.
- Wen Y et al. The efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: A systematic review and meta-analysis based on seventeen randomized controlled trials. International Journal of Surgery 2020;79:111-119.
