CCORDING TO NEW ZEALAND RESEARCHERS, KIWI CAN increase the frequency of bowel movements for people with constipation. Today we explore how to use kiwi for constipation.

Have you ever had constipation? Constipation is a symptom and not a disease. A common definition is this:

Constipation: Bowel movements three or fewer times weekly, with difficulty passing stools.

The condition is common. While constipation is not uncommon, historical surveys suggest a higher dissatisfaction rate with pharmaceutical treatments.

Constipation

The Rome IV criteria for constipation offer that a patient must have had at least two of the following symptoms

According to the constipation criteria, a patient must have experienced at least two of the following symptoms over the preceding six months:

• Fewer than three spontaneous bowel movements per week
• Straining for more than one in four defecation attempts
• Lumpy or hard stools for at least 25 percent of defecation attempts
• Anorectal obstruction or blockage sensation for at least one-quarter of defecation attempts
• The sensation of incomplete defecation for at least 25 percent of defecation attempts
• Manual maneuvering is needed to defecate for at least 25 percent of defecation attempts

Moreover, the individual must “rarely have loose stools present without using a laxative and must not meet Rome IV criteria for irritable bowel syndrome (IBS).

A constipated patient may be otherwise asymptomatic or complain of one or more of the following: Abdominal bloating, defecation pain, rectal bleeding, spurious diarrhea, or low back pain.

The following also suggests that the patient may have difficult rectal evacuation: Feeling of incomplete evacuation, digital extraction, tenesmus (a frequent urge to go to the bathroom without being able to go), or enema retention.

The following signs and symptoms, if present, are grounds for particular concern:

• Rectal bleeding
• Abdominal pain (suggestive of possible IBS with constipation [IBS-C])
• Inability to pass flatus
• Vomiting

Kiwi for constipation — New findings

While constipation is common, there is a high rate of dissatisfaction with pharmaceutical treatments. Enter the kiwi with the following properties:

• Kiwifruit cell walls have fiber and hold water. Both can soften stools and improve frequency.
• Kiwifruits have components (such as raphides) that may change mucin production.

The fiber found in kiwifruit cell walls swells and holds water, which can soften stools and increase stool frequency. Other components of kiwifruit, such as raphides, may alter mucin production, leading to improved laxation.

Researchers recruited 184 adults with constipation (or constipation-predominant irritable bowel syndrome) in Japan, New Zealand, and Italy. They also included healthy people as controls.

The study included 136 women and 48 men, a ratio consistent with constipation prevalence by gender. Subjects had an average age of 31 in Japan, 45 in New Zealand, and 37 in Italy.

The study participants recorded their bowel habits in the two weeks following recruitment, noting spontaneity, frequency, completeness, stool form, straining degree, and laxative use. The researchers then randomly assigned participants to one of the following groups:

• Consume two ripe green kiwifruits without the skins for four weeks.
• Psyllium 7.5 grams daily for four weeks. Psyllium is a first-line treatment for constipation, with a fiber content similar to kiwifruit.

After four weeks, treatments stopped for four weeks. Then the patient groups switched to the other treatment for an additional four weeks. The subjects had two five-gram bisacodyl suppositories as a drug “rescue therapy.”

Here are the results after the end of the four-week treatment period:

Those with functional constipation who ate kiwifruit had an average increase of about 1.5 bowel movements weekly. Those with irritable bowel syndrome-constipation reported an increase of 1.7. Both groups had less abdominal discomfort. The bowel frequency among the healthy subjects did not change.

Among those taking psyllium, only the irritable bowel syndrome-constipation group members had a bowel movement frequency increase (by 1.9 weekly).

My take — Kiwifruit and constipation

The bottom line? Kiwifruit consumption was associated with softening stools, less straining, and improved quality of life. These improvements were greater than those associated with psyllium.

I recommend two green kiwifruits for some patients with functional gastrointestinal problems. One caveat: Zespri International, a kiwifruit grower cooperative, employed two researchers. This company also provided some of the funding for the study and approved its design.

Other study limitations included the inability to blind subjects to the interventions. The authors did include a control group, however. In addition, the treatment duration was fairly short, at four weeks.

Do you eat kiwifruit?