Chronic constipation is more than an occasional nuisance. In the guidelines, it\u2019s described as unsatisfactory defecation due to infrequent stools, difficult stool passage, or both.
It affects quality of life and is common worldwide (the paper cites a global prevalence of ~10.1%).<\/p>\n\n\n\n
Most people try lifestyle changes first\u2014especially diet\u2014but many remain dissatisfied with results.
One reason: older guidance often stayed vague (\u201cincrease fiber,\u201d \u201cdrink more fluids\u201d) and left out other dietary strategies where evidence exists, or included recommendations without robust support.<\/p>\n\n\n\n
These are presented as the first comprehensive, evidence-based dietary guidelines specifically for managing chronic constipation in adults. They were built using four systematic reviews\/meta-analyses, then translated into recommendations using GRADE and a Delphi consensus process.<\/p>\n\n\n\n
Key headline numbers from the paper: 75 randomized controlled trials (RCTs) were included across the reviews, 59 recommendation statements were generated and accepted.
Recommendations cover supplements, foods, and drinks\u2014but no \u201cwhole-diet\u201d approach (e.g., \u201chigh-fiber diet\u201d as a general concept) received a recommendation due to lack of RCT evidence.<\/p>\n\n\n\n
1) Fiber\u2014but which fiber matters<\/strong><\/p>\n\n\n\n The big shift is that the guideline doesn\u2019t treat \u201cfiber\u201d as one thing.<\/p>\n\n\n\n Practical guidance from the recommendations:<\/p>\n\n\n\n \ud83c\udf00 Important: Fiber may increase gas\/flatulence, especially certain types (e.g., inulin-type fructans), so the pace of \u201cintroduction\u201d is important.<\/p>\n\n\n\n 2) Probiotics\u2014may help, but it\u2019s strain-specific and not universal<\/strong><\/p>\n\n\n\n Guidelines suggest that probiotics overall may increase the likelihood of clinical improvement, but it is often unclear which exact strains are responsible for the effect. Practical guidance from the recommendations:<\/p>\n\n\n\n 3) Magnesium oxide\u2014surprisingly \u201cguideline-ready\u201d<\/strong><\/p>\n\n\n\n For magnesium oxide, the guidelines provide fairly clear messages:<\/p>\n\n\n\n Practical guidance from the recommendations:<\/p>\n\n\n\n \u26a0 Clinical note: This should always be individualized, especially in people with kidney problems, specific therapies, or a sensitive GI tract.<\/p>\n\n\n\n 4) Senna \u2014 a surprise: \u201cno clear effect\u201d in these analyses<\/strong><\/p>\n\n\n\n Although senna is popular, these guidelines report that in meta-analyses it did not show a clear impact on \u201cclinical benefit\u201d or stool frequency compared to placebo (with low certainty of evidence).<\/p>\n\n\n\n Kiwi<\/strong><\/p>\n\n\n\n There is a practical, food-based recommendation:<\/p>\n\n\n\n Prunes<\/strong><\/p>\n\n\n\n Compared to psyllium, there is no clear advantage for stool consistency in available RCTs within these analyses.<\/p>\n\n\n\n This does not mean they \u201cdon\u2019t work for anyone,\u201d but rather that\u2014based on strict evidence from this set of studies\u2014they are not superior to an already proven effective option.<\/p>\n\n\n\n Rye bread<\/strong><\/p>\n\n\n\n Rye bread is interesting because:<\/p>\n\n\n\n Mineral-rich water<\/strong><\/p>\n\n\n\n Guidelines note that water with a high mineral content may help with \u201ctreatment response\u201d over a certain period, but effects on other symptoms are not always clear. \ud83d\udccc First: safety check (\u201cred flags\u201d)<\/p>\n\n\n\n If there is blood in the stool, unexplained weight loss, significant pain, anemia, nighttime symptoms, or newly developed constipation that changes rapidly\u2014this is a signal for medical evaluation and diagnostics, not just a \u201cdietary experiment.\u201d<\/p>\n\n\n\n \ud83d\udd01 Then: 4 weeks, one change at a time<\/strong><\/p>\n\n\n\n The most common mistake is changing 5 things at once, so we don\u2019t know what helped (or worsened things).<\/p>\n\n\n\n Example of a \u201c4-week test\u201d (from guidelines):<\/p>\n\n\n\n \ud83d\udcd2 Measure instead of guessing<\/strong><\/p>\n\n\n\n A simple diary for 10 days before and 10 days during the change:<\/p>\n\n\n\n Source: Eirini Dimidi, Alice van der Schoot, Kevin Barrett, Adam D. Farmer, Miranda C. Lomer, S. Mark Scott, Kevin Whelan. British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults<\/strong>.\u00a0Neurogastroenterology, 2025; DOI: <\/em>10.1111\/nmo.70173<\/a><\/u><\/em><\/em><\/p>\n\n\n\n\n
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For Bifidobacterium lactis, there is some signal that it may increase stool frequency (with a moderate level of evidence for this outcome), but in general there is no single probiotic solution that works for everyone.<\/p>\n\n\n\n\n
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\ud83c\udf5e<\/strong> Food and beverages: specific items included in the guidelines<\/strong><\/h5>\n\n\n\n
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Compared to psyllium, kiwi may slightly increase stool frequency, but it is not a \u201cmiracle solution\u201d and effects are generally modest.<\/li>\n<\/ul>\n\n\n\n\n
But it may also worsen global symptoms in some individuals (e.g., gas, bloating, discomfort),
And the \u201cdose\u201d used in studies was often quite high (e.g., 6\u20138 slices per day), which is not always practical in real life.<\/li>\n<\/ul>\n\n\n\n
Practical framework:\n\n0.5\u20131.5 L\/day for 2\u20136 weeks.
They also emphasize that there are no universal thresholds for what counts as \u201cenough minerals,\u201d and water composition varies.<\/p>\n\n\n\n\ud83d\udcdd<\/strong> How to translate this into FORMULA ZDRAVLJA practice (without overload)<\/strong><\/h5>\n\n\n\n
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\ud83d\udc9a THE HEALTH FORMULA<\/a> \u2013 prevention and healing begins with understanding<\/h5>\n\n\n\n