How an apple a day keeps the doctor away

Constipation may not top your list of worries if modern society collapses.  But it will become a problem if food shortages occur, curbing one’s intake of fruits and vegetables.

The elderly, especially, are susceptible, and many are hospitalized to alleviate this potentially painful condition.

The following article is first in a series on prevention and treatment of constipation.

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Apple tree in full blossom, North Ayrshire, Sc...

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Everyone suffers from occasional constipation. Usually it’s diet-related. Within a few days, things work their way out, so to speak.

But what if it’s a daily occurrence? What if you’re frequently bloated or plagued with abdominal discomfort due to constipation? What if your hemorrhoids bleed every time you pass a hard stool? What if you are elderly and decide not to eat because you fear the inevitable cramping?

Or what if the stool simply won’t come out on its own?  Will your colon burst from the pressure?

Fortunately, a better understanding of human bowel function can help prevent a chronic problem.

The human intestine was designed to pass banana-size stools most comfortably. It is easier for the colon to propel a banana-size stool forward than little marbles – there’s more to grip. Also, oversize but overly firm stools offer too much resistance to the muscles of the colon. Aim for stools the consistency of what I call “brown bananas” – not too big, not too small, not too hard, not too soft.

1919 advertisement for Jubol (laxative)

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Inadequate dietary fiber is the most common culprit for chronic constipation. Certainly many medications and certain diseases may also contribute, but most people who don’t have to raise or harvest their own food simply do not choose foods containing sufficient soluble fiber, the type of fiber that is able to absorb extra water. Bran is an excellent example of this. Though it’s flaky and dry when poured from a cereal box, it soaks up the milk and becomes nice and mushy. It does the same thing when passing through the colon. Meat, on the other hand, does not absorb extra water, nor does fat, whether inside your body or in a frying pan.

Therefore, remember that the first important ingredient in softer stools is sufficient water. If you eat bran all day but don’t have any fluids on board for it to absorb, your stools will be as hard as ever.

Also, fiber only softens stools as they are being formed. Once a stool is already formed, it’s a done deal. You simply have to wait for it to pass (or help it along with a stimulant laxative or enema, which most people prefer to avoid). Think of your intestine as a conveyor belt. You need to keep all your stools soft in order for it to work correctly. You don’t want a hard stool to plug up the works, which causes cramping as the softer stools that follow try to escape.

The bowel may need some re-training. If it’s grown used to constipation, it will need to stretch out a bit to accommodate a diet higher in fiber. This may cause mild discomfort or bloating until your body has adjusted. One word of warning: if you have a hard stool that is acting like a plug, you may experience significant cramping as your intestine tries to expel the obstruction.

As for increasing your fiber, “An apple a day keeps the doctor away” is a good place to begin. One medium apple contains approximately 3 grams of fiber. In comparison, a slice of white bread contains as many calories but only a fourth as much fiber.

The most natural sources of dietary fiber are vegetables and fruits. The skin of apples, pears, and other fruits contains a large amount of fiber, so don’t peel your fruit for best results. Strawberries, blackberries, and raspberries are good choices, along with peaches and plums. The infamous prune is, of course, simply a dried plum. Beans, carrots, broccoli, cauliflower, peas, spinach, and artichokes are high in dietary fiber as well.

Whole grains are also a good source of fiber. Choose whole wheat or whole grain bread instead of white bread. Choose brown rice over white rice. Choose raisin bran, oatmeal, or shredded wheat over Rice Krispies or Captain Crunch.

Aim for at least 5 servings a day of high fiber foods. Once your colon adjusts to the increased fiber and water in your diet it should be smooth sailing. There may be an adjustment period, however, during which you may experience a little bloating or abdominal discomfort. In the long run, though, you’ll not only be more comfortable but healthier as well, with all the natural foods you’ll be eating.

Sufficient calories, vitamins, and nutrients aren’t the only concern as you stockpile your supply of food. Make sure to include a good supply of foods high in soluble fiber – and choose ones that you and your family will actually eat.  A bushel of bran will do no good if it just sits in the corner.  Dried fruit is a good choice if fresh is unavailable, but must be taken with sufficient fluids.  For a list of fiber content of common foods see

Copyright © 2011 Cynthia J. Koelker, MD

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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