The ins and outs of constipation

As a dietitian, I have become very familiar with asking the hard questions and talking ‘‘bowels’’ with my patients. Constipation affects 1 in 5 people in New Zealand and can be a problematic issue causing bloating, gas, stomach cramps, loss in appetite, nausea, rectal tears (anal fissures) and haemorrhoids. Yet, despite this, it is a topic that is often swept under the rug, because who really wants to talk poo?

Ideally, we want to be moving our bowels 1-3 times every 1-3 days. Those who fall outside of this zone, and have a dry and firm stool that is difficult to pass, may benefit from looking deeper into their diet and lifestyle.

In healthy individuals, constipation can arise from a lack of fibre in the diet, poor fluid intake, physical inactivity, over use of laxatives, medications, ignoring the urge to go, and conditions such as Irritable Bowel Syndrome (IBS).

Let’s talk fibre

Fibre is a structural part of plants, found in the leaf, roots, stem and seeds. It is mainly located on the outside of the plant and, therefore, is often lost during milling or food processing.

There are two main types of fibre found in foods that prevent and relieve constipation by softening the stool and keeping us regular.

Insoluble fibre is found mainly in cereals, wholegrain/ multigrain bread, brown rice, seeds, nuts and fruit and vegetables. Insoluble fibre is not broken down in the body but, instead, acts as a bulking agent and helps to keep our bowels regular.

Soluble fibre is found in fruit and vegetables, legumes and oats. Soluble fibre ferments in the bowel and absorbs water, helping to soften stools and allow them to pass through the bowel more easily. Soluble fibre also helps to lower cholesterol and control blood sugar levels.

Currently Kiwis are falling behind in the fibre department, with the average New Zealand adult only managing to eat 19.6 grams of fibre per day.

This is well below the recommended intake of 25-30 grams per day and is likely to be the result of readily available, cheap, low fibre (and low nutrient) processed foods replacing wholegrains and fruit and vegetables in our diets.

What can we do to meet our fibre requirements?

Aim for 5+ a day of fruit and vegetables; at least two fruit and three vegetables. If possible, avoid peeling skins off fruit and vegetables as this removes the fibre.

Always choose breads and cereals.

When buying bread, cereals and crackers, look for foods which contain more than 6g of fibre per 100g.

Have a small handful of nuts every day.

Include kidney beans, chickpeas, lentils or other legumes in casseroles, curries, mince and soups.

Start the day with a high fibre cereal (such as Weetbix, oats or muesli) with a sprinkle of seeds, chopped prunes or kiwifruit.

Fluid also plays an important role in the constipation saga. Without water, fibre isn’t able to work to its full potential and we may still be left with a hard task on the toilet.

Increase your fluid intake when you increase your fibre intake, and aim for at least 6-8 glasses of fluid per day.

For those who are still struggling with constipation, despite adequate fluid and fibre intakes, there are fibre supplements that can lend a helping hand, rather than having to reach for the laxatives. Such fibre supplements include Benefibre, Metamucil, Phloe and Kiwicrush, which can be found at your local supermarket. wholegrain

Apple and Bran Muffins

2 c flour

2 c bran

1 tsp baking soda

1 tsp cinnamon pinch of salt

1⁄2 c natural yoghurt

1⁄2 c vegetable oil

1⁄4 c milk

2 eggs

1 tsp vanilla essence

1⁄2 c brown sugar

3 apples, grated

Preheat oven to 190˚C. In a medium bowl, mix flour, bran, baking soda, cinnamon and salt. In a large bowl, beat together wet ingredients and sugar.

Stir in apples, and gradually blend in the flour mixture.

Spoon the mixture into a greased muffin tray and sprinkle with sugar and cinnamon.

Bake for 20 minutes.

Homemade Danish crackers

Method

1⁄4 c rolled oats

1⁄4 c sesame seeds

1⁄4 c pumpkins seeds

1⁄4 c sunflower seeds

1 tsp baking powder

7/8 c flour

1⁄4 c oil

1⁄2 c water

1⁄2 c parmesan cheese

1⁄2 tsp salt

Mix all ingredients together in a large bowl.

With a rolling pin, roll out mixture in 2-3 batches on grease proof paper to thickness of pumpkin seeds. (The mixture is easier to work with when rolled out between two sheets of baking paper.)

Cut the mixture into cracker-size pieces but do not separate. Cook at 180˚C for 12-14 minutes or until golden.

Break crackers apart once cooled and enjoy.

Method