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Milk and Constipation

May 17, 2010 Written by JP       [Font too small?]

This is my second entry in a series of columns that will be carried on the Healthy Monday web site. As a reminder, the goal of the Healthy Monday program is to offer practical suggestions that may help reduce the incidence of preventable disease. In my opinion, one of the best ways to accomplish this objective is to address the underlying issues that lead to health disorders in the first place. Get to the root of the problem rather than simply rely on medications to manage symptoms.

There are certain health conditions that affect people of all ages. Chronic constipation is a good example. This reality is evidenced by the multitude of laxative drugs that are targeted to virtually every stage of life. But what’s rarely analyzed is why such disparate populations struggle with irregularity in the first place. A recent study in the May 2010 edition of the Journal of Pediatric Gastroenterology Nutrition suggests one plausible cause.

Researchers at the Hospital de Cruces, Spain conducted a trial examining the effects of dairy consumption in children living with chronic constipation. Sixty-nine youngsters took part in an examination of the relative impact of cow’s milk vs. rice milk in increasing the number of bowel movements per week.

  • 51% of the children who avoided cow’s milk (CM) demonstrated improvements.
  • A  group consisting of developmentally delayed children exhibited a 78% response rate to the CM-free diet.

The authors noted that there wasn’t any significant differences in fiber intake among the cow’s milk and rice milk groups. They also failed to find a consistent pattern of allergic reactions in the children who responded to the CM-free diet and those that did not. This determination was based on various “immunologic parameters”. This suggests that the regulating activity of CM-free diets was not the result of removing allergenic milk proteins, a previously suspected cause of constipation. (1)

If milk allergies/intolerances aren’t the culprits for the constipating symptoms found in children, then what is? I have a theory. High calcium concentrations (hypercalcemia) are known to promote constipation. Many modern diets feature a preponderance of calcium enriched foods and dairy products, and a relative lack of dietary magnesium. Magnesium is well documented as having a normalizing influence in promoting regular bowel function. Therefore, this imbalance between the levels of dietary and supplemental calcium/magnesium may be a powerful contributor to the current problem. (2,3)

Milk-Related Allergic Reactions
Source: Ital J Pediatr. 2010; 36: 5. (link)

Foods that are rich in magnesium, including green leafy vegetables, nuts and seeds are often plentiful sources of dietary fiber as well. This is relevant  because numerous studies indicate that consuming more fiber can be as effective as using over-the-counter laxatives. However, there are few distinct advantages to fiber when compared to laxatives: 1) fiber doesn’t stimulate peristaltic movement of the intestines which can lead to dependence; 2) fiber may allow for greater bioavailability of certain vital nutrients such Vitamin B12. (4,5,6)

Please keep in mind that not all dairy products are equal. In fact, select probiotic yogurts have been shown to yield “drastic and constant” benefits in patients living with constipation. As an added bonus, a recent Japanese study discovered that specially cultured yogurts also resulted in improvements in liver function and a reduction in LDL (“bad”) and total cholesterol. Not bad for a common breakfast food. (7)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well,

JP

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13 Comments & Updates to “Milk and Constipation”

  1. Mallory Says:

    i thought i was lactose intolerant, and always constipated when i ate dairy, as well as having my face break out.

    i took the advice from cooling inflammation, and started eating sauerkraut, live yogurt, kefir, pickles etc

    after a month i tried raw cheese from goats… SCORE!!!! it all went well… i think a healthy gut plays a HUGE role in constipation and milke sensitivity!!!!!!!

  2. JP Says:

    Thank you for sharing your experience, Mallory! :)

    This is great/welcome news for those that enjoy dairy and struggle with constipation. Much appreciated!

    Be well!

    JP

  3. Mark Says:

    I do not suffer from this problem, but should one consider supplementing the amount of magnesium daily along with eating more green vegetables? Is there one type of magnesium better absorbed by the body?

  4. JP Says:

    Mark,

    I think most people would benefit from adding some supplemental magnesium to their daily routine. An exception might be if your diet is already abundant in magnesium-rich foods and not top-heavy in calcium. People with poor kidney function are also advised to consult with their physicians prior to supplementing with added minerals such as magnesium.

    Magnesium citrate, glycinate and taurinate are examples of well absorbed magnesium chelates.

    Be well!

    JP

  5. tami Says:

    I HAVE A 2 YEAR OLD DAUGHTER AND SHE STARTED GETTING BACKED UP SINCE SHE WAS ABLE TO DRINK COW MILK. WELL JUST TWO WEEKS AGO I HAD TO ADMIT MY DAUGHTER INTO THE HOSPITAL BECAUSE OF THIS. SHE WAS FULL OF S***. LITERLY. WELL THEY PUMPED HER WITH GO LIGHTLY. THERE IS NOTHING LIGHTLY ABOUT THAT. WELL HER GI DOCTOR CALLED AND SAID SHE CAN NOT HAVE ANYTHING WITH MILK OR WHEY. WELL YOU NEVER KNOW HOW MUCH STUFF HAS WHEY IN IT UNTIL YOU GET A LIST. EVERYTHING ON THIS LIST WAS EVERYTHING MY DAUGHTER ENJOYS. WHAT IS SHE SUPPOSE TO EAT HORSE GRAIN? I DON’T MIND THE SOYMILK BUT EVERYTHING. MY HUSBAND AND I WANT TO FIND SOMETHING ELSE WE CAN DO THAT CAN HELP AND SHE CAN STILL EAT EVERYTHING SHE LOVES.

  6. JP Says:

    Tami,

    Fortunately there are more dairy alternatives available today than ever before. Health food stores and various online vendors are excellent resources for such products. As an example, we only drink almond milk in our household. I also frequently use coconut milk. I understand that this challenge (avoiding milk and whey) may appear very difficult at the moment. But with a little practice and research, I’m confident you’ll find suitable replacements for the foods your daughter enjoys. Many parents in similar situations have succeeded in doing so.

    Be well!

    JP

  7. JP Says:

    Updated 04/04/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27039383

    Nutr J. 2016 Apr 2;15(1):35.

    Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows’ milk.

    BACKGROUND: Cows’ milk generally contains two types of β-casein, A1 and A2 types. Digestion of A1 type can yield the peptide β-casomorphin-7, which is implicated in adverse gastrointestinal effects of milk consumption, some of which resemble those in lactose intolerance. This study aimed to compare the effects of milk containing A1 β-casein with those of milk containing only A2 β-casein on inflammation, symptoms of post-dairy digestive discomfort (PD3), and cognitive processing in subjects with self-reported lactose intolerance.

    METHODS: Forty-five Han Chinese subjects participated in this double-blind, randomized, 2 × 2 crossover trial and consumed milk containing both β-casein types or milk containing only A2 β-casein. Each treatment period was 14 days with a 14-day washout period at baseline and between treatment periods. Outcomes included PD3, gastrointestinal function (measured by smart pill), Subtle Cognitive Impairment Test (SCIT), serum/fecal laboratory biomarkers, and adverse events.

    RESULTS: Compared with milk containing only A2 β-casein, the consumption of milk containing both β-casein types was associated with significantly greater PD3 symptoms; higher concentrations of inflammation-related biomarkers and β-casomorphin-7; longer gastrointestinal transit times and lower levels of short-chain fatty acids; and increased response time and error rate on the SCIT. Consumption of milk containing both β-casein types was associated with worsening of PD3 symptoms relative to baseline in lactose tolerant and lactose intolerant subjects. Consumption of milk containing only A2 β-casein did not aggravate PD3 symptoms relative to baseline (i.e., after washout of dairy products) in lactose tolerant and intolerant subjects.

    CONCLUSIONS: Consumption of milk containing A1 β-casein was associated with increased gastrointestinal inflammation, worsening of PD3 symptoms, delayed transit, and decreased cognitive processing speed and accuracy. Because elimination of A1 β-casein attenuated these effects, some symptoms of lactose intolerance may stem from inflammation it triggers, and can be avoided by consuming milk containing only the A2 type of beta casein.

    Be well!

    JP

  8. JP Says:

    Updated 05/23/16:

    http://nutritionj.biomedcentral.com/articles/10.1186/s12937-016-0172-y

    Nutrition Journal 201615:56

    The effects of the DDS-1 strain of lactobacillus on symptomatic relief for lactose intolerance – a randomized, double-blind, placebo-controlled, crossover clinical trial

    Background: Lactose intolerance is a form of lactose maldigestion where individuals experience symptoms such as diarrhea, abdominal cramping, flatulence, vomiting and bowel sounds following lactose consumption. Lactobacillus acidophilus is a species of bacteria known for its sugar fermenting properties. Preclinical studies have found that Lactobacillus acidophilus supplementation may assist in breaking down lactose; however, no human clinical trials exist evaluating its efficacy in alleviating symptoms related to lactose intolerance.

    Objective: The aim of this randomized, double-blind, placebo-controlled, crossover study was to evaluate the effect of a proprietary strain of Lactobacillus acidophilus on relieving discomfort related to lactose intolerance.

    Methods: The study enrolled healthy volunteers between 18 and 75 years of age who complained of lactose intolerance. Screening visits included a lactose challenge visit to confirm eligibility based on a score of 10 or higher on subjective assessment of the following symptoms after lactose challenge: diarrhea, abdominal cramping, vomiting, audible bowel sounds, flatulence, and overall symptoms. Qualified subjects participated in a 2-arm crossover design, with each arm consisting of 4 weeks of intervention of either active or placebo product, with a 2-week washout period during crossover. The study product consisted of the DDS-1 strain of Lactobacillus acidophilus (Nebraska Cultures, Walnut Creek, California). The placebo was formulated from maltodextrin. Study participants were instructed to take the product once daily for 4 weeks. Data collected included subjective symptom scores related to lactose intolerance.

    Results: Longitudinal comparison between the DDS-1 group and placebo group demonstrated statistically significant reductions in abdominal symptom scores during the 6-h Lactose Challenge at week 4 for diarrhea (p = 0.033), abdominal cramping (p = 0.012), vomiting (p = 0.0002), and overall symptom score (p = 0.037). No adverse events were reported.

    Conclusions: The present study has found that this unique DDS-1 strain of Lactobacillus acidophilus, manufactured by Nebraska Cultures, is safe to consume and improves abdominal symptom scores compared to placebo with respect to diarrhea, cramping, and vomiting during an acute lactose challenge.

    Be well!

    JP

  9. JP Says:

    Updated 06/27/16:

    http://onlinelibrary.wiley.com/doi/10.1111/apt.13647/abstract

    Aliment Pharmacol Ther. 2016 Jul;44(1):35-44.

    Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation.

    BACKGROUND: Fibre supplements are useful, but whether a plum-derived mixed fibre that contains both soluble and insoluble fibre improves constipation is unknown.

    AIM: To investigate the efficacy and tolerability of mixed soluble/insoluble fibre vs. psyllium in a randomized double-blind controlled trial.

    METHODS: Constipated patients (Rome III) received mixed fibre or psyllium, 5 g b.d., for 4 weeks. Daily symptoms and stool habit were assessed using stool diary. Subjects with ≥1 complete spontaneous bowel movement/week above baseline for ≥2/4 weeks were considered responders. Secondary outcome measures included stool consistency, bowel satisfaction, straining, gas, bloating, taste, dissolvability and quality of life (QoL).

    RESULTS: Seventy-two subjects (mixed fibre = 40; psyllium = 32) were enrolled and two from psyllium group withdrew. The mean complete spontaneous bowel movement/week increased with both mixed fibre (P < 0.0001) and psyllium (P = 0.0002) without group difference. There were 30 (75%) responders with mixed fibre and 24 (75%) with psyllium (P = 0.9). Stool consistency increased (P = 0.04), straining (P = 0.006) and bloating scores decreased (P = 0.02) without group differences. Significantly more patients reported improvement in flatulence (53% vs. 25%, P = 0.01) and felt that mixed fibre dissolved better (P = 0.02) compared to psyllium. QoL improved (P = 0.0125) with both treatments without group differences.

    CONCLUSIONS: Mixed fibre and psyllium were equally efficacious in improving constipation and QoL. Mixed fibre was more effective in relieving flatulence, bloating and dissolved better. Mixed fibre is effective and well tolerated.

    Be well!

    JP

  10. JP Says:

    Updated 07/26/16:

    http://apjcn.nhri.org.tw/server/APJCN/25/3/487.pdf

    Asia Pac J Clin Nutr. 2016;25(3):487-96.

    Randomized, double-blind, placebo-controlled trial of Ficus carica paste for the management of functional constipation.

    BACKGROUND AND OBJECTIVES: Constipation affects up to 20% of the world’s population. The aim of this study was to investigate whether supplementation with Ficus carica paste could be used to treat constipation in Korean subjects with functional constipation.

    METHODS AND STUDY DESIGN: We conducted a randomized, double-blind, placebo-controlled trial. Subjects with functional constipation were orally supplemented with either F. carica paste (n=40) or placebo (n=40) for 8 weeks. We measured the efficacy and safety of F. carica paste. Primary outcomes (colon transit time) and secondary outcomes (questionnaire related to defecation) were compared before and after the 8-week intervention period.

    RESULTS: F. carica paste supplementation was associated with a significant reduction in colon transit time and a significant improvement in stool type and abdominal discomfort compared with the placebo. Blood parameters and clinical findings for organ toxicity remained within normal ranges.

    CONCLUSION: These results suggest that F. carica paste may have beneficial effects in subjects suffering from constipation.

    Be well!

    JP

  11. JP Says:

    Updated 08/08/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27492975

    Int J Food Sci Nutr. 2016 Aug 5:1-8.

    Effect of consumption of chicory inulin on bowel function in healthy subjects with constipation: a randomized, double-blind, placebo-controlled trial.

    Constipation is among the most common health impairments in Western countries. This study aimed to determine the effect of the chicory-derived fermentable dietary fiber Orafti® Inulin on stool frequency in healthy subjects with constipation. The study was conducted according to recent guidance documents for investigating bowel function and used a randomized, double-blind, placebo-controlled, cross-over design with a 2-week wash-out phase. Each study period comprised a run-in phase followed by 4 weeks daily intake of 3 × 4g inulin or maltodextrin (placebo). Forty-four healthy volunteers with constipation documented stool frequency and consistency, gastrointestinal characteristics and quality of life. Consumption of Orafti® Inulin significantly increased stool frequency compared to placebo (median 4.0 [IQR 2.5-4.5] versus 3.0 [IQR 2.5-4.0] stools/week, p = 0.038). This was accompanied by a softening of stools and trend toward higher satisfaction versus placebo (p = 0.059). In conclusion, Orafti® Inulin was effective in volunteers with chronic constipation and significantly improved bowel function.

    Be well!

    JP

  12. JP Says:

    Updated 09/28/16:

    http://link.springer.com/article/10.1007%2Fs00383-016-3899-9

    Pediatr Surg Int. 2016 Jul;32(7):683-9.

    The effect of food withdrawal in children with rapid-transit constipation.

    BACKGROUND: Rapid proximal colonic transit with anorectal holdup is a subtype of chronic constipation linked to food intolerance. We aimed to determine the effectiveness of dietary exclusion as a treatment for constipated children with rapid-transit constipation by scintigraphy.

    METHODS: Questionnaires on diet and symptoms were mailed out to 125 children with chronic constipation and rapid proximal colonic transit on nuclear transit study at our institute between 1998 and 2014 years. Patients were given instructions and encouraged to undertake a six-food elimination diet targeting common protein allergens (dairy, wheat, soy, eggs, nuts, seafood). Answers were completed by circling an option or on visual analogue scale. Results were evaluated statistically using GraphPad Prism 6 by a Wilcoxon matched-pairs rank test. P < 0.05 was considered significant.

    RESULTS: We received 44/125 responses, 26 patients [mean age 11 years (5-21)] had attempted elimination diet and 18 had not. Dairy and wheat were the most common foods eliminated and symptomatic improvement was greater for patients who had completely eliminated foods. Constipation, abdominal pain and pain on defecation were reduced (p < 0.01). Laxative usage decreased, although this was not statistically significant. Families encountered problems with dietary exclusion, particularly expense. Assistance from a dietician or nutritionist was sought by >50 % of families.

    CONCLUSION: Dietary exclusion is a promising strategy to treat constipation in children with rapid proximal colonic transit. However, it was hard for many families, demonstrating the need for identifying the cause more specifically and a better set of instructions for the family and/or dietitian to follow.

    Be well!

    JP

  13. JP Says:

    Updated 10/03/16:

    http://www.mdpi.com/2072-6643/8/10/605/htm

    Nutrients. 2016 Sep 28;8(10). pii: E605.

    Efficacy of Synbiotics in Patients with Slow Transit Constipation: A Prospective Randomized Trial.

    Synbiotic intake may efficiently restore the balance of gut microbiota and improve gastrointestinal functions. The aim of the study was to evaluate the efficacy of a synbiotic in patients with slow transit constipation. A total of 100 patients with slow transit constipation were randomized to receive either a synbiotic or placebo twice daily for 12 weeks. The primary efficacy endpoints were the clinical remission and improvement rates at weeks 4 and 12. Stool frequency and consistency, colonic transit time (CTT), evacuation and abdominal symptoms, patient assessment of constipation symptoms, gastrointestinal quality-of-life index scores, satisfaction scores, and adverse events were also monitored. The clinical remission rates reached 37.5% at week 4 and 45.8% at week 12 in the treatment group, compared to 13.3% at week 4 and 16.7% at week 12 in the placebo group (p < 0.01 for both comparisons). Over 12 weeks, 64.6% of the patients who received the synbiotic experienced clinical improvement, compared to 29.2% of the patients in the placebo group (p < 0.01). During the intervention period, patients who were treated with the synbiotic exhibited increased stool frequency, improved stool consistency, decreased CTT, and improved constipation-related symptoms. This randomized, placebo-controlled trial suggested that dietary supplementation with a synbiotic improved evacuation-parameters-associated symptoms and colonic motility in patients with slow transit constipation (STC).

    Be well!

    JP

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