Seniors & Constipation
A Problem Nobody Wants To Talk About

Constipation, it's a pesky, uncomfortable problem that no one likes to talk about. It affects many people, especially older adults, and I feel it deserves some discussion.

Constipation may be caused by a number of factors, including inadequate fluid intake, low fiber consumption, sedentary lifestyle, inadequate food intake, and even psychological distress or medication. These factors, combined with the reduction in intestinal motility that naturally comes with age, have many people reaching for the Correctol. There is a better way, though. In many cases, constipation can be relieved by simple dietary modifications.

Here are some suggestions for alleviating constipation through dietary and lifestyle changes alone.

First, be sure to drink enough fluid. Most of us need 8-10 eight ounce glasses of water daily. Water is absorbed by the stool in the large intestine, making the feces larger, heavier, and softer, and therefore easier to pass. Inadequate fluid intake may make stools small and hard, leading to constipation. Fluid intake may be increased by drinking water, juices, broth, or other non caffeinated beverages. Caffeinated drinks, though they contain water, actually dehydrate the body and are therefore not good sources of fluid. If you drink caffeinated beverages, it is suggested that you consume 8 ounces of water for each caffeinated drink, in addition to your normal 8-10 glasses of water. It is especially critical to drink enough fluid when increasing your fiber intake, which is discussed next.

Fiber consumption is essential to regular bowel movements. Insoluble fiber has a greater impact on bowel movements than does soluble fiber, and works by drawing more water into the stool to make it larger, softer, and heavier. Fiber, both insoluble and soluble, comes from the components of plant foods that are not digested by the body. A fiber intake of 25-35 grams is suggested for most people.

The fiber content of packaged foods is listed on the label under "Carbohydrates". Good sources of insoluble fiber include vegetables, fruits (both fresh and dried), whole grains, whole grain products, and legumes (beans, peas, and lentils). Therefore, the easiest way to consume enough fiber is to eat 5-9 servings of fruits & vegetables and 6-11 servings of whole grain products per day, as recommended by the USDA's Food Guide Pyramid. Some foods, such as prunes, figs, and raisins, contain natural laxatives as well as fiber, and some people find it helpful to include these foods in their diets daily. (Try this tasty prune recipe from our recipe board.) If you take liquid nutritional supplements such as Ensure or Boost, you can increase your fiber intake simply by choosing the fiber enriched forms of these products.

One caveat to keep in mind when increasing fiber-be sure that your diet includes enough calcium and calories. The DRI (Dietary Reference Intake) for calcium for all adults ages 51 and up is 1200mg per day. Calcium becomes important in a high fiber diet because fiber can bind some of the calcium consumed and cause it to be excreted. Besides, studies have shown that many Americans do not consume enough calcium to begin with. So, drink your milk/fortified soy milk!
Maintaining adequate caloric intake is important because high fiber diets tend to be filling, so you may eat less overall, and because fiber slightly decreases the amount of calories absorbed by the body. Average calorie needs for women are 1900 calories per day, and for men, 2300 calories per day. These numbers will vary based on age, activity level, height, and many other factors. As a general rule, consuming fewer than 1500 calories per day is inadequate. Check with your doctor or dietitian for a personalized calorie prescription.

Another factor that affects bowel regularity is physical activity. Exercise may relieve constipation by stimulating intestinal movement. Consult your doctor before starting an exercise program to ensure that you pick a safe, effective regimen.

Also, simply not eating enough can cause constipation because the volume of material that reaches the large intestine is too small to be passed along effectively. Strive to eat an adequate amount of healthful, high fiber foods each day.

Finally, if you think psychological distress (such as depression) or medication is causing your constipation, you may want to consult your doctor. A regimen of stool softeners or laxatives may be prescribed, or the offending medication may be changed. Psychological problems are best addressed by a professional counselor.

I hope this has helped to shed some light on the uncomfortable problem of constipation. Of course, if all else fails, a laxative may be needed occasionally; however, I am a strong proponent of trying more gentle, diet based remedies before turning to medication. As always, I wish all of you good luck and good health.

Erica Joy, Nutritionist


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SAM-e: From Europe, with Love

An antidepressant that also eases arthritis and detoxifies the body? That's what some researchers are saying about SAM-e, a substance which recently gained public attention in the United States because of its use abroad and many positive studies.

SAM-e is perhaps best known for its use as an antidepressant. Studies have shown that it may work as well as the traditional tricyclic class of antidepressants, but it also works faster and possibly with fewer side effects.

Italian researchers have shown that SAM-e may be as effective for treating osteoarthritis as the popular anti-inflammatory drugs ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve). And because it's a naturally occurring molecule found in virtually all body tissues and fluids, it tends to cause fewer side effects than synthesized drugs. It may also inhibit leukotrienes, a substance that regulates inflammation.

SAM-e also has been shown to improve the condition of people with liver-function problems such as stoppage of bile flow (also known as cholestasis). Bile helps the liver break down poisonous chemicals. SAM-e is believed to promote liver-cell secretion, which in turn increases bile production. It may also prevent or reverse liver damage due to alcohol, acetaminophen, steroid drugs, and lead. And in August 1998, SAM-e was designated by the U.S. Food and Drug Administration (FDA) as an "orphan drug" for the treatment of AIDS-related myelopathy (a disease of the spinal cord).

Produced primarily by the liver, SAM-e plays an important role in the building of brain chemicals such as serotonin, dopamine, and norepinephrine. Low levels of these neurotransmitters are linked to depression. SAM-e also is a building block for cysteine, glutathione, and taurine -- potent natural antioxidants produced within the body. It also promotes the creation of compounds essential for proper cell growth. From these varied functions come SAM-e's many different uses.

Potential uses of SAM-e include the treatment of Alzheimer's disease, migraine headaches, sleep irregularities, alcoholism, fibromyalgia, Parkinson's disease, peripheral neuropathy, and insulin-dependent diabetes mellitus.