Tidbits #23: Kiwi fruit for Chronic Constipation
Welcome to Friday Tidbits. This is a short email with morsels of information to help you tweak your life and health for optimum longevity and healthy ageing. This newsletter is free every 2 weeks.
Kiwi fruit for Chronic Constipation
Few people talk about not being able to poop regularly. The quality of life of over 10% of people is impacted by constipation1. In my clinic it is the second biggest problem that people deal with on a daily basis. Not being able to sleep through the night is the number one problem.
Constipation makes you miserable. You feel “too full”, bloated, crampy and heavy. You never feel really “empty”. One of the most common causes is not drinking enough water and antibiotics. Other causes include stress, travelling, not enough dietary fibre, too much dietary fibre, lack of exercise, delaying going to the toilet, pregnancy, ageing, illness and medications like painkillers.
Kiwifruit has been shown in quite a few studies to improve bowl movement frequency and relieve constipation. 2 3456
I will just mention the latest clinical trial here. In 2023 a randomised crossover controlled trial of 60 patients with functional constipation and 61 suffering from constipation-predominant irritable bowel syndrome (IBS-C) were assigned either 2 green kiwifruits or 7.5g psyllium husk per day for 4 weeks7. This was followed by 4 weeks of no treatment and then another 4 weeks where the treatment was swapped over for each patient. The results were compared to 60 healthy controls receiving psyllium as the standard first-line treatment for constipation both in individuals with IBS-C and functional constipation.
The primary outcome measured was the number of complete spontaneous bowel movements per week.
Compared with psyllium, kiwifruit consumption was associated with a greater improvement in constipation symptoms in the functional constipation group.
Results showed that compared to psyllium, two kiwifruits daily increased the number of complete spontaneous bowel movements in both the functional constipation and the IBS-C groups.
Psyllium treatment was not clinically effective in treating constipation in the functional constipation group but helped the IBS-C group.
The secondary outcome measures of abdominal pain, indigestion, straining and stool consistency also demonstrated improvements with daily kiwifruit intake.
Further more the daily kiwi fruit intake clinically and significantly improved constipation and overall GI symptoms in both treatment groups. While improvements in overall GI symptoms with psyllium treatment were only observed in the IBS-C group and not the functional constipation group.
Participants reported significantly less adverse events on kiwifruit than on psyllium, such as bloating.
Why does kiwifruits work?
The soluble fibre in kiwi fruit absorbs and hold water (think swelling) in the large bowel, which help to soften stool that can move more easily through the colon. A compound called raphides are needle-shaped calcium oxalate crystals that can cause microscopic scratch the inside of the mouth. Combined with the natural acid of kiwis can cause a stinging sensation. It is thought that raphides change the mucin production in the bowel, leading to improved laxation. Mucin is a sugary mucus produced by goblet cells that help with protection and lubrication of the gut lining.
Gold kiwifruit has higher vitamin C content and eight times the proteolytic activity of the enzyme Actinidin compared to green kiwis89. In an older unpublished study by L.N. Drummond, the kiwifruits used did not have any actinidin and was ineffective as treatment for GI discomfort.
Caution
Some people may have an allergic reaction to kiwifruit. Kiwifruits are part of the latex family and people that are allergic to latex can show cross-reactivity to plant-derived food allergens10. This is called latex-fruit syndrome. The plant compound class I chitinases are responsible for the cross-reactivity with latex. Fruits most frequently involved are kiwi, banana, avocado and chestnut.
Putting it into practice
Start with one kiwi fruit per day.
Yellow kiwis might be better.
Without the skin is fine.
More ripe is better.
I like to have it after dinner.
If you experience no negative side-effects, double to two kiwis per day.
Continue for 3 weeks.
Last words
Please see your medical practitioner if you suffer from chronic constipation. Constipation can be symptom of serious medical conditions that need to be ruled out.
Let me know if you have tried kiwifruits and what your experience was.
Choking
Forgive me this tangent. My small community of early morning swimmers had sad news this morning. In a tragic accident, Harry (not his real name) choked while having dinner last night. He is currently in hospital.
According to Australian statistics 1200 people died as a result of choking during 2020-2021. This represents 9% of injury deaths (4.6 per 100 000). In the USA 5,554 people died due to choking in 2022.
There is a sharp difference in age brackets, children under 4 years represent the highest proportion for hospitalisation followed by people over 65y.
It is heartening to know that very few children die from choking - 0.3 per 100,000 population.
Choking and suffocation was the second leading cause of death (falls being number one) for persons aged 85 and over - 98 per 100,000.
What to do in the case of choking incident
For many years the Heimlich manoeuvre was taught to help someone that is choking. This is no longer recommended in Australia and many other parts of the world.
Current first aid guidelines steps according to St John’s Ambulance and the Australian Red Cross for over people over 1 year:
Ask the person to relax and cough.
Call emergency (000 in Australia).
Lean the person forward then give 5 sharp blows to the back between the shoulder blades with the heal of one hand.
Give 5 chest thrusts by placing one hand in the middle of the person’s back for support and the heel of the other on the lower half of the sternum.
Alternate 5 back blows with 5 chest thrusts until help arrives.
Print out this pdf for reference.
The American Red Cross and British Red Cross recommendations are similar.
Recent Podcast
I like to listen to the Lex Fridman podcast on occasion. He asks unusual questions of his guests and is genuinely interested in the humanity behind the person. He can go down the philosophical rabbit hole sometimes, so if that is not your thing, choose the episodes carefully.
I was piqued to listen to the Kevin Spacey podcast #432 or on Youtube to learn more about the controversy that surrounds him. Kevin Spacey rose to infamy seven years ago when he was accused of a sexual abuse incident that happened in 1986. Spacey was acquitted and found not guilty in all the criminal and civil trials that followed.
Spacey’s movie career started in 1986 with the Meryl Streep in Heart Burn. Other memorable movies include LA Confidential, Swimming with Sharks, The Usual Suspects, Seven of course American Beauty. There are many more. The TV show House of Cards is a favourite in many households.
In the conversation with Lex, they talk about his early career, mentorship from Jack Lemmon and his career on stage and film. The sexual allegations are covered briefly and Spacey reflects on many aspects of his conduct in the past.
What stood out to me was the story of his childhood in the last 20 minutes. He grew up not knowing if his parents loved him. His father’s white supremacists views took a toll on his emotional health. I applaud Kevin Spacey for being vulnerable enough to share this pain.
This might get me cancelled. So be it. I have no opinion about Kevin Spacey’s guilt or not guilt.
In my opinion, this podcast is worth the listen.
Have a great weekend
Estelle
References:
Wong MYW, Hebbard G, Gibson PR, et al.. Chronic constipation and abdominal pain: Independent or closely interrelated symptoms? J Gastroenterol Hepatol 2020;35(8):1294–301.
Chang C.C., Lin Y.T., Lu Y.T., Liu Y.S., Liu J.F. Kiwifruit improves bowel function in patients with irritable bowel syndrome with constipation. Asia Pac. J. Clin. Nutr. 2010;19:451–457.
Chan A.O., Leung G., Tong T., Wong N.Y. Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients. World J. Gastroenterol. 2007;13:4771–4775. doi: 10.3748/wjg.v13.i35.4771.
EFSA Panel on Nutrition Novel Foods Food Allergens. Turck D., Castenmiller J., De Henauw S., Hirsch-Ernst K.I., Kearney J., Knutsen H.K., Maciuk A., Mangelsdorf I., McArdle H.J., et al. Green kiwifruit (lat. Actinidia deliciosa var. Hayward) and maintenance of normal defecation: Evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006. EFSA J. 2021;19:e06641. doi: 10.2903/j.efsa.2021.6641.
Bayer S.B., Gearry R.B., Drummond L.N. Putative mechanisms of kiwifruit on maintenance of normal gastrointestinal function. Crit. Rev. Food Sci. Nutr. 2018;58:2432–2452. doi: 10.1080/10408398.2017.1327841.
Bayer S.B., Frampton C.M., Gearry R.B., Barbara G. Habitual Green Kiwifruit Consumption Is Associated with a Reduction in Upper Gastrointestinal Symptoms: A Systematic Scoping Review. Adv. Nutr. 2022;13:846–856. doi: 10.1093/advances/nmac025.
Gearry R, Fukudo S, Barbara G, et al. Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort-Results of an International Multicenter Randomized Controlled Trial. Am J Gastroenterol. 2023;118(6):1058-1068. doi:10.14309/ajg.0000000000002124
Bayer SB, Heenan P, Frampton C, et al. Two Gold Kiwifruit Daily for Effective Treatment of Constipation in Adults-A Randomized Clinical Trial. Nutrients. 2022;14(19):4146. Published 2022 Oct 6. doi:10.3390/nu14194146
Boland M. Kiwifruit proteins and enzymes: actinidin and other significant proteins. Adv Food Nutr Res. 2013;68:59-80. doi: 10.1016/B978-0-12-394294-4.00004-3. PMID: 23394982.
Blanco C. Latex-fruit syndrome. Curr Allergy Asthma Rep. 2003 Jan;3(1):47-53. doi: 10.1007/s11882-003-0012-y. PMID: 12542994.
Many women take calcium and calcium can contribute to constipation… eating kiwi fruit sounds like a wonderful way to counteract that 😁