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Special Thanks to my team and Nicholas Norwitz – Oxford Ketone PhD Researcher and Harvard Med Student – for working diligently on research as well!

Study – World Journal of Gastroenterology

63 cases of idiopathic constipation were enrolled into the study

Patients were asked to go on a no fiber diet for 2 weeks

Thereafter, they were asked to reduce the amount of dietary fiber intake to a level that they found acceptable

Dietary fiber intake, symptoms of constipation, difficulty in evacuation of stools, anal bleeding, abdominal bloating or abdominal pain were recorded at 1 and 6 months

The median age of the patients (16 male, 47 female) was 47 years

At 6 months, 41 patients remained on a no fiber diet, 16 on a reduced fiber diet, and 6 resumed their high fiber diet for religious or personal reasons

Patients who stopped or reduced dietary fiber had significant improvement in their symptoms while those who continued on a high fiber diet had no change

Of those who stopped fiber completely, the bowel frequency increased from one motion in 3.75 days to one motion in 1.0 day

Those with reduced fiber intake had increased bowel frequency from a mean of one motion per 4.19 days to one motion per 1.9 days on a reduced fiber diet

Why This Is

The researchers speculated that there may be a disconnect between what the layman classifies as constipation and how it should be treated, and what constipation actually is

Most people define constipation as failing to pass stool – and what we’re told is that if we make more poop (by adding more fiber to the diet and bulking things up), it will be easier to “go”

However, here, the researchers speculate that the role of fiber in constipation is like merging cars in heavy traffic

If there’s a jam, adding more cars doesn’t clear up the congestion – so adding more fiber and increasing the volume and bulk of poop wouldn’t necessarily make it easier to go

Traffic Analogy:

The only way to alleviate slow traffic would be to decrease the number of cars and to evacuate the remaining cars quickly – adding more cars would only worsen congestion

In patients with idiopathic constipation and a colon packed with feces, reduction in dietary fiber would reduce fecal bulk and volume and make evacuation of the smaller and thinner feces easier

Adding dietary fiber would only add to the bulk and volume and thus make evacuation even more difficult.

Additional

It’s often stated (even in physiology textbooks) that bulking agents improve peristalsis*, there is no proof of this in practice nor experimentally

Regardless of the food ingested, small intestinal and right mid colonic contents are fluid and all indigestible dietary fiber is suspended therein

Dietary fiber, therefore, cannot act as solid boluses for the initiation of peristalsis – in fact, dietary fiber has been shown to inhibit peristalsis and hold up gaseous expulsion in human experiments

Dietary fiber is also associated with increased bloatedness and abdominal discomfort – insoluble fiber has been reported to worsen the clinical outcome of abdominal pain and constipation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435786/

Manipulating Bacteria

More than 1000 types of bacteria in our gut but over 90% come from either bacteroides or firmicutes

You can get changes in the gut within a single day and bacteroides are associated with weight loss AND are associated with keto diets

We can’t change our gut bacteria, but we can change our diet, which permits weight loss, which is associated with a change in gut bacteria

https://www.nature.com/articles/nature12820
https://www.ncbi.nlm.nih.gov/pubmed/29102613
https://www.nature.com/articles/nature25178

Nicholas Norwitz – Oxford Ketone PhD Researcher and Harvard Med Student: https://www.dpag.ox.ac.uk/team/nicholas-norwitz