Is Kiwifruit Better Than MiraLAX for Chronic Constipation?

Chronic constipation is a widespread issue affecting millions worldwide, causing discomfort, reduced quality of life, and increased healthcare costs. Conventional treatments like laxatives may provide temporary relief by helping to ease the flow of materials through the intestines but many patients with chronic constipation seek more natural, long-term solutions. In this guide, the efficacy of kiwifruit, prunes, and psyllium (MiraLAX) as potential remedies for chronic constipation has gained significant research interest.

Prevalence and impact of chronic constipation

Chronic constipation is a common gastrointestinal disorder that affects up to 16% of adults in the United States. The latest Dietary Guidelines for Americans, 2020–2025, states that over 90% of women and 97% of men do not meet the recommended daily intakes for dietary fibre. This condition can significantly impact an individual’s quality of life, leading to discomfort and embarrassment. The associated healthcare costs are substantial, with studies estimating the economic burden of irritable bowel syndrome with constipation (IBS-C) alone to be in the billions of dollars annually.

Conventional treatments

Conventional treatments to relieve constipation often include over-the-counter laxatives, such as MiraLAX (psyllium), Milk of Magnesia (contains magnesium), senna or prescription medications. While these drugs can provide temporary relief, they are not without their drawbacks. Laxatives may cause undesirable side effects like cramping, bloating, and diarrhoea, and their long-term efficacy is often limited, with studies showing they help fewer than half of patients and offer only a 7-15% improvement over placebo.

Natural alternatives

In recent years, researchers have explored the potential of natural, dietary-based interventions to address chronic constipation. Among the promising alternatives, three have gained significant attention: kiwifruit, prunes, and psyllium (MiraLAX).

Kiwifruit

Kiwifruit, particularly the green Hayward variety and the golden SunGold cultivar have been the subject of several clinical studies investigating their effects on constipation. These nutrient-dense fruits are rich in dietary fibre, enzymes like actinidin, and other compounds that may contribute to improved bowel function.

Prunes

Dried prunes have long been recognised as a natural remedy for constipation. Prunes are high in fibre, sorbitol (a natural laxative), and other beneficial compounds that can help regulate bowel movements.

Psyllium (MiraLAX)

Psyllium, the main ingredient in the over-the-counter laxative MiraLAX, is a soluble fibre derived from the husks of the Plantago ovata plant. Psyllium has been extensively studied for its effectiveness in treating chronic constipation by adding bulk to stool and improving bowel function.

How do kiwi fruit, prunes and MiraLAX compare?

To better understand the relative efficacy of these natural treatments, a recent clinical trial conducted by the Department of Gastroenterology University of Michigan compared the effects of kiwifruit, prunes, and psyllium (MiraLAX) in a group of 79 adults with chronic constipation.

Study design

The study was randomised, and partially blind in design and participants were assigned to one of three treatment groups:

• 2 whole green kiwifruits per day
• 50 grams of prunes (about 6 prunes) twice daily
• 6 grams of psyllium (MiraLAX) twice daily

Participants were instructed to avoid any other high-fibre foods or supplements containing the study interventions during the 4-week treatment period.

What did the study measure?

The main measure was the proportion of participants in each group who reported an increase of 1 or more complete spontaneous bowel movements (CSBMs) per week, compared to the 2-week baseline period.

Results

The results of the study showed that all three treatments were effective in increasing the number of weekly CSBMs:

• 45% of kiwifruit participants reported an increase of 1 or more CSBMs
• 67% of prune participants reported an increase of 1 or more CSBMs
• 64% of psyllium (MiraLAX) participants reported an increase of 1 or more CSBMs

While the prune and psyllium groups had slightly higher response rates, the differences were not statistically significant, indicating that all three treatments were equally effective in improving bowel function.

Other results

The study also measured several other things:

Stool consistency and straining

Both the kiwifruit and prune groups experienced significant improvements in stool consistency, as measured by the Bristol Stool Form Scale. Additionally, participants in the kiwifruit group reported a significant reduction in straining during bowel movements.

Side effects

When it came to tolerability, kiwifruit stood out as the most well-tolerated treatment. Only 11% of kiwifruit participants reported bloating, and none reported gas or abdominal pain. In contrast, the prune and psyllium groups experienced higher rates of side effects, such as bloating, gas, and abdominal pain.

This comparative study offers several important insights for healthcare providers and patients dealing with chronic constipation:

• Efficacy of natural treatments: The study confirms that all three treatments; kiwifruit, prunes, and psyllium (MiraLAX) can be effective in relieving the symptoms of chronic constipation, providing a good alternative to conventional laxatives
• Tolerability and satisfaction: Kiwifruit appears to be the most well-tolerated and preferred option among the three, with lower rates of side effects
• Personalised approach: Given the individual variability in response to the treatments healthcare providers should consider a personalised approach, taking into account patient preferences, tolerance, and specific symptoms when recommending natural treatments for chronic constipation

Limitations and future research

While this study provides valuable insights, it is not without its limitations. The number of participants may have been too small to detect statistically significant differences between the treatments on some of the measures. Additionally, the study was not fully blinded, as participants were aware of the assigned treatment.

Moving forward, larger, fully randomized, and double-blinded trials could help further confirm the comparative efficacy and long-term effects of kiwifruit, prunes, and psyllium (MiraLAX) in the management of chronic constipation. Exploring the combined effects of these natural treatments or investigating their impact on the gut microbiome could also be useful for future research.

Conclusion

Kiwifruit, prunes, and psyllium (MiraLAX) all have a role to play in the treatment of constipation. While the three treatments have shown similar efficacy in improving bowel function, kiwifruit stood out as the most well-tolerated and preferred option among study participants. As healthcare providers seek to personalise treatment plans for their patients, this research provides valuable insights to guide the integration of natural, dietary-based therapies alongside conventional approaches in the management of chronic constipation.

Sources

• Two Gold Kiwifruit Daily for Effective Treatment of Constipation in Adults—A Randomized Clinical Trial – PMC
• Exploratory Comparative Effectiveness Trial of Green Kiwifruit, Psyllium, or Prunes in US Patients With Chronic Constipation – PubMed
• Kiwifruit, Psyllium, or Prunes: Which Works Better for Treating Chronic Constipation? – Natural Medicine Journal
• Does Kiwifruit Help Chronic Constipation?