Doctors used 24-hour dietary recalls on 12,716 US adults, of whom 1290 suffered from constipation and 1067 had diarrhea. Those who ate the most ultra-processed foods had more than double the incidence of constipation as those who ate the least, and minimally-processed foods were associated with a markedly reduced incidence of constipation. Substituting 10 percent of ultra-processed foods with minimally processed foods was associated with 10 percent reduced risk for constipation (Clin Gastroenterol Hepatol, May 15, 2024:S1542-3565(24)00448-8). The data was corrected for diet quality and water and fiber intake.

Definitions of Food Processing
Unprocessed foods are usually made from one ingredient (plant or animal) and have undergone either no or almost no changes. Minimally-processed foods are usually a single ingredient but have undergone some processing, such as grinding (flour) or mashing (peanut butter), and may have some added ingredients to improve flavor, texture and shelf life: bread, cheese, pasta and so forth.

Ultra-processed foods are made by removing nutrients such as fiber, vitamins, minerals or antioxidants and adding dyes, preservatives, antioxidants, anticaking agents, flavor enhancers, sugars, fats, salt and other artificial ingredients that are usually designed to make you eat more: sugary drinks, candy, cookies, most breakfast cereals, most fast foods, snack foods and most other foods that come in packages. Food manufacturers know that adding salt and sugar to a food usually makes it taste better so you are more likely to buy their products. More than 75 percent of the North American diet consists of ultra-processed foods.

Chronic Constipation
Constipation is incredibly common in North America, with almost 20 percent of the population suffering from this disorder (Handb Exp Pharmacol, 2017, 239, 59–74). Constipation is generally defined as having fewer than three bowel movements a week, possibly with "a sensation of incomplete evacuation, abdominal bloating, straining, elongated or failed attempts to defecate, hard stools, and necessity of digital disimpaction" (J Clin Med, 2021;10(8):1738).

Lifestyle Changes to Treat Constipation
Our epidemic of constipation is due largely to the food industry that produces mostly ultra-processed foods that contain little or no fiber. People keep looking for constipation cures in a pill, but it is usually curable just with lifestyle changes:
• Diet: increase your intake of fiber, found in whole fruits, vegetables, whole grains, beans, nuts and other seeds. Try to avoid or limit refined carbohydrates (foods made from flour and added sugars) and other ultra-processed foods that contain little or no fiber.
• Exercise: Try to exercise every day. When you exercise while you have stool in your colon, you will usually develop giant contractions that push stool along your colon.
• Hydration: Drink plenty of fluid. Dehydration increases the rate that fluid is absorbed from your colon to make your stool harder. However, treating constipation with increased fluid intake is effective only in dehydrated patients.
• Staying regular: Get in the habit of trying to empty your colon at the same time of day every day.

My Recommendations
Eat lots of fiber: fruits, vegetables, whole unground grains, beans, seeds and nuts. I recommend prunes and apples. Try to exercise regularly and keep moving throughout the day.

Diana's Solution: Warm up a cup of your favorite bean or lentil soup (canned Goya brand Black Bean Soup is an easy choice). Stir in a few tablespoons of pecans (about 1/4 cup) that have been chopped up in a nut grinder. Diana says "Eating this every day has completely solved my chronic constipation problem."

Constipation can be caused by serious disease, so if you cannot control constipation with lifestyle changes, check with your doctor for a medical evaluation to try to find a cause and treatment.