Daily Dosage: As a dietary supplement, take three capsules in the morning and three capsules in the afternoon with 8 ounces of water. 45-60 days of continuous use is necessary for optimum results.

Ectopial Research:

Psyllium seed husk- A systematic review of all the research on traditional treatments for constipation, conducted by researchers at the University of Iowa, concluded that a good amount of evidence exists supporting the use of psyllium (1).

Another research review found that soluble fiber like psyllium is an effective treatment for constipation in patients with irritable bowel syndrome (2). When compared with lactulose and other laxatives, psyllium is a more effective treatment for simple constipation (more normal, well-formed stools and fewer hard stools) with less adverse effects (3).

Sixty percent of the patients were relieved of constipation after 24 hours, and 80% after 36 hours of psyllium treatment. As well, pysllium shows superior efficacy over docusate sodium (a common laxative) for softening stools, and has a greater overall laxative effect in patients with chronic idiopathic constipation (4).
 

Probiotics:Lactobacillus acidophilus and bacillus- Probiotics are beneficial bacteria (or flora) that reside in the digestive tract and create a healthy gastrointestinal environment.

Patients with constipation who were treated using yogurt containing Lactobacillus and rye bread reported that gastrointestinal symptoms resulting from the increase in fiber consumption were relieved (5). Another study indicated that lactic acid bacteria like Lactobacillus and lactulose is effective in treating constipation in human volunteers through normalizing the intestinal flora (6).
 

Oat bran- A natural product, oat bran consists mainly of soluble fiber, which is beneficial in relieving constipation in patients with irritable bowel syndrome (2).

Elderly patients with constipation can also benefit from oat bran supplementation. An open study showed a marked improvement in bowel frequency, stool consistency and pain on defecation, without side-effects (7). A clinical trial of oat bran for high triglycerides revealed reductions in lipids and increased frequency of bowel movements (8).
 

Slippery elm (inner bark)- This botanical acts as a stool bulking agent, similar to psyllium, helping to relieve constipation (9). Slippery elm contains soluble fiber and mucilage. The bark of this plant also softens the stool and is healing/soothing to the GI tract.
 

Althea officinalis (marshmallow)- Supplementing with Althea helps soften the stool, addressing a common problem in constipation (9). The plant contains mucilage polysaccharides, similar to slippery elm, which are healing/soothing to the GI tract. Furthermore, Althea exerts an antispasmodic effect which can prevent abdominal pain and cramping that can accompany laxative type treatments (10).
 

Buffered ascorbic acid (vitamin C)- Higher doses of the essentially nontoxic vitamin C soften the stool and increase the frequency of bowel movements. Depending on the individual’s toxicity level, bowel tolerance to vitamin C varies (11). Interestingly, children who suffer from chronic childhood constipation have higher levels of oxidative stress and lower levels of antioxidants like vitamins C and E (12). Supplementation with vitamin C may help prevent free radical damage.

Ectopial References: 

1. Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterology 2005 Apr;100(4):936-71.
    
2. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome.
    
3. Dettmar PW, Sykes J. A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin 1998;14(4):227-33.
    
4. McRorie JW et al. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther 1998 May;12(5):491-7.
    
5. Hongisto SM et al. A combination of fibre-rich rye bread and yoghurt containing Lactobacillus GG improves bowel function in women with self-reported constipation. Eur J Clin Nutr 2005 Oct 26; [Epub ahead of print]
    
6. Salminen S, Salminen E. Lactulose, lactic acid bacteria, intestinal microecology and mucosal protection. Scand J Gastroenterol Suppl 1997;222:45-8.
    
7. Valle-Jones JC. An open study of oat bran meal biscuits ('Lejfibre') in the treatment of constipation in the elderly. Curr Med Res Opin 1985;9(10):716-20.
    
8. Noakes M et al. Effect of high-amylose starch and oat bran on metabolic variables and bowel function in subjects with hypertriglyceridemia. Am J Clin Nutr 1996 Dec;64(6):944-51.
    
9. Mills S and Bone K. Principles and Practice of Phytotherapy. Churchill Livingstone, Edinburgh, UK 2000:179-180.
    
10. Lawrence Review of Natural Products, Althea officinalis, December 1991.
     
11. Wang JY et al. May chronic childhood constipation cause oxidative stress and potential free radical damage to children? Biomed Environ Sci 2004 Sep;17(3):266-72.
     
12. Cathcart RF 3^rd. Vitamin C: the nontoxic, nonrate-limited, antioxidant free radical scavenger. Med Hypotheses 1985 Sep;18(1):61-77.