Clinical Question: Are dried plums as effective as psyllium for the treatment of chronic constipation in adults?

Bottom Line: Dried plums -- or prunes, as our grandmothers called them -- are at least as effective as treatment with the bulk laxative psyllium (Metamucil) in patients with chronic constipation. Bowel movement frequency will double with 6 dried plums eaten twice daily, with improvements in stool consistency and constipation symptoms. Prunes are calorie dense; a dozen contain approximately 260 calories, though the glycemic index is low (10). (Level of Evidence: 1b)

Reference: Attaluri A, Donahoe R, Valestin J, Brown J, Rao SS. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther 2011;33(7):822-828.

Study Design: Randomized controlled trial (nonblinded)

Funding Source: Industry

Setting: Outpatient (any)

Synopsis: This study compared the effectiveness of equivalent fiber doses of dried plums and psyllium in 40 patients, almost all women, with chronic constipation. To be enrolled, patients had to have at least 3 months of symptoms, consisting of difficult and infrequent bowel movements, a sensation of incomplete evacuation, or a sensation of anorectal blockage (ROME III criteria). After a 1-week run-in to document baseline symptoms, the patients were randomly assigned to receive 6 plums twice a day or 1 tablespoon of psyllium (6 g fiber) per day for 3 weeks. Following 1 week of no treatment the same patients were assigned to the opposite treatment for another 3 weeks. This crossover design allows each patient to serve as his or her own control and decreases the number of participants needed to find a benefit if one exists. The number of complete spontaneous bowel movements was significantly higher with dried plum treatment, increasing from an average 1.7 per week to 3.5 per week with plums and 2.8 per week with psyllium (P = .001). Stool consistency scores were also significantly improved, though straining and global constipation symptoms did not differ between treatments. All scores reverted to baseline at the 6-week follow-up after the discontinuation of all treatment. A dozen plums adds approximately 260 calories to the daily diet; 1 tablespoon of psyllium adds 50 to 90 calories per day, depending on the product.