Thu, Dec 26, 2024
[Archive]
Volume 9, Issue 1 (Feb 2024)
JNFS 2024, 9(1): 144-151 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Shirdeli M, Yaghoubi F, Sadeghi-Nodoushan F, Marzban A. A Review of the Effect of Synbiotic Foods on Reducing and Treating Constipation in Fasted People during the Month of Ramadan. JNFS 2024; 9 (1) :144-151
URL: http://jnfs.ssu.ac.ir/article-1-643-en.html
URL: http://jnfs.ssu.ac.ir/article-1-643-en.html
Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Full-Text [PDF 577 kb]
(273 Downloads)
| Abstract (HTML) (1180 Views)
Introduction
Full-Text: (149 Views)
A Review of the Effect of Synbiotic Foods on Reducing and Treating Constipation in Fasted People during the Month of Ramadan
Mehrnoosh Shirdeli; MSc1,2, Fatemeh Yaghoubi; PhD3, Fateme Sadeghi-Nodoushan; MSc4 &
Ameneh Marzban; PhD*5
Ameneh Marzban; PhD*5
1 Department of Food Science and Technology, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan ,Iran.; 2 Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan ,Iran; 3 Department of Clinical Biochemistry, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 4 Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 5 Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
.
| ARTICLE INFO | ABSTRACT | |
| REVIEW ARTICLE | Background: Fasting during Ramadan is an obligatory duty for all Muslims in the world. One of the most common side effects of fasting is constipation if fasted people do not follow a proper diet. Therefore, the purpose of this study is to review the effect of synbiotic foods on reducing and treating constipation in fasted people during Ramadan. Methods: Search engines including PubMed, Scopus, Embase, Science Direct, Google scholar, Magiran, and scientific information database (SID) were applied with keywords such as Fasting, Synbiotics, Constipation, Ramadan, Digestive System, Probiotics and Prebiotics to find related articles published up to 2022. Finally, 45 articles were included in the review. Results: Synbiotics are actually oral supplements and a mixture of probiotics and prebiotics. The use of these compounds, in addition to reducing the complication of constipation, has other benefits that can be a step towards reducing the use of drugs and changing lifestyle not only this month but also at other times. Conclusion: The use of fiber-containing compounds, beneficial for the activity of the gastrointestinal tract, both microbial and to improve its peristalsis, is especially necessary in the elderly, whose peristalsis has decreased due to aging. The placement of synbiotic foods such as synbiotic dairy products will help to control this complication due to the presence of prebiotics and beneficial probiotics. Keywords: Fasting; Sinbiotics; Constipation; Ramadan. |
|
| Article history: Received: 27 May 2022 Revised:9 Nov 2022 Accepted: 9 Nov 2022 |
||
| *Corresponding author: amenemarzban@yahoo.com Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Postal code: 1449614535 Tel: +98 9172458896 |
Introduction
One of the main actions of humans is swallowing and excreting. Food enters the large intestine from the small intestine, and excretion is done by the large intestine. The stool enters the rectum from the colon. There are two important muscles at the end of the rectum that stool must pass through to leave the body. These two muscles are the internal sphincter muscle and the external sphincter muscle. The internal sphincter muscle is involuntary. This muscle opens automatically and allows feces to pass through it (Arco et al., 2022). When the feces enter the highest part of the anal canal, it is sensed by sensitive nerve cells. In this case, people who have a normal sensory system need to empty quickly. The external sphincter muscle is a voluntary muscle that you can control. In fact, this muscle keeps the stool in the rectum, so that the conditions for evacuation are achieved. Retention of stool repeatedly and many times causes nerve cells to become insensitive and constipation. Also, staying stool for a long time in the rectum and colon causes its water to be absorbed and the stool becomes hard. This is the reason for evacuation as soon as you feel a bowel movement (Scott et al., 2021).
Constipation is a symptom that can mean different things to different people, but it usually means that a person is having trouble opening his bowels. It affects one in seven people, and the two groups of people most likely to become constipated are young women and the elderly, especially those who need to take regular medications (Ribeiro et al., 2018). Constipation is a chronic disease that affects about 16% of the world's population. Research has shown that this complication is 2.3 times more common and symptomatic in women than men (Mugie et al., 2011, Scott et al., 2021). The disease seems to be related to age, diet, and lifestyle, and many health resources around the world are used to diagnose and treat it. However, common treatments in one-third of patients are unsatisfactory (Rantis et al., 1997).
It should be noted that constipation is one of the factors that has a significant impact on the quality of life and health-related quality of life in these patients is less than normal people in society (Arco et al., 2022, Chang, 2004). Due to its high prevalence, many resources are allocated to this disease. Among outpatient visits, constipation is one of the five most commonly diagnosed gastrointestinal problems diagnosed by physicians (Bharucha et al., 2013) and imposes a high economic burden on the patient and the community, which is due to the chronicity of this disease (Mohaghegh Shalmani et al., 2011).
Fasting during Ramadan is an obligatory duty for all adult Muslims in the world. One of the features of Ramadan compared to other months of the year is the restriction of food and beverage consumption. However, if a person's diet is changed in such a way that many essential nutrients are removed from the diet, several changes can be observed as a result (Ribeiro et al., 2018).
Healthy eating is especially important in fasting. One of the most common complications at this time is constipation. This complication is more common in adults during fasting due to the reduction of peristalsis. It is recommended that these people change their diet and take dietary supplements instead of using laxatives (Tamadoni et al., 2020).
In fact, starvation and low water intake lead to constipation. Reducing calorie intake and reducing physical activity also increase the risk of constipation. This problem is often seen due to changes in the pattern of meals and sleep during Ramadan, as well as irregularity and reduced peristalsis. People with constipation during Ramadan can largely cure this problem by having a proper nutritional pattern. The aim of this study is to review the effect of synbiotic foods on reducing and treating constipation in fasting people during Ramadan.
Materials and Methods
This review was extracted by searching the creditable databases, including PubMed, Scopus, Embase, Science Direct, Google scholar, Magiran, and scientific information database (SID) using keywords such as Fasting, Synbiotics, Constipation, Ramadan, Digestive System, Probiotics and Prebiotics from the published literature (English and Persian language). In this regard, a variety of studies including prospective cohort, retrospective, case-control, clinical guidelines, cross-sectional, and review articles were searched up to 2022.
The inclusion criteria consisted of articles that reported any possible correlation between symbiotic food and reducing and treating constipation. Search strategy yielded 242 publications; first, the abstracts were investigated and unrelated articles were excluded which resulted in 41 articles. Subsequently, the references of the publications yielded by the search were reviewed to identify additional relevant articles (4 articles), and a total of 45 articles were included in the review.
Results
Human digestive system
Perhaps until a decade ago, the general perception was that the gastrointestinal tract was the only place to absorb and digest food. However, research in recent years has revealed the fact that this unique system has many functions that are essential for human survival and health. Researchers have so far identified more than 500 species of beneficial and active microflora in the gastrointestinal tract (Harish K and Varghese T, 2006, Homayouni A et al., 2018).
In addition to affecting intestinal tissue health, the intestinal flora plays other important roles, including modulating the immune system, drug metabolism, normal peristalsis, breaking down toxins and dietary carcinogens, making vitamins, and fermenting some non-food items. It is digestible, absorbs little electrolytes, grows and differentiates intestinal epithelial cells, prevents the implantation of pathogenic bacteria such as Escherichia coli and Clostridia in the intestine, and acts as an allergen for the host (Barrea L et al., 2020, Capo et al., 2019, Song MW et al., 2021).
In general, intestinal bacteria are divided into beneficial, harmful, and neutral types for human health. Beneficial bacteria such as probiotics are inhibited by their growth and activity and prevent the multiplication of harmful bacteria. In addition, by synthesizing some essential substances for the body, such as vitamins and amino acids, they play an important role in maintaining good health. The use of probiotics as a supplement also has beneficial effects on the gastrointestinal health of patients. These microorganisms can help treat constipation by increasing peristalsis or reducing the passage of food through the gastrointestinal tract (Bonyadi et al., 2014, Sharma et al., 2014).
In general, the human intestinal microflora can be altered in three ways through the use of antibiotics, and the use of probiotics. For this reason, the use of foods or dietary supplements that increase the population of beneficial intestinal microflora will be very effective on a person's health (Ashaolu, 2020). It should be noted that in order to be healthy, the necessary balance between different types of gastrointestinal flora is essential and a change in diet can be one of the reasons for changing the gastrointestinal flora (Harish K and Varghese T, 2006, Homayouni A et al., 2018).
Constipation
Constipation is one of the most common digestive problems in the world that occurs in all people, but is more common in the elderly (Eor et al., 2019). Research has shown that the microbial flora in the gut changes during constipation. In the 7th century, a Japanese physician theorized that a proper microbial balance in the gut could prevent disease, and an imbalance of gut microbial flora could lead to a variety of diseases, including diarrhea, intestinal infection and radiotherapy, inflammation of the intestines and stomach, constipation, irritable bowel syndrome, Crohn's disease, inflammation of the colon, food allergies, and some cancers (Jaroszewska et al., 2019).
The most common complaint of patients is constipation. According to available articles, constipation is the most common gastrointestinal problem in the United States, between 4% and 28%, and in Iran it is 1.4% to 37%, which is more of a symptom than a disease. This problem is more common in women and adults aged over 65 years (Ramos CI et al., 2022). Clinical signs of constipation according to the Rome criteria protocol include defecation less than 3 times a week, straining during defecation, hard stools (in 25%), and feeling of lack of evacuation or insufficient evacuation. Many factors can affect the change of gastrointestinal flora and reduce peristalsis and, consequently, constipation, the most important of which are diseases and drug use, aging, dietary changes such as not consuming enough fluids and vegetables. For the treatment of constipation in most cases, the use of plenty of fluids and fiber, the use of laxatives, and toilet training are also recommended. Although these methods are useful in people without previous history, they do not guarantee the success of treatment (Botelho et al., 2020).
Nutritional and non-pharmacological treatment for constipation includes the consumption of sufficient amounts of dietary fiber and fluids (da Silveira et al., 2017). It should be noted that recent research has indicated the fact that fluid intake only increases the volume of urine and does not have a significant effect on increased peristalsis and fecal consistency. Moreover, although fiber intake is effective on intestinal microflora and fecal dilation, it does not provide significant results alone (Duron et al., 2020). The administration of fiber supplements to the diet does not bring stool volume to normal, which has been confirmed in a study in 2% of patients with the administration of 5 g of fiber daily. However, fiber supplementation reduces the time of oral anal transit and increases the number of peristalsis by 2 to 3 times a week; however, in reported cases of severe constipation by patients, it did not cause a significant reduction. Fiber supplements are not very desirable due to side effects such as bloating, bad taste, and abdominal distension, especially in the first few weeks of use (Linsenmeyer et al., 2022).
Conversely, in some patients, reducing fiber intake can be beneficial, for example, in the elderly or the elderly, sebum is not only ineffective, but also causes fecal incontinence in the second group (Ohkusa et al., 2019). In a study of clinical trials performed on patients with constipation, bifidobacterium lactis, Lactobacillus casei, and Escherichia coli were found to have an effect on evacuation frequency and degree of fecal consistency in adults (Ohkusa et al., 2019). In some studies, the positive role of some probiotic bacteria such as Lactobacillus has been proven in increasing peristalsis (Ohkusa et al., 2019). In a study in Germany, the effects of probiotics on the treatment of constipation were studied, which had positive effects and results (Sanctuary et al., 2019). In fact, probiotics can reduce the passage of food by stimulating peristalsis and help reduce and treat constipation. Therefore, in order to achieve the best option to reduce and treat constipation with the diet, researchers suggest the use of other treatment options, including live therapists, which is called probiotic therapy (Jafari et al., 2021).
Probiotic bacteria and probiotic therapy
The word probiotic, meaning "for life," was first coined in the early twentieth century by Elie metchnikoff. According to the WHO/FAO definition, probiotics are living microorganisms that, if consumed enough, can have positive effects on the host. Probiotics generally contain some beneficial bacteria and fungi (Górska et al., 2019).
Probiotic microorganisms are usually available as dry extracts in either dried or frozen forms that can be added to industrial and household food products (Huang and Hu, 2017). These microorganisms are consumed either as food supplements or as fermented or non-fermented food products (Tripathi and Giri, 2014).
A wide range of microorganisms are considered probiotics, but most of them fall into two categories including lactobacilli and bifidobacteria, both of which are naturally part of the beneficial flora of the gastrointestinal tract. In fact, it is called a probiotic product when it contains at least 107 live bacteria (Puebla-Barragan and Reid, 2019).
These microorganisms reduce some of diseases such as constipation by reducing the absorption of cholesterol in the intestine (Bubnov et al., 2017), competing with pathogenic bacteria for nutrients and their binding sites, lowering the pH of the intestinal environment, etc. (Eslami et al., 2019). The function of these organisms, in addition to beneficial effects on peristalsis, includes balancing blood pressure, preventing allergies, reducing diarrhea, and regulating and improving the function of the immune system (Zawistowska-Rojek and Tyski, 2018).
Their mechanism of action is such that by producing lactic acid and short-chain fatty acids, they reduce the pH of the colon, and as a result of this action, they increase the peristalsis in the stomach. Also, some probiotic species have the ability to convert bile salts to free bile, and thus increase the volume of water in the colon and are an effective factor in softening the stool and play an important role in improving excretion (Tang and Zhao, 2019).
Criteria for selecting probiotics include the ability to survive during processing and storage of the product, the ability to survive inside the intestinal tract, and a positive impact on the health of the host. Extensive therapeutic applications have been reported for probiotics, including prevention of urogenital diseases, osteoporosis and food allergies, reduction of constipation and control of inflammatory bowel disease, and protection against colon and bladder cancer (Chugh and Kamal-Eldin, 2020, Zawistowska-Rojek and Tyski, 2018). Probiotic therapy is a new science that has attracted the attention of many nutrition and medical researchers and has so far shown its effects on the treatment of inflammatory bowel disease and bacterial diarrhea as well as irritable bowel syndrome. However, limited studies have been conducted on this disease despite its prevalence (Afshar et al., 2020).
Prebiotic food
Prebiotics contain substances that improve the activity and composition of microflora living in the intestinal environment and thus are effective in promoting the health of the host (Kehinde et al., 2020). In fact, prebiotics are indigestible or poorly digestible oligosaccharides that selectively stimulate the growth or activity of probiotics once they reach the intestinal environment as a source of carbon or energy (Yan et al., 2018). These compounds are mainly from carbohydrates such as dietary fiber, lactose, lactulose, oligosaccharides, starch and have properties such as resistance to intestinal environment, fermentability by intestinal microflora, beneficial effects on the host, and resistance to various food processes in industry (Kehinde et al., 2020). The effect on intestinal microflora, strengthening the immune system, reducing inflammatory diseases and intestinal cancer, effect on fat metabolism, increasing mineral absorption, and lowering blood cholesterol are among the most important beneficial effects of these compounds (Ballan et al., 2020).
Synbiotic food
Sybiotics are actually mixed supplements of probiotics and prebiotics that have beneficial effects by helping to grow and strengthen beneficial microorganisms in the host's digestive tract (García et al., 2019, Yu et al., 2017). In fact, the addition of prebiotics to synbiotic food increases the survival of probiotics and thus increases the shelf life of the food (Khodadad and Sabbaghian, 2010, Patel et al., 2014). A variety of synbiotic food types are produced around the world, including ice-cream, yogurt, cheese, sour cream, powdered milk, kefir, komis, juices, meat products, sauerkraut, pickles and fermented soy products, and soy milk. Since these compounds increase probiotics, the effects of probiotics will increase (Szlufman and Shemesh, 2021).
Conclusion
Fasting is an important duty for all Muslims in the world. Due to the limited consumption of water and food at certain times, in order to maintain good health, it is necessary to have a suitable selection of food at the time of ‘Iftar’ and ‘suhoor’. Some people suffer from constipation due to not following a proper diet, which is much more necessary for these people if they have a previous background. The use of fiber-containing compounds, beneficial for the activity of the gastrointestinal tract, both microbial and to improve its peristalsis, is especially necessary in the elderly, whose peristalsis has decreased due to aging, but the placement of synbiotic foods such as synbiotic dairy products will help to control this complication these days due to the presence of dietary fiber (prebiotics) and beneficial microorganisms for the gastrointestinal tract (probiotics). Consumption of these beneficial foods is recommended to all people, not only during Ramadan, but also as a necessary change in the diet, which not only reduces and treats constipation, but also has various effects on a person's health.
Acknowledgment
Thanks are owed to the Vice -Chancellor of Research and Technology in Yazd Shahid Sadoughi University of Medical Sciences for providing us the access to scientific databases.
Authors’ contributions
Marzban A and Shirdeli M were involved in designing and supervising the survey. Sadeghi-Nodoshan F and Marzban A were involved in designing the study, data collecting, and data analyzing. Shirdeli M and Yaghoubi F participated in writing the manuscript. All authors critically reviewed the manuscript and approved the final version submitted for publication.
Conflict of interest
The authors declare no conflict of interest.
References
Afshar P, Shokrzadeh M, Raeisi SN, Ghorbani-HasanSaraei A & Nasiraii LR 2020. Aflatoxins biodetoxification strategies based on probiotic bacteria. Toxicon. 178: 50-58.
Arco S, et al. 2022. Functional constipation in older adults: Prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life. Gerontology. 68 (4): 397-406.
Ashaolu TJ 2020. Immune boosting functional foods and their mechanisms: A critical evaluation of probiotics and prebiotics. Biomedicine & Pharmacotherapy. 130: 110625.
Ballan R, Battistini C, Xavier-Santos D & Saad SMI 2020. Interactions of probiotics and prebiotics with the gut microbiota. Progress in molecular biology and translational science. 171: 265-300.
Barrea L, et al. 2020. Nutrition and immune system: from the Mediterranean diet to dietary supplementary through the microbiota. Critical reviews in food science and nutrition. 61 (18): 1-25.
Bharucha AE, Pemberton JH & Locke GR 2013. American Gastroenterological Association technical review on constipation. Gastroenterology. 144 (1): 218-238.
Bonyadi F, Tukmechi A & Mohebalian H 2014. An overview of probiotics and their role in cancer management. Journal of Mazandaran University of Medical Sciences. 24 (112): 128-140.
Botelho PB, Ferreira MVR, de Mesquita Araújo A, Mendes MM & Nakano EY 2020. Effect of multispecies probiotic on gut microbiota composition in individuals with intestinal constipation: A double-blind, placebo-controlled randomized trial. Nutrition. 78: 110890.
Bubnov RV, et al. 2017. Comparative study of probiotic effects of Lactobacillus and Bifidobacteria strains on cholesterol levels, liver morphology and the gut microbiota in obese mice. EPMA Journal. 8 (4): 357-376.
Capo F, Wilson A & Di Cara F 2019. The intestine of Drosophila melanogaster: An emerging versatile model system to study intestinal epithelial homeostasis and host-microbial interactions in humans. Microorganisms. 7 (9): 336.
Chang L 2004. Epidemiology and quality of life in functional gastrointestinal disorders. Alimentary pharmacology & therapeutics. 20: 31-39.
Chugh B & Kamal-Eldin A 2020. Bioactive compounds produced by probiotics in food products. Current opinion in food science. 32: 76-82.
da Silveira EA, Falco MO, Nery MW & Turchi MD 2017. Effectiveness of nutritional treatment and synbiotic use on gastrointestinal symptoms reduction in HIV-infected patients: Randomized clinical trial. Clinical nutrition. 36 (3): 680-685.
Duron DI, Hanak F & Streicher JM 2020. Daily intermittent fasting in mice enhances morphine-induced antinociception while mitigating reward, tolerance, and constipation. Pain. 161 (10): 2353-2363.
Eor JY, et al. 2019. Laxative effect of probiotic chocolate on loperamide-induced constipation in rats. Food research international. 116: 1173-1182.
Eslami M, et al. 2019. Are probiotics useful for therapy of Helicobacter pylori diseases? Comparative immunology, microbiology and infectious diseases. 64: 99-108.
García C, Bautista L, Rendueles M & Díaz M 2019. A new synbiotic dairy food containing lactobionic acid and Lactobacillus casei. International journal of dairy technology. 72 (1): 47-56.
Górska A, Przystupski D, Niemczura MJ & Kulbacka J 2019. Probiotic bacteria: a promising tool in cancer prevention and therapy. Current microbiology. 76 (8): 939-949.
Harish K & Varghese T 2006. Probiotics in humans–evidence based review. Calicut medical journal. 4 (4): e3.
Homayouni A, Azizi A, Ehsani M, Yarmand M & Razavi S 2018. Effect of microencapsulation and resistant starch on the probiotic survival and sensory properties of synbiotic ice cream. Food chemistry. 1 (111): 5-50.
Huang R & Hu J 2017. Positive effect of probiotics on constipation in children: a systematic review and meta-analysis of six randomized controlled trials. Frontiers in cellular and infection microbiology. 7: 153.
Jafari T, Ganji F, Batenipoor M & Nasiri J 2021. Ramadan fasting dietary patterns and gastrointestinal discomforts. Journal of nutrition, fasting and health. 9 (2): 137-145.
Jaroszewska A, Biel W & Sobolewska M 2019. Impact of effective microorganisms and manure on the chemical properties of Japanese khotweed leavels and their use in the production of functional foods. Pakistan journal of agricultural sciences. 56 (2).
Kehinde BA, Panghal A, Garg M, Sharma P & Chhikara N 2020. Vegetable milk as probiotic and prebiotic foods. In Advances in food and nutrition research, pp. 115-160. Elsevier.
Khodadad A & Sabbaghian M 2010. Role of synbiotics in the treatment of childhood constipation: a double-blind randomized placebo controlled trial. Iranian journal of pediatrics. 20 (4): 387.
Linsenmeyer W, Garwood S & Waters J 2022. An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients. Journal of the Academy of Nutrition and Dietetics.
Mohaghegh Shalmani H, et al. 2011. Direct and indirect medical costs of functional constipation: a population-based study. International journal of colorectal disease. 26 (4): 515-522.
Mugie SM, Benninga MA & Di Lorenzo C 2011. Epidemiology of constipation in children and adults: a systematic review. Best practice & research clinical gastroenterology. 25 (1): 3-18.
Ohkusa T, Koido S, Nishikawa Y & Sato N 2019. Gut microbiota and chronic constipation: a review and update. Frontiers in medicine. 6: 19.
Patel PJ, Singh SK, Panaich S & Cardozo L 2014. The aging gut and the role of prebiotics, probiotics, and synbiotics: A review. Journal of clinical gerontology and geriatrics. 5 (1): 3-6.
Puebla-Barragan S & Reid G 2019. Forty-five-year evolution of probiotic therapy. Microbial cell. 6 (4): 184.
Ramos CI, Nerbass FB & Cuppari L 2022. Constipation in Chronic Kidney Disease: It Is Time to Bridge the Gap. Kidney and dialysis. 2 (2): 221-233.
Rantis PC, Vernava AM, Danie GL & Longo WE 1997. Chronic constipation—is the work-up worth the cost? Diseases of the colon & rectum. 40 (3): 280-286.
Ribeiro TP, de Freitas ES, Clemente R, da Cruz FK & dos Santos TC 2018. Development of digestive organs of female broilers under varying post-hatch fasting times. Semina: Ciências Agrárias. 39 (2): 893-898.
Sanctuary MR, et al. 2019. Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms. PloS one. 14 (1): e0210064.
Scott SM, et al. 2021. Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation. Neurogastroenterology & motility. 33 (6): e14050.
Sharma P, Tomar SK, Goswami P, Sangwan V & Singh R 2014. Antibiotic resistance among commercially available probiotics. Food research international. 57: 176-195.
Song MW, Kim K-T & H-D P 2021. Probiotics as a Functional Health Supplement in Infant Formulas for the Improvement of Intestinal Microflora and Immunity. Food reviews international. 39 (2): 858-874.
Szlufman C & Shemesh M 2021. Role of Probiotic Bacilli in Developing Synbiotic Food: Challenges and Opportunities. Frontiers in microbiology. 12: 811.
Tamadoni R, Nafisi Bahabadi M, Morshedi V, Bagheri D & Torfi Mozanzadeh M 2020. Effect of short‐term fasting and re‐feeding on growth, digestive enzyme activities and antioxidant defence in yellowfin seabream, Acanthopagrus latus (Houttuyn, 1782). Aquaculture research. 51 (4): 1437-1445.
Tang X & Zhao J 2019. Commercial strains of lactic acid bacteria with health benefits. In Lactic Acid Bacteria, pp. 297-369. Springer.
Tripathi MK & Giri SK 2014. Probiotic functional foods: Survival of probiotics during processing and storage. Journal of functional foods. 9: 225-241.
Yan YL, Hu Y & Gänzle MG 2018. Prebiotics, FODMAPs and dietary fiber—conflicting concepts in development of functional food products? Current opinion in food science. 20: 30-37.
Yu T, et al. 2017. Effects of prebiotics and synbiotics on functional constipation. American journal of the medical sciences. 353 (3): 282-292.
Zawistowska-Rojek A & Tyski S 2018. Are probiotic really safe for humans? Polish journal of microbiology. 67 (3): 251.
Constipation is a symptom that can mean different things to different people, but it usually means that a person is having trouble opening his bowels. It affects one in seven people, and the two groups of people most likely to become constipated are young women and the elderly, especially those who need to take regular medications (Ribeiro et al., 2018). Constipation is a chronic disease that affects about 16% of the world's population. Research has shown that this complication is 2.3 times more common and symptomatic in women than men (Mugie et al., 2011, Scott et al., 2021). The disease seems to be related to age, diet, and lifestyle, and many health resources around the world are used to diagnose and treat it. However, common treatments in one-third of patients are unsatisfactory (Rantis et al., 1997).
It should be noted that constipation is one of the factors that has a significant impact on the quality of life and health-related quality of life in these patients is less than normal people in society (Arco et al., 2022, Chang, 2004). Due to its high prevalence, many resources are allocated to this disease. Among outpatient visits, constipation is one of the five most commonly diagnosed gastrointestinal problems diagnosed by physicians (Bharucha et al., 2013) and imposes a high economic burden on the patient and the community, which is due to the chronicity of this disease (Mohaghegh Shalmani et al., 2011).
Fasting during Ramadan is an obligatory duty for all adult Muslims in the world. One of the features of Ramadan compared to other months of the year is the restriction of food and beverage consumption. However, if a person's diet is changed in such a way that many essential nutrients are removed from the diet, several changes can be observed as a result (Ribeiro et al., 2018).
Healthy eating is especially important in fasting. One of the most common complications at this time is constipation. This complication is more common in adults during fasting due to the reduction of peristalsis. It is recommended that these people change their diet and take dietary supplements instead of using laxatives (Tamadoni et al., 2020).
In fact, starvation and low water intake lead to constipation. Reducing calorie intake and reducing physical activity also increase the risk of constipation. This problem is often seen due to changes in the pattern of meals and sleep during Ramadan, as well as irregularity and reduced peristalsis. People with constipation during Ramadan can largely cure this problem by having a proper nutritional pattern. The aim of this study is to review the effect of synbiotic foods on reducing and treating constipation in fasting people during Ramadan.
Materials and Methods
This review was extracted by searching the creditable databases, including PubMed, Scopus, Embase, Science Direct, Google scholar, Magiran, and scientific information database (SID) using keywords such as Fasting, Synbiotics, Constipation, Ramadan, Digestive System, Probiotics and Prebiotics from the published literature (English and Persian language). In this regard, a variety of studies including prospective cohort, retrospective, case-control, clinical guidelines, cross-sectional, and review articles were searched up to 2022.
The inclusion criteria consisted of articles that reported any possible correlation between symbiotic food and reducing and treating constipation. Search strategy yielded 242 publications; first, the abstracts were investigated and unrelated articles were excluded which resulted in 41 articles. Subsequently, the references of the publications yielded by the search were reviewed to identify additional relevant articles (4 articles), and a total of 45 articles were included in the review.
Results
Human digestive system
Perhaps until a decade ago, the general perception was that the gastrointestinal tract was the only place to absorb and digest food. However, research in recent years has revealed the fact that this unique system has many functions that are essential for human survival and health. Researchers have so far identified more than 500 species of beneficial and active microflora in the gastrointestinal tract (Harish K and Varghese T, 2006, Homayouni A et al., 2018).
In addition to affecting intestinal tissue health, the intestinal flora plays other important roles, including modulating the immune system, drug metabolism, normal peristalsis, breaking down toxins and dietary carcinogens, making vitamins, and fermenting some non-food items. It is digestible, absorbs little electrolytes, grows and differentiates intestinal epithelial cells, prevents the implantation of pathogenic bacteria such as Escherichia coli and Clostridia in the intestine, and acts as an allergen for the host (Barrea L et al., 2020, Capo et al., 2019, Song MW et al., 2021).
In general, intestinal bacteria are divided into beneficial, harmful, and neutral types for human health. Beneficial bacteria such as probiotics are inhibited by their growth and activity and prevent the multiplication of harmful bacteria. In addition, by synthesizing some essential substances for the body, such as vitamins and amino acids, they play an important role in maintaining good health. The use of probiotics as a supplement also has beneficial effects on the gastrointestinal health of patients. These microorganisms can help treat constipation by increasing peristalsis or reducing the passage of food through the gastrointestinal tract (Bonyadi et al., 2014, Sharma et al., 2014).
In general, the human intestinal microflora can be altered in three ways through the use of antibiotics, and the use of probiotics. For this reason, the use of foods or dietary supplements that increase the population of beneficial intestinal microflora will be very effective on a person's health (Ashaolu, 2020). It should be noted that in order to be healthy, the necessary balance between different types of gastrointestinal flora is essential and a change in diet can be one of the reasons for changing the gastrointestinal flora (Harish K and Varghese T, 2006, Homayouni A et al., 2018).
Constipation
Constipation is one of the most common digestive problems in the world that occurs in all people, but is more common in the elderly (Eor et al., 2019). Research has shown that the microbial flora in the gut changes during constipation. In the 7th century, a Japanese physician theorized that a proper microbial balance in the gut could prevent disease, and an imbalance of gut microbial flora could lead to a variety of diseases, including diarrhea, intestinal infection and radiotherapy, inflammation of the intestines and stomach, constipation, irritable bowel syndrome, Crohn's disease, inflammation of the colon, food allergies, and some cancers (Jaroszewska et al., 2019).
The most common complaint of patients is constipation. According to available articles, constipation is the most common gastrointestinal problem in the United States, between 4% and 28%, and in Iran it is 1.4% to 37%, which is more of a symptom than a disease. This problem is more common in women and adults aged over 65 years (Ramos CI et al., 2022). Clinical signs of constipation according to the Rome criteria protocol include defecation less than 3 times a week, straining during defecation, hard stools (in 25%), and feeling of lack of evacuation or insufficient evacuation. Many factors can affect the change of gastrointestinal flora and reduce peristalsis and, consequently, constipation, the most important of which are diseases and drug use, aging, dietary changes such as not consuming enough fluids and vegetables. For the treatment of constipation in most cases, the use of plenty of fluids and fiber, the use of laxatives, and toilet training are also recommended. Although these methods are useful in people without previous history, they do not guarantee the success of treatment (Botelho et al., 2020).
Nutritional and non-pharmacological treatment for constipation includes the consumption of sufficient amounts of dietary fiber and fluids (da Silveira et al., 2017). It should be noted that recent research has indicated the fact that fluid intake only increases the volume of urine and does not have a significant effect on increased peristalsis and fecal consistency. Moreover, although fiber intake is effective on intestinal microflora and fecal dilation, it does not provide significant results alone (Duron et al., 2020). The administration of fiber supplements to the diet does not bring stool volume to normal, which has been confirmed in a study in 2% of patients with the administration of 5 g of fiber daily. However, fiber supplementation reduces the time of oral anal transit and increases the number of peristalsis by 2 to 3 times a week; however, in reported cases of severe constipation by patients, it did not cause a significant reduction. Fiber supplements are not very desirable due to side effects such as bloating, bad taste, and abdominal distension, especially in the first few weeks of use (Linsenmeyer et al., 2022).
Conversely, in some patients, reducing fiber intake can be beneficial, for example, in the elderly or the elderly, sebum is not only ineffective, but also causes fecal incontinence in the second group (Ohkusa et al., 2019). In a study of clinical trials performed on patients with constipation, bifidobacterium lactis, Lactobacillus casei, and Escherichia coli were found to have an effect on evacuation frequency and degree of fecal consistency in adults (Ohkusa et al., 2019). In some studies, the positive role of some probiotic bacteria such as Lactobacillus has been proven in increasing peristalsis (Ohkusa et al., 2019). In a study in Germany, the effects of probiotics on the treatment of constipation were studied, which had positive effects and results (Sanctuary et al., 2019). In fact, probiotics can reduce the passage of food by stimulating peristalsis and help reduce and treat constipation. Therefore, in order to achieve the best option to reduce and treat constipation with the diet, researchers suggest the use of other treatment options, including live therapists, which is called probiotic therapy (Jafari et al., 2021).
Probiotic bacteria and probiotic therapy
The word probiotic, meaning "for life," was first coined in the early twentieth century by Elie metchnikoff. According to the WHO/FAO definition, probiotics are living microorganisms that, if consumed enough, can have positive effects on the host. Probiotics generally contain some beneficial bacteria and fungi (Górska et al., 2019).
Probiotic microorganisms are usually available as dry extracts in either dried or frozen forms that can be added to industrial and household food products (Huang and Hu, 2017). These microorganisms are consumed either as food supplements or as fermented or non-fermented food products (Tripathi and Giri, 2014).
A wide range of microorganisms are considered probiotics, but most of them fall into two categories including lactobacilli and bifidobacteria, both of which are naturally part of the beneficial flora of the gastrointestinal tract. In fact, it is called a probiotic product when it contains at least 107 live bacteria (Puebla-Barragan and Reid, 2019).
These microorganisms reduce some of diseases such as constipation by reducing the absorption of cholesterol in the intestine (Bubnov et al., 2017), competing with pathogenic bacteria for nutrients and their binding sites, lowering the pH of the intestinal environment, etc. (Eslami et al., 2019). The function of these organisms, in addition to beneficial effects on peristalsis, includes balancing blood pressure, preventing allergies, reducing diarrhea, and regulating and improving the function of the immune system (Zawistowska-Rojek and Tyski, 2018).
Their mechanism of action is such that by producing lactic acid and short-chain fatty acids, they reduce the pH of the colon, and as a result of this action, they increase the peristalsis in the stomach. Also, some probiotic species have the ability to convert bile salts to free bile, and thus increase the volume of water in the colon and are an effective factor in softening the stool and play an important role in improving excretion (Tang and Zhao, 2019).
Criteria for selecting probiotics include the ability to survive during processing and storage of the product, the ability to survive inside the intestinal tract, and a positive impact on the health of the host. Extensive therapeutic applications have been reported for probiotics, including prevention of urogenital diseases, osteoporosis and food allergies, reduction of constipation and control of inflammatory bowel disease, and protection against colon and bladder cancer (Chugh and Kamal-Eldin, 2020, Zawistowska-Rojek and Tyski, 2018). Probiotic therapy is a new science that has attracted the attention of many nutrition and medical researchers and has so far shown its effects on the treatment of inflammatory bowel disease and bacterial diarrhea as well as irritable bowel syndrome. However, limited studies have been conducted on this disease despite its prevalence (Afshar et al., 2020).
Prebiotic food
Prebiotics contain substances that improve the activity and composition of microflora living in the intestinal environment and thus are effective in promoting the health of the host (Kehinde et al., 2020). In fact, prebiotics are indigestible or poorly digestible oligosaccharides that selectively stimulate the growth or activity of probiotics once they reach the intestinal environment as a source of carbon or energy (Yan et al., 2018). These compounds are mainly from carbohydrates such as dietary fiber, lactose, lactulose, oligosaccharides, starch and have properties such as resistance to intestinal environment, fermentability by intestinal microflora, beneficial effects on the host, and resistance to various food processes in industry (Kehinde et al., 2020). The effect on intestinal microflora, strengthening the immune system, reducing inflammatory diseases and intestinal cancer, effect on fat metabolism, increasing mineral absorption, and lowering blood cholesterol are among the most important beneficial effects of these compounds (Ballan et al., 2020).
Synbiotic food
Sybiotics are actually mixed supplements of probiotics and prebiotics that have beneficial effects by helping to grow and strengthen beneficial microorganisms in the host's digestive tract (García et al., 2019, Yu et al., 2017). In fact, the addition of prebiotics to synbiotic food increases the survival of probiotics and thus increases the shelf life of the food (Khodadad and Sabbaghian, 2010, Patel et al., 2014). A variety of synbiotic food types are produced around the world, including ice-cream, yogurt, cheese, sour cream, powdered milk, kefir, komis, juices, meat products, sauerkraut, pickles and fermented soy products, and soy milk. Since these compounds increase probiotics, the effects of probiotics will increase (Szlufman and Shemesh, 2021).
Conclusion
Fasting is an important duty for all Muslims in the world. Due to the limited consumption of water and food at certain times, in order to maintain good health, it is necessary to have a suitable selection of food at the time of ‘Iftar’ and ‘suhoor’. Some people suffer from constipation due to not following a proper diet, which is much more necessary for these people if they have a previous background. The use of fiber-containing compounds, beneficial for the activity of the gastrointestinal tract, both microbial and to improve its peristalsis, is especially necessary in the elderly, whose peristalsis has decreased due to aging, but the placement of synbiotic foods such as synbiotic dairy products will help to control this complication these days due to the presence of dietary fiber (prebiotics) and beneficial microorganisms for the gastrointestinal tract (probiotics). Consumption of these beneficial foods is recommended to all people, not only during Ramadan, but also as a necessary change in the diet, which not only reduces and treats constipation, but also has various effects on a person's health.
Acknowledgment
Thanks are owed to the Vice -Chancellor of Research and Technology in Yazd Shahid Sadoughi University of Medical Sciences for providing us the access to scientific databases.
Authors’ contributions
Marzban A and Shirdeli M were involved in designing and supervising the survey. Sadeghi-Nodoshan F and Marzban A were involved in designing the study, data collecting, and data analyzing. Shirdeli M and Yaghoubi F participated in writing the manuscript. All authors critically reviewed the manuscript and approved the final version submitted for publication.
Conflict of interest
The authors declare no conflict of interest.
References
Afshar P, Shokrzadeh M, Raeisi SN, Ghorbani-HasanSaraei A & Nasiraii LR 2020. Aflatoxins biodetoxification strategies based on probiotic bacteria. Toxicon. 178: 50-58.
Arco S, et al. 2022. Functional constipation in older adults: Prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life. Gerontology. 68 (4): 397-406.
Ashaolu TJ 2020. Immune boosting functional foods and their mechanisms: A critical evaluation of probiotics and prebiotics. Biomedicine & Pharmacotherapy. 130: 110625.
Ballan R, Battistini C, Xavier-Santos D & Saad SMI 2020. Interactions of probiotics and prebiotics with the gut microbiota. Progress in molecular biology and translational science. 171: 265-300.
Barrea L, et al. 2020. Nutrition and immune system: from the Mediterranean diet to dietary supplementary through the microbiota. Critical reviews in food science and nutrition. 61 (18): 1-25.
Bharucha AE, Pemberton JH & Locke GR 2013. American Gastroenterological Association technical review on constipation. Gastroenterology. 144 (1): 218-238.
Bonyadi F, Tukmechi A & Mohebalian H 2014. An overview of probiotics and their role in cancer management. Journal of Mazandaran University of Medical Sciences. 24 (112): 128-140.
Botelho PB, Ferreira MVR, de Mesquita Araújo A, Mendes MM & Nakano EY 2020. Effect of multispecies probiotic on gut microbiota composition in individuals with intestinal constipation: A double-blind, placebo-controlled randomized trial. Nutrition. 78: 110890.
Bubnov RV, et al. 2017. Comparative study of probiotic effects of Lactobacillus and Bifidobacteria strains on cholesterol levels, liver morphology and the gut microbiota in obese mice. EPMA Journal. 8 (4): 357-376.
Capo F, Wilson A & Di Cara F 2019. The intestine of Drosophila melanogaster: An emerging versatile model system to study intestinal epithelial homeostasis and host-microbial interactions in humans. Microorganisms. 7 (9): 336.
Chang L 2004. Epidemiology and quality of life in functional gastrointestinal disorders. Alimentary pharmacology & therapeutics. 20: 31-39.
Chugh B & Kamal-Eldin A 2020. Bioactive compounds produced by probiotics in food products. Current opinion in food science. 32: 76-82.
da Silveira EA, Falco MO, Nery MW & Turchi MD 2017. Effectiveness of nutritional treatment and synbiotic use on gastrointestinal symptoms reduction in HIV-infected patients: Randomized clinical trial. Clinical nutrition. 36 (3): 680-685.
Duron DI, Hanak F & Streicher JM 2020. Daily intermittent fasting in mice enhances morphine-induced antinociception while mitigating reward, tolerance, and constipation. Pain. 161 (10): 2353-2363.
Eor JY, et al. 2019. Laxative effect of probiotic chocolate on loperamide-induced constipation in rats. Food research international. 116: 1173-1182.
Eslami M, et al. 2019. Are probiotics useful for therapy of Helicobacter pylori diseases? Comparative immunology, microbiology and infectious diseases. 64: 99-108.
García C, Bautista L, Rendueles M & Díaz M 2019. A new synbiotic dairy food containing lactobionic acid and Lactobacillus casei. International journal of dairy technology. 72 (1): 47-56.
Górska A, Przystupski D, Niemczura MJ & Kulbacka J 2019. Probiotic bacteria: a promising tool in cancer prevention and therapy. Current microbiology. 76 (8): 939-949.
Harish K & Varghese T 2006. Probiotics in humans–evidence based review. Calicut medical journal. 4 (4): e3.
Homayouni A, Azizi A, Ehsani M, Yarmand M & Razavi S 2018. Effect of microencapsulation and resistant starch on the probiotic survival and sensory properties of synbiotic ice cream. Food chemistry. 1 (111): 5-50.
Huang R & Hu J 2017. Positive effect of probiotics on constipation in children: a systematic review and meta-analysis of six randomized controlled trials. Frontiers in cellular and infection microbiology. 7: 153.
Jafari T, Ganji F, Batenipoor M & Nasiri J 2021. Ramadan fasting dietary patterns and gastrointestinal discomforts. Journal of nutrition, fasting and health. 9 (2): 137-145.
Jaroszewska A, Biel W & Sobolewska M 2019. Impact of effective microorganisms and manure on the chemical properties of Japanese khotweed leavels and their use in the production of functional foods. Pakistan journal of agricultural sciences. 56 (2).
Kehinde BA, Panghal A, Garg M, Sharma P & Chhikara N 2020. Vegetable milk as probiotic and prebiotic foods. In Advances in food and nutrition research, pp. 115-160. Elsevier.
Khodadad A & Sabbaghian M 2010. Role of synbiotics in the treatment of childhood constipation: a double-blind randomized placebo controlled trial. Iranian journal of pediatrics. 20 (4): 387.
Linsenmeyer W, Garwood S & Waters J 2022. An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients. Journal of the Academy of Nutrition and Dietetics.
Mohaghegh Shalmani H, et al. 2011. Direct and indirect medical costs of functional constipation: a population-based study. International journal of colorectal disease. 26 (4): 515-522.
Mugie SM, Benninga MA & Di Lorenzo C 2011. Epidemiology of constipation in children and adults: a systematic review. Best practice & research clinical gastroenterology. 25 (1): 3-18.
Ohkusa T, Koido S, Nishikawa Y & Sato N 2019. Gut microbiota and chronic constipation: a review and update. Frontiers in medicine. 6: 19.
Patel PJ, Singh SK, Panaich S & Cardozo L 2014. The aging gut and the role of prebiotics, probiotics, and synbiotics: A review. Journal of clinical gerontology and geriatrics. 5 (1): 3-6.
Puebla-Barragan S & Reid G 2019. Forty-five-year evolution of probiotic therapy. Microbial cell. 6 (4): 184.
Ramos CI, Nerbass FB & Cuppari L 2022. Constipation in Chronic Kidney Disease: It Is Time to Bridge the Gap. Kidney and dialysis. 2 (2): 221-233.
Rantis PC, Vernava AM, Danie GL & Longo WE 1997. Chronic constipation—is the work-up worth the cost? Diseases of the colon & rectum. 40 (3): 280-286.
Ribeiro TP, de Freitas ES, Clemente R, da Cruz FK & dos Santos TC 2018. Development of digestive organs of female broilers under varying post-hatch fasting times. Semina: Ciências Agrárias. 39 (2): 893-898.
Sanctuary MR, et al. 2019. Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms. PloS one. 14 (1): e0210064.
Scott SM, et al. 2021. Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation. Neurogastroenterology & motility. 33 (6): e14050.
Sharma P, Tomar SK, Goswami P, Sangwan V & Singh R 2014. Antibiotic resistance among commercially available probiotics. Food research international. 57: 176-195.
Song MW, Kim K-T & H-D P 2021. Probiotics as a Functional Health Supplement in Infant Formulas for the Improvement of Intestinal Microflora and Immunity. Food reviews international. 39 (2): 858-874.
Szlufman C & Shemesh M 2021. Role of Probiotic Bacilli in Developing Synbiotic Food: Challenges and Opportunities. Frontiers in microbiology. 12: 811.
Tamadoni R, Nafisi Bahabadi M, Morshedi V, Bagheri D & Torfi Mozanzadeh M 2020. Effect of short‐term fasting and re‐feeding on growth, digestive enzyme activities and antioxidant defence in yellowfin seabream, Acanthopagrus latus (Houttuyn, 1782). Aquaculture research. 51 (4): 1437-1445.
Tang X & Zhao J 2019. Commercial strains of lactic acid bacteria with health benefits. In Lactic Acid Bacteria, pp. 297-369. Springer.
Tripathi MK & Giri SK 2014. Probiotic functional foods: Survival of probiotics during processing and storage. Journal of functional foods. 9: 225-241.
Yan YL, Hu Y & Gänzle MG 2018. Prebiotics, FODMAPs and dietary fiber—conflicting concepts in development of functional food products? Current opinion in food science. 20: 30-37.
Yu T, et al. 2017. Effects of prebiotics and synbiotics on functional constipation. American journal of the medical sciences. 353 (3): 282-292.
Zawistowska-Rojek A & Tyski S 2018. Are probiotic really safe for humans? Polish journal of microbiology. 67 (3): 251.
Type of article: review article |
Subject:
public specific
Received: 2022/05/27 | Published: 2024/02/21 | ePublished: 2024/02/21
Received: 2022/05/27 | Published: 2024/02/21 | ePublished: 2024/02/21
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
