SUMMARY BackgroundTreatment of chronic constipation remains challenging with 50% of patients dissatisfied with current therapy. There is an unmet need for natural and safe alternatives. Dried plums (prunes) have been used traditionally for constipation but their efficacy is not known.

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While sorbitol has this natural laxative effect, the small intestinal absorption of sorbitol varies across individuals with nearly one half being able to completely absorb a 10 g load. 4 The efficacy of dried plums for constipation is likely to depend at least in part upon the degree of malabsorption in the individual. While it is clear that dried plums aid functional constipation, the clinical significance of this finding may only be limited to those without associated abdominal bloating, discomfort and pain [i.e. irritable bowel syndrome (IBS)]. In addition to exerting an osmotic effect, sorbitol is also rapidly fermented by colonic bacteria, and this can induce abdominal pain and bloating in patients with IBS, presumably via luminal distension. Indeed, a challenge study, applying doses of sorbitol similar to those delivered via the dried plums, induced symptoms in the majority of patients with IBS. 5Sorbitol is a FODMAP and its content is minimised in the low FODMAP diet that has efficacy in patients with IBS.6 It would be prudent to warn patients being treated with dried plums that, there is a risk of exacerbating symptoms of bloating and abdominal discomfort if already present.

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