Did you know that the use of All Bran in our diets goes back to the early 1900s? It was introduced to combat a condition known as auto-intoxication, based on the curious but fashionable theory of the time which held that retained waste in the colon caused self-poisoning.
According to a recent edition of the British Medical Journal, our fixation with a regular bowel habit can be traced back to the introduction of this theory. Auto-intoxication was regarded by much of the medical profession and most of the public as a most insidious disease. In one textbook, the contents of the colon were referred to as "a burden, fermenting, decomposing, putrefying, filling the body with poisonous substances". Auto-intoxication became a kind of catch-all diagnosis in the period 19001920, and was blamed for causing headaches, indigestion, impotence, nervousness, insomnia and many other conditions for which no other cause could be found.
Small wonder, then, that a ready market for all kinds of anti-constipation remedies quickly developed, from abdominal massage machines and colonic irrigation equipment to a subtly named bran cereal, Dinamite. Yoghurt was also seen as a good preventive treatment, but the real money-spinning was done in the laxative business. The manufacturers of Cascarets ran an advertisement warning of the dangers of "bowel bloat - a horrible slimy monster that makes man's life a misery". "Zam Zam", a rather onomatopoeically named preparation, was heavily advertised with a message designed to frighten parents into giving their children daily doses of sweetened phenolphthalein, a popular laxative of the 1920s and 1930s.
The ultimate remedy for constipation and auto-intoxication was surgery, popularised by a surgeon, Sir William Lane, based at Guy's Hospital, London. He maintained that streamlining the human "drainage system" by removing the colon was "the most satisfactory result of surgery known to us at the present time".
Luckily, the concept of autointoxication was rebutted by studies which showed that bowel toxins were unlikely to leach into the circulation. However, the fixation with a regular bowel habit remained and the concept of constipation as a "disease of industrialisation" developed.
Denis Burkitt, a graduate of TCD, who did a lot of research into the value of a high-fibre diet, described constipation as "the commonest Western disease". Industrialised, urban living, in his view, was associated with constipation and colon cancer, a link not found in those whose diet was based on wholegrain cereal foods.
So it is easy to see how bran remains a popular part of a healthy diet. The experts still advise a daily minimum of 30 grams of fibre, despite the latest research published last April which questioned whether cereal rich in fibre has a protective effect against bowel cancer.
How is constipation defined? The range of normal bowel motion frequency varies from twice per day to twice per week, although some people will move their bowels less frequently without any ill-effects.
Simple constipation, where there is no underlying cause, is associated with getting older, lack of regular exercise, a low fluid intake, lack of access to adequate toilet facilities and, of course, a diet low in fibre. Constipation in the elderly is due to poor tone in the muscles of the large intestine as well as a loss of function in the abdominal wall musculature.
THIS regular pattern of constipation is a nuisance, but is not lifethreatening. However, if you experience a sudden alteration in bowel habit with, for example, constipation alternating with diarrhoea, then this must be investigated urgently, as it could signal a tumour in the colon. Constipation and rectal bleeding, although most commonly caused by piles, could be a sign of rectal cancer and again should never be ignored.
Constipation is a feature of other diseases such as depression, anorexia, irritable bowel syndrome and diverticulitis. Lead poisoning and an underactive thyroid are rarer causes. Neurological conditions such as Parkinson's disease and multiple sclerosis are also associated with constipation.
Probably one of the commonest causes is drug therapy. Codeine is a frequent culprit, as are the older tricyclic antidepressants. Medication for Parkinson's disease and schizophrenia also cause constipation. Patients who are terminally ill and who require morphine must always be given treatment to prevent constipation.
What are the treatment options? The best is prevention, involving a hot drink first thing in the morning and lots of fluids throughout the day. Orange and prune juice are particularly helpful. Lots of exercise and bran should also be part of preventive treatment.
Laxatives are still popular, but the most important advice is not to fall into the trap of chronic use. By all means use them to relieve a particularly bad bout of simple constipation, but long-term use will damage the normal functioning of the bowel.
Even if further studies were to confirm the finding that bran does not protect from colon cancer, it is hard to see us being weaned off our daily diet of bran and roughage, which will at least continue to keep us "regular" and constipation-free.