An Act to End Constipation

(From my book CONDITIONS)

I never contemplated bananas very much until the other day, after I counseled a patient with diarrhea about the BRAT diet, consisting of bananas, rice, applesauce and toast. The next two patients I saw were in their 80's, on fluid pills and bothered by constipation. Both patients were eating at least one banana per day for fear of low potassium.

Since that day I have informally polled constipated patients about their breakfast habits. My early results suggest that more constipated patients have cereal with milk and banana for breakfast than their non-constipated peers.

Many processed grains, particularly wheat, can be constipating. Dairy products are also constipating for many people. But bananas, fruits with lots of fiber, are they also constipating?

Reading what scientific literature I was able to find on the subject of bananas and constipation, I found several mentions of a theory that unripe, starchy, bananas are constipating, whereas ripe bananas promote regularity.

The obvious next phase of my inquiry will be to ask my banana eating patients how they prefer their bananas, ripe or more “al dente”. I know that whenever I look at bananas in the store, too many black spots on the skin makes me think they’re about to go bad, and I prefer the less sweet taste of what might be considered unripe bananas.

When I lived in Sweden, I saw a little less constipation than here, so it was a surprise to me when I read that the Swedes eat more bananas than other westerners. I know for a fact that extra ripe bananas are not preferred there. My theory on why the Swedes aren't plagued by constipation to match their banana consumption is that they are more physically active, even into old age, than Americans. In my mother’s neighborhood, she and many other octogenarians were always out with their rolling walkers, going to the store, the bus stop or just taking a stroll.

I am beginning to formulate a better, more pragmatic approach to geriatric constipation now that I have become aware of the dichotomy of bananas. Of course, I have to also be more diligent in dispelling the myth that everybody on fluid pills has to eat a banana a day.

Another aspect of adult and geriatric constipation I have become more and more aware of is that many people with constipation get worse by eating high fiber foods. Patients with bulky, hard stools can get even bulkier stools from extra fiber. For such patients, high fiber breakfast cereal with milk and unripe banana is the ultimate insult to regularity, and a habit to be discouraged.

An apple a day may keep the doctor away as whole apples relieve constipation.

A banana a day, on the other hand, may bring about more business for the doctor.