Menu planning for constipation
For constipation, raise fibre to about 30-40 g gradually, drink 2.5-3 litres of fluid, keep regular meal and toilet times, and stay active.
Aim and principles of the diet
Aim: To plan a menu for a sedentary woman with chronic (atonic) constipation and calculate its energy, protein and fibre. Principles: Constipation means hard, infrequent stools (fewer than three a week) passed with straining. Common causes are low fibre, low fluid, inactivity and ignoring the urge, as well as some medicines, pregnancy and old age. Fibre holds water in the stool and adds bulk, which stimulates the colon to move (peristalsis). Insoluble fibre (bran, whole grains, vegetable skins) adds bulk; soluble fibre (isabgol, oats, fruits, pulses) softens the stool. The usual target is about 25-40 g fibre a day, raised gradually over 1-2 weeks to avoid gas. Fluid is raised to 2.5-3 L, because fibre needs water. A warm drink and breakfast trigger the gastrocolic reflex, so the patient keeps a regular time for meals and the toilet. Figs, raisins, prunes and papaya help, and curd and buttermilk support gut bacteria. Refined foods (maida, white bread, biscuits), too much polished rice, and tea or coffee in place of water are limited. Daily physical activity such as walking helps. In spastic constipation (often irritable bowel), older books advised a low-residue diet; now soluble fibre is added slowly. Isabgol (psyllium husk) is used only as the doctor advises.
Nutrient prescription: Mrs. C, 45 y, 160 cm, 58 kg, sedentary, chronic constipation
| Nutrient | Prescription | Basis and source |
|---|---|---|
| Ideal body weight | 54 kg | (160 − 100) × 0.9 |
| Energy | About 1600 kcal | 30 kcal/kg × 54 = 1620 |
| Protein | About 54 g | 1.0 g/kg (ICMR-NIN 2020 RDA 0.83 g/kg = 45 g) |
| Fibre | About 30-40 g | Usual adult target 25-40 g (Krause uses the US adequate intake of 25-38 g; ICMR-NIN 2020 about 40 g per 2000 kcal); raise over 1-2 weeks |
| Fluid | 2.5-3 L | 8-12 glasses; more in hot weather |
| Activity | About 30 minutes of walking daily | Helps colonic movement |
Foods to include and limit
| Food group | Include | Limit |
|---|---|---|
| Cereals and millets | Unsieved whole-wheat atta, broken wheat, ragi, oats, hand-pounded rice | Maida, white bread, biscuits, polished rice alone |
| Pulses | Whole grams, sprouts, sundal, dals with husk | None, but add slowly if gassy |
| Vegetables | Greens, beans, drumstick, carrot, salads with skin, gourds | Days with almost no vegetables |
| Fruits | Guava, papaya, orange with pulp, ripe banana, pear, figs, raisins, prunes | Strained juice instead of whole fruit |
| Milk | Curd, buttermilk, milk | Large amounts of cheese |
| Drinks | Warm water on waking, buttermilk, soups | Too much tea or coffee in place of water |
Sample one-day high-fibre menu (Mrs. C)
| Time | Menu | Approx. amount (raw) |
|---|---|---|
| 6.00 am | Two glasses of warm water and soaked dried figs | Dried figs 20 g (2 figs) |
| 7.00 am | Tea | Toned milk 100 mL, sugar 5 g |
| 8.00 am | Broken wheat vegetable upma | Broken wheat 40 g, vegetables 50 g, oil 4 g |
| 11.00 am | Guava with skin, and a glass of water | 100 g |
| 1.00 pm | Hand-pounded rice, phulka, tur dal, greens poriyal, salad, buttermilk | Rice 100 g; atta 25 g; tur dal 25 g; greens 100 g, oil 4 g; raw vegetables 75 g; buttermilk 200 mL |
| 4.00 pm | Tea with sprouted green gram sundal | Toned milk 100 mL, sugar 5 g; whole green gram 20 g, oil 2 g |
| 8.00 pm | Phulka (2), mixed vegetable sabzi, curd | Atta 50 g, oil 3 g; vegetables 100 g, oil 4 g; curd 100 g |
| 9.30 pm | Papaya, then warm milk | Papaya 150 g; toned milk 150 mL |
Worked calculation: Mrs. C's high-fibre menu
Mrs. C, 45 years, 160 cm, 58 kg, is a sedentary homemaker with chronic (atonic) constipation. Find her IBW, energy and protein needs and check the menu's energy, protein and fibre.
- IBW = (160 − 100) × 0.9 = 54 kg.
- Energy = 54 kg × 30 kcal/kg = 1620, about 1600 kcal.
- Protein = 54 kg × 1.0 g/kg = 54 g (the ICMR-NIN 2020 RDA of 0.83 g/kg would give 45 g).
- Fibre target: about 30-40 g a day, reached over 1-2 weeks, with 2.5-3 L fluid.
- Approximate values used (kcal and g protein per 100 g raw unless stated; rounded from Indian food composition tables, mainly IFCT 2017 and the older Nutritive Value of Indian Foods; a few, such as toned milk, are estimates): dried figs 250 and 3.5; toned milk 60 and 3 per 100 mL; sugar 400; broken wheat 320 and 10.5; mixed vegetables 30 and 1.5; oil/ghee 900; guava 50 and 1; rice 355 and 8; atta 320 and 10.5; tur dal 330 and 22; greens 35 and 3; buttermilk 15 and 0.8 per 100 mL; whole green gram 325 and 23; curd 60 and 3; papaya 35 and 0.5.
- Cereals (broken wheat 40 g, rice 100 g, atta 75 g): 723.0 kcal, 20.1 g protein, 15.7 g fibre.
- Pulses (tur dal 25 g, whole green gram 20 g): 147.5 kcal, 10.1 g protein, 5.7 g fibre.
- Milk and milk products (toned milk 350 mL, buttermilk 200 mL, curd 100 g): 300.0 kcal, 15.1 g protein, 0.0 g fibre.
- Vegetables (mixed vegetables 225 g, greens 100 g): 102.5 kcal, 6.4 g protein, 10.8 g fibre.
- Fruits (dried figs 20 g, guava 100 g, papaya 150 g): 152.5 kcal, 2.5 g protein, 11.0 g fibre.
- Oil and ghee (oil/ghee 17 g): 153.0 kcal, 0.0 g fibre.
- Sugar (sugar 10 g): 40.0 kcal, 0.0 g fibre.
- Energy = 723.0 + 147.5 + 300.0 + 102.5 + 152.5 + 153.0 + 40.0 = 1618.5 kcal.
- Protein = 20.1 + 10.1 + 15.1 + 6.4 + 2.5 = 54.2 g.
- Fibre = 15.7 + 5.7 + 10.8 + 11.0 = 43.2 g.
- Compare with the prescription: energy 1618.5 ÷ 1600 × 100 = 101%; protein 54.2 ÷ 54 × 100 = 100%.
- Fibre values used (g per 100 g raw, approximate): atta and broken wheat 11, rice 3, tur dal 9, whole green gram 17, vegetables 3, greens 4, guava 6, papaya 2, dried figs 10. The total (about 43 g) is slightly above the 30-40 g target, which is fine when fibre is raised slowly and fluid is 2.5-3 L.
- Each group is rounded to one decimal and the totals are the sums of those rounded figures; all values are approximate.
IBW 54 kg; prescription about 1600 kcal, 54 g protein and 30-40 g fibre. The menu gives about 1619 kcal (101%), 54 g protein (100%) and about 43 g fibre.
Preparation and serving tips, and result
- Do not sieve the atta: the bran is the fibre.
- Keep the skins on scrubbed cucumber, carrot and guava; use whole grams as sundal or in sambar.
- Raise fibre step by step over 1-2 weeks and give a glass of water with every meal and between meals.
- Encourage a fixed toilet time after breakfast and a 30-minute walk every day.
- Result: The high-fibre menu gives about 1619 kcal, 54 g protein and about 43 g fibre, with 2.5-3 L fluid, meeting Mrs. C's prescription.
In the diet kitchen, constipation is common among bed-bound and elderly patients. Small changes to the normal menu help everyone: whole-wheat phulka instead of white bread, a sundal or sprouts at tea time, greens and a fruit with skin on each tray, and a jug of water at the bedside.
Short answer: “How does fibre relieve constipation?” Fibre holds water and adds bulk to the stool, which stimulates peristalsis and makes the stool soft and easy to pass.
Short answer: “Why must fluid be increased along with fibre?” Fibre needs water to soften the stool; high fibre with little fluid can make constipation worse.
Structured question: “Plan a high-fibre menu for a patient with constipation and state its principles.” Fibre 25-40 g raised gradually; fluid 2.5-3 L; whole grains, whole grams, greens, fruits with skin, figs; regular meal and toilet times; daily walking; limit maida and refined foods. Menu: warm water and figs, broken wheat upma, guava, hand-pounded rice with phulka, dal, greens and salad, sprouts, phulka with vegetable and curd, papaya.
The four Fs of constipation: Fibre, Fluid, Fitness and a Fixed toilet time.