Dr. Keith Roach

DEAR DR. ROACH: I’m severely constipated. My doctor has me on seven medications and supplements. I would like your opinion on taking all of them throughout the day. They are Movantik (I take Tylenol with codeine), magnesium citrate, MiraLAX, apple cider vinegar gummies, magnesium oxide, a probiotic and Linzess. — F.F.
ANSWER: Opioids, such as codeine, can cause severe constipation. Unlike the pain relief it gives, the constipation tends to remain just as bad over time, getting worse if the opioid dose is increased, which makes treatment challenging.
Initial treatment, for everybody who has constipation, starts with lifestyle changes like drinking more water, getting regular exercise (even just walking), and adding more fiber to your diet. (Apple cider has no proven benefit; however, many “gummies” contain fiber.)
Over-the-counter treatments like magnesium and polyethylene glycol (MiraLAX) are also a standard treament. Magnesium citrate is generally preferred for constipation over magnesium oxide, and I don’t see the benefit in taking both. Probiotics also help some people. Often, using several different agents is more effective and come with fewer side effects than taking just one agent at a higher dose, so I think your regimen isn’t as unreasonable as it may sound.
Linzess is specifically for the constipation form of irritable bowel syndrome (IBS-C), but it can be used for other underlying causes of constipation. It is expensive, but effective for many. However, naloxegol (Movantik) is specifically for opioid-induced constipation. It works exclusively in the bowel. Since it is not absorbed, it does not cause withdrawal symptoms. It is also expensive, and has the potential for drug interactions, so it needs to be used cautiously.
I’ve seen many people overuse treatments for constipation. These medicines need to be used at a frequency to allow regular and comfortable bowel movements, which do not have to be every day.
DEAR DR. ROACH: I read a recent column about saturated fat, chicken breast and the nutrition label. It was pretty obvious to me (former registered dietitian here) that the reader was unaware of how to use the labeling information on the chicken. I believe the reader may have confused that the chicken was 3% saturated fat, when in fact the 3% on the label signified that a serving contained 3% of the current recommendation for saturated fat on a 2,000-calorie diet.
A lesson in label-reading and advertising nutrition claims might be in order. — S.L.
ANSWER: Nutrition labels can hold great information, but can also be confusing. The U.S. Department of Agriculture had to make assumptions about serving sizes and caloric intake, but for most people, the assumptions are pretty reasonable.
The first thing I look at is portion size. These are standard, but may not be what you expect. For example, if you have a big (16 ounce or 450 gram) steak, that’s five servings of red meat. Look at the package to see how many servings are included in the container you are buying. I look at the calories per serving, but some people just can’t stand to look at those and focus instead on the nutritional information.
The label will list the macronutrients (fat, carbohydrates, protein) in grams and break down the different types of fat by grams and percent of recommended daily intake. For chicken breast, as S.L. states above, you could eat many (33!) servings before reaching your maximum recommended saturated fat intake. For carbohydrates, avoiding added sugars is healthier. Most people benefit from reducing sodium as well.
The Food and Drug Administration has a detailed guide on reading nutrition labels at tinyurl.com/fdafoodlabel.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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