With Zelnorm Gone, What Now?

The sentiment from many patients and doctors who heard that Zelnorm had been pulled from the shelf was “what now?” The US Food and Drug Administration (FDA) moved to stop the maker of Zelnorm, Novartis, from selling the drug in the United States due to an increase in heart disease amongst people taking the drug.

Zelnorm, used primarily in women with irritable bowel syndrome who are constipated, was a mildly effective drug at best.  And given it had side-effects, could only be used for four to six weeks, and might worsen constipation once the drug was stopped, many patients and practitioners considered the drug not helpful.  Simple dietary and supplemental treatments for constipation exist that are more effective, have longer lasting effects, and have almost no side effects.


A few small changes to diet and a modest supplementation routine can have a dramatic affect on the occurrence of constipation.

The key to preventing constipation is to adjust your eating habits to ensure your body is getting the nutrients it needs:

  • Water. Most people have heard that it is a good idea to drink 8 to 12 glasses of water a day; this is especially true for people with constipation.  Water helps ensure that the stool is soft and can be easily moved out of the body.  While you can focus on getting your 8 to 12 glasses of water a day, a much more accurate way to maintain your fluid level is to watch the color of your urine. When you don’t drink enough water, your urine becomes more concentrated and yellow. If you maintain your urine light-yellow to clear in color, then you are getting enough water.
  • Fiber.  Foods high in fiber are an important aid in maintaining regularity, not to mention the terrific cholesterol lowering benefits.  Every time you sit down to eat, add at least one (or more) fruits or vegetables to your plate.  Some of the more popular and tasty choices are cabbage, beets, carrots, brussel sprouts, turnips, cauliflower, and apples.  This little trick can send you well on your way to getting a healthy dose of regularity-inducing fiber.

Another great source of fiber can be found by eating whole grains in whole form (instead of grains that have been ground into a flour).  Rice, oatmeal, and the more exotic grains like amaranth, millet, quinoa, barley and others are a great addition to any meal and provide the bulk that helps prevent constipation.

  • Dietary Supplements.  For those with active lifestyles that find it difficult to eat foods rich in fiber another option is to supplement your diet.
  • Flax Seed.  One of the best fiber supplements is ground flax seeds.  Not only are flax seeds a great source of fiber, but they benefit the body in other ways. Ground flax seed is also a source of essential fatty acids, which support the cardiovascular, reproductive, immune, and nervous systems.  Flax seeds are also fermented by colon bacteria into beneficial phytochemicals (such as good estrogens) that help reduce the occurrence of diseases such as breast and ovarian cancer.
  • Probiotics.  Another great supplement for constipation and irritable bowel is probiotics.  Your gut is full of bacteria; they live in harmony with you and are very beneficial to humans. There are good bacteria and bad bacteria in our guts and they, usually, are in balance.  Being under stress, taking antibiotics and other drugs, or eating foods that are not good for us, can all impact this ecological balance in favor of the bad bacteria.  A probiotic supplement contains many of the good bacteria, and supplementing can tilt the balance in favor of the good bacteria.  Bacteria also make up some 2/3 of the dry weight of stool, so supplementing with probiotics increases the mass of stool, which, in turn, reduces constipation.

Zelnorm may be off the market, but people with irritable bowel syndrome need not look too far for a solution to their constipation.  A simple change in diet and a few supplements should be enough to prevent future occurrences.

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