Can Ensure Cause Constipation?
Ensure itself is not inherently constipating, but the lack of dietary fiber in standard nutritional supplements can contribute to constipation, particularly in older adults and those receiving enteral nutrition. The solution is to use fiber-containing nutritional products whenever possible.
The Fiber Connection
Standard nutritional supplements like Ensure typically contain minimal or no dietary fiber, which is the primary concern for constipation risk:
- Fiber-containing enteral nutrition products should be used routinely to prevent constipation and normalize bowel function in patients receiving nutritional supplementation 1
- Dietary fiber intake is usually low in geriatric patients who rely on nutritional supplements, making adequate fiber intake particularly important 1
- The recommended daily fiber intake of 25g for normal laxation in adults applies equally to older patients receiving nutritional support 1
Evidence for Fiber's Role in Prevention
Multiple studies demonstrate that fiber-containing formulas actively prevent constipation:
- Fiber-containing enteral nutrition products contribute to normal bowel function and should be used unless bowel function is already compromised 1
- Studies in tube-fed elderly patients show that dietary fiber normalizes bowel functions, with doses of 12.8-28.8g per day significantly improving stool frequency and consistency 1
- Each gram of fiber consumed increases wet stool weight, with wheat bran being most effective (7.2g increase per gram consumed), followed by fruits and vegetables (6g per gram) 1
Practical Recommendations
Switch to fiber-containing versions of nutritional supplements as your first-line approach:
- Fiber-fortified enteral products have been proven effective in multiple controlled trials for maintaining normal bowel function 1
- If standard Ensure is being used, consider switching to Ensure with added fiber or supplementing with additional fiber sources 1
- Adequate fluid intake (8-10 ounces with fiber supplementation) is essential for effectiveness 2
If Constipation Develops
Should constipation occur despite fiber-containing products:
- Add PEG 3350 (Miralax) as the most effective treatment, which increases complete spontaneous bowel movements by 2.90 per week 2
- Psyllium fiber supplementation is the preferred first-line fiber supplement if additional fiber is needed beyond the nutritional product 2, 3
- Doses greater than 10g/day of supplemental fiber and treatment duration of at least 4 weeks appear optimal for symptom improvement 3
Important Caveats
Avoid finely ground wheat bran powder, as it can paradoxically decrease stool water content and worsen constipation 2
- Introduce fiber gradually to minimize bloating and gas, which are common side effects 1, 2
- Ensure adequate total fluid intake throughout the day, not just with the supplement itself 4
- In patients with very low baseline fluid intake (lowest quartile), focus specifically on increasing hydration 2
The key takeaway: Ensure is not directly constipating, but its lack of fiber creates risk. Using fiber-containing nutritional products from the start prevents this problem entirely 1.