Review of the 2001–2002 St. James’s Hospital Study on Flaxseed for Constipation in Hospitalized Elderly Patients

This is a practical, hospital-based interventional study led by Roslyn Tarrant (RD), along with J.B. Walsh and Cathal Walsh, conducted in the Medicine for the Elderly Unit at St. James’s Hospital, Dublin. The work, dated 2001–2002 (presented around 2002), focused on adding flax (referred to as linseed in the original text) to the diets of hospitalized elderly patients to manage constipation. The provided text appears to be an article or summary (titled “Nutrition – The natural fibre provider”) written by Tarrant, likely published in a nursing, geriatric, or dietetic journal/magazine around that time, summarizing the study’s rationale, methods, results, and conclusions.

The study is not a large-scale randomized controlled trial (RCT) but a small, pragmatic, cross-sectional trial (n=28 initially) where patients served as their own controls in a before-and-after design over 12 weeks. It reflects real-world geriatric nursing practice in addressing a common, burdensome issue in hospitalized older adults.

Study Design and Methods

• Participants: 28 elderly patients (mean age 79 years; 15 males, 8 females reported in results, with some dropouts). Inclusion required documented constipation, ability to ingest flax, willingness to participate, and full stay in rehabilitation/long-stay wards. Exclusions: severe dysphagia, IBS/altered bowel patterns, ileostomy/colostomy.
• Patient Profile: Mostly post-stroke (66%), with neurological conditions (17%), respiratory issues (4%), or other (13%). Mobility was low—62% completely immobile (bed/wheelchair-bound), only 8% fully mobile.
• Baseline Fiber Intake: Low, with 31% <12g/day, 51% 12–18g/day, 18% 18–24g/day (recommended 15–24g/day).
• Intervention (Phase II, weeks 7–12): 10–20g (1–2 dessert spoons) of flax daily, added to normal foods (e.g., breakfast cereal + warm milk pudding/yoghurt in evening). Divided doses, managed by catering/nursing staff with dietitian oversight.
• Phase I (weeks 1–6, control): Usual diet, monitoring bowel frequency (via nurse charts), oral/rectal laxative use (drug cardex), fiber intake (24-hour recalls, food tables), and mobility (Functional Ambulation Categories).
• Outcomes: Bowel frequency, laxative use (adjusted individually as bowels improved), fiber estimates, and cost savings from reduced laxatives. No strict randomization or blinding, but patients acted as own controls.

Key Results

• Dropouts: 5 of 28 (18%) due to insufficient fluid intake (3) or intolerance to flax (2).
• Bowel Frequency: Mean increase of 10.4 bowel motions per patient during the flax period.
• Laxative Use: Mean time to oral laxative reduction: 15.1 days. Complete discontinuation of rectal laxatives. Significant overall reduction in oral and rectal preparations.
• Cost Savings: Mean €27 per patient from reduced laxative use.
• Other Notes: Laxatives were tapered gradually (not stopped abruptly). No major adverse effects reported beyond the intolerances leading to dropout.

Strengths

• Practical and Relevant: Addresses a high-prevalence issue (constipation in up to 51% of elderly females, 39% males; laxative use in 20–30% community elderly, 75% in institutions). Demonstrates flax as a simple, natural, cost-effective alternative to laxatives, which can lead to abuse, dependency, or complications.
• Real-World Implementation: Flax integrated into hospital meals, with multidisciplinary input (dietitian, nursing, catering, OT/PT). Highlights flax’s dual soluble/insoluble fiber benefits (bulk-forming, peristalsis stimulation) and advantages over bran (less risk of mineral malabsorption).
• Positive Outcomes: Clear reductions in laxative reliance, improved bowel frequency, and financial benefits—supporting flax as a safe, long-term option for elderly constipation management.
• Emphasis on Hydration: Acknowledges key limitation (no detailed fluid monitoring) and stresses 1.5L/day fluid intake to avoid risks like impaction with bulk fibers.

Limitations

• Small Sample and Design: n=23 completers; no parallel control group, placebo, or blinding—prone to bias (e.g., expectation effects, changes in care over time).
• Subjective/Observational Measures: Bowel charts rely on nursing documentation; laxative adjustments individualized (not standardized).
• No Detailed Stats: No p-values, confidence intervals, or subgroup analyses provided. Fluid intake not rigorously tracked—a critical confounder, as dehydration worsens constipation and bulk fibers require adequate fluids.
• Generalizability: Hospitalized, mostly immobile/post-stroke elderly; may not apply to community-dwelling or less frail older adults.
• Publication Level: Appears as a conference presentation/abstract or professional article rather than peer-reviewed journal paper, limiting scrutiny.

Overall Assessment and Relevance Today

This early 2000s Irish hospital study provides supportive, pragmatic evidence that adding ground or whole flax (10–20g/day) to the diet can effectively reduce constipation symptoms, laxative dependence, and costs in hospitalized elderly patients. It aligns with broader evidence (e.g., later RCTs showing flax superior to psyllium in some constipation contexts and benefits for gut motility/SCFA production). The findings remain relevant, as constipation persists as a major geriatric issue, and natural fiber interventions are preferred over chronic laxatives to avoid side effects.

Key takeaway quote from the article: “The inclusion of linseed [flax] in patients’ diet (1-2 dessertspoons) was a safe, practical, relatively simple and effective measure to manage constipation in the elderly. Significant improvements were observed in terms of cost-effectiveness and reduction in use of rectal preparation.”

If people have a particularly low fibre diet or have limited mobilty flax is a good solution and well tolerated but a conservative start to including it in the diet is recommended.  For modern use: Start with 1 tbsp ground flax daily (better absorbed), increase gradually to 2 tbsp, always with plenty of water (at least 1.5–2L/day) to prevent issues.  Can be taken twice per day.  Consult a healthcare provider, especially for those on medications or with swallowing difficulties. This study is a solid early example of evidence-based dietary management in geriatric care.