{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:01:54Z","timestamp":1790226114188,"version":"4.1.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Introduction<\/jats:title>\n Functional constipation is one of the most common disorders of gut\u2013brain interaction. Adequate hydration is recommended as first-line therapy, yet evidence regarding the efficacy of sulfate- and magnesium-rich mineral water remains limited. Therefore, this study investigated its efficacy and safety in a nationwide decentralized randomized controlled trial.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this randomized, double-blind, controlled parallel-group trial, adults with chronic constipation according to the Rome IV criteria consumed either 1\u202fL\/day of sulfate- and magnesium-rich mineral water (HSM) or a low-mineralized control water (LSM) for 3 weeks following a one-week run-in period. Participants maintained a total daily fluid intake of at least 1,5L\/day. The primary outcome was the change in weekly bowel movement frequency after 3 weeks. Additional analyses were conducted after 2 weeks of intervention. Secondary outcomes included stool consistency, responder rates, time to treatment response, constipation-related symptoms (PAC-SYM), constipation-related quality of life (PAC-QoL), gastrointestinal transit time, laxative use, and safety.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After 2 weeks (additional analysis), bowel movement frequency increased significantly more in the HSM group than in the control group (mean change: 1.31\u202f\u00b1\u202f3.24 vs. 0.34\u202f\u00b1\u202f2.49 bowel movements\/week;\n p<\/jats:italic>\n \u202f=\u202f0.043). This effect was more pronounced in participants with moderate-to-severe constipation (\n p<\/jats:italic>\n \u202f=\u202f0.022). No significant between-group difference was observed at the end of week 3 (\n p<\/jats:italic>\n \u202f=\u202f0.144). Time to treatment response was significantly shorter with HSM water than with control water (median 9 vs. 16\u202fdays;\n p<\/jats:italic>\n \u202f=\u202f0.042), accompanied by a higher responder rate in participants with moderate-to-severe constipation (\n p<\/jats:italic>\n \u202f=\u202f0.043). No significant between-group differences were observed for stool consistency, constipation symptoms, quality of life, or gastrointestinal transit time. Both interventions were well tolerated, and only mild transient adverse events were reported.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Daily consumption of 1\u202fL of sulfate- and magnesium-rich mineral water, combined with adequate hydration, improved bowel movement frequency at week two and accelerated treatment response in adults with chronic constipation, whereas the between-group difference at the registered primary endpoint (week three) was not statistically significant. These findings suggest that sulfate- and magnesium-rich mineral water may serve as a safe, non-pharmacological dietary approach for the management of chronic constipation under real-world conditions.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n \n https:\/\/clinicaltrials.gov\/<\/jats:ext-link>\n , DRKS00034871.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1924028","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:37:51Z","timestamp":1790224671000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Daily consumption of sulfate- and magnesium-rich mineral water enhances bowel function in adults with chronic constipation: a randomized double-blind real-world trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Katharina","family":"Mansouri","sequence":"first","affiliation":[{"name":"Institute of Food and One Health, Leibniz University Hanover","place":["Hanover, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Hanh","sequence":"additional","affiliation":[{"name":"Independent Researcher","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronja","family":"Meyer","sequence":"additional","affiliation":[{"name":"Institute of Food and One Health, Leibniz University Hanover","place":["Hanover, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Hahn","sequence":"additional","affiliation":[{"name":"Institute of Food and One Health, Leibniz University Hanover","place":["Hanover, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1016\/j.cgh.2013.12.005","article-title":"Efficacy and safety of a magnesium sulfate\u2013rich natural mineral 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