Deciphering the anti-constipation characteristics of palm dates (Phoenix dactylifera): a review

ABSTRACT Phoenix dactylifera, commonly known as palm dates, is an inexpensive dietary staple in many countries. It is rich in many nutrients and bioactive chemicals, which are responsible for its health benefits. Folk medicine has suggested that P.dactylifera has potent anti-constipation effects. Although many studies have investigated its physiological mechanisms and phytochemistry against diseases like colon cancer, hypertension and diabetes mellitus, research unraveling this fruit’s laxative properties is limited. Studies characterizing the phytochemical, micromolecular and macromolecular composition of Phoenix dactylifera revealed numerous compounds with anti-constipation properties. The flavonoid, phenol, dietary fiber and mineral content were identified as the likely protagonists collectively contributing to Phoenix dactylifera’s laxative properties.


Introduction
Constipation is the sixth most commonly reported gastrointestinal (GI) disease, [1,2] and is defined as the 1) inability to pass less than 35 g of stools daily; 2) less than 3 bowel movements in 7 days; 3) a fecal water weight of less than 70%; and 4) a gastrointestinal (GI) transit time of more than 5 days by the Rome IV Criteria . [3]Constipation significantly impacts individuals' quality of life (QOL) and accounts for a prevalence between 14-30% in the general population . [4,5]onstipation can be broadly categorized into two main groups: functional and somatopathic constipation.Functional constipation (FC), also referred to as primary constipation is not caused by other diseases.It may be due to a prolonged colon passage, defecation disorder, poor intake of fluids or dietary fibers, medication (ex.opioids, antipsychotics, diuretics and anticonvulsants) or situational factors like a way of life, lack of exercise/immobility . [1,5]Contrary to FC, somatopathic constipation occurs secondary to diseases such as diverticulosis . [1,6]Once secondary causes of constipation are excluded, lifestyle adjustments like increasing dietary fiber and fluid intake are suggested.However, more often than not, patients may be prescribed medication with anti-constipation properties to alleviate their symptoms and increase gastrointestinal motility . [7]urgatives, laxatives and cathartics all fall under the umbrella of anti-constipation medicines.Whilst all three classes work to increase defecation, they differ in their action intensity.Purgatives have a stronger action resulting in more fluid evacuation from the rectum whilst laxatives act slower to relieve acute non-dietary constipation.Therefore, laxatives are milder than purgatives.Cathartics which promote the evacuation of the colon, are even stronger in action than the two.Thus, cathartics are the most intense followed by purgatives and finally laxatives . [8]Laxatives are composed of chemicals to increase stool motility frequency . [9]They are the commonest class of medicines which are normally prescribed against constipation due to their stimulatory effect to defecate which is brought about through increased water and electrolyte transport into the bowel mucosa whilst softening hardened feces too.Laxatives can be loosely classified into seven types as demonstrated in Table 1 . [10,11]Since most laxatives are available as over-the-counter medication, they are often purchased to self-manage constipation resulting in low drug compliance and effectiveness . [10]espite laxatives' widespread availability, the gold standard initial management for functional constipation is a nonpharmacological approach encompassing dietary and lifestyle interventions . [6]n fact, patients are leaning more toward accessible over-the-counter botanical supplements and natural remedies as to modern drugs.This paradigm reflects folklore passed down through generations which details traditional remedies that may be employed to treat constipation . [2]Recent studies have extensively investigated the beneficial properties and biochemical mechanisms of such treatments, notably the use of Aloe vera and Senna as anti-constipation remedies . [2]Folklore from countries around the world, highlight Phoenix dactylifera, commonly known as palm dates, as a potent natural remedy against constipation.
To our knowledge, no published literature has described the components, and their respective mode of action, that are responsible for mediating the anti-constipation properties of this fruit . [2,12]ur review addresses this gap in knowledge by providing an updated overview of the physiological mechanisms within the human body of the known constituents found in Phoenix dactylifera that potentially contribute to the fruits' laxative properties.Recent relevant literature was identified by using combinations of free text keywords pertaining to Phoenix dactylifera, its constituents and their mode of action in PubMed and Google Scholar databases.Table 1.A summary of the types of laxatives available and their characteristics . [1,3]The table describes some of the commonest classification of laxatives and their characteristics that are clinically used to treat patients suffering from constipation.As observed most laxatives act by increasing fecal volume and GI transit time whilst simultaneously softening stools.

Type of laxative Characteristic Bulk-forming laxatives
• Slightly absorbed in the gut • Composed of natural or synthetic polysaccharides • Improves water absorption in the bowel, increasing the volume and softness of feces as a consequence.
• Promotes the dilation of the intestinal wall and thus propulsive motor function.

Osmotic laxatives
• Are not reabsorbed during bowel transit.
• The first drug of choice to manage FC.
• Hypertonic in nature and promotes an increase in fluid contents in the intestinal lumen to soften feces.
• Is not digested in the small intestines.
• Promotes an increase of peristaltic movements in the colon.
• Enhances water retention in the bowel and fecal volume and softness is increased.
• Does not cause fluid and electrolyte loss.
• Softens stool and increases its volume.
• Increases colon transit

Stimulant laxatives
• Consists of anti-reabsorptive and secretagogue-acting agents that prohibit the reabsorption of liquid and sodium from the bowel lumen.
• Direct impact on the myenteric plexus resulting in enhanced propulsive motor function.
• Their surfactant effect eases the defecatory process.

Methodology
Literature Search Strategy Using PubMed and Google Scholar a literature search was conducted using the key terms, "the pathogenesis of constipation," "the classification of constipation," "the physiological mechanisms of laxatives," "the laxative properties of Phoenix dactylifera," "Phoenix dactylifera as an anti-constipation agent," "phytochemicals as laxatives," "the pharmacokinetics of Phoenix dactylifera," "Phoenix dactylifera and GI motility" and "Phoenix dactylifera and GI transit time."The articles used for this review were primarily selected on the basis of their title and abstract relevance.
Inclusion and Exclusion Criteria Inclusion criteria included studies detailing how the phytochemicals within Phoenix dactylifera exert their laxative properties to prevent and/or reduce constipation.Animal studies supporting such evidence were included in this review.Furthermore, the pharmacological safety and toxic effects of Phoenix dactylifera were highlighted.
Exclusion criteria comprised of any articles detailing Phoenix dactylifera's health benefits and respective physiological mechanisms that were not related to its anti-constipation and/or laxative properties.Articles not related to Phoenix dactylifera but other palm date species were excluded.Articles that were not written in English, contained irrelevant or insubstantial data and articles where the full text was inaccessible were excluded from this review.
Strengths and Limitations An exhaustive literature search for studies detailing the physiological mechanisms of how Phoenix dactylifera exerts its anti-constipation and laxative properties was performed.A total of 71 relevant articles were used in this review out of the 100 articles that were initially deemed appropriate.This review tries to bring together all the present information on the topic discussed.Therefore, it aims to pool all this information in one article, making such data readily accessible for future studies by others.
Due to the gap in knowledge in this area of study, despite the efforts to include as many recent studies as possible, articles from 1980 to 2022 were incorporated into this review.Furthermore, due to the inadequate and insubstantial amount of data and literature present on how Phoenix dactylifera exerts these properties, in-depth explanations of the physiological mechanisms mentioned throughout this review were limited.In addition, human studies depicting such properties by Phoenix dactylifera could not be included since none were present at the time that this review was done.

P. dactylifera plant
[15] This monocotyledon belonging to the Arecaceae family, having over 2,500 species, is known by locals as the Tree of Life since every part of the tree can be used in various applications without anything going to waste . [16]. dactylifera thrives in dry, arid regions in the presence of well-drained soil . [17]They are cultivated all over the globe since they are an excellent source of low-cost food.They are cultivated in large quantities in tropical and sub-tropical regions, particularly in the Middle East and Southwest Asia.Egypt, Tunisia, Saudi Arabia, Algeria, Iran and Pakistan are among the top ten countries that mass produce dates around the globe, whilst Spain is Europe's main date producer . [18,19]. dactylifera's phytochemistry, bioactive components and nutrient composition are responsible for the numerous reported health benefits of the fruit, such as preventing colon cancer [20] and maintaining normoglycemic blood glucose levels . [21]P.dactylifera date fruits may be consumed during any of the three major maturity stages out of five as demonstrated in Figure 1.Khalal (pre-ripe and crunchy fruit), Rutab (ripe and soft fruit) and Tamar (sundried and dried fruit) . [19]Expectedly the chemical composition of the fruit varies during each stage of maturity . [23,24]

Phytochemicals and bioactive compounds with laxative properties
Flavonoids Flavonoids which are found in many plants and fruits have a polyphenolic structure and belong to a class of plant secondary metabolites.There are known to have several health benefits including but not limited to anti-oxidative, anti-inflammatory, anti-mutagenic and anti-carcinogenic properties . [25]n saying this they have attained an essential role in the medicinal, pharmacological and cosmetic industries . [25]s seen in Figure 2, quercetin, is one of the numerous flavonoids that are found in many fruits, including P.dactylifera.It is known for its many health benefits like its anti-constipation properties.As summarized in Figure 3, quercetin is known to exert its anti-constipation role on various levels, such as: manipulating signaling pathways, influencing GI hormone levels and the gut microbiome as well as altering fecal composition.
Quercetin reduces the expression of aquaporin 3 (AQP3) messenger ribonucleic acid (mRNA) as well as the vasoactive intestinal peptide (VIP)-cyclic adenosine monophosphate (cAMP) -protein kinase A (PKA)-AQP3 signaling pathways which are involved in intestinal water reabsorption.Aquaporins play a vital role in controlling the osmosis of water across the colon which would naturally influence the composition of feces.When AQP3 is expressed on the colon's surface, it will cause an increased absorption of water into the vascular system since osmotic pressure in the colon is less . [26]onsequently, due to this water loss in the colon, the feces would become hard causing defection Immature, peasized fruit.
Fruit becomes oblong in shape.
The fruit is green, bitter, hard and unsuitable for consumption.
Fruit becomes yellow or red.
The fruit is mature, hard and ripe.
Water content decreases but sugar content increases.
Fruit become soft and black or brown in colour.
Increased sugar and decreased water content.
Fruit obtains a dehydrated appearance.
Colour of the skin and underlying flesh darken with time.The process for palm date fruits to fully mature following pollination takes approximately 7 months.This process occurs yearly and by the end, a maximum of ten bundles of dates weighing 10 kg each are produced . [22].problems and thus constipation . [26]Thus, the presence of quercetin decreases intestinal AQP3 while down regulating signaling pathways which promote intestinal water reabsorption, which was demonstrated in a recent in-vivo study by Liu & Zhi (2021) who demonstrated that supplementation of quercetin cured loperamide-induced-constipation in rats by increasing fecal water content and weight.Quercetin also promotes the growth of beneficial gut flora, specifically Bifidobacteria and Lactobacillus, while inhibiting the growth of harmful bacteria like Enterococcus and Fusobacterium.In doing so, the synthesis of butyric acid (form acetic acid) and short-chain fatty acids (SCFAs) is increased which improves ileal propulsive contractions.SCFAs promote ileal propulsive contractions by inducing prolonged propagated contractions and discrete clustered contractions . [26,29]Thus, SCFAs can directly stimulate ileal and colonic smooth muscle contractility . [27]This enhancement of gut motility by SCFAs may involve the release of intestinal serotonin which is released by activated colonic enterochromaffin cells.This will promote laxation by stimulating secretion and propulsive motility . [30]evels of the GI hormones which promote motility and peristalsis namely motilin, gastrin, acetylcholine esterase (AChE) and substance P were increased following the administration of quercetin at 25 mg/kg and 50 mg/kg in loperamide-induced constipation in rats . [26]Conversely, quercetin suppressed the production of the inhibitory GI hormones, somatostatin and VIP, achieved by upregulating the receptor tyrosine kinase (c-kit), stem cell factor (SCF) and glial cell line-derived neurotrophic factor (GDNF) pathways whilst downregulating the transient receptor potential cation channel subfamily V member 1 (TRPV1) and nitric oxide synthases (NOS) pathways as depicted in Table 2 . [26]part from quercetin increasing GI transit time and defecation, it also induces histological changes.In constipated animal models, the thickness of the transverse colon layer, mucus layer, muscle and flat luminal surface was observed to be thinner than normal.These layers had improved to a healthier thickness as did mucin production upon quercetin administration . [28]henols Phenols which are secondary plant metabolites have several health benefits such as acting as an antioxidant, anti-inflammatory and anti-constipation agent . [19][28] .
hydroxyl group attached to a 6-carbon aromatic ring . [32]P.dactylifera's phytochemical composition includes numerous phenols, which contribute to the fruits' laxative properties.Caffeic acid (CA) which is depicted in Figure 4, is produced by several plant species and is also found in many daily products like coffee, wine and tea . [33]Apart from CA exhibiting anti-oxidant, anti-inflammatory and anti-carcinogenic properties, it also promotes intestinal motility and increases GI transit time by downregulating nitric oxide synthase (NOS) gene expression.Consequently, the production of nitric oxide (NO) is suppressed.NO is responsible for controlling GI motility through the relaxation of GI smooth muscles and its vasodilatory activity.Thus, NO suppression would result in increased intestinal peristalsis and thus enhanced GI motility . [34]Caffeic acid is also considered a prokinetic agent as it can depolarize the interstitial cells of Cajal (ICC) in the murine small intestines which are considered the pacemaker cells of GI motility.However, further research is required to attain a better understanding of the mechanisms of how caffeic acid influences GI contraction where the ICC are concerned . [35]ble 2.The effects of quercetin on GI hormones and mechanistic pathways . [26]Quercetin influences the levels of many GI hormones as well as several mechanistic pathways that influence GI motility.In each case, the overall effect of quercetin is to ensure healthy intestinal mucosa by repairing any damage brought about by constipation, improving GI contractility and motility and finally relieving constipation . [26,31].

Hormone/ Pathway affected by quercetin Action brought about Motilin levels increased
Motilin affects water and electrolyte transport.This induces the secretion of pepsin, promoting gastric contractions and small intestine segmental movement.Overall, intestinal transfer time and colonic movement are increased.

Gastrin levels increased
This hormone induces the secretion of gastric acid and pepsinogen into the stomach.It also promotes the growth of the digestive tract mucosa, the contraction of the GI smooth muscle and the relaxation of the pyloric sphincter.Therefore, it aids in relieving constipation.

Somatostatin levels reduced
It decreases the release of GI hormones like motilin and gastrin.This results in the small intestinal transit time becoming significantly slower.Substance P levels increased Substance P modulates the contraction of the GI tract, intestinal motility and gastric acid secretion.This accelerates GI transit time.

Acetylcholine esterase levels increased
Regulates GI muscle contraction and mucus secretion.This relaxes colonic and rectal muscles too, to allow defecation to occur more smoothly, thus relieving constipation.

Downregulates TRPV1 and NOS pathways
Activation of TRPV1 results in the production of neurotransmitters like nitric oxide which promotes muscle relaxation.Consequently, this would lead to an intestinal motility disorder and thus constipation.By downregulating the expression of TRPV1 and NOS (NOS results in nitric oxide production), GI repair is promoted, relieving constipation since some of the damage is being repaired.Upregulates the mRNA of c-kit and SCF c-kit and SCF promote the proliferation, growth and reproduction of the interstitial cells of Cajal which influences GI function and intestinal neural transmission, thus having a positive impact on GI motility.Since in constipation the cells are negatively impacted (i.e.their density is decreased), quercetin upregulates their production via c-kit and SCF pathways.This consequently results in improved GI neural transmission and thus improved GI motility.Upregulates the GDNF pathway Ganglion cell function is regulated.Furthermore, by upregulating this pathway, intestinal damage caused by constipation is repaired, relieving constipation symptoms.Gallic acid, ferulic acid and chlorogenic acid as shown in Figure 5, are additional phenols present in P.dactylifera that also promote GI transit . [31]Similar to quercetin, these phenolic compounds influence the gut microbiome by promoting the colonization of beneficial bacteria whilst suppressing the habitation of pathogenic flora which summatively enhances GI transit . [31,36]In addition, gallic acid regulates NO synthesis by regulating the genetic expression of NOS whilst ferulic acid (FA) increases gastric emptying . [31,37]As demonstrated in a study, FA dose-dependently stimulates the basal tone of isolated rat fundus (at 0.05 mmol/L) and isolated Guinea pig ileum (at 2-20 μmol/L) . [34]his particular effect is aided by the release of endogenous prostaglandins from the gastric and intestinal mucosa.Therefore, FA has a prokinetic effect on the gut . [34]Chlorogenic acid promotes the production of colonic serotonin which consequently enhances GI motility, resulting in improved defecation . [38]This not only promotes intestinal motility but since chlorogenic acid repairs intestinal barriers it aids in maintaining gut health and integrity, preventing the colonization of parasitic bacteria . [39]llic acid Ferulic acid Chlorogenic acid

Dietary fiber content and its contribution to p.dactylifera's laxative effects
Dietary fiber (DF) is defined as the consumable part of a plant which is not hydrolyzed and digested by enzymes found in the GI tract.This encompasses cellulose, pectins and non-starch polysaccharides among other macromolecules . [40]The recommended daily intake of DF is 25 g/day.A low dietary fiber intake is associated with an increased risk for constipation.Consumption of P.dactylifera dates can contribute to up to 32% of the required daily DF.Hence the inclusion of P.dactylifera date fruit in one's diet may help increase fecal mass, adding to the fruit's laxative properties as depicted in Figure 7 . [14]F in P.dactylifera is an amalgamation of polysaccharides and oligosaccharides which form both insoluble and soluble fibers . [15]The DF in dates can range from less than 1.9% to over 20.5% of the fruit's weight depending on the date species and its stage of maturity.Approximately 84-94% of the DF present is composed of insoluble fiber, while the remaining 6-16% makes up the soluble fiber . [17]ate seeds, which are often used in food processing, have a greater amount of DF amounting to 67-74% . [17]eta-glucan, a subunit of insoluble DF, has a very strong laxative effect.As depicted in Figure 6, it is composed of D-glucose monomers linked by beta-glycosidic bonds, [44] and is considered a substrate for intestinal flora.It can restore microecological balance which aids in overcoming intestinal dysbiosis as observed in constipation.One way in which beta-glucan shifts the metabolic state toward energy production is via the increased production of SCFAs via gut microbial fermentation . [41,42]By

Irritates the gut mucosa
This induces water and mucus secretion in the colon, increasing laxation.
Stimulates substance P, serotonin and AchE production.
This maintains mechanical intestinal barries and the integrity of the mucus membrane.
Inreases the epxression of tight junction proteins, ensuring intestinal integrity.

Soluble Fibre
Has a remarkable water-holding capacity.
Promotes stools to be evacuated more smoothly.
Repels digestions by the gut flora.
Thus, increases the bulk and water content of the feaces.
stimulating the expression of substance P, serotonin and acetylcholinesterase, beta-glucan ensures the repair of mechanical intestinal barriers and the integrity of the mucous membrane . [43]Intestinal integrity is ensured as beta-glucan increases the expression of tight junction proteins.Through this, GI motility is maintained as well as via the regulation of the immune system and microbiota . [42]nsoluble fiber has also been reported to irritate the gut mucosa, which in turn stimulates water and mucus secretion in the large colon.Similarly, soluble fiber has a significant water-holding capacity that resists dehydration resulting in the formation of a gel-like surface in the gut.Thus, since fiber repels digestion by the gut microbiome and increases the viscosity of the GI tract, it allows stools to be excreted more smoothly and efficiently, as it adds mass, water content and weight to the feces . [42,43]herefore, it is safe to say that the DF within P.dactylifera can act as a prebiotic, since it is a nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of health-promoting bacteria in the colon, thus improving the host's health . [17]gnesium content and its contribution to p.dactylifera's laxative effects Magnesium (Mg 2+ ) as seen in Figure 8, is the fourth most abundant cation in the body serving as a vital cofactor for over 600 enzymes in the body, [45] and the Required Dietary Allowance (RDA) for Mg 2+ in adults is 410-420 mg/daily in males and 310-320 mg/daily in females .[46] The Mg 2+ content in P.dactylifera is approximately 68 mg/100 g which thus contributes to 15% of the total RDA.Mg 2+ can form sulfate or citrate salts, which increases water retention within the bowel due to its osmotic effect and since magnesium is not completely absorbed by the gut.This indirectly alters GI motility.Mg 2+ also promotes peristalsis and regularizes bowel movements, relieving constipation .[47] The laxative effect brought about by Mg 2+ is also attributed to the mechanisms involving the function of cholecystokinin and peptide YY endocrine secretions which amplify the expression of NOS and the antimicrobial action of Mg 2+ .Thus, the anti-constipation effects of Mg 2+ are attributed to increasing stool frequency and not stool consistency .[45] Figure 8.The atomic structure of magnesium.
Animal studies demonstrating p.dactylifera's laxative property Al-Qarawi et al. (2003) demonstrated that undialyzed ethanol and water extracts obtained from the flesh and pit of P.dactylifera dates increased GI transit by 4-22% in mice in a dose-dependent manner.However, the GI transit was decreased by 4-24% when a water extract from dialyzed date flesh was used. . [48]Yasin et al. (2015) similarly reported that 0.02 and 0.04 mL/kg of aqueous date flesh extract, ethanolic date flesh extracts (0.01, 0.02 and 0.04 mL/kg), aqueous date pit extract (0.01 mL/kg) as well as ethanol date pit extract (0.02 and 0.04 mL/kg) significantly reduced gastric transit time in a dosedependent manner.Contrarily, when aqueous dialyzed date flesh extract was used, gastric transit time increased . [49]tudies have also revealed that the appreciable sucrose and melatonin content in dates as described in Figure 9, increase GI transit too . [48]Sucrose increases the volume of the meal caused by osmotic inhibition of fluid absorption by the unabsorbed carbohydrate.As a result, this induces peristalsis, increasing propulsion . [50]With respect to melatonin, although the exact mechanism through which it regulates GI motility has not yet been established, it is believed that melatonin increases GI transit time by blocking nicotinic channels that respond to acetylcholine and/or via the interaction between melatonin and calcium-activated potassium channels . [51]imilarly, another in-vivo study conducted on rats showed how aqueous date pulp extract (150 and 300 mg/kg), dose-dependently increased GI transit activity more significantly than palm sap . [52,53]his supports the ethnomedicinal theory that P.dactylifera dates can function as natural laxatives . [54]armacological safety of p.dactylifera[57][58] In fact, doses as high as 5,000 mg/kg of the aqueous date extract resulted in no mortality or toxicity symptoms being observed in the group of animals it was subjected to.Only mild liver histological changes were noted which were reversed after 3 weeks . [55]nother study on P.dactylfera's toxicity, similarly supported the fruit's safety, since animal autopsy revealed that no harm was done to any vital organs, no physiological function disturbances were noted and no hazardous toxins were detected . [56]t is traditionally believed, especially in Eastern Countries, that to obtain the maximal laxative effects in dates, one must soak 5 to 6 dates in water and leave them submerged throughout the night.The syrup produced is drunk the following morning.This should help relieve constipation and improve GI health . [15,59]Although literature pertaining why P.dactylifera syrups work more effectively as laxatives than their counterpart fruit is very limited and the underlying mechanism is not yet known, it can be speculated that the syrup produced upon soaking the dates is rich in various liberated bioactive chemicals, particularly magnesium.As previously discussed and as seen in Table 3,  Dietary fiber DF restores microecological balance in the gut, shifts the metabolic state toward energy production, ensures intestinal integrity and stimulates the expression of substance P, serotonin and acetylcholinesterase.It also increases the mass, water content and weight of feces.

Sucrose Melatonin
Overconsumption of soluble fibers can result in injury to the distal colon and enhancement rather than suppression of tumorigenesis.This may be due to the significant increase in fermentation in the proximal colon with poor delivery of health-promoting fermentation products in the distal colon.This overfermentation may also lead to toxic product production like sulfides which are toxic to colonic epithelium.Thus, the recommended dietary intake shouldn't be overly exceeded to prevent unwanted harm.[42,44,65]   Magnesium Magnesium increases water retention in the bowel, promotes peristalsis and regularizes bowel movements, increasing stool frequency.
When magnesium levels reach 5-10 mEq/ L, ECG abnormalities occur including prolonged PR interval and widened QRS interval.At greater concentrations, side effects will worsen including muscle weakness and respiratory paralysis.[45,66]   Melatonin Regulates GI motility and increases GI transit time by blocking nicotinic channels or by interacting with calcium-activated potassium channels.
Although literature supports the general notion that melatonin is relatively safe, doses greater or equal to 10 mg of melatonin increase the probability of adverse events like tiredness, fever and diarrhea.[51,67]   Sucrose Increases meal volume and induces peristalsis promoting GI motility.
Whilst sucrose can aid GI motility, overconsuming products rich in this sugar can contribute to dental carries and tooth decay and negatively impact insulin sensitivity.Date fruits have a total sugar content of about 78.6%.This is mainly composed of fructose and glucose with a small amount being sucrose.Seeing the great amount of natural sugars this fruit has, they should still be consumed in moderate amounts.[50,68,69]  magnesium plays a vital role in increasing stool frequency and thus this may be why the syrup has a greater overall effect in relieving constipation . [70]urthermore, a product containing 40 mL of dates syrup, 10 mL of fig paste, 1 g of pectin, 0.25 g of ginger extract and 10 mL of barley water and wood apple juice had not only revealed to be greatly accepted by consumers with respect to its sensory characteristics but also to be rich in fiber, iron, phosphorus, calcium and magnesium.The syrup was also naturally sweet, unlike most modern laxatives which have artificial sweeteners making them addictive as well as aversive to one's health.Therefore, this syrup showed great potential to treat GI disorders like constipation . [71]

Concluding remarks
This review has established a better understanding of how P.dactylifera may exert its laxative properties.Seeing the similarities that have been drawn between its physiological function and those of modern laxatives depicted in Table 1, it is evident that both P.dactylifera dates and modern laxatives exert their mechanistic function in similar ways to relieve constipation.For instance, bulk-forming laxatives can be said to mimic DF since they are polysaccharide-based and increase the water content and mass of feces, allowing an easier transit of the stools through the bowel.Similarly, osmotic laxatives work by increasing the water content in feces just like quercetin, fiber and Mg 2+ do.Furthermore, these laxatives have Mg 2+ salts which are similar to those formed by the Mg 2+ in Phoenix dactylifera.Likewise, the laxative, macrogol, stimulates defecation, softens stools by increasing water content and promotes colon transit.This is comparable to the nature of how the various bioactive constituents in P.dactylifera exert their function.
In conclusion, as evidenced by a large body of published literature, the laxative properties of P. dactylifera dates are not the result of one particular phytochemical but rather the accumulative effects brought about by the various phytoconstituents, ranging from minerals to phenols to fiber.It is evident that P.dactylifera dates have great potential to lead to the development of a plant-based laxative drug to combat constipation.However, more research and clinical studies are required to attain a better understanding of P.dactylifera's laxative properties, physiological mechanisms, efficacy and safety.

Disclosure Statement
No potential conflict of interest was reported by the author(s).

Figure 1 .
Figure 1.The five maturity stages of the palm date fruit adapted from Baliga et al., 2011; Morita et al., 2017.The process for palm date fruits to fully mature following pollination takes approximately 7 months.This process occurs yearly and by the end, a maximum of ten bundles of dates weighing 10 kg each are produced .[22] .

Figure 2 .
Figure 2. The chemical structure of quercetin.

Figure 4 .
Figure 4.The chemical structure of CA.

Figure 5 .
Figure 5.The chemical structures of gallic acid, ferulic acid and chlorogenic acid.

Figure 6 .
Figure 6.The chemical structure of beta-glucan.

Figure 9 .
Figure 9.The chemical structures of sucrose and melatonin.

Table 3 .
A summary of the bioactive chemicals in P.dactylifera that contribute to its laxative properties.As depicted below the laxative property of P.dactylifera is a cumulative effect of several bioactive phytochemicals rather than one chemical alone.