As a general rule, you should have at least one preferably two motions daily, and not too far away from your meals either. If you do not at least have one bowel motion each and every day, or if you have inconsistent motions - in terms of how often (frequency), how they look (texture) then you have constipation. In this article we will explore some causes and effects of constipation, and also take a look at how some diets can be a real problem with this annoying complaint and I'll also give you some tips on how to improve this complaint. I have yet to find a case yet which cannot be corrected with natural methods, and over 90% of constipation will respond to simple adjustments in lifestyle. The doctor's answer is generally either a laxative, or a fibre supplement like Metamucil®. I've got a better idea, let's find and treat the actual cause of the constipation. Some practitioners would define constipation as the passage of a hard stool. Whilst another therapist I once knew told a patient that it was perfectly acceptable for her to have a bowel motion every ten days, if that was normal for her! In my opinion, it is the frequency and texture of your bowel motions which are all important factors, not the term constipation, which will always remain arbitrary. The frequency of bowel motions (how often you go) is important because it tells me how good your gut is functioning, and also how well your 'gastro-colic reflex' is working. Of course we are not taking account here if you have acute diarrhoea from an infection or parasites, giardia, appendicitis, etc. When you eat food it passes from your mouth down the oesophagus and into your stomach. The stomach then tells the colon to empty, and this is why (you should) after a meal feel like going to the toilet. This communication between the top end of the digestive system and the bottom end is called the 'gastro-colic reflex'. In other words, the top tells the bottom that it must empty, because there is food coming down its way.
The Eyeball Test
OK, let's get over it, poo, bottoms, toilets - this is an area we are not comfortable with, let alone talk about. Do you ever look at your bowel motions? I call this the eyeball test. It surprises me how many patients I speak with do not look at their motions. Do look regularly, it will give you a valuable insight into how your digestive system is functioning.
The texture of the stool is important, and will determine not only how easy the motion is passed, but can also tell us a lot about the actual health of your digestive system. The longer a motion is in the bowel, the more likely that it will become increasingly dry by way of the bowel absorbing water from it, and therefore make the motion much more difficult to pass. Very loose stools on the other hand, can pass much too easily, and have not been long enough in the bowel to firm up, you will know all about this with a campylobacter infection. Take a look at the Bristol Stool Chart, it was developed by Dr.Heaton at the University of Bristol and was first published in the British Medical Journal in 1990. If you are in category 1 - 2, you are quite constipated indeed. No. 3 is starting to look more like a normal motion. I'll bet many out there can relate to the "snake" motions in No. 4, this tells me that you are having problems with peristalsis and/or constipation, particularly in the recent past. Colonics are great for restoring the bowel in this situation. Peristalsis basically means a distinctive pattern of smooth muscle contractions that propels foodstuffs and through your esophagus and intestines. Stress has quite an amazing effect here, and this is why many will be able to relate to snake like motions - periods of stress have a potent effect on impairing the peristaltic effects in your bowel. Perhaps you felt "gutted" about something? Stress draws blood away from the gut towards the muscles. This in turn can slow digestion and peristalsis down considerably, then constipation occurs. Will a laxative work here?, don't waste your time, try a chill pill instead.
Have you noticed that when animals eat, many will want to have a motion not long after? You will commonly find this with young children as well. They have a very active gastro-colic reflex, and in my experience the elderly have a poor one. As adults, many unfortunately "hang on" until the last minute - we all have something too important, and go to the toilet when it is more convenient to actually do so. I have found this to particularly so with the always busy people with occupations like real estate, taxi, truck or courier drivers, shop keepers, etc. Many have consulted me over the years with bowel issues - generally constipation.
If you ignore the subtle signs of "needing to go" long enough, your bowel can become quite lazy, and so will you. And then when you really want to go - your bowel won't! So what are you going to do from now? If you feel like going, you should GO.
Constipation Cause
Diet & Lifestyle
The most common cause of constipation in Western culture would have to be a lack of dietary fibre combined with a poor sedentary lifestyle. I can remember years ago reading a book about the San Bushmen of the Kalahari Desert in Africa. These little bush people are hunter-gatherers who for many thousands of years have supported themselves living in the desert. They hunt mainly various kinds of antelope, but their daily diet has always consisted more of the fruits, nuts and roots and seeds which they seek out in the harsh desert. It has been found that the bushmen pass many small motions daily, rather than their Western counterparts, who go on average once daily. The bushmen rarely if ever suffer from any type of digestive problem because of their naturally whole food and high fibre-based diet. We have not only slowly reduced our fibre intake over the years, and eaten a diet increasingly high in processed foods with substantial amounts of sugar, salt and fat, we have also adopted strange diets to control our weight which include little fibre, low carbs and high protein.
For many years, fat was public enemy # 1, but the Atkins and South Beach diet gurus are blaming obesity on primarily eating too many carbs. Bread sales are down, people have become more reluctant to buy the humble spud. Pasta makers in the USA were so panicky recently that they actually sponsored a conference of scientists and nutrition experts to say that their product is healthy. On the other hand, eggs, formerly shunned for cholesterol, are selling more than ever. Animal protein has all of a sudden become king of the hill - and so have the health problems associated with it.
These diets started the "low GI" craze around the world as millions embraced the South Beach and Atkins diets. The drug companies even jumped onto this bandwagon, battling for a market once dominated by our older citizens, the market for dietary laxatives. Because many Kiwis have gone completely carbo crazy in diets that are low in fiber and high in fiber-less animal protein, they are also less likely to face a big movement - towards the bathroom. As a result, sales of fiber laxatives in NZ were booming by 2004, when the high-protein & low carb craze was at its height. Hopefully, Atkins and the South Beach diet are passing food fads. If not, Kiwis may awake one day to find that they are not only more obese but they have numerous digestive health problems like constipation, kidney stones and hemorrhoids & high cholesterol caused by these diets. It is interesting to note that both diets were developed by medical doctors, and not naturopaths. Have these diets really contributed to excellent health in those who created them? Questions arise about the personal health of both these doctors. Dr. Atkins death was supposedly the result of a fall, but doubts have surfaced about his health at the time of his death at age 72.
The Atkins Diet
How many people have tried the Atkins diet and ended up fatigued, muscle aches & pains, constipated or with other digestive problems? I'll bet many of you out there can relate to this, after going onto a low carb and high protein diet, high in saturated fats and cholesterol. Dr. Atkins can't help but concede the health benefits associated with fiber, in his own words: "plenty of fibre can be found in vegetables, nuts and seeds, fruits, beans and whole unrefined grains" The 2 week "Induction phase" of this diet tells you to completely avoid the starchier carbohydrate foods - the ones that most Kiwis like to eat, the foods which help to bulk up the bowel motions: breads, pasta, carrots, corn, parsnips, peas, potatoes in all forms and squash, but pumpkin is allowed. In addition, this diet also allows a person to have 2-3 tablespoons of heavy cream or one ounce of sour cream daily, along with lashings of meats, eggs and bacon. No wonder this is a popular diet with Kiwis, but spare a thought for your poor bowel and liver and kidneys groaning under the strain. The fatty tissue of an animal is also generally where the toxins are stored, so this is not my favourite way to encourage a patient towards a healthier diet and permanent weight management. Atkins is certainly not ideal for vegetarians or vegans as it is a meat-heavy based (protein) diet. This diet has been linked in the States to osteoporosis, heart disease, colon cancer and kidney disease. It is also below the recommended daily values for several vitamins and minerals such as calcium, potassium and magnesium.
I know that there will be many people out there who have benefited short-term from this approach, but I'll bet there are probably many more who didn't benefit at all long term. According to medical examiner's reports, Atkins had a history of heart disease and heart attacks. His weight of 129 kg would have placed the 6-foot-tall doctor in the obese category, perhaps a good candidate for.....a healthy weight loss program?
Dr. Atkins was well aware of the constipation link to his high protein diet, and therefore recommend that all his followers start taking products like Metamucil ® or Splenda ®). (both containing toxic aspartame). During the induction phase, the Atkins diet may also have a strong diuretic effect for some of its followers, which means a loss of a large amount of water causing a reduction in weight, along with a loss of valuable electrolytes which contain the minerals potassium, magnesium and calcium. This is what causes the leg cramps, and fatigue and weakness many are familiar with this dietary approach. This is why you initially feel good, you loose weight, your energy is up. But this is all short lived, you then start to get tired and grumpy and your bowels play up. The best way to replace these minerals is to add (a little) sea salt to your food to taste and take a chelated mineral supplement (preferably in citrate form) that includes calcium, magnesium and potassium. Also, make sure this supplement contains plenty of trace elements and vitamins, to allow the liver to process the fat & protein more effectively. Many Atkins critics are skeptical of how a high-protein, high-fat diet can result in weight loss - permanently. Like ALL diets, research shows that people can keep off weight lost with Atkins, as long as they don't go back to eating the way they used to eat. In my experience, most people tend to gravitate slowly back towards the foods they used to eat before they started the diet anyway. And the weight slowly comes back again - no wonder that weight-loss franchises are popping up around town like mushrooms. It has always been my belief that any effective permanent solution to weight management must also address your emotional challenges, including food cravings and addictions, self-image issues and other self-sabotaging behaviors. These psychological issues are not addressed in both the Atkins' or South Beach Diet books.
The South Beach Diet. Also called the "Atkins Lite". The Tufts University Health and Nutrition Letter commented on the South Beach Diet in their May 2004 issue: "Disappointingly, the South Beach Diet, developed by a Dr. Agatston, is simply yet another version of Atkins wrapped within a gimmick." Like Atkins, there are different phases in South Beach Diet. You eat normal portion sizes in Phase 1, but just about all carbohydrate are restricted. Like Atkins, this is the strictest phase in the diet and will last for two weeks, and instead of lots of red meats, bacon, etc, this diet emphasises lean meats such as chicken, turkey, fish, and shellfish. Low GI vegetables are allowed as well as low-fat cheese, nuts and eggs. Dieters should expect to lose somewhere between 4 to 6 kilos, but again, is it any wonder you get constipated on this regime? Here we go again - shades of Atkins, you stop all carbs such as breads, pasta and potatoes. You are told to eat plenty of protein (meats) as well as low GI vegetables (greens) which you don't normally eat in these amounts. And of course you get just about completely blocked up.
Dr. Agatston's most significant oversight may be his lack of understanding of trans saturated fats. These artery-clogging fats are to be found in margarine, shortening and many foods such as hot chips, doughnuts and many processed foods, they increase your risk of heart disease and diabetes. Early in The South Beach Diet, Agatston states that trans fats are dangerous; yet, on page 54, he claims that "hot chips and potato chips are actually healthier choices than baked potatoes ".According to Agatston, the glycemic index "measures the degree to which eating a particular food increases your blood sugar and therefore contributes to weight gain." With this logic, a person is better off eating ice cream or a chocolate bar instead of a baked potato because the glycemic index of a potato is higher than the other two.
The high protein & low carb diets have been around for awhile, in 1967, a Dr. Irwin Stillman wrote the "Doctor's Quick Weight Loss Diet," allowing his patients to eat only meat, eggs, and cheese. Stillman himself died of a heart attack, a similar fate to all doctors it seems who advocate this high protein diet approach. Any diet such as this, composed of 90% protein is necessarily short of other vital substances; should you fail to take a vitamin supplement, you run serious risk of vitamin deficiency. Because this diet is low in roughage, you will most certainly be constipated, and although Stillman recommends daily to consume eight glasses of water, it will certainly send you to the bathroom frequently to urinate, not to pass motions! In his book, Dr. Agatston openly admits that he actually takes statin pharmaceutical drugs that are used to lower cholesterol. "I personally take aspirin, fish oil capsules, and a statin drug" he writes.
But Dr. Agatston, you may not be aware that studies around the world have shown that people on a high fiber vegetarian diets can reduce their cholesterol almost as much as people on statin drugs. Perhaps Dr. Agatston would benefit from a high fibre diet, not the reverse. I'll bet that the San Bushmen of the Kalahari have never heard of high cholesterol, let alone a statin drug to lower it.
A detailed discussion of the causes and treatments of constipation goes way beyond the scope of this article, but here are some of the more common ones I see in the clinic. Examples range from conditions such as irritable bowel syndrome, diverticular disease, infection of the abdomen (e.g. a bacterial, parasite problem or appendicitis) to painful anal conditions that make the person afraid to open their bowels both physically or psychologically. The elderly and very young are groups often afflicted with constipation.
Constipation causes
- Improper chewing of food, not paying attention with eating: watching TV or reading whilst eating. This can be a real problem, is this you? If you are finding it difficult to go and you can relate to the TV watching or reading- just turn the TV off or stop reading while you eat! Chewing food to a fine particle size makes sense - it facilitates digestion and absorption, improves peristalsis and bowel function. A quote from the Bible: "Chew your grains until they are liquid".
- Dehydration - not enough water. Probably one of the most common of causes. Aim for 30 mls per kg of bodyweight each day when the weather is hot. You may not be having anywhere near that amount, particularly if you have been quite constipated for years.
- Insufficient intake of dietary fiber The diets above may well fall into this category, too much protein and too little fibre. Keep you fluid intake high and make sure you eat ample fibre.
- Long periods of immobility, stress or depression.- Having regular bowel motions to me is a bit like a woman having a regular period. It comes in cycles, and when things go well they tend to stay well - until something happens. If you have recently had problems in going, look what happened just recently. A change in lifestyle? A separation or divorce, change of occupation? Did you start new medication?
- Medication - Loperamide is an anti-diarrhoea drug which reduces peristalsis and increases intestinal transit time, causing constipation in some. Codeine & morphine are used to control pain but also unfortunately reduce the motility of the stool, and some antidepressants do this as well. Even aspirin can seriously affect the digestive tract, particularly the stomach, liver & small bowel. You may want to get your medications checked out carefully to see if they are a factor in your constipation. So many drugs affect your liver's function, and can cause congestion here.There will be alternatives to drugs in case there is a constipation connection.
- Gallbladder problems - This is an area that comes up so often in the clinic. The 4 F's - flatulent, forty, fat and fertile. Is that you? I find that many women aged between about 35 - 45, they may like chocolate, wine & nibbles like cheese & crackers, and this group is often affected with constipation or a sluggish bowel. When the gallbladder becomes sluggish, your bowel slows down. Bile is produced by the liver & stored in the gallbladder & helps to soften the stool and facilites excretion. Gallbladder removed? - then take digestive enzymes, e.g., fats & oils are not digested/absorbed well by these folk. Take a digestive enzyme when you take a fish-oil supplement, or Vitamin A. Remember the eye-ball test - After you go to the toilet, look! Herbs are awesome here - see your herbalist.
Eric's Top Constipation Tips:
o Eat smaller, more frequent meals and avoid overeating at one sitting. Take time to eat, breathe slowly and chew food thoroughly.
o Try beans as kidney and chick peas, lentils, fresh fruit and vegetables, dried fruits (not too much), If you're not used to eating a lot of fiber slowly increase your intake as you may initially have increased flatulence, gas. Soaking beans first in water (and freezing them after soaking) and discarding the water you soaked them in, may help to reduce flatulence from this group. A hot tip I picked up in the States: add a few drops of Lugol's Solution ® or potassium iodide to the water when you soak beans - you will have less gas. It really works! (unless you are allergic to iodine)
o Reduce your caffeine intake as caffeine may promote constipation by causing you to loose fluids.
o Add unprocessed oat bran to hot cereals and yogurt. Eat bran cereals or shredded wheat, foods made with whole grains.
o Foods that lubricate the intestines - beet, okra, kiwi fruit, seaweed spinach, sesame seed & oil, honey, pear, prune, peach, apple, apricot, walnut, pine nut, almond, alfalfa sprouts, carrot, cauliflower
o Foods which promote motions - cabbage, papaya, peas, sesame seeds, coconut, kumara, asparagus, figs, kiwi fruit
o Herbs & foods that soothe the intestines - marshmallow root, flax seeds, fenugreek seeds, psyllium seeds, licorice root, slippery elm bark
o Good bacteria enhancing foods - miso, sauerkraut, yoghurt, kombucha mushroom, kefir, quark
o Decrease intake of saturated (animal) fats (animal and increase essential fatty acids (cold-water fish, nuts, and seeds). It is best to take Omega 3 (arctic cod liver oil) daily in small amounts)
o Eat more fresh fruits, vegetables and whole grains. Basic stuff, but often taken for granted.
o Drink more water. Warm lemon water taken before meals stimulates digestion. Try the juice of ½ a lemon in water in the morning before breakfast. REMEMBER to drink plenty of liquids. You need more fluid particularly when you have more fiber for fiber to work effectively.
o Stewed or soaked prunes, 1 to 3 a day, have a slightly laxative effect. Prune tea - 3 prunes in a 250ml cup, add boiling water, leave stand until warm, drink & eat the prunes. Have 1 cup per day.
o Flax meal, 1 heaping tsp. in 8 oz. of apple juice, provides fiber and soothes the digestive tract. Follow with an additional 8 oz. of water. LSA (linseed/sunflower/almond - equal parts, finely ground up together) mix is excellent too. Slippery elm bark powder is good, but is a bit pricey lately.
o Aloe Vera - Take 10 - 30mls twice daily in a glass of water before meals.
o Colonic hydrotherapy - I have solved very tricky cases of constipation with recommending a course of colonics plus other complementary and alternative methods of healing. There is no question about the huge difference a professional colon therapist can bring to the patient by utilising colon hydrotherapy.
o Liver and bowel detox Go and see your practitioner, you will be glad you did. And, you'll probably loose a fair amount of weight as well. Some of my favourite herbs here are Artichoke, St Mary's Thistle, Picorrhiza and Tumeric.
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