It seems we all have our pet names for it...doo-doo, poop, number two, or others not quite fitting for a family magazine. But no matter how you say it, regular, bulky but soft and easy bowel movements are vital to good health. Oh sure, most all of us have a little problem now and then. But something is seriously wrong when four and a half million people in the United States say they are constipated most or all of the time.
As a nutritionist, I am as interested in what comes out of the human body (or if it comes out) as what goes in. Unfortunately, as in most everything in the health arena, there are big disagreements as to how one should maintain bowel regularity. Conventional medicine generally disparages the use of anything beyond a high-fiber diet, more fluids, and more exercise. Yet, complementary approaches embrace numerous other therapies based on theories that conventional medicine hasn’t fully accepted.
Depending on whom you ask for advice, the gamut of recommendations can run from "don’t worry if you only have two or three bowel movements a week" to "transit time for waste material should be no longer than eighteen to twenty-four hours." The latter means we should all be having at least one bowel movement a day. Generally, the health practitioners who say it doesn’t matter that you don’t doo-doo everyday are accepting the fact that most people eat a highly refined, high-fat, low-fiber diet...a sure-shootin’ recipe for constipation.
Eating more fiber to induce bowel regularity is the golden rule. But there’s a lot of consumer confusion over what constitutes heavy-duty fiber sources. Nutritional biochemist Ruth DeBusk, Ph.D., R.D., is a forward-thinking specialist in bowel dysfunctions and works closely with six gastroenterologists in a Tallahassee, Florida, digestive disease clinic. She has a four-part anticonstipation program that she’s never seen fail. Her first directive is to increase fiber intake to twenty-five to thirty-five grams a day by eating fruits, vegetables, dried beans, and peas. Talking in grams can be a foreign language if you don’t have a nutritionist’s education, but it’s easy to add up when you estimate that a serving of fruit or vegetables has about two to three grams of fiber. In addition, you can use the dietary fiber count on the Nutrition Facts label of food products. DeBusk points out that a half cup of bran cereal gives eleven to thirteen grams of fiber, about half the day’s worth in one shot!
DeBusk doesn’t recommend whole grains as part of her fiber formula as she finds too many people are wheat and/or gluten sensitive. So it’s imperative to find out whether you are intolerant or sensitive to gluten as eliminating this from your diet can make all the difference. Moreover, it’s always a good idea to avoid products with refined white flour. As one colonic therapist so aptly points out, a mixture of white flour and water makes a very effective plaster and can do the same in your GI tract.
DeBusk’s other anticonstipation recommendations include drinking eight to ten (eight-ounce) glasses of water every day. She also insists that because caffeine is a powerful diuretic that flushes water out of your system, you should drink a cup of water for every cup of caffeinated beverage you drink, such as coffee, cola, or tea. Thirdly, DeBusk pushes regular aerobic exercise to tone the muscles of the intestines to keep them in shape for moving their contents along.
Her final recommendation has been used by alternative practitioners for years and is now being recognized among conventional medicine types as a vital component to digestion and good health. This is the use of live active cultures acquired by eating yogurt (certified living cultures) or taking high-quality probiotic supplements. These cultures, or probiotics, are the friendly bacteria in our gut that are key to maintaining or restoring a healthy intestinal tract environment. The large intestine alone contains about three pounds of bacteria — both beneficial and detrimental. The unfriendly bacteria, under certain circumstances, will overcome the beneficial bacteria and produce toxins and carcinogens in the bowel. Constipation can result from an upset in this microflora balance and may even be a symptom of parasitic infection.
Another approach to relieving constipation, but generally scorned by conventional medical practitioners, is colon hydrotherapy or colonics. A licensed or certified hydrotherapist gently pumps gallons of filtered water in and out of your colon via the rectum to dislodge accumulations of stagnating fecal waste believed to produce toxins that can poison the body. Naturopath Mark Groven, supervisor of physical medicine at the Bastyr University natural health clinic in Seattle considers colonics a part of a total general wellness program, "We use colon hydrotherapy to tonify the bowel to help produce a better elimination practice for the body." However, he emphasizes that the treatment is not appropriate for people with medical problems such as appendicitis, hepatitis, and ulcerative colitis and should be used only under the supervision of a naturopathic or traditional doctor. There’s little in the way of scientific research documenting the benefits of colonic therapy but I’ve talked with many who are convinced that the procedure is pivotal to their continuing good health. Nonetheless, that sort of measure is considered anecdotal — personal accounts that have not been verified by science.
There are a number of other approaches to ease constipation that also have no clear scientific evidence to support them yet appear anecdotally to be quite effective in aiding bowel movements. Complementary therapists often recommend a riser that sets in front of the toilet. When you sit on the toilet and place your feet on the riser, your knees are well above the level of your hips and makes for a squatting posture that’s very conducive to elimination. Hand-in-hand with this is making sure you respond to the call of nature. Repressing your urge to defecate can weaken the signal and make matters worse. In addition, a little straining is a natural part of moving one’s bowels but doing it to excess can contribute to hemorrhoids.
Using laxatives, even herbal laxatives, can be tricky because if used routinely and excessively, they can damage nerve cells in the wall of the colon. Laxatives act as chemical irritants stimulating the muscular walls of the colon to abnormally contract to expel the irritating substances.
However, complementary practitioners do recommend several food sources that are natural laxatives and can become part of a daily routine. For instance, lemon juice is said to be very cleansing to the intestinal tract. Drinking a cup of hot water (always filtered!) with the juice of half a lemon first thing in the morning can add a capital R to regularity. You should rinse your mouth immediately as lemon juice can erode tooth enamel. A tablespoon of ground flaxseeds, which can be added to juicing ingredients, yogurt, or the like, can be a great intestinal lubricant. Aloe vera juice is another intestinal helper that aids in forming soft stools. Drinking a half-cup of aloe juice in the morning and at night can make life more pleasant for those who are bowel movement-challenged. Have you tasted aloe? It’s very palatable. And let’s not forget that old standby, the prune, and its less potent cousin, the fig.
Don’t confuse your body by trying all these methods at once; introduce one at a time, note any changes that take place and, if needed, add the others gradually.
Of course, constipation, in some cases, can be the result of complications that go beyond the scope of this column. Yet, as I tirelessly preach (nag?!) "listening" to your body is a first-rate approach to good health. And if it says, "I need help" I urge you to find an integrative-minded healer who can coach you to inspire your body’s natural healing energies.
Disclaimer: This column is for information only and no part of its contents should be construed as medical advice, diagnosis, recommendation or endorsement by Ms. Ephraim.
Rebecca Ephraim is a registered dietitian, certified clinical nutritionist and a nutrition reporter specializing in integrative medicine issues.
© Rebecca Ephraim. All rights reserved.