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by
Konstantin
Monastyrsky
Dietary fiber, eight
glasses of water, and a low-fat diet — the
sacred cows of American nutritional dogma — break natural bowel
movements, and cause hard stools, irregularity, constipation, or
constipation-predominant IBS. When patients seek medical help, they are
routinely recommended to add more fiber, drink more water, and reduce
fat even further. This misguided and harmful advice
guarantees chronic constipation, hemorrhoids, and diverticulosis to
virtually anyone, and it is behind
the epidemics of inflammatory bowel disease and colon cancer. This guide
condemns this pig-headed practice and teaches you how to restore natural bowel
movements without
resorting to fiber and laxatives.
Moving the bowels is an instinct, not an acquired trait.
You don't need to teach newborns to move their bowels — it comes to them
just as naturally as breathing or crying. Similarly, there are seniors
who have never had a problem moving their bowels naturally, and are free
from common colorectal disorders, such as irregularity, constipation,
hemorrhoids, or diverticulosis.
There are several, noteworthy characteristics of these
natural bowel movements, that equally apply to happy babies, healthy
seniors, and everyone in-between:
-
Strong defecation urge. Ideally, a
strong sensation to move the bowels is experienced after each major
meal, or at least once daily.
-
Small-sized stools. The stools are
small, soft, and finger-sized, sometimes barely formed. By the
Bristol Stool Scale
classification they correspond to type 4 to 6.
-
Small volume of stools. The weight of
the
stools is usually no more than 100-150 grams per bowel movement.
-
Unnoticeable act. The act of
defecation is an effortless, quick, and complete passing of stools.
It is no more noticeable than the act of urination. There is
absolutely no conscious effort or straining.
If your bowel movements aren't as described above, it
means they are no longer “natural,” and you are facing an elevated risk
of major and minor colorectal disorders — from the ubiquitous hemorrhoids to
colon cancer, and just about anything else you can find under the
Colorectal Diseases heading of any medical reference.
This guide will teach you how to restore natural
bowel movements (assuming the damage you've already acquired
hasn't gone too far), how to prevent new damages, and, above all, how
to protect yourself from colon cancer.
Medical textbooks don't have a definition for a
natural bowel movement, but there are plenty of terms which describe
“unnatural” bowel movements. These are irregularity, costivity, large
stools, hard stools, straining, incomplete emptying, constipation,
and constipation-predominant IBS.
When patients seek help with any of the above
conditions, the doctors commonly translate all of them into two succinct
terms — constipation or irregularity. For brevity, I'll use the
word/term “constipation” throughout this guide instead of an awkward and
lengthy “unnatural bowel movement,” or an unspecific and tentative
“irregularity.”
Diarrhea is also an unnatural condition, but on the
opposite side of the spectrum. I'll devote a separate guide to the
management of diarrhea soon.
BOWEL MOVEMENTS DEMYSTIFIED
When doctors themselves
seek guidance, they check out The Merck Manual of Diagnosis and Therapy,
a highly influential and revered compendium of medical know-how.
According to its publisher, it’s “the world's most widely used
medical textbook.” Here is what the Constipation[1]
section of the manual tells them (image modified to fit this page):
As you can see, according to Merck, unnatural bowel
movements are perfectly acceptable. On the other hand, expecting a
natural bowel movement is an “incorrect belief.”
I don’t have a clue who the “experts” were who wrote this
heresy, and what sources they consulted while writing it, and who the editors were who let
it to print, but that's exactly what it says. Damn
the endless body of human experience, damn academic knowledge, damn
existing medical textbooks, and damn published research.
And the manual goes on to reinforce the dogma: “Physicians
must explain that daily bowel movements are not essential…”
And if patients ignore these recommendations, they are likely to be “obsessive-compulsive”
and may get depressed “from the failure to defecate daily.”
Considering the Merck's indisputable stature and authority, neither
doctors nor patients are likely to ever question these recommendations.
As certain as rain in Georgia, a well-meaning doctor —
already preconditioned to think that anyone complaining of constipation
may be a psychotic crank — translates this asinine advice into
comforting language, so the nutcase in front of him won't go postal:
— You have nothing to worry about, dear (...cranky
bitch!..). It’s probably in your head (...get a shrink, dummy!..).
— Thank you, doctor (...you, patronizing asshole!..). Thank you very much
(...thanks for nothing, bastard!..). I’ll try not to worry (...I need to
find a better doctor...).
— You are very welcome, dear (...what an idiot...). And don’t forget the fiber! See
you soon. (...God, make her disappear...) Next patient,
please!
This theater of the absurd plays day in, day out
in medical offices everywhere. So it shouldn't surprise anyone to learn
that constipation happens to be “the most
common digestive complaint in the United States, outnumbering all other
chronic digestive conditions [2].”
Here is what a truly knowledgeable and concerned doctor
or nutritionist should have actually told you about restoring natural
bowel movements whatever your complaint happens to be:
What causes abnormal stools (The
primer on fecal engineering)
Ideally, dear, you should move your bowels every day,
preferably after each major meal. Your stools are supposed to be small,
light, and barely noticeable, just like when you were a baby when you
enjoyed absolutely natural bowel movements.
Constipation, irregularity, and hard stools have many causes. Major among them are the
damage to intestinal flora, or disbacteriosis; the use of fiber to
replace dead bacteria; the enlargement of internal hemorrhoids; an
unfortunate tendency to withhold stools until the right bathroom is
available; the use of laxatives; and the side effects of many
commonly-used medicines.
Your age, dear, doesn't affect
natural bowel movements directly unless you've been experiencing
problems for a long
time, and your colon, rectum, and anus have already been irreversibly
damaged by large stools. Obviously, the older you are, the more profound
the damage. That's why people connect abnormal bowel movements with age.
If your colorectal organs are healthy, a normal diet
doesn't play a significant role in natural bowel movements, even
with moderate amount of fiber,
except for the dietary fat factor. Fat is essential to stimulate
defecation. This diet-constipation connection is one of the most
difficult to accept, because people commonly equate food with stools.
Let me explain to you this food-stools connection in
greater detail, otherwise you'll have a hard time restoring natural
bowel movements or getting rid off constipation:
The largest component of stools is water — 65% to 85%.
With low-fiber diets, undigested food remnants represent from 5% to 7%
of total stool volume. With high-fiber diets, they represent 10% to 15%.
That’s why healthy people who fast or can’t eat solid food because of a
sudden medical emergency still continue to move their bowels — food, as
they say, doesn't make the weather.
This surprising disconnect between food and stools
becomes self-evident after breaking down food staples into five basic
components — water, carbohydrates, protein, fat, and fiber. Only fiber
is indigestible. The rest are digested either completely or almost
completely:
Water from food and drinks is completely absorbed in
the small and large intestine. Only about 100 ml (3 oz) of “embedded”
water is excreted along with normal stools, but this is proportionately
more in a high-fiber diet. Water content in excess of 85% [3] — just a
10% difference — is characteristic of diarrhea.
Simple and complex carbohydrates (sugars and
starches) digest completely in the small intestine (except lactose,
which is fermented), and are absorbed into the blood as glucose,
fructose, and galactose. More than 0.5% of undigested carbohydrates in
the stools is considered abnormal [4].
Protein from meat, fish, fowl, dairy, seafood and
plants digests completely and is absorbed into blood as amino acids. So
there’s no protein in normal stools, except burned meat.
Close to 95% of all consumed fat is absorbed in the
small intestine. Fat in stools in excess of 6% [5] of consumed fat is
considered abnormal. This condition is called steatorrhea.
All food contains insoluble mineral salts and
the earth’s
minerals, which reach the large intestine undigested. This indigestible
portion of food is called ash, and is determined by cremation. Normal
stools contain from 0.2% to 1.2% of ash.
Thus, if your daily menu includes 200 g of meats (2 g
of ash), 100 g of fat (5 g undigested), and 200 g of digestible
carbohydrates (1 g of ash), only 8 grams — one-and-a-half teaspoons — of
undigested food residue will reach the large intestine. That’s not
enough to even get noticed in the toilet bowl.
The feces are kneaded into stools by intestinal peristalsis, with a generous serving of
mucus secreted by the intestinal mucous membrane. The mucus binds
together food residue, intestinal bacteria, and metabolic debris — dead
body cells and remnants of metabolic activity shed by the liver along
with bile.
After all is said and done, normal stools contain
around 75%
water. In other words, if you consume a low-fiber diet, your body expels
25 grams of undigested organic and inorganic matter for each 100 grams
of stools, and only eight of those grams come from food.
The water in formed stools is retained by dead cells
and intestinal bacteria, which are also single-cell organisms. Bacteria
reside on the surface of the mucous membranes. They divide and die in huge
numbers round-the-clock. The dead siblings are shed into the lumen
(colon’s cavity) and become an essential part of the stools. By some counts,
dead bacteria represent up to 50% of dry stool matter, or almost 11
grams for each 100 grams of stools. (100 g – 75 g water – 5 g fats ) *
50% = 10 grams.
When bacteria are present, fiber has a moderate effect
on the size and weight of stools because the bacteria ferment up to half of
the insoluble fiber, while soluble fiber gets fermented completely. Thus, if
your intestinal bacteria are alive and well, and you consume daily 20-30
grams of fiber from natural sources, it may add only 30 to 60 grams to the
weight of your stools.
But if the intestinal bacteria are mostly dead (which
is what causes constipation in the first place), and the dietary fiber
remains unfermented, your stool weight will go up by 100-150 grams,
because fiber attracts water up to five times its weight. The ensuing
doubling of the stools’ weight and size — the bulking up, conventionally
speaking, — will eventually cause the metamorphosis already described in
all of the preceding guides.
According to Human Physiology by Schmidt and Thews —
a textbook for medical students — people who consume fiber-rich diets
excrete around 400 grams of stools daily. But that goes down to just 72
grams on a low-fiber diet, which is ideal! But with such a minuscule
amount of normal stools, it’s paramount not to miss bowel movements.
Otherwise small stools quickly dry out, become costive, and get
difficult to pass out.
Keep in mind that the drying out of stools happens
regardless of the bacteria count — normal stools become dry when the
moisture content drops as little as 10% down to 65%.
When bacteria are missing altogether, the stools are
dry from the get-go. That’s why “fiber replacement therapy” works not
just figuratively, but literally — fiber retains water in place of
the missing bacteria, though it isn’t as efficient at keeping up the
moisture as are bacterial cells. Remaining live bacteria keep devouring
fiber and causing all of those prominent side effects of “rumination.”
There is only one reliable way to prevent the drying up
of stools and ensuing costivity — move your bowels after each major
meal, because the act of eating ALWAYS initiates the sequence of events
that stimulate defecation. These successive unconscious events are
called, respectively, the gastrocolic reflex, peristaltic mass movement, and
the defecation urge. That’s how our gut is wired by nature to move the bowels.
Unfortunately for most Westerners, once the potty
training begins, the parents and teachers work really hard to unwire
this miracle of nature. That’s so that you can finally leave the house
without a diaper and sit through a class without interrupting it. It’s
possible because the final stage of defecation doesn’t take place until
you consciously permit it by relaxing your external anal sphincter.
As we grow up, we learn to suppress the defecation urge
by constricting our rectums with our pelvic muscles. While still young,
we squint, grimace, and cross our legs to accomplish it; later in life
we can suppress all but the strongest urge, completely unnoticed and
wrinkle-free.
But this essential social skill has a downside. If you
keep suppressing defecation for too long, usually over a day, retained
stools gradually impact, dry out, harden up, and require straining to
get expelled regardless of size. When that happens, the chaffing of dry
stools against the delicate lining of the anal canal causes big-time
pain and scary-looking bleeding. (The straining makes matters much
worse, as described here...)
And that's before taking
into account the impact of fiber on stool size! Once fiber gets shoveled
down into the gut, enlarged stools become even more difficult to pass
out because the adult's anal canal is a tiny 35 mm (1.4") in diameter.
How big is this 35 mm aperture? Lets compare it with the popular U.S.
coins:
And — don't forget this — it
is 35 mm when the anus is stretched out to the max, and there are no
enlarged internal hemorrhoids to constrict it. Technically, your fist is
about the same size as your fully stretched mouth — try to swallow your
fist to get an idea what your anus feels like when your stools are close
to or more than 35 mm in size.
To give you even a better idea of just how “jammed up”
are these quarters, take a look at this illustration. It compares a
Q-tip with an anatomical cross-section of the anus and rectum. Keep in
mind that the proportions on all of these illustrations are 1:1.
Obviously, they look smaller on the screen, so you may want to look at
an actual Q-tip to get a better sense of the real sizes:
That is how small and tight the human rectum, anus, and
anal canal really are. Much smaller than you may think looking at your
behind in the mirror. You can learn all that and much more from any
anatomy book:
“The Rectum is about 12 cm. long
[...] The Anal Canal
[...] measures from 2.5 to 4 cm.
in length.”
[Gray's
Anatomy]
Thus, for truly effortless passing, the stools must be
soft, moist, light, and no larger than a nickel coin or one's middle
finger (15-20 mm) on this illustration:
These kind of picture-perfect, finger-sized, soft and
moist stools require no more effort to pass out than urination. In other
words, normal defecation is a practically unnoticeable act.
On the other hand, if the stools are large... Lets use
a pickle — something we can both relate to without looking at the “real
thing” — to compare it vis-à-vis the anus. As you can see even a
smallish Corby pickle is huge relative to the anus and anal canal. And
not just the anus — the pickle is about the same size as the entire
rectum.
So, if any one, dear, tells you that large, formed
stools every other day or two are normal, give them that Corby pickle,
and ask them to jam it up their anus, and then tell you how normal it
feels. If that experience does not get them out of the pickle you got
yourself into, nothing will...
To summarize, you should move your bowels as soon as
you sense the defecation urge, usually after each major meal. In this
ideal situation, stools are soft, small, and barely formed, which is
perfectly normal. They weight no more than 100-150 grams.
If this optimal frequency isn’t attainable, you should
pass stools at least daily, usually after breakfast. In this case, the
stools accumulated over a 24-hour period are larger, heavier, and more
formed, but still passable.
On the other hand, when:
Your stools are larger than your middle
or index finger, or…
Your stools weigh substantially more than two
standard-issue ballpark wieners, or…
You need to strain, or you are experiencing
discomfort, or…
You don’t have effortless stools at least daily, or…
You are supplementing with fiber, or rely on prune
juice, oatmeal, and/or laxatives...
…or all of the above, this truly means that something
is wrong. Nonetheless, you aren't considered constipated until you don't
move the bowels for more than three consecutive days. Thus, as long as you
can keep straining to squeeze out stale, stinking, chaffing stools every three
days, then, medically speaking, you are just irregular, or not yet worse enough
to warrant medical treatment. That's the essence of it.
— Thank you, doctor, this was a great explanation. I
am beginning to understand now. But I am still not clear on how to get
rid of constipation?
— Unfortunately, dear, there are no drugs or
treatments that I can prescribe to you. And you are better off not using
fiber or laxatives.
— So what should I do, then, doctor?
— I would love to help you more, but our appointment
is already 30 minutes too long. Your insurance company isn't paying me a
penny for talking 'crap', and I have other patients waiting. There is this
medical writer in New Jersey, whose name is Constantine-something, and he wrote a FiberMenace.com
web site. That's where I learned these things I just
told you. Read his site. Find what applies to you, and follow it. You
will
not suffer from constipation ever again! I am embarrassed to admit it,
but it helped me too! This guy is a genius.
— But what about The Merck Manual, doctor? The
printout I brought is the complete opposite of what you just told me.
— Oh, forget about this rubbish, dear... It's a pharmaceutical
company, for laughing out loud! If they don't have a drug for something,
it's always your fault, not theirs... From their perspective, you are
a nutcase! Would you like me to send you to a psychiatrist, dear? I hope not...
— Thank you doctor! Thank you very much! I am so
lucky to know you! And I mean it... (...crying...)
— See you soon, dear. Don't cry, you’ll be fine
now... Just get rid of that fiber!.. Don't strain!.. It's f-i-b-e-r-m-e-n-a-c-e-dot-com.
(...God, I lost another patient... She is so cute... Oh,
well...) Next patient, please!
Bad advice: the harder they try — the faster you die...
That was, as I said, a best-case scenario. In real life,
even if you meet a nice, caring doctor who won't take you for an
obsessive-compulsive psycho, and who will go out of his/her way to help
you, the primary recommendations
would still boil down
to the following well-known list:
(1) Consume 20 to 30 grams of fiber
daily to ensure adequate stool bulk;
(2) Drink at least eight glasses of
water daily to keep stools moist;
(3) Exclude animal fat because it
causes constipation;
(4) Exercise regularly to stimulate intestinal
activity;
(5) Tone up lax abdominal muscles because they improve
elimination;
(6) Reduce stress, because it contributes to
constipation.
Too bad none of these
recommendations are even remotely helpful for restoring natural bowel
movements! And some are downright
harmful. Let's go over them one by one:
Q. Is it true that dietary
fiber prevents or relieves
constipation?
No, it isn’t. As I already explained in my book,
here, and pretty much elsewhere on this
site, fiber from fruits, vegetables, grains, bran, and laxatives is the
PRIMARY cause of chronic, persistent constipation and related colorectal
disorders.
For those who are familiar with the large intestine’s
anatomy, it isn't difficult to comprehend why fiber’s most heralded
asset — its ability to bulk up stools — is complete nonsense. The
fiber’s journey inside the large intestine begins not by going down, but
by going up, up, and up the ascending colon. And the weightier it is, the
longer it takes, because the peristaltic propulsion inside the colon
isn’t strong enough to move up very heavy 'loads.'
This also explains how astronauts who spend months on
end in the International Space Stations don’t experience constipation,
even though their stools are WEIGHTLESS. And when they do, they don’t
use fiber, but conventional laxatives, such as Ducolax® or Senade [6].
Q. Is it true that drinking more
water prevents or
relieves constipation?
No, it isn’t. Actually, sipping two, three, five, ten
or more liters of water wouldn’t produce soft and moist stools because
drinking water per se never reaches the large intestine of a healthy
person. In fact, death from water intoxication would happen faster than
this water reaching the bowels.
For starters, the gastrointestinal tract isn’t a
straight pipe. Next, water gets absorbed in the small intestine long
before it reaches the large intestine. In case it doesn’t, you get hit
with diarrhea. This only happens when inflammation, soluble fiber, or
laxatives cause intestinal malabsorption.
Next, the large intestine excretes about 100-150 ml of
water a day along with normal stools. That’s around six-nine tablespoons of
water from about 30 to 40 liters (8 to 10 gallons) present in the
adult body at any time — more than enough to keep stools moist long
after you die from dehydration.
Even more facts: According to Karl Fischer’s [7] method
of measuring the water content of feces, the difference in water content
between hard, formed, grayish stools (that’s as bad as it gets) and
normal stool is less than 15 ml — a tablespoon’s worth. Obviously, you
don’t need to drink two liters of water to make up for one tablespoon.
Finally, the large intestine recovers sodium chloride —
table salt in plain English — back from stools. Salt is needed body-wide
to keep blood adequately salty, to prevent edema, to avoid dehydration,
to make sweat, and to synthesize hydrochloric acid for gastric digestion.
If you don’t consume enough salt, stools get dehydrated even faster
thanks to the intense recovery of this precious sodium chloride from the large
intestine.
It’s worth noting that regular table salt is also the
primary source of dietary iodine in the American diet. Iodine is
required for a healthy thyroid function. Hypothyroidism happens to be one
of the major causes of persistent, chronic constipation.
Incidentally, a low-salt diet lowers blood pressure not
because salt causes it (salt consumed in moderation absolutely doesn’t,
the idea that it does is another big lie, waiting to get debunked), but because, at least initially, sodium deficiency causes
dehydration. In turn, this reduces the volume of blood. Less blood in
the system = less blood pressure. That’s a no-brainer.
Later on, the low thyroid function kicks in and slows
down the metabolism. Slow metabolism, in turn, reduces heart output and
muscle tone. Along with hypotension (low blood pressure), these are the
top reasons behind chronic fatigue in general, and “colon fatigue”
(a.k.a. lazy gut) in our particular case.
If you are still in denial over eight glasses of water,
the arch-conservative Journal of the American Dietetic Association nods in
agreement with some of these points:
“It is a common but erroneous
belief that the increased weight [of stool] is due primarily to water.
The moisture content of human stool is 70% to 75% and this doesn’t
change when more fiber is consumed. In other words, fiber in colon is
not more effective at holding water in the lumen than the other
components of stool [8].”
If there is a connection between water
consumption and constipation, it’s actually the complete
opposite: the more water you consume, the drier the stool gets,
because the excess water consumption causes the depletion of
potassium with excess urination. Potassium happens to be the key
mineral responsible for water retention in the stools. This very
pervasive fiber-water myth is discussed in Chapter 2, Water
Damage.
And, by the way, all that calcium and magnesium
that your heart, teeth, joints, and bones are craving 24/7
gets pissed away as well. The more you drink, the faster...
End of story.
Q. Is it true that regular
exercise stimulates intestinal
activity?
No, it isn’t. In fact, you can exercise yourself
senseless and get even more constipated because, among other things,
vigorous physical activity inhibits motility — a fancy term for forward
propulsion of stools inside large intestine. Reconfirmed by checking up
Rome II:
“Active or chronic [sic] physical exercise has probably no
major effect on the functions of healthy colons.
[9]”
And, besides, most
people move their bowels for the first time just after waking up and having
breakfast. A good night’s sleep is hardly 'exercise.'
That erroneous concept came from correctly noting that
fit and healthy people complain of constipation less often than
sedentary types. But that concomitance (more exercise — less
constipation) is an outcome of good health habits, not exercise. If
there were a connection, constipation simply wouldn’t exist among
athletes, laborers, gym-goers, and beach jocks and bunnies. But of course, that
isn’t remotely the case. This doesn’t mean that you shouldn’t exercise.
You absolutely should for all the other benefits it gives you.
There are several good reasons behind morning stools.
First, while you are asleep horizontally, the large intestine propels
feces toward the rectum. The propulsion up the ascending colon in the
upright position is quite limited. Second, you are relaxed and not yet
constrained by clothing. Third, eating breakfast stimulates the
defecation urge. Finally, because you may be more comfortable using your
own bathroom, you are less likely to suppress the defecation urge and
will take immediate advantage of all of the above circumstances.
If you don’t eat breakfast at home, you may stimulate
defecation by slowly drinking a glass of warm water. This simple method
is often as good a stimulant as eating. If you don’t experience any
urge, you may have anorectal nerve damage caused by fiber, straining,
hemorrhoids, scarring, enlarged colon, medications, laxatives, diabetes,
vitamin deficiencies, surgeries, and other factors described
here.
Q. Is it true that toning up
lax muscles helps to relieve
constipation?
No, it isn’t. Actually, stronger pelvic and abdominal
muscles only help you to strain harder, and straining aggravates
constipation and its side effects more than any other single factor. And
that’s before considering the impact of straining on hemorrhoids,
hernias, diverticular disease, intestinal obstructions, genitourinary
disorders, and other possible complications. As I already explained,
normal defecation requires no more abdominal “push” than urination. It
ain’t childbirth, dahlings…
If you still keep straining after reading this,
consider taking a Lamaze class to reduce pain and anxiety. Just imagine
the helping hand and reassuring voice of your beloved spouse guiding you
along: exhale darling, push, push, push, poop… You are doing great!…
Inhale, relax, relax, relax… Okay, let’s do it again!
Please note again that I am not against having toned
and beautiful “six pack abs” per se, but against using them to “relieve
constipation.” A small, but significant difference.
Q. Is it true that
stress causes constipation?
No, it isn’t in healthy people. In fact, stress, especially intense,
causes the complete opposite of constipation: diarrhea of equal
intensity. Hadn’t you ever experienced a nasty churning inside your gut
while facing a first date, or crucial exam, or job interview, or speed
trap, or close call, or IRS audit, or… perhaps even from reading this
article?
It’s indeed true that depression and anxiety inhibit
digestive functions, and may, indirectly, contribute to constipation —
but not much as long as you keep eating. The more likely culprits are
the medicines taken for anxiety, depression and insomnia — along with
a runaway mind, drugs dull the nerves and muscles vested with
elimination duties all too well.
Then, there are always those anal-retentive types, who
are constipated no matter what. For them, it’s probably
true. Still, treating high-strung personalities with fiber is as effective as pounding the
wall with one’s fist — more damage, not less, to the wall and to the
fist.
Q. Is it true that animal fat causes constipation?
No, it isn’t. In fact, it’s the complete opposite:
low-fat diets cause constipation while excess fat causes diarrhea.
Anyone who tells you otherwise needs a mental check considering that
vegetable oils have been used as potent laxatives for millennia.
Chemically, flax, olive or castor oils are fat just as much as lard,
tallow, or
butter — except they are liquid and easier to swallow in one large dose.
Any fat taken at once in large quantities as a
“purgative” overwhelms the intestinal fat-breaking enzymes and remains
largely undigested. This condition blocks the absorption of fluids
throughout the entire length of the small and large intestines, and
causes a surge of fluids straight down into the rectum. The large volume
of fluid inside the rectum causes diarrhea just like an enema does.
That’s all there is to it.
Is this a safe fix for persistent constipation? No, it
is neither safe nor effective. First, you may end up dehydrated because
fluids can’t be absorbed. Second, oil-based laxatives cause soiling or
persistent fecal incontinence. Third, vegetable oils may contain
carcinogenic trans fats, plant-derived toxins, and allergic irritants
that may cause intestinal inflammation. Fourth, mineral oil (it’s
indigestible, but still gets absorbed into the blood) may cause severe
poisoning and lipid pneumonia.
To add insult to injury, oil laxatives are impractical
for severe constipation, because oil coats up hardened stools and
prevents surging fluids from breaking them down. The resulting diarrhea
is called paradoxical, because fluids flow around stools, while they
remain stubbornly lodged inside the large intestine.
Finally, why do low-fat diets contribute to
constipation? Dietary fat stimulates the release of bile from the
gallbladder, which, in turn, stimulates the gastrocolic reflex. This in
turn stimulates peristaltic mass movement, which, in turn, stimulates
defecation. No fat in the diet = not enough bile in the system to get
the ball rolling:
“Energy-rich meals with a high fat content increase
motility [propulsion of stools]; carbohydrates and proteins have no
effect.” (Source: Human Physiology
[10])
Case closed!
Apparently, that harebrained conjecture about animal fats and constipation came from
observing the costivity effect of the Atkins diet. But this fluke has
nothing to do with fat, and everything to do with fiber — or, more
accurately, with the absence of fiber in low-carb diets. Naturally,
stools sans fiber lack the bulk to get coaxed out on their own from a
large intestine damaged by years and years of fiber dependence.
I’ve lavished extra attention on the fat-constipation
connection because anything remotely related to fat, and,
indirectly, to cholesterol, is so controversial.
Talking of cholesterol… Every single cell in your body
is covered by membranes made from the molecules of cholesterol. The
intestines happen to be one of the most demanding consumers of
cholesterol, because all of the cells that make up intestinal membranes
get turned over (replaced) daily. The cholesterol needed to make up
these cells comes from food or is synthesized by the liver as LDL
(“bad”) cholesterol. Whenever you restrict food sources of cholesterol,
your liver has to produce more LDL cholesterol to compensate for the
deficit.
On the other hand, HDL (“good”) cholesterol is the
principal component of bile. The more fat you ingest, the more bile is
made by the liver to digest it, and, correspondingly, the level of HDL
cholesterol goes up.
Thus, if you limit dietary fat and cholesterol, the
“bad” goes up to kill you, and the “good” goes down, to kill you more.
On the other hand, the Atkins diet, with its plentitude of animal fat
and cholesterol, has been consistently shown to lower the “bad” and raise the “good”
cholesterol — just what the doctor ordered.
This phenomenon — less animal fat, more “bad”
cholesterol — hasn’t, of course, escaped the attention of statin-makers
(LDL-lowering drugs such as Lipitor, Zocor, Crestor, Mevacor, Pravachol,
Vytorin, etc.). No wonder they promote low-fat diets with the
vengeance of John McClane — the less animal fat you consume, the higher
the LDL. And that sells more statins.
At this point, it shouldn’t surprise you that
constipation and diarrhea are listed among the most common side effects
of statins [11]. Oh, well…
Recommendations: no downside,
just upside-down
For starters, let’s not pile up any more damage.
Exercise for health, fun, and weight-loss reasons, but exercise doesn't
stimulate intestinal activity — it inhibits it. If your colon is stuffed
with week-old stools, then exercises that engage abdominal muscles may
have a stimulating effect. But that's similar to straining, and has
nothing to do with normal defecation.
It's also perfectly OK to tone up lax, abdominal
muscles to improve your body shape, but don't use these muscles to
squeeze out stools—unless you have a death wish! By all means, reduce
stress in your life, because stress hormones affect your cardiovascular
system, your mood, your sleep, your appetite, and so on. But it makes no
significant difference for constipation. In fact, an occasional jolt is
a very effective laxative.
Now, lets get down to the business of restoring natural
bowel movements:
Step 1. Reduce fiber consumption and break any
dependence on laxatives to the absolute minimum as described
throughout this site, and particularly
here. Obviously, it's best if you read Fiber Menace — its last three
chapters deal exclusively with a trouble-free transition to a low-fiber
lifestyle. This step is essential to reduce stool size and restore
proper (physiological) stool morphology.
Step 2. Reduce water consumption as
described in Chapter 2 of Fiber Menace: Water Damage. This step is
important, particularly if you already have upper digestive disorders or
are over 40, because overconsumption of water causes indigestion,
gastritis, enteritis, and, surprisingly, dehydration. You are better off
avoiding and preventing all these conditions to avoid their cascading
influence on constipation.
Step 3. Get off fat-free diets. Fat is
the single most important factor in the physiology of defecation. This,
we have already established above. Fat is also critical for normal
digestion, a healthy GI tract, vitamin absorption, heart and brain
function, blood cells, hormones, supple bones, and, of course, to
overcome constipation. You can learn more about it
here.
Step 4. Normalize stools. Use
Colorectal Recovery Program
to attain small and effortless stools. The duration depends on the
degree of acquired colorectal damage. The goal is to eliminate
straining, reduce pressure on internal hemorrhoids, and restore
anorectal sensitivity. If you are still relatively young and
“undamaged,” you should be able to restore natural bowel movements
within a few weeks to a few months. With damage, it may take longer. If
you aren't affected by IBS, I recommend using Colorectal Recovery
Program for at-least three months. Thereafter, you can continue using
Hydro-C. If you are affected by IBS, just follow the IBS guidelines.
Step 5. Restore your intestinal flora.
This step is executed in parallel with Step 4. The in-depth background
about the role and function of intestinal flora is available
here.
Step 6. Restore/awaken your anorectal sensitivity.
Without this you'll never feel the urge to move your bowels, and won't
be able to initiate unassisted, regular bowel movements. Even when the
anorectal sensitivity is beyond repair, there are “ways and means” to
attain desired results. More on this subject is
here.
And that's all there is to it — a ton of fun reading,
several, inexpensive supplements, some bowel re-training, and “they
moved their bowels happily ever after.” Good luck!
***
Author's note:
Dr. Atkins' controversial death in 2003 ruined my
chances for the successful publishing of Fixing Up The Atkins Diet.
Since constipation was the No.1 side effect of his namesake diet, the
title Constipation Unplugged jumped into my mind as an idea for
another book.
After two years of researching and writing this new book, I
found that the word “fiber” appeared in the draft more often than the
word “constipation.” After some deliberation, Constipation Unplugged
was rechristened into Fiber Menace. The rest, as they say, is the
history of nutrition.
Fiber Menace is already having an effect on the
medical community. More and more articles are appearing about the harms
and futility of drinking too much water. And while preparing this page
for publication, I was surprised to come across a recently updated
(August 1st, 2007) article about constipation on the web site of The
International Foundation for Functional Gastrointestinal Disorders
(IFFGD), which I quoted in Fiber Menace back in 2005. Here is
their new tune regarding dietary fiber:
“Dietary fiber is
often effective in improving mild constipation. However, it
has less consistent results with more severe constipation,
possibly worsening symptoms in patients with slow colonic
transit (colonic inertia)
[12]”
Despite the good beginning, the rest of IFFGD's site
still recommends fiber to relieve and prevent constipation—though only
for healthy people this time around. That's one good way to become
unhealthy, and turn “mild” constipation into “severe.”
No surprise there — Procter & Gamble, the maker of
Metamucil, is one of IFFGD’s corporate sponsors [link],
so IFFGD is already “covering its bases” with a skillfully worded
disclaimer to absolve itself from future culpability. As is usually the
case when there is a choice between making a buck and making people
healthy, the buck wins.
Please don't forget to send
a link to this page to
anyone you know, suspect, or believe may be affected by constipation.
For all the work I do, nothing elicits as much happiness and joy among
my readers as being able to go to the bathroom without a fear. Make someone happy and joyful
again!
Konstantin Monastyrsky
Footnotes
You can click the Backspace key on your keyboard or
the browser's Go back button to return to the referring text.
Click the
[link]
to view the source site or document in the new window (when available). The
references for this guide were compiled in early 2008. Some of the links
may not match at a later date because publishers may revise their web
sites. In this case, try searching cached pages on Google, or contact
the respective publishers.
[1] Constipation; The Merck Manual of Diagnosis and
Therapy; 18th edition; on-line version [link]
[2] Epidemiology of constipation in the United
States. Sonnenberg A. Koch TR., Dis Colon Rectum. 1989 Jan;32(1):1–8.
[3] R. Jensen, D. Buffangelx, G. Covl,
CLINICAL CHEMISTRY, Vol. 22,No.8,1976 1351
[4] Stool Analysis; Digestive Disorders Health
Center; WebMd.com [link]
[5] Malabsorption Syndromes; The Merck Manual of
Diagnosis and Therapy; on-line edition [link]
[6] International Space Station Integrated Medical
Group (IMG) Medical Operations Book All Expedition Flights, Mission
Operations Directorate, Operations Division, JSC-48511-E1, 24 August
2000 [link]
[7] R. Jensen, D. Buffangelx, G. Covl,
CLINICAL CHEMISTRY, Vol. 22,No.8,1976 1351,
[8] Position of the American Dietetic Association:
Health Implications of dietary fiber; Journal of The American Dietetic
Association; July 2002; Volume 102; Number 7, page 995
[9] Rome II: The Functional Gastrointestinal
Disorders;
C29.7:731; by Douglas A. Drossman (editor);
[10] R.F. Schmidt, G. Thews. Colonic Motility.
Human Physiology , 2nd edition. 29.7:731.
[11] What are the side effects of statins; MedicineNet.com (a service of WebMD); [link]
[12] Dietary Fiber; International Foundation for
Functional Gastrointestinal Disorders [link]
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