Ask The Doctor: Constipation

QuestionI am a 35 year old male and I have been troubled with intermittent abdominal pain for many years. The pain is kind of crampy and seems to come and go in no particular pattern. My primary care doctor has done the full workup, upper and lower GI, x-rays, blood tests, etc. and tells me everything is normal and that I have irritable bowel syndrome (IBS). I asked him about my bowel patterns (about every other day) and was told this is normal. Can you help me with this as I just don’t feel quite right.

Answer: The question you bring up is one that I often hear in my practice. At the heart of the question is “what are normal bowel habits?” Surprisingly, in this seemingly fundamental subject there is little consensus and almost no discussion. You may be surprised to learn that in all the years of medical school and postgraduate training, the subject of normal bowel habits was never brought up or discussed. I guess we were supposed to sort this out on our own. Most doctors feel that everyone has his own unique pattern which is normal for him–some people have bowel movements two or three times a day and others two or three times per week. Either is considered OK.

However, the research of Denis Burkett, a British physician who lived and worked in Africa for many years, contradicts this view. He noted that Africans eating their traditional diet have between one to three substantial bowel movements every day and that the transit time (amount of time between ingestion and excretion) is 24 hours or less. He believed that there was a connection between the ease of elimination these people experienced and the very low incidence of various bowel diseases (hemorrhoids, appendicitis, colitis, Crohn’s disease, ulcerative colitis, gall bladder disease and cancer of the colon.) Dr. Burkett attributed this robust bowel health and absence of bowel disease to the high amount of fiber, both soluble and insoluble in the native African Diet. This is certainly part of the explanation, although high amounts of fermented foods (which contribute to beneficial flora in the intestines), use of bitter vegetables and herbs (which stimulate the bile and therefore aid in the digestion of fats) and liberal consumption of foods rich in vitamin D such as insects and dried shrimp (vitamin D is very important for the health of the colon) are also likely factors. Another factor is the African method for preparing high fiber foods, which invariably involves soaking and fermenting, because while dietary fiber speeds elimination time, high fiber foods that have not been prepared correctly can be very irritating and can actually damage the villi in the small intestine, leading to poor absorption. It seems, therefore, that the key is not solely the fiber content (which is why adding Metamucel, a source of insoluble fiber to the normal American diet is at best a poor solution) but the whole diet, including preparation methods, as well as daily exercise such as walking, gardening, swimming, etc.

Your problem sounds like IBS from constipation. Having this lifelong bowel pattern gradually weakens the walls of the intestine, leading to a tendency to spasm. Often a diet that leads to this type of bowel pattern produces deficiencies in minerals, especially magnesium, which further exacerbates the problem. My guess is that if you do the following, your bowel movements will become regular inside of one month, your cramps will end and in general you will feel an improved sense of well being.

  1. Eat a more traditional diet as outlined in Nourishing Traditions by Sally Fallon, with emphasis on plenty of properly prepared whole grains, and vitamin D rich foods like butter and shell fish. Cod liver oil as a supplement will provide additional vitamin D.
  2. Every morning, grind one tablespoon flax seeds in a mini grinder and add to 4-8 ounces Beet Kvass. Soak five minutes and drink. This is an excellent source of fiber, enzymes and special fatty acids.
  3. Before bed, use 1/2-1 teaspoon Swedish Bitters in warm water. (This will help stimulate the bile.)
  4. Three times a week, for one hour, put a castor oil compress over the abdomen. (This will help stimulate and detoxify the intestinal tract.) You will need some cold pressed castor oil, flannel clothes, plastic wrap and an electric heating pad. Saturate the flannel with castor oil and lay it over the abdomen. Cover with saran wrap and lay the heating pad on for one to two hours. The pad should set from medium to high–don’t burn yourself. Soaked flannel can be stored in a plastic bag and reused.
  5. Engage in some moderate, enjoyable exercise such as walking, swimming, rebounding or gardening at least 20 to 30 minutes per day.

First published in Price-Pottenger Nutrition Foundation Health Journal