Preventing constipation naturally

Preventing constipation naturally

Constipation is a frequent complaint that affects upwards of 100 million Americans on a regular basis, and in traditional systems of medicine such as Ayurveda, is considered to be a precursor to any number of more serious health issues. By some medical definitions constipation is only diagnosed if the patient hasn’t had a movement for more than one week. This designation is based purely on statistical averages, i.e. what is “normal” in society. Some people have frequent BMs, whereas others only poop 1-2 times a month. But statistical averages say nothing about the condition itself, nor about the importance that it plays in health and disease.

Part of the issue is that “constipation” is a subjective term. Some of my patients tell me they are constipated even though they have regular BMs – it’s just that they don’t feel “empty” or properly “satisfied” after a BM. Other people only have a BM every couple days, and think that this is normal and natural. According to Ayurveda, everyone should have between 1-2 bowel movements a day, and so if you are having at least one BM a day we cannot say that you are constipated. However, it doesn’t necessarily indicate that you are having healthy BMs, and this is sometimes what people mean when they say they’re “constipated”.

Which brings us to the subject of poop itself – what is it? Mostly it is bacteria – over 60% by volume – and whatever indigestible fibers and foodstuffs the bacteria have been fermenting. If the BM is particularly smelly, it says something about the weakness of your stomach and gastric digestion – probably there is too much undigested protein making its way to the large intestine, encouraging bacterial putrefaction rather than fermentation. If this is you, reduce the protein in your diet so you can digest it properly, and take more bitter-tasting leafy greens and herbs like gentian or barberry before meals to stimulate the stomach and liver. And if it smells too fermented, sort of like a sweet compost-like odor, cut back on the carbs and other sweet foods, and take pungent-tasting herbs to enhance digestion such as garlic and ginger.  What you eat has a tremendous impact upon your digestive health, so pay attention! As you can see, I also recommend that you smell your poo, since as gross as it might sound, it provides good information about the nature of the bacteria that live in your gut. Normally a BM doesn’t have a particularly strong smell, apart from the fact that its poop and so still smells rather…well… “poopy” – but in a good way. Hey, nobody said we’re talking about roses here!

Since your BM is mostly bacteria, this is a good place to start when dealing with constipation. In essence, constipation is a deficiency of the “probiotic” bacteria such as Lactobaccillus and Bifidobacteria that live and grow inside your colon to produce a healthy BM. Thus an important place to start with constipation is in restoring the GI ecology. The best way to do this is to regularly eat live culture foods, and in particular, fermented vegetables. Unlike fermented foods such as kefir, kombucha, sourdough, wine, mead and beer which contain yeasts that can inhibit a healthy gut ecology, fermented veggies are totally bacterial, and totally beneficial. In my book Food As Medicine, I describe the simple process of making fermented veggies, and include recipes of common examples such as sauerkraut, kimchi, carrot pickle and relish. Compared to expensive store-bought probiotic supplements that are almost entirely dead by the time they get to your fridge, home-made fermented veggies are powerhouses of healthy bacterial colonies that only cost pennies a day. I recommend eating fermented veggies on a daily basis as a good way to prevent constipation. Sometimes it takes a little bit to get used to them, but once you experience their benefits, you will probably come to crave these foods.

Some people are constipated because they’re simply too dry. Drinking 1-2 large glasses of warm water first thing in the morning is a good way to get things moving, particularly if you get up early, before sunrise. In Ayurveda, sleeping in promotes constipation by countering the natural flow of vata dosha, which reaches its full expression just before sunrise. If drinking warm water alone doesn’t help, mix 1 tsp of triphala churna (powder) in with the first glass of water. While triphala is frequently recommended, there are many other herbs that are equally as useful, and can be taken first thing in the AM too. Yellowdock root tincture is particularly good for constipation, as is dandelion root and barberry rootbark. All three of these herbs as well as triphala are bitter in taste, stimulating bile release from the liver and gall bladder, which in turn stimulates intestinal peristalsis. Ensuring that the liver is properly stimulated, you can also try to introduce fattier foods into the diet, which helps to lubricate the intestine. Examples include meat soups and stews, eaten with steamed buttered vegetables or vegetables sauteed in fat. Likewise, taking demulcent herbs such as aloe, marshmallow and slippery elm can be helpful as well. For painful, difficult evacuation, you can even inject 2-3 ounces of warm sesame oil prepared with a pinch of rock salt into the rectum before bed.

There are many factors involved in constipation, and here I am only covering a few. To get more detail please visit my website at, and my monograph on constipation.

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On the issue of gluten…

On the issue of gluten…

Gluten intolerance is not only a ubiquitous issue, but an entire industry of “gluten-free” foods has been created around it. Here are some of my thoughts on the issue of gluten, taken from Food As Medicine: The Theory and Practice of Food. pages 51-54. If you would like to make a traditional Indian flatbread that reduces gluten to negligible, please review my recipe for sourdough roti, thepla and parantha.

Over thousands of years of experimentation we have learned to process cereals to limit the negative effects of antinutrient factors, including grinding, germination (p. 116), fermentation (p. 127) and cooking. While innovations in modern technology would have us dispense with many of these methods, history demonstrates that when we fail to observe traditional measures there can be dramatic repercussions. Pellagra arose as a mysterious disease in the South-Eastern US during the early 1900’s, just a few years after cornmeal had been introduced as food to feed the poorer classes. Pellagra ravages the body causing skin lesions, chronic diarrhea and dementia, killing the victim in just a few years. It took almost 50 years before a scientist discovered that pellagra was caused by a niacin (vitamin B3) deficiency. Years later it was discovered that the traditional Aztec practice of processing corn with an alkali such as wood ash or lime (called nixtamalization) releases niacin trapped in the outer shell of the kernel.

While pellagra is now a rare occurrence, its underlying cause finds resonance in a whole new epidemic of gluten intolerance. Gluten is a naturally occurring protein found in the seeds of grass species including wheat, spelt, kamut, rye and barley. When ground into a flour gluten gives these cereals a glue-like consistency that allows the dough to rise, trapping the gasses released by the leavening agent like a balloon fills with air. Etymologically the word ‘gluten’ is derived from the Latin word ‘glutinis’ meaning ‘glue’, and it is perhaps no surprise that the sticky properties of gluten are used to good effect in other applications such as paper-making, wallpaper paste, paper-mâché and play-dough.

Given the sticky, glue-like property of gluten and flour it is easy to appreciate that gluten is very difficult to digest. At the extreme end are those who suffer from celiac disease, and exhibit a profoundly negative response to gluten consumption, manifesting characteristic symptoms including abdominal pain, steatorrhea, constipation and malabsorption. Although less than 1% of the population is diagnosed with overt celiac disease, researchers suspect gluten intolerance may be much more common than previously thought,[1] affecting up to 29% of the US population.[2] Beyond the effect on digestion, gluten intolerance is associated with a number of other issues including:

  • weight loss[3]
  • anemia[4]
  • fatigue[5]
  • dermatitis herpetiformis[6]
  • psoriasis[7]
  • autoimmune thyroiditis[8]
  • type 1 diabetes[9]
  • uveitis[10]
  • Addison’s disease[11]
  • infertility[12]
  • inflammatory bowel disease[13]
  • autoimmune liver disorders[14], [15]
  • pancreatitis[16]
  • peripheral neuropathy[17]
  • dementia[18]
  • epilepsy[19], [20]
  • anxiety[21]
  • migraine[22]
  • fibromyalgia[23]
  • arthritis[24], [25]
  • osteoporosis[26]
  • cancer[27], [28]

The typical advice given to confirmed celiacs and those suspected of gluten intolerance is to avoid gluten-containing foods such as bread, pasta, pastries, muffins and breakfast cereal. Gluten however is hidden in many foods, used by industry as an adhesive and excipient in processed and prepared meats, processed cheeses, condiments, sweeteners and candy, as well as breads “made without flour”. Given its prevalence in the food supply gluten avoidance can be a difficult task for the consumer, especially outside of big cities and major centers, and itself can be a cause of chronic anxiety.[29]

Given the association of gluten intolerance with chronic disease it is not surprising that the popularity of gluten-free products has exploded in the marketplace. Manufacturers have found clever ways to use non-gluten flours such as rice, buckwheat, corn, sorghum, teff, tapioca, arrowroot, potato, coconut, soy bean, guar bean and locust bean to make familiar products. While many of these alternatives do seem to lessen the symptoms associated with gluten intolerance, the question arises if we are substituting one problem for another. Very few of these alternatives were traditionally milled into a fine flour and used in baked goods, and many have the same types of antinutrient factors and immune sensitizers as gluten-containing cereals such as wheat.

It could be that much of the issue with the widespread gluten intolerance that seems to have evolved from thin air, like corn and pellagra, is in large part an artifact of not observing traditional methods of food preparation. Traditional methods of bread making, like the nixtamalization of corn, is an involved process that includes sprouting, roasting and stone-grinding the cereal to a coarse flour. The key element is the incorporation of a sourdough culture comprised of naturally occurring bacteria and yeasts. Apart from their use as leavening agents, these organisms ferment starches and produce enzymes in the process that effectively hydrolyze the gluten, turning it into easily digestible proteins.[30] Clinical research shows that when sourdough is used in the preparation of baked goods it is surprisingly well tolerated among patients with celiac disease.[31] Making real sourdough bread however is an artisan skill that requires time and effort to practice (see page 128).

[1] Harrison MS, Wehbi M, Obideen K. 2007. Celiac disease: more common than you think. Cleve Clin J Med. 74(3):209-15.
[2] Fine K. 2003. Early Diagnosis Of Gluten Sensitivity: Before the Villi are Gone. Available from
[3] Nelsen DA Jr. 2002. Gluten-sensitive enteropathy (celiac disease): more common than you think. Am Fam Physician. 66(12):2259-66.
[4] Ibid.
[5] Ibid.
[6] Ibid.
[7] Birkenfeld S, Dreiher J, Weitzman D, Cohen AD. 2009. Coeliac disease associated with psoriasis. Br J Dermatol. 161(6):1331-4.
[8] Ch’ng CL, Jones MK, Kingham JG. 2007. Celiac disease and autoimmune thyroid disease. Clin Med Res. 5(3):184-92.
[9] Bhadada SK, Kochhar R, Bhansali A, Dutta U, Kumar PR, Poornachandra KS, Vaiphei K, Nain CK, Singh K. 2011. Prevalence and clinical profile of celiac disease in type 1 diabetes mellitus in north India. J Gastroenterol Hepatol. 26(2):378-381.
[10] Krifa F, Knani L, Sakly W, Ghedira I, Essoussi AS, Boukadida J, Ben Hadj Hamida F. 2010. Uveitis responding on gluten free diet in a girl with celiac disease and diabetes mellitus type 1. Gastroenterol Clin Biol. 34(4-5):319-20.
[11] Elfström P, Montgomery SM, Kämpe O, Ekbom A, Ludvigsson JF. 2007. Risk of primary adrenal insufficiency in patients with celiac disease. J. Clin. End. & Metab. 92(9): 3595
[12] Collin P, Vilska S, Heinonen PK, Hällström O, Pikkarainen P. 1996. Infertility and coeliac disease. Gut. 39(3):382–4.
[13] Leeds JS, Höroldt BS, Sidhu R, et al. 2007. Is there an association between coeliac disease and inflammatory bowel diseases? A study of relative prevalence in comparison with population controls. Scand. J. Gastroenterol. 42(10):1214–20
[14] Niveloni S, Dezi R, Pedreira S, Podestá A, Cabanne A, Vazquez H, Sugai E, Smecuol E, Doldan I, Valero J, Kogan Z, Boerr L, Mauriño E, Terg R, Bai JC. 1998. Gluten sensitivity in patients with primary biliary cirrhosis. Am J Gastroenterol. 93(3):404-8.
[15] Volta U, Rodrigo L, Granito A, et al. 2002. Celiac disease in autoimmune cholestatic liver disorders. Am. J. Gastroenterol. 97(10):2609–13
[16] Patel RS, Johlin FC, Murray JA. 1999. Celiac disease and recurrent pancreatitis. Gastrointest. Endosc. 50(6): 823–7
[17] Hadjivassiliou M, Rao DG, Wharton SB, Sanders DS, Grünewald RA, Davies-Jones AG. 2010. Sensory ganglionopathy due to gluten sensitivity. Neurology. 75(11):1003-8.
[18] Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. 2006. Cognitive impairment and celiac disease. Arch Neurol. 63(10):1440-6.
[19] Canales P, Mery VP, Larrondo FJ, Bravo FL, Godoy J. 2006. Epilepsy and celiac disease: favorable outcome with a gluten-free diet in a patient refractory to antiepileptic drugs. Neurologist. 12(6):318-21.
[20] Mavroudi A, Karatza E, Papastavrou T, Panteliadis C, Spiroglou K. 2005. Successful treatment of epilepsy and celiac disease with a gluten-free diet. Pediatr Neurol. 33(4):292-5.
[21] Addolorato G, Capristo E, Ghittoni G, et al. 2001. Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scand. J. Gastroenterol. 36(5): 502–6
[22] Gabrielli M, Cremonini F, Fiore G, Addolorato G, Padalino C, Candelli M, De Leo ME, Santarelli L, Giacovazzo M, Gasbarrini A, Pola P, Gasbarrini A. 2003. Association between migraine and Celiac disease: results from a preliminary case-control and therapeutic study. Am J Gastroenterol. 98(3):625-9.
[23] Wallace DJ, Hallegua DS. 2004. Fibromyalgia: the gastrointestinal link. Curr Pain Headache Rep. 8(5):364-8.
[24] Sökjer M, Jónsson T, Bödvarsson S, Jónsdóttir I, Valdimarsson H. 1995. Selective increase of IgA rheumatoid factor in patients with gluten sensitivity. Acta Derm Venereol. 75(2): 130–2
[25] Al-Mayouf SM, Al-Mehaidib AI, Alkaff MA. 2003. The significance of elevated serologic markers of celiac disease in children with juvenile rheumatoid arthritis. Saudi J Gastroenterol. 9(2):75-8.
[26] Kemppainen T, Kröger H, Janatuinen E, Arnala I, Kosma VM, Pikkarainen P, Julkunen R, Jurvelin J, Alhava E, Uusitupa M. 1999. Osteoporosis in adult patients with celiac disease. Bone. 24(3):249-55.
[27] Holmes GK, Stokes PL, Sorahan TM, Prior P, Waterhouse JA, Cooke WT. 1976. Coeliac disease, gluten-free diet, and malignancy. Gut. 17(8): 612–9
[28] Ferguson A, Kingstone K. 1996. Coeliac disease and malignancies. Acta Paediatr Suppl. 412:78-81.
[29] Häuser W, Janke KH, Klump B, Gregor M, Hinz A. 2010. Anxiety and depression in adult patients with celiac disease on a gluten-free diet. World J Gastroenterol. 16(22):2780-7.
[30] De Angelis M, Cassone A, Rizzello CG, Gagliardi F, Minervini F, Calasso M, Di Cagno R, Francavilla R, Gobbetti M. 2010. Mechanism of degradation of immunogenic gluten epitopes from Triticum turgidum L. var. durum by sourdough lactobacilli and fungal proteases. Appl Environ Microbiol. 76(2):508-18.
[31] Di Cagno R, De Angelis M, Auricchio S, Greco L, Clarke C, De Vincenzi M, Giovannini C, D’Archivio M, Landolfo F, Parrilli G, Minervini F, Arendt E, Gobbetti M. 2004. Sourdough bread made from wheat and nontoxic flours and started with selected lactobacilli is tolerated in celiac sprue patients. Appl Environ Microbiol. 70(2):1088-96.

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Old-fashioned Sauerkraut

Old-fashioned Sauerkraut

Sauerkraut is the classic food of Eastern Europe, derived from the German term for ‘soured cabbage’. Like many leafy greens the cabbage is a hybrid of the wild mustard (Brassica oleracea), and its healing and medicinal virtues have long been extolled by the ancients. Of cabbage, Cato the Elder claimed many uses: in the treatment of digestive disorders and colic, as well as arthritis, ulcers, nasal polyps, deafness and tumors, and applied topically as a poultice for wounds, sores and infection. In the 1950s, raw cabbage juice caught the attention of researchers, and was found to have anti-ulcer and anti-inflammatory effects in the digestive tract. Like rapini and other brassicas, cabbage contains organosulfur compounds including phenethyl isothiocyanate and sulforaphane that have been shown to have potent antioxidant and anti-tumor properties.

Given the rather ubiquitous presence of cabbage and cabbage-like sisters including sui choy all over the world, it is no surprise there is such a diversity of live culture cabbage dishes, from the traditional European sauerkraut, to Kimchi (p. 186) in Korea. The following recipe favors the European palette, and contains herbs that are good for relieving gas and bloating, but can just as easily be left out for a simpler flavor.

2 lbs. grated cabbage (~ one cabbage head)
1 onion, chopped fine
1 tbsp. salt
½ tsp. dill seed
½ tsp. savory seed
½ tsp. coriander seed
½ tsp. black pepper
½ tsp. caraway seed

Mix the grated cabbage and onion in a large, clean mixing bowl with clean hands, and add in the salt and herbs. Knead and squeeze the vegetables well for about 5 minutes, ensuring that everything is well mixed and sloppy, as the salt and kneading will pull a lot of the water out of the veggies. Stuff this mixture into a clean, dry, large wide-mouth mason jar, pressing down as you add each handful, allowing the juices to rise above the level of the vegetables. Seal the jar and set it aside for 1-2 hours, and then with clean hands, push down again on the mixture so that more brine rises to the surface. If there isn’t enough brine, top up the jar with some water, seal the jar and shake well, ensuring that the veggies are now lying below the surface of the brine. Any material that lies above the surface of the brine may get moldy. Put the jar aside, but make sure to open the lid and release the (stinky) gasses that accumulate a few times a day, for the first few days. The ferment is typically established within 4-5 days, after which you can drain off any excess liquid that you added. Reseal and set aside for 2-3 weeks and then enjoy, storing in the fridge to preserve the flavor and prevent it from becoming too sour.