The actual definition of constipation is difficult to nail down.  Traditional medical texts say it’s not necessary to have a bowel movement every day and suggest that as little as three a week fall within the normal range.  Herbalists, on the other hand, are of the opinion that one to three bowel movements per day is closer to what should be considered the norm.  Each meal that enters the stomach triggers reflex movements in the colon and can lead to a bowel movement.  There are many factors that can slow the digestive process down such as fat in the diet, stress, and inactivity during the day time.  However, it is normal to have at least one bowel movement a day upon rising in the morning or following the morning meal.  Constipation that comes on suddenly or persists may require a visit to the doctor to rule out serious causes such as intestinal obstruction, hypothyroidism, or side effects from medication.

It’s important not to resort to laxatives if you feel you do not have regular bowel movements, as laxatives–both chemical and herbal–are a common cause of chronic constipation.  While occasional use is considered safe, habitual use can lead to dependence, which not only damages the bowel, but upsets the body’s mineral balance.  When dependent on laxatives, it’s important to discontinue use slowly so your digestive system has a chance to readjust.

Self Help

There are simple, practical steps you can take to help treat chronic constipation:

• Eat more fiber.  Fiber increases the bulk of the stool and binds water, thus making the stool softer.  The best sources of fiber are fresh fruits and vegetables.  Incorporate psyllium products or soluble fiber such as oat bran and guar gum, which are easily digested, into your diet
• Set aside a specific time each day (usually after breakfast or dinner) for having a bowel movement
• Do not resist the urge to have a bowel movement
• Exercise daily
• Do not use enemas regularly
• Drink eight glasses of warm or hot water daily; according to Chinese medicine warm or hot water relaxes the intestines

Western Treatments

When the need for treatment for chronic constipation escalates to needing the care of a physician, there are a number of treatments that Western medicine resorts to, spanning from normal laxatives, to suppositories, to surgical intervention.  Each treatment has varying degrees of side effects an unappealing consequences to the patient.

Currently, a great deal of research is being done on each section of the intestine, as each part of the organ has a network of nerves that controls its muscles.  Much of this research involves neurotransmitters (chemicals that nerves use to communicate with each other).  This research is allowing scientists to develop drugs that stimulate and inhibit various nerves in the colon that propel colonic content.  Such drugs have great potential in the treatment of constipation.  The first of these drugs is currently in clinical trials and will be available soon.  How effective they’ll be over how much of the population remains to be discovered.

A Case Study in TCM Treatment

A 51-year-old woman presented with a conventional diagnosis of IBS.  Her main complaint was chronic constipation, which was only relieved by drinking senna tea.  She reported that all kinds of food gave her indigestion, which started as a burning in the throat and then turned into nausea and bloating twenty minutes after eating.  She also complained of insomnia which was relieved somewhat using Elavil (Amitriptyline), the dosage of which had just recently been increased. Traditional Chinese diagnosis revealed that her pulse was wiry, and tongue normal-colored and dry. She also appeared to be a worrier. She was prescribed an herbal tea containing taurine, magnesium glycinate, biota seed, White Peony root, tang kuei root, fu shen sclerotium, bupleurum root and others. She was also given an herbal formula which combined, among others, poria sclerotium, coix seed, barley shen qu, magnolia bark, angelica root and pueraria root. Dietary recommendations involved avoiding fruit (which can ferment in the stomach, causing bloating) for one week, exercising (light aerobics), and going for a walk after each meal. After reading about the side effects of Elavil (including indigestion and constipation), she became concerned and began reducing the dosage under the direction of her doctor over a period of three months, while incorporating the herbs. Under this regimen, all symptoms gradually improved.

Lactose intolerance is a condition in which the lining of the small intestine does not produce adequate amounts of an enzyme called lactase, making it more difficult for the body to digest lactose. Lactose is the naturally occurring sugar in milk and dairy products, and it’s extremely common in diets from all over the globe. With less lactase in the body, most lactose in the food being eaten is moved unprocessed into the colon. At this point, naturally occurring bacteria interact with this lactose, resulting in bloating, gas, and diarrhea—the primary external symptoms of lactose intolerance. Low levels of lactase may occur as symptoms of other intestinal disorders, viral, or bacterial, infection, sand cystic fibrosis. Some individuals with symptoms of milk intolerance or allergy are sensitive to the milk protein, casein, rather than milk sugar.

To be sure, people of Northern and Southern European decent are the least likely demographic to be born with or develop lactose intolerance. This is a result of centuries of being exposed to the advent of farming and the maintenance of livestock in European areas. To this day, North Americans and Northern Europeans are the only mammals that drink the milk as adults and many proponents of natural therapies and alternative medicine feel that milk consumption is unnecessary for healthy adults.

In general, there are three types of lactose intolerance, outlined below:

Primary lactose intolerance: The human body typically produces higher amounts of lactase at birth and during early childhood development, as milk is generally an infant’s primary source of nutrition. As a person ages, their diet grows and becomes more varied. Lactase production naturally decreases due to the fact that the individual has become less reliant on milk as his or her primary staple. There is a gradual decline in lactase levels over time that may ultimately manifest as symptoms of lactose intolerance.

Secondary lactose intolerance: Sometimes, when the body encounters illness, surgery, or injury to the small intestine, the body will naturally decrease its production of lactase, resulting in symptoms of lactose intolerance. IBS, celiac disease, and Crohn’s disease—to name a few—can all cause the small intestine to produce less lactase. If an individual seeks out treatment for their intestinal distress, oftentimes lactase levels may restore themselves and the painful symptoms of lactose intolerance will improve.

Congenital lactose intolerance: Occasionally, babies are born with a complete (or nearly complete) absence of lactase activity. This rare condition is passed down generationally as an autosomal recessive gene trait. In order for this type of lactose intolerance to occur, both parents must be lactose intolerant themselves. Babies born with an inability to produce lactase will get sick from breast milk and will typically require lactose-free infant formulas. Another factor to consider with babies that are born lactose intolerant is whether or not they were born premature. Premature babies have a propensity to have decreased lactase production from birth.

Self Help

Currently, no treatment exists for lactose intolerance that would allow an individual’s body to product more lactase. Individuals with lactose intolerance generally find the most relief from abstaining from dairy products and finding lactose-free substitutes for their diet. Below are some of the primary ways a person living with lactose intolerance can seek relief from their symptoms:

• Some people aren’t as sensitive to yogurt and cheese products. Eliminating milk before eliminating these dairy products may allow an individual to have a more varied diet, despite the fact that their body doesn’t produce a typical amount of lactase.
• Try substituting goat’s milk for cow’s milk. Many people find that goat or sheep milk will elicit less of an allergic reaction than cow’s milk.
• If symptoms persist, completely eliminating dairy products in exchange for alternatives like soy, rice, or almond milk may be the key.
• Watch out for hidden lactose in the products you buy. Words like “whey,” “milk byproduct,” “fat-free dry milk powder,” or “milk solids” all indicate products that probably contain lactase.
• Try and over-the-counter lactase enzyme supplement. These supplements come in tablet or liquid form and may aide in the digestion of dairy products.

If getting your daily intake of calcium and vitamin D are major concerns of yours, there are a surprising number of foods without lactose that will supply you with an adequate dose of these essential vitamins and minerals. Some of these foods include:

• Broccoli
• Canned salmon
• Oranges
• White beans
• Kale
• Seaweed
• Foods fortified with calcium (e.g., orange juice, instant oatmeal, tofu, and soymilk)

Western Treatments

Lactose intolerance is perhaps one of the few common conditions that typically cannot be treated with invasive Western treatments. As mentioned above, there are over-the-counter tablets and liquids that people with lactose intolerance can try, but these remedies do not work for everyone. As a general rule, those living with lactose intolerance are instructed by their health care practitioner to abstain from consuming dairy products, seeking calcium and vitamin D from alternative sources and/or fortified goods.

A Case Study in TCM Treatment

A 32-year-old woman had begun experiencing symptoms of lactose intolerance during her teens and early 20’s. Her family physician officially diagnosed her at the age of 30. The patient exhibited severe cramping, bloating, and diarrhea every time she consumed dairy products. She was prescribed an herbal combination bovine colostrum complex (IgG 25% Lactoferrin 7.1 mg/gm IGF) with the understanding that she was to abstain from all dairy products for 60 days. After the 60 day mark, she was to slowly reintroduce certain dairy products, one at a time. If there were any negative symptoms, she was to eliminate that item from her diet once again. By the end of the year, the patient reported experiencing virtually no symptoms, and was able to eat yogurt on occasion.

Conventional medicine does not have much to offer an individual with a chronic digestive problem. Doctors can turn off an inflammatory reaction with drugs, repair physical damage, or remove a disease organ. However, there is little they can do to restore normal health. But you can do this for yourself and I can show you how! Even if you cannot attain perfect health, you can at least improve your level of health. It is likely you can reduce the usage of medication and avoid their side effects by following herbal and dietary supplement protocols and lifestyle adjustments I will be publishing weekly on this blog. Genes may predispose you to a digestive disorder, but it is your lifestyle that determines whether you control your digestive disorder or your digestive disorder controls you.

Stress Reduction

In the many years I’ve worked with digestive clients, I have noticed that most people with digestive disorders are poor adapters to stress.  They are more likely to have flare-up of their disease during, after, or in anticipation of a stressful event.  Friends and colleagues may face the same situation but have a different reaction, perhaps a headache, shoulder or neck pain, the cold or the flu, rather than a digestive disorder.  This with chronic problems of the digestive tract tend to hold their tension there.

Even if you have been given a set of genes that make your abdomen seem like a minefield, you can reduce your symptoms with stress reduction exercises and activities.  Digestive problems tend to run in families. If you have a digestive disorder, it is likely that another member of your family has one also, even if it has a different medical name. In my own family, my aunt has Crohn’s disease, my dad has had gastric ulcers. Other family members have problems such as constipation, nervous stomach, or intolerance to fats, which have not required a medical diagnosis.  Therefore, being born with a predisposition toward digestive problems does not mean that you cannot control it, in part with stress reduction.

Diet

Essential to changing your digestive health is changing your diet. Some of the suggestions on this site, such as avoiding milk, are well documented in the medical literature.  Others are based on the experience of practitioners, ranging from traditional herbalists to modern allergy specialists. I have developed a daily digestive diet that will help you identify trigger foods, that is, foods that don’t agree with your system and cause symptoms or flareups.

Once you learn what your trigger foods are, and after a period of elimination, you can usually eat small amounts of the desired foods on an occasional basis. Products that I am sensitive to are beets, raw vegetables, and juices. I like the taste of beets, and can eat small amounts occasionally without suffering diarrhea. I can tolerate salads only when seasoned with black pepper, and when they have minimal amounts of dressing.

Another dietary area of consideration is the underlying temperature of your constitution—hot or cold.  This determines which foods you can tolerate and which you must eat with caution. My own constitution is cold, so the warming black pepper counterbalances the cooling effect of the raw vegetables. If the weather is especially cold and damp and my digestive system is not functioning optimally, I only eat cooked vegetables. I’ve found that most vegetable and fruit juices do not agree with my system. Above all, I have found through years of practice that the best diet for me is the one I was raised on, namely meat, fish, soup, vegetables, fresh fruit, and some sort of starch.  However, for someone with a hot constitution it may be more appropriate to eat more cooling fruit and raw vegetables, and less meat. Ultimately, through trial and error you must identify which foods are problematic for you.  The effort will be well worth it.

Acceptance and Reconciliation

For myself, a change of attitude was as important as a change of diet.  Digestive symptoms are part of the body’s warning system. Just like a burglar alarm that makes loud noises when there is an unwanted intruder, your body gives you a signal when you have introduced something that is unwanted and continues giving you warning signals until you stop. Instead of countering the symptoms, take them as guides in your detective work to discover what is bothering you. On this site, I offer several exercises to determine possible causes of your digestive symptoms.

For a long time I lamented the fact that I couldn’t eat certain foods and drink alcohol. Now, I have not only accepted these limitations, but I see their good aspects. For example, by reducing my alcohol intake I am protecting my liver and digestive system. After quitting regular drinking for thirty days, I realized that some of my headaches and digestive problems were due to alcohol. Clearly, I didn’t need it. I may still choose to drink or eat foods I am sensitive to, but now I know how to moderate their effects with herbs and other dietary supplements.  The only food I have had to eliminate completely is popcorn, which invariably wreaks havoc on my system no matter what precautions I take.

The suggestions put forward on this blog are meant to be a complement to, not a substitute for, your medical doctor’s instructions and your own “gut feelings.”, I’ll introduce quick tips you can implement to eliminate or avoid digestive symptoms.

Why I Use Chinese Medicine

The Chinese have a very old culture. They have been using herbal remedies for thousands of years.  The first medical text was written about two thousand years ago and it is still used by students of Chinese medicine. In the U.S., over one million patients use acupuncture and Chinese herbs each year.

In China, the most common treatments for digestive disorders are herbs and nutritional therapy.  Hospital studies have been conducted proving that appropriately administered herbs can even circumvent gastrointestinal surgeries in many cases.

Chinese tradition views digestive patients according to their condition or temperature. Haven’t you met people who run hot, or boil over at the slightest insult? Don’t you know people who are always cold when others are warm? Chinese medicine takes these constitutional factors into account before prescribing herbs or making dietary recommendations. Foods, as well as people, can be similarly classified. For example, chili peppers are warming and ice cream is cooling. According to traditional Chinese medicine, people with digestive disorders should not consume foods or beverages colder than room temperature. This means no iced drinks and iced foods, nor should drinks or food be eaten right out of the refrigerator. Raw foods, such as salad, should be consumed cautiously when the weather is cold, and never during flare-ups. Fried foods should be avoided.

Chinese herbalists even caution us to dress appropriately.  Wearing skimpy clothing can subject one to drafts. This leads to poor circulation, which interferes with digestion and other processes.

As examples of the above principles of Chinese medicine, take the following two individuals: William, a 24 year-old college student and athlete who has Crohn’s disease, gets entirely different herbs than Grace, a frail 85 year-old grandmother who has the same disease. William has what is considered a hot condition. He complains of fevers, bloodshot eyes, and shooting abdominal pain. Grace feels cold and tired all the time and has diarrhea; she is said to have a cold condition. I recommended that William take herbs that had cooling, and pain relieving properties. He was advised to abstain from alcohol and spicy food. I also suggested that he not train so vigorously, to prevent exhaustion. I recommended that he drink peppermint tea (hot or at room temperature), as it has anti-spasmodic properties. Grace was counseled to take warming herbs, as well as to eat and drink everything hot. I also recommended ginger tea, which has warming properties.

Below is a chart for you to assess your basic constitution; dietary and lifestyle suggestions are also included.

Cold Condition

A person with many of the following symptoms is considered to have a cold pattern and should be treated accordingly. 

• Cold hands and feet (can also be due to liver pattern)
• 
  Cold lower back
• 
  Low energy
• 
  No desire
• 
  Fearful
• 
  Frequent urination
• 
  Feels better in the summer
• 
  Rarely sweats
• 
  Loose stools (can also be due to heat)
• 
  Weak voice
• 
  No desire to drink
• 
  Clear or white phlegm
• 
  Lack of appetite
• 
  Clear urine
• 
  Dizziness
• 
  Edema
• 
  Delayed menstruation, pale menstrual blood

Pulse: Sinking, slow
Tongue: Pale or white coating

Limit:

• Intake of dairy products
• Intake of salads or uncooked foods
• Never use ice

Emphasize:

• Meats: Beef or chicken soup
• Teas: Ginger
• Cinnamon
• Cloves
• Chinese ginseng
• Spices: Nutmeg
• Garlic (if no sensitivity)
• Black pepper
• Fennel
• Orange or tangerine peel (in tea or soups)

Lifestyle Tips:

• Always dress warmly especially in winter
• Eat everything hot
• Try to get daily exercise to improve your circulation

Hot Condition

A person with many of the following symptoms is considered to have a hot pattern, and should be treated accordingly.

• 
  Feels warm all over
• 
  Frequently thirsty
• 
  Smokes
• 
  Feels stress, anxiety
• 
  Easily angered
• 
  Constipation (can also be due to cold)
• 
  Athletic
• 
  Feels better in winter
• 
  Sweats a lot
• 
  Prone to afternoon slump
• 
  Dark urine
• 
  Loud voice
• 
  Dominating, aggressive
• 
  Easily upset
• 
  Overly emotional
• 
  Irritable
• 
  Dry cough
• 
  Yellow phlegm
• 
  Thin
• 
  Early and heavy menstruation, bright red blood
• 
  Insomnia

Pulse: Rapid
Tongue: Red, or sticky yellow coating

Limit:

• Spicy food, alcohol, coffee
• Salads and other raw foods during flare-ups
• Avoid fried foods
• Take care not to get too hot or exhausted in the spring and summer

Emphasize:

• Vegetables: Vegetable soups, cucumber, cooked cabbage, cooked greens
• Teas: Peppermint, chamomile, dandelion, chrysanthemum, red raspberry leaf, American ginseng
• Spices: Seaweed
• Orange or tangerine peel (in tea or soups)

Lifestyle Tips:

• Try to engage in daily meditation or prayer as well as exercise

Summary

I have discussed the most important aspects of digestive healing: stress reduction, avoiding trigger foods and beverages, accepting limitations, and enjoying life. In the following posts, I will provide a multifaceted, natural approach to the identification and treatment of various digestive disorders.