Constipation

Constipation

A few years ago, I was interviewed for Dan Rather's Eye on America program on CBS. In another segment of the same program, Rather interviewed the commissioner of the Food and Drug Administration (FDA), David Kessler, M.D. The program showed me in my habitual fieldwork environment, on location in Ecuador, wearing my exotic jungle garb. Dr. Kessler was shown in his office wearing his usual coat and tie. Although we never actually met or debated on that program, the difference in our garb spoke volumes.

Dr. Kessler and I disagreed about herbs and nutritional supplements. He has come down rather hard on them, while I am convinced that they can be useful. They're a cheap way to prevent some conditions, ameliorate others and even cure a few. But the FDA does not allow any medicinal claims for herbs and supplements unless they have been proven to FDA satisfaction with extensive clinical trials.

As of 1995, it cost $500 million to jump through the FDA hoops to prove any new drug, herb or supplement to be safe and effective. Few marketers of herbs or supplements have that kind of spending money. Drug companies, which do have the money, can justify the expense because once they get a new drug approved, they usually have a patent entitling them to exclusive marketing rights for many years. During that time they can recoup many times over the investment made in the approval process. But who in their right mind would spend hundreds of millions to prove that prune juice is a good laxative? (It is.) You can't patent prunes, so you could never make your money back.

In Praise of Prunes

When Dan Rather's producer called, he asked me what questions Rather should ask Dr. Kessler. I told him to have Rather offer Dr. Kessler a bottle of prune juice and ask if he considered it a safe, effective laxative. If he answered no, I suggested that Rather request that Dr. Kessler drink some and experience the results for himself. If he answered yes, I suggested that Rather ask why FDA labeling regulations prohibit prune juice marketers from stating that prune juice is a safe, effective, gentle laxative.

At my supermarket, prune juice costs only $1.30 a quart, making it probably the cheapest, least unpleasant laxative now available. At my nearby herb store, effective botanical laxatives--rhubarb root, cascara sagrada bark, senna pods and leaves and psyllium seeds and husks--are almost as cheap, but they don't taste half as good.

Meanwhile, FDA-approved commercial laxatives, many of which have senna, cascara sagrada or psyllium in them, are comparatively costly. And many Americans do use prune juice as a laxative. So why won't the FDA allow it to be labeled as such?

Facts on Fiber

The sad fact is that most Americans probably wouldn't need a laxative, herbal or otherwise, if they ate right. Doctors know that a high-fiber diet controls constipation by keeping things moving through the intestine.

Thanks to a family history of colon cancer, I was already a high-fiber freak when I first heard a talk by Denis Burkitt, M.D., a respected British surgeon who has spent a lifetime working in East Africa. Dr. Burkitt noted that in nonindustrial societies, among them the African communities where he worked, people eat a very high-fiber diet and rarely suffer from constipation. In fact, the only people Dr. Burkitt ever saw with constipation while in Africa were wealthy people who ate the same low-fiber diet that so many Americans eat.

Here's a sure-fire formula to create a problem with constipation: Take all the fiber-rich fruits, vegetables and whole grains out of your diet. In their place eat lots of meats, fats and dairy foods. No wonder an estimated 10 percent of Americans suffer from constipation, with at least 20 percent of the elderly complaining of it.

When I say that diet can control constipation, I'm not just talking about prune juice. Every whole-grain item and every fiber-rich fruit and vegetable helps prevent and relieve constipation. In folk medicine the foods that get special recognition as laxatives include almonds, apples, avocados, chicory, dandelion, dates, endive, figs, flaxseed, grapes, mangos, papayas, papaya, persimmons, pineapple, prunes, rhubarb, rutabagas, soybeans, turnips, walnuts and watercress. You might easily contrive any number of soups and salads from this list.

If you are constipated, the first thing you should do is change your diet to the "double high five" by eating five fruits and five vegetables a day. If you are still constipated after two days, increase your fruit and veggie intake while diminishing your intake of low-fiber foods like meats and refined breads. Also, I'd recommend that you avoid tea if constipation is a problem for you. Tea is rich in tannins, which is one reason that it is recommended as a treatment for diarrhea. Tannins help bind stools and hold back bowel movements.

Fruit and vegetable juices also work, especially those that retain much of their fiber. Prune juice tops the list, of course, but some juice advocates say that apple-pear juice is a particularly good laxative. Among vegetable juices, asparagus, jícama and potato have been suggested.

Some people who favor juicing use machines that eject most of the fiber. When it comes to treating constipation, that's a big mistake, because fiber is precisely what you want.

Green Pharmacy for Constipation

Several herbs can also help prevent and treat constipation.

Flax (Linum usitatissimum). Also known as linseed, flaxseed as an herbal treatment for constipation gets an endorsement from Commission E, the body of scientists that provides advice on herbal treatments to Germany's equivalent of the FDA. Commission E suggests taking one to three tablespoons of whole or crushed flaxseed two or three times a day for chronic constipation.

A special word of warning: If you try this remedy, make sure that you also get plenty of water--at least eight full glasses a day--to keep all that bulk moving through your digestive system.

Psyllium (Plantago ovata). Tiny psyllium seeds contain a fiber called mucilage, which absorbs a great deal of fluid in the gut. This makes the seeds swell. They add bulk to stool, and as stool becomes bulkier, it presses on the colon wall, triggering the muscle contractions we experience as "the urge." Psyllium is quite popular in Germany, and Commission E approves taking three to ten tablespoons a day for chronic constipation.

As with flaxseed, psyllium needs water to work, and if you take it without water, it might obstruct your digestive tract.

And if you have asthma, don't take this herb. There have been several reports of allergic reactions to psyllium, including a few serious asthma attacks from inhaled seed dust.

You should also watch how you react to this herb if you have allergies. If allergic symptoms develop after you take it once, don't use it again.

Aloe (Aloe, various species), buckthorn (Rhamnus catharticus), cascara sagrada (Rhamnus purshianus), frangula (Frangula alnus) and senna (Cassia senna). These herbs all contain powerful natural laxative chemicals called anthraquinones. With certain reservations, Commission E endorses all of these herbs for treating chronic constipation.

I suggest trying any of these anthraquinone herbs only as a last resort. You should try a high-fiber diet and other, gentler herbs before reaching for any of these. Any herb that contains anthraquinones can be unpleasantly powerful.

If you use buckthorn, cascara sagrada or frangula, which are all barks, insist on aged bark. The anthraquinones in fresh bark irritate the digestive tract and may cause bloody diarrhea and vomiting.

Anthraquinone laxatives should not be taken over long periods of time or during pregnancy or nursing. If you take these laxatives for long periods, you may become dependent on them. That's why I call them a last resort.

Senna Leaflets and seed pods of senna are used to make a powerful laxative.

Fenugreek (Trigonella foe-num-graecum). Like psyllium, fenugreek seeds contain fluid-absorbing mucilage. If you use fenugreek seeds, make sure you drink plenty of water to keep things moving along. And don't use more than two teaspoons at a time, as any more may cause abdominal distress.

Rhubarb (Rheum officinale). I like this constipation-relief recipe from physician Ronald Hoffman, M.D., that was published in Parade magazine: Puree three stalks of rhubarb without the leaves. Add one cup of apple juice, a quarter of a peeled lemon and one tablespoon of honey. It will make a thick, tart drink that should do the trick.

Dr. Hoffman is right about rhubarb. It contains a natural laxative chemical that's roughly equivalent to that in cascara sagrada and senna. It's also high in fiber. Remember, though, that its laxative action can be pretty powerful; you should probably try some other methods first.