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A recent review of scientific literature looked at the state of modern digestion and elimination. Researchers found reports of sluggish elimination common, but inconsistent from country to country. Americans, in particular, seem unsure how to classify their bathroom habits, with survey results ranging from 2% all the way up to 27% of the population. (1)
The medical definition of normal elimination is considered to be at least three bowel movements a week. (1) However, Ayurveda and many health professionals subscribe to the one bowel movement a day rule. Ayurveda says this should be a complete elimination within the first hour of waking up.
The newest studies on the gastrointestinal system are showing correlation, if not causation, between irregular bowel movements and many serious health issues. (3)
Ayurveda maintains that 85% of the body’s overall health depends on the digestive tract. It is the seat of the mind, emotions, physical health, and the body’s ability to naturally detoxify.
Balancing the Gut Flora
Our microbes, whom make up 90% of all the cells in the body, reside in what is referred to as our microbiome – in primarily the large intestine. The environment for these microbes must be precise to support optimal health.
Sluggish or loose stools are indicators that the environment may be out of balance, and that a risk exists for the proliferation of opportunistic microbes that can negatively impact healthy elimination.
Probiotic supplementation, which boosts beneficial gut bacteria, is used to support the frequency and consistency of the stool. Probiotics are quickly gaining support in the larger medical community. In one recent study, Bifidobacterium lactis was particularly effective in supporting normal transit time as well as healthy consistency and frequency of bowel movements. (4)
Bile Flow is Key
Healthy bowel function, which supports the stability and proliferation of good gut bugs, depends on the complete digestion of foods upstream in the stomach, pancreas, gallbladder and small intestine.
New research is now pointing to the regulation and production of adequate bile from the liver as a key component in healthy, normal elimination. (5) After digestion, leftover toxins in the large intestine are re-absorbed back into the bile where it ends up in the liver. Over time, the liver can become congested and the production of bile will slow down. This can lead to congestion of the gallbladder and poor bile flow into the intestines. Bile is the ultimate upstream regulator of the stool’s consistency, frequency and intestinal transit time. (5) Maintaining the healthy production of bile is key to regular elimination.
Herbs and foods that boost bile flow are called cholagogues and can be easily found. Some of my favorites are:
Fiber-rich foods, such as fruits, green veggies, whole grains and beans are also key to healthy and regular bowel movements. Fiber scrubs the gut of excess mucus and toxins, attaches to toxin-carrying bile and escorts it to the toilet, and provides food for the good microbes that proliferate in the intestines. The goal is to reach 50 grams of fiber each day.
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Be Aware of Laxatives
According to WebMD, there are four basic types of laxatives. (6)
1. Bulking agents
Food such as bran, or products such as Citrucel, Metamucil, Fibercon and plants like psyllium, chia, and flax can ease occasional constipation by absorbing more fluid in the intestines. This makes the stool bigger, which gives you the urge to pass the stool.
Risks: Bulking agents attract water and regular use can pull excess water off the intestinal wall. Over time, this can dehydrate the bowel and cause more chronic elimination concerns. In addition, most bulking agents expand greatly inside the intestines and, if used excessively, they can potentially distend the intestines, reducing their ability to contract and move fecal matter to the toilet. This can eventually result in a chronically sluggish, overly distended and dehydrated bowel.
2. Stool softeners
Products such as Colace lubricate and soften the stool in the intestine, making it easier to pass. Stool softeners do not often cause problems but they don’t work as well if you don’t drink enough water during the day.
Risks: The side effects from stool softeners can include sore throat, nausea, and skin rashes associated with dehydration. Stool softeners are also potentially habit forming and are not considered safe to use for more than 1 week without a doctor’s supervision. (7)
3. Osmotic laxatives
Products such as Fleet Phospho-Soda, Magnesium, Milk of Magnesia, or Miralax and non-absorbable sugars, such as lactulose or sorbitol, hold fluids in the intestine and draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water if you use this type of laxative.
Risks: Once again, the mechanism for somatic laxatives is to pull water off the stool. Long term use can dehydrate the bowel making it more challenging for natural regular elimination, leading to dependency. Side effects can include malabsorption of key minerals, electrolyte disturbances and kidney strain. (8)
4. Stimulant laxatives
Products such as Correctol, Dulcolax, Ex-Lax, Feen-a-Mint, or Senokot speed up how fast a stool moves through the intestines by irritating the lining of the intestines. Regular use of stimulant laxatives is not recommended as it can compromise the absorption of vitamin D through the intestinal wall.
Herbal stimulant laxatives include Cascara sagrada, Senna, Aloe latex, Frangula and prunes. Herbal laxatives that stimulate or irritate the bowel employ a constituent called Anthranoids that induce gut motility, stimulating a decrease in transit time. They also reduce fluid absorption and increase secretion in the colon, with the “end result” of softer stools.
Risks: Stimulant laxatives change the tone and feeling in the large intestine and can easily and quickly create a chemical dependency. Large doses can result in cramping and watery stools. Additionally, studies are inconclusive as to their overall efficacy. (8)
As bowel irritants, long term use can irritate and inflame the intestinal wall. Controversy exists as to whether this causes severe or lasting harm to the gut, but Ayurveda clearly says to be kind and gentle to the intestinal skin. (8)
Healthy Alternatives to Laxatives
The first step in supporting healthy elimination is to tone the bowel muscles and lubricate the intestinal villi and gut wall. Triphala (also spelled Trifala) is a classic Ayurvedic formula that consists of three fruits which safely and effectively treat occasional constipation (9):
- Haritaki tones the muscular wall of the gut.
- Amalaki supports the health of the intestinal skin and villi.
- Bibhitaki boosts the removal of mucus and toxins from the wall of the gut.
Triphala is not a harmful, bowel-irritating laxative like senna, cascara sagrada and others which can also be habit-forming. Clinically, I find it useful as a bowel sweep for short-term eliminative support when traveling and during times of stress, and to help reset the lower digestive function.
For Dry Stools and Intestines
The slippery elm and licorice are soluble fibers, which help to form a viscous layer between the intestinal wall and potential irritants. When the gut gets stressed and dry it must be shielded and lubricated naturally with herbs. These slimy fibers, in combination with the triphala blend, support the reset of healthy bowel function and are easy to quickly wean off once elimination is balanced.
To activate the other herbs you need to bring water to the intestines as quickly as possible after digesting them. A small amount of psyllium attracts just enough water to the other herbs to activate them and allow them to effectively lubricate the intestinal mucosa and gut.
As I mentioned above, I am not a big fan of psyllium as a bulking agent for regulating the stool. It sucks water off the gut wall and dehydrates the bowel, potentially turning sluggish bowels into a chronic concern. But a very small, non-bulking dose of psyllium used to attract water works brilliantly.