Yes, it’s time for another poo-post, I’m sorry. I experience an uncomfortable reaction at the prospect of documenting my ablutions and my first instinct (my gut instinct?) is not to do so. It is, however, a totally natural part of life, I mean, we all do it for heaven’s sake! So why shouldn’t we talk about it? Ok, it’s unpleasant, distasteful and, the way some people do it, quite gauche but it need not be the case. Bowel health is critical to all-over health, the gut is intrinsically connected to every other organ and function in your body, it should be spoken about. I won’t resort to childish and ambiguous euphemisms or juvenile toilet jokes (well, not often, anyway) I will just address this subject factually and clinically and I hope that this will encourage others to do the same.
Bowel Cancer Awareness have been making valuable efforts to reduce the stigma of potty-talk with Bowel Cancer Awareness Week in early June spreading the message to talk about gut health and reduce the embarrassment people feel about this topic. I particularly enjoyed their catchphrase, “join the bowel movement!” I thankfully don’t have bowel cancer, but I do believe in the message BCA are putting forward, that we ought not to feel so ashamed about a bodily function for which we are ultimately, not responsible! Passing solids does not make you a dirty person and if something is not happening quite the way it should down there, you should talk to someone about it. We should not suffer in silence!
The Bristol Chart, developed by Dr Ken Heaton in the 1990s, is a pretty accurate gauge of gut health. The scale shows 7 types of stools ranging from constipation to extreme diarrhoea and gives numbers for each deviation. Basically, your stool should be somewhere in the middle of the spectrum most of the time and if it falls outside those parameters for longer than a couple of months, you need to see a doctor.
Well anyway, as many of you know, I originally came to the doctor with, inter alia, Irritable Bowel Syndrome, so stool monitoring is something I’ve just come to accept. I also cast my eye over my cats’ stools too as often as I can (ie. when they go in the tray) because it’s such a good indicator of general health. I had been constipated for a long time, then had daily diarrhoea for a few months, then back to constipation. Being “backed up” alone wouldn’t be so bad in and of itself but the agonising, twisting, bring-you-to-your-knees pain that comes from having wind you cannot pass through a blocked tube is crippling. That’s why I went on GAPS.
The Constipation Situation
Here’s the thing, GAPS made me more constipated. How do you get more constipated? Well, you just stop passing anything. Actually, for the first week on GAPS I didn’t pass any solids whatsoever. According to Dr Natasha Campbell-McBride, this is quite common. Stage 1 of the Intro Diet is simply boiled meats and meat stocks, soft-boiled non-fibrous vegetables, skins removed, sauerkraut juice and small amounts of fermented dairy if can tolerate it. Prior to my commencing GAPS, I found I had a reaction to dairy (constipation! Quel surprise) so I avoided that component for the most part.
Basically, the GAPS Intro has no fibre. No fibre, are you mad? That’s what I thought at first too, after all, fibre is what all the GPs, the TV and the gastroenterologist have been ramming down our throats, isn’t it? Yes, this is true, but for some people, fibre is actually the source of the problem! Who knew. The reason it’s so often touted as a miracle is because it literally brushes the walls of your gut, kind of like your teeth, giving you a good clean out. But for some people, all that brushing and cleaning can actually be a real irritant so the early stages of the GAPS Diet aim to remove any potential irritants to normalise the stool before gradual re-introduction of “normal” foods. Well, that didn’t work for me and frankly, if something is as unpleasant as eating boiled meat and mushy vegetables and does not have an immediate positive effect, I start looking at alternatives.
The GAPS Intro Diet is complex and a little confusing at times. The basic principle is this: remove all irritants (Stage 1) and stay on that stage until the stool normalises. Gradually introduce other foods (Stage 2 onwards) constantly monitoring for reactions. If any reactions occur, revert to the previous stage. S, in essence, if your symptoms never go away, you could stay on Stage 1 forever. Now this is where it gets really confusing… if Stage 1 makes you constipated, what do you do?
I posited this very question to a group of GAPS afficianados and got various different responses, interestingly none of them saying to just stay on Stage 1! Dr Natasha recommends daily enemas until things start happening on their own. I am a little bit scared of enemas, they are not a common practice in Australia and I had a heck of a time trying to buy an enema kit (it’s not like in Seinfeld, where Kramer just bought one at the drugstore) they’re simply not available in stores. I have actually bitten the bullet and ordered one off the internet, but it will take some weeks to arrive.
Other suggestions included increasing the sauerkraut juice, increasing fats in the diet and introducing juicing earlier than the diet normally suggests.
According the GAPS book, the patient should begin consuming sauerkraut juice on day 1, having a teaspoon in every bowl of broth (which we have at least with every meal, more often if possible) and increase from there. Once the patient progresses, you can start eating the kraut itself, but until then, just the juice.
I tried increasing the juice beyond a teaspoon a bowl but it’s actually quite strong tasting and when I poured a tablespoon into a large bowl of broth, I was greeted with what really tasted like a bowl of fermented cabbage juice. I don’t know if there are people out there who enjoy that kind of thing, but I do not like the flavour enough to drink a litre of it, so I have stayed at 1tsp per bowl of broth and that’s quite enough for me, thank you very much.
I’m still really struggling to get my head around this “fat is good for you” thing, but I’m certainly not complaining. Unfortunately however, my favourite way to consume fat has always been in conjunction with sugar… think chocolate, cakes, pastries and puddings. Fat as a savoury, particularly from meat after my years of vegetarianism, was very foreign to me and it’s taken some getting used to just to resist skimming the solids off the surface off the soup but I’m getting there. I don’t take the fat off when I make my stock, and I try to eat as much of the fat when I eat my meat as I can too. Did it help? No, not really.
Although I have been off dairy for a few months now, Dr Natasha strongly recommends people who don’t have a true allergy to eat some fermented dairy. If you don’t have gut symptoms, you can pick and choose, but if you do there are certain rules to follow.
Patients with diarrhoea, says the doc’, tend to do better on higher protein/lower fat fermented dairy products like yoghurt and milk kefir.
Patients with constipation tend to do better on high fat dairy products like butter and ghee (not fermented) and crème fraiche. She suggests beginning with crème fraiche made from yoghurt starter and then progressing to kefir starter as the latter is more aggressive and the symptoms of die off from kefir are likely to be more pronounced than yoghurt. Well, I didn’t have any yoghurt starter but for some reason I did have kefir so I gave that a go, mincing one sachet of commercial starter in with 400g of fresh organic double cream. It is, I must say, absolutely delicious and something I’ll definitely eat forever, but did it get my insides moving? Alas, no.
Beginning with the juice of one carrot, then progressing to a full cup and then finally adding other vegetables such as beetroot and celery, ginger and mint usually occurs in Stage 4 of the Intro Diet but for patients with chronic constipation, Dr Natasha recommends starting earlier (I heard her say this in a radio interview but it does not appear in the book).
Juice has been a real saving grace for me because frankly, if I didn’t get something fresh across my palate I was going to starve myself to death rather than eat another bowl of slops. I have discovered a deep love for beetroot and carrot juice and am surprised to discover I actually enjoy the taste of juiced celery! I have become so addicted to my daily juice that I nearly cried when my juicer had a near-death incident (it’s ok, he survived) and if it gets to about 3pm and I haven’t had my juice yet, I start getting twitchy like a hungry toddler.
But, I hear you asking with baited breath, did it cure the constipation? You can probably guess from my track record by now. No, it did not.
So what did help? To be honest, it’s a battle only half won and it’s certainly not over yet, but for me, the best treatment thus far has actually been the reintroduction of some fibre into my diet!
I decided, after adhering to Stage 1 for a week and then adding juicing in week 2 that I was simply going to hurl myself off a cliff if I had to continue on this bland diet, waiting for my enema kit to arrive, so I figured I’d do some experimentation. After all, as the good doctor has been known to say, all bodies are individual and what works for one patient won’t work for another. The GAPS protocol is correct but as far as the nitty gritty details, you have to find your own equilibrium. So, that in mind, I kept progressing through the diet, introducing new foods every few days and watching for unusual reactions.
A GAPS patient I chat to online pointed out to me that this could be the source of much inaccuracy. If the toxins form the previous offending food are still in the digestive tract, they could be causing reactions by absorption through the gut wall. Thus, it is impossible to know what food is causing what reaction if you are backed up. While I totally agree with this reasoning (it’s hard to argue with logic) if the main symptom you aim to treat is the constipation itself then it seems silly to remain on a diet that’s known to cause constipation waiting for an enema kit that may never arrive!
So I introduced egg yolks, then the whites, then scrambled eggs in ghee. Then I introduced stews and (gods be praised!) fresh herbs. I started eating gravlax and avocado and solid sauerkraut (not just the juice) and none of this made much of a difference until I found nuts. Activated walnuts, to be precise. At first they are consumed ground in to a flour and mixed with eggs and mashed pumpkin to make little pancakes and then, if no reactions occur, you can eat them whole. Well, I love nuts and I didn’t wait very long to start scarfing them by the handful and even though I felt an initial twinge of guilt, I don’t regret a thing now because guess what? Thanks to those nuts, there was movement at the station. Toot toot!
The stool is still most definitely not ideal but it is actually coming out and really, when it comes to this kind of thing, the old expression, “better out than in” couldn’t be truer. Plus, with some movement at least, I’m no longer spending hours in writhing agony as the gas build-up in my bowel threatens to blow a gasket.
I’m going to continue to progress through the GAPS stages and see how I go. Maybe when my kit arrives I will try the dreaded enema again and see what happens. Maybe I will remove some foods and revert through the stages backwards if need be but who knows? Perhaps by then my gut will be normalised by all this lovely healthy food. Fingers crossed! Not legs.