Vail health: Fiber-ful and flavorful
Special to The Washington Post
If you’ve ever been constipated, you don’t need me to explain how unsettling it is to feel so … unmoved.
Occasional constipation – when you’re traveling or pregnant, for instance, or when your diet’s off kilter – is common, and though it’s uncomfortable, you know that soon it will pass.
But when constipation is chronic, seeking relief can become an obsession.
Danielle Svetcov has turned her lifelong battle with constipation into a career move, writing “The Un-Constipated Gourmet: Secrets to a Moveable Feast.” It came out this summer and has a large potential audience: According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 4 million Americans have frequent constipation, accounting for 2.5 million physician visits a year.
“It’s the common cold of the gut,” Svetcov observes.
Svetcov, who has suffered from uncooperative bowels her whole adult life, had her first colonoscopy at age 21. Neither that test nor subsequent ones have pinned down any pathology as the cause of her condition. Looking for guidance, she started collecting tips from fellow constipees (I just made that word up), gathering home and folk remedies from anyone willing to share.
“Some people would tell me in an exclamatory way, with no shame, `Oh! My grandma in Greece did this …,’ ” she says. “Others would speak in hushed voices or whisper to me, ‘I have a recipe . …’ “
Just as she had discovered that she can count on a piece of very dark chocolate – one with more chocolate than sugar, she says – to spur her bowel activity, others she talked to swore by other prompts: coffee, of course, and beans. But her list of what she calls “key foods,” those recommended to her as sure bets for curbing constipation, also includes miso and mangoes, cashews and cultured yogurt, boysenberries and booze. Many foods on the list are fiber-filled and thus conventional choices for getting things chugging along, but others counter long-held beliefs. For instance, she recommends cheese, which some say binds the bowels; others believe the fat in cheese helps oil the machinery, so to speak.
Svetcov encourages people to experiment, to move beyond laxatives and bran cereal to incorporate high-fiber foods that actually taste good. In fact, I came by “The Un-Constipated Gourmet” when Post recipes editor Bonnie Benwickpassed it along to me, with her endorsement, after trying some of its recipes. While I haven’t yet cooked them myself, Svetcov’s offerings sure don’t sound medicinal. There are recipes for bacon-wrapped dates (it’s the dates, not the bacon, that work here), black bean and roasted corn salad with mango (a key-food trifecta) and persimmon pudding. Persimmons, the author tells us, “contain twice as much dietary fiber as apples. And if you eat the peel, I can almost guarantee results.”
She’s so sure you can get your colon contracting, she concludes with a few recipes that promise to cork you up if things get out of hand. Items such as matzoh pancakes and milk toast, she says, promise to build a “bulky, starchy dam” in your innards.
Svetcov, a writer and literary agent living in San Francisco, makes clear that she is neither a physician nor a dietitian. So how does her book jibe with standard medical advice about relieving constipation?
Amy Foxx-Orenstein, an osteopathic physician and gastroenterologist at the Mayo Clinic in Rochester, Minn., explains that various forms of constipation respond to different treatments. Everyone’s bowel patterns are different: Some folks go several times a day, while others may eke out a movement only every other day. Constipation is defined as having fewer than three bowel movements per week.
Of the major forms of chronic constipation, she explains, those related to irritable bowel syndrome, or to age, diet or even certain medications, tend to respond best to gradually adding fiber to the diet, which Foxx-Orenstein calls “the first line of therapy.”
But when constipation is due to a pelvic floor dysfunction, meaning that the sphincter muscles down there won’t relax enough to let stool pass, fiber can actually make things worse, Foxx-Orenstein says, adding to the bulk of stuff that’s just sitting in your colon. (The longer that digested food sits in your colon, the more of its liquid is absorbed by the body, which makes the stool harder – and harder to pass.) Biofeedback, which helps train sufferers to tune in to and better manage those muscles, is the preferred treatment for this form of constipation; Svetcov’s recipes, other than those such as hot water or tea that add extra liquid to your diet, aren’t likely to help much.
There’s a third kind of constipation, known as slow-transit; it occurs when the nervous system and those muscles don’t communicate well, causing matter to linger too long in your intestines. For this, Foxx-Orenstein says, the sufferer needs to signal the nerves to trigger HAPC, which stands for – are you ready? – high-amplitude-propagating contractions). Caffeine, hot beverages and even the simple act of waking up in the morning are familiar and powerful HAPC triggers. So is eating a bowl of fiber-rich cereal with milk (or whatever liquid you choose); the ensuing “nice big fiber ball in the stomach” usually gets that party started, Foxx-Orenstein says, as distending the belly signals the colon that it’s time to go. For slow-transit constipation, she says, eating breakfast and then drinking something hot “is the best intervention you can do.” Hence the likely efficacy of Svetcov’s morning meal of bran-rich French galettes (or pancakes) topped with fiber-filled warm rhubarb sauce, washed down with a glass of warm water.
But not everyone is comfortable admitting they’re constipated, Svetcov has found.
So she’s taken to inscribing books with this message: “I know you don’t need this book, but how kind of you to have it around the house for all your stuck guests!”