Chapter 19: Effortless Elimination — The Thatched Hut Diet

“For I am full of matter, the spirit within me constraineth me. Behold, my belly is as wine which hath no vent; it is ready to burst like new bottles.” Job 32:18-19

During my third year in medical school I went to Zululand to pursue research on tuberculosis. The British surgeon at the hospital wrote me to come in September, and several hours after stepping off the train I found out why. Most Zulu men worked in the diamond and gold mines hundreds of miles to the north and only came home at Christmas. The surgeon put a scalpel in my hand, pointed out the linea nigra, the thin, pigmented skin stripe running midline from the pubis to the navel and said, “Cut along the dotted line.” We did four Caesarian sections my first day. Every Thursday he gave me a break from the incessant deliveries and took me in a van to an outlying clinic. The first week we went to a thatched farmhouse in the heart of rural Zululand where we treated local farmers and cowherders who presented with primarily infectious and nutritional disorders I had not yet even learned of. He also taught me to pull teeth, as no dentists were available. A week later we went to a clinic on the Zululand border where the villagers commuted from their huts to factories in nearby towns. There we saw diabetes, hypertension, obesity and constipation. I was now in familiar territory.

Lurching home on the rutted roads, the wise surgeon and I talked about the phenomenon of diseases of urban life. In his thirty years in Zululand, he had never seen a case of colon cancer and only rarely saw obesity and constipation at the thatched farmhouse. “Did you notice that the lady with hypertension was wearing a watch? She is paid according to how many parts she stamps per hour. Her cousin, whom we saw last week, doesn’t even know what an hour is. The city cousin also eats city food – processed and salty.”

One year later in India, I met a senior physician, Denis Burkitt, who had spent his life in Africa, and had described an uncommon tumor among young men and boys, Burkitt’s lymphoma. He explained that he had become an astute observer of human stools because in Uganda, the great outdoors in which he loved to walk about, was the outhouse of preference. Ugandans had impressed him with their large, soft stools which have a high water content. Rural African stools resemble a cow pie more than an American or British stool he told us, and have a faster transit time, with undigested roughage from supper showing up the following morning instead of days later, as is often the case in the west. Most importantly, he concluded, the nature of the stools of rural Africans helps explain their protection from diseases of western civilization. Rural Africans rarely develop some of Westerner’s most common disorders: constipation (and constipation’s immediate consequences – the hemorrhoids, varicose veins and hernias that result from pelvic congestion and straining at the stool), diverticulosis, irritable bowel syndrome, diabetes, obesity, elevated cholesterol and it’s consequences i.e. heart attacks and strokes. They rarely develop one of America’s most common cancer’s: recto-colon cancer (his logic being that there are fewer carcinogens in the stool having less contact time with the wall of the colon). During the decade after our conversation, the medical community was eager to debunk Dr. Burkitt’s theory that a soft, high-fiber stool was the solution to most of our ills. In one study, adding fiber alone for a few years to the diet of Western subjects who had eaten a standard western diet all their lives did not reduce the incidence of colon cancer. These subjects did not have an African unrefined diet, nor would they tolerate one. Perhaps after a life of refined food, the carcinogenic horse had already left the barn. My own practice experience has confirmed that nearly everyone with chronic constipation, irritable bowel syndrome and diverticulosis will improve when eating what I call a “Thatched Hut Diet” –  in honor of our Zululand clinic.

Constipation: a Relative Matter

Medical textbooks commonly define constipation as “a lack of fulfillment following a bowel movement,” relegating the problem to the field of the subjective. Indeed some people pass a small, hard rock only once a week and are symptom free in ignorant bliss, while others have an abundant stool several times a day yet feel the world is coming to an end. Nonetheless, if you feel relief immediately after your first stool in three days, you know you have constipation. The old Ayurvedic texts profess that an easy, daily motion, like a good night’s sleep and freedom from worry, is the reflection of living in accord with the laws of nature –  an expression of suitable diet and exercise, and of synchrony with circadian rhythms.

According to the Ayurvedic texts, constipation is understood to be a disorder of the physiological operating principle governing transport and movement in the body, called vata. More specifically, the impulse for the expulsion of materials outward and downward through the pelvis, called apaana vata, is weak and irregular. Apaana means outward and creates the driving force for the elimination not only of stool but also of gas, urine, menstrual fluids, semen and babies. Indeed, because the pelvis is the center of so much movement in the body, the ancient texts call it vata-sthaana, the seat or house of vata, which, like the seat of a government or the house of a family, is the site in which vata congregates.

Since it governs movement, vata is likened to wind (and literally means wind) and creates a drying, shifting, cold, rough and brittle influence in the body when it becomes imbalanced, mimicking the effects of aging. In the pelvis, a vata imbalance presents itself as a drying, irregular and weakening effect on elimination. Intestinal motility becomes weak, irregular and sluggish. Since the main function of the colon is to reabsorb water from the stool, thus making elimination much more convenient and preventing dehydration, the prolonged time the stool spends in the colon makes the stool dry and hard, thus stretching the colonic tissues. In surgery I have noticed that the colons of patients with chronic constipation resemble an aging body. The colon becomes irregular, weak, thin-walled, pouched, stretched and dry, including its contents. The normally muscular walls with ample folds appear withered and smooth and are often blackened from use of stimulant laxatives like cascara and senna.

Chronic constipation is usually due to a sluggish colon or to poor emptying,89 but both result in a vicious cycle of mischief. It may start when your stool becomes pasty and dry, as after a plane trip during which you spend the day sitting, eating starchy foods, getting dehydrated, and missing your chance to eliminate in the morning. As things slow down, your colon fills and stretches. Then, as when you blow up a balloon, the bigger the colon becomes, the easier it stretches. The muscles in the colon’s walls lose their mechanical advantage and, over time, they lose their tone and strength. As a slave who is asked to shoulder an excessive burden, the effort only makes her weaker, especially if the taskmaster adds the strain of a whip, a laxative.

Relief from Constipation

This brings us to the value of the Thatched Hut Diet, a diet that mimics what you would eat if you ate only the food that you could grow on your own land, without anyone to refine, process or package the harvest. It is also similar to what the homesteading prairie pioneers must have eaten. This diet contains large amounts of raw fiber from unrefined grains, seeds, legumes and vegetables, which absorb water, functioning like a sponge. This diet also eliminates the cement we add to our usual fare in the form of refined foods. The Thatched Hut Diet breaks the vicious cycle by creating a stool with a high water content, which by definition is softer and more voluminous. Here are the practical points.

1. Avoid constipating foods. Unfortunately, most people, including people with chronic constipation, have no idea what is actually constipating! Most importantly, avoid white flour. Do you remember how you made paste as a kid? White flour and water. A few hours later your paper scraps were fused. This partly explains the high prevalence of constipation in societies that live on this staple. During the eight days of Passover when Jews eat no leavening, taking only matzo made from flour and water, they observe the tradition of eating raisins and prunes as an antidote. The word pasta, pastry and paste in fact derive from the same root; so practice moderation with these and with most kinds of bread, as well as with crackers, pretzels and cookies. Cheese, fowl, tea, potatoes, bananas and white rice can also be constipating. While you are at it, skip nearly everything that is refined, processed or packaged, except raw staples like grains and lentils.

2. Don’t forget constipating medications. Ask your doctor if you are on any constipating medications including antihistamines, antacids, tranquilizers, antidepressants, antihypertensives, antispasmodics, narcotics, cough syrups and many others.

3. Go for high fiber foods. Fiber holds water and stimulates the mucous membranes. Instead of white flour, use whole wheat or bulgur wheat, and instead of wheat, substitute barley, rye, oats, brown rice, corn, buckwheat and quinoa (a delicious Andean grain high in protein). Beware of millet, however, which the ancient Ayurvedic texts describe as being potentially constipating.

4. Include nuts and seeds. Take about the amount that fit in your fist. Put them in your cooking such as in stir fry veggies and casseroles (not macaroni and cheese – the ultimate glue) and eat them for snacks. Include sesame seeds, pumpkin seeds, melon and squash seeds, sunflower seeds, etc. Use almonds with the skin instead of blanched. Avoid peanuts, which are not really nuts, but legumes and will just add heaviness and gas to an already uncomfortable situation.

5. Drink plenty of fluids. If you are chronically constipated you may unconsciously suppress thirst, get dehydrated and reabsorb water from your colon. You may need to note the glasses of fluid you drink each day. Black tea, which may be constipating, and coffee, which is diuretic, don’t count.

6. Eat abundant amounts of fruit. At least four servings a day. After all, a fruit is a tree’s way to trick an animal into eating its seed. The tree packages it in a sweet, enticing, aromatic container containing a good dose of natural fiber and laxatives, which hustle the seed through the animal’s digestive system to get deposited a few miles away in a pile of manure. There are more pleasant ways to get your dose than the traditional prune juice. Taking fresh fruit is better nutritionally and more likely to become a permanent habit, in addition to providing both soluble and non-soluble fiber. But avoid fruits that may create gas, including pears, as well as bananas, which are constipating. One traditional Ayurvedic remedy is a handful of fresh grapes or freshly squeezed grape juice at bedtime.

7. Add other sources of fiber. The natural fibers in the Thatched Hut Diet may be all you need. You can also add flax seeds or bran. The best time for fiber supplements is with your meals, added to oatmeal or granola, for example. One of the finest sources is flax seed. Note what happens when you soak a teaspoon of seeds for a few hours: they swell with water and become mucinous. In your GI tract, flax seeds hold water and create lubrication. You can mill flax seeds fresh in your coffee grinder (for an omega-3 bonus) or use them whole. You may also drink the soaked seeds by themselves with some juice.

8. Psyllium seed husks. Psyllium is the treatment of choice if you don’t get your desired results from dietary changes alone. Nearly all the psyllium in the world today is grown in India, where the Ayurvedic physicians have long prescribed it. I recommend brands that utilize the unrefined husk and leave out the sweeteners and other unnecessary additives. Add psyllium gradually to the diet, starting with a bare half teaspoon, and take it with juice or water just before the meal. If you start taking fiber too enthusiastically, you may experience bloating or gas and give up. Work up to a good teaspoon or two with each meal.

9. Granola.
This can be a remarkable cure, because people actually eat it. Homemade granola provides more useful fiber with fewer calories and fat than the packaged varieties. Use whole oat, rye, barley and almond flakes, bran, flax, and sesame, pumpkin and sunflower seeds. Bake it well because these grains are harder and rougher than wheat. Mix the raw grains with a little warm olive oil or ghee (clarified butter) before baking at 325 degrees, stirring often until it turns a few shades darker. This usually takes about 45 min to 65 minutes. I spoon in some maple syrup as it is cooling. You can then add dried fruits such as raisins and date bits. A bowlful with milk or yogurt is all many people may need to conquer their irregularities.

10. Eat fresh. Reduce your use of canned, frozen, and packaged foods. In addition to making food constipating, processing and preserving removes many vitamins and minerals. When you are shopping, remember the thatched hut.

11. Get plenty of exercise.
The best kinds are those that involve some bending to massage the abdominal organs and muscles. Housework is excellent as are yoga postures that involve forward bends. The easiest and most effective is the child pose: Sitting on your heels with your shins on the floor, bend your chest to your knees, hold for 15 seconds and repeat. You can almost feel the squeezing action lending you a hand.

12. Establish your colon’s circadian rhythms.
Use the gastro-colic reflex. Whenever you eat, nerve and hormone messages are sent by the stomach to the colon, signaling that new inventory has arrived and that room needs to be made by moving out the old. The Ayurvedic texts recommend a glass of warm water in the morning on arising. If you are leaving home early, prepare some warm water with a little salt and lemon juice to take when you awake during the night. Find a regular time, ten to thirty minutes after you awaken, to sit on the toilet non-judgmentally for a minute or two, even if you think nothing will transpire. This is akin to toilet training. Culture this habit for a month or two and your colon will begin to keep time with the drumbeat of dawn.

13. Cultivate good stool habits.
Make your visits to the bathroom brief and pay attention to what is going on in your body. Leave War and Peace in the den. Don’t strain – this is the best prevention for hemorrhoids and fissures.90

14. Try squatting. I once noticed that Asian visitors who had been walking barefoot outside left footprints on our toilet seat. They were using the toilet the way nature originally intended. It is not, however, the way the manufacturer intended and can result in a broken toilet. Instead, try putting two large cans or wood blocks about six to eight inches high as footrests on both sides of the bowl. Sit on the toilet regularly with your feet and knees elevated. If this position –  which naturally compresses the abdominal contents and tilts the pelvis –  seems more efficient, you can purchase a permanent, more elegant footrest that slides behind the bowl and out of the way. 91

15. Avoid habitual use of laxatives. Use them only to prevent or relieve the most uncomfortable circumstances. Keep in mind that constipation is best managed through prevention. Regular use of senna, castor oil, irritant laxatives, milk of magnesia, cascara and their like can only make the problem worse by interfering with the normal tone of the colon and creating both dependence and tolerance. You will eventually need increasingly bigger doses. If people with healthy elimination find themselves constipated for several days after taking a laxative for a diagnostic test or a therapeutic cleanse, imagine what laxatives are doing to your already feeble, listless colon.

16. Triphala. One fortunate exception to the above advice is the regular use of the Ayurvedic remedy triphala. Phala means fruit and triphala is a combination of three fruits92 that have been dried, powdered and usually pressed into tablets. Triphala is traditionally used as an upper digestive aid and as a tonic. It nourishes the skin and eyes and aids weight loss. Its side benefit is gentle laxation. You can take it in the morning or at bedtime. The usual dose is one to eight half-gram tablets. For faster effect, soak your dose in a half-cup of water for a few hours then drink, dregs and all. If you are a regular user of laxatives, don’t expect much from triphala until you have implemented the rest of the program above. Triphala can be found at most health food stores.

17. Avoid enemas. They are unnecessary if you properly implement this Ayurvedic program. If, however, hard, impacted stools still develop, it is preferable to use a simple oil retention enema than to take a laxative. The oil will soften and lubricate the hardened stool, making it easier to pass without the disruption in your natural rhythm created by a laxative. The Ayurvedic medical texts recommend sesame oil but olive oil is a reasonable substitute. Avoid mineral oils which are harsh, and do not have the same nourishing effect as sesame oil on the rectal and colonic walls. Discard the contents of a Fleet enema syringe (the best thing someone with chronic constipation can do with these irritating salts) and use the syringe to administer two ounces of lukewarm sesame oil. Lie on your left side for ten minutes to allow the oil to ascend the sigmoid colon and then go about your day (with an optional disposable liner in your underwear in case you forget the oil is there).

One precious side benefit of the Thatched Hut Diet is that in improving elimination, it makes you more active, thus preventing other common serious disorders: heart disease, diabetes, hypertension and obesity. Listen to your body’s song, learning to select and enjoy whole, unrefined, fresh ingredients and every aspect of your health will benefit.

89 Sluggish bowels and poor empyting both have many causes including other disorders and medications, so a visit to your physician may be in order. A blood test and exam, including a manual rectal exam, to rule out easily treatable causes like hypothyroidiam should be your first step if the problem is significant or new.
90 See Chapter 31: Disorders of the Pelvic Diaphragm.
92 A mixture of the dried powders of the fruits of amalaki (Emblica officinalis), harataki (Terminalia chebula) and bibhitaki (Terminalia belerica)