Elimination (er, Poop) Pt. 1

We’re all about what goes in. Is it organic and locally sourced? Or, is it free of fat, gluten, pesticides, gmos and lactose?  Many of us, most of the time, meticulously monitor what goes in our mouths. How does the food make us feel?  Does it make us bloated or sleepy or energetic?  For me, a root beer float made with Zevia Root Beer and Straus vanilla ice cream make me feel really, really good.
We spend very little, if no, time thinking about or, dare I say look at, what comes out the other end.  Everything that exits the body, like our urine, mucus, vomit, blood and feces, gives a good indication of what’s going on in the inside. Like the mouth being the beginning of the digestive tract, the anus is the last stop. If you’re not thinking about the exit end, then you’re missing half the picture.  What lands in the toilet can tell how your gastrointestinal tract is functioning and give clues to infections, digestive problems and even cancer, celiac disease, crohn’s disease, chronic pancreatitis and cystic fibrosis.
It was not until I started studying and practicing Ayurveda that anyone cared about my elimination. While growing up, there was never a peep about poop.  Because my family and friends never talked about it, I never really knew what was normal or healthy.  Truthfully, It wasn’t until I lived with a boyfriend that I realized, and was somewhat astounded, that some people pooped daily and often at the same time.
The big Q is what is normal. Bowel habits vary from person to person. What’s normal for me may not be normal for you.  For some people 3 poops a day is as normal as 3 poops a week. Lots of factors can affect your regularity, such as diet, travel, medications, hormonal fluctuations, sleep patterns, exercise, illness, surgery, childbirth, stress and a whole host of other things. The red flag is if there are unexplained changes in your habits, which could alert you to something sinister going on inside.
Besides frequency, the “ease” with which you move your bowels is important.  According to Mercola.com, “If you need to push or strain, something is off – moving your bowels should take no more effort than urinating or passing gas”.  On one end of the scale is constipation and diarrhea on the other.  It takes 18 – 72 hours to convert food into poop.  If this time is shortened, the body doesn’t have time to absorb the water, so it results in diarrhea.  Or, if the transit time is longer, the body has absorbed too much water and it results in hard, difficult-to-pass stool.
Straining, incomplete elimination, bloating, crampiness is no bueno and indicates constipation. Chronic, untreated constipation can lead to fecal impaction (doesn’t sound good), which can be a serious medical condition. Up to 20% of the population is constipated and generally more women than men.  Be cautious of laxatives as they can be addictive and easily misused, causing chronic constipation. Still, according to WebMD, 85% of doctor visits for constipation results in a prescription of a laxative.  Laxatives should be avoided or considered a last resort and used for a very short period of time.
Part Two comes next week, where we’ll look at the “quality”, including shape, color, odor and consistency of feces.  In the meantime, maybe you’ll take a second to take a peek behind you before you flush.



Elimination (er, Poop), Pt. 2

Poop cannot be used as a conversation starter. unless you’re a doctor, and that’s still iffy.  If you’ve got a dog, you hope it’s solid for easy pick-up.  Old-timers say they’re “pooped” when they’re had a long day. Ayuvedic docs routinely want to know about it.
Last week we touched the verboten topic of feces or poop.  Why?  Because it’s never talked about, even among friends.  So, we’ll explore it together.  Let’s continue where we left off.
Straining and incomplete elimination is no way to spend your time on the john. Many folks treat constipation with laxatives. But before hobbling to your local Rite-Aid and scanning the multiple shelves for the Philips Capsules or MiraLax make sure you’ve thoroughly exhausted other ways of increasing the “transit time”. Excessive use of laxatives can cause damage the muscular function of the bowel, drain the body of water, vitamins and minerals, cause kidney stones or kidney failure and you may need more and more of the laxative to get results, until eventually the laxatives do not work.
Dealing with constipation is cheap and easy, but you’ve got to make some changes. I try. Drink more water. Move. Eat more fruits and vegetables. Get more fiber. There are two types of fiber, one is soluble, which is absorbed, slows down the transit and allows more nutrients to be absorbed; and two, insoluble that is undigested by you but becomes food for gut bacteria (good) and bulks poop up like glue.
Fortunately, I like prunes. I pop a couple a day, unless I forget, which is most days. I also like Calm. It’s a magnesium drink that can be used as a mild laxative. The literature says it “normalizes tension on colon walls allowing for a normal peristaltic action”.
There is a visual guide to evaluate the “quality” and “form” of poop. Developed by researchers at the Bristol Royal Infirmary, it’s called the Bristol Stool Form Scale, or BSF scale for short. It helps docs talk to patients without overly grossing them out. There are pictures and descriptions of various kinds/types/shapes of feces.  You can see the chart here.
Here we go:
Type 1:  Deer poops, like nuts, hard to pass, lumps are hard and scratchy.
Type 2:  Sausage-like but lumpy. Most destructive by far because its size is near or exceeds the maximum opening of the anal canal and can cause extreme straining, anal canal laceration, hemorrhoidal prolapse, or diverticulosis.
Type 3:  Sausage with cracks.  Irritable bowel syndrome is likely. Flatulence is minor.
Type 4:  Smooth, soft, consistent surface,  like snake, 1-2 inches in diameter and up to 18 inches long.
Type 5:  Soft blobs, breaks apart on impact. Although considered borderline normal, it can be difficult to make it to the bathroom on time and may require a whole lot of toilet paper.
Type 6:  Fluffy pieces with rough edges, a mushy stool.  Suggests a hyper-active colon, too much potassium or spike in stress.
Type 7:  Watery, entirely liquid, no solids. Diarrhea.
It’s worth reminding ourselves that everyone has their own normal, but Type 4 and 5 are considered optimal.

Is that enough elimination talk?  I think yes, so we’ll call it quits (for now). There’s a lot more we could cover, but we’ll save it for another day.  Thanks for hanging in there with me.



The Left Side

You know I don’t talk politics in my newsletter.  You get enough of that from a wide variety of sources (I hope).  This article, however, is indeed about the right (not to be confused with “correct”) side versus the left. It’s not about blue versus red, but about the body, of which I am more familiar and friendly with.
I was feeling a bit cruddy, let’s say nauseous.  This is usually due to a headache, but I didn’t have one.  I’m pretty sure it was an artifact from being in Mexico for 2+ weeks (*smile*).  Besides taking a plethora of over-the-counter medication, which I refuse to do, the best cure is time and sleep, as it is for many things. Lying on the bed,  I tried to get comfortable or find a position that I could relax, feel better and doze off.  Like a child, I was frustrated at being able to comfort myself.
Some years ago I had heard that it was good for digestion to lay on the left side, having something to do with the ascending and descending colon. I gave it shot and spent several minutes lying on my left.  Sure enough, I started feeling better, a lot better.  There must be something to this, I thought.  So I did some googling.
Many of our body organs have a twin in each side of the body, like the kidneys and ovaries.  Some are housed on the left side, notably the stomach, heart, large intestine and pancreas.  So, can lying on one side of the body make a difference?  Yes.
According to the article I read at LifeHack there is a small body of research that says that for many people sleeping on the left side can be better for health and sleep. This stems from Ayurveda (which I practice), the sister to yoga which deals with health and medicine.  Sleeping on the left side is good for our digestion, backs and even hearts because of how our organs are positioned.
Here are six heath factor per the above article:
1. Lymphatic drainage. Because the left side of our body is the dominant lympathic side, lying on the left side can increase the lymphatic system’s efficiency.  “Western research has also found that sleeping on the left side can help the body process waste materials from the brain”.
2. Improved digestion.  Because of gravity, lying on the left allows food waste to easily move from the large intestine into the descending colon (helping the morning movement).  The stomach and pancreas also hang naturally.  The image above, which was attached to the article helps visualize.
3. Great for Pregnancy.  Doctors recommend that pregnant women sleep on their left sides.  According to this site, “It can also help to relieve pressure on the back, keep the uterus from squeezing the liver, and increase blood flow to the uterus, kidneys, and fetus”.
4. Heart Health.  Sleeping on the left side may help to take some pressure off the heart.  It’s about gravity again as it facilitates lymph drainage toward and aortic circulation away from the heart. (Note:  There’s some debate over whether sleeping on the left or right side is best for heart health.)
5.  Reduces Heartburn.  Lying on the left side can help reduce acid reflux symptoms.  The New York Times reported a study where researchers recruited a group of healthy subjects and fed them high-fat meals to induce heartburn.  After the meals, they spent 4 hours on either the left or right side.  They found the “total amount of reflux time was significantly greater” when the subjects were on their right side.
6. Help with Back pain.  If you have chronic back pain, try switching to your left side, which can relieve pressure on the spine.

So, now we both know that lying on our left side can have some health benefits.  The next time you’re feeling a bit full or have some digestive distress, give it a shot.  As always, I appreciate your comments and feedback.

What is Normal?

Should you put your foot over your head?  Should you use no, 3 or 5 blankets in shoulderstand?  Should you bend your knees in a forward fold.  If you do not practice yoga, you may be wondering why in the hell we’d put our foot over our heads or we’d stand on our shoulders.

When we see limber, young white women on the cover of the yoga magazines in fancy poses and colorful tights and tops, we get the impression that this is yoga.  It may be for them, but may not be for you.  It’s always frustrating to hear that people do not try yoga because they are too stiff or have bad balance, as if touching your toes with straight legs is “yoga”.  Perhaps you try the poses in class and wonder why you have such difficulty.  You may become discouraged or force your body into painful poses or quit yoga all together.

Let’s talk about what is “normal” flexibility?  There’s a term “range of motion”.  It’s the measurement of the movement around a joint.  It takes into consideration the ligaments, tendons, muscles and bones associated with the joint. A healthy joint should have good range of motion and move in all directions permitted to that joint  For example, the range of motion of your elbow is about 50 degrees. Try this. Hold one arm straight ahead of you.  Bend your elbow to bring your hand toward your head. It’s considered normal range of motion for your hand comes about as far as your ear (90 degrees would bring your hand to your shoulder).  If you’re interested in the range for other joints, see the reference below.  

Knowing what is normal is helpful in yoga because it gives you a gauge of where we should be heading. This depending a lot, of course, of whether there is an injury or other restrictions.  If you have a “normal” range of motion, then you should be quite happy.  But, I usually see students struggle mentally and physically because they don’t look like their yoga teacher or neighbor even though they are within a healthy range of motion for that particular joint.  

Going beyond normal range of motion can have consequences. We are seeing labral tears in the hips of yoga students who are overdoing hip stretching (see link below).  What about shoulderstand?  The normal range of motion for the neck in flexion (chin toward chest) is 50 degrees. When doing shoulderstand without props, the neck is being pushed to 90 degrees of flexion leading to a flattened cervical spine. So, if it’s painful to do shoulderstand without props you are probably very normal (see Mary Richards and Lizzie Lasater’s video below).

Having a balanced body with good range of motion in all joints is important. Lifestyle, like sitting or having poor posture, can affect your range.  Improving  the movement of your joints will take some time as you stretch the tight areas. You will find some or a lot of discomfort as tight fascia, muscles and ligaments regain their more natural position and allow more movement in the joint.  Patience, consistency, patience, good instructions and more patience is required.  If you’re curious about your own range of motion you can assess yourself or contact a physical or yoga therapist.  I refer to Mukunda Stiles book, Structural Yoga Therapy.  http://www.goodreads.com/book/show/199515.Structural_Yoga_Therapy

It’s understandable to push ourselves to achieve a shape, even though it’s not optimal for the health of the body. I’ve done it and I do it. But, I challenge my body with respect and knowledge, rather than aggressively pushing and forcing. There’s a difference.  Hopefully this has given you a starting point to begin to think about what is normal for you.

Click to access 13-585a.pdf

Do You Know What Your Pelvis is Doing?

There is the “tuck” and the “tilt”. In all yoga poses, the pelvis is doing something in order to accommodate the shape. Just when things are getting good and the body has found it’s groove, the teacher gives the instruction to change the tilt of the pelvis. You might hear “drop” or “tuck” your tailbone.  Whaa?
I believe the body has innate intelligence and it does.  It’s usually best to let the body to do what it needs to do.  Usually, but not always.  For example, in back bends, the lower back needs to bend. Simple. The shape and function of the lumbar spine (lower back) is to bend backward (and forward).  When backbending, “allow”, not force, your lower back to bend into the dome shape.  Tucking or lengthening the tailbone gives the body the opposite information. Here’s another example. When taking the arms up, the body needs to raise the shoulder blades too. Once your arms are up, being asked to pull them down is counterproductive.
In mountain pose (tadasana) it’s sometimes tricky to find the correct position of the pelvis, especially because some of us have some pretty bad posture. Years of sitting and slouching or carrying heavy purses or wearing fancy high heeled shoes has skewed the way we stand. I’m included, for sure. The body’s innate intelligence has been hijacked by fancy chairs, airline seats, and book-filled backpacks (especially kids)  So, it’s no wonder, when we try to “stand tall” in mountain pose our bodies wonder “how?”. Our default pelvic position may not be optimal. Some of the cause may also be structural, like tight hamstrings, stuck hips, and residuals from previous injuries.
The print and online magazine, Yoga International, has a great article on the specific subject of the pelvic tilt in mountain pose.
In mountain pose, then (and in other neutral-spine poses such as tabletop, plank, chaturanga, chair pose, downward facing dog, and staff pose), the pelvis should be tipped forward until the lower back curves in gently. “Tucking/scooping the tailbone, as commonly taught in these poses, is not beneficial to the function of the spine. In fact, that instruction, often given ‘to protect the back,’ makes it harder to engage the transverse abdominal muscle and the multifidus muscles which stabilize the back.”
Many of us are “stuck” in either a posterior or anterior tilt, according to the article.  There are animated gifs that illustrate how the pelvis moves to a neutral position.  I recommend you take a look.
You’ve seen the posterior tilt: the lower back flattens, the thighs, head and shoulder move forward and the chest collapses. This is pretty common. While standing in line at Whole Foods, Just look around. Check out your own posture.  I’m constantly having to correct myself. As a yoga instructor, I see it all of the time. Here are the cues, which I like, that Yoga International offers:
“Tip your tailbone until the lower back curves in.”
“Stick you butt back”
“Press the tops of your thighs back”
or even “Widen your sitting bones”
If you’re a student of yoga, you know we move everything, especially the pelvis. Cat/Cow, forward folds and bridge pose all change the tilt of the pelvis. This is compared to other activities like like running, walking, cycling or swimming, which carry a fairly stable pelvic orientation. That’s why yoga should be a part of everyone’s movement regime.

New Guidelines for Back Pain

You’ve got back pain and up to 80% of Americans do or will have in their lifetime. Here’s a shocker–put on your seat belt:  Do not call the doctor.  This is advice coming from a doctor.  No, it’s not because you lost your Affordable Care Act insurance and now have to sell more blood to take care of your medical bills.  No, it’s not because the doctors aren’t pressured by Big Pharma to dole out the addict-inducing opioids, scans and injections.  It’s because doctors how have new guidelines handed down by the American College of Physicians for the treatment of back pain. This is big news, I’m pretty sure.

According to the previous guidelines, the first line of therapy was medication. This may be obvious to you.  Now, pills, even the over-the-counter pain relievers and anti-inflammatories, should not be first choice, according to the February 14 reporting in the New York Times, Lower Back Ache? Be Active and Wait It Out, New Guidelines Say and an accompanying opinion on February 17.  The new recommendation is to look for nonpharmacological therapies first.  Whaa?  No prescription pad, no trip to CVS, no side-effects, no out-of-pocket expense?  What could it be that is as effective as the almighty, chalky white, round pill?  Okay, you’re way ahead of me.  Yes, yoga.  But more, like exercise, acupuncture and massage therapy.  Did they mention yoga?  Yes, they did.

From the NYT:

“Doctors should reassure their patients that they will get better no matter what treatment they try, the group said. The guidelines also said that injections were not helpful, and neither was acetaminophen, like Tylenol, although other over-the-counter pain relievers like aspirin, naproxen or ibuprofen could provide some relief.”

Patient without acute back pain, that which lasts 4 weeks or less and doesn’t radiate down the leg, do not need to see the doctor.  They’re making an analogy to the common cold:  “it can be annoying when it happens, but most of the time it will not result in anything major or serious”.

The placebo effect even works wonders, even when the patients knew they were taking a placebo.  Studies have shown that patients with chronic low back pain reported less pain and disability on a placebo than those in the control group.

The article explains that some people with chronic back pain tend to shut down and avoid their usual activities.  This is the opposite of what needs to be done.  People need to return to their normal activities.  The article quotes a doctor stating, “I know your back hurts, but go run, be active, instead of taking a pill.”

Before you start cheering and thinking there was a least one speck of good news this week, it’s not all so rosy.  Patient want the quick fix.  There are incentives for doctors to push the pills, scans and injections.  Medical insurance does not pay for the remedies, like massage, tai chi, yoga, mindfulness training or chiropractic manipulation.  Doctors don’t often have a referral system for therapies outside the allopathic medical system.

Here is what I recommend if you’ve got non-chronic back pain.  Stop doing what’s causing the pain.  Much back pain is from our lifestyle, like sitting, doing stupid things or periodic tasks like weed pulling or a weekend pick-up basketball game.  After resting the area for 24 hours or so, start some gentle movement, but staying out of pain.  As time goes on, you’ll be able to move a bit more. You can add massage, acupressure or acupuncture, or other modalities you’re comfortable with.  Of course, there are reasons to see a doctor and to seek emergency medical care.  I’ve added a list in the Notes below.

If you’re interested in how yoga can help with low back pain, I have lots of information, so please feel free to ask me.


Contact your doctor if pain: Is constant or intense, especially at night or when you lie down, spreads down one or both legs, especially if the pain extends below your knee, causes weakness, numbness or tingling in one or both legs, occurs with unintended weight loss, occurs with swelling or redness on your back
Seek emergency medical care:  Call 911 or emergency medical help or have someone drive you to the emergency room if your back pain: occurs after a high-impact car crash, bad fall or sports injury, causes new bowel or bladder control problems, occurs with a fever