April 10th, 2013 by Digestive Detective
Everybody poops. Its a matter of fact and a matter of health. While discussing our bathroom habits is still considered somewhat taboo, having a sense of your elimination process is an important determinant of both digestive and overall health. Factors such as stool frequency, motility, color, texture, and transit time can all send signals as to the effective function (or lack thereof) of your gastrointestinal tract. The goal of this article is to serve as a "primer on poop" -- guidelines that will help you identify any issues that may be occurring with your digestion/elimination and some simple tips to improve your bowel movements.
The Bristol Stool Chart was developed by Dr. Ken Heaton at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997. While additional, advanced diagnostic measures have been developed to assist in determining transit time, this identification chart still serves as a good, basic at-home tool in assessing general digestion/elimination function. Types 1–2 indicate constipation, with 3 and 4 being the ideal stools (especially the latter), as they are easy to defecate while not containing any excess liquid, and 5, 6 and 7 tending towards diarrhea.
Common vs. Normal
But what are the root causes of constipation, diarrhea, and abnormal stools? This is the important factor to consider. While many individuals may chalk up a loose stool or infrequent movements to simply being par for the course, this is not the case. While these situations may be common for you or other friends and family members, it may not necessarily be normal. Common does not equate to normal - digestive disorders are unfortunately common but indicate dysfunction in the body; therefore these common outcomes are signals from your body telling you something is awry. Let's take a closer look at the potential causes of malformed movements.
Introducing the Poop Police.
The Poop Lineup
In his seminal work, How to Eat Move and Be Healthy, holistic health practitioner Paul Chek provides this creative, illustrative chart to help identify the "crappy culprits" that may result from poor diet and other lifestyle behaviors. Here are the descriptions for each in the lineup and their causes (courtesy of How to Eat, Move & Be Healthy):
Sinker n’ Stinker – This guy is named as he behaves. He is like a smelly piece of black coal that sinks to the bottom of the bowl after an arduous attempt to squeeze him out with tremendous force. His appearance is due to an over exposure to toxins such as processed foods, environmental toxins and medical drugs.
The Swimmer – This guy is light in color and floats. He is a pain to flush. His appearance is due to a high content of undigested fat. Lack of optimal bile and/or pancreatic lipase secretion, gallbladder function (or presence of a gallbladder altogether) may result in this fatty stool.
Bodybuilder – This dude is JACKED! He is typically big and round. He makes you strain to get him out of ya. If you pop a blood vessel in your eye ball when you poop, you've probably met this guy. His appearance is due to eating too many protein bars, shakes, and a general over-consumption of protein.
Pellet Man – Looks like rabbit poop. His appearance is due to altered states between peristalsis (the contraction of smooth muscles to propel contents through the digestive tract) and dehydration which can slow/halt the movement of digested contents through your system.
Diarrhea – “If you’re sliding into first, and you feel something burst… “, this guy needs no introduction. His appearance is due to a poor diet full of processed foods and your body’s attempt to purge you of it. Additionally, other toxins and irritants such as gluten may serve to irritate the GI tract resulting in inflammation and diarrhea.
The Flasher – If you can identify what you've eaten by looking at your poop, you are being flashed! Undigested food particles making an appearance in your bowl is a sure sign that this guy has crashed your party. His appearance is due to food intolerance and an inflamed gut wall.
The Poopie Policeman - This guy is “The Shit”! He is what all of our poopies strive to look like. He is well-shaped (with a consistent contour); passes easily; light brown in color; smells earthy – not foul, yet he floats… but not too much. Ahhhhhh.
Now that we've viewed the varieties of specific stool abnormalities and some of their causes, let's break it down to some simple guidelines you can follow:
- Consistency. Look at the texture of your stool. Again, it should be formed and slightly firm, and should float/"swim" slightly but not entirely.
- Regularity. I'm always surprised when I speak with a client and they inform me that their last stool was 3 days ago or that they go maybe 2-3 times per week. THIS IS AN ISSUE. While everyone is somewhat different, you should have a bowel movement reflective of your eating and should eliminate at least once per day. If 2-3 or more days pass without passing, you are constipated and your body is signaling some significant digestive dysfunction.
- Abnormalities. As highlighted above, abnormal anomalies such as a foul stench, undigested food particles, malformed shape/texture, and irregular color are signs of some poop problems. Since we touched on smell, particles, and shape above, let's briefly look at color:
Brown - Normal stool color caused by bilirubin, a pigment resulting from the breakdown of red blood cells.
Yellow - Excess fat in the stool, such as due to a malabsorption disorder. An irritated mucosal barrier in the gut from a disorder such as Celiac or other food intolerance may be partly to blame.
Green - Indication of hyper-motility where bile doesn't have time to break down completely.
White or clay-colored - A lack of bile in stool. Anti-diarrheal medications may also cause this discoloration.
Black - May indicate bleeding in the upper gastrointestinal tract. This can also result from intake of iron supplements.
Red - While some foods may discolor your stool red, such as beets or cranberries, red discoloration may also indicate bleeding in the lower gastrointestinal tract such as with hemorrhoids. If you see actual blood or have a red or black stool that you cannot link to a food or medication you've taken, consult with your physician.
- Period of Time - Transit time refers to the period of time it takes from consumption of a meal until it has been completely digested and its remnants eliminated from the body. From the time of ingestion of a meal, it takes approximately 2 hours for the first part of the meal to reach the small intestine and then another 4 to 6 hours for all of the meal to reach the colon/large intestine. The length of time it takes for the remnants from the meal to pass through the large intestine is much longer, typically 12 to 24 hours. During that time, bacteria in the colon ferment the residue, a process that in part results in the production of a few vitamins such as vitamin K and some B vitamins. Transit time can be impacted by the very nature of the food we eat, the state in which we eat it, and the state of our GI tract.
Junk in = junk out. Eating highly refined, processed, and inflammatory foods will only serve to irritate and inflame the gut and potentially weaken the intestinal tight junctions that prevent passage of pathogens and undigested food particles from entering general circulation. Refined seed oils that are high in omega-6 fatty acids, gluten-containing grains, and sugary, processed foods can all serve as irritants to the gut lining and foster inflammation.
Unhealthy gut = unhealthy elimination. If years of poor dietary habits, antibiotic overuse, stress, and toxins have plagued your system, then your GI tract is unfortunately the first line of defense that takes the brunt and suffers the injury. Blunted villi (the tiny hairlike projections that move food along and help secrete digestive enzymes), dysbiosis (imbalance of good to bad bacteria in the gut), pathogenic infection, and loose junctions of the intestinal wall all inhibit proper digestion, absorption, and elimination.
High stress = digestive mess. The state in which we eat food and operate on a daily basis directly influences our ability to digest and defecate. Most are familiar with the sympathetic nervous system aka the "fight or flight" branch; juxtaposed is the parasympathetic nervous system, or the "rest and digest" side of the system. With chronic stress, the sympathetic nervous system is constantly activated, which dampers activity of the digestive system by slowing peristalsis and decreasing secretion of digestive enzymes.
Start a Movement
Now that we're knee deep in it, let's conclude by identifying some essential points for proper pooping:
- CHEW YOUR FOOD. It sounds simple, but this basic measure is the very first step in optimal digestion and elimination. Chewing, or mastication, is the initial step of mechanical digestion that helps us begin to break down and increase the surface area of food so that digestive enzymes can act upon it. Chewing well gives time for the enzyme salivary amylase to begin breaking down carbohydrates. Chew slowly and completely before swallowing.
- EAT REAL FOOD. Avoid refined, processed, and inflammatory foods mentioned earlier and stick to whole, real foods. Nutrient-dense, real foods offer vital vitamins, minerals, and other compounds that supply our bodies with the materials they need to function optimally.
- EAT PLENTY OF FIBER. Fiber is sorely missing from the standard American diet, and even that of healthy eaters. The recommended daily amount is 35g so track your fiber intake and incorporate high fiber foods that serve to bulk up stool and facilitate motility of food through the GI tract. If you've adopted a Paleo diet, you've eliminated 2 categories of high fiber foods (whole grains and legumes) so be sure to make up the difference with nuts, seeds, fiber-rich fruits and veggies. (if you experience trouble digesting high-fiber vegetables or find they irritate your gut, check out this great article from Integrative Health Practitioner Chris Kresser.)
- EAT PLENTY OF FAT. Yup, you heard right - get some fat in that diet! Fat consumption elicits the release of the hormone cholecystokinin (CCK) which triggers the output of enzyme-rich pancreatic juice and expulsion of bile from the gallbladder. If you suffer from fatty stools or have gallbladder issues, check out my article on gallbladder health here. Eating fats with veggies also ensures absorption of the beneficial fat-soluble vitamins found within them. Opt for saturated fats from grass-fed butter/meats, ghee, and coconut oil; unsaturated fats from cold-water fish, olive oil, nuts and seeds.
- SMART SUPPLEMENTATION. Once you've incorporated the steps above, you may want to additionally consider augmenting with one or more specific supplements to aid digestion, particularly when you find that the steps above don't quite solve all of your GI troubles. I'm always a proponent of "food first" but if you have adjusted your diet and are still experiencing poop problems, then one or more of the following may be the aid your body needs to course correct, rebalance, and maximize digestion and elimination:
- Probiotics. Mounting clinical evidence supports the role of probiotics in the prevention and treatment of acute and antibiotic-associated diarrhoea, as well as treatment of allergies and intestinal, liver and metabolic diseases. According to researchers, "These positive effects are generally attributed to the ability of probiotics to regulate intestinal permeability, normalise host intestinal microbiota, improve gut immune barrier function and equilibrate the balance between pro-inflammatory and anti-inflammatory cytokines." A multi-strain probiotic with at least 10+ billion CFUs (colony forming units - the measure of viable microbes). Synergistics Pro-Bio 12 and Floramend from Thorne Research are both high-quality brands. You can also opt to "supplement" your diet by including fermented foods. Personally I'm a big fan of Vital Choice's line of cultured veggies: carrots, kimchi, sauerkraut and beets (my favorite!).
- Gallbladder/Fat digestion support. If you've experienced a sluggish gallbladder or have had yours removed, then a gallbladder support supplement may serve crucial in ensuring appropriate fat digestion. Try Digest GB from Pure Encapsulations or Bio-Gest from Thorne Research. Both provide ox bile, digestive enzymes, and cholerectic compounds.
- Stomach acid support. A lack of stomach acid can serve to inhibit proper break down of food as well as render your stomach more prone to infectious agents and pathogens. Stomach acid (HCL) secretion is also a trigger for digestive enzyme reactions and release down the chain of the GI tract. Temporarily supplementing with betaine and pepsin can improve the environment of the stomach for digestion and eventual elimination. HCL #2 with betaine and pepsin from Synergistics is a good, cost-effective option.
- Gut-building amino acids. Key amino acids such as glycine, proline, collagen, and glutamine serve to support the tissues of the mucosal lining. One of the best places to get a rich source of these aminos is from a nice fresh pot of bone broth. Simple to make in a slow cooker, mineral-rich bone broth has been used therapeutically to heal inflamed and irritated gut barriers. Link here for a quick, simple recipe. If pressed for time or looking to up the ante with these gut-building compounds, consider Great Lakes Gelatin - Collagen Hydrolysate and inexpensive (yet highly effective) Glutamine powder.
I hope this "primer on poop" shed some light on the importance of elimination and provided some insight into the signs you should look for when working to improve your digestive health. As always, if you are experiencing significant symptoms relating to your GI tract or any aspect of your health, consult with your physician. (DISCLAIMER: The content of this article and website do not constitute medical advice and should not substitute your physician's recommendations.)
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