Issue 119: The Importance of Regularity

Many of my clients have something in common: trouble with pooping.

Yep. We’re going there! You might find some surprises and insights as you read. So many people have no idea what’s normal and healthy.

Let’s talk about it.

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What’s Normal for You?

1. Pooping daily
   
2. Pooping Once Every Few Days
3. Loose Stools
4. Stinky Poops
   
   

Well guess what? Everyone should be pooping daily and they shouldn’t smell bad (well, only a little)!

Digesting food takes a lot of steps. When something about the process isn’t working right, that’s when bowel symptoms above show up. Briefly and oversimplified, here’s what happens with digestion when you eat:

• Mouth: Chewing and amylase in saliva (an enzyme that digests carbohydrates) break down food before you swallow it. The better it’s broken down here, the easier your stomach has it.
• Stomach: When it senses food is coming, the stomach produces hydrochloric acid (HCl) and pepsin (an enzyme that breaks down proteins) to really dissolve that food into mush. The ramping up of HCl triggers the release of Intrinsic Factor, which carves vitamin B12 off of those animal proteins to be used in the body.
• Small Intestine: Bit by bit, the stomach squirts the mush through a sphincter into the small intestine. Various enzymes released by the pancreas swoop in to finish up digestion. They break carbs into single and double sugars, divide protein chains into individual amino acids, and separate and emulsify fats into little bubbles called micelles so they can be transported safely.
• Absorption: All these tiny molecules, along with vitamins, minerals, and phytonutrients, are absorbed into the bloodstream and sent to the liver to be repackaged and put to use.
• Large Intestine/Colon: Everything that isn’t absorbed gradually clumps up in the colon as stool to be released. This includes: fiber, viruses, bacteria, and metabolic breakdown products of things like spent red blood cells, hormones, cholesterol, and more.
  
  

Very few people chew thoroughly, yet the whole process of good digestion starts there. If you take nothing else away from this newsletter, remember to chew your food to mush!

Potty Talk

I’m always surprised when clients tell me they poop normally - every two or three days. Y’all, that’s constipation!

Our bodies are built like a flowing stream. Food goes in. The body does its thing. Stool forms as un-digestible stuff and waste products build up in the colon. And then we release it. Every single day - sometimes two or three times. It should look like a sausage (with or without cracks), happen at a fairly routine time, not be overly urgent, and be easily and completely passed. It should not be particularly stinky. No, really. And it should mostly be brown. If it’s regularly a different color, consult a practitioner.

So check out one of my favorite diagnostic tools, the Bristol Stool Chart:

Types 1 and 2: Typically constipation is easy to address by increasing our fiber and fluid intake. Did you know that we are designed to consume 25-30 grams of fiber daily in food? Most Americans only get about 15 grams. Fiber also absorbs water, making stools comfortable and easy to pass.

If increasing fiber and fluid intake isn’t quite enough to relieve constipation, we can explore supplements, like magnesium citrate or magnesium oxide. I usually don’t use magnesium oxide because the molecule is large and poorly absorbed, so the person won’t get the additional benefit of the magnesium itself. Other magnesium formulations typically don’t affect stool quality or frequency.

Life experiences can also lead to constipation. Stress in particular can shut down (or overstimulate) that flow. More below.

Why do we care about constipation? When stool sits in the colon too long, the body begins to reabsorb certain elements that are supposed to depart the body. For example, that water that makes it easy to pass? It can be reabsorbed into the bloodstream, drying out the stool and exacerbating the constipation. Hormones and cholesterol can also be reabsorbed, which can mess with the levels of these in your body.

Remember: flowing stream. Out with the old, in with the new.

Type 5: An added bonus to fiber is that it gives an all important bulk to our stool so that it becomes more sausage-like and comfortable.

Types 6 and 7: There are a number of potential contributors to loose, watery, urgent stools. It can be as simple as eating something that doesn’t agree with you, and once your body has a chance to heal, stool returns to normal.

Food allergies, intolerances, and sensitivities can trigger inflammation in the gut lining. When that happens, it’s very similar to eating something that doesn’t agree with you. Up to 70% of your immune system lines your intestinal tract. If it senses a danger, it will cause water to enter the bowel and trigger the nerves to stimulate movement to wash that danger right out!

Interestingly, how healthy your digestive tract is defines to a great degree whether you will have a food intolerance or sensitivity. Once the lining is healed and functioning properly, most foods stop being such a trigger.

Illnesses from the common cold to cancer can cause inflammation everywhere, including in the intestines. Some medications - either prescribed or OTC - can lead to inflammation and loose stools. Talk to your doctor about prescriptions if your stools change. OTC meds like ibuprofen, naproxen sodium, and acetaminophen all can damage the lining of your gut and create inflammation.

Whether you have enough stomach acid (hydrochloric acid, or HCl)  to kill pathogenic viruses and bacteria can be super important. For example, Helicobacter pylori is the cause of stomach ulcers, and it can’t take hold if there is adequate stomach acid. H. pylori also inhibits production of more stomach acid so it can proliferate. As food becomes poorly digested due to lack of HCl, it enters the intestinal tract in particles that are big enough to cause irritation. The inflammation of the stomach lining can travel up and down the gut. These and other microbes can lead to inflammation, low grade (or sharp!) pain, and issues with stool.

And back to fiber! It is the primary fuel source for all kinds of symbiotic beneficial bacteria that support our gut and, frankly, our overall health. Pathogenic bacteria and yeast relish refined flour and sugars because these help them multiply. When we eat low fiber in our meals, the “bad” bacteria can grow in number while the symbiotic bacteria languish. And there you have it: inflammation thrives.

Unfortunately, once there is a big imbalance (called dysbiosis) in these various bacteria, sometimes we need to eat a low fiber diet for a while before adding it back in. Those with Inflammatory Bowel Diseases, diverticulitis, and small intestine bacterial overgrowth (SIBO) might follow specific low fiber food plans while the flare heals. Work with a qualified CNS (after checking with your doctor) to design a healing plan and prevent future flares.

Mood & Bowel Habits

There is a strong connection between anxiety, depression, high stress lives and bowel habits. An inflamed gut lining will send signals to the body and brain that something’s not right - the body must be in danger - and this can affect mood status and resilience significantly. Conversely, anxiety, depression, and stress are mood states that integrate the body’s protective mechanism known as “fight, flight, or freeze.” When we enter that protective state, what’s happening with our poop either becomes urgent (diarrhea: get rid of it fast so we can run) or completely shut down (constipation: we don’t have time for that). Gut bacteria status also influences how much the protective state affects the bowel.

This cycle is known as Irritable Bowel Syndrome (IBS). It can show up as persistent diarrhea or constipation, or even alternate between the two. The issues of IBS can ultimately result in more significant gut health issues over time.

The good news is that clinical integrative nutrition practitioners have accessible ways to stop the cycle and normalize stools. Examples of these can be found here where we Cultivate the Pause, and here, where we discuss stress resilience.

Upshot

The upshot is that a lot of people take for granted that what’s happening in the bathroom is a normal part of life when it really isn’t! Bowel habits are key participants in your overall health status - don’t ignore them!

Medical Nutrition Therapy (using food and supplements) and lifestyle practices can heal the intestinal lining, improve your digestion, and make your stools a consistent Bristol 3 or 4. I can predict right now that when that happens several other health items you assume are part of life (or aging!) will also heal.