Healthy Poop: What is Your Digestive Tract Telling You?

July 25, 2016 | Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

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 Healthy Poop: What is Your Digestive Tract Telling You?
Poop. It’s a topic that most individuals feel squeamish about at the least, yet it is essential for basic health. Knowing what healthy bowel movements are can provide great insight into gut, liver, gallbladder, immune, and pancreas health. It can even tell you something about your nervous system. Before you flush, take a peek at what your body is telling you about your insides and how happy or unhappy it may be.

Appearance and Color

Normal healthy stool color is brown. The brown color reflects the presence of bilirubin from the liver. Different shades of brown may occur. Colors outside of brown reflect something has changed. Anything outside of the norm should be appropriately evaluated with your health care provider. Newborns and infants may have different colors than children and adults.

Black stool may reflect medications like bismuth or Pepto-Bismol or iron supplements. Tar colored stools may reflect bleeding problems from ulcers or cancer up high in the digestive tract and must be checked out. Aspirin and ibuprofen/NSAIDs are common causes for bleeding in the upper digestive tract that leads to tarry looking stools.

Light or pale colored stools reflect concerns with the liver and bilirubin. Friendly flora is essential for bilirubin management.

Green colored stool may be seen with rapid motility and diarrhea due to bile pigment in the stool. Green food coloring and large intakes of dark green leafy vegetables with poor digestion may also cause this color change.

Red colored stools may reflect bleeding from hemorrhoids and straining at the stool, anal fissures or bleeding in the lower intestinal tract. Bleeding from the colon and rectum is red. Bleeding from higher up in the intestinal tract is black. Never dismiss these color changes. Foods like beets and large intake of red food color products may change the shade of stool to more reddish-violet and is isolated to the food consumption.

Oily or Greasy Stools

Oily: The appearance of an oily sheen in stool and toilet bowel water should not occur but reflects fat malabsorption. This may occur for a number of reasons. A one-time occurrence after a meal very high in fat may simply indicate over-indulgence. If the oily sheen persists or keeps coming back, then this may reflect poor fat digestion or fat malabsorption. This is often seen with insufficient pancreatic enzymes. The exocrine pancreatic function is failing to produce enough enzymes to help your body break up and absorb the fats ingest thru the diet.

Greasy looking stools may also occur with poor or compromised gallbladder function. When the gallbladder has been removed, bile acids or bile salts are still excreted from the liver, but not in the same quantity or amount had the gallbladder been intact. Poor gallbladder function coincides with stressed liver function. Not only is there difficulty in digesting fats, but it makes it harder to lose abdominal fat. Curcumin, oregano oil, and d-limonene may help support the gallbladder and/or bile acid flow.

Undigested Food Particles

Regular or frequent presence of undigested food particles in stools may reflect lack of chewing foods thoroughly, low stomach acid, insufficient pancreatic enzymes, lack of bile acids, and/or rapid motility. Chewing foods until they are liquid, consuming raw fruits and vegetables, reducing or eliminating processed foods, and not eating on the run can make a significant improvement in your digestion. Aging also causes the pancreas to make less digestive enzymes. This is why the foods that you ate as a teenager and twenty-something now cause nightmarish indigestion in middle-age and older. Insufficient pancreatic enzymes may lead to greasy, floating stools, and the visible presence of undigested foods.

Mucus in Stools

Infrequent trace amounts of mucus are not worrisome, but significant or large amounts of mucus in the stool with diarrhea may be related with high levels of inflammation and inflammatory bowel disorders like Crohn’s disease or ulcerative colitis or it may be related to intestinal infections. On the other hand, insufficient mucus in the stool is often linked with chronic constipation and food allergies.

Form and Size

Normal, healthy stool is well-formed and 6-12 or more inches in length. Adequate soluble and insoluble dietary fiber of 25-50 grams per day, adequate hydration, and beneficial bacteria are fundamental to healthy stool formation.

Small pieces and ribbon-like stool typically reflect irritability within the intestinal tract. Often, there is a feeling of excessive churning, indigestion and likely a history of irritable bowel syndrome. Soft stool like pudding or oatmeal, watery stool or rice water stools are also not desirable. This often relates to some underlying change with motility, germ overgrowth, inflammation, insufficient enzymes or stomach acid, food intolerances and allergies. It may even be related with GMO and glyphosate additions to our food supply as these changes affect the healthy gut microbiome.

Small, hard pieces like rabbit pellets are not desired or healthy. It may simply reflect inadequate water or fiber intake. It indicates that transit time is slow and constipation is a real concern. Sudden changes or persisting significant problems with pellet-type stool may indicate impacted stool or blockages. Constipation concerns are addressed further below.

Large, voluminous bowel movements may be related with constipation, bowel motility disorders, pancreatic disorders, malabsorption difficulties, Celiac, or Crohn’s disease. Liquid stools are never normal and have several causes.

Odor of Stools

Healthy bowel movements have very little odor. Strong or offensive odors often reflect poor digestion. Poor protein digestion leads to putrification and carbohydrate maldigestion creates fermentation which can lead to methane and sulfur-rich odors. Sulfur-rich foods like cruciferous vegetables, legumes, meats, and eggs may briefly increase odor.

Frequency/ Bowel Regularity

There are many different viewpoints on this topic. Frequency refers to the number of times per day a bowel movement occurs. Holistic viewpoints recommend one to three well-formed, adequate sized bowel movements per day.

Bowel regularity requires the urge to relieve one’s self. Lack of an urge to have a bowel movement or the overwhelming, accident inducing urges are both concerns that must be improved upon. Internal body clocks and gut bacteria play very important roles in keeping this normal urge intact. The health of the digestive tract’s nervous system is fundamental to this urge.

Digestion Transit Time

Transit time refers to the time it takes from consuming the food to the time that it is excreted through the stool. Transit time may be different than frequency and regularity. In the field of clinical nutrition, a healthy transit time is generally considered 18-24 hours. The medical viewpoint of normal transit times may range from 1-3 days or longer. Think about this for a moment. If you are consuming an average of 3-5 pounds of food per day, have one bowel movement every three days which consists of rabbit pellets and hard-to-pass stool followed by a soupy mess, it is far from ideal. If you have cared for infants and toddlers, you will know that dirty diapers occur like clockwork after a meal.

Bowel motility is dependent on the body’s internal clocks. Getting off schedule with travel, change in time zones, work-shift changes, and changes in meal timing are notorious for causing the occasional irregularity. When the irregularity gets locked in, then a cascade effect plays out, which even affects mental health and autointoxication, the release of digestive hormones, neurotransmitters, leptin, bile acids, gallbladder function, and even cortisol that relates to gut motility.

Transit Time Test

To get an idea of what your transit time is, consume a large serving of beets or whole kernel corn at one meal. Beets will change the color of the stool to a darker reddish hue and whole kernel corn is hard to digest. The hulls can be seen in the stool. Watch for the color change or the presence of the corn kernels in the stool and note how long it has been after these foods were consumed. Check the subsequent bowel movements after the initial identification to see if there is any indication that these foods are still passing through the bowel. Note the amount of time that has passed between the time that you consumed the foods to the time that the last identification of the challenge food was seen in the stool. This is your transit time.

Transit times less than 18 hours are rapid and may reflect bowel irritability, pancreatic insufficiency, overactive thyroid problems, adrenal insufficiency, gastric bypass changes, gut flora imbalances, and even neurotransmitter imbalances as they direct bowel motility. This often leads to poor absorption of nutrients, insufficient B vitamins, and loss of fat soluble vitamins which leads to a plethora of symptoms that may seem unrelated.

Transit times greater than 24 hours reflect sluggish motility. This can happen for many reasons. Simply ignoring the urge to have a bowel movement may lead to irregular or delayed emptying. Sedentary lifestyles, dehydration, high sugar intake, low fiber intake, and pain medications compromise healthy motility. Narcotic pain medications are especially problematic and can lead to the newer diagnosis of “opioid induced constipation.”

Sluggish bowel motility or constipation may reflect low thyroid function, adrenal cortisol imbalances, imbalanced electrolytes, i.e. excess calcium intake relative to potassium and magnesium, gut flora imbalances, insufficient fiber, type 2 diabetes, and food allergies. Children with chronic constipation seen as small hard pellets or slow transit times may actually be struggling with underlying food allergies. Research shows dairy allergy is a common cause for chronic constipation in children.

Bowel motility habits are also directly linked to the health of the digestive tract’s own internal nervous system, the enteric nervous system. This enteric nervous system talks directly to the brain and is in constant communication. Changes in bowel motility are sometimes the first signs of stress in this system. In neurodegenerative disorders like Parkinson’s disease, constipation is actually recognized as the first indication that something is going on years before the symptoms of tremors and changes in gait occur. Traumatic brain injuries like concussions or other challenges to the nervous system may affect the nervous system in the digestive tract. Other neurological challenges affecting the gut are developmental delays, chemotherapy/ radiation therapy, and surgical trauma.

Strengthening the tone of the vagus nerve and enteric nervous system helps keep healthy function of the gut intact. Gargling until your eyes tear several times per day, humming, and other things that trigger the gag reflex stimulate the vagus nerve. This helps to strengthen healthy nerve signals in the gut to the brain. Several nutrients support healthy nerve function and also support gut health in other ways. These include DHA, magnesium, B vitamins, zinc, coenzyme Q10, l-carnitine, choline, calcium and vitamin C. Additional protection occurs with melatonin and glutathione because of their antioxidant activities. The digestive tract and vagus nerve tone also responds to deep breathing, physical exercise, and meditation.

Small Intestine Bacteria Overgrowth and Ileocecal Valve

Sluggish bowel function may reflect or contribute to concerns higher up in the digestive tract. As bowels slow down, it can create pressure on a valve, called the ileocecal valve that is located between the small intestine and large intestine, near the appendix. When this valve is forced to stay open, the bacteria in colon can move upward, back into the small intestine and even up into the stomach. When these germs gain a stronghold in the small intestine because of faulty ileocecal valve function, it leads to small intestine bacteria overgrowth or SIBO. It can also lead to fungal or candida overgrowth in the small intestine. This is known as SIFO or small intestine fungal overgrowth.

The consequences of SIBO/SIFO leads to increased gut permeability, food allergies, liver stress with chemical sensitivity and poor detoxification, brain fog, attention problems, fatigue, increased aches and pains, stiffness, sinus congestion, asthma, COPD, gallbladder stress, and even skin rashes. GERD or acid reflux medication and symptoms reflect SIBO/SIFO and the functional changes of how the ileocecal valve works.

Gas, Bloating, Burping, Belching

Passing very small amounts of gas is considered normal. However, burping and belching and any amount of belly bloating, reflect concerns. Burping and belching reflect a stomach struggling to do its job. It may simply be related to not thoroughly chewing your food, overeating, and eating while stressed. These stressors require the stomach to work much harder at production of stomach acid. Stomach acid production takes high amounts of energy to produce. Low thyroid function, adrenal fatigue, germ overgrowth like H. pylori, zinc deficiency, processed foods, and gallbladder stagnation all impact stomach acid function making it harder to make stomach acid and digest food.

Lack of stomach acid causes slow breakdown of foods leading to fermentation, rumbling, and gas production. As a result of the fermentation, the gas pressure in the stomach pushes up against the sphincter between the esophagus and stomach. When the pressure builds up, the little bit of acid refluxes up into the esophagus and creates the sensation of heartburn.

Antacids often worsen digestive health, while providing a momentary Band-Aid. Grazing, eating excessively, and eating out of the normal circadian and leptin rhythms of the body affect stomach acid production and function. Belly bloating in any amount reflects fermentation and either bacteria or yeast overgrowth. Bloating is not normal. Lower bowel gas also reflects fermentation and putrefaction of poor digested foods, germ overgrowth, and poor transit time.

Individuals who consume a very low carbohydrate diet can lead to changes in short chain fatty acids levels (SCFA) in the colon. Lack of SCFA leads to changes in gut bacteria and contributes to changes in slower bowel motility. This change may actually increase the risk of colon cancer and irritable bowel syndrome as SCFA protect the lining of the colon and colonic cells. It can also lead to an increase lower bowel gas.

The first goal is to recognize if your bowel movements are trying to tell you something. Are there significant or abrupt changes that don’t resolve with dietary changes or healthy nutrition?  It is often said, “We are what we eat”. More aptly and healthfully stated is “We are what we digest”. What is your body telling you? How healthy is your gut?

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