Gut Speak, Week 3
Digestion and Poop Talk
Digestion of food begins at the mouth and ends at the anus- 22 feet, or 6.7 yards of amazing processes that sustain life. The gut is a semi-permeable barrier that runs from your esophagus down to your small intestine (comprised of your duodenum, jejunum and ileum), followed by your cecum (the beginning of the large intestine or colon), which ends at the rectum/anus. Most of the absorption of nutrients happens in the small intestine, which is the first stop after food leaves the stomach. You absorb the nutrients from food in your small intestine through tiny villi.
Without a functional gut, especially the small intestine, you quickly fade into nutrient deficiencies that can lead to death. Patients can survive total esophagectomy, gastrectomy, and colectomy, but loss of the entire small bowel is fatal without some sort of external support, such as total parenteral nutrition (TPN). TPN means that you are fed nutrients directly to your cells through your bloodstream. It is expensive, non-optimal for the long term and is rife with problems of its own - like increased risk of infection. Even though it is not optimal, you can still live a fairly normal life with 50% of the intestinal length that you were born with. That in and of itself is amazing!
Let’s talk about your poop for a minute. Poop is totally essential to life. “Everybody Poops” was one of my favorite kids’ book of all time! Dietitians get a little geeky about talking fecal. The presence of poop means the presence of digestion which means the presence of life. We can learn a lot about the health of a person through poop talk. Pay attention to your poop and what it is telling you. How often do you go? What does it look like (i.e. color & consistency)? Are you straining and straining or barely making it to the bathroom in time, multiple times per day?
Optimal poop consistency is not too hard and not too soft. You should not need to strain at all, nor should your stool be liquid. No baby rabbit turds or hard turds that go “plop” when they hit the water. No greasy, frothy stools. If you consistently have suboptimal poop consistency, don’t hesitate to consult your doctor. Dairy Queen soft-serve consistency is your goal. If the consistency of your poop does not allow for it to evacuate easily, you may have a fiber problem, a gut flora imbalance or a hydration problem. If you are not at a Dairy Queen soft-serve consistency with a nice S-curve in the toilet at least once per day, then you may want to try increasing your total daily fiber intake to at least 30-35 grams per day on average.
Pay attention to getting both soluble and insoluble fiber sources. Soluble fiber should be at least 25% of your total daily fiber intake, while insoluble fiber sources should comprise 75% of your total fiber intake each day. Read food labels and track your fiber intake with a food log tool like Myfitnesspal tracker to get a feel for where your fiber intake resides on the spectrum. Good poop consistency is like getting an A+ on the exam!
If your stools are consistently dark black, you could have bleeding high up in the gut. If you see dark black stools consistently, consult your doctor. If you have cherry red blood in your stool, you likely have an issue lower down in the gut, like an anal fissure or hemorrhoids. Cherry red blood tends to be associated with less serious conditions than black tarry stools, but either way consult your doctor asap! Get your baseline colonoscopy done at age 50 (or better yet the American Cancer Association now says age 45). Absolutely don’t wait til age 50 if you see blood in your stool or if you have a strong family history of colon cancer. Straining to evacuate can lead to hemorrhoids over time. If you have them, you will likely know. Itching, burning and bleeding when you go are all signs of internal and/or external hemorrhoids.
Normal elimination can vary from individual to individual. Normal can still be 3 days between poops, but most people go at least once per day, if not multiple times each day. Talk to your doctor if you feel you are pooping less than normal or more than normal. Most people feel best when they have a predictable pattern. Travel, illness, stress, hormones, and other factors can influence intestinal transit time.