​How many times should we poop a day or a week?? What should a healthy poop look like? This unfortunately can be kind of hard to study because most people don't really think about their poop much nor do they know what is considered normal. So when asked in a survey to describe their bowel frequency and texture, some people may not even really know how to answer these questions. Do you know?? 
 
Unfortunately, WE DON'T TALK ABOUT POOP ENOUGH. Granted, it’s not the best table talk (unless of course you’re out to dinner with a group of dietitians), but it is something we all need to be aware of and educated about.
 
A recent study in 2017 studied the US population via a survey asking these exact questions. How often do you poop each week and what does it look like (based on the Bristol stool chart). Here is what they found:
 
3% have < 3 poops per week
60% have 3-7 poops per week
30% have 8-14 poops per week
6% have 15-21 poops per week
1% have >21 poops per week
 
They also found that normal poops happen more often in men than women, in those with a higher education and income, in those requiring less medications (<2 per day), and in those who eat more fiber (>20g per day). 
 
Based on the above results, researchers concluded that normal for the US population is considered at least 3 poops per week up to 3 poops per day. However, this doesn't really highlight the other considerations of what is considered a healthy bowel movement such as the texture of the poop (is it firm, sticky, loose, pebble-like), the stool weight (how big is it), or the sense of complete evacuation (do you feel empty afterwards?). 

​Another study of Coastal Indians, who eat a predominately plant based diet, found that the average stool frequency was 14 poops per week, mostly resembling an easy to pass smooth banana. They also found that vegetarians and more physically active individuals tended to pass stool more frequently. Average stool weight in Asia is also much higher than that of a Western populations, with an average of 311g per 24 hours. Stool weight in many Western populations is low (80-120g per day) which is associated with an increased risk of colon cancer. Stool weights of 150g per day can help reduce this risk. 
 
So what is considered optimal?? Clinically, I do not agree with 3x per week! The Western population as a whole is not eating enough fiber. If you look at other higher fiber eating populations, they average 2 poops per day, with an average poop weight of 150g. This translates to TWO LARGE, firm but not hard, easy to pass, bowel movements per day. I also see this in my clients. When they are pooping 2x per day, they feel good, they look good, and they are happier. 
 
So just because you are pooping every day, it does not mean your poop is considered optimal. If you are concerned about your pooping habits, work with a gut health dietitian (like me!)

In healthy individuals after eating a mixed meal, it usually takes about 4-5 hours for that meal to completely empty the stomach and 5-6 hours for that meal to empty the small intestine. This all can vary depending on what you eat and how well your gut muscles are working. 
 
Eventually, the remaining unabsorbed food matter (like fiber) and water, move through the ileocecal valve, the doorway from the small intestine to the large intestine. As the unabsorbed matter passes through the ileocecal valve, the large intestine  monitors how much undigested material there is. If there are increasing amounts of undigested food, especially fats, it signals to the small intestine to S L O W  D O W N.  This is called the ileal break and is necessary to help maximize our absorption of nutrients. This mechanism also reduces our appetite. This is why when individuals struggle with diarrhea, they often do not have much appetite. 
 
Once the unabsorbed liquid food matter passes through into the large intestine a few things happen:

• Water, sodium, and chloride are absorbed to create a dehydrated mass including sloughed off dead gut cells, fiber, waste (hormones, chemicals, toxins), bile salts, bacteria, and small amounts of unabsorbed nutrients and food. Normal stool is about 75% water and 25% solids.
• Most of our gut bacteria reside in the large intestine and ferment undigested food especially fiber. I call this our FERMENTATION STATION. However, undigested protein and fats also act as fuel for gut microbes (this generally leads to a more dysbiotic profile). 
• When bacteria ferment fiber, they produce short chain fatty acids and vitamins such as biotin and vitamin K2. 
• The dehydrated mass of waste is then compacted in the rectum, along with bilirubin from broken down red blood cells (which makes poop brown), and is released through the anus, as POOP!

​On average in healthy folks it takes about 30-40 hours for the mass to travel the entire 1.5 meters of the large intestine, going up along your right side (called the ascending colon), across your upper abdomen (called the transverse colon) and back down your left side (called the descending colon). In individuals struggling with idiopathic constipation, their colonic transit time can be greater than 100 hours! When colonic transit time is slowed and stool is stagnant in the colon, it allows chemicals, toxins, and hormones originally bound for elimination, to be reabsorbed into circulation. This can increase your risk of hormonal imbalance and impaired detoxification due to increased stress on the liver and kidneys. Also, slowed transit time can contribute to diverticulosis and colon cancer, as well as the overgrowth of bacteria and fungus in both the small and large intestines. Furthermore, slowed motility usually presents along with hard to pass stools and straining, leading to uncomfortable hemorrhoids. 
 
The total amount of time for a meal to be digested and absorbed and the remainder excreted as a bowel movement is called your gastrointestinal transit time (GTT). If your transit time is <12 hours you are likely struggling with nutrient malabsorption, if your transit time is >48 hours then you are likely struggling with constipation. If it takes more than 72 hours for food to travel from mouth to toilet, there is significant backup. I find that around 24 hours is usually the sweet spot for most—what you ate yesterday, leaves you today!
 
Are you curious what your stool transit time is? Generally, if you eat a higher fiber diet, stool transit time should be faster than if you eat a low fiber diet. However, if you eat a high fiber diet and still struggle with constipation something else is going on. This is the perfect time to work with a gut health dietitian for guidance. 

TESTING YOUR STOOL TRANSIT TIME
Although not the gold standard, testing stool transit time at home can give you a rough estimate on your personal window. Sesame seeds remain undigested and pass through the gut intact. White hulled sesame seeds are more easily seen than dark sesame seeds. Alternatively, eat a steamed red beet.
 
THE SESAME SEED (or red beet) CHALLENGE

1. Mix  ~2 tablespoons of white sesame seeds into a glass of room temperature water or eat a steamed medium red beet.
2. Drink it up and write down the date and time in the chart below. Then wait and monitor every stool until you see the white sesame seeds or colored red stool. 
3. Write down the date and time and calculate the difference in hours. This is your personal stool transit time. 
4. Continue to monitor your stools until all the sesame seeds or red stool has been evacuated. Make note of last bowel movement with sesame seeds or red color. 

You WANT a stomach NINJA, not a stomach COUCH POTATO.  
 
Once food is swallowed as a bolus, it enters the stomach and stretches the stomach lining, activating stretch receptors and stimulating the parietal cells to make more stomach acid. In fact, the gastric phase is responsible for 60% of stomach acid production whereas the cephalic phase is responsible for about 30%. Continuous activation of the enteric nervous system (which can be influenced by the parasympathetic and sympathetic nervous systems) also stimulates the release of gastrin causing an increase in strong and vigorous muscle contractions, and pepsinogen from chief cells. Pepsinogen, in the presence of adequate amounts of stomach acid, is then activated to pepsin, a protein digesting enzyme.
 
As your stomach churns your food and mixes it with stomach acid and digestive juices, it also starts the process of B12 digestion and absorption. Stomach acid separates B12 from animal proteins so that B12 can bind to another protein called intrinsic factor which is only produced in the stomach. This process is essential in order to absorb B12 from our food. Plus, it can also kill potentially harmful bacteria, viruses, and parasites, coming in through your food. So now your stomach is not just a powerful blender…it is a mean blender NINJA. 
 
After foods have been properly broken down, the stomach gradually releases the stomach contents (now called chyme) into the upper small intestine. However, if you have a higher fat or higher fiber meal, stomach emptying is slowed, and can contribute to longer feelings of fullness, than if you had a low fat processed meal, like cereal. 
 
Common symptoms of low stomach acid:

• Bloated after meals
• Belching/burping
• Protein rich meals "feel heavy"
• Excessive fullness after meals
• “Deja Vous” poos (you see food that you ate like greens, carrots, grains, etc)
• Brightly colored stools (acid breaks down color pigments)
• Constipation/diarrhea
• Acid Reflux and heartburn
• Brittle nails/hair
• Food sensitivities
• Chronic nutrient deficiencies (especially B12 and iron)
• Excessive gas

I see many of the aforementioned symptoms in my practice all the time. There are many reason why someone might have low stomach acid, and sometimes there is more than one variable involved. Below I have highlighted those that I see most often. 

1. Stress directly inhibits the parasympathetic nervous system ("rest and digest) and negatively impacts the enteric nervous system, leading to reduced digestive functioning, including stomach acid production and gastric motility. 
2. Low stomach acid production is common is those with advanced age (>65), mostly related to a chronic atrophic gastritis from a current or previous H. Pylori infection. Pepsin production also declines by 40%.
3. About 50% of people world-wide have an H. Pylori infection which reduces stomach acid production and can lead to gastritis and ulcers. 
4. Antacids (TUMS, Prilosec, and Pepcid) impact stomach acid production. TUMs directly neutralize stomach acid via calcium carbonate while Prilosec and Pepcid work at the cellular level, directly inhibiting stomach acid production in the first place. A single 20mg dose of omeprazole can reduce stomach acid by more than 90%, where as a single 5mg of Pepcid reduces stomach acid by 40%. 

 
Okay, now you likely want to know, “Do I have low stomach acid?” If you experience chronic digestive issues and any of the symptoms mentioned above, then the answer is  likely yes. Once you address your stomach acid production, then you can help improve many things downstream on the river of gut health. Therefore, it is essential to address this first!
 
How do you Test for Low Stomach Acid? 
The gold standard is a Heidelberg Stomach Acid Test and can get expensive, averaging around $350. Unfortunately, many GI doctors do not run this test, even when patients ask for it. If you want an alternative to this, then check out the simple at home test below to see if you struggle with low stomach acid.
 
Baking Soda Challenge
Although this test is not supported by any studies, it can be a simple and cheap way to check your stomach acid production. All you need is a fresh container of baking soda and water. 

1. Mix ¼ teaspoon of baking soda with ½ cup of cold water.
2. Drink this mixture on an empty stomach upon waking. 
3. Watch the clock and document how long it takes until you start burping. 
4. If you burp within the first 2-3 minutes, you likely have enough stomach acid. 
5. However, if its take 3-5 minutes, then stomach acid production is likely suboptimal. 
6. If it takes >5 minutes, then you likely have very low stomach acid levels. 
7. Repeat this test 3 times to get an average result and better sense of your normal. 

 
If your results suggest LOW stomach acid, then it’s time to figure out WHY and work with a gut expert. If you want my help and guidance, then make your discovery call today!

​Using our five senses (seeing, smelling, hearing, touching, and tasting) we trigger the start of digestion via the cephalic phase. Our senses stimulate the parasympathetic nervous system (rest & digest) to communicate via the vagus nerve to our enteric nervous system which governs our gastrointestinal tract. This results in the release of a variety of different neurotransmitters, chemicals, and hormones that stimulate the parietal cells to secrete stomach acid and to stimulate the stomach to start churning slowly. It is as if we placed a skillet on the burner and turned it on. 
 
Overall the cephalic phase contributes to about 30-50% of our total stomach acid production! And did you know that simply talking about food can stimulate this same response? A research study from 1986 found that simply talking about appetizing food for 30 minutes without seeing it, smelling it, or tasting it, increased stomach acid secretion by 66% whereas seeing and smelling food only stimulated stomach acid secretion by 23-46%. Other topics of conversion did not elicit any stomach acid production. This goes to show, that what we are thinking directly impacts our digestion more than what we are seeing or smelling, and that seeing and smelling really just stimulate stomach acid production because we start THINKING more about food. 

​Now let me put this into perspective. What is different between these two scenarios?
 
Scenario #1: 
It’s breakfast time! You go to the fridge and quickly pull out a mason jar of chia berry overnight oats even though you really don't have appetite for it. Instead of sitting down you eat a few bites, get dressed, eat another few bites, put on your shoes, and then gobble down the rest. You quickly grab your bag and head to the car to go to work. 
 
Scenario #2: 
It’s breakfast time! You look into the fridge, think “hmmm, what sounds good? Oh yea, a fried egg on avocado toast sounds delicious!” You heat up the skillet, add a little dollop of butter and hear it sizzle, you crack open the egg on the skillet and hear “tsishhhh” as the egg hits the heated pan. You place a piece of toast in the toaster and wait until your egg and toast are done. As you wait, your appetite builds and builds, and you can’t wait to enjoy the ooey, gooey delicious mess that awaits you. Your toast pops up, you top it with creamy avocado, your crispy, fried egg, and sit down at the table to enjoy this fork and knife breakfast meal. 
 
Although both meals are healthy choices, scenario two allows for optimal digestion because not only is more time spent thinking about food, but the preparation of the food allows all of the senses to be active. If scenario one is your go-to relationship with food, then it is no surprise why you may feel overly full and bloated. When eating in a rushed, hurried, and stressful state of mind, we inhibit the parasympathetic nervous system, and therefore inhibit the stimulation of the vagus nerve and the enteric nervous system. Our energy is shunted away from “rest and digest” and rather focused towards “fight or flight” and our sympathetic nervous system. 

Since the cephalic phase primes the gut for the meal to come, we cannot overlook how powerful it is to simply, slow down when it comes to food. We must allow time in our busy days to appreciate and to look forward to the foods and meals we consume. The saying “eat to live” easily distracts us away from the importance of acknowledging our food as something more than just simply fuel but as something that should be enjoyed. Seeing food through the eyes of a “foodie” can be one very helpful step that can enhance your gut health.
 
Some Tips from your Gut Health Expert:

1. If you are emotionally stressed, it is better not to eat at all until you can calm yourself down.
2. Instead of grabbing food and going, grab food and sit. Take the time to look at your food, think about how tasty the food is going to be, and enjoy your meal slowly. 
3. Take 3-5 deep belly breaths before sitting down to a meal to activate your parasympathetic nervous system.
4. Put away the cell phone, put away the computer, put away the book. Focus on your meal at hand. 
5. Learn to enjoy the process of cooking. Turn on some music, enjoy a small glass of wine, and get inspired by a recipe or whatever is in your fridge. 
6. Cook together with friends and family (once we are able to reunite again)!
7. Plate your food nicely. The more appetizing a meal looks, the more you activate the enteric nervous system. A little parsley garnish can go far!

Are there any changes you are willing to make to your eating routine to enhance your cephalic phase? Share with me below!

Did you know that taste can influence our digestion? We have five tastes: sweet, salty, bitter, sour, and savory (umami). These taste receptors are located not only on the tongue but also throughout the entire body including (but not limited to) the entire GI tract, as well as the immune system, heart and even the brain. 
 
Bitter plant compounds, are most often used to support digestion. In fact, they have been used for centuries to relieve common gut symptoms such as indigestion, bloating, and feeling full fast. Interestingly, research has found that we have 25 different bitter receptors each stimulated by different bitter compounds. These receptors are also found in the stomach, and once stimulated, support stomach acid production. Therefore, bitter greens (such as radicchio, chicory, endive, kale, arugula), citrus (especially citrus peels), rhubarb, and caffeinated beverages like coffee, green and black tea, can all support healthy stomach acid production. Beer and wine can also stimulate stomach acid production due to their alcohol content and as well as their bitter compounds. However, keep in mind that alcohol itself can contribute to irritating GI symptoms. 

Why is this important? For good gut health, we need proper stomach acid secretion. Stomach acid is essential to help us break down and digest our food (especially protein) and acts as a barrier for incoming bacteria either via our food or oral cavity. Stomach acid also triggers the release of bile from the gallbladder and triggers the release of digestive enzymes from the pancreas. Therefore, stomach acid is essential for optimal digestion. 

​Furthermore, bitter compounds are also found in the duodenum (first part of the small intestine), and directly stimulate the release of cholecystokinin (CCK). CCK is a hormone which stimulates the release of bile from the gallbladder and the release of digestive enzymes from the pancreas. Bile is essential for the absorption of fats and fat soluble vitamins A, E, D, K and digestive enzymes are essential to break down all of our food into small enough particles for easy absorption. 

If you are motivated to increase your bitter foods for enhanced digestion check out the ideas below. There are many options besides eating an arugula salad that can help boost your daily bitter intake. 
​

• Make endive boats as an appetizer.
• Mix in chicory greens into your salad greens.
• Make a winter kale and radicchio salad
• Try sauteed radicchio in a pasta dish.
• Make a rhubarb compote and mix into yogurt or top on pancakes
• Add lemon zest to salad dressing or mix into steamed rice for aroma.
• Top your pizza with arugula after baking.
• Add a splash of grapefruit juice to your water. 
• Make a citrus and avocado salad.

Clinically, besides bitter foods, bitter herbs found in tinctures can be helpful for more immediate relief. I suggest taking the bitters directly into the mouth and then swishing the bitters around for a few seconds before swallowing. I often recommend the following:
 
Iberogast: 20 drops with meals or 60 drops before bed
Urban Moonshine Original Bitters: 1 dropperful before meals
Urban Moonshine Calm Tummy Bitters (safe for pregnant mamas)
Herb Pharm Better Bitters: 1 dropperful before meals
Swedish Bitters: 1 tsp before meals