What you don’t know about healthy bowel function could kill you.
Men can be obscenely proud of their shit. Guys will brag about an especially large or tortuous bowel movement. With rare exceptions, an eight and a half pound shit is as close as a man may ever come to experiencing the miracle of childbirth. I made this. This came out of my body.
A friend of mine, who I’ll call John, recently had an eight and a half pound bowel movement. It took him more than two days to pass, and required his wife’s intimate assistance—she had to break it up with her hand so John could move it out. It still took agonizing hours, on his hands and knees in his bathtub, to move his bowels. You can see why he weighed that bowel movement. I told everyone who’d listen about John’s nightmarish shit, which is how I learned the word “bezoar,” from a friend who collects strange knowledge. A bezoar, a phytobezoar in particular, is what John and his wife figure he suffered from.
Bezoars are large masses of undigested matter that collect in the stomach. The kind John had is made up of the hard to digest portions of fruits and vegetables. They can result from insufficient stomach acid, which nutritional therapist Craig Fear says is far more common than acid overproduction. “Food just sits in that poor acid production environment, and it makes people feel bloated and sick to their stomach. It’s a root cause of heartburn, ironically.” Undigested food refluxes, rising up from the stomach and causing heartburn. “Chronic use of acid blockers makes things worse.”
Bezoars are also a possible side effect from having gastric bypass surgery, which removes parts of the stomach and small intestine. John, it turns out, had this surgery almost ten years ago, and had become complacent in following the special diet prescribed to him: he can’t eat much fiber, has to crush his pills, and takes extra vitamins because he can no longer absorb them as readily with his shortened GI tract.
With bezoars at one end of the bowel movement spectrum, far in the red zone for constipation, at the other end is Louis CK’s state of “shit emergency”: explosive diarrhea.
Frequent diarrhea and/or constipation might mean IBS—irritable bowel syndrome—lactose intolerance, or celiac disease, which is an immune response to gluten. These conditions can be managed with diet. However, there are more serious diseases, such as Crohn’s and colitis, which while somewhat manageable, are also linked to colorectal cancer, the third most common cancer in the United States. An urgent need to hit the men’s after every meal isn’t only uncomfortable and embarrassing. It can point to potentially life threatening problems, most of them poorly understood.
The relationship between our brains and our guts is so closely intertwined that even in mainstream medicine, the mind and the gut are starting to be viewed as a single system. “It’s a frontier of science,” says Fear. “We have just scratched the surface of what these cells can do. We have trillions of bacteria in our digestive tract, more than we have cells in our body.” Of those trillions, we’ve identified close to a thousand species of bacteria in the human gut. If “we” are only our human DNA, we are seriously outnumbered.
The relationship we have with the bacteria in our digestive tracts—and microbes elsewhere in our bodies, with each bend of the tract, or fold of skin, providing a unique ecosystem—is mostly symbiotic. In the digestive tract, “good” bacteria break down the food we eat so our bodies can use it, and prevent “bad” bacteria from taking over. “Probably 10-15% of our gut flora are pathogenic,” Fear says, “but in a healthy environment they don’t cause problems.” When the balance of good to bad bacteria is out of whack, we get sick. That imbalance is known in medicine as an “overgrowth” of pathogenic bacteria.
Normal bowel function can be upset by all kinds of environmental factors, including stress and prescription drugs, particularly birth control in women. Up to 20% of people have chronically irritated bowels. In bariatric surgery patients, the direct removal of parts of the digestive tract takes out whole neighborhoods of the human biome. But the chief causes of diarrhea, according to Fear, are antibiotics (taken directly or indirectly, through animal products), overconsumption of sugar and other processed foods, and food allergies and sensitivities.
A new medical treatment for pseudomembranous colitis is the fecal transplant, or fecal bacteriotherapy. Pseudomembranous colitis causes diarrhea or irritated bowels because of an overgrowth of C. dificile bacteria, and is associated with the use of antibiotics. For the fecal transplant, bacteria are harvested from a healthy person’s colon, then delivered by enema into the patient. Healthy bacteria colonize the patient’s intestines, successfully treating the symptoms and returning the patient’s gut flora to a state of health.
SIBO, pronounced “SEE bow,” small intestinal bacterial overgrowth, is what Fear believes is the root cause of IBS. “A common symptom of IBS is they eat and then have to go real quick. It impairs their life, it’s embarrassing. IBS is a controversial diagnosis, meaning we don’t know what else to call this, don’t know what to do with it. People are left with no solutions except an acronym. They’re not given any help: they’re told to ‘learn to live with it.’ A regular doctor would I suppose prescribe Metamucil, and to eat a low fat diet. I would start with food.”
Men seek medical and nutritional advice in far lower numbers than women. Most of Fear’s clients are women—about 80 percent—a number he says is also typical of his colleague’s caseloads. Men will talk about digestive complaints among ourselves, in a jocular way that minimizes our fear and suffering, to master what is out of control or that we don’t understand. Even my friend John, who suffered for days before he could pass his phytobezoar—and really should have gone to the emergency room to treat, because of the dangers of intestinal blockage—resisted seeing a specialist after the event.
Although Fear mentions digestive complaints like heartburn and bloating on his website and in his book, hardly anyone comes to him with their digestive troubles foremost on their mind. “It’s almost always a secondary complaint,” says Fear, of serious issues like alternating diarrhea and constipation. That is, unless the client has already been diagnosed with IBS, in which case, mainstream medicine offers little relief.
Craig Fear advises all of his clients to eat “good” fats such as butter from grass fed cows, and coconut oil. “Healthy fats actually help with regularity. Fat soothes the bowel wall.” Fear’s other recommendations include eating more cultured foods, like kimchi, and bone stocks, both of which are highly nutritious and easy to digest; and to avoid processed foods and sugar.
He also strongly suggests going gluten free, at least for a trial period, to see if it offers any relief. Celiac disease, an immune reaction against gluten, is rare in the US, according to one large scale trial, with less than 1% of the population affected. However, modern grains can present difficulties, even in the absence of an immune response. “Grains can be a problem because they’re hard to digest,” says Fear. We don’t prepare grains in traditional ways that make them easier on our digestive systems, he explained, such as sprouting, soaking, and fermenting. In some cases, he also suggests clients eliminate dairy, in case of lactose intolerance, a far more common condition in adults, particularly people of color. Symptoms of lactose intolerance include diarrhea and bloating.
Digestion should not be painful: if you regularly have bloating, heartburn, constipation, or other discomfort associated with eating, you should speak to your doctor about your symptoms. Digestion should be regular, too. How do you know if your bowel movements are normal? Craig Fear says that if you tend to get up at the same time each day, and have one comfortable BM in the morning, this is a good sign of healthy bowel function. “If you have to go to the bathroom after every meal, that’s not normal. Normal bowel movements should take place at a much slower pace. Between 19 and 24 hours after you eat is when food should exit the bowels.”
Before you flush, take a look at your output. Dr. Mercola has a post on his site that includes the Bristol Stool Chart—with illustrations—describing the ideal form, color, and even scent of a healthy bowel movement. The “Holy Grail” of poop is “smooth and soft,” “like a sausage or a snake,” all in one piece that enters the water like an Olympic diver, with barely a sound. It shouldn’t float or splash like a log, be broken up into a lot of little poops, be white, yellow, gray, or red in color, cause you to strain to eliminate, or be so sticky that it’s difficult to clean yourself after. It shouldn’t smell terrible. It definitely should not constitute an emergency.
According to the Mayo Clinic website, one of the signs of colorectal cancer is a change in bowel movements. Death rates from colorectal cancer are high—they’re the third leading cause of cancer related death in men, and mortality rates are much higher among black men than white men with colorectal cancers—but the numbers are dropping because of early screening. If you suffer frequent diarrhea or constipation, have experienced a change in what’s normal, or see bloody stool, see your doctor.
You can take some control of your health—and the comfort of elimination—by changing what goes into your body. Fear points out with a chuckle that “Louis CK has done well for himself: he could afford to hire a personal chef.” CK knows he feels awful when he finishes a Cinnabon, a message he could better heed. (Warning: This video is not safe for work at all, but is a hilarious and telling example of the messages we give and receive about men’s self control when it comes to what goes into and comes out of our bodies.)
Some final notes on healthy bowels:
Good enough is good enough. An 80/20 rule, where 80% of what you eat is good, healthy, traditionally prepared food, free of processed ingredients and sugar, may be good enough, in Fear’s opinion.
When your guts are telling you something, listen: honor the mind-gut connection.
Wherever your starting point, you can make better choices, whether it’s in a grocery store or a restaurant.
The starting point of your digestive tract, and for good bowel health, is your mouth. As Hippocrates, the father of medicine famously said, “Let food be thy medicine and medicine be thy food.”
If you see blood in your stools, or are unable to pass a bowel movement, get medical care right away.