The Blog Chicks team came across this very good article on gut health written by Joanna Baker, principal nutritionist and dietitian at Melbourne based Everyday Nutrition. We are fortunate to have been given permission by her to publish this for the benefits of our readers. The team at Blog Chicks cannot emphasise enough the importance of the digestive system on your wellbeing and hope you enjoy reading it as much as we did!
What goes in, has to come out. While it’s not usually dinner time conversation, everyone poops. But whats “normal” when it comes to poop? Read on to find out.
Your poop is essentially what’s left of the food and fluid you consume after your body (and gut microbiome) has taken the nutrients it needs. What you eat affects your digestive system and your poop can give us insight into the functioning of your digestive tract and what you’ve eaten over the past day or two
What is gut health?
In the past, the digestive tract was considered a relatively simple tube that food passed through, the nutrients (vitamins, minerals, fats, carbs and proteins) absorbed and what was left over was flushed away. In the past few years, the research on gut health has certainly exploded, so much so that there isn’t enough room for it all in my head anymore! We now know the gut microbiome is linked to the immune system, mental health, autoimmune diseases, diabetes, heart disease, body weight, some cancers and IBS, with the 1-2kg of bacteria that make up your gut microbiome some of the biggest players in this.
Like all things “sciencey” though, the more we learn, the more we realise there is to learn about gut microbiome. We can now take a stool sample and define what bacteria make up an individual’s gut microbiome. The problem is, that since your gut microbiome is more individual than finger prints, there is no gold standard to compare this to, nor any classification of what is healthy or unhealthy. In fact, current research is beginning to indicate that what your communities of bacteria do is more important than what strains of bacteria you do, or don’t, carry.
So what does science know about what makes up a healthy gut? Well know that:
- A lot of bacteria (abundance) is a good thing
- A lot of different kinds of bacteria (diversity) is a good thing
- A functioning and intact gut barrier (including a healthy mucus layer, epithelial cells with tight junctions and a responsive lamina propria) is important for immune function
- Effective digestion and absorption of food for nutrition
- Digestive comfort
- Absence of disease or damage
- A resilient gut microbiome that bounces back to your normal after an “insult” e.g. a course of antibiotics or a big weekend at the local pub
What’s normal and what’s not when it comes to poop?
When it comes to digestion and poop, its normal to have some fluctuations day to day. In fact, this is reflective of a varied and balanced diet. If your diet or lifestyle changes or you need to take a medication for one reason or another, its likely you will see this reflected in your poop. If this is transient and settles back to normal pretty quickly, it’s not a cause for concern. But, if symptoms persist it may be a sign of something that may need addressing.
There is also a wide range of what’s normal when it comes to how often you should visit the smallest room. Anything from three times a day to once every three days is considered within normal. If you fall somewhere in this, you’re comfortable and your stool is formed and easy to pass, then you’re doing well. Essentially, it’s often not necessarily how often you’re going as it is about how happy you are when you do go. If, however, you are falling outside of this or you are experiencing discomfort or poorly formed stool, that’s when it likely needs a little digging to find out what’s going on.
- Diarrhoea is defined frequent stools (more than 3 per day or more than your “usual”) that are loose or watery, about a type 6 or type 7 on the Bristol stool chart. Not only is this inconvenient, it can also be painful, cause dehydration and make people feel queasy.
Some causes of diarrhoea include:
- Virus’s (gastro) or food poisoning
- Medications e.g. antibiotics or magnesium
- Bacteria or parasites that don’t belong
- Lactose or fructose malabsorption (FODMAPs)
- Other types of food intolerances (e.g. salicylates or amines)
- Bile acid malabsorption
- More serious stomach and bowel conditions like inflammatory bowel diseases or cancers
- Problems with the gut-brain axis like IBS
- Constipation is the opposite of diarrhoea. Poop that is small, hard, dry, infrequent or incomplete and difficult or painful to pass. On the Bristol stool chart we might be looking at a type 1 or type 2. Constipation can make people feel bloated and backed up and over the long term can result in diverticular, haemorrhoids or fissures.
Some causes of constipation include:
- Not enough fibre in your diet
- Lack of physical activity
- Food intolerances
- Medications e.g. opiates, calcium supplements or antidepressants
- More serious stomach and bowel conditions like inflammatory bowel diseases or cancers
- Problems with the gut-brain axis like IBS
- Colour of your poop. In most cases, poop is brown, but it can change to a certain degree based of what you’ve eaten. For example, if you eat a lot of spinach for dinner, you may notice that your pop has a green hue the following day. Also food colouring can change the colour of your poop. In these cases, it’s not a cause for concern.
- Light coloured poop may be related to bile acid malabsorption, an infection or inflammation (my son did a white poop once after recovering from a virus), liver function or something going on in the gall bladder or pancreas
- Red poop. If not from red food colouring red poop is often due to blood in the stool. When it’s a small amount, it may be haemorrhoids or fissures from constipation or menstrual blood if it’s that time of the month. Other causes of blood in the stool may be due to infections, blockages, IBD or cancers. If you are regularly experiencing bleeding without an identifiable cause, this is something to discuss with your doctor.
- Black poop can be due to iron supplements, liquorice, large serves of blueberries or more serious, it can also be related to bleeding somewhere along the digestive trat in which case, you’ll want to discuss with your doctor
- Food in the stool is quite normal and not usually a cause for concern. This is super common with fibrous foods like corn, seeds or capsicum. If your stools are formed and comfortable, pay little attention.
- Floating stool, particularly if it’s also fatty looking can be a sign of bile acid malabsorption, pancreatitis, an infection or excessive gas.
- Foul smelling poop. While its normal for poop to have a distinctive smell, if the smell changes dramatically or is particularly acrid this can be the result of malabsorption, virus’s, infections or parasites, bowel conditions like coeliac or IBD, pancreatitis or genetic conditions like cystic fibrosis.
When to see your doctor
There are a few “red flags” that are important to discuss with your doctor and shouldn’t be ignored. In these cases, it’s better to go along and find out its nothing that ignore it and find out too late that something more serious is going on.
“Red flag” symptoms include:
- Unexplained weight loss
- Unexplained blood or bleeding
- Heart burn that doesn’t respond to antacids
- Changes in your “normal” bowel routine
- IBS type symptoms if you have a family history of bowel conditions or are over 50 years of age
How you can improve your gut health?
First of all, I think that it’s important to identify that Irritable Bowel Syndrome (IBS) is not necessarily a reflection of poor gut health. We know from medical testing that people with IBS are medically healthy and have a healthy and intact gut, so there is nothing to “heal” as such. Although we don’t know what causes IBS, we do know that hypersensitive nerves in the gut and an over-communication of information between the gut and the brain play a major role in the pathogenesis of IBS symptoms. But, whether you have IBS or not, there are lots of things you can do to maximise the diversity and abundance of your gut microbiome.
Forget the expensive supplements that promise to have magical gut healing powers and get back to basics with fibre, fibre and fibre. Fibre is the part of food that our body can’t break down. Instead, fibre passes through the digestive tract and provides fuel and nourishment to your gut bacteria. Making sure these bacteria are well fed will keep them abundant and healthy, so that they can protect your gut lining and perform the tasks that keep you and your gut healthy.
In addition to keeping your gut bacteria fighting fit:
- Fibre gently expands in the stomach and makes you feel fuller for longer
- Fibre slows digestion and keeps blood sugar levels stable
- Fibre aids in reducing cholesterol and blood pressure
- Fibre facilitates the production of short chain fatty acids and reduces the risk of bowel cancers
- Fibre acts like a sponge, soaking up water and making stool softer, bulkier and easier to pass. This property is beneficial if you suffer from either diarrhoea or constipation.
If you are following a low FODMAP diet, you’ll know that many high fibre foods or certain types of fibre are not well tolerated. This can make it difficult to meet fibre needs and is likely the reason that we see a reduction in diversity and abundance of gut bacteria on as little as 3 weeks on a low FODMAP diet. With this in mind, it’s a good idea to pay extra attention to including plenty of low FODMAP high fibre foods like low FODMAP serves of oats, sourdough bread, low FODMAP nuts and seeds, canned lentils and chick peas as well as low FODMAP fruits and vegetables. If you are struggling to fill the fibre gap, it might be worth discussing a FODMAP Friendly fibre supplement like Kfibre with your FODMAP trained dietitian.
Research shows us that the variety of plant foods we eat is directly reflected in the variety and abundance of gut microbiota that live in your gut. The American gut project found that people who ate 30 or more plant foods in a week had a much more diverse and abundant gut microbiome than those who ate 10 or less. How many different plant foods do you eat each week?
The following foods are just some examples of plant foods that have low FODMAP serves and can be included on phases of the low FODMAP diet:
- Fruits & veggies: carrots, parsnip, capsicum, lettuce, pumpkin, eggplant, tomato, cucumber, broccoli, corn, coconut, berries, firm bananas, rock melon, honey dew melon, citrus, pineapple, dragon fruit, passionfruit
- Nuts, seeds & legumes: peanuts, brazil nuts, almonds, macadamias, chia, flax, pepitas, pine nuts, edamame, firm tofu, canned lentils, canned chick peas, canned butter beans
- Cereals & grains: Oats, millet, sourdough, buckwheat, rice, quinoa, sorghum, teff
- All herbs and spices
Probiotics & prebiotics
Probiotics add new bacteria to your gut microbiome and prebiotics provide food for the microbiota that are currently living there. Prebiotics are a good thing, they are like fertiliser that keeps the garden of bacteria living in your intestines. But when it comes to probiotics, how an individual responds is variable, if all our microbiomes are different it makes sense that probiotics will behave differently in different environments. This means that there no one rule as to if you should or shouldn’t take a probiotic and if you should, which one you need to take. However, there are lots of foods that naturally contain probiotics and prebiotics. Including these functional in your diet you not only get the benefit for the probiotics and prebiotics, you also get the other nutritional benefits the food provides. Think of probiotic foods like lactose free yoghurt, miso, tempeh, low fodmap serves of sauerkraut and prebiotic foods like whole grains, nuts, legumes, fruits and vegetables.
Getting enough sleep is something that we hear about often, but is surprisingly under-appreciated in favour of work or play. Making sure to keep a good sleep routine allows your body a chance to rest, digest and recharge. Chronic poor sleep impacts stress levels, glucose metabolism and has been shown to alter gut microbiome.
Persistent and chronic stress puts pressure on the whole body, including the gut. Additionally, we are whole beings and we can’t have physical health, if our mental health is suffering. Take time out for yourself with mediation, mindfulness, spending time in nature, reading, a massage, laughing and connecting with friends and loved ones, yoga or cuddling a pet.
When I ask people how much they drink, the answer is either “oh heaps” or “not enough”. Having enough to drink is essential to many body functions from energy production to keeping your gut lining hydrated and lubricated to helping to prevent constipation. If you’re not getting your 8 glasses a day, this can be a simple way to promote improved gut function.
FODMAPs & Gut Health
Following a low FODMAP or any restricted diet is going to limit your food variety, increase risks of nutritional deficiencies and impact on your social life. Given that we know that IBS doesn’t cause physical damage, managing it is all about managing symptoms. There are four main groups of FODMAP and then a further 3-4 subgroups. For many people strictly limiting all four, is more than what is necessary to achieve good symptom management. FODMAPs play an important role in physical wellbeing, lifestyle and of course, gut health so it’s important to move through challenges and establish your individual threshold to the various FODMAP groups. After all, for gut health, physical health and mental health, our ultimate goal is maximum variety and minimal digestive upset.
To learn more about the author and her practice Everyday Nutrition, visit their website here: https://everydaynutrition.com.au