Healthy Bowel Movements

Photo: Constipation by flickr/Alexander Ekman
Photo: Constipation by flickr/Alexander Ekman

The form, frequency, and transit time of bowel movements may play an important role in colon health. Larger bowel movements rid the body of excess estrogen. A minimum of 200 grams of fecal output (about a half pound) per day is the goal for cancer prevention. Fiber from whole foods can prevent diverticulosis and constipation, while eating meat and processed foods may increase one’s risk for conditions such as diverticulosis. Foods high in antioxidants may also help increase stool size, whereas fat blocking drugs and certain fish can cause anal leakage.

Bowel Movement Frequency

Comparing the regularity of omnivores, vegetarians, and vegans.

The fiber in flax seeds and other whole plant foods is more than just about reducing our risk for the heart disease and cancer. More than just the discomfort constipation can increase risk for hiatal hernia, varicose veins, hemorrhoids and painful conditions with names like anal fissure.

The biggest study on bowel movement frequency in history was recently published comparing the bowel habits of 15,000 meat eaters to 5000 vegetarians and a thousand vegans. Being vegetarian and especially vegan is strongly associated with a higher frequency of bowel movements. Moreover, having a high intake of dietary fibre and fluids and a high BMI are associated with an increase in frequency of bowel movements(BM).Vegans for example were about 3 times more likely to have daily BMs.

Bristol Stool Chart

Bristol Stool Scale or Bristol Stool Chart is a medical aid designed to classify the form of human faeces into seven categories. Sometimes referred to in the UK as the "Meyers Scale", it was developed by Heaton at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997).

Seven different classifications:
Type 1: Looks like rabbit droppings. Separate hard lumps, like nuts, hard to pass.
Type 2: Looks like a, bunch grapes. Sausage-shaped, but lumpy.
Type 3: Looks like corn on the cob.
Type 4: Like a sausage or snake, smooth and soft.
Type 5: Looks like chicken nuggets.
Type 6: looks like porridge, and
Type 7: Looks like gravy.

Meat-eaters, on average, poop out corn cob(Type 3) stools, while vegetarian and vegan on average, type 4, like sausage, smooth and soft. Vegans actually ended up beating vegetarians, because none of the vegans had the hard rabbit-turd stools, whereas a few of the vegetarians, like a bunch of the meat-eaters, struggled to pass type 1’s.

Photo: Bristol Stool Scale by Wikipedia

Stool Size Matters

Larger bowel movements are associated with lower risk of appendicitis, colon cancer, constipation, and diverticulitis.

The bigger our bowel movements, the healthier we may be. The risk of low stool weight includes bowel cancer, diverticular disease, appendicitis, various anal diseases - even perhaps, the healthfulness of breast tissue.

Chart: Mean daily stool weight and colon cancer incidence
Chart: Mean daily stool weight and colon cancer incidence

From a study of 23 populations across dozen countries, a graph, of average daily stool weight versus colon cancer incidence. As you can see, once you get down around 200 grams, colon cancer rates really seem to skyrocket. That's about half a pound. And once people start dropping quarter pounds or 25 grams, though, colon cancer incidence doubles.

The link between stool size and colon cancer may be related to transit time, the number of hours it takes for food to go from your mouth to anus. The larger your stool, the quicker the transit time, the easier it is for your intestines to move things along.

People don’t realize, though, you can have daily bowl movements and still be effectively constipated. You can be regular, but five days late.

What you’re seeing today you may have eaten last week. If you want to test it for yourself, you can eat a big bowl of beets and see when things turns pretty in pink.

Food Mass Transit

Most women experience a four-day intestine transit time, likely too long to meet the target 200 gram (half pound) minimum fecal output for cancer prevention.

How long food takes to get from one end to the other depends on gender and eating style. If you’re a vegetarian male it should just be a day or two, though if you eat meat it could end up being 5 days. Female vegetarians also mostly 1 or 2 days but those who eat meat are most likely looking at 4 days.

Chart: Bowel transit time (h)
Chart: Bowel transit time (h)

If it’s just 24, 36 hours your daily stool weight, which is what's flushing out all that excess estrogen and cholesterol, is probably going to hit that half pound target, though if it’s a couple days you may be hurting.

Or, if you have a really good bathroom scale, you can just measure stool weight directly, to see if you hit that half pound minimum.. by of course weighing yourself before and after, not, you know, messing up your scale.

Kiwi fruit for Irritable Bowel Syndrome with constipation

Photo: Kiwi Fruit by flickr/justusbluemer
Photo: Kiwi Fruit by flickr/justusbluemer
A kiwi fruit intervention was found to improve bowel function in those suffering from irritable bowel syndrome with constipation. Two kiwis a day for a month in this study funded by, of course, the world’s largest marketer of kiwis. They did find such a kiwi intervention “shortens colon transit time, increases defecation frequency, and improves bowel function”

This was accomplished without side-effects such as heart attacks and stroke associated with the primary drug prescribed to treat the condition, tegaserod, the most frequently prescribed drug for irritable bowel.

When to see a doctor

If you've made lifestyle changes that can contribute to having more frequent bowel movements, and you have no other signs or symptoms, you're probably in good health. Make an appointment with your doctor, however, if you're experiencing:

Changes in the consistency, volume or appearance of your bowel movements, such as repeatedly passing narrow, ribbon-like stools or loose, watery stools, abdominal pain, blood, mucus in your feces

Bowel Movement Frequency, NutritionFacts.Org, Dr Michael Greger
Link: http://nutritionfacts.org/video/bowel-movement-frequency/ (Accessed: 2013 Mar)

Stool Size Matters, NutritionFacts.Org, Dr Michael Greger
Link: http://nutritionfacts.org/video/stool-size-matters/ (Accessed: 2013 Mar)

Food Mass Transit, NutritionFacts.Org, Dr Michael Greger
Link: http://nutritionfacts.org/video/food-mass-transit/ (Accessed: 2013 Mar)

Bowels of the Earth, NutritionFacts.Org, Dr Michael Greger
Link: http://nutritionfacts.org/video/bowels-of-the-earth/ (Accessed: 2013 Mar)

Bowel movements: the scoop on poop, NutritionFacts.Org, Dr Michael Greger
Link: http://nutritionfacts.org/2011/09/29/bowel-movements-the-scoop-on-poop/ (Accessed: 2013 Mar)

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Bowel function measurements of individuals with different eating patterns. G.J. Davies, M. Crowder, B. Reid, & J.W. Dickerson. Gut, 27(2):164-169, 1986.

Fecal weight, colon cancer risk, and dietary intake of nonstarch polysaccharides (dietary fiber). Cummings JH, Bingham SA, Heaton KW, Eastwood MA. Gastroenterology. 1992 Dec;103(6):1783-9.

Bowel transit, stool weight, and diverticular disease. Watts GT. Lancet. 1977 Sep 10;2(8037):564.

Haemorrhoids-postulated pathogenesis and proposed prevention. Burkitt DP, Graham-Stewart CW. Postgrad Med J. 1975 Sep;51(599):631-6.

Effect of dietary fibre on stools and the transit-times, and its role in the causation of disease. Burkitt DP, Walker AR, Painter NS. Lancet. 1972 Dec 30;2(7792):1408-12.

Fibre and bowel transit times. Gear JS, Brodribb AJ, Ware A, Mann JI. Br J Nutr. 1981 Jan;45(1):77-82.

Stool form scale as a useful guide to intestinal transit time. Lewis SJ, Heaton KW. Scand J Gastroenterol. 1997 Sep;32(9):920-4.

Kiwi fruit improves bowel function in patients with irritable bowel syndrome with constipation. Chang CC, Lin YT, Lu YT, Liu YS, Liu JF. Asia Pac J Clin Nutr. 2010; 19(4):451-7.

Updates on treatment of irritable bowel syndrome. Hammerle CW, Surawicz CM. World J Gastroenterol. 2008 May 7; 14(17):2639-49.