Let's Talk Poop

 What, no one wants to talk about POOP, Poo, Crap... Stool talk is generally not socially acceptable in today's society. TMI!!  Historically it was not so taboo. People would sit next to each

other in public restrooms and chat while voiding. Times change. It may not be comfortable to talk to friends about your stools but we are nurses and you can talk poop with us. It is a topic we are trained in.  This topic and evaluation parameters can tell us about how well your intestines are functioning. 

How fast do I poop? It takes 2-5 days to digest foods and have the remains leave the body as stool. Surprising isn't it. This video from Doctor Gut is very informative on the digestion process. What you eat can cause this variance. More fiber can speed the process. People with inflammatory bowel disease may have a faster timeframe for food processing. Inflamed guts push food through faster due to the irritated bowel lining, stools are also looser or thinner because the stool does not say in the large intestine as long. 

How often do you poop? It is normal to poop up to 3 times a day to 3 times a week. More or less frequency can be signs of constipation or diarrhea, see your doctor if these persist. 

How to score your stool? the Bristol stool scale gives some general definition of different types of stool. 

What do different colors mean?

• Yellow stool - can be a sign of liver or pancreatic problems, too Much fat infection, Giardia, Celiac disease or poor diet. 
• Black stool - bleeding in upper GI track or eating liquorice, Bisthmus, or iron supplements
• Red stool - bleeding in lower intestine, hemorrhoids, or eating red foods
• Orange stool - Look for orange foods you may have eaten, pumpkin, squash, carrots, sweet potatoes
• Green stool - Food mass passing too quickly or excessive greens intake or green food coloring 
• White stool - pale or clay colored - possible bile duct blockage, see a doctor!
• Brown stools - dark or light, are normal color for stools. This color comes from the bile - a substance in your liver that helps you digest fats. As it moves through your intestines it changes color to brown and colors your food waste as it goes. 

Is gas bad or good? 

Gas is an indicator of the food you have eaten as it breaks down in your intestine. These foods can cause more gas than others, alcohol, asparagus, beans, cabbage, coffee, cucumbers, dairy, eggs, fish, garlic onions and prunes. If you have problems digesting some foods they may move more slowly through your intestine and ferment causing smell or gas. 

Why do stools smell?

Stools are digested food. Food that has been broken down by various enzymes, acids, and mechanical breakdown as it moves through the digestive tract. Bacteria in our intestine break down, ferment and further digest and eat this food. These chemical processes cause various smells.  Severe or unusual smells over time may be a sign of infection. 

Why does my poop float or sink?

Floating stools do so due to fats. This may be a sign of poor fat absorption. See your doctor if this persists for more than a few days. Healthy stools sink.  

Resources:

https://en.wikipedia.org/wiki/Bristol_stool_scale 

https://www.youtube.com/watch?v=3B5W4PWWX7U

https://www.health.com/condition/digestive-health/how-long-does-it-take-to-digest-food

https://www.webmd.com/digestive-disorders/what-do-different-poop-colors-mean#:~:text=The%20color%20is%20the%20result,chemical%20changes%20and%20turn%20brown. 

Why Is Having A Healthy Gut Microbiome So Important?

You may have noticed there has been a lot of discussion regarding a healthy gut microbiome for optimal health. But what exactly is the gut microbiome? Bacteria, viruses, fungi and other microscopic living things are referred to as microorganisms, or microbes. Trillions of these microbes exist inside your intestines and on your skin and most are found in the “pocket” of your large intestine called the cecum. There are over 1000 microbes in the gut and they serve different functions. Many of them are required for good health and the microbes in the gut can weigh anywhere from 2-5 pounds, roughly the weight of the human brain! 

Now that you know where the gut microbiome is, you may now be asking yourself “what does the gut microbiome do and how does it affect the functioning of my immune system?” The foods we eat can affect the diversity of bacteria present in the gut. Studies are finding it is important to have a varied gut microbiome for optimal health. Some bacteria digest breast milk which is important for proper growth of infants. Other bacteria digest fiber and produce short chain fatty acids which are important for managing weight, preventing Type 2 diabetes, heart disease, and the risk of cancer. The gut microbiome also controls how your immune system works by communicating with immune cells and controlling how you respond to infections. It also supports the epithelial lining of the intestines.

So why does our gut microbiomes become imbalanced? Changes can occur from overuse of antibiotics, changes in diet i.e. the highly processed Western diet, stress, lack of physical activity, and poor sleep. These changes can cause our gut to become “leaky”, commonly known as leaky gut. The epithelial lining in the intestines becomes permeable allowing toxins, bacteria, antigens, and the proteins from food to leak out into the surrounding tissues and bloodstream causing activation of the immune system and the development of auto-immune diseases; Inflammatory Bowel Disease (IBD), specifically Crohn’s and Ulcerative Colitis, are associated with significant changes in the gut microbiome.  Genetic and environmental factors are also contributors. 

So what can we do to improve our gut health? First of all it is important to get enough physical exercise, develop good sleep habits, participate in stress reduction modalities such as meditation or yoga, and focus on improving dietary habits. Your first step should be to concentrate on eating whole, minimally processed foods such as fruits, vegetables, nuts, seeds, unrefined carbohydrates, olive oil, and fish, if you are not a vegetarian or vegan. It is also important to limit the amount of sugar and alcohol you consume. Next, begin focusing on eating foods high in pre and probiotics, identify and eliminate foods you are sensitive to, and determine and treat any gut infections you may have such as H. Pylori.

Our gut microbiome is the key to good health.  If you have many digestive issues and/or auto-immune diseases start looking at the foods you eat. Write down everything you eat for three days (be honest) and you might be surprised to see what you are actually eating. Once you begin focusing on eating a minimally processed diet you might be surprised with how much better you feel!

References:

https://www.healthline.com/nutrition/gut-microbiome-and-health#TOC_TITLE_HDR_10

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440529/

Belkaid Y, Hand T. Role of the microbiota in immunity and inflammation. Cell. 2014;157(1):121-141.

The Standard American Diet, why it’s so SAD and how to avoid it!

I am not going to preach about which eating plan to follow, but I am certain that the Standard American Diet (SAD) is not the one.  The word diet means the food a person usually drinks and eats. It does not mean to lose weight and the best diet is not the same for everyone.  What I am certain of, is that we should be eating a diet full of whole, minimally processed foods.
The SAD diet is full of processed foods. It is too high in omega 6 fatty acids. Omega 6 fatty acids are found in vegetable oils, margarine, corn, and poultry fat. We require only small amounts of omega 6 fatty acids for tissue repair. On the other hand, omega 3 fatty acids are important for heart health, cancer prevention, and brain and vision health.  Omega 3 fatty acids can be found in fatty fish such as salmon and sardines, flaxseed, and chia seeds. We should consume a 1:1 ratio or 2:1 ratio of omega 3 fatty acids to omega 6 fatty acids. The SAD diet creates a 1:16 ratio. Yikes! This imbalance leads to chronic inflammation in the body, poor sleep, and autoimmune disease. Unfortunately, the number of processed, sugary, and nutrient poor foods that end up on our grocery store shelves increases every year.  Many of these foods target children leading to chronic health problems at an early age such as obesity, Type 2 Diabetes, migraines, ADHD, constipation, and other digestive problems. When we eat a highly processed diet, we are stressing our digestive system. When our digestive system is compromised so is our immune health. Many people don’t realize our immune system begins in our gut and 80% of our serotonin is produced in our gut and not our brain. The gut is often called the second brain.  When we feed our bodies whole food not only does our physical health improve but mental health as well. 
I can’t have a conversation about the SAD diet without discussing sugar. Sugar makes up about 10% of the daily caloric intake of the average American. Studies have shown the negative effects of sugar on our health. A 2014 study published in JAMA Internal Medicine showed a correlation between sugar and death from heart disease. I am sure many people don’t realize that a 20 oz bottle of soda contains 65 grams of sugar.  This is about 2 shot glasses.  You might think that turning to artificial sweeteners is the answer, but they are not any better for your body. It’s also important to remember that the fat in fat free foods is often replaced with sugar. 
You are probably wondering what to do now. The answer is simple; switch to whole foods such as fruits and vegetables, whole grains, beans, eggs, nuts and seeds, low mercury fish, grass fed beef, and poultry. Everyone’s diet will vary based on food preference. I am sure many of you have heard of primarily shopping the perimeter of the grocery store. Most of the processed foods are in the aisles, but I have seen grocery stores sneak processed foods into the perimeter. Some people can change their entire diet immediately, but most people need to make small changes. For those who need to take baby steps, begin with breakfast. Start your day with a balanced meal of complex carbohydrates, protein, and healthy fat. Balancing your blood sugar in the morning will lead to better food choices throughout the day. Next, try and limit your sugar intake to no more than 6 teaspoons per day. When you read a food label, look for “included sugar.”  Four grams equals a teaspoon. If you don’t think you consume a lot of sugar because you drink your coffee black you will probably be surprised by how much sugar is in your diet. It’s also helpful to plan.  Prepare hard boiled eggs for the week. Make several salads in mason jars to bring for lunch. Prepare chilis, bean soups or pot roast in your instant pot or crock pot. I love to make a delicious vegetable soup for the week. You can also prepare burrito bowls and always carry healthy snacks such as carrot sticks and nuts. One thing I love to do is eat leftovers from dinner for breakfast.
It’s important to be aware that when you begin to switch to a whole foods diet, cravings for processed sugary foods will arise. If you keep giving in, you will get stuck, and your body won’t be able to get off the processed foods. Some tips for when those cravings strike are to take a walk, perform slow deep abdominal breathing, drink a glass of water, and use essential oils. Grapefruit is an amazing oil to combat those sugar cravings. Peppermint can help suppress appetite but also helps clear your mind.  It can also help with headaches that can develop during the first few days of removing processed foods.  Finally, cinnamon is a wonderful blood sugar balancer which can decrease sugar cravings.
Once you have established a minimally processed whole foods diet you can decide how strict you want to be.  Some people relax their diet on vacation only whereas others follow a 80-90% whole foods diet with 10-20% less nutritious food daily. For me, I allow myself a serving of 80% dark chocolate daily and I have a friend who has one diet coke per day. Figure out what works for you. Just remember that food is medicine, and you truly are what you eat!
References
Frazier, Karen, “Nutrition Facts. The Truth About Food”, Rockridge Press, Berkeley, Ca, 2015
Lipinski, Elixabeth, “Digestive Wellness. Strengthen the Immune System and Prevent Disease Through Healthy Digestion”, McGraw Hill, New York, 212.
Sizer, Frances, Whitney, Eleanor, “Nutrition Concepts and Controversies 14th Edition”, Cengage Learning, Boston, 2014.

GMOs; Genetically Modified What?

One of the latest buzz words in the world of nutrition is GMOs, or genetically modified organisms. Just hearing the phrase genetically modified makes me go hmmm, especially when it comes to our food.  In my integrative health program, we watched several documentaries on GMOs. The documentary Food Evolution is pro GMO, but I am not sure I agree. 
First, let's talk about what GMOs are. GMOs are organisms in which DNA has been altered using bioengineering techniques. Genetically modified crops increase crop yields by making the crops resistant to bugs, GMOs are thought to increase nutrition, increase growth, and make farming easier. For example, one of the most common crops containing GMOs is Bt corn.  Bt comes from naturally occurring bacteria, Bacillus Thuringiensis. This bacteria lives in soil and produces a toxin that kills insects by making their intestines burst.  Corn is then genetically modified to express the gene Bt toxin, allowing it to produce its own insecticide, therefore resistant to pests and decreasing the need for pesticides. Bt corn is found in many processed foods in the form of high fructose corn syrup.  Many livestock consume Bt corn on factory farms. GMO crops are very common in the United States and about 80% of food found in the grocery store contain at least one genetically modified ingredient. These foods include canola, soybeans, corn, cotton, alfalfa, sugar, beets, potatoes, summer squash, and some apple varieties. Labeling of GMO foods is currently not mandated, but in 2022 it will be required for food produced with GMOs to have the term “bioengineered food” somewhere on the packaging.
So we have learned that GMO crops increase crop yield, allow crops to be resistant to pests, increase nutrition, make farming easier, decrease pesticide use, and lower consumer costs.  The FDA, USDA, and the EPA have deemed GMOs safe for consumption.  Sounds great, right? So why the worry?  We would hope that Bt toxin would be destroyed once in our digestive tracts, but this is not the case. A Canadian study found that Bt toxin was present in 93% of pregnant women tested, 80% of umbilical blood in their babies, and 67% of non-pregnant women.  There is concern that the Bt toxin may be transferred to our gut and the bacteria in our gut will then be able to replicate this toxin. Scientists have found that mice fed Bt corn showed elevated antibodies and increased white blood cells associated with allergic and immune responses. It has been determined that the genetically modified soybean contains a unique protein that binds to IgE and may evoke dangerous allergic reactions. Rats fed GM potatoes mounted a slower immune response and mice fed GMO peas developed inflammation. Further studies have shown rats fed diets high in GMOs had higher death rates and greater organ damage.  We also need to remember that we are consuming foreign genes.
 These studies make me question if GMOs could be one of the reasons why so many auto-immune disorders have been diagnosed along with food allergies. The FDA ensures that researchers who develop GMO foods run tests to make certain that allergens aren’t transferred from one food to another.  In the mid-1990s, a study found that adding a protein from Brazil nuts to GMO soybeans could trigger an allergic reaction in people sensitive to Brazil nuts.  After scientists discovered this, they discontinued this GMO food. This sounds like good news, but can this ensure no negative health consequences from consuming the Bt toxin?  Another concern is GMOs being linked to cancer.  Since cancers are caused by DNA mutations, some people worry that eating foods with added genes may affect DNA.  The American Cancer Society reports that there are no links to GMO containing foods and cancer, but there have been no long-term studies on the effects of consuming GMOs. 
One of the “positive” attributes of GMOs are crops being resistant to herbicides, such as Roundup. This means that farmers can use Roundup without fear of it harming their own crops leading to greater crop yield. This sounds like a great benefit for the use of GMOs, but is it really?  Insecticides sprayed onto food can be washed off, but genetically modified crops containing Bt can't be separated. The food is modified from its natural state and the toxin is part of the food. In 2010 the American Academy of Environmental Medicine recommended that physicians tell patients to remove GMO foods from their diets. 
GMO is a fairly new technology and more long-term studies need to be done to determine health effects. Currently, the only way to know if GMOs are not in your food is to see the label “non-GMO” on the package. You can also shop at a grocery store that tries to limit the number of GMO containing foods.  We are told that they are safe, but so were cigarettes and vaping until correlations to illness were recognized. Will this be the case with GMO’s?  I don’t know but I choose to limit them in my diet because if something is genetically modified then I feel there must be some health consequence. You can choose to consume them or not, although right now it might be difficult to remove them completely since food manufacturers aren’t required to disclose them.  Do your own research and see what you find.  Be sure to look at research that covers the pros and cons. If you are suffering from autoimmune issues or food sensitivities do your best to take most of them out of your diet and see what happens. You may be surprised. I have heard stories from people who focused on removing GMOs from their diets leading to improvement in their health and the health of their children. The choice is yours.

References
Chutkan, Robynne MD, The Microbiome Solution. A radical New Way to Heal Your Body from the Inside Out, Penguin Random House, New York, New York, 2015.
Frazier, Karen, Nutrition Facts. The Truth About Food, Rockridge Press, Berkeley, California, 2015
Charu Verma , Surabhi Nanda , R.K. Singh , R.B. Singh and Sanjay Mishra, A Review on Impacts of Genetically Modified Food on Human Health, The Open Nutraceuticals Journal, 2011, 4, 3-11  2011,  
Raman, Ryan MS, RD, GJournaling alMOs; Pros and Cons Backed by Evidence, Healthline, July, 2, 2020.