Hello everyone! Welcome back to another Friday blog. Today I wanted to talk about a subject that we all hate talking about - Poop. How often should you go? Some people think it is normal to skip days and go every other day, 2-3 times a week, or even once a week! So, what is normal and why should we care about it?

“The majority of individuals (95.9%) reported a bowel movement frequency of 3–21 per week, upholding the common metric of normal frequency (three bowel movements per week up to three per day).” However, this was only related to frequency, not consistency of stool or ease of elimination. Unfortunately, there really aren’t many “studies” on this. Here is the Bristol’s Stool Chart to help evaluate type of stool, color (brown is due to dead red blood cells and bile), consistency, etc. However, we can extrapolate a LOT from what we know. The stool is waste products, toxins, bacteria and viruses as well as undigested food particles, etc that your body wants OUT!!! 

A review article published in 2015 found: “Fecal output in healthy individuals was 1.20 defecations per 24 hr period and the main factor affecting fecal mass was the fiber intake of the population. Fecal wet mass values were increased by a factor of 2 in low income countries (high fiber intakes) in comparison to values found in high income countries (low fiber intakes). Feces had a median pH of 6.64 and were composed of 74.6% water. Bacterial biomass is the major component (25–54% of dry solids) of the organic fraction of the feces. Undigested carbohydrate, fiber, protein, and fat comprise the remainder and the amounts depend on diet and diarrhea prevalence in the population. The inorganic component of the feces is primarily undigested dietary elements that also depend on dietary supply.”

A great analogy is your trash. Your trash can is not very big. If you let your trash build up and spill over, pretty soon the floor and surrounding area becomes gross, stinky and contaminated. If you let your trash spill over for 2-3 days, or imagine a week…you get the picture. In fact, the longer the waste products and toxins sit in your colon, the more get re-absorbed and can make their way to other parts of the body, leading to many chronic health conditions and diseases that we all face. If you suffer from constipation, you are 400 x more likely to get Parkinson’s!!! We need to evacuate our toxins!! The longer these waste products sit in your colon, the more local irritation and inflammation begins to occur. This can lead to the beginning stages of colorectal cancer. It can also lead to diarrhea, constipation, straining, micro-tearing, bleeding, bloating or other symptoms that can drive you to take a laxative/other over the counter medication or even see a gastrointerologist.

The most recent report by the NIH:

• digestive disease is the primary diagnosis in a total of 66.4 million ambulatory care visits to physicians’ offices and hospital emergency and outpatient departments in the United States each year.
• 2018 national inpatient samples identified 4.0 million hospitalizations with a primary diagnosis of digestive diseases and 16.5 million hospitalizations with a primary or secondary diagnosis of digestive diseases.
• analyses focusing specifically on the clinical and economic burden of emergency department visits identified 18.7 million emergency department visits with a primary diagnosis of digestive diseases and costs totaling $107.6 billion in 2018.

Here are some other interesting facts on GI disorders:

• Twenty million Americans suffer from chronic digestive diseases.
• Digestive diseases necessitate 25% of all surgical operations.
• Digestive diseases are one of the most prevalent causes of disability in the workforce.
• More Americans are hospitalized with digestive diseases than any other condition.
• Digestive diseases rank third among illnesses in total economic cost in the United States.
• Fourteen million cases of acute digestive diseases are treated in this country each year, including one-third of all malignancies and some of the most common acute infections.
• Digestive diseases represent one of the Nation's most serious health problems in terms of discomfort and pain, personal expenditures for treatment, working hours lost, and mortality.
• Colorectal cancer is the 2^nd leading cause of cancer death among American men and women – and is responsible for over 51,000 deaths annually.

Many times, the diagnosis is IBS (irritable bowel syndrome), a chronic, debilitating, functional gastrointestinal disorder. Symptoms can include abdominal pain, bloating, altered bowel behaviors or fluctuations between constipation and/or diarrhea.  “IBS is often referred to as spastic, nervous or irritable colon. Its hallmark is abdominal pain or discomfort associated with a change in the consistency and/or frequency of bowel movements. Although the causes of IBS have not to date been fully elucidated, it is believed that symptoms can occur as a result of a combination of factors, including visceral hypersensitivity, altered bowel motility, neurotransmitters imbalance, infection and psychosocial factors.”Inflammatory bowel diagnoses may also include Crohn’s disease or ulcerative colitis. 

Constipation can create direct harm causing hemorrhoids, anal fissures, anal prolapse, pain, feel unwell and reabsorb toxins and waste. Indirect harm occurs from taking laxatives, lubricating agents, “smooth move” tea, etc. chronically to get bowel to move. This creates a lazy bowel. 

So, what are some things that contribute or cause digestive issues?

• Diet -  eating the SAD (standard American diet) full of sugar, processed foods and devoid of polyphenols and fiber that our microbiome and our mitochondria need for us to be healthy. You grow the “bad bugs” that produce bad products, like H₂S (hydrogen sulfide) gas. FYI, this is prevalent among autistic children. Stinky poop = bad bugs. These bad bugs produce stinky gas!!!
• Eating too often - Most of us eat from the time we wake up till we go to bed. We often disrupt the MMC (migrating motor complex). Allow your body time to clean, clear out and perform repairs
• Sedentary lifestyle - can contribute to constipation - takes longer to remove waste.
• AGEs (advanced glycated end products) - this happens when we heat sugar with proteins or starches causing them to become damaged. This happens with microwaving food, grilling meat and veggies - those burned, crispy edges that are so tasty. Caramel (burned sugar and butter) is 100% glycated milk proteins, for example. These create inflammation and damage that form an outer layer - like a callus - on damaged tissue. This tissue doesn’t function normally after that. Damaged cells become damaged tissue - resulting in a damaged organ - this leads to organ failure.
• GMO foods - plants are genetically modified to produce that modified gene, such as BT - a pesticide. When you consume GMO plants, you are consuming what the plant makes too.
• Be careful with gluten - even in healthy individuals who think they can tolerate gluten, the gliadin protein can initiate zonulin to open the tight-junctions, causing a transient leaky gut. This is now understood to be one of the major triggers and initiators for autoimmune disorders - thyroid, for example.
• Gut dysbiosis - altered microbiome - the bad bugs that produce damaging postbiotic products outnumber the good guys that produce health-promoting products. Avoid industrialized meat that are given antibiotics, corn, soy and other garbage that is in their food. When we eat them, we eat what they ate.
• Inhibited neurotransmitter signaling - “gut microbiota regulate the production, transportation, and functioning of neurotransmitters… microbiome dysbiosis affects cognitive function, especially in neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease.”
• Medications that can damage your gut and cause leaky gut. They also damage your microbiome and mitochondria - ibuprofen and other NSAIDs, aspirin, proton-pump inhibitors (heartburn) - blocks ALL system in the body that rely on proton pumps to , poisons your mitochondria, statin drugs and more…
• Food additives, preservatives and colorings - ex: multiple protein bars contain sucralose, which studies show 1 packet destroys 50% of your microbiome. 
• Toxins - Inorganic - fire, air pollution, heavy metals - Organics - glyphosate, herbicides, pesticides, antibiotics, preservatives - “Glyphosate, is applied to wheat crops before harvest to encourage ripening resulting in higher glyphosate residues in commercial wheat products within North America. Glyphosate inhibits the shikimate pathway, a pathway exclusive to plants and bacteria.” By inhibiting this pathway, plants and bacteria are unable to synthesize folates and aromatic amino acids that are crucial for OUR HEALTH. Furthermore, glyphosate is a powerful chelator of minerals from the soil - stealing zinc, magnesium, etc. This is why we are all deficient in these trace minerals!! Studies now demonstrate that glyphosate also causes damage in the gut lining opening our tight-junctions!! Check out blog #50!  Biotoxins - Many toxins are also found in makeup, soaps, lotions and sunscreens! Be careful what you put on your skin - it ends up getting processed inside your body -
• Heavy metals (HMs) - mercury, lead, cadmium… - “The gut microbiota are the first line of defense against the toxic effects of HMs, and there is a bidirectional relationship between the two. Thus, HM exposure alters the composition and metabolic profile of the gut microbiota at the functional level, and in turn, the gut microbiota alter the uptake and metabolism of HMs by acting as a physical barrier to HM absorption and by altering the pH, oxidative balance, and concentrations of detoxification enzymes or proteins involved in HM metabolism. Moreover, the gut microbiota can affect the integrity of the intestinal barrier, which may also in turn affect the absorption of HMs.”
• Infections/latent infections - many viruses or other microorganisms can cause digestive problems during or even post-infection. Think about Lyme disease due to tick infections, or mosquito-vectored infections. Researchers are finding this is true in some patients post-acute Covid-19 syndrome (PACS). They experienced “gastrointestinal-related symptomatology in loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility and irritable bowel syndrome.”
• Dehydration -

• “lack of water, calcium, and magnesium can cause ulcers, gastritis and acid reflux because the stomach doesn’t have enough water to produce digestive acid.” 
• Constipation - the colon soaks up water to create a solid stool. If there is a lack of water, the stool will be hard, or in pebbles.
• Bloating/nausea - Often due to overeating because thirst usually occurs when people are 1-2 percent dehydrated. It often masquerades as hunger and the body doesn’t know the difference - another great reason to drink an 8oz glass of water with ACV prior to a meal!!
• Bad breath - “dehydration leads to decreased saliva production, leading to a medical condition called halitosis (bad breath). The decrease in saliva production may also cause the sensation of “food getting stuck in your throat” (dysphagia)” 
• SIBO - small intestinal bowel overgrowth - your gut microbes primarily populate the large intestine. When too many or the wrong kind of bacteria migrate up into the small intestine they begin to feed on food not meant for them. They overwhelm the good guys and interfere with digestion and absorption of nutrients. “For SIBO to occur, one or more of these functions must be failing. Gastric acid, bile, enzymes and immunoglobulins are some of the chemicals that control bacteria in the small intestine. Different conditions can inhibit these chemical functions. The emptying of food contents from the small intestine into the large intestine is another important cleansing mechanism. If this mechanism is slowed or impaired, the bacteria in the small intestine have more time to breed, and the bacteria in the large intestine may begin to creep upward.”
• Eating late/Overeating - Your body needs at least 3 hours before you go to bed to digest your food and allow you to go into a rest/sleep mode. When you eat late or eat too much, your body hasn’t been able to get rid of the food in your stomach. You lie down and pretty soon you experience “heartburn” or “indigestion.” This can be miserable for a lot of people. Here’s a simple trick when this happens. HELP your stomach by increasing the acidity to digest your food faster. Squeeze the juice of a whole lemon - or 2T ACV. Take it like a shot. Follow with a small amount of water to rinse the esophagus. You will have relief in <5min.

So, here’s the thing. You have NO IDEA how good you can feel when you successfully and completely eliminate your waste products on a daily basis. As a side effect you get mental clarity, energy, a feeling of wellbeing…Now that we know what to avoid, what should we be doing to enhance normal and complete elimination? 

• Feed your microbiome - polyphenols and fiber! Your microbiome converts the polyphenols and the fiber into bioactive molecules that uncouple your mitochondria. There are multiple benefits of “polyphenols in modulating mitochondrial processes that favor the regulation of energy expenditure and offer benefits in the management of obesity, especially thermogenesis and mitochondrial biogenesis.” HP-EVOO, rainbow of veggies and fruits - organic!!! Most of your bowel movement should primarily consist of bacteria and their offspring from division from feeding on what you feed them - It should actually be substantial and move with ease. If it doesn’t, change their diet by giving them what they need to be healthy - therefore, making you healthy.
• Hydrate - drink plenty of filtered water - if you don’t get a filter, you BECOME the filter - Don’t forget to replace electrolytes - make sure if you buy them prepared, many have sugar, hidden sugars or artificial sugars to make them palatable. I personally use fresh lemon in water and take a few granules of Hawaiian Alaea red clay sea salt (high in trace minerals and iron-oxide). This aides in stomach pH and absorption of nutrients. If you are an athlete, you can take it a step further and check out the one Tom Brady uses.
• Sleep - get on a good wake/sleep cycle - this allows your organs time to do their jobs and clean up - stop eating at least 3 hours before bed. 
• Stop snacking - about 90 min after a meal, you may notice a rumble in your stomach. This DOESN’T mean that you are still hungry - 😂 - even though that chocolate is calling your name! This is the MMC (migrating motor complex) - like the street sweeper -  “MCC starts mostly in the gastroduodenal region and then migrates towards the proximal ileum. Feeding interrupts MMC and instead induces a “fed pattern” of phasic contraction which causes an increase in mucosal contact time and delays transit.” This can be very bad late at night and interrupt your sleep and many other clean-up cycles that happen when you sleep. “MMC is a cyclic, recurring motility pattern of the smooth muscle layers that occurs during fasting in the stomach, small intestine or colon. The duration of the whole cycle is about 130 min. MMC has been suggested to be involved in the propulsion of gastric content and control of bacterial growth in the intestinal lumen.”
• Exercise - particularly aerobic exercise stimulates blood flow while contracting muscles stimulate moving things along. This enhanced blood flow helps the smooth muscles of the intestinal tract to do their job. 
• Reduce chronic stress - meditate, deep breathing…Stress makes your digestion halt - if you’re trying to run from a tiger, you can’t stop to poop!!
• Hot/cold - take a hot bath with epsom salt (magnesium sulfate). Magnesium and sulfate are both readily absorbed transdermally (through the skin). This helps you get set for sleep! You can also stimulate systemic blood flow by following with a cold shower x 1 min. This helps to upgrade your mitochondria too. 
• ACV - apple cider vinegar (acetic acid) is an amazing mitochondrial uncoupler, improves insulin sensitivity, aides in normalizing pH in the stomach - great taken with 8 oz water (1-2 T) 15-30 min prior to meals has been shown to be as effective as metformin in controlling blood sugar. 
• Magnesium - most of us are deficient, due to soil depletion. Increase consumption of foods high in magnesium - dark leafy greens - This can be a game changer both for sleep and for digestion. If you feel you may need supplementation, magnesium citrate is well absorbed and used to aid in digestion while magnesium glycinate is more beneficial for sleep. There are multiple forms of magnesium. Avoid taking inorganic forms due to poor bioavailability. Make sure you get one that suits your body and what’s going on with you best. 
• Fasting - give your body a period of rest. You can do time-restricted eating and increase the rest period. A few days a week, try skipping either breakfast or dinner and eat within a 6 hour window. This gives your body 18 hours of rest/repair mode. You can also do a 24 hour fast once a week or once a month depending on how much healing needs to happen. 
• HP-EVOO - High polyphenol extra virgin olive oil - THE HERO!!
• helps with digestive lubrication making it easier to go.
• Polyphenols are anti-inflammatory, antioxidants, anti-cancer, neuroprotective and incredible mitochondrial uncouplers. Polyphenols in the EVOO supply the necessary food that the mitochondria need to make energy, and that the microbiome need to stay healthy. Check out blog #64!
• EVOO is a rich source of melatonin - one of only 2 antioxidants active in mitochondria (other one is glutathione)
• EVOO is a rich source of vitamin E and vitamin K
• EVOO helps reverse fatty liver disease! When you take a shot of EVOO in the morning on an empty stomach, it goes to work right away in the liver. It tells the brain you don’t need any glucose produced for the blood and to switch to a fat-burning mode. It stimulates your bile ducts to open and release the sludge that has been stuck and clogging things up - you feel profoundly better -
• OA (oleic acid) helps to heal your gut lining and reverse leaky gut!
• The microbes in turn make postbiotic molecules that are sent as messages that tell the mitochondria what to do. Some of these messages are in the form of a gas, such as NO (nitric oxide) that relaxes our blood vessels.
• “The ability of EVOO to act as both a prebiotic, stimulating the growth of beneficial bacteria, and an antibacterial, suppressing the growth of pathogenic bacteria, is likely attributable to the array of phenolic compounds EVOO contains. Approximately 90%–95% of ingested phenolic compounds escape digestion in the small intestine and reach the colon, where they are catabolized into bioactive secondary structures—metabolites of their respective parent phenolic compounds that have been transformed by resident microbiota and can modify the composition of the gut microbiota.”