It always surprises me how many times medical issues come up around the dinner table. Maybe it’s because I am a physician and I have been brought up around physicians. It is like we have a tattoo on our forehead that says “Hey you, I’m a doctor and sure, I would love to hear about your bowel movements!” Apparently, this is a rite of passage as we age. I cannot tell you how many patients I have obtained as a result of the dinner conversation and a question “Who’s you doctor?” Followed by, “You need to see my doctor.” Another question that individuals pass around at the dinner table is “How are your bowel movements?” I wish I could say I was joking but I am not.
Which brings me to a subject that needs to be discussed. Bowel movements and constipation. It appears to be a common occurrence as we get older, but the younger generation is also catching on as well. More than 60% of the United States population reports digestive issues including 16% who experience constipation. I believe there is increased constipation due to lack of activity, not enough fluid intake, and anxiety which can cause constipation predominant irritable bowel. More importantly is the lack of fiber in our diet.
I had a patient who will go by “Mitch”, who came to me one day with a yellow legal pad filled with notes that he had written down which he labeled “keys to a healthy life”. He asked me if I wanted the list because his kids wanted no part of it and I said, of course. He told me, he reads a lot of men’s magazines and writes down the healthy pointers that lead to a healthy life. Over the years he accumulated this list that he feels will help one stay healthy. Besides the obvious: exercise, increased fluids, whole foods, good sleep etc.. the #1 factor on his list was “psyllium fiber”. I asked him why psyllium was #1. He had asked me if I had bowel issues and I replied, “No, I am pretty good there”. He asked me again, “Have you ever had a bowel movement on psyllium?” I replied, no and he said “Call me when you do.” It was then that I knew what he was referring to and have never looked back. (Except in the toilet) 🙂 We will talk about this later.
So why is fiber so good and where can you find it? Fiber is found mainly in plant foods such as fruits, vegetables, whole grains and members of the bean family called legumes. It not only is known for its ability to prevent or relieve constipation, but it has other effects as well. It can help you maintain a healthy weight and lower the risk of diabetes, heart disease and certain types of cancer, especially colorectal cancer, as well as cancers of the esophagus, stomach and pancreas. The decreased cancer risk is the result of a byproduct called butyrate that is produced by the gut bacteria when it ferments dietary fiber. It also promotes the growth of normal cells in the colon, helping promote a healthy gut barrier.
Fiber includes parts of plant foods that the body cannot digest or absorb. The body breaks down typical nutrients such as fats, proteins and other carbohydrates including starches and sugars and absorbs them. Fiber, on the other hand, passes somewhat intact through the stomach, small intestine and colon. There are two main types of fiber. Soluble fiber, which dissolves in water. If forms a gel-like material in the stomach which slows down digestion. It can help lower cholesterol and blood sugars but if you are a diabetic, fiber alone is not enough to control it and if you have high cholesterol that needs treatment it will not replace the effects of a medication. It will just help lower it. Soluble fiber is found in oats, peas, beans, apples, bananas, avocados, citrus fruits, carrots, barley and psyllium. Insoluble fiber is a type of fiber that does not dissolve in water. It supports a movement of material through the digestive system and adds bulk to the stool. It can be helpful for people with constipation and do not regularly pass stool. On that note, everyone is different when it comes to bowel movements. You may notice when I ask you how your bowel movements are and you reply “normal”, I will ask “what is normal for you?”. You will be surprised at the answers I get. A majority of people are daily or multiple times in a day. I have some people to go every 3 to 4 days. I had one individual say she went every 2 weeks and did not think that was abnormal. So please do not feel you have to go every day. The key is if you are straining to go then you need to do something about it as no one should strain.
The daily fiber requirements for adults depend on age. The recommendation is 21 g for women older than 50. 25 g for women age 50 or younger. 30 g for men older than 50 and 38 g for men 50 or younger. A high-fiber diet will promote less likelihood of constipation. It increases the weight and size of stool and softens it as long as there is plenty of water that goes with it. In general, bulky stool is easier to pass and lowers the chance of constipation. It does this by absorbing water and adding bulk to the stool. This will also decrease the risk of hemorrhoids and diverticulosis, when inflamed can result into an infection called diverticulitis. It has also been linked to low risk of colon cancer as well and it serves as a food for your gut microbiome. I think targeting 30 grams a day would be great for everyone.
If you want to go the natural route there are nutritious foods that can help you get more daily fiber which include whole grains such as barley, bulger, brown rice and whole-wheat bread or pasta. Fruits, vegetables, beans, peas and other legumes as well as nuts and seeds. Refined or processed foods are usually lower in fiber. The grain refining process removes the outer coat called bran from the grain which in turn, lowers the amount of fiber and other nutrients in the grain.
More often than not people will use supplements to reach their fiber recommendations. Many people turn to fiber supplements to ease constipation and meet daily fiber requirements as only about 5% of adults in the United States consume enough fiber from foods alone. Fiber supplements are available in various forms including powders, Gummies, capsules, wafers and snack bars. Fiber supplements are either natural such as psyllium (Konsyl or Metamucil). Metamucil has sugar substitutes so the more natural psyllium would be in the form of Konsyl or psyllium husk. One side effect of the natural form can be excessive gas formation and bloating and if this is the case I then would recommend Citrucel (methylcellulose) which is more of a synthetic fiber or calcium polycarbophil (FiberCon). The key to any fiber supplementation is making sure you have plenty of water with it. If you are even a little dehydrated it can backfire and cause constipation. If you want to have fun with an experiment, take some psyllium or Metamucil, mix it in a cup with just enough water to wet it then mix and let it sit for 5 minutes. If you remember making adobe as a project in elementary school, you will understand what I mean by this. It is hard (no pun intended) to pass a brick through the colon. For me personally, I think the powdered versions work better. It may take a while to get used to the taste but it reminds me of my childhood when I used to make the orange drink “Tang” because that’s what the astronauts drank in space. I like Metamucil or Costco’s version (because I like a bargain) but find the one that you like or hate the least and stick to it. You will thank me and Mitch when you do.
Lastly, do not be afraid to look at the bowl when you are done. I am not trying to gross you out, but you will be amazed. You will say “there is no way all that came out that fast”. You will also save money on toilet paper. Trust me, you will know what I am talking about. Also, it’s good to note the color. Black stool can be a sign of bleeding from the stomach (typically black and tarry) what we physicians describe as melena. Also, bright red blood could be from a hemorrhoid, anal fissure (which typically presents with pain upon defecation) or a bleeding diverticulum. Maroon stool, yes marron, could be blood from the right side of the colon. There is a lot to be learned from our bodies trash. There is nothing to be embarrassed about. It is natural and if someone tells you they don’t have bowel movements they are literally full of it. 🙂 Stay healthy my friends.
Doug
