Try This: How To Poop Better

Hi ,

Try This: How To Poop Better 💩This week, I want to kick things off with an all-too-familiar story. The other day I was talking to a friend of mine about one of my favorite topics, the gut microbiome, which led to us talking about how often we “go to the bathroom.”My friend said to me, “About one or two times,” to which I replied, “Same here, one or two times a day is my normal.” She looked at me completely shocked and said, “That’s how often I go every week!” If that’s you, you’re definitely not alone. This week I’m going to walk you through my step-by-step protocol of strategies you can try to get some relief, and if you’re already going regularly, I have some helpful suggestions to keep it that way.Passing bowel movements (BMs) every day is one of the cheapest, easiest, and most natural forms of detoxification—it’s your body’s way of taking out the trash. Constipation is one of the most common gastrointestinal problems in the US affecting about 42 million Americans with a higher prevalence in women and those who are 65 and older (1). What’s more, three out of five people who are constipated don’t even bring it up to their doctor because it’s become so normalized (2).Before we get into my protocol this week, let’s first define what “regular” is to determine whether or not you are constipated.How do I know if I’m constipated?How often you “go” varies from person to person, but if you’re not having a BM at least once a day, or if you depend on your morning cup of coffee to get things going, these are signs you might be dealing with constipation. Other signs include having less than three BMs per week and feelings of incomplete evacuation, blockage, straining, or lumpy/hard stools at least 25% of the time you go (3).How do you know if your stool is abnormal if you don’t exactly know what normal looks like? There’s actually an official guide called the Bristol Stool Chart (below) you can use to determine if your stool is considered “normal” or not.On the Bristol Stool Chart, Type 4 is optimal (smooth and soft), but anywhere between types 3-5 is considered normal. Types 1 and 2 are hard and suggestive of constipation and types 6 and 7 are associated with diarrhea (4). More often than not, if your stool looks like the lower end of the Bristol Stool Chart, you probably have some constipation going on.

Derived from (Koppen et al, 2016)Root causes of constipationEating a standard American diet high in refined carbohydrates and sugar and low in fiber can lead to constipation because fiber softens stool to make it easier to pass. We know for sure that the Standard American Diet is bad for digestion,  but nowadays we are also dealing with the Processed Wellness Diet that includes packaged organic, gluten-free, vegan, and "clean" foods. The problem is, at the end of the day, processed food is still processed food whether it’s from Whole Foods or Walmart.Dehydration is another common factor that leads to constipation that so many people face. Not drinking enough water makes stool harder and more difficult to pass. That’s why I always recommended starting your day off with water first thing in the morning.On top of dehydration, a sedentary lifestyle keeps stool stagnant. Even just a little bit of movement can help speed things along. Any one of these factors alone can result in constipation, but oftentimes (especially in Western cultures) all three of them occur together, which explains why constipation is so common in our world today.Other drivers of constipation include: bacterial or viral infection, food poisoning, certain medications, changing your routine, stress, and anxiety. Some of these are a lot more complicated and could require you digging into the root cause with a practitioner.Is your diet ghosting you of your poo?In addition to eating a Standard American Diet high in refined carbs and sugar, low-carb ketogenic diets and carnivore diets are continuing to grow in popularity. These diets have helped a lot of people reach their health goals and even reverse chronic diseases like cancer, diabetes, and autoimmunity when done correctly. However, they tend to put dietary fiber in the back seat.Anecdotally, people who are experiencing troublesome, debilitating symptoms that just don’t seem to go away after multiple interventions often turn to the carnivore diet.My business partner Dr. Hyman shares that these diets can work to provide some relief for extremely troublesome cases of gastrointestinal issues, but they aren’t actually getting to the root of why they’re there in the first place. Ultimately, we want to get to a place where our gut can tolerate vegetables.If you follow a certain eating pattern or are struggling with constipation in general, it might be time to look under the hood—starting with optimizing your gut health and revamping your diet and lifestyle to get things moving.In any case, if you’re not passing a BM seamlessly every day, my protocol this week might help.The ProtocolI. Hydration. We are made up of 60% to 75% water—a lack of it can be a major contributor to constipation. We need water to carry out most of the metabolic processes in our bodies (5), and to keep our digestion flowing. Even mild dehydration can halt stool motility (6), stopping it dead in its tracks (or in this case, tract!). The amount of water you need depends on many factors: where you live (hot/dry climate, high altitude), the season, your activity level, how much you sweat, the foods you eat, your age, gender, and overall health.There’s no magic number that works for everybody, you know your body best. I like to stack my water intake by getting plenty of water in the morning to set myself up for hydration the rest of the day (see recommendation #1 below). Drinking half your body weight in ounces of water every day is a great rule of thumb to go by. So a 180-lb person would need to drink 90 ounces, or about eleven 8-ounce cups per day (7). Paying attention to your body’s ways of telling you it’s dehydrated is the first step to preventing constipation. Generally speaking, if you are eating a whole foods diet with plenty of fiber (up next) and drinking plenty of water first thing in the morning, you’re going to be in pretty good shape. Your body will let you know when it needs more, so it’s important to pay attention to its cues. If you’re feeling thirsty, have dry, cracked lips, or dark yellow urine, or even start to lose the ability to concentrate, these are signs you might be dehydrated.Even if you drink water regularly throughout the day, you can’t properly hydrate (i.e. bring water into your cells) unless you have the right balance of electrolytes (salt, potassium, and magnesium). Try This:1. Water Stack. Before you reach for your coffee in the morning, have at least 1 liter of filtered water first—that’s about two 16-ounce cups. This is a great way to make sure you’re starting your day off hydrated. I like to add a little lemon to mine for some flavor and electrolytes about three times a week.Pro-tip: Ditch the plastic water bottle and drink from a reusable stainless steel bottle throughout the day to avoid exposure to BPA and phthalates. Adding lemon or lime juice (for potassium and magnesium) with a pinch of salt to filtered water will ensure you’re properly hydrating.2. BodyBio E-Lyte Concentrate of Pure Electrolytes. E-Lyte’s blend of purified water, potassium, sodium, and magnesium mimics the body’s natural electrolyte levels for optimal hydration, replenishment, and energy. This concentrated electrolyte blend is great on days when you’re more active and losing electrolytes through sweat. II. Increase your fiber intake. Most Americans get less than half of the recommended daily fiber intake—that’s 25 grams per day for women and 38 grams per day for men (8)(9). Unfortunately, less than 5% of Americans are meeting this fiber intake goal and 95% of Americans are meeting (or exceeding) the USDA’s recommended maximum of three servings of refined carbohydrates per day (10).That means the majority of people are missing out on the incredible benefits of fiber for our gut health and overall health. In addition to helping you “go”, fiber feeds our good gut bacteria and cultivates a healthy gut microbiome, lowering our risk for chronic diseases like IBS, cancer, heart disease, obesity, autoimmunity, and type 2 diabetes (11)(12)(13)(14)(15)(16)(17)(18)(19). It is important to get both soluble fiber (the kind that binds to and gets rid of toxins and excess cholesterol) and insoluble fiber (the kind that adds bulk to stool and regulates bowel movements) in your diet. The best way to do this is to eat a variety of complex carbs from fruits, vegetables, nuts, and seeds.In my opinion, my dear friend Dr. Terry Wahls has some of the best advice for upping your fiber intake. Her Wahls Protocol is designed for people with chronic autoimmune conditions, but it’s also great for supporting optimal health. Dr. Wahls recommends eating 9 cups of vegetables a day to meet your daily fiber goals. In addition to fiber, you’re also getting polyphenols and micronutrients that support detoxification. Here’s the breakdown (1 cup = 1 cup raw vegetables, or ½ cup cooked):

• 3 cups of leafy green vegetables (kale, collards, chard, spinach, or lettuce)

• 3 cups of sulfur-rich vegetables (cabbage, broccoli, cauliflower, onions, garlic, Brussels sprouts, mushrooms, asparagus)

• 3 cups of (different) colored fruits or vegetables (berries, citrus fruits, beets, carrots)

Note: The Wahls Protocol excludes nightshades (tomatoes, potatoes, eggplant, and peppers). I steer away from these because they give me digestion problems, but if you do well on them they can be a great source of fiber and nutrients.Try This:1. Start slow and work your way up. Increase your fiber intake gradually by starting out with what you can handle and slowly increasing your intake to avoid gas, bloating, and cramps (20)(21). Dr. Wahls suggests cooking your vegetables to make them easier to digest if you’re having gastrointestinal problems.Spread out your cups of vegetables throughout the day and get plenty of water to keep things moving (22). If you don’t drink water when increasing your fiber intake, you run the risk of backing yourself up even more.2. My Big Fat Fiber salad. One of my favorite ways to get my cups in is to make a big salad every day that has a ton of vegetables in it. My salad contains at least 2 cups of leafy greens, colorful fruits and vegetables, sulfur-rich vegetables (great for gut health and detoxification), and healthy fats. This makes it easy because counting the grams of fiber I eat in a day is complicated and unsustainable for me, so it's a good gauge and predictable meal to make sure I’m hitting my goals. Here’s what my Big Fat Fiber Salad consists of:

• 2 cups of leafy greens: arugula, collard greens, chopped romaine, or spring mix.

• 2 cups of sulfur-rich vegetables: my go-to is baby broccolini and bok choy (cooked and then added to the salad), I’ll often add some purple cabbage, too. 

• 2 cups of colorful fruits and vegetables: small amounts of sweet potatoes, cucumbers, sometimes I’ll even add a small amount of blueberries. Healthy fats: avocado (also a great source of fiber), olives, sea salt, lemon, extra virgin olive oil, and some seeds (pumpkin or sesame).

• In addition to olive oil, lemon, and salt, I’ll sometimes throw on some Primal Kitchen Dressing if I want to get fancier!

III.  Movement. Daily movement improves constipation by speeding up the time it takes for stool to pass through your GI tract (23)(24)(25). Aerobic exercise especially (i.e. walking, jogging, swimming, biking) ramps up your heart rate, gets your blood flowing, and stimulates peristalsis—the contraction and relaxation of muscle that propels stool down and out (24). Brisk walking for just a few hours a week can improve constipation, and even increase beneficial gut microbes associated with healthy bowel movements (26)(27). Some light walking after a meal can help with digestion, but if you’re doing intense exercising, wait for at least one hour after eating to keep blood in your abdomen to help with digestion, instead of sending it to your muscles.Try This:1. Jumping exercises. Jumping jacks, jumping rope, or even jumping on a mini-trampoline for a few minutes can be great for moving things along. 2. Yoga. Doing some gentle yoga stretches can tone the colon and get your bowels moving. Certain poses that involve twisting or squeezing your abdomen massage your digestive tract and move stool through your intestines. Give these 8 yoga poses a try to relieve constipation.IV. Apply pressure. There are home remedies you can try that involve applying pressure to, or massaging, certain areas of the body to relax muscles and facilitate bowel movements. These methods have been around for centuries which just goes to show they work—the proof is in the poop! Note: these techniques aren’t recommended for pregnant women.Try This:1. Acupressure. An ancient healing art that uses finger pressure on specific points of the body, acupressure increases bowel movements and improves stool formation by promoting peristalsis and stimulating the vagus nerve, the nerve that connects your brain to your gut, and helps support digestion (28)(29). Here are some acupressure points you can try to help relieve constipation.2. Abdominal massage. Abdominal massage has been shown to alleviate constipation, reduce stomach pain, and gastrointestinal discomfort (30)(31). One popular technique involves placing your palm on your abdomen and making small circular motions around your belly button.Splurge!I. Non-habit-forming natural laxatives. If you already gave my other recommendations a try and still aren’t having success, a gentle herbal laxative can help. In addition to upping your fiber intake, properly hydrating, and getting some physical movement in, these herbal laxatives are great for that extra little push.Try This:1. Oxy-Powder Oxygen Based Intestinal Cleanser. Global Healing’s Oxy-Powder is designed to support proper digestion and detoxify your system while you sleep. It uses ozonated magnesium oxide to relieve bloating, gas, and constipation.Magnesium citrate is another form that some people take for constipation relief. Don’t take too much because it can have the reverse effect and you could end up on the other end of the Bristol Stool Chart, with diarrhea. 2. Mucosave. Made from prickly pear and olive leaf extract, Mucosave has been clinically proven to alleviate gastrointestinal symptoms associated with acid reflux and poor digestion. The prickly pear helps heal and protect the mucosa of the gastrointestinal tract and its olive leaves provide soothing and antioxidant activity.3. Triphala. The healing properties of triphala, an ancient Ayurvedic herbal medicine, are pretty remarkable (32). Triphala is a natural laxative that significantly improves constipation, abdominal pain, flatulence, and the frequency and formation of bowel movements (33)(34).  Organic India Triphala is a gentle, nourishing blend of medicinal plants that work together to promote deep internal cleansing. II. Squatty potty. The squatty potty is more than just a trend, there’s actually research behind it as being a significant way to help you evacuate more easily (35). We’ve only been using toilets for a short period of time compared to the bigger picture of our evolution as humans (36). The squatty potty mimics how our ancestors went, and they went that way for a reason. Sitting at a 90-degree angle doesn’t support our colon's natural anatomy, it creates a kink in our rectum so it can’t fully relax.Try This:1. Raise your feet so the hips are flexed. This takes the pressure off and allows your poo to pass with less strain. You don’t need anything fancy, even just putting your feet up on a stack of books can help. 2. The Original Squatty Potty. For those of you who want the perfect conditions for a free-flowing poo, a Squatty Potty might be worth the investment.III. Still need an extra push? If you tried my protocol and are still having constipation trouble, supplementing with a high-quality organic fiber supplement like the ones listed below can help give your stool that extra push to complete its 5-foot journey through your large intestine to arrive at its final destination. Always consult with your doctor before taking fiber supplements because they can interfere with medications and cause gastrointestinal side effects in some people when not dosed appropriately. Try This:

• Acacia Fiber: Heather’s Tummy Fiber Organic Acacia Senegal contains prebiotic soluble fiber that supports the growth of beneficial gut bacteria and regulates bowel movement to alleviate constipation. Start with a low dose (½ teaspoon) twice daily mixed with room temperature liquid, and gradually work your way up.  

Everybody poops, but if you’re not going regularly (at least once per day) you’re missing out on your body’s innate detoxification system. Start with the basics and see if that helps get your bowels going: make sure you’re properly hydrated, get in more fiber-rich foods, move around a little to get your blood (and digestion) flowing. If you don’t see any improvement there, try my list of gentle herbal/mineral laxatives above. If you’re still not easily passing your poo, working with a Functional Medicine doctor can help you get to the root of what’s going on and why. Try my protocol and see what works for you. It might just be what you need to help you go, and regularly at that. I’d love to hear your feedback on what worked, didn’t work, and if you’re feeling lighter on your feet! Text me at 302-200-5643.References: For the full list of 36 references cited here, head on over to my blog.Here's to your health,Dhru Purohit