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Bowel Movements
18 Nov 2020
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Today, I watched videos by Dr Greger on bowel movements. Not a pleasant subject to study but an important one. What did I learn? What kind of bowel movements (shape, size, softness, frequency) are associated with good health and absence of chronic lifestyle diseases?

Dr Greger: Bowel MovementsStool SizeBowel Movements: the Scoop on Poop (2011).

Dr McDougall: In Search of the Perfect Bowel Movement - Part 1, The McDougall Newsletter, Vol 1, Issue 9, Sep 2002.

Dr Linda Carney: The Scoop on Poop (2015) — great article!

In every video below, Dr Greger highlights the relationship between plant-based diets, frequent bowel movements, 'soft and bulky' stools and prevention of chronic lifestyle diseases.

(2020) How Many Bowel Movements Should You Have Every Day?

(5 mins) Transcript.

Dr Greger first asks, 'what is normal bowel movement'? Is it more like 2-3 times a week or 2-3 times a day? And how do we know what 'normal' is? Most of this video focuses on constipation - many people have to strain and apply pressure to trigger stool movement. Does all this straining and pressure application lead to diseases? Yeah, it's believed to be a contributory factor to diseases like diverticulosis, hiatal hernia and so on.

Does Squatty Potty help? It's a device that has recently emerged in the market to change the angle at which we defecate -- instead of sitting on modern toilet bowls, we go into more of a squatting position with this device, just like our ancestors did. Dr Greger says that we can achieve a similar effect by simply bending forward (so that our thighs apply pressure against our abdomen).

… but wait a minute! Why apply all this pressure? And why discover creative ways to apply even more pressure, when we know that pressure may lead to diseases like hiatal hernia and diverticulosis? What's the root cause of the problem? Why are stools difficult to pass for some people?

The root cause is believed to be lack of fiber in the diet.Now fiber is found exclusively in plants (but if we start processing plants to generate processed food, we often create fiber-deficient foods). Thus we have yet another argument to consume plant-based foods (only plants have fiber) in their whole form (processed plant foods are often fiber deficient).

Memorable quotes from this video:

"Defecation should not be a painful exercise. This is readily demonstrable. For example, the majority of rural Africans eating their traditional fiber-rich, plant-based diets can usually pass, without straining, a stool specimen on demand."

Cardiologist Dr Joel Kahn once said you know you're eating a plant based diet "when you take longer to pee than to poop."

(2011) Stool Size Matters

(2 mins) Transcript. An old video by Dr Greger that highlights theassociation between large volumes of bowel movements and lower risk of appendicitis, colon cancer, constipation, and diverticulitis.

An interesting insight in this video: "People don't realize you can have daily bowel movements, and still be effectively constipated. You can be regular, but five days late. What you're re flushing today you may have eaten last week. If you want to test it for yourself, all you need to do is eat a big bowl of beets and see when things turns pretty in pink. And ideally, it should be down in the 24- to 36-hour range to reach that half-pound target."

… so what foods take a long time from mouth to anus? And which foods take little time? Dr Greger explains it in the next video called 'Mass Food Transit' (see next video).

(2011) Food Mass Transit

(1 min) Transcript. A short, insightful video. He defines 'transit time' as time taken between food intake and bowel movements (associated with that food). First, Dr Greger explains that vegetarians have shorter duration between food consumption and bowel movements (about 1-3 days); meat consumption may extend this to 4-5 days! The average duration is also a function of gender (women have longer transit times). Finally, he explains the inverse relationsip between transit time and stool mass in a graph: if the transit time is shorter, average stool weight is more! In his previous video titled 'Stool Size Matters', Dr Greger points out that smaller volumes of stool size are associated with myriad chronic diseases.

(2007) Bowel Movement Frequency

(1 min) Transcript. An old, short video by Dr Greger. Excerpt:

The biggest study on bowel movement frequency in history was recently published, comparing the bowel habits of 15,000 meat eaters to 5,000 vegetarians and 1,000 vegans. The researchers conclude that being vegetarian, especially vegan, is strongly associated with a higher frequency of bowel movements. Vegans, for example, were about 3 times more likely to have daily BMs. Like I always said, vegans are just regular people.

(2010) Bristol Stool Scale

(3 mins) Transcript. An interesting video that summarizes a classification of stools depending upon their shape and size. Next, Dr Greger studies what kind of stools are passed by omnivores, vegetarians and vegans. But Dr Greger doesn't explain whether any type of stool shape and size is associated with disease.

(2012) Bulking Up on Antioxidants

(2 mins) Transcript. Summary: "ven when fiber and fruit and vegetable intake are kept constant, choosing foods richer in antioxidants may increase stool size, which is associated with lower cancer risk."

(2013) Prunes vs Metamucil vs Vegan Diet

(4 mins) Transcript. Summary: "The average number of bowel movements a week is compared between those eating prunes, those taking a fiber supplement (psyllium), and those eating a strictly plant-based diet." What did the study show? Baseline: 1.7 bowel movements per week on average; with prunes, the number incresead to 3.5 per week, with metamucil (psyllium husk based), the number increased to 2.8 per week. Dr Greger then wonders,

If this is what adding one plant can do — 3.5 bowel movements a week — what if all you ate was plants? Where do vegans rate?

Vegans have 10.9 bowel movements a week!
(2011) Bowels of the Earth

(2 mins) Transcript. This video studies a curious statistic: Which country has the largest (and smallest) average stool size?

And the winner of the Bowels of the Earth contest was Tonga at 531! The only other country to make the 200 target was India, who gets the silver at 311, with individual measurements ranging up to 1,505 grams — that's more than three pounds a day! That's impressive. And the bronze goes to Japan at 195 — almost made the cutoff. Everyone else fell short, though, with the smallest stools in the world colored red, white, and blue. U.S. vegetarians fared better, though, as did vegetarian and especially vegan Brits.

There actually was one population that did even worse than the standard American diet. The smallest average population bowel movement size ever recorded: New Yorkers. That's less than 3 ounces a day.

… and what are large bowel movements associated with? Dr Greger reminds us:

… what are they eating in Tonga? Well, this was recorded decades ago, when they were still eating their traditional plant-based diet of taro, greens, sweet potatoes, fruit, more greens, bananas, cabbage, etcetera.

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