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There's a reason you say that you feel things in your gut: It's where 7,000 strains of bacteria live, working to break down and digest the food you eat. It houses an elegant network of nerves second in size only to your brain's. About 90 percent of the feel-good hormone serotonin is made in your gastrointestinal tract. And the microbes in there help your immune system fend off illness. No wonder when you get nervous or stressed you have to run to the bathroom, right?
You probably don't think much about digestion, and even less about number two, until something goes wrong. When pooping becomes a problem, though -- whether it's from diet, stress or a bug -- it's all you can think about. Fortunately, we've got the inside info you need to keep your system humming along nicely.Digestion 101
Your body has an ingenious system to extract nutrients from the foods you eat, then get rid of the waste. Enzymes in your saliva get things started, helping to break down food before it heads into the stomach. Once it's there, muscular action plus acid work together to digest food more. This might take a few hours. Then a valve opens and closes to send the stuff bit by bit into the small intestine -- which if you uncoil it is about 20 feet long! Digestive enzymes from the liver and pancreas capture the nutrients you need, which are absorbed into your body through the lining of the intestine. That part can take two to six hours. What's left heads into the colon (about five feet long, and also known as the large intestine), where poop is created. Feces are stored in the final foot of the colon and when enough is there, you feel the need to go.
The entire process ranges from about 12 to 48 hours for most people. What's the ideal time from food to feces? Less than 24 hours, says Robynne Chutkan, M.D., medical director of the Digestive Center for Women in Washington, D.C., and a member of the LHJ Medical Advisory Board. "Faster is healthier because in general, nutrient-rich high-fiber foods move through the gastrointestinal tract more easily." Want to check your transit time? Eat some fresh corn and notice when the kernels come out. "Ideally, it's the next morning," says Dr. Chutkan. To pick up the pace, think fiber: In one study, a high-fiber diet lowered transit time through the gut from 48 hours to 12.How Often Should You Go?
When it comes to intestinal output, it's probably no surprise that you are what you eat. In the United States, where our diet contains more meat, more processed foods and less fiber than in other countries, we tend to go once a day, or even less. But in parts of the world with high-vegetable, high-fiber diets, people may go two or three times a day, says Dr. Chutkan. It shouldn't take too long to get the job done, either. Reading on the john isn't a good idea, as it can train your colon to take its time. Eventually you won't be able to poop quickly, the way you should. So try to minimize toilet time.Check Before You Flush
When it comes to poo, any shade of brown is normal, but...
Green can signal an infection like gastroenteritis (especially if stool is loose), undigested bile from food moving too fast when you have diarrhea, food coloring or some vitamin supplements.
White or beige can come from a bile duct obstruction, a pancreatic disorder or antidiarrhea drugs.
Black can be caused by upper-GI bleeding, iron supplements, black licorice or Pepto-Bismol.
Red can come from lower-GI bleeding, beets or red food coloring.
A bit of blood when you wipe usually signals hemorrhoids but can be a sign of bacterial dysentery, colitis, diverticulitis or colorectal cancer.Preventing Colorectal Cancer
Eating a high-fiber diet with lots of fruits, vegetables and whole grains has been linked to a lower risk of colorectal cancer, says Linda Lee, M.D., director of the Johns Hopkins Integrative Medicine & Digestive Center. These foods speed up the transit time through your digestive system, which may play a role, although more research is needed.
Exercise can help by lowering your body's need for insulin, which promotes the growth of colorectal cancer cells, says Charles S. Fuchs, M.D., director of the gastrointestinal cancer center at the Dana-Farber Cancer Institute. He recommends that you also limit red meat to twice a week, talk to your doctor about taking a daily aspirin of 325 mg and make sure you're getting enough vitamin D.
"For women, getting a colonoscopy at 50 or sometimes even sooner is crucial, especially since I've been seeing women as young as in their 30s being diagnosed -- and with no family history," says Dr. Chutkan. Don't ignore symptoms such as blood in the stool, unusual abdominal pain, a change in how often you go to the bathroom, anemia or unexplained weight loss.When The Going Gets Tough
Pay attention if your time spent on the toilet changes dramatically.
Constipation happens when stool travels too slowly through your gut, so it becomes harder, drier and more difficult to expel. Hard-pellet poop that goes plop, plop, plop into the toilet may be diet-related, often from too much meat and processed foods and not enough fiber. Getting more fiber, such as whole grains and psyllium (aim for 25 to 30 grams a day), will bulk it up so it comes out quickly and easily in a nice big C-shaped bundle. Lots of water and regular exercise keep it moving, too. Having weak pelvic floor muscles may also lead to constipation. Doing Kegel exercises or biofeedback can retrain your muscles.
Diarrhea occurs when food takes the fast lane through your GI tract. It can become chronic for many reasons, says Joel Mason, M.D., professor of medicine and nutrition at Tufts University. A condition like irritable bowel syndrome, Crohn's disease, ulcerative colitis or celiac disease could be the culprit. Or it could be lactose or other food intolerance, a parasite like giardia, an antibiotic you've been taking, food poisoning, contaminated water you drank while traveling or even artificial sweeteners like sorbitol. Avoiding dairy products or wheat eases diarrhea for some people who have an intolerance. If you have a GI bug, try a few days on the BRAT diet (bananas, rice, applesauce, toast) and be sure to stay hydrated by drinking plenty of water. Over-the-counter antidiarrheal meds can be helpful, but you should avoid them if you have a fever or are passing blood. See your doctor to find the underlying cause rather than just treating symptoms, says Dr. Mason.
Irritable bowel syndrome can cause cramps, bloating, abdominal pain and constipation or diarrhea -- or both. IBS is common, but the cause is not well understood. And there's no one-size-fits-all remedy, says Dr. Mason. If you're diagnosed, make sure that an underlying condition like celiac disease, lactose intolerance, parasites or a thyroid problem have been excluded, advises Dr. Chutkan.
Fecal incontinence, an inability to control bowel movements, affects more than 5.5 million Americans. Women are susceptible if they've had damage to the pelvic floor during childbirth -- and an episode can be traumatic, says Jennifer Christie, M.D., director of gastrointestinal motility at Emory School of Medicine. Treatment ranges from biofeedback, where you retrain your muscles, to surgery to repair damage or weakness. A new treatment, sacral nerve stimulation, attaches electrodes to the muscle, kind of like a pacemaker for your sphincter.Foods that Keep Your Gut Happy
Our experts share their favorite colon-friendly foods.
Vegetables - Go for high-fiber leafy greens like kale and spinach as well as broccoli, Brussels sprouts and cabbage. Most beans are high in fiber, especially split peas, lentils, black beans and lima beans. Sweet potatoes are also packed with fiber.
Fruits - The more fibrous fruits like apples, pears and berries (be sure to eat the skins) are a better choice than tropical fruits like bananas, mangoes and pineapple, which have more sugar and less fiber.
Whole Grains - Whole-grain bread and high-fiber cereal are good sources of fiber. If you're sensitive to gluten in whole wheat, try quinoa and brown rice, which are both easy to prepare and high in fiber.
Nuts and Seeds - Snack on raw, unsalted almonds and seeds. A quarter cup of sunflower seeds has almost 5 grams of protein. Ground flaxseed is a good source of fiber and omega-3 fatty acids. Add them to yogurt, mix into smoothies or sprinkle on salads.
Psyllium - Psyllium husks (as in Metamucil) are great even if you already eat a lot of fiber, says Dr. Chutkan. They bulk up the stool and relieve constipation and diarrhea. Start with 1 teaspoon in water twice a day and gradually increase to 1 tablespoon twice a day.
Water - It's very important to help keep all that fiber moving through your system, says Dr. Lee. You need to drink at least 8 cups of water a day to maintain good digestive function.Do You Need Probiotics?
A healthy colon hosts a balanced population of bacteria. If your intestinal flora get out of whack, possibly because a course of antibiotics has killed off the good guys as well as the bad, you can end up with diarrhea. "In the vast majority of cases, the original organisms recolonize within a week or two," says Dr. Lee. Probiotic supplements can hurry along the fix. For the average person, though, Dr. Lee says, "Taking probiotics isn't going to hurt you, but there's no guarantee that they make you healthier in the long run." Yogurt has some probiotics, too. Dr. Chutkan recommends unsweetened, full-fat Greek yogurt, which is strained to remove a lot of the lactose and sugar and may be better tolerated by people who are lactose intolerant.It's A Gas
Gas may seem like the body's punch line, but it's actually a normal part of bacterial fermentation in the gut. We pass gas 14 times a day on average (yes, women do it, too) and fortunately, most of it is silent and odorless. What if it's painful or makes you feel bloated? Try keeping a food diary to identify problematic foods. If you've been on antibiotics, you can use probiotics to reestablish helpful bacteria. Gas aids like Beano may help with the digestion of complex carbohydrates found in beans and cruciferous vegetables by converting them to easily digestible sugars, says Dr. Chutkan.
Originally published in Ladies' Home Journal, October 2012.