Optimal Bowel Movement Position

Optimal Bowel Movement Position.jpeg

Compared to rural African populations eating traditional plant-based diets, white South Africans and black and white Americans have more than 50 times more heart disease, 10 times more colon cancer, more than 50 times more gallstones and appendicitis, and more than 25 times the rates of "pressure diseases"--diverticulitis, hemorrhoids, varicose veins, and hiatal hernia.

As I discussed in my Should You Sit, Squat, or Lean During a Bowel Movement?, bowel movements should be effortless. When we have to strain at stool, the pressure may balloon out-pouchings from our colon, causing diverticulosis; inflate hemorrhoids around the anus; cause the valves in the veins of our legs to fail, causing varicose veins; and even force part of the stomach up through the diaphragm into our chest cavity, causing a hiatal hernia (as I covered previously). When this was first proposed by Dr. Denis Burkitt, he blamed these conditions on the straining caused by a lack of fiber in the diet. He did, however, acknowledge there were alternative explanations. For example, in rural Africa, they used a traditional squatting position when they defecated, which may have taken off some of the pressure.

For hundreds of thousands of years, everyone used the squatting position, which may help by straightening the "anorectal angle." There's actually a kink at almost a 90-degree angle right at the end of the rectum that helps keep us from pooping our pants when we're just out walking around. That angle only slightly straightens out in a common sitting posture on the toilet. Maximal straightening out of this angle occurs in a squatting posture, potentially permitting smoother defecation. (I remember sitting in geometry class wondering when I'd ever use the stuff I was learning. Little did I know I would one day be calculating anorectal angles with it! Stay in school, kids :)

How did they figure this out? Researchers filled latex tubes with a radiopaque fluid, stuck them up some volunteers, and took X-rays with the hips flexed at various angles. They concluded that flexing the knees towards the chest like one does when squatting may straighten that angle and reduce the amount of pressure needed to empty the rectum. This idea wasn't directly put to the test until 2002, when researchers used defecography (which are X-rays taken while the person is defecating) on subjects in sitting and squatting positions. Indeed, squatting increased the anorectal angle from around 90 degrees all the way up to about 140.

So should we all get one of those little stools for our stools, like the Squatty Potty that you put in front of your toilet to step on? No, they don't seem to work. Researchers tried adding a footstool to decrease sitting height, but it didn't seem to significantly affect the time it took to empty one's bowels or decrease the difficulty of defecating. They tried even higher footstools, but people complained of extreme discomfort using them. Nothing seemed to compare with actual squatting, which may give the maximum advantage. However, in developed nations, it may not be convenient. But, we can achieve a similar effect by leaning forward as we sit, with our hands on or near the floor. The researchers advise all sufferers from constipation to adopt this forward-leaning position when defecating, as the weight of our torso pressing against the thighs may put an extra squeeze on our colons.

Instead of finding ways to add more pressure, why not get to the root of the problem? "The fundamental cause of straining is the effort required to pass unnaturally firm stools." By manipulating the anorectal angle through squatting or leaning, we can more easily pass unnaturally firm stools. But why not just treat the cause and eat enough fiber-containing whole plant foods to create stools so large and soft that you could pass them effortlessly at any angle?

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

In all seriousness, even squatting does not significantly decrease the pressure gradient that may cause a hiatal hernia. It does not prevent the pressure transmission down into the legs that may cause varicose veins. And this is not just a cosmetic issue. Protracted straining can cause heart rhythm disturbances and reduction in blood flow to the heart and brain, resulting in defecation-related fainting and death. Just 15 seconds of straining can temporarily cut blood flow to the brain by 21% and blood flow to the heart by nearly one-half, thereby providing a mechanism for the well-known "bed pan death" syndrome. If you think you have to strain a lot while sitting, try having a bowel movement on your back. Bearing down for just a few seconds can send our blood pressure up to nearly 170 over 110, which may help account for the notorious frequency of sudden and unexpected deaths of patients while using bed pans in hospitals. Hopefully, if we eat healthy enough, we won't end up in the hospital to begin with.

Wondering How Many Bowel Movements Should You Have Every Day? Watch the video to find out!

The "forcing part of your stomach up through the diaphragm into our chest cavity" phenomenon is covered in my video Diet and Hiatal Hernia. The "ballooning of out-pouchings from our colon" is called diverticulosis. There's a video I did about 6 years ago (Diverticulosis & Nuts), but I have some new and improved ones available: Diverticulosis: When Our Most Common Gut Disorder Hardly Existed and Does Fiber Really Prevent Diverticulosis?

More on that extraordinary African data here:

So excited to be able to slip in a plug for Dr. Kahn's work. His brand of "interpreventional cardiology" can be found at www.drjoelkahn.com.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Optimal Bowel Movement Position

Optimal Bowel Movement Position.jpeg

Compared to rural African populations eating traditional plant-based diets, white South Africans and black and white Americans have more than 50 times more heart disease, 10 times more colon cancer, more than 50 times more gallstones and appendicitis, and more than 25 times the rates of "pressure diseases"--diverticulitis, hemorrhoids, varicose veins, and hiatal hernia.

As I discussed in my Should You Sit, Squat, or Lean During a Bowel Movement?, bowel movements should be effortless. When we have to strain at stool, the pressure may balloon out-pouchings from our colon, causing diverticulosis; inflate hemorrhoids around the anus; cause the valves in the veins of our legs to fail, causing varicose veins; and even force part of the stomach up through the diaphragm into our chest cavity, causing a hiatal hernia (as I covered previously). When this was first proposed by Dr. Denis Burkitt, he blamed these conditions on the straining caused by a lack of fiber in the diet. He did, however, acknowledge there were alternative explanations. For example, in rural Africa, they used a traditional squatting position when they defecated, which may have taken off some of the pressure.

For hundreds of thousands of years, everyone used the squatting position, which may help by straightening the "anorectal angle." There's actually a kink at almost a 90-degree angle right at the end of the rectum that helps keep us from pooping our pants when we're just out walking around. That angle only slightly straightens out in a common sitting posture on the toilet. Maximal straightening out of this angle occurs in a squatting posture, potentially permitting smoother defecation. (I remember sitting in geometry class wondering when I'd ever use the stuff I was learning. Little did I know I would one day be calculating anorectal angles with it! Stay in school, kids :)

How did they figure this out? Researchers filled latex tubes with a radiopaque fluid, stuck them up some volunteers, and took X-rays with the hips flexed at various angles. They concluded that flexing the knees towards the chest like one does when squatting may straighten that angle and reduce the amount of pressure needed to empty the rectum. This idea wasn't directly put to the test until 2002, when researchers used defecography (which are X-rays taken while the person is defecating) on subjects in sitting and squatting positions. Indeed, squatting increased the anorectal angle from around 90 degrees all the way up to about 140.

So should we all get one of those little stools for our stools, like the Squatty Potty that you put in front of your toilet to step on? No, they don't seem to work. Researchers tried adding a footstool to decrease sitting height, but it didn't seem to significantly affect the time it took to empty one's bowels or decrease the difficulty of defecating. They tried even higher footstools, but people complained of extreme discomfort using them. Nothing seemed to compare with actual squatting, which may give the maximum advantage. However, in developed nations, it may not be convenient. But, we can achieve a similar effect by leaning forward as we sit, with our hands on or near the floor. The researchers advise all sufferers from constipation to adopt this forward-leaning position when defecating, as the weight of our torso pressing against the thighs may put an extra squeeze on our colons.

Instead of finding ways to add more pressure, why not get to the root of the problem? "The fundamental cause of straining is the effort required to pass unnaturally firm stools." By manipulating the anorectal angle through squatting or leaning, we can more easily pass unnaturally firm stools. But why not just treat the cause and eat enough fiber-containing whole plant foods to create stools so large and soft that you could pass them effortlessly at any angle?

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

In all seriousness, even squatting does not significantly decrease the pressure gradient that may cause a hiatal hernia. It does not prevent the pressure transmission down into the legs that may cause varicose veins. And this is not just a cosmetic issue. Protracted straining can cause heart rhythm disturbances and reduction in blood flow to the heart and brain, resulting in defecation-related fainting and death. Just 15 seconds of straining can temporarily cut blood flow to the brain by 21% and blood flow to the heart by nearly one-half, thereby providing a mechanism for the well-known "bed pan death" syndrome. If you think you have to strain a lot while sitting, try having a bowel movement on your back. Bearing down for just a few seconds can send our blood pressure up to nearly 170 over 110, which may help account for the notorious frequency of sudden and unexpected deaths of patients while using bed pans in hospitals. Hopefully, if we eat healthy enough, we won't end up in the hospital to begin with.

Wondering How Many Bowel Movements Should You Have Every Day? Watch the video to find out!

The "forcing part of your stomach up through the diaphragm into our chest cavity" phenomenon is covered in my video Diet and Hiatal Hernia. The "ballooning of out-pouchings from our colon" is called diverticulosis. There's a video I did about 6 years ago (Diverticulosis & Nuts), but I have some new and improved ones available: Diverticulosis: When Our Most Common Gut Disorder Hardly Existed and Does Fiber Really Prevent Diverticulosis?

More on that extraordinary African data here:

So excited to be able to slip in a plug for Dr. Kahn's work. His brand of "interpreventional cardiology" can be found at www.drjoelkahn.com.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Optimal Bowel Movement Frequency

Optimal Bowel Movement Frequency.jpeg

Lasting for 3,000 years, ancient Egypt was one of the greatest ancient civilizations--with a vastly underestimated knowledge of medicine. They even had medical subspecialties. The pharaohs, for example, had access to dedicated physicians to be "guardian[s] of the royal bowel movement," a title alternately translated from the hieroglyphics to mean "Shepherd of the Anus." How's that for a resume builder?

Today, the primacy of the bowel movement's importance continues. Some have called for bowel habits to be considered a vital sign on how the body is functioning, along with heart rate, blood pressure, and breathing rate. Medical professionals may not particularly relish hearing all about their patients' bowel movements, but it is a vital function that nurses and doctors need to assess.

Surprisingly, the colon has remained relatively unexplored territory, one of the body's final frontiers. For example, current concepts of what "normal" stools are emanated primarily from the records of 12 consecutive bowel movements in 27 healthy subjects from the United Kingdom, who boldly went where no one had gone before. Those must have been some really detailed records.

It's important to define what's normal. When it comes to frequency, for example, we can't define concepts like constipation or diarrhea unless we know what's normal. Standard physiology textbooks may not be helpful in this regard. One text implies that anything from one bowel movement every few weeks or months to 24 in just one day can be regarded as normal. Once every few months is normal?

Out of all of our bodily functions, we may know the least about defecation. Can't we just ask people? It turns out people tend to exaggerate. There's a discrepancy between what people report and what researchers find when they record bowel habits directly. It wasn't until 2010 when we got the first serious look. In my video, How Many Bowel Movement's Should You Have Everyday? you'll see the study that found that normal stool frequency was between three per week and three per day, based on the fact that that's where 98% of people tended to fall. But normal doesn't necessarily mean optimal.

Having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes like heart attacks and strokes. Having a normal cholesterol level in a society where it's normal to drop dead of heart disease--our number-one killer--is not necessarily a good thing. Indeed, significant proportions of people with "normal bowel function" reported urgency, straining, and incomplete defecation, leading the researchers of the 2010 study to conclude that these kinds of things must be normal. Normal, maybe, if we're eating a fiber-deficient diet, but not normal for our species. 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. The rectum may need to accumulate 4 or 5 ounces of fecal matter before the defecation reflex is fully initiated, so if we don't even build up that much over the day, we'd have to strain to prime the rectal pump.

Hippocrates thought bowel movements should ideally be two or three times a day, which is what we see in populations on traditional plant-based diets. These traditional diets have the kind of fiber intakes we see in our fellow Great Apes and may be more representative of the type of diets we evolved eating for millions of years. It seems somewhat optimistic, though, to expect the average American to adopt a rural African diet. We can, however, eat more plant-based and bulk up enough to take the Hippocratic oath to go two or three times a day.

There's no need to obsess about it. In fact, there's actually a "bowel obsession syndrome" characterized in part by "ideational rambling over bowel habits." But three times a day makes sense. We have what's called a gastrocolic reflex, which consists of a prompt activation of muscular waves in our colon within 1 to 3 minutes of the ingestion of the first mouthfuls of food to make room for the meal. Even just talking about food can cause our brains to increase colon activity. This suggests the body figured that one meal should be about enough to fill us up down there. So maybe we should eat enough unprocessed plant foods to get up to three a day--a movement for every meal.

I know people are suckers for poop videos--I'm so excited to finally be getting these up! There actually is a recent one--Diet and Hiatal Hernia--that talks about the consequences of straining on stool. Hernias are better than Bed Pan Death Syndrome, though, which is what I talk about in in my video, Should You Sit, Squat, or Lean During a Bowel Movement?

Here are some older videos on bowel health:

For more on this concept of how having "normal" health parameters in a society where it's normal to drop dead of heart attacks and other such preventable fates, see my video When Low Risk Means High Risk.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Optimal Bowel Movement Frequency

Optimal Bowel Movement Frequency.jpeg

Lasting for 3,000 years, ancient Egypt was one of the greatest ancient civilizations--with a vastly underestimated knowledge of medicine. They even had medical subspecialties. The pharaohs, for example, had access to dedicated physicians to be "guardian[s] of the royal bowel movement," a title alternately translated from the hieroglyphics to mean "Shepherd of the Anus." How's that for a resume builder?

Today, the primacy of the bowel movement's importance continues. Some have called for bowel habits to be considered a vital sign on how the body is functioning, along with heart rate, blood pressure, and breathing rate. Medical professionals may not particularly relish hearing all about their patients' bowel movements, but it is a vital function that nurses and doctors need to assess.

Surprisingly, the colon has remained relatively unexplored territory, one of the body's final frontiers. For example, current concepts of what "normal" stools are emanated primarily from the records of 12 consecutive bowel movements in 27 healthy subjects from the United Kingdom, who boldly went where no one had gone before. Those must have been some really detailed records.

It's important to define what's normal. When it comes to frequency, for example, we can't define concepts like constipation or diarrhea unless we know what's normal. Standard physiology textbooks may not be helpful in this regard. One text implies that anything from one bowel movement every few weeks or months to 24 in just one day can be regarded as normal. Once every few months is normal?

Out of all of our bodily functions, we may know the least about defecation. Can't we just ask people? It turns out people tend to exaggerate. There's a discrepancy between what people report and what researchers find when they record bowel habits directly. It wasn't until 2010 when we got the first serious look. In my video, How Many Bowel Movement's Should You Have Everyday? you'll see the study that found that normal stool frequency was between three per week and three per day, based on the fact that that's where 98% of people tended to fall. But normal doesn't necessarily mean optimal.

Having a "normal" salt intake can lead to a "normal" blood pressure, which can help us to die from all the "normal" causes like heart attacks and strokes. Having a normal cholesterol level in a society where it's normal to drop dead of heart disease--our number-one killer--is not necessarily a good thing. Indeed, significant proportions of people with "normal bowel function" reported urgency, straining, and incomplete defecation, leading the researchers of the 2010 study to conclude that these kinds of things must be normal. Normal, maybe, if we're eating a fiber-deficient diet, but not normal for our species. 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. The rectum may need to accumulate 4 or 5 ounces of fecal matter before the defecation reflex is fully initiated, so if we don't even build up that much over the day, we'd have to strain to prime the rectal pump.

Hippocrates thought bowel movements should ideally be two or three times a day, which is what we see in populations on traditional plant-based diets. These traditional diets have the kind of fiber intakes we see in our fellow Great Apes and may be more representative of the type of diets we evolved eating for millions of years. It seems somewhat optimistic, though, to expect the average American to adopt a rural African diet. We can, however, eat more plant-based and bulk up enough to take the Hippocratic oath to go two or three times a day.

There's no need to obsess about it. In fact, there's actually a "bowel obsession syndrome" characterized in part by "ideational rambling over bowel habits." But three times a day makes sense. We have what's called a gastrocolic reflex, which consists of a prompt activation of muscular waves in our colon within 1 to 3 minutes of the ingestion of the first mouthfuls of food to make room for the meal. Even just talking about food can cause our brains to increase colon activity. This suggests the body figured that one meal should be about enough to fill us up down there. So maybe we should eat enough unprocessed plant foods to get up to three a day--a movement for every meal.

I know people are suckers for poop videos--I'm so excited to finally be getting these up! There actually is a recent one--Diet and Hiatal Hernia--that talks about the consequences of straining on stool. Hernias are better than Bed Pan Death Syndrome, though, which is what I talk about in in my video, Should You Sit, Squat, or Lean During a Bowel Movement?

Here are some older videos on bowel health:

For more on this concept of how having "normal" health parameters in a society where it's normal to drop dead of heart attacks and other such preventable fates, see my video When Low Risk Means High Risk.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Diet and Hiatal Hernia

Diet and Hiatal Hernia.jpeg

In terms of preventing acid reflux heartburn, high-fat meals cause dramatically more acid exposure in the esophagus in the hours after a meal. I talked about this in Diet and GERD Acid Reflux Heartburn. High fiber intake decreases the risk, but why? One typically thinks of fiber as helping out much lower in the digestive tract.

A systematic review and meta-analysis published in 2013 found a highly significant protective association between esophageal adenocarcinoma and dietary fiber intake, suggesting that individuals with the highest fiber intakes have an approximately 30% lower risk of cancer. This could be because of the phytates in high-fiber foods slowing cancer growth, fiber's anti-inflammatory effects, or even fiber removing carcinogens. But those are all generic anti-cancer effects of whole plant foods. Specific to this type of acid irritation-induced esophageal cancer, fiber may reduce the risk of reflux in the first place. But how?

As you can see in my video, Diet and Hiatal Hernia, hiatus hernia occurs when part of the stomach is pushed up through the diaphragm into the chest cavity, which makes it easy for acid to reflux into the esophagus and throat. Hiatus hernia affects more than 1 in 5 American adults. In contrast, in rural African communities eating their traditional plant-based diets, the risk wasn't 1 in 5; it was closer to 1 in 1,000--almost unheard of. Hiatus hernia is almost peculiar to those who consume western-type diets. Why are plant-based populations protected? Perhaps because they pass such large, soft stools, three or four times the volume as Westerners.

What does the size and consistency of one's bowel movement have to do with hiatal hernia? A simple model may be helpful in illustrating the mechanism that produces upward herniation of the stomach through the hole (called the esophageal hiatus) in the diaphragm, which separates the abdomen from the chest. If a ball with a hole in its wall is filled with water and then squeezed, the water is pushed out through the hole. If we liken the abdominal cavity to the ball, the esophageal hiatus in the diaphragm corresponds with the hole in the ball. Abdominal straining during movement of firm feces corresponds to squeezing the ball and may result in the gradual expulsion of the upper end of the stomach from the abdominal cavity up into the chest. It's like when we squeeze a stress ball. Straining at stool raises pressures inside our abdominal cavity more than almost any other factor.

In effect, straining at stool puts the squeeze on our abdomen and may herniate part of our stomach up. "Consistent with this concept is the observation that in Africans the lower esophageal sphincter is entirely subdiaphragmatic, whereas it usually straddles the diaphragm in Westerners and is above the diaphragm in the presence of hiatus hernia."

This same abdominal pressure from straining may cause a number of other problems, too. Straining can cause herniations in the wall of the colon itself, known as diverticulosis. That same pressure can backup blood flow in the veins around the anus, causing hemorrhoids, and also push blood flow back into the legs, resulting in varicose veins.

Hiatal hernia is not the only condition that high-fiber diets may protect against. See:

I also have a load of other bowel movement videos:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Diet and Hiatal Hernia

Diet and Hiatal Hernia.jpeg

In terms of preventing acid reflux heartburn, high-fat meals cause dramatically more acid exposure in the esophagus in the hours after a meal. I talked about this in Diet and GERD Acid Reflux Heartburn. High fiber intake decreases the risk, but why? One typically thinks of fiber as helping out much lower in the digestive tract.

A systematic review and meta-analysis published in 2013 found a highly significant protective association between esophageal adenocarcinoma and dietary fiber intake, suggesting that individuals with the highest fiber intakes have an approximately 30% lower risk of cancer. This could be because of the phytates in high-fiber foods slowing cancer growth, fiber's anti-inflammatory effects, or even fiber removing carcinogens. But those are all generic anti-cancer effects of whole plant foods. Specific to this type of acid irritation-induced esophageal cancer, fiber may reduce the risk of reflux in the first place. But how?

As you can see in my video, Diet and Hiatal Hernia, hiatus hernia occurs when part of the stomach is pushed up through the diaphragm into the chest cavity, which makes it easy for acid to reflux into the esophagus and throat. Hiatus hernia affects more than 1 in 5 American adults. In contrast, in rural African communities eating their traditional plant-based diets, the risk wasn't 1 in 5; it was closer to 1 in 1,000--almost unheard of. Hiatus hernia is almost peculiar to those who consume western-type diets. Why are plant-based populations protected? Perhaps because they pass such large, soft stools, three or four times the volume as Westerners.

What does the size and consistency of one's bowel movement have to do with hiatal hernia? A simple model may be helpful in illustrating the mechanism that produces upward herniation of the stomach through the hole (called the esophageal hiatus) in the diaphragm, which separates the abdomen from the chest. If a ball with a hole in its wall is filled with water and then squeezed, the water is pushed out through the hole. If we liken the abdominal cavity to the ball, the esophageal hiatus in the diaphragm corresponds with the hole in the ball. Abdominal straining during movement of firm feces corresponds to squeezing the ball and may result in the gradual expulsion of the upper end of the stomach from the abdominal cavity up into the chest. It's like when we squeeze a stress ball. Straining at stool raises pressures inside our abdominal cavity more than almost any other factor.

In effect, straining at stool puts the squeeze on our abdomen and may herniate part of our stomach up. "Consistent with this concept is the observation that in Africans the lower esophageal sphincter is entirely subdiaphragmatic, whereas it usually straddles the diaphragm in Westerners and is above the diaphragm in the presence of hiatus hernia."

This same abdominal pressure from straining may cause a number of other problems, too. Straining can cause herniations in the wall of the colon itself, known as diverticulosis. That same pressure can backup blood flow in the veins around the anus, causing hemorrhoids, and also push blood flow back into the legs, resulting in varicose veins.

Hiatal hernia is not the only condition that high-fiber diets may protect against. See:

I also have a load of other bowel movement videos:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Striving for Alkaline Pee and Acidic Poo

Stool pH and Colon Cancer.jpg

More than 30 years ago, an idea was put forward that high colonic pH promoted colorectal cancer. A high colonic pH may promote the creation of carcinogens from bile acids, a process that is inhibited once you get below a pH of about 6.5. This is supported by data which shows those at higher risk for colon cancer may have a higher stool pH, and those at lower risk have a low pH. There was a dramatic difference between the two groups, with most of the high risk group over pH 8, and most of the low risk group under pH 6 (see Stool pH and Colon Cancer).

This may help explain the 50-fold lower rates of colon cancer in Africa compared to America. The bacteria we have in our gut depends on what we eat. If we eat lots of fiber, then we preferentially feed the fiber eating bacteria, which give us back all sorts of health promoting substances like short-chain fatty acids that have anti-inflammatory and anti-cancer properties. More of these organic acids were found in the stools of native Africans than African Americans. More acids, so lower pH. Whereas putrefactive bacteria, eating animal protein, are able to increase stool pH by producing alkaline metabolites like ammonia.

The pH of the stools of white versus black children in Africa was compared. Children were chosen because you can more readily sample their stools, particularly the rural black schoolchildren who were eating such high fiber diets--whole grains, legumes, nuts, vegetables, fruits, and wild greens--that 90% of them could produce a stool on demand. Stuffed from head to tail with plants, they could give you a stool sample at any time, just as easy as getting a urine sample. It was hard to even get access to the white kids, though, who were reluctant to participate in such investigations, even though they were given waxed cartons fitted with lids while all the black kids got was a plate and a square of paper towel.

The researchers found significantly lower fecal pH in those eating the traditional, rural plant-based diets compared to those eating the traditional Western diet, who were eating far fewer whole plant foods than the black children. But, remove some of those whole plant foods, like switch their corn for white bread for just a few days and their stool pH goes up, and add whole plant foods like an extra five to seven servings of fruit every day, and their stool pH goes down even further and gets more acidic. It makes sense because when you ferment fruits, veggies, and grains, they turn sour, like vinegar, sauerkraut, or sourdough, because good bacteria like lactobacillus produce organic acids like lactic acid. Those who eat a lot of plants have more of those good bugs. So, using the purple cabbage test highlighted in my video, Testing Your Diet with Pee & Purple Cabbage, we want blue pee, but pink poo.

If you compare the fecal samples of those eating vegetarian or vegan to those eating standard diets, plant-based diets appear to shift the makeup of the bacteria in our gut, resulting in a significantly lower stool pH, and the more plant-based, the lower the pH dropped. It's like a positive feedback loop: fiber-eating bacteria produce the acids to create the pH at which fiber-eating bacteria thrive while suppressing the group of less beneficial bugs.

It might taken even as little as two weeks to bring stool pH down on a plant-based diet. In a study published in the British Journal of Cancer, a dozen volunteers carefully selected for their trustworthiness and randomized to sequentially go on regular, vegetarian, or vegan diets and two weeks in, a significant drop in fecal pH was achieved eating completely plant-based.

But there are differing qualities of plant-based diets. For example, the two groups followed in the study I mentioned earlier had dramatically different stool pH, yet both groups were vegetarian. The high risk group was eating mostly refined grains, very little fiber, whereas the low risk group was eating whole grains and beans, packed with fiber for our fiber-friendly flora to munch on.

Just as a "reduction of high serum cholesterol contributes to the avoidance of coronary heart disease," a fall in the fecal pH value may contribute to the avoidance of bowel cancer and through the same means, eating more whole plant foods.

More on colon cancer prevention in:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Kitti Sukhonthanit © 123RF.com. This image has been modified.

Original Link

Striving for Alkaline Pee and Acidic Poo

Stool pH and Colon Cancer.jpg

More than 30 years ago, an idea was put forward that high colonic pH promoted colorectal cancer. A high colonic pH may promote the creation of carcinogens from bile acids, a process that is inhibited once you get below a pH of about 6.5. This is supported by data which shows those at higher risk for colon cancer may have a higher stool pH, and those at lower risk have a low pH. There was a dramatic difference between the two groups, with most of the high risk group over pH 8, and most of the low risk group under pH 6 (see Stool pH and Colon Cancer).

This may help explain the 50-fold lower rates of colon cancer in Africa compared to America. The bacteria we have in our gut depends on what we eat. If we eat lots of fiber, then we preferentially feed the fiber eating bacteria, which give us back all sorts of health promoting substances like short-chain fatty acids that have anti-inflammatory and anti-cancer properties. More of these organic acids were found in the stools of native Africans than African Americans. More acids, so lower pH. Whereas putrefactive bacteria, eating animal protein, are able to increase stool pH by producing alkaline metabolites like ammonia.

The pH of the stools of white versus black children in Africa was compared. Children were chosen because you can more readily sample their stools, particularly the rural black schoolchildren who were eating such high fiber diets--whole grains, legumes, nuts, vegetables, fruits, and wild greens--that 90% of them could produce a stool on demand. Stuffed from head to tail with plants, they could give you a stool sample at any time, just as easy as getting a urine sample. It was hard to even get access to the white kids, though, who were reluctant to participate in such investigations, even though they were given waxed cartons fitted with lids while all the black kids got was a plate and a square of paper towel.

The researchers found significantly lower fecal pH in those eating the traditional, rural plant-based diets compared to those eating the traditional Western diet, who were eating far fewer whole plant foods than the black children. But, remove some of those whole plant foods, like switch their corn for white bread for just a few days and their stool pH goes up, and add whole plant foods like an extra five to seven servings of fruit every day, and their stool pH goes down even further and gets more acidic. It makes sense because when you ferment fruits, veggies, and grains, they turn sour, like vinegar, sauerkraut, or sourdough, because good bacteria like lactobacillus produce organic acids like lactic acid. Those who eat a lot of plants have more of those good bugs. So, using the purple cabbage test highlighted in my video, Testing Your Diet with Pee & Purple Cabbage, we want blue pee, but pink poo.

If you compare the fecal samples of those eating vegetarian or vegan to those eating standard diets, plant-based diets appear to shift the makeup of the bacteria in our gut, resulting in a significantly lower stool pH, and the more plant-based, the lower the pH dropped. It's like a positive feedback loop: fiber-eating bacteria produce the acids to create the pH at which fiber-eating bacteria thrive while suppressing the group of less beneficial bugs.

It might taken even as little as two weeks to bring stool pH down on a plant-based diet. In a study published in the British Journal of Cancer, a dozen volunteers carefully selected for their trustworthiness and randomized to sequentially go on regular, vegetarian, or vegan diets and two weeks in, a significant drop in fecal pH was achieved eating completely plant-based.

But there are differing qualities of plant-based diets. For example, the two groups followed in the study I mentioned earlier had dramatically different stool pH, yet both groups were vegetarian. The high risk group was eating mostly refined grains, very little fiber, whereas the low risk group was eating whole grains and beans, packed with fiber for our fiber-friendly flora to munch on.

Just as a "reduction of high serum cholesterol contributes to the avoidance of coronary heart disease," a fall in the fecal pH value may contribute to the avoidance of bowel cancer and through the same means, eating more whole plant foods.

More on colon cancer prevention in:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Kitti Sukhonthanit © 123RF.com. This image has been modified.

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Why Smoothies are Better Than Juicing

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Studies such as a recent Harvard School of Public Health investigation found that the consumption of whole fruits is associated with a significantly lower risk of type 2 diabetes, whereas fruit juice consumption is associated with a higher risk, highlighting the dramatic difference between eating whole fruits and drinking fruit juice. Cholesterol serves as another example. If we eat apples, our cholesterol drops. On the other hand, if we drink apple juice, our cholesterol may actually go up a little. Leaving just a little of the fiber behind--as in cloudy apple juice--was found to add back in some of the benefit.

We used to think of fiber as just a bulking agent that helps with bowel regularity. We now know fiber is digestible by our gut bacteria, which make short chain fatty acids (SCFAs) out of it. SCFAs have a number of health promoting effects, such as inhibiting the growth of bad bacteria and increasing mineral absorption. For example, experimentally infused into the rectum of the human body, SCFAs can stimulate calcium absorption, so much so that we can improve the bone mineral density of teenagers just by giving them the fiber naturally found in foods like onions, asparagus, and bananas.

Our good bacteria also uses fiber to maintain normal bowel structure and function, preventing or alleviating diarrhea, stimulating colonic blood flow up to five-fold, and increasing fluid and electrolyte uptake. The major fuel for the cells that line our colon is butyrate, which our good bacteria make from fiber. We feed them, and they feed us right back.

If the only difference between fruit and fruit juice is fiber, why can't the juice industry just add some fiber back to the juice? The reason is because we remove a lot more than fiber when we juice fruits and vegetables. We also lose all the nutrients that are bound to the fiber.

In the 1980's, a study (highlighted in my video, Juicing Removes More Than Just Fiber) found a discrepancy in the amount of fiber in carob using two different methods. A gap of 21.5 percent was identified not as fiber but as nonextractable polyphenols, a class of phytonutrients thought to have an array of health-promoting effects. Some of the effects associated with the intake of dietary fiber in plants may actually be due to the presence of these polyphenols.

Nonextractable polyphenols, usually ignored, are the major part of dietary polyphenols. Most polyphenol phytonutrients in plants are stuck to the fiber. These so-called missing polyphenols make it down to our colon, are liberated by our friendly flora and can then get absorbed into our system. The phytonutrients in fruit and vegetable juice may just be the tip of the iceberg.

For those that like drinking their fruits and vegetables, these findings suggest that smoothies may be preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing. But we may be losing more than we think.

For those that like drinking their fruits and vegetables, this suggests smoothies are preferable. I can imagine people who eat really healthy thinking they get so much fiber from their regular diet that they need not concern themselves with the loss from juicing, but they may be losing more than they think.

Why are polyphenol phytonutrients important? See, for example, my video How to Slow Brain Aging by Two Years

Not that fiber isn't important in its own right. Check out:

For more on smoothies, check out:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Craig Sunter / Flickr

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A Simple Yet Neglected Cure for Childhood Constipation

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Back in the 1950s, it was suggested that some cases of constipation among children might be due to the consumption of cow's milk. But it wasn't until 40 years later that it was finally put to the test. We used to think that most chronic constipation in infants and young children was all in their head--they were "anal retentive"--or had some intestinal disorder, but a group of Italian researchers studied 27 consecutive infants who showed up in their pediatric gastroenterology clinic with chronic "idiopathic constipation" (meaning they had no idea what was causing it), and tried removing cow's milk protein from their diet.

Within three days on a cow's milk protein-free diet, 21 out of the 27 children were cured. There were clinical relapsea during two subsequent cow milk challenges, meaning when they tried giving the children back some cow's milk, the constipation reappeared within 24 to 48 hours. The subjects came back after a month and stayed cured, and their eczema and wheezing went away, too! The researchers concluded that many cases of chronic constipation in young children--more than three quarters it seemed, may be due to an underlying cow's milk protein allergy.

Chronic constipation is a common problem in children, for which fiber and laxatives are prescribed. If those don't work, several laxatives at progressively higher dosages can be used, and that still may not work. Five years later, a considerable number of kids are still suffering. In fact, chronic constipation may even extend into adulthood. To cure the disease in just a few days by eliminating cow's milk was a real breakthrough.

But it was an open trial, meaning not blinded or placebo-controlled. We didn't have such a trial until a landmark study was published in the New England Journal of Medicine--a double-blind, crossover study, comparing cow's milk and soy milk. The study enrolled 65 kids suffering from chronic constipation, all previously treated unsuccessfully with laxatives; 49 had anal fissures and inflammation and swelling. The researchers gave them either cow's milk or soy milk for two weeks and then switched it around.

In two thirds of the children, constipation resolved while they were receiving soy milk, and the anal fissures and pain were cured. None of the children receiving cow's milk had a positive response. In the 44 responders, the relation with cow's milk protein hypersensitivity was confirmed in all cases by a double-blind challenge with cow's milk. All those lesions, including the most severe anal fissures, disappeared on a cow's milk-free diet, yet reappeared within days after the reintroduction of cow's milk back into their diets.

This may explain why children drinking more than a cup of milk a day may have eight times the odds of developing anal fissures. Cutting out milk may help cure anal fissures in adults, too. Cow's milk may also be a major contributor to recurrent diaper rash as well.

Why does removing cow's milk treat these conditions? Studies that have looked at biopsy tissue samples in patients with chronic constipation because of cow's milk protein hypersensitivity have found signs of rectal inflammation, suggesting that cow's milk protein was inducing an inflammatory response.

Studies from around the world have subsequently confirmed these findings, curing up to 80 percent of kids' constipation by switching to soy milk or rice milk. A common problem with the studies, though, is when they switched kids from cow's milk to non-dairy milk, the kids could still have been eating other dairy products. That is, they didn't control the background diet...until recently. A 2013 study (highlighted in my video, Childhood Constipation and Cow's Milk, got constipated kids off all dairy products and 100 percent were cured, compared with 68 percent in the New England Journal study.

Isn't this amazing? I just kept thinking, "why didn't I learn this in medical school?" Is the dairy lobby so persuasive that a cheap, simple, safe, life-changing intervention like this remains buried?

Until now!

If you appreciate learning what your child's pediatrician probably never did, please consider making a donation to the 501c3 nonprofit charity that keeps this website going. I don't make a penny off the site, but it does require substantial server and logistics costs.

Make sure to check out tomorrow's video: Treating Infant Colic by Changing Mom's Diet.

Avoiding dairy may be important for infant health too. Watch my 3-part video series:

Then the effects on adolescents and beyond:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Melissa Wiese / Flickr

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