Let’s Talk Poop

poop01People just don’t want to talk about poop.  Their poop, other people’s poop or poop in general and I think it’s a bit of a shame to avoid the topic, especially in the context of diet and the impact it has on the digestive system and elimination.

So let’s talk about it now and get it out of the way so that we can, ahem, move on…

Our hang ups about backing the big, brown motor home out of the garage is perhaps one of the greatest ruinations to a very low-carb (VLC) eating style.  When I meet people who’ve quit their VLC eating plans and I ask them why they quit, the number one reason they give was the impact on their number two.  When I ask if they ever discussed the issues with anyone in their VLC support network, I get some nervous and shameful looks and ultimately a response along the lines of who would want to talk about that?  So why should someone quit an otherwise successful VLC eating style simply because they can’t pump a clump of dump out of their rump?

When you first start eating VLC and you’re on a quest to read all things about VLC, you see occasional nods to the fact that you can suffer constipation as a result of eating low-carb.  What these resources fail to fully convey is the intensity of that constipation, it’s chronic nature and perhaps most importantly, how to correct it and carry on eating VLC.

When I first started eating low-carb, constipation was the least of my worries.  After a decade of eating a “healthy” diet of low-fat and whole grains my gastro-intestinal tract was in ruins.  I had suffered from diverticulosis for nearly six years with frequent, intense bouts of diverticulitis.   For those who’ve never suffered a diverticular attack let me assure you it is gut wrenching (no pun intended).  To add insult to injury, my diverticulitis would manifest in the very explosive opposite of constipation and was completely incapacitating.   Eventually, I chose to have surgery, in my thirties no less, to remove the section of my colon that had weakened and threatened to rupture.  Short term, surgery removed my symptoms but longer term they had started to come back.  My entire digestive system was a hotbed of inflammation and it let me know every chance it got and usually in the most inconvenient ways possible.

bears and pooI learned very quickly after switching to VLC that in the absence of flour and grains many chronic, painful and embarrassing gastrointestinal issues I had simply vanished.  In fact, after years of having visits to the toilet that defied description in their unrivaled viciousness, I was now having the quickest, most effortless and unnoticeable visits one could imagine.  I was living that loo roll commercial of dancing bears and flowers.  Only better.

 

However, having been cautioned by Atkins and a myriad of VLC blogs and message boards telling me constipation would be on the horizon, I waited for the day when my production would stop.

Incidentally, this may be a good place to remind the gentle reader that, medically speaking, you’re constipated if you are having three or fewer bowel movements in a week or are experiencing poo that is hard, dry and difficult or painful to pass.  At least that’s what the National Library of Medicine has to say about it.

I also think there is a discrete difference between a slowdown in elimination (you used to go daily, now you go every 4 -5 days) versus a change in consistency/output (you used to create massive, soft loaves of poo and now your shooting out rock-hard hand grenades but with the same frequency and regularity as always).

That last part is important – if you’re still pooping as regularly as you always do (or nearly so) but the quality of that poo has changed, then your problem may not be constipation so much as a failure to adequately digest the high fat content of your food.

If you want your bowel movements to be a practically unnoticeable act, you need your poo to have lots of water in it.  Water makes up about 75% of your bowel movements. The other 25% comprises of dead and live bacteria, cells from your body (primarily from your liver), and mucus.  Soluble fibers are broken down during digestion and form a part of your poo but most soluble fibers (nuts & beans) aren’t part of a VLC diet.

Foods containing insoluble fiber (corn, oat bran, and carrots) are difficult for your body to digest and often show up in your poo looking relatively unchanged.  Again, on VLC, you aren’t likely to be eating much insoluble fiber – except in leafy/cruciferous vegetables.

When your poo is comprised of high fat molecules, the fat pushes the water out and away.  Your stool becomes denser, harder and very difficult to pass without Lamaze-like breathing and contortionist positions whilst perched on the loo.

The bitch about science is it often contains near comical irony.  Such is the case with fat and poo because while fat can cause stools to become hard and nasty (hydrophobic), it’s also a necessary ingredient to promote a bowel movement in the first place and too much fat can actually result in diarrhea.  So we need to eat fat to poo but we also need to make sure we’re digesting that fat properly and offsetting the fact that it will make our poo more hydrophobic.

Now, notice – nowhere have I said you poo less frequently by eating high fat.  What I’m pointing out is that your poo has become harder, denser and potentially painful as it takes more effort to pass.  However, you may still be going at the same frequency as before – or if you’re going less frequently, it’s just a little less than normal – you’re not going days and days without a poo.  If you are going days and days without a poo, then in my book you’re constipated.  If you’re going fairly regularly but with great difficulty you’re not so much constipated as in need of some modifications to help the poo become softer and easier to pass.

This is what I think happens to many VLC eaters but we confuse this with “constipation”.  In my book, constipation creates hard, dense stools because the crap sits around for days while being desiccated by your colon.  What I’ve experienced (and I think many others VLC eaters do) is a regular (daily or multi-day) movement of painful poop pinecones.

I think these delightful little porcupines of fecal matter occur because we’re not able to digest (emulsify) all the fat we’re eating and this is preventing water from remaining in the stool so it can become more elongated, soft and easier to pass.

So what are we to do?

A quick Google search of “how to soften hard stools” will result in many sites recommending basically the same things:

  • Eat more fiber
  • Drink more water
  • Getting enough exercise
  • Take time to have a bowel movement when you need to
  • Use laxatives only if your doctor says you should
  • Ask your doctor if medicines you take may cause constipation

And perhaps ironically, you’ll find an equal number of sites refuting the effectiveness of all of these solutions.  So like everything, reader beware!

Here’s a recipe I’ve used that has brought some relief to me in the past:

  1. Watch that you do not get dehydrated but don’t drink more water than usual (water you drink doesn’t make it to your colon.  So drinking a ton of water won’t soften up Mr. Hanky.  However, if you’re dehydrated, your body will suck water from your colon to help restore homeostasis – making Mr. Hanky more like Mr. Hard-N-Craggy.
  2. If you’ve recently introduced a new food to your diet, try not eating it for a few days to see if it is causing the problem.  I’m pretty much a mono-eater.  Sometimes when I introduce a new food it will change my elimination habits.  I just have to reintroduce it in smaller quantities until my body adapts to it.
  3. Cut back on fat consumption – Just for a few days.  Supplement with calories from insoluble fiber sources.  In other words, ramp up eating lower-carb leafy-cruciferous veggies.  The increased carbs and natural fiber will help your poo to soften and the reduction of fat should allow more water to penetrate the poo and soften it.
  4. Use a non-stimulant stool softener like docusate sodium to help more water penetrate the poo and soften it.  I don’t recommend laxatives, just stool softeners.
  5. Go as soon as you feel the need to go.  This is actually more important than it seems.  Back in our Paleo days, as soon as we got the itch to drop anchor, we simply crouched and went (provided we weren’t in immediate danger of being eaten by a predator – shout out to all my Paleo-peeps!).   However, in modern society there are all manners of attempts to control and limit elimination time.  The fact is that the longer you delay pinching a loaf, the more time your colon has to suck water out of it (and make it harder and denser).   So go as soon as practically possible.
  6. Use an over the counter, sugar-free, fiber supplement like Benefiber.  I actually swear by a generic brand that I put into my morning tea.  Two teaspoons adds  1 gram of net carb – which frankly, I don’t count in my carb count because it’s made no difference in my weight, even when I’ve used that serving size two or three times a day.
  7. Don’t sit and strain.  If something’s not happening after a few minutes, step away and try again a few minutes later.  The more you stress, strain and build pressure, the more likely you are to do damage – like a painful case of hemorrhoids or an anal fissure.  This is because all the effort you’re placing on your lower abdomen muscles is causing your rectal sphincter to lock up and the very rich blood supply to your rectum to swell.  Just relax and stay close to the bathroom so you can try again as soon as you feel the urge (and you will feel it again).

Bottom line: Don’t give up on your VLC eating style if you encounter problems with number two.  Just make small modifications to see what works with your individual body and will help move things along.

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