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Why is pooping such a taboo topic? Every single living being does it. Do you ever wonder how it became such an embarrassing, private endeavor? These are thoughts that keep me awake at night. Seriously. I really need to get more sleep.
I will tell you that gastrointestinal (GI) issues are some of the most common reasons patients are referred to see me. Interestingly though, seeing a registered dietitian nutritionist (RDN) is usually not the first thing people think to do when they have GI issues. I find that weird, because typically food is a major culprit in triggering said issues; so much so that our GI docs will not receive a consult until the patient has met with an RDN at least once. The GI docs’ rationale (rightfully) is that most of the patients who are consulted to them have some uncovered food sensitivities, not some major medical situation. Therefore, if the GI issue(s) can be “fixed” with nutritional interventions, the GI docs can save their time for more complex cases.
Probably the most important thing I can say about our guts is that NOBODY has a deficiency in Miralax. Nobody; that’s not a “thing.” If you have to “go on a Miralax regimen,” then you haven’t discovered the root of your GI problems. Miralax is an over-the-counter (OTC) laxative. Sure, it will make you poop; that’s what it does. However, the more important thing is to figure out why you can’t poop. A healthy GI tract is one that has a bowel movement at least once every day that is soft but not loose, formed but not hard, and light to dark brown in color. Your poop should pass easily without strain.
The most common, albeit definitely not the only, cause of constipation is either inadequate fiber, inadequate water, inadequate physical activity, or all of the above. Increasing fiber without increasing water (usually at least 60-80 oz/day of water are needed by most of us) will actually make your constipation worse.
The best way to increase fiber intake is NOT through OTC fiber supplements. If you’re not eating enough fiber-rich foods, you’re also not getting critical nutrients to support your overall health. The best ways to increase fiber are actually through an increase in whole vegetables and whole fruits. You can also get more fiber (and nutrients) by switching white flour grains to 100% whole grains whenever possible; but vegetables and fruits are still the top way to get fiber. Read more about fiber here.
Interestingly, there is no standard medical definition of diarrhea. Did you know that? Diarrhea is a pretty subjective thing. Some people consider loose stools a form of diarrhea, although they are just annoyingly soft poop. Diarrhea, in any way perceived by the bearer, is a nuisance and sometimes even painful.
Sudden onset diarrhea
Especially watery and/or explosive diarrhea accompanied by a fever is most likely either foodborne illness or a GI virus. In either case, these are acute conditions for which medical attention is often necessary. Hydrate, hydrate, hydrate, and replace electrolytes through sports drinks and/or bone broth. The most current scientific evidence has debunked the requirement for the BRAT (bananas, rice, applesauce, toast) diet for acute GI conditions. It’s not like you can’t have these foods, and odds are they will be the only thing you feel like eating. However, the research shows that resuming a “normal” diet as soon as you’re ready is advised.
You’ll know it when you have it. Persistent, often varied consistency stools nowhere close to solid. Chronic diarrhea is not accompanied by a fever. Sometimes chronic diarrhea lasts from weeks to months to years unless interventions are sought by medical professionals. In any case, diarrhea means your guts aren’t doing their vital jobs – absorbing nutrients, absorbing water, majorly assisting with immunity and supporting mental health.
Sometimes inadequate fiber can contribute to diarrhea. The cool thing about fiber is that it can soften poop to help in constipation and it can also solidify poop to help in diarrhea. This is the reason that bananas are incorrectly touted to “constipate you” (read more about that here). Bananas can “bulk up” stool in patients with diarrhea, yet they can also provide much-needed soluble fiber to help you pass hard, constipated stool in the right conditions (like with enough water).
Chronic diarrhea most often means that you have developed food sensitivities and/or an auto-immune disorder somewhere along the line. Despite the fact that you may have consumed gluten your entire life, you can still have genetics + some physiological trigger = celiac disease even in your 40s+. You may test completely negative for celiac disease, yet you may still have a gluten intolerance. You may have consumed dairy your whole life, and suddenly develop diarrhea from dairy. Although red meat tends to be an annoying nutritional scapegoat, it is less possible (but still possible) to cause GI issues. The point is, every single individual GI issue is different, and therefore managed differently. If you have skin issues, migraines, or other health problems, then that should be a clue that you are having food sensitivities.
Most importantly is to not try to handle your GI issues alone. You may eventually figure things out, but an RDN can help you sort through things a little more efficiently and with sound scientific support. Mass amounts of misinformation will come from well-meaning friends, family, and the internet, and some can seem like they are helping while masking what is really going on (i.e. Miralax doping).
Things that won’t independently cure you of your GI issue without other interventions include:
- Avoiding red meat and dairy
- Taking a laxative every day
- Taking OTC fiber supplements
- Avoiding bananas or cheese
- Eating more bananas or cheese
Things that could help your GI issue along with other interventions include:
- Increasing fiber through improving intake of whole foods
- Increasing water intake to at least 60-80 ounces a day
- Incorporating fermented foods and/or OTC probiotic supplements into your routine
- Checking your diligence with food safety practices
- Checking your refrigerator temperature (you could be chronically consuming spoiled foods)
- Increasing physical activity (for constipation, not as much for diarrhea!)
- Trial an avoidance of lactose
- Trial an avoidance of dairy altogether (could be milk protein sensitivity)
- Trial of avoidance of gluten (including putting your gluten-free bread in a gluten-crumb-filled toaster)
- Trial of avoidance of one of the most common food allergens (find them here)
- Trial of a FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) elimination and reintroduction regimen
If you have acute diarrhea, see a doctor. If you have constipation or chronic diarrhea, see a registered dietitian nutritionist as part of your quest for a medical cure. If nutritional interventions do not improve the condition, there could be more going on or you and your RDN haven’t solved the mystery yet. If nutritional interventions do help, there still could be more going on. And finally, even if you’re not sure, nutritional interventions are typically a critical piece of solving the GI mystery no matter the diagnosis.
Cheers to more satisfying poops and better overall health as you heal your guts!
xoxo – Casey