As I get older, I've noticed that my friends are talking more about subjects we once considered taboo. Maybe it's the Facebook effect, or perhaps the loss of bodily shame associated with going through childbirth. Maybe it's a function of having young kids at home, so the subject of bodily functions becomes as common as the weather. Whatever it is, I'm finding that the topic of poo comes up in conversation. A lot.
The truth is, this doesn't bother me a bit. It's not a coincidence that I wound up working as a dietitian in a gastroenterologist's office. I've long been fascinated by the digestive process in general, and the intestines in particular. My favorite diagram of the gut—a veritable road map of the windy, twisty turns through the small intestine into the colon that marks the site of each nutrient's absorption along the way—is faded and dog-eared from my frequent and intense study. Some consult tea leaves to read clues into the universe. I consult poo.
To be clear, only a medical doctor can diagnose diseases, and I have no such credential. If your poos are of concern, you should always consult your doctor. However, I've discussed enough poos in the context of their owners' diets to become pretty good at helping my patients hone in on what dietary factors may be behind their bathroom woes. And if you're not too squeamish to continue, I thought I'd share some of my best—ahem—nuggets.
• Strangely-colored poos: Green or yellow poos generally hint at rapid transit, or poos passing abnormally fast through your intestines. Poo gets its typical brown color from bile, a greenish emulsifier that's secreted by your liver and gallbladder to aid in the digestion of fats. Bile needs to spend several hours in the colon to develop this color, which means that poos passing through too quickly may retain the greenish hue. Furthermore, if you've recently eaten green veggies—like spinach—that green poo may also result from chlorophyll, due to incomplete digestion from rapid transit. If you've eaten beets in the past few days, your normal brown poo may be tinted magenta from the beet pigments; totally normal and harmless. Other shades of red—or even blue—can result from food dyes; take special note, ye Froot Loop and Kool-Aid lovers among us. Black poos may often result from high intake of supplemental iron. However, if yours is black and you haven't used iron, it could suggest bleeding in the GI tract that's worth checking out. Unless you've recently used Pepto-Bismol, poos that are pale (or white) in color are not likely the result of something you've eaten and are worth having checked out by a gastroenterologist sooner rather than later.
• Undigested food particles in the poo: Fragments of fibrous foods, like corn kernels, tomato skins, quinoa grains, whole flaxseeds, raw leafy greens, or fruit seeds often show up recognizably intact in a poo. This is normal, and it shows that your high-fiber diet is doing its job of providing indigestible material to bulk up the poo and feed the beneficial bacteria that live in your colon. Rest assured, it does not mean you're not absorbing the nutrients in your food.
• Poos with a strange consistency: Loose, poorly-formed poos that resemble Shredded Wheat generally suggest rapid transit. In other words, the poo is moving too quickly through the colon to allow for the excess water to be re-absorbed by the body. One dietary strategy to correct this is to go easy on the raw veggies, and choose foods at each meal that will help slow down transit time while contributing to fecal bulk. The best foods for the job are those high in gummy, soluble fibers, like oats or oat bran, rice, barley, root vegetables (including carrots and potatoes), applesauce or peeled apples, banana and papaya. In some cases, a soluble fiber supplement like Benefiber, Citrucel or psyllium husk can also work wonders toward achieving the Platonic ideal of a poo: soft, bulky, well-formed, and easy to pass. Talk to your doctor or dietitian to see if a fiber supplement is appropriate for you.
Poos that are visibly oily tend to hint at malabsorption—or, abnormally poor absorption, of fat—and this can have multiple underlying causes. Often, such oily poos will be unusually stinky as well. Dietary causes of this condition include consumption of a type of fish called escolar (often improperly labeled as "white tuna" on sushi menus) or oilfish (often mislabeled as "butterfish," or even cod!), or the fat replacer Olestra in a reduced-fat product. If diet is the cause, the problem should resolve itself once the offending ingredient leaves your system within a day or so. Otherwise, the cause may be medical, and you should consult a gastroenterologist.
• Multiple, urgent poos first thing in the morning: There's a normal, hormonally-induced phenomenon called the gastro-colic reflex that takes place soon after waking and throughout the day in response to eating. It's a contraction of the digestive system's muscles designed to keep food moving along to make room for whatever's coming down the pike. The three strongest triggers of this reflex are waking up, drinking coffee, and eating. (Note that it's not the caffeine in coffee, but rather a compound called cholinergic acid. Caffeinated tea should not have the same effect, but decaf coffee will.) So if you tend to guzzle two cups of Joe and down your breakfast within an hour of waking, don't be surprised if you're rushing to the toilet in the middle of it all. Spacing out the timing of these three stimuli over the course of your morning—or saving your coffee for later in the day—may help keep things running a little more smoothly.
If you've got poo woes that this primer doesn't address, don't be afraid to snap a digital photo, and make an appointment to share it with your friendly, local gastroenterologist. As the popular children's book by Taro Gomi correctly asserts, "Everyone poops!" There's no shame in discussing yours with a qualified health professional.
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Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.