Image Credit: theogeo / Flickr. This image has been modified.

Bowel movements: the scoop on poop

Years ago we learned that those eating plant-based diets are just “regular” people. In a study comparing omnivores, vegetarians, and vegans profiled in my Bowel Movement Frequency video, researchers found a “very clear trend towards an increasing number of bowel movements with a more rigorous degree of vegetarianism.” For example, even meat-eating women who piled on the fruits and veggies and ate the same amount of fiber had only a quarter the odds of having a daily bowel movement compared to women eating vegan. But does this translate to decreased disease risk?

 This year marks the 40th anniversary of the publication of Painter and Burkitt’s landmark paper “Diverticular Disease of the Colon: A Deficiency Disease of Western Civilization” (PDF here). Just as scurvy is a vitamin C deficiency disease, they argued, diverticulosis is a fiber deficiency disease, the result of not eating whole plant foods. No surprise, then, that the majority of older Americans are afflicted with this condition.

As I explain in my diverticulosis video, a lifetime of straining to pass stools that aren’t softened and bulked up by fiber can eventually balloon pockets out through the weakest points in the wall of our colons. These bulging outpouchings can get inflamed, infected, and even lead to a life-threatening rupture of our intestines. More than 100,000 Americans are hospitalized every year for this preventable condition.

This summer, a team of scientists at Oxford released the results of a study (PDF here) in which 15,000 vegetarians and vegans were followed for nearly a dozen years. Compared to meat eaters, vegetarians had 35% less risk of being hospitalized or dying from diverticulitis, and those eating vegan appeared to eliminate 78% of the risk.

What’s most surprising is that even after controlling for fiber intake, those on plant-based diets still had significantly lower risk, leading the researchers to suggest that meat itself may increase the risk of diverticular disease “by altering the metabolism of bacteria in the colon, which could lead to a weakening of the colon wall….”

In addition to enhanced regularity, vegetarians and vegans also get points for achieving the preferred stool size and shape. The bigger the better. For example, one reason why women eating vegetarian may have lower breast cancer rates is because they have larger bowel movements, the topic explored in last Friday’s video, Relieving Yourself of Excess Estrogen.

On Monday, Stool Size Matters offered a tip on how to use beets to measure one’s intestinal transit time, and Tuesday’s Food Mass Transit revealed that it may take an average of four days for food to get from one end to the other in women eating a standard American diet, too slow to meet the target half-pound-minimum fecal output for optimal cancer prevention.

Yesterday’s Bowels of the Earth contest revealed which country has the largest average stool size (i.e. who’s #1 at number 2), and which population has the smallest (New Yorkers!).

Check out my other 23 videos on colon health, everything from a Toxic Megacolon Superbug to Greasy Orange Rectal Leakage.

-Michael Greger, M.D.

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


32 responses to “Bowel movements: the scoop on poop

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    1. I’m a retired physician who has heard you speak a couple of times and enjoy your material and approach but I’m a fast reader and would like to read your material. How can I do this.




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    2. Hi Dr. Gregor, I suffer from pelvic floor dysfunction (I think) and have no issue with transit time as per a recent Sitz marker test. What I do experience though is an intense pain over my right eye when I cannot have a bowel movement. Also, I have virtually no sensation in my rectum. Might you know what is causing my difficulties or what I can do to help? I am vegan and have been for over 3 years.




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  1. Off topic I know Doctor, but I wanted to know if you can help offer direction on getting off of my Blood pressure medicine. I only take a low dose, but when I stop, my blood pressure does go up into a borderline range. I am Vegan, and do regularly eat red lentils.
    Thanks in advance!




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    1. Bananas, 20 a day, blended with berries and flax (ground) seeds, dates as snacks and any other whole fruit or veggie. Every night eat a handful of pecans with a one-pound salad consisting of purple cabbage, kale, broccoli and spinach. Eat more if you can. Use a fat-free dressing like catalina. Give it a month and you’ll be off your meds. See your doctor before stopping your prescription. Get off slowly; lots of that stuff can have serious withdrawals.




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  2. Hi David, I’d have to know a little more about your diet and exercise habits to give you a more detailed answer, but off the top of my head: are you watching your sodium intake http://nutritionfacts.org/videos/salt-ok-if-blood-pressure-is-ok Processed foods are one of the worst offenders as far as sneaking sodium into your diet. Vegan cheeses and meat substitutes are loaded with the stuff.
    Regular exercise is also one of your best weapons against high blood pressure.




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    1. A recent randomized, cross-over, placebo-controlled study failed to find any benefit of aloe vera over placebo in the treatment of irritable bowel syndrome. There is, however, evidence that peppermint oil may help. In general, the available science suggests that the purported benefits of aloe are overblown, and given recent reports of aloe-induced hepatitis, I would recommend against ingesting it. Applied topically, though, to second degree (blistering) burns, aloe vera does seem to accelerate healing. Thank you so much for your question–I’m always happy to look things up for folks.




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  3. This is all very interesting!  What about personal “experience” of the TMI kind?  My personal experiences differ from the results of these studies.

    Ready for a little TMI?  Ok, a lot of TMI?  :)

    A few years ago, I decided to head toward vegetarianism.  I also started eating very healthy–organic, local, fresh, homemade, etc.– and quit smoking.  I took up a “flexitarian” diet, consisting of no meat on most days and small amounts of meat once or twice a week.

    At some point during that time, I also developed a rectocele (unbeknownst to me until a few months ago).  The last year and a half, I was  feeling increasingly constipated, stools were difficult to pass and yet rather thin.  Of course, cancer was my fear. 

    Then I discovered the rectocele.  I decided to up the fiber even more, via grains, veg and inulin.  Things became even more difficult.  I was having the urge to defaecate every day, several times a day, but it was far from easy.

    This past month, I had two house guests back to back.  They are both meatetarians, To keep them happy, I cooked meat, just like back in my olden days when it was a slab of meat as the main and the rest as sides.

    And wouldn’t you know it, regular bowel movements ever since.  No splinting, no straining.  They are the right color, larger in size, etc.

    I really hate to cave to this and leave my dreams of being a vegetarian in the dust, but…. if I can avoid surgery for the rectocele I will. 

    Incidentally, wasn’t there a study recently revealed about the rather marked increase in colon cancer risk among vegetarians, perhaps due to the large amount of fiber and therefore the scraping of the intestines (scraping releasing mucous, thus requiring healing followed by possible DNA replication mistakes ergo cancer)?




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    1.  Sorry to hear about the rectocele. There are many factors that go into the development of a rectocele as I’m sure you are aware. It is not unusual for the symptoms to be made worse by the increase in fiber and bulk of the stool. Given your history it appears that you have two choices. The first to continue what you are doing to minimize the problems caused by the rectocele or to have the rectocele surgically repaired and to resume a whole food plant based diet. Given the risks of the standard american diet as it relates to arterial disease, cancer, autoimmune disorders, obesity, diabetes, osteoporosis and neurological disorders it would be easy to argue for the surgical repair with improved nutrition. I haven’t seen the study that you are referring to but all the studies I have seen and the current best hypothesis is that fiber reduces the risk of colon cancer when all the other variables are taken into consideration. As each case is unique it is important to work with your physician(s) to help you make the right decision for yourself. Good luck.




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  4. About 6 months ago, I switched to a plant-based diet but am having terrible diarrhea. I cannot eat anything “healthy” (especially legumes, green leafy vegetables and berries) without almost immediate diarrhea. I sometimes go on a bread/cheese/meat diet for a day or two, just to obtain relief of the diarrhea! Is this something normal, in your experience? Even after eating essentially plant-based for 6 months, the diarrhea does not seem to want to disappear. I have had stool tests and blood tests, all of which are normal. I’m so sad and confused… it seems like the world’s best diet, is turning out to be my worst nigthmare! If you have any thoughts, I woudl be thrilled to read them. Many, many thanks for your blog and videos which are truly fantastic, and very much appreciated.




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    1. Hey MarilouGarson, Sorry to read about your diarrhea aka “mudd butt”. I know it sucks, literally. Thanks for sharing with all of us. Sounds like you might me getting too much fiber. I would be interested to know what your diet was on a typical plant-based day. Also try consuming some probiotics (no yogurt) to boost your healthy gut bacteria. I’ve used GOL (Garden Of Life) Raw Probiotics and they did a fantastic job with regulating my digesting and relieving diarrhea constipation after a round of antibiotics or stomach bug




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  5. Dear Dr Greger,

    I have been vegetarian for about 25+ years and virtually vegan for about 5 years. I contracted prostate cancer some years ago (I think) although it was diagnosed Dec 2012 (Gleason 3+4). I have had a prostatectomy in March and am about to have radiation therapy BUT the medics have had me on the CT scanner four different times (4 hour round trip) to set up the scanner and mark my pelvis area, but my bowel is never correct – too much gas or faeces. I used a de-gas pill and now they gave me laxatives (2 x 2 times a day) which I took 1 x 2 times a day. I think the problem is timing because my bowel is very efficient and healthy, 1-2 movements every day, but they think I need laxatives.

    Is a vegan bowel more likely than the average one to move waste in a continuing kind of process? I had an enema last trip but they waited an hour before I went on the CT again. They told me the scan was fine on the day but now they rang to say there was too much faeces in it.
    I just want to get the scan right but I’m not sure laxatives are going to make any difference.
    Any suggestions?




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  6. What about frequency? I only go once a day and I would say it is large. Just wondering if what people say about going after every meal is correct.




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  7. Hi dr. Greger. I was diagnosed with stage 4 breast cancer metastatic to the liver. I am on a vegan diet and I go very often (about 3-5) on bad days. My bowel is loose and sometimes I don’t feel complete evacuation. What can I do? I have lost a lot of pounds and can’t gain weight on a vegan diet (is that possible, I’m pooping more than I need to?




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    1. Adirel: I’m so sorry to hear about your cancer. Not only your cancer, but your other problems too.

      I’m not a doctor nor an expert, but I have seen some articles that address people who want to gain weight on a vegan diet. These articles suggested eating lots of calorie-dense, whole foods such as: nuts, seeds, avocados and maybe even olives. You can make all sorts of sauces and dips out of these foods. Or even just load up on nut butters like peanut and almond butter. Whether or not something counts as calorie dense or not might depend on a lot on your existing diet. If you are eating a lot of low-fat or fat-free salads and raw veggies, then just about anything would be higher calorie density – including say tofu.

      While you may not be a teen and/or an athlete, the following page may interest you. Not all of the recommendations on the page are whole foods, but there are some good ideas that may help and it is a site (Vegetarian Resource Group) that I trust.
      http://www.vrg.org/teen/veg_athlete_weight_gain.php

      Since I am not a doctor, I do not know if these suggestions are a good idea for your situation. I just thought you might find these ideas helpful.

      Good luck.




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  8. Interesting. I thought it would be a no-brainer because of the fiber for plant-based dieters but even with plenty of that + eating protein slows it down. No wonder every time I turn my plant-based diet into a flexitarian diet I end up with smaller, more infrequent poo. I knew it was the protein but I don’t really eat that much. But it sure makes a difference. –Good to know.




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  9. Hello Dr.Greger,

    When eating a plant based diet my increased bowel movements cause me to have to wipe so much that I begin to bleed, or there is already blood in my stool. I am a young male who does exercise and has been an athlete most of my life.
    How do I fix this, either through changing diet or through a certain type of bath tissue or etc. ? I dont think I can eat a plant based diet if I keep having to go to the bathroom 2-3 times a day ( #2)

    Thanks

    Ghee Buttersnaps




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    1. Sorry to read about your problem. Going on a plant based diet does change the frequency and size of the stool… http://nutritionfacts.org/video/bowels-of-the-earth/ and http://nutritionfacts.org/video/food-mass-transit/. This requires some adjustments and 2-3 stools is typical for those on higher fiber diets. Based on current science benefits far outweigh problems. That said, bleeding can be caused by local irritation, hemorrhoids and other conditions some serious so it is important to have the correct diagnosis before embarking on fixing the problem. Having your regular provider check would be a good idea. If the problem is found to be due to local irritation you can look at changing the texture of tissue, avoiding tissue with chemicals, gently cleaning with plain water and soft cloths, and protecting the area with creams/ointments which help while avoiding making the problem worse. Based on a proper diagnosis you and your provider should be able to come up with an approach that works for you and your circumstances. Good luck.




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  10. Hi i have been vegetarian for the last 3 years now but manly vegan with occasional dairy 1 a month…I have been having problems with my BM’s for the past few months in the sense that ..sorry for the TMI but are not bulky more sludgy and sticky???? I eat lots of veggies, a green smoothie a day legumes and such…worried as to why this is???




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    1. Hello there – I would also make sure you’re drinking plenty of water. It’s difficult to say what exactly is causing this without being examined. There are many reasons why bowel patterns change. I would recommend following up with your primary care physician/gastroenterologist in order to rule out any underlying issues. Wishing you all the best!




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  11. A friends says being primarily plant based for almost a year now continues to cause frequent urgent bm’s that start at 4 am- wake him up – then he has 3-4 BMs a day. He hoped he would adjust like it says in your book but it has not. Thus he wants to eat meat and dairy to slow down his bowels. Anything he can do for this and remain plant based?




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    1. Hi Paulette, What your friend is describing is actually not abnormal at all. Albeit somewhat unusual for the average American. In fact if the character of your friend’s stools are large, soft formed and bulky that’s exactly how they should be, and he should be passing one not long after each full meal. So, 3-4 a day is just about right. As far as the urgency, the idea of being able to hold your stool until it’s convenient to go to the bathroom is also not normal or natural. The peristaltic contractions of our colon are strong enough to empty the entire left side of our colon in a single movement and if we answer when mother nature calls by going to the bathroom, we are cooperating with the normal and natural way that our colons were designed to function. If your friend doesn’t have to be up yet at 4am perhaps a good bowel movement will get him nice and relaxed so he can fall back asleep nice and easy.




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  12. This all makes a lot of sense however, I have cut meat out of my diet for over 6 months now due to heath benefits although 2 months in started to have issues with regular bowel movements. On the rare occassions where I have had meat, I will have a very healthy bowel movement the next day. The past week we have just been away on holidays & I ate meat nearly everyday there & noticed that I was going to the toilet nearly twice everyday. I am so confused as I have read so often that it should be the opposite. My question is, has there been any studies, or do you have any idea about meat causing more regular bowel movements? Kind regards!




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  13. Hi!
    I am 18 years old and have been vegan for nearly 11 months now. I eat mostly whole foods, high carb and low fat with lots of grains, legumes and veggies. Something I noticed is that my poop is now very similar to a sludge. It is not one solid thing and although it passes easily, I often cannot do complete elimination. Is it possible that I am in taking too much fiber from greens? What can I do?

    I hate the feeling of still having some poop sitting around inside but I havent found a way to get it to evacuate.




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    1. Hi, Niko. Congratulations on making the transition to a whole food, plant-based diet. Without knowing more about your specific intake, it is difficult to give you a definitive answer to your question. Are you aware of Dr. Greger’s Daily Dozen? There is a free app for Apple and Android devices to help you plan what to eat. It may be that you are eating more fruit than you need. This could cause your bowels to be less firm. Although fruit may be a culprit, eating apple and banana together may help firm things up. I hope that helps!




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  14. Saw your videos got very inspired, i have been a diabetic for last 14 years
    i was taking Novolog 25 units every meal, 120 units daily of Tresiba, 1 300mg of invokana , 50 mg of januvia. and twice a day 1000 mg of metformin. I am very pleased to say that have been vegan for 2 months, lost 17 lbs , now weigh 217 lbs, and my Cholestrol dropped 70 points, i am now off both my insulin, invokana and Januvia, Only taking Metformin and 5 mg of glipizide , which my doctor thinks will be off in a month or so, A1c became 6.3 , I wanted to thank you for the information , never was i ever told that being vegan can make such a drastic difference in my life. I am now strictly vegan and never felt this way since i was 30 years of age. Thank you very much for your informative videos on your website




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  15. Any tips to help me solidify my stool as a vegan would be appreciated. I have been vegan 2 months now and feel great about the decision. I had been vegetarian for 2 years 20 years ago and kept considering the ethical and ecological reasons for veganism but Dr. Greger’s book helped me to finalize the decision with his medical and nutrition science. I have a much more varied diet than I ever had in my life but I would really like firmer stool as well. I started consuming much more bananas, grains such as rice or quinoa and beans in the last month to add some variety and slow thing down. I had been mainly consuming greens, fruit, nuts and seeds the first month. I am usually having 3-5 BM’s per day. Although the BM’s are easy I get a little tender on the highest frequency days. Thanks in advance.




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  16. SD Lindsay,

    May I suggest that you evaluate your diet with an elimination provocation technique ? This would give you a better idea of what item/s within the diet is indeed causing you some issues.

    You could be allergic or just reactive/sensitive to some of the new products with your changes. There is no simple method for the E/P process but be patient as I suspect your going to find a specific food or group is part of the problem. Remember this could also be as simple as an increase in some fibers that are irritating to your guts….

    Play detective and I know you will find the cause.

    Dr. Alan Kadish moderator for Dr. Greger




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