Optimal Bowel Movement Frequency

Image Credit: Sally Plank

Optimal Bowel Movement Frequency

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:

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.


42 responses to “Optimal Bowel Movement Frequency

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  1. Is there any evidence that collected stool in the colon, that sits for several days and weeks, will begin to “leak out” and or start to create toxins in body, as well as adversely effecting the macrobiome?




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    1. Hi Bev,
      I think what you’re referring to is leaky gut syndrome. It happens when tiny particles inside the intestines escape through the intestinal wall, wind up in your blood, and cause problems. This is very rare and is usually accompanied by other digestive discomfort. Your intestines are made to keep the bad stuff in so it does not get to the rest of the body and in healthy individuals it works just fine.




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  2. I go at the same time every day. Love plant based been like it for nearly a year.
    Before this i had to go to hospital for constipation and had regular constipation and haemorrhoids :( and now i am regular 1-2 times a day.
    I also noted when i haven’t emptied my bowels as often i am really fatigued, as soon as i go to the toilet and empty i feel like someone made me very light and an incredible surge of energy, compared to if i miss a regular stool movement the opposite and i feel very heavy and weak.
    It is always straight after my first meal that i finish my 16-18 hour fast. Pass 2 varies more but is usually after Meal 2. Its nice to know when you go and you don’t have to worry about unexpectedly needing to go.
    Also haven’t had one bad stomach either (among any other illness not even cold but thats crazy ..), so happy. Thanks DR G i cant remember why i decided on what studies it was and presented by but i know you definitely helped decide that plant based was for me and even still to this day and i haven’t been happier my whole life, which is weird as i lost a lot and i was depressed and cried a lot before. Now every day i wake up happy.
    I guess its down to;
    Intermittent fasting. I wake up happy as i’m hungry and i know i can feast.
    Eating large quantities and the food being carbs and sweet fruit :)
    The health i feel and that fact i don’t get ill or have health worries.
    Hearing more good things about the foods im eating of people like DR G :)




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    1. Note to add to above:
      I found out my vitamin D was 6 Just recently and the fact i have felt so good with no getting ill is another crazy point. So now i’m about to start taking vitamin D, when my levels get up i should feel even better but have to see as i feel incredible and i’m not sure if that could even happen noticeably.




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    2. What’s a typical daily food menu for you?

      And how often do you 16 hour fast? 100 percent vegan? Coffee, chocolate, vitamins,
      probiotics, etc.? Supplements. This might help me greatly, in many areas. Thanks for
      any info.




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    3. The combination of intermittent fasting and plant-based works really well for many of us, especially if we have a slower metabolism. Saves a lot of time each morning preparing food. Keeps the middle aged tummy at bay. Feels much healthier.




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  3. I appreciate the framing of “normalcy” within this article. Normalcy has been pushed way out of bounds in a lot of respects in our modern society.

    Diet, work, exercise, environment, business, you name it, we need to adjust our values. I find money is generally the driving force here, perpetuating consumer culture, and eroding healthy values in the process.

    Thanks for being a champion for better values, Dr. Greger.




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  4. I believe the United Kingdom study also mentioned what consistency a proper BM should be ? I think it said somewhere around semi soft and able to hold its shape? I find when I eat a whole foods /plant based diet that is about half complex carbs(beans and/or potatoes, whole grains ) and half yellow and green vegetables (like the Dr McDougall “Maximum weight loss plan”) I end up with bouts of diarrhea where i go 4 times a day. I have never been diagnosed with irritable bowel syndrome, or Chrones, but somehow I think my microbiome does not like green and yellow vegetables, or meat analogs like “Seitan” . Finally, I notice that when I go “off the wagon” and eat cheese and meat along with green and yellow vegetables the diarrhea seems to abate and my BMs seem to return to “normal. Hope you don’t think I have “Bowel Obsession Syndrome”.




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    1. KT! Seitan is nothing but concentrated gluten. One of the absolutely worst things you could eat if you have a sensitive gut. Many people seem to have at least some sensitivity to wheat gluten.
      Also, some people do better with steamed veggies, instead of raw ones.




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      1. Just wanted to say “Thanks” for the information on Seitan, and steaming rather than fresh veggies. I think I just am fighting the fact that I may be gluten sensitive.




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    2. I have a similar thing with bouts like that but I notice is just when I don’t pay attention to my fibre intake- ground flax seed. Love that people are mature enough to talk about something so important.

      Happy Super Pooper RN




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  5. Why is having 3 meals a day considered normal?
    I almost never feel the need to eat more than twice a day. Do eat a large volume, huge salad, stir-fry or lots of bean soups when I do. Like Paul, I generally fast about 16 hours. I do drink decaf coffee with raw cocoa powder, turmeric, and cayenne plus some blackstrap molasses before my work-out. The blackstrap molasses is because, not eating any meat, my iron levels tend to be low. Also need some fuel to go my usual 3 miles.




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  6. It is simple to train the body for bowel movement. I eat more of a meat based diet but have no problems with 3 movements after waking up before breakfast. I eat a lot and don’t really out on weight. After lunch and before bed I may feel the urge as well.
    By not releasing it “into the wild” we are recirculating it in our bodies. Hence all the maladies. The colon area absorbs it back into the blood stream.
    Most people hang on to it. When you start the practice of sitting and pushing, it becomes natural in a very short amount of time.
    It’s in there, you gotta find the magic to let it shine.




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  7. Just for the (poop) record, as an RN, I did in fact (via verbal report per patient) record a patient’s last BM upon their hospital admission, and each subsequent movement was always recorded (or was supposed to be) during patient hospital stays. : )




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  8. WFPB is the only way to go. No more constipation. I have lived in Asia for the last 11 years and it’s said by many that the asian toilet (known as a squat pot) is the best position to assume when having a BM. However, my preference is a western toilet here in Thailand. I imitate the asian toilet by elevating my feet (and hence raising my knees) about 8-12 inches on a small stool. Works slicker than rain rolling of a roof gutter. I’m 74 and never felt better. The part about a satisfying BM is true. Gives me all kinds of energy.




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  9. BIDET WATER-WASHING Add water-washing of the rectum to this discussion. The bathtub spout & drain provides a good tool for those who don’t have bidet sprays installed. Dr. Mercola sells an inexpensive (~ 30$) bidet attachment for most toilets. Water washing prevents haemorrhoids from forming, because the water causes no friction rub of the sensitive anus area. Water washing cleans the area inside the rectum as well with some practice, Water-washing stimulates a more complete bowel movement for those who may have a tendency to retain fecal material. Avoiding toilet paper reduces the anus contact with the chlorine & other chemicals found in commercial TP, also reducing haemorrhoids. Ecologically much less water is used in Water-Washing than in TP paper-making. The largest use market in forestry is actually TP, so together we can save the world’s forests from their primary TP complication in municipal sewage systems.
    HUMAN FECAL PELLETS
    I’m vegan 29 years, vegetarian 45 years, eat about 80% raw mostly from the garden fresh & have typically one bowel movement every morning & occasionally a second later in the afternoon. When I was in my late teens working in high-mountain Canadian & USGS research of structural geological mapping, our exercise of climbing was so intensive, that my bowel movements came out in uniform consistent deer-like pellet puzzle-pieces without smell.
    GETTING HUMANITY’S SHIT TOGETHER
    Cities & rural areas could be supplying some 30% of human-energy needs (heating, driving etc) through methanization of human, dog & cat fecal matter added with ground kitchen plant-cutting compostables mixed into anaerobic methanization units. capturing the methane, ethanol & fertilizer available from massive volumes of fecal, urine & plant (vegetable/fruit) refuse can supply every population’s energy needs. Fecal, urine & plant material are the smell & health hazard in sewage & garbage which keep waters & materials from reuse, recycling. Such natural gas capture can provide all internal combustion transport needs. Here are 3 films which I helped produce with Radio-Canada visiting Vermont’s cow-power program & Sweden’s human-gas-stations & bus-fleets. https://sites.google.com/site/indigenecommunity/design/5-bio-digestion-toilet




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  10. I eat a mainly Whole Foods plant based diet (I occasionally use maple syrup at home and may eat out- though still vegan and “healthy” – on occasion). I also exercise regularly and drink a fair amount of water. I still am lucky to have one “good” bowel movement a day. I even started taking a probiotic daily and while it has helped some I only go once a day at most. What might the problem be?




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    1. Hi Lindsey: this is Dr. Daniela Sozanski, Moderator with Nutritionfacts.org and Naturopathic Doctor in Atlanta, GA.
      This is a question I have been asked many times, and I must admit that I have seen people reacting very differently when exposed to whole food diets: some go to 2-3 bowel movements a day, and others are at barely one a day with occasional skipping.
      A few thoughts:
      You may naturally need more fiber so doubling up on leafy greens may help; in addition a combination of steel cut oats, oat bran, flax seed and almond milk may work wonders; please visit my Facebook page newhealthahead (new health ahead in one word) for the whole little protocol; warning, you surely need to drink at least one extra liter of water/day to move the fiber bulk along and it may worsen the symptoms for the first few days.
      Equally important, some people may naturally need more magnesium than others, so a focused approach to naturally increase magnesium intake may also prove beneficial: try kelp, one single serving supplies about 750 mg of magnesium; also oats, almonds, cashews and seeds.
      Let me know if it works.
      I hope it helps, Daniela




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  11. Is there an optimal length of fibre for the perfect stool?
    For example is fibre that has been through a blender better or worse for bowel movements?




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  12. In “How not to die” you mentioned the Five-to one-Rule about carbohydrate/fiber.
    I bought organic Scottish oatmeal, The nutrition facts says:
    Total carbohydrates 23 g
    dietary fiber 4g
    soluble fiber 2g
    insoluble fiber 2g
    1. What is the difference between dietary fiber soluble and insoluble fiber?
    2. If I multiply 4×5=20. the fiber content of my oatmeal is below what you recommend, correct?




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  13. Great question! Soluble fiber dissolves in water and can be fermented by intestinal bacteria. Some fatty acids can be formed from these building blocks.

    Insoluble fiber acts like a scrub brush, in some ways, and is also necessary for our overall GI health. Most foods contain both types of fiber, to some degree.

    I am not certain about the five to one rule (although that certainly makes sense to me) so I will post your question to the team. Cheers!




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  14. This article hit home with me and I thought I would share my experience with you. My normal was once a day or atleast that is what I always experienced and thus expected. However, since going on a primarily plant based diet, very little meat and no processed meats, I have become a 2 a day person. But there is also a significant difference. These new movements are fast and complete. There is no sitting on the toilet waiting for something to happen. When I am finished I am finished. Now here is the other great benefit… smell is gone and very little wiping is required.
    My energy levels are higher and I feel leaner. I am not a doctor; however, I have now educated myself through trail and change as to what modifications I need to make to my diet based on my stool. Sounds far fetched but it works.
    I know this is an delicate topic but I thought I would share my experience with you.




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