Should You Sit, Squat, or Lean during a Bowel Movement?

Should You Sit, Squat, or Lean during a Bowel Movement?
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Squatting and leaning can help straighten the anorectal angle, but a healthy enough diet should make bowel movements effortless regardless of positioning.

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Compared to rural African populations eating traditional plant-based diets, white South Africans and black and white Americans not only have more than 50 times the heart disease, 10 times more colon cancer, and more than 50 times more gallstones and appendicitis, but also more than 25 times the rates of so-called pressure diseases—diverticulitis, hemorrhoids, varicose veins, and hiatal hernia.

Bowel movements should be effortless. When they’re not, when we have to strain at stool, the pressure may balloon out-pouchings from our colon, causing diverticulosis, inflate hemorrhoids around the anus, cause the valves in the veins of our legs to fail, causing varicose veins, and even force part of the stomach up through the diaphragm into our chest cavity, causing a hiatal hernia, as I covered previously. When this was first proposed by Dr. Burkitt, he blamed these conditions on the straining caused by a lack of fiber in the diet, but did acknowledge there were alternative explanations. For example, in rural Africa they used a traditional squatting position when they defecated, which may have taken off some of the pressure.

For hundreds of thousands of years, everyone used the squatting position, which may help by straightening the “anorectal angle.” There’s actually a kink right at the end of the rectum, almost a 90-degree angle that helps keep us from pooping our pants when we’re just walking around, but that angle only slightly straightens out in a common sitting posture on the toilet. Maximal straightening out of this angle occurs in a squatting posture, potentially permitting smoother bowel elimination. (I remember sitting in geometry class thinking, “When am I ever going to use this?”; little did I know I would one day be calculating anorectal angles with it—stay in school, kids.)

So how did they figure this out? They filled latex tubes with a radiopaque fluid, stuck them up some volunteers, took X-rays with their hips flexed at various angles, and concluded that flexing the knees towards the chest, like one does squatting, may straighten that angle and reduce the amount of pressure required to achieve emptying of the rectum. But it wasn’t put to the test until 2002, when researchers used defecography, which are X-rays taken while the person is defecating, in sitting and squatting positions.  And indeed, squatting increased the anorectal angle from around 90 degrees all the way up to about 140.

So, should we all get one of those little stools for our stools, like the squatty potty that you put in front of your toilet to step on? No, they don’t seem to work. The researchers tried adding a footstool to decrease sitting height, but it didn’t seem to significantly affect the time it took to empty one’s bowels or significantly decrease the difficulty of defecating. They tried even higher footstools, but people complained of extreme discomfort using them. So, nothing seemed to compare with actual squatting, which may give the maximum advantage, but, in “civilized” countries, it may not be convenient. But, a similar effect can be achieved if you lean forward as you sit, with your hands on or near the floor. They advise all sufferers from constipation to adopt this forward-leaning position when defecating, as the weight of your torso pressing against the thighs may put an extra squeeze on your colon.

But instead of finding ways to add even more pressure, why not get to the root of the problem? The fundamental cause of straining is the effort required to pass unnaturally firm stools. By manipulating the anorectal angle through squatting or leaning you can more easily pass unnaturally firm stools; but why not just treat the cause? And eat enough fiber-containing whole plant foods to create stools so large and so soft that you could pass them effortlessly at any angle. Cardiologist Dr. Joel Kahn once said you know you know you’re eating a plant based diet when “you take longer to pee than to poop.”

But seriously, even squatting does not significantly decrease the pressure gradient that may cause hiatal hernia. It does not prevent that pressure transmission down into the legs that may cause varicose veins. And this is not just a cosmetic issue. Protracted straining can cause heart rhythm disturbances, reduction in blood flow to the heart and brain, sometimes resulting in defecation-related fainting and death. 15 seconds of straining can temporarily cut blood flow to the brain by 21%, cut blood flow to the heart nearly in half, thereby providing a mechanism for the well-known bedpan death syndrome. You think you have to strain sitting; try having a bowel movement on your back. Bearing down for just a few seconds can send your blood pressure up to nearly 170 over 110, which may help account for the notorious frequency of sudden and unexpected deaths of patients while using bedpans in hospitals. Of course, hopefully, if we eat healthy enough, we won’t end up in the hospital to begin with.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Shawn Campbell via Flickr.

Compared to rural African populations eating traditional plant-based diets, white South Africans and black and white Americans not only have more than 50 times the heart disease, 10 times more colon cancer, and more than 50 times more gallstones and appendicitis, but also more than 25 times the rates of so-called pressure diseases—diverticulitis, hemorrhoids, varicose veins, and hiatal hernia.

Bowel movements should be effortless. When they’re not, when we have to strain at stool, the pressure may balloon out-pouchings from our colon, causing diverticulosis, inflate hemorrhoids around the anus, cause the valves in the veins of our legs to fail, causing varicose veins, and even force part of the stomach up through the diaphragm into our chest cavity, causing a hiatal hernia, as I covered previously. When this was first proposed by Dr. Burkitt, he blamed these conditions on the straining caused by a lack of fiber in the diet, but did acknowledge there were alternative explanations. For example, in rural Africa they used a traditional squatting position when they defecated, which may have taken off some of the pressure.

For hundreds of thousands of years, everyone used the squatting position, which may help by straightening the “anorectal angle.” There’s actually a kink right at the end of the rectum, almost a 90-degree angle that helps keep us from pooping our pants when we’re just walking around, but that angle only slightly straightens out in a common sitting posture on the toilet. Maximal straightening out of this angle occurs in a squatting posture, potentially permitting smoother bowel elimination. (I remember sitting in geometry class thinking, “When am I ever going to use this?”; little did I know I would one day be calculating anorectal angles with it—stay in school, kids.)

So how did they figure this out? They filled latex tubes with a radiopaque fluid, stuck them up some volunteers, took X-rays with their hips flexed at various angles, and concluded that flexing the knees towards the chest, like one does squatting, may straighten that angle and reduce the amount of pressure required to achieve emptying of the rectum. But it wasn’t put to the test until 2002, when researchers used defecography, which are X-rays taken while the person is defecating, in sitting and squatting positions.  And indeed, squatting increased the anorectal angle from around 90 degrees all the way up to about 140.

So, should we all get one of those little stools for our stools, like the squatty potty that you put in front of your toilet to step on? No, they don’t seem to work. The researchers tried adding a footstool to decrease sitting height, but it didn’t seem to significantly affect the time it took to empty one’s bowels or significantly decrease the difficulty of defecating. They tried even higher footstools, but people complained of extreme discomfort using them. So, nothing seemed to compare with actual squatting, which may give the maximum advantage, but, in “civilized” countries, it may not be convenient. But, a similar effect can be achieved if you lean forward as you sit, with your hands on or near the floor. They advise all sufferers from constipation to adopt this forward-leaning position when defecating, as the weight of your torso pressing against the thighs may put an extra squeeze on your colon.

But instead of finding ways to add even more pressure, why not get to the root of the problem? The fundamental cause of straining is the effort required to pass unnaturally firm stools. By manipulating the anorectal angle through squatting or leaning you can more easily pass unnaturally firm stools; but why not just treat the cause? And eat enough fiber-containing whole plant foods to create stools so large and so soft that you could pass them effortlessly at any angle. Cardiologist Dr. Joel Kahn once said you know you know you’re eating a plant based diet when “you take longer to pee than to poop.”

But seriously, even squatting does not significantly decrease the pressure gradient that may cause hiatal hernia. It does not prevent that pressure transmission down into the legs that may cause varicose veins. And this is not just a cosmetic issue. Protracted straining can cause heart rhythm disturbances, reduction in blood flow to the heart and brain, sometimes resulting in defecation-related fainting and death. 15 seconds of straining can temporarily cut blood flow to the brain by 21%, cut blood flow to the heart nearly in half, thereby providing a mechanism for the well-known bedpan death syndrome. You think you have to strain sitting; try having a bowel movement on your back. Bearing down for just a few seconds can send your blood pressure up to nearly 170 over 110, which may help account for the notorious frequency of sudden and unexpected deaths of patients while using bedpans in hospitals. Of course, hopefully, if we eat healthy enough, we won’t end up in the hospital to begin with.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Shawn Campbell via Flickr.

Doctor's Note

The “forcing part of your stomach up through the diaphragm into your chest cavity” phenomenon is covered in Diet and Hiatal Hernia. The “ballooning of out-pouchings from your colon” is called diverticulosis. I did a video on this about six years ago (Diverticulosis & Nuts), and I have some new and improved ones coming up soon:

Diverticulosis: When Our Most Common Gut Disorder Hardly Existed and Does Fiber Really Prevent Diverticulosis?

More on that extraordinary African data here:

So excited to be able to slip in a plug for Dr. Kahn’s work. His brand of “interpreventional cardiology” can be found at http://www.drjoelkahn.com.

If you missed the last video in this series, check out How Many Bowel Movements Should You Have Every Day?

If you haven’t yet, you can subscribe to my videos for free by clicking here.

91 responses to “Should You Sit, Squat, or Lean during a Bowel Movement?

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  1. What if we were to create a ‘food science’ division within the CDC that was tasked with doing what Dr. Greger does, which is convey nutrition information based on the latest science. This would be offered to the public not as fact set in stone but our latest best information, so as the science changes so would the recommendations. I know there are ways to set up advisory groups such that they remain faithful to science rather than politics.

    The USDA could still promote US agriculture but would be limited to claims supported by the quarterly or semi-annual CDC nutrition findings. As the science changed so would the ability of the USDA to make claims about food items.

    Our approach to nutrition in this country is a joke and it’s a national shame. I mean that literally and say it with great discouragement. Not only are millions of people dying from consuming junk in place of real food without understanding what they’re doing, but our competitive standing in the world is jeopardized by our abysmal health. The US military lowered its health requirements for entry because they had to to accommodate our declining health. This is just one example and it doesn’t even touch on how diet affects intelligence or the potential for happiness in life, which – all things equal in this digital age – could be argued are more important than a fit military.




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    1. I think it’s a grand idea, but that would be very difficult to set up as the powers that be will do everything they can to block it. They have no interest in exposing the truth, it runs against their profits. They cannot see the long-term benefit to humanity, and how that affects civilization but they can see the numbers for next quarter shrinking. They would have to adjust and they don’t like change. No one likes change, but few have the billions and trillions they do to squelch unprofitable changes at every turn possible. Best of luck.




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    2. An eloquent plea for a sane approach to increasing nutritional education on a nationwide scale, UCBAlum. I feel likewise discouraged given how powerful the profit motive is within the food “industry.” My optimism comes when I see the many urban gardens and farmers’ markets springing up around the country. And when I witness public schools starting to offer healthier food options in the cafeterias. The grassroots efforts will hopefully ramp up and turn things around. And perhaps some of the incremental positive changes within agencies like USDA under Democratic leadership will trickle down, too. UCSCAlum :-)




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      1. Hi Joseph. I finally got around to considering PCRM’s efforts to expand nutrition education to which you have linked. As progressive as my politics is, and as much as I wish PCRM to continue fighting the ‘good fight,’ I have to say that the ENRICH Act makes absolutely no sense whatsoever, and allow me to explain why I believe this is so.

        The ENRICH Act died in the 113th Congress and has a 1% chance of passage in the 114th.
        https://www.govtrack.us/congress/bills/113/hr4427
        https://www.govtrack.us/congress/bills/114/hr1411
        Folks can read this two-page proposed legislation here:
        https://www.govtrack.us/congress/bills/114/hr1411/text

        The bill calls for the Secretary of Health and Human Services to redirect $15million of existing bugdet over a three year period, providing for grants of up to $500,000/year/medical school. This means that up to 10 medical schools per year could possibly benefit (15,000,000/500,000/3)=10.

        On the other hand, let’s take a look at what a measly $500,000/year can do to improve nutrition education among prospective doctors. PCRM is hosting a two-day conference July 31-Aug 1, 2015. The cost of student registration is $310, and two nights at the Grand Hyatt Washington is $189×2=378, for a total of 310+378=$688. $500,000/$688=726. That’s 726 medical students could attend this conference for free. If you divide this by the 10 medical schools that could possibly benefit from the ENRICH Act in any given year, that is 72 medical students from each of these ten medical schools could attend this conference at minimal outlay to themselves. Better than push for the ENRICH Act (which is going nowhere), PCRM should address its donor-class supporters to provide half a million dollars annually to send 726 medical students to attend this conference every year.
        http://www.pcrm.org/health/diets/nutrition-medicine-conference/conference-home

        Again, I want to stress that I am progressive in my politics, but I have to say that legislation such as this feeds into the ‘narrative’ of the Nanny State and is thus counterproductive.




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    3. UCBAlum, I am neither unsympathetic to your concerns, nor an apologist for the status quo. I do want to add something to this discussion especially in light of the Mission Readiness letter provided by Joseph. After all, this forum is literally international in scope and the idea that, as a nation, we are literally too fat to defend America, while no state secret, is most unsettling indeed.

      To begin, it seems the CDC is doing its part to inform the public on a wide range of public health concerns including yours and ours:
      http://www.cdc.gov/HealthyLiving/

      The Mission Readiness letter was signed 4/8/2010. And, on 12/13/2010 President Obama signed into law the overwhelmingly bi-partisan passed Healthy, Hunger-Free Kids Act of 2010:
      https://www.whitehouse.gov/blog/2010/12/13/president-first-lady-child-nutrition-bill-basic-nutrition-they-need-learn-and-grow-a
      https://en.wikipedia.org/wiki/Healthy,_Hunger-Free_Kids_Act_of_2010
      http://www.gpo.gov/fdsys/pkg/PLAW-111publ296/pdf/PLAW-111publ296.pdf

      It takes years to implement laws such as this, it just doesn’t happen overnight. But the law has been/is being implemented as far as I can tell:
      http://www.fns.usda.gov/school-meals/healthy-hunger-free-kids-act

      This is an example of federal implementation of the law, which if we can sit through reading even some of it we can see these USDA rules are actually being implemented at the State and local levels:
      http://www.gpo.gov/fdsys/pkg/FR-2012-01-26/pdf/2012-1010.pdf

      I don’t have any answers. I just want to say that these problems are being addressed. And, as you have pointed out, they are dam* complex and the solutions are long in the making in the sausage factory that is our [insert characterization of your choice here] democracy. Thank you.




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      1. The SAD diet apparently reduces IQs also…in that the US seems hell bent on starting wars it can’t win or finish? (although they are very profitable?) But maybe there is hope after all…if the 1% realize that fat kids can’t fight their wars?

        The solution will be robots? Fat dopey people easier to keep under control…but just wait till the robots figure out what’s going on.




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    4. No doubt that there is plenty of room for improvement on nutritional information coming out of government and industry. There is so much misinformation on the Internet that a large portion of the country thinks they are doing well by following the latest quack diet like Paleo, low-carb, low-fat, and many more that simply do not focus on the nutrition/calorie ratio of whole plant-based products.
      But I do not think it is lack of nutrition knowledge that leads most to follow the addictions that they gathered while growing up. I think most know that french fries or pizza do not have the nutrition of broccoli or berries.
      The country is wasting a lot of money on food stamps and school lunch programs that are allowed to be spent for less than the best nutrition.

      I am certainly all for the best nutritional information being widely disseminated but I do not expect significant changes in the typical Western diet.




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  2. bed pan death. I didn’t think i’d learn anything this video. BPD and complications of straining were informative.

    But as the other Dr. indicated, as fast and easy as urination when eating proper foods. I mentioned leaning in a comment here some time ago.




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  3. OK, being the perpetual smart ass I am, I have a ton of poop jokes I’d like to insert as comments – but I know this really is a serious subject so I am doing my best to restrain myself – but yes, it is a strain to do so.

    I can speak from personal experience that fiber from a plant based vegan diet makes all the difference in the world to both texture and volume of stool. As long time vegan or near vegan the issue is entirely obvious if by chance I don’t eat my normal diet. The difference shows up within 24 hours in the bathroom. My body offers up a kind of bio-feedback which is very non-technical but quite effective – no radioactive dye or x-rays required.

    The information you’ve provided is so simple one would think that those suffering from constipation would quickly adopt a plant based diet. But alas I doubt this will be the actual effect. Rather than eating more healthy, most folks likely just take additional fiber in some form. In point of fact I suggest that this is the advice offered by most doctors with patients suffering from poor bowel function. The vast majority of folks would rather drink a glass of goo than eat whole brown rice, multigrain bread or have a big serving of steamed kale.

    It is sad when the solution to a set of related problems is so simple, yet so often ignored.




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    1. mdouble, I relate to your ‘bio-feedback’ experience exactly. And, isn’t it a relief getting back to the foods that restore the movements we were meant for? Thinking of the reaction of the ‘vast majority of folks’ going vegan reminded me of this post-lawsuit Oprah video I saw on the youtubes. It is extremely well done and worth watching.
      https://www.youtube.com/watch?v=tCw-GMyhJEo




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  4. Thanks for making these videos! It is truly appreciated.
    I have some questions that are a little off topic regarding resistant starch.
    There seems to be an astonishing amount of papers on it, but as a layman it`s hard to get a good picture of benefits, sources etc. as I haven`t found that many trustworthy places like this that have compiled the info.
    Does retrograde RS(from cooling cooked starches) have the same properties as the other type?
    What are the best sources? Cold maize porridge seems to be good.
    And what are the benefits and how do these differ from the benefits of other types of fiber?




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  5. What a thorough and informative video, filled with lots of new terms like “Defecography” , “recto-anal angle”, and “bed pan death syndrome”.




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  6. All this makes sense as regards defecation, but I’d love to see a Nutrition Facts video about the interaction between sitting/squatting and the health of the pelvic floor muscles– especially from a women’s health standpoint. Does a lack of squat-developed tone in the pelvic floor lead to complications during childbirth, and contribute to common post-partum issues like incontinence?




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  7. I have IBS (my main problem is bloating/distention), but I’ve noticed
    that my stomach/intestines can’t handle too much fiber. I get very
    bloated and constipated. So I’ve eaten mainly basmati rice and
    vegetables and some chickpeas the last couple of weeks and the last 10
    days I’ve had trouble on the toilet. The following is TMI.. just so you
    guys know..
    But my stool is just gooey.. It used to be “perfect”, but the last
    around 11 days I’ve done chocolate balls in the evening that contains
    dates and oats and cocoa powder.. and that contains a lot of fiber.. And
    my belly is much more distended and I have just too much air in my
    belly and a couple of days ago when I went to the bathroom it was like
    fireworks in their when I pooped :( I really can’t handle fiber
    apparently.. and not dates either I guess :( And now I have pain down
    there when I touch it, even lightly with the paper :( UHHHHHHHHH :(




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    1. Hi Jenny. Nothing is “TMI” considering this video is about the best way to poop! Ugh. It sounds like you are in some pain :( My sincere condolences. Here are some videos on irritable bowel syndrome. It is a complex disorder with no known cause, but diet has been shown to help. Many foods are lower in fiber. Tofu, nut butters, pasta, and rice (white). Juicing or peeling foods may be an option, too. Has you doctor told you to limit fiber? What strategies are you trying to help tackle these painful feelings? I may ask one of our NF volunteer doctors to weigh-in. Thanks for your note and best of luck finding relief lets keep this conversation going.




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      1. This may not help Jenny, but when I was pregnant with my last child I had a problem with hemorrhoids and grated raw potato was so soothing. I just loved wiping my bum with grated potato! And leaving a little bit on there. Have we reached TMI yet, Joseph?




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      2. Thanks for your answer Joseph!
        I don’t live in the US, I live in Sweden, and the doctors here don’t know a squat about IBS. They say to just eat more fiber and it will get better. But it doesn’t.
        I’ve tried out the low FODMAP diet and have stayed away from everything on it, but I get kinda bored of it after a while and start to eat dates again, which is a no-no on the diet. I used to eat sugary things etc but haven’t done that for a while so I have no “treats” nowadays except for the chocolate date balls. That’s why I always get back to them. Popcorn popped in coconut oil makes me feel bad as well. And so many say that keeping a low fat intake is the best a person can do,.. Even if you have IBS or not. I’m very sensitive to bad food combining. When I eat potato chips, which is very rare, and eat some dates after, I immediately after feel it in my stomach and I get very bloated and the next day it’s not fun visiting the bathroom. It gets like fireworks then and it’s very annoying. I can’t eat food, since that makes me non-hard on the toilet as well..
        I’m a vegan btw.. And have been for over 2 yrs. And I don’t eat gluten since 2 yrs back either. The doctor needed to see if I was gluten intolerant (celiac disease), so I had to eat gluten for 1,5 months.. Before that I had been without gluten for 7 months.. And then needed to eat it again for 1,5 months to take tests… I haven’t felt so bad, like ever, like when I ate gluten, it was awful… I couldn’t almost hold it in.. My stomach was in so much pain. But after those 1,5 months I did the test, and I wasn’t intolerant to gluten… But I’m still VERY sensitive to it, even though I wasn’t intolerant…




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  8. Wouldn’t lifting weights cause the same straining problems as those described in the video? Also, it seems to me that eating a fiber-rich diet is only part of the equation. The other part is exercise, which, as I understand it, helps promote the peristaltic action of the colon.




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    1. Good points! The 3 F’s come to mind from an old Nutrition Course (or maybe even my Mother): Fluid, Fiber and (F)Physical activity. Surely moving the body more will help peristaltic action. And lifting heavy weights might cause unnecessary strain leading to hernia. Life with Care!




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  9. It surprises me that the squatty potty wasn’t found helpful. I have 2 piles of 3 bricks (my cheap version) on either side of my throne and have found them to be enormously helpful. I simply put my feet on top of the bricks and do my thing. The bricks are not that high, they just raise my knees up a little higher than my hip. I do lean a little forward. Bottom line, is i will go out of my way to use the bricks.




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  10. Do you have any suggestions for me? I have been eating whole food plant based for over 2 years, but I still have constipation. I drink 3 liters of water per day, and eat mostly fruits and veggies, some raw and some cooked. I am still having trouble with hard stools, and my back hurts badly every morning when I wake up, until I have my first bowel movement, as if the hard stool is pressing into my back causing back pain. I am using the bathroom everyday though, but it still feels like I am backed up and I am getting some varicose veins even though I am still pretty young.




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    1. Just a thought – one which i’m sure many people don’t think about – but the one thing that blocks me up is vegetables. I can have a little on occasion…but if I do so daily – larger stools that do not want to move. Seems to be more green vegetables, I have no problems with mushrooms & bean sprouts – but leaves of any kind, broccoli, etc…forget it. Too much fruit can do it too – especially bananas.
      A diet high in whole grain bread keeps me regular with smaller & effortless toilet time : )
      I have learnt everyone is different and you need to experiment as to what your body likes and doesn’t. Just because it is natural does not mean your body will appreciate it.




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      1. I eat lots of fruits and veggies, but that is almost all I eat. I do not eat bananas but I do eat mostly fruit, sometimes rice or oatmeal.




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    2. Always fascinated and happy to see a name like Diabetes Cured. To your point, when I became type one diabetic I was of course thirsty all the time so I figured that I needed to drink more and it probably kept me from going into a coma. So I got in the habit of drinking a good deal of water. I also lived in Arizona and found that I had no problem running in 100 degree weather if I drank 1.5 liters of water before hand. (I did slosh for a few blocks). Point is I really don’t think 3 liters is enough. Probably should be more like 4 or 5 unless you are sedentary and inside all the time. Also, as to diet, you did not mention pulses. I try to get beans at least 2 times per day and it does help. I also add in flax seed whenever I have the chance. That’s always my weird breakfast concoction of mushrooms, ground flax,black eyed peas, lots of greens, and tomatoes all slow cooked but with the greens added last and only to wilt. Pretty good with the right spices.




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      1. Thanks Stewart, mine was severe type 2 diabetes, and I was able to go off blood sugar medication in only 10 days of being vegan! A1C from 9.0 down to 4.7.

        If pulse is the same thing as smoothie, I have fruit smoothies every day! Great suggestions, I will try more water and adding more flax seeds and report back, thanks!




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    3. I have the same problem – lower front and back pain until I have a bowel movement. The pain is so severe that it wakes me during the night and I am unable to bend over. I had a colonoscopy, which determined I had a “very narrow sigmoid”. I eat a very high fiber diet and that usually helps. I also occasionally use a suppository to get things moving.




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      1. Interesting, do you need a colonoscopy to diagnose that? I am a 30 year old female with no plans to have a colonoscopy in the near future. Is there anything natural you can do to reverse the narrow sigmoid?




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        1. I am not sure if there are other ways to diagnose a narrow sigmoid. My doctor suggested fiber supplements and stool softeners, which I chose not to take. I have the more success with a plant based diet, which includes at least a cup of beans everyday! This allows me to eliminate first thing in the morning so the pain is not interfering with my day.




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  11. Hi Joseph, I have an unrelated question that I don’t know where to ask, so I’ll ask here: do all dietitians (meaning the ones like you who have an actual college degree for the practice) count calories to prescribe a diet for a patient? Or are there different methods other than calorie counting that you may use/adopt in your practice? I guess what I’m asking is, is there a norm in regards to calorie counting for the practice of your profession?
    Thank you in advance for clarifying.




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    1. Hey, JV. That is an excellent question! Many RD’s differ in their dietary approaches. Some work for institutions that dictate what they prescribe like a hospital, school, or in a research setting (think clinical study). Private practice RD’s have more flexibility. I let folks who want to count calories count them, but it’s been my experience that 99% they prefer not to count. Calorie counting is hard for some. It takes time and lots of work tracking. I find that additional stress and worry when it comes to counting calories takes away from healing. Focusing on the right foods takes counting out of the equation. Proof of this method comes from this study I helped facilitate and co-author A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study. In this study weight loss and better glycemic control was achieved without calorie counting or portion control. Yes, I told folks to eat as much food as they wanted and yet they still lost weight! Dr. Greger highlights this study in the video Plant-based Workplace Intervention. Other studies that use this approach can be found in Dr. Barnard’s research where study participants received either a low-fat strict plant-based diet or a typical diet for diabetes and found significant changes in weight loss and insulin levels. Dr. Greger presents the study in this video. So it appears this type of approach not counting calories works for weight loss and diabetes management. I have helped publish other research on migraine headaches and diabetic neuropathy with the same approach and same results. (NOTE: If you want me to link those studies I can).

      Lastly, have you seen these videos on calorie restriction? Calorie restriction vs plant-based diet and Benefit of calorie restriction without actually restricting.

      So there are many approaches and not one is right or wrong, but I’ve found avoiding the calorie counting burden is preferred. Thanks for asking!




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      1. Thank you for such a comprehensive response Joseph! Very clarifying and deeply interesting! Will look into the researches you mentioned! And how incredible that I ended up asking you about a subject that you’ve even researched on yourself!
        I just have one lingering question on it though: I understand it has been proven to work for weight loss, but how about applying this approach for weight gain on people who want/need to gain healthy weight? And I don’t mean just a few pounds but for gaining let’s say over 10 to 15 pounds? Or even 20? Do you think this is possible by applying the same approach?
        Or at least is it like people reach their ideal weight regardless of whether that is weight gain or weight loss?
        (I’m asking regarding the non-calorie counting on a low-fat vegan diet like the researches you mentioned).
        Hope I was clear in my phrasing of this, if not, do let me know, I’ll try to ask in a clearer way! :)

        Again thank you so very much for your input!




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        1. :-) Well the approach will be much much harder! This is for weight loss and disease prevention. If someone needs to gain weight I may first ask why? Due to a disease or because they are malnourished and simply not eating enough? A different ball game altogether and I would need more information. Adding calories in any form is not ideal (ice cream, butter), but surely eating more calories from whole foods and perhaps focusing on healthful fat sources could work. More nuts and seeds, avocados, high kcal smoothies, etc. So no, the approach would not be similar. In fact the opposite, as I would encourage calorie counting and monitoring if someone in a developed country needed to add 20 pounds. Again, need more information!




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  12. Thank you, Dr. Greger, for introducing Dr. Kahn. I had never heard of him…until now! Which brings me to this thought: how about an “Angies List”-esque website for plant-based health care providers? I gotta believe that if it existed, people would come. I certainly would. In honor of your generous spirit, I offer this idea to any enterprising soul who wants to run with it and make it a reality on one condition: they have to inform you about the website so you can link to it in Doctor’s Note.




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    1. Sounds neat! I think a list like this may even exists. Plantrician Project and maybe others. I have a post with links about finding a doctor (or how to talk with your doctor) that is more nutrition-focused. Dr. Kahn has a website. But I see what you mean. If one is created (or I am missing one that exists) please add it here! I will even consider writing a blog post about the many plant-focused health care folks that exist, and then maybe Dr. Greger can link it within his ‘Doctor’s Note’ in related videos? Good thoughts! To be continued… Thanks, Lawrence.




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  13. TOPIC NOT POOP: sorry to spoil the fun but am looking for some “partners” in ADHD diet and lifestyle and management without drugs. Just got blown off by Alan Brown and fired from my job, so no extra money to throw at it and books or videos. Any good input fantastically appreciated. Be glad to go direct and not clog up the arteries of nutritional dataflow. But will say that seeking to minimize dietary negatives (fake coloring and such) is how I found Dr. Greger. and ultimately became part of this troupe.




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    1. Have been living in Asia since 1992 and this is the only way I go. This happens to be Japanese, but other similar versions can be found all over Asia. When I encounter a ‘western toilet, I just lift the seat up and squat on the rim of the bowl. Works perfectly well.




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        1. appears that your “reply” fell in the wrong place. As to TOPIC POOP-sure whatever suits you. WFPB means it’s irrelevant to me. Takes as long to wipe as to poop whether squatting in the woods or sitting on a standard American throne (SAT) or upon a handmade composting outhouse, or conventional.




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    2. Wade: I don’t know if there is anything there or not, but have you checked out Yahoo groups? Yahoo seems to have groups for just about any interest and they are free. It allows you to connect/share ideas with people around the world who share your interest. Just a thought.

      If you are interested in learning more about Yahoo Groups, here’s what Wikipedia says:
      https://en.wikipedia.org/wiki/Yahoo!_Groups

      Here’s where you can search for groups by subject:
      https://groups.yahoo.com/neo

      Good luck!




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      1. Thanks Thea. I did look at groups on Craigslist, oh the mess they are. I really enjoy forums and spend hours every day replying and posting to various ones. When I seek out ADHD type forums or sub-sections I never do get (have yet) engaged like I do in all my other interests. I kept hammering at it yesterday and messaged/spoke to three different ADHD folks. Of the two professionals- one is a coach who is going to give me a call soon. I might look at those as well.




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    3. Follow up reply: Even if there isn’t a group exactly like you are talking about already, you might be able to piggy back on an existing group that talks about ADHD or lifestyle w/out drugs separately and bring in the second topic to see if people have the same interest. Then you could start a splinter group or at least get support in the main group from people who are also interested.




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  14. I see info on eliminations per day/week etc…but not much on transit times. Wondering what is the typical time from when somethings goes in the mouth and when it comes out the other end?

    If I eat my typical 90-95% veggie foods things go well….get into the nuts or cottage cheese….etc…things can slow way down.

    From one walking alimentary canal to another….keep them canals on the move…




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    1. Hi Fred, this video touches on it briefly: http://nutritionfacts.org/video/food-mass-transit/

      I believe Dr. Greger had a more detailed overview somewhere, but I can’t find the video. It may have been in one of the hour-long videos. I thought I recalled details about transit time between different countries and even different U.S. cities (with some jokes about cranky New Yorkers). Have you seen any of the year-in-review lectures yet?




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    2. Hi Fred. b00mer gave a great link below. Dr. Greger address transit time in this blog. Make sure to click the many hyperlinks within that blog as transit time is discussed in many of the videos like “Stool Size Matters




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    3. Fred, This is a very delayed reply to a comment you made regarding 9 months ago referencing the NutritionFacts.org video “Should You Sit, Squat or Lean During a Bowel Movement?” You wondered “what is the typical time from something goes in the mouth and when it comes out the other end? ” As one of the new NF moderators, I’m looking over old videos to see if there were unaddressed questions. What you were referring to is called transit time (from eating to excreting) which can range from 24 to 72 hours. As you are aware different foods transit at different times. Hydration can also affect timing, but fatty or high protein animal foods, as you are aware, can slow down the process. Glad you’re eating 90-95 % veggie foods which will as you said, “keep them canals on he move.”




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  15. When I lived in Japan in the early 70’s, our toilet was flush to the floor. As an MD, I have seen fainting, pulmonary emboli, often with death or severe morbidity in hospitals after straining at a BM. As a patient having surgery, I try to eat lots of fruits and vegetables before and after surgery, hydrate, and have figs/dates/prunes on hand. Just falls themselves may be catastrophic in the fragile. I just cannot understand why hospitals serve such lousy food. In over 40 years of working in hospitals, I only ate their food about 5 times!. Please note that stress may play a large role in hemorrhoid development as well.




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    1. Thanks for sharing, Dr. Haile. I would add not just poor food, but fast-food!!! I feel like I am taking crazy pills sometimes to learn that McDonalds and Burger King are offered at Children’s Hospitals and V.A.’s alike. Here is a report on how Hospitals contract with fast-food. Disheartening to say the least. We need more doctors like you who focus on nutrition, and bowel movements. :-)




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      1. Health care is under too much control of the drug companies: we need good food/hydration/exercise and simple strategies such as the forward position at no to low cost. Thank you.




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  16. Hemorrhoids, back to the theme here of straining at the toilet. Mine were never from straining to go, couldn’t be as haven’t had that issue in years-although only a recent convert to WFPB. I did strain sometimes to NOT go*, pretty sure that’s just a sphincter thing-not a system wide pressure distribution. Don’t know if that may have contributed to my encounters with hemorrhoids, but am nearly convinced (knocks wood 3x) that WFPB plus flaxseed has everything so wonderful down there-that the “H” may never be a problem again. I’m sure that mine were caused by lifting heavy things, which i do with my legs and not my back. Where some men get hernias, I got the other. I lift more carefully since making that connection, but also know that my diet has improved everything arterial and otherwise in my body. The benefits observed tally is getting bigger every day.

    *This is where flaxseed must be tried to fully understand. “Bulking” up means LESS density, less density means less pressure as there is more “give” in the contents of the colon. Net effect personally observed: much more _manageable urgency_ in regard to defecation. This is a very good thing.




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    1. What should be the fat parentage (in calories) in a healthy diet? should be it be 10%? 20%?
      Are there any scientific works on that? thanks.




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      1. Ron B: I think the answer depends a bit on how healthy the person is. Some people who are very sick with certain diseases, like heart disease, need to have diets with the absolute minimum fat. Where as healthy people may do better or at least fine with a bit more fat. It may also depend a bit on lifestyle. Are we talking about an athlete or a couch potato?

        Putting that aside, assuming we are talking about a mythical typical person, I like to use the Okinawans as my starting guide for these types of questions. Traditional Okinawans are some of the healthiest people on the planet. Their fat amount as a percentage of calories was 6%. (Data derived from analysis of U.S. National Archives, archived food records, 1949 and based on survey of 2279 persons.)

        Now I temper that information with the fact that I’m not Okinawan and my situation is different. Doctors who have had great success in getting people to a healthy place and then keeping them healthy for years and years (such as Dr. McDougal, Dr. Barnard, Dr. Esselstyn, etc) seem to aim for about 8-10% fat.

        But you could still argue that those diets are for sick people. So, here’s another way to get at an answer: We have a ton of scientific works backing up the benefits of eating a whole food plant based (WFPB) diet free of meat, dairy and eggs. People on this site who generally follow that diet and who use a website tool called cronometer to track their nutrients seem to report about 12-15% fat. That’s just what they get naturally when they eat beans, intact grains, fruits, veggies and 1-2 ounces of nuts. And maybe a trivial amount of oil or avocado. It’s not a definitive answer, but we seem to have enough evidence support this range of fat as a healthy amount.

        Could more fat be healthy? I would guess that it depends on the package/food that you are eating (fat from whole, non-tropical nuts being more healthy than fat from animal sources) and other factors such as exercise, etc.

        What do you think?




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        1. I thought of another factor to consider: age of the person. Children have tiny tummies and it is my understanding (from reading VRG (vegetarian resource group), a well-researched site) that kids can have trouble getting enough calories from bulky health foods like broccoli. So, kids need to eat more calorie-dense foods (compared to adults), which is likely to include foods like nuts and full-fat tofu in order to squeeze in all the calories they need. My conclusion from this info is that maybe kids either need or can better tolerate more fat (from healthy foods) compared to adults. That’s just a theory I have.




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          1. Thea, thanks for your reply.
            I’m asking this because: I eat whole food plant based diet, and I use cronometer.
            Apart from the standard stuff of whole food plant (e.g., fruits, vegetables, etc) I also eat:
            2 table spoon of flax seed, 1 oz (one handful) of walnuts (or almonds) and 4 gr of raw cacao nibs per day.
            Overall I consume ~2300 calories (I exercise a lot). I feel great, and in great health.

            And here is the punch line: I found out (by cronometer) that I consume 20% calories from fat.
            Now, on one hand I hear that the goal is 10% (e.g., the famous 80-10-10 diet), on the other hand Dr. Greger claims that nuts, flax seeds & raw cacao nibs are healthy.
            so, what is the right way?
            I can easily give up the nuts & seeds and eat fruits instead, but is that the right way? I’m not sure.




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            1. Ron B: Ah. I can see where you are coming from. It is a good question/concern. I just don’t think there is a 100% known answer. In other words, I don’t think we have enough evidence for anyone to tell you that your diet is not healthy. (But I’m not an expert, so take that for whatever it is worth.) From my perspective, you sound like someone who is a healthy adult male who is eating an extremely healthy diet. So, if it were me, I wouldn’t worry about the fat percent. Though I can understand always wanting to tweak one’s diet to do just a bit better. In your case, I think most people (myself included) can only dream of getting where you are right now…

              One thing that struck me about your post is that it’s pretty shocking how easy it is to get to 20%.

              I am curious: What would cronometer say if you took out the 4 gr of cacao nibs? I agree that they are probably pretty healthy, especially in the context of your diet, but if I were going to give up one of those higher fatty foods, it would be the nibs over the nuts and seeds. Not because I have hard evidence to against the nibs, but because we have such good evidence in support of the flaxseeds and walnuts. And the evidence in support of the cacao just seems to me to be less solid. And the evidence against saturated fat seems to be pretty good (though maybe more just for saturated fat from animal sources…) But I’m not saying you should give up the nibs. I’m just curious how much the nibs affect your fat %. (Not that you have to answer. It is just my curiosity.)

              Maybe someone else will chime in on their opinion about the fat %. My bottom line for your case is: Since I am starting to read the book Whole, and since you are eating such great whole foods, focusing on fat % doesn’t seem worth your energy.

              Good luck!




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            2. Ron, do you have a specific health condition which indicates that you should be aiming for a very low fat diet, such as the 80-10-10? If not, it seems that the conservative way to go would be to take the lower bound of the official guideline (20-35% calories from fat), and leave it at that.

              My experience differs from Thea’s in that I find it hard to get down to 20% fat or below (too many nuts & seeds, probably). Right now I’m probably getting around 60 carbs/ 30 fat/ 10% protein (I find it a lot easier to go easy on the protein, and have to force myself to eat my beans and tofu). But everyone’s different. Going mainly by the official recommendations (WHO, USDA, etc.) and choosing their midpoints, the most sensible macronutrient ratios would be something like 60% carbs, 15% protein, and 25% fat. But I think climate and activity also have a lot to do with the ideal ratio. Hotter climates would indicate more carbs and less fat; mostly aerobic exertion would require more carbs and less protein, while weigh-lifting or resistance training probably benefits from more protein (and less carbs). That’s just my hunch.

              Even with my getting 30-35% calories from fat, my TC (170) isn’t too bad, nor the LDL (87).One of these days I’ll get motivated to go low fat, and I’d be curious to see what effect, if any this has on my cholesterol. When I was very active–doing 3-4 hrs. of strenuous cycling for a few months, my total cholesterol got down to 145, so I think activity may play as large a role as diet (I wasn’t totally vegan back then).




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              1. Thanks Jason & Thea. This discussion is very helpful.
                I do have mild systolic hypertension (130), so I take 4 TS (40 gr) of flax seeds each day.
                Also 1 oz of nuts per day. This leads me to 20% fat and roughly 6 gr of saturated fat.
                Blood pressure seems to be improved. Regarding LDL, I had 120 before 3 years, and now after becoming vegan I have LDL of 68 (HDL stayed 55 as before). So, there is no question the vegan diet is great…
                I just want to point out:
                It’s very difficult to go below 20% fat and 6 gr saturated fat per day. I’m not sure it’s healthier. As you can see in my diet: only flax seeds and 1 oz of nuts (rest of diet is only non-fat whole food plant based), and I have 20%.
                When you read Dr. Greger recommendations he doesn’t mention the “right” percentage, on one hand. On the other hand he does talk about low fat vegan diet. So… What does “low fat” means? 20%? 30%?




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  17. When I was in China (20 yrs ago), the “hole in the floor” toilets were ubiquitous. We dubbed them “squatty potties” because you placed your feet on either side of the hole and squatted. But, if you went to “fancier” places in China they had “Western toilets”. Oddly, I noticed that the toilet seats on public Western toilets were always dirty and scuffed up where the thighs would normally land in a seated position. I deduced that some Chinese had never been instructed in the use of Western toilets and were placing their feet on the seat in order to squat, thus roughing up the finish and dirtying the seat. Not wanting to sit where someone had just stood with their dirty shoes, I did the same – I climbed up and squatted on a Western toilet. Fast forward 19 yrs to when I heard of the product mentioned in this video and about the “angle”. Instead of buying the product, I began squatting on our home toilets for bowel movements. (FYI – for women – don’t try to urinate while squatting on a Western toilet – it goes everywhere – you have to sit down for that.) At first it was hard to balance and I had to hold on to something (the wall, the sink, the toilet paper dispenser, etc.), but now it is easy and natural to balance without holding. (I do Yoga – it’s basically malasana position without the mudra.) I do remove my shoes first to avoid the dirty, scuffed seat scenario. It must look odd in a public bathroom… you know, when you look under the door to see if the stall is available… what they see is just a pair of shoes! ha ha ha! I wonder what they think when they see that!? But I’d rather put my socks on a public seat than my bare thighs anyway! I’ve been doing it about a year – I have never fallen in once! Has it been beneficial? I spent my whole life terribly constipated on a normal American diet. By FAR the MOST helpful and influential change was not how I sat, but what I ate. Within 2 weeks of switching to whole-food plant-based (WFPB) diet, I was going once or twice a day (seated), as opposed to once or twice a MONTH! Before WFPB it would take a lot of straining, a lot of time, a lot of pain, and often even tearing of the anus. It was so bad that I actually had to go lay down and rest afterward. It was miserable (but great for wilderness backpacking/camping because I never had to dig a hole for a BM the whole trip!). After WFPB diet, I got an “urge” at least every day, and as mentioned in this video, it took less time to make a BM than it did to empty my bladder! (Empty bladder plus washing hands was timed at 1 min and 30 seconds.) No pushing, no pain, no tears, no concern that it might be too big/hard to flush down – soft, smooth, easy – no effort, just “let go” and out it comes. Back to the benefit of squatting: who cares after getting such relief from changing diet? You do? OK. I’ll tell you. The biggest difference is that cleaning up is easier/quicker because the affected area is more exposed and the stool may pass by without getting other adjacent parts dirty. (Yuck, sorry). Technique: I am a petite person with narrow hips – I don’t know if a larger person would feel comfortable because the placement of your feet is restricted by the width of the toilet. You can try flat footed on the sides (if you do not practice Yoga, you may not be able to do this), you can try tip-toe on the sides where you’re sort of sitting down on your elevated heels (almost), and if flexibility is still an issue, you can put your heels on the front part of the toilet allowing the front half of your feet to point downwards of the front of the toilet and sort of sit on your heels. Or you can do just one leg like that and sit normal with the other leg. Caution: I do this directly on the seat – I do not lift the seat – because there is man-pee on the rim that I do not want on my socks! However, you need to check the seat for stability first. Make sure it will not slide left and right. Make sure it is strong enough to bear your weight. I am 105 lbs. I can squat on a fairly flimsy hollow plastic seat – but barely. So you may want to make sure the seat is made of a solid material – maybe not molded plastic… And please make sure you have something to hold on to, or suddenly grab, in case you start to lose balance! Enjoy!




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    1. ReluctantVegan: This is a great post. It was kind of you to take the time to describe some technique and dos and donts. I have heard of the idea of squatting on western style toilets, but this is the first time I have been inspired to try. Don’t know if will mind you, but I’m thinking seriously about it.

      You had me smiling in a couple of places. Glad you never fell in! ;-)




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    2. Forgot to say: Pull the waste band of your trousers down to the crease of your knee NOT all the way down to your ankles or you may get an unpleasant surprise.




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      1. I didn’t want to do it, but you made me do a Google image search for ‘malasana position without the mudra.’ Congratulations on being the most fit vegan lady in the world! Gives a whole new meaning to ‘Crouching Tiger, Hidden Dragon.’ ;-)




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        1. LOL Ha! NOT. I did the same on google and have now edited the post to from malasana to Upavesasana. Yeah – I can’t do those bizarre positions that came up on google.




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  18. Anyone interested in further information on Squatting to go to the loo can visit my website………..www.emptyingthebowel,com




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  19. Okay more about poop than I thought I’d ever care about.

    I’ll never forget when living in Japan in the early 70’s… Their toilets were flush to the floor. Everyone had to squat straddled over a toilet flush to the floor… They appeared to know something about this phenomenon we’ll before the American outhouse.




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  20. Last year I first heard about the “squatty potty from one of my health advisers. Being curious by nature I tried it, using the grandkids step stool for the toilet at home and a box at work. I liked it. For me it facilitates the process on the toilet and also it has another benefit. Last year I started on a driving route at work and the muscles in my back started acting up. Research showed that the common advice for truck drivers to get back relief is to do back stretches several times a day. After I started to use my toilet step stools I found I no longer needed to do back stretches and my back has been fine ever since. Plant based for 5 years.




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  21. There’s a product called “Nature’s Platform,” which one can find on the internet, which is much better than the “squatty potty” that Dr. Greger referred to in the video. It’s a flat platform that fits directly over the toilet boil (not the cover) and is supported by a base that stabilizes it against the floor. You simply climb onto the platform and squat. The manufacturer advises you to take off your pants before squatting, but I’ve found that you can simply drop them once you’re on the platform and they stay conveniently out of the way.

    Squatting in this way is definitely more “efficient” than in the standard sitting position. You do have to be able to squat down all the way or nearly all the way, however, which I am able to do, but which many people find difficult or impossible. A complete squat, which is often called “the Asian squat,” is one that many Westerners cannot negotiate. So for them, it wouldn’t be practical, because their joints aren’t flexible enough. If you’ve been squatting since childhood and have maintained your flexibility, it shouldn’t be a problem, unless you’re older and your joints have grown stiff and arthritic. So for a lot of people, the seated toilet is better, more accommodative.

    I’ve tried the “squatty potty” (as pitched on “The Shark Tank”) and found it impossible to use, so I returned it for a refund. A full squat, using “Nature’s Platform” is far superior, because it really is nature’s preferred method. :-)




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  22. Very surprised that you claim the Squatty Potty doesn’t work. I have been using it for years and have a difficult time going without it. I see tremendous benefit from my Squatty Potty and wouldn’t be without it.




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  23. I couldn’t help but click on the link to this video, and now I can’t help but leave a comment to the effect that I feel terrible for people who must be told how to properly take a shit…




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  24. What about “bearing down” during the second stage of labor, Does that also cause oxygen loss? Does a lack of squat-developed tone in the pelvic floor lead to complications during childbirth, and contribute to common post-partum issues like incontinence?




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  25. I don’t understand…Im on a vegan diet…I eat lots of beans, oats, fruits, and everyday for the past week I have had bad constipation and today had blood in the stool and called my doctor (since I just had a fecal occult test that was positive back 6 months ago) she said to take miralax and try to increase fiber intake even more? I don’t understand what am I doing wrong?

    Please help. she said my issue is most likely due to external hemorrhoids, can these heal? I have health related anxiety with panic attacks, and am afraid now. what do I do?




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  26. Hi Doctor. Big fan of your website. I watch your videos all the time. I’m doing a geriatric psych rotation right now during my 4th year of medical school. Why does constipation cause altered mental status? Thanks.




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  27. “longer to pee then poop…” That’s funny. About two years ago my GP, during a routine checkup asked about my bowel movements. I said, “it takes me longer to urinate than it does to defecate.” BTW, I’m not a vegan, but I must be doing a few things right. My only problem is I have 2 significant BMs before lunch (then I’m good for the day). The first shortly after breakfast, which is no problem because I’m home, the second within the next two hours, which can be difficult if I’m on the road. No diarrhea, no loose stools, just a sense of urgency. Guess mother nature waits for no one…




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  28. There was a youtube video I saw once, where a guy simply strained and tensed his upper body (while standing) for 25 secs and then he fainted (dropped to the floor like a brick). Most of the of the comments (and I) even thought that it was faked… that force-induce fainting is possible.
    I do recall forcing my poop out and feeling light headed and even started seeing stars… well I can only imagine.




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  29. I like my Squatty Pottty! I am a woman that does have regular stool, so that is not why I got the squatty potty. It makes wiping my butt so much easier. Angles my legs up and my butt forward. Making easier access for my toilet paper to reach it’s target and do a nice smooth job.




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