Stool Size Matters

Stool Size Matters
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Larger bowel movements are associated with lower risk of appendicitis, colon cancer, constipation, and diverticulitis.

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The bigger our bowel movements, the healthier we may be. The risk of low stool weight includes bowel cancer, diverticular disease, appendicitis, various anal diseases—even, perhaps, the healthfulness of breast tissue.

From a study of 23 populations across a dozen countries, a graph of average daily stool weight versus colon cancer incidence. As you can see, once you get down around half a pound (200 grams or so), colon cancer rates really seem to skyrocket. And once people start dropping quarter-pounders, colon cancer incidence quadruples.

The link between stool size and colon cancer may be related to transit time; the number of hours it takes for food to go from mouth to anus. The larger our stool, the quicker the transit time, the easier it is for our intestines to move things along.

People don’t realize you can have daily bowel movements, and still be effectively constipated. You can be regular, but five days late.

What you’re flushing today you may have eaten last week. If you want to test it for yourself, all you need to do is eat a big bowl of beets and see when things turns pretty in pink. And ideally, it should be down in the 24- to 36-hour range to reach that half-pound target.

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 Dianne Moore.

Please consider volunteering to help out on the site.

The bigger our bowel movements, the healthier we may be. The risk of low stool weight includes bowel cancer, diverticular disease, appendicitis, various anal diseases—even, perhaps, the healthfulness of breast tissue.

From a study of 23 populations across a dozen countries, a graph of average daily stool weight versus colon cancer incidence. As you can see, once you get down around half a pound (200 grams or so), colon cancer rates really seem to skyrocket. And once people start dropping quarter-pounders, colon cancer incidence quadruples.

The link between stool size and colon cancer may be related to transit time; the number of hours it takes for food to go from mouth to anus. The larger our stool, the quicker the transit time, the easier it is for our intestines to move things along.

People don’t realize you can have daily bowel movements, and still be effectively constipated. You can be regular, but five days late.

What you’re flushing today you may have eaten last week. If you want to test it for yourself, all you need to do is eat a big bowl of beets and see when things turns pretty in pink. And ideally, it should be down in the 24- to 36-hour range to reach that half-pound target.

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 Dianne Moore.

Please consider volunteering to help out on the site.

Doctor's Note

For more info on fiber intake and colon health, check out these videos:
Breast Cancer and Constipation
Can Flax Seeds Help Prevent Breast Cancer?
Fiber vs. Breast Cancer
Breast Cancer Survival and Lignan Intake

And be sure to check out my other videos on bowel movements

Also check out my associated blog posts: Stool Size and Breast Cancer RiskBowel Movements: the scoop on poopOptimal Phytosterol Dose and Source; and Best Treatment for Constipation.

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

48 responses to “Stool Size Matters

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  1. Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out the other videos on bowel movements. Also, there are 1,449 subjects covered in my other videos–please feel free to explore them!

    1. Hi Dr Greger. I so value the research and info you impart. I am 74 (F) and have been told that I need not have any more colonoscopies. I have spastic colon and an abundance of diverticula in spite of being a vegetarian, now vegan, for 32 years. My mother died of colon cancer. Therefore, I have been diligent about getting regular exams. Lately I am not forming full stools in spite of the high fiber diet. I have ordered some bowel treatment items from Dr. Schultze’s site. I am afraid not to have the colonoscopies. What would you suggest to a patient presenting as I am? Thank you very much. Lynn

      1. Hi Dr. Greger.
        I have been vegan for 8 years now but I eat a lot of junkie vegan foods. The Impossible burger is my favorite!! As a result I am 70lbs heavier than I was eating meat and potatoes. I struggle to stay plant based and recently, being a healthy plant based eater but when I eat a lot of veggies and fruits, I have diarrhea and also feel unsatisfied.
        Any advice on how to get healthy and lose weight without going to the bathroom constantly?

        1. Hello Taxi, and thank you for your question.

          I am a family doctor with a private practice in lifestyle medicine, and am a “Health Support Volunteer” for this website. Most of the patients I see are either overweight or obese — as are more than 2/3 of all Americans. You bring up an important problem: just being “vegan” is not sufficient, not when you eat “a lot of junkie vegan foods”, as you call them. Dr. Greger and I both advocate a “whole foods plant based” (WFPB) diet.

          The Impossible Burger’s four main ingredients, in order, are: water, textured wheat protein, coconut oil, and potato protein. The meaty taste comes from soy leghemoglobin, which also makes the cooked burger “bleed” like beef does. There are no whole plant foods in an Impossible Burger. Coconut oil is not a healthy choice. See this video by Dr. G: https://nutritionfacts.org/video/does-coconut-oil-clog-arteries/

          You mention that when you eat a lot of veggies and fruits you get diarrhea, and also don’t feel satisfied. This brings up several issues/questions:

          1) What exactly are you eating right now? It would be helpful to write down everything you eat and drink for three full days, including portion size. Then you can take this information to a dietician and (s)he can give you a summary of the nutritional content, including calories, protein, fat, carbohydrates, sugars, and micronutrients.

          2) Besides being obese (70+ lb.s overweight probably means you’re obese), do you have other health concerns, such as diabetes, hypertension, or high cholesterol? Each of those conditions might mean you should modify your diet slightly; but luckily, a WFPB diet has been shown to help ALL of those problems.

          3) Do you like to cook, and buy your own groceries? If so, you would be wise to look at a site like this one, which gives you a 21-day meal plan, including grocery lists: http://www.pcrm.org/kickstartHome/mealplan/week-1.

          If you don’t cook for yourself much, there are still some great options for you to get healthy foods. One is to order prepared frozen entrees, so all you need to do is defrost and heat them in a microwave. Here is a link to one website where you can order these: https://www.plantpurenation.com/products/plantpure-challenge-package-1.

          4) Regarding veggies and fruit causing diarrhea, I have a couple of comments. First, when you say diarrhea, do you mean loose stools, or do you mean watery diarrhea? Because anybody eating a WFPB diet — which means a diet that is very high in fiber, will have at least two to three loose bowel movements per day. That should be regarded as “normal”. See this article by Dr. G. about the “optimal” BM frequency: https://nutritionfacts.org/2017/08/03/optimal-bowel-movement-frequency/?utm_source=NutritionFacts.org&utm_campaign=2c39046174-RSS_BLOG_WEEKLY&utm_medium=email&utm_term=0_40f9e497d1-2c39046174-23843473&mc_cid=2c39046174&mc_eid=8486225ff4

          Secondly, it takes a week or two for your body to get adjusted to a healthy high fiber diet; the population of bacteria in your colon has to change to a healthy pattern. See this video by Dr. G: https://nutritionfacts.org/video/how-to-change-your-enterotype/ — the amazing thing is that the good bacteria take over within as little as four days!

          5) Regarding not feeling “satisfied” after eating more fruits and veggies: I’m assuming you mean not feeling as full as you do after eating foods that are more calorically “dense”. The main thing I’ll say about that is that by the time most Americans feel “full”, they’ve eaten WAY too many calories. It helps to eat more slowly. Also, what you’ll find if you stick to a healthy WFPB diet for a few weeks, is that you will gradually lose your craving for junk food, and you’ll start to just feel better — more alert, healthier, more energetic. Here’s a video by Dr. G about the mental health benefits of a WFPB diet: https://nutritionfacts.org/video/plant-based-diets-for-improved-mood-and-productivity/

          So, I hope these suggestions help. You should feel good that at least you’re avoiding the harmful effects of meat, dairy, and eggs!
          Dr.Jon
          PhysicianAssistedWellness.com
          Health Support Volunteer for NutritionFacts.org.

  2. Last summer I read a PDF book by a Buddhist monk discussing vegetarianism. Contrary to popular belief, Buddhism does not mandate vegetarianism for either monks or lay people. The monk who authored this book eventually decided to go vegetarian. He explained that one of the reasons why he delayed this decision was that he was turned off by a fetish that some sectors of the veg*n community has for discussing their inner workings like bowel movements, digestion, etc. He warned readers that these things could turn other people away from vegetarianism.

  3. I have read that there are some risks with larger bowel movements, primarily poor nutrient retention due to increased size and frequency. Is it reasonable too assume there could be a risk with a diet to high in fiber that does not permit for optimal nutrient absorption?

    1. My guess is that that risk would be more due to inadequate hydration, which it never hurts to bring awareness back to. Excuse me while I grab some water…

  4. The suggested home experiment of consuming a bowl of beets and estimating transit time sounded like an excellent way to do simple self-diagnosis. A clever and straightforward home health check-up! I hope to hear more tips like this in future.

  5. I think transit time is a relatively old tool-of-the-trade for naturopaths. I first heard of it in the early 70s via a Marin, California naturopath but I don’t know, it may have been used for centuries. It’s easy to check in any case so the connection must have been recognized quickly by the first beet eaters though they might have panicked at first thinking it was blood.

  6. A good probiotic is also helpful in this regard, though not to “make up for” a trashy diet. A “good probiotic” is an operational definition: one that works for you. Since you may discover more than one that works well, over time I would rotate between those types and brands you find that work rather than getting the same one each time you buy a bottle.

    Another thing that is even more than helpful, it’s essential (learned from an Indian yoga teacher), is squatting for elimination. Can you argue with 100% natural? Essential but not sufficient of course. Diet seems to be #1. At an extreme, the former Roy Walford MD, longevity maven (calorie restriction studies) opined that the [Best Diet+No Exercise] would be better than the [Worst Diet+Good Exercise].

      1. I had very very frequent soft stools on a vegan diet. I increased SOLUBLE fiber, mangoes and psyllium containing a higher percentage of soluable versus insolvable and bingo, problem solved!

  7. I do not have large bowel movements but rather many small bowel movements throughout the day.  I eat a lot of fiber, especially raw vegetables.  Please comment.  Susan

    1. Hi, I have an anal fissure that is almost healed (6 months now).  It is much better but still bothers me daily.  I am taking Mirlaxa ever day- i never used to, although i was often constipated from childhood.  Now my stools are much smaller than they used to be.  The less mirlax I take- the more my fissure hurts.  Do you have any ideas to help?  Thanks.

  8. There may be people that aren’t aware of this, but another product that one should stay away from is bleached flour, & animal protein from meat, milk, & eggs which can get caught up in the pockets of the colon & create diverticulosis which can lead to diverticulitis. Just imagine anyone that has ever done paper mache will remember that the way they made glue is by taking bleached flour & water, then mixing it together.

    1. Wow…this is absolutely wrong. So much so, that I’m positive that you made it up. You can eat whatever you want. If you are prone to diverticulitis all you have to do is up your fiber. Especially from raw veggies like broccoli and carrots…but oatmeal and all bran works as well. Shoot for a minimum of 20 grams a day. The vast majority of the planet eats food with white flour and don’t have diverticulitis. AND NOBODY is eating flour and water (which would be digested anyway) as cooking and other ingredients change the chemical composition of flour. It’s not even remotely close to eating paste.

  9. I have just started my plant based whole foods “diet”/lifestyle 2 weeks ago and I’ve noticed that I have alot less bowel movements??? I thought I would have more… Alot more gas but less of the other any insight would be great!!! Thanks

    1. The opposite should be true, at least two a day. Exercise plays a key role in bowel movements as well. If you are not getting enough exercise this could be the case.

  10. My wife and I have changed to a whole foods plant based diet over a year a go. My wife recently had a physical and it showed that she had an over active thyroid. She has never had a problem before. What is the best way to remedy this through diet? We are both in our late 40’s.

    1. Look into adding cruciferous vegetables to your diets. I believe they’ve been associated with at least slightly reducing thyroid activity.

  11. I have been reading many of your posts on various topics and want to thank you for your contribution and service. I am a lay (uncredentialed) nutrition advocate, so this is not based on science, but is mainly experiential. Is it possible that Alzheimmers is diabetes of the brain and that hemrrhoids and anal fissures are anal diabetes? I recently noticed the biggest culprit in sabotaging healing the latter, but in healing almost anything, is sugar (and oil, of course). I used to label most illness as candida of the…………..(name the organ), but it may be less fungal and more sugar based. What’s your take on this? Being a natual healer (72 years & no medication; run/walker of 8-10 miles daily), i am always looking to understand reasonable theory so that if it strikes me as true, i can use it skillfully. Thank you for your time and consideration. Sincerely, Sandra

    1. Sandra: “72 years & no medication; run/walker of 8-10 miles daily” is simply amazing. That’s so cool.

      I am a lay person myself, but thought I might be helpful: Dr. Barnard has two books which may help answer your questions. He explains the nature of diabetes in his book: Dr. Neal Barnard’s Program for Reversing Diabetes. He also goes into Alzheimers in his newest book: Power Foods For the Brain. (The first book, diabetes, would be the most relevant of the two for your question.) While I don’t speak for Dr. Greger, based on Dr. Greger’s videos and recommendations, I guess that Dr. Greger would support the information in both of those books.

      After reading those books and doing some additional research, my personal opinion is that it does not make sense to classify Alzheimmers as “diabetes of the brain”. If you ever read those books, I would be curious if you have a change of thoughts.

      I hope when I’m 72 that I move as much as you do. That’s quite inspirational. Good luck.

  12. My bowel movements have grown in size and regularity. One huge one every morning. Some nearing a pound. I was beginning to become concerned about the size, but now I understand why. I am 65, as I learn more about nutrition, I eat more plant based. I have been doing this now for the past 15 months. I am now almost 100% plant based diet. Very interesting.

  13. OK I have to admit that I had kind of a grade school giggle moment watching this video. I know it’s a very serious subject, and I mean to diminish the importance of the topic with stupid jokes, but then you also know the say, humour is the best medicine, so I guess I had my daily dose.

    I’ve always been something of a smart ass (pun intended). I just couldn’t get my mind out of the toilet, which instisted on running through a series of really crappy jokes.

    After going through the list I finally concluded that, when one had ambitions to be a really big sh*t, maybe, in light of good colon health, that might be a really positive thing.

  14. I believe there is such thing as impaired digestion or slow digestion. Ancient Indian medicine recommends pranayama or breathing techniques to increase digestive fires. It is also my understanding that nothing bad survives in oxygen…. I also believe that slow digestion gives rise to allergies…..my beliefs in response to slow transit time……

  15. above it says larger stool size is associated with lower risk of amongst other things constipation, I think there needs to be a lot of research done on this in relation to what co factors reduce that risk, because my wife has sever constipation even though we both eat the same things and visits the stool room only once every 3 or so days and has as a result large stools. Transit time has to be in the days. I have daily usually 2-3 time daily movements and have a transit time of about 10-14 hours and have DV, so there’s a lot of compounding factors that I think are missing.

    1. If you are whole food plant based you should have at least one bowel m movement everyday. If not I would look at the diet. Any dairy products could cause immobility in the bowel. Children often have a horrible problem with this. Make sure your wife is getting some exercise that makes her breath heavily and avoid prescription medications that cause constipation like pain killers. Don’t live thirsty.

  16. Dear Michael, Please can you tell me a few things about poop. I think I have seen it all when it comes to poop and pee due to being a toilet cleaner in busy toilet facility for three years.
    No 1! Big poops cause big problems re blocked loo’s so I am suprised they are good, is there a ‘too big’ size? Often when a poop is big the food bits can be still seen or at least give a colour/texture so I assumed they were not healthy.
    No 2! what’s the poop scoop on really splatty poos? These are worse on weekends(due to booze or diet?) by my unsceintific reasearch but they occur constantly among the general public (I would estimate 1 in 5 women and 1 in 3 or 4men) and are the bain of my life, so awful to clean up as get on underneath of loo seat etc.
    No 3! Is it true that floaters are caused from dairy products? I read that somewhere.
    No 4! ahh the perfect poo on the bristol chart, I would like to get there but I am more of a 1-3 girl, if I did a plant diet, how long would it take to get to No four, and how long for my few day old poo’s to evacute? yours sincerely Miss S, a wannabe poopologist.

    1. So glad to learn about ‘big poops’ since that means that anal sex will be a lot easier for both parties and most importantly a new group of protected Americans, the analists. Most people aren’t aware that there is new protected class being formed in the BLT community whereas Bisexuals, Lesbians and Tranny’s have enjoyed their new powers and liberties, now ‘analists’ are the next up and comers and this group number one need is very related to the topic of this conversations, a stretchy anus. Analist’s are men who prefer to penetrate anuses. What nice about this group is that they don’t discriminate in the least and are happy to penetrate the anus of either a woman or man and this group displays an enviable sexist-free selection process. Perhaps those with ‘large poops’ can find a way to identify themselves to this new group who would likely prefer those with large stretchy anuses (as evidenced by their large poops) in order to better facilitate their anal penetration. If you do have ‘large poops’ please identify yourselves to that the analist’s can attempt to make contact and get to know you and your anus a little better?

  17. I drink lots of water and legumes, grains and tubers and go once a day, but it sounds like I’m dropping tic-tacs all the time. My mom eats McDonald’s all the time and goes every hour. It’s not fair.

    What’s going on? Will exercise fix this?

  18. How about to invent a toilet that can weigh the stool and analyze the pH content? It could measure the urine pH too! I think we have a winner!

  19. Some days my Bms seem normal.. s shaped right diameter and color then I’m constipated for 2-3 days when I travel , then I’m like a rabbit poop, then my stools are skinny..is water all I need to do to fix it?

    1. The elephant in the room is that vegetarians and wasting our most precious vital resource by endless toilet flushes of their defecation. How much water does it take to flush a vegetarian’s two or three bowel movements compared to a normal persons one-a-day bowel movement? There should be a toilet tax imposed on vegetarian households for choosing to maintain a diet that wastes water. I suggest that ‘toilet meters’ are created and installed and households can start paying per flush especially in condos and apartments.

  20. So, what do you do if it (transit time) is not in the ideal range? I’ve tested to be about 60 hours once and 39 hours after adding chia seeds and probiotics to my diet. I eat a WFPB diet to the tune of Chef AJ’s UWL program – so a lot of vegetables and starches. Am I on the right track with the chia seeds and probiotics? Before going WFPB, my bowel movements barely occurred every other day. I will continue testing, but wonder if there is something else I could/should be doing?

  21. I was finally compelled to make changes to my own diet, or else continue to live with damaging constipation. When I was younger, it wasn’t much of a problem; but now I seem to require lots of plant foods including fruits, vegetables, whole grains, beans, seeds, and nuts. Spending twenty minutes on the toilet struggling to eject the last few bothersome rabbit pellets is a real strain on the body, and forcefully passing a larger, hard stool is always very painful.

    Bowel function can be surprising and unpredictable, but my stools are now usually large and soft, about 16″ long. And sometimes I pass a second, smaller stool later in the day. I do still need to apply some initial force and effort, but then the stool slides out very quickly.

    When I was younger, I typically ate some fruit, some vegetables, two slices of whole grain bread, and some brown rice. Not a lot of fiber, but even so, my morning stools were large, soft and impossible to retain if I delayed too long. I only needed to sit and relax my anus, and my rectum emptied with no effort whatsoever. Then I removed whole grains from my diet and my bowel function changed for the worse.

    Hopefully, I will once again attain totally effortless defecation; but large, soft stools seems like a good start.

  22. Straining!

    After going plant-based and always forming large stools, I still needed to learn to stop straining, straining, straining…which was a really strong habit formed over a lifetime. Waiting for a strong urge before going to the toilet also helped.

    Now I simply sit calmly and relax, reminding myself not to do any straining–but it’s still not easy. For awhile it can be very frustrating until I sense the beginning of movement as gravity takes over and the long stool slowly slides out. And my rectum completely empties. Before, straining seemed to encourage partial stool retention and I would need to remain seated, or even return in a few minutes.

    Don’t just sit there, do something! No! Don’t do something, just sit there! Then you’ll really do something.

  23. hi,
    I’m mostly on dr Greggers diet. I mostly have 4s but pretty often I have 6 (like every 4th or 5th) – should I worry? I weren’t able to find good correletion with type of food though. Any thoughts?

  24. Hi I’m a health support volunteer. If you have having regular bowel movements everyday, you’re doing better than most westerners. The only thing we would recommend is increased fiber and following Dr. Greger’s daily dozen more closely. Here are a few videos you might like:
    https://nutritionfacts.org/video/prebiotics-tending-our-inner-garden/
    https://nutritionfacts.org/topics/fiber/
    https://nutritionfacts.org/topics/bowel-movements/

    NurseKelly

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