"How Many Bowel Movements Should You Have Every Day?"
Ancient Egypt was one of the great civilizations,
lasting for 3,000 years,
its knowledge of medicine vastly underestimated.
They had medical sub-specialties.
The pharaohs, for example, had access
to dedicated physicians to be guardians
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 its importance continues,
with some calling for bowel habits to be considered
a vital sign on how the body is functioning,
along with blood pressure, heart, breathing rate.
Although we may not particularly like hearing the details
of someone else's bowel movement,
it is a function that nurses and doctors need to assess.
Surprisingly, the colon remained relatively unexplored territory,
one of the body's final frontiers.
For example, current concepts of what "normal" stools are like
primarily emanates from the detailed 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 really detailed records.
The reason we need to define normal,
when it comes to bowel movement frequency, for example,
is how else can you define concepts like constipation or diarrhea
if you don't know what normal is.
Standard physiology textbooks may not be helpful in this regard
implying that anything from one bowel movement
every few weeks or months to 24 a day can be regarded as normal.
Once every few months?
Of all human bodily functions defecation
is perhaps the least understood and least studied.
Can't you just ask people? Turns out people tend to exaggerate.
There's a discrepancy between what people report
and what researchers find when they actually have them recorded.
It wasn't until 2010 when we got the first serious look,
defining normal stool frequency as 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 --
not necessarily a good thing.
And indeed significant proportions of people
with "normal bowel function"
reported urgency, straining, incomplete defecation,
leading the researchers to conclude that
that kind of thing must just be normal.
Normal, maybe, if you'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.
See, the rectum may need to accumulate
4 or 5 ounces of fecal matter before the defecation reflex is fully initiated,
and so if you don't even build up that much over the day you'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 you see in populations
on traditional plant-based diets, on the kind of fiber intakes
you see in our fellow great apes, and what may be more representative
of the types 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 2 to 3 times a day.
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.
Even just talking about food can cause your brain to increase colon activity.
This suggests the body figured that one meal should be just enough
to fill you up down there.
So maybe we should eat enough unprocessed plant foods
to get up to three a day, a movement for every meal.