Hi, I’m Anna Mapson and this is the Inside Knowledge for People with IBS. If you are looking for relief from unpredictable and painful gut symptoms, maybe you just don’t know what to eat to stop your bloating, excessive gas and stomach cramps. I hope this podcast series will give you information you need to make positive changes to your diet and life style. It’s all for people with a dodgy digestion to get back to living instead of spending time on the toilet or thinking about poo.
Because let’s face it, there are more enjoyable things to do with your life.
So let’s go on with the first episode. As, this is the first one I thought I’d just introduce myself. If you don’t yet know me. I am Anna Mapson. I’m a registered nutritional therapist and I’m based in the UK. But I work with people all over the world who have IBS and other gut health conditions like SIBO, which is small intestine bacterial overgrowth.
We’ll definitely come back to SIBO. And also, I just want to make sure that this podcast series is really practical. It’s giving you some things that you can actually put into place in your own life, in your own time to do to improve your digestion and start feeling better.
What have you normalised (that’s definitely NOT normal)?
Now, my opening question for you on this episode, talking about normal digestion is actually what have you normalized that isn’t actually normal.
So, for example, some of the things that my clients have started working with me and they’ve been experiencing have been:
- going for over a week without a poo.
- Or maybe you are going 11 times a day for weeks on end.
- Maybe you are regurgitating food into your mouth every time you bend over,
- or you have eliminated so many foods that cause your IBS symptoms that you’re only now eating about five to 10 foods a week.
- maybe you constantly get congratulated on being pregnant and actually it’s just massive bloating. [00:02:00]
- Perhaps you wake up every day with stomach cramps,
- or you wake up in the middle of the night with stomach pains.
- Have you had to run behind a bush in a park and had a poo because of an urgent need to go whilst you’re out walking?
- Or maybe you just fear eating everything and so you’re so worried about food. It’s affecting your life.
For people who don’t have IBS, those kind of symptoms can sound really, really shocking. But if you’ve been suffering with really bad digestive problems, I’m sure that you’ve had problems as bad as that all the time as well.
Don’t ignore digestive issues – normal digestion
So why do we normalize it? Why do we just put up with it? Well, firstly, what I find with my clients is that sometimes you don’t know it’s that bad because you’ve got used to it. Because it’s been going on for so long. And it can be quite embarrassing to tell people about your digestive habits. So maybe you don’t talk to people and you don’t realize that this is so unusual.
I mean, secondly as well, it’s just kind of embarrassing to have to talk about bodily functions. And so you probably keep your feelings to yourselves and you don’t want to talk about what’s been going on in the bathroom. Other times, some of my clients just don’t have any energy to make the changes. It takes so much thought and motivation to start changing your diet, to start taking control of the symptoms.
Normal digestion isn’t painful
It just feels easier to accept the pain and the embarrassing symptoms and just get on with it. The other thing is if people can’t actually see your symptoms, it’s harder for them to understand you. And this is an invisible symptom like abdominal abdominal pain, feeling nauseous, like feeling constipated.
It’s harder to explain it to friends and family. Because actually they can’t see your pain in such a way they could if you had a major bruise that was really visible. And this then sometimes leads you to just keeping your worries to yourself rather than asking for help. So I just hope this episode is going to really explain to you what you are aiming for, what’s normal and what’s not normal.
A normal bowel movement
And then let’s think about what you can actually go and do about it. When we’re talking about poo, normally we use the Bristol stool chart. Which describes various types of poo from very hard type one to very watery type seven. So there’s different pictures that go with this, and you can Google it to have a good look.
Normally on the Bristol stool chart we’re looking for like type 4, which is in the middle. Which is described as smooth, like a sausage or a snake, and it’s soft. It’s easy to pass. It doesn’t cause you any pain. It doesn’t get stuck, and it doesn’t leave you with that sort of urgency and dashing to the loo.
Now also, we’re looking for things like no undigested food pieces. Of course, there might be things like sweet corn and seeds and tomato skins, which do go through you undigested. Just because our bodies can’t break them down as well. But actually you shouldn’t see loads of bits of food every time you’re going to the toilet.
The colour of poo
In terms of like a colour, mostly you’re looking for a darkish brown colour. Sometimes when it’s very, very light [00:05:00] in colour, it could indicate you are not absorbing your dietary fats, like you’re not breaking them down. Well, obviously you don’t want any blood or mucus to be there when you wipe or in the poo itself.
This would indicate that there is some bleeding normally in the rectum or the anus, just around the bit where the poos come out. That would be like fresh blood. Now, sometimes it can feel really scary when you see that. It might just be down to haemorrhoids, which are small veins which pop out into the anus or outside your body and they can just bleed a little bit.
So sometimes it’s just that. But I would say if you do see any blood or any mucus when you’re going to the toilet, then do go to the doctors and get that checked out.
In terms of mucus, often that’s a sign of some slight inflammation in the last bit of your colon. That’s in similar to when you have a cold. Your body is producing mucus to try to deal with some sort of low level infection.
Ideal frequency of poos in normal digestion
Now, in terms of frequency of a bowel movement, ideally you wanna go one to two times a day, but up to three times a day is considered completely normal if you go up to three times a week. That is also considered normal in terms of medically. But I would suggest if you’re not going every day, you may start to feel a bit more bloated.
And so in an ideal world, we are going for at least once a day. The other thing is you really want it to be easy to pass without any straining, any urgency as well. You don’t want that dashing to the toilet. And you don’t want necessarily any pain associated with going for a poo. So ideally we want a well-formed poo, easy to pass.
It’s not too hard, not too soft, and just something that feels quick as well, so you’re not sat on the toilet, for 10 to 15 minutes just to pass some few little pebbles.
Now in terms of like what the differences are between all them when you’re getting very [00:07:00] dry, hard bitty poo, it normally means it’s been sitting in your digestion for quite a long time.
And the water has been reabsorbed. Now, this could be, if you are very dehydrated. Your body will try and extract as much water as it can out of the waste material, out of the excess food that’s not been broken down and absorbed. And try and extract water.
Now, the longer that’s sitting inside your colon the harder that poo is going to become. The other thing that will happen is that you will start to get more fermentation of the bacteria. So this is what happens a lot with people who are constipated. Not going for a daily poo, is that you get very hard dry stools. And then also you get a lot of fermentation. A lot of gas, and it can be quite painful.
Now, at the other end of this scale, we’ve got lots of watery, diarrhoea, almost like liquid with no solid pieces in it. Sometimes you’ll see bits of undigested food that are dashing through you. Now, this generally means you’ve got quite a fast transit time and the food is coming out way too quickly. The issues with that is that you’re potentially not absorbing all the nutrients.
So you could be eating a really good, healthy diet, but you’re not actually getting enough of the goodness out. One of the main misconceptions with IBS is that when you eat something, it goes straight through you and you get rid of it straight away. When you eat food, it can stimulate a digestive reflex that does evacuate your bowel.
Is food going straight through you?
So it’s possible that when you eat, it triggers the need to go to the toilet. But it’s probably not the same food that you’ve just eaten. That does happen if you get food poisoning or something. In which case your body is like evacuating everything, you will immediately be getting rid of the thing that you’ve just eaten.
Like it will be going straight through you until the poisonous substance is gone. You could be vomiting, you could be getting diarrhoea. Now if you’ve got diarrhoea predominant IBS, you might feel as if the food’s going through you all the time. And actually we do know from studies that people who’ve got IBS might have a faster digestive transit time. But actually your stomach emptying and small digestion are normally quite similar to people who don’t have IBS.
Time taken for normal digestion
On average, the stages of your digestion are you eat something and it sits in your stomach for between one and five hours. So this might be a bit of a shock to you. Sometimes you think that it goes straight into your intestines. And it’s straight into your large intestine, for example, and it’s then it’s evacuated as a poo.
But actually it’s kind of normal for majority of your food to be in your stomach for two to three hours. And then around 50% of that will have gone out by about that time.
Then your food moves into your small intestine where it sits for another like two to six hours. And again, like 50% will be cleared through in two to three hours. And then food sits in your large intestine for anywhere between 20 to 40 hours. So this means the overall time of your digestion could be quite a lot longer than you think.
What affects your bowel transit time?
It’s so your transit time could depend on lots of things. It could depend on the types of food that you are eating.
Your stress levels affect digestion
It could depend on your mental state because we know that, sometimes stress and anxiety can also speed up our digestion. And at the same time, being really chronically stressed can also slow it down.
So yeah, your mood and how you’re feeling and what else you’re doing, like how active you are. This all plays a part as well. as well as things that stimulate the gut. Like potentially coffee or alcohol. And these all have an impact as well. But in terms of like the macros, so that’s like carbs, proteins, and fats.
The more foods you eat that containing simple carbohydrates like a white bread sandwich, that’s more likely to pass through you much quicker. If you’re eating a mixed meal that in contains some protein like meats or fish or cheese. And some fats as well. And that would also slow down your digestion.
So when I’m looking at my client’s dietary patterns, it gives an indication alongside their symptoms of what might be triggering the transit time changes. Sometimes people are getting erratic habits and they were sometimes going for getting food, passing through them really quickly and sometimes really slowly.
Your homework – test your bowel transit time at home
Now, a little homework that you can do is to try and test your own digestive transit time by eating something that isn’t easily digested. It’s not easily broken down. There are three things that I suggest. One is sweet corn. Second is beetroot and the third white sesame seeds. Now these all stay for different reasons inside our gut seeds.
The white sesame seeds generally will be visible in your poo, especially if you eat about two tablespoons worth. That’s quite a lot, but you could mix it in with some yogurt. Mix it with some porridge, and you won’t really break that down. So you should see a combination of those white seeds in the toilet bowl.
Beetroot will show up as a very red colour. You shouldn’t necessarily see clumps of beetroot, but the colour and the staining of the rest of the stool will really be visible.
And then sweet corn as well as the last one. Again, the skins of the sweet corn kernels are not well digested and should show up in your poo in the next day or two.
So all you need to do is eat one of those three things. Then see how you see how long it takes to see them again in the toilet.
Later in this series, I’ll be talking a bit more about the FODMAP diet, which is a tried and tested IBS diet. Just to be aware that sweet corn and also beetroot can be quite rapidly fermented by our gut bacteria. And so may cause you some fermentation and bubbling and gas.
I guess if you know that, which one of those is gonna be best for you?
That’s why we’ve got three options there of sweet corn, sesame seeds or beetroot, and hopefully one of those you can give a go.
When to see a doctor about your poo
So thinking now about what are the red flags around bowel habits, we’ve covered what’s normal, we’ve thought, talked about IBS in terms of where some of the variations on what’s normal, but what are the things that you could actually make sure you get a doctor to check out?
Well talking about the colour of the poo I mentioned about blood. If you do see any blood or significant mucus for a long time in your poo. Go and get that checked out with a doctor. If you see any black looking poo, which might feel like look like coffee granules, that could indicate you’ve got bleeding in your intestines and needs checking out.
I will just say though, just be very careful in case you’ve just taken some iron tablets because that can change your poo to black and isn’t something that you should worry about so much.
Looking for digestive red flags
Other red flags I would really encourage you to get checked out by a medical professional would include bloating that doesn’t go away.
Abdominal pain that is consistent and doesn’t go away, or that happens every single time you eat, including also feeling a lump in your abdomen that wasn’t there before. Also if you’ve had a massive change in your bowel habits, for example, you’ve increased the number of times you go significantly or reduced it massively, and there isn’t any explanation that you can think of.
Other red flags to look out for
Definitely unexplained and unintentional weight loss. If you’ve lost particularly around 10% of your body weight within six months, this is a cause of concern. And also, if you’ve just got real overriding fatigue or tiredness that doesn’t go away, that isn’t explained by a lack of sleep, or you know, a particularly busy time at work.
So these are all things that are really important for somebody else to check you out. Don’t self-diagnose anything and don’t just think it’s just IBS.
When you’ve done your bowel transit time, what are you gonna do with the data? Well, it’s worth thinking about what it means for you. It might be worth doing it every couple of weeks to see if things change. What I would suggest you do first of all, is to think about if food is moving through you too quickly, what could the drivers of that be?
Food that can cause diarrhoea
Now, sometimes it could be down to dietary drivers that you are eating food that is increasing the water level in your gut and that is creating a lot of liquid stool and it’s moving through you quickly. This might be down to foods such as a lot of fruit, like high fructose foods, foods that contain sorbitol, mannitol.
These are polyols that can really commonly draw water in and create a lot of loose diarrhoea. It could also be stress, so it could be not down to your diet. It could be other things that are causing you to have a fast transit time.
Probably the quickest that food would move through you in a healthy digestion is about 24 hours. And the longest time would be about 48 hours really. That is just the maximum amount of time before food is left, sort of sitting around fermenting too long in the colon.
Is your slow digestion normal?
So if food is moving through you really slowly, think about the drivers of are you getting enough physical movement in your day? Are you eating enough fibre? Are you drinking enough water? These are all common constipation considerations.
At the end of this episode, now, you should know a bit more about what is normal digestion, what are the red flags and things for you to watch out for.
And also how you can test your own bowel transit time. This will give you the first bit of information. I’m going to provide more tips and things that you can do to better understand your digestion.
As well as some of the things you can do in order to improve your IBS. If you’ve enjoyed this episode, there will be more to come.
This is only the first one, but also check out my Instagram @goodnessme_nutrition, where I’ve got loads of videos about IBS and gut health and things that you can do.
Otherwise, I will see you soon. Goodbye.