We eat for a variety of reasons, most importantly to sustain life. Unsurprisingly, the decisions we make about what we consume can have a huge impact on our health. Equally important is how our bodies eliminate the waste created by what we ingest. After all, what goes in must come out. Are there hard and fast rules about what constitutes a healthy …let’s just say it, poo? Sean Gibbons, a microbiologist at the Institute for Systems Biology in Seattle, joins The Excerpt to discuss what bowel movements, or a lack of them, reveal about our health.Episode Transcript available hereAlso available at art19.com/shows/5-ThingsSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Chapter 1: What is the main topic of this episode?
Hello, and welcome to The Excerpt. I'm Dana Taylor. Today is Thursday, March 27, 2025, and this is a special episode of The Excerpt. We eat for a variety of reasons, most importantly, to sustain life. Unsurprisingly, the decisions we make about what we consume can have a huge impact on our health. Equally important is how our bodies eliminate the waste created by what we ingest.
After all, what goes in must come out. Are there hard and fast rules about what constitutes a healthy, let's just say it, poo? Sean Gibbons, a microbiologist at the Institute for Systems Biology in Seattle, now joins us to discuss what bowel movements, or a lack of them, reveal about our health. Thanks for joining me, Sean.
Thanks for having me, Dana.
I think we all have an idea about what's normal for us, but how often should we be going? Is there an ideal frequency?
Chapter 2: What is considered a healthy bowel movement frequency?
There's no hard and fast ideal frequency, I would say. Currently, clinically, there's a wide range that's considered healthy. Everything from three times a week to three times a day is considered fairly normal. And that's very wide. But based on what we'll talk about here soon, I would say maybe once every other day or a couple times a day is probably where you want to be.
That's kind of the Goldilocks zone.
You conducted a study last year that gave you insights into the effects of having a regular or irregular bowel movement and that effect on our gut microbiome. First, how many people took part in the study and how were they categorized?
So this was a large cohort of individuals from a scientific wellness company called Aravale. And we had approximately three to four thousand people in this cohort. We filtered down the number of people who were a part of this particular study by looking at those who were the healthiest among them. So we got down to maybe two thousand or so people who had no reported diseases.
Chapter 3: What were the key findings from Sean's study on bowel movements?
whose clinical chemistries like their LDL cholesterol and their insulin resistance were all in the sort of healthy range. So these were as healthy as we could find.
And what did you learn regarding frequency and our gut microbiome? Let's start with those with high level frequency.
Those who had a high bowel movement frequency, which is maybe four or more bowel movements a day, which is classified as diarrhea, they showed signatures of stress on their liver. Their liver enzymes were out of range. They also saw higher levels of inflammation. This isn't perhaps that surprising because we know that we produce bile. That's excreted into our bowel.
And if we are experiencing diarrhea, we actually lose a lot of our bile through defecation. And our body has to work hard to produce more of it. And that puts strain on the liver. And inflammation has long been known to be associated with diarrhea as well.
And what about those who experience low frequency?
So those who are on the low end, which is, you know, three or fewer times per week, kind of constipated individuals, they showed a rise in microbially derived metabolites in the bloodstream from the fermentation of proteins. So microbes fermenting proteins into these molecules like p-creosol or endoxyl or phenylacetate.
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Chapter 4: How does bowel movement frequency relate to gut health?
And many of these molecules are toxins to the kidneys, the liver, and even to the brain. So these are not necessarily that good for us, and they've been linked to chronic diseases.
What are some of the underlying conditions that our bowels may be warning us about?
One of the main reasons we embarked on this study is that there are all of these associations out there between several different chronic diseases and bowel movement frequency. So for example, those who have neurological conditions like Parkinson's disease or Alzheimer's disease, Oftentimes before they get diagnosed with these diseases, they have had maybe decades of chronic constipation.
So constipation tends to precede these things. Similar for chronic kidney disease, we see that constipation often precedes the disease condition, but no one really knew whether that was correlation or causation.
is it just a side effect of the disease or is the constipation perhaps a driver of disease ideology and so that's why we focused on these healthy individuals because these folks were not sick this is before any disease has manifested itself and yet we're still seeing the sort of metabolites and risk factors associated with these diseases elevated in the bodies of these people who are experiencing aberrant bowel movement frequency
We've talked about frequency, but what can you share with us about the Bristol stool chart?
It's a way of kind of measuring frequency by eye. So it's a scale between one and seven, where on one end you have watery stools, diarrhea, and on the other end you have dry, hard pellet kind of stools, which is on the constipated end. And in the middle, you have the nice, smooth kind of sausage texture to the stool, which is where you want to be, essentially.
It's a way to kind of measure water content and transit time just by visually inspecting your stool.
As you know, two people can consume the same meal and experience vastly different results. What are some of the things that impact the amount of time it takes for food to make its way through our digestive system? And why is gut transit time important?
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Chapter 5: What does the Bristol stool chart reveal about bowel health?
There's a lot of work, I think, that needs to be done still in this area, but it is known that travel, long distance travel on airplanes, for example, can give rise to transient constipation. So that's a well-known factor. There's also traveler's diarrhea. People can often catch a bug when they're traveling somewhere, and that can induce differences in their transit time.
And then shift workers, people who have disrupted sleep patterns or abnormal sleep patterns, The schedule of their dietary intake, their eating, can be somewhat different from the normal mealtimes that most of us experience. And this can affect these processes we're talking about, organic acid production, protein fermentation, constipation, diarrhea.
So we know it does affect things, but I think more work needs to be done to understand it better.
What steps can people take on their own to improve their rate of frequency and hopefully the health of their gut microbiome?
Chapter 6: How does diet affect gut transit time?
So in this population of people we were studying, we had questionnaire data about their lifestyle. We found some perhaps unsurprising things. So for example, those people who were in this Goldilocks zone of pooping, they tended to eat more vegetables and fruits. So eat your fresh fruits and vegetables. They also tended to be more hydrated. So be sure to drink plenty of water.
That helps with motility. And they had higher levels of activity. They were wearing Fitbit trackers. So we could track how many steps they were taking. So between diet, exercise and hydration, these simple factors can help improve your bowel health.
And when should someone seek further guidance from their doctor? What are a few of the things that should not be ignored?
Well, if you're experiencing chronic bouts of constipation or diarrhea, you should talk to your clinician because these could be underlying conditions of other problems in your body. But bowel movement frequency itself isn't often monitored that closely by clinicians. However, our study, I think, points to the fact that maybe that's the future, right?
Maybe the future of medicine should include this as a parameter that we pay closer attention to. Because even though we haven't causally proven that the rise of these metabolites in the blood due to constipation will eventually lead to something like a neurodegenerative disease, it seems likely that that could be the case.
And that by having long-term levels of constipation or diarrhea, we might be increasing our risk for chronic diseases. So it might be very important to pay attention to it and to keep in that Goldilocks zone.
What about colonics? Some people swear that they're the gateway secret to healthy digestion. Do you have a take on that?
I don't have a strong take on it. Again, I'm not a clinician. I'm a PhD, so I can't give medical advice. I don't have a lot of data on colonics, so I don't know a ton there, other than it is the case that people who are getting a colonoscopy get the functional equivalent of a colonic right there. They get cleaned out before the procedure.
What we find is in people who take Miralax or have themselves cleaned out, It's a window of opportunity for opportunistic pathogens. So we'll sometimes see that people are colonized by organisms like Clostridioides difficile. Even if they don't get sick, they're sort of benignly colonized by these things in these windows of opportunity when their commensal microbiome biomass is depleted.
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