Podcast Episode #38: All About Poop

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 Topics:
1 : From backed up to too loose. [4:09] 2: Child with excessively loose stools daily. [16:12] 3: Messy eliminations. [29:15] 4: HCl supplements, mucus and hard stool. [38:18] 5: Trouble going  and a stressful life [44:06

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LIZ WOLFE: Hey everyone, I'm Liz Wolfe. Diane Sanfilippo is here, too. [laughs] Welcome to the Balanced Bites podcast. That started a little more quickly than I thought. We'll get it, though. Maybe after a year. Maybe after 52 podcasts, we'll get it.

DIANE SANFILIPPO: Maybe.

LIZ WOLFE: Maybe. Probably not, though. So a little statement of CYA: The materials and content contained in this podcast are intended as general information only, and not considered a substitute for professional medical advice, diagnosis, or treatment.
So I guess we've got some quick opening stuff for everybody. We're booked up, the Balanced Bites podcast is booked up through Fall 2012. We have a lot of people…

DIANE SANFILIPPO: You mean the workshop?

LIZ WOLFE: excited about it. Wait, yeah.

DIANE SANFILIPPO: Because the podcast isn't booked up. I'm like, hold on.

LIZ WOLFE: Is that how I said it? Oh my God.

DIANE SANFILIPPO: Good morning.

LIZ WOLFE: It's early. Can we start over?

DIANE SANFILIPPO: [xxx] [laughs]

LIZ WOLFE: Oh my gosh, so you do this part. You do the workshop part.

DIANE SANFILIPPO: [laughs] We're pretty much booked up for the fall. We have one weekend that we're just kind of like nailing down a couple of possible locations for, and I think it's early November and it's looking like if we do fill it up, just so people can have a heads up, it will be a West Coast date or two. But otherwise, yeah, totally booked up and I actually just loaded up a couple more of the events which we'll get up on the page, so we are going to be just mostly, it looks like we're mostly all over the East Coast, which is easy for us because we don't have to change time zones. But yeah, we're bouncing pretty much all over New Jersey, Florida, Massachusetts, Atlanta, Rochester, so yeah, we're pretty much hanging out in the East Coast this fall. But if people are interested, if you want to talk to your gym owner about having us come in or if you own a gym or you're a coach at a gym, we will start taking requests for next year, 2013. You know, winter, spring, like January, February, March kind of deal, and we'll start taking requests for that because we're full otherwise. So yeah.
And this weekend, you and I will both be up at CrossFit Games Northeast Regionals, and apparently…

LIZ WOLFE: In Canton, Massachusetts.

DIANE SANFILIPPO: In Canton, Mass. Well, somebody tweeted to me yesterday, like oh when are you leaving for Canton, and I was like, what are you talking about? I'm going to Boston.

LIZ WOLFE: [laughs]

DIANE SANFILIPPO: I was thinking like Boston area, you know, just to me, I'm thinking Massachusetts is in Boston.

LIZ WOLFE: Oh my God.

DIANE SANFILIPPO: Yeah, I know Canton as like Akron-Canton, like it's not in Ohio or something. Anyway, I was like, I'm not going there. I'm going to Boston, and someone's like, you better check your map. I was like, I'm not driving anyway, so, oh, oops, my bad. I just was like not paying attention at all. Yeah, so we'll be up there.

LIZ WOLFE: Yeah.

DIANE SANFILIPPO: You can find Liz at the Steve's Original/PaleoKits table/booth, etc. You'll find me wearing some kind of purple and/or orange combination, possibly hanging out under a giant black tent with a big orange leaf on it, supporting Jason Schroder, Brazen Athletics, one of my coaches, so I'm really excited about that. And then, yeah, that's pretty much it.

LIZ WOLFE: Cool.

DIANE SANFILIPPO: So do you want to get into some questions?

LIZ WOLFE: Yeah, let's do it. All right, so…now do we need to introduce this podcast? This is our…this is a digestion specific podcast.

DIANE SANFILIPPO: [laughs]

LIZ WOLFE: We're going to be talking a little bit. One of everybody's very favorite parts about our workshop is the portion in which we discuss poop. And it's a very important topic. We're going to talk about it a little bit today. Poop can tell you a lot about what's going on inside your body, so here we go.
Question number one from Gemma: “This question is a bit of a doozy, and I apologize for the fact that I’m about to share way too much information about by bowel movements.” That's okay, Gemma. We love it.

DIANE SANFILIPPO: [laughs]

LIZ WOLFE: “Here goes.”

DIANE SANFILIPPO: That's what this podcast is all about.

LIZ WOLFE: That's what this is all about. “Here goes: for as long as I can remember, I’ve had normal healthy BMs twice a day, like clockwork. Since beginning a Paleo diet about a year and half ago, this has changed. While eating a clean Paleo diet, I find that I only eliminate every few days, and even then it’s a struggle. (Feeling constipated, very small eliminations) When I have a cheat meal or day, I have a normal movement, but nothing uncomfortable. I know that this may not seem like it’s out of the ordinary, but there’s more. As part of a gym challenge, we recently started eating Paleo in Zone proportions. This has resulted in a large increase in the number of veggies and fruit I eat, even though I *thought* I was eating a lot. My movements have become incredibly loose, frequent and urgent. I still have the urge first thing in the AM, but now I usually have 2 or 3 eliminations in the first hour of waking up. I understand that this is to be expected with increased fruits and veggies, however nothing has seemed to improved despite eating this Paleo/Zone way for 4 weeks straight. The rest of the foods we eat has stayed the same. I was supplementing with a daily probiotic, but I’ve cut it down to every 3 or 4 days and still have the issue. Eating Paleo has eliminated my husband’s IBS, yet I am having more toilet trouble than ever. Please help! Thanks for all you do.”
And as far as a very clean Paleo/Zone diet, it looks like Gemma is eating are eggs, lean organic sausage, chicken, steak, ground beef, some fish. Tons of veggies including asparagus, broccoli, cauliflower, green beans, Brussels sprouts, spinach, cucumbers. Fruits like blackberries, blueberries, cantaloupe, pineapple, apples, grapes.
She tries to get at least half of her carbs from veggies. She uses olive oil, butter, avocado & nuts for fat. Virtually no dairy, although it’s never bothered her digestion. Supplements with 3 grams of fish oil a day, Jarrow Formulas probiotic capsule. Good sleep. 8 hours plus every night. Lots of water and CrossFit 3-4 days per week.

DIANE SANFILIPPO: Okay. So I've got a couple of things to recommend for Gemma. First off, let me talk about what I think is happening, possibly before she switched her diet, so I don't know exactly what she was eating before, but if she was having issues of constipation before, it's pretty common. I hear this a lot and sometimes people like, Liz, you and I kind of talk about this a lot. People go into a Paleo diet and just kind of like pick a handful of foods and stick to those, and forget to try other foods or forget that they may need a different balance of just like general, you know, types of vegetable matter coming in. So typically when somebody's dealing with constipation, eliminating every few days, it's a struggle at that, I've said this before a million times answering questions on this podcast, but I'll just outline it again. The handful of things that people really need to consider and I've had this work every single time I have people do this. First, just stress. You know, how stressed are you? If you're very stressed, constipation is going to be a lot more likely. Second, how hydrated are you? She sounds like she's pretty hydrated, so probably not a problem for her. The third thing is getting in starchy vegetables, and I haven't seen any of that in her list, so I don't know, again, what she was doing before Zone. There's no reason why she might eliminate those when she went into Zone proportions, which for people who don't know, Zone diet means they are eating 40% of your calories from carbohydrates, 30% from protein, and 30% from fat. So it's actually a lot of vegetable matter to be eating, if you're not, especially if you're not eating anything starchy. So anyway, getting in some starchy vegetables and then making sure that your probiotic levels are good. So she said that previously, she was eating it-she was taking a supplement daily, but she's cut it back. That supplement may not be the right one for you, if it's not working. I definitely recommend getting in food forms of probiotics, like fermented cabbage or carrots, sauerkraut. See how you do with the sauerkraut. If it doesn't feel good for you, then make some fermented carrots. That's kind of the basics for alleviating symptoms of constipation, just from a basic approach, so stress management, hydration, and proper starches, and that means the soluble fiber, the insides of sweet potato vs. the outside flesh. It's that starchy material vs. crunchy vegetables like broccoli. And the probiotic content that's in your gut. So that's kind of the okay, what you were doing before approach.
Now looking at the switch that she's made and the types of foods that she's eating, it looks like she's probably increased her insoluble fiber content dramatically. So what that means is she's getting in less of the stuff that the bacteria in our gut can eat, which is the soluble fiber. They eat that and essentially creates a more well-formed stool for us to eliminate easily. That's a good thing. We want that. 80% of the dry weight of our stool is bacteria, so we want that to be happening, and that's a positive thing. Now we can do that with different fats as well, like short-chain fatty acids actually do help to feed bacteria as well. So for people who aren't eating a ton of carbs, they can tend to help feed them with that, short chain fats, so things like butter, primarily that butyric acid will do that. So what's happening with the insoluble fiber is, it basically performs a sweeping action through your digestive system. We don't digest it. We don't break it down entirely, and it just creates more motility. So a lot of people try to take stuff like psyllium husks or high fiber supplements when they're constipated because it helps move things through because we don't digest it. So again, that's the things like broccoli, asparagus, cauliflower, Brussels sprouts, you know, it does not mean that these should be difficult to digest for everyone, but she's probably getting a ton of them in. She may not be chewing them as well as she should be. Her stomach acid may not be as sufficient as it should be, so for all of these reasons, it may just be too much insoluble fiber for her. Same thing with fruit. Fruit can literally like blow through your system if you're not already well balanced. I mean, I know a lot of people who just a couple of pieces of fruit in a day is way too much, so what I would do is have her shift…
First of all, I would have her shift away from any sweet fruits, and move to something starchy, so if she wants to do fruit, you know, try a banana or try plantains, which are way starchier, less sweet. And I would also have her change out some of these more insoluble-rich vegetables for things like sweet potato. And that's kind of a no-brainer when it comes to, you know, doing CrossFit workouts. Get that in your meals after a workout. That should help for a couple of reasons. One, it's going to replace the insoluble fiber with soluble fiber, and it's going to feed that beneficial bacteria in the gut to help form the [xxx] agents a little bit better. So the probiotics that she's taking, again it may be not the right one for her, you know. If she was taking it before and it wasn't working, like if it's not…if your eliminations aren't going well, change your probiotic supplement or get off of it for a little while. Perhaps try a, you know, if you do well with the dairy, as you're saying you do, try finding a well-sourced like raw milk yogurt or something that's from a local farm that you can access. Some people have easy access to that. We've been kind of talking about that on my Facebook page a bunch, and you know, if you can access that and do okay with it, fine. If you're doing a Zone diet, you won't be able to do the best form of that dairy, which will be full-fat. I don't recommend that anyone does a low or nonfat dairy. So you know, perhaps this isn't the time for it, but the reality is, too, if your eliminations aren't going well, and you're trying really hard to do this Paleo/Zone thing, if it's not working for your digestion and elimination, you know, it may not be the right thing for you. But try this approach. Switch your vegetable matter to have more starchy. See how that goes for you. I don't know…I don't know if there was anything else. And just make sure that the water that you're drinking, the tons of water daily, be sure that you're drinking that away from your meals, so that your stomach acid is as adequate as it can be each time that you're eating, to make sure that you're breaking down and digesting food as best you can.
Do you have more on that for that woman?

LIZ WOLFE: Yeah. All right, no, I don't think…I don't have any more on kind of the physiology stuff. Like good on this gym for doing what it can do to get people on a good, you know, Paleo type diet. The Zone thing, in my opinion, is just not very useful except for a sort of rule of thumb. I think that it's great for people, like when we're first getting clients off of a diet of basically fueling with sugar and crappy food. It's a great rule of thumb that helps people get more protein and more fat. It helps them not fear fat. But in general, I think it just makes things a little more complicated than they necessarily need to be. So I'm not a huge fan of trying the Paleo/Zone thing because it is so so dense in soluble fibrous veggies.

DIANE SANFILIPPO: Mm-hmm.

LIZ WOLFE: It's just almost impossible…it's almost not fun. So I…

DIANE SANFILIPPO: Yeah, I mean, we also get a lot of people who report things like gas and bloating when they do that, especially because they're eating a lot of those cruciferous vegetables: broccoli, cauliflower, Brussels sprouts, which I love. They're great, but they can be really tough to digest for a lot of people, and people don't seem to think that vegetables are hard to digest, but they're typically harder to digest for people than animal proteins, so yeah, that can definitely be a tricky one.

LIZ WOLFE: I mean, I'm just contextualizing…a lot of people feel like, you know, we hear eating more vegetables is associated with weight loss. It's associated with all of these different things. Vegetables…it is more difficult for your body to extract calories, especially from raw vegetables from necessarily other sources of nutrients, and that's a little bit more complex than I just made it sound. But for example, when people go on these raw, you know, vegan type vegetarian or even raw anything diets, whether that includes meat or not, your body does extract fewer calories from that food to simplify it a lot. And that's not always a good thing. I mean, it can explain a little bit of weight loss, but are we looking at getting the most nourishment we possibly can, you know, the most bang for our buck or what? So there's a lot of kind of things to consider, but when it comes to the whole…

DIANE SANFILIPPO: There are definitely benefits to getting a lot of those types of foods for certain people, right? So it's like, if this doesn't feel good for your body, then we need to make a substitute.

LIZ WOLFE: Okay.

DIANE SANFILIPPO: It's why she submitted the question, so it's all good.

LIZ WOLFE: Yeah, right. Love it. Okay, cool. Next question's from Clark. “For someone a solid three months into a Paleo plus dairy lifestyle and one month into pure Paleo, no dairy, what are some things you would recommend for curing IBS?” You know what? Did we do this one yesterday, er, like last week?

DIANE SANFILIPPO: Did we cover this one?

LIZ WOLFE: We totally did.

DIANE SANFILIPPO: Let's go to the next one.

LIZ WOLFE: Yeah.

DIANE SANFILIPPO: I'll check on it, actually, and we may have or we may have planned it and we may not have gotten to it. I don't remember if we got to it.

LIZ WOLFE: Okay.

DIANE SANFILIPPO: I know we covered some stuff about FODMAPs.

LIZ WOLFE: All right, I'll switch to this next one. From Karen: “Hey Diane and Liz,
So here is a question for you that I just can’t figure out. Hopefully you guys can help! I made the transition to eating clean, real, paleo food about a year and a half ago. Went cold turkey! And because I do all the cooking, my husband and three kids are along for the nutritional ride. My kids, still being little (now 2 years, 3 years, and 6 months old), made the transition smoothly. No fuss over no more pancakes or sandwiches. And my husband hardly complains either. That being said, we are almost 100% paleo at home (except for the occasional gluten free waffles a special treat now and then). And when we eat out, which is no more than once a week if even that often, my husband will eat whatever he wants off the menu, but I usually order the kids something gluten free and let them splurge on some grains and dairy (usually something like cheese quesadillas on corn tortillas). So really the only gluten exposure my kids have is at church, where they give out animal crackers, and at Granny’s house, where she gives out lovely 100-calorie packs of cookies (sigh), and cake whenever we go to birthday parties and such.
So…that is the background. Here is the problem/question. My 2 year old son has TERRIBLE BMs. And when I say terrible, I mean that every single time he goes he ends up in the bathtub to clean up. It is nasty. It's really, smelly, watery, and grainy. This has been going on for about 3 months now. I talked to his pediatrician about it and she ran some labs to check for a bunch of stuff like giardia and other bacteria. Everything came back normal. She recommended a children’s chewable probiotic. That didn’t help. We chatted about possibly checking for some food allergies, but she told me that he doesn’t eat much gluten the tests wouldn’t be accurate anyway. She doesn’t know what to do next and basically told us to wait it out?! SO my husband and I decided to put him on a strict 30 day elimination diet. No gluten, dairy or legumes AT ALL. (We ARE bringing in a box of gluten free animal crackers to church so he doesn't feel left out…but other than that on Sunday mornings, no grains either). There is still no change in his BMs. HELP! Should we just continue with the super strict elimination diet for longer? Maybe 30 days isn’t enough? Can eating too much fruit cause this? I do let me kids eat a lot of fruit. Here is a basic day of food for my son:
breakfast: eggs and spinach cooked in coconut oil and a banana.
snack – nuts, apple, turkey slices, grapes (probably not all of those on the same day)
lunch – usually protein leftovers from dinner, sweet potatoes, orange
snack – banana/coconut smoothie, raisins, 90% dark chocolate (again, not all of these at the same time!)
dinner – some sort of quality protein source and a few veggies.
for snack, carrots.
Do you have any ideas? Suggestions? We are willing to try anything at this point. Thanks!”
Diane?

DIANE SANFILIPPO: So wow, it sounds like a really tough situation, so I definitely…phew, I feel badly for Karen here, but it seems like there's really always something to try. You know, so kind of like what else can we do? And it really depends on how intense you want to be about creating a diet that's a little more therapeutic and possibly healing vs. you know, just trying to keep finding things to eliminate. So a couple of things. One idea, you know, which you could start with this, see how you do. This is just adding something vs. really changing everything. Getting in some more like gut healing or more, I don't know if this is like the right word, but the more like solidifying matter into his bowels, so some l-glutamine might be a really useful supplement for him. It's very easy to give to anyone. You can get it in a powder form and I would just try a small amount. Like for adults, I generally say anywhere from 4 to 10 grams a day, which is not even that much. But the sort of upper limit or side effect, if you've taken too much tends to be constipation. Now if somebody's dealing with very loose eliminations, that might be, you know, something…not that you want to work toward constipation, but if that's really what the upper limit kind of leads to, then that tells you that that might be something beneficial for him, just something that will help solidify that stuff more. It'll help heal his gut up.
He's still eating a lot of potentially really allergenic foods, so if you wanted to really strip this down to something that is considered more of a strict elimination, there would be no eggs, no nuts or seeds, and I would really limit the fruit. I think the banana is probably fine. Things like…things like grapes, you didn't mention apple, oh, you did mention apples, those can be irritating because they do have types of carbohydrates that are tougher to digest. So the way that this is really outlined for him would be meats, well cooked veggies, and primarily, I would refer you to my Paleo foods list, and try and avoid more of the FODMAP vegetables because they do tend to be harder to digest. So keeping it more toward the sweet potatoes, carrots, green beans, even those types of things are easier than things like cruciferous vegetables. So meats, non-FODMAP vegetables. Coconut oil is a good fat. It's tough to know if he's getting too much of it. If he's getting too much fats, that could also lead to some loose stools, but I wouldn't point to that first as a possibility. Typically, it's some of these other issues. But I would get rid of the eggs and I would get rid of any nuts or seeds or nut butters because those things can all be really irritating to digestion.
If he does eat eggs every single day and he's getting this response every single day, that could be just a shotgun. Just drop the eggs and see what happens. A lot of people are very, very sensitive and/or even, you know, frankly allergic to eggs. So if he's having that issue, boom, you're done. But really, keeping good track of exactly what he's eating and maybe even come back and comment to us like what is, you know, a 3 day food diary look like for him, and how does that kind of play out in terms of digestive function thereafter. So those are the things I would recommend just in terms of dietary things to try. You know, if he's pretty open to eating whatever you put in front of him, which it sounds like he is, I would definitely make some bone broth. He doesn't have to drink that on its own. You can make soups and stews out of it and kind of just serve that to him. Some really helpful nutrients for healing the gut. A lot of mineral content in there as well as some glycine, which should help him. That's kind of the big stuff.
I would definitely also avoid dried fruit, like the raisin and really again keep it to meats and veggies, so if you need to try some new vegetables, I'd get some winter squash, butternut squash, maybe even some summer squash like zucchini. Those can be okay as well. Do you have more ideas for her, Liz?

LIZ WOLFE: Yeah, I'm kind of trying to figure out what exactly has been eliminated because usually when I do the quote elimination diet with folks, there are no eggs, there is very little kind of insoluble type fibrous, you know, fruits that we kind of discussed earlier. There's no nuts.

DIANE SANFILIPPO: Mm-hmm.

LIZ WOLFE: There's no processed meats or anything like that, so I'm wondering if maybe she kind of means just more of a strict Paleo diet with no cheats.

DIANE SANFILIPPO: Mm-hmm.

LIZ WOLFE: That's maybe what she's saying, so you know, like you said, eliminating the eggs, pulling a lot of that stuff out, and just changing the way this looks to a focus on, you know, cooked meats, some good animal fat from grass-fed animals, prioritizing good fats, getting in some of that fermented cod liver oil and butter oil from GreenPasture.org. Unfortunately the Cinnamon Tingle is sold out until the end of May. So sad. But it's look like there are kind of a bunch of things that can kind of be flipped around. I think maybe pulling the dark chocolate would probably be a good thing for now. It can be a little bit kind of hyperstimulatory, especially in little ones. But I think, you know, especially in the context of, you know, an elimination diet, if somebody is wanting to try that, you really do want to look at nutrient density and you and I both are really pro-prioritizing the quality and the variety of fats over anything else. Really, you know, vegetables, yes, are important, but you want to make sure you're getting the fat soluble vitamins as well as enough fat to really digest, assimilate them properly, which is part of the reason I love that cod liver oil/butter oil blend. you want to make sure you're getting appropriate K2. Appropriate soluble fiber to make sure that you're, you know, getting some gut healing action from your gut flora itself as well as types of stuff like l-glutamine, that are going to help with that kind of turnover, the regeneration of the gut lining and the enterocytes. There are a lot of things that could be done here. I think there's a lot of opportunity, but…

DIANE SANFILIPPO: This may also be, sorry go ahead.

LIZ WOLFE: No, I just think it's important that Karen kind of looks at what changed between the point that the child is eliminating okay and then when they were not. What changed there?

DIANE SANFILIPPO: Yeah.

LIZ WOLFE: And is the kid chewing well? Are these meals happening, you know, while running around in the backyard? Or is the kid sitting, chewing really well and making sure that everything is properly dispersed within the body or is just going straight through?

DIANE SANFILIPPO: Yeah, she may also, you know, be able to track some of the stuff, use some of the recommendations that we both just made, or, you know, she may be a really good candidate to get a practitioner to work with, one on one, and just kind of keep some food logs and get some ideas about what direction to go next. You know, if she does all this stuff and tries some of the things that we're recommending, like you had a really good point, you know, what is this elimination she's doing? Really just looks like a basic kind of possibly more strict-ish Paleo diet. That's not really the type of elimination diet that we recommend for gut healing. Like a gut healing protocol, you know, if this is what he's dealing with, you know….a gut healing protocol is really in order. There will be meal plans for this in my book as well as some supplement recommendations, so you know, people are like, she's talking about these things, what does it mean? You'll have an outline of kind of what eat this, don't eat that. You know, even within the framework of healthy Paleo foods, they're not all okay for everyone all the time. But yeah, she may want to try some things for a couple of weeks and then, if this is getting really out of hand, just work with somebody one on one and, you know, you can contact either of us, and if we can't help you, we have absolutely some referrals that we can make, some people who can help you out.

LIZ WOLFE: Yup.

DIANE SANFILIPPO: Hmm.

LIZ WOLFE: All right.

DIANE SANFILIPPO: So it looks like we did answer that other question, so we have…

LIZ WOLFE: Ding.

DIANE SANFILIPPO: We're getting some help organizing questions for the podcast, and she probably hadn't heard the last podcast right before she did this, so yeah, she probably missed the fact that we had just covered that question. No big deal. We'll go on to the question from Carolyn.

LIZ WOLFE: It's all good. And whomever submitted that particular question missed the last podcast, Clark, we answered your question last podcast, so go back to episode 37. All right, next question from Carolyn:
“Got a poop question for ya!
But first…” Let's stroke our egos a little bit, Diane.
I want to say how fantastic it has been listening to your podcast! I just started from BB podcast numero uno and slowly catching up to real time. I LOVE it and you both inspired me to start my own blog and spread the good word about Paleo/primal and how it has improved the health of myself and my family. Loving every minute of it”
That is awesome. Okay. Here's the question:”Why do I have to wipe so much? I mean I know how to do it, I've been doing it for 27 years. But I have noticed that since going Paleo my eliminations aren’t as regular (once every other day) than before (which I read on the Paleohacks blog…” Oh, Paleohacks [laughs].
“might be because I’m absorbing more of the nutrients into my body so there isn’t as much waste?). [laughs]

DIANE SANFILIPPO: I love the series that come out of that.

LIZ WOLFE: Oh, Paleohacks. “Anyway, when I do go and I feel done, I have to wipe a lot. It's light brown in appearance and tube shaped with tapered ends (not sure if that is relevant but figured I’d throw it out there).” Oh my God [laughs] This girl's hilarious.
” Leaky butt? I don’t know.” [laughs]

DIANE SANFILIPPO: [laughs] Sometimes people think we're saying “leaky butt”

LIZ WOLFE: This is hilarious. ” I mean I’m not trying to drop an O-ring and I feel finished, so what gives? Or doesn’t? When I try to go again nothing comes out. I realize how ridiculous this question sounds and it is a little embarrassing asking about it, but it has been really bothering me, in more ways than one. This has been happening every since we switched to Paleo. If it is relevant I am not overweight, 5’3″, 115 pounds, I have been the same size for 12 years. Overall I feel really healthy.”
“Sleep starts at 10:00/10:30, Up at 5:30/5:45 AM, about 7.5 hours. I sleep like a baby and always have. Food is early morning: 3 eggs, leftover veggies, 1 serving of fruit – sometimes a fruit salad with bananas, apples, pineapple and coconut milk. A mug of caffeinated tea with a teaspoon of palm sugar on my way to work. Noon: dark leafy greens or veggies leftovers. Protein left over from dinner: salmon, grass-fed beef, chicken-we mix it up. A piece of fruit. 6 PM-protein: grass-fed beef, chicken, turkey-we mix it up. Occasional snacks are half cups of nuts, all kinds. Two to three pieces of homemade beef jerky, one cup of baby carrots, 2 stalks celery, and some almond butter. Water as needed. Paleo indulgences include 70% dark chocolate a few times per week, and red wine a few times per week. Too much?
Before Paleo, we ate a healthy plate diet. Made a lot of fresh vegetables, tomato sauce from scratch, whole wheat pastas and breads. Organic everything as much as possible. Cereal for breakfast, a variety of fruits, cakes, and cookies really only on special occasions like birthdays or holidays. So in our big family that means one time per month or so.” I think that's what's pretty relevant.

DIANE SANFILIPPO: Yeah.

LIZ WOLFE: A slight intolerance to dairy potentially. What do you think?

DIANE SANFILIPPO: So I mean, I think a couple of things that we've already covered with how to kind of solidify things, no pun intended. But getting eliminations to be a little bit more solid, she can kind of listen to what we've said that before for everyone thus far. Because it really applies across the board. I would-I don't know-it's like she's got [sigh] a couple of things here. Like one, the color and shape seem totally fine, so you know, what she's eliminating, it's not anything to be too concerned about. Sometimes when people kind of make this switch, it takes awhile to sort of get your biliary function, your bile production and secretion to sort of catch up to the kind of fats that you're eating and the amount of fats that you're eating. That can be a reason why some people have loose or looser eliminations. She's not really saying that they're loose. It kind of sounds like they have this like more pasty quality to them. I would definitely try just from a mechanical standpoint, squatting when you eliminate. So that could mean just putting some kind of box in front of the toilet to get your feet up to a higher level, so that your knees come up higher. And that might actually really help the elimination be a bit cleaner, like quite literally, you know, cleaner as it comes out of your body and passes through. We are meant to be in squatting position when we eliminate. So the idea that we're sitting, if that is causing any trouble, it's like, just change that position. Now obviously that's not easy if you're in an office or something like that, but whatever you can do to kind of bring your knees up even closer to your body is always going to be a good idea.
I would definitely try switching things up a bit in terms of kind of your usual intake. I've said this before, but kind of switching out the fruit and possibly the leafy greens for things that are a bit starchier. So that butternut squash…I have a whole list of Paleo carbs and you can kind of look like, mostly it's you know, root vegetables and tubers that are starchier, so cassava, taro, butternut squash, sweet potatoes, yams. You could even do a little bit of white potato. There's not a whole lot of nutrient value to white potato, but if it, you know, a little bit here and there helps you eliminate, that's totally fine. It's mostly just pure starch. But that's really what I would recommend. She's not mentioning anything about probiotics foods, so finding a source of a well made raw sauerkraut and then obviously starting a batch on their own. There's a recipe on the blog. Make some raw sauerkraut. But because it does take around 2 weeks to make it, you know, it may be more worthwhile to try and buy some like at the local food coop or, you know, there's some at Whole Foods, Bubbie's brand. It's not the most dense, I don't think, in probiotic content, but it can be better than nothing just to start out. So if you can find one that looks a little bit more hippie-granola-ish of a sauerkraut. Seriously, like kind of the more random the label looks, [laughs] the more gnarly stuff's growing in it, I think it might kind of have…I'm kind of kidding, I mean. You know. There are a lot of different brands, but it's totally…it varies very regionally in terms of what's available to people, but check labels at a local health food or even like vegetarian or vegan type of shop will carry those things, so you might want to check that out. Those are kind of my bigger recommendations. These are stuff that we've kind of been recommending all along in terms of fighting loose eliminations, but also making sure that you're having enough eliminations, so she's kind of walking the line between the two-those two sides. More thoughts there?

LIZ WOLFE: Just stay away from Paleohacks. I mean, don't stay away from Paleohacks. There's some fun stuff going on there. But you've just got to take a lot of things…some of the things that you read on there with a grain of salt there. There's some extremely intelligent people offering great advice, but don't use that as your only source. As this person did not…they, you know, reached out to us. Definitely a good idea to reach out to a practitioner. Generally, I don't find that looser or softer stools are because your body is pulling more nutrients from food. That's generally not the case.

DIANE SANFILIPPO: Yeah, that would be the opposite.

LIZ WOLFE: It would be the opposite, yes, so yeah, just make sure you are getting your information from double-checking that information as she has done. So there you go. I love Paleohacks. It can be a-it can yank you in and you don't always know who's answering your questions. Sometimes you do, sometimes you don't.
Okay, I'm now going to have an angry mob of Paleohackers at my door here in about 2 hours.

DIANE SANFILIPPO: Well, they're all me just with different names, so not a problem.

LIZ WOLFE: Different handles. [laughs] Okay, good. All right, next question. Michelle asks….well, first she says,” I love the podcast. Thanks for everything you do.” Thank you, Michelle. Very nice. “I have recently started with HCL supplementation (have a history of low stomach acid). After a couple of weeks I started noticing much harder stools and also noticed that I have much more phlegm and mucus. I don’t get the feeling of warmth or other discomforts. Should I be concerned? Thanks a lot.”
I'll just jump in on this one. HCL that Michelle is talking about is basically just it's a stomach acid supplement: hydrochloric acid. Betaine hydrochloride, you may hear it as well. It's basically just supportive of your stomach acid production. What…now, okay, so Diane, you and I are the same page about this. For a long time, the kind of standard and evaluating how much supplemental stomach acid you needed was to do a stomach acid challenge, which basically meant you take a few with meals, up until the point that you feel a little bit of warmth or, you know, just very light kind of almost a burn in your stomach. And at that point, you consider that your dosage, you back off maybe one capsule and go from there to support your stomach acid production.
What you and I are thinking at this point is that while stomach acid supplementation is often a good thing, that particular signifier, the warmth or that general kind of the burning in the stomach is not necessarily what we want to even be looking for when it comes to this stuff. Really, the idea that you're supposed to get that warming sensation in order to know that that's your dosage, I think maybe a little bit off. I actually think it's a good thing when people get up to a certain point and do not feel that warmth because I think it means they have a good, intact stomach lining. And if the stomach lining is compromised, I think you'd be a lot more likely to feel that kind of extra burn from the acid, and it would probably also be a reason that your stomach was not producing or that you were not producing enough stomach acid because the body and its innate intelligence is kind of reading the fact that you cannot handle that stomach acid. So hopefully that makes sense. I would say, no, you don't need to be concerned if you're not feeling that warmth…Stomach acid for some people just doesn't have as much utility as for others. I think it's a good idea in the short term. For Michelle, noticing harder stools, noticing more phlegm-like mucus, I don't know. That's something actually I had not heard before. Is that something you're familiar with, Diane?

DIANE SANFILIPPO: No, I wonder, too, if like basically her body is responding to the increased acid with more mucus production? Which would be good. Like that's kind of a good response, right?

LIZ WOLFE: Yeah.

DIANE SANFILIPPO: You know, maybe it's much…I've definitely heard this from other people before who I would consider to be like pretty healthy low-stress people who probably do have really sufficient mucosal lining intact, stomach lining, that have taken tons of HCL just as this test and never felt the warmth. But I don't know. Noticing much harder stools is a really interesting thing-response there. I, you know, I would definitely just back off of it. I think…I don't think she says this, but one of the things we also tell people to look at because this is kind of the poop podcast, like you can tell if your stomach acid is working if you are not, you know, belching or getting reflux, not feeling bloating, and your eliminations look good. So you know, people get like, oh, I should be taking this. I probably don't have enough, but if you're not, you know, if you're not belching or hiccupping or having that bloated response, if your eliminations are good, then you're probably okay. You know, like…

LIZ WOLFE: Mm-hmm.

DIANE SANFILIPPO: Not everybody needs tons of this stuff, and try this doing like a little bit, maybe one or two capsules or you know, tablets. See how that feels. I definitely, you know, I don't know what much harder stools means. Were they very loose before? So are they normal now? Like, we don't know what that means, but if they're much harder and difficult to pass, then that definitely is a problem and you know, I don't really know why a ton of stomach acid would do that, but perhaps her body is kind of putting out a little bit more of a defense if she's taking in too much. So, yeah.

LIZ WOLFE: I thinking a little bit more information would probably help us with this one because like you said, we don't know what was going on before, we don't know. You know, just even throwing in something really random out there…maybe she's eating a ton of protein and before this point, she wasn't breaking it down. That's something hydrochloric acid is really useful for, breaking down protein. Perhaps now, you know, down the pike, she's got a lot more protein that she's digesting and assimilating and that can give you a little harder stools. But we are also not 100% sure what type of stool she's talking about, what things were like before, what food was like before, that type of thing, so Michelle, if you want to jump in and let us know kind of a little bit more what's going on, we'll certainly look at it again.
All right. Next question from Emily: Hi there,
My question is about my poop. sorry so gross.” It's not gross, people. It's poop. It's natural. Everybody poops.

DIANE SANFILIPPO: Everybody poops.

LIZ WOLFE: Everybody poops. “I don't go regularly. I have been eating strict paleo since September 2011, and feeling great !! just not having great success with bowel movements etc. I'm thinking I'm a little too go go go as in work etc. I'm always super busy and sometimes stressed if it's a really busy week. I'm a personal trainer and a waitress so trying to juggle both.” I actually think you've answered this one before.

DIANE SANFILIPPO: You do?

LIZ WOLFE: I do. I really do. I think back in the day I tried to put together a poop podcast and maybe threw this one in there and then it ended up being a grab-bag podcast. I'm a personal…It's okay, we can answer it again. “I'm a personal trainer and a waitress, so trying to juggle both, eat meat veggies small amounts of fruit mostly berries, few nuts, lots of coconut products like milk, oil and flakes. and I always have protein at every meal. I eat very clean and never cheat so to speak. last time I did, yes that made me go to the loo!
I was wondering if you think I should take a pro-biotic or any foods I could consume to help my bowel movements ? Thanks so much in advance.”
What do you think? What do you think, Diane?

DIANE SANFILIPPO: I think pretty much the same, the same stuff that we've been kind of telling everyone about how to change things up. We don't know-meat, veggies, fruit mostly berries, a few nuts, lots of coconut products-I don't know if there's anything like new or specific. But yeah, probiotic foods, if she's not eating them now, definitely, but I don't know if she's not having great success with her bowel movements, I don't really know what that means. Do we know what that means? I'm like, I'm trying to like put this together. If she's really stressed, you can have either way. Like it sounds like she's got some constipation, you think that's what's happening?

LIZ WOLFE: I think so, and you know, constipation is-it's a subjective, like a subjective symptom. So some people feel they're constipated when their stools are too hard, they're too small, they're not frequent enough. They're difficult to get out, feelings of like incomplete evacuation, fewer than a certain amount of stools per week, and you know, just to throw it out there, and we say this a lot in our Balanced Bites workshops, but just because something is average doesn't mean that it's optimum, so generally, you'll-the transit time, you'll hear even from gastroenterologists that an average transit time's like 50 hours, even up to a hundred hours. But really…

DIANE SANFILIPPO: Oh my God.

LIZ WOLFE: an optimal transit time is much shorter than that. Like 12 to 24 to 30 hours, maybe. And maybe you can throw out there your bowel transit test. Both of us use that with our clients. But really like I said, this is a little bit subjective, but I would say, hydration is really, really important, kind of a first line of defense. Sometimes treating constipation or trouble going is a process of trying one approach, seeing if it works, then if it doesn't, then you move to the next thing. You know, you might need more soluble fiber. You might be dehydrated. You might have a little bit of a deficiency of HCL, like what we were talking about before. You might have a little bit of biliary congestion, dysbiosis, it can be food allergies. And you know, even a low functioning thyroid. In our previous questioner asking a little bit about stools, I think she said she had a little bit of hypothyroid going on, so you know, that can be a part of it as well. There's a ton of different factors that can play into this type of stuff, and a lot of different approaches. So if one thing doesn't work, it doesn't mean you're stuck with it, literally. Ha-ha. Stuck. But we just have to be willing to mess around with it.

DIANE SANFILIPPO: Yeah, and I think sometimes…sometimes the like qualitative information vs. just the quantitative of like, oh exactly like how much are you eating of these things, like you know, when we talk about just…we get this a lot. Like we read a question, and kind of by the end of it, it sounds like the person has almost answered their own question. She was kind of in the middle of this question and saying I think I'm a little too go go go. I've had plenty of clients who are like, yeah, you know, I can't really go to the bathroom all week, and then by the weekend, I feel fine and I eliminate just fine. And you know, inevitably, I'll ask about their job and they're stressed out. Well, this girl is working two jobs, trying to juggle both. Stress will get in the way of everything you do nutritionally. So, you know, I know a lot of people who will constantly be like “But I'm eating perfect food.” And I just know that they're the kind of person who, like I think you said this before, Liz, has that compassionate personality where they're kind of taking on the stress of everyone, taking everything, and internalizing it. And that's lovely to be that kind of person to others, but the reality is what that does to your system is…it wrecks it. I mean, you can, you know, you can be struggling with issues even like leaky gut, where you just are malabsorbing and like not getting in nutrients, even though you're eating tons of food because you are stressed out. And the same thing can happen, you know, your body can basically just be in that fight or flight mode all the time. And you never rest and digest, and you never get to that point where you just chill out and can eliminate comfortably. You know, fight or flight can either cause people to on the one hand, eliminate very quickly, you know. You're kind of like startled or stunned, nervous or scared or whatever's happening, and you get that like need to empty your bowels feeling immediately. Or, it can go to the other side, you know, where you're just completely backed up because blood flow is not really adequately getting to your digestive system. And it sounds kind of out there, but it's true, you know, and we talk about stress a lot, and like this continuum I like to kind of use this notion of like a scale of 1 to 10 of stress, and our body maybe is able to handle this like level 7, 8, 9 at very short increments of that sort of acute stress, and then come back to a level 2 of just like low-level nothing really. But what we're living with today is like this level 4, 5, 6 of chronic, just the stressful lifestyle, whether it's go go go, you know, not eating in a calm, relaxed state when we are eating, toxins in our environment, just all kinds of different stressors that feed into it, and just put us at this level of chronic, moderate stress all the time. So I do tend to think that for a lot of people who are having sort of these like, nagging, I can't figure it out problems, and they are that Type A personality, trying to do everything, the lifestyle factors are like 80% of the game. Like you just cannot fix things with food that your lifestyle's constantly dragging you in the other direction.

LIZ WOLFE: Yup.

DIANE SANFILIPPO: So that's what I think.

LIZ WOLFE: I'm with ya.

DIANE SANFILIPPO: So that's that.

LIZ WOLFE: So that's it. That's all I have for the day.

DIANE SANFILIPPO: That's it?

LIZ WOLFE: Unless you have anything else, you know, shocking?

DIANE SANFILIPPO: Shocking? No. Still working on wrapping up the book and man, this is a lot of work. I'm just putting it out there. I am not complaining. I'm very happy to be able to do this, and get kind of a lot of the information that's in my head, in my practice, in my work, to get it out there. You know, you can't fit everything you know in one book. There's something. [laughs] There's something I learned, in case anyone's wondering. Well, this is not what you talked about…

LIZ WOLFE: Well, I probably could, but whatever…

DIANE SANFILIPPO: No. I'm like, holy jeez, this is like, I already have a list of ideas of like, okay, all this stuff isn't fitting in this book, and I don't know that I want to do this whole process again. It's very stressful, but I have all these other ideas. So anyway, long story short, I'm trying to get that finished up, like details, whatever, in a couple of weeks actually, and yeah, it's set to release August 7th. That's supposed to be a pretty hard on sale date, so for people who are like, what is this book? What is she talking about? You can hop on to the website. If you go on to the website for this podcast, there's a link on the right hand side at BalancedBites.com for the book, Practical Paleo, available for pre-order on Amazon. There will be nutritional meal plan and supplement/lifestyle recommendations for digestive support, so there's a ton of information about poop in the book. There's an entire chart, you know, if you can look at what's happening in the toilet and figure out what's going on with your body, a lot of information about digestion, all of that. So a lot of things that we're covering here will be outlined kind of in easy to understand simple terms in the book, and that's it. [xxx]

LIZ WOLFE: It'll actually get everyone to look at Diane's book.

DIANE SANFILIPPO: [laughs]

LIZ WOLFE: Yeah, well, see you in a couple of hours. We'll be at the Northeast Regionals. Come see me, excuse me, come see me at the PaleoKits booth. I'll be there repping Steve's Club National Program and PaleoKits. Come get some beef jerky. It'll be fun. All right, talk to you soon, D.

DIANE SANFILIPPO: All right. Til next time.

LIZ WOLFE: Next time.

Cheers!
Diane & Liz