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How do you debunk popular ideas about fiber’s role in digestion and elimination without being accused of committing a sacrilege, when it has already become a gold-standard treatment for “regularity,” a miracle laxative, and a concept so embedded in the minds of doctors and patients alike that it’s no longer even questioned by anyone?

Well, there are “sacred truths,” and then there are the long-established, indisputable facts of human physiology:

Breast milk has zero fiber, yet healthy babies produce abundant (relative to their weight and size) stools several times daily.

People who fast for weeks at a time have regular stools, even though they consume nothing but water.

Some people (the lucky ones) who attempted the Atkins Diet, had no problem with constipation, even though their diet contained zero or minor amounts of fiber.

Indigenous Inuit (Eskimo) people, who inhabit the Arctic coast of North America, some parts of Greenland, and northern Siberia, consume a fiber-free diet, and aren’t affected by constipation.

None of the above makes any sense, conventionally speaking. People can’t have regular stools without consuming any fiber, right?

Wrong! The reason you’re stumped is simple: you’ve been conditioned to believe that normal stools are made mainly from food, and that fiber is required to make them. Inevitably, the next logical inference forms a familiar logic:



It seems perfectly logical, right?

Wrong again! Actually, normal stools shouldn’t contain any remnants of undigested food. Dietary proteins, fats, carbohydrates, and even fiber must digest completely. If something you ate exits your body as is, it means it wasn’t digested or couldn’t get digested to begin with, such as denatured protein (burnt meat). Technically, even indigestible fiber should be fermented by intestinal bacteria.

That’s why a stool exam that shows any visible remnants of undigested fats, proteins, or carbohydrates, or even specks of undigested fiber (any at all), points to impaired digestion, and one disease or another that affects the organ(s) responsible for digestion and the absorption of a specific nutrient. That much is written in any medical reference book, and the observation of stools is widely used as an effective diagnostic tool for disorders of digestion and the digestive organs.

So what, then, are stools made from, if not food and fiber? Primarily water, intestinal bacteria (single cell, free-living microorganisms), dead bacteria and cells shed by the body, mineral salts, coloring pigments, and traces of fat. Intestinal bacteria are by far the largest component of stools. Let’s repeat again the quotation that opens this chapter [R.F. Schmidt, G. Thews Human Physiology, 2nd edition, a medical school textbook, -KM]:

“There are over 400 species of bacteria in the colon; bacteria make up 30%–50% of the total dry matter in the feces, or even 75% according to other calculation. [1]”

Besides other important tasks, these abundant bacteria make normal stools, unless they are completely or partially decimated by the vestiges of civilized living, or even—harder to believe—by dietary fiber.

Intestinal flora—the sum of all indigenous bacteria that reside inside the intestinal tract (the host)—is considered an organ in itself, just like the liver or bone marrow, because the bacteria perform a range of essential, health-critical functions that can’t be reliably duplicated by any other means. Researchers determined these functions by comparing sterile lab animals (without any intestinal flora) with control animals that had normal flora. All of these findings have been confirmed in people as well. Here’s a brief listing of the intestinal flora’s most important functions:

Water retention in stools. Single cell organisms, such as bacteria, contain mostly water, encircled by impenetrable membranes. In large quantities, they provide normal stools with its amorphous qualities. That’s why dry stools reliably point to disbacteriosis.

Formation of normal stools. Since bacteria represent the most dominant component of normal stools, their absence may cause persistent chronic diarrhea or hard, rock-like stools (Type 1 on BSF scale).

Manufacturing of essential vitamins. Bacteria synthesize a whole range of substances, including certain B-complex vitamins, vitamin B12, and vitamin K, which is essential for proper blood coagulation.

Protecting the intestinal epithelium (mucosa) from pathogens. Normal intestinal flora controls the population of undesirable bacteria, such as Candida albicans (yeast) or the infective strains of E. coli. The mechanisms of protection are numerous—competition for food supply, adhesion to the intestinal mucosa, maintenance of desired pH balance, and production of peroxides and enzymes, which kill foreign bacteria.

Tissue development and regeneration. The intestinal mucosal membrane (epithelium) and lymphatic tissues (Peyer’s patches) of sterilized lab animals are poorly developed vis-à-vis healthy animals. The shortcomings of a weak mucosal membrane for intestinal health and underdeveloped lymphatic tissues for immunity are self-evident.

Immunity. Normal intestinal bacteria are responsible for enabling phagocytosis—the body-wide destruction of pathogenic bacteria, viruses, allergens, and other foreign objects by phagocytes, which are specialized blood cells responsible for non-specific (before antibodies) immune system defenses.

Besides the obvious conditions (constipation, diarrhea, and disorders related to B- and K-vitamin deficiencies) other common conditions that have been associated with disbacteriosis are irritable bowel syndrome, ulcerative colitis, Crohn’s disease, fatigue, diabetes, colon and breast cancers, acne, eczema, psoriasis, asthma, allergies, joint diseases (rheumatoid arthritis, gout, osteoarthritis), and others.

BSF Scale:

» Type 1: Separate hard lumps, like nuts

Typical for acute disbacteriosis. These stools lack a normal amorphous quality, because bacteria are missing and there is nothing to retain water. The lumps are hard and abrasive, the typical diameter ranges from 1 to 2 cm (0.4–0.8”), and they’re painful to pass, because the lumps are hard and scratchy. There is a high likelihood of anorectal bleeding from mechanical laceration of the anal canal. Typical for post-antibiotic treatments and for people attempting fiber-free (low-carb) diets. Flatulence isn’t likely, because fermentation of fiber isn’t taking place.

» Type 2: Sausage-like but lumpy

Represents a combination of Type 1 stools impacted into a single mass and lumped together by fiber components and some bacteria. Typical for organic constipation. The diameter is 3 to 4 cm (1.2–1.6”). This type is the most destructive by far because its size is near or exceeds the maximum opening of the anal canal’s aperture (3.5 cm). It’s bound to cause extreme straining during elimination, and most likely to cause anal canal laceration, hemorrhoidal prolapse, or diverticulosis. To attain this form, the stools must be in the colon for at least several weeks instead of the normal 72 hours. Anorectal pain, hemorrhoidal disease, anal fissures, withholding or delaying of defecation, and a history of chronic constipation are the most likely causes. Minor flatulence is probable. A person experiencing these stools is most likely to suffer from irritable bowel syndrome because of continuous pressure of large stools on the intestinal walls. The possibility of obstruction of the small intestine is high, because the large intestine is filled to capacity with stools. Adding supplemental fiber to expel these stools is dangerous, because the expanded fiber has no place to go, and may cause hernia, obstruction, or perforation of the small and large intestine alike.

» Type 3: Like a sausage but with cracks in the surface

This form has all of the characteristics of Type 2 stools, but the transit time is faster, between one and two weeks. Typical for latent constipation. The diameter is 2 to 3.5 cm (0.8–1.4”). Irritable bowel syndrome is likely. Flatulence is minor, because of disbacteriosis. The fact that it hasn’t became as enlarged as Type 2 suggests that the defecations are regular. Straining is required. All of the adverse effects typical for Type 2 stools are likely for type 3, especially the rapid deterioration of hemorrhoidal disease.

» Type 4: Like a sausage or snake, smooth and soft

This form is normal for someone defecating once daily. The diameter is 1 to 2 cm (0.4–0.8”). The larger diameter suggests a longer transit time or a large amount of dietary fiber in the diet.

» Type 5: Soft blobs with clear-cut edges

I consider this form ideal. It is typical for a person who has stools twice or three times daily, after major meals. The diameter is 1 to 1.5 cm (0.4–0.6”).

» Type 6: Fluffy pieces with ragged edges, a mushy stool

This form is close to the margins of comfort in several respects. First, it may be difficult to control the urge, especially when you don’t have immediate access to a bathroom. Second, it is a rather messy affair to manage with toilet paper alone, unless you have access to a flexible shower or bidet. Otherwise, I consider it borderline normal. These kind of stools may suggest a slightly hyperactive colon (fast motility), excess dietary potassium, or sudden dehydration or spike in blood pressure related to stress (both cause the rapid release of water and potassium from blood plasma into the intestinal cavity). It can also indicate a hypersensitive personality prone to stress, too many spices, drinking water with a high mineral content, or the use of osmotic (mineral salts) laxatives.

» Type 7: Watery, no solid pieces

This, of course, is diarrhea, a subject outside the scope of this chapter with just one important and notable exception—so-called paradoxical diarrhea. It’s typical for people (especially young children and infirm or convalescing adults) affected by fecal impaction—a condition that follows or accompanies type 1 stools. During paradoxical diarrhea the liquid contents of the small intestine (up to 1.5–2 liters/quarts daily) have no place to go but down, because the large intestine is stuffed with impacted stools throughout its entire length. Some water gets absorbed, the rest accumulates in the rectum. The reason this type of diarrhea is called paradoxical is not because its nature isn’t known or understood, but because being severely constipated and experiencing diarrhea all at once, is, indeed, a paradoxical situation. Unfortunately, it’s all too common.

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