What is Gut Health?
Good digestion is a key indicator of a healthy gut and overall well-being. The gut plays a vital role in nutrient absorption, immune function, and even mood. However, many people may not be aware of the signs that indicate their digestive system is functioning optimally.
The topic of gut health is becoming more and more prominent in the health and fitness space, but there are a lot of complexities and nuances involved in assessing issues and finding the right recipe for success for each individual.
Like many subjects in the health and fitness industry, the topic of gut health is particularly prone to conflicting information, and it can be confusing about where to start in troubleshooting gut issues or if they even need troubleshooting!
There are many ways to get the gut to a healthier place, from the basics of increasing food quality and ditching your Standard American Diet type foods to more advanced interventions such as an elimination diet with specific supplementation interventions.
But to what extent does digestion need to be abnormal enough to warrant a protocol?
Is there any amount of gas that is normal? What about bloating and stomach distension? And that loose stool you get each time you eat pizza is totally normal, right?
In this post, we’ll discuss an evidence-based view on good and bad digestion and when someone might benefit from a gut protocol.
Table of Contents
Signs of Good Digestion
Your clients may ask you, “What does good digestion mean?” or “What does good digestion look like?” Both of these are fair and valid questions, as your client may be aware of the importance of good digestion, but they may not be aware of what that looks like.
Below I will answer the following:
- What is “normal” digestion?
- What is normal, healthy stool and bowel movement frequency?
- Is there a normal amount of gas, or is all gas indicative of gut issues?
- How do we distinguish between minor gut changes vs. a deeper, chronic gut health issue?
A Healthy Stool
Readers be warned — this section features your fair share of toilet talk, but if you’re an astute fitness coach, you’re having these conversations with your clients regularly. There are many aspects to stool that are worthy of consideration, but the two easiest factors to address that provide valuable insights are form and frequency.
What Does a Healthy Stool Look Like?
Many of you might be familiar with the Bristol Stool Chart (see link below), but many may not be.
The Bristol Stool Chart was developed in England by Stephen Lewis and Ken Heaton at the University Department of Medicine, Bristol Royal Infirmary. It was suggested by the authors as a clinical assessment tool in 1997 after a previous prospective study conducted in 1992 had shown an unexpected frequency of defecation disorders related to the shape and type of stool. So it’s well-validated and has stuck around to today, and is still commonly used to assess digestive disorders and gut health.
A Bristol Stool Chart is divided up into 7 variations of stool, from chronic constipation to normal to diarrhea (image below). Types 3 and 4 are considered normal stools and indicate a healthy gut. Anything below type 3 is not ideal and can indicate constipation and anything above type 5 tends toward diarrhea.
Part of the brilliance behind the Bristol Stool Chart is that it is relatively easy to use and implement as an assessment tool.
However, there are many things that can be going on in the digestive tract to cause constipation or diarrhea. In a nutshell, slow transit through the digestive tract (which gives time for more water to be reabsorbed), dehydration, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), and inflammatory bowel disease (IBD) could potentially cause constipation.
On the other hand, fast transit through the digestive tract (not enough time for water to be reabsorbed) can cause diarrhea, but some of the other issues I just described — IBS, SIBO, and IBD — could also cause diarrhea. This is most likely due to dysbiosis at the root of IBS/SIBO, and there’s good evidence that autoimmune IBD begins with a dysbiotic (imbalanced) gut microbiome which can contribute to other issues.
Other health complications strongly connected to gut dysbiosis include autoimmune diagnoses such as Hashimoto’s.
How Often Should You Have a Bowel Movement?
Bowel movement frequency is the second consideration regarding a healthy gut and healthy digestion.
A normal stool frequency will depend on a few factors, but most people should generally be going at least once a day. Once every other day can be “normal” in some situations, but if you’re only going once or twice a week, this falls into the category of chronic constipation.
Situations where you might have decreased stool frequency, maybe once every other day, and it still be “normal” would be things like:
- If you’re deep into a calorie deficit (reducing food portions and energy availability) and low on food in general. If you have less food coming in, you’ll have less waste going out. Being very deep into a cut and getting very lean, we may have downregulation of the thyroid axis, which could contribute to slower transit times and lead to the possibility of some short-term constipation. This is not necessarily “normal,” but it is normal for the context of where you are at the time. Constipation due to a calorie deficit is not necessarily something that we would want to occur for long periods of time, but it is easily reversible and expected within the context of a significant energy deficit.
- Another possible consideration is if you’re eating a very low-waste diet. A diet like a carnivore diet or keto diet that doesn’t have a significant amount of indigestible fiber is most likely going to cause less frequent bowel movements. However, I’d still say going every other day in this situation is “normal.” We’d still strive for daily bowel movements or at least every other day on the slower side of transit time. Anything longer than every other day, and you’re looking at potential gut health issues.
When examining stool frequency, it is important to consider the above variables within the context of other symptoms and biofeedback. For example, straining when attempting to pass a bowel movement, excessive fullness, or abdominal pain would be signs of larger problems. Pairing any of these with decreased stool frequency provides insights into potential issues that are not normal or optimal in terms of digestive health. These symptoms would indicate underlying gut troubles beyond low waste or food intake.
Having a bowel movement several times a day can also be healthy and normal.
Stool form would be the first thing to look at here. If it’s anything above a 4 on the Bristol Stool Chart, then it’s not a good thing, but if you’re going 3–4x a day and your stool comes out at a 3 or 4, I’d look at the rest of your lifestyle.
Do you eat a very high-fiber diet? Are you in a mass-gaining phase right now and are just eating excessive amounts of food in general? If those are the case and stool form is good, then going several times a day could also be healthy.
If none of these things are true and you’re going 3-4x a day, even with a 4 (or if that 4 is bleeding into 5 territory), we might have to look further and troubleshoot.
When is Diarrhea or Constipation a Big Issue vs. Transient?
There are occasions when diarrhea or constipation is a significant issue rather than something that “works itself out,” so here are some considerations.
If your diet is full of processed foods, high in sugar, devoid of vegetables, etc., and you have constipation or diarrhea every now and then, then the first step is to minimize the amount of processed foods and include more whole, micronutrient- and fiber-dense foods, and see if the diarrhea or constipation resolves. If it resolves after taking the basic steps, then while there still might have been an underlying issue, it wasn’t a serious or tough-to-resolve one.
If you’re eating mostly whole, micronutrient- and fiber-dense foods, drinking enough water, etc., but still have issues, look at how often you’re experiencing issues. The frequency of constipation or diarrhea will determine whether there are gut health issues you need to address.
Acute vs. Chronic Diarrhea and Constipation
The medical field defines chronic constipation as 3 or fewer bowel movements per week for at least 3 months, whereas chronic diarrhea is defined as regularly having loose stools for at least 4 weeks.
If your constipation is acute, this could be due to minor factors. For example, maybe you’re doing a lot of travel — airplanes are dehydrating because the change in atmospheric pressure causes fluid shifts to the lower extremities and induces changes in blood viscosity which can accelerate dehydration. Couple that with the fact that airplane cabin air is near 0 percent humidity, and it’s a recipe for dehydration.
Acute constipation could also occur due to any interruption to a dietary routine that might cause you to eat less fiber for the time being.
It’s a similar situation with diarrhea; if it’s acute, there may have been a bug on those vegetables you didn’t thoroughly wash or in the sushi or medium rare steak you ate for lunch. However, you should still pay attention even during acute bouts of diarrhea, as they may be a sign of a developing gut health issue.
It could also be due to a food sensitivity, and the more you trigger that food sensitivity, the more frequently you’ll be inducing intestinal inflammation, which could develop into more serious issues.
If you experience chronic diarrhea or constipation, it’s a serious issue and should be evaluated by a doctor for medical issues, like small or large intestinal wall problems. If serious medical issues are ruled out, and it’s just deemed IBS or idiopathic (meaning the cause is unknown), then it should be addressed through an elimination diet and a full gut protocol if all the basic factors are covered already.
How Much Gas and Bloating Is Normal?
For many people, it can be tough to determine between regular gas and bloating from problematic gas and bloating.
We can look at a few things to assess this crudely. The relevant factors are frequency, scent, and presence of other symptoms like stomach distension/GERD/etc.
There are two factors going into gas production, the diet and how many residues (i.e., fiber) are present, and the types and amounts of microbes in the gut.
Additionally, there are two factors going into whether symptoms are present, the type and amount of gas and the sensitivity of the individual’s gut.
Whenever someone is experiencing severe bloating or pain combined with excess gas, that indicates they have “visceral hypersensitivity.” Visceral hypersensitivity means that the gut becomes very sensitive to things like gas production and excess fecal matter, and even a small amount of gas can give them symptoms like pain and bloating. In contrast, if a healthy individual produced the same amount of gas, they’d barely feel it, if at all.
Visceral hypersensitivity is a hallmark of IBS, SIBO, and IBD.
If the bloating is chronic, as in you’re getting bloated and gassy very frequently on a daily basis, then this is an indication that you may have a real gut health issue.
Types of Gas
Let’s dig a little further into types of gas.
Hydrogen and CO2 are the main gasses produced in a healthy gut, but in some versions of SIBO, methanogenic (methane-producing) archaea can dominate, and then methane becomes the dominant type of gas the gut produces. This type of gas will have a different scent than normal, and the presence of chronic constipation can be a sign of methane-dominant SIBO. The presence of methane in the large intestine significantly slows down transit time, which leads to constipation.
The second most common type of SIBO is when hydrogen gets overproduced. Diarrhea is the predominant symptom for individuals who have hydrogen SIBO.
A third and more rare type of SIBO is hydrogen sulfide dominant. Hydrogen sulfide is another gas produced by everyone, but it can be overproduced in dysbiotic situations. This type of gas will give that really nasty, sulfur-type scent. So if your gas chronically smells like this, there may be an issue going on.
Don’t get me wrong, nobody’s farts smell like roses, but there’s a difference between things smelling mildly bad for a short time vs. room-clearing, offensive farts that stick around and have that sulfur scent.
To recap, if you have gas, but it’s not super frequent (think like 10-ish times per day, not 10-ish times per hour), not frequently accompanied by bloating, pain, etc., and it also doesn’t have an extremely strong, abnormal scent, then this is probably normal gas.
Other Signs of Poor Gut Health
Now that we’ve covered the more nuanced pieces of the topic, the other symptoms are a little more cut and dry.
There is no amount of acid reflux or GERD that is normal. If reflux is present, it should be investigated further to determine the source.
In terms of bloating and stomach distension, we talked a bit about this already, so you should be halfway clued in, but chronic bloating and stomach distension are not normal either and should also be investigated.
Remember, we’re thinking about types and the amount of gas and sensitivity of an individual. If someone just ate an abnormally large meal and experiences bloating as a one-off, then it’s probably not an issue.
Similarly, if someone downs 50-60g of fiber in one sitting, which is not too unheard of these days, with low-carb wraps, breads, and things like Quest bars providing around 15 grams of fiber per serving, then there will be a larger volume of gas.
Even a healthy person without visceral hypersensitivity can potentially experience bloating from producing a large amount of gas, so look at these types of things along with frequency. If it’s chronic, daily bloating from normal-sized meals, then it’s probably an issue.
Gut Health Tips
Hopefully, this has been helpful – I know some people in the fitness space who, if they pass gas once a day, are chomping at the bit to look for gut health remedies, which they probably don’t need to do if it’s only at that level.
To give a final recap:
- You always want a 3 or 4 on the bristol stool chart.
- Passing gas several times a day is fine as long as you’re not experiencing daily bloating/stomach distension along with it, and you’re not making people’s eyes tear up and clearing rooms with the smell.
- If you have daily GERD (acid reflux), daily bloating or pain, smelly, persistent gas, and anything above or below a 3 or 4 on the Bristol stool chart consistently, you should probably make some changes to improve your gut health.
Check out my other gut health posts to dive deeper into this topic and learn how to improve overall health by addressing your gut:
