Anyone who has ever visited a WholeHealth Chicago Functional Medicine practitioner knows that lots of questions focus on digestion. The reason for this goes all the way back to the ancient Greek physician Hippocrates, who is alleged to have said “All disease begins in the gut.”
This concept is not at all taught in medical school.
Although our practitioners might begin with “how’s your digestion?” we’ll go much further, one end to the other so to speak, from the acidic taste in your mouth (acid reflux) to the itchiness around your anus, occasionally a sign of parasites or candida.
In between lie heartburn, nausea, food intolerances, bloating, and many more digestive issues. You’ll likely be asked about the consistency of your stools and maybe asked to pick your poop (great title for a TV quiz show) out on a Bristol Chart.
Patients frequently come to see us believing they’re constipated, but often they get it wrong. I myself ask a question that echoes a high school essay assignment, “What does constipation mean to you?” substituting the word constipation for the more frequently asked democracy, freedom, or America.
Clearing the air on gut issues
To set the record straight, constipation means three or fewer bowel movements a week, with stools that are hard and dry, difficult or even painful to pass. We’ll ask “How long does it take you to poop?” and sometimes a patient will respond with a look of agonizing despair.
Constipation is usually related to what you eat and your state of hydration. It often comes and goes and may disappear altogether once you recognize that a diet of low-fiber hamburgers, fries, and diet Cokes isn’t the healthiest choice for your gut.
We’ll also ask about chronic skin conditions. If you think about it for a moment, you’ll realize that your skin and the lining of your digestive tract are a single continuous body part. A few gastroenterologists do acknowledge that they’re internal dermatologists, which to me is quite insightful considering I’ve never actually encountered an active working relationship between a gastroenterologist and a dermatologist.
But instead of thrusting the clinical equivalent of a garden hose into either or both your digestive orifices (the preferred diagnostic tool of the medical profession), functional practitioners stress function, which means determining just how well your digestive system is working.
Testing for function
Our most frequently used diagnostic tests evaluate how well you’re digesting and absorbing the foods you eat. We can check on the health and well-being of the five pounds of bacteria in your large intestines (your microbiome) and whether you might have an excessively permeable intestine (leaky gut). We can also look for hidden food sensitivities and check on whether your gut is so sluggish that large intestine bacteria have meandered upward to your small intestine and are producing excess gas whenever you eat (this is called small intestine bacterial overgrowth or SIBO, with bloating a key symptom).
Gut sluggishness is rarely caused by disease and is most often, as I mentioned, related to diet and hydration. But chronic gut sluggishness can muck up your microbiome. This itself has been linked to a variety of chronic illness including liver disease, autoimmune disease, psychological disorders, obesity, and diabetes.
So what’s with the blue poop?
What’s really useful in Functional Medicine is to know how long it takes you to digest, absorb, and evacuate what you’ve eaten. This is known as your gut transit time (GTT) and measuring it can give you a pretty good idea about the state of your microbiome.
Gastroenterologists occasionally measure GTT, but somehow manage to turn the excruciatingly simple into the brutally complex, having you swallow wireless transmitters or capsules containing radioactive markers.
Here are some GTT time frames: normally, your stomach will empty in five or six hours, the digested food spending another five hours in your small intestine and anywhere from ten to 60 hours in your large intestine. This varies widely from person to person, and one person can also have a wide range of transit times depending on the food eaten, exercise, hydration, and other factors.
If the process consistently goes too quickly, you may not be getting maximum nutrition from your food. If it moves too slowly, you’ll have chronic constipation and an altered microbiome.
Functional medicine practitioners may suggest you try the blue-poop test to measure your gut transit time. All you do is eat some food to which you’ve added enough royal blue food dye (such as this one) to make it blue. It’s pure simplicity, and unlike swallowing a radioactive capsule the food won’t get stuck in your small intestine.
Eat the blue food, write down the date and time, and then start watching for blue poop.
When your poop comes out blue, write down the date and time and calculate the number of hours since you ate the blue food. A typical normal range is anywhere between 15 and 60 hours. But don’t worry if your gut is a bit sluggish. Remember, this is usually a functional issue rather than disease.
All you need to do is exercise a bit more, increase the amount of fiber you eat (fruits and vegetables are excellent sources), eat some fermented foods like yogurt or fermented cabbage or take probiotics, drink more water, eat less meat, and eliminate processed food and refined white flour products.
Here’s a link to a blue muffin recipe (though I don’t recommend making a habit of these). If you prefer, make blue scrambled eggs or a blue omelet.
At the end of the blue-poop experiment, you’ll have a lot of information on your gut transit times. If you want some help evaluating gut health or determining if a chronic health problem can be traced to an unhealthy gut, give us a call and schedule an in-person or phone consultation with one of our practitioners.
In the meantime…
David Edelberg, MD