Microbes, Motility and More: How Do I Know if my Poop is Normal?


This presentation, titled Microbes, Motility and More: How do I know if my Poop is Normal? features Kristina Campbell MSc and many special guests. This presentation was done at CDHF’s #TrendingNow: Putting the Biggest Gut Health Trends under the Microscope November-January 2022.

Learning Objectives:

  • What gut health means and the definition of ‘normal’
  • How to rate bowel movements and what a healthy bowel movement looks like
  • Facts on the average frequency of bowel movements
  • An overview of gut motility and the “blue poo challenge”
  • Basic info on your gut microbiome and how to keep your microbes well fed

Disclaimer: This presentation and the information within it is not a substitute for medical advice. Please speak to a qualified health care provider about your unique situation.

One of the major questions answered in this presentation was “how is gut health defined?”

Kristina explains that gut health is normal structure and function of the digestive tract. What does that mean exactly? Dr. John Damianos, M.D., who’s a resident physician at Yale New Haven Hospital in the Department of Internal Medicine answers with the below:

“I like to think of five different aspects:

  1. Nutrient absorption
  2. Structure
  3. Motility
  4. Gut microbiota
  5. Gut brain connection

The first component I like to think about is, is it doing its job in doing that? Is the gut absorbing nutrients?

And so there are multiple disease states such as celiac disease or Crohn’s disease that affects the small intestine where you have inflammation in the small intestine that doesn’t allow nutrients to be properly absorbed. And so, people may have vitamin deficiencies, iron deficiency, anemia, they may have trouble gaining weight, their stools may be fatty, they may have a lot of diarrhea; and so, these would be concerns that might clue me into the fact that they may be having sort of malabsorption disorder. So, that’s the first component.

The second component is are the organs and the mucosa structurally intact?

And so this can take part in many different ways. And so, for instance, in the esophagus, eosinophilic esophagitis might have chronic inflammation that leads to scarring or stricture. Same thing with chronic gastroesophageal reflux disease or heartburn. Similarly, with inflammation anywhere in the bowels, so in the inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, you can have rip roaring inflammation throughout the colon that distorts the architecture and prevents it from doing its normal job. And then you can also have multiple GI cancers, whether that’s esophageal cancer, stomach cancer, small bowel tumours, which are rarer, or what’s very common and what most people know about colorectal cancer. So, cancers of the colon and rectum; so masses and inflammation, any sort of distortion of the architecture.

The third component is the motility.

So, are things moving through the gut in the appropriate way, at the right speed, not too fast, not too slow? And every part of the digestive tract can be affected in terms of having good motility or having dismotility. And so, with the esophagus, there are a multitude of esophageal dismotility disorders, including achalasia, being potentially one that most people may have heard of, and then some rarer ones in the stomach, gastroparesis, where the stomach is essentially paralyzed and has trouble emptying at the proper rate.

There are many types of small bowel dismotility. Autoimmune diseases such as scleroderma and other connective tissue disorders can have dismotility of the small bowel. And then with respect to the colon, chronic idiopathic (meaning you don’t know the exact cause of it) constipation, chronic diarrhea. These can present this way, reflecting dismotility of the colon as well.

The fourth component is the health of the gut microbiota.  

So, these are friendly microbes in our gut that vastly outnumber the cells in our body that include bacteria, viruses, fungi, archaea that can either help our digestive health and systemic health or harm it. 

And many factors influence the composition and the function of the gut microbiota, including factors from very early on in life, including the maternal milieu and the placental milieu.  So, even before birth, medications of the mother is on, mode of delivery – C-sections versus vaginal births, breastfeeding versus formula, diet is the most impactful way that that the gut microbiota is altered.

Certain medications, such as antibiotics, certainly alter it.  Stress can alter the microbiota, environment, additives in the diet as well.  And this concept of dysbiosis, or an abnormal gut microbiome, has been implicated in many different gastrointestinal and systemic disorders.  And so there’s tremendous interest in targeting the gut microbiota to treat and prevent some of these disorders.

And then the last component that I think about is the gut brain axis and is there concordance between the gut and the brain?  

And so, the gut is often called the second brain.  Our gut has an extensive network of nerves that enervate it, and it links very closely to the gut microbiota to our immune system. And so, it’s really its own organ that is — I always think of it as the other side of the coin that the brain and central nervous system are a part of.

And there are 44 disorders of so-called gut brain interactions where there is dysfunction somewhere along the gut brain axis.  And there are ones that affect the upper GI tract and lower GI tract, ones that people may know about include irritable bowel syndrome and functional dyspepsia, dysentery defecation would be another one of these.  And all of these are due in part to dysfunction along this gut brain axis and are not completely explained by the other components that I mentioned before.

And so when I think of gut health, it’s really those five components, and I look for these symptoms that I mentioned before that might suggest that somebody has some sort of dysfunction within their gut.  And then based on symptoms, and then, you know, if they’re in the office looking at a deeper history, physical exam, labs and imaging, we can then clue where exactly this dysfunction is and then hopefully diagnose and treat it.”

So how do you know if you have good gut health versus not good gut health?  Kristina mentions that medically, where we are at right now is if you have no diagnosis, that means you’re normal.  So, there are some sort of threshold that you cross if you have a diagnosis of a GI disease or digestive disease, whereas everyone else kind of falls into this general category of normal. To help answer the question, Kristina interviews Dr. Richard Hunt. Watch the video interview to hear what he has to say about what your poop is telling you!

About the Speaker: Kristina Campbell, a science and biotechnology writer, is author of The Well-Fed Microbiome Cookbook and co-author of the academic textbook Gut Microbiota: Interactive Effects on Nutrition and Health (which has a second edition forthcoming). Kristina specializes in translating microbiome science and helping the general public sort fact from fiction when it comes to gut health, probiotics, and prebiotics.