Poop, “Gut Health,” And Holding New Science Lightly

Plus! Summaries & findings from 5 recent studies on the gut microbiome

I am deeply interested in the gut microbiome, like a lot of people these days, and particularly a lot of people with weird immune-y, fatigue-y, inflame-y chronic conditions. I’ve written before about poop, and I published test results from own gut microbiome, and I generally believe that the composition of the microbial community in my gut has a huge impact on my current and future health.

But here’s my issue: UGH it’s so complicated, and humans know so little, and the research is coming out so quickly. When I try to read about gut microbiota, I’m like OMG THERE’S SO MUCH I DON’T KNOW I GOTTA STOP RIGHT NOW. I fear that my opinions are being shaped by fads, that I’m over-focusing on some certain study that’s not actually rigorous enough, that I’m not trained in interpreting scientific research data, that I have confirmation bias.

In other words, I’m like almost everyone else trying to learn about this booming, insanely complex area of knowledge. I know that some people, faced with a huge lake of new information, feel excited and voracious. Not me. I feel fear.

So what is a person to do in this context? I don’t want to give up and just wait ten years for final findings to make their way into formal medical advice. I don’t want to go get a degree in microbiology or statistics. I do want to read more and talk to more experts, but that will take time, and I will simply never keep up with everything unless I make this my main thing. And yet, I feel compelled to know more, because of what’s happening in my own body.

A third poop update

I am now going to share more gross poop details than I have in the past, because I honestly wish I knew more about the workings of other people’s bowels, and by sharing maybe you will feel inclined to share with me, too. Because I’m just sitting here in my own world thinking: damn what is going on here! Anyone else with me? If a description of my poop is too much for you, please happily skip to the next section.

For the last many months, I have stabilized in what I would call a state of well-moving constipation. Wait, what? Here’s what I mean: each day, I have 3-6 bowel movements, each small and hard, and often composed of many small pieces. All the poop floats, which, as I understand it, can indicate malabsorption of fat or an excess of gas. This all seems wildly abnormal, but also much more manageable than other poop eras I’ve experienced, for example chronic diarrhea or non-moving constipation that actually becomes painful and problematic in all sorts of ways.

Here are some wild facts: researchers estimate that up to 28 percent of people struggle with constipation, and women are more likely to have constipation than men (there are theories that this difference is linked to female sex hormones). I don’t know about you, but I’m a thirty-five year-old woman living in a big city and I feel like almost every woman I know well enough to talk with about poop is constipated. Constipation prompts about 2.5 million patient visits per year and costs over $7,500 per patient. There is also mounting evidence that constipation can be an early warning sign for certain diseases. For example, one study found that men who had a bowel movement less often than once per day had four times the risk of developing Parkinson’s Disease, versus men who had two bowel movements per day. Constipation also commonly co-occurs with a range of autoimmune diseases.

Holding new facts lightly

Ok, so I just dropped some facts, but are they true? We’ve all seen the headline one year that coffee is bad for you and the headline the next year that coffee is good for you. Do we actually know that constipation costs $7,500 per patient? No, we don’t. That was surely the work of some twenty-three year-old analyst or junior lab associate doing her best at her new job. Are we certain that constipation is correlated with Parkinson’s risk? We are not, and that study I cited was done in 2001, which was (and I can’t believe this) over TWENTY years ago (though there have been many related studies since, including one this year finding that gut microbiome changes indicating Parkinson’s may be detectable long before motor symptoms.)

But, in my view, the fact that we don’t know all the specifics FOR SURE does not invalidate the value of learning about the general picture, and should not disempower me from seeking new information. This is at odds with how medical research works today, and how doctors typically view patient-led research (annoying, irresponsible, a waste of time). The prevailing approach in medicine is to study and study and study, and, through the amazing scientific research and review process, hone in on more and more certain truths over long periods of time. Once a topic has been studied rigorously, then new findings make their way into official recommendations. (There are some very glaring exceptions to this where official recommendations are based on literally nothing, and many of these are in the world of women’s health. But that is a topic for another time).

Until this whole long process has taken place, the official position is that there is “no evidence” to support, say, probiotic use for almost any gastrointestinal issue. And I get that this is an important mechanism for preventing harm that could be caused by making recommendations without sufficient evidence to back them up. But at the same time, there is a lot of relevant information out there for the many people who are currently suffering, and shutting these people out of the new information because we aren’t “experts” also seems potentially very harmful.

So, as I usually do, I’d like to suggest a middle way. I don’t think the move is to glom on to that newest study on the gut microbiome and shift your whole diet to meet its recommendations. And I am also not suggesting shutting yourself off to new research that could be really helpful for you because there haven’t been repeated, large, double-blind, placebo-controlled trials (which are, by the way, reallllly hard to do in the context of the gut). You are smart! You can read! You know your body best! Go forth and learn.

The key for me, though, is to hold new facts lightly, more as suggestive directional arrows. Each new fact is like a single brush stroke in a Monet: I need to stand back a little to see something emerge, rather than fixate on one purple blob coming from one author at one time. And, moreover, if I want to stay sane in the world of guts, nutrition, and health, I have to accept that anything I believe now really might be wrong. I also have to accept that my approach won’t be completely and rigorously scientific, it will also be driven by what “feels” true to me based on my own experience. We are conditioned to think of this intuitive method of evaluating information as invalid, but it seems like, having been the only one ever to live in my body, my own intuition about it should count for something.

Nudging versus transforming

It is hard for someone with perfectionist tendencies to read new information and hold it lightly. I’m not doing everything that the researchers are recommending exactly as prescribed! I’m doing it wrong! What if I’m missing something important!

Well, here’s the thing: I definitely am missing something important, we all are, researchers and doctors included. There’s just a lot that people don’t know. So, rather than trying to find the big, amazing, perfect solution to solve my constipation and fix my microbiome once and for all, I’ve started to like the idea of nudging.

I’m nudging my knowledge a little bit this way and that as I read new things, hopefully towards truth, but definitely sometimes away from it.

I’m nudging my microbial communities by trying various changes, to see if we can work together a little bit better.

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For the amount of time I spend writing about mysterious health issues, the time I spend researching is probably tenfold. So, I’m trying a new format. Whenever I write a post like the one above, I’ll be sharing the most valuable research I’ve collected on that particular subject. This section of research, complete with my own summary of the findings and links to the studies, will be a special benefit for my paid subscribers. Thank you for your support!

5 recent studies and their findings on the gut microbiome (to be held lightly)

The following studies suggest answers to some interesting questions…

• How do diets high in fermented foods and plant based fiber affect the gut microbiome?

• How does the gut microbiome differ in patients with ME/CFS?

• Is gut microbiome composition primarily determined by genes or lifestyle?

• Does the gut microbiome affect the the progression of Alzheimer’s?