Everything You Need to Know About Poop

By
Poo is no longer taboo.Photo: Bobby Doherty

Suddenly, it seems like we’re all talking about poop. At dinner parties, at the grocery store, on Snapchat. At play, in part, is a broader cultural trend in making public discourse of formerly taboo body functions (see, for example, last year’s viral-marketing campaign for Thinx menstrual underwear). But in the case of our bowel movements, there’s actually much to discuss.

For one, the 2010s have turned out to be a golden age of crap science. Discoveries around the world have been made about the microbiome — the millions of microbes that reside throughout your body and intestines and, consequently, your excrement — and its role in an astonishing array of conditions. A 2015 University of Minnesota study showed that doctors may one day be able to predict a colon-cancer sufferer’s prognosis by examining his gut bacteria, where elevated levels of two particular gut bugs may indicate how far the disease has progressed. Other recent findings reported that, compared with non-autistic kids, those with autism had ­drastically altered degrees of certain intestinal bacterial species; in another paper, treating mice with Bacteroides fragilis improved their autism-like behavioral symptoms. And a recently formed coalition of four U.S. research centers called the MS Microbiome Consortium even believes we may one day be able to treat patients with multiple sclerosis and other autoimmune diseases by altering their gut bacteria — largely through dietary changes and probiotic supplements. It’s not surprising, then, that just this month the White House announced the launch of the National Microbiome Initiative, which will involve major investigations of the human-gut microbiome, funded by $121 million from the government plus an additional $400 million from private donors.

Photo: Joe McKendry

Beyond diseases, studies in animals have hinted at what scientists call a “gut-brain axis” — that is, that the bacteria and viruses found in the gut may influence the brain and thereby behavior; a finding published in Gastroenterology in 2011 revealed a typically shy set of mice became “bold and adventurous” after taking a mixture of antibiotics that significantly altered their gut composition. Other studies on the human microbiome have found that the makeup of a person’s gut bacteria is personalized enough to potentially play a role in forensics: A 2015 finding published in Science showed that researchers were able to identify people by their microbiological aura — bacteria shed throughout their homes (and, theoretically, in their toilets).

The boom of scatological breakthroughs extends past the medical field, too. In 2014 in the U.K., a bus fueled by bio­methane gas — created from human (and food) waste — made its inaugural journey, traveling from Bristol to Bath. In a widely viewed recent YouTube video, Bill Gates drinks water that just five minutes earlier had been literal shit (it was to demonstrate the power of his new Omni Processor project, dedicated to turning human waste into water and electricity).

Alongside all this new fecal science and technology, we’ve seen a burst of more individualized advancements: bowel-tracking apps helping our quest for an ever-more “quantified” self; colonic treatments at new New Age spas; the $25 plastic Squatty Potty that did an estimated $15 million in sales last year. In Israel, meanwhile, a pair of scientists say they can tailor a nutrition plan for you after you give a stool sample. There’s a 4,000-person waiting list. —Melissa Dahl

6 Moments When Feces Entered the Public Discourse

2005: On an episode of The Oprah Winfrey Show, Winfrey asked Dr. Oz what shape the ideal excrement should be. (Like the letter S, which indicates smooth movement through the intestines.)

2008: Jamie Lee Curtis appeared on our television screens to tell us about Activia, the yogurt “scientifically proven” to help digestion.

2010: In actuality this was not scientifically proven, and Dannon was ordered to pay $45 million to settle a lawsuit over the false claim.

2012: Gwyneth Paltrow introduces the Goop Cleanse, a $425 digestive-cleansing kit.

2013: Howard Stern enthusiastically (and graphically) endorses the Squatty Potty on his SiriusXM radio show.

2016: Both Kylie and Kris Jenner Instagram photos of their respective $10,000 Toto toilets, designed to be used with a high-tech rear-cleansing washlet.

I’ve Made Thousands of Dollars Donating My Bowel Movements

Photo: Joe McKendry

Openbiome is a nonprofit organization located just outside Boston that relies on healthy volunteers to donate their excrement — sort of like a feces bank — to be used for fecal transplants for people with a recurrent form of the potentially life-threatening gastrointestinal infection C. difficile. When fecal matter from a healthy person is introduced into the gut of a person with C. diff, the healthy microbes take over, crowding the C. diff out. At $40 a pop, someone who donates every day for a year could make $14,000. But only 2.8 percent of applicants pass the intense screening process. Here’s the story of one who did.

****

My story begins with my Maltese puppy with a horrible diarrhea problem. The week we got her, she had these really serious gastrointestinal issues. She was miserable. And so I kept doing all this research online to try to figure out how I could help her, but Google kept pulling up results for humans instead of dogs. So that’s how I found out about OpenBiome. Here I am commiserating with my puppy about what she was going through, and I came upon this opportunity to help people suffering from their own bowel issues.

I had to fill out a long application, then six months went by, then I had to go in for a medical exam. They needed my entire medical history— I had to answer about 15 pages of questions, everything you would find on a blood-donor questionnaire plus questions about my gastrointestinal and infectious-disease history. It turns out that I’m a super-duper pooper. It might be my vegan diet. I don’t know.

I’ve been doing it for about three months, and I drop off my donations about five to seven times a week. I’ve made about $3,000 so far from just pooping. I have a little routine going. They give you this little tray that fits into your toilet bowl underneath the lid and a big plastic tub. It kind of looks like a Tupperware container. I position myself over the tray, then I just go. If I’m having pellet poop and it’s not the right quality, that’s not going to work. The poop should ideally look kind of like a snake. When I’m done, I seal it up in a plastic container they give you and I bring it into the office. I’m a morning pooper, so it works out really well. I go, drop off my sample, and then on the way home drive by a Trader Joe’s and pick up some groceries. At first it took some getting used to. You just kind of look at it and go, I have a sample of poop in the passenger seat next to me. The folks at OpenBiome sometimes will shoot us donors testimonials from patients saying thank-you. Like, “Hey, I had a transplant, and it was instantaneous— I felt better immediately.” And, you know, it’s something I’m going to be doing anyway.” —As told to M.D.

How May We Clean Your Colon?

By Amanda MacMillan

Our current colonic resurgence includes a slew of niche and newfangled spa treatments designed to leave your system cleaner than ever, the purported benefits ranging from relieved constipation to increased concentration. Of course, gastroenterologists are skeptical. Here, an assessment of the city’s latest options from Gina Sam, director of the Mount Sinai Gastrointestinal Motility Center — as well as a few very satisfied customers. (Understandably, they asked that their last names not be used; as free as people may be about discussing the inner workings of their bodies, there are still some limits.)

Colon hydrotherapy
What it is
: A nozzle is inserted into the rectum, and the lower intestine is flushed with gallons of water. Fluid Water Therapy (22 E. 21st St.) has one of the city’s only FDA-approved open-system devices, which means that waste can be released straight into a basin—instead of through an inch-thick tube like in more common closed-system devices. The 30-minute treatment takes place in a recliner with a drainage opening. $150 per session.

What an enthusiastic client says: “I’m 65 and always constipated, and this helps me feel cleaned out. I had my first colonic at another spa, but it felt like some kind of homemade enema. The machine at Fluid is far superior: comfortable, professional, and the environment is very soothing.” —Denise, Upper East Side

What the skeptical doctor says: “In general, gastroenterologists do not recommend colonics. There could be complications, like intestinal tears from the nozzle or electrolyte imbalances. Plus, you’re flushing out the good bacteria along with the bad.”

Lymphatic drainage
What it is
: The “Ultimate Flush” package at the cozy Provence Wellness Center (150 E. 55th St.) combines colon hydrotherapy with lymphatic drainage — a procedure that, in this case, uses an ultrasoundlike wand to send vibrational pulses throughout the body. It’s meant to target lymph nodes and increase circulation, and it supposedly works for everything from weight loss to better skin. $235 per package.

What an enthusiastic client says: “I like to go every week or two. The lymphatic combo helps break up and stimulate the release of waste faster, so much more comes out than with a regular colonic. It helps with swelling in my stomach and legs in particular. It feels like your whole body becomes lighter.” —Terri, Upper East Side

What the skeptical doctor says: “Our body is designed to get rid of toxins naturally — that’s what our liver and our kidneys are for. And there is just no scientific support that something like vibration is going to help us do that better.”

Coffee enema
What it is
: The coffee enema at Gravity East Village (515 E. 5th St.) starts with castor oil on the abdomen to stimulate the liver. Then, low-acid organic coffee is freshly ground, mixed with water, and funneled six to eight inches into the colon and held there for ten minutes while clients lie on their side. They release — in private, on the toilet — and repeat a second time. Proponents say the caffeine provides a mild buzz and stimulates the release of stored-up bile. $140 per session.

What an enthusiastic client says: “I have been having colonics for 20 years and have just recently introduced coffee enemas into my regime. When done together — the enema following a colonic — you feel like you can fly. My energy is also increased not only that day but for weeks afterward.” —Melissa, Tribeca

What the skeptical doctor says: “The caffeine will get absorbed and may provide a laxative effect. Enemas are fairly safe, since they use less water and don’t permeate as far as a colonic. But again, you don’t have to detox your liver. It’s already doing that.”

Maya abdominal massage
What it is
: Developed by a naturopathic doctor, this is a noninvasive technique meant to treat digestive problems, infertility, and urinary incontinence. Manual pressure is applied to the pelvic region, with an aim to release blockages and guide organs into their proper positions. At the high-end clinic The YinOva Center (74 E. 11th St.), patients are also taught how to perform the technique on themselves. $275 for a two-hour consultation and massage.

What an enthusiastic client says: “It was deep at times, and there were some areas that ached more than others. But my therapist had me take a deep breath, and, with a gentle change of her angle, she was able to release areas that I didn’t even know were tight! Over the next 24 hours I felt even lighter.” —Rachel, Tribeca

What the skeptical doctor says: “This may help relieve constipation for some people who have scar tissue in their colon or slow-moving stool. Massage can stimulate peristalsis, a movement of the intestines that helps move things along.”

Panchakarma
What it is
: This 5-to-21-day Ayurvedic cleanse is personalized by dosha (in Ayurvedic medicine, everyone falls into one of three mind-body types known as doshas) and aims to restore balance to the mind, body, and soul. It’s offered at the no-frills New York Ayurveda (315 W. 55th St.) and includes body oiling, enema, and a strict diet of rice and lentils. It culminates in a final “day of purge” involving laxatives and clarified butter. From $699.

What an enthusiastic client says: “I do it twice a year, in the spring and the fall. It’s been life-changing: Eating such a restrictive diet is extremely taxing, physically and emotionally. But then you come out feeling clearheaded and lighter. I’ve even lost five pounds.” —Mel, Upper West Side

What the skeptical doctor says: “Laxatives help move water through the body, so if the patient is constipated, they can help pull the stool with the water. But overusing them can cause fatigue, headaches, and electrolyte abnormalities.”

Probiotic colonic
What it is
: There’s an entire colonic menu to choose from at La Casa Spa (41 E. 20th St.), with add-on therapies like pulsed magnetic energy, far-infrared waves, and the infusion of French “marine plasma,” a.k.a. seawater. The newest offering uses a solution of probiotics — the gut-friendly bacteria found in yogurt and fermented foods — dissolved in water instead of plain H2O. $150.

What an enthusiastic client says: “The last time I did a colonic at another spa, not much happened. But when I got the probiotic treatment at La Casa, so much came out. (They position a mirror so you can see what’s happening.) I’m hoping that the probiotics help my seasonal allergies, too.” —Chastity, Gramercy Park

What the skeptical doctor says: “Probiotics can do wonders for your gut when you take them as supplements or as food. But there are no studies, at least not yet, that show they have a beneficial effect when placed in the colon.”

The New Tools to Help You Go

Or so they claim. Brennan Spiegel, an expert from the American Gastroenterological Association and the director of Cedars-Sinai Health Services Research, assesses four bowel-movement-improvement products.

By Susan Rinkunas

Photo: Joe McKendry

Probiotic Butter
Probiotics are good bacteria similar to those that live in our bodies. The thinking goes that by taking either probiotic supplements or eating fermented foods that contain these active cultures (like yogurt), you can help manage or prevent GI symptoms like diarrhea, bloating, and constipation. And in this quest, people have spent more than $32 billion on probiotics in 2013; the category is expected to reach $52 billion by 2020. Probiotics are being added to everything: There are probiotic burritos, probiotic butter substitutes, even probiotic drinking straws. But while studies looking at pills containing probiotics have found a “tiny” benefit for GI problems compared with placebos, there are millions of strains, and not all have been tested. Certain strains have been studied and branded for use in Align probiotics and Activia yogurt, but Spiegel says neither is very effective for his patients. If he does recommend them, it’s for people who have bloating and gassiness and don’t want to use antibiotics.

Bottom line: Taking probiotics might help relieve symptoms, but they’re not miracle pills, nor are they FDA-approved for this use.

Squatty Potty
This toilet-base footstool brings your knees up into what the company says is a more natural position that unkinks the rectum and makes it easier to go. (The last section of the large intestine is bent so that we keep it together the rest of the time.) Spiegel says this is plausible, as are claims that it can help with hemorrhoids, since straining could indeed lead to swollen veins around the anus. Relief of constipation and bloating aren’t totally far-fetched either.

Bottom line: Very legitimate claims, but you could get a similar effect by leaning forward on the toilet.

Bidet Attachments
Some companies argue that bidets are more sanitary than wiping, while some doctors have said they’re a good option for people with hemorrhoids or those who go a lot, like people with irritable bowel syndrome with diarrhea. (And the $10,000 Japanese Toto toilet — which is designed to be used with a rear-cleansing washlet — has become a status symbol in Upper East Side penthouses.) Sure, wiping in the wrong direction can promote urinary-tract infections in women, but Spiegel says it’s a pretty well-known fact that people should wipe toward the back, not the front. Overrubbing with toilet paper can lead to irritation or skin breakage, which can lead to infection, but that’s fairly uncommon, he says.

Bottom line: If you use supersoft toilet paper and still get irritated, then maybe a bidet is a better choice for you. But otherwise it’s just personal preference.

Poop-Tracking Apps
There are apps that just track how often you go. But the mere fact that you went isn’t necessarily helpful information (maybe it’s a strained, unhealthy bowel movement). However, being able to log specific symptoms like bloating, stomach pain, and nausea can help identify patterns or determine how much GI problems are affecting your life. Apps like GI Buddy, Tummy Trends, and Spiegel’s own MyGiHealth prompt users to tick off symptoms in addition to selecting size and shape when logging their deposits.

Bottom line: They can be helpful when they ask for detailed information. Otherwise, probably not worth it.

And How We’ll Use No. 2 in 2022

Fecal weight-loss pills
Researchers at Massachusetts General Hospital are conducting a study where overweight people will take pills containing freeze-dried fecal microbiota from thin donors. Experts believe that gut bacteria influence digestion and fat storage, and there’s evidence that receiving gut bacteria from an obese person versus a lean one leads to more weight gain in mice. Plus there’s the case of the woman who gained 34 pounds after she received a fecal-microbiota transplant from her overweight daughter to treat a C. difficile infection. If obese-person microbes can make people gain weight, perhaps thin-person microbes can help overweight people slim down.

Vibrating laxatives
Some people with chronic constipation don’t get relief from medications on the market, or they experience side effects as they take increasingly higher doses. Israeli researchers are testing a device called Vibrant, using U.S. federal funding to study capsules that vibrate (imperceptibly) once they reach the large intestine to jump-start the natural movements that help ferry waste along.

A feces-to-water machine
In January 2015, Bill Gates debuted the Omni Processor, a waste-treatment plant that uses steam, an incinerator, and a filtration system to turn sewage into drinking water while also generating electricity. The hope is to drastically improve sanitation in developing countries. A team tested it in Senegal last year, and it’s working on a new version that burns garbage in addition to human waste.

Cities powered by human fertilizer
Even places with advanced sanitation systems are using poop for electricity. A utility in Washington, D.C., which also treats sewage in Northern Virginia and Maryland, is the first company in North America to use a pressure-cooker system that converts leftover sludge into electricity — effectively by burning the methane gas produced by the microorganisms in the sewage. The by-product is then sterilized and can be sold as fertilizer at stores like Home Depot.

Poop charcoal briquettes
Another two-for-one sanitation solution: A start-up called Sanivation installs lightweight toilets in the homes of Kenyan families and charges about $7 per month for twice-a-week waste removal. At its treatment plant, it turns the poop into charcoal briquettes that can be sold as fuel.

What’s It Like Studying Other People’s Feces?

Jessica Richman co-founded the Silicon Valley start-up uBiome in 2012. Here’s how it works: You mail in a stool sample, and uBiome studies it and reports back on your gut health. Meanwhile, the data it collects goes toward its ultimate goal of sequencing the human microbiome.

Photo: Joe McKendry

What have your citizen scientists taught you about poop so far?
We have one guy who found a correlation between potato starch and Bifidobacterium, a bacteria that helps you sleep. He started eating potato starch to increase Bifidobacterium in his gut to see if it would help him have more restful sleep. And it did. Another person went on a ketogenic diet, eating mostly fat and water, because the idea is that you can lose weight quickly if you don’t eat carbohydrates. We could see her microbiome change pretty dramatically to fat-digesting bacteria versus carbohydrate-digesting bacteria within three days.

Have you experimented on yourself?
I test myself a lot. There’s a specific bacteria that I happen to be moderate in that burns a lot of calories because it uses sugar for energy. It’s associated with lower rates of diabetes, but there hasn’t been a lot of research into how to influence it. I don’t have diabetes, but I’m interested in having bacteria burn more of my energy so that I can eat more without gaining weight. I’m experimenting with increasing that bacteria and seeing how it affects me. I haven’t analyzed all the data yet, but it’s been interesting to see the change not only in my energy utilization but the actual composition of my microbiome.

What have you learned about the ideal look and shape of our poop?
The smoother the better. That means you’re probably eating enough fiber and fairly healthy. The look and feel also indicate things like how long it’s been in your body and how hydrated you are. If you’re very dehydrated, you might’ve noticed, it kind of dries up.

Lauren Schwartzberg

The Foods to Help You Go

From most healthy to least healthy.

Photo: Joe McKendry

Navy beans
Fiber binds with other food in the digestive tract, helping it move along quickly and efficiently. Half a cup of cooked navy beans contains nearly ten grams of fiber — about a third of what you should get every day.

Bran cereal
A half-cup of bran cereal (like Fiber One) has about 14 grams of fiber. Oat-bran muffins have about five grams each.

Artichokes
One of the highest-fiber vegetables, with seven grams per half-cup.

Pears
A medium pear has between five and six grams of fiber. Apples are a good runner-up, with about four grams each.

Sweet potato
A sweet potato baked in its peel has about four grams of fiber. It’s also high in potassium, which can trigger bowel movements.

Pumpkinseeds
More than five grams of fiber per cup.

Bulgur
A half-cup of this hearty whole grain has four grams of fiber, double that of brown rice.

Berries
Raspberries and blackberries have about four grams of fiber per half-cup. But too much fruit can cause diarrhea because of its high sugar content.

Prunes
Just like your grandmother said.

Popcorn
Three cups of air-popped popcorn has between three and four grams of fiber.

Coffee
The chlorogenic acid in coffee is believed to increase stomach-acid levels and production of gastric acid, helping food travel out of the body more quickly. The effect has also been seen in people who drink decaf.

Bananas
Not getting enough potassium (a medium banana has 422 mg.) can cause constipation. But too much can give you the opposite problem, so don’t overdo it.

Sugar-Free Candy
Maltitol, a natural sugar alcohol found in sugarless gums and candies, can cause diarrhea. (One Amazon review for sugar-free gummy bears said they could “power wash your intestines.”)

Detox Tea
Beware herbal blends that claim to have a cleansing or regulating effect: They often contain laxatives like senna leaf or aloe vera, which aren’t recommended for long-term use.

Chipotle
That is, when it’s just had an E. coli outbreak.

A.M.

And a few at-home constipation remedies

As told to Katy Schneider

“I swallow a tablespoon of olive oil chased with a tablespoon of apple-cider vinegar. It works, but it’s revolting.” —Ally, Park Slope

“Canned pumpkin. Works great on cats too. I’ll eat five spoonfuls. For a cat, I mix about a spoonful and a half with their wet food.” —Ian, Harlem

“This is going to sound insane, but Oreos. Six will do it. On an empty stomach. They go straight through me.” —Elizabeth, Bushwick

“Liter of cold water, one bunch of kale — raw and torn off the stems. Will unblock you; could also raise the dead.” —Eric, Jackson Heights

“I go by the national French rule, CCC. Café, clope, caca … coffee, cigarette, poop.” —Lolita, East Village

“I drink a smoothie with flaxseed oil, almond butter, blueberries, strawberries, almond milk, and plant protein. And take 400 mg. of magnesium pills. Works every time.”—Lili, Chelsea

“Castor oil and a day off. It’ll make you lose five pounds.” JP, Crown Heights

*This article appears in the May 30, 2016 issue of New York Magazine.