How to know if you have gut issues

We are used to some degree of rumblings and gas from the stomach. The problem comes down to what’s normal and what’s not. I don’t believe that we can ‘draw a line in the sand’ and say that symptoms that fall beyond this line are not okay. Rather, the more symptoms you have, the more likely it is that this is something you need to fix.

That being said, I believe that many people suffer from gut issues without realizing it. Simply because the symptoms are often very mild and temporary; easily dismissed as normal rumblings of the tummy.

I was one of these people just a few years back. Looking at how my tummy behaves now compared to then, I can see a radical change. Simply because of what I consider as normal is different today. Other people have told me similar stories.

What I’m getting at is asking you not to dismiss this section because you don’t think you have gut issues. You may very well have, but you just don’t realize it. And those gut issues may very well wreck havoc on your skin.

In fact, a study from 1992 showed that almost half of the over 2000 people studied had abnormal bowel movements, which is a definite sign of gut problems.

Breath and stool analysis

Various breath and stool analyses exist for detecting SIBO, bacterial imbalance, and other gut problems. But they all require help and participation from a doctor, and you’ll have to pay for them. These tests aren’t 100% accurate, but they are the best diagnosis tools available today. I’m not going to cover them here as it’s a discussion you should have with your doctor.

Home measures for monitoring gut health

Let’s talk about what you can do at home. These all involve the rather unpleasant task of monitoring your bowel movements. I, of course, understand that this is not the most pleasant task, and I’m not here to say you have to do it. Rather I want to give you the necessary tools and leave it for you to decide whether you are willing to do this for your skin.

Let’s first talk about a few ways to monitor your bowel movement and then see how to use these in monitoring your gut health.

The Bristol Stool Form Scale

Regularity is one of the hallmarks of a healthy gut, and gut problems often show as changes in both defecation frequency and form. The researchers at the University of Bristol in the UK did a rather unpleasant analysis by measuring intestinal transit time (i.e., how long it takes for food to pass through the digestive system) and observed that similar intestinal transit times tend to produce similar looking bowel movements. Based on these observations they created the Bristol Stool Chart and classified stools into seven different types.

Type 1: Separate hard lumps, like nuts (hard to pass)
Type 2: Sausage-shaped, but lumpy
Type 3: Like a sausage but with cracks on its surface
Type 4: Like a sausage or snake, smooth and soft
Type 5: Soft blobs with clear cut edges (passed easily)
Type 6: Fluffy pieces with ragged edges, a mushy stool
Type 7: Watery, no solid pieces. Entirely liquid

Here’s what they look like.

Image from WikiMedia Commons.

Reading the Bristol Stool Form Chart

Types 1 and 2 indicate constipation.
Types 3 and 4 are said to be ideal
Types 5 to 7 indicate varying levels of loose stools and diarrhea.

While this chart is not perfect, it has been validated in other studies, and when intestinal transit time is modified with laxatives or diarrhea drugs, the stool form changes correspondingly. Similarly, treating gut problems have been shown to shift stool forms towards types 3 and 4.

That makes this a useful tool for monitoring and ‘measuring’ gut health. For me, stool form has been an accurate indicator of my gut health. I’ve noticed that eating onions (or some other high FODMAP foods) shifts my bowel movements towards types 1 and 2, and acne usually follows a day later.

The stool form chart is especially useful when you combine it with keeping an eye on bowel movements.

Ease of bowel movement

There’s much debate in the natural health movement about what constitutes natural bowel movement. Much of this discussion is best left unseen and unheard, but it’s clear that some signs go along with healthy bowel function:

Strong need to go. You should have a strong (but not urgent) need to go after at least once a day.
Effortless act. There shouldn’t be any straining or effort required. Everything should come out quickly and easily without feeling of incomplete defecation. #2 shouldn’t be any harder than #1.
Pass easily. Impacted stools are hard to pass, and you feel pressure from stools passing through the anal canal. Healthy stools pass without straining or pressure.
Pass quickly. A healthy bowel movement is over in a minute. Anything more than that is a sign that something is wrong.
Complete in one sitting. Healthy bowel movements pass in one go. Feeling that you haven’t been able to eliminate everything, or having to go again shortly, is not a good sign.
Neutral odor. The odor of bowel movement depends on what was ‘eaten’ and what is actually in your gut. Different substrates (proteins, carbs, fats, fiber, etc.) and different bacteria produce different gasses. Healthy bowel movements from a healthy gut should have a neutral or mild odor. Offensive odors usually indicate incomplete digestion or the presence of pathogenic bacteria that have just enjoyed a large meal.

In sum, your visit to the toilet should be a rather quick, easy, and uneventful moment. Straining, urgency (i.e., I need to go NOW!), pain or feeling you haven’t completely passed a stool are all signs that something is wrong.

Digestive symptoms

In diagnosing constipation and gut problems, doctors often use various questionnaires, such as the Constipation Assessment Scale. These are calculated from common digestive symptoms and signs, such as:

Bloating
Abdominal discomfort
Irregular bowel habit, as discussed above
Blood in the stool
Gas and flatulence
Heartburn
Use of laxatives or enemas to help with elimination

I’m not suggesting that you formally calculate your ‘constipation score,’ rather that you simply keep an eye on these things as they are all signs of digestive problems. Another thing to look for is symptoms getting better after a bowel movement. That should be a big red flag for gut issues.

Food and symptom journal

Keeping a casual eye on these things doesn’t help much. Most people without overt digestive problems experience these things occasionally, and the symptoms are easy to dismiss as usual rumblings from the stomach. That’s where keeping a journal comes in handy. When you write down your symptoms and the date and time of their occurrence, you can identify patterns you might otherwise miss. It’s also likely that certain foods trigger or aggravate your symptoms. Without tracking food intake and symptoms in a journal, it’s hard to identify the culprit foods.

This doesn’t have to be complicated. You could do the following:

Note down everything you eat
Pay attention to any discomfort and rumblings from the digestive system for 2 to 3 hours after a meal. Sometimes the symptoms appear quickly; this is usually the case for abdominal pain. But sometimes they take a few hours, as in the case of bloating and excess gas. Pay particular attention to signs of rumbling, bloating and feeling of pressure in the stomach or intestines, excessive gas, and heartburn.
It’s helpful to note down bowel movements also. Using a few words describe your bowel movement and the Bristol Stool Scale type. For example, normal (3) or straining (2).

Keeping a food and symptoms journal doesn’t have to take a long time or a lot of effort. You need only spend a few minutes a few times a day noting things down. And this minuscule investment can yield surprising returns in knowledge.

Management guru Peter Drucker says you can’t manage what you don’t measure. In my experience, this certainly holds true for my gut. I’ve been aware of the link between gut and skin health for quite some time now, but I always assumed it was a problem for other people. Because there seemed to be nothing wrong with my gut.

Using the simple tips outlined in this chapter, I noticed some problems with my bowel movements. I also found out that onions and leeks don’t agree with my gut. Eliminating those foods and regularly eating fermented foods has provided much needed ‘zen’ to the bathroom.

I’ve also noticed a connection between acne breakouts and gut problems. Most of the time my gut is happy and peaceful, but it does get disturbed occasionally. And it’s usually followed by acne breakout a day or two later.

Testing for low stomach acid

Low stomach acid (hydrochloric acid, HCL) secretion is one of the main causes of SIBO and dysbiosis.

The Heidelberg Stomach Acid Test

The gold standard medical test for low stomach acid. The test involves swallowing a small capsule with a radio transmitter that measures the pH of your stomach as you drink a solution of baking soda. This test gives you the most accurate results. Unfortunately, it costs $300 to $400 and requires a visit to a doctor.

Home tests

Here are a few tests you can do at home to assess whether your stomach produces enough HCL. Unfortunately, these tests haven’t been scientifically validated, and I can’t say how accurate they are.

If you already know that you have an ulcer, stop here and do not do any of the following tests. If you have a stomachache, try the lemon juice test first.

Lemon juice test

When you have stomach pain, take a tablespoon of lemon juice. If this makes the pain leave, you may have too little stomach acid. If it makes your symptoms worse, then you may have too much stomach acid.

If your pain increased after the lemon juice test, do not do the HCL test below. You could have an ulcer or too much stomach acid. Never take the following test if you have an ulcer.

Baking soda test

This test involves drinking water with some baking soda. When baking soda mixes with HCL, it creates carbon dioxide gas that causes burping.

Here’s how to do it:

Mix 1/4 teaspoon of baking soda in 4-6 ounces of cold water first thing in the morning and before eating or drinking anything.
Drink the solution.
Time how long it takes you to start belching. Time up to five minutes.

In theory, if your stomach produces adequate amounts of stomach acid, you’ll likely belch within two to three minutes. Early and repeated belching may be due to excessive stomach acid (but don’t confuse these burps with small burps from swallowing air when drinking the solution). If it takes more than 3 minutes for you to start belching, then you could have low stomach acid.

Because the time frames can vary from person-to-person, as well as how they drink the solution, this test is only a good indicator that you might want to do more testing to determine your stomach acid.

This test is not accurate enough to rule out low stomach acid. To rule out low stomach acid, you will need to try the Heidelberg test or Betaine HCL challenge test.

Betaine HCL challenge test

This test relies on the idea that your stomach should produce enough stomach acid to digest food but not so much as you cause pain and discomfort. By supplementing with HCL, you can assess whether your stomach indeed produces sufficient amounts of acid. You’ll need some Betaine HCL supplements for this.

Here’s how to do it (from SCDLifestyle.com):

Eat a meal with 15 to 20 g of protein; roughly 6 ounces of meat, or 3 eggs, or equivalent.
In the middle of the meal, take one HCL pill (650 mg)
Finish the meal and pay attention to your stomach

There are possible 2 outcomes from this test.

The first is that you won’t notice anything. This could mean you have low stomach acid levels.
If you start to feel stomach distress characterized as heaviness, burning, or hotness – then these are signs that your stomach produces enough acid.

This test isn’t foolproof either and should be repeated at least one more time on a different day to confirm the first test. One of the biggest causes of false test results is the amount of protein eaten at the meal, so make sure to eat a chunk of meat with the test. If you do get some burning, don’t worry it will pass in about an hour. You can also mix up a 1/2 teaspoon of baking soda and drink it to help stop the discomfort.