Speaker A [00:00:00]:
Hi, everyone. Thanks for joining me today on this solo episode of the Paralysis Nutrition Podcast. I don’t have any fun guests today, but I’m talking about a really, really important topic. Poop. We’re going to talk about poop today. We’re going to call it the poop Trifecta. That is what I think is really the key to bowel health when it comes to the paralysis community. Welcome to the Paralysis Nutrition Podcast, where changing your eating habits is the key to losing weight, improving bowel health, and feeling your best.
Speaker A [00:00:37]:
I’m your host, Fatima Fakouri. I’m a registered dietitian who’s married to a quadriplegic and specializes in nutrition for paralysis. Get ready to be inspired, educated, and motivated so you can take control of your health using the power of food. Let’s get started. This is the Paralysis Nutrition Podcast. So what is the poop trifecta? The poop Trifecta is something that I have come up with. It is part of the framework that I use in the paralysis nutrition coaching program to help people with spinal cord injury and different types of. Basically, there’s different reasons why people have paralysis, right? So not just spinal cord injury, but spina bifida, transverse myelitis, spinal stenosis, guillain barrel.
Speaker A [00:01:25]:
And so if you have neurogenic bowel, you need to know about the poop trifecta. And so trifecta is three things, right? So fiber, fluid, and stress. These are the three key components that you need to work on if you have neurogenic bowel. So before we dive into the poop trifecta and the different parts of it and everything, I just want to reflect. I want you to reflect a little bit about what has been the effect of your bowel health on your life. So what comes to mind when you think about going to the bathroom? What kind of feelings do you have when it comes to your bowel program? And just kind of give yourself a few seconds to think about this. As the wife of a quadriplegic, I don’t personally have the experience, but listen, my life and my husband’s life, they are, you know, kind of intertwined, right? Because we’re married and we live together, we have with kids. And so when his bowels are not right, my life is not right.
Speaker A [00:02:37]:
And when it comes to regulating your bowel program, that’s really what the poop trifecta is about. Fiber, fluid and stress. So thinking about what bowel program has been for you, I’m going to guess that it’s not a great Wonderful, lovely experience. Even if you’re one of those people that’s like, my bowels are good. Nothing to complain about. It probably still takes you 30 to 45 minutes to go to the bathroom, maybe longer. I have so many discovery calls with people where they say, you know, I ask them, how’s your bowels? How are they? How has it been going? And so many people say, my bowels are good. And then I dig a little deeper, and I say, well, how long does it take? And sometimes they say an hour.
Speaker A [00:03:27]:
Sometimes they say 30 minutes, sometimes they say hour and a half. And I swear, the. I don’t know how to describe it. It’s like the baseline for being upset about your bowels is a lot higher when you have paralysis, because it just sort of becomes normal to spend all this time in the bathroom. And it doesn’t really need to be like that. So many people that I speak to have been struggling for years, and it’s just sort of become normalized. So spending an hour in the bathroom is not actually good. Just because other people take 2 hours and 3 hours and only poop once a week doesn’t mean that it taking you an hour or 90 minutes to poop is good.
Speaker A [00:04:14]:
Right? We have to not compare ourselves to other people. You just have to look at yourself, right, and say, hey, it takes me X amount of time right now. Maybe it could take less. And I guarantee you, if you follow the framework of the poop trifecta, you will spend less time pooping, you will feel less bloated, you will spend less time in the bathroom, and you can even get off of these laxatives and senna and Cholase and Miralax. You don’t necessarily need to be on those things. And I’ll tell you this, most people are still following the advice that they got in rehab. And when you were in rehab. So if you had a spinal cord injury, you likely went to rehab, right? And they give you advice, but it’s in a medical setting.
Speaker A [00:05:07]:
And in that medical setting, there are a bunch of doctors and nurses. There might be a couple of dietitians. Those dietitians are not trained in neurogenic bowel or paralysis. They are clinical dietitians. They’re just like any other dietitian that left, you know, graduate school and their program. They don’t teach us anything about neurogenic bowel. They don’t teach us anything about paralysis or even people with disabilities. The only reason that I know anything about this and that I care about it is because my husband is Quadriplegic.
Speaker A [00:05:38]:
And so I realized when I met him and that he was going once a week, twice a week, he was really bloated. It would take him forever to go to the bathroom. I realized, oh, the way that he’s eating has a huge effect on this, obviously. Right. Because I’m a dietitian, I know that diet affects everything, especially your gut health and of course, your weight and your general health as well. But it’s really obvious that if you’re not eating well, your bowels are not going to be in good shape. So the advice that you got in rehab was likely that you will need laxatives, that you will always need to rely on things to help you go. And so I want you to sort of open your mind to the idea that you could spend less time pooping, more time living your best life if you change your diet.
Speaker A [00:06:34]:
And maybe you don’t even need those poopy pills. I call them poopy pills. So before I get into the poop trifecta, I want to share a work in progress story. I know a lot of times I’m telling success stories, and that’s because I love to share my client’s success. It makes me feel so happy for them. I think it’s encouraging and motivating for the community, you know, to hear that their peers who are other people living with paralysis, are having success in weight loss and bowel health and all kinds of different areas of health just by changing their diet. So I want to share today a work in progress story. So this client, his name is Chris, and he has been paraplegic for over 20 years.
Speaker A [00:07:22]:
Ever since rehab, he has been drinking Miralax every single day. And he’s been in my program for about two months now, maybe a little less. Maybe it’s been like seven weeks. And so he’s been drinking Miralax every single day for 20 years. Side note, do you know what is in Miralax? Miralax active ingredient is P, E G. Polyethylene glycol. That is plastic. Polyethylene glycol is a common form of plastic.
Speaker A [00:07:53]:
So Miralax every single day. Basically, you’re drinking plastic every single day. That is not good for your body. When he joined my program, he was drinking Miralax every single day. And it was taking him four to five hours to poop. And he would go once a week. This is probably the most extreme case of constipation that I’ve ever dealt with in the paralysis nutrition program. I’ve been at it for almost two years.
Speaker A [00:08:19]:
This is the longest I’ve ever heard. Four to five hours is the longest anyone has ever said it takes them at least in my program. And once a week is, you know, pretty bad. Drinking Miralax every day is pretty bad. So now he joined my program. It’s been almost two months. And this is a work in progress. We’re not done with Chris.
Speaker A [00:08:40]:
Chris is not done. I’m not done with Chris, and he’s not done with me. We still have a lot of work to do. But as of today, his bowel program is down to about two hours. Okay, from four to five hours. It’s down to two hours, and he is pooping four times a week. He’s a lot less bloated, and he’s not drinking Miralax anymore. It’s been ever since he joined my program.
Speaker A [00:09:06]:
Almost two months ago, he stopped taking Miralax. And he was really scared to stop taking it because, like so many other people with spinal cord injury, he just had this mindset of, I can’t poop without this. Like, I need to take things to help me poop. But what he didn’t realize, or I should say, there’s. This is no fault of his. What he didn’t know, what wasn’t told to him, was that you need to eat right for neurogenic bowel. Just because you’re paraplegic, in his case, paraplegic, doesn’t mean that you have to take something like Miralax or laxatives every day of your life. Doesn’t mean that you have to spend hours in the bathroom.
Speaker A [00:09:49]:
Absolutely not. Change your diet, change your lifestyle habits, and you can spend less time in the bathroom. So this is a work in progress. He’s down to two hours. He’s off the Miralax, and he’s going four times per week. Now, I asked him, I just had him on a group zoom call about two days ago. I said, okay, Chris, you’re going four times per week. What days are you skipping? He said, well, I always skip the weekend, Saturday and Sunday.
Speaker A [00:10:21]:
And I said, okay. And then he says he skips another day during the week. I said, listen, I don’t want you to skip Saturday, Sunday. You have to pick one of those days and you have to go. So like I said, work in progress. We’re going to touch base, he and I in the group next week, and I’ll see how that went. He says he feels like he could go, but he’s just not used to it. And so having the support and Accountability, not just from me, but from the other group members as well, right? Everyone’s cheering him on.
Speaker A [00:10:47]:
Everyone’s happy to hear he’s off the Miralax. Everyone’s happy to hear that he’s down to two hours now. Compare. Comparison is the thief of joy, right? He hears people in the program, like my client Jason, who’s in the same group as him, went from 90 minutes in the bathroom every day. He’s also paraplegic. 90 minutes a day, every day for 11 years. And he is down to now 30 minutes every day. He also doesn’t use a suppository.
Speaker A [00:11:16]:
So when Chris hears Jason’s story, he’s not, like, comparing himself, but he’s able to see that, hey, if I change my eating habits, I can cut down my time as well, right? And so he’s down from four to five hours, down to two hours. Jason is down from 90 minutes to 30 minutes. Comparison is the thief of joy. We don’t compare our health, our bowels, our body to anyone else. But do you see, it’s very common, these issues, this constipation. Whether you’re starting at 90 minutes or you’re starting at four hours, you can cut that time down because I guarantee you are not eating a gut healthy diet for paralysis today. You’re not, because no one told you what that means. You don’t know what that is.
Speaker A [00:12:05]:
And so now I’m going to get into what is the poop trifecta. So the three things that are in the poop trifecta, right? Fiber, fluid, and stress. Let’s go through them. Number one, fiber. Where does fiber come from? Fiber comes from carbs. That’s right. There is no fiber in protein foods. There’s no fiber in, like, meat, Right? There’s no fiber in fats.
Speaker A [00:12:29]:
Oh, except for avocado. Avocado is a fat that’s high in fiber. But other than that, you guys, you have to eat carbs. So many people who start my program are afraid of carbs because they have gone on all these crazy diets like keto and Atkins and low carb and whatever, and they’re scared to eat fruit. They’re scared to eat whole grains because they think that carbs are bad. I’m here to tell you that if you don’t eat enough carbs, I’m talking about enough, not too many. If you don’t eat enough carbs, there’s no way that you can get enough fiber. So four dietary fiber recommendations, they are broken down by gender.
Speaker A [00:13:09]:
So for women, it’s about 25 grams a day. And the general recommendation for men is about 38 grams a day. So by the way, you guys, how outdated is it that they have? It’s outdated. I’m sure it’s going to change. I feel awkward even just saying, like, there’s a number for men and there’s a number for women. It really should probably be based on height and weight and I’m, you know, my hands are tied. That’s just. Those are the recommendations.
Speaker A [00:13:35]:
I don’t make them up. But yeah, very 1985 to be based on men and women. Anyway, I digress. Let’s say somewhere between 25 and 40 grams, right? Everybody’s different. If you’re a larger, if you’re living in a larger body, you’re going to need more fiber. If you’re living in a smaller body, you’re going to need less fiber. And so the number one, like the top of the poop trifecta is fiber. So you need to eat your dietary fiber from real foods.
Speaker A [00:14:06]:
And the foods that are high in fiber are going to be fruits, whole grains, vegetables, and you can even just Google this. In my upcoming program, Poop Easy with Paralysis comes out on November 26, I’m going to have an entire module on fiber and high fiber foods and how to get enough fiber and how to read food labels and all this stuff. But for the purposes of the podcast, let’s just say number one is dietary fiber. You’re gonna find it in carbs, complex carbs. So your whole grains and your fruits and your vegetables and you gotta read your food labels because, for example, not all pastas are created the same. If you buy white pasta, it’s very, very low in fiber. But if you buy something like a chickpea pasta or you buy a black bean pasta, they’re much higher, much, much, much, much higher in fiber. So read those food labels.
Speaker A [00:15:11]:
You need to get enough dietary fiber every day. So again, somewhere between 25 and 40 grams, depending on your, on your size, not on your gender. So number one is fiber. Okay. Number two is fluid. Now it’s interesting because I feel like there are two kinds of people in this world. There are people who are so dehydrated and don’t drink enough water. And then there are people who drink so much water, nobody is drinking like the exact right amount because most people just don’t know how much they’re supposed to drink.
Speaker A [00:15:44]:
So I Recommend at least 2 liters of water a day that does not include coffee, soda, anything that has caffeine that have caffeine are diuretic. Okay? So they do not count. Water counts, seltzer counts, herbal teas, those count. And I want you to drink at least 2 liters, and that’s 64 ounces. Now, the fiber and fluid need to be balanced. So if you are a person who is living in a larger body, 64 ounces is not going to be enough water to keep things moving because you’re probably going to be eating closer to 38, 40 grams of fiber per day. So 64 ounces is a starting point. You do not necessarily get enough fluid if you’re drinking two liters.
Speaker A [00:16:35]:
Myself, I’m about 120 pounds. Yes. I’m stating it publicly. I’m stating my weight. I need about 60, 64 ounces. Right. My husband, who hasn’t been weighed in a long time, but he is probably around, I’m going to guess, you guys, maybe like 1 80, maybe something like that. And he’s a tall drink of water, over 6ft tall.
Speaker A [00:17:00]:
So his goal is more like 80 to 90 ounces of water per day because he aims to drink half of his body weight in ounces. So he’s 180 pounds. He should be going for like 90 ounces of water. I don’t think that he gets 90 ounces of water. He probably gets somewhere between 70 and 80. But again, like I always say, he’s not my client, he’s my husband. I can only do so much. So for fluid, you want at least 2 liters per day.
Speaker A [00:17:33]:
And if you are getting to 2 liters a day and you are still constipated, you might need to go up. I have so many clients that say 64 helped, but 80 makes me feel great in terms of ounces. Also, kind of a side note, I know that a lot of people struggle with bladder issues. I know it’s. It’s just something that we gotta work out. So you don’t want to flood yourself with, you know, high, high amounts of water. You want to increase it slowly and see how you do. Also, planning, you know, when you’re going to drink this water is a good idea because if you are going to leave the house and you’re not going to be able to pee, you know, all of this stuff is, is relevant, right, to how you plan out your day in terms of eating and drinking.
Speaker A [00:18:20]:
So number two, part two of the trifecta is fluid, at least 64 ounces, but possibly closer to 80 or 90 or even more, because if you’re in a much larger body, you Might need more. So that’s fluid. Number three is stress management. So many people, when I ask them, what’s your stress level? They say, well, I’m not really stressed. And then I dig a little deeper and they have a lot on their mind. I mean, bowel issues on their own are super stressful. So if you’re listening to this episode, you probably have a spinal cord injury, you have a loved one with a spinal cord injury and you probably directly or indirectly, in my case, Indirectly, right. Because it’s my husband who’s quadriplegic.
Speaker A [00:19:04]:
You know how bowel issues can affect your life. Told this story before. I’m going to tell it again briefly. Two years ago, my husband missed Christmas because he was in the bathroom. And it really sucked because Christmas Eve was so much fun. We hosted, it was wonderful. Everyone came over and this was 2019. And then the next day I had to get the kids dressed and myself dressed and go to my mother in law’s house by myself because Ray was like, oh, I have to go to the bathroom.
Speaker A [00:19:34]:
So that was unfortunate and, you know, sad. That’s sad. You shouldn’t be missing out on holidays or social events or even just little things like going out to dinner or a coffee date or whatever. You shouldn’t be having to spend beautiful days locked in the bathroom. Right. So this stress around bowels, just this one source of stress, is really profound. And I think so many people, it just becomes a part of life. It just becomes baseline.
Speaker A [00:20:08]:
Like you’re not even aware of the fact that it’s stressing you out. Life with spinal cord injury is stressful. You know, thinking about things like, for example, at the time I’m recording this episode, it’s almost Halloween and I’m just thinking, oh, are we going to go trick or treating? The kids are three and five. How are we going to do it? Is my husband going to come? Is it going to be cold? Is it going to rain? If we go in town, is it going to be accessible? Because the sidewalk situation, whatever, whatever. Don’t even get me started on pumpkin picking, apple picking, any of these autumn New York things, because they’re really just not accessible at all. And so there’s just a lot, there’s a lot to think about when you’re living with a spinal cord injury. And I think, you know, so much of this is not talked about. So think about, how are you feeling? Are you stressed? And obviously the other stressors, like work and life and family and other health issues, all of this stuff is stressful.
Speaker A [00:21:10]:
And so managing your stress is huge when it comes to your bowel health, right? And it has a lot to do with hormone balance. It has a lot to do with cortisol and stress and all these different things. And so if you are dealing with constipation, for example, and bloating and things like this, you gotta start working on your stress first. Work on your fiber and fluid, right? You gotta balance out your fiber and fluid and then start practicing some mindfulness, whether you want to start meditating. I have this great app that I have on my phone. There’s a bunch of free ones, but I actually. I actually invested in a paid one because. Trying to prioritize stress management.
Speaker A [00:21:58]:
And I can listen to these guided meditations, and they’re really, really great. They have short ones that are three, four minutes. They have ones that are 10, 20 minutes. And you’re not just sitting there by yourself. It’s a guided meditation. So it’s kind of walking you through, you know, I should say talking you through, right? You can listen to it in your earphones. So doing some sort of mindfulness, some meditation, even journaling, you know, I just think that there is so much going on in everyone’s life these days. Hello.
Speaker A [00:22:33]:
We’ve been riding upon the Panda express, as I like to call it, for the last year and a half. You know, and there was no vaccine, and now there is a vaccine, and people with spinal cord injury are at higher risk because they’re immune compromised. And it’s just like, let’s add that on top of bowel issues, on top of bladder issues, on top of wheelchair life, you know, it’s a lot. So be aware of what’s going on with you inside, right? Like mentally, emotionally, what is going on with you. And when you balance your fiber, your fluid, and your. You manage your stress, your bowel health will improve. Now, I can say that confidently today because I’ve had hundreds of clients go through the paralysis nutrition coaching program. But two years ago, I could not have said that so confidently because I didn’t have a method, right? I only had my husband.
Speaker A [00:23:33]:
He was my little guinea pig. And I noticed what things worked for him and what didn’t work for him. But nutrition is a science, right? It’s not like hocus pocus. It’s not me giving you this witch’s brew of supplements. It’s not really what it is. Eat real food. Drink more water. Manage your stress.
Speaker A [00:23:51]:
Eat a lot of plants. This is what I’m here to preach. Not a crazy diet, not a juice, cleanse not drinking kale or celery or God knows what else is out there these days. Eating real food, drinking water, managing your stress. That’s the poop trifecta. So if you are out there and you are struggling with your bowels, I want you to know you’re not alone. There are thousands of people, I don’t know, maybe there’s millions, I don’t know who are struggling because they have neurogenic bowel. And nobody ever told them the right way to eat.
Speaker A [00:24:28]:
Nobody ever told them, like, hey, just because you have neurogenic bowel doesn’t mean that you are. This is how it is that you’re always going to be constipated, you’re always going to be bloated, you know, your schedules always kind of, kind of be up in the air because we just don’t know. No, that’s not actually true. And I’m sorry if you didn’t get good advice at rehab. Most dietitians in rehab don’t know a ton about paralysis, spinal cord injury, neurogenic bowel. And there are usually automatic orders in place in spinal cord injury units for laxatives and for senna and for softeners. Right? That’s just part of it. That’s just how they take care of you.
Speaker A [00:25:11]:
And I will say this, I’ve said this on a prior episode before. I don’t actually think that rehab is the best place to teach people about nutrition. Rehab is a place to learn how to go home and take care of yourself. Right. I think that nutrition is kind of level, level three probably, right? The ot, the pt, the respiratory therapy, the getting your meds right, getting your house set up. This is what you need to be focused on at rehab. And in the next few months, nutrition is probably not going to be at the top of your radar, especially if you have an sci, you know, in the beginning phases. So now that you have listened to this episode, you can go ahead and you can follow me on social media.
Speaker A [00:25:57]:
I’m Aralysis Nutrition. I’m on Facebook, I’m on Instagram. And if you want to get started on pooping easier with paralysis, you can go to my website, paralysisnutrition.com freesnackguide and you can download your free gut healthy snack guide. It has 20 recipes that are high fiber, they’ve got probiotics, and they are designed by me. They are designed put together for you people with neurogenic bowel who need help pooping. How many times have I said poop this episode? You guys, I don’t even know I’m all pooped out. I hope this was helpful and I will see you next time. Take care.
Speaker A [00:26:44]:
That’s our episode for today. Thanks for listening. I hope you enjoyed it and that you learned something new. Remember, if you want to lose weight with paralysis, improve your bowel health and feel your best you can. It’s possible, you just have to change your eating habits. If you need inspiration on how to get started, check out The Paralysis Nutrition Cookbook 101 Recipes to Help you lose weight and improve bowel health. The cookbook comes with a bonus 30 day meal plan and is the perfect way to start eating healthier. You can find it online@paralysis thisisnutrition.com Cookbook I’ll talk to you again soon.
