My parents love checking poo. They always have. Stopping to check the dog’s poos during walks, discussing their own after every bathroom visit, pointing out and commenting on random excrement in the park "a bit sludgy that one", "Yeah, I wouldn’t be happy with that". As a teenager I found this level of oversharing mortifying. A little piece of me died inside when they returned from the toilet giving a thumps up or declaring "good colour and slipped out easily" (gross) and "solid effort" (even my love of puns wouldn’t endear me). And then there was the negative feedback "I had to flush three times" (please stop sharing) or etched in my memory "it was green" (excuse me whilst I vomit in my mouth). Sometimes silence said it all. A sad and subtle shake of the head indicated definite room for improvement followed by a supportive pat on the shoulder from the other. I refused to join in despite their plea: “You must check what you’ve left in the loo sweetie, that’s how you know how well you are doing”. With what? In life?
But my folks were right. Without knowing the science behind it, their instinct was spot on. Your poop, or stool to use the medical term, can tell you plenty about the functioning of your digestion and your overall health. I also now know that my overall health has a huge impact on my fertility.
So below I explore how I am going about healing my gut, including:
- what to look for in a poo (sorry),
- fabulous cookbooks for gut friendly meals,
- bone broth to sooth the tummy,
- what I am cutting from my diet,
- daily actions to help me detox
- and more.
P.S. Just to be clear, I am not a doctor or dietitian (if I were I would be better at spelling that word). This post is exploring my experience with gut healing, but our bodies are all so different that what works (and doesn't) for me may be completely different for others. We should all listen to our bodies. Apart from when they tell us to eat sugar, it's OK to ignore that one.
What has gut health got to do with fertility?
According to Hippocrates, “All disease begins in the gut” and it appears that the bearded Father of Modern Medicine may have been on to something. More and more research is being released on the impact of the microbiome on our physical and mental wellbeing and how it is linked to disease, obesity, immunity and hormone regulation, all vitally important factors impacting on fertility. It is not just Western medicine and research that has noted this connection (possibly coming a little bit late to the party), as Eastern medicine has been aware of the impact of digestion on health for donkey’s years. According to Traditional Chinese Medicine, many of my hormonal irregularities and fertility chart anomalies are linked to the energy and functioning of my liver, spleen and kidneys.
There are three main concerns about my digestive health that cause me to ponder their possible contribution to my infertility:
1. Poor gut health resulting in malabsorption of vitamins and nutrients
Research has shown that deficiencies in certain vitamins and minerals (vitamin D immediately springs to mind) can negatively impact fertility. For those like me who used oral contraceptives for many years, use of the pill can further deplete your nutrient stores. It has been shown that the key nutrient depletions caused by the pill are folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc. Hang on one merry second, isn’t that also the list of nutrients that research shows to be essential for fertility? Damn you, you wretched little pill. So I buy a bucket load of good quality supplements and eat a balanced, healthy, organic diet. But what happens if my gut health is so poor that the vitamins and minerals cannot be properly absorbed? Do I remain deficient, but with really expensive nutrient rich wee?
2. Food intolerances, inflammation, and autoimmunity
This trio appear to be intricately linked and I’m concerned about all three. Lara Briden ND suggests that PCOS may be caused by inflammation —or chronic immune activation—resulting from stress, environmental toxins, intestinal permeability and inflammatory foods like gluten or A1 casein. I have suspicions that inflammation may be contributing to my hormonal imbalance (or vice versa) and tests have shown that I have thyroid antibodies and antibodies reacting to gluten, although both are subclinical.
3. Detoxification and excess estrogen
My fertility charts, showing long pre-ovulatory and short post ovulatory phases, may indicate that I am estrogen dominant. So how does my body rid itself of excess oestrogen? Yep, you guessed it – it poops it out. There is an interesting video on the research available on the Nutritional Facts website. My nose, which despite being well in to my 30s still has teenage blackheads, also indicates that I have toxins coming out through my skin. Supporting detoxification within my body (which goes wider than strictly digestion) could help my body to rid itself of excess hormones, chemicals, toxins and unwanted food products.
So here is what I am doing to fix things.
Measuring and improving my gut health and nutrient absorption
Assessing my gut health – the hunt for the ‘Golden Bristol’
Doctor’s working at the University of Bristol created a scale to measure types of faeces, known as the Bristol Stool Form Scale or the Meyers Scale. The reasoning behind the name the Meyers Scale escapes me, as it was developed by Dr. Lewis and Dr. Heaton. Maybe Dr Meyers was their least favourite colleague or rival, as honestly, who would want a sh*t scale named after them? I suffer with a recurrent fear that I will be patient zero for a new and horrendous infectious disease that is named after me, despite my pleas. “He’s really poorly because he caught Amber." "Oh no, not Amber!". "Yep. It was horrible. There was pus everywhere".
Anyway, I digress. The theory behind the Bristol Stool Scale is that you can get a good sense of the functioning of your digestive system from looking into the toilet bowel before you flush. The scale is used by doctors in the UK, proof of which was my GP whipping it out (the scale, not anything else) during a visit to request a blood test for celiac disease. I am using the scale to tweak my diet and lifestyle until I am consistently hitting those 4’s (sausage or snake like, smooth and soft), a quest which is known informally in our household as ‘the hunt for the golden Bristol’. 3’s are also good and would win runner up, if poos has their own beauty pageants. (By the way, if these existed, my parents would definitely attend.) My husband cruelly vetoed my suggestion of hanging a print of the Bristol Stool Scale in our bathroom (maybe even a scratch and sniff poster) as he is of the impression that this type of relevant and educational wall art does not seamlessly fit with our bathroom design. Apparently our ‘look’ is less sh*t based medical charts, more Farrow and Ball.
The Bristol Stool scale has become a close companion during my journey to heal my gut. I assess progress by judging my grading on the scale, the urgency, the frequency and the size. In this context, size does matter. Three big, non-urgent golden Bristols per day would be the poo pinnacle for me. Maybe even worth sending a WhatsApp photo to my parents, to make them proud. But I often fall short of this utopia and my gut screams out for further love and attention. And when it does, this is what I do for support:
Improving my digestion by following diets designed to be easy on the gut
The GAPs diet (Gut and Psychology Syndrome) is one that I have followed on and off with ranging levels of strictness over the past year. It is a protocol designed by Dr Natasha Campbell-McBride, a Russian neurologist with a degree in human nutrition, and is focused on providing the body with easy to digest foods to allow the gut time to heal, before reintroducing the trickier customers back into the diet. Natasha believes that nearly all illness, including infertility, can be traced back to poor gut health. During my time hanging out around the bottom end of the Bristol Scale, it was this diet that thrust me back up the chart and in to the realms of normal digestion. It reinvigorated my dream that maybe, someday, steady 4s would be mine for the taking. But be warned, it is a restrictive diet and so is definitely only for the truly committed. Mere mortals like me with a lust for sugar and a penchant for potatoes will suffer. One further negative, other than it being impossible to buy an acceptable shop bought lunch, is that it made my husband and I feel a little tired. Maybe it was our bodies healing? Maybe it was reduced grains and carbs? Regardless, it was definitely worth it for my dramatic reduction in ‘poo-unamis’.
Cookbooks I use for easy digestion:
Hemsley and Hemsley, cruelly referred to in our household as the 'smug sisters' due to us considering them to be too 'worthy' on their TV cooking show, have an excellent website with many recipes that can be made when following the GAPS diet. Every single dish that I have made from their site and cookbooks have been delicious, which is no mean feat given the restrictiveness of some of the diets and my questionable ability in the kitchen. They provide plenty of recipes if you are going gluten and diary free.
The Gut Health Diet Plan does exactly what it says on the front cover, it provides recipes that help the gut to take a break and heal whilst also providing tasty meals.
Possibly my all time favourite cookbook and the one that I cook from the most. Nearly all recipes are gluten and dairy free except for the use of butter, which can be well tolerated by some people intolerant to lactose anyway. Pablo's chicken, a healthy take on southern fried chicken, slow roasted lamb with anchovies and the sticky toffee pudding (gluten and refined sugar free) are must tries.
Another corker from the Hemsley sisters. Packed with healthy gluten and dairy free recipes. Great all rounder with recipes for soups, smoothies, snacks, meals. Check out the salty cajun-roasted cauliflower, a snack that my husband and I tuck into whilst watching telly and a great replacement for popcorn, as well as the chicken comfort pi and super simple fish fingers.
When focusing on gut issues, looking for easy to digest and nutritious meals, this book has been a lifesaver. The food is delicious and my attempts look just like the pictures, which is rare (and there are plenty of full colour pictures of the meals to gawp at). Of particular note is this book's accessible recipes to get some liver in to your diet (beef and liver burgers with wasabi mayo and pan fried Indian spiced liver) which are edible for even the staunchest liver haters, like me.
Preparing food in a way that aids digestion
The Weston A Price Foundation is a not-for-profit organisation that encourages the eating of nutrient-dense foods using traditional preparation techniques. The website has plenty of free information and guidance on nutrition and disseminates the findings of nutrition pioneer, Dr Weston Price. The food principles focus on traditional food preparation which makes food more easy to digest in the human gut, such as soaking grains and nuts, sprouting seeds and fermenting foods. It requires quite a bit of preparation and forward planning in my cooking, but it has been worth it.
Cookbooks for food preparation techniques
This book is teaching me all the techniques that my great grandparents would have known and used, but we all seem to have forgotten. Soaking grains and beans and sprouting seeds to make them more digestible and nutrient dense. Making broths and fermenting foods. My gut is thanking me for buying this book. It resembles a textbook with recipes and just to warn you all, there are no photographs. On the plus side, this means that everything I cook I assume is perfect, without having a picture to prove otherwise.
This cookbook takes its readers back to first principles of traditional, good old fashioned cooking. Great for anyone interested in following a Weston A Price style diet. It has recipes for fermenting and sprouting, making your own condiments, yoghurt and butter. This book is where I learnt about my all time favourite hot drink, Golden Milk (turmeric and ginger milk). The fabulous photos make me want to quit my job and buy a small holding in the country.
Drinking bone broth to sooth my gut
Nearly every health conscious cookbook I own bangs on about the benefits of bone broth. The GAPS book by Natasha McBride says that bone broths "provide building blocks for the rapidly growing cells of the gut lining and have a soothing effect on any areas of inflammation in the gut. That is why they aid digestion and have been known for centuries as healing folk remedies for the digestive tract". Nick Barnard in Eat Right says that "stocks are richly endowed with easily assimilated mineral derived from the marrow, cartilage and bone, as well as the vegetables". He states that "chicken and other meat broths and stocks were featured and recommended in many pre-World war II cookbooks as the best foods to strengthen, protect and cure". I am sold on the benefits of bone broth. I love it and sincerely believe that it does me good. Even if I am wrong and just drinking a mug of placebo, to be honest, I'm still happy with that.
Bone broth is an acquired taste and my husband described his one and only cup as 'Beefy. Greasy. Horrible'. I would class that as a one star review. Our cat Roger happily laps it up, but he drinks from the loo and licks his own arse, so I'm not sure his taste buds can be trusted. If you are unsure whether you'd like it, health food stores, Crussh and apparently now even Pret sells bone broth, so testing out a cup could be a good way to go before making a whole batch at home. If you find bone broth acceptably drinkable then from an economic point of view, as well as ensuring the quality of the ingredients, it makes plenty of sense to batch make it at home, saving some pennies for another crazy infertility whim. The recipe I use to make my bone broth is available here for anyone brave enough to try.
Sometimes I use a carcass left over from my cooking, but more often than not I buy my bones from the local butchers. I still remember my misplaced apprehension when first asking for bones from the butcher. Like I was confirming the password to a secret society, my eyes darted around the store as I shuffled forward, lent over the counter and whispered "chicken necks?". Much to my surprise, he didn't bat an eyelid. "How many do you want?" "Ooh, I don't know. A bag full?" "Would you like other parts of the carcass too?" "Yes, random carcass bits sound lovely, thanks." And it was as easy as that.
The GAPS book by Natasha McBride says that 'probiotic supplementation is absolutely vital for treating any of the GAPS conditions'. Probiotics are especially important if you have been on antibiotics, which is everyone who has undergone the dreaded HSG fertility test.
I (and anyone who has ever been in a room with me when I've farted) can tell you that my gut bacteria is quite frequently 'off' and so in order to help with the rebalancing I take probiotics. Not being able to afford tests to check which bacteria is winning the feudal dispute in my stomach, I opt for taking an everyday probiotic consisting of 5 billion of the most common good bacteria. I opt for the Optibac brand, as it undertakes its own research and creates its probiotics based on evidence (here is the research on Optibacs For Every Day probiotics).
The GAPS book by Natasha McBride says that therapeutic dose of probiotics varies according to the individual and their health status, but as a general guideline recommends an adult to have 15-20 billion of bacteria cells per day. When my digestion was extremely bad and I was just starting off on my hunt for the Golden Bristol I used Optibac's Extra Strength daily probiotics for a few months, which contain 20 billion live microorganisms per capsule. It was a proud moment when I graduated on to the Everyday probiotics, which are the sort taken by health conscious people, but those who don't dash to the loo every morning at 6:00 am clutching their tummy's and hoping beyond hope that they will make it in time.
An alternative, and more natural way to get bacteria into your system is by eating fermented foods such as sauerkraut, kimchi, kombucha, kefir etc. The bacterial strains entering your system are not controlled to the same degree as taking a probiotic capsule, but it is a traditional way of introducing more good bacteria into the diet.
My four favourite fermented foods:
Kombucha is fermented tea, sometimes with added flavour such as ginger. It is delicious and sold in health food stores, online and some lunch establishments such as Crussh (in London). By purchasing a SCOBY you can easily make it yourself, some would say 'foolproof' (although I am the fool who has attempted and been defeated). I bought mine online from Happy Kombucha.
If I don't consume dairy, what am I doing drinking raw goat milk kefir?Interestingly, the kefir grains reduce the lactose in the milk and it also makes casein (the protein in milk) easier to digest. Milk kefir is said to be digestible by people who are lactose intolerance. In addition, raw (as opposed to pasteurised) milk contains bacteria and enzymes that aid digestion. I buy my raw goat milk kefir from The Chuckling Goat.
Water kefir grains are different grains to those used in milk. It is genuinely easy to make and can be flavoured to individual tastes. Plain lemon, lemon and ginger, turmeric and ginger are my favourites. I buy my water kefir grains from Happy Kombucha and they also include with your purchase instructions on how to make kefir and care for the grains.
I try for a daily forkful of sauerkraut (fermented cabbage). After making it at home once and finding that massaging the cabbage to soften it was more work then I was willing to put in, I have since been buying mine from a local health food store. The trick is to find organic, raw (traditionally made, not pasteurised or heated) sauerkraut.
Then finally, adding supplements
Only once my digestion had healed to a sufficient degree that every trip to the bathroom was no longer more traumatic than the battle of the Somme did I add supplements back in to my diet. Before that stage, I was not confident that my body was capable of absorbing all that I was supplying and I feared that i was overloading my delicate systems. More information on the supplements that I take and why is available here.
Food intolerances, inflammation, and autoimmunity
Identifying the elements in my diet that are causing my digestive symptoms (my kryptonite, as Bulletproof’s Dave Asprey would say) is of vital importance if I am ever to reach optimal health. To do this I must establish whether I have an allergy or an intolerance to any foods. Guess work and my own human experiment of trial and error has only got me so far. Is 'Amber Pooey Pants' the result of the mouthful of gluten that I had yesterday, or the cup of tea I had with breakfast, or the scoop of ice-cream I had an hour ago, or a combination of these, or a food item that I assumed was innocuous and hasn’t even crossed my mind? Given that the digestive symptoms may not always be immediate, it can be difficult to pinpoint the cause.
Testing for allergies
Celiac disease (allergy to gluten) may be rare but it can be a major contributing factor to a struggle to conceive. Doctors can undertake a blood test for celiac’s disease and may suggest other tests in addition. The unfortunate issue with celiac testing is that in the UK doctors recommend eating gluten twice a day for six weeks prior to having the test. Six. Whole. Weeks. If gluten is something that causes cramps and disaster pants, this may be a huge drawback. Although my celiac test came back negative (I had some antibodies but not enough to show celiac disease) the digestive symptoms during my 6 weeks on gluten confirmed that it is one for me to avoid.
Testing for intolerance
There are tests available to check for food intolerances, such as private tests from online sites such as Medichecks. I am saving my pennies to have this done. You can also use private lab tests to check the level of vitamins and minerals in your blood to identify any deficiencies that may be impacting your health. For example, such blood tests showed that my vitamin D level was lower than desirable and my levels of B12 were too high, allowing me to adjust my supplement regime.
Keeping a poo record
There’s an app for everything these days and as I like to take things (possibly) a step too far, I also keep track of my bowel movements and digestive symptoms via the My Symptoms app. The app allows you to keep a record of your poops using the Bristol scale and compare it against the food that you are eating, your energy levels, sleep and exercise. The My Symptoms app uses a clever algorithm to predict the most likely causes of digestive or other symptoms that you are experiencing, which could help in catching the likely culprits for food intolerances. The app can be insightful, but only after a couple of months of committing to the laborious process of inputting the data daily. For me it has made abundantly clear two things that I had long suspected: 1) that the amount of water I drink has a huge impact on my energy levels and 2) that ordinary builders tea sends me sprinting to the loo within an hour (now affectionately known as bringing on my 'tea wees'). The app may associate symptoms with certain foods that you have not previously considered problematic, although the only way to formally diagnose an issue would be through medical testing as the app can only hint at problems based on your statistics.
Help reduce inflammation by cutting out common aggravators
Common foods that cause digestive problems for many people include gluten, sugar, dairy (also know as the trio of deliciousness) and soy (I can take it or leave it). I'm playing it safe in cutting out all these aggressors. I have become what my brother refers to as a 'pickatarian'. Eating foods to which I am intolerant is likely to cause inflammation in my body, and inflammation in turn contributes to my hormonal imbalance, so I'm ignoring the disparaging remarks and plodding on my path of picky food preferences.
Gluten - Removing gluten from my diet was difficult due to the fact that it is so prevalent in the Western diet. Gluten is contained in wheat, barley and rye and whilst I don't miss cooking with gluten at home, eating out or buying a conventional lunch from a supermarket becomes pretty tricky. It is hard to hide that I am following a gluten free diet and many friends and colleagues give me a wry smile when I tell them, no doubt classifying me in their minds as fad follower. But I truly believe that within the next ten years everyone will be avoiding gluten and I will be able to return the wry smile of a know-it-all.
Sugar - For me, going sugar free represented sad, sad times. My great loves in life are 1) my husband, 2) my family and friends 3) Cake. (Cake is followed closely by hot baths and extreme weight loss TV programmes). Eating cake was a daily pleasure and I could barely stomach a cup of tea without also grazing on a slice. But reading up on the potential impact of sugar on my fertility made me put down the dessert spoon and withdraw my hand from the biscuit tin. For my top tips for going sugar free, top sugar switches, key resources and delicious recipes, check this out.
Dairy - Cutting out dairy gave me cause to pause because it is a food group, and I promised myself that I would not cut out a food group unless following the advice of a professional. But then I thought, sod it. I still eat butter (lots of it), drink raw milk kefir and eat eggs (I'm fully aware that cows don't lay eggs, but some people consider eggs to form part of the dairy isle) but otherwise I am dairy-free.
Soy - To me, tofu is the Devil's food and I don't drink soy milk, preferring nut milks as an alternative to dairy. So cutting out soy makes no difference to my life. Easy peasy. The only time I notice is when I'm forced to pass on the offer of soy sauce on my salmon and watch my husband with envy as he tucks in.
Detoxification and estrogen dominance
As previously mentioned, my fertility charts indicate that my body may be estrogen dominant, as suggested by the long phase before ovulation and short phase post ovulation (a good example is shown in the chart to the right). In order to increase my fertility and encourage a bun to be placed in the oven, I need to balance my hormones to achieve happy, health cycles. One way I believe this can be achieved is through my body learning to rid itself effectively of excess hormones and toxins that can contribute to the imbalance. A helpful video on the Nutritional Facts website describes the role of stools in relieving the body of excess oestrogen, which is one of the reasons that I have been focusing so intently on the hunt for the Golden Bristol.
In addition to encouraging nice and healthy number 4s, I want to help my body to rid itself of any unwanted toxins, waste and hormones before I fall pregnant, so that I may in the best and cleanest state possible.
During a Fertility Friday Podcast, Lisa Leger a Holistic Reproductive Health Practitioner who has been working in the field for almost 30 years, used the mnemonic SKILL to describe the organs involved in detoxification: Skin, Kidneys, Intestines, Lungs, Liver. It is a good reminder for me that I should be considering all of these when detoxing my body.
My daily detox routine:
I neck a morning shot of algae, consisting of both chlorella and spirulina. I'm not going to lie, it tastes pretty foul - a hold your nose and knock it back job. Chlorella and spirulina are two algaes that nourish the body and assist with detoxification. The brand of chlorella powder I use is Earth Circle Organics and my spirulina powder is by Naturya. I do a teaspoon of each mixed with filtered water each morning.
Water and lemon
Every morning on first waking I drink a pint of filtered water with fresh organic lemon to help awaken and support my digestion. It is a cheap and easy step to implement in to my morning routine,
Dry body brushing
Dry body brushing stimulates and supports the lymphatic system, helping to rid my body of toxins. Using soft strokes towards the direction of my heart, I brush the skin all over my body each day before my morning shower.
I use activated charcoal both to ingest and as part of a face pack. The activated charcoal capsules sold by Bulletproof are a much less gritty experience than drinking the charcoal powder in filtered water. This is less of a daily routine and more of a necessary helping hand when I feel I need it or I've gone on a binge or bender. Charcoal binds to toxins as it passes through the body into the toilet bowl. It is a fantastic ingredient for a face mask as it removes blackheads. The face mask recipe I use is available here.
How I measure progress with detoxification and estrogen dominance
My assessment of progress is judged on three things:
1) The balance between my follicular and luteal phases on my fertility charts. A balanced chart which shows the same number of days (hopefully around 14 days) would be a great indicator that my estrogen dominance had subsided and my hormones are back in balance. I'm getting there through the positive changes I've made, but I'm not yet at 14 days follicular / 14 days luteal. Instead I am at 16/11, but that is much better than my starting position of 36/8.
2) The clarity of my skin. Reduced blackheads on my face means less toxins being released through my skin.
3) My stool. The bigger the better when it comes to reducing estrogen and I have to assume that frequent, perfect 4s show that my digestion and natural detox systems are motoring along, full speed ahead.
Although stress is not the topic of this post, it would be amiss not to mention in passing that all of the above good deeds may as well be flushed down the loo if I don't tackle my stress. Stress is toxic to the body and could override all my good work quicker than I can say stress cadet.
So there we have it. Everything that I have been doing , drinking, eating, reading and rubbing (dry body brushing reference, nothing else) in order to fix my poor, sorry gut. To end, I would like to wish everyone the best of luck on their digestive quest. Happy pooing!