The Sixth Vital Sign and Pressure diseases

The Sixth Vital Sign and Pressure diseases

Compared to rural African populations eating traditional plant-based diets, white South Africans and black and white Americans not only have more than 50 times the heart disease, 10 times more colon cancer, and more than 50 times more gallstones and appendicitis, but also more than 25 times the rates of so-called pressure diseases—diverticulitis, hemorrhoids, varicose veins, and hiatal hernia.

Bowel movements should be effortless. When they’re not, when we have to strain at stool, the pressure may balloon out-pouchings from our colon, causing diverticulosis, inflate hemorrhoids around the anus, cause the valves in the veins of our legs to fail, causing varicose veins, and even force part of the stomach up through the diaphragm into our chest cavity, causing a hiatal hernia

When this was first proposed by Dr. Burkitt, he blamed these conditions on the straining caused by a lack of fiber in the diet, but did acknowledge there were alternative explanations. For example, in rural Africa they used a traditional squatting position when they defecated, which may have taken off some of the pressure.

Burkitt also noticed a causal relationship between varicose veins, deep vein thrombosis, and haemorrhoids in relation to “faecal arrest which is the result of a low-residue diet”.

Br Med J. 1972 Jun 3;2(5813):556-61.

Varicose veins, deep vein thrombosis, and haemorrhoids: epidemiology and suggested aetiology.

Burkitt DP.


Current concepts on the aetiology of varicose veins, deep vein thrombosis, and haemorrhoids have been examined and, in the light of epidemiological evidence, found wanting.It is suggested that the fundamental cause of these disorders is faecal arrest which is the result of a low-residue diet.

PMID: 5032782 PMCID: PMC1788140

[Indexed for MEDLINE] Free P

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J R Coll Physicians Lond. 1975 Jan;9(2):138-46.

Dietary fibre and ‘pressure diseases’.

Burkitt DP.

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Lack of fibers….stool stagnation “arrest”, straining and unadapted anorectal angle

The Evolutionary Poop Squat

For hundreds of thousands of years, everyone used the squatting position, which may help by straightening the “anorectal angle.”  A bowel expert corroborates:

Med Hypotheses. 1989 Feb;28(2):71-3.

Primary constipation: an underlying mechanism.

Sikirov BA.


Primary (simple) constipation is a consequence of habitual bowel elimination on common toilet seats. A considerable proportion of the population with normal bowel movement frequency has difficulty emptying their bowels, the principal cause of which is the obstructive nature of the recto-anal angle and its association with the sitting posture normally used in defecation. 

The only natural defecation posture for a human being is squatting. The alignment of the recto-anal angle associated with squatting permits smooth bowel elimination. This prevents excessive straining with the potential for resultant damage to the recto-anal region and, possibly, to the colon and other organs. There is no evidence that habitual bowel elimination at a given time each day contributes considerably to the final act of rectal emptying. The natural behavior to empty the bowels in response to a strong defecation reflex alleviates bowel emptying by means of the recto anal inhibitory reflex.

There’s actually a kink right at the end of the rectum, almost a 90-degree angle that helps keep us from pooping our pants when we’re just walking around, but that angle only slightly straightens out in a common sitting posture on the toilet. 

Maximal straightening out of this angle occurs in a squatting posture,  permitting smoother bowel elimination.

So how did they figure this out? They filled latex tubes with a radiopaque fluid, stuck them up some volunteers, took X-rays with their hips flexed at various angles, and concluded that flexing the knees towards the chest, like one does squatting, may straighten that angle and reduce the amount of pressure required to achieve emptying of the rectum. 

But it wasn’t put to the test until 2002, when researchers used defecography, which are X-rays taken while the person is defecating, in sitting and squatting positions. 

And indeed, squatting increased the anorectal angle from around 90 degrees all the way up to about 140.

The mechanism ? 

The weight of your torso pressing against the thighs may put an extra squeeze on your colon.

Root cause

But instead of finding ways to add even more pressure, why not get to the root of the problem? The fundamental cause of straining is the effort required to pass unnaturally firm stools. 

By manipulating the anorectal angle through squatting or leaning you can more easily pass unnaturally firm stools; but why not just treat the cause? 

And stop with this Keto and Paleo madness (See our analysis that debunk these diets) and eat enough fiber-containing whole plant foods to create stools so large and so soft that you could pass them effortlessly at any angle while giving the right conditions for the bacteria therein to populate the Soil, sequester carbon and feed Almighty Earth.

Squating AND plant-based foods for bowel diseases

Squatting does not significantly decrease the pressure gradient that may cause hiatal hernia and other. 

It does not prevent that pressure transmission down into the legs that may cause varicose veins. 

And this is not just a cosmetic issue. Protracted straining can cause heart rhythm disturbances, reduction in blood flow to the heart and brain, sometimes resulting in defecation-related fainting and death. 

15 seconds of straining can temporarily cut blood flow to the brain by 21%, cut blood flow to the heart nearly in half, thereby providing a mechanism for the well-known bedpan death syndrome. 

You think you have to strain sitting; try having a bowel movement on your back. Bearing down for just a few seconds can send your blood pressure up to nearly 170 over 110, which may help account for the notorious frequency of sudden and unexpected deaths of patients while using bedpans in hospitals. 

With morphin the lying down poop of hospital patients is big problem

Chronic Diseases Related to Bowels

Familial colorectal cancer occurred significantly more often in patients who had a higher faecal load than the controls. Four malignancies and 25 adenomas were identified. An increased faecal load in the colon with or without delayed transit will increase bacterial counts and create a chronic inflammation of the colonic mucosa, which is a risk factor for cancer onset. A functional bowel disorder is then likely to occur with gradually transition from a primary functional disease into specific organic diseases. A diet rich in fibre and regular physical activity have a therapeutic and preventive effect on colorectal diseases associated with faecal retention. A “common cause” was earlier proposed for constipation, colon diverticula, cancer, appendicitis, and haemorrhoids. The actual results of the present studies support this unifying theory for these diet-related diseases, in which the functional retention of faeces maybe the common cause.

PMID: 25748875

[Indexed for MEDLINE]

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Lancet. 1976 Apr 10;1(7963):768-70.

Pressure changes in varicose veins.

Martin A, Odling-Smee W.


Pressures in the superficial leg veins of 24 patients with varicose veins and 6 normal controls were studied. In the controls there was no rise in pressure in the veins on increasing the intra-abdominal pressure, but in the patients with varicose veins pressure rose significantly. Squatting was no better than sitting in preventing transmission of intra-abdominal pressure to the leg veins. It was concluded that the difference in the positions adopted for defaecation is not the cause of the wide variation in the geographical distribution of varicose veins.

NOT squat…so fiber…

Hiatus Hernia too

Br Med J. 1979 Feb 3;1(6159):344.

Abdominal and thoracic pressures during defecation.

[No authors listed]

PMID: 421112 PMCID: PMC1597656

[Indexed for MEDLINE] Free PMC Artic

Absence of squatting super bad

Trans Am Clin Climatol Assoc. 1948;60:78-86.

Bed Pan Deaths.

McGuire J, Green RS, Courter S, Hauenstein V, Braunstein JR, Plessinger V, Iglauer A, Noertker J.

PMID: 21407688 PMCID: PMC2242053

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Straining Bad

Stroke. 1984 Jan-Feb;15(1):76-9.

Transient changes in cerebral vascular resistance during the Valsalva maneuver in man.

Greenfield JC Jr, Rembert JC, Tindall GT.


Measurements of cerebral spinal fluid pressure, arterial pressure, and internal carotid artery blood flow were obtained in a series of patients during a Valsalva maneuver. During straining (phase II), an 11% reduction in mean arterial pressure was associated with a 21% decrease in internal carotid flow from control values; and following release (phase IV), the 19% increase in mean arterial pressure produced a 22% increase in internal carotid artery flow. Perfusion pressure computed as the mean arterial pressure minus cerebral spinal fluid pressure and internal carotid artery blood flow were used to calculate an index of cerebral vascular resistance. The data indicate that a modest but significant decrease in vascular resistance occurred during phases II and III followed by return to control levels during phase IV. These changes in vascular resistance were not rapid enough or of sufficient magnitude to maintain constant cerebral perfusion during the Valsalva maneuver.

PMID: 6229907

The Evidence points to one and only once Solution: the ancestral evolutionary based squat

Lack of fibers….stool stagnation “arrest”, straining and unadapted anorectal angle

Anorectal angle

Dig Dis Sci. 2003 Jul;48(7):1201-5.

Comparison of straining during defecation in three positions: results and implications for human health.

Sikirov D.


The aim of the study was to compare the straining forces applied when sitting or squatting during defecation. Twenty-eight apparently healthy volunteers (ages 17-66 years) with normal bowel function were asked to use a digital timer to record the net time needed for sensation of satisfactory emptying while defecating in three alternative positions: sitting on a standard-sized toilet seat (41-42 cm high), sitting on a lower toilet seat (31-32 cm high), and squatting. They were also asked to note their subjective impression of the intensity of the defecation effort. Six consecutive bowel movements were recorded in each position. Both the time needed for sensation of satisfactory bowel emptying and the degree of subjectively assessed straining in the squatting position were reduced sharply in all volunteers compared with both sitting positions (P < 0.0001). In conclusion, the present study confirmed that sensation of satisfactory bowel emptying in sitting defecation posture necessitates excessive expulsive effort compared to the squatting posture.

PMID: 12870773

[Indexed for MEDLINE]

So, should we all get one of those little stools for our stools, like the squatty potty that you put in front of your toilet to step on?

 No, they don’t seem to work. 

The researchers tried adding a footstool to decrease sitting height, but it didn’t seem to significantly affect the time it took to empty one’s bowels or significantly decrease the difficulty of defecating. 

They tried even higher footstools, but people complained of extreme discomfort using them. 

So, nothing seemed to compare with actual squatting, which may give the maximum advantage.

But, in “civilized” countries, this ancestral Paleolithic practice is poopooed on.

Holistic Savoir-Faire

While it may not be economically and politically correct to rip off all of the sitting toilets of the Land (which any educated and concerned Congress should do), nor would it be “convenient” or socially accepted to poop behind trees (notwithstanding the trees need for fertilizers), there may be a partial solution to the Poop crisis in this country and those countries that emulate the US. 

Indeed, it was figured out that if one leans forward as you sit, with your hands on or near the floor, this forward-leaning position when defecating may be a temporary fix, especially for a constipation plug.

Take part of article with regard to STOOL in tool  box


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