|Seven Advantages of Squatting
Reference: Tagart REB. The Anal Canal and Rectum: Their Varying Relationship and
Its Effect on Anal Continence, Diseases of the Colon and Rectum 1966: 9, 449-452.
Man, like his fellow primates, has always used the squatting position for resting, working and performing bodily functions. Infants of every culture instinctively squat to relieve themselves. Although it may seem strange to someone who has spent his entire life deprived of the experience, this is the way the human body was designed to function.
And this is the way our ancestors performed their bodily functions until the middle of the 19th century. Before that time, chair-like toilets had only been used by royalty and the disabled. But with the advent of indoor plumbing in the 1800's, the throne-like water closet was invented 22 to give ordinary people the same "dignity" previously reserved for kings and queens. The plumber and cabinet maker who designed it had no knowledge of human physiology – and sincerely believed that they were improving people's lives.
The new device symbolized the "progress" and "creativity" of western civilization. It showed that Man could "improve" on Nature and transcend the primitive cultural practices followed by the poor "benighted" natives in the colonies. The "White Man's Burden" typified the condescending Victorian attitude toward other races and cultures.
The British plumbing industry moved quickly to install indoor plumbing and water closets throughout the country. The great benefits of improved sanitation caused people to overlook a major ergonomic blunder: The sitting position makes elimination difficult and incomplete, and forces one to strain.
Those who could not overlook this drawback had to keep silent, because the subject was considered unmentionable. Furthermore, how could they criticize the "necessary" used by Queen Victoria herself? (Hers was gold-plated, befitting the self-styled "Empress of India.")
So, like the Emperor’s New Clothes, the water closet was tacitly accepted. It was a grudging acceptance, as evidenced by the popularity of "squatting stools" sold in the famous department store, Harrods of London. As shown below on the left, these footstools merely elevated one's feet in a crude attempt to imitate squatting.
Learn more about this comparison
The rest of Western Europe, as well as Australia and North America, did not want to appear less civilized than Great Britain, whose vast empire at the time made it the most powerful country on Earth. So, within a few decades, most of the industrialized world had adopted "The Emperor's New Throne."
150 years ago, no one could have predicted how this change would affect the health of the population. But today, many physicians blame the modern toilet for the high incidence of a number of serious ailments. Westernized countries have much higher rates of colon and pelvic disease, as illustrated by this report in theIsrael Journal of Medical Science:The prevalences of bowel diseases (hemorrhoids, appendicitis, polyps, ulcerative colitis, irritable bowel syndrome, diverticular disease, and colon cancer) are similar in South African whites and in populations of prosperous western countries. Among rural South African blacks with a traditional life style, these diseases are very uncommon or almost unknown.19
The following sections will examine these and other diseases in more detail to see how an unnatural toilet posture could produce such a wide range of harmful effects.
|Toilets from Ancient Times
Pictures of ancient public toilets tend to confuse westerners, who assume that they were used in the sitting position. This impression is often reinforced by the pose of a comical tourist.
But, in reality, these are squattoilets.
The ancient Romans used the posture shown below on the left. (Togas were more convenient than trousers, and provided some degree of privacy.)
The tourists shown below might be surprised to learn that, except for royalty and the disabled, everyone used the squatting position until the second half of the 19th century.22
Note: The Sulabh International Museum of Toilets website claims that archeologists have found "sitting-type" toilets at ancient sites, thousands of years old. The author of the site, Dr. Bindeswar Pathak, was asked for his evidence that these toilets were used in the sitting position. He replied that he actually has no evidence, but was simply repeating the assumptions of western archeologists.
In the diagram of the colon, please locate the cecum, the appendix and the ileocecal valve. The left side of the diagram corresponds to the right side of the body.
The cecum is a small pouch where the colon begins, in the lower right section of the abdomen. Wastes from the small intestine flow into the cecum through the ileocecal valve (theoretically a one-way valve.) The appendix is a narrow tube attached to the cecum, with a channel opening into the cecum.
Waste matter can get lodged in this channel, causing the appendix to become infected and inflamed. Immediate surgery must be performed to remove the appendix before it bursts. Otherwise, the result is usually fatal.
Why does the appendix get blocked with fecal matter? Did nature make a blunder in its design?
One clue comes from the field of epidemiology. Appendicitis is a disease of westernized countries, virtually unknown in the developing world.19,31 The reason is that the cecum was designed to be squeezed empty by the right thigh, in the squatting position. On a sitting toilet, it is physically impossible to compress the cecum.
Instead, one pushes downwards with the diaphragm, while holding one's breath. This maneuver inflates and pressurizes the cecum. It is analogous to squeezing a tube of toothpaste in the middle and causing the bottom of the tube to inflate. The pressure can easily force wastes into the appendix, with disastrous consequences.
The back-pressure can also overwhelm the ileocecal valve, whose purpose is to protect the small intestine from fecal contamination. Barium enema exams and intestinal surgeries routinely show the leakage of wastes into the small intestine. Crohn's Disease develops in the area soiled by this toxic backwash.
Despite all the straining, the cecum never gets evacuated. Residual wastes adhere to the colon wall, increasing the risk of cancer and inflammation (including appendicitis.)
By contrast, in the squatting posture, the right thigh squeezes the cecum from its base. Its contents are thoroughly expelled into the ascending colon, where peristalsis carries them away. There is no need to hold one's breath or push downwards, since the posture generates the pressure automatically.
The force is all directed upwards, so the appendix stays clean and the ileocecal valve stays closed. These organs were not "poorly designed" – as is currently taught in medical schools. Like the rest of the colon, they were designed with squatting in mind.
Historical Background of Appendicitis
Most people assume that appendicitis has always been with us. But in fact, it emerged quite recently, coinciding with the introduction of sitting toilets toward the end of the 19th century.22 According to the Medical Journal of Australia,The epidemiology of appendicitis poses many unanswered questions. Almost unknown before the 18th century, there was a striking increase in its prevalence from the end of the 19th century, with features suggesting it is a side effect of modern Western life.30In 1886, Reginald Heber Fitz, a Harvard Professor of Pathological Anatomy, became the first doctor to recognize and name the disease. He was also the first one to propose treating it by removing the appendix.18
The conservative British medical establishment resisted the novel appendectomy procedure until after the turn of the century, when it was used to save the new king's life. In 1901, the Prince of Wales, Albert Edward, underwent an emergency appendectomy, just two weeks before his scheduled coronation as King Edward VII. His successful recovery finally convinced British surgeons that this operation was the only way to save the victims of this "mysterious" new disease.20
Currently, 7% of the U.S. population will contract appendicitis at some point in their lifetime (according to www.emedicine.com). The figure would be even higher, except that 40,000 "incidental appendectomies" are performed each year (according to Harper's Index, Feb, 2002.) "Incidental" means there was nothing wrong with the appendix, but the surgeon happened to be operating on another organ nearby – in most cases performing a hysterectomy.
Appendicitis is the most common reason for a child to need emergency abdominal surgery. Young people between the ages of 11 and 20 are most often affected (according to www.KidsHealth.org).
Modern medicine recognizes that appendicitis is primarily a disease of the Western World.31 They attribute this to the (allegedly) greater amount of fiber in the diet of the Third World. However, the fiber theory has never been substantiated, as evidenced by this quote from www.KidsHealth.org:There are no medically proven ways to prevent appendicitis. Although appendicitis is rare in countries where people eat a high-fiber diet, experts have not yet shown that a high-fiber diet definitely prevents appendicitis.
Many residents of the developing world, not wanting to appear "backward", feel obliged to adopt western toilets. This trend is causing health problems that were previously unknown among squatting populations. Appendicitis is one example, as reported by webhealthcentre.com, a health care portal based in India (retrieved in 2001):The Indian type of toilet is more conducive to complete evacuation than the Western toilet. With the western style closets becoming popular in India, there is a risk of increased incidence of appendicitis.
Unfortunately, western doctors have never made the connection between toilet posture and appendicitis. Their understanding of this disease has advanced little in the century since Dr. Frederick Treves performed his famous appendectomy (mentioned above) on the Prince of Wales.
Ironically, Sir Frederick (knighted for saving the king's life) lost his own daughter to appendicitis.27 Despite being highly skilled at surgery, he had no idea what causes the disease, or how to prevent it.
Now his successors have a chance to redeem their profession. By informing their patients (and their children) about the health hazards of the modern toilet, they can prevent a great deal of needless suffering.
|Colitis and Crohn's Disease
The website www.crohnsresource.com defines Crohn's Disease as... a chronic and serious inflammatory disease of the gastrointestinal tract that affects more than 500,000 Americans. People with Crohn's disease may experience a number of symptoms including diarrhea, abdominal cramps and pain, fever, rectal bleeding, loss of appetite, and weight loss....The cause of Crohn's disease has not yet been discovered.Inflammatory bowel disease (IBD) includes Crohn's Disease, ulcerative colitis and irritable bowel syndrome. IBD affects approximately 2 million Americans and can have devastating consequences. 20 to 40% of ulcerative colitis patients eventually require surgery for removal of the colon, according to the University of Maryland Medicine website. Up to 70% of patients with Crohn's disease require surgery at some point in their disease course to remove parts of the intestine.
IBD is confined to countries of the Western World, according to a study published in The Lancet.21 A 1997 article reported that "The last half of this century has seen a rising incidence of inflammatory bowel disease in developed countries," but notes "... the apparent absence of IBD in developing countries." [italics added]
For many years, researchers assumed that a different diet was protecting the developing world from IBD. "What else could it be?" They did not realize that these cultures have no uniform diet. For example, the Masai cattle-herders of central Africa are almost exclusively carnivorous. The Hindus of India are vegetarian. Other groups subsist on fish, or even on insects.
On testing their hypothesis, doctors were forced to conclude that "No special diet has been proven effective for preventing or treating this disease." (from the University of Chicago Hospitals website.)
Currently another theory has become popular among epidemiologists. They believe that fecal contamination of food and water in the developing world "naturally innoculates" children against inflammatory bowel disease. In other words, the Western World is too antiseptic to allow the immune system to produce the necessary antibodies.
This theory reflects a common misconception about the "superior hygiene" of the developed world. Westernized countries are proud of their high standards of cleanliness, but they are unaware that their internal cleanliness compares poorly with the rest of the world.
Colon hygiene depends on the effectiveness of daily elimination. Human beings were designed to perform their bodily functions in the squatting position. In order to be squeezed empty, the colon needs to be compressed by the thighs. Furthermore, the puborectalis muscle needs to be relaxed and the ileocecal valve from the small intestine needs to be closed. By ignoring these requirements, the sitting toilet makes it impossible to empty the colon completely.
Incomplete evacuation causes wastes to stagnate in the lower regions of the colon. In these areas, virulent bacteria can establish colonies, inflaming the surrounding tissues. Depending on where in the colon it occurs, and which strain of bacteria is involved, this inflammation is called by different names. Appendicitis, diverticulitis, ulcerative colitis, and Crohn's Disease can all be considered as various forms of inflammatory bowel disease. (Ileitis will be discussed below.)
Therefore, what protects the developing world is not "squalid conditions" but just the opposite: the natural cleanliness that comes from evacuating as nature intended. The relevance of toilet posture is also confirmed by the historical evidence. Inflammatory bowel disease and irritable bowel syndrome emerged in the West toward the end of the 19th century, as the use of sitting toilets became more and more common.22,28
This explanation is supported by a recent article in HealthScout News entitled "E. Coli Linked to Inflammatory Bowel Disease" (February 5, 2002):An intestinal infection caused by strains of a common bacterium may be linked to the development of inflammatory bowel disease, a new study says. French researchers report that a heightened immune interaction between Escherichia coli and the cells lining the intestine may result in the symptoms experienced by people with inflammatory bowel disease (IBD). They suggest their work indicates antibiotics might be a useful tool when treating IBD.
Another form of Crohn's Disease is "ileitis" or inflammation of the small intestine. It results from fecal matter being forced backwards into the small intestine during evacuation. The ileocecal (IC) valve is designed to prevent this toxic "backflow" – but only in the squatting position. The IC valve needs to be supported by the right thigh in order to withstand the pressure built up during elimination. A more detailed explanation of this process can be found in two other sections: Contamination of the Small Intestine and Appendicitis.
The anatomy and demographics of inflammatory bowel disease imply that squatting would be useful for prevention. Anecdotal evidence suggests its potential for use in treatment as well. Mr. Wallace Bowles, an Australian researcher, has extensively reviewed the medical literature and has surveyed converts to the natural squatting position:I have received reports regarding several people, aged between 5 and 45 years, diagnosed with Crohn’s Disease. Inflammatory bowel conditions are shown to react most positively when the cumulative injury of seated elimination is relieved by squatting. People with IBD who have changed to the squat posture for bowel movements report significant improvement within a few weeks and, in time, have lost all symptoms of this horrendous condition.
[from personal communication with Mr. Bowles]
More research is clearly needed, but it can be easily and non-invasively done by any gastroenterologist or any patient with colitis or Crohn's Disease. Each successful outcome will not only relieve the patient's own suffering, but will also help to validate a promising strategy to prevent inflammatory bowel disease.
Note: The book Triumph Over Disease By Fasting And Natural Diet, by Jack Goldstein, recounts a remarkable self-cure of ulcerative colitis after the failure of conventional treatment.
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The colon is a tube, five to six feet in length, which stores wastes from the small intestine and moves them, by rhythmic muscular contractions, to the rectum. In the process, water is continuously extracted, to prevent dehydration. If the flow is interrupted for any reason, the continual drying process can leave wastes "cemented" to the colon wall.
The sitting toilet obstructs the flow, because it ignores four basic requirements:
The kink where the sigmoid joins the rectum, mentioned above in point 1, serves an important function in preventing incontinence. It "applies the brakes" to the flow of peristalsis, reducing the pressure on the puborectalis muscle.
For safety, nature has deliberately created obstacles to evacuation that can only be removed by squatting. In any other position, the colon defaults to "continence mode." This is why the conventional sitting position deprives the colon of support from the thighs and leaves the rectum choked by thepuborectalis muscle.
These obstacles make elimination difficult and incomplete – like trying to drive a car without releasing the parking brake. Chronically incomplete evacuation, combined with the constant extraction of water, causes wastes to adhere to the colon wall. The passageway becomes increasingly constricted and the cells start to suffocate. Prolonged exposure to toxins will often trigger malignant mutations.
This explanation would suggest that colon cancer is related to constipation. According to a 1998 report in the journal, Epidemiology,3 "People who frequently felt constipated were more than four times as likely to develop colon cancer as those who did not complain of constipation." The study also found that using commercial laxatives frequently was associated with "substantially increased risk of colon cancer."
A Lesson from the Developing World
In contrast with constipated western societies, the developing world is relatively free of colon cancer, as this 2009 study found:Colorectal cancer, however, is not uniformly common throughout the world. There is a large geographic difference in the global distribution of colorectal cancer. Colorectal cancer is mainly a disease of developed countries with a Western culture. In fact, the developed world accounts for over 63% of all cases. The incidence rate varies up to 10-fold between countries with the highest rates and those with the lowest rates.For decades, researchers have been trying to explain the absence of colon cancer in the developing world. Some have speculated that perhaps E. coli bacteria in the water and food somehow stunts the growth of cancer cells in the intestine.
This theory reflects the common belief that our society is "clean" while the developing world is "dirty." In terms of colon hygiene, exactly the opposite is the case. What protects the developing world from bowel disease is the natural cleanliness that comes from evacuating as nature intended. By contrast, our contrived toilet posture leads to fecal stagnation – the primary cause of colon cancer and inflammatory bowel disease.
Dr. Burkitt's Mistake
Lacking this knowledge, researchers have focused on dietary factors. They have repeatedly tried to prove that a high-fiber diet prevents colon cancer. This theory dates from the early 1970's when Dr. Denis Burkitt (1911-1993), a British missionary doctor (pictured here), reported a dramatic difference between colon cancer rates in America and Africa. According to his article in the Journal of the Royal Society of Medicine,colon cancer is nearly 15 times as common in black Americans as in Africans.40
Dr. Burkitt believed that high levels of fiber in the African diet protected the natives from bowel disease. However, at least three recent major studies have shown the fiber theory to be incorrect, as reported by the Associated Press:Study: Fiber Doesn't Prevent Cancer
By Emma Ross -- AP Medical Writer
October 13, 2000
LONDON (AP) - Evidence is mounting that fiber might not prevent colon cancer after all, with a new study suggesting that one type of supplement might even be bad for the colon.
The theory that a high-fiber diet wards off the second-leading cancer killer has been around since the 1970s, but the evidence was never strong. The concept began to crumble last year when the first of three major U.S. studies found it had no effect.
In the latest study, published this week in The Lancet medical journal, European researchers found that precancerous growths, or polyps, were slightly more likely to recur in those taking a certain fiber supplement. ...[Full article].
The above article appeared on October 13, 2000. Five years later, medical researchers – at their wits' end – were still testing the same discredited theory. On December 14, 2005, The Boston Globe reported on the latest attempt by the Harvard School of Public Health:Eating a lot of fiber-rich vegetables, fruits, and whole grains does not appear to reduce a person's chances of getting colorectal cancer, researchers found in the largest study yet to test the popular and longstanding idea about preventing the third most common cancer....
"It became an urban myth," said Dr. David Ryan, medical director of the gastrointestinal cancer center at Massachusetts General Hospital. ''It takes a lot of time to deconstruct those.".... [Full Article]
Dr. Burkitt's Redemption
Dr. Denis Burkitt obviously guessed wrong – and led the western world on a "wild goose chase" for over three decades. But, in his defense, it should be noted that he was aware of the health benefits of squatting. His 1979 best-selling book Don't Forget Fibre in Your Diet (translated into 9 languages) acknowledges that the Africans' use of squat toilets might be as important as their diet in protecting them from colon cancer and other diseases.
Western researchers ignored this hypothesis, partly because toilet posture was considered a taboo subject. They also probably believed that the western world could never revert to squatting, even if sitting toilets were proven to be harmful. So, they simply hoped that modifying the diet would be enough.
Now that the fiber theory has clearly failed, they will have to reconsider Dr. Burkitt's alternate explanation. They may be surprised by the public's openness to a simple change that could save many lives.
Constipation, especially when chronic, can have very damaging effects on the colon. The colon is constantly extracting water from its contents, to transform liquid wastes into solid. As a result, if elimination is not regular and complete, the wastes will dry and become cemented to the walls of the colon.
Constipation has been shown to increase the risk of colon cancer3 and has been implicated in diverticulosis and appendicitis. "Cumulative lifetime use of commercial laxatives was also associated with increased risk of colon cancer."3
Squatting prevents constipation in four ways:
To summarize, the colon is equipped with an inlet valve (the ileocecal valve) and an outlet valve (the puborectalis muscle). Squatting simultaneously closes the inlet valve, to keep the small intestine clean, and opens the outlet valve, to allow wastes to pass freely. The sitting position defeats the purpose of both valves, making elimination difficult and incomplete, and soiling the small intestine.
The sphincter muscle, commonly regarded as the outlet valve, is actually not capable of preventing incontinence. It involves voluntary effort and is only for short-term emergencies. Maintaining continence requires the continuous grip of the puborectalis muscle. This grip is not released in the sitting position, so it must be forced open by straining. Straining repeatedly over a number of years can lead to hemorrhoids, which can therefore be classified as a repetitive strain injury.
Doctors have long recognized the connection between sitting toilets and constipation. For example, F.A. Hornibrook in The Culture of the Abdomen,published in 1933:Man's natural attitude during [elimination] is a squatting one, such as may be observed amongst field workers or natives. Fashion, in the guise of the ordinary water closet, forbids the emptying of the lower bowel in the way Nature intended. Now in this act of [elimination] great strains are imposed on all the internal organs….
It is no overstatement to say that the adoption of the squatting attitude would in itself help in no small measure to remedy the greatest physical vice of the white race, the constipation that has become a contentment.5u
These sentiments are echoed in Our Common Ailment, written by H. Aaron and published in 1938:When the thighs are pressed against the abdominal muscles in this position, the pressure within the abdomen is greatly increased, so that the rectum is more completely emptied. Our toilets are not constructed according to physiological requirements. Toilet designers can do a good deal for people if they will study a little physiology and construct seats intended for proper [elimination].6top of page
|A Clinical Study of Sitting versus Squatting
In April, 2002, an Iranian radiologist, Dr. Saeed Rad, published a study which compared the effectiveness of sitting versus squatting for evacuation.24 One of his conclusions relates to the cause of a type of hernia known as "rectocele," which is a bulge of the front wall of the rectum into the vagina.
Thirty subjects participated in the study – 21 male, 9 female – ranging in age from 11 to 75 years. Each patient received a barium enema so the internal mechanics of evacuation could be recorded on an X-Ray image. Each patient was studied in both the squatting and the sitting positions.
Using these images, Dr. Rad measured the angle where the end of the rectum joins the anal canal. At this junction point, the puborectalis muscle creates a kink to prevent incontinence. Dr. Rad found that when the subjects used sitting toilets the average angle of this bend was 92 degrees, forcing the subjects to strain. When they used squat toilets, the angle opened to an average of 132 degrees. At times it reached 180 degrees, making the pathway perfectly straight.
Using squat toilets, all the subjects reported "complete" evacuation. "Puborectalis relaxation occurred easily and straightening of the rectum and anal canal facilitated evacuation. The anal canal became wide open and no folding was noticed in the terminal rectum."
In the sitting position, "a remarkable folding was created in the terminal rectum predisposing it to rectocele formation, and puborectalis relaxation was incomplete." All the subjects reported that elimination felt "incomplete" in the sitting position.
Dr. Rad also measured the distance from the pelvic floor to the perineum. In the sitting position he found that the pelvic floor was pushed downwards to a significant degree. (A detailed discussion of the connection between sitting toilets and pelvic organ prolapse – including rectoceles – can be found in thegynecological disorders section.)
Dr. Rad concluded that the use of the squat toilet "is a more comfortable and efficient method of bowel evacuation" than the sitting toilet.
Different types of squat toilets
|Contamination of the Small Intestine
Dr. William Welles, a San Diego chiropractor, discovered that the modern toilet causes fecal contamination of the digestive system in 70 to 80% of the population.
The ileocecal (IC) valve, between the small intestine and the colon, is designed to prevent the backflow of wastes. If it leaks, E.coli bacteria can enter the small intestine and get absorbed into the bloodstream. This puts a strain on the liver which has to remove these toxins.
The invasion of fecal bacteria (called "colo-ileal reflux") can also cause inflammation of the small intestine. This condition is called "ileitis" and is a form of Inflammatory Bowel Disease.
According to Dr. Welles,My discovery of a dysfunctional ileocecal valve in approximately 80% of my patients is also confirmed by modern medicine. The ICV is so commonly found to be dysfunctional in surgeries of the bowel and in barium enema studies that it is believed to be inherently faulty in its design.2
Drawing on the research of F.A. Hornibrook, Dr. Welles suspected that the faulty design responsible for this problem was not nature's but man's.Hornibrook states that the design of the Western toilet defies the laws of nature by encouraging the user to bear down without the natural support given the abdominal walls by the thighs when one is in the squatting posture.2Then, he used muscle-testing to verify his hypothesis.When individuals sat in the position encouraged by the western toilet and bore down so as to eliminate fecal matter, the muscles weakened immediately and the ileocecal valve was blown out....The ICV is critical to proper intestinal plumbing, and its dysfunction is the root cause of many of the diseases of modern civilization.... 2In his article, Dr. Welles also discusses other ailments caused by the sitting toilet – including colon cancer, hemorrhoids, hernias and pelvic organ prolapse. He concludes with some strong words of advice:Cast aside your preconceived ideas as to what is normal and use your rational mind to act on what has been stated above. At any given time in history it is possible to look back and find great faults with the habits of previous civilizations. I believe that future generations will one day look back at our aberrant habit of using the modern toilet – and cringe. 2top of page
Diverticulosis is a type of hernia caused by years of chronic straining. The outer layer of the colon ruptures, allowing the inner lining (the "mucosa") to bulge out in pouches or sacs. It is similar to an inner tube that bulges out through weak spots in a worn-out tire.
Diverticulosis typically occurs in the sigmoid colon, in the lower left section of the abdomen. According to the National Digestive Diseases Information Clearinghouse:About half of all Americans age 60 to 80, and almost everyone over age 80, have diverticulosis. When the pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25% of people with diverticulosis...
... Diverticulitis can lead to complications such as infections, perforations or tears, blockages, or bleeding. These complications always require treatment [surgery] to prevent them from progressing and causing serious illness.1These statistics might seem to imply that diverticulosis is an inevitable part of growing old. Dr. Berko Sikirov, the Israeli physician who conducted successful clinical research on the use of squatting to treat hemorrhoids, disagrees:Colonic diverticulosis develops as a result of excessive straining at defecation due to habitual bowel emptying in a sitting posture, which is typical of Western man. The magnitude of straining during habitual bowel emptying in a sitting posture is at least three-fold more than in a squatting posture and upon urge. The latter defecation posture is typical of latrine pit users in underdeveloped nations.
The bowels of Western man are subjected to lifelong excessive pressures which result in protrusions of mucosa through the bowel wall at points of least resistance. This hypothesis is consistent with recent findings of elastosis of the bowel wall muscles, the distribution of diverticula along the colon, as well as with epidemiological data on the emergence of diverticulosis coli as a medical problem and its geographic prevalence.9The geographic prevalence mentioned by Dr. Sikirov is confirmed by medicinenet.com, a well-respected medical website:Diverticular disease is common in the Western world but is extremely rare in areas such as Asia and Africa.Mainstream medicine has never considered the relevance of evacuation posture to diverticulosis. They attribute its high prevalence in our society to "insufficient dietary fiber." But they offer no evidence to support their theory. (The same theory was used for decades to explain colon cancer until it was disproved by several recent studies.)
An excerpt from The Mayo Clinic on Digestive Health illustrates a common fallacy used to promote the theory:Diverticular disease emerged after the introduction of steel rolling mills, which greatly reduced the fiber content of flour and other grains. The disease was first observed in the United States in the early 1900's around the time processed foods became a mainstay of the American diet ...23The Mayo Clinic is correct to blame a technological innovation – but which one?The same Industrial Revolution that produced the steel rolling mill also made the porcelain throne a fixture throughout the western world.22
Dr. Denis Burkitt, the British surgeon who popularized the fiber theory, also strongly advocated the use of squat toilets to prevent diverticulosis and hiatus hernias.41 His only mistake was to assume that diet was the crucial factor and squatting was secondary, instead of the other way around.
The claim that dietary fiber protects against diverticulosis was finally tested in a recent study involving 2,104 participants, 30–80 years old. They underwent outpatient colonoscopies from 1998 to 2010 and were interviewed regarding diet and physical activity.
The study, published in the February, 2012 issue of Gastroenterology, found that "A high-fiber diet and increased frequency of bowel movements are associated with greater, rather than lower, prevalence of diverticulosis. Hypotheses regarding risk factors for asymptomatic diverticulosis should be reconsidered."
In a media interview, the lead author, Anne F. Peery, MD put it more bluntly:"Our study makes it clear that we don't really understand why diverticula form."
The journal article also discusses the impact of this disease on health care costs:"The complications of diverticulosis cause considerable morbidity in the United States; health care expenditures for this disorder are estimated to be $2.5 billion per year."
To solve their "mystery," the researchers need to examine the biomechanics of evacuation. They will find that a western toilet strains the sigmoid colon in three ways: