A while back, I gave a bit of Link Love to Nature’s Platform (thanks, NeoPaleo), a contraption that fits over regular toilets and allows users to squat instead of sit. I included it mainly for the laughs, a bit of tongue-in-cheek (no, not that cheek – the other one!) ribald humor that was somewhat relevant to the Primal lifestyle (because let’s face it, Grok was definitely a squatter), but then I got to thinking: maybe there really is something to squatting. At the very least, I owed it to our bowels to look a bit deeper into the subject, to try to get to the bottom of it, as it were.
I’ve always been one to pull up a stool, have a seat, and ruminate on the past. Learn from what our ancestors did. They made mistakes, sure, but they also made great strides, and to simply wipe that history clean and discard the wisdom contained therein is foolish. If we do that, we risk flushing vital information down the toilet. This is of course old news to most of our regular readers, who take the concept to heart, especially in regards to evolutionary diet and fitness. With every fiber of our being, we pattern our behavior after our ancestral history, because that’s when the formative years of human evolution occurred. Homo sapiens have been eating certain things and exercising a certain way for hundreds of thousands of years, and it doesn’t make sense to mess with a good thing.
So where does historical defecation posture fit into all this? Well, if you’re going by years, we’ve been eating grains far longer than we’ve been sitting down to poop. There have been a few exceptions, of course. Moenjo-daro, a 2600 B.C. Indus Valley city-settlement, featured advanced “Western style” toilets, for example, and the Pharoahs and upper-class Romans may have sat to handle their business (they certainly had toilets). Up until the 19th century, though, sitting toilets were a luxury reserved for the affluent. And even then, the sitting toilet was only widely adopted in the West. Everyone else squatted – and most continue to do so today. I go to Thailand fairly often. I can vouch for the prevalence of squat toilets. We’re the weird ones for sitting down to poop, if you want to go by sheer numbers. Worldwide, sitting is actually just the number two method.
If you want to be anal about it, there may actually be some concrete physiological benefits to squatting.
For one, squatting opens up the recto-anal angle, allowing the squatter to be a bit more lax when handling business. Sitting down to poop, on the other hand, constricts the passageways and requires more straining to push things through. The Israeli researcher Dr. Berko Sikirov, an especially adamant proponent of the squat method, identified the “underlying mechanism” behind constipation: “the obstructive nature of the recto-anal angle” in the sitting position. Constipation often leads to excessive straining (“at least three-fold more than in a squatting posture”), which has been fingered as a probable cause of colonic diverticulosis by Sikirov.
Hemorrhoids are another fixture of Western society that don’t enjoy the same prevalence in “squatting” countries. Sikirov assumed the defecation posture might be the culprit, so he gathered a relatively small group of hemorrhoid sufferers – twenty of them, to be exact – and “treated” them with the squatting method. The results were noteworthy: more than half showed marked improvement within weeks or days, while the rest took a bit longer. Everyone improved. Unfortunately for us, the necessary follow up research (on account of the small sample size) has yet to be conducted. The American Society of Colon and Rectal Surgeons don’t seem interested in the possible therapeutic value of squatting. In fact, you might even say Sikirov is the butt of their jokes.
Colon cancer is relatively rare in third-world countries, and now that the fiber hypothesis is all but dead, some suggest chronic constipation (possibly from sitting to poop) is to blame. These claims seem a bit more dubious, judging from this study’s (PDF) conclusion: that aberrant crypt foci (ACF) is the most likely cause of colorectal cancer, and that a cause-and-effect relationship between constipation and cancer cannot be established. Squatting may help clear the road, but I doubt it’s the key to preventing colon cancer.
Proponents also claim that seated toilet-induced “fecal stagnation” causes appendicitis and Crohn’s disease, both of which are rare in traditional cultures and relatively common in westernized cultures. I lean toward diet being the general cause, but I admit defecation positions and their possible health ramifications aren’t my area of expertise, so I’ll relay the information all the same. The appendix, seen here right next to the ceceum, may be vulnerable to fecal blockage (which is actually one of the official possible causes of appendicitis when waste is eliminated from a sitting position. In a stunning display of disturbing imagery, the folks at Nature’s Platform liken it to squeezing a toothpaste tube in the center and seeing both the bottom and top inflate with paste: when sitting, the ceceum cannot be completely vacated and the contents spill out haphazardly, presumably into the adjacent appendix and small intestine, causing appendicitis and Crohn’s disease. When one squats, however, the ceceum is squeezed empty from its base by the right thigh.
As I said earlier, I can’t make the call. Nature’s Platform seems well-sourced, and the references that offer free abstracts or texts check out just fine. There are obvious benefits to squatting – reduced constipation, less straining – and there’s definitely a strong evolutionary precedent for it, but the claims about cancer, appendicitis, and Crohn’s disease aren’t exactly verifiable. I’d say that squatting to eliminate is technically Primal, but I don’t think it’s necessary. Can’t hurt to try, though (unless you have bad knees and joints, of course). In fact, I’d urge you to give it a shot at least once, as long as you’re physically able. A few of our forum members seem to enjoy it.
Let me know what you think. Ever tried it? Will you now? Experiences? Thanks, everyone!
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.