# Trisha Pasricha: How to Get to Poophoria, Making Your Bowel Movements a Joy!

An episode of [Ground Truths](https://invisiblenetwork.ai/podcast/1728526108), 10 Apr 2026, 57 min.

Audio: https://api.substack.com/feed/podcast/192031513/d7e974470e40eac9f1ce394d1e417edd.mp3

Dr. Trisha Pasricha is a gastroenterologist, Assistant Professor at Harvard Medical School, and the Ask a Doctor columnist for The Washington Post. Her new book gets deep into the stigmatized, taboo, rarely discussed topics of our bowel movements and farts, no less the science that backs that up, with lucid explainers for the mechanisms (such as the gut-brain axis). Her research is on the gut origin of Parkinson’s disease. Here’s a quote from Trisha early in the book: “I’m not a wellness guru. I’m a scientist.” Another quote from a Vanderbilt professor: “An effortless, socially appropriately timed bowel movement is the second greatest bodily pleasure known to man.” The proportion of people with bowel issues is remarkable, a brief summary: Some of the topics covered in our lively, fun and highly informative conversation: —The 3 P’s Propulsion, Pliability, Pelvic Floor —Ten Myths —99% of farts have no odor; the 1% that do are from hydrogen sulfide, Pepto-Bismol substantially reduces the latter (and an incredible experiment of people with rectal tubes and judges smelling their gas) —What is the normal frequency of pooping? —the Bristol Scale of poop appearance and what it means —Transit time —The uselessness and danger of bowel cleanses —Fibermaxxing —5 minutes max on the toilet and positions to help propulsion —Psyllium and laxatives —The art of wiping and bidets —Fecal incontinence —Not to miss urges and the TRPV1 and PIEZO2 receptors —Impact of coffee, alcohol, NSAIDs (Ibuprofen, aspirin, naproxen, etc), and hydration —What are the different definitions of constipation? —What gives poop its color? ******************************************** Thank you YOUR DOCTOR KLOVER, Nickhil Jakatdar, Ph.D., Bob Fleischman, karemm, Jessica Nguyen, and >600 others for tuning into our live video with Trisha Pasricha! Join me for my next live video and newsletters in the app. And a big thanks to Ground Truths subscribers (> 200,000) from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. Please join! If you found this interesting PLEASE share it! Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered. Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support 47 summer interns in 2025! We aim to accept even more of the several thousand who will apply for summer 2026. Get full access to Ground Truths at erictopol.substack.com/subscribe

## Transcript

[0:00] So we are live now,
[0:02] and we'll start getting some folks to join us,
[0:04] and we'll get rolling.
[0:08] SPEAKER_00: Such a delight to have you.
[0:10] SPEAKER_00: And the book was published yesterday?
[0:12] SPEAKER_01: It came out yesterday, yeah.
[0:14] SPEAKER_01: It was a big, exciting day.
[0:17] SPEAKER_01: Now we travel to New York, which is where I am now.
[0:20] SPEAKER_01: So now you're just barely seeing the side of my hotel room right now.
[0:25] SPEAKER_00: That's great.
[0:26] SPEAKER_00: And you haven't done a live soft deck yet, right?
[0:29] SPEAKER_01: I haven't.
[0:30] SPEAKER_01: I have done some live YouTubes, but this is going to be a first.
[0:33] SPEAKER_01: Do people have the ability to ask us questions?
[0:36] SPEAKER_00: Yes.
[0:37] SPEAKER_00: I'm going to mention that as we get going.
[0:40] SPEAKER_00: There's a little thing where a right message,
[0:42] SPEAKER_00: and if people have questions,
[0:43] SPEAKER_00: we'll take those as well.
[0:44] SPEAKER_00: Yes.
[0:45] SPEAKER_01: Oh, this will be so much fun.
[0:46] SPEAKER_00: Yeah.
[0:47] SPEAKER_00: Yeah.
[0:47] SPEAKER_00: There'll be some questions, I'm sure.
[0:50] SPEAKER_01: I hope so.
[0:51] SPEAKER_00: Yeah,
[0:52] SPEAKER_00: well,
[0:52] SPEAKER_00: we're starting to gain a quorum here with the first 100 plus,
[0:57] SPEAKER_00: and soon we'll have several hundred folks.
[1:01] SPEAKER_00: Okay, so it's Ground Truths.
[1:03] I'm welcoming you,
[1:04] Eric Topol,
[1:05] and my friend,
[1:07] Dr.
[1:07] Tricia Pazricha,
[1:09] who is a
[1:10] SPEAKER_00: Harvard faculty member, assistant professor, a gastroenterologist.
[1:16] SPEAKER_00: She's the daughter of a gastroenterologist.
[1:18] SPEAKER_00: I don't know what chromosome that is,
[1:20] SPEAKER_00: who actually was one of the pioneers of neuro gastroenterology.
[1:25] And she's written a new book that just officially was published
[1:28] yesterday.
[1:29] You've been pooping all wrong with the subtitle,
[1:33] how to make your bowel movements a joy.
[1:36] And she has this term,
[1:38] pooforia,
[1:39] which kind of mean like we're marching to Pretoria.
[1:42] SPEAKER_00: We're all marching to pooforia.
[1:45] I love this because my favorite quote in the book comes from a
[1:50] colleague at
[1:50] SPEAKER_00: Vanderbilt who said,
[1:52] SPEAKER_00: an effortless,
[1:54] socially appropriately timed bowel movement is the second
[1:58] greatest bodily pleasure
[2:00] SPEAKER_00: known to man.
[2:02] SPEAKER_00: Okay, so that's pretty big.
[2:03] SPEAKER_00: Okay.
[2:05] SPEAKER_01: Poor word's ever been spoken.
[2:07] SPEAKER_00: My goodness.
[2:08] SPEAKER_00: Well, welcome.
[2:08] SPEAKER_00: It's so wonderful to have you on the Ground Truths, Tricia.
[2:13] SPEAKER_01: Oh, my gosh.
[2:14] SPEAKER_01: It's my pleasure to be here.
[2:15] SPEAKER_01: Thanks for having me.
[2:17] SPEAKER_00: Well,
[2:17] so first thing I want to get into is that everybody's
[2:22] interested in this because
[2:24] SPEAKER_00: almost half of us,
[2:25] SPEAKER_00: 40%,
[2:25] SPEAKER_00: probably plus,
[2:27] SPEAKER_00: have daily disruptive bowel problems,
[2:31] SPEAKER_00: right?
[2:31] SPEAKER_00: So it's so darn common.
[2:34] And 75%,
[2:35] I'm one of them,
[2:36] can't bring themselves to poop in a public bathroom.
[2:41] SPEAKER_01: Yes.
[2:42] SPEAKER_01: Isn't that astounding, that 40%?
[2:43] SPEAKER_01: I mean,
[2:44] SPEAKER_01: that's such a big,
[2:45] SPEAKER_01: because I don't think that,
[2:46] SPEAKER_01: I mean,
[2:46] SPEAKER_01: I think what's amazing about that number,
[2:48] SPEAKER_01: 40% of Americans,
[2:49] SPEAKER_01: is that it's probably not people who necessarily have a diagnosis,
[2:53] SPEAKER_01: right?
[2:53] 40% of Americans don't have an official diagnosis of IBS or
[2:56] some disorder per se.
[2:58] SPEAKER_01: But it's like half of us struggle with our bowel movements every day.
[3:03] SPEAKER_00: Yeah.
[3:03] SPEAKER_00: And,
[3:04] SPEAKER_00: you know,
[3:04] the thing about the book that's so great is just like your
[3:08] column in the Washington
[3:09] SPEAKER_00: Post,
[3:09] SPEAKER_00: Ask the Doctor,
[3:10] SPEAKER_00: you have a great sense of humor.
[3:12] SPEAKER_00: And it's an easy read because you convey things so plainly.
[3:21] SPEAKER_00: Everyone can understand this,
[3:22] SPEAKER_00: even when you get into the science,
[3:24] SPEAKER_00: which we'll talk about,
[3:26] SPEAKER_00: which things like the gut-brain axis and other matters.
[3:30] SPEAKER_00: Now, I'm also one of the 33% who can't stay regular on a vacation.
[3:36] SPEAKER_00: I'm surprised that number isn't even higher, you know, but 33%.
[3:39] SPEAKER_00: And then 15% have irritable bowel problems.
[3:43] SPEAKER_00: syndrome, IBS.
[3:44] SPEAKER_00: So the numbers are staggering.
[3:47] SPEAKER_00: And interestingly, for the actual disorders, it's more in the young.
[3:50] SPEAKER_00: I would have guessed it was more in the older folks.
[3:54] SPEAKER_00: You may want to elaborate on that.
[3:56] SPEAKER_01: Yeah, you're right.
[3:57] SPEAKER_01: So irritable bowel syndrome is one of those interesting things that
[4:00] SPEAKER_01: It tends to be diagnosed more in younger people.
[4:04] SPEAKER_01: However,
[4:04] SPEAKER_01: constipation,
[4:05] SPEAKER_01: without the irritable bowel syndrome,
[4:07] SPEAKER_01: and the distinction is sometimes a little bit blurry,
[4:09] SPEAKER_01: but irritable bowel syndrome is a little bit more characterized by pain,
[4:12] SPEAKER_01: discomfort,
[4:12] SPEAKER_01: cramping.
[4:13] SPEAKER_01: Constipation has a lot of different definitions,
[4:16] SPEAKER_01: but it's more about how difficult it is to go,
[4:19] SPEAKER_01: the frequency.
[4:20] SPEAKER_01: Constipation gets worse as we age.
[4:22] SPEAKER_01: that's been shown in a lot of different studies.
[4:24] SPEAKER_01: So people tend to become more constipated as they age.
[4:27] SPEAKER_01: But what's this interesting paradox,
[4:29] SPEAKER_01: and there's been a lot of really cool research about this recently,
[4:31] SPEAKER_01: is that irritable bowel syndrome tends to get better with age.
[4:35] SPEAKER_01: And there are a lot of theories and hypotheses about why this is.
[4:38] But one of them is that irritable bowel syndrome tends to
[4:42] affect women more than men.
[4:45] And it seems to be that some of the pain signaling is mediated
[4:48] by estrogen.
[4:49] SPEAKER_01: And so there seems to be this change that can occur
[4:52] SPEAKER_01: possibly in a positive way around the time of menopause and thereafter,
[4:56] SPEAKER_01: through which the pain signaling tends to dampen a little bit.
[4:59] Because it's been this paradox that people have observed for
[5:01] decades about like,
[5:02] SPEAKER_01: where do all the irritable bowel patients go after a certain age?
[5:06] SPEAKER_01: They're mostly young people.
[5:08] SPEAKER_01: And it tends to get better,
[5:09] SPEAKER_01: even at least the good thing is that,
[5:11] SPEAKER_01: you know,
[5:11] SPEAKER_01: the pain might get a little better,
[5:13] SPEAKER_01: even if the constipation part doesn't so much.
[5:16] SPEAKER_00: Yeah.
[5:17] SPEAKER_00: So,
[5:18] uh one thing that everyone should know of course is that
[5:21] there's no real normal
[5:23] frequency it ranges from three times a day to every three days
[5:27] or so so you don't
[5:29] if you fit in that in that range you're probably all right but
[5:32] one of the things
[5:33] that i kind of get your views on you you of course mentioned
[5:36] how we as children we
[5:38] get potty trained and uh this book is kind of like the potty
[5:42] training for adults
[5:45] SPEAKER_00: I don't know if you would accept that.
[5:47] SPEAKER_01: I hope so then.
[5:47] SPEAKER_01: I hope it's viewed that way.
[5:49] You know,
[5:50] it's funny you say that because I am like deep in the trenches,
[5:52] potty training.
[5:53] SPEAKER_01: I have a three-year-old son, just turned three.
[5:56] SPEAKER_01: And I know, I spent so much time talking to him about this.
[6:00] SPEAKER_01: In the last few months,
[6:01] I know he is not going to remember a single word of what we
[6:04] talked about later,
[6:05] SPEAKER_01: right?
[6:05] SPEAKER_01: And like,
[6:05] SPEAKER_01: I don't remember what I was taught when I was that young,
[6:07] SPEAKER_01: but for the most part,
[6:08] that is the most important conversation we have is when we are
[6:12] two or three years
[6:13] SPEAKER_01: old.
[6:13] SPEAKER_01: And afterwards,
[6:15] SPEAKER_01: Just like we go to the dentist and the dentist every six months is like,
[6:18] SPEAKER_01: are you brushing all four quadrants?
[6:19] SPEAKER_01: Are you making sure you get your gums?
[6:21] SPEAKER_01: Nobody's checking in on us on this aspect of our lives, right?
[6:24] Every couple of months,
[6:25] like everyone just shuts the door,
[6:27] assumes you have it under control.
[6:29] SPEAKER_01: And then you end up with these statistics,
[6:31] like actually 40% of us absolutely do not have it under control
[6:34] when we become
[6:34] SPEAKER_01: adults.
[6:35] SPEAKER_00: No, it's actually striking.
[6:37] SPEAKER_00: And the sad truth, unfortunately, now that I read your book, um,
[6:42] SPEAKER_00: when you're getting it all ready.
[6:44] SPEAKER_00: I've reread it for our discussion today.
[6:46] But now you're going to be in my head every time I go for
[6:51] number two,
[6:52] you know.
[6:54] SPEAKER_00: Oh my gosh.
[6:55] SPEAKER_00: And all those people who read this book,
[6:57] SPEAKER_00: you're going to be,
[6:58] SPEAKER_00: you know,
[6:58] SPEAKER_00: you're going to have this embedment,
[7:00] a little occupying in their brain because so many great tips
[7:03] that we're going to
[7:04] SPEAKER_00: get into.
[7:05] SPEAKER_00: So
[7:06] SPEAKER_00: The first thing, I mean, obviously you've got, it's rich.
[7:09] SPEAKER_00: You've got the 10 myths.
[7:11] SPEAKER_00: We'll get into that a bit.
[7:12] SPEAKER_00: But the three Ps, propulsion, pliability, the pelvic.
[7:17] I want to get first into that area because a lot of your points
[7:23] are really summed
[7:24] SPEAKER_00: up in the three Ps.
[7:25] SPEAKER_00: So propulsion first.
[7:28] SPEAKER_00: the Valsalva maneuver.
[7:30] SPEAKER_00: This isn't the one that is going to help with laxatives.
[7:34] SPEAKER_00: And you talk about the contractions, HAPCs.
[7:37] SPEAKER_00: Maybe you could tell us more about those.
[7:40] SPEAKER_01: Yeah.
[7:40] SPEAKER_01: So...
[7:43] SPEAKER_01: When I talk to patients about having a bowel movement,
[7:46] SPEAKER_01: I try to give them this framework,
[7:48] which is you need all three of these P's to be working together
[7:53] in order to have an
[7:53] SPEAKER_01: effective bowel movement.
[7:54] And the analogy I usually make is like trying to squeeze
[7:57] toothpaste out of the
[7:58] SPEAKER_01: toothpaste too,
[7:58] SPEAKER_01: right?
[7:59] SPEAKER_01: So the squeeze of the toothpaste, that's the propulsion.
[8:02] SPEAKER_01: And as you said,
[8:03] SPEAKER_01: There's some part of that we can control through La Balsalva maneuver.
[8:07] SPEAKER_01: Some part of it our bodies can do on their own,
[8:09] SPEAKER_01: such as with these high amplitude propagated contractions,
[8:13] SPEAKER_01: right?
[8:13] SPEAKER_01: These hapses is what they're called.
[8:15] SPEAKER_01: And that is basically your body's own way.
[8:18] SPEAKER_01: It happens a few times a day of strongly contracting the colon.
[8:22] SPEAKER_01: And we feel that.
[8:23] SPEAKER_01: That's what that urge is when we have to go.
[8:25] SPEAKER_01: It's your colon contracting.
[8:26] SPEAKER_01: Yeah.
[8:27] SPEAKER_01: But too often,
[8:29] SPEAKER_01: we try to go,
[8:31] we try to generate a balsalva maneuver at a time when our colon
[8:33] is not ready.
[8:34] SPEAKER_01: It's not ready to play ball.
[8:35] SPEAKER_01: It's not contracting.
[8:37] And so we have to generate even more pressure on our own to
[8:39] make that work.
[8:40] SPEAKER_01: And so ideally,
[8:41] you would try to go generate just a little bit of a balsalva
[8:44] when your body's doing
[8:45] SPEAKER_01: half the work for you.
[8:47] SPEAKER_01: That's one piece.
[8:48] SPEAKER_01: That's the propulsion.
[8:49] SPEAKER_01: The pliability is how soft.
[8:51] SPEAKER_00: Before we leave the propulsion,
[8:53] SPEAKER_00: I just want to emphasize,
[8:55] SPEAKER_00: don't resist the urge,
[8:57] SPEAKER_00: as you point out.
[8:58] SPEAKER_00: Thank you.
[8:59] SPEAKER_00: You get that signal, go.
[9:00] SPEAKER_00: Because if you don't go,
[9:02] SPEAKER_00: Then you're going to lose,
[9:04] SPEAKER_00: you're going to go to a different Bristol scale,
[9:07] SPEAKER_00: which we'll talk about.
[9:08] SPEAKER_00: You're going to lose some of that ease of the propulsion.
[9:13] SPEAKER_00: So,
[9:14] SPEAKER_00: you know,
[9:15] I have a friend who kept missing the urges and he wound up with
[9:19] a fissure and all
[9:20] SPEAKER_00: kinds of stuff.
[9:20] SPEAKER_00: So don't miss that.
[9:22] I mean,
[9:22] you obviously make that point,
[9:24] but propulsion starts with that urge or signal,
[9:28] right?
[9:28] SPEAKER_01: I appreciate you saying that.
[9:30] SPEAKER_01: And actually,
[9:30] I think this is one of the most important ways that we do have
[9:34] some control over,
[9:35] SPEAKER_01: that we kind of constipate a way in which we constipate ourselves,
[9:38] SPEAKER_01: right?
[9:39] SPEAKER_01: Like some parts, aspects of our physiology are out of our control.
[9:42] This one,
[9:43] this choice to resist the urge is almost entirely a social
[9:47] problem.
[9:48] SPEAKER_01: Like we are resisting the urge because the timing doesn't feel right.
[9:50] SPEAKER_01: Like we're at work,
[9:51] SPEAKER_01: for example,
[9:52] SPEAKER_01: which is where,
[9:53] SPEAKER_01: as you mentioned,
[9:54] SPEAKER_01: 75% of us don't really want to go because it's a public restaurant.
[9:58] SPEAKER_01: So we're saying, you know what?
[9:59] SPEAKER_01: Let's not go now.
[10:00] SPEAKER_01: Let's try again later tonight.
[10:01] SPEAKER_01: But the problem,
[10:02] SPEAKER_01: as you said,
[10:02] SPEAKER_01: is that your colon is going to be working for the next 12 hours,
[10:07] SPEAKER_01: continually sucking water out of whatever is in your stool.
[10:10] SPEAKER_01: So later...
[10:12] SPEAKER_01: You know,
[10:12] at night when you're comfortable and you're in the safety and
[10:14] comfort of your own
[10:14] SPEAKER_01: bathroom,
[10:15] SPEAKER_01: suddenly your colon is not contracting.
[10:17] SPEAKER_01: So you have to generate so much more pressure.
[10:19] SPEAKER_01: And as you mentioned, the poop has changed.
[10:22] SPEAKER_01: It is no longer that soft, plush poop.
[10:24] SPEAKER_01: It has gotten all of its water sucked out of it for 12 hours.
[10:27] SPEAKER_01: So it's going to be way worse.
[10:27] SPEAKER_01: So I am totally with you.
[10:29] I always tell people,
[10:30] don't resist the urge because you're only going to hurt
[10:33] yourself.
[10:34] Yeah,
[10:35] well,
[10:35] I hope that folks take that adage that advice is really
[10:39] important.
[10:40] SPEAKER_00: Now we move on to this pliability story,
[10:43] SPEAKER_00: and there's some surprising things there,
[10:45] SPEAKER_00: but maybe you can set the groundwork for that.
[10:49] SPEAKER_01: Yeah,
[10:50] SPEAKER_01: so the pliability,
[10:51] SPEAKER_01: that is how plush or soft the stool is,
[10:54] SPEAKER_01: or how soft the toothpaste is,
[10:55] SPEAKER_01: if we go back to that analogy.
[10:56] And there are a lot of different things that go into why a
[10:59] stool is soft or isn't
[11:01] SPEAKER_01: soft,
[11:02] SPEAKER_01: or hard and brittle.
[11:04] One of the most important ones,
[11:05] I think,
[11:05] that is undervalued is simply fiber intake.
[11:10] SPEAKER_01: You know,
[11:10] I think half of our problem would be solved here if we were all
[11:14] meeting our fiber
[11:15] SPEAKER_01: goals.
[11:16] SPEAKER_01: And as simplistic as that sounds and boring as that sounds,
[11:18] because every doctor has been telling everybody this since the
[11:21] dawn of time,
[11:22] SPEAKER_01: it's still true that 95% of Americans don't meet their fiber goals.
[11:26] SPEAKER_01: And it's also true that as you start to meet your fiber goals,
[11:30] SPEAKER_01: your poop is going to become fluffier and fluffier and fluffier.
[11:32] SPEAKER_01: And sometimes I have people who
[11:34] suddenly start going vegan and they'll eat a lot of different
[11:37] plants,
[11:37] which is wonderful.
[11:39] SPEAKER_01: But then suddenly they're like, I have diarrhea now.
[11:42] SPEAKER_01: And actually, they don't have diarrhea.
[11:43] They just have much softer stool than they're used to living
[11:46] with having grown up
[11:47] SPEAKER_01: on the American diet.
[11:49] SPEAKER_01: And it's okay.
[11:50] As you mentioned,
[11:51] there's a huge range,
[11:52] but it is okay to go two or three times a day.
[11:55] You probably will once you're meeting your fiber goals because
[11:58] it's just so soft
[11:58] SPEAKER_01: and it's easy to come out.
[12:02] Yeah,
[12:02] and what was interesting,
[12:04] obviously,
[12:04] you brought up the fiber maxing.
[12:06] SPEAKER_00: You didn't call it that,
[12:07] SPEAKER_00: but,
[12:07] SPEAKER_00: you know,
[12:07] SPEAKER_00: get a lot of fiber,
[12:09] SPEAKER_00: you know,
[12:10] SPEAKER_00: 25 grams,
[12:10] SPEAKER_00: 30 grams,
[12:11] SPEAKER_00: more fiber,
[12:12] SPEAKER_00: the better.
[12:13] SPEAKER_00: And you brought up one that I didn't know about,
[12:15] SPEAKER_00: the gold kiwis is one of the real hot tickets for that,
[12:19] SPEAKER_00: right?
[12:20] SPEAKER_00: Yeah, I knew about prunes, but the gold kiwis are big.
[12:24] SPEAKER_00: And the other thing that was interesting is coffee.
[12:29] SPEAKER_00: You wrote about how...
[12:30] Coffee,
[12:32] real coffee is a winner,
[12:33] but decaf is like one third potency for its effect.
[12:38] SPEAKER_00: What about tea?
[12:39] SPEAKER_00: Does tea do anything?
[12:40] SPEAKER_00: Hot drinks in general?
[12:42] SPEAKER_01: You know what?
[12:43] SPEAKER_01: That's a really great question because right now,
[12:46] drinking warm water first thing in the morning is like really
[12:48] trending on social
[12:49] SPEAKER_01: media.
[12:50] SPEAKER_00: I didn't know that.
[12:51] SPEAKER_00: Oh, wow.
[12:52] SPEAKER_01: Yeah, it's very perceptive.
[12:54] SPEAKER_01: Yeah.
[12:54] So,
[12:56] coffee has been really well studied to trigger this thing
[12:58] called the gastrocolic reflex.
[13:00] And the gastrocolic reflex is this reflex that we think is
[13:05] mediated via the brain,
[13:06] wherein...
[13:07] There's some mechanical stretch receptor that reacts to what
[13:10] you've immediately eaten.
[13:12] SPEAKER_01: And coffee seems to be something that very potently activates this.
[13:15] And then that is why within seconds or even minutes of eating
[13:18] or drinking coffee,
[13:19] SPEAKER_01: you have to go to the bathroom.
[13:20] It's not because something passed so quickly that meal is
[13:23] moving all the way down,
[13:24] right?
[13:24] SPEAKER_01: I think people sometimes wonder if that's what's happening.
[13:27] SPEAKER_01: But it's really just this reflex arc.
[13:29] SPEAKER_01: But coffee seems to do this really well.
[13:31] SPEAKER_01: decaf coffee has been shown.
[13:33] One of the researchers who I really admire studied coffee
[13:37] head-to-head against
[13:38] SPEAKER_01: decaf coffee and then water.
[13:40] SPEAKER_01: They have studied tea.
[13:42] SPEAKER_01: And it seems that like it's maybe weekly applicable,
[13:47] SPEAKER_01: but it is true that any stretch,
[13:49] SPEAKER_01: like the reason I think drinking hot water in the morning,
[13:51] SPEAKER_01: tea or not tea,
[13:53] SPEAKER_01: can be helpful is because anything that stretches the stomach
[13:56] SPEAKER_01: will actually move your bowels a little bit.
[13:58] SPEAKER_01: And so that's also why when people eat their biggest meal of the day,
[14:01] SPEAKER_01: dinner time,
[14:02] SPEAKER_01: that's a pretty common time to have to go to the bathroom.
[14:04] SPEAKER_01: The most common time is first thing in the morning,
[14:06] but there's a second wave that happens for people often after
[14:08] their coffee or after
[14:09] SPEAKER_01: dinner.
[14:11] And all those people in line at coffee shops are not just
[14:15] addicted to caffeine or
[14:16] SPEAKER_00: some of these just want to activate their gastrocolic reflex.
[14:19] SPEAKER_01: Totally.
[14:20] SPEAKER_01: How many people can't do unless they have a cup of coffee?
[14:23] SPEAKER_01: I'm one of them.
[14:24] SPEAKER_01: I need coffee in the morning.
[14:25] SPEAKER_01: Yeah.
[14:26] SPEAKER_00: All right.
[14:27] SPEAKER_00: So now returning back to pliability, we talked about the Kiwis.
[14:31] One of the things that surprised me of many things was that
[14:36] getting really good
[14:37] SPEAKER_00: hydration,
[14:39] SPEAKER_00: which obviously for other reasons is important,
[14:42] SPEAKER_00: but it doesn't really change much with respect to your poop.
[14:46] SPEAKER_00: Is that true?
[14:47] SPEAKER_01: Yeah.
[14:48] SPEAKER_01: I think that,
[14:48] SPEAKER_01: you know,
[14:49] usually we tell people about lifestyle changes when someone
[14:53] comes in and they're
[14:53] SPEAKER_01: constipated as their doctor.
[14:55] SPEAKER_01: And
[14:56] SPEAKER_01: Yeah, you can drink more water.
[14:57] SPEAKER_01: I don't actually think that dehydration,
[15:02] SPEAKER_01: unless it's an extreme case,
[15:03] SPEAKER_01: like you're out in the heat.
[15:05] SPEAKER_01: Actually,
[15:05] SPEAKER_01: I do think when you're traveling,
[15:06] people go on these international flights and they have these
[15:09] like the world's
[15:09] SPEAKER_01: tiniest cup of water is given to you by the stewardess.
[15:12] SPEAKER_01: I do think you can get dehydrated in that scenario.
[15:14] SPEAKER_01: But otherwise,
[15:15] I think you're actually your colon does a really good job of
[15:18] regulating how much
[15:19] SPEAKER_01: water it is or is it drawing out of your poop at any one point.
[15:22] SPEAKER_01: For me, the bigger deal is fiber.
[15:24] SPEAKER_01: And actually,
[15:25] SPEAKER_01: I love that you mentioned the kiwis because sometimes people,
[15:29] SPEAKER_01: I mean,
[15:29] SPEAKER_01: it's very common that people have constipation,
[15:31] SPEAKER_01: but they want like a natural fix,
[15:33] SPEAKER_01: right?
[15:33] Like people sometimes don't want to take a medicine and I
[15:35] respect anything that
[15:36] SPEAKER_01: someone wants to do to change their diet.
[15:38] SPEAKER_01: Um,
[15:39] SPEAKER_01: For a long time,
[15:40] SPEAKER_01: people had studied psyllium husk,
[15:42] SPEAKER_01: which is this fiber supplement which I really like,
[15:44] SPEAKER_01: and they'd studied it head-to-head with prunes,
[15:46] SPEAKER_01: and they'd found that,
[15:47] SPEAKER_01: yeah,
[15:47] SPEAKER_01: prunes is,
[15:48] SPEAKER_01: like,
[15:48] SPEAKER_01: actually incredibly effective.
[15:49] SPEAKER_01: Our grandmothers were correct.
[15:50] SPEAKER_01: Prunes work.
[15:51] SPEAKER_01: Psyllium husk works.
[15:52] SPEAKER_01: But then in the last...
[15:54] SPEAKER_01: About since 2021, there have been two nice randomized controlled trials.
[15:58] SPEAKER_01: One of them was published in the American Journal of Gastroenterology,
[16:00] SPEAKER_01: where they looked at both yellow kiwis and gold kiwis,
[16:04] SPEAKER_01: two a day.
[16:05] SPEAKER_01: You do not have to eat the peel, just to be clear.
[16:08] SPEAKER_01: But two a day is as effective as prunes, but they don't cause bloating.
[16:12] Because prunes sometimes,
[16:13] if you eat a lot of them,
[16:15] it can cause bloating.
[16:15] SPEAKER_01: Kiwis don't seem to do that, but they're very effective.
[16:18] SPEAKER_00: Hot tip on the gold kiwis.
[16:21] SPEAKER_00: All right.
[16:21] Now,
[16:22] you mentioned that you take the psyllium,
[16:25] you put it in your coffee every day.
[16:27] SPEAKER_01: Yes.
[16:28] SPEAKER_01: I love this.
[16:30] SPEAKER_00: Yeah.
[16:30] SPEAKER_00: Now,
[16:31] SPEAKER_00: but one thing I wondered about,
[16:32] SPEAKER_00: so then you have to drink the coffee quickly because otherwise,
[16:37] SPEAKER_00: yeah,
[16:38] SPEAKER_00: I kind of enjoy drinking the coffee slowly.
[16:41] SPEAKER_00: Would you advise everybody should take psyllium?
[16:44] SPEAKER_00: And by the way,
[16:45] every important point that everyone should realize that you
[16:48] make throughout the
[16:49] SPEAKER_00: book,
[16:50] SPEAKER_00: laxatives,
[16:51] SPEAKER_00: they stay in the gut.
[16:52] SPEAKER_00: They're not addictive.
[16:53] SPEAKER_00: They don't get gut to brain.
[16:55] SPEAKER_00: So psyllium, you don't have to worry about being addicted to.
[16:58] SPEAKER_00: But do you recommend psyllium broadly?
[17:01] SPEAKER_01: I do.
[17:02] SPEAKER_01: And I'm sure you appreciate, too, as a cardiologist.
[17:04] SPEAKER_01: You know, there's no...
[17:06] SPEAKER_01: psyllium has been shown,
[17:07] SPEAKER_01: one,
[17:07] SPEAKER_01: to help lower a little bit,
[17:08] SPEAKER_01: not profoundly,
[17:09] SPEAKER_01: but a little bit of cholesterol.
[17:10] SPEAKER_01: And the way it works is it's a soluble fiber.
[17:14] SPEAKER_01: And so you have to,
[17:15] SPEAKER_01: this is really important,
[17:16] SPEAKER_01: you have to drink it in at least eight ounces,
[17:18] SPEAKER_01: like a full cup of water,
[17:20] SPEAKER_01: in my case,
[17:20] SPEAKER_01: coffee.
[17:21] SPEAKER_01: The reason I drink it in coffee is because I don't,
[17:24] SPEAKER_01: you know,
[17:24] SPEAKER_01: as a journalist,
[17:25] SPEAKER_01: I don't endorse any particular brand of psyllium.
[17:28] SPEAKER_01: What I do like to get is like the flavorless,
[17:30] SPEAKER_01: like unbranded,
[17:31] SPEAKER_01: whatever's the cheapest kind I can find.
[17:33] SPEAKER_01: Um,
[17:34] SPEAKER_01: If you're going to go the flavorless route,
[17:35] SPEAKER_01: which is what I like because I don't like getting artificial sweeteners,
[17:38] SPEAKER_01: you kind of want to mask it in the coffee.
[17:41] SPEAKER_01: Otherwise, it'll taste a little chalky.
[17:42] SPEAKER_01: So once I put it in coffee, to me, it actually tastes like totally fine.
[17:45] SPEAKER_01: But I do have to chug it.
[17:47] Or you will find that your coffee turns into gel and this has
[17:50] happened to me on occasion.
[17:51] SPEAKER_01: That's not fun.
[17:52] SPEAKER_01: But it's important to remember that if you don't drink enough water,
[17:56] SPEAKER_01: what you see happen in your cup,
[17:58] SPEAKER_01: that gel,
[17:58] SPEAKER_01: I mean,
[17:58] SPEAKER_01: that will happen in your stomach.
[18:00] And there are sometimes these cases where people feel like
[18:02] they've become more
[18:03] SPEAKER_01: constipated rather than less constipated.
[18:05] SPEAKER_01: And that's not the goal.
[18:06] SPEAKER_01: But that usually just means that you didn't drink enough water with it.
[18:10] SPEAKER_00: All right.
[18:10] SPEAKER_00: Well,
[18:10] SPEAKER_00: if you're chugging the coffee,
[18:12] SPEAKER_00: it better not be too hot,
[18:13] SPEAKER_00: then you'll get,
[18:14] SPEAKER_00: you know,
[18:14] SPEAKER_00: hurt your throat.
[18:15] SPEAKER_01: Yeah, I have to wait until it comes long.
[18:16] SPEAKER_01: I have a whole routine with it.
[18:18] SPEAKER_01: If you really don't want to go through what I go through,
[18:20] SPEAKER_01: they sell,
[18:20] SPEAKER_01: like,
[18:21] SPEAKER_01: orange and berry flavors.
[18:22] SPEAKER_01: You mix it in your water.
[18:23] SPEAKER_01: But,
[18:23] SPEAKER_01: you know,
[18:23] SPEAKER_01: what's great about it is because it's soluble,
[18:25] it works for people who want a little bit of softer stool who
[18:29] are dealing with
[18:29] SPEAKER_01: constipation.
[18:30] SPEAKER_01: It also works, actually, if you have looser stool.
[18:32] SPEAKER_01: It can kind of help add some bulk and bind that stool together.
[18:34] SPEAKER_01: Yeah.
[18:35] SPEAKER_01: So it's a shape shifter.
[18:36] Cillium is one of the few ones that we recommend for both
[18:38] constipation and diarrhea.
[18:39] SPEAKER_01: So it's, I mean, it's a great, it's a great one.
[18:41] SPEAKER_01: It doesn't get, obviously it doesn't get absorbed.
[18:44] SPEAKER_00: Yeah, we just had a question from Julie.
[18:46] SPEAKER_00: And by the way, you know, we've got so many hundreds of folks on board.
[18:49] If you have questions,
[18:49] just put them in the message and I'll try to get to them.
[18:52] But one question was,
[18:54] can you have the cillium in capsules so you don't have to deal
[18:57] with that?
[18:58] SPEAKER_01: You can, very perceptive question.
[19:00] SPEAKER_01: The problem with capsules,
[19:01] SPEAKER_01: the reason I don't do it is because you have to,
[19:03] SPEAKER_01: in order to achieve the right dose,
[19:05] SPEAKER_01: you actually have to take a bunch of capsules.
[19:07] It's like eight or nine capsules to get what would be in a
[19:10] teaspoon of it,
[19:11] SPEAKER_01: like four grams of fiber,
[19:12] SPEAKER_01: which is like a huge amount of fiber in just a small amount.
[19:16] SPEAKER_01: So if you're okay swallowing a bunch of pills, by all means, go for it.
[19:20] SPEAKER_01: I find that a little bit annoying.
[19:22] SPEAKER_01: So I just drink it in coffee, but not everybody wants to do what I do.
[19:26] SPEAKER_00: You know,
[19:26] SPEAKER_00: since so many of us have trouble when we're traveling,
[19:31] SPEAKER_00: could you go with the psyllium plan just on traveling?
[19:35] SPEAKER_01: I do.
[19:36] SPEAKER_01: I mean,
[19:36] it's so common that people get backed up on vacation and it's
[19:40] like day four,
[19:41] SPEAKER_01: day five,
[19:42] SPEAKER_01: and they haven't gone once.
[19:44] And that's miserable because it's your vacation and you've been
[19:47] waiting for it.
[19:47] SPEAKER_01: And I think that there's a couple of reasons why it happens.
[19:51] SPEAKER_01: One is,
[19:52] SPEAKER_01: you know,
[19:52] I think people don't appreciate that your colon operates on a
[19:55] circadian rhythm,
[19:56] SPEAKER_01: meaning unlike a lot of other organs in your body,
[19:59] SPEAKER_01: I mean,
[19:59] SPEAKER_01: your heart rate certainly slows down when you sleep to some extent,
[20:02] SPEAKER_01: but your colon becomes pretty quiescent at night.
[20:04] SPEAKER_01: I mean, that's why people tend to wake up and then they have to pee.
[20:08] It's because your kidneys are pushing,
[20:10] you know,
[20:10] urine into your bladder 24-7.
[20:12] SPEAKER_01: Your colon is not moving when you go to sleep.
[20:14] SPEAKER_01: So it's very rare that people have to wake up to poop.
[20:17] SPEAKER_01: And if you do, you should probably talk to your doctor.
[20:19] SPEAKER_01: But the problem is that,
[20:20] SPEAKER_01: one,
[20:20] SPEAKER_01: if your circadian rhythm gets thrown off when you're traveling,
[20:24] SPEAKER_01: your colon circadian rhythm is going to get thrown off.
[20:26] SPEAKER_01: And then when you go on vacation...
[20:28] SPEAKER_01: people are not drinking their morning coffee.
[20:31] SPEAKER_01: They're not eating the foods they're used to eating.
[20:33] SPEAKER_01: Like they're not going for their morning walk with their dog.
[20:35] SPEAKER_01: Walking can help stimulate contractions.
[20:38] SPEAKER_01: So I tell people to bring your fiber supplement.
[20:41] SPEAKER_01: I bring mine.
[20:42] I also tell people to be a little bit more aggressive about
[20:46] seeking out fiber.
[20:48] SPEAKER_01: This is what I do.
[20:49] SPEAKER_01: Like usually when I go in the past,
[20:51] SPEAKER_01: when I went on vacation,
[20:52] SPEAKER_01: I would be all about just like eating pasta six times a day and pastries.
[20:57] SPEAKER_01: But
[20:58] And now I very aggressively seek out a real adult vegetable at
[21:03] least once in one
[21:05] SPEAKER_01: meal a day,
[21:05] SPEAKER_01: like peas,
[21:06] SPEAKER_01: which are very,
[21:07] SPEAKER_01: very high fiber,
[21:07] SPEAKER_01: or Brussels sprouts,
[21:08] SPEAKER_01: broccoli.
[21:09] SPEAKER_01: Not just like that,
[21:10] SPEAKER_01: you know,
[21:10] SPEAKER_01: like a side Caesar salad,
[21:11] SPEAKER_01: which is not going to give you too much bang for your buck.
[21:14] SPEAKER_01: That won't count.
[21:15] You need something that's real and you need to be a little bit
[21:17] more aggressive
[21:17] SPEAKER_01: about it,
[21:17] SPEAKER_01: probably than you would at home.
[21:19] SPEAKER_00: Right, for sure.
[21:21] SPEAKER_00: Now, you've got a lot of questions about psyllium, interesting one.
[21:24] SPEAKER_00: One, Eric Gold said, does it contain lead?
[21:31] SPEAKER_01: Well, that's always the concern with supplements.
[21:33] I mean,
[21:34] in general,
[21:34] I'm like you,
[21:35] I don't really love supplements for anything.
[21:40] SPEAKER_01: To me, fiber is kind of not quite a supplement.
[21:42] But what I would say is that you should always go for any
[21:47] supplement that has been
[21:48] SPEAKER_01: vetted by these third-party testing companies.
[21:51] SPEAKER_01: And that data is out there.
[21:53] SPEAKER_01: And you can find the ones that are considered safe and have low levels.
[21:57] SPEAKER_00: All right.
[21:57] SPEAKER_00: Well, we got so much to cover.
[21:59] SPEAKER_00: We may come back, but I want to then move on.
[22:02] SPEAKER_00: We had pliability.
[22:03] SPEAKER_00: Now we get to the pelvic action.
[22:06] SPEAKER_00: And you get to the five minutes.
[22:09] SPEAKER_00: Don't go more than five minutes.
[22:12] SPEAKER_00: Smartphone, not a good idea.
[22:14] SPEAKER_00: Bringing your smartphone in there, it causes more trouble.
[22:18] But tell us about this maneuver that you have where you get
[22:22] your knees up or you have stiletto.
[22:24] SPEAKER_00: I don't have those.
[22:26] SPEAKER_00: Or you have other ways to get in a position that powers your pelvis,
[22:31] SPEAKER_00: unlike the way we are doing it today.
[22:34] SPEAKER_01: Yeah.
[22:34] SPEAKER_01: So the third P is the pelvic floor.
[22:36] SPEAKER_01: And I'll say off the bat,
[22:38] SPEAKER_01: when I tell patients about the pelvic floor,
[22:40] SPEAKER_01: what I'm talking about is like,
[22:42] SPEAKER_01: imagine trying to squeeze a toothpaste tube and never taking the cap off.
[22:46] SPEAKER_01: You can take all the stimulant laxatives you want.
[22:49] SPEAKER_01: You can have the softest, plushest stool in the world.
[22:51] SPEAKER_01: And if you don't take that cap off, that toothpaste isn't going anywhere.
[22:54] SPEAKER_01: And that's the pelvic floor.
[22:55] SPEAKER_01: It's this set of more than 12 muscles that have to coordinate together
[22:59] SPEAKER_01: just at the exit hatch to have a good bowel movement.
[23:02] SPEAKER_01: And usually when I mention that this is an underappreciated,
[23:06] SPEAKER_01: underdiagnosed cause of constipation,
[23:08] SPEAKER_01: a lot of the times men say,
[23:10] SPEAKER_01: oh,
[23:10] SPEAKER_01: this can't be me.
[23:11] SPEAKER_01: I remember my wife had pelvic floor dysfunction after childhood.
[23:15] That is a different type,
[23:16] just to be clear,
[23:17] very different type of pelvic floor dysfunction.
[23:18] This one does affect men,
[23:20] and it's something we think about for men and women.
[23:21] SPEAKER_01: And there's lots of different ways that this can happen.
[23:25] SPEAKER_01: But
[23:26] SPEAKER_01: To your point,
[23:27] one of the most common things that we do in the pelvic floor
[23:30] that works against us
[23:32] is we sit in a position on the toilet in which this muscle
[23:37] called the puborectalis
[23:38] SPEAKER_01: muscle in the pelvic floor basically chokes the colon shut.
[23:42] SPEAKER_01: When we sit at a 90-degree angle,
[23:43] SPEAKER_01: as I'm sitting right now,
[23:45] SPEAKER_01: the colon is this long straight tube just there at the end,
[23:48] SPEAKER_01: and it's closed shut.
[23:49] Now,
[23:49] this is great because when we're sitting at work,
[23:52] when we're having a chat with a friend,
[23:53] SPEAKER_01: We want that to be closed.
[23:54] SPEAKER_01: We don't want that to be nice open door.
[23:57] SPEAKER_01: However,
[23:57] we sit the same way when we're trying to have a bowel movement
[24:00] and it's really
[24:01] SPEAKER_01: working against us.
[24:03] SPEAKER_01: And the way that we can relax that fuborectalis muscle is to squat.
[24:08] SPEAKER_01: That's how we used to do it thousands and thousands of years ago.
[24:11] SPEAKER_01: It is how my two-year-old in diapers will still do it.
[24:14] SPEAKER_01: He will pop the deepest squat of his life.
[24:17] And it's just something that we know intuitively when we're
[24:19] young is an effective way to do it.
[24:20] SPEAKER_01: Now, nobody's going to squat today.
[24:22] SPEAKER_01: I get that.
[24:22] SPEAKER_01: Like we don't even, our problems are not built for that.
[24:25] SPEAKER_01: And I don't want people to go into their backyards, like nothing crazy.
[24:28] SPEAKER_01: But all you have to do is raise your knees above the level of your waist.
[24:32] SPEAKER_01: So you can use a stool,
[24:33] SPEAKER_01: could use stilettos,
[24:34] SPEAKER_01: you could use a box from your mail,
[24:37] SPEAKER_01: like whatever it takes.
[24:38] SPEAKER_01: All you have to do is raise it up.
[24:39] SPEAKER_01: And everybody,
[24:40] SPEAKER_01: whether or not you self-identify as having constipation,
[24:43] SPEAKER_01: they've done these studies in healthy adults.
[24:45] SPEAKER_01: Everybody reports that, wait a minute, this is so much easier to go.
[24:49] SPEAKER_01: So try it.
[24:50] It's what we,
[24:51] you know,
[24:52] we designed the modern toilets really to work against our own
[24:55] anatomy.
[24:56] Oh,
[24:57] it's just one of so,
[24:59] so many tips here that I hope these people who are
[25:03] listening today and subsequently you're going to pick up
[25:06] because it's just so rich.
[25:07] Now,
[25:08] we got through the three Ps and we're going to go to the 10
[25:13] myths,
[25:13] okay?
[25:14] SPEAKER_00: And by the way,
[25:14] SPEAKER_00: you know,
[25:15] SPEAKER_00: we're looking for this Cinderella moment,
[25:17] SPEAKER_00: you know,
[25:19] SPEAKER_00: and you're getting good advice on how to get to the Cinderella moment.
[25:22] SPEAKER_00: Now,
[25:22] the 10 myths are really interesting because so many of them are
[25:27] misconceptions
[25:28] SPEAKER_00: that,
[25:28] SPEAKER_00: you know,
[25:28] SPEAKER_00: run deep.
[25:30] SPEAKER_00: We talked about the range of frequency of poop.
[25:34] SPEAKER_00: We talked about laxatives.
[25:36] SPEAKER_00: We talked about that constipation isn't a single thing.
[25:39] SPEAKER_00: It's undigested food in the stool.
[25:43] SPEAKER_00: It's okay.
[25:45] SPEAKER_01: Yeah.
[25:46] So commonly people are like,
[25:47] I saw these corn kernels or I saw some beans from the night
[25:51] before.
[25:51] SPEAKER_01: Does that mean I'm not absorbing my food?
[25:53] SPEAKER_01: And actually, you know, it's funny, but it's a good reminder that
[25:57] SPEAKER_01: fiber is something we by design cannot absorb.
[26:01] SPEAKER_01: We should not be absorbing fiber, right?
[26:02] SPEAKER_01: Like that is something we feed our microbiome.
[26:05] SPEAKER_01: And so even though to you,
[26:07] SPEAKER_01: to the naked eye,
[26:08] SPEAKER_01: yeah,
[26:08] it probably looks like that whole kernel looks pretty close to
[26:11] how it went in.
[26:12] SPEAKER_01: Actually, it's probably not exactly the same.
[26:14] SPEAKER_01: You know, your microbes have been fermenting it to some extent.
[26:18] And it's okay to see those little pieces of undigestive fiber
[26:22] because it's not your
[26:23] SPEAKER_01: job to absorb it.
[26:24] SPEAKER_01: You are eating that stuff in order to feed your microbes.
[26:27] SPEAKER_00: All right, and then we got the bile responsible for the color.
[26:32] We talked about the older folks and the younger folks with the
[26:35] bowel issues.
[26:36] SPEAKER_00: Now we're going to get to the myth number seven, gas.
[26:41] SPEAKER_00: Okay, so this is one of my favorite experiments in your book.
[26:45] SPEAKER_00: I mean,
[26:45] SPEAKER_00: there's several,
[26:46] SPEAKER_00: but because you're quoting and you give the references for these,
[26:50] SPEAKER_00: and this one is just so wild.
[26:52] SPEAKER_00: It's unimaginable.
[26:53] SPEAKER_00: Can you review it?
[26:55] SPEAKER_00: When you get the book, folks, if you don't have it, page 192, okay?
[27:00] SPEAKER_00: It's an experiment by the king of farts, Dr. Levitt.
[27:05] And tell us about these people that were volunteering to have
[27:09] their gas analyzed.
[27:11] SPEAKER_01: Oh, my gosh.
[27:11] SPEAKER_01: This one,
[27:12] SPEAKER_01: yeah,
[27:12] SPEAKER_01: the experiment is like,
[27:14] SPEAKER_01: the experimental design is the best part of the story here.
[27:16] SPEAKER_01: So Michael Levitt, a hero,
[27:20] SPEAKER_01: Oh, yeah.
[27:21] SPEAKER_01: Oh, yeah.
[27:39] SPEAKER_01: This experiment is amazing.
[27:41] SPEAKER_01: Hilarious.
[27:42] SPEAKER_01: So what he did was he took a group of healthy volunteers.
[27:45] SPEAKER_01: He actually took men and women.
[27:47] So we're going to talk a little bit about the differences
[27:49] between the sexes here.
[27:50] But he took a mixed group and he had them come in and basically
[27:55] eat what he called
[27:56] SPEAKER_01: a flatulogenic diet,
[27:57] which was beans and then this artificial sweetener that would
[28:02] cause you to be a
[28:02] SPEAKER_01: little bit extra gassy the day before and then the morning of.
[28:06] SPEAKER_01: he would come in.
[28:06] And this is where,
[28:07] like,
[28:07] I need you to bear with me,
[28:08] okay,
[28:08] as I describe what's been supposed
[28:10] SPEAKER_00: Don't bear down, just bear with you.
[28:12] SPEAKER_01: Don't bear down by any means.
[28:14] They come in and they have a rectal tube inserted that is then
[28:18] that one end of the
[28:18] SPEAKER_01: tube makes a tight seal with their bodies.
[28:22] Then the other end goes to this gas impermeable collection that
[28:27] enters a chromatograph.
[28:30] SPEAKER_01: And he's able to identify several things.
[28:33] SPEAKER_01: One, what is the composition of the gas?
[28:35] SPEAKER_01: And what we've learned is that 99% of
[28:39] SPEAKER_01: Human intestinal gases are odorless, 99%, but 1% contain sulfur.
[28:45] SPEAKER_01: And it's actually just 1% that is the problem for everyone.
[28:49] SPEAKER_01: That is an important finding.
[28:51] SPEAKER_00: Yeah, most people think all farts are bad smell.
[28:54] SPEAKER_00: And we're talking about 1%, hydrogen sulfide.
[28:58] And another fascinating thing is that you take Pepto-Bismol and
[29:02] you can get rid of
[29:02] SPEAKER_00: the smell in most of those,
[29:04] SPEAKER_00: right?
[29:04] SPEAKER_00: So if you're going on a hot date...
[29:07] SPEAKER_00: and you don't want to have,
[29:09] SPEAKER_00: and you're prone to farting,
[29:10] SPEAKER_00: you may want to load up with a Pepto-Bismol.
[29:13] SPEAKER_00: Who would have known?
[29:14] SPEAKER_01: Yes,
[29:14] SPEAKER_01: it's easy and safe,
[29:16] SPEAKER_01: and it'll give you some peace of mind because the Pepto-Bismol,
[29:18] SPEAKER_01: the bismuth,
[29:19] SPEAKER_01: neutralizes the sulfur.
[29:21] SPEAKER_01: And if you
[29:22] SPEAKER_01: take aspirin long term,
[29:23] SPEAKER_01: like maybe you shouldn't take too much Pepto-Bismol,
[29:25] SPEAKER_01: you should talk about it with your doctor,
[29:26] SPEAKER_01: but for the most part,
[29:26] SPEAKER_01: Pepto-Bismol is very safe.
[29:28] SPEAKER_01: It neutralizes the gases.
[29:30] SPEAKER_01: And then the second part of his experiment is that he had two,
[29:34] SPEAKER_01: this is like where it gets really special,
[29:35] SPEAKER_01: the two independent gases rate the smell of the gas from zero to eight,
[29:41] SPEAKER_01: I believe it was.
[29:42] SPEAKER_01: And then they averaged it together in terms of odor intensity.
[29:45] And what he found was that the women tended to have a higher
[29:49] odor intensity than the men
[29:52] SPEAKER_01: However, the men had a larger volume every time they passed flatus.
[29:58] And so the judges ultimately decided that it kind of equalized
[30:01] between the 16 and the sexes.
[30:03] SPEAKER_01: So there was no clear winner.
[30:04] SPEAKER_01: There was only several losers in the experiment.
[30:07] SPEAKER_00: Yeah, well, the sex specificity of farting was really interesting.
[30:10] You know,
[30:11] the women more in the silent but deadly category and the men
[30:14] just more farts.
[30:16] SPEAKER_00: And what I loved was Dr. Levitt said,
[30:20] SPEAKER_00: that the worst job in science is to be a filetous odor judge.
[30:26] SPEAKER_00: How could anybody sign up for that?
[30:28] SPEAKER_00: And then the rectal tube people, who would have these?
[30:32] And there was another experiment you had with the rectal tubes
[30:35] where it was being
[30:37] SPEAKER_00: used to judge transit time,
[30:39] SPEAKER_00: right?
[30:40] SPEAKER_01: Yes.
[30:41] SPEAKER_00: Tell us about that one.
[30:42] SPEAKER_00: Because that's not quite as wild, but still.
[30:45] SPEAKER_01: But it's still...
[30:47] SPEAKER_01: It's,
[30:48] SPEAKER_01: I've thought so much about how these experiments,
[30:50] SPEAKER_01: like how they must have gone through the IRB.
[30:53] SPEAKER_01: And because they were NIH funding,
[30:54] SPEAKER_01: I don't have proof of this,
[30:55] SPEAKER_01: but I'm pretty sure probably nobody was paid for their time.
[30:59] Probably everyone had to volunteer because,
[31:00] you know,
[31:01] like you really can't necessarily babysit.
[31:02] SPEAKER_01: So anyway, fun aside.
[31:04] But so then the other experiment that is fascinating is that
[31:07] there's a group of
[31:07] SPEAKER_01: people in order to figure out,
[31:10] SPEAKER_01: you know,
[31:10] SPEAKER_01: I mentioned earlier when we were talking about propulsion,
[31:12] that there are certain activities throughout the day that cause
[31:15] the colon to
[31:15] SPEAKER_01: contract.
[31:16] SPEAKER_01: in these high amplitude propagated contractions, what we call them.
[31:20] SPEAKER_01: So these are just like really strong contractions.
[31:22] And it's important to know when those happen because that's the
[31:26] time to lean into
[31:26] SPEAKER_01: your physiology and say,
[31:28] SPEAKER_01: I should go when my colon is going to do most of the work for me.
[31:31] The way we figured out when the colon does that naturally
[31:34] during the day was this
[31:36] SPEAKER_01: experiment in which they had a group of healthy volunteers.
[31:40] SPEAKER_01: They put a
[31:42] SPEAKER_01: rectal probe about halfway up the colon.
[31:46] SPEAKER_01: And it was measuring the contractions throughout the whole time.
[31:49] SPEAKER_01: And then they told everyone to just go to work,
[31:52] SPEAKER_01: go about your day,
[31:53] SPEAKER_01: go about your business,
[31:54] and just see what happens over the course of a normal day with
[31:57] this thing there.
[31:59] SPEAKER_01: And amazingly, people did.
[32:01] SPEAKER_01: They did go to work.
[32:02] SPEAKER_01: They kind of did eat what they were going to eat.
[32:05] And I don't know what happened when they did have to have a
[32:07] bowel movement because
[32:07] SPEAKER_01: I imagine the probe would have come out.
[32:09] SPEAKER_01: But
[32:10] SPEAKER_01: They don't go into that in the methods.
[32:11] But what we learned from that experiment is all of the stuff we
[32:15] talked about is we
[32:15] SPEAKER_01: learned that the colon stops doing those contractions at night.
[32:19] We learned that the colon is most active in the first one,
[32:22] one and a half hours of waking.
[32:24] SPEAKER_01: That's when the colon is most active,
[32:26] SPEAKER_01: which is why,
[32:27] SPEAKER_01: you know,
[32:27] I think this idea about like everyone should have a bowel
[32:29] movement in the morning,
[32:31] that sort of comes from the fact that your colon is naturally
[32:34] primed in the
[32:35] SPEAKER_01: morning.
[32:36] SPEAKER_01: We learned that exercise moves it.
[32:37] SPEAKER_01: We learned that things like coffee do it all through those methods,
[32:40] SPEAKER_01: which sounds so wild,
[32:41] but those people taught us everything we needed to know about
[32:44] our own bodies.
[32:45] SPEAKER_00: And the transit time varies from one person to the next, right?
[32:49] SPEAKER_00: I mean,
[32:49] SPEAKER_00: if I eat some humongous salad,
[32:52] SPEAKER_00: which would be a typical dinner for me,
[32:55] SPEAKER_00: my transit time could,
[32:56] SPEAKER_00: for at least,
[32:57] SPEAKER_00: would that...
[32:58] SPEAKER_00: largely be consistent from one person in a person?
[33:03] Or could that even vary depending on all the other things that
[33:06] are going on?
[33:07] SPEAKER_01: You're so right.
[33:08] SPEAKER_01: It does vary from person to person.
[33:09] SPEAKER_01: And then depending on what you eat, you can influence how fast things go.
[33:13] So,
[33:13] for example,
[33:14] salad,
[33:15] a high-fiber diet is just going to take more time to move
[33:18] through.
[33:18] SPEAKER_01: That's a good thing.
[33:19] SPEAKER_01: I mean, you kind of want that time for your colon to
[33:22] SPEAKER_01: feed on what you've given it.
[33:23] SPEAKER_01: If you eat spicy foods,
[33:25] SPEAKER_01: though,
[33:25] SPEAKER_01: for example,
[33:26] SPEAKER_01: which I often do,
[33:27] you speed things up because that capsaicin triggers these
[33:30] receptors that start
[33:32] SPEAKER_01: contracting all the way from your esophagus,
[33:34] SPEAKER_01: your stomach,
[33:35] SPEAKER_01: your small bowel,
[33:35] SPEAKER_01: all the way down to the colon.
[33:37] And then fatty foods like high-fat meals will slow things down
[33:40] a little bit.
[33:40] SPEAKER_01: So depending on the mix of what you've
[33:43] SPEAKER_01: you can influence your own day-to-day transit time.
[33:45] And then that's going to be reflected in what you look at,
[33:48] which I hope everybody looks.
[33:50] SPEAKER_01: You should look every time you go.
[33:51] SPEAKER_01: It's going to look a little bit different.
[33:53] SPEAKER_01: If it's been there for a long time,
[33:55] SPEAKER_01: been sitting there for a while,
[33:56] SPEAKER_01: it's going to eventually start to be a little bit firmer,
[33:58] SPEAKER_01: a little harder.
[33:59] If it's just breezing through,
[34:01] floating naturally,
[34:01] it's going to be a little bit softer.
[34:03] SPEAKER_00: Well,
[34:03] SPEAKER_00: yeah,
[34:03] SPEAKER_00: you start the book with a person with two PhDs,
[34:07] SPEAKER_00: professor who doesn't look at their stool.
[34:09] And then you mentioned,
[34:10] of course,
[34:10] this is this idea of not wanting,
[34:13] it's so taboo.
[34:14] SPEAKER_00: You don't even want to look at it.
[34:16] SPEAKER_00: But the point about this is really the appearance,
[34:21] SPEAKER_00: the so-called Bristol scale,
[34:23] SPEAKER_00: by the way,
[34:24] SPEAKER_00: I don't like sausage.
[34:26] SPEAKER_00: I don't eat any meat.
[34:27] And so Bristol five,
[34:29] which is the soft serve ice cream appearance is a lot more
[34:33] SPEAKER_00: It sounds better than the four with the sausage.
[34:36] SPEAKER_00: I don't know.
[34:36] SPEAKER_00: But there's a whole range from Bristol one to, what, ten or something?
[34:41] SPEAKER_01: Yeah, from one to seven.
[34:43] SPEAKER_00: Seven, that's it.
[34:44] SPEAKER_00: Yeah, yeah.
[34:45] So that appearance is actually helpful because the healthy type
[34:49] of appearance would
[34:50] SPEAKER_00: be in that kind of,
[34:51] SPEAKER_00: what,
[34:51] SPEAKER_00: four or five category?
[34:53] SPEAKER_01: People tend to aim for that sausage or maybe diet.
[34:57] SPEAKER_01: snake-like looking four, Bristol four.
[35:00] SPEAKER_01: But truly,
[35:01] SPEAKER_01: for me,
[35:02] SPEAKER_01: anything that is not super,
[35:04] SPEAKER_01: super firm,
[35:05] SPEAKER_01: pebbly,
[35:06] SPEAKER_01: like little rabbit pellets,
[35:07] SPEAKER_01: nobody wants that.
[35:08] SPEAKER_01: On the other end of the extreme, nobody wants pure liquid either.
[35:12] SPEAKER_01: But anywhere in between could be normal.
[35:14] SPEAKER_01: Most people do tend to fall in that four range.
[35:17] SPEAKER_01: People like that.
[35:18] SPEAKER_01: They think that that's healthy.
[35:19] SPEAKER_01: But I will say that, you know, it depends a lot on
[35:23] SPEAKER_01: who you are,
[35:24] SPEAKER_01: where you live,
[35:24] SPEAKER_01: how you're behaving,
[35:25] SPEAKER_01: because we found that in countries that eat more of a high-fiber diet,
[35:30] SPEAKER_01: there still tends to be on the fluffier end,
[35:31] SPEAKER_01: which we might consider,
[35:33] SPEAKER_01: if we've grown up eating mostly ultra-processed food,
[35:36] SPEAKER_01: we might think that that is too soft,
[35:38] SPEAKER_01: that's diarrhea.
[35:38] SPEAKER_01: But again, it's just a matter of perspective.
[35:40] SPEAKER_01: It actually could be totally normal.
[35:42] SPEAKER_00: Yeah, no, that's very helpful.
[35:45] SPEAKER_00: All right, so we've got kind of the three Ps, the myths, the gas story.
[35:51] SPEAKER_00: Amazing.
[35:52] SPEAKER_01: That's amazing.
[35:54] SPEAKER_00: And,
[35:55] SPEAKER_00: you know,
[35:56] SPEAKER_00: one of the things I thought was really interesting,
[35:58] SPEAKER_00: and this goes back to your high school days and the Intel competition,
[36:03] SPEAKER_00: is that the brain gut story is fascinating.
[36:06] And if you did an experiment on how you figure this out,
[36:10] just telling a lie
[36:11] would get your digestive tract into high gear maybe you could
[36:15] amplify that yeah you know
[36:18] SPEAKER_01: We have known for more than a hundred years that our thoughts,
[36:22] SPEAKER_01: our mood really strongly immediately impacts our bowels.
[36:27] SPEAKER_01: And one of the earliest experiments was Ivan Pavlov.
[36:30] You guys all remember that story about this scientist who rang
[36:34] a bell and he
[36:36] SPEAKER_01: associated it with bringing his dog their meals.
[36:38] And so it got to the point that eventually he could just ring
[36:41] the bell and not
[36:42] SPEAKER_01: bring them food,
[36:43] SPEAKER_01: but they would start to salivate just at the sound of the bell.
[36:46] SPEAKER_01: And if you take a step back,
[36:48] SPEAKER_01: that is telling us that just our thoughts,
[36:51] SPEAKER_01: just thinking about food,
[36:53] SPEAKER_01: can actually create changes and start digestion.
[36:56] SPEAKER_01: The first phase of digestion begins in our head.
[36:59] Thinking about food right now,
[37:00] my favorite dessert is like a gooey chocolate cake.
[37:03] SPEAKER_01: And if I think about that long enough,
[37:05] SPEAKER_01: the chocolate melting,
[37:07] SPEAKER_01: I'm actually,
[37:07] my pancreas is going to start to secrete insulin because it's
[37:09] anticipating this
[37:10] SPEAKER_01: happen.
[37:11] SPEAKER_01: I am going to start salivating.
[37:12] SPEAKER_01: And
[37:14] We've known about this side of the equation for,
[37:16] like I said,
[37:17] decades and decades.
[37:18] SPEAKER_01: And they kept studying it in the 1950s and 1960s.
[37:22] SPEAKER_01: What I came to find is that we all,
[37:26] SPEAKER_01: when we're nervous,
[37:28] we've experienced this sensation of like a sinking feeling in
[37:31] the pit of our
[37:31] SPEAKER_01: stomachs.
[37:32] I used to get this when I was in high school,
[37:33] like right before I went on stage.
[37:35] SPEAKER_01: In fact, if I talk about this too much, I'll like relive it.
[37:37] But like if I blew my lines on stage,
[37:39] I would start to feel so cold in my stomach.
[37:42] SPEAKER_01: And sometimes you feel it like,
[37:43] SPEAKER_01: you know,
[37:44] SPEAKER_01: like people right before they turn at karaoke,
[37:45] SPEAKER_01: they've got to use the bathroom.
[37:47] SPEAKER_01: And I tried to figure out what that sensation was.
[37:50] SPEAKER_01: And it wasn't because I was like necessarily some child genius.
[37:54] The idea came to me because this is like a fun story,
[37:57] but my mom used to work for the FBI.
[37:59] SPEAKER_01: She told me she's murdered.
[38:01] SPEAKER_01: And she told me so much about these lie detector tests.
[38:03] So I became obsessed with this idea about how to evade lie
[38:06] detector tests.
[38:07] SPEAKER_01: And you can't mask that feeling you get in the stomach,
[38:09] SPEAKER_01: even if you can like control your heart rate.
[38:12] SPEAKER_01: So I use this device that is similar to an EKG.
[38:15] It's called an EGG,
[38:17] an electrogastrogram,
[38:18] to measure the electrical activity in the stomach.
[38:20] SPEAKER_01: And what I found,
[38:22] which built on other people's research where they figured out
[38:25] the molecular
[38:25] SPEAKER_01: mechanisms,
[38:26] SPEAKER_01: but what we found altogether is that when you are stressed or nervous,
[38:32] SPEAKER_01: the brain releases a hormone called corticotropin-releasing hormone,
[38:35] SPEAKER_01: which basically...
[38:37] SPEAKER_01: grinds the stomach to a halt.
[38:39] SPEAKER_01: It stops moving.
[38:40] SPEAKER_01: And I saw in my experiments that when you're lying,
[38:43] SPEAKER_01: instead of the stomach contracting regularly,
[38:45] SPEAKER_01: it goes into this state called arrhythmia,
[38:46] SPEAKER_01: where there's kind of this chaotic pattern.
[38:49] SPEAKER_01: And it's why people feel a little nauseated when they're nervous,
[38:53] SPEAKER_01: because your stomach is not pushing things forward.
[38:55] SPEAKER_01: But at the same time,
[38:57] SPEAKER_01: I didn't find this, this is other groups.
[38:59] SPEAKER_01: But at the same time, your colon starts to contract.
[39:02] SPEAKER_01: Your stomach isn't moving.
[39:03] SPEAKER_01: Your colon is ramping up.
[39:04] And that's why people have to use the bathroom also when
[39:07] they're nervous and
[39:08] SPEAKER_01: they're also very queasy.
[39:10] And so this was sort of how people thought about the gut-brain
[39:12] connection,
[39:13] SPEAKER_01: this angle of it for a really long time.
[39:16] And it was my foray into the field of neuro gastroenterology,
[39:19] which I love.
[39:20] But it's been in the last couple of decades that we've been
[39:23] thinking more and more
[39:24] SPEAKER_01: about the other side of that equation,
[39:26] SPEAKER_01: which is,
[39:27] SPEAKER_01: okay, we know how much our thoughts influence our guts.
[39:30] How much does our gut influence our thoughts,
[39:32] influence our depression,
[39:33] influence our mood?
[39:34] And what I study,
[39:35] my NIH grant studies Parkinson's disease of all things,
[39:38] right?
[39:38] SPEAKER_01: And it's like...
[39:39] SPEAKER_00: Which starts in the gut, right?
[39:41] SPEAKER_01: Which starts in the gut.
[39:42] SPEAKER_01: I mean, it's surprising.
[39:44] It surprises a lot of people why a gastroenterologist has a
[39:47] grant to study Parkinson's.
[39:48] SPEAKER_01: But we do believe,
[39:50] SPEAKER_01: at least a subset,
[39:51] SPEAKER_01: maybe not everywhere,
[39:52] SPEAKER_01: but a subset of people,
[39:54] SPEAKER_01: Parkinson's starts in the gut.
[39:55] SPEAKER_01: And we know this from...
[39:57] SPEAKER_01: translational studies that have found that that misfolded protein called
[40:01] SPEAKER_01: alpha-synuclein,
[40:02] SPEAKER_01: which is the hallmark of Parkinson's disease,
[40:05] SPEAKER_01: we see it in the brain,
[40:07] SPEAKER_01: it starts to misfold in the gut years,
[40:10] SPEAKER_01: if not decades,
[40:10] SPEAKER_01: before it reaches the brain in a subset of people,
[40:12] SPEAKER_01: and it travels up the vagus nerve in this staged fashion.
[40:16] And this was shown and hypothesized in the early 2000s,
[40:20] and it's been shown since.
[40:22] So my lab is trying to figure out what are the triggers of this
[40:25] misfolding in the gut,
[40:27] whether there's a way to intervene before it reaches the brain
[40:30] and how we can
[40:31] identify it ultimately in the gut and maybe change the course
[40:35] of somebody's health.
[40:36] SPEAKER_01: And these are like big lofty goals.
[40:38] SPEAKER_01: We're several, several years away from it.
[40:40] SPEAKER_01: But if there's a way to intervene early.
[40:41] SPEAKER_00: Well,
[40:42] SPEAKER_00: I just think the emphasis,
[40:44] SPEAKER_00: which is in a whole nother section in the book,
[40:46] SPEAKER_00: the science here,
[40:48] is fantastic because the gut-brain bidirectional interactions
[40:53] are extraordinary.
[40:54] SPEAKER_00: You touch on a few, the vagal nerve,
[40:56] the corticotropin release factor,
[40:58] the stress fear,
[41:00] cephalic phase of digestion.
[41:03] One thing that's very dear to me is what you call the TRPV1
[41:08] receptor,
[41:08] but the piezo receptor.
[41:10] My colleague,
[41:11] my very close friend,
[41:13] Artem Patapushin,
[41:14] got the Nobel Prize for that back in 2021.
[41:16] SPEAKER_00: Yes, he did.
[41:17] SPEAKER_01: Oh, my goodness.
[41:19] SPEAKER_00: That's everything.
[41:19] And like when you have that urge,
[41:21] that's the piezo2 receptor or connected to the TRPV1.
[41:26] SPEAKER_00: So this is, you know, mass cell activation, the microbiome.
[41:32] SPEAKER_00: You cover the science.
[41:34] SPEAKER_00: here explicitly.
[41:35] SPEAKER_00: So this is not just a book that is about,
[41:37] SPEAKER_00: you know,
[41:38] how to make a better bowel movement and have joy and how to
[41:41] have Cinderella
[41:42] SPEAKER_00: moments.
[41:43] SPEAKER_00: It's also gets into the science.
[41:45] SPEAKER_00: But I do,
[41:46] SPEAKER_00: a lot of the practical things you can touch on here with me,
[41:51] SPEAKER_00: Tricia,
[41:52] SPEAKER_00: you did touch on alcohol.
[41:55] SPEAKER_00: And NSAIDs, nonsteroidal and anti-inflammatory.
[41:58] SPEAKER_00: So what's the take on each of those?
[42:00] SPEAKER_01: Yeah.
[42:01] SPEAKER_01: Yeah.
[42:02] SPEAKER_01: Your gastroenterologist is never going to love when you take NSAIDs.
[42:06] SPEAKER_01: And the reason for that,
[42:08] SPEAKER_01: and there's a similar reason for alcohol,
[42:10] is that there is this phenomenon called increased intestinal
[42:14] permeability,
[42:15] SPEAKER_01: which is where if you picture...
[42:17] Your gut is lined with all of these cells that are really
[42:19] closely opposed to each
[42:20] SPEAKER_01: other,
[42:21] SPEAKER_01: but actually those cells can just slightly open up.
[42:23] SPEAKER_01: There are these gaps that can happen.
[42:25] SPEAKER_01: And those gaps happen to us all during the day.
[42:28] SPEAKER_01: It's actually kind of part of our normal experience.
[42:30] SPEAKER_01: They can open up a little bit when we're eating food.
[42:33] SPEAKER_01: They open up a little bit when we're stressed.
[42:35] SPEAKER_01: And that opening of those gaps between the cells lining our gut,
[42:39] SPEAKER_01: that's called increased intestinal permeability.
[42:41] SPEAKER_01: Now,
[42:42] SPEAKER_01: there's this whole phenomenon,
[42:42] SPEAKER_01: I'm sure you've seen this too,
[42:44] SPEAKER_01: Eric,
[42:44] SPEAKER_01: on social media about leaky gut,
[42:46] SPEAKER_01: which is kind of a separate conversation because people have taken this
[42:51] physiological phenomena and they sort of started to ascribe a
[42:54] lot of different
[42:55] SPEAKER_01: symptoms and blaming this idea of leaky gut.
[42:57] SPEAKER_01: It's complicated because...
[42:59] SPEAKER_01: Increased intestinal permeability is quite real,
[43:01] SPEAKER_01: and one of the things that can cause this is alcohol.
[43:04] SPEAKER_01: Alcohol use increases the odds that things can move into the lining,
[43:10] SPEAKER_01: into the bloodstream,
[43:11] SPEAKER_01: that maybe you don't want to enter that area.
[43:13] SPEAKER_01: And so,
[43:14] alcohol has probably been the best studied of all the factors
[43:17] that we're going to
[43:17] SPEAKER_01: talk about that can increase intestinal permeability.
[43:21] SPEAKER_01: which eventually over time can lead to scarring in your liver.
[43:25] And then eventually over time,
[43:26] that scarring can maybe become a problem like cirrhosis.
[43:28] SPEAKER_01: We don't want this to happen.
[43:30] There are other reasons not to drink alcohol,
[43:32] which the former surgeon general has pointed out.
[43:34] SPEAKER_01: We've related to cancer risk and things to try to minimize it.
[43:37] SPEAKER_01: But NSAIDs too, and NSAIDs are things like ibuprofen, they're aspirin.
[43:43] SPEAKER_01: We take them all the time for all kinds of reasons, right?
[43:45] SPEAKER_01: If we have a headache, if we have knee pain...
[43:49] There's a surprising amount of people who still come to the ED
[43:52] every single year
[43:53] SPEAKER_01: with ulcers,
[43:54] SPEAKER_01: with erosions,
[43:55] SPEAKER_01: with damage,
[43:55] SPEAKER_01: with gastritis,
[43:56] SPEAKER_01: which is inflammation in the stomach because of these NSAIDs.
[44:00] And so we tend to avoid—and that's partly mediated by this
[44:04] increased intestinal permeability.
[44:05] SPEAKER_01: So in GI, we say—
[44:08] SPEAKER_01: If you can take something else,
[44:10] SPEAKER_01: for example,
[44:10] SPEAKER_01: Tylenol,
[44:11] SPEAKER_01: acetaminophen,
[44:11] SPEAKER_01: if you can take that instead,
[44:13] SPEAKER_01: it works just as well.
[44:14] SPEAKER_01: Alternate.
[44:15] SPEAKER_01: Try to alternate.
[44:16] SPEAKER_01: The other big thing about NSAIDs,
[44:17] SPEAKER_01: and this is certainly true for women,
[44:19] a lot of women take them with cramps around the time of their
[44:22] menstrual cycle.
[44:24] SPEAKER_01: If you take it early,
[44:26] It actually is much more effective than when you're in a
[44:30] full-blown cramp,
[44:31] SPEAKER_01: you're already in the middle of a migraine,
[44:33] SPEAKER_01: for example,
[44:34] SPEAKER_01: and then trying to chase it.
[44:35] SPEAKER_01: That's where we see people take a dose.
[44:37] SPEAKER_01: It doesn't work.
[44:38] SPEAKER_01: 30 minutes later, they'll take another dose.
[44:39] SPEAKER_01: It's not working.
[44:40] If you had actually just taken it early at the first whiff of
[44:43] that migraine,
[44:43] SPEAKER_01: the first whiff that your period's about to start...
[44:46] SPEAKER_01: you can actually stave off some of that cramping,
[44:49] some of that pain with fewer NSAIDs than if you had chased it
[44:52] later and tried to be
[44:54] SPEAKER_01: a little stoic and avoid medicines in the first place.
[44:56] SPEAKER_01: So it's a little bit of a trick,
[44:57] but this is certainly very true if you're somebody who deals
[45:00] with a lot of period
[45:01] SPEAKER_01: cramps and you're like,
[45:02] SPEAKER_01: well,
[45:02] SPEAKER_01: how can I minimize my NSAID use?
[45:04] SPEAKER_01: Actually, taking it earlier can help you.
[45:06] SPEAKER_00: No, it's great.
[45:07] And again,
[45:08] there's a whole chapter on women and the whole issues that
[45:13] surround the GI issues
[45:17] SPEAKER_00: poops and the whole works.
[45:18] SPEAKER_00: Now, you mentioned social media and all the predators out there.
[45:27] SPEAKER_00: Also, they are pushing big time cleansing.
[45:32] SPEAKER_00: Cleansing your gut.
[45:34] SPEAKER_00: And the auto intoxication.
[45:37] SPEAKER_00: This is just ridiculous.
[45:39] SPEAKER_00: It started with the Kellogg guy of Kellogg's cereal.
[45:44] SPEAKER_01: Kellogg fame.
[45:45] SPEAKER_01: I know.
[45:45] SPEAKER_01: He was right about so many things.
[45:47] SPEAKER_01: So we're talking about,
[45:48] SPEAKER_01: I think it was Henry or Harvey Kellogg's,
[45:50] SPEAKER_01: who he was obsessed with fiber and brand in particular.
[45:54] SPEAKER_01: And in that regard, I think he was spot on.
[45:57] SPEAKER_01: Like he seems to understand that this is very healthy for you.
[45:59] SPEAKER_01: It would help you with digestion.
[46:01] SPEAKER_01: But he had this idea that what we eat, this is his word, not mine.
[46:06] SPEAKER_01: Whatever you eat starts to putrefy inside of you,
[46:08] SPEAKER_01: especially if you were a meat eater,
[46:10] SPEAKER_01: like that that meat would sit there and become toxic.
[46:13] SPEAKER_01: And I mean, he wasn't the first.
[46:16] SPEAKER_01: He was just maybe one of the loudest in American history on this subject.
[46:19] But certainly people had this idea that your stool,
[46:22] your poop is somehow toxic to you.
[46:25] SPEAKER_00: And that's not true at all.
[46:26] I mean,
[46:26] if we just break down,
[46:28] you know,
[46:28] a reminder what poop is,
[46:30] it's mostly bacteria.
[46:31] SPEAKER_01: It's mostly your microbiome.
[46:33] SPEAKER_01: Like,
[46:33] SPEAKER_01: they've done these studies where they've looked at these,
[46:35] SPEAKER_01: at different analyses of people's poop.
[46:37] SPEAKER_01: They found it's mostly bacteria.
[46:39] But then the rest of it is all this insoluble material that is
[46:42] just the fiber that
[46:43] SPEAKER_01: you can't digest.
[46:44] SPEAKER_01: So none of this is toxifying.
[46:46] And yet,
[46:48] there is such an industry out there about juice cleanses or
[46:52] elapsatives and proteining.
[46:55] SPEAKER_01: And you think that like,
[46:56] SPEAKER_01: if you've had this,
[46:57] SPEAKER_01: this is what I see often in my clinic,
[46:59] SPEAKER_01: someone's had,
[46:59] SPEAKER_01: you know,
[47:00] SPEAKER_01: like a weekend where they,
[47:01] SPEAKER_01: maybe it's a bachelorette party,
[47:03] SPEAKER_01: a bachelor party,
[47:04] SPEAKER_01: they feel that they've like overdone it.
[47:05] And they're like,
[47:06] well,
[47:06] let me just juice cleanse for three days and that'll reset me.
[47:11] SPEAKER_01: That's not the solution.
[47:12] Like you might feel better because you're eating less ultra
[47:15] processed foods during
[47:16] SPEAKER_01: that time that will make you feel better.
[47:18] SPEAKER_01: But actually,
[47:19] you're taking all of the fiber out by cleansing and just
[47:22] drinking the juice,
[47:23] SPEAKER_01: which is just the sugar and the water.
[47:24] SPEAKER_01: Your gut wants fiber at the end of the day.
[47:27] SPEAKER_01: And you're not actually, there's nothing in there to cleanse.
[47:31] SPEAKER_01: There's this myth that
[47:32] SPEAKER_01: We must have poop like caking the lining of our small intestine,
[47:36] SPEAKER_01: our bowels,
[47:36] SPEAKER_01: and it's just sitting there.
[47:38] SPEAKER_01: Totally not the case.
[47:38] SPEAKER_01: Your gut is so slippery.
[47:40] SPEAKER_01: It's lined with mucus.
[47:41] SPEAKER_01: Nothing sticks to that gut as the way you think it is.
[47:44] If you're feeling bloated,
[47:45] it's not because there's this cake stool in there.
[47:47] You might have stool in there that's like kind of slowly moving
[47:50] its way along,
[47:50] SPEAKER_01: but stick there the way you think.
[47:53] SPEAKER_00: Well,
[47:53] SPEAKER_00: you know,
[47:53] you're saving hundreds of millions of dollars for the
[47:56] unnecessary and potentially
[47:57] SPEAKER_00: harmful cleanses.
[48:00] SPEAKER_00: I would, yeah.
[48:02] SPEAKER_00: Now, another thing that you help a lot on is the subject of wiping, okay?
[48:07] SPEAKER_00: So along the lines of everything we've talked about,
[48:11] SPEAKER_00: whether it's farts or poop,
[48:14] SPEAKER_00: there's also the issue of wiping.
[48:16] And it was interesting how you point out that your parents
[48:20] named you Shusha.
[48:22] SPEAKER_00: That's Risha with TP.
[48:25] And by the way,
[48:26] I couldn't agree more with you that you point out in the book.
[48:29] SPEAKER_00: One-ply toilet paper?
[48:30] SPEAKER_00: No.
[48:31] SPEAKER_01: Outlaw that stuff.
[48:34] SPEAKER_01: You don't know how many people,
[48:35] SPEAKER_01: Eric,
[48:35] SPEAKER_01: I talk to who are like,
[48:36] SPEAKER_01: no,
[48:37] SPEAKER_01: one-ply is like,
[48:39] SPEAKER_01: it doesn't,
[48:39] SPEAKER_01: you know,
[48:40] SPEAKER_01: like they're like,
[48:40] SPEAKER_01: oh,
[48:40] SPEAKER_01: two-ply makes me feel like I'm leaving residue on my body.
[48:43] SPEAKER_01: Are you?
[48:45] SPEAKER_01: One-ply is horrible.
[48:47] SPEAKER_00: Oh, no, the worst.
[48:48] SPEAKER_00: I mean,
[48:49] SPEAKER_00: Yeah,
[48:50] SPEAKER_00: we had that in the house recently by mistake,
[48:52] SPEAKER_00: and I just said,
[48:53] SPEAKER_00: uh-uh,
[48:53] SPEAKER_00: no,
[48:53] SPEAKER_00: I'm not going there.
[48:55] SPEAKER_00: Now, this also, you are big on a bidet.
[48:59] SPEAKER_00: Yes.
[48:59] SPEAKER_00: It's, of course, great if you can have a bidet.
[49:02] But if you don't have a bidet,
[49:04] which that would be,
[49:05] I guess,
[49:05] the ideal solution to wiping.
[49:07] SPEAKER_00: Absolutely.
[49:08] SPEAKER_00: Yeah.
[49:09] SPEAKER_00: Then what do you do to be a good wiper?
[49:12] SPEAKER_01: Yes.
[49:13] SPEAKER_01: To do it right.
[49:13] SPEAKER_01: Thank you for asking these good questions.
[49:15] SPEAKER_01: Yes.
[49:16] I do feel really strongly about my two-ply and I feel really
[49:19] strongly about my good day.
[49:20] SPEAKER_01: Yeah.
[49:22] SPEAKER_01: So first of all,
[49:23] I think one thing that nobody really appreciates is that the
[49:26] skin back there is
[49:27] SPEAKER_01: really delicate.
[49:29] SPEAKER_01: We treat it like it must be able to withstand.
[49:31] SPEAKER_01: whatever the heck we throw at it.
[49:33] SPEAKER_01: It's like dealing with poop all the time.
[49:35] SPEAKER_01: It's got to be super sturdy.
[49:36] SPEAKER_01: It's not.
[49:37] Anybody who has dealt with constipation knows that that area
[49:41] can tear so easily and
[49:42] SPEAKER_01: then it becomes irritated so easily too.
[49:44] SPEAKER_01: Like if you've ever prepped for a colonoscopy,
[49:47] SPEAKER_01: it takes very little diarrhea before that area gets really raw and angry.
[49:51] SPEAKER_00: Yeah, yeah, really.
[49:52] SPEAKER_01: So we have to respect it.
[49:53] And I think that,
[49:54] yeah,
[49:55] toilet paper,
[49:56] if you have to pick one,
[49:57] please pick two ply.
[49:58] SPEAKER_01: Show some self-love and pick two ply.
[50:01] SPEAKER_01: I worry about, I have a friend who keeps one ply at home.
[50:03] SPEAKER_01: I'm like, why would you buy this for yourself?
[50:05] SPEAKER_01: What does this say about you?
[50:06] SPEAKER_01: And anyway, but the bidet is the right way.
[50:09] SPEAKER_01: If you can't use a bidet,
[50:10] SPEAKER_01: and I especially tell people this,
[50:12] like who are prepping for a colonoscopy where you know you're
[50:15] going to have some
[50:15] SPEAKER_01: diarrhea.
[50:16] SPEAKER_01: Wet wipes can be helpful during a prep.
[50:20] SPEAKER_01: You just, whatever the packaging says, you shouldn't actually flush them.
[50:24] SPEAKER_01: There's no such thing as a flushable wet wipe.
[50:26] SPEAKER_01: They don't actually degrade.
[50:28] SPEAKER_01: If you live in Massachusetts as I do, they will destroy your home.
[50:31] SPEAKER_01: Don't learn that the hard way.
[50:33] SPEAKER_01: But if you're not,
[50:34] SPEAKER_01: even if you're wiping,
[50:35] SPEAKER_01: I tend to like to tell people to just dab,
[50:38] SPEAKER_01: to gently dab rather than to do like this super vigorous squeaky clean.
[50:42] SPEAKER_01: If you're going for the squeaky clean,
[50:44] SPEAKER_01: you should join team bidet.
[50:46] SPEAKER_01: You will feel squeak clean all the time.
[50:48] But I think just like vigorously wiping with like this scratchy
[50:51] little one ply,
[50:52] SPEAKER_01: you're just damaging your skin.
[50:54] SPEAKER_00: Yeah, yeah, no, I mean, this is important stuff.
[50:57] I know some people say,
[50:59] you know,
[50:59] you're getting into the weeds here,
[51:01] but hey,
[51:02] you know what?
[51:03] SPEAKER_00: This is all important.
[51:04] Even also you brought out that some 8% have fecal incontinence
[51:09] and there's a lot of stuff here.
[51:11] SPEAKER_00: We won't get into everything,
[51:12] but I tried to make sure we hit on so much of the important
[51:17] things that you
[51:18] SPEAKER_00: reviewed.
[51:18] Now,
[51:19] we are still at a time,
[51:21] Tricia,
[51:22] where the world considers pooping to be unspoken,
[51:27] a stigma.
[51:30] SPEAKER_00: I mean,
[51:30] SPEAKER_00: even with Artemis II,
[51:31] SPEAKER_00: with the problems they've had with the toilet,
[51:34] SPEAKER_00: they talk about number two.
[51:36] SPEAKER_00: They don't call it by name.
[51:39] SPEAKER_00: The word poop, oh no, you just can't even do that.
[51:42] SPEAKER_00: Even bowel movement, you can't even talk about that.
[51:45] SPEAKER_00: So how are we,
[51:46] SPEAKER_00: your book is going to open things up because you've done,
[51:48] SPEAKER_00: basically,
[51:50] you have done a great service here with all these just
[51:55] remarkable things that
[51:57] SPEAKER_00: people don't like to talk about,
[51:58] SPEAKER_00: they don't talk about,
[52:00] SPEAKER_00: but now they have to because this book is going to just shake them up.
[52:05] SPEAKER_00: Um,
[52:05] SPEAKER_00: so what have I missed here of the,
[52:08] SPEAKER_00: I mean,
[52:09] SPEAKER_00: I,
[52:10] it's obviously we have been speaking for about 50 minutes and
[52:14] that's impossible to
[52:15] SPEAKER_00: cover everything in this book,
[52:16] SPEAKER_00: but I try to get at least people warmed up to what's in it and how,
[52:21] SPEAKER_00: how helpful it is.
[52:23] SPEAKER_00: Uh, and, uh, have I missed something?
[52:26] SPEAKER_00: Is there something more that, that we should touch before we close?
[52:30] SPEAKER_01: I think I love ending on that note.
[52:32] SPEAKER_01: I mean,
[52:33] this one statistic that really bothers me is that this was a
[52:37] study from the UK,
[52:38] but one in three people who suffer from bowel issues will avoid
[52:42] seeing their doctor
[52:43] SPEAKER_01: because they're so embarrassed by them.
[52:45] SPEAKER_01: And so
[52:46] Anything I can do to help destigmatize and get people to help
[52:50] and to normalize
[52:51] SPEAKER_01: this,
[52:51] SPEAKER_01: for goodness sakes.
[52:52] SPEAKER_01: I mean, this is just our bodies.
[52:53] SPEAKER_01: There's nothing to be ashamed of.
[52:55] SPEAKER_01: And also,
[52:56] SPEAKER_01: I hope people remember,
[52:57] SPEAKER_01: when you go to talk to a gastroenterologist about this,
[52:59] SPEAKER_01: you're talking to someone who has chosen to do this for a living.
[53:04] SPEAKER_01: Like, nobody forced us to become gastroenterologists.
[53:06] SPEAKER_01: You don't have to be embarrassed.
[53:08] SPEAKER_01: You cannot embarrass me.
[53:10] SPEAKER_01: So get the help that you need.
[53:14] SPEAKER_00: Well,
[53:14] SPEAKER_00: you know,
[53:14] SPEAKER_00: I remember back the ads for Coles would say,
[53:19] SPEAKER_00: take one of these for a BM in the AM,
[53:22] SPEAKER_00: you know.
[53:23] SPEAKER_00: Oh, that's clever.
[53:25] SPEAKER_00: Yeah, but, you know, there's so much more to this.
[53:28] SPEAKER_00: The point that you get to in your subtitle,
[53:31] SPEAKER_00: how to make your bowel movements a joy.
[53:34] SPEAKER_00: I mean, who would ever envision that?
[53:36] SPEAKER_00: Now, old people, you know, they think about that a lot, right?
[53:40] But the fact that everyone,
[53:42] everyone,
[53:43] and I'll go back,
[53:43] for those who joined late,
[53:45] SPEAKER_00: My favorite quote in the book was,
[53:48] SPEAKER_00: you know,
[53:50] SPEAKER_00: if we can get to this,
[53:51] SPEAKER_00: an effortless,
[53:52] socially appropriately time-bound movement is the second
[53:56] greatest bodily pleasure
[53:58] SPEAKER_00: known to man.
[53:59] SPEAKER_00: Okay, I'll let you figure out what the first one is.
[54:02] SPEAKER_00: All right, so we have had a fun discussion.
[54:05] SPEAKER_00: Trisha, you are a gem.
[54:07] I just,
[54:09] you know,
[54:09] not only are you a Washington Post Ask a Doctor columnist,
[54:14] this book,
[54:15] SPEAKER_00: all the work that you do to, you know, advance the science.
[54:18] SPEAKER_00: And like you said,
[54:19] SPEAKER_00: your work you're doing on Parkinson's,
[54:21] a lot of people don't realize that this is very much in so many
[54:25] people rooted in
[54:26] SPEAKER_00: their gut rather than their brain.
[54:27] SPEAKER_00: Hopefully we'll get some progress.
[54:29] SPEAKER_00: We need something there for Parkinson's.
[54:31] SPEAKER_00: We still don't have a disease modifying intervention there.
[54:35] SPEAKER_00: So hopefully you'll be successful in working through the gut.
[54:38] SPEAKER_00: But
[54:38] SPEAKER_00: Thank you.
[54:39] SPEAKER_00: Thank you for this work and putting it together and taking the time.
[54:44] SPEAKER_00: I've had so much fun.
[54:45] SPEAKER_00: You made me laugh so much.
[54:46] SPEAKER_00: My nose is running.
[54:49] SPEAKER_00: And look,
[54:50] SPEAKER_00: everybody,
[54:52] if you think you have perfect Bristol scale four and you go
[54:56] everything perfect,
[54:58] SPEAKER_00: maybe this book isn't for you,
[54:59] SPEAKER_00: but it's probably for other people you know to get this book.
[55:02] SPEAKER_00: Makes a great gift, right?
[55:04] SPEAKER_00: Most of us have a problem.
[55:06] SPEAKER_00: Yeah.
[55:07] SPEAKER_00: Yeah.
[55:07] SPEAKER_00: At least sometimes.
[55:08] And we didn't even get into running and we didn't get deep into
[55:12] vacations and whatnot.
[55:14] SPEAKER_00: But really, it's a great book.
[55:15] SPEAKER_00: So congratulations on the work.
[55:17] SPEAKER_00: I was so pleased to be an endorser for the book months ago.
[55:21] SPEAKER_01: Yes.
[55:22] SPEAKER_01: You're right here on the back.
[55:24] SPEAKER_01: Eric Topol.
[55:24] SPEAKER_01: Doctor, I'm going to read your quote.
[55:26] SPEAKER_01: Doctor Posrecha's brilliant book takes us on the path to Puforia.
[55:30] SPEAKER_01: Thank you.
[55:31] Yeah,
[55:32] well,
[55:32] Prephoria,
[55:33] like I said,
[55:33] marching to Prephoria,
[55:35] the new Pretoria adage.
[55:38] SPEAKER_00: Thank you so much, Tricia.
[55:40] And we'll follow this book to the top of the bestseller list
[55:43] because that's where it's headed.
[55:45] SPEAKER_01: I'm aiming for the number two spot.
[55:46] SPEAKER_01: I don't want to be number one.
[55:48] SPEAKER_00: For a day or two.
[55:49] SPEAKER_00: It's okay.
[55:50] SPEAKER_00: It's okay.
[55:52] SPEAKER_00: Thanks, everybody, for joining.
[55:54] SPEAKER_00: Sorry we didn't get to all your questions.
[55:55] SPEAKER_00: I tried to get to some of them.
[55:57] SPEAKER_00: It's just been fantastic.
[55:59] SPEAKER_00: We've got well over 600 folks on board, and it's been mesmerizing.
[56:05] It's always great to get into an area that people won't talk
[56:09] about,
[56:09] and you did it.
[56:10] SPEAKER_00: So thanks.
[56:11] SPEAKER_01: Thank you for having me, Eric.
[56:14] SPEAKER_00: You take care.
[56:15] SPEAKER_01: Bye.
[56:16] SPEAKER_00: Bye-bye now.
[56:17] SPEAKER_00: Thanks, everyone.

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