Full Transcript for Fiber Maxxing and Poo Maxxing, with Dr. Trisha Pasricha

the bathroom. Let's get this potty started. 37 00:02:14.430 --> 00:02:18.169 Let's learn all about poo and turds and how we 38 00:02:18.210 --> 00:02:21.370 can start feeling healthier in our guts. And if you 39 00:02:21.530 --> 00:02:25.639 know someone who is having gut troubles, spends ages in the. 40 00:02:25.620 --> 00:02:28.020 Toilet, send them this episode. 41 00:02:28.039 --> 00:02:47.750 They will laugh and learn. Hi, Trisha. Welcome to the show. Oh, 42 00:02:47.789 --> 00:02:48.189 my gosh. 43 00:02:48.229 --> 00:02:49.409 Thank you for having me. 44 00:02:49.430 --> 00:02:51.009 We're going to have so much fun. I've done my 45 00:02:51.069 --> 00:02:52.129 morning poo already. 46 00:02:52.159 --> 00:02:53.719 So, oh, my God. 47 00:02:53.849 --> 00:03:02.120 In honor of. I'm so delighted. So, Trisha, you have 48 00:03:02.139 --> 00:03:08.860 a dream. You have a dream to give us poop-phoria. 49 00:03:09.620 --> 00:03:10.379 Is that right? 50 00:03:10.860 --> 00:03:13.620 Poo for you. That's what I want everyone to achieve. 51 00:03:13.879 --> 00:03:17.099 And despite what I think people think when they hear 52 00:03:17.139 --> 00:03:20.990 that term, it's actually a state where thinking about your 53 00:03:21.009 --> 00:03:25.710 bowel movements, poop, poo, is the absolute least of your 54 00:03:25.750 --> 00:03:28.930 daily concerns. It's where you're not thinking about this day 55 00:03:28.949 --> 00:03:33.849 to day, where it just happens effortlessly, quickly, And you're done. 56 00:03:33.930 --> 00:03:35.830 And you feel light, easy. You go about the rest 57 00:03:35.849 --> 00:03:38.610 of your day and you're not obsessing about this. That's 58 00:03:38.650 --> 00:03:39.669 what poo-phoria is. 59 00:03:40.490 --> 00:03:43.150 Ah, okay. Because it does also sound like that great 60 00:03:43.210 --> 00:03:45.270 feeling when you evacuate very well. 61 00:03:45.330 --> 00:03:47.969 That's like, I just, I think that's straight up euphoria. 62 00:03:48.530 --> 00:03:53.789 But just the state of being of poo-phoria. That's like 63 00:03:53.990 --> 00:03:54.650 a way of life. 64 00:03:54.830 --> 00:03:58.449 And how many of us do not have pooforia right now? 65 00:03:58.509 --> 00:04:01.909 There was this study, 40% of Americans say that their 66 00:04:01.949 --> 00:04:04.370 bowel habits disrupt their daily lives. So that is like 67 00:04:04.409 --> 00:04:06.789 a huge, I mean, when I heard that statistic, it's 68 00:04:06.830 --> 00:04:09.069 a couple years old now, but I was astounded. That's 69 00:04:09.090 --> 00:04:12.069 like almost one in two of us who are quietly 70 00:04:12.090 --> 00:04:14.659 dealing with it. And that doesn't mean that's 40% of 71 00:04:14.680 --> 00:04:17.360 people who have a diagnosis of some kind, you know, 72 00:04:17.420 --> 00:04:19.980 who have even sought attention for it, but it's 40% 73 00:04:19.980 --> 00:04:23.389 of people who maybe are just quietly dealing Suffering with 74 00:04:23.410 --> 00:04:26.110 this daily problem that really shouldn't be a problem for 75 00:04:26.490 --> 00:04:27.230 that many people. 76 00:04:27.610 --> 00:04:27.889 Yeah. 77 00:04:28.550 --> 00:04:28.769 Yeah. 78 00:04:28.810 --> 00:04:32.379 So today, we're not going to suffer it quietly. We 79 00:04:32.420 --> 00:04:35.680 are going to be loud and proud. Loudly. We're going 80 00:04:35.699 --> 00:04:39.120 to suffer loudly. So, Trisha, clearly you love talking about poo. 81 00:04:39.300 --> 00:04:44.379 Very comfortable with talking about our guts. And you have 82 00:04:44.420 --> 00:04:48.370 tied this to growing up in a very poo-forward house. 83 00:04:48.569 --> 00:04:52.990 There's no shame around poo. Yes. Your dad is a gastroenterologist. 84 00:04:53.050 --> 00:04:56.120 Tell us about what was it like growing up in 85 00:04:56.160 --> 00:04:59.459 this dream home? It's the best. 86 00:05:00.720 --> 00:05:03.920 So my, yeah, my dad is a gastroenterologist and he 87 00:05:04.379 --> 00:05:07.980 was and is a neurogastroenterologist like myself. But when he 88 00:05:08.000 --> 00:05:12.120 got into the field, Neurogastroenterology was, like, really emerging. Like, 89 00:05:12.129 --> 00:05:13.660 it was a pretty new field. 90 00:05:13.920 --> 00:05:17.860 This is all about the gut-brain-gut-nerves connection. 91 00:05:18.220 --> 00:05:21.519 Yeah, the, like, brain in your gut. Like, we were 92 00:05:21.560 --> 00:05:24.290 learning so much about the enteric nervous system. That's the 93 00:05:24.329 --> 00:05:26.629 brain that's in the gut that we now know is, like, 94 00:05:26.850 --> 00:05:29.970 running the show in our bodies. Yeah. And so he's 95 00:05:30.009 --> 00:05:32.600 a scientist. And so he would bring all of this 96 00:05:32.660 --> 00:05:36.339 excitement home about all the studies he was doing. And 97 00:05:36.459 --> 00:05:37.860 like he'd want to share with us at the dinner 98 00:05:37.879 --> 00:05:39.800 table because that was like our time together. You know, 99 00:05:39.819 --> 00:05:43.149 and like you can't talk about how cool the enteric 100 00:05:43.170 --> 00:05:45.689 nervous system is if you can't say the word poop. 101 00:05:45.889 --> 00:05:48.329 Like you're not going to get past and like get 102 00:05:48.350 --> 00:05:51.060 to the good stuff if you can't have a conversation 103 00:05:51.100 --> 00:05:51.379 about it. 104 00:05:52.379 --> 00:05:53.680 That's what it was like growing up. 105 00:05:54.339 --> 00:05:54.920 Now, when. 106 00:05:55.750 --> 00:05:58.100 You were in the seventh grade. There was a very 107 00:05:58.240 --> 00:06:04.040 important dinner conversation that happened that kicked off a study, really, 108 00:06:04.100 --> 00:06:07.379 that you did. Can you tell us about this? So 109 00:06:07.399 --> 00:06:09.939 I guess I'll start you off because in your book, 110 00:06:10.040 --> 00:06:14.709 you describe your dad talking about this device that he 111 00:06:14.730 --> 00:06:17.990 was using to better

understand gastroparesis, which is where the 112 00:06:18.029 --> 00:06:22.230 stomach doesn't empty properly into the small bowel. Yes, exactly. 113 00:06:22.850 --> 00:06:26.170 And from this dinner table chat, You write in your book, 114 00:06:26.910 --> 00:06:32.769 a crazy plan was beginning to form. What was the 115 00:06:32.829 --> 00:06:33.860 crazy plan? 116 00:06:34.939 --> 00:06:36.980 Well, okay, the other half of me that you have 117 00:06:37.009 --> 00:06:39.259 to know about is that, I mean, if you thought 118 00:06:39.279 --> 00:06:43.319 I had a weird enough childhood experience, my mother used 119 00:06:43.360 --> 00:06:44.579 to work for the FBI. 120 00:06:44.600 --> 00:06:47.560 That was the other half of my childhood. Amazing. We're 121 00:06:47.579 --> 00:06:48.300 all very proud of her. 122 00:06:48.540 --> 00:06:51.600 But she could never tell us about what she did 123 00:06:51.860 --> 00:06:54.259 for the FBI. Because she'd have to kill us. 124 00:06:55.370 --> 00:06:55.730 Just kidding. 125 00:06:55.889 --> 00:06:57.829 I don't know if that part's true. But at any rate, 126 00:06:57.870 --> 00:06:59.050 we didn't know too much about what she did. We 127 00:06:59.069 --> 00:07:00.790 just knew it was so cool that she worked for 128 00:07:00.810 --> 00:07:01.009 the FBI. 129 00:07:01.029 --> 00:07:01.550 Like, I wish I knew. 130 00:07:01.850 --> 00:07:03.990 But one thing she did tell us about was lie 131 00:07:04.009 --> 00:07:05.930 detector tests. That was a big thing at the FBI 132 00:07:05.949 --> 00:07:10.350 in the 1980s, 1990s. And how basically how tough they 133 00:07:10.449 --> 00:07:14.819 were sometimes to pass. But also how, you know, she 134 00:07:14.860 --> 00:07:16.800 had to go through one to get her job. And 135 00:07:16.819 --> 00:07:18.319 then I think she was trying to improve it and 136 00:07:18.339 --> 00:07:18.839 perfect it. 137 00:07:19.399 --> 00:07:20.920 And when you say how hard it is to pass, 138 00:07:20.939 --> 00:07:22.959 as in even if you're telling the truth, it looks 139 00:07:23.019 --> 00:07:24.120 like you're lying? 140 00:07:25.240 --> 00:07:27.550 Yeah, like, you know, so the main way that people 141 00:07:27.790 --> 00:07:30.709 traditionally did a lie detector test was through something that's 142 00:07:30.730 --> 00:07:33.970 basically like an EKG, an electrocardiogram. And that measures your 143 00:07:34.009 --> 00:07:35.870 heart rate, right? But the problem is that, you know, 144 00:07:35.930 --> 00:07:39.740 like if you're unprepared and you're just stressed, like you can, 145 00:07:39.949 --> 00:07:40.860 your heart will be beating. 146 00:07:41.079 --> 00:07:41.259 Yeah. 147 00:07:41.300 --> 00:07:43.120 Like sort of, and it's like hard. And then you're like, 148 00:07:43.160 --> 00:07:44.920 oh my God, now I'm like caught in a lie 149 00:07:44.939 --> 00:07:47.759 and it'll really spike. But if you're really good and 150 00:07:47.779 --> 00:07:49.480 you know how to beat the lie detector test, like 151 00:07:49.500 --> 00:07:50.360 this was during the Cold War. 152 00:07:50.379 --> 00:07:51.220 This is how I know these stories. 153 00:07:51.459 --> 00:07:54.689 But it's like these spies would put these tacks in 154 00:07:54.730 --> 00:07:57.170 their shoe and they would step on a tack every 155 00:07:57.209 --> 00:07:59.910 time they were asked a question. And that pain would 156 00:07:59.949 --> 00:08:01.990 cause their heart rate to spike. So whether they were 157 00:08:02.009 --> 00:08:04.610 telling the truth or lying, it would look like their 158 00:08:04.629 --> 00:08:06.470 heart rate just kind of runs a little high. And 159 00:08:06.490 --> 00:08:08.110 that was like an old spy trick, I'm told. 160 00:08:08.430 --> 00:08:11.730 Gosh, who I would have killed to be at your 161 00:08:11.750 --> 00:08:13.069 dinner table growing up. 162 00:08:13.329 --> 00:08:14.240 Oh my gosh. 163 00:08:14.920 --> 00:08:18.800 Poo on one side, spies on the other. This is amazing. 164 00:08:19.680 --> 00:08:22.379 And the perfect marriage. Do you really think about it? 165 00:08:22.379 --> 00:08:24.730 A hundred percent. Oh my goodness. 166 00:08:25.430 --> 00:08:29.230 Remarkably, these two get along like songbirds. They are like 167 00:08:29.350 --> 00:08:32.210 just a perfect couple. But At any rate, so I 168 00:08:32.250 --> 00:08:34.929 thought a lot about the fact that, you know, we've, 169 00:08:35.389 --> 00:08:37.350 spies have come up with these ways to mask their 170 00:08:37.389 --> 00:08:41.110 heart rate, but nobody could beat, I was a theater kid, 171 00:08:41.350 --> 00:08:44.460 nobody had figured out how to hide this feeling that 172 00:08:44.509 --> 00:08:48.500 you get when you're nervous, going on stage or telling 173 00:08:48.580 --> 00:08:50.440 a lie, where you get this like, you know what 174 00:08:50.460 --> 00:08:52.440 I'm talking about, this sinking feeling in the pit of 175 00:08:52.480 --> 00:08:55.629 your stomach. And yeah, your heart's racing too, but it's 176 00:08:55.669 --> 00:08:58.269 something else. There's like something else happening where you feel 177 00:08:58.289 --> 00:09:01.690 like this cannonball drop in your gut. What was that 178 00:09:01.769 --> 00:09:03.679 feeling was what I thought about a lot growing up. 179 00:09:03.779 --> 00:09:06.919 And how do we capture whatever that thing was? And 180 00:09:07.059 --> 00:09:12.389 so formative dinner table experience, seventh grade. My dad is 181 00:09:12.429 --> 00:09:14.950 telling me this completely, you know, he's always talking about 182 00:09:14.990 --> 00:09:16.710 his research and he's like very excited to try to 183 00:09:16.750 --> 00:09:18.649 explain what he's doing. So he tells me about this 184 00:09:18.690 --> 00:09:23.039 device called an EGG, an electro gastrogram, which is very 185 00:09:23.179 --> 00:09:26.139 similar to the electrocardiogram, but it's measuring the electrical activity 186 00:09:26.159 -->

00:09:29.460 of the stomach and That was my light bulb moment 187 00:09:29.539 --> 00:09:31.940 because this whole, like for years, I've been thinking about 188 00:09:32.340 --> 00:09:33.960 how do I make the lie detector test better? 189 00:09:33.980 --> 00:09:34.700 Yeah. 190 00:09:34.799 --> 00:09:38.240 And then my dad tells me there's this fringe device 191 00:09:38.320 --> 00:09:42.860 out there that just scientists in neurogastroenterology know about and 192 00:09:42.899 --> 00:09:45.159 care about and have been studying. And I'm like, wait, 193 00:09:45.740 --> 00:09:48.980 you could use your stomach as a lie detector. What 194 00:09:49.019 --> 00:09:51.639 if we use the EGG? And I like, I was like, 195 00:09:51.659 --> 00:09:53.240 you know, I think I had like pressured speech and 196 00:09:53.259 --> 00:09:54.879 I was like telling my parents like all about my 197 00:09:54.940 --> 00:09:57.580 Gigi's plan. And at the end of it, my dad 198 00:09:57.620 --> 00:10:01.230 was like, great. Well, why don't you study it? 199 00:10:01.779 --> 00:10:02.419 And so we did. 200 00:10:02.490 --> 00:10:04.210 So for the next like set, and it took me 201 00:10:04.250 --> 00:10:07.210 a long time to do this study. But for the 202 00:10:07.250 --> 00:10:11.059 next several years, kind of perfected the protocol perfectly. brought 203 00:10:11.100 --> 00:10:15.299 in volunteers, had people basically assigned to randomize either telling 204 00:10:15.350 --> 00:10:18.169 the truth or lying while I was measuring the electrical activity. 205 00:10:18.549 --> 00:10:21.389 And the cool thing that I found is that when 206 00:10:21.450 --> 00:10:24.830 you tell a lie, your electrical activity of your stomach, 207 00:10:24.889 --> 00:10:27.940 which actually you have a normal rhythm, your stomach, when 208 00:10:27.960 --> 00:10:30.759 you're not eating, contracts at about three cycles per minute. 209 00:10:30.860 --> 00:10:31.480 And that's happening. 210 00:10:31.500 --> 00:10:33.399 You don't know about it. It's happening in the background. 211 00:10:33.980 --> 00:10:36.649 When you're nervous, when you're telling a lie, that rhythm 212 00:10:36.720 --> 00:10:40.419 gets thrown into total chaos. It's called arrhythmia. There's no 213 00:10:40.500 --> 00:10:43.720 set pattern. And you can see it happen. Even if 214 00:10:43.759 --> 00:10:46.019 that person is like looking cool as a cucumber and 215 00:10:46.340 --> 00:10:49.820 they're acting natural, they're talking naturally, you see this change 216 00:10:49.879 --> 00:10:52.100 happening in their stomach when they get nervous. 217 00:10:52.139 --> 00:10:53.970 And that's what we measured. 218 00:10:54.330 --> 00:10:56.490 And I went on to fame and fortune in my 219 00:10:56.529 --> 00:10:56.889 high school. 220 00:10:57.169 --> 00:10:57.690 I'm just kidding. 221 00:10:57.970 --> 00:11:00.549 I won a science fair, but I did not get 222 00:11:00.590 --> 00:11:02.950 to sit at the cool kids table. But it was 223

00:11:03.070 --> 00:11:06.070 kind of what got me excited. To become a scientist myself. 224 00:11:06.509 --> 00:11:09.850 So what do we know about what is that cannonball feeling, 225 00:11:09.870 --> 00:11:11.980 that pit in your stomach? 226 00:11:12.129 --> 00:11:16.440 What is happening is your amygdala sends the signal to 227 00:11:16.639 --> 00:11:21.779 release this hormone called corticotrophin-releasing hormone. And that, in turn, 228 00:11:21.879 --> 00:11:24.879 goes through the bloodstream and starts this cascade that ultimately 229 00:11:25.000 --> 00:11:29.230 grinds your stomach to a halt. So a hormone gets released. 230 00:11:30.009 --> 00:11:33.889 Yep. Stomach slows down. but there's a but. 231 00:11:35.120 --> 00:11:38.399 There's a literal but, which is that your colon speeds up. 232 00:11:39.000 --> 00:11:41.519 When this is happening, that same hormone, which is slowing 233 00:11:41.559 --> 00:11:44.730 down your stomach, causes your colon to rev up, which 234 00:11:44.779 --> 00:11:46.730 is why a lot of people are like, why do 235 00:11:46.830 --> 00:11:49.269 I have to poop right before it's like my turn 236 00:11:49.309 --> 00:11:51.850 at karaoke or right before I have to give a presentation? 237 00:11:51.889 --> 00:11:53.389 Like suddenly I have to go. And then once your 238 00:11:53.429 --> 00:11:55.860 presentation's over, you actually don't have to go to the bathroom. 239 00:11:55.879 --> 00:11:58.629 Like you're fine. Well, it's because that same hormone, which 240 00:11:58.690 --> 00:12:00.669 is making you feel nauseated, like you want to throw up, 241 00:12:00.990 --> 00:12:02.759 is also making you have to go to the bathroom 242 00:12:02.779 --> 00:12:05.360 at the same time. And once you calm down, once 243 00:12:05.399 --> 00:12:07.980 that stressor is over, all of it kind of goes 244 00:12:08.019 --> 00:12:09.480 back to its normal function very quickly. 245 00:12:10.179 --> 00:12:14.570 Interesting. And so, Tricia, you seem to have very visceral 246 00:12:14.710 --> 00:12:18.129 memories of blowing your lines on stage as a theatre kid. 247 00:12:18.149 --> 00:12:18.470 I know. 248 00:12:18.490 --> 00:12:19.710 This is like a core memory. 249 00:12:20.210 --> 00:12:22.789 Is there one? Tell me. What are you thinking of as... 250 00:12:23.879 --> 00:12:26.600 Oh my gosh. Why are you doing this to me, Wendy? Okay. 251 00:12:27.059 --> 00:12:31.740 It was the high school production of Christmas Carol. I 252 00:12:31.919 --> 00:12:37.919 was the ghost of Christmas past. It was like a prize. 253 00:12:38.000 --> 00:12:41.620 I nailed the audition. People were jealous, man. And so 254 00:12:41.659 --> 00:12:44.149 I'm on stage and I don't even remember the line 255 00:12:44.190 --> 00:12:46.210 anymore because I only remember the emotion. But I do 256 00:12:46.269 --> 00:12:49.730 remember I'm like halfway through my monologue and I just 257 00:12:49.809 --> 00:12:52.779 totally like cannot remember where to go.

And there's these 258 00:12:52.799 --> 00:12:56.340 like awkward silence where I'm like grasping the wheels are going. 259 00:12:56.379 --> 00:12:57.559 I'm like, what do I do? What do I do? 260 00:12:57.980 --> 00:13:00.730 And I feel that like that sensation. And luckily my, 261 00:13:00.730 --> 00:13:03.149 you know, I don't want the word is co-star like 262 00:13:03.210 --> 00:13:06.269 the other, the dude who was playing Ebenezer Scrooge. He 263 00:13:06.330 --> 00:13:08.330 like jumped in and just kept going. We just kept going. 264 00:13:08.710 --> 00:13:09.830 But I thought about that. 265 00:13:09.889 --> 00:13:12.139 Not only did I think about it like after it happened, 266 00:13:12.740 --> 00:13:15.529 I sometimes, you know, I'm how old am I? 267 00:13:15.559 --> 00:13:16.059 I'm like 37. 268 00:13:16.059 --> 00:13:20.509 I wake up. I have dreams. I'm on stage and 269 00:13:20.549 --> 00:13:22.789 I can't remember what is the play I'm even here for? 270 00:13:22.809 --> 00:13:23.389 What are my lines? 271 00:13:23.570 --> 00:13:27.389 So anyway, formative memory. I know really deeply what that 272 00:13:27.460 --> 00:13:29.730 feeling is. Obviously, I had to study it. 273 00:13:30.000 --> 00:13:33.379 Wow. But you didn't put your pants on. 274 00:13:34.730 --> 00:13:38.129 No, thank God. That would have really taken... Could have. 275 00:13:37.950 --> 00:13:40.289 Been worse, is what I'm trying to say. Could have 276 00:13:40.350 --> 00:13:42.509 been way worse, yes. Don't worry, I won't talk to 277 00:13:42.529 --> 00:13:48.250 you about any more memories from high school. Appreciate you. 278 00:13:48.330 --> 00:13:52.950 So in your book, you describe going back to sort 279 00:13:53.009 --> 00:13:56.740 of our scientific understanding of... what's happening in our guts 280 00:13:56.820 --> 00:13:59.799 when we're nervous throughout the day as our emotions are 281 00:13:59.820 --> 00:14:02.600 going up and down. You described this fascinating case report 282 00:14:02.620 --> 00:14:05.080 from the 1940s of a soldier. 283 00:14:06.279 --> 00:14:10.169 Yes. Tell me about this study. It was World War II. 284 00:14:11.190 --> 00:14:13.750 And there was a soldier who was in this ward 285 00:14:13.850 --> 00:14:17.370 and because of his wounds, his whole abdomen is exposed. 286 00:14:17.830 --> 00:14:20.250 And so the doctor who's taking care of him can 287 00:14:20.389 --> 00:14:24.179 see his abdomen. And what's interesting is that he found 288 00:14:24.220 --> 00:14:28.379 that this soldier, he could like literally watch in real 289 00:14:28.460 --> 00:14:32.269 time how quickly his stomach is moving, whether he's having 290 00:14:32.309 --> 00:14:34.570 a lot of what we call peristalsis or movements in 291 00:14:34.590 --> 00:14:37.009 the gut, and when his gut seemed to be calm 292 00:14:37.070 --> 00:14:40.529 and happy and relaxed. And what he found is that, yeah, 293 00:14:40.549 --> 00:14:42.889 like when he ate, there was some movements of it, 294 00:14:42.950 --> 00:14:45.759 like when he was kind of walking around and exerting himself, 295 00:14:45.820 --> 00:14:48.460 like he could see movement. But it was during moments 296 00:14:48.539 --> 00:14:52.950 of psychological stress, that he saw suddenly the most amount 297 00:14:52.990 --> 00:14:54.919 of movement through his gut. And so there was this 298 00:14:54.980 --> 00:14:58.100 moment that he documented and wrote about where a bunch 299 00:14:58.139 --> 00:15:01.220 of fellow soldiers are brought in who are like freshly wounded, 300 00:15:01.299 --> 00:15:02.720 hot off the battlefield. I think it was a really 301 00:15:02.779 --> 00:15:06.320 traumatic moment in the ward. And the patient was very, 302 00:15:06.340 --> 00:15:08.419 very stressed and upset by it. That's when the most 303 00:15:08.470 --> 00:15:11.950 movement occurred. And witnessing this, he writes it up. It 304 00:15:12.090 --> 00:15:16.169 sparks part of the journey of a doctor from Cornell 305 00:15:16.250 --> 00:15:19.340 who's reading this against 1940s. And he's like, let me 306 00:15:19.379 --> 00:15:22.240 do a set of experiments to prove this, to show 307 00:15:22.299 --> 00:15:27.190 that not physical stress, but psychological stress causes acute changes 308 00:15:27.230 --> 00:15:29.090 to our gut. So then he starts to do these 309 00:15:29.110 --> 00:15:32.240 experiments where he puts people live through a set of 310 00:15:32.279 --> 00:15:35.159 kind of psychological tests. Like he'll say, tell me about. 311 00:15:35.629 --> 00:15:38.139 you know, your stressful marriage or talk to me about 312 00:15:38.179 --> 00:15:40.460 this like difficult relationship you have with your son. And 313 00:15:40.679 --> 00:15:43.659 he even pretended to find cancer in one. 314 00:15:43.580 --> 00:15:44.159 Of his patients. 315 00:15:44.220 --> 00:15:46.139 And this is like ethics is like a whole separate 316 00:15:46.159 --> 00:15:47.159 conversation about these studies. 317 00:15:47.179 --> 00:15:48.740 Like I, it was a problem, but. 318 00:15:49.259 --> 00:15:50.879 What he found is that while he's putting these people 319 00:15:50.919 --> 00:15:53.169 through it and he's looking through this like early version 320 00:15:53.190 --> 00:15:55.509 of a colonoscope. So like kind of a rigid scope 321 00:15:55.570 --> 00:15:59.149 looking from the inside, he saw that when they were 322 00:15:59.210 --> 00:16:01.899 stressed out and talking about these difficult experiences and he 323 00:16:01.919 --> 00:16:04.500 could see the rectum spasming and moving, right? 324 00:16:04.570 --> 00:16:06.620 And this is something we experience, right? 325 00:16:06.639 --> 00:16:09.210 Like we, like I felt it on stage. Like we 326 00:16:09.330 --> 00:16:12.590 feel this all the time when we're really acutely stressed. 327 00:16:13.269 --> 00:16:18.570 So how is the brain and the gut communicating with 328 00:16:18.610 --> 00:16:19.129 each other? 329 00:16:19.250

--> 00:16:20.830 What is exactly happening there? 330 00:16:21.809 --> 00:16:22.210 Yeah. 331 00:16:22.250 --> 00:16:24.110 So remember, okay, so we've got the brain in our 332 00:16:24.149 --> 00:16:27.610 heads and the brain in our heads is this big collection, 333 00:16:28.370 --> 00:16:32.029 essentially a network of neurons. And you actually have a 334 00:16:32.129 --> 00:16:34.820 very similar set. You have like these two sets of 335 00:16:34.860 --> 00:16:37.220 neurons throughout your whole gut. And that's what we call 336 00:16:37.240 --> 00:16:39.279 the enteric nervous system or the brain in your gut. 337 00:16:40.120 --> 00:16:43.440 So the main way it communicates and has to communicate 338 00:16:43.820 --> 00:16:47.230 is through the vagus nerve. The vagus nerve is this big, is, 339 00:16:47.240 --> 00:16:51.340 you know, like wandering, hence the name vagus for wandering 340 00:16:51.720 --> 00:16:54.460 nerve that has these tendrils that go throughout the organs 341 00:16:54.500 --> 00:16:57.159 of your body. But the gut really gets the lion's 342 00:16:57.179 --> 00:17:00.779 share of that innervation and And what's fascinating is that 343 00:17:01.399 --> 00:17:03.340 much of that communication is going from the gut up 344 00:17:03.379 --> 00:17:03.940 to the brain. 345 00:17:03.960 --> 00:17:08.460 And you, in your lab, you study how diseases that 346 00:17:08.480 --> 00:17:11.660 we commonly think of as being brain diseases actually are 347 00:17:12.500 --> 00:17:14.740 interacting with the gut in interesting ways. And I'm thinking 348 00:17:14.799 --> 00:17:20.609 of Alzheimer's, Parkinson's disease. Yeah, yeah. And in fact, in 349 00:17:21.410 --> 00:17:28.160 James Parkinson's seminal essay on Parkinson's disease in 1817... which 350 00:17:28.380 --> 00:17:33.890 he called the shaking palsy, he talked about how Parkinson's 351 00:17:34.009 --> 00:17:38.869 was connected to the stomach and the bowels. 352 00:17:39.529 --> 00:17:41.789 So tell me, what is the connection here? 353 00:17:41.869 --> 00:17:42.329 Yeah. 354 00:17:42.910 --> 00:17:46.089 You know, in those case series that he wrote about, 355 00:17:46.410 --> 00:17:50.180 he's describing tremors. He's describing difficulty with walking and movement, 356 00:17:50.200 --> 00:17:52.599 like all of the classic symptoms we think about with Parkinson's. 357 00:17:52.819 --> 00:17:56.880 But in several of the patients, he also writes about 358 00:17:57.369 --> 00:18:01.819 how severe their constipation was. It is so bad. Laxatives 359 00:18:01.859 --> 00:18:04.079 are not working. And he's writing about this over and over, 360 00:18:04.119 --> 00:18:06.799 but it's not clear to him at that point in 361 00:18:06.839 --> 00:18:09.500 time why, or if this is connected in some way 362 00:18:09.519 --> 00:18:11.460 to the Parkinson's. It seems like it should be, but 363 00:18:11.480 --> 00:18:14.359 it's not clear why. And I would say for the 364 00:18:14.440 --> 00:18:19.369

next almost 200 years, people thought about Parkinson's as being 365 00:18:19.410 --> 00:18:23.490 in the almost ending in the brain. The hallmark of 366 00:18:23.509 --> 00:18:27.109 Parkinson's is this protein called alpha-synuclein protein, and it misfolds 367 00:18:27.309 --> 00:18:28.369 in Parkinson's disease. 368 00:18:28.890 --> 00:18:31.849 In the brain, you can see this protein misfolding. 369 00:18:31.869 --> 00:18:34.529 Yes, and they've done, and this is like just incredibly 370 00:18:34.569 --> 00:18:38.109 well studied because they've done autopsy studies. We know really 371 00:18:38.170 --> 00:18:41.839 well what happens to alpha-synuclein in the brain. When it misfolds, 372 00:18:41.910 --> 00:18:45.460 it causes, it's part of the reason why dopamine neurons die. 373 00:18:45.980 --> 00:18:48.869 And those dopamine neurons in the brain are what's responsible 374 00:18:48.900 --> 00:18:51.490 for movement. And so that's why the tremors, the rigidity 375 00:18:51.509 --> 00:18:54.769 in these things start to develop. But it turns out 376 00:18:54.950 --> 00:18:57.569 that if you were to do autopsies on people who 377 00:18:57.609 --> 00:19:00.930 have Parkinson's disease, you actually would see that their guts 378 00:19:01.089 --> 00:19:06.210 too are riddled with misfolded alpha-synuclein protein. And in the 379 00:19:06.250 --> 00:19:09.410 case of the gut, what we think can happen is 380 00:19:09.430 --> 00:19:12.789 that that misfolded protein sort of bumps up into other 381 00:19:12.890 --> 00:19:16.849 alpha-synuclein and induces that alpha-synuclein protein to misfold. And it 382 00:19:16.890 --> 00:19:18.430 just propagates and propagates. It's like a. 383 00:19:18.450 --> 00:19:22.430 Domino effect all the way. Yeah. And then it gets 384 00:19:22.470 --> 00:19:24.829 into the brain. How? 385 00:19:24.910 --> 00:19:29.109 Slowly but surely through the vagus nerve. And that's a 386 00:19:29.150 --> 00:19:31.369 process that takes years. And you might say, okay, how 387 00:19:31.390 --> 00:19:34.009 do we know that? And we know it for several ways. 388 00:19:34.109 --> 00:19:37.369 But one way is we've staged it. Like you can 389 00:19:37.430 --> 00:19:43.279 inject in mice. You can inject preformed alpha-synuclein sort of 390 00:19:43.400 --> 00:19:46.710 fibrils and watch them misfold. And you can stage, you 391 00:19:46.730 --> 00:19:49.609 can watch it track from the stomach up the vagus nerve. 392 00:19:49.740 --> 00:19:52.519 And then to the brain. It's going, the protein is 393 00:19:52.640 --> 00:19:54.599 moving through the vagus nerve? It's moving upwards. 394 00:19:54.700 --> 00:19:56.980 It's almost like a prion because it's like, you know, 395 00:19:57.059 --> 00:20:00.089 once it comes in contact with another alpha-synuclein protein, that 396 00:20:00.190 --> 00:20:02.490 one starts to misfold and it sort of moves like that. 397 00:20:02.509 --> 00:20:03.750 Wow. 398 00:20:04.210 --> 00:20:06.529 And If you ask,

and this is what I started 399 00:20:06.549 --> 00:20:08.210 to ask my patients when I was just starting out 400 00:20:08.250 --> 00:20:11.509 as a gastroenterologist, my patients with Parkinson's disease, if you 401 00:20:11.630 --> 00:20:15.880 ask them, 80% of people with Parkinson's disease, one, have 402 00:20:15.920 --> 00:20:20.720 GI symptoms. The overwhelming majority have GI symptoms. And many 403 00:20:20.740 --> 00:20:24.950 of them will say, my constipation started... Years, if not decades, 404 00:20:25.009 --> 00:20:27.890 before my tremors started. Started well before. 405 00:20:28.089 --> 00:20:31.819 So I just think now anyone with constipation listening is 406 00:20:31.859 --> 00:20:33.420 going to be freaking out here. 407 00:20:33.440 --> 00:20:34.900 Yes, right. 408 00:20:35.000 --> 00:20:35.559 We don't want that. 409 00:20:35.680 --> 00:20:36.480 We do not want that. 410 00:20:36.920 --> 00:20:40.099 How should they be thinking about this? How should we 411 00:20:40.160 --> 00:20:43.059 all be thinking about trying to use this information to 412 00:20:43.119 --> 00:20:44.670 reduce our risk of Parkinson's disease? 413 00:20:44.769 --> 00:20:47.839 Yeah. So yeah, a few things about this. So one, 414 00:20:48.000 --> 00:20:50.660 constipation will come for us all at some point or another. 415 00:20:50.880 --> 00:20:53.059 So if we were to say everyone who gets constipation 416 00:20:53.079 --> 00:20:55.299 is going to get Parkinson's, we'd be in trouble. As 417 00:20:55.339 --> 00:20:57.980 we age, we get more risk of constipation. When we 418 00:20:58.029 --> 00:21:00.589 go on vacation, we get constipated. So don't feel that 419 00:21:00.650 --> 00:21:03.069 just because you're constipated, you're going to get Parkinson's disease. 420 00:21:03.109 --> 00:21:05.869 The way I think about it is if somebody comes 421 00:21:05.950 --> 00:21:09.059 to my clinic and they're like, you know, like 40s, 50s, 422 00:21:09.430 --> 00:21:12.470 new constipation, not something they've ever dealt with before. First 423 00:21:12.490 --> 00:21:13.930 of all, I look for other things that could be 424 00:21:13.970 --> 00:21:17.019 going on and causing it. If they were to say, 425 00:21:17.579 --> 00:21:19.720 you know what, like I also, I lost my sense 426 00:21:19.759 --> 00:21:21.880 of smell a couple of years ago, or I've been 427 00:21:22.119 --> 00:21:25.410 having trouble sleeping. I'm acting out my dreams. That's another 428 00:21:25.450 --> 00:21:28.609 sign of prodromal Parkinson's. If you start to tell me 429 00:21:29.069 --> 00:21:33.450 about constipation plus other signs, other symptoms, oh my, by 430 00:21:33.470 --> 00:21:36.250 the way, my grandfather had Parkinson's disease. That's when I 431 00:21:36.289 --> 00:21:38.279 start to take this a little bit more seriously. And 432 00:21:38.299 --> 00:21:39.920 I say, you know what, we should really think about it. 433 00:21:39.960 --> 00:21:42.880 And frankly, you know, the ways that we would tell somebody, look, 434 00:21:42.900 --> 00:21:45.539 you're worried about Parkinson's, let's reduce your risk for it. 435 00:21:45.910 --> 00:21:47.470 The things I'm about to tell you to do that 436 00:21:47.589 --> 00:21:49.789 are the things that we should probably all be doing anyway. 437 00:21:50.089 --> 00:21:51.490 The things that have been shown to reduce your risk 438 00:21:51.509 --> 00:21:55.880 for Parkinson's, number one is exercise. And not just sort 439 00:21:55.890 --> 00:21:59.779 of like low walking, but like moderate to vigorous physical 440 00:21:59.839 --> 00:22:02.640 activity regularly every week. It's been shown to reduce your 441 00:22:02.660 --> 00:22:04.859 risk of Parkinson's, but also slow progressions. 442 00:22:05.299 --> 00:22:09.000 And we just keep learning about the ways that the 443 00:22:09.079 --> 00:22:12.369 gut and the gut microbiome more generally are contributing to 444 00:22:12.440 --> 00:22:14.869 many different diseases. And I wanted to get your take 445 00:22:15.730 --> 00:22:19.819 on this just fascinating study that came out about peanut 446 00:22:19.960 --> 00:22:24.240 allergies just recently. So basically what they did is they 447 00:22:24.279 --> 00:22:29.279 did a fecal transplant and it's, that found that it 448 00:22:29.380 --> 00:22:32.400 might help some people with peanut allergies. And I have 449 00:22:32.440 --> 00:22:35.039 been fascinated to hear that scientists are no longer giving 450 00:22:35.059 --> 00:22:37.880 people poo smoothies, which they used to. 451 00:22:37.900 --> 00:22:40.750 Do you remember the days of the poo smoothies? 452 00:22:40.769 --> 00:22:44.470 These were capsules, right? They were frozen capsules. I remember 453 00:22:44.589 --> 00:22:48.490 reporting on... Thank goodness. And they literally had a blender 454 00:22:48.529 --> 00:22:53.299 in the lab. So, anyway, science progressing all the time. 455 00:22:53.319 --> 00:22:55.740 You have to start somewhere, right? You have to start somewhere. So... 456 00:22:56.150 --> 00:23:00.359 In this study, very civilised frozen poo pills and they 457 00:23:00.420 --> 00:23:04.339 gave them to 15 people with peanut allergies and six 458 00:23:04.400 --> 00:23:08.809 of them could then handle more peanuts. They then did 459 00:23:08.849 --> 00:23:11.990 this thing called the challenge. You give people peanuts. Yeah. 460 00:23:12.170 --> 00:23:14.130 And they found that, you know, yeah, for six out 461 00:23:14.150 --> 00:23:16.470 of the 15, it did help them. They could handle 462 00:23:16.549 --> 00:23:20.910 more peanuts. Yes. After this fecal transplant, what do you 463 00:23:20.950 --> 00:23:24.890 think is happening here? Why might, obviously, small study didn't 464 00:23:24.930 --> 00:23:31.009 help everyone, but why might changing your microbiome help with 465 00:23:31.069 --> 00:23:32.089 a peanut allergy? 466 00:23:33.099 --> 00:23:35.299 Allergies, peanut allergies, doesn't feel like it should

have anything 467 00:23:35.359 --> 00:23:38.099 to do with anything related to your colon per se. 468 00:23:38.980 --> 00:23:41.079 But I think what people don't appreciate is that your 469 00:23:41.160 --> 00:23:44.380 gut is actually your largest immune organ. 470 00:23:44.400 --> 00:23:47.440 It's huge. And it has to be that way because. 471 00:23:48.190 --> 00:23:52.009 We are putting God knows what into our bodies every 472 00:23:52.089 --> 00:23:52.609 single day. 473 00:23:52.670 --> 00:23:55.690 It's the welcome mat for the world in a way. Yes, 474 00:23:55.869 --> 00:23:56.690 it is, right? 475 00:23:56.849 --> 00:24:00.390 But our body does a great job of filtering out 476 00:24:00.430 --> 00:24:02.410 and making sure we don't get harmed. But to the 477 00:24:02.450 --> 00:24:07.029 point is our microbes, they play a big role in 478 00:24:07.269 --> 00:24:10.150 teaching our immune system how to behave, right? So in 479 00:24:10.190 --> 00:24:13.829 this case, in the peanut allergy, they think that part 480 00:24:13.869 --> 00:24:17.819 of why the fecal transplant helped because the fecal transplant 481 00:24:18.390 --> 00:24:21.690 sort of potentially primed some of these people, didn't work 482 00:24:21.710 --> 00:24:25.029 for everybody, but some of them with bacteria that could 483 00:24:25.089 --> 00:24:29.940 help dampen that allergic immune response. And so I think 484 00:24:29.980 --> 00:24:33.380 it's interesting, this was a phase one trial. We've done 485 00:24:33.420 --> 00:24:36.920 a lot of good studies on fecal microbiota transplant that 486 00:24:36.960 --> 00:24:38.839 have not panned out. I want to be really clear 487 00:24:38.859 --> 00:24:40.900 about this because I get this kind of all the time. 488 00:24:40.920 --> 00:24:44.119 Everyone's like, hey, should I blend my cousin's poop in 489 00:24:44.140 --> 00:24:47.609 the smoothie? Because I get this. Don't, first of all, 490 00:24:47.650 --> 00:24:48.630 do not try this at home. 491 00:24:48.809 --> 00:24:52.170 Oh gosh, don't DIY your fecal transplants. 492 00:24:52.549 --> 00:24:54.289 You never, never. 493 00:24:54.509 --> 00:24:56.349 What is it not worked for, by the way? 494 00:24:56.809 --> 00:25:00.329 It's not worked for Parkinson's disease. You can imagine there's 495 00:25:00.369 --> 00:25:04.490 a lot of excitement about that. And I don't think 496 00:25:04.539 --> 00:25:06.910 it's because it can't work, won't work. 497 00:25:07.119 --> 00:25:09.180 I think it's because it's so complicated. 498 00:25:09.200 --> 00:25:12.119 Like, who's got the right poop? Like, whose poop do 499 00:25:12.140 --> 00:25:15.809 we consider normal? Whose poop do we consider healthy? Is 500 00:25:15.910 --> 00:25:18.230 there such thing? I think this is a step in 501 00:25:18.250 --> 00:25:19.410 the right direction, but I just want to like sort 502 00:25:19.430 --> 00:25:22.009 of like just bring everyone back down to earth for 503 00:25:22.029 --> 00:25:23.930 like a hot minute, which is to say like we're 504 00:25:24.009 --> 00:25:25.890 not there yet with FMT. 505 00:25:26.690 --> 00:25:29.619 After the break, some of the worst advice that Trisha 506 00:25:29.680 --> 00:25:32.099 is hearing online about how we can take care of 507 00:25:32.160 --> 00:25:32.680 our guts. 508 00:25:33.359 --> 00:25:35.720 You want to hear this, trust me. And if you've 509 00:25:35.759 --> 00:25:36.039 got a. 510 00:25:36.099 --> 00:25:39.660 Friend that has gut issues or you think might be 511 00:25:39.700 --> 00:25:43.009 suffering in silence, maybe send them this episode. It'll open 512 00:25:43.049 --> 00:25:54.400 up a conversation. And there's fictives. Hey, it's Wendy from 513 00:25:54.460 --> 00:25:56.579 Science Versus, and I want to tell you about a 514 00:25:56.619 --> 00:26:00.049 podcast that I love, Science Friday. They cover all sorts 515 00:26:00.089 --> 00:26:03.430 of amazing things in the weird and wonderful world of science, 516 00:26:03.809 --> 00:26:07.490 from how concussions affect our brain to the inner secrets 517 00:26:07.769 --> 00:26:10.700 of a snake with a spider on its tail. It's 518 00:26:10.740 --> 00:26:13.019 a lot of news that you can use and some 519 00:26:13.039 --> 00:26:15.279 that you can't, but you're going to love anyway. It's 520 00:26:15.319 --> 00:26:18.859 hosted by Ira Flato and Phyllis Flora Lichtman, who is 521 00:26:18.920 --> 00:26:21.650 an old friend of the show and loves a pun 522 00:26:21.789 --> 00:26:24.490 as much as we do. Science Friday is on every 523 00:26:24.509 --> 00:26:26.549 day wherever you get your podcasts. 524 00:26:34.920 --> 00:26:35.380 Welcome back. 525 00:26:35.400 --> 00:26:39.819 Today, I'm chatting with neurogastroenterologist and author of You've Been 526 00:26:39.900 --> 00:26:44.089 Pooping All Wrong, Dr. Trisha Pasrisha. Let's jump back in. 527 00:26:44.930 --> 00:26:49.089 So let's start with just some of the basics around 528 00:26:49.759 --> 00:26:53.079 poo because even basics feel like a mystery because we 529 00:26:53.099 --> 00:26:55.880 don't really talk about it. So let's just, so what 530 00:26:55.920 --> 00:27:00.799 exactly is poo? What is coming out of it, Trisha? Yeah. 531 00:27:00.839 --> 00:27:05.200 So that's an incredibly fundamental question and a really interesting one. 532 00:27:05.319 --> 00:27:08.839 I think what people believe poop is, is just all 533 00:27:08.900 --> 00:27:11.220 the waste products that your body doesn't need. Like you 534 00:27:11.259 --> 00:27:13.769 have extracted all the good stuff through your small intestine. 535 00:27:13.789 --> 00:27:15.809 Everything you don't need comes out as poop. And that's 536 00:27:15.849 --> 00:27:19.150 at least partially true, but it's actually not what the 537 00:27:19.190 --> 00:27:23.230 majority of your poop is. So obviously scientists have studied this. 538 00:27:23.789 --> 00:27:27.349 They've looked at, through mass spec, what is the composition 539 00:27:27.369

--> 00:27:30.109 of poop. It's mostly your microbes. And then the rest 540 00:27:30.150 --> 00:27:32.799 of it is all this sort of soluble and insoluble 541 00:27:32.839 --> 00:27:34.839 material and fiber that you can't digest. 542 00:27:34.859 --> 00:27:36.039 A little bit of corn in there. 543 00:27:36.059 --> 00:27:36.869 Squished together. Yes. 544 00:27:36.950 --> 00:27:40.920 Yeah. That's amazing. When you look down, that's your microbes 545 00:27:40.980 --> 00:27:41.420 in there. 546 00:27:41.700 --> 00:27:42.900 Say hello. 547 00:27:43.019 --> 00:27:43.299 Yeah. 548 00:27:43.359 --> 00:27:44.779 Next time you peek in. 549 00:27:45.160 --> 00:27:48.900 And I think before reading your book, I had this 550 00:27:48.960 --> 00:27:52.200 idea that poo was brown because because it's just this 551 00:27:52.420 --> 00:27:54.799 mixture of all the stuff you've eaten and maybe some 552 00:27:54.839 --> 00:27:58.420 excretion products, kind of like when you're painting and you're 553 00:27:58.440 --> 00:28:00.720 in preschool and you use all the paints and eventually 554 00:28:00.740 --> 00:28:01.200 it just kind of gets. 555 00:28:01.259 --> 00:28:05.460 Everything ends up brown. Brown. Totally. But why is our 556 00:28:05.480 --> 00:28:13.769 poo brown? Yeah, totally wrong. Bizarrely, our poop would be white, 557 00:28:13.880 --> 00:28:17.670 like a whitish clay colored. The only reason it's brown 558 00:28:17.910 --> 00:28:19.069 is because of bilirubin. 559 00:28:19.109 --> 00:28:21.150 So we produce... bile, right? 560 00:28:21.190 --> 00:28:23.809 It's this digestive kind of salt that we produce that 561 00:28:23.829 --> 00:28:27.470 helps break things down. The bilirubin in that bile is 562 00:28:27.490 --> 00:28:30.059 what makes it brown. If you were to take that out, 563 00:28:30.990 --> 00:28:33.099 and sometimes that happens if somebody gets a gallstone or 564 00:28:33.119 --> 00:28:35.660 if there's something else blocking the release of bile into 565 00:28:35.680 --> 00:28:39.319 your small bowel, what comes out is this pale, bizarre 566 00:28:39.359 --> 00:28:41.339 looking clay colored stool. If you ever see one of those, 567 00:28:41.359 --> 00:28:43.160 you will remember it the rest of your life. 568 00:28:43.349 --> 00:28:46.289 Wow. And what about, so on the odd occasion, someone 569 00:28:46.309 --> 00:28:47.789 can even have a silver poo. 570 00:28:49.210 --> 00:28:50.069 Oh, my gosh. 571 00:28:50.170 --> 00:28:50.410 Yes. 572 00:28:50.450 --> 00:28:54.299 The poop of legends. The mystical silver poop. 573 00:28:54.319 --> 00:28:55.190 I can't believe you brought that up. 574 00:28:55.539 --> 00:28:56.380 Yes. 575 00:28:56.599 --> 00:28:58.420 And if you're watching this on video, you can take 576 00:28:58.460 --> 00:29:00.099 a look at these images. This is from the British 577 00:29:00.180 --> 00:29:04.599 Medical Journal of someone's silver poo. What might be going 578 00:29:04.619 --> 00:29:08.569 on if silver poo exits your butthole? 579 00:29:09.789 --> 00:29:11.910 So there's only been a handful of these cases reported. 580 00:29:12.130 --> 00:29:14.430 I read one in the New England Journal of Medicine. 581 00:29:14.450 --> 00:29:17.450 So we're talking about the BMJ. New England Journal of Medicine. 582 00:29:17.470 --> 00:29:19.279 Like this is a top tier poop. 583 00:29:19.339 --> 00:29:21.799 Yeah. This is not something that gets published in like 584 00:29:21.859 --> 00:29:25.420 a low impact factor journal. And it's so rare. So 585 00:29:25.460 --> 00:29:25.859 what it is. 586 00:29:25.900 --> 00:29:28.160 So like, OK, so first of all, two things are 587 00:29:28.180 --> 00:29:32.029 happening simultaneously. One, you're blocking the passage of bile somewhere. 588 00:29:32.240 --> 00:29:34.109 That's going to give you that whitish color. 589 00:29:34.390 --> 00:29:34.609 Yes. 590 00:29:34.690 --> 00:29:38.349 Second, a second emergency is occurring in which you are 591 00:29:38.450 --> 00:29:44.220 bleeding somewhere. probably your upper GI tract, because the acid 592 00:29:44.259 --> 00:29:47.319 from your stomach, when it mixes with blood, it turns 593 00:29:47.400 --> 00:29:52.839 this shiny black color. so somebody who poops black who 594 00:29:52.859 --> 00:29:55.880 sees like this tarry looking pitch black stool should be 595 00:29:55.920 --> 00:29:58.880 worried that they're having a bleeding ulcer in their stomach 596 00:29:58.920 --> 00:30:01.940 or maybe their small bowel when you see this shiny 597 00:30:02.000 --> 00:30:05.059 black mix with this like clay colored white you get 598 00:30:05.240 --> 00:30:10.049 shiny silver alchemy and it's like kind of pretty but 599 00:30:10.069 --> 00:30:12.529 it is an emergency what a shame that it's an 600 00:30:12.589 --> 00:30:15.549 emergency and not you know I know not just like 601 00:30:15.630 --> 00:30:17.990 a sign that you're it's the next coming I know. 602 00:30:21.079 --> 00:30:23.259 So there are a lot of ideas that we have 603 00:30:23.420 --> 00:30:26.500 about what it is to have a healthy poo, a 604 00:30:26.539 --> 00:30:29.920 healthy bowel movement, dare I say it. And one is 605 00:30:29.960 --> 00:30:32.880 that we should be aiming for pooing once a day. 606 00:30:33.329 --> 00:30:35.849 I think I always thought that was like vaguely helpful. 607 00:30:35.910 --> 00:30:37.829 Every now and then I'll have a day where I'm like, wow, 608 00:30:38.609 --> 00:30:44.349 three times. Okay. Do you worry when a patient comes 609 00:30:44.410 --> 00:30:47.369 to you and is doing poos more than. 610 00:30:47.369 --> 00:30:52.859 Once, less than once a day? I don't actually obsess 611 00:30:52.920 --> 00:30:55.900 over the number. What I really focus on is how 612 00:30:55.960 --> 00:30:59.039 comfortable you feel. You know, like I would rather not 613 00:30:59.059 --> 00:31:02.859 you say, I had one poop this morning. I go 614 00:31:02.960 --> 00:31:06.279 every single day. But when I go, I

strain for 615 00:31:06.279 --> 00:31:09.680 20 minutes and I'm sitting in there and you emerge 616 00:31:09.720 --> 00:31:11.680 and it looks like you've ran this marathon. But yeah, 617 00:31:11.720 --> 00:31:14.099 I go once a day. That's not normal to me. 618 00:31:14.420 --> 00:31:16.460 You know, even though, yeah, you've checked that box. 619 00:31:16.579 --> 00:31:17.000 Yeah. 620 00:31:17.660 --> 00:31:19.440 So like, you know, there was this big study that 621 00:31:19.480 --> 00:31:22.089 was done actually by my colleagues at Beth Israel that 622 00:31:22.109 --> 00:31:26.569 show that people who consider themselves to have normal bowel habits, 623 00:31:27.009 --> 00:31:30.990 they go anywhere in America from once every three days 624 00:31:31.099 --> 00:31:32.440 to up to three times per day. 625 00:31:32.480 --> 00:31:34.500 So it's a big range, you know? And like, I 626 00:31:34.539 --> 00:31:34.980 think the. 627 00:31:34.940 --> 00:31:38.059 Part that people don't appreciate is that in other parts 628 00:31:38.099 --> 00:31:40.160 of the world where people are eating a higher fiber 629 00:31:40.200 --> 00:31:43.920 daily diet, not our sad American diet, people go more often. 630 00:31:44.359 --> 00:31:46.779 People are really into fiber maxing right now, which I 631 00:31:46.799 --> 00:31:49.940 am a thousand percent here for. People are going to 632 00:31:50.000 --> 00:31:52.579 find that they're going to go more often. They're just 633 00:31:52.619 --> 00:31:54.769 like this is their body's like going to be suddenly 634 00:31:54.940 --> 00:31:58.069 overwhelmed and amazed by how soft their poop is. It's 635 00:31:58.130 --> 00:32:02.039 suddenly effortless. They're not straining. And you might go twice 636 00:32:02.099 --> 00:32:04.440 a day and that's totally okay. It's just easy to go. 637 00:32:04.599 --> 00:32:05.920 You might even go three times a day and just 638 00:32:06.099 --> 00:32:07.700 embrace this new side of yourself. 639 00:32:08.079 --> 00:32:10.680 And why is that happening if you're fiber maxing? Why 640 00:32:10.700 --> 00:32:12.720 are you then going more? Why is it nice to 641 00:32:12.769 --> 00:32:15.470 do a poo? Give us your elevator pitch for fiber 642 00:32:15.509 --> 00:32:19.569 for those who haven't joined the fiber train. Yeah, well, okay. 643 00:32:19.589 --> 00:32:21.569 So here's the interesting thing about fiber is that like 644 00:32:21.589 --> 00:32:24.779 there's this big disconnect where people think I need more 645 00:32:24.839 --> 00:32:27.539 fiber because my body needs this to be healthy. 646 00:32:27.619 --> 00:32:27.900 Wrong. 647 00:32:28.460 --> 00:32:30.859 You don't eat fiber for your own body. You eat 648 00:32:30.960 --> 00:32:34.150 fiber to feed your microbes. Your microbes that are living 649 00:32:34.170 --> 00:32:36.930 in your microbiome, they need fiber to survive. 650 00:32:37.089 --> 00:32:39.049 And different species, you know, we have like lots of 651 00:32:39.069 --> 00:32:39.990 different species living in there. 652 00:32:40.329 --> 00:32:43.130 They actually thrive on different kinds of fiber. Fiber is 653 00:32:43.170 --> 00:32:45.210 not just this one thing. So you really want to 654 00:32:45.250 --> 00:32:49.150 get this diversity of fibers into your diet because that fiber, 655 00:32:49.349 --> 00:32:51.299 you can't break it down. We don't have the enzymes 656 00:32:51.319 --> 00:32:53.380 to break it down. So it's going to travel through 657 00:32:53.440 --> 00:32:56.319 your small intestine. As it's doing so, the part that 658 00:32:56.380 --> 00:32:58.210 does help you is that if it is like a 659 00:32:58.279 --> 00:33:02.119 soluble fiber, like psyllium husk is a nice fiber supplement, 660 00:33:02.700 --> 00:33:05.839 it's going to drag water with it and keep things 661 00:33:05.920 --> 00:33:09.380 nice and soft and plush. So your poop, all that waste, 662 00:33:09.440 --> 00:33:11.940 is suddenly going to become really easy and soft to pass. 663 00:33:12.079 --> 00:33:15.329 But once that fiber hits your colon and those microbes 664 00:33:15.369 --> 00:33:19.630 start fermenting it, they produce short-chain fatty acids, which then 665 00:33:19.710 --> 00:33:22.029 can be absorbed into your body and then have these 666 00:33:22.150 --> 00:33:25.599 anti-inflammatory compounds in other parts of your body, far away 667 00:33:25.640 --> 00:33:28.099 from your colon, to your heart, to your brain. And 668 00:33:28.240 --> 00:33:30.440 that process does a lot of good for you and 669 00:33:30.460 --> 00:33:32.940 your long-term health. That's why we eat fiber. But it's 670 00:33:32.980 --> 00:33:37.789 really not because you yourself are directly the reason. It's 671 00:33:37.829 --> 00:33:41.789 this indirect benefit you get by nourishing and feeding your microbes. 672 00:33:41.910 --> 00:33:45.910 Yeah, this is crazy to me that you feed your microbes, 673 00:33:45.930 --> 00:33:50.529 you keep them happy, then they produce these short-chain fatty 674 00:33:50.630 --> 00:33:54.920 acids and that then goes throughout your body. to help you. 675 00:33:54.940 --> 00:33:59.180 I mean, that symbiosis, it's so beautiful. It's crazy, right? 676 00:34:00.119 --> 00:34:05.329 Yeah. I mean, it's amazing that we can't produce these 677 00:34:05.640 --> 00:34:08.349 to that extent on our own. Like if we, and 678 00:34:08.369 --> 00:34:11.469 you know, like if we didn't have those microbes and 679 00:34:11.489 --> 00:34:15.409 we weren't producing those short chain fatty acids, they've done 680 00:34:15.449 --> 00:34:19.170 these studies. I mean, this is the reason why high 681 00:34:19.190 --> 00:34:22.289 fiber diet, it's associated with lower risk of dementia, of 682 00:34:22.369 --> 00:34:25.389 cardiovascular disease. It all can be traced back to that 683 00:34:25.610 --> 00:34:28.630 indirect benefit we're getting from what the microbes are doing 684 00:34:28.650 --> 00:34:30.570 to us. So we got to be

nice to them too. 685 00:34:30.630 --> 00:34:33.849 We have to give them fiber. And obviously 95% of 686 00:34:33.949 --> 00:34:36.829 us today are not meeting our fiber goals. We're hurting 687 00:34:36.869 --> 00:34:39.309 them and they're hurting us by, you know, just like 688 00:34:39.329 --> 00:34:40.230 this indirect pathway. 689 00:34:40.789 --> 00:34:44.380 And so you like to take a psyllium husk. Did 690 00:34:44.480 --> 00:34:51.469 you notice your poo's got better once you prioritized fiber 691 00:34:51.510 --> 00:34:53.269 in your own life. 692 00:34:53.730 --> 00:34:56.889 I will say like if you take psyllium everything just 693 00:34:56.909 --> 00:34:59.329 becomes soft easy effortless like you know we have this 694 00:34:59.530 --> 00:35:02.170 adage and we can talk about this more where I 695 00:35:02.190 --> 00:35:04.610 like to tell my patients don't spend more than five 696 00:35:04.659 --> 00:35:06.840 minutes in the bathroom you know like that stick to 697 00:35:06.860 --> 00:35:11.219 the five minute rule and ideally to be if I'm 698 00:35:11.239 --> 00:35:14.619 being so honest it should be like 30 seconds. It 699 00:35:14.639 --> 00:35:16.320 should be like an in and out job. Like even 700 00:35:16.400 --> 00:35:19.260 five minutes to me feels like way too much time. 701 00:35:19.380 --> 00:35:22.510 But once you are meeting your fiber goals, assuming there's 702 00:35:22.530 --> 00:35:24.730 not something else going on, like with pelvic floor dysfunction, 703 00:35:25.250 --> 00:35:26.090 it's an in and out job. 704 00:35:26.550 --> 00:35:30.110 So why don't you want people spending more time in 705 00:35:30.130 --> 00:35:32.550 the toilet? Why do you think once you get the call, 706 00:35:33.159 --> 00:35:35.119 I've heard you say it. I love that. Yeah. That 707 00:35:35.159 --> 00:35:36.000 is what it feels like. 708 00:35:36.579 --> 00:35:37.179 You get the call. 709 00:35:37.199 --> 00:35:40.739 Yes. You should go and go quickly. Respond to it. 710 00:35:40.860 --> 00:35:42.119 Respond to the call. 711 00:35:42.340 --> 00:35:45.989 So what happens if you don't respond to that call? 712 00:35:46.090 --> 00:35:51.010 Because a lot of people are embarrassed to or just 713 00:35:51.250 --> 00:35:54.929 really can't go in public. Say the call comes when 714 00:35:54.949 --> 00:35:59.320 you're in the mall or in your office or your workplace. 715 00:35:59.500 --> 00:36:01.860 Then you get the call. So what happens if you 716 00:36:01.920 --> 00:36:06.789 don't answer the call and you hold it in? Okay, 717 00:36:06.849 --> 00:36:08.949 so here's what I want people to picture. 718 00:36:09.929 --> 00:36:12.530 The reason you have to answer the call when the 719 00:36:12.570 --> 00:36:17.280 call comes is because if you delay, you think, it's fine, 720 00:36:17.949 --> 00:36:19.579 I can put this off. I'm going to just return 721 00:36:19.619 --> 00:36:22.119 to that same poop a couple hours from now. I'm 722 00:36:22.139 -->

00:36:23.880 going to come home. It'll be a safe space. It 723 00:36:23.940 --> 00:36:27.019 is not the same poop. Two hours from now, you 724 00:36:27.079 --> 00:36:29.260 are dealing with a different poop than the one you 725 00:36:29.400 --> 00:36:31.679 are when the call comes. And the reason why is 726 00:36:31.719 --> 00:36:35.119 that one of your colon's many important jobs, one of 727 00:36:35.199 --> 00:36:38.769 them is to constantly suck water out of whatever's in there. 728 00:36:38.789 --> 00:36:39.769 That's what it's going to do. 729 00:36:39.989 --> 00:36:42.010 It's going to do that around the clock, like it 730 00:36:42.050 --> 00:36:47.210 or not. And if you ignore that call, it's going 731 00:36:47.230 --> 00:36:49.469 to sit there and it's going to get drier and 732 00:36:49.530 --> 00:36:54.030 harder and more pebbly. So three hours later, when you're ready... 733 00:36:54.340 --> 00:36:56.510 First of all, can we talk about what the call is? 734 00:36:56.670 --> 00:36:58.170 Yes. Please. 735 00:36:58.530 --> 00:37:03.250 The call is simply the rectum spasming. That's what that 736 00:37:03.329 --> 00:37:05.849 feeling is, that sensation like, shoot, I got to go. Suddenly, 737 00:37:05.889 --> 00:37:09.570 what is this? It's your rectum spasming. That is the 738 00:37:09.699 --> 00:37:13.059 best time to go because your rectum is doing the 739 00:37:13.139 --> 00:37:15.480 work for you. It is trying to push this out. 740 00:37:15.960 --> 00:37:19.119 Three hours later, when you're in your comfy home bathroom, 741 00:37:19.460 --> 00:37:22.480 you feel safe, but you don't actually have the call 742 00:37:22.619 --> 00:37:26.199 anymore because You have to do all the work to 743 00:37:26.380 --> 00:37:29.239 generate pressure to push it out. So you have to 744 00:37:29.300 --> 00:37:32.900 do an enormous Valsalva maneuver at that point. Because if 745 00:37:32.920 --> 00:37:35.039 your rectum was contracting, you just do a little one 746 00:37:35.199 --> 00:37:38.800 and it'll come right out. Without that squeeze from your rectum, 747 00:37:38.960 --> 00:37:39.800 you've got to do it. 748 00:37:40.059 --> 00:37:41.519 And now to make matters. 749 00:37:41.360 --> 00:37:44.239 Worse, you're dealing with a completely different poop. It's like 750 00:37:44.320 --> 00:37:45.010 now drier. 751 00:37:45.110 --> 00:37:45.630 It's harder. 752 00:37:45.710 --> 00:37:47.750 It's not as squishy and soft. It does not want 753 00:37:47.769 --> 00:37:50.110 to come out anymore. So when you get the call 754 00:37:50.150 --> 00:37:52.969 that's a gift, you should respond to it. And you 755 00:37:53.010 --> 00:37:55.269 should move on with your day because you're not going 756 00:37:55.289 --> 00:37:58.030 to get those. The stars will not align again the 757 00:37:58.050 --> 00:37:59.329 way they are in that moment. 758 00:37:59.369 --> 00:38:03.389 It's so relatable, Tricia. It's so relatable. Tell me about it. 759 00:38:03.590 --> 00:38:09.199 So in your book, there's this fascinating stat that your 760 00:38:09.739 --> 00:38:14.920 sphincters are contracting, was it seven times an hour? 761 00:38:15.880 --> 00:38:16.780 Yeah. 762 00:38:16.940 --> 00:38:19.599 What are they doing? Why are they doing that? 763 00:38:20.429 --> 00:38:24.309 Let's talk about, this is an underappreciated job of the sphincters, 764 00:38:24.329 --> 00:38:26.750 but have you ever asked, I've thought, I think about 765 00:38:26.789 --> 00:38:29.110 this all the time, obviously, but like, how is it 766 00:38:30.170 --> 00:38:34.269 that our bodies know? You know, if you're sitting with friends, 767 00:38:34.929 --> 00:38:39.469 that it's safe to release gas, but it's not safe 768 00:38:39.550 --> 00:38:41.210 to release solid or liquid. 769 00:38:41.869 --> 00:38:43.869 And you can tell, like, you know, you're like, this 770 00:38:43.909 --> 00:38:44.210 is okay. 771 00:38:44.230 --> 00:38:46.630 I just have to fart. Well, how does your body 772 00:38:46.670 --> 00:38:50.739 know that? The way it knows is because Your sphincters 773 00:38:50.800 --> 00:38:55.650 have these tiny sensory neurons that are just constantly sampling 774 00:38:55.789 --> 00:38:59.489 the internal environment and sending that feedback up to your 775 00:38:59.530 --> 00:39:03.079 brain saying, wait, this is gas. All clear. You can 776 00:39:03.119 --> 00:39:04.199 let this out safely. 777 00:39:04.320 --> 00:39:05.360 Or whoa, whoa, whoa. 778 00:39:06.340 --> 00:39:09.460 Do not let go. And that's what those sphincters are 779 00:39:09.500 --> 00:39:11.599 doing for you. And you had no idea because it's 780 00:39:11.639 --> 00:39:14.519 in the background. And one of the ways that keeps 781 00:39:14.559 --> 00:39:17.219 the integrity of the sphincters and the job they're doing 782 00:39:17.340 --> 00:39:20.429 are actually your hemorrhoidal cushions. We think that's the function 783 00:39:20.530 --> 00:39:23.269 of your hemorrhoids. Because, by the way, you have internal hemorrhoids. 784 00:39:23.570 --> 00:39:26.929 They sometimes bleed like stink. Those are the ones that 785 00:39:26.969 --> 00:39:29.969 are constantly sampling that environment and giving that information. 786 00:39:30.230 --> 00:39:35.429 Back to you. Can you first, with a brush, paint 787 00:39:35.469 --> 00:39:37.449 me a picture of a hemorrhoid? Yeah. 788 00:39:38.510 --> 00:39:46.760 Hemorrhoids are just... Picture a cushion. A cushion on a circular... 789 00:39:47.269 --> 00:39:50.429 you know, like those 1970s, like a circular couch. And 790 00:39:50.449 --> 00:39:54.280 the cushions are the hemorrhoids. The couch is like where 791 00:39:54.320 --> 00:39:57.179 your rectum and your sphincters are, the center being the sphincters. 792 00:39:58.139 --> 00:40:02.059 And normally, so we all have hemorrhoids, whether you like 793 00:40:02.119 --> 00:40:04.420 to believe that or not, they're all there. But normally 794 00:40:04.480 --> 00:40:07.489

they're flat, they're deflated. They're just these cushions of veins. 795 00:40:08.409 --> 00:40:11.949 But over time, for some people, if you get into 796 00:40:11.989 --> 00:40:17.550 this pattern of straining constantly and Because you're constipated, sometimes 797 00:40:17.630 --> 00:40:21.449 those veins can start to engorge. And when they engorge 798 00:40:21.840 --> 00:40:24.539 and they start to fill up, those cushions can become 799 00:40:24.579 --> 00:40:28.360 plumper and plumper and plumper and juicier. And then sometimes 800 00:40:28.440 --> 00:40:31.880 they can become so plump and juicy that the internal 801 00:40:32.039 --> 00:40:35.840 ones pop out and say hello. And those are called 802 00:40:36.000 --> 00:40:40.269 prolapsing hemorrhoids. And you can feel those. They're very uncomfortable. 803 00:40:40.329 --> 00:40:41.909 You can sometimes push them back in. 804 00:40:41.929 --> 00:40:46.309 Uh-huh. And you did a study looking at whether sitting 805 00:40:46.369 --> 00:40:49.639 on the toilet for a long period of time affects 806 00:40:49.699 --> 00:40:52.599 the risk of hemorrhoids. And when I say sitting on 807 00:40:52.639 --> 00:40:55.739 the toilet, I'm talking to anyone who's bringing their phone in, 808 00:40:56.519 --> 00:40:59.199 sucked into whatever you're watching. 809 00:40:59.219 --> 00:40:59.280 Yes. 810 00:41:00.440 --> 00:41:02.400 You're watching a Science Versus episode. 811 00:41:02.460 --> 00:41:03.420 I get it. 812 00:41:03.719 --> 00:41:05.500 You wait until the end, but all of a sudden 813 00:41:05.519 --> 00:41:07.280 you've been sitting on the toilet for half an hour. 814 00:41:07.840 --> 00:41:12.090 Is that a problem? Major problem. 815 00:41:12.510 --> 00:41:17.030 You know, for me, like social media and smartphones in 816 00:41:17.050 --> 00:41:21.230 the bathroom is like the same thing as bringing your 817 00:41:21.250 --> 00:41:24.949 smartphones to your nightstand when you're trying to go to sleep. 818 00:41:25.030 --> 00:41:28.190 Like it only does bad things for you, for your health, 819 00:41:28.210 --> 00:41:30.559 for your well-being. And so what we found in our 820 00:41:30.599 --> 00:41:33.440 study is that people who bring their smartphones in, yeah, 821 00:41:34.519 --> 00:41:36.639 not only are they spending more time, that's a problem, 822 00:41:36.659 --> 00:41:41.969 like more than five minutes, but they also are inadvertently 823 00:41:42.050 --> 00:41:45.409 spending more time simply because of the smartphone and not 824 00:41:45.449 --> 00:41:47.949 doing the job they came in to do. Whereas for 825 00:41:47.969 --> 00:41:51.010 most of us in the past, you'd come in, you'd read, 826 00:41:51.030 --> 00:41:52.989 you know, like whatever was sitting there, the back of 827 00:41:53.010 --> 00:41:55.539 the shampoo bottle, that wasn't going to, like, you weren't 828 00:41:55.559 --> 00:41:58.059 going to stick around to get to the 14th ingredient. 829 00:41:58.099 --> 00:42:00.420 You would do your job and you'd move on. Whereas 830 00:42:00.440 --> 00:42:02.679 with the smartphone, it's like, God, this science versus episode 831 00:42:02.719 --> 00:42:05.409 is gripping. Like, I'll just, I might as well see 832 00:42:05.449 --> 00:42:10.210 where this conversation is going and you'll stick around and. 833 00:42:09.030 --> 00:42:11.289 Completely forget why your pants are around your ankles. 834 00:42:11.750 --> 00:42:14.309 And that's the problem because it's that long amount of 835 00:42:14.349 --> 00:42:17.650 time sitting there on this open bowl without any pelvic 836 00:42:17.670 --> 00:42:20.969 floor support that we hypothesize is the reason that not 837 00:42:20.989 --> 00:42:23.610 just one time, like, You know, everyone's allowed to watch 838 00:42:23.849 --> 00:42:26.550 one season finale of like the pit on the commode 839 00:42:26.630 --> 00:42:28.150 every now and then. But if you do it day 840 00:42:28.250 --> 00:42:30.829 after day, year after year, and you start doing this 841 00:42:30.889 --> 00:42:32.309 at a young age, that's what we. 842 00:42:32.250 --> 00:42:34.030 Think puts you at the risk of the hemorrhoids later on. 843 00:42:34.030 --> 00:42:36.610 Do you want to tell me about your study here? 844 00:42:37.210 --> 00:42:38.389 Your groundbreaking. 845 00:42:38.409 --> 00:42:38.489 Yeah. 846 00:42:39.289 --> 00:42:40.050 Groundbreaking. 847 00:42:40.090 --> 00:42:42.369 This was not the study I thought we, like the 848 00:42:42.409 --> 00:42:45.989 Pastricha Lab, would become most famous for, but I'm here 849 00:42:46.030 --> 00:42:48.070 for it. So we asked people coming in for their 850 00:42:48.090 --> 00:42:51.239 screening colonoscopies. You know, how much time do you spend 851 00:42:51.300 --> 00:42:52.840 on your smartphone when you're in the commode? What do 852 00:42:52.860 --> 00:42:55.119 you do when you're on your smartphone and you're in 853 00:42:55.139 --> 00:42:57.260 the bathroom? And then we asked them about their diet, 854 00:42:57.280 --> 00:42:59.219 their exercise. And then we did their colonoscopy and we 855 00:42:59.239 --> 00:43:01.849 took a look. And we noted who has hemorrhoids, who. 856 00:43:01.809 --> 00:43:02.750 Doesn't have hemorrhoids. 857 00:43:02.809 --> 00:43:04.989 And then this is what we found is that people 858 00:43:05.349 --> 00:43:09.190 who bring their smartphones into the bathroom, they had a 859 00:43:09.190 --> 00:43:14.159 46% higher chance of having hemorrhoids. So I just tell people, look, 860 00:43:14.500 --> 00:43:17.659 set a two TikTok limit, you know, or like set 861 00:43:17.699 --> 00:43:18.860 a five minute timer limit. 862 00:43:19.500 --> 00:43:22.860 And so why does sitting in the toilet then increase 863 00:43:22.900 --> 00:43:24.179 the risk of hemorrhoids? 864 00:43:24.699 --> 00:43:28.239 So the hemorrhoid cushions are held together by connective tissue. 865 00:43:28.659 --> 00:43:32.219 And it's a nice, firm, elastic connective

tissue. Over time, 866 00:43:32.280 --> 00:43:35.989 you sit on this open bowl without any counterpressure. That 867 00:43:36.030 --> 00:43:39.230 connective tissue will start to weaken and weaken and weaken 868 00:43:39.309 --> 00:43:41.969 until suddenly it's not enough to hold the hemorrhoids together 869 00:43:42.050 --> 00:43:43.429 and they pop and they burst. 870 00:43:43.989 --> 00:43:46.989 I'd love to talk about a couple of myths around 871 00:43:47.070 --> 00:43:50.510 poo and the gut that are happening online because the 872 00:43:50.670 --> 00:43:54.849 gut is being invoked a lot on social media these days. Yeah, 873 00:43:55.110 --> 00:43:59.429 I know. Tell us what gives you, what's given you 874 00:43:59.469 --> 00:44:04.010 the shits recently when it comes to gut health ideas online. 875 00:44:05.030 --> 00:44:06.289 So much. Can I tell you? 876 00:44:07.130 --> 00:44:08.630 Can I tell you the one that's like bothering me 877 00:44:08.710 --> 00:44:09.070 right now? 878 00:44:09.090 --> 00:44:09.949 Yes, please. 879 00:44:09.969 --> 00:44:12.570 Which is that, okay, there's this idea that you have 880 00:44:12.590 --> 00:44:15.510 a parasite. that has taken hold of a lot of 881 00:44:15.610 --> 00:44:20.070 people on social media. But actually, it's very common. I 882 00:44:20.150 --> 00:44:23.170 used to think this is really fringe. Very, very average 883 00:44:23.190 --> 00:44:25.530 people come to my clinic convinced that they have a parasite. 884 00:44:25.550 --> 00:44:26.670 They haven't traveled anywhere. 885 00:44:27.150 --> 00:44:28.030 Kind of exciting. 886 00:44:28.389 --> 00:44:30.909 There's no classic risk factors, but they kind of just 887 00:44:30.969 --> 00:44:36.210 know they have it. And sometimes they think they've seen 888 00:44:36.230 --> 00:44:38.650 a parasite. And what I have seen to be the 889 00:44:38.690 --> 00:44:42.650 case is that people go online, get these parasite cleanses, 890 00:44:43.570 --> 00:44:46.800 They take them and they see like basically their own 891 00:44:46.860 --> 00:44:50.039 intestinal lining shed. And they're like, my God, this is, 892 00:44:50.219 --> 00:44:52.940 I've cleared the parasite because I've taken this thing. 893 00:44:52.980 --> 00:44:55.039 What are they taking? What are they swallowing? 894 00:44:55.159 --> 00:44:59.800 Like really harsh stuff that are being sold as peritoneal 895 00:44:59.820 --> 00:45:03.639 or like herbal remedies and these things. And they are seeing, 896 00:45:03.679 --> 00:45:05.019 like I've seen pics because I get pics. 897 00:45:05.119 --> 00:45:05.780 Yeah. 898 00:45:05.800 --> 00:45:08.130 Like I'll see them. I'll be on the, like, you know, 899 00:45:08.150 --> 00:45:10.110 like I'll see the sample and I'm like, this is 900 00:45:10.130 --> 00:45:13.309 not a parasite. By the way, we have incredibly good tests. 901 00:45:13.900 --> 00:45:17.880 for parasites in a clinic setting. We don't miss this. 902 00:45:18.000 --> 00:45:20.880 If someone has a parasite, we'll catch it. That's not 903 00:45:20.920 --> 00:45:23.739 even the dark side of it. It's dark already. The 904 00:45:23.780 --> 00:45:26.659 darker side is that now in the world of cyclospora, 905 00:45:27.110 --> 00:45:32.150 I feel like people have felt very validated that actually 906 00:45:32.170 --> 00:45:35.369 I could and I need this parasite cleanse. 907 00:45:36.050 --> 00:45:39.860 Sticking with stuff online these days is there's this meme 908 00:45:39.880 --> 00:45:42.889 that's been going around for a while that's hot girls 909 00:45:42.949 --> 00:45:48.530 have stomach issues too and you're out of this um 910 00:45:48.690 --> 00:45:51.429 yeah and we we got questions about this from our 911 00:45:51.449 --> 00:45:55.219 listeners as well are women at an increased risk of 912 00:45:55.280 --> 00:46:00.159 these sort of complex severe stomach issues than men what's going. 913 00:45:59.940 --> 00:46:02.360 On here I thought you were going to ask, are 914 00:46:02.420 --> 00:46:05.400 hot girls at an increased risk? Like, I don't think 915 00:46:05.440 --> 00:46:10.719 we've done that study. But we certainly know. My lab, 916 00:46:10.739 --> 00:46:13.829 which I'm getting so many ideas. But yeah, women are 917 00:46:13.849 --> 00:46:15.889 at a much higher risk of getting IBS. 918 00:46:15.989 --> 00:46:17.670 Really? It's interesting. 919 00:46:17.710 --> 00:46:20.289 Why is that? We've known this for a long time. 920 00:46:20.309 --> 00:46:22.949 There are a lot of different reasons. And some of 921 00:46:22.989 --> 00:46:25.989 these we're really just learning about in the last five years. 922 00:46:26.110 --> 00:46:29.500 But I'll tell you one big reason, which is estrogens. 923 00:46:30.530 --> 00:46:33.170 estrogen levels. And so, you know, when we're younger, and 924 00:46:33.210 --> 00:46:35.130 a lot of people get diagnosed with young women, they're 925 00:46:35.150 --> 00:46:37.489 in their 20s. Like, they'll say, my symptoms really started 926 00:46:37.530 --> 00:46:42.550 in high school, in college, 30s. And what's interesting is 927 00:46:42.590 --> 00:46:46.099 that sometimes we do see that as women get older, 928 00:46:46.460 --> 00:46:50.219 they enter their 50s, 60s, 70s, it's rare to make 929 00:46:50.280 --> 00:46:54.199 a new diagnosis of IBS at that point. So the 930 00:46:54.260 --> 00:46:57.360 hallmark of IBS, just to be clear, it's pain. It's 931 00:46:57.500 --> 00:47:01.199 not just diarrhea. It's not just constipation. IBS comes in 932 00:47:01.219 --> 00:47:03.860 those flavors. You can have IBS with constipation. You can 933 00:47:03.880 --> 00:47:05.820 have IBS with diarrhea. You can have a mixed picture. 934 00:47:06.260 --> 00:47:08.619 But pain is what makes us say, this is not 935 00:47:08.639 --> 00:47:12.619 just chronic constipation. This is IBS, irritable bowel syndrome. There's 936 00:47:12.639 --> 00:47:14.349 been several big studies that have come out in the 937

00:47:14.389 --> 00:47:17.849 last five years that have shown that estrogen is part 938 00:47:17.889 --> 00:47:21.010 of what modulates pain signaling. Interesting, because I was. 939 00:47:21.889 --> 00:47:26.699 chatting to Dr. Jessica Bersikowski at the University of Melbourne 940 00:47:27.360 --> 00:47:29.760 to research for this chat. And she did this fascinating 941 00:47:29.800 --> 00:47:33.760 study into IBS patients. It was a small study, but 942 00:47:33.980 --> 00:47:38.219 really interesting where she gave them, her and her team, 943 00:47:38.550 --> 00:47:42.909 fructans and then measured, she had a control group. So 944 00:47:42.929 --> 00:47:45.670 some had IBS, some didn't, and measured exactly how much 945 00:47:45.769 --> 00:47:52.010 gas was being produced in their belly and found that Everyone, 946 00:47:52.050 --> 00:47:54.809 whether they're in this study, whether they had IBS or not, 947 00:47:54.989 --> 00:47:57.409 had the same amount of gas being produced. So the 948 00:47:57.449 --> 00:48:01.170 microbes were eating up the fructans, fighting out the gases. 949 00:48:01.190 --> 00:48:03.969 It was the same amount of gas being produced. But 950 00:48:04.010 --> 00:48:08.960 the people with IBS who were experiencing pain, what she 951 00:48:09.000 --> 00:48:11.639 did find was different because they were in an MRI scanner. 952 00:48:11.960 --> 00:48:16.300 And she could see that in their brain, their interpretation 953 00:48:16.320 --> 00:48:19.900 of pain, the pain in the brain looked different to 954 00:48:19.920 --> 00:48:20.639 the control group. 955 00:48:20.739 --> 00:48:20.880 Yes. 956 00:48:21.239 --> 00:48:23.420 So this is what you're talking about here. They were 957 00:48:23.460 --> 00:48:29.079 interpreting that little bit of extra gas, extra pressure as pain. 958 00:48:29.530 --> 00:48:30.389 That was the problem. 959 00:48:30.429 --> 00:48:32.690 It was the nerves. It was the brain that was 960 00:48:32.730 --> 00:48:36.849 interpreting the signal differently. Is this what you're describing? This 961 00:48:36.909 --> 00:48:38.010 is exactly right. 962 00:48:38.050 --> 00:48:41.469 And I think that sometimes we think that what is 963 00:48:41.489 --> 00:48:44.309 the underlying problem in IBS? I mean, that's what everyone 964 00:48:44.349 --> 00:48:47.639 wants to know because they're like, I mean, almost the hallmark, 965 00:48:47.699 --> 00:48:50.599 the way we define clinically IBS is all your tests 966 00:48:50.659 --> 00:48:54.199 are normal, right? That's very frustrating to hear. You feel 967 00:48:54.239 --> 00:48:57.780 really dismissed when that happens. But it turns out we're 968 00:48:57.800 --> 00:49:00.340 just talking about standard clinical tests that are normal. If 969 00:49:00.440 --> 00:49:02.119 we were to do, and they've done this, the only 970 00:49:02.139 --> 00:49:03.679 reason I can say this is because they've done this 971 00:49:03.739 --> 00:49:08.460 in research studies. If we were

to look for, say, TRIPV1, 972 00:49:08.539 --> 00:49:13.750 which is this receptor on pain signaling molecules, those receptors 973 00:49:14.070 --> 00:49:18.190 that signal pain to the brain, they're expressed more than three. 974 00:49:18.010 --> 00:49:20.380 Times as much in people who have IBS. in the 975 00:49:20.420 --> 00:49:21.539 colon so. 976 00:49:21.440 --> 00:49:24.980 That means these you have the same nerve cells in 977 00:49:25.019 --> 00:49:28.199 a healthy person versus someone as IBS the IBS patient 978 00:49:28.610 --> 00:49:31.750 is going to have more receptors that are perceiving pain 979 00:49:31.829 --> 00:49:33.869 and then sending those signals up to the brain. 980 00:49:34.010 --> 00:49:36.969 What is the worst GI advice that you see. 981 00:49:36.849 --> 00:49:41.139 Online People think juice cleanses are like somehow vaguely like 982 00:49:41.159 --> 00:49:43.210 it has this wellness sheen. 983 00:49:43.250 --> 00:49:44.230 They're colorful. 984 00:49:44.289 --> 00:49:47.190 It looks like something like influencers would do. What are 985 00:49:47.210 --> 00:49:50.570 juice cleanses but fruits and vegetables from which you have 986 00:49:50.630 --> 00:49:54.539 removed the fiber? You've taken the fiber out. You've juiced them. 987 00:49:54.880 --> 00:49:57.159 And so all you get is the sugar. And like 988 00:49:57.980 --> 00:50:00.440 to me, it's like the reason that's so bad is 989 00:50:00.519 --> 00:50:04.420 because You feel good, like you think you're doing something 990 00:50:04.460 --> 00:50:07.079 really good and you think it, like, but actually you're 991 00:50:07.099 --> 00:50:08.880 taking all the good stuff out. I hate to see 992 00:50:08.900 --> 00:50:10.219 a juice cleanse. 993 00:50:10.280 --> 00:50:13.119 It's so sad that that trend has really survived the 994 00:50:13.159 --> 00:50:17.739 test of time. I know, I know. As we're winding down, 995 00:50:17.800 --> 00:50:26.250 it is time for our Oddball Questions. Trisha, what is 996 00:50:26.309 --> 00:50:33.789 a conspiracy theory that you secretly have a soft spot for? Okay. Ooh. 997 00:50:33.809 --> 00:50:34.349 Stick with me. 998 00:50:35.849 --> 00:50:38.929 We, this is like, this is really niche, but I'm 999 00:50:38.969 --> 00:50:41.559 not the only one who like kind of does. 1000 00:50:41.199 --> 00:50:45.239 Buy into this. Okay. Stay with me, Wendy. All right. 1001 00:50:45.380 --> 00:50:45.659 I'm here. 1002 00:50:45.800 --> 00:50:51.059 We think that we've evolved to live with microbes in 1003 00:50:51.099 --> 00:50:54.920 our gut. But what if we've got it backwards and 1004 00:50:55.039 --> 00:51:00.599 we have simply evolved to become better vessels for the microbes? 1005 00:51:00.980 --> 00:51:05.059 Like humans, are the perfect vessel for them. 1006 00:51:05.079 --> 00:51:06.400 I know. 1007 00:51:06.659 --> 00:51:10.079 Like, think about our behaviors. Like, why do we eat fiber, right? Like, 1008 00:51:10.460 --> 00:51:13.320 we don't have the enzymes. Fiber is not for us. 1009 00:51:13.780 --> 00:51:17.769 It's for them. Why do we thrive in these close, 1010 00:51:17.889 --> 00:51:22.429 tight-knit social communities? There are a lot of other reasons, sure, 1011 00:51:22.489 --> 00:51:26.139 for our own survival, but the closer our community... The 1012 00:51:26.179 --> 00:51:28.880 more we're transmitting our microbes to each other. They've done 1013 00:51:28.900 --> 00:51:31.440 these studies. So I have this, like, you know, I 1014 00:51:31.440 --> 00:51:33.889 bought into this idea. My mind is, like, blowing. 1015 00:51:33.969 --> 00:51:35.429 Yes. Right now. Isn't it? 1016 00:51:35.469 --> 00:51:38.309 Like, we're here for them. They're not here for us. 1017 00:51:38.590 --> 00:51:39.369 Whoa. 1018 00:51:39.530 --> 00:51:40.090 Think about it. 1019 00:51:40.090 --> 00:51:43.659 I'll never stop thinking about it. Me neither. What's the 1020 00:51:43.719 --> 00:51:46.840 weirdest thing you've seen in someone's gut? You do colonoscopies 1021 00:51:46.880 --> 00:51:49.719 day in, day out. Oh, my gosh. 1022 00:51:50.619 --> 00:51:50.699 Um. 1023 00:51:52.730 --> 00:51:56.610 Well, your eyes lit up like nothing we've seen before 1024 00:51:56.989 --> 00:51:59.650 as just the visions of people's guts. The visions of 1025 00:51:59.690 --> 00:52:03.170 like the stuff we fished out at 2 a.m. The 1026 00:52:03.190 --> 00:52:05.469 weirdest thing I probably can't tell you because I know that, 1027 00:52:05.699 --> 00:52:07.480 you know, like anything I say that person will be like, 1028 00:52:07.539 --> 00:52:09.940 oh my God, I know that was me. But what 1029 00:52:09.960 --> 00:52:13.460 I can tell you is this. Okay. 1030 00:52:14.079 --> 00:52:18.179 People often, it's not uncommon for the GI doctor to 1031 00:52:18.199 --> 00:52:22.280 get called to the emergency room because of... Because if 1032 00:52:22.480 --> 00:52:25.719 some object has made its way into someone's rectum. 1033 00:52:25.800 --> 00:52:26.260 Yes. 1034 00:52:26.940 --> 00:52:30.429 And we get this call pretty often. And I just 1035 00:52:30.469 --> 00:52:35.289 want people to know that if you'll notice, I never 1036 00:52:35.489 --> 00:52:36.670 ask you how it got there. 1037 00:52:37.269 --> 00:52:39.179 Like I never ask because.... 1038 00:52:40.130 --> 00:52:40.329 Yeah. 1039 00:52:40.510 --> 00:52:41.719 I know how it got there. Yeah. 1040 00:52:41.780 --> 00:52:43.179 You know, and the person sitting in front of me 1041 00:52:43.380 --> 00:52:44.340 knows how it got there. 1042 00:52:44.400 --> 00:52:46.440 Yes. But 90% of the time. They put it up 1043 00:52:46.579 --> 00:52:47.829 their butt. That's how it. 1044 00:52:47.860 --> 00:52:48.500 They put it up there. 1045 00:52:48.579 --> 00:52:50.920 Yes. They just, and it's, that's so big. Yes. 1046 00:52:51.059 --> 00:52:52.960 You know, but 90% of the time, the person in 1047 00:52:53.000 --> 00:52:56.739 front of me, without my prompting at all, that

person 1048 00:52:56.980 --> 00:52:59.179 offers an explanation. They'll be like, you know what? 1049 00:52:59.519 --> 00:52:59.940 Sat on it. 1050 00:53:00.579 --> 00:53:01.699 I sat on it weird. 1051 00:53:02.639 --> 00:53:03.090 And I'm like. 1052 00:53:03.619 --> 00:53:03.820 Yeah. 1053 00:53:04.769 --> 00:53:06.929 Okay. Yeah. I didn't ask. 1054 00:53:07.409 --> 00:53:09.739 And can we, I'm just here to get it out. Like, 1055 00:53:09.860 --> 00:53:11.139 one way or another, we're going to help you. 1056 00:53:11.300 --> 00:53:14.420 Yes. I know you've learned your lesson. 1057 00:53:14.440 --> 00:53:17.219 Like, you don't need me to, like, we don't have 1058 00:53:17.260 --> 00:53:20.550 to talk about this again. I know it won't happen again. 1059 00:53:21.230 --> 00:53:23.150 Yes. And actually, every now and then, it does happen again. 1060 00:53:23.170 --> 00:53:26.829 We get these repeat flyers. Oh, gosh. Guys, that's why 1061 00:53:26.889 --> 00:53:32.030 sex therapists say flared bass. Okay, we've talked about a 1062 00:53:32.050 --> 00:53:36.349 lot of controversial things, but I've saved the best for last, Trisha. 1063 00:53:36.889 --> 00:53:38.909 Oh my gosh, what could be coming? You walk into 1064 00:53:38.949 --> 00:53:42.690 a public toilet. You need to do a poo. Right. 1065 00:53:43.130 --> 00:53:52.480 Do you put paper down or not? Oh. I say 1066 00:53:52.539 --> 00:53:57.559 controversial because I have heard from microbiologists that putting paper... 1067 00:53:57.980 --> 00:54:00.719 on the toilet seat is a waste of time because 1068 00:54:00.739 --> 00:54:05.320 the microbes are so little. It's like, it's like a 1069 00:54:05.460 --> 00:54:10.650 fishnet that they can just go through. And yet there is, 1070 00:54:11.150 --> 00:54:14.630 there is a psychological element to it. And I wanted 1071 00:54:14.650 --> 00:54:16.369 to know where you sat on this. 1072 00:54:17.690 --> 00:54:21.199 And I see what you did right there. And the 1073 00:54:21.239 --> 00:54:24.179 reason I hesitated in, and this is also revealing is 1074 00:54:24.219 --> 00:54:26.860 that There's not a great reason for this. It's not 1075 00:54:26.900 --> 00:54:29.719 really the microbe thing that bothers me. I almost never sit. 1076 00:54:29.840 --> 00:54:32.519 I hover when it's a public bathroom. 1077 00:54:32.960 --> 00:54:35.659 Even to poo? Even to poo? 1078 00:54:35.679 --> 00:54:39.599 I'm just so good at it that the job will 1079 00:54:39.619 --> 00:54:39.940 get done. 1080 00:54:40.440 --> 00:54:47.329 Wow. I know. I know. But I would rather not sit. 1081 00:54:52.920 --> 00:54:55.579 I hopped it once. I hopped it once to do 1082 00:54:55.659 --> 00:54:57.570 a poo and I overshot. 1083 00:54:57.590 --> 00:55:01.409 And do you. 1084 00:55:01.269 --> 00:55:06.789 Know there is nothing scarier than when you don't hear 1085 00:55:06.849 --> 00:55:12.909 the plop. Because that's how I knew what I did. 1086 00:55:12.949 --> 00:55:19.110 I was like, where was the flop? And then to 1087 00:55:19.190 --> 00:55:25.050 look around. And then the horror upon horror. So I 1088 00:55:25.170 --> 00:55:30.639 don't offer any more. I can't trust myself. I mean, it. 1089 00:55:30.539 --> 00:55:34.519 Takes practice, but you can get there. But I guess 1090 00:55:34.559 --> 00:55:37.000 I would say, like, if there's, I usually would wipe, 1091 00:55:37.059 --> 00:55:38.340 if I see anything visible. 1092 00:55:38.360 --> 00:55:38.760 Yeah. 1093 00:55:38.880 --> 00:55:41.000 I would certainly wipe that down, but I'm not somebody 1094 00:55:41.019 --> 00:55:42.219 who would just, like, lay. 1095 00:55:42.000 --> 00:55:46.559 Down preemptive paper. Okay, I'm crying. I'm laughing. Me too. 1096 00:55:46.880 --> 00:55:50.380 Appreciate you getting vulnerable with us. 1097 00:55:50.949 --> 00:55:59.739 That was amazing. There we go. Thank you so much. 1098 00:56:01.480 --> 00:56:06.969 You're so welcome. My pleasure. That was Dr. Trisha Pasrisha, 1099 00:56:07.030 --> 00:56:10.570 neurogastroenterologist at Harvard Medical School, and her new book is 1100 00:56:10.710 --> 00:56:14.150 You've Been Pooping All Wrong. If you liked this episode, 1101 00:56:14.210 --> 00:56:15.380 please tell us about it. 1102 00:56:15.380 --> 00:56:16.480 We're on social media. 1103 00:56:16.500 --> 00:56:21.260 We're also now on YouTube at Science VS Podcast. And 1104 00:56:21.320 --> 00:56:23.719 if you liked what you heard, if you learnt something, 1105 00:56:23.760 --> 00:56:26.460 if you thought a friend might enjoy a little laugh 1106 00:56:26.619 --> 00:56:31.380 and a little learn, please send this episode along. If 1107 00:56:31.400 --> 00:56:33.300 you want to know more about the science of whether 1108 00:56:33.320 --> 00:56:35.320 to put paper on the toilet, then you've got to 1109 00:56:35.380 --> 00:56:37.960 listen to this episode of Every Little Thing. We're going 1110 00:56:37.980 --> 00:56:40.409 to put a link in the show notes. It's hosted 1111 00:56:40.429 --> 00:56:44.789 by Flora Lichtman, who now co-hosts Science Friday. Thanks for watching. 1112 00:56:45.710 --> 00:56:49.349 This episode was produced by Akedi Foster-Keys and me, Wendy Zuckerman, 1113 00:56:49.449 --> 00:56:51.769 with help from the team at Science Versus. We're edited 1114 00:56:51.849 --> 00:56:55.010 by Blythe Terrell. Mix and sound design by Bobby Lord. 1115 00:56:55.150 --> 00:56:58.260 Music written by Bobby Lord, Bumi Hidaka, So Wiley, Emma 1116 00:56:58.300 --> 00:57:01.119 Munger and Peter Leonard. An extra thanks to the Zuckerman 1117 00:57:01.139 --> 00:57:04.760 family and Joseph Lavelle-Wilson. I'm Wendy Zuckerman. Back to you 1118 00:57:04.780 --> 00:57:05.099 next time.