The POOP Conversation You KNOW You Need (Stinky Farts, Colon Cleanses, IBS + Food Intolerances) with Dr. Trisha Pasricha

Here’s a run down of what we discussed in today’s episode: Why Do We Always Have to Poop in Stores? (Breaking the Taboo) The Gut–Brain Axis: How Stress and Emotions Affect Digestion Can Your Gut Affect Your Brain? IBS, Mood & ADHD Connections IBS Isn’t “All in Your Head”: The Role of Mast Cells Why Your Poop Smells (and What It Means) Laxatives, Dependency & What’s Actually Safe Do You Need a Colon Cleanse or Detox? (Spoiler: No) Colonics, Coffee Enemas & Wellness Myths Debunked The 3 P’s of Poop: Pelvic Floor, Pressure & Stool Quality How to Improve Your Poop: Fiber, Hydration & Daily Habits Check in with today’s amazing guest: Dr. Trisha Pasricha Website: trishapasricha.com Instagram: instagram.com/trishapasrichamd Book: You’ve Been Pooping All Wrong Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase: Amazon Barnes & Noble Amazon Kindle Apple Books Google Play Kobo Apple Books (Audiobook) Audible abbeyskitchen.com/hunger-crushing-combo • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters: Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books: Hunger Crushing Combo™ E-Book Protein 101 E-Book 👋 Follow me! Instagram: @abbeyskitchen TikTok: @abbeyskitchen YouTube: @AbbeysKitchen Blog: abbeyskitchen.com Book: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

  This episode is brought to you by State Farm. Football has a play for just about everything. You can go deep, keep it on the ground, or draw up something nobody sees coming. And whether you want to run a flea flicker or the tush push, you need a plan to fit your unique situation. That's why State Farm takes the time to get to know you, so they can help personalize coverage for your life and budget. Now that's a solid game plan. Like a good neighbor, State Farm is there.

• 0:29Speaker 01

  IBS was traditionally thought of as being all in our heads. Like, this was like, you need to de-stress.

• 0:38Abbey Sharp?

  Welcome to another episode of Bite Back with Abby Sharp, where I dismantle diet culture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good. If you think poop is just poop, well, think again. Today, we are diving, yes, I'm saying we're diving, into the surprisingly fascinating world of your bowels. From pelvic floor problems masquerading as constipation, to what your poop smell is really trying to tell you, to the truth about laxatives, cleanses, and why so many of us are apparently pooping all wrong. I'm joined by the brilliant Dr.

• 1:22Abbey Sharp?

  Tricia Pasricha, a Harvard-trained gastroenterologist, researcher, and author of the brand-new book, You've Been Pooping All Wrong. In this episode, we are unpacking the massive role of our pelvic floor in constipation, the brain-gut axis, and how we know that IBS is not just a mental problem, the biggest poop myths the wellness world refuses to let die, plus some more taboo topics like smells, laxatives, colonic, and cleanses. I'll also end on some of my dietitian tips for helping you get that perfect soft snake out of the cage.

• 2:03Abbey Sharp?

  So whether you are a chronic IBS struggler, or suffer occasional disruptions from travel or schedule changes, buckle up, my friends. We are about to change the way you think about your bathroom routine forever. Let's get into it.

• 2:26Abbey Sharp?

  Tricia, I am so excited. Thank you so much for joining me. Like, I am an IBS girly. I was just so excited when I heard about this book and I read it front to back. No joke, it did not disappoint. So, thank you.

• 2:38Speaker 01

  Thank you. And also, I'm so glad to talk to you and I'm so excited to be here. So, thanks for the invite.

• 2:43Abbey Sharp?

  Amazing. Okay, so, okay, so first of all, we gotta like, let's break the ice on this taboo topic that should not be taboo. And I gotta just ask, like, why does everyone have to poop when they go to Target?

• 2:56Speaker 01

  Great question. First of all, thanks for saying that out loud. We're not alone. You're not alone, whoever's here listening to this. There are a lot of different reasons, right? Like, for some people, it's the Target. Some people, it's the shopping mall. A lot of people, it's a bookstore. And, you know, and that's actually been like, written about in the Japanese media, like a lot. This is like a phenomenon that is worldwide. But there's something, I think, about a pattern that develops, you know? And so I think the thing to learn about our guts is that our guts can be trained and they can be trained into a routine. In fact, our colons love a routine. They're unlike any other organ in our body, right? Like, our heart is kind of doing the same thing throughout the 24 hours of the day.

• 3:39Speaker 01

  It slows down at night. The colon really has a strong circadian rhythm and it just, it abides by these different rules. So, if we train it to sort of feel like the bathroom in the Target is a safe place. I'm comfortable. I'm in my happy spot right now. I'm browsing some reading materials. I'm activating my vagus nerve. You have to go to the bathroom? That pattern is going to start to repeat every time you go. And so, it's like, as bizarre as this sounds, we see, I see this all the time with my patients and with my girlfriends and, and, you know, any kind of friend, that there's places in our lives that we just think of as like our safe place and they're just like, it's where we go. And so, that's why that bathroom is always crowded.

• 4:21Abbey Sharp?

  Hmm. I, okay, first of all, I'm Canadian and I have IBS-C. So I'm like, I need a Target. I need a Target. I will go to the Target every day when I'm having a bit of a digestive situation. I, I need to just live in a Target. Apparently all this IBS-C girlies need to be in the Target. Okay.

• 4:39Speaker 01

  Yeah, yeah, like as if we needed another reason.

• 4:42Abbey Sharp?

  Right. As if I need to spend my more money, basically, on things I don't need. Um, okay, but I've got so many questions. I don't even know where to start. I'm very excited about this. Clearly, this is my jam.

• 4:54Speaker 01

  I'm so happy. Let's dive in.

• 4:56Abbey Sharp?

  Oh, let's talk about poop. Okay. So, I mean, obviously, for something that is so natural, like we as a society have just like trained ourselves out of intuitively answering nature's call. And like, you know, like, we've got all these rules about like, when we can poop and where and like, what if it smells? And like, what if we miss our pooping window? Like, this is the shit I think about all the time. Right? Like, oh, it's, it's rough. And so here on my channel, we, we definitely talk a lot about the brain-gut access. And, you know, this is this bi-directional communication system.

• 5:30Speaker 01

  Yes.

• 5:30Abbey Sharp?

  Via the vagus nerve that links your thoughts and emotions and stress with how your gut operates. And so I'm curious, like, for folks that have sensitive tummies, like, we know how like, stress can cause some of these IBS symptoms. Like, we get butterflies, we might get urgency, etc. But what about that opposite direction? Because we don't talk about that very often. How does our gut affect our brain?

• 5:57Speaker 01

  Yes. Okay, so much to unpack here. And I'm so excited to talk about all of it. So I think a lot of people, just like you said, a lot of people are really familiar with this idea that our brain impacts our gut. And I'm a neuro-gastroenterologist, meaning I studied gastroenterology. I'm, I am a gastroenterologist. But then I did a subspecialty fellowship in neurogastroenterology, which is the study of the gut-brain connection. So this is, and I run a lab that studies this communication. So this is totally my jam as well. And I think that way of thinking about the brain as influencing the gut is really like, the traditional way of thinking about every organ in our body. The brain is dictating what we're, the rest of our body is doing, all through the vagus nerve. So the vagus nerve is this long nerve, for anyone who's not familiar. It's the largest cranial nerve in our body. It connects the brain, not just to the gut, but to every major organ.

• 6:43Speaker 01

  Within and and people have known about how the brain influences got for several decades. Like there were these classic experiments in the 1950s, which I often cite that were done at Cornell. They were actually done on Cornell medical students, but where they found that acute stress. So they would stress these medical students. This is going to sound really unethical and it like was, but they would stress these medical students by making them believe that the researchers were seeing like a colorectal cancer. And they would watch as they were doing this kind of like early equivalent of a kind of colonoscopy, how their colon started to contract and squeeze as these students started to believe that what the researchers were seeing was cancer. And that was some of our earlier insights into how in real time, our thoughts, our beliefs, our fears, our anxiety

• 7:28Speaker 01

  can can manifest in these like very real ways. And then, of course, the researchers did, just to be clear, did tell the students like, just kidding, it wasn't.

• 7:36Abbey Sharp?

  Just kidding, not cancer.

• 7:39Speaker 01

  Good one. I know, like, and today we're like, what?

• 7:43Abbey Sharp?

  Oh, for sure.

• 7:44Speaker 01

  This would never have gone through.

• 7:45Abbey Sharp?

  Yeah, yeah.

• 7:46Speaker 01

  But it was like a good example of how we learned. But that's the old way of thinking about it. And I think what we have now found in like just decades more of research is that 90% of the communication on that vagus nerve highway is from the gut up to the brain, not the other way around. And so we're seeing so much more within the last several years and even decades about research that's showing us how everything from our outside environment that makes its way into our stomachs, into our guts, into our small bowels and colons, that all gets influenced by our microbiome, which are these trillions of bacteria that live inside our guts. And then the products that they make, the bacteria breaking down what we've put into our bodies and what they produce and how

• 8:30Speaker 01

  different kinds of bacteria produce different metabolites. And those not just influence our gut, but they get absorbed into our bloodstream. So they really influence our brains and the rest of our health. So we're starting to learn about all of these different things. And it's it's not, you know, it started out as a smaller field, neuro-gastroenterology, like in the 1990s. It's now blossomed into a much bigger, more exciting factor because, you know, I think if we look at things historically, and I know you're you've been suffering with IBS, so you'll you'll you'll, I'm sure this will resonate. I see this in my own patients. IBS was traditionally thought of as being all in our heads. Like this was like a struck, you need to de-stress.

• 9:05Abbey Sharp?

  Yep.

• 9:06Speaker 01

  You know, and like what you need is maybe you need cognitive behavioral therapy. Maybe you need like something for depression, some treatment for your anxiety. And sure, people with IBS do have more depression anxiety. Objectively true. Who wouldn't? It's a chronic disease, like, right? But it's the root cause, the problem of IBS we're discovering, like many of these disorders, is in the stomach. It's in the gut. It's in the colon. It's not in the brain, but there is this feedback loop. And then once something, you know, wherever that that cycle starts, whether it's the brain or the stomach, once it starts, it becomes a cycle. And sometimes, cutting it off at the, at the level of the brain makes sense. Sometimes cutting it off at this, at the level of the gut is what we really need to do and what we overlook.

• 9:50Abbey Sharp?

  Hmm. I, I think this is so interesting because you're right. I just, I remember like, uh, maybe like six months ago, I had a colonoscopy and, um, just because again, like my IBS symptoms, I'm like, oh, there's must be something going on. Like what, like, let's see. And of course, guess what they wrote in my report? Symptoms from stress. Consider stress relief. That was it. That's what I got. I was like, very helpful, very helpful, of course. Yes.

• 10:17Speaker 01

  Great. Yeah. And, and you know, that's the, that's, honestly, this is the like frustrating thing that got me into this field. Um, because one, I mean, there's so much culturally tied to this, but like IBS disproportionately affects women. It affects men, but women are almost twice as likely to get IBS than men. And so there's just been this like longstanding tradition in a lot of areas of medicine to take these symptoms that we can't immediately understand, and we didn't understand them for a long time and say, okay, if we don't know what it is, it's gotta be stress. It's gotta be in her head. Um, and I think the tragedy is that even today. There are a lot of physicians out there who and and everyone who hasn't caught up with

• 10:59Speaker 01

  the literature and are still saying things like that. So I'm sorry that you heard that. But you know, I think what I find exciting about the field, like that's what got me into it and said, like, we've got to change this. I'm not the only one. A lot of people have done some incredibly good research here in this field, which is like changed what I thought about IBS too. But I think we're now finding that there is so much that can happen in the gut that we will never see on a colonoscopy. Like a colonoscopy, we're getting the you take a look on just the surface level, right? Like, imagine if like, we think that you have a problem inside your heart, and all we're doing is like, looking at your chest. We're like, saying, okay, well, what does it look like on the skin? That's kind of what we're doing with a colonoscopy. And we're saying like, yeah, this looks normal,

• 11:42Speaker 01

  looks fine. And we maybe we get some biopsies of the skin above your heart. But like, we're never taking a look with an EKG, whenever and that's exactly, you know, what we've been doing in IBS for so long is we're like scratching the surface with these biopsies. When what's happening in IBS often is at the level of what we call the enteric nervous system. The enteric nervous system is this network of nerves that runs deep throughout the entirety of your gut. It lives in the muscle layer. That muscle layer, you're never going to see in a colonoscopy, because, to be frank, if we if we got all the way that deep, we'd be perforating you, we'd be causing a big hole in your gut. You don't want that to happen. But it is as complex as what we the central nervous system, which is your brain. And those two things are what's connected by the vagus nerve. You have to do really

• 12:27Speaker 01

  specialized tests to be able to see that. We just don't do that in clinical practice. We do that all the time in research. So we know that these changes are real, that they're there, and they've been well quantified, well studied. But for the average person walking in with IBS, they're just not going to get those kinds of tests. And then the average, you know, doctor might say, well, okay, the tests are normal. Right. This is just, you know, this is in your head. This is stress. In your head. Yeah.

• 13:03Abbey Sharp?

  You know, from reading your book, one of the things that I did not know anything about that I thought was very interesting was the potential role of mast cell activation that can actually be seen via scope in folks with IBS and food sensitivities when like no other physical markers are present. And again, like this is very validating to those of us with IBS who have, again, been told it's in our head. Can you kind of like talk a little bit about that? Like what and how could we use this clue of like mast cell involvement in IBS to perhaps cure or reduce symptoms?

• 13:38Speaker 01

  Yes. Okay, so let's talk about what IBS is for just a second and what all of these symptoms are. So you know, IBS is, the way it's currently defined clinically, is somebody who has some form of abdominal pain that's linked to having a bowel movement. And it has to be going on for several months. That's really broad. Like that will encompass a lot of different kinds of people. And the truth is that we all agree, researchers, clinicians, that IBS is a very broad term that probably encompasses a lot of different kinds of pathologies. And as you pointed out, some people have IBS that manifest as more frequent stools or diarrhea. Some people have IBS that manifest more as constipation. Both of these things are linked by stress. And we can talk about the different mechanisms, but they manifest

• 14:21Speaker 01

  completely opposite ends of the spectrum. I think there's people who have like IBSM, which is IBS mix. And like, these terms, I think, like, don't actually really help anybody because they're not talking about the pathophysiology of what's going on. But that's just kind of how they've been classified. But there's a lot of people who have, and a lot of people with IBS have food sensitivities. They're not necessarily food allergies. Like if you did tests of their blood, those blood tests would be normal. It's not like an allergy that an allergist would treat you for. And they're not like celiac disease, which is this autoimmune condition where people have a reaction to gluten. But nonetheless, people with IBS and other people who don't have IBS have gluten intolerance all the time. So there's just a lot of different kinds of syndromes going on. Now, as I mentioned before, we used

• 15:05Speaker 01

  to not be able to get any kind of meaningful information from just a standard colonoscopy or an upper endoscopy. That's the, upper endoscopy is the like cyst or test of a colonoscopy where we look through the stomach and look at your small bowel. And a couple of years ago, a group of researchers in Belgium said, you know what? Like, maybe the reason we're never getting the answers during these endoscopy procedures is because we are doing them at the wrong time. And if you think about it, anyone who's gotten a colonoscopy before, you have to fast since at least midnight that night before, and you're taking the prep like later on. And that's of like, you know, a whole other conversation. Yeah, I know you feel like just got through this. And, and you know, and the prep is, you know, there we have strategies around that. But at any rate, you're not eating at the time.

• 15:50Speaker 01

  And there's a good reason why. And that's because when you eat, we don't want food in your stomach when you're under sedation to accidentally come back up and get into your lungs. Like, that's very dangerous. So there's a good reason why we did it that way. But if our goal is to understand why people have symptoms when they eat, is the wrong way to do the test. So researchers did this study that was actually ultimately published in Nature. It was like, if this was one of the studies that blew my mind and made me really get excited about, about research in this field. But what they did was say, okay, you know what we're going to do in this very controlled experimental environment? We're going to take people who have IBS and we are going to, through the scope, just spray this slurry of classic trigger foods, like dairy containing products, like gluten containing products, like seafood, et cetera.

• 16:34Speaker 01

  And we're just going to like gently spray a little bit onto that surface of the gut that we're seeing and just see what happens. We're going to watch it in real time. And to their surprise, to everyone's surprise who read this paper, these are people who they tested their blood for food allergies, who all their tests were otherwise normal. When they sprayed these certain trigger foods, they watched that surface of the, of the gut erupt in these kind of like wheels and red flares that you might see as if you're having an allergic reaction on the skin, but inside their guts. And you would never have seen this if you hadn't been looking at the time they were eating. And it told those researchers that, wow, every time this person is eating the foods

• 17:15Speaker 01

  that they're saying is triggering them, it is causing this like really real reaction, which if we were to see that happening to someone at the dinner table, we'd panic. We'd say, oh, my God, get, let's go to the emergency room. This is horrible. But somebody who's just sitting there looks fine and is saying, oh, I feel awful. Eventually, when all the tests are negative, everyone's like, Okay, well, you know, like, what, yeah, like, you're being difficult, like, this is like, I don't know why you're like, to eliminate all this stuff. But actually, there was a very real pathology. And so one of the things that they ultimately did was they looked at microscopically, what are these foods doing? Some of this was being mediated for some patients by mast cells. So mast cells are these inflammatory cells

• 17:57Speaker 01

  that are often seen in an allergic reaction in other parts of your body. In the stomach, in the, and in the small bowel, in these patients that they were looking at, they were just staying right there in the gut. So you wouldn't catch them. Like, if you got a blood test, they stay there, but they released all of these inflammatory compounds and molecules when they, when these foods came in contact with the surface of their, of their gut. And they, those mast cells triggered the nerve cells. So the nerve, we have nerve cells throughout our whole gut, those cause pain. So not only is there inflammation, but it's incredibly painful. People have abdominal discomfort and, and frank pain from eating these foods. And they were able to find in subsequent studies that if they were to give these patients medications that inhibited the mast cells,

• 18:43Speaker 01

  stop them from erupting and, and causing a lot of inflammation, they could mitigate their pain. That's huge. Like, we don't, that is one of those treatments that I think almost none of my patients who come in my clinic for IBS have ever been told is Never. a possibility, right? Like, yeah, it's, it's just not something that people usually think about because, again, their tests are not, like, who is thinking that they have, like, mast cell mediated problems, but they do in some subset of patients. Now, again, the problem is that I'm not doing that test on a lot of my patients with IBS who come in. And so, but what I am doing is thinking about this as a possibility, and I'm trying and seeing, and, and seeing what may or may not work.

• 19:25Speaker 01

  And so I think I'll say that, like, the gap here is that we do need to, and the field is working really hard to do this, we do need to come up with a way to do these kinds of tests. I don't think every single person with IBS has mast cell mediated disease, but clearly a lot of people do. We need to figure out how to identify them and treat them and not make it a little bit of guesswork. But until we can, at very least, it's important to find a doctor who is at least thinking about all these other possibilities and not just saying, why don't we get you on an SSRI or an SNRI for pain, which you may well need, and that would be great, but uh, but we can't stop right there.

• 20:01Abbey Sharp?

  Right. Oh, that is fascinating. Oh, my gosh. I love this science. I love it, baby. Okay, okay.

• 20:10Abbey Sharp?

  I want to do like a quick and dirty speed round on some like taboo poop subtopics.

• 20:15Speaker 01

  My favorite.

• 20:16Abbey Sharp?

  Love it. Thank you.

• 20:18Speaker 01

  Good.

• 20:18Abbey Sharp?

  Of course. Okay, you ready?

• 20:20Speaker 01

  Ready.

• 20:20Abbey Sharp?

  Let's do it. Can we make our shit not stick?

• 20:24Speaker 01

  There are a couple of different ways. So one, okay. The reason that our gas and our poop smells is being driven by sulfur. Okay, so that's present in and or created by a lot of the foods that we eat.

• 20:40Speaker 01

  Certain foods are known to trigger that reaction a little bit more strongly. So if you feel like really strongly, first of all, I, I, I don't think we should be so worried about poop stinking.

• 20:52Abbey Sharp?

  I agree.

• 20:52Speaker 01

  You're not. I just want to say like culturally, this is what it is, you know, and there's no one among us, no one who is immune. Okay. Like who has like the world's most beautiful smells. We're all doing the same thing and we shall be allowed to eat what makes us happy.

• 21:07Abbey Sharp?

  For sure.

• 21:07Speaker 01

  If, and I, I do think like I tell patients who have a lot of anxiety about pooping in public restrooms, like they're at work all day. They have no choice or they're traveling. And this is a lot, like I say, just carry around a little handheld spray, like they sell these like little poopery, like you can bring it. That will make you feel better. I don't think we owe that courtesy necessarily to the world, but like, fine, like if that helps you do that. If you have like a high stakes, like outing, conference, hot date, and you're like, they're, listen, I'm with you culturally. I like, don't, but I really don't want to stink up the place at my boyfriend's house that I've just started dating. Then I would say, take some Pepto Bismol before that event. Okay. Now Pepto Bismol,

• 21:51Speaker 01

  the bismuth, it's so Pepto Bismol is bismuth subsalicylate. The bismuth neutralizes 99% of those sulfur containing odors in our poop. Okay. Like, so we think of Pepto Bismol and bismuth.

• 22:03Abbey Sharp?

  No, it's a heartburn, indigestion, upset stomach, diarrhea.

• 22:08Speaker 01

  Oh, my.

• 22:08Abbey Sharp?

  Oh, my God.

• 22:10Speaker 01

  You grew up with the same commercials.

• 22:11Abbey Sharp?

  It just came out. Yeah.

• 22:12Speaker 01

  Yeah. It like, it triggered something real deep, right?

• 22:15Abbey Sharp?

  Yes.

• 22:16Speaker 01

  So that's what we think of it for. But, and this is not like the main reason I think people buy it, but it is very effective for the smell. So like, you know, I was just telling some, some of my patients, like around the holidays or whatever, you know, the event is, take a little bit beforehand and it will help you. Like if you have to go to the bathroom, as well, you should, you should feel comfortable doing that. Like anywhere you need to go and responding to the call of nature, or if you have to pass some gas, like this will help you for that. But other, if, if not, you could always carry your poopery with you.

• 22:47Abbey Sharp?

  I like that.

• 22:48Speaker 01

  And any other neutralizing spray.

• 22:50Abbey Sharp?

  I love that. And FYI, just so people know, like people, some people who feel like they get these like notoriously smelly farts, there are like a lot of supplements that are very popular that can cause more smelly farts, like collagen, creatine, BCAAs, whey protein, all of those like inulin chicory root fiber, you know, bars and things like that. Very popular. And if you're like wondering like, hey, I'm eating quote unquote healthier, why am I smell like, why am I so gassy and farty and it stinks? Maybe one of those things. So maybe the Pepto Bismol will help with that, too. I love that. I love that hack.

• 23:26Speaker 01

  It'll help. But I will tell you, just so nobody is surprised, Pepto Bismol also has this other side effect where it can turn your poop black. Okay. Like, so don't let that shock you. Don't be like, oh, my God, what's going on? Because the other thing that turns poop black is blood.

• 23:40Abbey Sharp?

  Oh, that's right.

• 23:41Speaker 01

  Yeah. Well, iron from blood, like if it's from, if you're bleeding in your stomach, it mixes with your acid, it turns black. Iron supplements do it, too. So. If you see that turn normally, like if you see black poop and you're not taking anything that should do it, you gotta call your doctor. You gotta maybe go to the emergency room, especially if you're feeling like you're in pain, dysolated, go to the emergency room. But if you start taking Vapivismal, you see a black poop, just know that that can happen.

• 24:07Abbey Sharp?

  Okay, good, good hot tip. I love that.

• 24:09Speaker 01

  Yes.

• 24:10Abbey Sharp?

  Okay, laxatives, like, I mean, we usually, you know, see a lot of people say, like, we should try to avoid like more stimulant laxatives like Sena, because they affect muscle contraction. If we want to use a laxative, go for more osmotic laxatives like Megcitrate or whatever. But if we are needing to rely on something like Sena or Dulcolax or whatever, like, what is the risk of our body becoming dependent on them if we use them regularly?

• 24:38Speaker 01

  One of the most common questions that I get. And so let's, let me just talk about laxatives in general, right? So there's different ways that you can try to make having a bowel movement easier. The osmotic laxatives, which are like Miralax or Lactulose, what those are trying to do is, is bring in this substance, like Miralax, into the, into your stool, and that draws water in from the rest of your body. It draws it into your colon, and it makes it nice and fluffy and soft, so it can pass easily. And for some people, that's enough. But there are, everybody's different. And so there are people where the problem is really not how soft or fluffy the poop is. Like, that could be sufficient, but it's just that the colon's not contracting. And that's more, that problem is often more a

• 25:22Speaker 01

  problem with the enteric nervous system, with the nerves. And so, in some cases, people, a stimulant laxative is very helpful, because that's really helping augment those contractions over. With everybody who needs a little bit of help, we try, usually we recommend saying, let's try adding fiber, let's change your diet, let's try exercising, because exercise also stimulates those contractions. So we try all those other things. But I have no, no problem telling people, if you need a medicine, you need something like a stimulant for, for the long term, like that's what you need, right? Like that's, I don't tell people with, um, you know, insulin dependent diabetes, you know, eventually we want to get you off your insulin. Right. You, that's just what you need. Like same with blood pressure. We congratulate people for being consistent with their

• 26:02Speaker 01

  blood pressure meds, but we all have this like fear and a little bit of embarrassment and stigma about needing a laxative. When our colon has diseases and conditions, just like every other organ in our body. And so like, I think we should eliminate that sense of shame. But with that sense of shame is also what you said is this fear that we've generated. I think we did this as doctors, that maybe you can become dependent on laxatives. So let me explain that. And specifically those stimulant laxatives like Sena, which, you know, I, I like Sena, um, because it is very powerful and it can come in like T form, which you can kind of titrate and people like that a lot. But, um, there have actually never been any studies that have convincingly shown that stimulant laxatives damage your body in any way, or that you develop a dependence, like a

• 26:47Speaker 01

  chemical neurological dependence on them. That is, that's totally not true. Um, and also what's not true is that you haven't, you don't develop, um, da- damage to your nerves such that when you stop them, you're actually in like a bigger hole than when you started. That's not been shown. So I think the reason this whole myth started was because some of the earlier clinical trials were for a shorter period of time, like two to three months, and they just didn't study them long term. At the time that the trials were done, we now have decades of data of people using these who, uh, do great with them. Right? Like it's true. When you, when you start them, you might be starting them because you have a condition that's not going to go away and you might just need them for life. But I will also tell you, and you may have experienced this yourself.

• 27:28Speaker 01

  Everybody's bowels respond so differently over the course of weeks, over the course of months, to different changes in your lifestyle, some of which you are aware that you've made. You might say like, I'm traveling right now. I know things are really off. You might not even know sometimes that, you know, how much your stress is affecting your body, or how much a, a small change in like an additive you're putting into your coffee is changing your stool, um, that. It I often tell people when I counsel them on starting laxatives, like, don't be surprised if you don't need this anymore.

• 27:59Abbey Sharp?

  Yeah.

• 27:59Speaker 01

  In a couple of weeks to months, like you, you, you, I know you have constipation, but this doesn't have to be for life and you might not even know why things have changed, but something will have changed in your life and, and that's okay. And you, we gotta just kind of keep going with the flow and titrating as things move along.

• 28:14Abbey Sharp?

  Yeah, that's great. That's great.

• 28:29Abbey Sharp?

  Okay, I've got another one, um, because there's this pervasive narrative that we have pounds and pounds of extra poop and toxins in our gut just sitting around and we need like a colon cleanse or a detox to like fix this problem.

• 28:41Speaker 01

  Yes.

• 28:41Abbey Sharp?

  What's, what are your thoughts?

• 28:43Speaker 01

  Uh, you know, part of me like almost wishes it were true. Like there are so many people I think who like want it to be the case that if they were just to detox, just to cleanse their colon, like all their problems would be solved. And yeah, maybe they'll shed 20 pounds, like who knows how much poop is just caked along the sides of the walls. This is the kind of stuff I hear.

• 29:01Abbey Sharp?

  Yeah.

• 29:01Speaker 01

  Um, it's not true. And the way I know it's not true is because I look inside people's colons every day and it's not there. And, and, um, when we're doing CT scans, we're doing colonoscopies, that's not there. Now, it's certainly true if you have, you know, a condition where you have a lot of constipation, the, you will have more poop in your body at any one, one time, but it's not like sort of like lining the walls and possibly get out. Your, the inside of your colon is so slippery. It's got like this mucus layer all over it that nothing is sticking to it the way I think people picture. And also if you're having a bowel movement every day, every other day, or more often, uh, as might be the case if you're having a high fiber diet, which I highly encourage, um, then you're going to be doing just fine.

• 29:45Speaker 01

  And, and this idea that something is in our bodies, it really dates back, like that's like putrifying was the word that was used like in the 1910s. Um, it comes from this idea that like when we eat things like meat or other kinds of foods that like when sitting out in room temperature go back. It's like, well, why, why it should, it's been in my body for a day. Like, shouldn't it go bad too? No, it's because when that food hits your body, it is immediately immersed in this highly acidic environment in your stomach. That breaks it down and then it moves on to your small bowel where it's further digested into the tiniest, tiniest

• 30:24Speaker 01

  portions that get absorbed by your body. So it's no longer in any way molecularly resembling that thing that's sitting out on your table. Uh, so you don't need to detox. You don't need to do colonic cleanses, which always make me a little nervous. The overall risk of a cleanse, the thing that worries me most is like someone would cause a little hole or a tear in their gut when they're putting things up there that they shouldn't. That risk is really low, but it's real enough that I think like, why would you do that? And why would you introduce things into your colon that don't belong? That could potentially throw off your microbiome. I don't love this idea at all, but I also think you don't need to do that because you know what? We have a liver that is detoxifying everything that comes through our guts for us and we have to treat our liver with respect. Don't get me wrong. Like we shouldn't.

• 31:06Speaker 01

  We shouldn't pound it with like five alcoholic drinks a day. That's really hard on the liver. And anything else that, you know, like a lot of ultra processed foods, these things do stress the liver out. But you're not going to undo that damage by doing a juice cleanse for three days. Like you will undo that damage by changing your lifestyle for the long term and, and changing a pattern of, of how you eat and, and things. So. So yes, to everybody who's like thinking like, let me just lose 20 pounds by trying to do this de-cox. That won't happen. It shouldn't happen. You're actually just going to lose a ton of water because you might give yourself a lot of diarrhea and then, and then it'll come back.

• 31:40Abbey Sharp?

  Yeah. And I mean, the irony of the juice cleanse for gut health is that these juices contain no fiber, which is actually what we want.

• 31:45Speaker 01

  Thank you.

• 31:46Abbey Sharp?

  When it comes to improving, improving her gut health and regular bowel movements. It gets so asinine and like.

• 31:51Speaker 01

  Mind blowing. Thank you for saying that. Yes.

• 31:55Abbey Sharp?

  And you kind of like touched on this, like with these cleanses, but like up the other end, I guess is the colonic. Like, should we be like flushing our, our bowels with coffee or just like warm water for God's sakes? Like. How dangerous is this?

• 32:10Speaker 01

  Well, like, so I have patients on every end of the spectrum of of disease. And so I I do have patients who have very serious colonic motility conditions who use enemas often.

• 32:21Abbey Sharp?

  Yes.

• 32:22Speaker 01

  Um, and they they're doing that for a medical reason and they're doing it in a controlled environment. We we know how to how to treat them and we and we help. But um, the average person who doesn't have those specific conditions shouldn't be putting things up there that don't belong, especially like anything that can cause trauma. That makes me worried. Um, and it makes me worried, like I said, because it could introduce a chemical in there that we don't want. It could also kind of disrupt the flora, the the microbiome in there. And we don't want that. And um, so there's and there's been absolutely zero studies, okay, of these like I of these coffee enemas or anything else, that they're going to help with any of the things that people I've people come to me for the just the wildest ideas about what they'll do for their bodies,

• 33:05Speaker 01

  but they don't do any of those things. The only thing an enema can do that has been shown is that it it can help like break up stool in there if you have like a really serious condition. Um, but that applies to so few people that I I really don't want the average person to think that this is a a good idea, because on TikTok, someone told them that it like really changed their life.

• 33:25Abbey Sharp?

  Yeah, yeah. And I mean, the reality is like, most people are getting these kind of colonic or like colon irrigation treatments at like sketchy med spas by like, who knows? These are not medically supervised. Like, that's also my concern with a lot of these these kind of treatments. But, okay, I want to finish off um, with a very quick discussion on um, you know, the pelvic floor piece, because in the book you talk about like the three P's of a good poop, um, propulsion, which is the pressure in our bodies to push the stool out, pliability, which comes down to like the softness of the stool, which I'll talk about at the end of the show myself, and then pelvic floor, which I feel like no one is talking about in the context of IBS.

• 34:08Speaker 01

  Totally.

• 34:08Abbey Sharp?

  So can you like, talk a little bit about like, why is the pelvic floor and like, how is that involved in like, our ability to have a good bowel movement for especially for folks who like are struggling? Talking with that IBS piece.

• 34:21Speaker 01

  Yes, I I am totally in agreement with you that the pelvic floor is on nobody's radar. When we hear pelvic floor, everyone thinks like, oh, we're talking about like traumatic childbirth situations. And like, someone's like, oh, yeah, I got pelvic floor PT. We think that that's like referring to just women.

• 34:39Abbey Sharp?

  Yep.

• 34:39Speaker 01

  Who are getting PT for like urinary incontinence or other kinds of issues related to like some traumatic childbirth situation.

• 34:46Speaker 01

  It is an incredibly common and underappreciated problem for constipation. Like completely separate from anything related to what's going on in the front. And what we think is happening and and the and it the problem is that it can look, when you have what's called pelvic floor dysfunction, it can look very similar to IBS, to just chronic constipation. You yourself might not know, your doctor might not know, just hearing your story, whether the issue is an issue with the colon not pushing moving things along or the pelvic floor not relaxing and contracting appropriately. So the pelvic floor is several different muscles that make up the very end

• 35:30Speaker 01

  of the both the gut, because the gut at the very end has these two sphincters, the internal and external anal sphincter, those are considered part of the pelvic floor. And yes, you have two sphincters, they're like wrapped around each other. And then all these muscles that kind of support the end of the colon called the rectum and and just the like bottom part of the the area. And paradoxically, what we need to happen with those sphincters is we need them, they're usually should be nice and contracted at rest, right? Otherwise, we'd all have a problem all day long. But when we're going to the bathroom, we're trying to poop, we paradoxically need them to relax and open up. But while we need them to do that, we are bearing down and straining.

• 36:12Speaker 01

  And if you think about that, like I'm doing this right now, my hands are clenched, I'm clenching. But I want those sphincters to relax and open up. And it's like, it feels like this should be like pooping should be the most intuitive thing in the world. Everybody does it, and yet a lot of us are not doing it wrong. And we eventually. The more we strain, maybe we start straining more because of another problem, because of a lack of fiber, because we have slow motility for some other reason. We start to strain more, the more we strain, the more we train without really knowing it, subconsciously, those sphincters to tighten up, such that even when we remove the thing that was the problem the first was, maybe we go on a higher fiber diet. We started eating like the Mediterranean lifestyle and suddenly that problem's gone away.

• 36:56Speaker 01

  The sphincters have changed. We've trained them wrong, right? And that, that is so common. People say like, I went, I like in college, my college years is when this all started. And it's because people, that's like a time when people really change their diets, change their lifestyle. And then that lingers. And so it could be that now you're in your thirties, forties, and you're struggling. And it's because of just this change that has happened slowly but surely over the years. Your muscles have changed. The good news about this is that, one, we can easily test for it. It's done at specialized GI centers, but every kind of major city will, will have people who test this. But it's a simple test that basically just looks like, are the muscles in your pelvic floor relaxing at the right time? And are they contracting appropriately at the right time to give you that push? And if you ha- if you have pelvic floor dysfunction,

• 37:42Speaker 01

  eighty to ninety percent of people will get better just with PT, just with physical therapy. Like just get better after two to three months of this. Like, we're not talking about a lifelong medication. We're just talking about retraining. And it's a special kind of physical therapy called biofeedback, but it is like just an incredibly helpful thing that if more people knew about it, a lot more people would get help easily because I sometimes liken the pelvic floor to being like a tube of toothpaste, right? So we're going to hit you with all these laxatives. That's what you're going to be doing at home and what your doctor will tell you that are trying to squeeze toothpaste out of the tube. So they'll, they'll make the squeeze stronger, they'll make the toothpaste softer. But if we never take that cap off, then nothing's going to ever come out. And sometimes when I send a patient to pelvic floor physical therapy with this biofeedback therapy,

• 38:26Speaker 01

  It is like suddenly that cap gets taken off and they like all these laxatives they're taking, they're like, whoa, we don't, we actually never needed this in the first place. Or like, we have like overshot and you can come back, but until you do, they're like, I've tried so many laxatives, I've tried everything on the books, the prescription stuff, the over the counter stuff, nothing is working. If that sounds like you, you should really think about pelvic, and that's actually what the American Gastroenterological, the American College of Gastroenterology have these guidelines that say, if somebody with constipation has failed one or more of these laxatives, you have to think about pelvic floors, you have to look for it and test it.

• 39:00Abbey Sharp?

  I am so grateful that you brought this up. And actually, in reading the book, I have to tell you, I was like, inspired to make an appointment. I had an assessment yesterday.

• 39:11Speaker 01

  Good for you.

• 39:12Abbey Sharp?

  It's weird, guys. It's weird. Like, it's weird. They're, someone's putting their fingers up your ass and pressing around a little in there. But I think that you're right, like, this is not being talked about. No doctors ever told me to consider this.

• 39:33Speaker 01

  Yes.

• 39:33Abbey Sharp?

  And so, yeah, I think that this, this is really the way forward for a lot of people who have tried everything else, to really just kind of like relearn that piece. So I'm grateful for, for reading your book and, and for you spreading these words because unfortunately, while this topic remains taboo, like, it shouldn't be because we're all going through it. And

• 39:55Speaker 01

  Yes.

• 39:56Abbey Sharp?

  Everybody knows how good it feels to have a good poop. So like,

• 40:01Speaker 01

  Yes.

• 40:01Abbey Sharp?

  We really, like, we all really want this. Whether we want to talk about it or not, we want this. We want this, guys. So, uh, this is fantastic. Definitely, everyone listening, preorder Tricia's book, You've Been Pooping All Wrong. I read it. I loved it. And so, I'm going to also, of course, be leaving lots of links to where everyone can find your content because it is fantastic. So I love it. We'll all be taking a step towards pooforia, as you call it. I think this is great.

• 40:30Speaker 01

  Thank you, Abby. Thank you for having me on.

• 40:33Abbey Sharp?

  Thank you.

• 40:35Abbey Sharp?

  Okay, guys, I have gotten so much out of today's conversation and even more out of Tricia's book. Just putting it out there, it is a winner. Now, as we close up, I really want to lend my experience and expertise to the second P of Tricia's three Ps of pooping, AKA the pliability, as this is where nutrition and lifestyle comes into play. So here's a really quick and dirty of what I, as a dietitian, want you to focus on if you're aiming for perfect soft sausage-like stools every time. Number one, dial in your fiber, but don't go too nuts. We want to aim for around 25 to 38 grams for women and

• 41:20Abbey Sharp?

  men respectively. Ideally from a combination of soluble fiber, which makes our stool soft and smooth, so things like oats, chia, flaxseedum, apples, beans, and barley, and insoluble fiber, which adds bulk and speeds things up from things like veggies, whole grains, and the skins of other plants. In Tricia's book, she recommends adding a silium fiber supplement, which is really the gold standard. But if you find that it causes some bloating, I actually much prefer partially hydrolyzed guar gum, which is another low FODMAP soluble fiber that dissolves clear and is a lot easier for folks prone to gas and bloating.

• 42:01Abbey Sharp?

  Number two, pay attention to hydration. If your stool looks like hard pebbles, you need to up your water with small sips throughout the day. If your stool is really super duper loose or watery, it's time to up the fiber and probably to limit the alcohol and caffeine. Number three, eat consistently and eat enough calories. Skipping meals, eating erratically, and under eating can significantly disrupt motility because your body is not getting that gastrocolic reflex that tells you that it's time to poop. And then over time, with consistent under eating, you will eventually see your GI muscles

• 42:44Abbey Sharp?

  ...atrophy, which slows down your motility. So make sure you're consistently eating at least three meals a day at regular times with enough calories total to fuel your body, while also adding in a source of fluid, fiber, protein, and some healthy fats, AKA my hunger crushing combo. Number five, practice a relaxing morning routine, which might mean getting up a few minutes before your family so that you can have a quiet cup of coffee, tea, or water, go for a little quick walk, or do some gentle stretching, or perhaps engage in other acts of quiet, peaceful self-care. A relaxed mind will mean a relaxed bowel.

• 43:29Abbey Sharp?

  But on that note, happy pooping, my friends. I hope that people can feel that this is a safe place to learn about just like a traditionally taboo topic that really should not be taboo at all, because say it with me, folks, everybody poops. And a big thank you again to Dr. Trisha for teaching us how to reclaim our inherent pooping wisdom. I will be leaving a link in the show notes for where you can find her new book, You've Been Pooping All Wrong. Signing off with Science and SaaS, I'm Abby Sharp. Thanks for listening.

• 44:11Speaker 00

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