Fiber Maxxing and Poo Maxxing, with Dr. Trisha Pasricha

Have you been puzzled by your poos or felt down about your dumps?? You’re not alone! So many of us are struggling with gut issues, which is why fiber is having a major moment. But even though we’re secretly guzzling psyllium husk, tons of us are too embarrassed to talk about our poo problems. No more! We’re putting an end to the silence on stool with Dr. Trisha Pasricha. She’s a neurogastroenterologist and author of “You’ve Been Pooping All Wrong.” We find out what poo actually IS and how often you should go — plus, we get the dirt on the surprising connection between your brain and your gut, and how it might be the key to understanding diseases like Parkinson’s. Find our transcript here: ScienceVs In this episode, we cover: Time stamp and titles for each chapter (first chapter must start at 00:00, minimum 3 chapters) (00:00) Intro (02:45) What does it mean to reach “poophoria”?? (04:37) Living in a poo-forward household (05:54) Stomach lie detector (11:06) That sinking feeling in your stomach (13:48) The gut-brain connection (17:05) Parkinson’s and Alzheimer's (22:05) Fecal transplants (26:09) Poo 101 (29:46) Fiber-maxxing and how often you should go (34:52) Why you shouldn’t linger on the toilet (43:09) Myths around poo (49:42) Oddball questions This episode was produced by Ekedi Fausther-Keeys and Wendy Zukerman, with help from Rose Rimler, Meryl Horn, and Michelle Dang. We’re edited by Blythe Terrell. Wendy Zukerman is the executive producer. Fact checking by Erica Akiko Howard. Video editing and sound by Bobby Lord. Music written by Bumi Hidaka, Peter Leonard, Emma Munger and Bobby Lord. Thanks to the researchers we spoke to for this episode including Dr. Jessica Biesiekierski, as well as Humdinger Studios in Melbourne, and WGBH Studios in Boston. Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. You can also find us on YouTube, TikTok and Instagram. Learn more about your ad choices. Visit podcastchoices.com/adchoices

• 0:01Speaker 00

  It is not the same poop. Two hours from now, you are dealing with a different poop than the one you are when the call comes. First of all, can we talk about what the call is?

• 0:10Speaker 01

  Yes, please.

• 0:11Speaker 00

  The call is simply the rectum spasming. That's what that feeling is, that sensation like, shoot, I gotta go. Suddenly, what is this? It's your rectum spasming.

• 0:21Speaker 01

  Wow. Do do do. Science chats with our favorite nerds. Yeah. Are you pooing all wrong? Hi, I'm Wendy Zukerman, and this is Science Versus. Today on the show, why so many of us have gut issues, what we can do about it, and how healthier poos might just make you happier. A survey of more than 70,000 Americans found that in just one week, around one in four had abdominal pain, one in five said they'd felt bloating, diarrhea, and/or constipation, and one in 20 people said they'd pooed their pants.

• 1:04Speaker 01

  That's a lot of us dealing with this crap. And worse still, surveys find that many of us are just too embarrassed to talk about this stuff with our doctor. And so, we just live like this in silence. But no more. Our guest today is a caca warrior. She is fighting the good fight here. Her name is Dr. Trisha Pasricha. She's a neurogastroenterologist at Harvard Medical School and director of the Institute for Gut-Brain Research at Beth Israel Deaconess Medical Center, where she researches how diseases in your brain, like Parkinson's, can start in your gut. Trisha also wrote the bestselling book called, You've Been Pooping All Wrong, because she

• 1:47Speaker 01

  ultimately wants us to open up our hearts and our sphincters and learn more about how we can take care of our guts and go to the toilet just right. She wrote in her book that it's time to give your poop the Cinderella moment it deserves. So pop on your gown and your glass slippers, but forget the ballroom. We're heading to the bathroom. Let's get this potty started. Let's learn all about poo and turds and how we can start feeling healthier in our guts. And if you know someone who is having gut troubles, spends ages in the toilet, send them this episode. They will laugh and learn.

• 2:38Speaker 02

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• 4:00Speaker 02

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• 4:08Speaker 03

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• 4:45Speaker 01

  Hi, Trisha. Welcome to the show. Oh my gosh, thank you for having me. We're gonna have so much fun. I've done my morning poo already, so.

• 4:53Speaker 00

  Oh my God, in honor of. I'm so delighted.

• 5:01Speaker 01

  So, Trisha, you have a dream.

• 5:03Speaker 00

  You have a dream.

• 5:05Speaker 01

  To give us poop foria. Is that right?

• 5:11Speaker 00

  Poop foria, that's what I want everyone to achieve. And despite what I think people think when they hear that term, it's actually a state where thinking about your bowel movements, poop, poo, is the absolute least of your daily concerns. It's where you're not thinking about this day to day, where it just happens effortlessly, quickly, and you're done. And you feel light, easy, you go about the rest of your day, and you're not obsessing about this. That's what poo foria is.

• 5:39Speaker 01

  Ah, okay. Because it does also sound like that great feeling when you evacuate very well.

• 5:45Speaker 00

  That's like, I just, I think that's straight up euphoria. But just the state of being of poo foria, that's like a way of life.

• 5:55Speaker 01

  And how many of us do not have poo foria right now?

• 5:58Speaker 00

  There is a study, 40% of Americans say that their bowel habits disrupt their daily lives. So that is like a huge, I mean, when I heard that statistic, it's a couple of years old now, I was astounded. That's like almost one in two of us who are quietly dealing with it. And that doesn't mean that's 40% of people who have a diagnosis of some kind, you know, who have even sought attention for it. But it's 40% of people who maybe are just quietly suffering with this daily problem that really shouldn't be a problem for that many people.

• 6:27Speaker 01

  Yeah. Yeah. So today, we're not gonna, we're not gonna suffer quietly. We are gonna be loud and proud.

• 6:34Speaker 00

  Loudly. We're gonna suffer loudly.

• 6:36Speaker 01

  So, Trisha, clearly you love talking about poo. Very comfortable with talking about our guts. And you have tied this to growing up in a very poo-forward house, that there's no shame around poo. Your dad is a gastroenterologist. Tell us about what was it like growing up in this dream home?

• 6:58Speaker 00

  It's the best. So my, yeah, my dad is a gastroenterologist, and he was and is a neurogastroenterologist like myself. But when he got into the field, neurogastroenterology was like really emerging, like it was a pretty new field.

• 7:14Speaker 01

  This is all about the gut-brain, gut-nerves connection.

• 7:18Speaker 00

  Yeah. The like brain in your gut. Like, we were learning so much about the enteric nervous system. That's the brain that's in the gut that we now know is like running the show in our bodies.

• 7:28Speaker 01

  Yeah.

• 7:29Speaker 00

  And so, he's, he's a scientist. And so, he would bring all of this excitement home about all the studies he was doing. And like, he'd want to share with us at the dinner table, because that was like our time together. You know, and like, you can't talk about how cool the enteric nervous system is if you can't say the word poop. Like, you're not gonna get past and like get to the good stuff if you can't have a conversation about it. And that's what it was like growing up.

• 7:54Speaker 01

  Now, when you were in the seventh grade, there was a very important dinner conversation that happened that kicked off a study, really, that you did. Can you tell us about this? So, I guess I'll, I'll start you off, because in your book, you, you describe your dad talking about this device that he was using to better understand gastroparesis, which is where the stomach doesn't empty properly into the small bowel.

• 8:21Speaker 00

  Yes, exactly.

• 8:22Speaker 01

  And from this dinner table chat, you wrote in your book, a crazy plan was beginning to form.

• 8:32Speaker 01

  What was the crazy plan?

• 8:35Speaker 00

  Well, okay, the other half of me that you have to know about is that I, I mean, if you thought I had a weird enough childhood experience, my mother used to work for the FBI. That was the other half of my childhood.

• 8:46Speaker 01

  Amazing.

• 8:47Speaker 00

  We're all very proud of her, but she could never tell us about what she did for the FBI. Because she'd have to kill us. Just kidding. I don't, I don't know if that part's true, but at any rate, we didn't know too much about what she, we just knew it was so cool that she worked for the FBI and like, I wish I knew. So, but one thing she did tell us about was lie detector test. That was a big thing at the FBI in the 1980s, 1990s. And how basically, how tough they were sometimes to pass. But also how, you know, she had to go through one to get her job. And then I think she was trying to improve it and perfect it.

• 9:19Speaker 01

  And when you say how hard it is to pass, as in even if you're telling the truth, it looks like you're lying?

• 9:25Speaker 00

  Yeah, like, you know, so the main way that people traditionally did a lie detector test was through something that's basically like an EKG, an electrocardiogram. And that measures your heart rate, right? But the problem is that, you know, like if you're unprepared and you're just stressed, like you can, your heart will be beating.

• 9:41Speaker 01

  Yeah.

• 9:41Speaker 00

  Like sort of, and it's like hard, and then you're like, oh my God, now I'm like caught in a lie and it'll really spike. But if you're really good and you know how to beat the lie detector test, like this was during the Cold War, this is how I know these stories. But so like these spies would put these tacks in their shoe and they would step on a tack every time they were asked a question. And that pain would cause their heart rate to spike. So whether they were telling the truth or lying, it would look like their heart rate just kind of runs a little high. And that was like an old spy trick, I'm told.

• 10:08Speaker 01

  Gosh, what I would, what I would, who I would have killed to be at your dinner table growing up. Oh my gosh. Poo on one side, spies on the other. This is amazing.

• 10:19Speaker 00

  And the perfect marriage. Do you really think about it?

• 10:22Speaker 01

  A hundred percent. Oh my goodness.

• 10:25Speaker 00

  Remarkably, these two get along like songbirds. They are like just a perfect couple. But at any rate, so I thought a lot about the fact that, you know, we've, spies had come up with these ways to mask their heart rate, but nobody could beat, I was a theater kid, nobody had figured out how to hide this feeling that you get when you're nervous, going on stage or telling a lie, where you get this like, you know what I'm talking about? This sinking feeling in the pit of your stomach.

• 10:53Speaker 01

  Yes.

• 10:53Speaker 00

  And yeah, your heart's racing too, but that's something else. There's like something else happening where you feel like this cannonball drop.

• 10:59Speaker 01

  Yes.

• 11:00Speaker 00

  In your gut.

• 11:00Speaker 01

  Yes.

• 11:01Speaker 00

  What was that feeling was what I thought about a lot growing up. And how do we capture whatever that thing was? And so, formative dinner table experience.

• 11:10Speaker 01

  Yes.

• 11:10Speaker 00

  Seventh grade, my dad is telling me this completely, you know, he's always talking about his research and he's like very excited to try to explain what he's doing. So he tells me about this device called an EGG, an electro gastrogram, which is very similar to the electrocardiogram, but it's measuring the electrical activity of the stomach. And that was my lightbulb moment because this whole, like for years I've been thinking about, how do I make the lie detector test better?

• 11:34Speaker 01

  Yeah.

• 11:34Speaker 00

  And then my dad tells me, there's this fringe device out there that just scientists in neurogastrontology know about and care about and have been studying. And I'm like, wait, you could use your stomach as a lie detector? What if we use the EGG? And I like, I was like, you know, I think I had like pressured speech and I was like telling my parents like all about my GGG's plan. And at the end of it, my dad was like, great, whoa, why don't you study it? And so we did. So for the next like, and it took me a long time to do this study. But for the next several years, kind of perfected the protocol, brought in volunteers, had people basically assigned to randomize either telling the truth or lying while I was measuring the electrical activity.

• 12:18Speaker 00

  And the cool thing that I found is that when you tell a lie, your electrical activity of your stomach, which actually you have a normal rhythm, your stomach, when you're not eating, contracts at about three cycles per minute. And that's happening, you don't know about it, it's happening in the background. When you're nervous, when you're telling a lie, that rhythm gets thrown into total chaos. It's called arrhythmia. There's no set pattern and you can see it happen, even if that person is like looking cool as a cucumber and they're acting natural, they're talking naturally, you see this change happening in their stomach when they get nervous.

• 12:52Speaker 01

  Wow.

• 12:53Speaker 00

  And that's what we measured and it, you know, I went on to fame and fortune in my high school. I'm just kidding. I won a science fair, but I did not get to sit at the cool kids' table. But it was kind of what got me excited to become a scientist myself.

• 13:06Speaker 01

  So what do we know about what is that cannonball feeling, that pit in your stomach?

• 13:11Speaker 00

  Yeah. What is happening is your amygdala sends this signal to release this hormone called corticotrophin releasing hormone. And that in turn goes through the bloodstream and starts this cascade that ultimately grinds your stomach to a halt.

• 13:26Speaker 01

  Hmm. So a hormone gets released.

• 13:30Speaker 00

  Yep.

• 13:30Speaker 01

  Stomach slows down.

• 13:33Speaker 00

  But there's a but.

• 13:34Speaker 01

  Mm hmm.

• 13:35Speaker 00

  There's a literal but, which is that your colon speeds up. When this is happening, that same hormone, which is slowing down your stomach, causes your colon to rev up, which is why a lot of people are like, why do I have to poop right before it's like my turn at karaoke or right before my, I have to give a presentation? Like suddenly I have to go, and then once your presentation's over, you actually don't have to go to the bathroom. Like you're fine. Well, it's because that same hormone, which is making you feel nauseated, like you want to throw up, is also making you have to go to the bathroom at the same time. And once you calm down, once this, that stressor is over, all of it kind of goes back to its normal function very quickly.

• 14:10Speaker 01

  Interesting. And so Tricia, you seem to have very visceral memories of blowing your lines on stage as a theater kid.

• 14:18Speaker 00

  I know. This is a core memory.

• 14:20Speaker 01

  Is there one? Tell me, what are you thinking of?

• 14:23Speaker 00

  Oh my gosh, why are you doing this to me, Wendy? Okay, it was the high school production of Christmas Carol. I was the ghost of Christmas past. It was like a prize, like the, I nailed the audition, like people were jealous, man. And so I'm on stage and I don't even remember the line anymore because I only remember the emotion, but I do remember I'm like through, halfway through my monologue and I just totally like cannot remember where to go. And there's these like awkward silence where I'm like grasping, the wheels are going and I'm like, what do I do? What do I do? And I feel that's like that sensation. And luckily my, you know, I don't know what the word is, co-star, like the other, the dude who was playing Ebenezer Scrooge, he like jumped in and just kept going, we just

• 15:08Speaker 00

  kept going, but I thought about that. Not only do I, did I think about it like after it happened, I sometimes, you know, I'm, how old am I? I'm like 37. I wake up, I have dreams. I like, I'm on stage and I can't remember what is the play I'm even here for, like what are my lines? So anyway, formative memory. I know really deeply what that feeling is. Obviously I had to study it.

• 15:30Speaker 01

  Wow. But you didn't, you didn't put your pants or anything?

• 15:34Speaker 00

  No, thank God. That would have really taken.

• 15:37Speaker 01

  Could have been worse, is what I'm trying to say.

• 15:39Speaker 00

  Way worse, yeah.

• 15:40Speaker 01

  So, don't worry, I won't talk to you about any more memories from, from high school.

• 15:46Speaker 00

  Appreciate you.

• 15:47Speaker 01

  Um, so in your book, you describe, going back to sort of our scientific understanding of what's happening in our guts when we're nervous throughout the day as our emotions are going up and down. You describe this fascinating case report from the 1940s of a soldier?

• 16:06Speaker 00

  Yes.

• 16:07Speaker 01

  Tell me about this study.

• 16:09Speaker 00

  It was World War II. And there was a soldier who was in this ward and because of his wounds, his whole abdomen is exposed. And so the doctor who's taking care of him can see his abdomen. And what's interesting is that he found that this soldier, he could like literally watch in real time, how quickly his stomach is moving, whether he's having a lot of what we call peristalsis or movements in the gut. And when his gut seemed to be calm and happy and relaxed. And what he found is that, yeah, like when he ate, there was some movements of it, like when he was kind of walking around and exerting himself, like he could see movement. But it was during moments of psychological stress that he saw suddenly the most amount of movement through his gut.

• 16:54Speaker 00

  And so there was this moment that he documented and wrote about where a bunch of fellow soldiers are brought in who are like freshly wounded, hot off the battlefield. I think it was a really traumatic moment in the ward and the patient was very, very stressed and upset by it. That's when the most movement occurred. And witnessing this, he writes it up. It sparks part of the journey of a doctor from Cornell, who's reading this, again, it's 1940s. And he's like, let me do so, a set of experiments to prove this, to show that not physical stress, but psychological stress causes acute changes to our gut. So then he starts to do these experiments where he puts people live through a set of kind of psychological tests. Like he'll say, tell me about, you know, your stressful marriage or talk to me about

• 17:38Speaker 00

  this like difficult relationship you have with your son. And he even pretended to find cancer in one of his patients. And this is like ethics is like a whole separate conversation about these studies. Like I, it was a problem, but.

• 17:48Speaker 01

  Yeah.

• 17:49Speaker 00

  What he found is that while he's putting these people through it and he's looking through this like early version of a colonoscope, so like kind of a rigid scope, looking from the inside. He saw that when they were stressed out and talking about these difficult experiences, he could see the rectum spasming and moving, right? And this is something we experience, right? Like we, like I felt it on stage, like we feel this all the time when we're really acutely stressed.

• 18:13Speaker 01

  So how is the brain and the gut and communicating with each other? What is exactly happening there?

• 18:21Speaker 00

  Yeah. So remember, okay, so we've got the brain in our heads. And the brain in our heads is this big collection, essentially a network of neurons. And you actually have a very similar set. You have like these two sets of neurons throughout your whole gut. And that's what we call the enteric nervous system or the brain in your gut. So the main way it communicates and has to communicate is through the vagus nerve. The vagus nerve is this big, is you know, like wandering, hence the name vagus for wandering nerve that has these tendrils that go throughout the organs of your body. But the gut really gets the lion's share of that innervation. And what's fascinating is that much of that communication is going from the gut up to the brain.

• 19:05Speaker 01

  And you, in your lab, you study how diseases that we commonly think of as being brain diseases actually are interacting with the gut in interesting ways. And I'm thinking of Alzheimer's, Parkinson's disease.

• 19:17Speaker 00

  Yeah, yeah.

• 19:19Speaker 01

  And in fact, in James Parkinson's seminal essay on Parkinson's disease in

• 19:25Speaker 00

  Yes.

• 19:26Speaker 01

  1817, which he called The Shaking Palsy, he talked about how Parkinson's was connected to the stomach and the bowels. So tell me, what is the connection here?

• 19:42Speaker 00

  Yeah. You know, in those case series that he wrote about, he's describing tremors, he's describing difficulty with walking and movement, like all of the classic symptoms we think about with Parkinson's. But in several of the patients, he also writes about how severe their constipation was. Like, it is so bad, laxatives are not working. And he's writing about this over and over, but it's not clear to him at that point in time why, or if this is connected in some way to the Parkinson's. It seems like it should be, but it's not clear why. And I would say for the next almost 200 years, people thought about Parkinson's as being in the brain, starting in the brain, almost ending in the brain. The hallmark of Parkinson's is this protein called alpha-synuclein protein, and it misfolds

• 20:27Speaker 00

  in Parkinson's disease.

• 20:28Speaker 01

  In the brain, you can see this protein misfolding.

• 20:32Speaker 00

  Yes, and they've done, and this is like just incredibly well-studied because they've done autopsy studies, we know really well what happens to alpha-synuclein in the brain.

• 20:40Speaker 01

  Mm-hmm.

• 20:41Speaker 00

  When it misfolds, it causes, it's part of the reason why dopamine neurons die. And those dopamine neurons in the brain are what's responsible for movement. And so that's why the tremors, the rigidity and these things start to develop. But it turns out that if you were to do autopsies on people who have Parkinson's disease, you actually would see that their guts too are riddled with misfolded alpha-synuclein protein.

• 21:04Speaker 01

  Hmm.

• 21:06Speaker 00

  And in the case of the gut, what we think can happen is that that misfolded protein sort of bumps up into other alpha-synuclein and induces that alpha-synuclein protein to misfold, and it just propagates and propagates.

• 21:18Speaker 01

  It's like a domino effect all the way.

• 21:20Speaker 00

  Yeah.

• 21:21Speaker 01

  And then it, and then it gets into the brain. How?

• 21:24Speaker 00

  Slowly but surely through the vagus nerve. And that's a process that takes years. And you might say, okay, how do we know that? And we know it for several ways, but one way is we've staged it. Like, you can inject in mice, you can inject preformed alpha-synuclein sort of fibrils and watch them misfold. And you can stage, you can watch it track from the stomach up the vagus nerve and then to the brain.

• 21:51Speaker 01

  It's going, the protein is moving through the vagus nerve?

• 21:54Speaker 00

  It's moving upwards. It's almost like a prion, because it's like, you know, once it comes in contact with another alpha-synuclein protein, that one starts to misfold, and it sort of moves like that.

• 22:02Speaker 01

  Wow.

• 22:04Speaker 00

  And if you ask, and this is what I started to ask my patients when I was just starting out as a gastroenterologist, my patients with Parkinson's disease, if you ask them, 80% of people with Parkinson's disease, one, have GI symptoms. The overwhelming majority have GI symptoms. And many of them will say, my constipation started years, if not decades, before my tremors started, started well before.

• 22:28Speaker 01

  So I just think now anyone with constipation listening is gonna be freaking out here.

• 22:34Speaker 00

  Yes, right. We don't want that. We do not want that.

• 22:37Speaker 01

  What, how should they be thinking about this? How should we all be thinking about trying to use this information to reduce our risk of Parkinson's disease?

• 22:45Speaker 00

  So, yeah, a few things about this. So one, constipation will come for us all at some point or another. Like, so like, if we were to say everyone who gets constipation is gonna get Parkinson's, we'd be in trouble. You know, as we age, we get more risk of constipation. When we go on vacation, we get constipation. So don't, don't feel that just because you're constipated, you're gonna get Parkinson's disease. The way I think about it is if somebody comes to my clinic and they're like, you know, like 40s, 50s, new constipation, not something they've ever dealt with before, first of all, I look for other things that could be going on and causing it. If they were to say, you know what, like, I also, I lost my sense of smell a couple of years ago, or I've been having trouble sleeping, I'm acting out my dreams, that's another sign of prodromal Parkinson's.

• 23:27Speaker 00

  If you start to tell me about constipation plus other signs, other symptoms, oh, by the way, my grandfather had Parkinson's disease, that's when I start to take this a little bit more seriously and I say, you know what, we should really think about it. And frankly, you know, the ways that we would tell somebody, look, you're worried about Parkinson's, let's reduce your risk for it, the things I'm about to tell you to do that are the things that, like, we should probably all be doing anyway. The things that have been shown to reduce your risk for Parkinson's, number one is exercise. And, and not, not just sort of like low, you know, walking, but like moderate to vigorous physical activity regularly every week. It's been shown to reduce your risk of Parkinson's, but also slow progression.

• 24:05Speaker 01

  And we just keep learning about the ways that the gut and the gut microbiome more generally are contributing to many different diseases. And I wanted to get your take on this just fascinating study that came out about peanut allergies just recently. So basically what they did is they did a fecal transplant and

• 24:27Speaker 00

  Yes.

• 24:28Speaker 01

  It's, that found that it might help some people with peanut allergies. And I have been fascinated to hear that scientists are no longer giving people poo smoothies, which they used to. Do you remember the days of the poo smoothies?

• 24:40Speaker 00

  These were capsules, right?

• 24:41Speaker 01

  They were like frozen capsules. I remember

• 24:44Speaker 00

  Thank goodness.

• 24:45Speaker 01

  Reporting on, and they literally had a blender in the lab. So anyway, science progressing all the time.

• 24:53Speaker 00

  You have to start somewhere, right?

• 24:54Speaker 01

  You have to start somewhere. So in this study, very civilized, frozen poo pills, and they gave them to 15 people with peanut allergies, and six of them could then handle more peanuts. They then did this thing called the challenge, you give people peanuts.

• 25:11Speaker 00

  Yeah.

• 25:12Speaker 01

  And they found that, you know, yeah, for six out of the 15, it did help them, they could handle more peanuts after this fecal transplant. What do you think is happening here? Why might, obviously, small study, didn't help everyone, but why

• 25:26Speaker 00

  Right.

• 25:27Speaker 01

  might changing your microbiome help with a peanut allergy?

• 25:32Speaker 00

  Allergies, peanut allergies, doesn't feel like it should have anything to do with anything related to your colon per se, but I think what people don't appreciate is that your gut is actually your largest immune organ.

• 25:44Speaker 01

  It's huge.

• 25:45Speaker 00

  And it has to be that way because we are putting god knows what into our bodies every single day.

• 25:52Speaker 01

  It's the welcome mat for the world, in a way, our gut, right?

• 25:56Speaker 00

  Yes, it is, right. Like, but our body does a great job of filtering out and making sure we don't get harmed. But to the point is, our microbes, they play a big role in teaching our immune system how to behave, right? So in this case, in the peanut allergy, they think that part of why the fecal transplant helped, because the fecal transplant sort of potentially primed some of these people, didn't work for everybody, but some of them, with bacteria that could help dampen that allergic immune response. And so I think it's interesting, this was a phase one trial.

• 26:32Speaker 01

  Hmm.

• 26:33Speaker 00

  We've done a lot of good studies on fecal microbiota transplant that have not panned out. I want to be really clear about this, because I get this kind of all the time. Everyone's like, hey, should I, should I blend my cousin's poop in the smoothie? Because, like, I get this. Don't, first of all, do not try this at home.

• 26:48Speaker 01

  Oh, gosh, don't DIY, don't DIY your fecal transplants.

• 26:52Speaker 00

  We never, never.

• 26:54Speaker 01

  What has it not worked for, by the way?

• 26:56Speaker 00

  It's not worked for Parkinson's disease. You know, you can imagine there's a lot of excitement about that.

• 27:02Speaker 01

  Okay.

• 27:03Speaker 00

  And I don't think it's because it can't work, won't work. I think it's because it's so complicated. Like, who's got the right poop? Like, whose poop do we consider normal? Whose poop do we consider healthy? Is there such thing? I think this is a step in the right direction, but I just want to like, sort of like, just bring everyone back down to earth for like a hot minute, which is to say, like, we're not there yet with FMT.

• 27:26Speaker 01

  After the break, some of the worst advice that Tricia is hearing online about how we can take care of our guts. You want to hear this, trust me. And if you've got a friend that has gut issues or you think might be suffering in silence, maybe send them this episode. It'll open up a conversation. And there's Finkers.

• 27:55Speaker 04

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• 29:40Speaker 07

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• 29:56Speaker 07

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• 30:16Speaker 01

  Welcome back. Today, I'm chatting with neurogastroenterologist and author of You've Been Pooping All Wrong, Dr. Trisha Pasricha. Let's jump back in. So let's start with just some of the basics around poo. Because even basics feel like a mystery because we don't really talk about it. So let's just, so what exactly is poo? What is coming out of us, Trisha?

• 30:41Speaker 00

  Yeah, so that's an incredibly fundamental question and a really interesting one. I think what people believe poop is is just all the waste products that your body doesn't need. Like, you have extracted all the good stuff through your small intestine. Everything you don't need comes out as poop. And that's at least partially true, but it's actually not what the majority of your poop is. So obviously, scientists have studied this. They've looked at, through mass spec, what is the composition of poop? It's mostly your microbes. And then the rest of it is all this sort of soluble and insoluble material and fiber that you can't digest.

• 31:16Speaker 01

  A little bit of corn in there.

• 31:17Speaker 00

  Squished together.

• 31:18Speaker 01

  Yes.

• 31:18Speaker 00

  Yeah.

• 31:19Speaker 01

  That's amazing. When you look down, that's your microbes in there.

• 31:23Speaker 00

  Say hello. Yeah, next time you peek in.

• 31:26Speaker 01

  And I think, I think before reading your book, I had this idea that poo was brown because it's just this mixture of all the stuff you've eaten and maybe some excretion products, kind of like when you're painting and you're in preschool and you use all the paints and eventually it just kind of gets...

• 31:42Speaker 00

  Everything ends up brown.

• 31:45Speaker 01

  Brown.

• 31:45Speaker 00

  But totally.

• 31:46Speaker 01

  Why is our poo brown?

• 31:48Speaker 00

  Yeah, totally wrong. Bizarrely, our poop would be white, like a whitish clay-colored. The only reason it's brown is because of bilirubin. So we produce bile, right? It's this digestive kind of salt that we produce. It helps break things down. The bilirubin in that bile is what makes it brown. If you were to take that out, and sometimes that happens if somebody gets a gallstone or if there's something else blocking the release of bile into your small bowel, what comes out is this pale, bizarre-looking clay-colored stool. If you ever see one of those, you will remember it the rest of your life.

• 32:24Speaker 01

  Wow. And what about, so on the odd occasion, someone can even have a silver poo?

• 32:30Speaker 00

  Oh, my gosh.

• 32:31Speaker 01

  Yes.

• 32:31Speaker 00

  The poop of legends, the mystical silver poo. I can't believe you brought that up.

• 32:37Speaker 01

  Yeah, so, and if you're watching this on video, you can take a look at this image. This is from the British Medical Journal of Someone's Silver Poo. What might be going on if a silver poo exits your butthole?

• 32:50Speaker 00

  I, so there's only been a handful of these cases reported. I read one in the New England Journal of Medicine. So we're talking about the BMJ, New England Journal of Medicine. Like, this is a top-tier poop.

• 33:00Speaker 01

  Yeah.

• 33:01Speaker 00

  This is not something that gets published in like a low-impact-factor journal. And it's so rare. So what it is, so like, okay. So first of all, two things are happening simultaneously. One, you're blocking the passage of bile somewhere. That's going to give you that whitish color.

• 33:15Speaker 01

  Yes.

• 33:16Speaker 00

  Second, a second emergency is occurring in which you are bleeding somewhere, probably your upper GI tract, because the acid from your stomach, when it mixes with blood, it turns this shiny black color.

• 33:31Speaker 01

  Mm.

• 33:32Speaker 00

  So somebody who poops black, who sees like this tarry-looking pitch-black stool, should be worried that they're having a bleeding ulcer in their stomach or maybe their small bowel. When you see this shiny black mix with this like clay-colored white, you get shiny silver alchemy. And it's like, kind of pretty, but it is an emergency.

• 33:52Speaker 01

  What a shame that it's an emergency and not, you know...

• 33:56Speaker 00

  I know, not just like a sign that you're, it's the next coming, I know.

• 34:02Speaker 01

  So there are a lot of ideas that we have about what it is to have a healthy poo, a healthy bowel movement, dare I say it. And one is that we should be aiming for pooing once a day. I think I always thought that was like vaguely helpful. Every now and then, I'll have a day where I'm like, wow, three times, okay. Is, do you, do you worry when a patient comes to you and is doing poos more than once, less than once a day?

• 34:32Speaker 00

  I don't actually obsess over the number. What I really focus on is how comfortable you feel.

• 34:38Speaker 01

  Hmm.

• 34:39Speaker 00

  You know, like, I would rather not you say, I had one poop this morning. I go every single day, but when I go, I strain for 20 minutes. And I'm sitting in there, and you emerge, and it looks like you've ran this marathon. But yeah, I go once a day. That's not normal to me. You know, even though, yeah, you've checked that box.

• 34:58Speaker 01

  Yeah.

• 34:59Speaker 00

  So like, you know, there was this big study that was done, actually by my colleagues at Beth Israel, that showed that people who consider themselves to have normal bowel habits, they go anywhere in America from once every three days to up to three times per day. So it's a big range, you know? And like, I think the part that people don't appreciate is that in other parts of the world where people are eating a higher-fiber daily diet, not our sad American diet, people go more often. People are really into fiber-maxing right now, which I am 1,000% here for.

• 35:29Speaker 01

  Mm-hmm.

• 35:30Speaker 00

  People are going to find that they're going to go more often. They're just like, this is, their body's like, going to be suddenly overwhelmed and amazed by how soft their poop is. It's suddenly effortless. They're not straining. And you might go twice a day, and that's totally okay. It's just easy to go. You might even go three times a day. And just embrace this new side of yourself.

• 35:49Speaker 01

  And why is that happening if you're fiber-maxing? Why are you then going more? Why is it nice to do a poo? Give us your elevator pitch for fiber, for those who haven't joined the fiber train.

• 36:00Speaker 00

  Yeah, well, okay. So here's the interesting thing about fiber, is that like, there's this big disconnect where people think, I need more fiber because my body needs this to be healthy. Wrong. You don't need fiber for your own body. You need fiber to feed your microbes. Your microbes that are living in your microbiome, they need fiber to survive. And different species, you know, we have like lots of different species living in there, they actually thrive on different kinds of fiber. Fiber's not just this one thing. So you really want to get this diversity of fibers into your diet because that fiber, you can't break it down. We don't have the enzymes to break it down, so it's going to travel through your small intestine. As it's doing so, the part that does help you is that if it is like a soluble fiber, like psyllium husk is a nice fiber supplement,

• 36:44Speaker 00

  it's going to drag water with it and keep things nice and soft and plush. So your poop, all that waste, is suddenly going to become really easy and soft to pass. But once that fiber hits your colon and those microbes start fermenting it, they produce short-chain fatty acids, which then can be absorbed into your body and then have these anti-inflammatory compounds in other parts of your body, far away from your colon, to your heart, to your brain. And that process does a lot of good for you and your long-term health. That's why we eat fiber. But it's really not because you yourself are directly the reason. It's this indirect benefit you get by nourishing and feeding your microbes.

• 37:23Speaker 01

  Yeah, this is crazy to me, that you feed your microbes, you keep them happy, then they produce these short-chain fatty acids, and that then goes throughout your body to help you. I mean, that symbiosis, it's so beautiful. It's crazy, right?

• 37:41Speaker 00

  Yeah. I mean, it's amazing that we can't produce these to that extent on our own. Like, if we, and you know, that, you know, like, if we didn't have those microbes and we weren't producing those short-chain fatty acids, they've done these studies. I mean, this is the reason why high-fiber diet, it's associated with lower risk of dementia, of cardiovascular disease. It all can be traced back to that indirect benefit we're getting from what the microbes are doing to us. So we got to be nice to them, too. We have to give them fiber. And obviously, 95% of us today are not meeting our fiber goals. We're hurting them, and they're hurting us by, you know, just like this indirect pathway.

• 38:22Speaker 01

  And so you like to take a psyllium husk. Did you, did you notice your poos got better once you prioritized fiber in your own life?

• 38:35Speaker 00

  I will say, like, if you take psyllium, everything just becomes soft, easy, effortless. Like, you know, we have this adage, and we could talk about this more, where I like to tell my patients, don't spend more than five minutes in the bathroom. You know, like, stick to the five-minute rule. And... Ideally, to be, if I'm being so honest, it should be like thirty seconds. It should be like an in and out job. Like even five minutes to me feels like way too much time. But once you are meeting your fiber goals, assuming there's not something else going on, like with pelvic floor dysfunction, it's an in and out job.

• 39:07Speaker 01

  So why don't you want people spending more time in the toilet? Why do you think, once you get the call? I've heard you say it. I love that.

• 39:16Speaker 00

  Yeah.

• 39:16Speaker 01

  That is what it feels like. You get the call. You should go and go quickly.

• 39:21Speaker 00

  Respond to it.

• 39:22Speaker 01

  Respond to the call. So what, let's, first, what happens if you don't respond to that call? Because a lot of people are embarrassed to, or just

• 39:32Speaker 00

  Right.

• 39:32Speaker 01

  really can't go in public. Say the call comes when you're in the mall or in your office or your workplace.

• 39:40Speaker 00

  Yeah.

• 39:40Speaker 01

  Then you get the call. So what happens if you don't answer the call? And you

• 39:45Speaker 00

  Yeah.

• 39:46Speaker 01

  you hold it in?

• 39:48Speaker 00

  Okay, so here's what I want people to picture. The reason you have to answer the call when the call comes is because if you delay, you think, it's fine, I'll, like, I can put this off. I'm gonna just return to that same poop a couple hours from now. I'm gonna come home, it'll be a safe space. It is not the same poop. Two hours from now, you are dealing with a different poop than the one you are when the call comes. And the reason why is that one of your colon's many important jobs, one of them is to constantly suck water out of whatever's in there. That's what it's gonna do. It's gonna do that around the clock, like it or not.

• 40:24Speaker 01

  Mm hmm.

• 40:25Speaker 00

  And if you ignore that call, it's gonna sit there and it's gonna get drier and harder and more pebbly. So three hours later, when you're ready, first of all, can we talk about what the call is?

• 40:38Speaker 01

  Yes, please.

• 40:39Speaker 00

  The call is simply the rectum spasming. That's what, that's what that feeling is, that sensation, like, shoot, I gotta go. Suddenly, what is this? It's your rectum spasming. That is the best time to go because your rectum is doing the work for you. It is trying to push this out. Three hours later, when you're in your comfy home bathroom, you feel safe, but you don't actually have the call anymore. You have to do all the work to generate pressure to push it out. So you have to do an enormous Valsalva maneuver at that point. Because if your rectum was contracting, you just do a little one and it'll come right out. Without that squeeze from your rectum, you've gotta do it.

• 41:21Speaker 00

  And now, to make matters worse, you're dealing with a completely different poop. It's like now drier, it's harder, it's not as squishy and soft. It does not wanna come out anymore. So when you get the call, that's a gift, you should respond to it and you should move on with your day. Because you're not gonna get, the stars will not align again the way they are in that moment.

• 41:40Speaker 01

  It's so relatable, treasure, it's so relatable.

• 41:44Speaker 00

  Tell me about it.

• 41:44Speaker 01

  So in your book, there was this fascinating stat that your sphincters are contracting, was it seven times an hour?

• 41:57Speaker 00

  Yeah.

• 41:58Speaker 01

  What are they doing? Why are they doing that?

• 42:01Speaker 00

  Let's talk about, this is an underappreciated job of the sphincters. But have you ever asked, I've thought, I think about this all the time, obviously. But like, how is it that our bodies know? You know, if you're sitting with friends, that it's safe to release gas, but it's not safe to release solid or liquid.

• 42:22Speaker 01

  Mm hmm.

• 42:23Speaker 00

  And you can tell, like, you know, you're like, this is okay, I just have to fart. Well, how does your body know that? The way it knows is because your sphincters have these tiny sensory neurons that are just constantly sampling the internal environment and sending that feedback up to your brain, saying, wait, this is gas. All clear, you can let this out safely. Or whoa, whoa, whoa, do not let go. And that's what those sphincters are doing for you. And you had no idea because it's in the background. And one of the ways that keeps the integrity of the sphincters and the job they're doing are actually your hemorrhoidal cushions. We think that's the function of your hemorrhoids. Because, by the way, you have internal hemorrhoids, they sometimes bleed like stink.

• 43:07Speaker 00

  Those are the ones that are constantly sampling that environment and giving that information back to you.

• 43:12Speaker 01

  Can you first, with a, with a brush, paint me a picture of a hemorrhoid?

• 43:18Speaker 00

  Yeah. Hemorrhoids are just, picture a cushion.

• 43:25Speaker 00

  A cushion on a circular, you know, like those nineteen seventies, like a circular couch. And the cushions are the hemorrhoids, the couch is like where your rectum and your sphincters are, the center being the sphincters.

• 43:38Speaker 01

  Mm hmm.

• 43:39Speaker 00

  And normally, so we all have hemorrhoids, whether you like to believe that or not, they're all there. But normally, they're flat, they're deflated, they're just these cushions of veins. But over time, for some people, if you get into this pattern of straining constantly, because you're constipated, sometimes those veins can start to engorge. And when they engorge and they start to fill up, those cushions can become plumper and plumper and plumper and juicier. And then, sometimes, they can become so plump and juicy that the internal ones pop out and say hello. And those are called prolapsing hemorrhoids. And you can feel those, they're very uncomfortable, you can sometimes push them back in.

• 44:23Speaker 01

  Uh huh. And you did a study looking at whether sitting on the toilet for a long period of time affects the risk of hemorrhoids. And when I say sitting on the toilet, I'm talking to anyone who's bringing their phone in, sucked into whatever you're watching. You're watching a Science Versus episode, I get it. You wait until the end, but all of a sudden, you've been sitting on the toilet for half an hour. Is that a problem?

• 44:52Speaker 00

  Major problem. You know, for me, like, social media and smartphones in the bathroom is like the same thing as bringing your smartphones to your nightstand when you're trying to go to sleep. Like, it only does bad things for you, for your health, for your well-being. And so what we found in our study is that people who bring their smartphones in, yeah, not only are they spending more time, that's a problem, like more than five minutes, but they also are inadvertently spending more time simply because of the smartphone and not doing the job they came in to do. Whereas for most of us in the past, you'd come in, you'd read, you know, like whatever was sitting there,

• 45:34Speaker 00

  the back of the shampoo bottle, that wasn't gonna, like, you weren't gonna stick around to get to the fourteenth ingredient. You would do your job and you'd move on.

• 45:41Speaker 01

  Yeah.

• 45:41Speaker 00

  Whereas with the smartphone, it's like, God, this Science Versus episode is gripping. Like, I'll just, I might as well see where this conversation is going and you'll stick around and completely forget why your pants are around your ankles. And that's the problem. Because it's that long amount of time sitting there on this open bowl without any pelvic floor support that we hypothesize is the reason that, not just one time, like, you know, everyone's allowed to watch one season finale of like The Pit on the commode every now and then. But if you do it day after day, year after year, and you start doing this at a young age, that's what we think puts you at the risk of the hemorrhoids later on.

• 46:15Speaker 01

  Mm hmm. Do you wanna tell me about your study, Hia? Your groundbreaking?

• 46:19Speaker 00

  Yeah. Groundbreaking. This was not the study I thought we, like, the Pasricha lab would become most famous for, but I'm here for it. So we asked people coming in for their screening colonoscopies, you know, how much time do you spend on your smartphone when you're in the commode? What do you do when you're on your smartphone and you're in the bathroom? And then we asked them about their diet, their exercise. And then we did their colonoscopy and we took a look. And we noted who has hemorrhoids, who doesn't have hemorrhoids. And then this is what we found, is that people who bring their smartphones into the bathroom, they had a forty-six percent higher chance of having hemorrhoids. So I just tell people, look, set a two TikTok limit, you know, or like, set a five-minute timer.

• 47:00Speaker 01

  And so just tell, so why does sitting in the toilet then increase the risk of hemorrhoids?

• 47:06Speaker 00

  Just, so the hemorrhoid cushions are held together by connective tissue. And it's a nice, firm, elastic connective tissue. Over time, you sit on this open bowl without any counter pressure, that connective tissue will start to weaken and weaken and weaken until suddenly, it's not enough to hold the hemorrhoids together and they pop and they burst.

• 47:25Speaker 01

  I'd love to talk about a couple of myths around poo and the gut that are happening online. Because the gut is being invoked a lot on social media these days.

• 47:35Speaker 00

  Yeah, I know.

• 47:37Speaker 01

  Tell us, what gives you, what's given you the shits recently when it comes to gut health ideas online?

• 47:46Speaker 00

  So much, can I tell you? Can I tell you the one that's like bothering me right now?

• 47:50Speaker 01

  Yes, please.

• 47:51Speaker 00

  Okay. There's this idea that you have a parasite that has like taken hold of a lot of people on social media. But actually, it's like very, like, people, you know, like, I used to think this is really fringe. Very, very average people come to my clinic convinced that they have a parasite. They haven't traveled anywhere, kind of exciting. There's no classic risk factors, but they kind of just know they have it. And sometimes they see, they think they've seen a parasite. And what I have seen to be the case is that people go online, get these parasite cleanses, they take them and they see, like, basically their own intestinal lining shed. And they're like, my God, this is, I've cleared the parasite because I've taken this thing.

• 48:34Speaker 01

  What are they taking? What are they swallowing? What, God?

• 48:37Speaker 00

  Like, really harsh stuff that are being sold as parat, or like herbal remedies and these things. And there's, they are seeing, like, I've seen pics, because I get pics.

• 48:46Speaker 01

  Yeah.

• 48:47Speaker 00

  Like, I'll see them, I'll be on the, like, you know, like, I'll see the sample and I'm like, this is not a parasite. By the way, we have incredibly good tests for parasites in a clinic setting. Like, we don't, we don't usually, we don't miss this. Like, if someone has a parasite, like, we'll catch it.

• 49:01Speaker 01

  Wow.

• 49:02Speaker 00

  That's not even, like, the dark side of it, it's dark already.

• 49:04Speaker 01

  Yeah.

• 49:05Speaker 00

  The darker side is that now, in the world of cyclospora, I feel like people have felt very validated that, that actually, we, I could, I like, and I need this parasite cleanse.

• 49:17Speaker 01

  Sticking with stuff online these days is, there's this meme that's been going around for a while that's, hot girls have stomach issues too. And you're out of this?

• 49:30Speaker 00

  Yeah.

• 49:31Speaker 01

  And we, we got questions about this from our listeners as well. Are women at an increased risk of these sort of complex, severe stomach issues than men? What's going on here?

• 49:42Speaker 00

  I thought you were gonna ask our hot girls, I didn't think.

• 49:46Speaker 00

  Like, I don't think we've done that study.

• 49:47Speaker 01

  Yeah.

• 49:48Speaker 00

  But we certainly know.

• 49:51Speaker 00

  My lab, which I'm getting so many ideas. But, but, um, yeah, women are at a much higher risk of getting IBS.

• 49:57Speaker 01

  Really?

• 49:58Speaker 00

  It's interesting, we've, yeah.

• 49:59Speaker 01

  Why is that?

• 49:59Speaker 00

  We've known this for a long time.

• 50:01Speaker 01

  Uh huh.

• 50:02Speaker 00

  There are a lot of different reasons. Um, and some of these we're, we're really just learning about in the last five years. But I'll tell you one big reason, which is estrogen, estrogen levels. And so, you know, when we're younger and a lot of people get diagnosed, young women, they're in their twenties. Like they'll say, my symptoms really started in high school and college, thirties. And what's interesting is that sometimes we do see that as women get older, enter their fifties, sixties, seventies, it's rare to make a new diagnosis of IBS at that point.

• 50:34Speaker 01

  Hmm.

• 50:35Speaker 00

  So the hallmark of IBS, just to be clear, it's pain. It's not just diarrhea, it's not just constipation. IBS comes in those flavors. You can have IBS with constipation, you can have IBS with diarrhea, you can have a mixed picture. But pain is what makes us say, this is not just chronic constipation, this is IBS, Irritable Bowel Syndrome. There's been several big studies that have come out in the last five years that have shown that estrogen is part of what modulates pain signaling.

• 51:01Speaker 01

  Interesting, because I was chatting to Dr. Jessica Bersikowski at the University of Melbourne to research for this chat, and she did this fascinating study into, um, IBS patients. It was a small study, but really interesting, where she gave them, her and her team, fructans, um, and then measured, she had a control group, so some had IBS, some didn't, and measured exactly how much gas was being produced in their belly. And found that everyone, whether they, in this study, whether they had IBS or not, had the same amount of gas being produced. So the microbes were eating up the fructans, fighting out the gases. It was the same amount of gas being produced.

• 51:45Speaker 01

  But the people with IBS who were experiencing pain, they were, what she did find was different because they were in an MRI scanner. And she could see that in their brain, their interpretation of pain, the pain in the brain, looked different to the control group.

• 52:02Speaker 00

  Yes.

• 52:02Speaker 01

  So it was that, this is what you're talking about here. They were interpreting that, that little bit of, of extra gas, extra pressure as pain. That was the problem. It was the nerves, it was the brain that was interpreting this signal differently. Is this what, is this what you're describing?

• 52:18Speaker 00

  This is exactly right. And I think that sometimes we think that, what is the underlying problem in IBS? I mean, that's what everyone wants to know because they're like, I, I mean, almost the hallmark, the way we define clinically IBS is all your tests are normal, right? That's very frustrating to hear. You feel really dismissed when that happens. But it turns out, we're just talking about standard clinical tests that are normal. If we were to do, and they've done this, the only reason I can say this is because they've done this in research studies. If we were to look for, say, TRIP V1, which is this receptor on pain signaling molecules, and those receptors that signal pain to the brain, they're expressed more than three times as much in people who have IBS, in the colon.

• 53:02Speaker 00

  So that means these, you have the same nerve cells in a healthy person versus someone with IBS, the IBS patient is going to have more receptors that are perceiving pain and then sending those signals up to the brain.

• 53:15Speaker 01

  What is the worst GI advice that you see online?

• 53:19Speaker 00

  People think juice cleanses are like somehow vaguely, like it has this wellness sheen, they're, they're colorful, it looks like something like influencers would do. What are juice cleanses but fruits and vegetables from which you have removed the fiber?

• 53:33Speaker 01

  Hmm.

• 53:33Speaker 00

  You've taken the fiber out, you've juiced them. And so all you get is the sugar. And like, I, to me, it's like, the reason that's so bad is because you feel good. Like you think you're doing something really good and you think it like, but actually you're taking all the good stuff out. I hate to see a juice cleanse.

• 53:51Speaker 01

  Hmm, it's so sad that that trend has really survived the test of time.

• 53:55Speaker 00

  I know, I know.

• 53:58Speaker 01

  As we're winding down, it is time for our audible questions.

• 54:06Speaker 01

  Tricia, what is a conspiracy theory that you secretly have a soft spot for?

• 54:13Speaker 00

  Okay.

• 54:14Speaker 01

  Ooh.

• 54:15Speaker 00

  Stick with me.

• 54:17Speaker 00

  We, this is like, this is really niche, but I'm not the only one who like kind of does buy into this. Okay, stay with me Wendy, all right?

• 54:26Speaker 01

  I'm here.

• 54:27Speaker 00

  We think that we've evolved to live with microbes in our gut. But what if we've got it backwards and we have simply evolved to become better vessels for the microbes? Like humans are the perfect vessel for them. I know. Like think about our behaviors, like why do we eat fiber, right? Like fiber, we don't, we don't have the enzymes. Fiber is not for us, it's for them. Why do we thrive in these close, tight knit, social communities? There are a lot of other reasons, sure, for our own survival, but the closer our community, the more we're transmitting our microbes to each other. They've done these studies.

• 55:11Speaker 00

  So I have this, this like, you know, I bought into this idea.

• 55:14Speaker 01

  Blowing.

• 55:15Speaker 00

  Yes.

• 55:16Speaker 01

  Right now.

• 55:16Speaker 00

  Isn't it like, we're here for them, they're not here for us.

• 55:19Speaker 01

  Whoa.

• 55:21Speaker 00

  Think about it.

• 55:21Speaker 01

  I'll never stop thinking about it.

• 55:23Speaker 00

  Me neither.

• 55:24Speaker 01

  What's the weirdest thing you've seen in someone's gut? You do colonoscopies day in, day out.

• 55:30Speaker 00

  Oh my gosh, um.

• 55:34Speaker 00

  Well, I, I can't.

• 55:35Speaker 01

  Your eyes lit up like nothing we've seen before as, as just the visions of people's guts.

• 55:40Speaker 00

  Visions of like the stuff we fished out at 2:00 AM. The weirdest thing, I probably can't tell you because I know that, you know, like anything I say that person will be like, oh my God, I know that's, that was me.

• 55:50Speaker 01

  Hmm.

• 55:51Speaker 00

  But what I can tell you is this.

• 55:54Speaker 00

  Okay, people often, it's not uncommon for the GI doctor to get called to the emergency room because of, because of some object has made its way into someone's rectum.

• 56:07Speaker 01

  Yes.

• 56:08Speaker 00

  And we get this call pretty often.

• 56:10Speaker 01

  Whoa, yes.

• 56:11Speaker 00

  And I just want people to know that if, you'll notice, I never ask you how it got there.

• 56:18Speaker 01

  Hmm.

• 56:18Speaker 00

  Like I never ask because, yeah, I know how it got there.

• 56:22Speaker 01

  Yeah.

• 56:23Speaker 00

  You know, and the person sitting in front of me knows how it got there.

• 56:25Speaker 01

  Yes.

• 56:26Speaker 00

  But 90% of the time.

• 56:28Speaker 01

  They put it up there, but that's how it.

• 56:29Speaker 00

  They put it up there.

• 56:30Speaker 01

  Yes.

• 56:30Speaker 00

  They just, and it's, that's so big. You know, but 90% of the time, the person in front of me, without my prompting at all, that person offers an explanation. They'll be like, you know what?

• 56:40Speaker 01

  Sat on it.

• 56:41Speaker 00

  I sat on it weird. And I'm like.

• 56:45Speaker 01

  Yeah.

• 56:46Speaker 00

  Okay.

• 56:46Speaker 01

  Yeah.

• 56:47Speaker 00

  I didn't ask, and can we, I'm just here to get it out. Like one way or another, we're going to help you.

• 56:52Speaker 01

  Yes.

• 56:53Speaker 00

  I know you've learned your lesson. Like I, you don't need me to like, we don't have to talk about this again. I know it won't happen again.

• 57:02Speaker 01

  Yes.

• 57:03Speaker 00

  And actually, every now and then it does happen again, we get these repeat flyers, but.

• 57:06Speaker 01

  Oh gosh, guys, that's why sex therapists say flare base.

• 57:12Speaker 01

  Okay, we've talked about a lot of controversial things, but I've saved the best for last, Tricia.

• 57:18Speaker 00

  Oh my gosh, what could be coming?

• 57:19Speaker 01

  You walk into a public toilet, you need to do a poo. Right, do you put paper down or not? Oh, um, I say controversial because I have heard from microbiologists that putting paper on the toilet seat is a waste of time because the microbes are so little. It's like, it's like a fishnet that they can just go through. And yet, there is, there is a psychological element to it. And I wanted to know where you sat on this.

• 57:59Speaker 00

  And I'll, I see what you did right there. And the reason I hesitated in, and this is also revealing, is that there's not a great reason for this. It's not really the microbe thing that bothers me. I almost never sit, I hover when it's a public.

• 58:12Speaker 01

  Even to poo? Even to poo?

• 58:15Speaker 00

  I'm, I'm just, I, yeah, I'm so good at it that like, it does, the job will get done.

• 58:21Speaker 01

  You are, wow.

• 58:22Speaker 00

  I know, I know.

• 58:27Speaker 00

  But I would rather not sit.

• 58:34Speaker 01

  I hovered once, I hovered once to do a poo and I overshot.

• 58:42Speaker 01

  And do you know there is nothing scarier than when you don't hear the flop?

• 58:51Speaker 01

  Because that's, that's how I knew what I did.

• 58:57Speaker 01

  I was like, where was the flop? And then to look around.

• 59:03Speaker 00

  And then the horror upon horror.

• 59:06Speaker 01

  So I don't hover anymore, I don't, I can't trust myself.

• 59:11Speaker 00

  You got me in your dick's practice, but you can get there. I believe you. But I guess I would say like, if there's, I usually would wipe, if I see anything visible. Yeah, I would certainly wipe that down, but I'm not somebody who would just like lay down preemptive.

• 59:24Speaker 01

  Okay, I'm crying.

• 59:27Speaker 00

  Me too.

• 59:30Speaker 00

  Appreciate you getting vulnerable in us. That was amazing.

• 59:38Speaker 01

  Very good.

• 59:39Speaker 00

  Thank you so much. You're so welcome, my pleasure.

• 59:46Speaker 01

  That was Dr. Tricia Pesariccia, neuro-gastroenterologist at Harvard Medical School. And her new book is You've Been Pooping All Wrong. If you liked this episode, please tell us about it. We're on social media, we're also now on YouTube at Science VS Podcast. And if you liked what you heard, if you learnt something, if you thought a friend might enjoy a little laugh and a little learn, uh, please send this episode along. If you want to know more about the science of whether to put paper on the toilet, then you've got to listen to this episode of Every Little Thing. We're going to put a link in the show notes. It's hosted by Flora Lichtman, who now co-hosts Science Friday. Thanks for watching. This episode was produced by Akadi Foster Keys and me Wendy Zukerman,

• 1:00:30Speaker 01

  with help from the team at Science Versus. We're edited by Blythe Terrell. Mix and sound design by Bobby Lord. Music written by Bobby Lord, Bumi Hidaka, So Wiley, Emma Munga and Peter Leonard. An extra thanks to the Zuckerman family and Joseph Lavelle Wilson. I'm Wendy Zukerman, back to you next time.

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