The red flags that may be hiding in your poop

When’s the last time you looked at your poop? Dr. Trisha Pasricha says you should look every time because it could save your life. A change in bowel habits is the number one indicator someone might have colon cancer, a disease on the rise in people under 50 in the United States. Host Regina Barber https://www.npr.org/people/1082526815/regina-g-barber gets into what’s driving this trend with Trisha; plus, some shapes and colors you should keep an eye out for (did you know silver poop is a thing sometimes?). If you liked this episode, check out our first episode with Dr. Trisha: Are you pooping all wrong? http://lnk.to/HSZe4h Interested in more science health news? Email us your question at [email protected] mailto:[email protected]. Support public media with NPR+ and enjoy perks for over 25 podcasts like this one. This show’s perks include sponsor-free listening. Learn more at plus.npr.org http://plus.npr.org/. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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  Are you following Short Wave yet? It's the best way to get new episodes as soon as they drop. Look for the follow button at the top of our show page in your podcast app of choice. Or in Apple, it's a plus sign. Give it a little tap and you're good to go. All right, here's the show. You're listening to Short Wave from NPR. It's time to talk about something we all have in common, our poop. Starting with the interesting shades it might come in.

• 0:47Speaker 02

  A silver poop is so rare, but it is possible that it was written up in the New England Journal of Medicine a few years ago. And what had happened was there was a person who was simultaneously experiencing two emergencies.

• 1:00Speaker 01

  And who better to talk about it with than Dr. Tricia Posricha, a gastroenterologist and medical journalist? Talking with her was a good reminder to me that paying attention to your stool could save your life, especially in the case of silver poop.

• 1:16Speaker 02

  They had an ulcer in their stomach and it was bleeding. And it caused their poop to turn that tarry, sticky, shiny black. But at the same time, there was something blocking their bilirubin. So then they had this white stool mixed with the shiny black. And it came out this like silver bullet, beautiful, diamondy silver poop.

• 1:38Speaker 01

  As fun and interesting as it may look, it's also a sign to take immediate action.

• 1:42Speaker 02

  Yeah, take a pick, but definitely go right to the emergency room.

• 1:46Speaker 01

  Tricia says there's another reason to keep an eye on your number twos. Since the 1990s, the rates of colon cancer have increased among people under 50 years old. In 2018, the American Cancer Society lowered the recommended age for people screening from 50 to 45 years old, which can mean a colonoscopy.

• 2:04Speaker 02

  Colonoscopies save lives because they prevent cancers, not because they detect cancers. We catch these polyps, which are these growths that are not yet cancer, but you know, 5% to 10% of them will go on to become cancer if we don't remove them.

• 2:19Speaker 01

  For folks who haven't gotten their colonoscopy, Tricia says one of the biggest indicators that you need to see a doctor is a change in the color, shape, or frequency of your bowel movements.

• 2:30Speaker 02

  I really do think that this deep stigma we have about talking about pooping and talking about our bowels is tied to these cases in some ways. Because about one in three people will avoid talking to their doctor about their bowel habits because they're so embarrassed by them. And when it comes to early onset colorectal cancer, one of the biggest problems is that we're catching these cases late.

• 2:55Speaker 01

  So today on the show, why paying attention to your poop could prevent colon cancer. Plus, life hacks to keep you healthy and stinky free. I'm Regina Barber and you're listening to Short Wave, the science podcast from NPR.

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• 4:34Speaker 01

  All right, Dr. Tricia, we're talking a lot about the fact that our poops can change. And those changes are worth noting to your doctor. So let's give people some foundation on how their poops can look. Like there's this scale called the Bristol scale. And it's like basically ranking your poop, right?

• 4:52Speaker 02

  Yeah, so this is a nice, easy way to look at what your stool looks like. Look at that shape and that consistency. And so the scale is from one to seven, with four being right in the middle. It's that like perfect, smooth, snake-like stool that people dream of. And then above that, you have types one, two, and three. And one on the extreme end of that spectrum is like these hard little rabbit pebbles. And if you're seeing that, it probably means that poop has been in your colon for the longest. And as you make your way down that scale from two to three, it starts to become a little bit more formed, more bunched together.

• 5:35Speaker 02

  When you hit four, it's this like smooth sausage. And then five and six, it starts to get fluffier and fluffier. And by the time you hit the end of the scale, which is a type seven, it's just water. Most people actually do live in a, in America, live in a type three or four stage, which is like smooth sausage, or maybe like a little, a couple little cracks in that sausage.

• 6:01Speaker 01

  So what are, what are the things that people would see? And like, what are the changes that they should be, you know, cautious of?

• 6:10Speaker 02

  Yeah, certainly anything that looks like blood, that is a literal red flag. Unless you've had beets, if you've had a beet salad, you'll get a pass for one maroon-colored stool. But like, and even if you're like, no, I had it two days ago, it might be two, three days late. But then black, like tarry, sticky, black, shiny stool, that too could happen if the blood mixes with the acid from your stomach, it can turn black. So those things are emergencies. Those are like, talk to your doctor.

• 6:33Speaker 01

  Like red and black, bad.

• 6:34Speaker 02

  Yes. Pain and abdominal pain. It doesn't have to be 10 out of 10, I think my appendix has burst kind of pain. It can just be this like kind of low-grade dull pain that's there and it wasn't there before. That should bring you in. And then anything that's like weight loss that you didn't intend, iron deficiency anemia. And then the most important one, which I tell people about, is a change in your bowel habits. This means something has changed to your pattern. Maybe it's new diarrhea, your stools are more loose than they used to be. Maybe they're suddenly more narrow and thin than they used to be. Any change for you, and this requires you looking every day, you have to know what's

• 7:18Speaker 02

  normal for you, probably there will be some etiology that is perfectly reassuring. But you should at least just get someone to lay eyes on the situation.

• 7:28Speaker 01

  And there's other reasons why your poop could suddenly turn a different color, right?

• 7:31Speaker 02

  It's actually funny, I get this a lot from college students who like start drinking for the first time in large quantities, but they'll often poop like purple when they come to college. But they'll have drunk like half a bottle of red wine the night before. And I'm like, you know what? First of all, we have to have a conversation about this. But also, it's probably the anthocyanins that were in your red wine that gave you this like nice purplish, bluish poop the next day.

• 7:55Speaker 01

  I should have said this earlier for our listeners. You wrote a book all about this called You've Been Pooping All Wrong. And you say in the book, yellow and green are also okay.

• 8:04Speaker 02

  It depends. So if you were to say, I have this like new yellowish poop and I have diarrhea and I feel ill, I would say you need to go to the, maybe even the urgent care or the emergency room, because maybe you have an infectious diarrhea. If you were to say, my poop is a little yellow and I've been doing this keto diet for the last two, three weeks, then I might say, you know what? Maybe that's okay.

• 8:28Speaker 01

  All that fat.

• 8:28Speaker 02

  Yeah, exactly. There's another color that is an emergency, which is white. White poop or grayish, pale, clay-colored poop, that is actually the natural color of our poop without bilirubin. Bilirubin is this digestive enzyme that we produce on our own. That's what gives it the brown color, the bile salts in this, in this juice called bilirubin. But if you have a gallstone potentially, if you have a cancer potentially, or something else obstructing that bilirubin, your poop can turn white. So that is an emergency, no matter what.

• 9:04Speaker 01

  In your book, you said like poop is stinky and farts are stinky, but there are a way to make them not stinky.

• 9:11Speaker 02

  Yeah, this is like one of the biggest life hacks, I feel like, for people, especially relevant on dates, like relevant when you're meeting the in-laws for the first time, whatever the situation might be that you've deemed high risk, you can take Pepto Bismol.

• 9:27Speaker 01

  Yep.

• 9:27Speaker 02

  Beforehand. So it's the sulfur gas that gives farts their smell. And bismeth subsalicylate, which is the compound that is in Pepto Bismol, that actually really, really effectively binds those sulfur-producing gases. And so you'll be able to kind of neutralize that sulfur. Now, you probably shouldn't take it for days and days and days on end, especially if you're taking something like aspirin at the same time. But for just like a couple day trip, like, or even just one night, totally safe to do.

• 9:56Speaker 01

  But your, but your poop will be black.

• 9:58Speaker 02

  Yeah, but be forewarned that there will be a change. Hopefully not one that others will notice just looking at you.

• 10:05Speaker 01

  OK, totally. So going back to the more serious situation, like the high amount of cancer in young people, why are more young people getting this kind of cancer nowadays?

• 10:18Speaker 02

  Yeah, that's the question. One of the most common ideologies that a lot of the data is pointing towards is our diet, and it is specifically ultra-processed foods. And it's probably a lot of different factors beyond that as well. But ultra-processed foods do two things. One, they introduce these chemicals and additives and high sugar and high salt that our microbiome doesn't love at all and can cause microscopic inflammation. And then the second thing is that ultra-processed foods notoriously are low in fiber. Fiber is protective against colorectal cancer. And then I think what's really disturbing about that is that in these early onset cancer cases particularly,

• 11:01Speaker 02

  a lot of the studies point towards our diets when we're young, like in our adolescence and our teenage years, when we're eating ultra-processed foods as young kids, when we're drinking these sugar-sweetened beverages. That's been shown to be linked. And so sometimes it's not necessarily like what you did in your 30s and then you get diagnosed at 37. A lot of the time, it's stuff that has been brewing for a long time and in some cases, well before you really even had conscious control over and the kind of even the knowledge over what you were doing because it happened so early in life.

• 11:33Speaker 01

  Mm-hmm. Let's end on something that people can do for themselves to make themselves healthier, happier. What advice do you have for me, for our listeners, to poop better?

• 11:45Speaker 02

  I mean, you know, the first thing I ask myself in a day, or at least the last thing I ask myself towards the end of the day is like, what have I done to feed my microbiome today? And I think if you think about that question, it'll change what you do over the course of the day. Because I've studied the gut-brain connection now for more than a decade. And the enteric nervous system, that is this network of nerves that lives in your guts, has really made me view the gut as this brain. It's not just this set of plumbing and pipes. And I want people to think and treat their guts like this really delicate brain, which it is, and to think about their microbiome,

• 12:29Speaker 02

  which is kind of running the show behind so much of your health, as something that you, it is your responsibility to feed and nourish. And so for me, practically speaking, what that means is I try every day to meet my fiber goals. And I'm doing that because I'm thinking specifically about what are my microbes going to eat? If you don't give them fiber, they don't have anything to eat. And then two, I think about if I can, I try to eat something fermented every day, like a probiotic food. Like maybe that's Greek yogurt, maybe that's sauerkraut or kimchi. Or in Indian cuisine, we have dosas, which are fermented, which are lovely. But something fermented also helps fuel the microbiome. And there have been very big studies on fermented foods will change those microbes in a really good way.

• 13:14Speaker 02

  So if I could do one thing, meet your fiber goals. Like that's one, two, and three. And then four, toss in a little fermented food.

• 13:25Speaker 01

  I hope that our, you know, discussion helps other people talk about their poop. And I want to thank you so much.

• 13:32Speaker 02

  I really appreciate you having me on. Thank you.

• 13:38Speaker 01

  Shortwavers, if you found this episode to be helpful and fun, share it with a friend, especially if that friend, like me, is due for their first colonoscopy. Sharing is caring. This episode was produced by Breila McCoy and edited by our showrunner, Rebecca Ramirez. It was fact-checked by Tyler Jones, and the audio engineer was Anlee Huang. I'm Regina Barber. Thank you for listening to Short Wave from NPR. My inbox, my medical inbox, I don't accept personal photos, OK? But my medical inbox is filled with pictures of people's poop.

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