Pod Insights This Podcast Will Kill You Ep 201 Poop Part 2: Flushed away About this episode Poop is an incredibly valuable and massively underutilized resource. However, most of us don’t see it that way because of our evolutionarily ingrained disgust towards poop. Flush toilets and intricate sewer systems have revolutionized health and hygiene by whisking our poop far away where we don’t have to think about it. But that poop has gotta go somewhere, and eventually, not thinking about it isn’t going to be an option. Similarly, not thinking about our individual poop is asking for disaster, since what we produce can reveal a great deal about our gut and overall health. In this episode, we explore the problems that poop can cause on both the individual and population level. From constipation to fiber, and the Great Stink to communal poop sponges, we’re continuing our journey into the curiously fascinating world of poop.
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Transcript 15,433 words · 8 speakers
0:01 Speaker 00 This is exactly right.
0:06 Speaker 01 Hey, I'm Niall Rogers. This fall, I'll be driving across the country, meeting some of today's coolest and most fascinating artists. We'll explore the stories before the moments that changed everything. Because every musician remembers the moment where it all began. Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.
0:39 Speaker 02 Running a business means keeping pace with the latest tech. You put a lot into building your enterprise software stack, and scrapping it to integrate AI is out of the question. That's why IBM Technology works with all the apps, data, and models you need. It's another way IBM helps you build on the technology you rely on. Let's create smarter business. IBM. Visit ibm.com to learn more.
1:08 Speaker 03 Sir, I traversed this day by steamboat the space between London and Hungerford Bridges between half past 1 and 2 o'clock. It was low water, and I think the tide must have been near the turn. The appearance and the smell of the water forced themselves at once upon my attention. The whole of the river was an opaque, pale brown fluid. In order to test the degree of opacity, I tore up some white card into pieces, moistened them so as to make them sink easily below the surface, and then dropped some of these pieces into the water at every pier the boat came to. Before they had sunk an inch below the surface, they were indistinguishable, though the sun shone brightly at the time.
1:53 Speaker 03 And when the pieces fell edgeways, the lower part was hidden from sight before the upper was underwater. Near the bridges, the feculants rolled up in clouds so dense that they were visible at the surface, even in water of this kind. The smell was very bad and common to the whole of the water. It was the same as that which now comes up from the gully holes in the streets. The whole river was, for the time, a real sewer. Having just returned from out of the country air, I was perhaps more affected by it than others. But I do not think I could have gone on to Lambeth or Chelsea, and I was glad to enter the streets for an atmosphere which, except near the sinkholes, I found much sweeter than
2:38 Speaker 03 that on the river. I have thought it a duty to record these facts, that they may be brought to the attention of those who exercise power or have responsibility in relation to the condition of our river. There is nothing figurative in the words I have employed, or any approach to exaggeration. They are the simple truth. If there be sufficient authority to remove a putrescent pond from the neighbourhood of a few simple dwellings, surely the river which flows so many miles through London ought not to be allowed to become a fermenting sewer. The condition in which I saw the Thames may perhaps be considered as exceptional, but it ought to be an impossible state, instead of which, I fear, it is rapidly becoming
3:23 Speaker 03 the general condition. If we neglect this subject, we cannot expect to do so with impunity, nor ought we to be surprised if, ere many years are over, a hot season gives us sad proof of the folly of our carelessness. I am, sir, your obedient servant, M. Faraday, Royal Institution, July 7, 1855.
4:33 Speaker 04 There's just so many good parts, Erin.
4:35 Speaker 03 So many good parts.
4:37 Speaker 04 Seculence.
4:38 Speaker 03 Seculence.
4:39 Speaker 04 The smell was very bad.
4:41 Speaker 03 The smell was very bad. Like, I have no more synonyms for feculence, and so I'm just gonna have to go with the sheer reaction of very bad.
4:49 Speaker 04 Very bad.
4:50 Speaker 03 Very bad.
4:52 Speaker 04 I mean, and also, this is not an exaggeration.
4:55 Speaker 03 Oh.
4:56 Speaker 04 I am not being figurative with this.
4:57 Speaker 03 There is no figurative language in this, sir.
5:01 Speaker 04 I love it. I love it so much.
5:04 Speaker 03 I love it, too. I love it. I love it. It's ridiculous. And it will, I will touch more on the specific situation that this became the center focus of
5:16 Speaker 04 Right.
5:16 Speaker 03 in this episode.
5:17 Speaker 04 Can't wait.
5:18 Speaker 03 It's gonna be great. And I already said in the firsthand where that came from, M. Faraday.
5:23 Speaker 04 M. Faraday.
5:24 Speaker 03 There you go.
5:25 Speaker 04 Okay.
5:25 Speaker 03 Hi, I'm Erin Welsh.
5:27 Speaker 04 And I'm Erin Allman-Updike.
5:28 Speaker 03 And this is This Podcast Will Kill You.
5:30 Speaker 04 Welcome to poop part two.
5:32 Speaker 03 To poop two. Poop number two.
5:34 Speaker 04 Poop number two.
5:37 Speaker 03 We're way too pleased with ourselves.
5:39 Speaker 04 Ah, we just think we're so clever.
5:41 Speaker 03 We do. Okay, so if you have not tuned into the first episode in this poop series, part two, two-part series, do it.
5:51 Speaker 04 Do it.
5:52 Speaker 03 You know, what are you waiting for?
5:53 Speaker 04 Just go listen to it.
5:55 Speaker 03 You don't have to listen to it in order, but it will make-
5:58 Speaker 04 This will still make sense.
5:58 Speaker 03 It'll still make sense.
5:59 Speaker 04 Yeah.
5:59 Speaker 03 But you should do it.
6:00 Speaker 04 It's a great episode. I'm really proud of it.
6:02 Speaker 03 Yeah. You're gonna learn a lot.
6:05 Speaker 04 Yeah.
6:05 Speaker 03 Just like you will in this episode. So, last episode, we went over sort of how we make poop.
6:09 Speaker 04 Right.
6:10 Speaker 03 And why poop is actually a gold mine, rather than like the waste that we presently view it as.
6:16 Speaker 04 Right.
6:17 Speaker 03 And today, we're gonna go over what happens when our poop doesn't go to plan.
6:22 Speaker 04 Right.
6:23 Speaker 03 And, I guess.
6:24 Speaker 04 Yes.
6:25 Speaker 03 And also, um, why poop is actually gross and what we do about it.
6:31 Speaker 04 The flip side of the coin.
6:33 Speaker 03 You know, poop is many things.
6:34 Speaker 04 It is, so many things.
6:35 Speaker 03 Poop contains multitudes.
6:37 Speaker 04 It does. It really does.
6:38 Speaker 03 It really, truly, truly does.
6:40 Speaker 04 Ed Yong.
6:41 Speaker 03 Thank you.
6:42 Speaker 04 Um, yeah, it's gonna be a great episode. I'm really excited about it. But first.
6:45 Speaker 03 But first.
6:46 Speaker 04 It's Quarantini time.
6:47 Speaker 03 What are we drinking this week?
6:49 Speaker 04 Same thing we drank last week, drink number two.
6:51 Speaker 03 The drink number two.
6:52 Speaker 04 We're actually drinking water, which is also important for your poop, but.
6:56 Speaker 03 It is, as we learned.
6:58 Speaker 04 If you want to drink a Quarantini, it's poop number two.
7:00 Speaker 03 It's poop number two.
7:01 Speaker 04 I mean, drink number two.
7:03 Speaker 03 We keep saying that.
7:04 Speaker 04 Yeah, yeah, yeah.
7:05 Speaker 03 You know, uh, it's, it's basically a chocolate mint martini. It's great. It's pretty easy to make.
7:11 Speaker 04 You can do it at home.
7:16 Speaker 03 As you can with all of our Quarantinis, I would assume.
7:19 Speaker 04 We'll post the full recipe for that Quarantini on our social media channels. Are you following us there? Cause you should definitely check it out and follow us.
7:26 Speaker 03 You should, you should. Um, our website, which we may be putting Quarantini stuff on. Maybe we'll try that out tonight, you know? You can find other things, though.
7:35 Speaker 04 Yep.
7:36 Speaker 03 You can find so many things. You can find transcripts. You can find, uh, links to our bookshop.org affiliate page, our Goodreads list, which needs some updating, links to music by Bloodmobile, firsthand account form, contact us form, sources for each and every one of our episodes. Sounds like I know it starts with an S. And, um, also YouTube videos. You can find links to that.
7:59 Speaker 04 Including this one, which we are very excited to be bringing you from the Exactly Right Network Studios.
8:04 Speaker 03 Yes, yes, yes. Yeah.
8:06 Speaker 04 The end.
8:06 Speaker 03 The end. Follow us on YouTube. Follow us on social media. Uh, check out our website on the reg.
8:13 Speaker 04 On the reg.
8:14 Speaker 03 What are we?
8:14 Speaker 04 Let's just do it.
8:15 Speaker 03 Let's just do it?
8:16 Speaker 04 Yeah.
8:16 Speaker 03 Okay, fantastic. Let's take a quick break.
8:19 Speaker 04 And then you'll tell us about poop.
8:22 Speaker 03 Sewers.
8:22 Speaker 04 Sewers. Give it to me.
8:25 Speaker 03 Okay.
8:27 Speaker 01 Hey, it's Nile Rodgers, host of Before the Moment, a Lincoln original series. I'm driving across the country, meeting some of today's most fascinating artists. We're exploring the stories before the moment that changed everything. This week, I'm joined by my friend, John Legend. How does music actually enter your mind?
8:49 Speaker 05 I'm not sure why or how the music comes to me, but I think people who love music and write music, our brains are just filled with music. Like, we have listened to so much music, we've been a part of so much music. I think of the story that I want to tell, the mood that I want to create with the music, start playing chords, see where they lead me.
9:11 Speaker 01 Sometimes, I'm just not even thinking about music, right? And I hear this little thing, and I go, oh, that could be this.
9:21 Speaker 05 You know, you just have to be ready for when the inspiration hits.
9:24 Speaker 01 Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.
9:48 Speaker 03 Poop is gross.
9:53 Speaker 04 I love that that's a sentence that you wrote down.
9:55 Speaker 03 Love said. Oh, yeah, I was like, how do I start this?
9:57 Speaker 04 Poop is gross.
9:58 Speaker 03 Poop is gross.
9:58 Speaker 04 It is grody.
9:59 Speaker 03 It is, it is. There is no getting around it. Like, okay, yeah, we can talk about how important it is as a resource, we can break it down into like, what makes up poop? How do we make poop? Everyone poops. Pooping is not shameful.
10:12 Speaker 04 Yeah.
10:13 Speaker 03 No, I'm behind all that.
10:14 Speaker 04 Yeah.
10:14 Speaker 03 The fact remains, poop is gross.
10:16 Speaker 04 It's gross.
10:17 Speaker 03 It's gross. After all, it can contain pathogens, or it can signal your presence to a predator, or it can attract flies that lay eggs that hatch maggots. Speaking of which, if you are tuning into the YouTube, we have maggot art.
10:30 Speaker 04 We do.
10:32 Speaker 03 Yes, somewhere here. Yep. Anyway, yeah, you can see it. It's incredible. But maggots are also gross. You know, it's just, it is what it is. Poop, the disgust that poop evokes in us is probably evolutionarily ingrained because we don't want to be near it. You know, it's that, it's all, again, the pathogens, all that stuff.
10:54 Speaker 04 Yeah.
10:55 Speaker 03 And this aversion that we feel for poop, it's not new, right? It's not a product of our modern sanitation system or like a remnant of prudish Victorian sensibilities.
11:04 Speaker 04 That's good to know.
11:05 Speaker 03 It's, yeah, right. It's not just like, it is, it is normal to feel disgusted by poop.
11:10 Speaker 04 Okay.
11:10 Speaker 03 Charles Darwin even called disgust one of the six universal, universal emotions.
11:15 Speaker 04 Oh, that's so interesting.
11:16 Speaker 03 Yeah. And this disgust for poop, it's not specific to humans. Many animals go out of their way to avoid poop, like having designated latrines far away from their burrows, or grazing only in areas uncontaminated by poop. This was a real issue in Australia after the poop, uh, cow poop mounted. Yeah, because they were like, I'm not, I'm not eating here.
11:37 Speaker 04 Thirty million tons, I believe.
11:39 Speaker 03 Right, yeah, yes, every year, yeah.
11:41 Speaker 04 Oh, yeah.
11:42 Speaker 03 For much of human history, poop didn't pose too much of a logistical issue.
11:47 Speaker 04 Okay.
11:47 Speaker 03 For humans, right? We were living in small groups, we were moving around a bunch. It was a simple matter to just like, oh, the, you know, the call of nature, and you just take a little step.
11:56 Speaker 04 Go away from the river.
11:57 Speaker 03 Go away.
11:58 Speaker 04 You poop.
11:58 Speaker 03 Oh, actually, you didn't go away from the river necessarily.
12:01 Speaker 04 Oh, really?
12:01 Speaker 03 Yeah. But it wouldn't have mattered all that much.
12:04 Speaker 04 Because you were going to move on.
12:05 Speaker 03 You were going to move on.
12:06 Speaker 04 It was someone else's problem.
12:07 Speaker 03 Yep. And that is how Giardia is everywhere. And now it's all of our problem. But, yeah, so, and also, in addition to like, it not being a huge issue in terms of like, having to constantly be around your own poop, you're moving on, and our poop was an essential part of that nutrient cycle and seed dispersal. You know, you eat some berries here, you walk for a while, you poop over there.
12:33 Speaker 04 Now you have a new berry plant.
12:34 Speaker 03 Now you've got a new berry bush, yeah.
12:37 Speaker 03 And then it was also not just seeds for berry plants. It was also we're providing material for decomposers. We're fertilizing the ground. It's the typical circle of poop like we talked about. But then, of course, humans begin to live in larger groups. And for longer periods, we developed agriculture. We bred livestock. We built permanent settlements and poop became a problem.
13:01 Speaker 04 Okay.
13:02 Speaker 03 We used as much as we could to fertilize crops, AKA night soil. We dug poop pits on the fringes of our settlements. We designated communal pooping areas. We pooped on riverbanks and near streams so that the water would wash the poo away and out of sight.
13:16 Speaker 04 Okay.
13:18 Speaker 03 But every fix proved to be a temporary one as human populations grew and grew. Pit toilets filled to the brim. Poop shoots didn't always extend to the cess pit that collected sewage.
13:31 Speaker 04 Sorry, sorry, sorry. A poop shoot's a real thing?
13:35 Speaker 03 Is that a technical that I don't know? I was just imagining like a tube.
13:40 Speaker 04 Like what they use for construction?
13:41 Speaker 03 Exactly.
13:42 Speaker 04 I always thought your poop shoot was your butt.
13:44 Speaker 03 Well, yeah, I think that that's.
13:45 Speaker 04 But I love the idea of a.
13:47 Speaker 03 Multiple meanings.
13:49 Speaker 04 Shoot, like that was the thing they really had.
13:51 Speaker 03 I mean, there were, I'll get into it.
13:54 Speaker 04 Okay.
13:54 Speaker 03 But yes, there were pipes, more or less that, you know, or they would be uncovered essentially gutters.
14:02 Speaker 04 Gutters.
14:03 Speaker 03 Poop gutter, but poop shoot just sounds better.
14:05 Speaker 04 I love it.
14:05 Speaker 03 Yeah. And then there were indoor chamber pots that required frequent emptying at locations not within a quiet or a quick walk. You know, this was, there were a lot of different ways that poop just, you can't, you turn your back and suddenly there's a massive pile of poop that you have to do.
14:20 Speaker 04 Of course.
14:20 Speaker 03 Yeah.
14:21 Speaker 04 It's just like laundry.
14:22 Speaker 03 Okay, so it is.
14:24 Speaker 04 How does it accumulate?
14:27 Speaker 03 It's just like laundry. Okay, so to put the poop overload into perspective, let's consider Knossos, which is the largest city of the Minoan civilization, older than ancient Greece, located on the island of Crete. Around its peak, say 1700 BCE, there were 100,000 people living in Knossos, each pooping every day, of course, well, on average, for a total of 50 tons of poop per day.
14:55 Speaker 04 Wow.
14:56 Speaker 03 That's a lot of poop.
14:57 Speaker 04 It's quite a lot.
14:58 Speaker 03 Even in 1700 BCE, that's a lot of poop.
14:59 Speaker 04 Yeah.
15:00 Speaker 03 And it, of course, pales in comparison to what the city of New York makes in a single day today. And I singled out New York because that is where the data are available.
15:10 Speaker 04 Give it to me.
15:11 Speaker 03 Okay, so poop and pee combined to about 1,200 tons or 2.4 million pounds daily.
15:17 Speaker 04 Every day.
15:19 Speaker 03 Every day.
15:20 Speaker 04 2.4 million pounds of waste from our bodies.
15:25 Speaker 03 Is it waste, though, Erin? I thought we learned that it wasn't.
15:27 Speaker 04 It's a synonym for poop and pee.
15:30 Speaker 03 Turds.
15:31 Speaker 04 Turds. And pee. We can't forget the pee.
15:34 Speaker 03 We can't forget the pee. Yeah, it's a substantial portion.
15:36 Speaker 04 It is, yeah.
15:37 Speaker 03 Okay, so it's not New York today, but you could see why it would quickly become a pressing matter in need of an effective solution.
15:45 Speaker 04 Right.
15:46 Speaker 03 For the Minoans, that solution turned out to be water.
15:48 Speaker 04 Hmm.
15:49 Speaker 03 A handful of engineering-minded individuals realized the power of water as transportation, and they devised water supply systems that piped in rainwater to flush toilets. Toilets.
16:01 Speaker 04 They had flushing toilets in 1700 BCE?
16:04 Speaker 03 Yeah.
16:05 Speaker 04 Wow.
16:06 Speaker 03 I mean, so the toilets were pretty much localized to the Minoan civilization.
16:12 Speaker 04 Okay.
16:13 Speaker 03 But they were not just in palaces, like, they started out just in palaces. But yeah, I mean, and it wasn't like continuous supply.
16:19 Speaker 04 Okay.
16:20 Speaker 03 You had to dump it. You've ever been somewhere, you had to dump in water to the top?
16:23 Speaker 04 Yeah, yeah.
16:24 Speaker 03 Yeah, it's like that.
16:25 Speaker 04 Wow. That's so cool. And then they had pipes.
16:28 Speaker 03 I mean, and also the seats were like really wooded and splintery looking.
16:31 Speaker 04 Oh, for sure.
16:32 Speaker 03 I mean.
16:33 Speaker 04 Where did the poop go?
16:34 Speaker 03 Okay, so the water flushed the poop out of the building and down into the sewers that ran into the streams that ran into the sea. So it was all just sort of like connected.
16:41 Speaker 04 Downstream.
16:42 Speaker 03 Yep.
16:43 Speaker 04 Part of the water cycle.
16:44 Speaker 03 And since then, the world has never been the same.
16:46 Speaker 04 Wow.
16:47 Speaker 03 And remarkably, 4,000 years later, those drains still function perfectly after a large rain shower.
16:54 Speaker 04 Are you serious?
16:55 Speaker 03 They still wash every, they still wash right down like to the streams to the sea. Yeah. For thousands of years now, though, we have used water to do our dirty work, separating us from the poo that we produce so that we don't have to look at it or smell it or have it contaminate the water that we use. The invention of flush toilets and sewers, which we're, I'll talk about the modern flush toilet.
17:18 Speaker 04 Okay.
17:18 Speaker 03 Because this wasn't one that was like, this didn't-
17:19 Speaker 04 It didn't go everywhere.
17:21 Speaker 03 Spread, yeah, exactly. Um, they, it has ca, it has saved countless lives and it has made our day to days much more pleasant, right? Uh, but in allowing us to flush and forget, we have become divorced from the reality of poop, not as a waste product, but again, as a resource. From those first splintery wooden Minoan toilets to the seat-warming, water-spraying, high-tech toilets of today, we've been moving poop from here to way over there, radically upsetting the balance of nutrients like phosphorus and nitrogen across the landscape. And just as the early Minoans confronted the mounting poop problem in their city and devised a solution, we finally seem to be coming to terms with the fact that it's time
18:03 Speaker 03 for a new solution, or a suite of solutions, to contend with our growing poop issue, our cock catastrophe.
18:10 Speaker 04 Cock catastrophe.
18:11 Speaker 03 As we named it. I can't let that one go.
18:15 Speaker 04 No, that was really good. It was in the moment, too.
18:17 Speaker 03 It was, it was. We have proof of that. We didn't had, had to take a mo, take a break and then edit that out, brainstorm. Now, it sounds like we did, but we really didn't. So what I want to do now is take us through how we've dealt with our poo and pee and other liquid waste throughout history, and how a change in how we think of and deal with poop is really the only path forward.
18:41 Speaker 04 Okay.
18:43 Speaker 03 The Minoans were not the first or the only group in the ancient world to devise ways to manage the sewage that was produced in large cities. Around the same time, the Harappan civilization in what is now India also had a similar drainage system using deep gutters, which remove, with removable covers.
19:00 Speaker 04 Huh.
19:00 Speaker 03 So you could like-
19:00 Speaker 04 You could clean it out.
19:01 Speaker 03 Get rid of any, yeah, exactly. Connected from house to house, similar to the way that many of our modern sewage drainage systems work today.
19:09 Speaker 04 Wow.
19:10 Speaker 03 And so for cities that numbered in the tens of thousands, these Minoan and Harappan sewage systems, they did a decent job. No doubt, things were still stinky, especially if there wasn't a lot of rainfall and like cesspits probably got clogged, but it did all right considering.
19:27 Speaker 04 Yeah.
19:28 Speaker 03 Unfortunately, they were no match for the more than 1 million occupants of ancient Rome. I mean, really, the history of sewage systems and poop comes down to like, oh, no, there's too much poop. Oh, we fixed it. Oh, no, there's too much poop again. Oh, we fixed it again. Oh, no. You know, it just like repeats forever.
19:50 Speaker 04 Just over and over.
19:51 Speaker 03 Forever. Yeah. Okay. So how did ancient Romans fix it?
19:54 Speaker 04 Okay.
19:55 Speaker 03 With something called the cloaca maxima.
19:58 Speaker 04 Cloaca. Now that's a great word.
20:01 Speaker 03 It is a great word. Okay. Cloaca maxima.
20:05 Speaker 04 Tracina.
20:06 Speaker 03 I know.
20:08 Speaker 04 Cloaca. I feel like we should define because some people might not be.
20:12 Speaker 03 Yeah. No, I mean, we can. So my first exposure to the word cloaca came from what we use as the biological term.
20:20 Speaker 04 Correct.
20:21 Speaker 03 Meaning the single orifice through which many animals do all their business. Poop, pee, reproduce.
20:26 Speaker 04 Yeah.
20:27 Speaker 03 Cloaca.
20:28 Speaker 04 Cloaca.
20:29 Speaker 03 That usage only came into existence in like the 1800s.
20:32 Speaker 04 Okay.
20:33 Speaker 03 So the word cloaca existed before then and it was, it translates, it was, it basically translates into the word sewer. So cloaca maxima, greatest sewer.
20:41 Speaker 04 Greatest sewer of all time.
20:43 Speaker 03 Meaning like biggest, like largest.
20:45 Speaker 04 I love, I love imagining ancient Rome being like, this is the greatest.
20:49 Speaker 03 It's like very in line with how I think about ancient Rome.
20:52 Speaker 04 Yes, which might be totally inaccurate.
20:53 Speaker 03 I don't know very much. Yeah. Okay. But cloaca comes from the Roman goddess Cloacina, based on the word to clean.
21:01 Speaker 04 Oh, okay.
21:02 Speaker 03 So yeah, it has like.
21:04 Speaker 04 So sewers are cleanage.
21:05 Speaker 03 Clean. Yeah.
21:06 Speaker 04 Yeah.
21:07 Speaker 03 So yeah, the cloaca maxima, it really did live up to its name, though, in terms of its size. It was so big that entire wagons filled with hay could travel through it. It was massive.
21:19 Speaker 04 So it's like, like storm drain, like rivers that we have here in Southern California today? Like, like those?
21:25 Speaker 03 Like, you could take a boat, like a small boat, throughout it.
21:27 Speaker 04 Wow.
21:28 Speaker 03 Isn't that amazing?
21:28 Speaker 04 But it was just for sewage?
21:29 Speaker 03 It was just for, well, no, actually. So every day, it would handle a lot, millions of gallons of water and a million pounds of poop probably flowed through the cloaca maxima every day.
21:40 Speaker 04 Every day?
21:41 Speaker 03 Something around there.
21:43 Speaker 04 Okay.
21:44 Speaker 03 But like our sewer systems of today, it was not created necessarily to just handle human waste.
21:49 Speaker 04 Okay.
21:50 Speaker 03 It was mostly to prevent, to remove excess water during a rainstorm. And Rome was built on a swamp, basically.
21:56 Speaker 04 Oh, okay.
21:57 Speaker 03 It's the Houston of the ancient world.
22:00 Speaker 04 Okay. Oh, of the ancient world. The Houston. Someone's gonna get real mad about that.
22:06 Speaker 03 Houston is on a swamp.
22:07 Speaker 04 Yes, I know that.
22:08 Speaker 03 Okay. I'm just stating facts here.
22:13 Speaker 03 It's true. And so you have to drain, you have to drain the swamps to prevent flooding.
22:18 Speaker 04 Okay.
22:18 Speaker 03 And so that is what the cloaca maxima also did.
22:21 Speaker 04 Okay.
22:21 Speaker 03 Was mostly to just drain.
22:22 Speaker 04 Drain the swamp.
22:23 Speaker 03 The swamps.
22:25 Speaker 03 I don't know why this is so funny, but it is.
22:27 Speaker 04 It really is.
22:27 Speaker 03 But the cloaca maxima, I'm just gonna say it as many times as possible, was an engineering marvel. And the Romans poured money into its construction and its upkeep. It was a real, like, it's a real testament to how much they cared about sewage and sewer systems, is that the cloaca maxima parts of it are still standing where many, many, many other buildings have fallen.
22:48 Speaker 04 But they were like, this shall stand.
22:50 Speaker 03 Yes. Okay, do you want to hear more about what the toilet experience might have been like for someone in ancient Rome?
22:56 Speaker 04 Of course.
22:56 Speaker 03 All right. So if you're wealthy, you would have your own private latrine in your big house, likely situated over a dugout pit, or you'd be like, no, I'm gonna get a chamber pot and have someone just get that away from here.
23:08 Speaker 04 Get that rid of for me.
23:08 Speaker 03 I don't want even this in my, in my house.
23:10 Speaker 04 I'm gonna pay someone to do that, okay?
23:11 Speaker 03 Yeah, pay someone, nothing. Many wealthy citizens didn't want to connect their house to the cloaca maxima because the smell, it wasn't also like, there wasn't water piping continuously through.
23:23 Speaker 04 Got it. Okay.
23:24 Speaker 03 And so you kinda, it wasn't, things just would have hung out there, and then vermin.
23:31 Speaker 03 Yeah, you know, it's, I get it. But so that, but they were really the only people to enjoy privacy while pooping. We're the wealthy. Everyone else, that was, it was a luxury for them. Public toilets were constructed, used almost exclusively by men. It was not a safe place for women. They were found throughout the city, paid for often by the wealthier citizens who wanted to avoid poop in the streets. And that happened all the time.
23:57 Speaker 04 Poop in the streets?
23:58 Speaker 03 Yeah, there are so many inscriptions warning people against pooping in this alley or against this building or whatever. So there's one found in Pompeii that warned, quote, "Defecator, watch out for what might happen to you."
24:14 Speaker 03 In an alley.
24:15 Speaker 04 In an alley. Oh, stop pooping here.
24:18 Speaker 03 Defecator.
24:19 Speaker 04 Defecator.
24:20 Speaker 03 If you, if you poop, you will be cursed.
24:22 Speaker 04 That's a great diss, by the way.
24:23 Speaker 03 Yeah.
24:24 Speaker 04 We should call more people defecators.
24:25 Speaker 03 But everyone is a defecator.
24:26 Speaker 04 That's true.
24:26 Speaker 03 It's what we, you know.
24:27 Speaker 04 But to use it as a diss feels intentional.
24:30 Speaker 03 It does, it does. Okay, so these, these public toilets were housed under a low ceiling with small windows. So like, not a very pleasant, you know, place to be. And they were essentially marble benches carved with rows of holes. Just was hole after hole after hole. No dividers between the holes, so close that you could hold hands, you could carry on a whispered conversation or make after-work plans with your pooping partner. People weren't really wearing pants. It was more like a toga vibe situation, as far as I read, you know. I don't know how widespread togas were, if that's just like my image of ancient Rome. But you weren't totally exposed. So like, you weren't drop and traw the way that you would be.
25:12 Speaker 04 That you were today.
25:12 Speaker 03 Yeah.
25:13 Speaker 04 Okay.
25:13 Speaker 03 And so for wiping your heiny, there were, which I love, wiping, heiny is another great word. For wiping your heiny, there were communal, communal sea sponges on a stick. They were called tersorium or wiping thing. Yeah.
25:31 Speaker 04 So they just was like, a few of them scattered about?
25:34 Speaker 03 I don't know the, I don't know the numer, yeah, I don't know how many there were.
25:39 Speaker 04 Was there like water?
25:40 Speaker 03 Yes, there was.
25:41 Speaker 04 So the bucket of water that you rinsed it?
25:42 Speaker 03 There was a gutter of clean water to clean the sponge between uses.
25:47 Speaker 04 Okay.
25:47 Speaker 03 Mm-hmm.
25:48 Speaker 04 A sea sponge, that's actually genius.
25:50 Speaker 03 It is.
25:51 Speaker 04 Yeah.
25:51 Speaker 03 I mean.
25:52 Speaker 04 I love it.
25:53 Speaker 03 I don't know if I love it.
25:54 Speaker 04 The communal part.
25:55 Speaker 03 It's the communal part that really gets to me, yeah.
25:57 Speaker 04 It gets to me, too.
25:58 Speaker 03 And whether there was hand washing.
25:59 Speaker 04 Probably not.
26:00 Speaker 03 It's, it's, doesn't seem to be so. Who knows?
26:02 Speaker 04 Like, let me check.
26:04 Speaker 03 Right, yeah, let me, yeah.
26:05 Speaker 04 Nope, okay.
26:06 Speaker 03 Uh, so, the poop and pee would flow from these public toilets away into a sewer system where they eventually emptied into the river Tiber, which is also where people got their drinking and bathing water.
26:18 Speaker 04 Uh-huh, yeah.
26:20 Speaker 03 The filth might have been out of sight, out of mind, but it didn't mean it wasn't an issue. There was waterborne illness all over the place. It was, I mean, based on descriptions, like, it seemed pretty, pretty overrun with poop and pee.
26:35 Speaker 04 Poop.
26:35 Speaker 03 And there was a lot of, like, issues related to disease because of that.
26:38 Speaker 04 Yes.
26:39 Speaker 03 Okay, so, moving on from ancient Rome, though, throughout the medieval period and beyond, sewage construction in most of Europe was guided by the "get this poop as far away from me as possible" principle.
26:49 Speaker 04 Okay.
26:49 Speaker 03 Livestock manure was spread on fields for fertilization, and toilets operated under a similar logic as in ancient Rome, not the Minoan civilization.
26:58 Speaker 04 Okay.
26:59 Speaker 03 Uh, minus the cloaca maxima that effectively, uh, more or less effectively drained things away.
27:04 Speaker 04 Okay.
27:05 Speaker 03 So, there would be, like, outdoor latrines for the poor, you know, pits or barrels, which could then be, like, buried or taken away.
27:12 Speaker 04 Taken away.
27:12 Speaker 03 Uh, while the rich built private toilet rooms in their castles, where they, like, stuck out over the moat so that the poop and pee would travel down a chute into the water.
27:22 Speaker 04 A poop chute.
27:22 Speaker 03 Poop chute.
27:24 Speaker 04 This, that always makes me think of the Game of Thrones, the guy who died on the toilet. There was a, anyways, it doesn't matter, but there was a guy who died on the toilet. He got shot with, like, an arrow in the toilet, and his toilet room was, like, way up and off, away in the castle. It just was like-
27:39 Speaker 03 Historically accurate, despite it not being a historical show.
27:43 Speaker 04 Yeah.
27:43 Speaker 03 But no, I mean, that, I think that is, that's what I'm sort of imagining, these little rooms, like, just sort of cut out.
27:48 Speaker 04 Yeah.
27:49 Speaker 03 And then, like-
27:50 Speaker 04 Boop.
27:50 Speaker 03 Yeah.
27:51 Speaker 04 Okay, cool.
27:51 Speaker 03 Into the, the surrounding moat. So, like, it just, would just be poop in the moat.
27:56 Speaker 04 In the moat.
27:57 Speaker 03 Just horrible.
27:58 Speaker 04 Feeding the crocodiles or whatever.
28:00 Speaker 03 Crocodiles. Feeding something, the carp and catfish, I don't know. And so that's where it would stay until like the rains grew heavy enough and then the currents could carry it away.
28:10 Speaker 04 Okay.
28:11 Speaker 03 Okay. So as European cities exploded in population, the situation grew dire and more dire.
28:17 Speaker 04 Yes, it does.
28:17 Speaker 03 Poop piled up, multiple laws were passed. Like, this is how bad the poop was, right? There were many laws in many countries about public pooping. They were trying to regulate how much poop there was on the streets.
28:30 Speaker 04 Okay.
28:30 Speaker 03 So for instance, in Berlin, a 1671 law was passed that instructed every peasant visiting St. Peter's Church to take a pile of poop away. It was a popular dumping ground.
28:41 Speaker 04 So people would, so many people would poop there. It was like, you need to take poop with you when you go.
28:46 Speaker 03 Take, you gotta take poop away, yeah.
28:47 Speaker 04 Fascinating.
28:48 Speaker 03 I know. In 1531, a law in Paris required landlords to provide a latrine for every house.
28:56 Speaker 04 Wow, not until 1531.
28:59 Speaker 03 Yeah.
28:59 Speaker 04 Okay.
29:00 Speaker 03 Were the laws enforced?
29:01 Speaker 04 Ah.
29:02 Speaker 03 I don't know. Many people did their business in chamber pots in their home, which they then emptied out of the window after a yelled warning, like, "Look out below."
29:10 Speaker 04 Look out below.
29:11 Speaker 03 Yeah.
29:14 Speaker 03 The descriptions of people pooping everywhere in the streets or alleys and waste piled high, like, there are many of them, but there, it's, it's, it's too much. Okay, for example, quote, "The Louvre was a mess. People defecated without restraint or attempt at secrecy in the courtyards, on the stairs and balconies, and behind doors, without hindrance from palace attendants. On August 8th, 1606, an order was given prohibiting any resident of the Palace of Saint Germain from committing a nuisance therein. That same day, the king's son urinated against the wall of his room." End quote. So like, people would just seem to be pooping everywhere.
29:53 Speaker 04 That is so fascinating to me.
29:56 Speaker 03 It is to me, too.
29:59 Speaker 03 I don't know how.
30:00 Speaker 04 Yeah. That's like, you just, I mean, I guess if you don't really have an alternative.
30:05 Speaker 03 Great.
30:06 Speaker 04 If you don't have an alternative, you gotta go. Nature calls.
30:08 Speaker 03 Nature calls. And so it's like, and the laws were not effective. And it just kind of, of course, the problem keeps growing. But keeping in the theme with one man's trash is another's treasure.
30:20 Speaker 04 Uh huh.
30:20 Speaker 03 There was an entire occupation that sprung out from these soiled streets, the so-called nightmen.
30:26 Speaker 04 Oh.
30:27 Speaker 03 And so, also known as scavengers, these nightmen would walk the streets at night. They would empty out chamber pots and public toilets to either sell to farmers or just dump in the countryside. They would be like, I will handle your waste. People had like signs on like carriages or like wagons that were like, I am the best at this.
30:45 Speaker 04 Oh.
30:46 Speaker 03 I will make sure to do this.
30:47 Speaker 04 I love it.
30:48 Speaker 03 Yeah. Yeah. And when transport became a challenge, like there was just too much to carry or whatever, they dug out big pits and they held the waste there. And this is when they began to experiment with different chemicals and other additives to dissipate the smell, or they would heat the night soil to desiccate it.
31:04 Speaker 04 Ah.
31:05 Speaker 03 But guess what happened, Erin?
31:08 Speaker 04 Ah, something bad.
31:09 Speaker 03 I mean, kind of. Just populations keep growing.
31:14 Speaker 04 Yeah, there's just too much poop.
31:15 Speaker 03 And the nightmen just couldn't keep up. And so the situation was again, becoming dire. Fortunately, a hero was about to emerge.
31:24 Speaker 04 Who is it?
31:24 Speaker 03 Ajax, the first modern flushing toilet.
31:27 Speaker 04 Oh.
31:29 Speaker 03 It was invented by Sir John Harrington. Ajax was the name. He gave it.
31:33 Speaker 04 Okay, okay.
31:34 Speaker 03 In England, 1584, after being sent away by the Queen whom he offended with his poetry. It's a true story.
31:41 Speaker 04 Okay.
31:42 Speaker 03 Well, no one knows the exact details, but like, I can imagine the gossip was just, what did he say this time?
31:48 Speaker 04 Yeah.
31:48 Speaker 03 But he embarked on some home construction projects. And out of this creative retreat sprung the toilet. And it wasn't the first, like I mentioned, the Minowans and Harappans hold that tile, but it did involve a more advanced flushing system with valves and a cistern, kind of like what we think of today where it has that on top. And then, yeah. He named it Ajax and wrote an ode in its honor. And then the Queen, after getting over her irritation towards him, she visited, she tried it out, and she was like, I need one of these.
32:17 Speaker 04 Oh.
32:17 Speaker 03 So she had one built in her palace, home castle.
32:22 Speaker 03 Whatever it was, whatever it is, over the next couple of centuries, the toilet underwent several technological improvements that made it more feasible to we installed in lots of homes. And soon, everyone, it was like, I need this. Right. It's like a standard part of your home. Mm hmm. Its popularity was helped along by British plumber, Thomas Crapper, who did not invent the toilet, nor give his name to a slang word for poop. Sorry. But his name really was Crapper? Yeah.
32:53 Speaker 03 But he did a great job at marketing it. Of course. And he kind of helped to turn the toilet into a status symbol. Oh, wow. Everyone wanted one. Good for him. I want a crapper. I mean, yeah. And guess what happened? People were so happy to flush and forget, and the problem of excess poop was solved for a very brief period of time. Oh, dear. What the toilet had effectively done was move those individual cesspits from the home to the rivers that supplied the city with water, making one giant cesspit out of it. The situation again grew dire. How dire, you might ask? Oh, dear. Let's go to London, 1858, for the full picture. Okay.
33:38 Speaker 03 That summer was unusually hot and dry, but any enjoyment of sunny weather was thwarted by the shocking stench that emanated from the Thames. I've mentioned the Great Stink of 1858 before in our Typhoid Fever episode, and I read a quote in that episode that I think is worth dredging up for this one. Give it to me. This is from a newspaper reporting on the Great Stink, quote,
34:06 Speaker 03 "For the first time in the history of men, the sewage of nearly 3 million people had been brought to seethe and ferment under a burning sun in one vast, open cloaca lying in their midst."
34:21 Speaker 04 I remember this quote now because we made it into a reel. It's like one of our first reels that we ever made.
34:27 Speaker 03 I don't know why it just kills me every time.
34:29 Speaker 04 Because it's the word cloaca.
34:30 Speaker 03 And it's like, it is the word cloaca.
34:32 Speaker 04 Yeah.
34:33 Speaker 03 But it's also like poetic in a way.
34:35 Speaker 04 It is. It's beautiful and disgusting.
34:37 Speaker 03 Disgusting. It's really effective.
34:39 Speaker 04 It is.
34:40 Speaker 03 That is effective language right there.
34:44 Speaker 03 So, okay, the Thames had been getting more disgusting for years. But the Great Stink really galvanized many Londoners. Something had to be done about this. Not just because of the unpleasantness of having to breathe that vile air, but also because that air was thought to spread disease. Miasma was sort of the leading idea at the time. And it wasn't the air itself, but it certainly was the water, as John Snow revealed in his investigations of the London cholera outbreaks from a few years before, which was, of course, caused by the nasty and poorly functioning drainage systems in the city, those cholera outbreaks. So it took a few decades. I'm skipping over so much here in terms of like the history of sewage.
35:26 Speaker 04 Okay.
35:27 Speaker 03 But eventually, a massive and intricate sewer system was built to manage London's waste. The project was spearheaded by visionary engineer Joseph Basilgette. And the completed system, truly a modern marvel, still serves the city today.
35:42 Speaker 04 Wow.
35:43 Speaker 03 And there's a whole book about its design and Basilgette and the Great Stink. If you'd like to learn more, it's on one of these shelves here. The London sewer system, which acted as inspiration for many other cities, it operates with the goal of using water to wash away the city's poop and liquid waste. And in the brainstorming phase of this design, several options were presented and dismissed before landing on this present layout. One of these ideas involved transporting the waste to farms in the surrounding countryside to use as fertilizer. The annual value of four million people's excrement, which is in the City of London, was estimated to be about, worth about 1.7 million pounds in the 1880s.
36:27 Speaker 04 Oh, wow.
36:28 Speaker 03 Which is 178 million pounds today.
36:30 Speaker 04 Oh, wow.
36:30 Speaker 03 In terms of fertilizer. Yep. But England, not seeing the tremendous worth of this substance, opted to flush it away. A strategy in keeping with the sentiment of past centuries that poop was waste and nothing more. And this sentiment wasn't universally shared, even across Europe. In his book Les Mis, Victor Hugo questioned the similar approach that Paris took with its sewers. Quote, "What do we do with all this golden dung? It is swept into an abyss. All the human and animal manure which the world wastes if returned to the land instead of thrown into the sea would suffice to nourish the world," end quote.
37:09 Speaker 04 I mean, yeah, he's not wrong.
37:10 Speaker 03 Truth. And he wasn't just discussing a hypothetical strategy. For millennia, many cultures had a much different perspective on how best to deal with the amount of poop and pee that a growing city produced.
37:24 Speaker 03 Where the ancient Romans and modern Londoners saw the value of poop in its absence, other cultures saw its value as a fertilizer. Why did some parts of the world adopt the view of human excrement as a valuable thing and others as a thing to get as far away from as possible? One aspect was need. How many livestock you had, or how fertile your soil already was, or how much pasture land was even available. Maybe you were land limited, right? You couldn't just clear more land when all the nutrients were leached out of your soil. Or maybe you didn't have, and didn't have the land, to have these ample amounts of livestock that were producing manure that could be used as fertilizer. And so you're just like, I'm gonna use what's right in front of me. This is fertilizer, right here.
38:07 Speaker 04 I'm already making it.
38:07 Speaker 03 Yeah, yeah. Throughout Japan's history, for instance, both poop and urine was sold to farmers to fertilize their crops, called night soil. Japan didn't really have acres and acres of pasture land or many large livestock, and so night soil was highly valued. If you rented an apartment, your landlord technically owned the night soil that you produced. And so the rent was adjusted based on the number of people living in a room.
38:33 Speaker 04 How many people are pooping here?
38:34 Speaker 03 Yeah.
38:35 Speaker 04 Oh, that's so interesting.
38:35 Speaker 03 How much can I get for their poop? So if five people lived in one room, rent was free, for example. Yeah.
38:42 Speaker 04 That's hilarious.
38:43 Speaker 03 Pooping at a friend's house was considered a generous act. Because you're like, thank you for that.
38:50 Speaker 04 Oh, my God, I love that.
38:51 Speaker 03 I know. So you might wonder how this practice, which the use of night soil is still used in many parts around the world today, how it didn't lead to the spread of pathogens transmitted by poop. You know, we just talked about the great stink and cholera outbreaks and all of that. And a big part of it was how you process the poop, composting, right? You have to, what is the word? Ferment, ferment the poop, I guess. And so this, what would happen is like in this composting process, it would help to reduce the proliferation of pathogenic bacteria in the poop and break it down into its raw components, which were more readily used by plants.
39:27 Speaker 04 Yeah.
39:28 Speaker 03 It's, it's a part of the, it's the decomposition cycle, you know?
39:31 Speaker 04 Right, right, right.
39:33 Speaker 03 And the second was just like standard hygienic practices, right? Washing hands, boiling water, cooking vegetables, things like that. Japan wasn't alone in seeing the value of night soil. China was also well ahead of the curve when it came to seeing poop as a resource rather than waste. One strategy that people used in China was to let all the refuse, from humans, animals, other parts of agriculture, all mixed together with water in covered tubs and pits. And then after the fermentation process was complete, they would either pour this liquid manure directly onto the roots or let it dry in the sun, forming cakes, which would desiccate and then they could sell. Yeah, mixed with water and there's instant fertilizer.
40:13 Speaker 04 Yeah.
40:14 Speaker 03 Poop was so valued that in 1737, in China, there was an imperial treatise that commanded treasure night soil as if it were gold.
40:23 Speaker 04 Wow.
40:23 Speaker 03 Yeah.
40:24 Speaker 04 Seventeen hundreds, you said?
40:25 Speaker 03 Seventeen hundreds for that, but it had been going on for much longer, yeah. And so while most of Europe treated poop as a waste product exclusively, there were a few pockets that saw it differently. Some places that paid for poop rather than paying to have it be taken away. In parts of Belgium and in the Netherlands, farmers utilized night soil for crop fertilization. They constructed specialized casks that could hold over 100 gallons. The casks were loaded onto carts where they were dragged around by a horse. The farmer on the horse lifting the rope that like controlled a lever to be like, now release some more, now release some more.
40:59 Speaker 04 Okay.
41:01 Speaker 03 It's pretty ingenious.
41:01 Speaker 04 Yeah.
41:02 Speaker 03 And even in the US, in the late 1800s, there was a very successful night soil company based in New Jersey, who got paid twice for their labor. First to remove the poop in the first place.
41:13 Speaker 04 Ah.
41:13 Speaker 03 And then the second to sell fertilizer.
41:15 Speaker 04 Love it.
41:17 Speaker 03 And so, inspired by their success, a few sewage farms sprung up around the US, but eventually they fell out of favor by the end of the 19th century. As did night soil almost across the board. What changed? The invention of commercial fertilizer and the introduction of germ theory, whereby poop became the enemy and nothing more.
41:39 Speaker 04 Yeah.
41:40 Speaker 03 And I think it's important to note, and I feel like we didn't cover this in an actual episode, like a regular episode, but in a, there was a, The Devil's, The Devil's Element book club book, they, he talked about fertilizer and like guano, these islands of guano, and then people harvesting like bones from battlefields, like old battlefields to use as fertilizer.
42:03 Speaker 04 Right.
42:03 Speaker 03 And I just find that so, because a lot of that was happening in like the 1800s or so, and there was this huge rush prior to the introduction of commercial fertilizer. And poop was there all along.
42:13 Speaker 04 Right.
42:14 Speaker 03 It's just, yeah.
42:16 Speaker 04 It is really, really interesting.
42:17 Speaker 03 Right.
42:18 Speaker 04 Especially to think about that alongside the rise of germ theory, which like we talk about so much on this podcast.
42:23 Speaker 03 Yeah.
42:23 Speaker 04 And it is like so important, and your poop can make you quite sick.
42:26 Speaker 03 Ah, yeah.
42:27 Speaker 04 And so it's, it is just really interesting to think of those things as like side by side and like how, yeah.
42:33 Speaker 03 Right, to see it in one, like one, one angle.
42:36 Speaker 04 Right.
42:36 Speaker 03 One, one perspective of poop.
42:38 Speaker 04 Yeah.
42:38 Speaker 03 It's just that it is waste and nothing more and the enemy, and it's gonna make you sick.
42:42 Speaker 04 The end.
42:43 Speaker 03 And that's it. And that is true.
42:44 Speaker 04 It is true.
42:45 Speaker 03 And...
42:46 Speaker 04 Two things can be true.
42:47 Speaker 03 Uh huh. But what has, so that when these, when these things change, the introduction of commercial fertilizer and then germ theory. Things, even places that had long used night soil, it just, they kind of stopped. Like, many places stopped. Commercial fertilizer took over in the 20th century and that decree of treasure night soil, if it were gold, became a relic of the past. Poop was no longer a commodity. It was a thing to rid yourself of, a thing to fear. And today, most of the world is still stuck in that mentality, the really, we should be following that 18th century decree. Because it is wild how much waste we let go to waste.
43:30 Speaker 03 Functioning sewage systems are foundational to public health and everyone should have access to clean water because waterborne disease kills so many people every year. But it's also clear that our massive sewage plants have solved one big problem: removal of poop from our immediate proximity, while simultaneously creating another: too much poop in all the wrong places. We raise livestock on large-scale farms, where their manure leaches into the waterways near the farms. Meat and other food gets shipped to our local stores, removing those nutrients from where they were grown. Then we eat the food and poop it out, and that gets flushed into waterways, again, far from the original source of these nutrients.
44:11 Speaker 04 Yeah, and then it goes into the ocean, and then we get algal blooms.
44:13 Speaker 03 You get algal blooms, marsh decay, barren farmland, eroding soils, ecosystem collapse. Like, these are the consequences of nutrient redistribution across the landscape.
44:22 Speaker 04 Oh, man.
44:23 Speaker 03 The situation is, again, becoming dire. What do we do about it this time?
44:29 Speaker 04 Do you have an answer?
44:31 Speaker 03 I don't, I mean, I don't have an answer personally, but there are so many people, so many people who are working on this problem from many, many different angles. They're designing more efficient toilets, revisiting the idea of sewage farms, transforming human waste into fuel or fertilizer, even just rebranding poop into something that's, like, not shameful. Props to the poop emoji for that one. It doesn't, it was like, it was really funny, it was like a very popular emoji.
44:58 Speaker 04 Oh, I love the poop emoji.
44:59 Speaker 03 It's a great emoji, yeah. And it doesn't mean, like, there are many people working on this, and it doesn't mean that we have everything under control right now, but we do have possible paths forward and a ton of amazing innovators that are dedicated to this work and really passionate about it. Poop is a valuable resource as a fertilizer, as a source of public health data, like wastewater can tell us what pathogens are currently circulating.
45:22 Speaker 04 Yes.
45:22 Speaker 03 Huge. And it's also a valuable resource on an individual level. Like, what does your poo say about you?
45:30 Speaker 04 Such a good question.
45:31 Speaker 03 Well, Erin, this is where I pose that question to you. So you can tell me all about what we can learn from our poop.
45:38 Speaker 04 I cannot wait to do that.
45:42 Speaker 01 Hey, it's Niall Rogers, host of Before the Moment, a Lincoln original series. I'm driving across the country, meeting some of today's most fascinating artists. We're exploring the stories before the moment that changed everything. This week, I'm joined by rising star Sienna Spiral.
46:01 Speaker 06 I love the 60s. I feel really jealous that I wasn't alive for it. I'd be interested, like, knowing what that was like and seeing the way culture and art has progressed today. How do you find it?
46:11 Speaker 01 Wait a minute.
46:12 Speaker 06 I'm sorry, I have so many questions. Sorry.
46:15 Speaker 01 You're not nervous, are you?
46:16 Speaker 06 I am nervous.
46:17 Speaker 01 You are?
46:17 Speaker 06 I am. I feel, like, insecure about my experience. I know I shouldn't, but, you know, I'm 20. I haven't really lived my life yet. And then sitting in front of somebody that has lived an enormous life is intimidating. And sometimes I feel like talking about myself is just not as interesting. So that's why I feel a bit nervous. I'll try and, I'll try and ignore it, though.
46:36 Speaker 01 Please, dude. Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.
47:02 Speaker 04 So I ended last week's episode mostly just talking about what is typical when it comes to our poops. Right?
47:10 Speaker 03 Yeah.
47:11 Speaker 04 Yeah. And you talked us through, in last week's episode, if anyone missed it, all of the different ways that animals use our poop, poop as a resource. And poop, on a landscape-level scale, tells us so much about how, how we're dealing with our poop can tell us a lot.
47:28 Speaker 03 Yeah.
47:28 Speaker 04 But you're right, on an individual level, our poop can also tell us quite a lot. And I think there's an interesting... Balance, I guess, where a lot of us don't think about our poop at all. Like, we poop and it's done. It is out of our mind. We're not worried about it. We're not looking at it. We're not thinking about it. We're just maybe trying to think about it as little as possible.
47:51 Speaker 03 Right, right, right.
47:52 Speaker 04 And there are also many people who maybe spend a little too much time thinking about their poops or worrying about their poops. Or what is this one poop? Did I eat beets? Or is this colon cancer?
48:03 Speaker 03 I mean, that's a reasonable question to ask after a beet.
48:07 Speaker 04 After a beet poop?
48:08 Speaker 03 After a beet poop, yeah.
48:09 Speaker 04 Unless it's beets. But it is true that our poops can tell us so much about our health. And a lot of times, changes in our bowel movements might actually be an indicator of an underlying disease. Though my point with today is not necessarily to make everyone worried about their poops. It's more just to kind of understand the spectrum, okay?
48:32 Speaker 03 Yes.
48:32 Speaker 04 And since we already covered the range of typical, we can look back at our Bristol stool scale.
48:39 Speaker 03 Uh huh, uh huh.
48:40 Speaker 04 To understand the ways in which our poop can become atypical, if that makes sense.
48:46 Speaker 03 Love this.
48:47 Speaker 04 So if a perfect poop on that Bristol scale, which again goes from one to seven, where one are these hard, separate lumps, kind of like a nut of poop.
48:56 Speaker 03 Yep.
48:56 Speaker 04 Chunk, chunk, plop, plop. And type, sorry.
48:59 Speaker 03 I appreciate that extra little.
49:01 Speaker 04 Little too much. And a type seven is entirely liquid. Those are our two extremes: constipation and diarrhea.
49:10 Speaker 03 Yes.
49:10 Speaker 04 And so that's what I'm going to kind of focus on.
49:12 Speaker 03 Constipation and diarrhea.
49:13 Speaker 04 Constipation and diarrhea.
49:14 Speaker 03 Cool.
49:15 Speaker 04 So, and there's a lot of different ways to classify. Those are not the only poop problems that you can have. But constipation and diarrhea, I think, give us a lot of insight because that does kind of cover that whole spectrum, right? So there's a lot of different ways to classify or define both of these things. And I'll start with constipation because I love talking about constipation. So has that word been uttered in history?
49:40 Speaker 04 I say it in the office all the time.
49:42 Speaker 03 Okay, great.
49:43 Speaker 04 I love talking about constipation. How we actually define it, it's either with this Bristol stool scale, but it's never just exclusively with the Bristol stool. So it's usually hard or lumpy stools or needing to strain during a bowel movement. Or sometimes feeling like I just can't completely evacuate. Like you poop and you just feel like there's something still there that needs to come out, but it cannot come out.
50:07 Speaker 03 Okay.
50:07 Speaker 04 That feeling. If those things are happening, usually more than 25% of your poops, that's what's considered constipated.
50:15 Speaker 03 Huh, okay.
50:17 Speaker 04 Or sometimes it can be if you're having fewer than three bowel movements per week, that might also be considered constipated.
50:24 Speaker 03 Okay. How often, like, okay.
50:29 Speaker 04 I love that you're asking questions already.
50:31 Speaker 03 I know, I know. Well, you said fewer, you said more than, or 25%.
50:35 Speaker 04 25% of your poops.
50:36 Speaker 03 So who's watching that?
50:39 Speaker 04 That's such a great question. Who, like, how many of us are paying that much attention to our poop?
50:43 Speaker 03 Right.
50:44 Speaker 04 I don't know. Unless maybe you're dealing with constipation and then you probably are because a lot of times it's maybe more than 25%, right? It has to be at least that for us to call it constipation, according to the like Rome criteria, which is the criteria that we use. But a lot of people who deal with constipation have been dealing with it for a really long time. It's estimated, most of the studies cite that in the US, something like 12 to 15% are dealing with constipation. And a lot of times, unless we can identify the cause of constipation, it gets lumped under what's called like functional constipation, which really just means that we don't necessarily have an idea of what the mechanisms are. But it's estimated that up to 30% of people deal with constipation at least on an occasional basis. So they like sometimes have issues pooping.
51:30 Speaker 04 And that is thought to be an underestimate because these are data that are based on people who seek care.
51:35 Speaker 03 Right, of course.
51:36 Speaker 04 Right.
51:37 Speaker 03 Um, are you going to talk about the causes of constipation? Because I want to talk about functional constipation.
51:42 Speaker 04 Yeah, give it to me. What's your question?
51:43 Speaker 03 What are the causes of constipation?
51:45 Speaker 04 Great question.
51:46 Speaker 03 And at what point do you go, we don't know, but you're clearly constipated?
51:51 Speaker 04 Yeah, I mean, it totally depends on the scenario and also depends on how well it responds to the various treatment options, right?
51:57 Speaker 03 Yeah.
51:57 Speaker 04 But there's a lot of things that could cause it. It could be that you have slow gut transit, right? Which we know from last episode can be caused by a number of different things. Some of it might be genetics, some of it might be medications that you're on, some of it might be the diet that you are eating. Is that right? The diet that you're eating?
52:15 Speaker 03 Diet.
52:16 Speaker 04 The food?
52:16 Speaker 03 The...
52:17 Speaker 04 Your diet.
52:17 Speaker 03 Your diet.
52:18 Speaker 04 Some of it might be diet because fiber, as we know, can increase your stool transit time. And so if your diet is very low in fiber, then you might have prolonged transit time. So you might be more prone to constipation. Also, dehydration can put you at risk of harder stools. Physical activity increases your motility of your guts. And so we all live much more sedentary lifestyles, especially like in the US, we're quite sedentary. And so that is actually probably contributing to constipation.
52:51 Speaker 03 I see.
52:52 Speaker 04 But then there's other things too. There's like just actual dysmotility. There's something called Hirschsprung's, which is like where it's a genetic disorder where some of your nerve endings of your colon have not developed all of the way. And so you cannot get contraction the way that you should. So that can make it very hard to poop and you can get huge amount of stool buildup and things.
53:08 Speaker 03 Yeah.
53:09 Speaker 04 There's pelvic floor dysfunction, anal sphincter issues, like there's a lot of possibilities.
53:14 Speaker 03 A lot of possibilities. Are there a lot of solutions?
53:16 Speaker 04 Okay, question. I mean, yes and no, right?
53:21 Speaker 03 Okay.
53:22 Speaker 04 The main like ways that we go and deal with constipation for like a general rule are going to be using things like laxatives, which are going to hold on to water in your stool. So that is going to make your stool softer.
53:39 Speaker 03 Is that how they work?
53:40 Speaker 04 That's how they work.
53:41 Speaker 03 Tell me, tell me everything.
53:42 Speaker 04 They just so like, okay, Mirilax, which is polyethylene glycol. There's lots of different brand names of it. It's just a very large molecule.
53:48 Speaker 03 Okay.
53:48 Speaker 04 And so it just attracts water. And so you have this molecule. It doesn't get broken down in your digestive tract. So it's sitting in your colon, holding on to water. And therefore you have more water in your poop. Therefore, it is softer and easier to pass. And other, other osmotic laxatives work the same way. Lactulose, magnesium citrate, all these things. There's also some other ones that you can use, like stimulant laxatives. Those are things like bisacotal is one or Sena is another. And these are helping to stimulate peristalsis. They're helping to stimulate muscular contractions.
54:19 Speaker 03 Fascinating. So it's not like a laxative in the water aspect, but in the movement?
54:23 Speaker 04 It's moving. Yeah, it's helping with movement. And so what you might use might depend on what you think the underlying issue is.
54:30 Speaker 03 Okay.
54:30 Speaker 04 So it's going to be kind of person dependent. There's also stool softeners, but my favorite thing about stool softeners in medicine is that we use them all the time and there's like no data that they work.
54:41 Speaker 03 Wait, what?
54:42 Speaker 04 DocuSate is like one of the most commonly used things in hospitals and like people, like tell people to use it all the time. And there's like very little, if any, evidence that it, it's supposed to just like help make your stool more slippery is the idea.
54:57 Speaker 03 Like mucousy.
54:57 Speaker 04 Me, I don't know, but it doesn't like, it doesn't work.
55:00 Speaker 03 Okay, so, so when you say it doesn't work, do you mean that there have been studies that have found no effect or there have been no studies?
55:06 Speaker 04 There have been studies that have had no effect. Yeah. Unlike osmotic laxatives and things which do work.
55:12 Speaker 03 So why, why would you use a stool softener over a laxative?
55:16 Speaker 04 I don't know. I don't.
55:18 Speaker 03 Okay.
55:19 Speaker 04 Okay. But lots of people do. I don't know. It's thought to be less harsh.
55:22 Speaker 03 Okay.
55:22 Speaker 04 Right? Because it's not gonna like grab onto a bunch of water and then like have you at risk of diarrhea or something quite as much, right? Where you can easily overdo it with some laxatives. So you could end up with electrolyte imbalances if you overdo it on laxatives, things like that. But realistically, I don't know, because I don't, but.
55:39 Speaker 03 What about the, um, like prep for a colonoscopy?
55:42 Speaker 04 It's basically a huge jug of polyethylene glycol. Or sometimes we use sodium based ones too. So like other electrolyte ones.
55:49 Speaker 03 Electro, yeah.
55:50 Speaker 04 Yeah, yeah.
55:50 Speaker 03 Okay.
55:50 Speaker 04 But yeah, that's basically what it is, just like a huge jug of it. Chug, chug, chug with a lot of water because you're going to be pooping out a lot of water. I know, isn't that fun?
55:59 Speaker 03 Yeah.
56:00 Speaker 04 It's great.
56:01 Speaker 03 Fun, yeah.
56:01 Speaker 04 Fun.
56:03 Speaker 03 That's exactly the word that I would use.
56:04 Speaker 04 Yeah, but so that's like, I mean, that's how that's most of the ways that we try. And there's other newer medicines too, like there's a lot of, there's a lot of newer medicines that have mechanisms that I'm not going to get into because I'm not as familiar with it. But there's a lot of, because constipation is such an issue.
56:19 Speaker 03 Yeah.
56:19 Speaker 04 Um, there are a lot of interest in new ways to help deal with constipation when these are not effective. This is like go to first line, try it out. If it's not working, you need to see a specialist, kind of a thing.
56:30 Speaker 03 Okay, question about constipation and treatments. The like, uh, polyethylene glycol, et ceteras of the world. Are those for acute relief or in is the more like chronic relief fiber?
56:45 Speaker 04 Yes, it's yes and.
56:47 Speaker 03 Okay.
56:48 Speaker 04 Um, do you want to talk about fiber? I could skip.
56:50 Speaker 03 We can, no, we, we keep your notes the way you want them to keep.
56:53 Speaker 04 Let's talk about fiber.
56:54 Speaker 03 Great. I'm always, I'm always down to talk about fiber.
56:57 Speaker 04 I know, me too. Okay, so yes, laxatives, stool softeners, um, motility agents. These are things that are going to help treat constipation.
57:07 Speaker 03 Yes.
57:08 Speaker 04 What, if you are constipated. Fiber does not necessarily treat constipation, but it can help prevent constipation.
57:19 Speaker 03 Right, okay.
57:19 Speaker 04 Because like we talked about last episode, it's holding on to water in your stool. And so it is hugely beneficial in increasing transit time and in making your stool softer and in providing that bulking agent. And there's two major divisions of fiber. There's soluble fibers, which is like psyllium, husk, oats, pectins. And then there's insoluble fibers, which is like wheat bran, cellulose, lots of the things that are in our fruits and veggies and things.
57:44 Speaker 03 I can't believe we're getting to talk about insoluble and soluble fiber.
57:47 Speaker 04 Is it fun?
57:48 Speaker 03 So excited, yeah.
57:50 Speaker 04 And most of the, if you're getting your fiber from food sources and not from like a fiber drink that you're mixing, then you're getting a combination of soluble and insoluble fibers in most of the foods that you're eating. And then there's also, some of the fibers are like fermentable, and I talked a little bit about this last episode, like the bacteria in our guts can break them down and ferment them specifically to produce these like short chain fatty acids that they can then use to eat, like the bacteria eat, break down this fermentable fiber and eat it. And then some of the cells in our colon can also use what they break down as an energy source, these short chain fatty acids.
58:33 Speaker 03 Okay, uh, why choose one fiber over the other and why are they all important?
58:37 Speaker 04 They're all important. The answer is that they're all important. Some of them are increasing bulk in our stool and some of them are helping to feed the gut microbiome. And all of them are kind of doing both, like really, if we get into it. And so that, like, that is why fiber, that's why people get so like stoked about fiber and why fiber is such an important part. There's also so much interesting data on like fiber because of its effects on our gut microbiome in helping to treat or at least prevent the worsening of a lot of like inflammatory diseases. Colon cancer, we think, is involved, like our low fiber diets, we think are maybe involved in the increasing incidence of colon cancer that we see, especially in early onset colon cancer. It's not one thing, it's many things, but fiber's a part of that story.
59:22 Speaker 04 So it's, it's huge. And part of the reason that this is important to you is because constipation, while it's an issue in and of itself, it can be very painful, it can, like, constipation can cause its own set of problems. Constipation can also cause other problems. Constipation can put you at risk of things like diverticulosis, which are these little out pouchings of your gut wall, especially in the sigmoid colon, the part that sneaks around back before the rectum. And those little out pouchings can trap poop. And then can get infected or can burst or can burst into a blood vessel and cause a lot of bleeding. So diverticulosis can be a problem and constipation is a big contributor to diverticulosis.
1:00:06 Speaker 04 It's not the only thing, but it's one. Also hemorrhoids.
1:00:10 Speaker 03 Mm hmm.
1:00:11 Speaker 04 Okay. Uh, hemorrhoids are basically, everyone actually has hemorrhoids.
1:00:15 Speaker 03 Can I, before you go on to hemorrhoids?
1:00:17 Speaker 04 Give it to me.
1:00:18 Speaker 03 Cause I, I do wanna talk about hemorrhoids. But I wanna, I wanna go back to fiber unless we're done. Are you?
1:00:23 Speaker 04 No, that was my end of fiber. Yeah, tell me your question.
1:00:25 Speaker 03 Um, the relationship between fiber, I'm just stuck on these different insoluble, soluble, it's fermentable.
1:00:30 Speaker 04 Don't ask me more details.
1:00:31 Speaker 03 I know, but like when we, when we talk about a low fiber diet, it is of course across the board. But are we getting like, is a low fiber diet more low in soluble, insoluble?
1:00:43 Speaker 04 That's a good question.
1:00:44 Speaker 03 And are there relationships between these different fiber types and colon cancer, for instance, or like other outcomes?
1:00:51 Speaker 04 It's a good question. It's beyond, I don't know.
1:00:53 Speaker 03 Okay. And then, um, how much, so no one's getting enough fiber. How much is enough fiber? What does that look like? Are fiber, uh, do, do, are fiber, what do you call them? Fiber?
1:01:07 Speaker 04 Fiber cereals, fiber bars, fiber supplements.
1:01:09 Speaker 03 Fiber powders?
1:01:10 Speaker 04 Yeah.
1:01:11 Speaker 03 Yeah.
1:01:12 Speaker 04 I love these questions.
1:01:13 Speaker 03 Okay.
1:01:14 Speaker 04 Um, the recommended amount in the U.S. is like 28 to 35 grams of fiber a day.
1:01:17 Speaker 03 Okay.
1:01:18 Speaker 04 Okay. A cup of raspberries as an example. I can't believe I know this in my head because I didn't write any of this down.
1:01:23 Speaker 03 We've talked about this because raspberries especially are very high in fiber.
1:01:27 Speaker 04 Of all the fruits, they're one of the best because a cup of raspberries is like eight grams or so of fiber.
1:01:31 Speaker 03 A cup of, okay.
1:01:32 Speaker 04 So it's like pretty deuce. Um, kiwis also have a lot of fiber. Broccoli has a ton of fiber. Beans, especially white beans, so much fiber.
1:01:41 Speaker 03 Interesting.
1:01:42 Speaker 04 White beans, navy beans have more fiber than most other beans. Don't ask me why. No clue.
1:01:47 Speaker 03 Oh, lentils.
1:01:48 Speaker 04 Lentils, lots of fiber. Don't know how much. I don't have the rest of them memorized because I usually just give people a chart.
1:01:52 Speaker 03 Ooh.
1:01:53 Speaker 04 When I'm, I, it's one of my, that's my standard handout. If you come see me for a physical, that's literally part of my handout.
1:01:59 Speaker 03 Bring one, bring one next time.
1:02:00 Speaker 04 Yeah.
1:02:01 Speaker 03 Next time we're together.
1:02:02 Speaker 04 I just got it from the NIH website or whatever.
1:02:05 Speaker 03 Okay.
1:02:05 Speaker 04 Yeah.
1:02:06 Speaker 03 Still.
1:02:06 Speaker 04 I didn't make it. But no, so that's the recommended amount. And most of us are probably getting much less than that. Like if you, but your question about like fiber supplements and things like that can be really helpful, especially some of those soluble fibers like psyllium husk and things like that. You tend to tolerate really well because they're not going to be as fermentable. You're going to get a little bit less bloating potentially with those. But you could, you could get bloating with anything, especially if you're going from like no fiber.
1:02:34 Speaker 03 Right.
1:02:34 Speaker 04 To some fiber.
1:02:35 Speaker 03 Start, start small, baby steps.
1:02:36 Speaker 04 Baby steps, always.
1:02:37 Speaker 03 Yeah.
1:02:38 Speaker 04 This is not a medical advice podcast. Let me remind you all. We're just talking generalities. But yeah, so that's, did I answer all those questions? Those count. But of course, it is better if you're getting your fiber from Whole Foods because then you are getting a mix. And I don't know the answer as to like, what percentage should be this or that? And like, there's probably people who are doing those studies to kind of really look, look into it.
1:03:01 Speaker 03 Yeah.
1:03:02 Speaker 04 But I, I don't know the answer to that.
1:03:03 Speaker 03 I know. And this, like, we haven't said this yet, which I'm shocked that we haven't said this, but there are so many other topics that are related to poop.
1:03:12 Speaker 04 Yes.
1:03:12 Speaker 03 That we will cover.
1:03:14 Speaker 04 There's so many that I'm like, I will say this word and then we need to do a whole episode on it.
1:03:18 Speaker 03 Colon cancer.
1:03:18 Speaker 04 Colon cancer.
1:03:19 Speaker 03 Early onset colon cancer.
1:03:21 Speaker 04 So many things.
1:03:22 Speaker 03 Huge.
1:03:22 Speaker 04 Yeah.
1:03:23 Speaker 03 Diverticulosis.
1:03:24 Speaker 04 Speaking of, hemorrhoids.
1:03:26 Speaker 03 Hemorrhoids.
1:03:26 Speaker 04 So.
1:03:27 Speaker 03 This could be a whole episode.
1:03:28 Speaker 04 Oh, my God. It would actually would be a really fun episode.
1:03:30 Speaker 03 I want to know about the, I was thinking about the, the development of laxatives.
1:03:34 Speaker 04 Oh, interesting.
1:03:35 Speaker 03 Right?
1:03:35 Speaker 04 Okay, so we should do a whole episode on.
1:03:37 Speaker 03 The development of.
1:03:38 Speaker 04 Something.
1:03:38 Speaker 03 Hemorrhoid cream.
1:03:39 Speaker 04 Hemorrhoid cream.
1:03:40 Speaker 03 And whether it is true that you should put them under, put it under your eye for puffiness.
1:03:46 Speaker 04 I, I'm not gonna.
1:03:47 Speaker 03 I feel like, I feel like that was something in Miss Congeniality.
1:03:50 Speaker 04 Really?
1:03:51 Speaker 03 Is where I learned that.
1:03:52 Speaker 04 I mean, it's just like a low potency steroid usually. Anyways, we're getting off the point. Listen.
1:03:55 Speaker 03 Hemorrhoids.
1:03:56 Speaker 04 Hemorrhoids. Everyone has hemorrhoids. They're just collections of blood vessels that are in your rectum and your anus. So they function like cushions, basically, that help keep your anal canal closed because we want it closed most of the time. They help soften the transit of poop. So your poop has like, do, do. Think of it as like boinging off.
1:04:18 Speaker 03 Like a little pinball machine, like a pinball game.
1:04:20 Speaker 04 Gently off. But they also, they are basically collections of blood vessels and because they are venous vessels, like they're veins, not arteries, our veins can get swollen. And as they get swollen, they can sometimes burst open and bleed, either in small amounts or sometimes in larger amounts. And depending on where they form in the anal canal, your anal canal is so interesting. Because some of it has sensory sensation, the external part you can feel, it has a lot of nerve endings and the inner part does not. So if you have internal hemorrhoids, they generally don't have any like pain or discomfort or itching, but external hemorrhoids can cause quite a lot of itching and pain.
1:05:05 Speaker 04 Because especially, they don't tend to burst open, though they can. But they can get very large and very, very painful because they're like external. So you're basically like sitting on them. So those can be quite painful, like little water balloons filled with blood, basically, right around your anal opening.
1:05:24 Speaker 04 And so those are, you are at higher risk for those with constipation, like big, big, big time. Because it is all of that increased pressure and the straining, straining to poop really puts a lot of pressure on that anal canal. And so it really increases the pressure in those veins, so then blood pools up in there.
1:05:42 Speaker 03 I'm just, I'm thinking of, as someone who listens to a lot of like books on tape and in my car and when I'm running and walking the dog. And when someone gets in the car with me and I have like, you know, like a colorful scene in one of my books. And I'm imagining of all of our episodes.
1:06:00 Speaker 04 Someone is playing this and they walk in.
1:06:03 Speaker 03 And their, their like, I don't know, brother in law gets in the car and is like, you know.
1:06:09 Speaker 04 What exactly are you listening to?
1:06:11 Speaker 03 Bluetooth speaker, yeah.
1:06:12 Speaker 04 Yeah, this is one to share with your family.
1:06:14 Speaker 03 Please do.
1:06:14 Speaker 04 Because I'll keep going to tell you about anal fissures, which are another consequence of constipation.
1:06:20 Speaker 03 Consequence of constipation, not related to hemorrhoids?
1:06:22 Speaker 04 Uh, not, not directly related, except that they're both like an anal disease, basically. But anal fissures are also this increased pressure, sitting constipation. Patient issue, they're just teeny tiny little like paper cuts almost in the skin of the anus. And so they're super, super painful. So treatment for that is really to like, avoid constipation. And sometimes, sometimes you need surgeries and things like that to kind of help treat those. So yeah, so constipation is a big deal, right? Cause it can be a problem in and of itself. And it can cause all of these other problems. There's something called stercolitis. We won't even get there because it's quite extreme. But on the other end. Now I'm like, what? Google it after that. On the other end of the spectrum is diarrhea. Yes.
1:07:08 Speaker 04 And we've talked a lot about diarrhea. I spent more time on constipation because we don't ever really cover it on the podcast. But we've talked quite a lot about diarrhea. You define acute diarrhea as like three loose or watery stools in 24 hours. In 24 hours. As my kid will tell you, I only had two, so it's not diarrhea.
1:07:27 Speaker 04 They're well trained. But chronic diarrhea, we define as loose or watery stools, similar to constipation in at least 25% of your stools, lasting for at least three weeks. Okay. That would call chronic diarrhea. Yep. And one of the biggest issues with diarrhea is that you're getting a lot of water loss with it. Right, right. And diarrheal poops tend to be not only higher in water content, they also tend to be higher in protein content. And as you're losing all this water, you're also losing all those electrolytes that are with that water. So with diarrhea, you're at really high risk of dehydration and electrolyte imbalance. Protein? Yeah, because things are just not getting digested and broken down all the way. So fats too.
1:08:12 Speaker 04 So fats too, depending on the type of diarrhea. It could be, it just depends on, it depends on what your GI tract is able to absorb versus not. What do you mean by types of diarrhea?
1:08:24 Speaker 04 I mean, what is causing your diarrhea can affect the type of diarrhea that you are having. So, for example, if you have an infection that's just tearing through your GI tract so that your, say, colon just isn't really absorbing any water, then you're just gonna have really watery stools, but you're still gonna probably be absorbing all those nutrients because that happens in your small intestine.
1:08:50 Speaker 03 Yes.
1:08:51 Speaker 04 Okay. On the other hand, if you have no more gallbladder, then you are leaking out bile all the time.
1:09:00 Speaker 03 Yeah.
1:09:01 Speaker 04 So you might have less ability to digest fats. So you have more fat that just made it all the way through to your colon, and that is providing a slippery slide. Then you might have diarrhea that is more fatty and is floaty fatty. But there's just, I mean, there's lots of ranges of diarrhea.
1:09:21 Speaker 03 Okay.
1:09:21 Speaker 04 And like you were talking about, there's lots of ranges of smells of diarrhea. There's some people who are like, I can smell a C. diff diarrhea versus not. So is it infectious? Is it not? Is it chronic diarrhea? Is it more of an acute diarrhea? All of them, though, can put you at risk of things like electrolyte imbalance and dehydration and all of that.
1:09:39 Speaker 03 Chronic diarrhea. Okay.
1:09:41 Speaker 04 Yeah.
1:09:41 Speaker 03 Yeah.
1:09:42 Speaker 04 And prevalence rates, when it comes to diarrhea, I don't have like a one statistic like we do for constipation because they range hugely.
1:09:49 Speaker 03 Right.
1:09:50 Speaker 04 And we've talked so much on this podcast about acute infectious diarrhea, especially in low and middle income countries. How many kids die from diarrhea every year is in the millions. It's very depressing. But even in high income countries, it's estimated that chronic diarrhea, the prevalence can range from like 3% to 8%, which is not a small amount of people.
1:10:09 Speaker 03 No.
1:10:11 Speaker 04 So there's a lot of different things that can cause both constipation and diarrhea.
1:10:18 Speaker 04 But one that I want to kind of talk about because it can actually cause both. Okay. Is IBS. Yeah, okay, okay. Okay. Yeah. And again, this probably deserves its whole own. Oh, it does. We, we need to do one. Yeah, we do. Please don't take this as a, we're just gonna throw this in. No, no. But, but I can't do a whole, two episodes about poop and not talk about IBS. Of course not. Especially about problematic poops because talk about the poster child of problematic pooping. Yeah. It's IBS. So IBS or Irritable Bowel Syndrome, not the same thing, by the way, as IBD or Inflammatory Bowel Disease. Right. Which very commonly causes diarrhea, especially bloody diarrhea and is an autoimmune disease and inflammatory and a huge problem. Yeah.
1:10:59 Speaker 04 IBS is not that. It used to be like a diagnosis of exclusion, but it's not anymore. Oh, interesting. Now it's very much like you should positively diagnose this as IBS. What are the criteria? Well, they can, they can range a little bit, but the core, core criteria are recurrent cramping abdominal pain. Okay. So you get cramping pain and then changes in stool frequency or consistency. And this is where it can range. Some people have what's called IBS-C, which is IBS with constipation. Uh huh. Some people have IBS-D, which is IBS with diarrhea, and some people have mixed. CD. CDM, we call it though. Oh. Mixed.
1:11:41 Speaker 04 Because you have both either constipation or diarrhea, but you're having these changes in your stool frequency, like I'm having a poop all the time, all of a sudden. Okay. Or consistency where like I was having like a Bristol three or four and now I'm a seven. Okay, I'm just so confused about changes in. Yeah. Because that implies a time period. Yes. This has to be for at least three months and it has to be happening at least three, I think, three times a week. Is the. Three times a week. This is the criteria. Is the D or C? Is the, is the changes in your stool. Changes. Yeah. So like what is your, and it's associated with this cramping. So you're having this pain. Having the cramping. And then you have either a constipated poop or a diarrheal poop or one or the other. And it's happening for three months, you said?
1:12:26 Speaker 04 Yeah, yeah.
1:12:28 Speaker 03 Okay.
1:12:29 Speaker 04 And we still do not understand IBS. It's deserving of its whole own episode, but we are pretty sure that it is, at least in part, a disorder of the gut-brain axis, which is just so interesting and fascinating to me.
1:12:44 Speaker 03 I know. I mean, the phrase itself is really compelling.
1:12:47 Speaker 04 It is.
1:12:49 Speaker 03 And what's underneath the surface?
1:12:50 Speaker 04 What's underneath? We don't know.
1:12:52 Speaker 03 Great question.
1:12:52 Speaker 04 Great question. But yeah, so it's basically like your guts and your brain are not talking to each other the way that they should.
1:12:59 Speaker 03 Yeah.
1:13:00 Speaker 04 Your neurotransmitters are probably involved, serotonin, you have more of it in your gut than you do in your brain, etc.
1:13:05 Speaker 03 Yep, yep, yep.
1:13:06 Speaker 04 But then you also see with this intestinal dysmotility. So whether that is your guts are going too fast, and so you're just pooping your brains out because you're not absorbing things because they're moving too quickly, or you're going really slow and that's why you're constipated. And, this is really interesting, visceral hypersensitivity. And that's where you get this pain. So viscera is like your guts. And hypersensitive, meaning that your nerve endings are feeling more pain than they should.
1:13:34 Speaker 03 Interesting. So, because we've talked about hypersensitivity before. When?
1:13:39 Speaker 04 I don't remember.
1:13:40 Speaker 03 In the metriosis, maybe?
1:13:42 Speaker 04 Maybe, yeah, yeah.
1:13:43 Speaker 03 And so it's the same sort of thing. It's like those pathways have been carved out. And so like, it's like a superhighway to pain.
1:13:48 Speaker 04 Yeah, exactly.
1:13:49 Speaker 03 Okay.
1:13:50 Speaker 04 Exactly. But so, yeah, so there's a lot, there's a lot of research being done in IBS. There are a lot of new medications, especially to treat like IBS with constipation. There's medicines that are specific for that. Same thing with IBS with diarrhea. So like, there's a lot of research. But there's also a lot of people who just like suffer with either constipation or diarrhea, and they're looking for ways to manage it. And so they turn to things like fiber or prebiotics, which are all the rage right now, which is usually just fiber.
1:14:22 Speaker 03 Really?
1:14:23 Speaker 04 Yeah. They just market it in a weird and different way.
1:14:25 Speaker 03 Prebiotic.
1:14:26 Speaker 04 Prebiotics. That's what they're...
1:14:28 Speaker 03 Okay.
1:14:28 Speaker 04 And then probiotics is the other one.
1:14:30 Speaker 03 Ah.
1:14:31 Speaker 04 So let's talk a little bit more about probiotics. Because again, we can't talk about poop and not talk about probiotics.
1:14:35 Speaker 03 Can't.
1:14:36 Speaker 04 Not. I think the last time we talked about probiotics was in our C. diff. episode. Yep. Sure. I don't remember. I believe you. Honestly, though, that was a long time ago, that episode. And I'm not sure that we have that much more data than we did way back then. People use probiotics and they will recommend that you take probiotics for anything from diarrhea to constipation to bloating, whether that's acute infectious diarrhea or chronic diarrhea. Yeah. Right? There's very little data that show that there is a benefit to probiotics depending on the certain circumstance that you're using them for. Tell me about those circumstances.
1:15:14 Speaker 04 Well, most of the data, most of the data is on antibiotic-associated diarrhea or like after you use antibiotics or you're using antibiotics for something like C. diff. And even then, the data is really, really mixed. The biggest issue is that there's huge heterogeneity in how each of these studies are conducted. And who's conducting them? Who's conducting them? Mostly it's like people who are making supplements or yogurt or something. So there's that issue. Right. But there's also just huge heterogeneity in like which bacterial strains are they actually using in this study? How many bacteria are you actually getting in that capsule? Well, because it's got to go through your stomach. Exactly.
1:15:58 Speaker 04 It has to survive the acidic environment of your stomach. It has to make it through your small intestine to try and colonize your colon. We know now that that's like a 20-plus-foot journey. Yep. So that's not necessarily easy. There's also a huge issue with the fact that in the US, there's absolutely no regulation on these things because probiotics are regulated as supplements. See our supplement episode for so much more. Yeah. We, or they're sometimes classified as a food product, right? If it's like a yogurt or yogurt drink or something like that. So we don't have really any data on how much live bacteria are even in your gummy or your capsule or your juice drink, how much of those will survive, or if that particular
1:16:41 Speaker 04 strain is necessarily beneficial for you in your specific clinical scenario. I know.
1:16:47 Speaker 03 Honestly, it is really, it's really frustrating. Like the, I think, in particular, one of my, uh, one of my irritants is the probiotic soda.
1:16:57 Speaker 04 Yes.
1:16:58 Speaker 03 And I'm just like, it's soda.
1:17:00 Speaker 04 It's ju-
1:17:00 Speaker 03 It's sugar.
1:17:02 Speaker 04 Yeah.
1:17:02 Speaker 03 What?
1:17:03 Speaker 04 It's just-
1:17:04 Speaker 03 I mean, I'm sure there's more stuff in there, but like-
1:17:06 Speaker 04 Right. Some of them are, have prebiotics. So again, they've got like fiber or like non-digestible sugar.
1:17:10 Speaker 03 Okay.
1:17:11 Speaker 04 Great. Um, the other issue too, is that we have some data on a few species. We've got some decent data on bifidobacterium, that at least it's probably not harmful, on a few species of lactobacillus, that again, they are good colonizers and they're not harmful. Um, and Saccharomyces, which is actually a yeast.
1:17:28 Speaker 03 Right, right, right.
1:17:29 Speaker 04 But, that's just like three and like a couple of species of lactobacillus, right? So we're talking a handful of species out of the thousands that colonize our guts? Like, we don't know what we're doing when it comes to probiotics.
1:17:42 Speaker 03 We don't.
1:17:43 Speaker 04 Uh, so there are people who say, well, taking one or two species is never going to be enough. It's never going to do the thing that you needed to do. What we need is a fecal transplant, Erin.
1:17:53 Speaker 03 Okay. Before we talk about fecal transplants, I do, I feel like every time we end up talking about the microbiome, we did it more recently, Erin, and I don't remember what it was. We're always like, the hype is overrated and it's, the hype is not overrated for the microbiome itself.
1:18:08 Speaker 04 No.
1:18:08 Speaker 03 It is for our understanding of it.
1:18:11 Speaker 04 Correct.
1:18:12 Speaker 03 And how we are able to manage and optimize it.
1:18:15 Speaker 04 Yes.
1:18:15 Speaker 03 Because we just aren't there yet.
1:18:17 Speaker 04 Right.
1:18:17 Speaker 03 Maybe we will be, but we're not there.
1:18:19 Speaker 04 No, not even close. And I agree-
1:18:22 Speaker 03 Well, we are there with fecal transplants.
1:18:23 Speaker 04 Are we there with fecal transplants?
1:18:24 Speaker 03 Are we?
1:18:25 Speaker 04 No.
1:18:25 Speaker 03 Question mark.
1:18:25 Speaker 04 We're not. But fecal transplants are essentially like, that, that is one of the answers, right? It's like, well, okay, giving someone just some lactobacillus or lactobacillus and bifidobacterium, like too little bacteria. Is that going to change the entire architecture of their gut microbiome? Probably not, right?
1:18:42 Speaker 03 Yeah.
1:18:43 Speaker 04 But- Hitting them with someone else's entire gut microbiome might. And that's the idea behind fecal microbiota transplant, or FMT. This is a huge field of research. I will not do it justice. However, the idea is basically that you take a microbial community from a healthy person's guts, someone with Bristol III or IVs all the time.
1:19:06 Speaker 03 Beautiful poops.
1:19:06 Speaker 04 No bloating.
1:19:07 Speaker 03 Just exceptional.
1:19:08 Speaker 04 Love it all the time. And you give it to a person with some kind of gut disease. You give them some of their poop. Because in that poop, again, 50% of the biomass of their poop is bacteria. You can do this a few different ways. You can instill the poop into somebody via colonoscopy from the bottom, or an NG tube from the top. Because you wouldn't want to just eat it because that's gross. But you could make it into pellets. And then you could take it as a capsule. You can freeze dry them, or you can freeze them, either way. And there is so much research being done on this. It is used clinically already, but only in one scenario so far outside of the research sphere as of recording.
1:19:53 Speaker 04 So there is a FDA-approved treatment here in the US for recurrent C. diff infection that is an FMT.
1:20:04 Speaker 04 There's two approved products. One of them is given via an enema suspension. And the other one is oral capsules, which is just really exciting because that's so much more palatable to people.
1:20:16 Speaker 03 Yeah.
1:20:19 Speaker 04 And also like lower barrier to entry because you don't have to go into the office. You don't have to do it in clinic, etc.
1:20:25 Speaker 03 You could just poop.
1:20:26 Speaker 04 Exactly. You just pop it in your mouth. Swallow it down. So it's a very exciting area of research. But that's all that I really have about it. Because there's a lot of people who are wanting to use it for treatment of IBD. There's some really promising research in that area. There's some promising research on it for IBS even. Which I think is very exciting. But that's all that I really have about that.
1:20:48 Speaker 03 I mean, we could do a whole, another whole. I know that in our C. diff episode, we did like a big segment on.
1:20:53 Speaker 04 We did.
1:20:54 Speaker 03 FMTs.
1:20:54 Speaker 04 Shout out to Dr. Imajdi Osman, who we had on the pod.
1:20:58 Speaker 03 Great. Um, I, but I think that we could do a whole, a whole like update episode on it. Because I also want to know, like, okay, people who got a fecal transplant five years ago.
1:21:06 Speaker 04 How are they doing now?
1:21:07 Speaker 03 What is their poop like today?
1:21:09 Speaker 04 Yeah.
1:21:09 Speaker 03 Do they have the same microbes that they were, you know, laced with in that first FMT?
1:21:14 Speaker 04 Certainly not, I would think, that there's some turnover.
1:21:17 Speaker 03 Oh, I'm sure there's turnover, but I mean, like, how much does the community?
1:21:20 Speaker 04 The core community.
1:21:21 Speaker 03 Yeah.
1:21:21 Speaker 04 Oh, it's so interesting, Erin.
1:21:23 Speaker 03 I know.
1:21:23 Speaker 04 There's just so much, I think, about our guts and our poop that is exciting.
1:21:29 Speaker 03 I know, and but it's, it's very true, and I feel like it has been a field of, like taboo to talk about or to be excited about, or be like, it's really interesting, or anything like that. And so it's discouraged interest in this really promising field.
1:21:43 Speaker 04 Cause poop is gross.
1:21:45 Speaker 03 Right.
1:21:45 Speaker 04 But it's also awesome.
1:21:47 Speaker 03 Yeah.
1:21:48 Speaker 04 I love it. That's pretty much the end of what I got, Erin.
1:21:50 Speaker 03 Poop is gross, it is awesome, we love it.
1:21:52 Speaker 04 We love it.
1:21:53 Speaker 03 There's more to it.
1:21:54 Speaker 04 And we'll wash our hands after we poop.
1:21:56 Speaker 03 And we, we will certainly do that. Oh, should we tell the people where they can read more about fun poop stuff?
1:22:03 Speaker 04 Fun poop stuff.
1:22:03 Speaker 03 There is so much more when it comes to, A, the history of sewers, and B, what people are doing about solving the poop problem.
1:22:12 Speaker 04 I'm excited about that.
1:22:13 Speaker 03 So there's a book by Lina Zeldovich, who, if, I, I interviewed for a book club episode earlier this year for, about phage therapy.
1:22:21 Speaker 04 Yeah.
1:22:22 Speaker 03 Uh, but her earlier book is called The Other Dark Matter: The Science and Business of Turning Waste Into Wealth and Health.
1:22:28 Speaker 04 Love that.
1:22:28 Speaker 03 Really fascinating. Then by Stephen Halliday, The Great Stink of London: Sir Joseph Basilgette and the Cleansing of the Victoria Metropolis. And then another book by him as well, but it's like an illustrated coffee table book for sewers, and it's called An Underground Guide to Sewers, or Down Through and Out in Paris, London, New York.
1:22:48 Speaker 04 I love that.
1:22:48 Speaker 03 And it's, it's here, it's, it is honestly beautiful and really fun.
1:22:52 Speaker 04 It is gorgeous.
1:22:53 Speaker 03 And I loved it. It was great.
1:22:55 Speaker 04 I also actually had a book for this one. I never have books.
1:22:58 Speaker 03 I love that.
1:22:59 Speaker 04 But I did enjoy, by Dr. Fong, it's called Constipation Nation.
1:23:03 Speaker 03 I love that.
1:23:03 Speaker 04 Which is such a good title.
1:23:04 Speaker 03 Great title.
1:23:05 Speaker 04 I really did enjoy that book. I rarely read entire books and I actually read that whole entire thing. So that's how you know it was good. And that, there's like a lot more detail on constipation. I think there's even like, treat your constipation smoothies at the end, which is hilarious to me. But then I also loved, oh, this is where I have the citation for the paper we actually mentioned last episode.
1:23:24 Speaker 03 Oh, yeah.
1:23:25 Speaker 04 About how it takes only 12 seconds to poop. Because I didn't get into like, we spend so much time on the toilet.
1:23:30 Speaker 03 I mean, and that's related to hemorrhoids and that's related to...
1:23:33 Speaker 04 There was a 2025 paper that was like, if you spend time on the phone, you're at higher risk of hemorrhoids. And I was like, there's so much to this. Let's keep going.
1:23:39 Speaker 03 You're gonna do a hemorrhoid episode.
1:23:40 Speaker 04 Anyways, that paper was from 2017. It was called The Hydrodynamics of Defecation, published in Soft Matter.
1:23:46 Speaker 03 Soft Matter.
1:23:47 Speaker 04 And then I've got several papers on like, the global prevalence of constipation, on FMT. I also have some more data on, because we didn't get deep into this, but on colon cancer rates. And we're gonna talk more about colon cancer later this season. So you can find all of it on our website, thispodcastwithkylie.com, under the Episodes tab.
1:24:05 Speaker 03 You can. Thank you to Blood Mobile for providing the music for this episode and all of our episodes.
1:24:12 Speaker 04 Thank you to everyone here at The Exactly Right Studios.
1:24:15 Speaker 03 Thank you, thank you.
1:24:15 Speaker 04 And Tom and Leanna and Brent and Pete and everyone who's involved in making this podcast possible.
1:24:20 Speaker 03 Heck, yeah. A big thank you to our listeners who listen or watch or read the transcripts even, anyone, you know, who somehow enjoys or, you know, just partakes in this podcast. You don't even have to enjoy it. Thank you.
1:24:34 Speaker 04 Thank you.
1:24:35 Speaker 03 You've helped us out.
1:24:37 Speaker 04 As always, thank you also to our patrons. Your support really, really does mean the world to us, so we really appreciate it.
1:24:42 Speaker 03 Yes, thank you, thank you. Well, until next time, wash your hands.
1:24:46 Speaker 04 You filthy animals.
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Previous Ep 200 Poop Part 1: How the sausage gets made Next Special Episode: Jon Adams and Edmund Ramsden & Rat City Page updated October 31, 2026 · transcript and summary are machine-generated
