Scribble

Dr Sanjay Gupta

00:00:02

'Hey there, welcome to Chasing Life. Well, today on the podcast, we are going to tackle a kind of awkward topic. It's something we all do, but we rarely ever discuss, at least not in polite company, unless maybe you're the parent of a small child. I'm referring, of course, to having a bowel movement-- a BM. Known as going Number 2, pooping. There's all these euphemisms, both quaint and crude to describe this.

Dr Sanjay Gupta

00:00:29

Even though it is universal, it is completely natural, many of us get embarrassed simply talking about it openly. Sometimes we don't even discuss this with our own doctors.

Dr Sanjay Gupta

00:00:39

But here's the thing, what happens in our gut has a profound impact on our overall health, has an impact even on our brains. So today's guest is Dr. Tricia Pasricha. She's a gastroenterologist and the director of the Institute for Gut Brain Research at Beth Israel Deaconess Medical Center in Boston.

Dr Sanjay Gupta

00:01:00

She's a really remarkable writer, and she's come out with this new book called You've Been Pooping All Wrong, in which she boldly goes where very few are willing to venture. Trisha is going to demystify this vital but villainized bodily system. She's also going to share with us the secret to achieving what she calls poophoria. And yes, that means what you think it means.

Dr Sanjay Gupta

00:01:23

So stay with us today. Don't poop out. I'm Dr. Sanjay Gupta, and this is Chasing Life.

Dr Sanjay Gupta

00:01:35

I gotta say, I've really been looking forward to this, Dr. Pasricha, and I just want the audience to know, first of all, that I am super proud of you. You were our intern here at CNN Medical for, oh, I don't know, ages ago now. And I think we all knew that you were gonna go out and do some amazing things, which you have done. You're obviously a doctor, but you've written this amazing book, which I read, and i'm going to talk about that. And you're working for the Washington Post, you're really getting your voice out there. So welcome to Chasing Life and know that we're all just so proud of you.

Dr Trisha Pasricha

00:02:11

Oh my gosh, Dr. Gupta, it means so much. This is a huge full circle moment for me, so thank you for having me on.

Dr Sanjay Gupta

00:02:18

No, it's really our pleasure. We've all been looking forward to this. You sent me the book, and I think I was texting you at the time. I was flying to the West Coast from the East Coast, and I read the book in one sitting on my flight there. And I was totally taken with it. I think texted you right afterwards saying, I learned so much.

Dr Sanjay Gupta

00:02:39

And it was funny. The book is called, You've Been Pooping All Wrong. And part of me felt like I needed to cover the title a little bit because I didn't want anyone asking me.

Dr Trisha Pasricha

00:02:49

Have you been?

Dr Sanjay Gupta

00:02:52

How did you come up with the title?

Dr Trisha Pasricha

00:02:54

Yeah, the title is really a conversation starter, or a conversation stopper, depending on the situation. But it actually came from something that I heard myself saying in my mind all the time when I was meeting patients. And then eventually, I started saying it out loud. But I think that people who came to my clinic when I started up, so this was about five years ago when I finished GI fellowship and was practicing on my own. I began to realize that what I thought was completely normal and normalized conversations about our bowel habits and pooping and how our gut works, how the enteric nervous system works— these were not conversations other people had grown up having. And I only had them because my dad was a gastro... And still is a gastroenterologist and loves what he does and was always getting into the weeds of these conversations. So I thought it was very normal.

Dr Trisha Pasricha

00:03:50

I came to find out later, the hard way, that some people find these conversations very embarrassing. And they're not having these conversations all the time. And patients would come in to me, often they'd have one specific reason they'd come. Maybe they have abdominal pain, maybe they need a colonoscopy. But what they really wanted to ask sometimes was, is this normal? Is my bowel movement normal? They wouldn't even know some of the basics.

Dr Trisha Pasricha

00:04:14

And then you'd open up the door, you'd crack the door open to be like, well what do we know about this? What do you think is normal? And just the floodgates would open about how little people understood about their bodies. And sometimes I would find myself saying, wow, you've been doing this wrong your whole life. Let's start over. Let's just eliminate everything you thought you knew about how you're supposed to do this and how your body works. And let's just start from scratch.

Dr Trisha Pasricha

00:04:37

'And from there, I decided I was going to write a book about it, partially because I think it helps spread the word more easily. We know it's hard to get a GI doctor's appointment. But also for the fact that I think this topic has been stigmatized for so long. With that title, I really wanted to just say it, say it up front, say it loudly, and hope to try to de-stigmatize something that we're all worried about.

Dr Trisha Pasricha

00:05:01

40% of Americans struggle with their bowel habits every day, that's a huge number. And this is not people, these are not people who have a diagnosis per se, they don't necessarily have a labeled condition, but their bowel habit just interfere with their daily lives. I think we should change that because it doesn't have to be that way.

Dr Sanjay Gupta

00:05:19

I remember years ago, Oprah did a thing with Dr. Oz, and it was like one of the first things Dr. Oz ever did, I think, for the show. And we were talking about it; I happened to be on set that day. And it was about bowel habits. And it really interesting to me because they got really didactic. They showed what normal poop should look like. And what I can tell you is that while no one in that audience probably would have asked about it, everyone was fascinated by it. And because it affects all of us, but there's this taboo around it, this stigma around it.

Dr Sanjay Gupta

00:05:53

You didn't have it because you grew up in a family of gastroenterologists. But that's not the case for most people. Why do you think it is so taboo or stigmatized to talk about? And is that a US thing or is that a worldwide thing? Do different cultures sort of approach this differently?

Dr Trisha Pasricha

00:06:09

You know, I have a lot of theories about why this is the case. One is that I think from our early days, like probably the last time a lot of people have this conversation about pooping is when they were toddlers and when they're being potty trained. And even around that time —and I'm actually like really deep in potty training my two year old right now, so I like understand this. So it's close to my heart. But I think even around the time, a lot parents treat going to the bathroom as yucky, and they call poop yucky and they kind of start to make you feel like this is something that you need to have control over. It's embarrassing when you don't and you need to kind of distance yourself from it as soon as it's over.

Dr Trisha Pasricha

00:06:52

Like it can, and I think it spreads from the idea that yes you can spread diseases through poop and through not, you know, washing your hands. That was an old fear that I think has lingered, but it's taken on this like idea that it's disgusting. And by no means do I think you know, like overly delightful by any means, but I certainly don't ever want my kids to feel like that they should be embarrassed by what's going on and that we shouldn't have this conversation.

Dr Trisha Pasricha

00:07:14

Once you bring it up, once you just open the door to it, everybody wants to talk about it. In fact, everyone's relieved that someone's able to have this conversion and that they can get knowledge about it because it's the thing that I have found. I mean, I know this from my patients and from everyday experience that it's something that can make or break your day. You know, like being able to eat what you like and then being able comfortably get rid of it. That's something that people would give up a lot in their own life to be able to get back.

Dr Sanjay Gupta

00:07:43

Yeah, I think there's no question. And I think this is one of the few topics, I mean, joking aside, one of a few topics in medicine that is so significant and so poorly discussed or inadequately discussed at the same time. I mean I think perhaps things like addiction would sort of fall into that category, but this is something that is so basic to human biology and yet so rarely discussed.

Dr Sanjay Gupta

00:08:07

So the book, you know, I really does open the door to this and you know. I think like I said to you right away, I think this is gonna be a really, really important popular book because of that reason. You provide really sound medical guidance here, which frankly is very reassuring, I think, for a lot of people. And I think that that's gonna be...

Dr Sanjay Gupta

00:08:29

But 40% is a big number, Tricia. 40% of people have their daily lives disrupted because of their bowels. 15% have irritable bowel syndrome. Have those numbers gone up and what do you think is going on here?

Dr Trisha Pasricha

00:08:44

'Certainly those numbers changed a lot with the pandemic. And every time there's a big infectious outbreak, about one in three, one to four people do go on to develop irritable bowel syndrome. And so we certainly saw just a population-wide surge of irritable battle syndrome after COVID. But it's one of those things that you'll see if there's case of norovirus or if there is an outbreak of like everyone in your family gets food poisoning. It's actually a good percentage of people who get irritable bowel syndrome. And it may not be forever, but it may be something that lasts for months to years and people are living with. So over time, they track the number of cases of irritable bowel syndrome went up.

Dr Trisha Pasricha

00:09:23

The number of the 40%, has that changed over time? I think that, my guess that that particular number has probably stayed similar over time I mean, it's a big number. And I sometimes see this with my patients. A lot of people might think, Oh, I'm not in that group. I think I'm doing just fine. But sort of my litmus test for that is, ask your partner, do your bowel habits disrupt your daily life? And sometimes people are surprised because they're like, no, I am not constipated. I have no trouble. And their partners will be like, are you kidding me? You spend 45 minutes in the bathroom every morning. We're late to go out all the time.

Dr Trisha Pasricha

00:09:58

And sometimes you don't really realize how disruptive your habits are until you move in with somebody or until you go to college and you see what other people are doing or until your partner finally breaks and says, we have to talk about this. But you might have normalized what you're doing for so long simply because you don't know that it's actually not the average experience.

Dr Sanjay Gupta

00:10:19

You know, I read a stat that for younger people, 80% for some of these younger people, 80% of their diet is basically processed foods. Are processed foods part of the culprit here?

Dr Trisha Pasricha

00:10:30

'Yeah, I've read similar stats, and that's changed, certainly over time, and I think that's part of why IBS, I think, that section of the population has been growing and changing. It's not just the infections. And they've done a few studies on this in large epidemiological studies where they have linked ultra-processed foods with worsening symptoms in irritable bowel syndrome.

Dr Trisha Pasricha

00:10:55

'A lot of what we understand about ultra-processed foods and the gut, in irritable bowel syndrome and pain, comes from translational or basic studies. And in those studies, we have certainly found that ultra-processed foods decreases that mucus lining in our colon. That is so important, because our colons are lined with this layer of mucus that really protects us from the outside world. When these ultra-processed foods, some of the additives and chemicals in them deplete that layer, not only does it change the bacteria that are living there happily in that layer. Now they can't do that. But it makes you more susceptible to the outside world and the environment and what you're putting in there. And so we think that some of those things do have to do with it.

Dr Trisha Pasricha

00:11:36

'And of course, then there's this other very concerning finding that I know you've reported on about ultra-processed foods and this link to colorectal cancer. And we're certainly seeing a lot of early onset cases of coloreactal cancer, those have been rising for now several decades. And that link is starting to become much more clear with ultra-processed foods.

Dr Sanjay Gupta

00:11:53

We've been using two terms, irritable bowel syndrome and constipation. I think most people understand what constipate is, although there may be a medical definition of it as well. But first of all, with irritable bowels syndrome, what is it exactly?

Dr Trisha Pasricha

00:12:07

Yeah, that is a huge, huge question. Irritable bowel syndrome is one of those syndromes that I think when people hear that word, they think it's what we would call a diagnosis of exclusion. It's the diagnosis you give somebody when you don't know what's going on, when all the tests are normal.

Dr Trisha Pasricha

00:12:24

And in fact, we've, over the last two to three decades, really clarified what it is that's happening. So on the surface of it, irritable bowel syndrome is this incredibly common disorder. Where people have pain or discomfort associated with having a bowel movement. And there's some people who have constipation, there's people who've diarrhea, but in all cases of irritable bowel syndrome, there's a lot of discomfort that goes into that, and that's something that they live with for at least three months, often for several years.

Dr Trisha Pasricha

00:12:51

And the tricky thing about this is that most of the tests that we do in a standard clinical environment are negative, meaning you could get a colonoscopy, you'll get biopsies, they won't show any abnormality. You'll get blood work. Those probably won't show any abnormality. And sooner or later, your doctor will eventually say, well, okay, it's not something that's causing inflammation. It's certainly, you know, nothing worrisome. We're gonna call this IBS.

Dr Trisha Pasricha

00:13:19

And what's actually happened is a change in the enteric nervous system. The enteric system is this network of nerves throughout the gut that is in close communication with your central nervous system in your brain. And there are lots of different abnormalities in IBS. It's actually kind of like a lot of diseases where there's not one singular abnormality. It's multiple different things that happen. But one of the common themes is that the nerves in your gut become hypersensitive, meaning it takes a lot less for them to react and trigger and send pain signals up to the brain.

Dr Trisha Pasricha

00:13:53

The reason that we don't have a good test for that is that much of the enteric nervous system lives in the deep muscle layers of the gut. You can't reach that with a surface level biopsy on a colonoscopy. That would cause a hole in your colon. We certainly don't want to do that. But in research studies, we know it's there. So sometimes even knowing, yes, there is, people are aware that there is a true abnormality here, that is measurable, that is present, can be really validating and reassuring to people.

Dr Sanjay Gupta

00:14:21

What can our bowel habits tell us about our health?

Dr Trisha Pasricha

00:14:26

Yeah, I think they can tell you a lot. And I sometimes think about this statistic that came from the UK, but it really bothers me, which is that one in three people will avoid talking to their doctor about their bowel habits because they're so embarrassed. And I always sort of anchor with that statistic in mind because if you don't get in the habit of routinely looking, looking is the first step, knowing what your normal is, knowing what your kind of fluctuations in your pattern could be considered normal, you're not going to know when something is a little abnormal for you. There's a lot that you can learn first just by looking and understanding what your pattern looks like.

Dr Trisha Pasricha

00:15:06

One, the consistency tells you a lot. There's actually been very good data that shows that the consistency of the stool, so meaning how soft and fluffy it is versus how hard or pebbly it is, that can giive you a good sense of how quickly that stool has moved through your body. How long it's been sitting in your colon. Because one of the colon's jobs is to suck water constantly out from what's inside back into your bloodstream. So if it takes longer, more and more water is getting sucked and the stool becomes drier. It can tell you about that.

Dr Trisha Pasricha

00:15:37

The color can give you a lot of information. And certainly there's a very important point to be made that if somebody sees red, sees something that looks like blood, they haven't had beets, beets are a classic masquerader. But anything that looks like blood, you shouldn't assume is hemorrhoids, you shouldn't assume no big deal, until you have a doctor just confirm and make sure about that. So anything that looks like red is concerning.

Dr Trisha Pasricha

00:16:00

And then how you feel around the time. Are you feeling discomfort? Are you straining? Straining is a big sign. People often talk about frequency as being the most important thing, and to me, that can actually be the least important thing. How you feel, whether it was comfortable and effortless. Is the number one criteria for me about whether something is normal.

Dr Trisha Pasricha

00:16:23

If you go once a day, but you strain for 20 minutes and you strain your eyeballs out, I don't think that that's normal. But if someone's going, you know, every other day, but it's completely effortless, I think that's totally normal. So it really depends. But I think you have to ask yourself, how much time am I spending in the bathroom to do this? And am I disrupting my own life? Am I disrupting other people's lives because of this?

Dr Sanjay Gupta

00:16:48

More of my frank discussion with Dr. Trisha Pasricha right after the break.

Dr Sanjay Gupta

00:16:57

Welcome back to Chasing Life and my conversation with Dr. Trisha Pasricha about a universal, but taboo topic.

Dr Sanjay Gupta

00:17:07

Is there an ideal way that or amount even people should be should be having bowel movements?

Dr Trisha Pasricha

00:17:16

I think a lot of people think the answer to that is you should go once a day and you should go in the morning. And I think that your body actually is physiologically primed to go in morning. So it can be nice if you can lean into that natural physiology. And the reason for that is that your colon is kind of like the rest of you. It operates on this circadian rhythm more strongly than a lot your other organs. And so it goes into this really quiet, still state at night when you sleep, right? Like your heart is still beating, it might be a little slower. Your colon's really not moving too much at night.

Dr Trisha Pasricha

00:17:49

When you wake up though, it buzzes with activity for the first one or two hours upon waking, and your colon on its own is gonna contract more strongly than it's going to do so for most of the rest of the day. So if you can lean in and try to have a bowel movement during those first hours when your colon's doing the work for you, it means you have to do less work because you don't have to strain as hard.

Dr Trisha Pasricha

00:18:12

And then often in the morning, people are having a cup of coffee, which can, for one in three people, coffee triggers a bowel movement. It causes those contractions. You might go for a walk in the morning. That's very common. I walk my dog. Exercise and just even moving around gets things going. So you do a lot of things in the mornings that come together.

Dr Trisha Pasricha

00:18:29

But again, it's very common for people to experience another wave of just those natural contractions in your colon anytime they eat. So just eating that mechanical distension of your stomach sends a signal up to the brain in a reflex, and then it causes the colon to start to contract. It's why people sometimes within minutes of eating sometimes feel like they have to go to the bathroom. And it's not because that food suddenly made it all the way down to the colon. It's not the case, but it's this reflex, and it's totally normal.

Dr Sanjay Gupta

00:18:57

And again, I just want to emphasize this point you have to sort of compare yourself to you, right? I think that's again, one of the things I took away from the book is that things might be very normal for you might be very different for someone else. But what you're really concerned about doctor is when that individual has a change in bowel habits. Like if they start if they're going every couple of days and now they're growing three times a day or vice versa, that would be a concern.

Dr Sanjay Gupta

00:19:28

And why is that a concern? What do you think, what are you worried about at that point if someone has a change of bowel habits?

Dr Trisha Pasricha

00:19:35

Well, I worry about two things. One is I certainly worry if it comes to your attention because that change is now causing you problems. Like you now say, I have this urgency to go and I'm struggling socially, I can't make it to the bathroom. This is like bothering me. Or suddenly I'm straining. This is very uncomfortable. When you have symptoms, I'm always concerned and I will always try to figure that out.

Dr Trisha Pasricha

00:20:00

Sometimes it doesn't quite reach that level, even, of you saying this is overly bothersome. You might just say, I noticed that my stools are suddenly really, really thin. That doesn't inherently bother me, but it's new. It's different. It's weird. That bothers me because that's a change that's worth investigating why. Now, every time you have a change in your bowel habits, it may not be something worrisome. What I'm worried about with the change in the caliber and something becoming thin is that, could there be a mass or something squishing it that's causing it to be thin like that? But people are gonna have daily fluctuations.

Dr Sanjay Gupta

00:20:37

We've talked about processed and ultraprocessed foods being problematic. To sort of flip the script on that, is there an ideal diet for colon health?

Dr Trisha Pasricha

00:20:40

Yeah, they've done so many of these studies. Actually, a lot of them were done here by my colleagues at the School of Public Health, looking at the nurses' health study, which a lot people have heard of, trying to figure out what are the kinds of ways that we eat in America that are linked to better health outcomes with our guts.

Dr Trisha Pasricha

00:20:56

And I think that at the end of the day, what we've learned from a lot of these study is that it doesn't have to be so prescriptive, in terms of cutting out a lot of different foods. But it seems that diets that most closely mirror something like the Mediterranean diet seem to be beneficial, not just for your brain and for your heart, but really for your gut.

Dr Trisha Pasricha

00:21:17

'What the basic principles are that have been shown in the Mediterranean Diet and other kind of anti-inflammatory diets that benefit the gut are eating more fiber. That's like, if I could, like you said, if I can do just one, two, and three things, I would eat more fiber, eat more and eat more.

Dr Trisha Pasricha

00:21:32

And for women... It's, for under 50, it's 25 grams per day. For men, it is 38 grams per days. If you were to just stop and count, like one day, a typical day in your life, how many grams of fiber are you actually getting? 95% of us are not gonna be getting enough. And that's the first place to start.

Dr Trisha Pasricha

00:21:51

And then it's thinking about, okay, well, what are the ways to incorporate more whole grains? Yeah, I'm eating more vegetables, but can I eat a diversity of vegetables and fruits and legumes? Legumes are really underappreciated. And the fewer kind of inflammatory foods, which are the processed foods, the processed meats, the better. It's not all or nothing. It's never gonna be all or anything, but if you can start making small swaps, even if it's as little as a fiber supplement, that's better for your gut health.

Dr Trisha Pasricha

00:22:21

And the reason that it's great for your gut is we talk so much about, in popular culture, about probiotics and the microbiome. And the point that I want people to remember about the microbiome and why these foods matter is that your microbes feed off of the things we cannot digest, and usually that is fiber. It can be resistant starches and other things, but it's the fiber that makes their way down to the colon. And how much fiber you're getting, the kinds of fiber you are getting it, will change the species of the bacteria living there.

Dr Trisha Pasricha

00:22:52

And once they metabolize and they ferment these different kinds of foods that you are choosing to give them, they produce new compounds called postbiotics. The postbiotic is like the underappreciated part of the microbiome conversation that I think is the most important part.

Dr Trisha Pasricha

00:23:09

'Postbiotics are the compounds that the microbes produce. They're new compounds. You're not making them. They're not technically your body. They're coming from the bacteria, but you absorb them. They enter the bloodstream. And a lot of these postbiotics, people have heard of short-chain fatty acids —butyrate is a very commonly known one because certain bacteria tend to produce it. They're anti-inflammatory. They're the reason that we think your microbiome plays such a big role in dementia, in cardiovascular disease, in different kinds of cancers. It's these postbiotics that your bacteria are producing. And so ultimately, you can trace the pathway of those postbiotic back to what you're eating and what you're feeding yourself.

Dr Sanjay Gupta

00:23:49

You do talk about poophoria, which I think is another great term. What is poophoria and how do we get there?

Dr Trisha Pasricha

00:23:58

Yeah, poophoria is a state of mind. It's a way of living that is somebody who actually never thinks about their bowel movements. Poophoria is really where pooping is the least of your daily concerns. And as simple as that sounds, it's quite profound for a lot of people. It means you can eat the foods you enjoy, you get rid of them, and you're not tied physically or mentally to where the bathroom is. Nobody is bothered by what you're doing. You're not bothered by you're what you doing. And it's also not the thing that keeps you from going out to brunch with your friends, from a nice long hike with your dog, from traveling.

Dr Trisha Pasricha

00:24:42

All of these things get disrupted when you're not living with poophoria. And frankly, that's so many of us. A lot of people, I was just talking about this the other day, people can't poop at work. And these are small, it feels like small things, but they really can impact somebody's quality of life. And I, you know, as a gastroenterologist, I treat people who have a whole range of things going on. Some people are gonna need medications and more specialized treatment. A huge majority of people just need a little bit more education about how their bodies work, and making small changes in their own lifestyle that can improve things so much more than they even realized.

Dr Sanjay Gupta

00:25:23

It's a great book. Everyone, I hope, gets a chance to read this book. I am curious, being a dad of girls who are not that much younger than you now, what did your dad say when you read the book?

Dr Trisha Pasricha

00:25:35

Oh, he's the proudest dad in the world. He was so happy. I mean, he was moved to tears. It was really meaningful. But he really did just have such a big impact on who I became or the kind of doctor that I hope I still am today or I'm trying to be.

Dr Sanjay Gupta

00:25:51

It would be no surprise to me if he was very proud of you. We all are, and I really do hope everyone gets a chance to read the book. Thank you so much for being on the podcast and thank you for sharing the book with the world.

Dr Trisha Pasricha

00:26:04

Thank you so much for having me.

Dr Sanjay Gupta

00:26:09

That was gastroenterologist Dr. Trisha Pasricha. I should point out she gave one more tip at the end of the podcast, which is stop taking your phone into the bathroom. You end up spending way too much time there. Her new book is called You've Been Pooping All Wrong. It's out now. Thanks for joining us on Chasing Life. We'll see you next week.