Fiber Maxxing and Poo Maxxing, with Dr. Trisha Pasricha

It is not the same poop. Two hours from now, you are dealing with a different poop than the one you are when the call comes. First of all, can we talk about what the call is? - Yes, please. The call is simply the rectum spasming. That's what that feeling is, that sensation like, shoot, I gotta go. Suddenly, what is this? It's your rectum spasming. - Wow. ♪ Did it use science ♪ ♪ Jazz ♪ ♪ With our favorite nerds, yeah ♪ - Are you pooing all wrong? Hi, I'm Wendy Zuckerman, and this is Science Versus. Today on the show, why so many of us have gut issues? What we can do about it? And how healthy a poo's might just make you happier. A survey of more than 70,000 Americans found that in just one week, around one in four had abdominal pain, one in five said they'd felt bloating, diarrhea, and/or constipation. And one in 20 people said they'd poop their pants. That's a lot of us dealing with this crap. And we're still surveys find that many of us are just too embarrassed to talk about this stuff with our doctor. And so we just live like this in silence, but no more. Our guest today is a Kakawaria. She is fighting the good fight here. Her name is Dr. Trisha Pasrisha. She's a neuro-gastroenterologist at Harvard Medical School and director of the Institute for Gut Brain Research at Beth Israel Dekines Medical Center, where she researchers how diseases in your brain like Parkinson's can start in your gut. Trisha also wrote the best selling book called, "You've been pooping all wrong." Because she ultimately wants us to open up our hearts and our spincters and learn more about how we can take care of our guts and go to the toilet just right. She wrote in her book that it's time to give your poop the Cinderella moment it deserves. So pop on your gown and your glass slippers, but forget the ballroom. We're heading to the bathroom. Let's get this potty started. Let's learn all about poo and turds. And how we can start feeling healthier in our guts. And if you know someone who is having gut troubles, spends ages in the toilet, send them this episode. They will laugh and learn. [MUSIC PLAYING] Hi, Trisha. Welcome to the show. Oh my gosh, thank you for having me. We're going to have so much fun. I've done my morning poo already. So oh my god, in honor of, I'm so delighted. [LAUGHTER] So Trisha, you have a dream. You have a dream to give us poop for you. Is that right? Pooh for you, that's what I want everyone to achieve. And despite what I think people think when they hear that term, it's actually a state we're thinking about your bowel movements poop, poo, is the absolute least of your daily concerns. It's where you're not thinking about this day to day, where it just happens effortlessly, quickly, and you're done. And you feel light, easy, you go about the rest of your day and you're not obsessing about this. That's what poo for you is. OK, because it does also sound like that great feeling when you evacuate very well. I think that's straight up euphoria, but just the state of being of poo for you, that's like a way of life. And how many of us do not have poo for you right now? There was a study 40% of Americans say that their bowel habits disrupt their daily lives. So that is like a huge-- I mean, when I heard that statistic, it's a couple of years old now, it was astounded. That's almost one in two of us who are quietly dealing with it. And that doesn't mean that's 40% of people who have a diagnosis of some kind who have even sought attention for it, but it's 40% of people who maybe are just quietly suffering with this daily problem that really shouldn't be a problem for that many people. Yeah. Yeah, so today, we're not going to suffer quietly. We are going to be loud and proud. Loudly, we're going to suffer loudly. So Trisha, clearly, you love talking about poo. Very comfortable when talking about our guts. And you have tied this to growing up in a very poo-forward house that there's no shame around poo. Your dad is a gastroenterologist. Tell us about, what was it like growing up in this dream home? That's the best. So my dad is a gastroenterologist. And he wasn't, is a neuro-gastroenterologist, like myself. But when he got into the field, neuro-gastroenterology was like really emerging. It was a pretty new field. This is all about the gut brain, gut nerves, connection. Yeah. They're like brain in your gut. We were learning so much about the enteric nervous system. That's the brain that's in the gut. That we now know is running the show in our bodies. And so he's a scientist. And so he would bring all of this excitement home about all the studies he was doing. And he'd want to share with us at the dinner table, because that was our time together. And you can't talk about how cool the enteric nervous system is if you can't say the word poop. You're not going to get past and get to the good stuff. If you can't have a conversation about it. That's what it was like growing up. Now, when you were in the seventh grade, there was a very important dinner conversation that happened that kicked off a study, really, but you did. Can you tell us about this? So I guess I'll start you off, because in your book, you describe your dad talking about this device that he was using to better understand gastroparesis, which is where the stomach doesn't empty properly into the small mouth exactly. And from this dinner table chat, you wrote in your book, a crazy plan was beginning to form. What was the crazy plan? Well, the other half of me that you have to know about is that if you thought I had a weird enough childhood experience, my mother used to work for the FBI. That was the other half of my childhood. Amazing. We're all very proud of her. But she could never tell us about what she did for the FBI, because she'd have to kill us, just kidding. I don't know if that's true. But we didn't know too much about what she would just knew it was so cool that she worked with the FBI. And I wish I knew. But one thing she did tell us about was lie detector tests. That was a big thing at the FBI in the 1980s and 1990s. And how, basically, how tough they were sometimes to pass. But also how she had to go through one to get her job. And then I think she was trying to improve it and perfect it. And when you say how hot it is to pass, is it even if you're telling the truth that looks like you're lying? Yeah. So the main way that people traditionally did a lie detector test was through something that's basically like an EKG and electrocardiogram. And that measures your heart rate, right? But the problem is that if you're unprepared and you're just stressed, your heart will be beating. Yeah. And it's like heart. And then you're like, oh my God, now I'm caught in the lie and it'll really spike. But if you're really good and you know how to beat the lie detector test, this was during the Cold Wars is how I know these stories. But these spies would put these tax in their shoe. And they would step on a tack every time they were asked a question. And that pain would cause their heart rate to spike. So whether they were telling the truth or lying, it would look like their heart rate just kind of runs a little high. And that was like an old spy trick. I'm told, gosh, what I would, who I would have killed to be at your dinner table throwing out. Oh my gosh. Who on one side spies on the other? This is amazing. And the perfect marriage. Do you really think about it? 100% oh my goodness. Remarkably, these two get along like songbirds. They are like just a perfect couple. But at any rate. So I thought a lot about the fact that, you know, we've spies that come up with these ways to mask their heart rate. But nobody could beat. I was a theater kid. Nobody had figured out how to hide this feeling that you get when you're nervous going on stage or telling a lie. Where you get this like, you know what I'm talking about? The sinking feeling in the pit of your stomach. Yes. And yeah, your heart's racing too, but that's something else. There's like something else happening where you feel like this can't involve drop in your gut. Yes. So what was that feeling? Was what I thought about a lot growing up? And how do we capture whatever that thing was? And so, formative dinner table experience, seventh grade. My dad is telling me this completely, you know, he's always talking about his research. And he's like very excited to try to explain what he's doing. So he tells me about this device called an EGG, an electro-gastrogram, which is very similar to the electrocardiogram. But it's measuring the electrical activity of this stomach. And that was my life-old moment. Because this whole, like for years, I've been thinking about how do I make the lie detector test better? Yeah. And then my dad tells me there's this fringe device out there that just scientists in neuro-gastroenterology know about and care about and have been studying. And I'm like, wait, you could use your stomach as a lie detector. What if we use the EGG? And I like, I think I had like pressured speech. And I was like telling my parents all about my GGG's plan. And at the end of it, my dad was like, great. "Oh, why don't you study it?" And so we did. So for the next like set, and it took me a long time to do this study. But for the next several years, kind of perfected the protocol, brought in volunteers, had people basically assigned to randomize either telling the truth or lying while I was measuring the electrical activity. And the cool thing that I found is that when you tell a lie, your electrical activity of your stomach, which actually you have a normal rhythm, you're a stomach when you're not eating, contracts at about three cycles per minute. And that's happening. You don't know about it. It's happening in the background. When you're nervous, when you're telling a lie, that rhythm gets thrown into total chaos. It's called a rhythmia. There's no set pattern. And you can see it happen. Even if that person is like looking cool as a cucumber, and they're acting natural, they're talking naturally, you see this change happening in their stomach when they get nervous. And that's what we measured. And I went on to fame and fortune in my high school. I'm just kidding. I want a science fair. But I did not get to sit at the cool kid's table. But it was kind of what got me excited to become a scientist myself. So what do we know about? What is that cannonball feeling that peat in your stomach? Yeah. What is happening is, your amygdala sends this signal to release this hormone called corticotrophin-releasing hormone. And that in turn goes to the bloodstream and starts this cascade that ultimately grinds your stomach to a halt. So a hormone gets released. Yes, stomach slows down. But there's a butt. There's a literal butt, which is that. Your colon speeds up. When this is happening that same hormone which is slowing down your stomach causes your colon to rev up, which is why a lot of people are like, why do I have to poop right before it's like my turn at karaoke or right before I have to give a presentation. Like suddenly I have to go. And then once your presentation's over, you actually don't have to go to the bed, they're like, you're fine. Well, it's because that same hormone which is making you feel nauseated, like you want to throw up, is also making you have to go to the bathroom at the same time. And once you calm down, once that stressor is over, all of it kind of goes back to its normal function very quickly. Interesting. And so Trisha, you seem to have very visceral memories of blowing your lines on stage as a theoretical call. Is there a core memory? Is there one tell me? What are you thinking of? Oh my gosh, why are you doing this to me Wendy? Okay, it was the high school production of Christmas Carol. I was the ghost of Christmas past. It was like a prize. Like the, I nailed the audition. Like people were jealous, man. And so I'm on state and I don't even remember the line anymore 'cause I only remember the emotion. But I do remember, I'm like halfway through my monologue. And I just totally like cannot remember where to go. And there's these like awkward silence where I'm like grasping the wheels are going and I'm like, what do I do, what do I do? And I feel that's like that sensation. And luckily my, you know, I don't know what the word is co-star. Like the other dude who was playing Ebenezer Scrooge, he like jumped in and just kept going, we just kept going, but I thought about that. Not only do I think about it like after it happened, I sometimes, you know, I'm how old am I, I'm like 37. I wake up, I have dreams. I like I'm on stage and I can't remember what is the play I'm even here for. Like what are my lines? So anyway, formative memory. I know really deeply what that feeling is. Obviously I had to study it. Wow. But you didn't, you didn't put your pants or anything. No, thank God. That would have really taken. It's going to be what I'm trying to say. Wait, wait, wait, wait. Yes. Don't worry, I won't talk to you about any more memories from high school. I'll appreciate you. So in your book, you just grabbed, going back to, sort of our scientific understanding of what's happening in our gods when we're nervous throughout the day as our emotions are going up and down. You just grabbed this fascinating case report from the 1940s of a soldier. Yes, tell me about this study. It was World War II. And there was a soldier who was in this ward and because of his wounds, his whole abdomen is exposed. And so the doctor who's taken care of him can see his abdomen. And what's interesting is that he found that this soldier, he could literally watch in real time how quickly his stomach is moving, whether he's having a lot of what we call peristalsists or movements in the gut and when his gut seemed to be calm and happy and relaxed. And what he found is that, yeah, like when he ate, there was some movements of it. Like when he was kind of walking around and exerting himself, like he could see movement. But it was during moments of psychological stress that he saw suddenly the most amount of movement through his gut. And so there was this moment that he documented and wrote about where a bunch of fellow soldiers are brought in who are like freshly wounded, hot off the battlefield. And I think it was a really traumatic moment in the ward. And the patient was very, very stressed and upset by it. That's when the most movement occurred. And witnessing this, he writes it up. It sparks part of the journey of a doctor from Cornell who's reading this against 1940s. And he's like, let me do so a set of experiments to prove this, to show that not physical stress, but psychological stress causes acute changes to our gut. So then he starts to do these experiments where he puts people live through a set of kind of psychological tests. Like he'll say, tell me about your stressful marriage or talk to me about this like difficult relationship you have with your son. And he even pretended to find cancer in one of his patients. And this is like ethics is like a whole separate conversation about these studies, like it was a problem. But what he found is that while he's putting these people through it and he's looking through this like early version of a colonoscopes, so like kind of a rigid scope looking from the inside, he saw that when they were stressed out and talking about these difficult experiences, he could see the rectum spasming and moving. And this is something we experience, right? Like I felt it on stage. Like we feel this all the time when we're really acutely stressed. So how is the brain in the gut and communicating with each other? What is exactly happening there? Yeah, so remember, okay, so we've got the brain in our heads. And the brain in our heads is this big collection, essentially a network of neurons. And you actually have a very similar set, you have like these two sets of neurons throughout your whole gut. And that's what we call the interrac nervous system or the brain in your gut. So the main way it communicates and has to communicate is through the vagus nerve. The vagus nerve is this big, is you know like wandering, hence the name vagus for wandering nerve, that has these tendrils that go throughout the organs of your body, but the gut really gets the lion's share of that innervation. And what's fascinating is that a much of that communication is going from the gut up to the brain. And you, in your lab, you study how diseases that we commonly think of as being brain diseases actually are interacting with the gut in interesting ways. And I'm thinking of Alzheimer's Parkinson's disease. Yeah, yeah. And in fact, in James Parkinson's seminal essay on Parkinson's disease in 1817, which he called the shaking palsy, he talked about how Parkinson's was connected to the stomach and the bowels. So tell me, what is the connection here? Yeah. You know, in those case series that he wrote about, he's describing tremors, he's describing difficulty with walking and movement, like all of the classic symptoms we think about with Parkinson's. But in several of the patients, he also writes about how severe their constipation was. Like it is so bad, laxatives are not working. And he's writing about this over and over, but it's not clear to him at that point in time why, or if this is connected in some way to the Parkinson's, it seems like it should be, but it's not clear why. And I would say for the next almost 200 years, people thought about Parkinson's as being in the brain, starting in the brain, almost ending in the brain. The hallmark of Parkinson's is this protein called alpha-synucleon protein. And it misfolds in Parkinson's disease. In the brain, you can see this protein. And they've done, and this is like just incredibly well studied because they've done autopsy studies. We know really well what happens to alpha-synucleon in the brain. When it misfolds, it causes, it's part of the reason why dopamine neurons die. And those dopamine neurons in the brain are what's responsible for movement. And so that's why the tremors, the rigidity and these things start to develop. But it turns out that if you were to do autopsies on people who have Parkinson's disease, you actually would see that their guts, too, are riddled with misfolded alpha-synucleon protein. And in the case of the gut, what we think can happen is that that misfolder protein sort of bumps up into other alpha-synucleon and induces that alpha-synucleon protein to misfold. And it just propagates and propagates like a domino effect all the way. Yeah. And then it gets into the brain, how? Through the slowly but surely through the vagus nerve. And that's a process that takes years. And you might say, OK, how do we know that? And we know it for several ways. But one way is we've staged it. Like you can inject in mice. You can inject preformed alpha-synucleon sort of fibrils and watch them misfold. And you can stage. You can watch it track from the stomach up the vagus nerve and then to the brain. It's going-- the protein is moving through the brain. It's moving upwards. It's almost like a preion. because once it comes in contact with another alpha snoopy approaching that. that one starts to misfold and it sort of moves like that. - Wow. - And if you ask, and this is what I started to ask my patients when I was just starting out as a gastronologist, my patients with Parkinson's disease, if you ask them, 80% of people with Parkinson's disease, one, have GI symptoms. The overwhelming majority have GI symptoms, and many of them will say, "My constipation started "years if that decades before my tremors started, "started well before." So I just think now anyone with constipation listening is gonna be freaking out here. - So, right, we don't want that. - We do not want that. - What, how should they be thinking about this? How should we all be thinking about trying to use this information to reduce our risk of Parkinson's disease? - So yeah, a few things about this. So one constipation will come for us all at some point or another. So if we were to say everyone who gets constipation is gonna get Parkinson's, we'd be in trouble. As we age, we get more good risk of constipation. When we go on vacation, we get constipated. So don't feel that just because you're constipated, you're gonna get Parkinson's disease. The way I think about it is if somebody comes to my clinic and they're like, you know, like 40s, 50s, new constipation, not something they've ever dealt with before, first of all, I look for other things that could be going on and causing it. If they were to say, you know what, like I also, I lost my sense of smell a couple of years ago or I've been having trouble sleeping, I'm acting out my dreams. That's another sign of pro-dromal Parkinson's. If you start to tell me about constipation plus other signs, other symptoms, oh by the way, my grandfather had Parkinson's disease, that's when I start to take this a little bit more seriously and I say, you know what, we should really think about it. And frankly, you know, the ways that we would tell somebody, look, you're worried about Parkinson's, let's reduce your risk for it. The things I'm about to tell you to do that are the things that, like we should probably all be doing anyway, the things that have been shown to reduce your risk for Parkinson's. Number one is exercise. And not just sort of like low, you know, walking, but like moderate to vigorous physical activity regularly every week, it's been shown to reduce your risk of Parkinson's but also slow progressions. And we just keep learning about the ways that the gut and the gut microbiome, more generally, are contributing to many different diseases. And I wanted to get your take on this just fascinating study that came out about peanut allergies just recently. So basically what they did is they did a fecal transplant and it's that found that it might help some people with peanut allergies. And I have been fascinated to hear that scientists are no longer giving people poo smoothies, which they used to. So you remember the days of the food? These were capsules, right? They were cat and frozen capsules. I remember reporting on, and they literally had a blender in the lab. So anyway, science, progressing all the time. They have to start somewhere. So in this study, very civilized frozen poo pills, and they gave them to 15 people with peanut allergies and six of them could then handle more peanuts. They then did this thing called the challenge. You give people peanuts. Yeah. And they found that, you know, yeah, for six out of the 15, it did help them. They could handle more peanuts. After this fecal transplant, what do you think is happening here? Why might, obviously, small study didn't help everyone, but why might changing your microbiome help with a peanut allergy? Allergy's peanut allergies doesn't feel like it should have anything to do with anything related to your colon per se. But I think what people don't appreciate is that your gut is actually your largest immune organ. It's cute. And it has to be that way because we are putting, God knows what, into our bodies every single day. It's the welcome mat for the world in a way. I'm glad. Yes, it is, right? But our body does a great job of filtering out and making sure we don't get harmed. But to the point is our microbes, they play a big role in teaching our immune system how to behave, right? So in this case, in the peanut allergy, they think that part of why the fecal transplant helped, because the fecal transplant sort of potentially primed some of these people, didn't work for everybody, but some of them with bacteria that could help dampen that allergic immune response. And so I think it's interesting, this was a phase one trial. We've done a lot of good studies on fecal microbiota transplant that have not panned out. I want to be really clear about this because I get this kind of all the time. I was like, hey, should I blend my cousins poop in the smoothie because I get this. Don't, first of all, do not try this at home. Oh gosh, don't DIY your fecal transplants. You never, never. What is it not worked for, by the way? It's not worked for Parkinson's disease, you know? You can imagine there's a lot of excitement about that. Okay. And I don't think it's because it can't work, won't work. I think it's because it's so complicated. Like, who's got the right poop? Like, who's poop? Do we consider normal? Who's pooped do we consider healthy? Is there such thing? I think this is a step on the right direction, but I just want to look sort of like, just bring everyone back down to earth for like a hot minute, which is to say, like, we're not there yet with FMT. After the break, some of the worst advice that Trisha is hearing online about how we can take care of our guts, you want to hear this, trust me. And if you've got a friend that has gut issues or you think might be suffering in silence, maybe send them this episode. It'll open up a conversation. And there's vectors. Hey, it's Wendy from Science Verses. And I want to tell you about a podcast that I love. Science Friday. They cover all sorts of amazing things in the weird and wonderful world of science from how concussions affect our brain to the inner secrets of a snake with a spider on its tail. It's a lot of news that you can use and some that you can't, but you're going to love anyway. It's hosted by Ira Flattow and Flora Lickman, who is an old friend of the show and loves upon as much as we do. Science Friday is on every day wherever you get your podcasts. Welcome back today. I'm chatting with Neurogastery Interologist and author of, "You've been pooping all wrong." Dr. Trisha Passvisha, let's jump back in. So let's start with just some of the basics around, pooh, because even basics feel like a mystery because we don't really talk about it. So let's just, so what exactly is pooh? What is coming out of us, Trisha? Yeah, so that's an incredibly fundamental question. And a really interesting one. I think what people believe pooh is is just all the waste products that your body doesn't need. Like you have extracted all the good stuff through your small intestine. Everything you don't need comes out as poop. And that's at least partially true, but it's actually not what the majority of your poop is. So obviously, scientists have studied this. They've looked it through mass spec. What is the composition of poop? It's mostly your microbes. And then the rest of it is all this sort of soluble and insoluble material and fiber that you can't digest. Like it's cloning in, squished together. Yes, that's amazing. When you look down, that's your microbes in there. Say hello. Yeah, next time you peek in. And I think before reading your book, I had this idea that pooh was brown because it's just this mixture of all the stuff you've eaten and maybe some excretion products, kind of like when you're painting and you're in preschool and you use all the paints and eventually, it just becomes a brown, brown. But totally, why is that poop brown? Yeah, totally wrong. Bizarrely, our poop would be white, like a whitish clay colored. The only reason it's brown is because of billy rubin. So we produce bile, right? It's this digestive kind of salt that we produce. It helps break things down. The billy rubin in that bile is what makes it brown. If you were to take that out and sometimes that happens to somebody gets a gallstone or if there's something else blocking the release of bile into your small bowel, what comes out is this pale, bizarre looking clay color stool. If you ever see one of those, you will remember it the rest of your life. Wow. And what about, so on the odd occasion, someone can even have a silver poo. Oh my gosh, the poop of the legend. It's the mystical silver poo. I can't even put that up. Yeah, so if you're watching this on video, you can take a look at these images from the British medical journal of someone's silver poo. What might be going on if a silver poo exits your butthole? So there's only been a handful of these cases reported. I read one in the New England Journal of Medicine. So we're talking about the BMJ, New England Journal of Medicine. Like this is a top tier poop. Like this is not something that gets published in like a low impact factor drill, okay? And it's so rare. So what it is, so like, okay, so first of all, two things are happening simultaneously. One, you're blocking the passage of bile somewhere. That's gonna give you that whitish color. Yes. Second, a second emergency is occurring in which you are bleeding somewhere, probably your upper GI tract because the acid from your stomach, when it mixes with blood, it turns this shiny black color. Mm. So somebody who poops black, who sees like this tarry looking pitch black stool should be worried that they're having a bleeding ulcer in their stomach or maybe their small bowel. When you see this shiny black mix with this like clay colored white, you get shiny silver alchemy. And it's like kind of pretty, but it is an emergency. - What a shame that it's an emergency and not, you know? - I know, not just like a sign that you're, it's the next comment that I know. So there are a lot of ideas that we have about what it is to have a healthy poo, a healthy bowel movement. Dear, I say it. And one is that we should be aiming for pooing once a day. I think I always thought that was like, "Magally helpful every now and then I'll have a day where I'm like, well, three times, okay." - Do you worry when a patient comes to you and is doing poo's more than once, less than once a day? - I don't actually obsess over the number. What I really focus on is how comfortable you feel. You know, like I would rather not you say, I had one poop this morning, I go every single day, but when I go, I strain for 20 minutes and I'm sitting in there and you emerge and it looks like you've ran this marathon, but yeah, I go once a day. That's not normal to me. You know, even though yeah, you've checked that box. - Yeah. - So like, you know, there was this big study that was done, actually by my colleagues at Bethesuaal, that showed that people who consider themselves have normal bowel habits, they go anywhere in America from once every three days to up to three times per day. So that's a big range, you know? And like, I think the part that people don't appreciate is that in other parts of the world where people are eating a higher fiber daily diet, not our sad American diet, people go more often. People are really into fiber maxing right now, which I am a thousand percent here for. People are gonna find that they're gonna go more often. They're just like, this is their bodies, like gonna be suddenly overwhelmed and amazed by how soft their poop is. It's suddenly effortless. They're not straining. And you might go twice a day and that's totally okay. It's just easy to go. You might even go three times a day and just embrace this new side of yourself. - And why is that happening if you're fiber maxing? Why are you then going more? Why is it nice to do a poo? Give us your elevator pitch for fiber for those who haven't joined the fiber train. - Yeah, well, okay. So here's just the thing about fiber, is that there's this big disconnect where people think, I need more fiber because my body needs this to be healthy, wrong. You don't eat fiber for your own body. You eat fiber to feed your microbes. Your microbes that are living in your microbiome, they need fiber to survive. And different species, you know, we have lots of different species living in there. They actually thrive on different kinds of fibers, not just this one thing. So you really wanna get this diversity of fibers into your diet because that fiber, you can't break it down. We don't have the enzymes to break it down, so it's gonna travel through your small intestine. As it's doing so, the part that does help you is that if it is like a soluble fiber, like psyllium husk is a nice fiber supplement, it's gonna drag water with it and keep things nice and soft and flush. So your poop, all that waste, is suddenly gonna become really easy and soft to pass, but once that fiber hits your colon and those microbes start fermenting it, they produce short chain fatty acids, which then can be absorbed into your body and then have these anti-inflammatory compounds in other parts of your body, far away from your colon, to your heart, to your brain. And that process does a lot of good for you in your long term health. That's why we eat fiber, but it's really not because you, yourself, are directly the reason. It's this indirect benefit you get by nourishing and feeding your microbes. - Yeah, this is crazy to me, that you feed your microbes, you keep them happy then they produce these short chain fatty acids and that then goes throughout your body to help you. - I mean, that symbiosis, it's so beautiful. It's crazy, right? - Yeah, I mean, it's amazing that we can't produce these to that extent on our own. Like if we didn't have those microbes and we weren't producing those short chain fatty acids, they've done these studies. I mean, this is the reason why high fiber diet, it's associated with lower risk of dementia, of cardiovascular disease. It all can be traced back to that indirect benefit we're getting from what the microbes are doing to us. So we got to be nice to them too. We have to give them fiber. And obviously 95% of us today are not meeting our fiber goals. We're hurting them and they're hurting us by, you know, just like this indirect pathway. And so you like to take a ceilium husk. Did you, did you notice your booze got better once you prioritized fiber in your own life? I will say like if you take ceilium, everything just becomes soft, easy, effortless. Like, you know, we have this adage and we can talk about this more where I like to tell my patients don't spend more than five minutes in the bathroom. You know, like that stick to the five minute rule. And ideally to be, if I'm being so honest, it should be like 30 seconds. It should be like an in and out job. Like even five minutes to me feels like way too much time. But once you are meeting your fiber goals, assuming there's not something else going on like with pelvic flow dysfunction, it's an in and out job. So why don't you want people spending more time in the toilet? Why do you think once you get the call, I've heard you say it, I love that. That is what it feels like. You get the call. You should go and go quickly. Spawn to it, respond to the call. So what happens if you don't respond to that call? Because a lot of people are embarrassed to, or just great, really can't go in public, say the call comes when you're in the mall or in your office or your workplace, then you get the call. So what happens if you don't answer the call and you hold it in? Okay, so here's what I want people to picture. The reason you have to answer the call when the call comes is because if you delay, you think, it's fine, like I can put this up, I'm gonna just return to that same poop a couple hours from now, I'm gonna come home, it'll be a safe space. And the reason why is that one of your colon's many important jobs, one of them is to constantly suck water out of whatever's in there. That's what it's gonna do. It's gonna do that around the clock like it or not. And if you ignore that call, it's gonna sit there and it's gonna get drier and harder and more pebbly. So three hours later, when you're ready, first of all, can we talk about what the call is? Yes, please. That's what that feeling is. That sensation like, shoot, I gotta go. That is the best time to go because your rectum is doing the work for you. It is trying to push this out. Three hours later, when you're in your comfy home bathroom, you feel safe, but you don't actually have the call anymore. You have to do all the work to generate pressure to push it out so you have to do an enormous felsalva maneuver at that point. Because if your rectum was contracting, you just do a little one and it'll come right out. Without that squeeze from your rectum, you've got to do it. And now to make matters worse, you're dealing with a completely different poop. It's like now drier. It's harder. It's not as squishy and soft. It does not want to come out anymore. So when you get the call that's a gift, you should respond to it and you should move on with your day. Because you're not going to get those, the stars will not align again the way they are in that moment. It's so relatable, treasured, so relatable. Tell me about it. So in your book, there's this fascinating stat that your sphincters are contracting was it seven times an hour? Yeah, what are they doing? Why are they doing that? Let's talk about this as an under-appreciated job of the sphincters. But have you ever asked what I've thought, I think about this all the time, obviously. But like, how is it that our bodies know? You know, if you're sitting with friends, that it's safe to release gas, but it's not safe to release solid or liquid. And you can tell, you know, you're like, this is OK. I just have to fart. Well, how does your body know that the weight knows is because your sphincters have these tiny sensory neurons that are just constantly sampling the internal environment. And sending that feedback up to your brain, saying, wait, this is gas, all clear, you can let this out safely. Or whoa, whoa, whoa, do not let go. And that's what those sphincters are doing for you. And you had no idea, because it's in the background. And one of the ways that keeps the integrity of the sphincters and the job they're doing are actually your hemorrhoidal cushions. We think that's the function of your hemorrhoids. Because by the way, you have internal hemorrhoids. They sometimes bleed like stink. Those are the ones that are constantly sampling that environment and giving that information back to you. Can you first, with a brush, paint me a picture of a hemorrhoid? Yeah. Hemorrhoids are just picture a cushion. A cushion on a circular, you know, like those 1970s, like a circular couch. And the cushions are the hemorrhoids. The couch is like where your rectum and your sphincters the center being the swingters. And normally sweet. all have hemorrhoids, whether you like to believe that or not, they're all there, but normally they're flat, they're deflated, they're just these cushions of veins. But over time, for some people, if you get into this pattern of straining constantly, because you're constipated, sometimes those veins can start to engorge. And when they engorge, and they start to fill up, those cushions can become plumper and plumper and plumper and juicier. And then, sometimes, they can become so plump and juicy that the internal ones pop out and say hello. And those are called pro-lapsing hemorrhoids. And you can feel those. They're very uncomfortable. You can sometimes push them back in. Uh-huh. And you did a study looking at whether sitting on the toilet for a long period of time affects the risk of hemorrhoids. And when I say sitting on the toilet, I'm talking to anyone who's bringing their phone in, sucked into whatever you're watching. You're watching a science versus episode. I get it. You wait until the end, but all of a sudden, you've been sitting on the toilet for half an hour. Is that a problem? Major problem. You know, for me, like social media, and smartphones in the bathroom, is like the same thing as bringing your smartphones to your nightstand when you're trying to go to sleep. Like, it only does bad things for you, for your health, for your wellbeing. And so what we found in our studies that people who bring their smartphones in, yeah, not only are they spending more time, that's a problem with more than five minutes, but they also are inadvertently spending more time simply because of the smartphone and not doing the job they came in to do. Whereas for most of us in the past, you'd come in, you'd read a, you know, like whatever was sitting there, the back of the shampoo bottle, that wasn't going to, like you weren't going to stick around to get to the 14th ingredient. You would do your job and you'd move on. Whereas with the smartphone, it's like, God, this science versus episode is ripping. Like, I'll just, I might as well see where this conversation is going and you'll stick around and completely forget why your pants are around triangles. And that's the problem, because it's that long amount of time sitting there on this open bowl without any pelvic floor support that we hypothesize is the reason that not just one time, like, you know, everyone's allowed to watch one season finale of like the pit on the commode every year. But if you do it day after day, a year after year, and you start doing this at a young age, that's what we think puts you at the risk of the hemorrhoids later on. Do you want to tell me about your study? Yeah. Your groundbreaking. Yeah. Groundbreaking. This was not the study I thought we, like the Pastry Chalab would become most famous for, but I'm here for it. So we asked people coming in for their screening colonoscopies, you know, how much time do you spend on your smartphone when you're in the commode? What do you do when you're on your smartphone and you're in the bathroom? And then we asked them about their diet, their exercise. And then we did their colonoscopy and we took a look. And we noted, who has hemorrhoids who doesn't have hemorrhoids? And then this is what we found is that people who bring their smartphones into the bathroom, they had a 46% higher chance of having hemorrhoids. So I just told people, look, set a two TikTok limit, you know, or like set a five minute timer. And so just don't, so why does sitting in the toilet then increase the risk of hemorrhoids? Just so the hemorrhoid cushions are held together by connective tissue. And it's a nice firm, elastic connective tissue. Over time, you sit on this open bowl without any counter pressure, that connective tissue will start to weaken and weaken and weaken until suddenly it's not enough to hold the hemorrhoids together and they pop and they burst. I'd love to talk about a couple of myths around poo and the gut that are happening online because the gut is being invoked a lot on social media these days. Yeah, I know. Helus, what gives you, what's given you the sh*t recently when it comes to gut health ideas online? Oh my gosh. So much, can I tell you? Can I tell you the one that's bothering me right now? Yes, please. Okay. There's this idea that you have a parasite that has like taken hold of a lot of people on social media, but actually it's like very caughtly people, you know, like I used to think this is really fringe. Very very average people come to my clinic convinced that they have a parasite. They haven't traveled anywhere kind of exciting. There's no classic risk factors, but they kind of just know they have it and sometimes they see. They think they've seen a parasite and what I have seen to be the case is that people go online, get these parasite cleanses, they take them and they see like basically their own intestinal lining shed and they're like, my god, this is, I've cleared the parasite. What are they taking? What are they swallowing? What, guys? Like really harsh stuff that are being sold as parietal or like herbal remedies and these things. And they're, they are seeing, like I've seen pic because I get pic. Yeah. Like I'll see them. I'll be on the, like, you know, I'll see the sample and I'm like, this is not a parasite. By the way, we have incredibly good tests for parasites in a clinic setting. Like we don't, we don't usually, we don't miss this. Like if with someone has a parasite, like we'll catch it. That's not even like the dark side of it. It's dark already. Yeah. The darker side is that now in the world of cyclospora, I feel like people have felt very validated. That, actually, we, I could, like, and I need this parasite cleanse sticking with stuff online these days is there's this main that's been going around for a while that's, you know, hot girls have stomach issues too. And you got it. Yeah. And we, we got questions about this paralysis as well. Ah, women at an increased risk of these sort of complex, severe stomach issues than men. What's going on here? I thought you were going to ask our hot girls. I didn't think like I don't think we've done that study yet. But we have certainly known. Yeah. My lab, we're just, I'm getting so many ideas. But, but, um, yeah, women are at a much higher risk of getting IBS. Really? Yeah. Why is that? We've known this for a long time. There are a lot of different reasons. And some of these were, we're really just learning about in the last five years. But I'll tell you one big reason, which is estrogen, estrogen levels. And so, you know, when we're younger and a lot of people get diagnosed with young women, they're in their 20s. Like they'll say, my symptoms really started in high school and college, 30s. And what's interesting is that sometimes we do see that as women get older, they enter their 50s, 60s, 70s, it's rare to make a new diagnosis of IBS at that point. So the hallmark of IBS just to be clear, it's pain. It's not just diarrhea. It's not just constipation. IBS comes in those flavors. You can have IBS with constipation. You can have IBS with diarrhea. You can have a mixed picture. But pain is what makes us say, this is not just chronic constipation. This is IBS, irritable bowel syndrome. There's been several big studies that have come out in the last five years that have shown that estrogen is part of what modulates pain signaling. Interesting. Because I was chatting to Dr. Jessica Berserkowski at the University of Melbourne to research for this chat. And she did this fascinating study into IBS patient. So it's a small study, but really interesting where she gave them herna team fructons and then measured you out of control group. So some had IBS, some didn't and measured exactly how much gas was being produced in their belly. And found that everyone, whether they in this study, whether they had IBS or not, had the same amount of gas being produced. So the microbes were eating up the fructons, fighting out the gases. It was the same amount of gas being produced, but the people with IBS who were experiencing pain, they what she did find was different because they were in an MRI scanner. And she could see that in their brain, their interpretation of pain, the pain in the brain looked different to the control group. So it was that this is what you're talking about here. They were interpreting that that little bit of extra gas, extra pressure as pain. That was the problem. It was the nerves. It was the brain that was interpreting the signal differently. Is this what you're describing? This is exactly right. And I think that sometimes we think that what is the underlying problem in IBS? I mean, that's what everyone wants to know because they're like, I mean, almost the hallmark, the way we define clinically IBS is all your tests are normal, right? That's very frustrating to hear. You feel really dismissed when that happens, but it turns out we're just talking about standard clinical tests that are normal. If we were to do, and they've done this, the only thing I can say this is because they've done this in research studies, if we were to look for, say, trip V1, which is this receptor on pain signaling molecules, those receptors that signal pain to the brain, they're expressed more than three times as much in people who have IBS in the colon. So that means you have the same nerve cells in a healthy person versus someone as IBS. The IBS patient is going to have more receptors that are perceiving pain and then sending those signals up to the brain. What is the worst GI advice that you say online? People think juice cleanses are somehow vaguely. It has this wellness sheen. They're colorful. It looks like something like influencers would do. What are juice cleanses but fruits and vegetables from which you have removed the fiber? You've taken the fiber out, you've juiced them. And so all you get is this sugar. To me, it's the reason that's so bad. that is because you feel good. Like you think you're doing something really good and you think it, like, but actually you're taking all the good stuff out. I hate to see a juice cleanse. Mm, it's so sad that that trend has really survived the test of time. - I know, I know. - As we're winding down, it is time for our oddball questions. (upbeat music) Trisha, what is a conspiracy theory that you secretly have a soft spot for? (upbeat music) - Okay, stick with me. We, this is like, this is really niche, but I'm not the only one who, like, kind of does (laughing) fly into this, okay. Stay with me Wendy. All right, I'm here. - We think that we've evolved to live with microbes in our gut, but what if we've got it backwards and we have simply evolved to become better vessels for the microbes. Like humans are the perfect vessel for them. I know, like, think about our behaviors. Like, why do we eat fiber, right? Like, we don't, we don't have the enzymes. Fiber is not for us, it's for them. Why do we thrive in these close, tight-knit social communities? There are a lot of other reasons, sure for our own survival, but the closer our community, the more we're transmitting our microbes to each other. They've done these studies. So I have this, it's like, my body's like this idea. - Blowing. - Yes, right now. - Isn't it? Like, we're here for them. They're not here for us. - Whoa. - Think about it. - I'll never stop thinking about it. - Me neither. - What's the weirdest thing you've seen in someone's gut? You do colonoscopies day and day out. - Oh my gosh. - Yeah, your eyes went up like nothing we've seen before as just the visions of people's gut. - The visions of like a stuff we've fished out at 2 a.m. The weirdest thing I probably can't tell you because I know that, you know, like anything I say, that person will be like, oh my God, I know that that was me. But what I can't tell you is this. Okay, people off it. It's not uncommon for the GI doctor to get called to the emergency room because of, because of some object has made its way into someone's rectum. - Yes. - And we get this call pretty often. - Whoa. - Yeah, I just want people to know that if you'll notice, I never ask you how it got there. Like I never ask because, yeah, I know how it got there. - Yeah. - You know, and the person sitting in front of me knows how it got there. - Yes. - But 90% of the time, that's how it, they put it up there. - Yes. - And that's how, you know, but 90% of the time, the person in front of me, without my prompting at all, that person offers an explanation. They'll be like, you know what, sad on it. I sad on it, weird. And I'm like, yeah. - Okay. - Yeah. - I didn't know. - And can we, I'm just here to get it out. Like one way or another, we're gonna help you. - Yes. - I know you've learned your lesson. Like I, you don't need me to like, we don't have to talk about this again. - I know it won't happen again. - Yes. - And actually, every now and then, it does happen again. We get these repeat flyers, but oh gosh, guys. That's why sex therapists say flat bass. - Okay, we've talked about a lot of controversial things, but I've saved the best for last, Trisha. - Oh my gosh, what could be coming? - You walk into a public toilet. You need to do a purview. - Yeah. - Right. Do you put paper down or not? - Oh, I say controversial because I have heard from microbiologists that putting paper on the toilet seat is a waste of time because the microbes are so little, it's like, it's like a fish net that they can just go through. And yet, there is a psychological element to it and I wanted to know where you sat on this. - And I see what you did right there. And the reason I hesitated in this is also revealing is that there's not a great reason for this. It's not really the microbe thing that bothers me. I almost never sit. I hover when it's a public. - Even to poo? - Even to poo? - I'm, you can, I'm just, yeah, I'm so good at it that like the job will get done. - You are, wow. - I know. - I know. - But I would rather not sit. - Because I, I hope it wants to do a poo and I overshot. (laughing) - And you know, there is nothing scarier than when you don't need the blob. - Because that's, that's how I knew what I did. (laughing) - I was like, where was the blob? - And then to look around. - And then the horror, the horror. - It's a horror. - I don't know for anymore. I don't, I can't trust myself. - You know what I mean? You take practice when you can get there. - I can't, I can't. - But I guess I would say like if there's, I usually would wipe, if I see anything visible. - Yeah, I would certainly wipe that down, but I'm not somebody who would just like lay down preemptive. - Okay, I'm great. - I'm probably saying that. (laughing) - I think too. (laughing) - You should, you're getting vulnerable and that's, that was amazing. (laughing) - There we go. - Thank you so much. - You were so welcome, my pleasure. - That was Dr. Trisha Pasarisha, and you're a gastroenterologist at Harvard Medical School. And her new book is You've Been Pupig All Wrong. If you liked this episode, please tell us about it on social media, we're also now on YouTube @sciencevspodcast. And if you liked what you heard, if you learned something, if you thought a friend might enjoy a little laugh and a little learn, please send this episode along. (upbeat music) If you wanna know more about the science of whether to put paper on the toilet, and you've gotta listen to this episode of every little thing, we're gonna put a link in the show notes. It's hosted by Flora Lichtman, who now co-hosts Science Friday. Thanks for watching. This episode was produced by a Keri Bosticase, and me, Wendy Zuckerman, with help from the team at Science Verses, we're edited by Vlad Terrell. Mix and Sound Design by Bobby Lord, Music written by Bobby Lord, Bumihiraka, so Wiley, Emma Munga, and Peter Leonard. An extra thanks to the Zuckerman family and Joseph Lavell Wilson. I'm Wendy Zuckerman, fact you next time. [BLANK_AUDIO]