Fiber Maxxing and Poo Maxxing, with Dr. Trisha Pasricha

Welcome to Science Versus

0:00It 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 it, that's what that feeling is, that sensation like, shoot, I gotta go. Suddenly, what is this? It's your rectum spasming. Wow. Do-do-do Science Chats with our favourite nerds. Yay!

0:31Are 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 healthier poos might just make you happier. A survey of more than 70,000 Americans found that in just one week, around one in four had abdominal pain, one in five said they'd felt bloating, diarrhoea, and or constipation, and one in 20 people said they'd pooed their pants. That's a lot of us

1:05dealing with this crap. And worse still, surveys find that many of us are just too embarrassed to talk about this stuff with our doctor. And so we just live like this, in silence. But no more. Our guest today is a cucka warrior. She is fighting the good fight here. Her name is Dr. Trisha Pasrisha. She's a neurogastroenterologist at Harvard Medical School and director of the Institute for Gut Brain Research at Beth Israel Deaconess Medical Center, where she researches how

1:36diseases in your brain, like Parkinson's, can start in your gut. Trisha also wrote the bestselling book called You've Been Pooping All Wrong, because she ultimately wants us to open up our hearts and our sphincters and learn more about how we can take care of our guts and go to the toilet just right. She wrote in her book that it's time to give your poop the Cinderella moment it deserves. So, pop on your gown and your glass slippers, but forget the ballroom. We're heading to the

2:11bathroom. 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.

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Achieving true poop-phoria

4:44Hi, Trisha. Welcome to the show. Oh my gosh, thank you for having me. Oh my god, I'm so much fun. I've done my morning poo already. So, oh my god, in honor of. I'm so delighted. So, Trisha, you have a dream. You have a dream. To give us poop-phoria. Is that right? Poop-phoria. That's what I want everyone to achieve. And despite what I think people think

5:16when they hear that term, it's actually a state where thinking about your bowel movements, poop, poo, is the absolute least of your daily concerns. It's where you're not thinking about this day to day, where it just happens effortlessly, quickly, and you're done. And you feel light, easy, you go about the rest of your day, and you're not obsessing about this. That's what poo-phoria is. Ah, okay. Because it does also sound like that great feeling when you evacuate very well. That's like, I just, I think that's straight up euphoria. But just the state of being of poo-phoria,

5:52that's like a way of life. And how many of us do not have poo-phoria right now? There was this 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 years old now, I mean, I was astounded. That's like almost one in two of us who are quietly dealing with it. And that doesn't mean that's 40% of people who have a diagnosis of some kind, you know, who have even sought attention for it. But it's 40% of people who maybe are just quietly suffering with this daily

6:24problem that really shouldn't be a problem for that many people. Yeah. Yeah. So today, we're not gonna, we're not gonna suffer it quietly. We are gonna be loud and proud. Loudly. We're gonna suffer loudly. So, Trisha, clearly, you love talking about poo. Very comfortable with talking about our guts. And you have tied this to growing up in a very poo-forward house. There's no shame around poo. Your dad is a gastroenterologist. Tell us about what was it like growing up in this dream home?

The stomach lie detector study

6:58It's the best. So my, yeah, my dad is a gastroenterologist. And he was and is a neurogastroenterologist like myself. But when he got into the field, neurogastroenterology was like really emerging. Like it was a pretty new field. This is all about the gut, brain, gut nerves connection. Yeah. The like brain in your gut. Like we were learning so much about the enteric nervous system. That's the brain that's in the gut that we now know is like running the show in our bodies.

7:28Yeah. And so he's, he's a scientist. And so he would bring all of this excitement home about all the studies he was doing. And like, he'd want to share with us at the dinner table, because that was like our time together. You know, and like, you can't talk about how cool the enteric nervous system is if you can't say the word poop. Like you're not going to get past and like 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

8:00that kicked off a study really that you did. Can you tell us about this? So I guess I'll start you off because in your book, you, you describe your dad talking about this device that he was using to better understand gastroparesis, which is where the stomach doesn't empty properly into the small bowel. Yes, exactly. And from this dinner table chat, you wrote in your book, a crazy plan was beginning to form.

8:32What was the crazy plan? Well, okay. The other half of me that you have to know about is that I, I mean, if you thought I had a weird enough childhood experience, my mother used to work for the FBI. That was the other half of my childhood. 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, I don't know if that part's true, but at any rate, we didn't know too much about what she, we just knew it was so cool that she worked for the FBI. So, but one thing she did tell us about was lie detector tests. That was a big thing at the FBI

9:06in the 1980s, 1990s, and how basically how tough they were sometimes to pass, but also how, you know, she had to go through one to get her job. And then I think she was trying to improve it and perfect it. And when you say how hard it is to pass, as in, even if you're telling the truth, it looks like you're lying. Yeah. Like, you know, so the main way that people traditionally did a lie detector test was through something that's basically like an EKG, an electrocardiogram, and that measures your heart rate, right? But the problem is that, you know, like if you're unprepared and you're just

9:38stressed, like you can, your heart will be beating. Yeah. Like so difficult. And it's like hard. And then you're like, oh my God, now I'm like caught in a lie and it'll really spike. But if you're really good and you know how to beat the lie detector test, like this was during the cold war, this is how I know these stories. But so like these spies would put these tacks in their shoe and they would step on a tack every time they were asked a question and that pain would cause their heart rate to spike. So whether they were telling the truth or lying, it would look like their heart rate just kind of runs a little high. And that was like an old spy trick, I'm told.

10:08Gosh, what I would, what I would, who I would have killed to be at your dinner table growing up. Oh my gosh. Poo on one side, spies on the other. This is amazing. And the perfect marriage. Do you really think about it? A hundred percent. 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 had come up with these ways to mask their heart rate, but nobody could be, I was a theater kid. Nobody had figured out how to hide

10:43this feeling that you get when you're nervous, going on stage or telling a lie, where you get this like, you know what I'm talking about? This sinking feeling in the pit of your stomach. Yes. And yeah, your heart's racing too, but that's something else. There's like something else happening where you feel like this cannonball drop in your gut. Yes. Like 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. In seventh grade, my dad is telling me this completely, you know, he's always talking

11:14about his research and he's like very excited to try to explain what he's doing. So he tells me about this device called an EGG, an electro-gastrogram, which is very similar to the electrocardiogram, but it's measuring the electrical activity of the stomach. And that was my light bulb 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 neurogastroenterology know about and care about and have been studying. And I'm like, wait,

11:45you could use your stomach as a lie detector. What if we use the EGG? And I like, I was like, you know, I think I had like pressured speech and I was like telling my parents like all about my EGG's plan. And at the end of it, my dad was like, great. Well, 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

12:17electrical 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, your stomach, when you're not eating, contracts at about three cycles per minute. And that's happening. You don't know about it. It's happening in the background. When you're nervous, when you're telling a lie, that rhythm gets thrown into total chaos. It's called arrhythmia. There's no set pattern. And you can see it happen. Even if that person is like looking cool as a cucumber and they're acting natural, they're talking naturally, you see this change happening in their stomach when they get

12:51nervous. And that's what we measured. And it, you know, I went on to fame and fortune in my high school. I'm just kidding. I won a science fair, but I did not get to sit at the cool 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 pit in your stomach? What is happening is your amygdala sends the signal to release this hormone called corticotrophin releasing hormone. And that in turn goes to the bloodstream and starts this cascade that

13:24ultimately grinds your stomach to a halt. So a hormone gets released, stomach slows down. But there's a but. There's a literal but, which is that your colon speeds up. When this is happening, that same hormone, which is slowing down your stomach, causes your colon to rev up, which is why a lot of people are like, why do I have to poop right before it's like my turn at karaoke or right before I have to give a presentation? Like suddenly I have to go. And then once your presentation's over, you actually don't have to go to the bathroom. Like you're fine. Well, it's because

13:57that 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, Tricia, you seem to have very visceral memories of blowing your lines on stage as a theater kid. I know. This is like 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

14:28of Christmas Carol. I was the ghost of Christmas past. It was like a prize. Like I nailed the audition. Like people were jealous, man. And so I'm on stage and I don't even remember the line anymore because I only remember the emotion. But I do remember I'm like 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. I'm like, what do I do? What do I do? And I feel that like that

14:59sensation. And luckily my, you know, I don't know what the word is, co-star, like the other, the dude who was playing Ebenezer Scrooge, he like jumped in and just kept going. We just kept going. But I thought about that. Not only did I think about it like after it happened, I sometimes, you know, I'm, how old am I? I'm like 37. I wake up, I have dreams. I like, I'm on stage and I can't remember what is the play I'm even here for? Like, what are my lines? So anyway, formative memory. I know really deeply what that feeling is. Obviously I had to study it.

15:30Wow. But you didn't, you didn't put your pants or anything? No, thank God. That would have really taken, could have been worse is what I'm trying to say. Could have been way worse, yeah. So don't worry, I won't talk to you about any more memories from high school. Appreciate you. So in your book, you described going back to sort of our scientific understanding of what's happening in our guts when we're nervous throughout the day as our emotions are going up

16:00and down. You described this fascinating case report from the 1940s of a soldier who, tell me about this study.

Stress and gut motility

16:09It was World War II and there was a soldier who was in this ward and because of his wounds, his whole abdomen is exposed. And so the doctor who's taking care of him can see his abdomen. And what's interesting is that he found that this soldier, he could like literally watch in real time how quickly his stomach is moving, whether he's having a lot of what we call peristalsis or movements in the gut and when his gut seemed to be calm and happy and relaxed. And what he found is

16:40that, 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

17:16reading this against 1940s. And he's like, let me do a set of experiments to prove this, to show that not physical stress, but psychological stress causes acute changes to our gut. So then he starts to do these experiments where he puts people live through a set of kind of psychological tests. Like he'll say, tell me about, you know, your stressful marriage or talk to me about this like difficult relationship you have with your son. And he even pretended to find cancer in one of his patients. And this is like, ethics is like a whole separate conversation about these studies. Like I, it was a problem, but

17:48what he found is that while he's putting these people through it and he's looking through this like early version of a colonoscope. So like kind of a rigid scope looking from the inside. He saw that when they were stressed out and talking about these difficult experiences, he could see the rectum spasming and moving, right? And this is something we experienced, right? Like we, like I felt it on stage. Like we feel this all the time when we're really acutely stressed. So how is the brain and the gut and communicating with each other? What is exactly

18:20happening 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 enteric nervous system or the brain in your gut. So the main way it communicates and has to communicate is through the vagus nerve. The vagus nerve is this big, is, you know, like wandering, hence the name vagus for wandering nerve that has these tendrils that go throughout the organs of your body.

18:55But the gut really gets the lion's share of that innervation. And what's fascinating is that much of that communication is going from the gut up to the brain. 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,

Parkinson disease and the gut

19:20in 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

19:51think 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 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

20:25synuclein protein. And it misfolds in Parkinson's disease. In the brain, you can see this protein misfolding. Yes. And they've done, and this is like just incredibly well studied because they've done autopsy studies, we know really well what happens to alpha synuclein in the brain. 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

20:56on people who have Parkinson's disease, you actually would see that their guts too are riddled with misfolded alpha synuclein protein. And in the case of the gut, what we think can happen is that that misfolded protein sort of bumps up into other alpha synuclein and induces that alpha synuclein protein to misfold. And it just propagates and propagates. It's like a domino effect all the way. Yeah. And then it gets into the brain. How? Through the... Slowly but surely through the vagus

21:27nerve. And that's a process that takes years. And you might say, okay, how do we know that? And we know it for several ways. But one way is we've staged it. Like you can inject in mice, you can inject preformed alpha synuclein sort of fibrils and watch them misfold. And you can stage, you can watch it track from the stomach up the vagus nerve and then to the brain. It's going... The protein is moving through the vagus nerve. It's moving upwards. It's almost like a prion because it's like, you know, once it comes in contact with another alpha synuclein protein, that one starts to misfold. And it sort of

22:01moves 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 gastroenterologist, my patients with Parkinson's disease, if you ask them, 80% of people with Parkinson's disease, one, have GI symptoms. The overwhelming majority have GI symptoms. And many of them will say, my constipation started years, if not decades before my tremors started. Started well before. So I just think now anyone with constipation listening is going to be freaking

22:32out 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. Like, so like, if we were to say everyone who gets constipation is going to get Parkinson's, we'd be in trouble. You know, as we age, we get more risk of constipation. When we go on vacation, we get constipated. So don't, don't feel that just because you're constipated, you're going to get Parkinson's disease. The way I think about it is if somebody comes to my clinic and

23:07they're like, you know, like forties, fifties, new constipation, not something they've ever dealt with before. First of all, I look for other things that could be going on and causing it. If they were to say, you know what? Like I also, I lost my sense of smell a couple of years ago, or I've been having trouble sleeping. I'm acting out my dreams. That's another sign of prodromal Parkinson's. If you start to tell me about constipation plus other signs, other symptoms, oh my, by the way, my grandfather had Parkinson's disease. That's when I start to take this a little bit more seriously.

23:38And 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

Peanut allergies and microbes

24:04progressions. 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,

24:36which they used to. Do you remember the days of the poo smoothies? These were capsules, right? They were frozen capsules. I remember reporting on, and they literally had a blender in the lab. So anyway, science progressing all the time. You have to start somewhere, right? You have to start somewhere. So in this study, very civilised 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

25:09the 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? Allergies, peanut allergies, doesn't feel like it should have anything to do with anything related to your colon per se. But I think what people don't

25:40appreciate is that your gut is actually your largest immune organ. It's huge. 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. 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

26:14the 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. Everyone's like, hey, should I blend my cousin's poop in this smoothie? Because I get this. First of all, do not try this at home.

26:48Oh gosh, don't DIY, 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 can imagine there's a lot of excitement about that. And I don't think it's because it can't work, won't work. I think it's because it's so complicated. Like, who's got the right poop? Like, whose poop do we consider normal? Whose poop do we consider healthy? Is there such thing? I think this is a step in the right direction, but I just want to, like, sort of, like, just bring everyone back down to earth

27:22for, 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 Tricia is hearing online about how we can take care of our guts. You want to hear this, trust me. And if you've got a friend that has gut issues or you think might be suffering in silence, maybe send them this episode. It'll open up a conversation. And there's fictives. Experience a membership that backs what you're building with

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What actually is poop

29:42Welcome back. Today, I'm chatting with neuro-gastroenterologist and author of You've Been Pooping All Wrong, Dr. Trisha Pasrisha. Let's jump back in. So, let's start with just some of the basics around poo, because even basics feel like a mystery, because we don't really talk about it. So, let's just, so what exactly is poo? What is coming out of this, Trisha?

30:15Yeah, so that's, you know, an incredibly fundamental question and a really interesting one. I think what people believe poop is, is just all the waste products that your body doesn't need. Like, you have extracted all the good stuff through your small intestine. Everything you don't need comes out as poop. And that's at least partially true, but it's actually not what the majority of your poop is. So, obviously, scientists have studied this. They've looked at, through mass spec, what is the composition of poop? It's mostly your microbes. And then the rest of it is all this

30:46sort of soluble and insoluble material and fiber that you can't digest. A little bit of corn in there. It's kind of squished together. Yes. Yeah. That's amazing. When you look down, that's your microbes in there. Say hello. Yeah. Next time you peek in. And I think, I think before reading your book, I had this idea that poo was brown because it's just this mixture of all the stuff you've eaten and maybe some excretion products, kind of like when you're painting and you're in preschool and you use all the paints and eventually it just kind

31:17of gets... Everything ends up brown. Brown. But totally. Why is our poo brown? Yeah. Totally wrong. Bizarrely. Our poop would be white, like a whitish clay colored. The only reason it's brown is because of bilirubin. So we produce bile, right? It's this digestive kind of salt that we produce that helps break things down. The bilirubin in that bile is what makes it brown. If you were to take that out, and sometimes that happens if somebody gets a gallstone or if there's something else

31:49blocking the release of bile into your small bowel, what comes out is this pale, bizarre looking clay colored stool. If you ever see one of those, you will remember it the rest of your life. Wow. And what about... So on the odd occasion, someone can even have a silver poo. Oh my gosh. Yes. The poop of legends. The mystical. Silver poop. I can't believe you brought that up. Yeah. So, and if you're watching this on video, you can take a look at this image. This is from the British Medical Journal of someone's silver poo. What might be going on if a silver

32:22poo exits your butthole? I... So there's only been a handful of these cases reported. I read one in the New England Journal of Medicine. So we're talking about the BMJ, New England Journal of Medicine. Like this is a top tier poop. Yeah. This is not something that gets published in like a low impact factor journal. 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 going to give you that whitish color. Yes. Second. A second emergency is occurring in which you are bleeding somewhere, probably

32:56your upper GI tract because the acid from your stomach, when it mixes with blood, it turns this shiny black color. Mm-hmm. 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 mixed with this like clay colored white, you get shiny silver alchemy. And it's like kind of pretty, but it is an emergency.

33:26What 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 coming, you know.

Fiber maxing and your microbes

33:36So there are a lot of ideas that we have about what it is to have a healthy poo, a healthy bowel movement, dare I say it. And one is that we should be aiming for pooing once a day. I think I always thought that was like vaguely helpful. Every now and then I'll have a day where I'm like, wow, oh, three times. Okay. Do you, do you worry when a patient comes to you and is doing poos more than once, less than once a day?

34:06I 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 Beth Israel that showed that people who consider

34:39themselves to 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 going to find that they're going to go more often. They're just like, this is their body's like going to be suddenly overwhelmed and amazed

35:12by 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 the interesting thing about fiber is that like there's this big disconnect where people think I need more fiber because my body needs this to be healthy. Wrong. You don't need fiber for your own body. You eat

35:46fiber to feed your microbes, your microbes that are living in your microbiome. They need fiber to survive and different species. You know, we have like lots of different species living in there. They actually thrive on different kinds of fiber. Fiber is not just this one thing. So you really want to get this diversity of fibers into your diet because that fiber, you can't break it down. We don't have the enzymes to break it down. So it's going to travel through your small intestine. As it's doing so, the part that does help you is that if it is like a soluble fiber, like psyllium husk is a nice fiber supplement, it's going to drag water with it and keep things nice and soft and plush.

36:23So your poop, all that waste is suddenly going to become really easy and soft to pass. But once that fiber hits your colon and those microbes start fermenting it, they produce short chain fatty acids, which then can be absorbed into your body and then have these anti-inflammatory compounds in other parts of your body, far away from your colon, to your heart, to your brain. And that process does a lot of good for you 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

36:54you 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. And if we didn't have those microbes and we weren't producing those

37:28short 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 psyllium husk. Did you notice your poos got better once

38:05you prioritized fiber in your own life? I will say like, if you take psyllium, 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

38:38going on, like with pelvic floor 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. Respond to it.

Answering the call to go

38:56Respond to the call. So what, let's first, what happens if you don't respond to that call? Because a lot of people are embarrassed to, or just really can't go in public. Say the call comes when you're in the mall or in an, 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,

39:32it's fine. I'll, like, I can put this off. I'm going to just return to that same poop a couple hours from now. I'm going to come home. It'll be a safe space. It is not the same poop. Two hours from now, you are dealing with a different poop than the one you are when the call comes. And the reason why is that one of your cullin's many important jobs, one of them is to constantly suck water out of whatever's in there. That's what it's going to do. It's going to do that around the clock, like it or not. And if you ignore that call, it's going to sit there and

40:03it's going to 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. The call is simply the rectum spasming. That's what that feeling is, that sensation like, shoot, I got to go. Suddenly, what is this? It's your rectum spasming. That is the best time to go because your rectum is doing the work for you. It is trying to push this out. Three hours later, when you're in your comfy home bathroom, you feel safe, but you don't actually have the call anymore. You have to do all

40:41the work to generate pressure to push it out. So you have to do an enormous Valsalva maneuver at that point, because if your rectum was contracting, you just do a little one and it'll come right out. Without that squeeze from your rectum, you've 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

41:12will not align again the way they are in that moment. It's so relatable, Tricia. It's so relatable. Tell me about it. So in your book, there was this fascinating stat that your sphincters are contracting, was it seven times an hour? Yeah. Right. What are they doing? Why are they doing

Smartphones on the toilet

41:34that? Let's talk about, this is an underappreciated job of the sphincters, but have you ever asked, I've thought, I think about this all the time, obviously, but like, how is it that our bodies know, you know, if you're sitting with friends that it's safe to release gas, but it's not safe to release solid or liquid. And you can tell, like, you know, you're like, this is okay. I just have to fart. Well, how does your body know that? The way it knows is because your sphincters have these

42:06tiny 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

42:40like 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 are,

43:11the center being the sphincters. And normally, so we all have hemorrhoids, whether you like to believe that or not, they're all there. But normally they're flat, they're deflated. They're just these cushions of veins. But over time, for some people, if you get into this pattern of straining constantly, because you're constipated, sometimes those veins can start to engorge. And when they engorge and they start to fill up, those cushions can become plumper and plumper and plumper and juicier. And then sometimes they can become so plump and juicy that the internal ones

43:48pop out and say hello. And those are called prolapsing hemorrhoids. And you can feel those. They're very uncomfortable. You can sometimes push them back in. 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

44:22half 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 well-being. And so what we found in our study is that people who bring their smartphones in, yeah, not only are they spending more time, that's a problem, like more than five minutes,

44:53but 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 gonna, like you weren't gonna stick around to get to the 14th ingredient. You would do your job and you'd move on. Yeah. Whereas with the smartphone, it's like, God, this Science Versus episode is gripping. Like I'll just, I might as well see where this conversation is going and you'll stick around and completely forget why your pants are around your ankles. And that's the problem because

45:28it's that long amount of time sitting there on this open bowl without any pelvic floor support that we hypothesize is the reason that not just one time, like, you know, everyone's allowed to watch one season finale of like the pit on the commode every now and then. But if you do it day after day, year after year, and you start doing this at a young age, that's what we think puts you at the risk of the hemorrhoids later on. Do you want to tell me about your study here? You're groundbreaking. Yeah. Groundbreaking. This was not the study I thought we, like the Pastrisha Lab would become

45:59most 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

46:29tell people, look, set a two tick-tock limit, you know, or like set a five minute timer. And so just, so why does sitting in the toilet then increase the risk of hemorrhoids? 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 counterpressure, 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.

46:59I'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. Tell us what gives you, what's given you the shits recently when it comes to gut health ideas online. So much. Can I tell you, can I tell you the one that's like bothering me right now? Yes, please. Which is that, okay. There's this idea that you have a parasite that has like taken hold of a lot

47:31of people on social media, but actually it's like very cut, like people, you know, like I used to think this is really fringe. Very, very average people come to my clinic convinced that they have a parasite. They haven't traveled anywhere, kind of exciting. There's no classic risk factors, but they kind of just know they have it. And sometimes they see, they think they've seen a parasite. And what I have seen to be the case is that people go online, get these parasite cleanses. They take them and they see like basically their own intestinal lining shed.

48:04And they're like, my God, this is, I've cleared the parasite because I've taken this thing. What are they taking? What are they swallowing? What, God. Like really harsh stuff that are being sold as peritone or like herbal remedies and these things. And there's, they are seeing, like I've seen pics because I get pics. Yeah. Like I'll see them. I'll be on the, like, you know, like I'll see the sample and I'm like, this is not a parasite. By the way, we have incredibly good tests for parasites in a clinic setting. Like we don't, we don't usually, we don't miss this. Like if someone has a parasite,

48:35like 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, I like, and I need this parasite cleanse. But sticking with stuff online these days is there's this meme that's been going around for a while that's hot girls have stomach issues too. And you're out of this. Yeah. And we got questions about this from our listeners as well. Are women at an increased

49:10risk of these sort of complex, severe stomach issues than men? What's going on here? Yeah. I thought you were going to ask our hot girls at an increased risk. Like I don't think we've done that study yet, but we certainly know. My lab, which I'm getting so many ideas, but, but yeah, women are at a much higher risk of getting IBS. Really? It's interesting. We've, yeah. Why is that? We've known this for a long time. There are a lot of different reasons. And some of these we're, we're really just learning about in the last five years, but I'll tell you one big

49:42reason, 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 twenties. Like they'll say my symptoms really started in high school and college thirties. And what's interesting is that sometimes we do see that as women get older, they enter their fifties, sixties, seventies, it's rare to make a new diagnosis of IBS at that point. So the hallmark of IBS, it's just to be clear, it's pain. It's not just diarrhea. It's not just constipation.

50:16IBS 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 Bersikowski at the University of Melbourne to research for this chat. And she did this fascinating study into IBS patients. It was a

50:48small study, but really interesting where she gave them, her and her team, fructans and then measured, she had a control group. So some had IBS, some didn't, and measured exactly how much gas was being produced in their belly and found that everyone, whether they, in this study, whether they had IBS or not, had the same amount of gas being produced. So the microbes were eating up the fructans, fighting out the gases. It was the same amount of gas being produced,

51:19but the people with IBS who were experiencing pain, they were, what she did find was different because they were in an MRI scanner. And she could see that in their brain, their interpretation of pain, the pain in the brain looked different to the control group. So it was the, this is what you're talking about here. They were interpreting that, that little bit of, of extra gas, extra pressure as pain. That was the problem. It was the nerves. It was the brain that was interpreting this signal

51:49differently. Is this what, 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. Cause they're like, I, I mean, almost the hallmark, the way we define clinically IBS is all your tests are normal, right? That's very frustrating to hear. You feel really dismissed when that happens, but it turns out we're just talking about standard clinical tests that are normal. If we were to do, and they've done this, the only reason I can say this is because they've done this in research studies. If we were to look for say trip V1,

52:24which is this receptor on pain signaling molecules, and those receptors that signal pain to the brain, they're expressed more than three times as much in people who have IBS in the colon. So that means these, you have the same nerve cells in a healthy person versus someone has IBS. The IBS patient is going to have more receptors that are perceiving pain and then sending those signals up to the

Juice cleanses and bad advice

52:49brain. What is the worst GI advice that you say online? People think juice cleanses are like somehow vaguely, like it has this wellness sheen. They're, they're colorful. It looks like something like influencers would do. What are juice cleanses, but fruits and vegetables from which you have removed the fiber. You've taken the fiber out, you've juiced them. And so all you get is the sugar. And like, to me, it's like, the reason that's so bad is because you feel good. Like you think you're

53:19doing 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. 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.

Oddball questions and public restrooms

53:36Oddball Questions. Tricia, what is a conspiracy theory that you secretly have a soft spot for?

53:47Okay. Stick with me. We, this is like, this is really niche, but I'm not the only one who like kind of does buy into this. Okay. Stay with me, Wendy. All right. 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

54:20for them. I know. Like think about our behaviors. Like why do we eat fiber, right? Like fiber, we don't, we don't have the enzymes. Fiber is not for us. It's for them. Why do we thrive in these close, tight-knit social communities? There are a lot of other reasons, sure, for our own survival, but the closer our community, the more we're transmitting our microbes to each other. They've done these studies. So I have this, this like, you know, like God bought into this idea. Blowing. Yes. Right now. Isn't it? Like we're here for them. They're not here for us.

54:54Whoa. 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 in, day out. Oh my gosh. Um, well, I, I kept, I kept. Wow, your eyes lit up like nothing we've seen before as, as just the visions of people's guts. The visions of like the stuff we 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's, that was me. But what

55:25I can't tell you is this. Okay. People often, it's not uncommon for the GI doctor to get called to the emergency room because of, because of some object has made its way into someone's rectum. Yes. And we get this call pretty often. Whoa. Yes. And 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

55:59how it got there. Yes. But 90% of the time. They put it up their butt. That's how it, they put it up there. Yes. They just, and it's, that's so big. Yes. You know, but 90% of the time, the person in front of me, without my prompting at all, that person offers an explanation. Oh yeah. They'll be like, you know what? Sat on it. I sat on it weird and I'm like, yeah. Okay. Yeah. I didn't ask. And can we, I'm just here to get it out. Like one way or another, we're going to help you. Yes. I know you've learned your lesson. Like I, you don't need

56:31me 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 flared bait. 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 poo. Yeah. Right. Do you put paper down or not? Oh.

57:05Um. I say controversial because I have heard from microbiologists that putting paper on the toilet seat is a waste of time because the microbes are so little. It's like, it's like a fishnet that they can just go through. And yet there is, there is a psychological element to it and I wanted to know where you sat on this. And I will, I see what you did right

57:35there. And the reason I hesitated in, and this is also revealing is that there's not a great reason for this. It's not really the microbe thing that bothers me. I almost never sit. I hover when it's a public bathroom. Even to poo? Even to poo? I'm, I'm just, I, yeah, I'm so good at it that like, it doesn't, the job will get done. You are, wow. I know. I know.

58:01But I would rather not sit. Because I, because I, I feel like I hovered once, I hovered once to do a poo and I overshot.

58:16And you know, there is nothing scarier than when you don't hear the plop. Because that's, that's how I knew what I did. I was like, where was the plop? And then to look around. And then the horror upon horror. So I don't hover anymore. I don't, I can't trust myself. You, I mean, it takes practice, but you can get there. I believe in you. But I

58:50guess 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 paper. Okay. I'm crying. I'm laughing so bad. Me too.

59:04Appreciate you getting vulnerable with us. That was amazing.

59:12There we go. Thank you so much.

59:17You're so welcome. My pleasure. That was Dr. Tricia Pasrisha, Neurogastroenterologist at Harvard Medical School. And her new book is You've Been Pooping All Wrong. If you liked this episode, please tell us about it. We're on social media. We're also now on YouTube at Science VS Podcast. And if you liked what you heard, if you learned something, if you thought a friend might enjoy a little laugh and a little learn, please send this episode along. If you want to know more about the science of whether to put paper on the toilet,

59:50then you've got to listen to this episode of Every Little Thing. We're going to put a link in the show notes. It's hosted by Flora Lichtman, who now co-hosts Science Friday. Thanks for watching. This episode was produced by Akedi Foster Keys and me, Wendy Zuckerman, with help from the team at Science Versus. We're edited by Blythe Terrell. Mix and sound design by Bobby Lord. Music written by Bobby Lord, Bumi Hidaka, So Wiley, Emma Munger, and Peter Leonard. An extra thanks to the Zuckerman family and Joseph Lavelle Wilson. I'm Wendy Zuckerman. Back to you next time.

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