The Gut Health Episode: Harvard Doctor Reveals What’s Normal (and What’s Not)

Let me start with a confession.

I have wanted to do an episode on this topic for years, because there are a few things that we all think about. We all deal with and yet somehow we don't say them out loud. And you want to know what that topic is? Got issues.

At the top of that list, bloating, constipation, gas, IBS, and yes. You and I, we're going to talk about poop. I can't say that. We're going to have laughing. Because if you have got issues, welcome to the club.

That's the majority of people alive today. And for the longest time, I was dealing with bloating that made no sense. I would wake up feeling totally fine. And by midday, my jeans or tighter, my stomach is bulging out. I'm uncomfortable. In fact, it's happening right now.

It's probably because I have highways to jeans on and I would be thinking, what is going on?

I have family members who are always backed up, especially when we travel.

Friends who will not poop at work. They hold it in all day long.

“So today, you and I are getting curious, because we ignore our gut way more than you should.”

Mostly, probably the same reason I do. You're embarrassed or confused or maybe you've told yourself, "I just have gut issues. This is how it's always going to be." Today, we're changing that. This episode is the ultimate.

No shame, ask everything. God health conversation with one of the top neuro gastroenterologists. I said that right. I think neuro gastroenterologists in the world. Today, we're talking about what's normal when it comes to poop and what's not. The hidden reason why you may be struggling with bloating.

Constipation, and more importantly, exactly what you should do about it.

The shocking research that will make you never want to bring your phone in the bathroom again.

“We'll talk about coal in cancer risk and the signs you should never ignore.”

And the gut brain connection with really happening when you have butterflies in your stomach. Today, nothing's off limits. Nothing is too awkward and I promise you. If you've ever had that thought, is it just me? Or you've turned around to flush the toilet and thought, "What is that?" This is the episode where you stop guessing you stop feeling weird about your body or uncomfortable in your own skin and finally understand

what your gut has been trying to tell you. Because once you understand your gut feeling, you know how to work with your body instead of against it. [Music] Hey, it's Ren Mel and welcome to the Mel Robbins podcast. I am so fired up for our conversation today. I know we're going to laugh, we're going to learn. It's such an honor to be together and

to spend this time with you. And if you're new here, or somebody sent this episode to you. Maybe it showed up in your family group chat. I want to personally welcome you to the Mel Robbins podcast family. Today's guest is one of the world's leading experts on the gut-brain connection and how your body influences your mental health, stress, and decision-making. I'm talking about Dr. Trisha Pusrecha. Dr. Pusrecha is a board certified

neuro-gastrointerologist, a physician scientist, and an assistant professor of medicine at Harvard Medical School. She also holds a master of public health in biosetistics and epidemiology from Harvard. She's the director of the Institute for gut-brain research at Beth Israel Deaconis Medical Center, where she leads NIH-funded research on how the gut communicates with the brain and how that connection shapes anxiety, mood, and disease. She completed her residency at Johns Hopkins.

She's also earned a master's in public health from Harvard. She's gone on to specialize in neuro-gastro and neurology and so can't say the word. She's at impressive. She'll tell you how to say that word. At Mass General Hospital, the number one research hospital in the world. If she can help me with bloating and pooping, we're going to be good. I don't care how you say your specialty. Dr. Pusrecha is also the long time Ask a Doctor columnist for the Washington Post, where she's known for

telling the truth, busting medical myths, and tackling topics most people are too embarrassed to talk about. Including digestion, pooping, and gut symptoms that millions of people live with in silence. She's also the author of the new best-selling book You've Been Pooping All Wrong,

“which tells you pretty much everything you need to know about how fun,”

direct, informative, this conversation is going to be. Oh yes, we're going there. This is one of those conversations where I'm asking the questions that most of us are just

to the Mel Robbins podcast. Thank you so much for having me now. Oh my gosh, all right, we are going to dig into this. I cannot wait. I really can't wait to talk about poop. I know that we're going to get into that a little bit later, but I'd like to start by asking you. How would my life be different? If I take everything that you're about to teach us today to heart, I apply it to my life. I share with my friends what's going to change about my life.

“Your life is going to change in two big ways. First, you're going to stop thinking about your gut”

as a digestive organ. You're going to start thinking about your gut as a brain, because that's what it is. Your gut is a brain. It has more nerve cells than the entirety of your spinal cord. It is creating all the same neurotransmitters, like dopamine, like serotonin. And it is constantly sending signals up to the brain in your head through this information super-highway called the vagus nerve. And also, so many of the diseases that were most afraid of from

certain cancers to Parkinson's disease, these can all start in the gut. Once you realize that, everything changes because then you can realize you can change your health, not 10 years from now, but today, you can start to take control of your health through your gut, and that gives you real control. The second thing that's going to change for you is that you're going to realize this whole

time, your symptoms were never all in your head. All of those GI symptoms, the bloating,

“the trouble with digestion, the going to the bathroom, none of that was ever just stress. And I think”

the reason that so many people for so long haven't been believed is because some people aren't as familiar with all of the data and all of the research that I'm going to share with you today. And once you have that knowledge and that validation, it's going to give you power back an agency to get the help that you need. Wow. So Dr. Press region, let's just start with the basic level. What is the gut specifically? Yeah. Let me bring out this model here. Okay. Let's walk through it.

Okay. So she's pulling out, okay. Now we're all in medical school, everybody. She's, you've pulled out a plastic model of a human being and basically what I'm looking at. If you're listening, we're going to narrate this for you. We have a model that shows the insides of a human being. I recognize the lungs. I see like a bunch of squiggly stuff, which I guess are intestines. But

Dr. Press region is going to really narrate this for us. Yeah. And first thing I'm going to do is

actually I'm going to take the lungs out. I'm going to take the heart out just so we can say. Okay. I don't know though. It promise you I'm not that heartless. No fun and tented. Okay. So now I'm seeing, whoa, what am I seeing? Yeah. So this, what I'm going to walk you through is the gut. The gut is our way of referring to the gastrointestinal tract that is everything from the mouth. All the way back to the anus. Okay. Hold on a second. You've already taught me something.

“When I hear the word gut, I think for my belly button to my private parts. I think about the”

part that swells. I think about the part that hangs out over my pants. Yeah. I think about just that section. So the first thing that you want us to really reframe is that when you use the word gut, at least medically speaking, it's the mouth and all the things that connect your mouth all the way through until it goes out the other side. That is the entirety of the gastrointestinal tract. So everything that's part of that really, really long complicated tube, that's your gut. Huh. Hmm.

So let's walk through it. So suppose you take a bite of food. It goes through your mouth here. Yep. And now follow along. It goes through this tube, the back of your throat. Do you see this muscle that long tube is called the esophagus? Okay. And it goes from the esophagus down. You know what's interesting? Yeah. I don't know if you feel this way as you're listening this episode right now.

But I've always thought the esophagus, the esophagus actually goes down the front, like in front of

no. Did you see what I'm saying? No, it's so. It's hiding out in the back there. So I had to actually remove the heart for you to be able to get a little bit hurt. Yeah. It's in the back of your chest. For some reason I thought it was in front of it. Is that because like if it hurts, you like feel it in the front of the chest? It's weird. Yeah. When you get heartburned, right? It's all kind of in that same area because the esophagus travels through your chest cavity on its way down

to the abdominal cavity. Okay. And then when you have heartburn, you're sort of referring it to that general area and you're, you don't know exactly where it's coming from. Is it the back of the front and you perceive it as just being from your chest? Yes. Yes. Your esophagus is hiding all the way in the back. Wow. Mm-hmm. I'm going to take this liver out here too just so you can see better where the esophagus is going. So goodbye. Okay. So it's behind the liver. So it goes all the way back.

And then it connects here to your stomach. So this organ here is your stomach. That's where the food gets broken down and acidified and broken into these really small pieces. From this stomach, that piece of food is going to enter the small bowel first. That is just long,

That's where all the nutrients get absorbed. Okay. So everything that your body wants,

everything that it needs. Why is it called the small bowel? Because it looks pretty big. Like long. Yeah. It's long. You're right. It's long, but it is smaller in caliber. The large bowel, sometimes called the colon, is this larger C-shaped organ here. So it is shorter than the small bowel, the colon, but it's wider. Okay. I just want to describe this for you in case you're listening. Because I'm standing here or sitting here rather kind of surprised. Because I thought the intestines,

“you know, like if you think about your intestines, you think all this squiggly stuff, right?”

So you know what's interesting is it looks kind of like a brain. The intestines really have the same like macaroni shape. You're starting to get it. That's the brain. But here's where you got me and I'm

surprised. The colon isn't just the tail end of the macaroni. The colon is going up and around

all of the like small intestine. I thought it was just like the last foot or the last like little section. I thought really? Yeah. It has a long way to go. And that's because one of the jobs of the colon is that it sucks water out of at this point the waste that's there. Because everything that you don't, again, you've absorbed the nutrients you need in the small bowel. Now it's the waste that reaches the colon. All the waters getting sucked out. So is it goes along this way? It's getting drier

and firmer and harder. Eventually it makes its way to the back all the way to the back to your pelvis. So this is a female model. I'm going to hold this up. This is a cross section of your pelvis. A female pelvis. Okay. So this is your bum. Right. Here is the colon. The last part of the colon called the rectum. So this is where all that food you've eaten that has now become waste that has now been fermented by your microbiome. It hangs out here in the rectum until you're ready to release it

back until that. Hold on. Hold on. A lot of times we're ready. And now we're going to get into this. A lot of times we are ready for it to be released. But it is not releasing. And I know we're going to talk about all of this. Thank goodness for those fingers. The fingers or fingers that hold it tight. You have control over your external fingers. So if you say we are not ready, you can you're going to touch the door. Yes. You can shut that door. Most of the time. Yeah. There are times

where you can't. And then you can see. So this is the back of your colon and the part that's called the rectum. For in women we have our uterus here and then our bladder up front. So we'll wait the back. Wow. So how long should it take for the piece of food? So I had, I had scrambled eggs this morning. Yeah. So how long should it take for the eggs that I ate to go? Like if if things are working as they

“should. How long should it take from chewing it up and swallowing it for it to make the exit?”

It should exit your stomach that first part within four hours. Four hours. Yep. And if it's softer

easier to move through, doesn't have to do a lot of hard-breaking down like fiber foods. If it's something soft like eggs, it'll move through the stomach even quicker. But from the point from when it exits the stomach until you decide to release it into the world again, that process can take days. Because for a lot of people, it moves through the small bow over the next day or two hangs out in the colon. But we have control over that final step and there are some people for any number

of reasons who are going to hold on to it a little bit longer than others. So it can take a day, two days, sometimes even longer. Wow. But it's out of the stomach within hours. With an hour. Yeah. And sometimes even again, within 30 minutes, if depending on what you've eaten. That is absolutely fascinating. The thing about this, though, is that if you think about the gut just this way, and this is the way that I think a lot of us have learned about the gut in school,

you will think about the gut just as a digestive organ, and it is so much more than that. So the gut is also an immune organ, 70% of your body's immune system is here in the gut. What does that even mean? It means that all 70% of the immune cells and the protective barrier for you against everything the outside world is throwing at you is in the gut. So it's one of the

“most important defenses you have against the outside world. And I think people don't appreciate that.”

So the flu is going around. Yeah. Right. You're breathing in air or there's maybe some pollution. You're breathing in air. You're in standing next to somebody who's smoking. You're breathing in like it's going in through your mouth, right? Yeah. And so are you saying that from your mouth all the way down, the esophagus, into the stomach, the small intestine, the colon, the right, that that is protecting you from whatever was in the outside world, that you then either breathe

in through your mouth or you ate and food that might have some sort of cat. Is that what you're saying? That's exactly right. A lot of what we eat is obviously not sterile. We're putting all kinds of

got so many different things from the outside world. Chemicals, bacteria, whatever it is, someone is stopping you from getting sick most of the time and that's your gut. When it comes to respiratory infections, a lot of the immune response does start in the lungs and it starts elsewhere. But think about a lot of our respiratory illnesses like flu. So many people get diarrhea with the flu because your gut does get activated. That's part of the response. That's right. Wow. Okay.

“So is the immune piece of the gut? Is that simply protecting you from what's in the gut?”

Or does it also talk to the rest of your body? It talks to the rest of the body. So it helps coordinate the entire response. But you can think about it like we think of the skin as being that

first barrier against the outside world. But really the gut, if you look at the cross-sectional

area of your gut, I mean you pointed out this small bowel, it's huge. If you think if you were to spread it all out, it's huge. It is in contact all the time with things that we've come from the outside world. And so it's protecting you against the outside world. The gut is also doing more. It's also producing hormones. And so it's responsible for the hormones that regulate your blood sugar, for example, and also influence your mood. And then the other big thing, which I talk about all the

time is that your gut is a brain. It is the home to the end-terric nervous system. End-terric nervous system. You probably heard of the central nervous system. That's the brain in your head. But your gut has its own nervous system. Millions of nerve cells that are in communication with each other. They're in responding to signals from the outside world. And then they're communicating with the brain in your head through this long. I want you to imagine a long

winding nerve coming down from the brain, making its way to every organ inside your chest cavity, your abdominal cavity, and all through your gut. That's the vagus nerve. So Dr. Puss Recha, you're talking about it being the second brain and that the gut and the brain are in constant communication through all of these things that are called the vagus nerve. Yeah. But can you talk about the science and when researchers and medical experts realize there

“is a two-way communication and how that connection gets formed in a person?”

Yeah. We've known that the gut and the brain have been in communications for over a century. If you go back to the 1890s, 1890s, you'll see and Dr. journals. They were talking about how it's seen like things like emotional stress seem to cause this response of all places inside the gut. Mm-hmm. And there was a famous head of experiments that was done in the 1950s at Cornell. And the researchers had participants talk about really stressful emotional experiences. So they

would talk about an argument they had with their spouse or the financial troubles they were having. And while they were discussing these psychologically stressful events, the researchers used a prototype of a colonoscopes, so they looked directly at the colon from the inside. And as these people were talking, they would see the colon start to spasm and squeeze and move. And these people would

“experience stomach cramps and gut cramps. And I think that tracks with what I experience in real life,”

if I'm having an argument with my husband, which doesn't happen that often. But if I'm having

that, I sometimes feel cramps in my stomach, it's a very unpleasant feeling. The problem is that

for several decades, that was the way we framed the gut-brain connection entirely. We thought about that gut-brain connection as the brain talking down to the gut. It wasn't until the 1980s, 1990s, that my field, which is neuro gastrointrology, the study of the gut-brain connection, really crystallized. And that's when people said, "Wait a minute, this vagus nerve, this large nerve that's the conduit between the brain and the head and the brain

and the gut." Most of the signals, 80% of those signals, they're not going from the brain in the head down to the gut. They're going from the gut to the brain. So if most of the communication on the vagus nerve is happening from the gut to the brain, it completely flipped the script. What does it mean to you that 80% of the messaging begins in our guts telling our brains something? It makes me wonder, and this is what researchers then started to ask, "What if we had it backwards?

What if it is gut dysfunction?" That's responsible for our anxiety. What if it's gut dysfunction that causes depression? What if it's gut dysfunction that causes neurodegenerative disorders? And that completely changed our field, and it's still shaping medicine today.

Wow. I mean, that's a both radical and a crazy, amazing thing to believe.

I mean, I think it's true. I mean, it's more than a belief. I mean, it's more than a belief. I mean, I think God, I don't know, at this point we have decades now of data that's showing that this is true.

there are other ways that you can treat those symptoms or really go after those conditions

“and feel better in your life. Yeah. That's exactly right. I mean, if your whole life you've been told”

that your gut symptoms are due to stress. They're due to your anxiety. They're due to your depression. Yes. Then you're left only with this set of tools and medications and treatments that are going to address the brain in your head. That's all you have. So you're going to be taking things like anti-depressants and anxiety medicines. Maybe you'll do cognitive behavioral therapy. All of these tools are important and they have a really important place in treatment of these disorders. However,

once you realize that the gut can be the source of the problem, it opens this door to the whole other toolkit of treatments that will primarily target the gut to interrupt that vicious cycle. So it gives you options back. And even if it's not the actual source, it certainly is contributing to the extent to which the symptoms feel even worse. Absolutely. I mean, we don't think of the gut brain connection as just the brain talking to the gut or just the gut talking to the brain. We have

seen so many times it's a vicious cycle. If you have horrible gut symptoms as many people are living with every day, that can give you anxiety. And then the anxiety can fuel the gut symptoms. And vice versa. And it's not sometimes just intervening at the level of the brain in the head

“that can stop them. Sometimes you need to stop the upstream source and shut off the faucet.”

And that's looking at the gut. Well, what I love about this is that if you're somebody that really struggles with anxiety or you're a ruminator and you're constantly up in your head or you're feeling extremely depressed right now, going up in your head and wrestling your thoughts, feels like an overwhelming thing to do, knowing that you're going to talk to us about ways we can take better care of our gut that are clinically and research backed in terms of helping alleviate

those symptoms. That's amazing. So from a medical standpoint, when I say, I have a gut feeling,

yeah, or I've got butterflies in my stomach. What does that mean? Like, what's the science behind that? Yeah, those are real physiology. Those aren't just metaphors. So stress, fear, excitement. These can all trigger our amygdala. That's a certain part of the brain. It's an important emotional processing hub. It causes the amygdala to signal to another part of the brain to release a hormone called corticotrophine releasing hormone or CRH. CRH is two things. It acts on the stomach

“to slow it down and then it moves down to the colon and it speeds it up. So that's why when we are”

on a first date, we might feel butterflies in our stomach or when we have to give a presentation like right before we suddenly have to go to the bathroom. Why does that have right now? Why does that happen?

Why do I always have to pee or go number two, right before I'm about to give a speech or I'm about to

or I'm about to walk in here and do an interview with you, which like, why do I have to go the bathroom right now? Yeah. Well, early in my career, I discovered one of the mechanisms by which this happened. So what I did was I used a machine called an electro gastrogram. That's no, it's very similar to an EKG, which people used to measure the heart rate. Yeah. Right. And so the heart beats at this regular rhythm of 60 beats per minute or so. Well, it turns out your stomach is actually has its own rhythm.

And it's contracting at a regular rate of about three beats per minute. But what I found is that when you're telling a lie, that regular rhythm of three beats per minute, it goes into total chaos. It doesn't contract anymore at three beats per minute. It enters this chaotic rhythm called a rhythmia where there's no discernible pattern. And it turns out that that discovery where you could actually potentially use your stomach as a lie detector. It got an asteroid named after me.

But more importantly, it taught me something really profound about the gut and the brain, and which is this. The gut can respond to external information often so much quicker than your

conscious brain can process. And some people call that a gut feeling. But here's what we get wrong

about gut feelings. We often assign gut feelings. We label them as being good or bad inherently. And a gut feeling is neither good or bad. It's a scientific phenomena. It's a physiological signal, and it's simply a message. And that message is this. The stakes of this situation are higher than you realize. That's the message. It's not good. It's not bad. And we are the ones who give it this label and assign it some prophetic value that it's telling me something. But actually,

I think, if we're looking at this just on a scientific level, one of the most powerful tools

impossibly acting on what we're calling a gut feeling, we should learn to pause, listen to that

gut feeling, and instead of asking, is this good or bad, ask yourself, what am I missing about this situation? What is my gut perceiving that my brain in my head has not yet understood? Let me give you two examples. Great. So suppose you're a leader in your group and someone's presenting a new proposal and that proposal sounds great on paper and everyone in the room, they're nodding along, they like it. You suddenly get this tightening and you're gut.

Popular culture would say, oh, that's a gut feeling. It's a bad gut feeling. There's something off about this proposal. Yes. You should reject it. Yes. And maybe the proposal's horrible. I'm not

“sure, but I think it would be premature to say that what you should wonder and consider is,”

what if you're getting a gut feeling that's responding not to some inherent risk, but to novelty?

What if this proposal is challenging your way of thinking in a way you've never done before?

Maybe that's a wonderful thing. I love this idea that whenever you get a gut feeling, don't immediately go, oh, there's a gut feeling. Go to bed. What I'm hearing you say is, when you get a gut feeling, it's like ding ding ding, pay attention. That's right. There's something that I need to pay attention to. What's the second example? Well, so suppose you want to date. Yes. And you've met this new man. I love what you're wearing by the way on this date. I appreciate you.

I'm just wearing date is already going so well. Cool suit. She looks amazing. Okay. Thank you. So date is obviously going well. They're complimenting you. Yes. And the conversation is going fine.

And then maybe suppose that moment in the date comes where like your hand reaches out,

their hand reaches out fingers. Touch finger is tingling. Yep. Except nothing happens. Suppose you touch each other and you don't get butterflies. Now, of course, here we go. Pop science jumps in and says, oh, there's no spark. There's no chemistry. He's not the guy. She's not the girl. And you might assign a lot of value to that absence of a gut feeling and say,

“you know, at the spark, it just wasn't there. It's not worth it. I think a lot of people do. Totally.”

And what I'd like to remind you is that the physiology, again, your gut is not telling the future. It is not a good or bad thing when you have that feeling or when you don't have that feeling. Because what if what is happening in that moment is simply that you feel safe, that you feel completely regulated, is that not a wonderful thing? And maybe, right, like maybe this guy is not the right guy for you. I can't tell you that your gut is not telling you

that it's asking you to maybe go on one more date. Maybe gather more information and see if he's right guy. And he may still not be does actually a lot of research around what they call the slow burn relationship where there's not a ton of sparks in the beginning. But the more time you spend with somebody, the more you realize it's the calmness and the state of just being okay, that is really the beautiful thing. And a lot of us race towards that like excitement thing and read it is a good thing.

And maybe a lot of the excitement, ah, thing, sometimes is actually your body going, oh, this is just like the other six people that goes to do. Please don't lean into this. Yeah. And you don't know if this

“person could be different. Because just remember, you're good. It's not trying to write the story”

for you. It's simply asking you to read your own story more closely. I love that. So no more, I got a gut feeling. I'm doing it. It's I got a gut feeling. Oh, I got a pay attention. Yeah. And based on what's happening. Do I do it? Do I not? Boom. Gather more information. Don't act impulsively. Just take a beat. Now that we've talked about the gut, how many people have issues with the gut? Like how widespread is it? And can you list off some of the

common things that people can struggle with when it comes to the gut? Yeah. Well, here's a number that made me realize that we have a gut health crisis, hiding in plain sight. 40% 40% 40% of Americans say that their bowels disrupt their daily lives. 40%. So that means all of us know somebody, love somebody. Maybe we are somebody who's dealing with this every single day. And that's just the tip of the iceberg. 15% of Americans have irritable bowels syndrome. Three out of four Americans

can't poop in a public restroom. One out of three struggles to go to the bathroom on vacation, one out of ten live with chronic unexplained pain every time they eat one out of ten. And the kids are also not all right. In my own lab, we found that college students, about a quarter of college students spend more than 10 minutes at a time trying to have a bowel

as being sick. They wouldn't think necessarily that they have a problem. They kind of would have

normalized all these symptoms. And that is the entire problem. The problem is that we are not having

a lot of enough conversation about our gut health and acknowledging what all of us are going through.

“And I think part of that is due to the fact that most of what we learn about having a bowel movement”

comes from what our parents taught us when we were toddlers potty training. And what they taught us is pretty similar to what your grandparents taught them. And at some point, we have to ask ourselves can it really be true that grandma's method was a hundred percent flawless? Like there's nothing else the science can teach us about how to have a better bowel movement. And when I started my GI clinic soon after I was done training, one of the most common questions that fully grown

adult would ask me was just this. Are my bowel movements normal? And if that's the question that

we're all asking as adults, it taught me that we've just been winning it for way too long. And we all

think everybody else has it under control, but clearly the data shows us otherwise. Okay, I want to just dig in there just a little bit because how do you want us Dr. Puserecha? When it comes to gut health and the whole system from your mouth all the way to the exit and all of the important functions that happen there from hydration to nutrients to immunity, to hormone creation, which impacts your mood to all this unbelievable stuff that is happening in the gut.

How do you want us like medically speaking to actually think about our bowel movements? What is it? Because I'll just be this might be too too much information. But you know, every

“one of us has bowel movement and you have to turn around to flush the toilet. And I know I'm not the”

only person that looks down to see what's happening down there. But I don't know what I'm looking for and I don't know how to even think about the information that could be there to tell me something. I mean, because now all the big tests that everybody's doing to figure out your full-long Jevity and all this stuff. You got to poop in a dish and scoop it out and so we're testing it. But I'm glad we're talking about this because I think those numbers are jaw dropping.

40% of people are dealing with this. 15% of people have IBS three out of four people cannot go number two in a public bathroom. Yeah. In fact, I was having a conversation this morning with a couple colleagues. Both of whom admitted they don't go number two at work. Yeah. And we're at work. What? Eight, 12 hours a day. We think about how much-- Now, I think most of us think it's psychological, but I don't maybe it's not.

And I think it's insane that one out of three people can't go the bathroom in their on vacation or traveling when you're supposed to be relaxed. I know lots of people like that who will literally be traveling and it's been seven days since I've gone number two, hundred percent. Yeah. Okay. So let's talk about what is it data like how why is this

“important when it comes to gut health? Yeah. I think you're spot on. I don't think you need a lot”

of these third-party tests that will claim to look at all these different things in your stool when you just need to turn around and take a look. Because every time you go to the bathroom, it kind of like getting a little report card on your health. And so you can take a look and learn so much information just by what you're seeing and what you know about that bowel movement. All right. So I'm glad that you look, Mel. Okay. I find it so odd when I ask my patients,

well, what did your poop look like and they say, "I don't look." I think they're lying. I even to you as the doctor. Like, what do we hear for them, you know? And so like you have to look.

When you look, here's what I want you to be on the lookout for. The shape, the consistency of the

stool gives you a lot of information about how quickly that stool has been able to move through your colon. Okay. The color we're going to get into, that gives you a lot of information. How are you felt? Make note of that. How did you feel when you had a bowel movement? Were you in pain? Were you uncomfortable when you had a bowel movement? Did you feel better after you had one? Did you feel bloated in between? You can gather lots of different

information from what it looks like, how you felt, and then you can use that information to make some changes. What do you want to say to somebody who has chronic constipation and they're a clencher about the reality of that this might, because none of us have been trained to poop. And if you really think about it, one of the things I was thinking about is, I fall the sudden felt bad as a mom because I'm thinking about those diapers that you change. Your sweet little baby's

there and you're like, oh, what is this? This is like, oh my gosh, mustard poop is felt terrible.

so normal. I'm so glad you said that. I from day one, we treat our bodies, our bowel movements as

“this nefarious entity. It's so embarrassing. It's so yucky. It's so itchy. You shouldn't make poop jokes.”

It's so horrible. And we internalize that from when we're kids. And so suddenly after we're done potty training, nobody's checking in on you again to make sure you're doing it. Right? Like, we go to the dentist a couple of times a year and they're like, hey, did you do two minutes each set? Make sure you get your gums. Are you getting the back of your tongue? Who's asking you? What you do when you shut the door to have a bowel movement after you're done potty training? Nobody's

checking in. And it's so common, right, that I have patients who come to my clinic and it's actually the case that they've been dragged in by their partner and their partner will be like, every time I say, you know, we need to go somewhere and they'll be like, oh, just five minutes and they know it's going to be 60 minutes later that they come out. And what I want to say to you is that if you're somebody who has been struggling, you've tried what you feel like is everything. You've

tried the fiber. You've tried like the mirror legs. You exercise. You think, you know, you've done what you can. Maybe we've even tried a prescription medicine. It's not working. Consider that you could be in that one in three, which is so common. That's 33% that there are four of us in this studio right now. Well, I should be four of us with constipation. Four of us with constipation, then. Yeah, I'm sure I'll just speak for all this. We're all constipated today. At least one of us has a mechanics issue.

Absolutely right. That's incredible. And the beauty of it is unlike a lot of medical conditions where

the solution is going to be, I'm afraid you need this medication. You're going to have to take it

every day. You might need to take it at the same time every day. It becomes part of your lifestyle. The solution to this is a certain kind of physical therapy called biofeedback. That's the kind of therapy that's been proven. We're talking about eight to 12 weeks is what the studies have shown

“that 80 to 90% of people get better. But if you want to know a quick fix, yes, if you're not ready”

for the PT, yes, what one really important study found is that one out of six people who seem to have pelvic floor dysfunction like this, one out of six, the entire problem could be solved just by raising their knees above their waist when they had a bowel movement, using something like a stool, a stack of books, a pair of nice to let us raise their knees above their waist. I'm going to put my heels on and go, go number two, Chris. It'll help. Yes. Well, you know, it's funny you say that because

our every time our adult kids are home, I walk into my own bathroom, the garbage can is right in front of my toilet because they have moved it from the side to put it in front to put their feet up. Of course, they don't put it back. But that's because they're all that actual, that actual the mechanics of the knees being up. So I want you to picture. So again, this is the cross-section of the female anatomy. So what I'm pointing out to you is this is the rectum. Yep. And this is the

end of the colonel. And it's kind of curved. It's curved down. Now imagine that there is a rubber band around this last part of the tube that is choking it shut. We have a muscle, the puborectalis muscle that chokes that muscle close. That's a good thing. This muscle saves our butt. That's when that we don't want to work on. Okay. Exactly. However, we can't have a good bowel movement and relax that muscle. So it opens up that tube sitting in this 90 degree chair-like position

“that we have in our modern toilets. The best way to open up that tube is to squat, right?”

And squatting is something that we used to do thousands of years ago, but we've changed those mechanics. And obviously squatting is a difficult thing for a lot of people to do. And I'm not asking, actually, I don't squat, but I do raise my knees above the waist and you can just do that with something as simple as a stool. Oh, my God. I love you. And I'm loving this conversation. There's so many more questions that I have. I know there's so many questions that you

want me to ask her, but let's take a pause to give our sponsors a second to shine.

And I want to give you a chance to drop the link to this conversation in your family group chat, because I can't wait to see what your friend group says. Everybody is going to love this. Don't go anywhere. I haven't even gotten started with the embarrassing questions. And you don't want to miss it. Stay with us. Welcome back. It's your friend Mel Robbins.

Today you and I are here with Professor at the Harvard Medical School and renowned researcher and neurogastroenterologist Dr. Trisha Pusricha. We're talking about everything you need to know about gut health. All right. Dr. Pusricha. So what are the symptoms or the things that people complain about just because when we say gut issues, especially now that you're talking about mouth to the rear end, I would love to hear what are people coming in and actually

never ignore. And then we can talk about the symptoms that are simply what you're always going

“to experience until you understand what your body's trying to tell you. Yeah. One of the most common”

things that people come to my complaining about is that they struggle to have a bowel movement. And that can mean a lot of different things. Some people can say, "I go to the bathroom every single day." Great, but it takes me 20 minutes. I'm straining. It's hard. How long should it go? Less than five. Ideally, less than one minute. Okay. It should be an in and out job. Wow. Yeah. But if you're having a bowel movement every day, you might be told you might believe that that makes me normal,

but it's uncomfortable for you and you're spending 20, 30 minutes at a time. That's not normal. People complain about having discomfort, bloating, pain, cramps until they're able to have a bowel movement. And then for some people, the bowel movement helps the symptoms get better. Sometimes that's only momentarily. And then they come right back. And then they're there. And they're there. And they're building until the next bowel movement.

Scientists people complain about a lot of urgency. They're just interrupted by their at work. They're out with friends. And suddenly, out of nowhere, they have to go to the bout and have to do it now. There are a lot of people, one out of seven people. Okay. I want to just internalize this number. One out of seven people poop their pants regularly in America. That's what the studies have shown. So people feel so isolated, sometimes an embarrassed and ashamed,

when they have bowel accidents. It's actually more common than you think. And a lot of people are struggling and dealing with it. Even if nobody brings it up at your book club, a lot of people in that room will experience what you're experiencing. Sometimes people talk about that, floating, just plain old, bloating, which is so uncomfortable. It's this feeling of distension, that you're too, like you eat just a little bit, but you feel so full and you feel gassy.

That's a big complaint. And then there's another group of people who, if not so much having a bowel movement that's a problem, but eating is the problem. It feels like everything they eat causes them discomfort or even pain, maybe a little nausea. And they're not sure. They've tried everything. They've tried to eliminate all different kinds of foods. They've gone on all the different kinds of

“diets and they can't seem to pinpoint why. What is it about food that's giving the trouble?”

These are the kinds of people who come into my click. And of course, as I said, a lot of them have anxiety and depression. Certainly a lot of them stress feels these problems and makes them worse. But oftentimes it's not the stress that's the primary problem. Or the anxiety of the depression. Exactly. It's that your God is going haywire and you're not quite sure how to address it. And there are things that you're about to show us based on the research and based on your clinical

practice that will help us address it. What got symptoms should you never ignore because they

signal that something bigger could be happening? Yeah. Let me tell you about too. Okay. And this is this is one that I want people to pay attention because I think this could really save a life. So the things that I worry about first for colorectal cancer and something that I'm worried about a lot. I think every scientist in the country right now and in the world thinks is one of the most

“important scientific problems of our day is why are more and more younger people getting colorectal”

cancer? And so they did a study where they looked at what are the four most common symptoms of early onset meaning before the age of 50 colorectal cancer. But these also apply to colorectal cancer at any age. Okay. And so these four symptoms are one abdominal pain. Two rectal bleeding. Three iron deficiency enemia. This is a blood test that tells us that your red blood cells have become smaller and that's due to iron loss. This is really important in women because when women have

iron deficiency enemia, it can feel like fatigue or tired. You get the blood test oftentimes people will say this has to be due to your period because we lose a lot of iron. We lose blood with our periods. If you have these other symptoms or you're like late in a minute, but my periods are kind of light. I really want you to pause and not brush this aside. And then the fourth symptom

is the most important and also the most vague. So it's what makes it really complicated. It is

any change in your bowel habits. Meaning new diarrhea, new constipation, some change to the pattern. Maybe suddenly your bowel, your poop went from being really thick to a really, really thin. Anything that's new for you that seems to stick around get attention because this study found that people who have three or four of the four symptoms I just mentioned, they had a six fold higher likelihood of having colorectal cancer than people who had fewer. Six fold six

holes. So you've got stomach cramps, abdominal pain, abdominal pain, you have bleeding from your rear end. Yep. You have iron deficiency. Yep. And you have a change in kind of what is kind of historically your rhythm and how long would you see that change stick around like a week? Yeah. I would

have been some really high profile cases of celebrities who have said the only sign I had was

that fourth one. That's something changed in the pattern and I thought it was like my coffee or something else. But then I changed the coffee and it didn't go away. If you're worried, if something's off, don't wait. Don't brush it aside. It's normal to not be embarrassed by it. Just run it by your doctor. Dr. Press Reacher, why do you think there is this very troubling trend of so many young people not only getting but dying of colon cancer? Yeah. It's it's a important question. It's a big question.

“We used to think about cancer in general is being a function of arganetics and smoking, right?”

But we've stopped smoking so much as a society and obviously our genetics aren't changing but what can change with generations is something called epigenetics or changes to our genes that occur on top of the actual gene itself that can be due to influences from our environment. So as these cases have been rising we're arriving more and more at the conclusion that there has to be something in our environment that is changing and that environment could be the air we're breathing it could

be chemicals we're introduced to it could also be the foods we're eating. Don't you think it's ultra-processed foods? And all the chemicals then crap that's in food that's packaged and the people are especially during the United States? I really do. And there have been some major studies that have linked colorectal cancers specifically at a younger age to ultra-process food consumption. Is the rise in colon cancer in younger patients? Is that higher in a country like the United

States where you have like horrible regulations when it comes to ultra-process foods?

“It's a global trend and that's what's really worrisome. And of course the rise of ultra-process”

foods has not just been isolated to the United States it's been happening all over. What we've also found and they've done some really big studies here at Harvard and the Nurses Health Study they found that people who drink more for example sugar-sweetened beverages as children as teenagers they're more likely to develop early on sick colorectal cancer once they become younger adults. And we've been drinking more and more of these sugar-sweetened beverages as a society we've seen

that trend happen over times since the United States is alongside with ultra-process foods. And so it's probably a combination of a lot of different things. I also you know I tell all of my patients especially when I'm making this diagnosis that first of all cancer is not your fault.

It has never someone else's fault. Cancer is the result of so many things some of which we have

control over or some control over many of which we do not, right? And sometimes you say to yourself they can't be ultra-process foods. I hear this a lot like it can't be alcohol, it can't be

“ultra-process foods because how can I not honestly like people say like well my aunt you know drink”

you know seven drinks you know like a day or whatever and she lived to be the age of 90 and what I try to explain to people is that think about cancer as building a tower of building blocks as I explain it. Some people start out life with five blocks stacked against them and it only takes 10 to get cancer you your aunt may have started out with just one or two blocks and then suppose you eat a lot of process meets every day there's one more block you grow up in a town where

air pollution is really severe there's another two blocks and then suddenly you've hit 10 blocks and somebody who's had other patterns of behavior they're more sedentary than you whenever it is

they never hit that 10 block threshold and it feels unfair it feels hard to imagine why

but it's simply because we're starting at different places and a lot of the risk factors for polarity cancer in these cases that we've been seeing rising they start in our childhood it's they started a time when we may or may not have had that kind of control over our lives yeah wow I have so many people I need to send this to so I want to take a quick break because of that last topic we were just talking about three people popped into my mind and I bet the same thing

happened to you so take a moment share this episode and share Dr. Puss Recha with you do you know how amazing it is that we get access and get to spend time together with her and to learn all this holy cow thank you for being generous with the link thank you for being here and thank you for not going anywhere because we have so many more things to dig into when we return stay with us welcome back it's friend Mel Robbins today we are here with world renowned neuro gastroenterologist

her name is Dr. Trisha Puss Recha I know you're loving this as much as I am so let's just jump right back in so you're best selling book you've been pooping all wrong how to make your bell movements enjoy congratulations it focuses on how much you can learn by just focusing on your bell movements so can you explain to the person listening all the things that you can learn about your health

like I said that information that you get just by looking is like a report card on your health

“your poop just having a look and just thinking about that experience of when you had the”

bowel movement we'll tell you about the food you've eaten the quality of the food that you've eaten it's going to tell you about inflammation and possibly infections or the kinds of inflammation that come from our environment in our food it's going to tell you about how the brain in your gut is working you're going to get information by asking yourselves how often did I go in one day how did I feel when I went was it hard did I strain is the consistency rock solid or is it soft and floating

all of these pieces of information tell you about how your gut is functioning as a brain as an immune

organ as a hormone producing organ and that has an influence on your entire health I am so excited

to talk about our bowel movements we too let's start with what is normal doctor press reacha and what is not normal when it comes to poop for me a normal bowel movement has to just two things one it should be effortless shouldn't have to be straining shouldn't spend 20 minutes in there sweating straining your eyeballs out to it should occur at a socially appropriate time what does that mean socially appropriate meaning you shouldn't be worried about going out to have lunch with your

girlfriends you shouldn't be at work panicking when you're in the middle of a meeting and then not being able to give your presentation because of this you'll notice for me I didn't say your

“bowel movement has to be once a day and that's what everybody seems to have in their mind like once a day”

we have it in our minds that this is holy this is like the only path to God it doesn't have to be that way there is a whole range of what would be considered normal in terms of frequency okay and what is that range so my colleagues at Beth Israel did a study where they looked at this national sample of Americans who thought they had normal bowel movements and just said well how many times you're going and it turns out anywhere from three times in one day to once every three days isn't the range of normal

okay so if you fall in that happy comfortable range I am really happy for you if you're comfortable okay it turns out too that if you're meeting your fiber goals which for women over 50 is 21 grams a day or under 50 25 grams per day you're going to start to have fluffier more frequent bowel movements it's not going to be once a day and you should embrace that new you it's okay let me show you a couple models okay okay oh my god okay now if you're listening she is hold a doctor

press reach a is holding up poop but but I have to give a shout out to our team oh my god because our team creative geniuses ordered Plato and I cannot believe how realistic this is it's almost I can can smell it on the right you're seeing a log that is this embarrassing you're you're seeing a log that's maybe it's like a brought worst it's like about the size of a fat hot dog and it's you can see there are lines and it's almost like parts of pieces of poop have come together to

create the brought worst and then the one on the other that the other one because there's two here is about four inches long but there's it has like a sharpened tip and then it's got a thicker end so it's more like a you know like one of those things you'd throw into a pool that's

sink to the bottom that kids die for torpedo yeah yeah I think what you're described first of all

could you do a full description thank you let's move the model over so that those of you on YouTube can really see this and if you're listening just keep listening I'm going to narrate

“if you want to see what this all looks like the link to the YouTube version of this is also”

in the show notes you can find it or just Google you know Mel Robbins and Dr. Pussrecha there we go you know I think most people would consider this type of bowel movement to be normal to be the ideal and you know like this one right here the like smooth sausage some people call that a whiteless wonder yeah I think that's nice I think it's great when you have this bowel movement I don't think that's the only path to God like I said I think when you have more fiber in your diet

you start to get fluffier and fluffier and that's okay so is that is that what you would consider is this smooth torpedo shape yeah is that like that's that evidence of somebody's got a lot of fiber that's a fluffy bowel movement this is this is a lovely poo so these are these are good you're giving this an A like these are one of these are acceptable you totally you get an A for this you also in my books could make an A or an A minus if it's even softer I can see why the

team might not have been able to really show softer stool and play model what do you mean like

more floaty okay okay you could still get an A for those two um it's when it's like pure liquid

or it's just like really frequent that I think we can all agree that's not ideal okay um but if there's some shape to it and it's even fluffier than this beautiful sausage you're still winning um do you want it in one piece is that like a thing that that is important or is it okay if it's in a couple like I think if it comes out in a few small pieces that's okay when it comes out in one long piece like that what it's telling you is that you were able to efficiently expel it in all the

muscles in your pelvic floor we're moving in this nice coordinated dance to get it out in one try okay so hold on a second so when you have one of those ones it's like oh my god that came out of me you feel like you've lost a couple pounds like stuffed the toilet yes does that mean that you from the mechanics of it you've actually emptied out the length of the rectum like you've you've

really like you've just like because they're always like kind of satisfying and when it's a little

“strange you should have been against one trial just but yeah it's if it's long like that it”

means it didn't have time to sit and collect in your rectum and full and form this like larger clump so it just means it's coming out more quickly more efficiently it's not a bad thing I mean your rectum is built to accommodate increased spaces for more poop so that's fine but it means that you caught it the right time it's passing through you gave it a little push and it all just came right out now on the other hand I'm going to show you another set of models that's that that's

fallen right off I would tip that just like that there we go let me show you the other amazing model that your team put together oh my god these are like rabbit pellets on the bottom so little pieces that are very very hard and then the one on top so it's just like lots of little like pieces we've all had those yeah and then there's one on the top that is that looks like pieces that are just barely held together and these guys are hard as rocks these are the the chunky

pebbles yeah I've almost never met somebody who has one of these the chunky rabbit pellets and

felt like they had a good poop never they're not satisfying if you just drop a couple of those in you're like I'm not done I'll like hopefully I'll be back here in an hour or two but this is just that's not even an appetizer that's even minus yeah I don't know if you're going to pass but what is that telling you when you have those little like you know it's like beep beep you're like that's it yeah it can tell us one of two things one what we know absolutely is that this poop the one

that's the rabbit pellet has been sitting in your colon longer than any of these other poops because that is your colon's whole job it sucks water out of it so the longer poop sits in there whether it's because you decided this was not the right time to go to the bathroom I have a I'm on a

“hot date I'm going to hold it until tomorrow well the poop that you need to have tomorrow is going”

to look very differently than the poop you would have had today because you've held it in and now more and more water is going to get sucked out and it's going to look differently so if you're a person you're one of those you said doctor press reach a that three out of every four people do not don't number two it work yeah if you're somebody that's clenching yep all day it work which could be 10 to 12 hours you got to be in your own bathroom yeah are you causing

yourself to have harder poop because you're not allowing your body to just do what it needs to do yeah I mean when you feel that call that's usually your body's way of saying hey I'm helping you I'm doing some of the work right now your muscles are contracting it is providing you the propulsion if you ignore that call and this is why I mean one of the most fundamental things I teach people is don't ignore the call go bring some nice bathroom spray with you if that's

“what is you but go it work it's good for you if you ignore it you try to go later that night”

now you don't have that urgency because you've suppressed it your colon is not doing that work for you so you've got to do all the work yourself by doing a harder and harder vowel sound if I straining because it sucked all the water out of it and now you are looking at a different poop than you had 12 hours ago it was already going to be hard it's going to be way harder now and what is the one on top that is kind of in a long shape but it's like hard pellets together

I've seen some people who think that they're living their best life and this is how they poop every day and it could be normal oh I hate those because they come out and chunks I hate those yeah yeah everyone's a little different but this one to me if you were to say oh yeah I do this every other day and I feel fine in between I'd let you live your best life I wouldn't interrupt that but this one I'd like to have a little longer conversation about now

this may be getting too graphic but I do have some questions I'm a GI doc okay so what if you have like you know you go number two and the bowel movement has one section

does that make sense of perfect I know you're a GI doc you know you know you're still

“about this stuff okay yeah well let me tell you a fun fact we think that we're pooping”

just whatever we ate most of your poop they've confirmed this on electron microscopy is your bacteria oh well I know so take a look next time you're in there and say hello it's your microbiome that you're pooping the majority of it is not what you ate you've absorbed all the goods wait a minute so when I have but unless there's corn because you see the corn yeah all of the wine is corn make it through yeah everything you can't absorb we cannot absorb

and digest and break down corn why because it's fiber am I not chewing yet enough you can chew your heart's content but we don't contain the enzymes and the machinery to break the fiber now listen that's a good thing we need to eat more fiber because all the fiber that we're not absorbing we are giving as a gift to our microbiome and they love it they thrive off of the corn off of the cruciferous vegetables all the high fiber foods and it's not as

surprised to me that it sometimes those little chunks and pieces come out and we say oh there must be a problem in digestion no no it's normal it's not like we can't even bean shells like these things are all normal when I do colonoscopies on people have the time I can tell them what they had for dinner two nights ago you can see bits of it especially if they beat in a lot of

salad or something like that that's normal what we poop first of all the brown color that comes

from billy rubin that's something that we produce as part of our digestion it gives it that brown color different at different time points it's going to be a little more concentrated than others and at different time points is it's moving through your colon more and more water is going to be sucked from one end a little bit less from the other end the bacteria is going to concentrate in one side so it's okay to see a little bit of a gradient that's just how your body moves things along

got it let's talk about color please all right we can move the poop good job team that looks so realistic I feel like I can spell poop I know I don't I don't even feel good like wiping this down

“woof okay if you want to talk about color yeah let's talk about color all right so I've got a set of”

pantone color cards for you okay male okay i'm gonna hand these over to you these are colors that people have actually told me they've seen in their poop before so I want you to flash them over to me wow and let's talk about okay they're normal all right all right i'm gonna describe them yeah so uh apple green i'm looking at an apple green pantone so imagine a granny smith apple okay yeah that to me looks like the kind of diarrhea of baby has after they've had breast milk

yeah i mean this is a lovely bucolic shade i would say first of all male everyone's are

allowed to have a weird colored poop every now and then well that's that if i saw that as an adult i would think something's very wrong if you see this shade it's a little bit green maybe a little yellow and you have other symptoms like for example if a fever you have diarrhea so it's coming out quickly frequently it's liquidy this is a problem and you should talk to your doctor about it if you've been eating something high in chlorophyll maybe your green's powder is people actually can

get the occasional green colored poop if it's rare you don't actually need to panic about it if you know what you're eating that has changed the color no need to panic but if you do have other symptoms diarrhea fever after that oh that is like a a color that you have you have the flu yeah exactly yes you get things are moving quickly yeah for your system typically when it's that color that's right you tend to get diarrhea especially with the flu a okay cool all right so

this one is a pantone red plum that i'm gonna hand over and that looks like i've just eaten a beautiful beat salad i was gonna ask if you had beats last night yes yeah if you have this color and you've had beats you're good you don't need to necessarily panic unless you're feeling dizzy

“your lightheaded if you haven't had beats you see this color is kind of a maroon color you should”

absolutely talk to your doctor because this is bleeding until we prove otherwise oh whoa so blood can show up in our poop in any number of forms it can be a nice bright red it can be black it can be this maroon color when it's maroon it tends to mean that the bleeding may have come from a little bit higher up in our colon the bright red is a little bit lower down but this is still an emergency so any amount i mean if it's something that you're used to seeing you and your doctor of

already decided this is hemorrhoids you've gone through it comes back it feels the same all right just let them know non urgently but any amount i would talk to them especially if you have other symptoms like feeling dizzy feeling lightheaded okay so this next pan tone is called lightest sky and this looks like a uh that one of those white walkers from game of thrones this is what i would call

that my dog used to eat you know uh just like the zombie walkers you should run and not walk

this is actually an emergency i've never seen white poop yeah i hope you never do but people see it

and what does it mean remember i told you that our poop is actually only brown because we have Billy roobin yes if we took that Billy roobin away this is the color our poop would be we'd be like it would be hail clay what surprising isn't that bizarre it's bizarre clay colored at if we took the Billy roobin out so when we see this color it tells us there's a something blocking our Billy roobin it could be a gallstone it could be something more worries i'm even like a cancer if this is

been going on for one day two days call you doctor immediately because this could be a big emergency that's what color would be yeah well because i mean it's a kind of lovely well it is it's a lot prettier than but you wouldn't you'd have to have a different color toilet paper because you wouldn't

know if your poop was white whether or not you got it but here here's what here's what i'm going to tell

you you want to know why i thought poop was brown tell me because i thought when you eat all of this random stuff yeah and you blend it all together it just naturally blends to just a really milk kind of color like that's like i don't know that it's true when you look at the actual science of colors if you mix them all together they turn into poop brown but that's just what i

“thought like when you eat everything it just reduces to a brown color i think that's what a lot of”

people think but i think we're forgetting that again we're actually absorbing what is all we're going to do why is it in there it helps with digestion it helps break down with the food it helps break the food

down so it does help you with digestion you need those bile salts that are in there but we're absorbing

most of the hopefully most of the colorful nutrients that are in our food and what's left is the stuff we can't eat and then our bacteria and that's really what makes up this nice clay color poop okay this next one is pantone five one two five they don't have a they didn't name this one but it looks like eggplant like looks like a beautiful shiny purple eggplant and i i don't think well i feel like i may have seen like a little but it's probably the beat it probably was not that

purple specifically i'd definitely seen one or two of these in my lifetime okay it's um this is one of the one like you're talking like a whole like long log of that or pieces of it like everyone's allowed to have i think one or two purple poops in their lifetime really maybe more maybe less it can be due to something called the anthocyanins which are this pigment in certain nutrients like in berries for example okay those can give you a purple poop it can give you like a blueish

tinge poop even sometime then actually they're there and like red wine too if this is like a pattern though we do want to make sure we're not confusing the color for something that's a little

“bit more maroon like which makes us a little more worried for blood that's what yeah but if you're”

like i just ate two cups of blueberries in my smoothies yesterday i'm seeing this one purple poop i'm okay with that okay because you kind of can go oh the dragon fruit yeah the beat this makes oh the blueberries okay but if i can't remember yeah if it comes out of nowhere and again it's also think about it as part of the pattern if you're having lightheadedness if you have any pain any other warning sign with a new colored poop that should prompt you to say oh let me just

what does that tell you though usually what does that mean if you like are having purple poops it's two things it's either something in what you ate like these anthocyanins something in the food or we want to make sure it's not blood okay got it all right this next one is called fiesta and so this is like a cross this is like a orangeish reddish not like fire engine red more like cherry orangey red yeah like a fiesta it's a fiesta although it's not a fiesta because if you see this

“you should go to the emergence what does that mean this is bright red blood usually okay um and it”

usually means that it's coming from like close to the exit hatch like so you're bleeding from the last part of your colon maybe from hemorrhoids it can also be due to something called diverticular bleeding which are these small out pouchings in the colon so how much of that color in a log I get a pellet or whatever like how well because because you know occasionally you have my level of streak there and it has one but like and I'm assuming it's not that often that somebody

has an entire fiesta hot dog coming out but I don't know well I would say that anytime you see a fiesta it's just bright red even if it's a little bit you have to run it by your dog okay now here's a question yeah I can't really even gonna ask you this I'm so excited should you don't get like a sandwich bag or a dog bag yeah grab it yeah and bring it with you if you're

but I don't know that I would ever think to do that myself but if you're seeing one of these colors

do you think would you appreciate that if when I showed up we actually had the thing I love when my patients take a picture okay if they're not going to bring in the poop your picture it didn't happen okay take a picture get the color you don't have to bring in a sample but the color often your word is enough but sometimes seeing the color can help me say okay this is probably more upper GI bleeding versus lower GI bleeding helping make a decision about it but if you

see this like I and I want to just make sure I'm clear bleeding can be due to hemorrhoids which are very common very disruptive we don't want them but they're not necessarily killers but

“rectal bleeding is also one of the four signs of early onset chloractyl cancer and that's why I'm”

telling you even if you see just a little streak make sure we just double check and know that it's hemorrhoids okay I got you okay take the photo I'm gonna leave I'm gonna leave the poop in the toilet okay so all right pantone pirate black this is just like a jet black which I thankfully

have also never seen yeah thank goodness so jet black is really worrisome it means you're dying

because you're dying from the inside out is that what that means okay if that came out of me I would be like I am rotting from the inside out we can be a big emergency so this is not one that we say all let's just see what happens over the next couple days this is one that you go talk to your doctor and because this is a situation when you see jet black that is the color that your blood turns when it acidifies when it mixes with the acid in your stomach so a dark

tarry black especially if it's like sticky like it's sticking to that toilet bowl that makes

“me worry that it's coming from blood it's coming from blood higher up in your gut where it's okay”

touch the acid it can though a nice pirate black stool can come if you've been taking iron pills iron

pills can turn your poop into kidding yeah and ironically should you take iron I'm so confused

about iron like i'm your Swiss ticket with food in the morning and the evening does your does your poop get harder I mean like I started taking iron not now we're going to turn this into my own personal session here but I started taking iron because a lot of women are iron deficient a lot of us in menopause are yes and it really screwed up my routine in the bathroom I know iron does constipate you that's like one of the most like common side effects of iron pills so usually

I tell people actually there's two things I'd help people about iron one you don't actually have to take it every single day to replate your iron stores you can take it every other day okay and you actually like end up getting the iron unique it's only absorbed so much it wants and sometimes every day's actually overkill that can help with the conservation but I also usually tell people at the same time take a fiber supplement okay do both because it'll help with the

absorption yeah okay great yeah this last one pantone caramel this does look like a nice milky caramel color here isn't she a thing of beauty yes is that the color we're going for this is

“a nice color I mean I think you can have different shades of brown but I think we can all agree”

this is a pretty one okay so anything from say caramel to dark chocolate yeah in the zone totally in the zone just be on the lookout when you get too dark chocolate that you're not veering towards pirate black got it okay wow so helpful the more you know yes I've heard you talk about the five minute toilet rule what is that yes people should not spend more than five minutes at a time in the bathroom if you're in there for five minutes you've got your knees up on the stool or

feet up on the stool yep you're trying to relax into it and nothing's happening just pull up the pants and come back later yeah and this is really hard because we're all in there with our smart phones right and the reason this is important last year I did this study in my lab where we looked at people coming in for their screening colonoscopies and so we're taking a look directly with our eyes with our scope to see what's going on in their bodies and we asked them right before

they went in all about themselves how long do you spend in the bathroom do you take your smart phone in the bathroom with you how much fiber do you eat how much do you exercise what we found is that people who take their smart phones into the toilet with them they are more than five times just likely to spend more than five minutes at a time in the bathroom and they're at a 46% increase risk of having hemorrhoids we saw them with their eyes hitting me yeah and you know

what we think is happening is that I mean we get distracted with our smart phones when we're trying to go to sleep when we're waiting in the lines I'm like why would we not be getting distracted beyond the leaf in the bathroom when we bring our smart phones in and what that's doing is making us sit for longer than we intended on this seat that has an open bowl so there's no pelvic floor support and our hemorrhoids are actually just encouraged veins that's all they are and so as we're

that we put that pressure on our pelvic floor for a longer and longer periods of time over days

“over years it becomes our pattern we think that's how we get hemorrhoids holy cow so that actually”

makes sense let me just make sure I'm following yep so hemorrhoids and like explain to the person

listening who's never had a hemorrhoid because there was a person our family that got one for the

first time and it was a whole hi it's somebody should do a sitcom episode about it and preparation age and the panic about what one should do with it and the forward to understand that mom and dad actually had preparation age already in the house this is normal people get these things and so you have to put that up there what it's so I a hemorrhoid always thought a hemorrhoid was like irritation of the skin from something but you're saying it's actually the veins around your exit

that are filling it's just your body but yeah it's there's two kinds of hemorrhoids okay all right so there's internal hemorrhoids those are just inside the spinkters you often can't feel those we know you have them when we do your colonoscopy there's also external hemorrhoids those are the kinds that you can feel and they're the really bothers someone that can be itchy they can be irritated and flamed they're very sensitive to touch and then there's actually like a cousin

of the first kind which is an internal hemorrhoid that gets so heavy pops down oh like hangs out

you can hang out and you can be like an utter yeah people know they have those because they can kind of push them in and out oh you know what do you do well there's lots of different things you can

“do one you should start eating more fiber that's like always gonna be my answer to most everything”

we talk about but you sometimes can actually get like a simple outpatient surgical procedure if it's the kind that has like popped out to say hello and you need to push it back in but for the kinds that are just irritated itchy started on the outside something like preparation age or these like mild steroid creams can like really help get you through it and then sits bad sits bats are just like a fancy way of saying sit inside a bath a warm water and give that inflamed area

a little bit of time to heal do those a couple of times a day for a couple of days now doctor press reach out you also talk about being very intentional about toilet paper which seems weird but you say it matters a lot why yeah well because I because my my husband have this fight because I think there's two types of toilet paper there's a type that's stiff and like abrasive and that frankly feels kind of cheap and then there's the kind that feels puffy and fluffy but

the problem with that one is it leads all kind of lint all over the place you know like I yeah but it's but it's more comfortable so what do you want us to know about toilet paper and that it's actually mattering a lot I think what you're talking about is the difference between two ply just as good and then one ply yeah puffy and thin expensive cheaper yeah and I don't know who needs to hear this right now I do I want you to repeat after me Mel okay okay I am worthy

I am worthy I am enough I am enough I deserve two ply toilet paper I deserve two ply toilet paper I mean look at this this is one ply all right this is pathetic you don't need this on the most delicate part of your body and that's your rerent the tissue down there is so thin so delicate do not give it this pathetic one ply and for no more if you start to date somebody new you go over to their house you like them and then you go inside their bathroom

for the first time and horror upon horrors you see this inside their bathroom you got to run

for the hills that's a red flag we talked about red flags we're getting about a gut feeling if you see this how are they gonna ever fall in love with you because they don't even love

“themselves well they don't know and that's why you're here I see I didn't even know this people”

think that they're getting one ply because it's a little cheaper but the fact is when you use one ply you have to bunch up such a thickwan that you are breezing through that pathetic thin roll more so it's true you just left yes I also feel richer when I buy two ply it just feels like more it doesn't even necessarily have to be it just feels like fancy toilet paper I mean it's the least you deserve but I will say my dirty little secret about this which is actually quite clean

is that I don't think toilet paper is the answer here uh oh I think what we really need is the days okay yeah and I know a lot of people in this country are not ready for that conversation explain what of a day is for somebody who doesn't know because that was in that was another eye

this isn't just afraid me what was that yeah the day is gonna change your life okay

it changed a lot like they in in the US they surged in popularity during the pandemic and people's lives changed but other countries are way ahead of us on this so biday the simplest form of a biday is simply a nozzle that sprays your exterior okay that's all it can be now if that's one end of it these simple nozzle attachments are like pretty cheap you can install them yourself on the other end there are beautiful luxury bedays where you have a heated seat so well then

I'm gonna spend more than five minutes in there if I've got a heated seat it also has like an air dryer built in different like sort of frequency and intensity of the water all of this is for external use only by the way but biday's clean your bum in a way that toilet paper can't so somebody did this study back in 2023 there was a study that showed that your hands when you wipe after having a bowel movement have more microbes on them than people who use a biday really

even if your hands don't touch your butt they just touch the tissue paper you think that's

“too funny even with too much even actually I don't remember what quiet was but the point”

but toilet paper is not as clean as we think it is and I mean think about it this way and I know every parent can relate to this suppose you somehow get a little bit of poop on your hand a little bit of poop on your arm yeah would you in that moment consider it acceptable to just like smear it off with a little paper towel and go about your neck no no you it absolutely put I hope you would absolutely put some running water on that thing and make sure it was clean but for

some reason again with the most delicate tissue in our body we think wiping's okay let me ask you question yeah is there a wiping technique I think women are sometimes taught that it should be front to back and that's the idea is that we don't want to mix the bacteria from a rear end up front to decrease the risk of UTIs your nary tract infections there have been some studies that show

“that that's the case the best way to wipe up front is a gentle dab and I think that that if you”

have the ability to do that in the back that's the best way to a gentle dab keeps you from treating me like it's got the tears smearing it in I really think that like sometimes when we're like just scraping our bombs a lot of people have sensitivity in that area so people who have features who have hemorrhoids women who are postpartum I tell all my postpartum patients says just a gentle dab is all you need so doctor uh pus reacha what are the biggest gut health

myths that social media is pushing that you're just like I am so sick of seeing this yeah there's two big ones for me one is leaky gut okay leaky gut started as a very sound scientific phenomena in neuro gastroenterology this is what we study what we study is increased

intestinal permeability and that's where this idea of leaky gut first started so increase intestinal

permeability is simply this our guts are aligned with these cells on the surface and those cells are usually pretty tightly close together but different things happen throughout the day that caused the junctions between the cells to just slightly open up when they open up other cells can travel through back and forth chemical signals can move that's happening to all of us we have increase intestinal permeability multiple times during the day stress can do it what we eat can

do it infections can do it this is happening all the time there are very few known from start to finish situations where we can at this point conclusively say part of the problem and the mechanism was the increased intestinal permeability in this medical condition so for example one of those is liver fibrosis liver disease alcohol increases intestinal permeability and then those chemicals in toxins hit your liver and cause damage that's probably one of the cleanest stories in in

GI that we have for what increase intestinal permeability does okay it has been implicated in irritable bowel syndrome and there's some emerging data there however when you go on social media you'll hear these people who will say do you have brain fog are you bloated all the time sounds like leaky good and everyone will say wait a minute you have course I brain fog I am bloated all the time

I've never heard of this thing called leaky is that what this is because these are symptoms

bloating brain fog that are notoriously difficult to understand difficult to treat difficult to

“get helpful and now somebody's offering you an answer which is leaky gut which is the bane I think”

of every gastroenterologist's existence when we hear that brought up not because it's not real not because intestinal permeability is real but because that's not the root cause people treat leaky gut as the root cause of their problem and the second half of that real will be like and this is my

what is it about my lifestyle that might be increasing intestinal permeability is that thing in any way linked to the problems that I have because I've seen these cases mal where somebody will come in to me having self-treated for leaky gut for a year and the entire time what they had was celiac disease which also causes brain fog which also causes bloating and I hate to see us miss a medical diagnosis that we know how to treat that we can diagnose because we've sort of

attached onto something we've seen on social media so leaky gut that's a big one for me as a gastroenterologist second is probiotics there is this idea out there you would think this based on the marketing that every gastroenterologist wants everyone to be on a probiotic that we all need probiotics for your health these supplements that's not true in fact the American gastroenterological association does not recommend probiotics for most medical conditions really I know it comes as a shock because you

always see like recommended by most gastroenterologists or all gastroenterologists recommend

that's not the case it's not because I'm gonna tell you if you've come to me and you've been taking this probiotic for years that you've loved you digest better you poop now once a day easily that your probiotic is not working it could be working but we don't have enough robust data to say in whom it's always gonna work consistently that we can make a good recommendation for it

“and feel ethical about doing that yeah I mean here's the thing that I think people don't”

understand about the microbiome so if you think about your microbiome is a garden and the microbes that are living there they are like flowers or maybe they're like weeds and probiotics are supposed to give you and theory the good bacteria yeah meaning the bacteria that we've seen in some studies that seem to be associated with health and then there's some bacteria we label

is bad because they seem to be higher in people who have diseases the problem is that we actually

don't know if something that we're labeling as a bad bacteria or good bacteria is the cause of that condition or is the cause of your health because what if the bacteria we're seeing or calling bad or actually just a bacteria that are naturally growing in response to the fertilizer you're giving it and you're actually trying their best to help you but that's just what grows in

“that environment and the problem is not that you need to sprinkle probiotics on them but you need”

to focus on prebiotics prebiotics are like the fertilizer in the conditions that allows certain kinds of bacteria to grow and that's things like fiber it's the things that you don't digest that become the food for those bacteria so sometimes the solution is not necessarily a probiotic supplement but to say what have I fed my gut microbes today have I given it a high fiber meal have I had fruit today have had vegetables have I eaten something fermented and sometimes that's the

way that you can nudge the bacteria populations and you're got one way or another amazing now

doctor Pusricha is a neurogaster researcher and medical doctor what is one thing that you stopped doing that has had a huge impact on your gut health I stopped pretending like I was going to get enough fiber through my diet and I'm a gut health researcher like you said and I think about my gut health like way more than most people and so I thought for a really long time that I should I have to get all my fiber needs which for women over 50 is 21 grams per day for under 50 25

grams per day that I should get it through my diet that I should be like making these beautiful bento box lunches with like this colorful different like five different vegetables and fruits and it would happen for me like several days a week and then it just like wouldn't I have two kids I have like three jobs I'm just a normal person who's trying to get through the grocery store cereal aisle like everybody else and and then some some days I would just find myself like with my

husband leaning over the kitchen sink like picking off the macaroni of my kids plate and just saying

“like I'm full like let's call it a day right here and that's what we did and when I kind of let”

go being so virtuous about how I was going to meet my fiber needs I said okay let us just like plan on me not meeting my fiber needs through my diet what am I going to do then and then it clicked and then I found the laziest possible solution to just give my gut the the exact thing that needed and so I started taking a fiber supplement so I take selium every day selium is this powder it's a plant-based fiber supplement I mix it into my coffee it's a soluble fiber I'm mixing it

in the liquid that I'm drinking anyway you do have to drink it quickly and it does need to be taken with water the reason you have to drink it quickly is because it's a soluble fiber that turns into a gel that's what also makes selium so wonderful the cardiologists have loved selium for even longer than we have in gastroenterology because it can help lower cholesterol and we have

bulk to your stool if you have constipation it'll soften it up so it's great for your gut your bacteria like it it was just a shortcut that like freed me up and is no brainer because I'm not adding any extra time one teaspoon of selium gives you about four grams of fiber so if you have two teaspoons and you're like a third of the way there so even on the days when I'm meeting my fiber goals I just like get an A+ on my report card because I can see them that day and on the days that I

don't I still get an A+ because I've met them because I'm just doing the laziest possible thing and it it works sounds like the smartest possible thing doctor post-reacher what are your parting words I want people to remember that the gut is a brain remember that we treat the brain in our

head like it is the most important organ in our body and we do everything to protect it but if you

“think about your gut as a brain and that's what it is then you should treat it like your most”

precious organ like if you were going to go play football there is no way your mom would let you run out there without a nice thick helmet every single day you would wear a helmet if you rode your bike in downtown Boston traffic tour but ask yourself what have I done to protect my gut today and not only that not only do we not really protect it but we treat its distress signals as inconvenient and we brush them aside and it's not a coincidence at all that so many of the things

that I tell my patients are good for their gut health minimizing ultra-processed foods cutting down on alcohol eating more fiber that's incidentally the same list of things that will reduce your risk of dementia that's not a coincidence once you realize that your gut is a brain then treating it as the most precious organ of your body is not optional it's foundational to your

“entire health. Dr. Presricia I have loved meeting you I have loved this conversation I not only”

enjoyed it and enjoyed laughing but I learned so much that I didn't know and I feel just empowered so I just want to thank you thank you for the work that you're doing thank you for the way in which you teach thank you for the research that you are doing in your lab that is so cutting edge and exciting and I am just grateful that you're here so thank you thank you for having me thank you for letting me share this with everyone of course and I got a huge shout out to our team for the Played O Poop

and I also want to give you a shout out for spending time together with us and for listening to something that really is important I was astonished weren't you to hear those numbers the number of

people that are struggling with this aspect of your life and here's what I learned there are simple

things that you can do immediately now that you understand this there are things that you can do immediately that will help you change this aspect of your life and your health for the better thank you for being generous with this with your family this is going right in our family group chat at the Robins household and in case someone else tells you today I wanted to be sure to tell you

“as your friend that I love you and I believe in you and I believe in your ability to create a”

better life and every single thing that doctor has reached a told you today and taught you today and all the research that she shared today will absolutely help you have a better life and a better bowel movement and that's going to make your life better all right I will welcome you into the very next episode the moment hit play I'll see you there she's trained at Harvard completed her internal medicine reddit her internal medicine reddit

oh my well suppose I want to date yes and you've met this new man I love what you're wearing by the way on this date I appreciate you are wearing days already go so well cool suit she looks

amazing okay thank you now we're switching into the okay oh I so here for this is there anything

related to like how understanding your poop is going to make you healthier I want to go back to a question that I forgot to ask you so bottle air this is going back off top and it's really it's question number three you might want to tip that back up because you're about to fall on the table just like you're sliding off oh yeah I see the movement I see the smears okay maybe just all of that I'm wearing black we hold at the poop in the dye are you sure yeah or the person

and the pool yeah let's do the person we just put her guts back in my carefully the science experiment worked on the first time it was so good thank you oh my gosh it you were awesome you were awesome oh and one more thing and no this is not a blooper this is the legal language you know what the

entertainment purposes I'm just your friend I am not a licensed therapist and this podcast is not intended as a substitute for the advice of a physician professional coach psychotherapist or other qualified professional got it good I'll see you in the next episode